William E. Morgan, D.C.

The preferred setting to perform chiropractic clinical research may not be a private chiropractic office, or even a chiropractic college. The best place to perform chiropractic clinical research may be an integrated facility such as a hospital or major medical center. The rationale for this concept is diverse.

Why use integrated clinics for clinical chiropractic research?

Recruitment of Patients

There are more patients in large medical centers than in chiropractic clinics. Additionally, the patients who go to chiropractic clinics are biased toward chiropractic. While it may seem like a good thing to study patients who like chiropractic, this may cause an otherwise well designed research project to become tainted. For any study to be credible, bias must be minimized. Patients recruited at large integrated clinics are less likely to be prejudged toward chiropractic.

Along with minimizing bias, it is easier to recruit the right kinds of patients at integrated centers. For instance, to study how chiropractic affects ear infections, it would be simpler to recruit appropriate patients from a large otolaryngology clinic than a chiropractic clinic.

Depth of Expertise

Integrated settings are much more likely to have varied expertise. Imagine studying the affects of chiropractic adjustments on the vertebral arteries. Wouldn't it be convenient to have medical neurologists who specialize in strokes as consultants, investigators or as an information resource? Conversely, it is a good idea for chiropractors to be consulted by anyone studying the affects of manual medicine.

In addition to having various specialists, medical centers typically have more research-oriented practitioners than chiropractic clinics do. Chiropractors can learn a lot from their experience.

The Devil's Advocate

As odd as it may seem, the best friend of a research project may be the devil's advocate. In a multi-disciplinary clinic the researcher may find that an intellectual opponent is his/her best friend in finding the flaws in a research study. This medical adversary may be annoying in the clinic, but his criticism may help to fine tune a research proposal.

The likelihood of bias is decreased by having non-chiropractors scouring studies for partiality or prejudice. This will help to keep the research scientifically sound.

A Credible IRB

The Institutional Review Board (IRB) is a board of reviewers who review all research proposals that are to be performed at each institution. They must approve all research projects. It is their difficult job to analyze proposals and determine the impact of the research on patient safety, as well as the legality of the research, its scientific merit and several other factors. While chiropractic colleges have very credible IRBs, I am concerned about reliability when I hear of independent chiropractic researchers forming their own IRB, or worse yet, hiring their own IRB.

Conclusion

Since chiropractic education is predominately clinically-based (versus research-based) most chiropractors are not strong in research knowledge. Therefore we are easily led off course. While the possibility of being lead astray by a medical researcher exists, I am more concerned about false leadings from within chiropractic by doctors with a biased agenda.

Recently a chiropractic practice management company began promoting the use of research to "prove" chiropractic and to attract new patients. This company sites a recent poll that revealed that the public has far greater trust of scientists than they do of chiropractors. This business wants to promote their clients as "scientists" and use the guise of research to recruit patients for monetary gain. This company is imprudent and is misguiding its clients. Exploiting patients by calling practice promotion research is despicable.

I feel that chiropractic and mainstream researchers can work together to uncover the mysteries of chiropractic. But future chiropractic education must include a curriculum rich in ethical clinical research.