Emerging from Our Isolationism

Chiropractic is finally emerging from its long winter of isolationism into the warm light of science and of camaraderie with other health professions. This renaissance has been made possible by the hard work of people such as Drs. Sportelli and Wilk, whose efforts have helped to bring us to the present crossroads in our evolution.

We now require the concerted efforts and contributions of the profession-at-large: time, intellect, organization, and money. Most especially, we must bring our politicians, researchers, clinical innovators, representative practitioners, and educators together. We must tap into that talent which has lain dormant for so long, if we are to accomplish the next stage of development in chiropractic

The challenges and tasks facing this profession are several:

1. We must generate consensus guidelines for the practice of chiropractic, both in order to better aid our patients and to maintain our viability in the health care market. Guidelines will be created, by us or for us. Our autonomy is at risk here, but we are capable of meeting this challenge through chiropractic research and the consensus process.

    

2. In order to participate meaningfully in the ongoing process of standards development, we must work much more actively to develop hard copy data, especially information about chiropractic health care outcomes.

    

3. In order to provide our researchers with a realistic amount of resources (including but not limited to finances) we must develop and implement political strategies at the federal level to obtain grant monies for chiropractic education (i.e., developing the infrastructure) and research development. (The Agency for Health Care of Policy Research is a likely target, but other federal offices, such as the National Institutes of Health, must also be tapped.)

    

4. We must underwrite the advanced scientific training of a significantly greater number of chiropractors, so that we will have the personnel to use the federal research dollars we hope to solicit.

    

5. We must contribute a great deal more than in the past to the support of chiropractic colleges which continue to struggle under the impossible burdens of 80+% tuition-dependency. If we expect our schools to become institutions of higher learning, we must help them to excel in more than classroom instruction. As Dr. Adams of LACC has suggested, "teaching without research is like a confession without sin." While we seek greater support for chiropractic education from government, we must demonstrate our own commitment directly, both for the college's instructional and research missions.

    

6. We must grow past our traditional defensive thinking. Where in the past we thought of the scientific community as someone else out there who was going to judge us, now we must become the scientific community by collecting data and critically evaluating ourselves. We must begin to evolve philosophically from chiropractic principles as immutable truths to principles as guides to better chiropractic science. Our philosophy must become our activity rather than our dogma.

    

7. We must encourage our political organizations (ACA, ICA, etc.) to work more closely with the research community in this profession. The annual conventions of our trade associations ought to be a showcase for chiropractic science. We must insist that our professional associations greatly increase their commitment and involvement in the development of the science and art of chiropractic.

Contrary to the many predictions of doom and gloom that abound, I believe we can leap past several other disciplines in demonstrating our commitment to accountability through clinical research. The profession's recent collaborations with the RAND Corporation are an exemplary step in this direction. We must double, triple, and quadruple our efforts to collect the outcome measurements by which we can make more informed choices about patient care. It is a time both of challenge and opportunity for chiropractic.

The National Institute of Chiropractic Research is committed to this evolution. With the help of chiropractors, we will do all we can to meet these challenges.

Thank you for this opportunity to communicate.

Alan W. Fuhr, D.C.
President, National Institute
of Chiropractic Research
Phoenix, Arizona