The Relationship Between Research and Identity – A Report from the European Chiropractors Union

I recently returned from the European Chiropractors Union (ECU) annual conference in London, where I heard a landmark presentation from Dr. Scott Haldeman, DC, MD, PhD, FCCS(C), FRCP(C). In fact, he must be credited for a yeoman’s amount of work just to compile it. In Dr. Haldeman’s presentation, he shared some particularly interesting statistics to help us better understand chiropractic’s position in the world.  
For example, there are an estimated 100,000 chiropractors worldwide. The World Federation of Chiropractic has 85 membership countries.  Chiropractic is practiced legally in 89 countries, and we have colleges in 15 countries.

Throughout Dr. Haldeman’s remarks, it became evident that research is beginning to take hold in chiropractic circles. At the 2009 WFC biennial congress in Montreal, 149 abstracts were submitted, and 120 of them were accepted.  Thirty-two scientific platform presentations were offered, and 88 scientific posters were shared.  Eight of the keynote speakers were chiropractors who held PhDs with endowed university research chairs.
At the recent Association of Chiropractic Colleges’ Research Agenda Conference in Las Vegas, there were 94 platform presentations, 62 abstracts, and two keynote speakers with MDs. The ECU convention featured 12 platform presentations, 16 posters, and papers on topics ranging from the inclusion of manipulation or chiropractic in the Cochrane collaboration to our field’s impact on children.
What do these statistics mean to us?  Without the data gleaned from research, it is difficult for any profession to have a clear public identity.  Research makes our profession credible, helping the public understand there is an evidence basis to our approach. In a recent survey, 90 percent of DCs agreed that it is important for a profession to have a clear public identity, and yet most chiropractors who participated in the survey did not believe chiropractic’s identity was clear enough in today’s world.  Through research, we have an opportunity to change that perception.
And given this insight, what should chiropractic’s identity be?
Dr. Haldeman offered several options through his presentation, summarized below:
Option 1: We can be a philosophical belief system.  However, we still need research to prove our hypotheses.  For example, we know there are biomechanical and physiological changes that can occur in the spine on mechanical stimulation, but we have yet to obtain consensus on the definition of a subluxation.  
Option 2: We can be skilled practitioners of spinal manipulation.  There is considerable research that suggests that spinal manipulation is a beneficial treatment approach for spinal pain syndromes and certain sports injuries.  But the acceptance of manipulation as a legitimate option in the management of spinal pain has encouraged physical therapists, osteopaths and medical doctors to obtain skills and offer this form of therapy. Competition abounds.
Option 3: We can be wellness practitioners. Historically, chiropractic has emphasized a healthy lifestyle.  The problem is that all physicians, regardless of their training, provide this service.
Option 4: We can be spinal care clinicians or specialists.  But is there a need, and can chiropractic satisfy it?
Back problems are the leading cause of lost work days, and joint problems rank fifth. Of the 10 most costly medical conditions in the U.S., joint problems rank fourth and back problems are sixth.  These statistics alone indicate a need, but can we satisfy it?
Clinical competencies are mandated by the Council on Chiropractic Education (CCE). Over 90 percent of DCs already provide a differential diagnosis, use adjustments, recommend exercise and wellness care, and offer ergonomic advice. More than 80 percent provide advice in nutrition and stress reduction.  Since chiropractic is irreversibly linked to the spine, we also have the opportunity to become the authority on non-surgical management of spinal disorders.
What must be done to assume this identity is to continue researching our approach to care.  We must be perceived as mainstream by the general public, rather than an alternative therapy. Research is the primary way to disseminate information that will fundamentally change this perception. Neurologists are considered mainstream, and more than half of them attend annual scientific conferences.  The percentage of chiropractors that do the same is abysmally low.  Just think what we could do as a profession to position ourselves as primary spine care clinicians if we simply made research a top priority.  We are making progress, but carving out our niche requires us to make research a mainstream part of chiropractic, such that chiropractic itself becomes a mainstream part of the healthcare landscape.



Dr. Fuhr, Co-Founder and CEO of Activator Methods International, travels extensively to chiropractic seminars, conferences and events around the world. He will be providing his insights and perspectives from these visits as a regular guest commentator for The American Chiropractor. You can reach him at 602-445-4230 or email [email protected].

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