Looking Forward to the Future of Chiropractic

Twenty-five years ago, there was not much chiropractic science, at least not that you could easily point to or get your hands on. In my view, the progress we have made since then has been remarkable and historically notable. The challenges then were very significant; in fact, they seemed almost insurmountable. A prevalent attitude was that research might be antithetical to chiropractic. This was accompanied, not surprisingly, by a general lack of knowledge about how to go about doing research in our institutions, a lack of trained chiropractor-scientists and facilities for both basic and clinical research, and a major lack of money that could cover the costs of research projects. There was only one genuine peer-reviewed scientific journal for chiropractic (JMPT), and only a handful of high-quality textbooks published by established publishing houses.

All this was not for lack of trying on the part of some well-meaning individuals. A few chiropractic scientists were working, albeit in an isolated fashion. Scientific conferences sponsored by the FCER had just been initiated, and regular meetings of research-minded administrators were attempted. The CCE decreed that each college have a "research department" headed by a director of research, but these folks rarely had a staff or a large enough budget to really make a difference. I remember that the research directors of the chiropractic colleges had rarely even met each other, let alone worked together in any meaningful fashion. There was no cohesive and mutually-supportive community of chiropractic scholar-scientists as there is today, but the stage was being readied.

It was becoming abundantly clear that the future of chiropractic had to include the professional behavior of contributing to codified knowledge to support chiropractic theories, values and clinical activities. Furthermore, it was becoming abundantly clear we did not have much scientific data with which to do this. Even as a student, I remember being alternately appalled and anguished that the profession seemed to be so far behind the scientific curve. Now, I count myself lucky to have observed close-hand many of the remarkable changes that came along within a couple of decades.

Looking back, I can see the threads of several initiatives that bore fruit years later and continue to drive our research forward. These included, in no particular order of importance or timing, the advent of college funding for research training and projects by the FCER; the establishment of the Consortium for Chiropractic Research, with memberships from virtually all chiropractic colleges in North America at the time; the beginnings of annual research conferences by several organizations; and the discovery by textbook publishers that chiropractic was a major scholarly market. A number of scientific peer-reviewed chiropractic journals were started, some of which are now going stronger than ever. Of course, recognition that chiropractic-related research was worth funding by the federal government was a huge advance for the field.

One of the watershed events was when the profession persuaded the research institute RAND to examine the results of extant clinical trials of spinal manipulation for back pain in the late 1980s. In a surprise to many, RAND's independent and highly renowned researchers declared there to be as much or more research for manipulation for back pain as for anything anyone else was using. This, and related news around other chiropractic-related research, actually moved our signature procedure out of the category of investigational and into the category of mainstream. The AHCPR guidelines for back pain further nailed down this fact a few years later. At this point, no one could accurately say the profession was not doing its duty, at least with respect to back pain, the most common patient complaint in a chiropractor's office.

The 1990s saw even more research capacity develop in the profession. There are too many dedicated individuals and events to spend much space on here, but the result was a worldwide community of chiropractic scholars developed and started to communicate with one another. A number of chiropractors received and started to apply their PhD expertise in basic science research, and many tackled the challenges of clinical trial research. College administrators and political leaders began to experience the credibility and authority science can confer and began to provide greater resources to the burgeoning research effort.

As mentioned, a very significant milestone was in 1994, chiropractic colleges and scientists began to be directly funded by the federal government. Never before in our history had this happened. While initiated originally by effective political activity by our trade and educational associations, these sources of research funding have continued to grow over the past decade as a result of successful, highly competitive grant applications submitted to the National Institutes of Health and the Health Resources and Services Administration. For example, the Palmer Center for Chiropractic Research has, in its 13 years of existence, been able to attract more than $30 million to support highly innovative collaborative research. At the same time, chiropractic scientists began to be appointed to advisory boards at the NIH and similar organizations in other countries, to be invited to review manuscripts for major journals, and to sit on grant review committees at the highest levels. They were able to attract collaborations from mainstream university departments and even to attain joint faculty appointments.

These developments clearly have led to a steady increase in the quality, quantity, visibility and credibility of chiropractically generated and published research. High-level research conferences are well-attended. Faculty are encouraged to publish, and students currently in chiropractic college can now consider a career in chiropractic research, something simply not available 25 years ago.

Perhaps the most recent remarkable observation is that scientists with chiropractic backgrounds are now obviously leading the scientific world in some areas relevant to chiropractic AND medical practice. Witness the "Special Issue on Evidence-Informed Management of Chronic Low Back Pain Without Surgery," an entire issue of The Spine Journal (January/February 2008;8[1]); and the recently released, "The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders," published in Spine (Feb. 15, 2008 supplement). Both of these works of significant impact were led by scholars with chiropractic backgrounds. With the publication of these cutting-edge papers, the authority of chiropractic science took another major step forward.

When taking the long view, there is no doubt that the profession has made great strides in the science of chiropractic, but we must not be duped into believing our scientific and other challenges have been met. Success often generates it own challenges, and the research effort in chiropractic is no exception. The bar is now higher than ever to demonstrate clinical effectiveness and value for all aspects of chiropractic care. We still have the unenviable and large task of sorting out the many controversies that still plague the profession. As successful as we have been at developing an initial critical mass of chiropractic scientists, we still have many more good questions than good answers, and we need many more competent clinician-scientists. However, the satisfying lesson of the past quarter-century of developing chiropractic science is this: When committed and dedicated individuals and organizations go to work with focus and persistence, once-impossible things start to happen.