One of the great joys of being a chiropractor in this era is witnessing a number of historic changes in how the health care world interacts with chiropractors. It's true that the pressures of accountability, managed care, and competition are daily impacting us, but almost monthly I see major growth spurts in our profession's quest to improve what we do and our increasing participation in decision-making.
Take a couple of recent items reported in Dynamic Chiropractic: the National Institutes for Health's funding of a "Center for Chiropractic Studies"; and the involvement of a couple of chiropractic clinics in the Institute for Health Care Improvement's efforts to incorporate quality improvement in low back care along side the likes of the Mayo Clinic and Harvard-Pilgrim health plans.
In mid-June, another major landmark occurred for the profession with the event of the second federally sponsored workshop to establish a detailed and implementable research agenda for the chiropractic profession. The first national workshop in 1996 was sponsored by the Health Resources and Services Administration (of the Department of Health and Human Services) via a contract through the Palmer Center for Chiropractic Research, under the leadership of DCs Cheryl Hawk and Bill Meeker. That effort yielded a comprehensive inventory of research conducted to date in chiropractic, and a prioritized topical agenda pressing research issues that the profession and health service planners need to address. The full deliberations of that first conference made up a special issue of the Journal of Manipulative and Physiological Therapeutics in March of this year (Volume 20, Number 3) and makes for some insightful reading.
The product of the first workshop also identified fundamental problems within chiropractic's research infrastructure that have limited our ability to produce a greater amount and higher quality of research than we currently do. Among the limitations are the small number of individuals actively engaged in chiropractic research, the limited amount of release time for research activity at chiropractic schools, and the obvious lack of grant money for research.
The second workshop sought to flesh out concepts for actual research proposals including the establishment of research teams and potential approaches to funding, including a significant nod to educational research and faculty development within our schools. In addition to celebrating the accomplishments and magnitude of the workshop, all of this leads up to the topic of my column, which is how intimately research and education are linked. A quote I once heard, attributed to a university president, goes something along the lines: "Education without research is like confession without sin." The point being that without research to develop new knowledge, there is very little to teach. Although this metaphor of logic illustrates a conceptual link, there are actually more practical connections between the two.
Many universities and colleges have fully staffed grants offices that employ folks to identify potential sources of non-tuition dollars that support salaries and direct costs of research, and link areas of institutional expertise with potential sources of revenue. In addition, indirect costs for facilities and overhead are also realized from grants and contracts, which can help with the development and maintenance of facilities and support staff. The experience and culture of scholarship and career advancement associated with a research enterprise helps to attract and keep good minds who can serve as learning resources for students, as well as attractors and developers of more good faculty. It also creates opportunities for better interactions and rotation of a wide variety of "visiting scholars" to contribute to the college community.
Albeit, having come from an overly research-focused undergraduate system that de-emphasized teaching and learning in favor of research, any extreme focus to the exclusion of other forms of scholarship, teaching and service can have its own detrimental effects. Nonetheless, few would argue that chiropractic institutions anchor down the opposite end of that spectrum. In fact, chiropractic institutions only average about the equivalent of two full-time positions devoted to research, and the amount of money going to chiropractic research worldwide still doesn't even amount to the annual research budget of a single decent medical school.
As a result, a significant amount of research occurring in chiropractic is increasingly occurring outside of chiropractic institutions at major universities, in multidisciplinary care settings and even in the private sector. While objective, quality research about chiropractic related matters is a good thing regardless of where it occurs, it seems to me that the profession has a vested interest in maintaining and enhancing a major research footprint within the chiropractic academic setting. Thinking back on my undergraduate training, with all its limitations, I must say that having had courses in biochemistry and molecular biology from Nobel Prize winners like Stanley Miller (who was the first person to synthesize organic chemicals from inorganic substrates) and Francis Crick (of DNA fame) have left lasting impressions that influenced my aspirations beyond passing a final examination.
In chiropractic school, I also had the opportunity to learn from some great minds and a few "chiropractic celebrities," but there was an unfair attitude that prevailed, even into my eight year tenure as a faculty member, that "Those who can, practice; those who can't, teach." It's interesting to me that after 13 years of practice, I'm more closely identified by most of my colleagues as a "researcher" than as a clinician. And I've really only been involved in a half a dozen or so funded data studies, a small slice of pie for a researcher in the greater academic world that would hardly qualify me for reappointment to a typical major university faculty position in the health sciences.
Without letting the pendulum swing too far in the "publish or perish" direction, I believe it is imperative for a larger percentage of our institutions to prioritize and earmark resources for building our profession's research infrastructure at the college level. It was exciting to see educational research and faculty development projects get fleshed out at the National Workshop to Develop the Chiropractic Research Agenda, as well as other pressing research questions of our time.
A number of years ago, CCE established accreditation requirements that served as an incentive for a minor research presence in the colleges, but no regulation can stimulate a culture that builds on contributing to new knowledge for the benefit of all. In this era of the mainstreaming of chiropractic, it is my fervent hope that appropriate embracing of research and science for the primary purpose of benefiting the care of our patients will supplant the defensive, special-interest "guild mentality" of proving chiropractic works. It is also my hope that conducive environments for this kind of work develop and grow at a faster pace within our chiropractic schools. I would hate to see a long-term scenario where our profession's most productive research capacity occurs primarily outside the halls of our institutions. In my opinion, despite the gains and good work that have occurred to date at many schools, enhancement of research capacity and productivity within our colleges needs to become a higher priority right now. It's an exciting time to be a chiropractor, partly because of the accomplishments made to date and partly because the challenges we're are facing on an increasingly more level playing field are among the greatest our profession has faced.
Robert D. Mootz, DC
Olympia, Washington
moot235@lni.wa.gov
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