Systematic, impartial review of information is the keystone upon which all scientific progress is made. That said, I have become more aware than ever in the past year how that process can easily run amok, looking more like the chaotic "broom" scene in Disney's "The Sorcerer's Apprentice" than true common sense. Sometimes we become so enamored with the process that we forget the actual information contained in an inquiry, let alone its original intent. It is simply a matter of missing the woods for the trees, with a couple of lumberjacks thrown in, sporting their own agendas.
In a recent report submitted to the British government on the advisability of foxhunting, for instance, it was concluded that: "Despite a lack of firm scientific evidence, the inquiry was satisfied that hunting seriously compromises the welfare of the fox." It said the same thing about hunting deer, hares and mink.1
"Duh," I say. Rest assured that at the Foundation for Chiropractic Education and Research (FCER), we would never be caught investing in an undertaking such as this, wasting resources and personnel to pursue a research project whose outcome was obvious or hopelessly trivial. There has to be a question or controversy involving whether the proposed hypothesis or its null will be supported. If there is a consensus for a better treatment or outcome, the null hypothesis becomes a straw man and the research becomes invalid. In outcome studies, this principle has been described as clinical equipoise, a situation in which the ethics of subjects being recruited have not been compromised because patients have not been put into a treatment regimen whose outcome is known to be inferior. Rather, there is an honest question of which of the treatment alternatives being compared will produce better results.2 This then becomes a criterion by which we should accept or reject proposed clinical trials.3
A look at studies published in the medical journals over the past five years offers a revealing glimpse into how frequently randomized clinical trials (the so-called "gold standard") have been misinterpreted or even corrupted. Design flaws, sometimes appearing to be intentional, are responsible for this. Consider the following:
The importance of the observations attending the individual patient has been eloquently carried a step farther by Mark Tonelli, who argues that there will always be a region (an epistemological zone) in which the individual differences between individuals cannot be made explicit and quantified.18 To assume otherwise, to categorically assume that the entire answer to clinical treatment by any modality has been captured by the precision of analytic methods in the scientific literature, would be like saying that a medical librarian who has access to systematic reviews, meta-analyses, Medline, and practice guidelines provides the same quality of health care as an experienced physician.19
This is precisely where FCER recognizes the challenge of future research. Our program will always endeavor to involve the individual clinician and elevate the importance of the case study to its proper level of recognition. It is sometimes overlooked that all clinical trials were originally conceived by observations taken from individual cases. We ask that you provide every bit of input, through both advice and continuing membership, to FCER so that we may overcome an all-too-prevalent myth and ultimately provide the missing pieces to what is commonly regarded as evidence-based medicine.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
