Synopsis of Research Agenda Conference IV: Arlington Heights, IL, July 23-25, 1999

The North American chiropractic research community's continuing endeavors to assess and improve its lot found an excellent opportunity at the fourth in a series of yearly research agenda conferences under the direction of William Meeker,DC,MPH, and Cheryl Hawk,DC,PhD, and funded by the Health Resources and Services Administration. (See "Expanding Chiropractic's Research Consciousness and Competence" in the September 6th issue of DC, available at http://www.chiroweb.com/archives/17/19/16.html )

This three-day conference, held for over 200 registrants at a hotel in a Chicago suburb, offered a welcome mix of workshops, plenary sessions, floor debates and hallway schmoozing - all of which allowed ample opportunity for researchers in varied fields and clinicians to improve their skills and form closer and more extensive collaborations.

Specifically, the conference offered workshops on scientific writing (presented by Dana Lawrence,DC); interpreting the scientific literature (provided by Alan Adams,DC); and developing a successful grant proposal (presented by Israel Goldberg,PhD, who was the senior executive in charge of extramural programs of the National Eye Institute at the NIH). These were followed by a luncheon address on the use of appropriate research designs for chiropractic studies by Wayne Jonas,MD, former director of the Office of Alternative Medicine at NIH.

Afternoon workshops on the first day consisted of a session on the use of appropriate research designs for chiropractic studies by Cynthia Long,PhD; a briefing on the impact of research for practice, policy, public relations and education by Robert Mootz,DC and Daniel Hansen,DC; and an overview of successful research project administration from Joanne Odenkirchen and Betsy Singh,PhD, from the perspectives of both a clinical coordinator of extramural programs at NIH and the director of research in complementary medicine at the University of Maryland School of Medicine. The first day of the conference ended with a reception which offered the display of posters, plus a live performance with dancing by the Kabalas, a band representing what happens when klezmer music meets Devo.

After introductory remarks by Marc Micozzi,MD,PhD (founding editor of the Journal of Complementary and Alternative Medicine and author of the first textbook on this subject for physicians and medical students), various aspects of the research culture were examined in plenary sessions on the second day of the conference, including points of view from allied health care professions by Jacqueline Stolley,RN,PhD, and Christopher Bork,PhD,PT. Lunchtime roundtable discussions were devoted to research training opportunities and experiences, including FCER's programs for the support of individuals engaged in postdoctoral research.

Afternoon plenary sessions included reports on three aspects of the status of research in chiropractic, and a panel discussion on mentorship. The most provocative topic of the entire conference was a session on the relationship of the theory and practice in chiropractic, beginning with formal presentations by Robert Mootz,DC; William Meeker,DC,MPH; Howard Vernon,DC; and Craig Nelson,DC, and concluding with a debate with comments from the floor on the third and final day.

Two basic themes emerged from session after session at this conference:

1. The randomized clinical trial, beset with flaws and errors of interpretation when used prematurely in an attempt to build evidence, has appeared to be inconclusive at best in the two studies published last year in The New England Journal of Medicine, losing much of its luster as the "gold standard" in the process. Accordingly, RCTs must be supplanted by other types of outcomes research which encourage sound clinical observation, including the case series.

    

2. Subluxation may be a useful and possibly defining concept of chiropractic, but it is premature to accept it as a clinical reality. One must be both prepared and willing to modify (and possibly relinquish) it as a model should it become incompatible with new evidence as it becomes available.

It was refreshing to witness the candid input which was possible from both clinicians and researchers in a variety of fields in addition to chiropractic. The net effect of all these discussions was to define a conference which seemed to signify a considerable maturation of the chiropractic research community.