The Scientific and Ethical Dimensions of Chiropractic Research

Introduction

In spite of the human desire for a complete comprehension of the meaning of things, few human phenomena offer perfect or precise understanding. This is certainly true of human health and illness for which complete analysis, understanding, and control remain elusive. The pursuit of a thorough understanding of what comprises health, an explanation of illness and disease, and an identification of the most efficacious treatment or prevention of a specific health disorder depends significantly on the correct application of the methods of scientific research. In the case of traditional medicine, the initial trend toward science has been apparent since the mid-19th century, when the French physician and physiologist, Claude Bernard, recognized that developments in the basic sciences were gradually turning medicine "toward its permanent scientific path."¹

Chiropractic has also initiated a commitment to scientific research, which will ultimately contribute to a more refined understanding of the association between spinal health and general well-being, and to more efficient and effective chiropractic treatment of illness and disease. Chiropractic need not adopt a "medical model" of health and illness to conduct scientific research. However, chiropractic must conceptualize and apply the scientific method correctly in its research activities. In particular, doctors of chiropractic, who are encouraged to use research data in their diagnostic and treatment approaches, and who are solicited for financial support of research project and organizations, must become educated consumers of scientific research and, when possible, capable practitioners of field investigations.

Research and the Scientific Method

Most fundamentally, research involves trying to find new facts and ordering these facts into meaningful patterns.² Research is often viewed as a method for solving problems and seeking answers to questions. The primary purpose of science is to develop new knowledge. Science attempts to describe, predict, control, and explain phenomena. When science and research are wedded and an investigator employs the scientific method of research, certain phases or steps in the research should be apparent: the formulation of a hypothesis, which is a tentative proposition about the relation between two or more theoretical concepts; the deduction of empirical consequences of the hypothesis, i.e. identifying a real-life situation or constructing a simulation that will allow a test of the hypothesis; and, the test of the hypothesis by collecting empirically-based data.

The Norms of Scientific Research

When one conducts scientific research, certain norms are to be followed: 1) Knowledge claims, whatever their source, are to be judged by pre-established criteria that are common across all such claims. It is the quality of the work itself, rather than the characteristic of the research, the financial supporter, or the sponsoring institution that should be the focus of judgement. 2) Information is to be open to others; there is an obligation to communicate findings. For example, many universities have regulations limiting or banning research that cannot be freely published because of a sponsor's condition. Communication of findings covers both positive and negative findings, i.e., findings which support or fail to support the original hypothesis. 3) Data are to be gathered and interpreted without regard to personal expectations about what they should be or what they should show. This norm assures the integrity of scientific research. 4) The research community should maintain a necessary skepticism about new knowledge claims. Organized scientific skepticism questions new knowledge claims and searches for alternative explanations of findings. Unlike other approaches to knowledge development (e.g., adherence to authority or belief systems, or reliance on intuition), the challenge to new research-based knowledge is sought in science. 5) Objectivity in the design, conduct, and interpretation of findings should be strictly adhered to. Phenomena observed or measured by one researcher should be seen in the same way by another. Findings are not to be influenced by the researcher's emotions, biases, or expectations. 6) Scientific research findings should be replicable. Others should be able to duplicate the research procedures and observe the same results.

Equally important, replication should be a primary criterion for the acceptance of new scientifically-derived knowledge. 7) Scientific research should allow for self-correction. Hypothesis testing, coupled with reliance on empirically-based data, contribute to a "feedback loop" that refines knowledge assertions and replaces false or inaccurate ideas with more substantiated findings.³

Summary

The development of chiropractic scientific research and the usefulness of research findings for chiropractic clinical practice will depend, in great part, on the correct use of the scientific method and the adherence to the norms of scientific conduct in research. As Norman Cousins has noted, "It is reasonable to expect the doctor to recognize that science may not have all the answers to problems of health and healing. But is is not reasonable to expect him to give up the scientific method in treating his patients. The most important thing about science is the scientific method -- a way of thinking systematically, a way of assembling evidence and appraising it, a way of conducting experiments so as to predict accurately what will happen under given circumstances, a way of ascertaining and recognizing one's own errors, and a way of finding the fallacies in long-held ideas. Science itself is constantly changing, largely as the result of the scientific method. It is unreasonable, therefore, to expect the doctor to depart from this method, no matter how great the compulsion or persuasion."⁴

References

1. Silverman, W. "Human Experimentation: a guided step into the unknown." New York 1985; Oxford Press.
2. Plutchik, R. Foundations of Experimental Research. New York 1968; Harper and Row.
3. Krathwohl, D. Social and Behavioral Science Research. San Francisco 1985; Josey-Bass.
4. Cousins, N. Anatomy of An Illness. New York 1979; Bantam Books.