Dana Lawrence, DC, M. Med. Ed., MA
Over the past few years, there have been many calls for the creation of the scientist/practitioner. In large measure, these calls have been successful, something I can attest to since the number of submissions of articles to the Journal of Manipualtive and Physiological Therapeutics (JMPT) from field based practitioners has greatly increased. This is something that is of definite benefit to the chiropractic profession; it helps us produce a cadre of people with the skills necessary to help us properly document the science of our art. However, there is a very real danger that this work and effort will be lost if the rank and file of the chiropractic profession fails to read the work their colleagues are accomplishing. Where is the scholar/practitioner?
The chiropractic profession has undergone an information explosion. Today, we have the choice of reading and subscribing to nearly a dozen scientific journals, and there are many books available to our profession written by members of our profession. This creates a problem. How is the busy practitioner going to be able to keep up with all the new information?
The fact is, they are not. The subscription levels of all the chiropractic journals, at least those that are totally subscription driven (i.e.; not provided as part of a membership to an organization, where the journal is provided as part of the dues), are falling or have topped out. This is troubling because it means that what we publish may not be read. And this is dangerous for the profession because it means that, as some of these journals begin to fold (as is already happening), then the profession finds its outlets for publications becoming more limited. And that impacts upon the scientific endeavors of the profession.
In speaking with members within the research community, I sense that there is a fear that interest in science has begun to wane, that the efforts of the past few years to develop scientist/practitioners carries less importance than it once did, and not long ago. The profession seems to be involved in a shift of priorities, away from science and toward the legislative/insurance arena. This is not bad, in and of itself. There is certainly more than enough going on within that particular arena, enough to keep our leaders busy simply trying to maintain our practice and insurance rights. I would note that they may be helped, in part, by what the journals are publishing, since it is within these publications that we document what we do.
And there are problems within the journals themselves. How, for example, can the average reader determine what makes good science? What importance do the papers we publish have on the average practice? It is hard to see practical value in many of the research papers we publish, and many of the papers we publish are hard to read and filled with incomprehensible statistical analyses. I have often heard that the JMPT has few papers of practical value, by which I interpret the complaint to mean that we publish little which can immediately be applied to a busy chiropractic practice. While I understand the nature of the complaint, there is perhaps another way to view how the scientific journals offer information pertinent to practice.
For one thing, what we publish becomes part of the database of chiropractic practice. This means that, in essence, you become responsible for knowing what your profession is writing. You can indeed be asked for testimony about whether or not you are familiar with the papers the chiropractic profession publishes. You are responsible for knowing of new developments in therapy and practice, and these are published in the pages of scientific journals. But more so, you should want to know what chiropractors are finding out about what we believe and what we do. Where is the scholar/practitioner?
A short time ago, another journal editor related statements he had received from an indexing agency when seeking to gain indexing status for a chiropractic scientific publication. The agency, in turning down the request, noted that chiropractors don't subscribe to the database and they don't cite their own literature. There was no reason for the agency to grant indexing status because chiropractors, the likeliest user of the information database, wouldn't use it. That is a serious condemnation or our profession.
We need to read, support, and be conversant with what we publish. As part of preparing each issue of the JMPT, I scan over 600 scientific journals each month looking for abstracts of papers for publication within JMPT. I have it easy, however, since I am based within a chiropractic college and have access to a library which subscribes to these journals. For the average field doctor, this is not so easy. But you do have some options. You should first and foremost support those quality publications within the chiropractic profession, and if this seems to be a request for subscriptions -- it is; however, I advocate you subscribing to several. Your investment of money will be rewarded with rich new knowledge and a greater appreciation of the hard work your colleagues are doing.
You can also subscribe to the several secondary information sources in the profession (secondary source journals are those in which abstracts and discussions of other journal articles are published, but which do not publish new knowledge; primary source journals such as JMPT are those which publish new knowledge); the FCER's Spinal Manipulation is an example of a secondary information source. And for those of you with computers and modems (an increasingly large number) you can subscribe to several on-line databases such as Grateful Med or the newly announced Chirolars System, developed by chiropractors for chiropractors. These systems will allow access to a myriad of publication citations; however, I still note that support of primary source publications is paramount, and simply subscribing to the on-line system without support of the primary source publication ultimately hurts the primary source journal upon which the on-line system is based.
The concept of a scholar is one in which the acquisition of knowledge is important for its own sake. There is a love of learning, and there is an attempt to take that knowledge and in some manner use it, synthesize it in new and exciting ways, and apply it in new settings. This cannot be done if we don't read. We have developed a fertile research endeavor within chiropractic, and it is now time to develop individuals who read the research and then take that knowledge and do something with it, even if it is just to criticize what they read.
To a point, this is beginning to happen. To many people, the "Letters to the Editor" section of the JMPT, or any other publication, is the most interesting. The "Letters" section is important to an editor, because people generally won't write and criticize an article they haven't read. Critical reading skills are an important tool. Allowing differing points of view to be heard is important to an editor. Yet more proof that critical reading is occurring is the initiation of a number of "journal clubs." These clubs are nothing more than a group of doctors in a geographical area getting together on a regular basis (usually once a month) to review, criticize, and dissect papers they have assigned themselves to read. Typically, they will read a number of papers from several different publications, then get together and debate them. In some cases, continuing education credits may even be awarded.
Journal such as the JMPT have a mission to accomplish in documenting the scientific foundations for the chiropractic profession, and the profession would be a vastly poorer place without them. Indeed, our information would be lost, and our researchers would have a much more difficult time in getting their work published. The JMPT, generally seen as the premier bioscientific publication of the chiropractic profession, is received by only about one in eight chiropractors. Were this number higher, we could do so much more. And the same for our sister journals, all of whom try mightily to provide the chiropractic profession with material of significance and importance.
All of us are scholars, and we need only divert a small percentage of our time to the reading of our own accomplishments, to the ultimate benefit of all of us and those we serve. The scholar/practitioner resides in us all, and it is time to liberate him.
