Adjusting to Change

More than 90 percent of all the valid scientific research ever done in chiropractic was done in the last five years.

Call it an information explosion, future shock, a paradigm shift, or whatever you want, absorbing a lot of new information in a short period of time can create major problems. Chiropractic is conservative in more than one meaning of the word: Although superficial technique differences have proliferated in the past, conceptually and "philosophically" things have remained very much the same for a very long time. That's the good news. The bad news is that it is very likely that a lot of new and sometimes discrepant information will need to be absorbed in the near future, and with chiropractic's conservative history we do not yet have the mechanisms in place to do it.

Perhaps a good lesson could be taken from how governments operate. Any government which has no mechanisms in place to absorb or incorporate information about new conditions is liable to revolutionary overthrow. Perhaps the real brilliance of governments like the United States' is that we have continuous electoral change, response to the changing needs of the people, a constant, controlled governmental reaction which eliminates the need for cataclysmic and bloody real revolutions. In a very real sense then, democratically elected governments utilize the same principals as the scientific method: Elected officials are tentative solutions to changing problems held in place as long as they are observed to be both responsive and effective. That is also an exact description of scientific models or theories.

Which takes us back to the problem of absorbing new scientific information into the clinical practice of chiropractic. The Consortium for Chiropractic Research, now composed of ten chiropractic colleges and many other major chiropractic organizations, is in the process of developing, (really, inventing), such a process. Here's how it will work.

Once every year in the summer, at the Consortium's Conference on Research and Education (CORE) there will be about a dozen individual (two hour) presentations devoted to generic chiropractic diagnosis and treatment procedures. These generic topic areas, which we assume may change somewhat over time, have been developed in conjunction with the ACA Council on Technique, and will include such diagnostic categories as leg length inequality, x-ray marking, etc., and such generic adjustment categories as low force, short lever, etc.

Each two-hour session will begin with a clear description of the generic procedure. This will be followed by a description of how the major chiropractic techniques utilize this procedure, if at all, and how they rank the procedure in importance. These technique viewpoints will be personally presented by the major technique developers themselves.

Next in each session, a comprehensive review of all the relevant scientific and clinical literature will be presented by a professional reviewer. These reviews will be commissioned each year by the Consortium, and will have been rigorously peer reviewed (by the regular process of an indexed journal) before presentation.

The final part of each two-hour session will consist of a moderated discussion and consensual agreement process held among the technique developers and the scientific reviewer. Points of agreement and points of disagreement will be determined and recorded. The session will end by presenting ways to measure the effects of any suggested changes in individual clinical practice.

The CORE process will be published every year, but as a journal monograph, not on stone tablets. Every generic procedure will come up for re-examination about once every three or four years, and the professional literature reviewers involved will be different each time. Change is expected in every area, every time.

Another important component of this process every year will be the publication and incorporation of the findings of an accurate, projectable, national survey of attitudes and opinions of all chiropractors themselves with regard to the utilization and importance of these generic clinical procedures.

Finally, so that field doctors understand exactly how to implement any possible changes, this CORE process needs to become and remain the ongoing core of every continuing education curriculum and relicensure program.

At the Consortium for Chiropractic Research, we believe that this innovative provision for a controlled response in chiropractic is not only sensible, it is absolutely essential for the maximum benefit to patients and for the survival of the profession as we "adjust" to incoming scientific research knowledge.

Robert D. Jansen, Ph.D.
Executive Director,
(Pacific) Consortium for
Chiropractic Research
Sunnyvale, California

Individual memberships are $65 per year and include a subscription to the Consortium newsletter, which keeps doctors updated on Consortium activities and projects, e.g., standards of care. The membership dues may be charged to your Mastercard or Visa by calling 1-800-327-2289, or you may send a check to: The (Pacific) Consortium for Chiropractic Research, 1095 Dunford Way, Sunnyvale, California 94087.