Chiropractic Research, the FCER, and Their Future

By George McClelland, DC

As we move into the 1990s, the Foundation of Chiropractic Education and Research (FCER) is very pleased with the progress in chiropractic research that has developed through the 1980s. However, let me assure you that the FCER's Board of Trustees and staff are keenly aware of the criticisms our profession continues to receive due to the "lack of valid research in support of chiropractic care." This one phrase is persistently echoed by legislators, bureaucrats, industry, political medicine, and a growing segment of our own profession. And they are right!

The FCER has been able to funnel $3.2 million into awards, grants, fellowships, symposia, journals, and publications, as well as other research and educational media, during the last decade. This is a remarkable increase over the funding provided by FCER since its inception 36 years earlier. However, this does not begin to scratch the surface. In 1988, in my home state, Virginia, two medical colleges alone received $2 million for cancer research. That was the equivalent of our entire operational budget at FCER that year! That is the area in which we must compete.

So what lies ahead for the foundation? There is still broad variance in the research capability of the various chiropractic colleges. Prior to 1985, few chiropractic colleges even had viable courses on research methodology. It continues to amaze me that the leadership in our chiropractic colleges has not come to appreciate the fiscal impact that a dynamic research program can have on the schools and their operational budgets.

Just consider the effect industrial, federal, and private grants would have on the economics of our schools. In addition, how much more enthusiastic would alumni gifts become if the school they attended started to gain national recognition for the research it produced.

Unfortunately, this great variance in the research capabilities of our schools directly limits the number and quality of good research projects that the foundation receives for funding requests. Accordingly, in addition to our comprehensive grants and awards (over 80 in the last ten years), the FCER has initiated a number of other programs to try to stimulate research within our colleges. These have included fellowship awards for graduated DCs, student research awards, dissertation grants-in-aid, discretionary grants, a three year research residency program, and our major clinical research trial studies. Still, this has not resulted in developing the research programs and projects that this profession needs to see.

On numerous occasions the foundation has been asked about providing unrestricted grants. These were fairly common prior to 1980. The lesson that the foundation learned from this funding method was that, without the accountability, the research product would either not be forthcoming or would be of poor quality. There is certainly enough poor research in chiropractic today -- FCER does not intend to contribute more!

Perhaps it is time the Council on Chiropractic Education took a hard look at its educational standards regarding research. That section really poses little in the way of standards, but rather offers a list of questions (11) that "can serve as a guide in determining the adequacy of research activity within an institution." With such liberal "standards," there is minimal emphasis from our federally recognized accrediting agency to upgrade research within the profession.

Still, with this lack of emphasis on research, there are several research departments in our colleges that have been quite productive and are showing good promise toward future development. However, there is still a need to bring all of these research departments up to par. This is one reason the FCER formed the Chiropractic Research Commission (CRC) in 1977. Unfortunately, this organization of all the schools' research directors has done little more than meet in Round Table discussion annually. I expect to see new emphasis in this type of organization in the immediate future.

One of the areas in which I would like to see such an organization of researchers would be in developing workable protocols for controlled clinical trials within the college setting. Performing clinical trials continues to be a major hurdle for most of our chiropractic colleges. It is difficult to assign clinic patients for subjects when the clinics' student doctors are having difficulty making their patient quota for graduation requirements. Additionally, the FCER could work through an organization of researchers in developing better grantsmanship as well as constructing research paradigms that can aid the less developed research departments in preparing fundable projects.

FCER would like to continue to fund the large scale randomized controlled clinical trials, especially those that use the collaborative approach with other disciplines. We believe that chiropractic must continue to demonstrate its comparative value to other health care approaches.

The foundation will continue to look for sources of funding and attempt to coordinate these with appropriate programs and projects within the profession. It is exciting to think we might be able to establish more facilities like the Practice Consultants Clinical Research Center at National College, funded by Dr. William Harris and Practice Consultants, Inc.

The FCER has recently proposed a study which would evaluate federal funding priorities to help us determine why so few chiropractic-based projects have received funding, and how this might be improved upon. Currently, we are looking at several RFA's (Request for Funding Applications) that have been submitted by nationally known research organizations on this subject.

It has been suggested that the Florida study that was so successful should be repeated. However, it is difficult to find states where the same information would be as accessible. Additionally, we have learned that such information would have more political impact if we could utilize an independent agency, such as a university or non-aligned research organization, to do the study. We are looking into several possiblilities.

The foundation is involved in the "Standards of Care Project" initiated by the Pacific Consortium for Chiropractic Research. Although our primary purpose is to administer the funds from the ACA and NCMIC through restricted grants, accountability of these funds will be closely monitored. This is a laudable project that the consortium has taken on, and long overdue according to some. However, we as a profession must give this project close scrutiny so that it does not deter future growth and development of the profession.

In the next year I believe that the FCER should start developing some long-range planning. We have spent the last 46 years addressing basic research needs. It is now time to start looking toward the future of research in chiropractic. What are our needs going to be in the year 2000? We must evaluate new means to both develop research as well as disseminate it to the scientific field, our profession, and the health consumers we all serve.

To do all these things, the FCER needs the support of each chiropractor in the profession. This profession had spent nearly the last 100 years developing its philosophy and art. Now, if we are to stand and be counted with the other health care systems as we approach the 21st century, let us continue to develop the science that our art must also depend upon. Let us not be afraid to test our art in the face of others. As chiropractors, we know it works. We know it is effective in getting sick people well. We see it every day clinically. So let us allow science to test it and help us understand why it works.

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