Research is a fundamental aspect of every health care discipline. It supports the theoretical foundation of any discipline and helps to distinguish useful treatments and practices from those that offer no benefit or prove harmful. In addition, integrative health care therapies such as chiropractic, massage therapy and acupuncture have developed a sizable body of research to support their use. Research on the effectiveness of these therapies has helped facilitate their acceptance by conventional health care and the general public, and is a cornerstone of the shift toward evidence-informed practice across health care more generally.
Key to this acceptance is the effort to reduce language barriers between conventional health care and more person-centered, integrative approaches to health. As integrative practitioners are usually still in the minority within the larger health care system, it is particularly important that we be able to explain our work in terms others can grasp. Understanding research greatly improves our ability to communicate effectively with other health professionals through a shared frame of reference and a common language.
In addition to this general trend, there is an increased tendency for chiropractors, massage therapists, acupuncturists, yoga therapists and other practitioners to work in conventional health care settings as part of a team, or to become involved in multidisciplinary practices. With the growing trend toward interdisciplinary health care, the ability to communicate across disciplines will continue to assume greater importance.
Being able to locate and critically evaluate research in one's field is essential to providing the best possible care to your patients. Evidence-informed practice is here to stay as the new standard across health care, and complementary and integrative therapies are being held to it. Because news about recent research is often reported in the popular media, patients and/or other health care providers may approach practitioners with questions about what implications a new study might have. It is incumbent upon you to be able to discuss questions that arise from research in your field. Understanding how to evaluate research findings helps you to do this knowledgeably, with ease and confidence.
Research evidence also has assumed a major role in influencing health care policy on a national and international level. Policy decisions regarding what treatments are considered "best practices" and which will be reimbursed are increasingly based on research. Cost and consumer satisfaction also have become important study outcomes of interest.
I believe reading health care research offers every complementary practitioner a valuable tool for improving the quality of care you are able to offer your patients; and for ensuring that you and your loved ones receive the best possible health care. Understanding research is vital to the continued development of complementary therapies. And there is another yet important reason to become an informed consumer of research...
Science as a Social Activity
In evaluating the merit of any particular study, it's important to remember that science takes place via human interaction: through informal communication among colleagues with similar interests; more formal presentations and discussions at conferences; and publication of completed research findings in peer-reviewed journals. Knowledge-building is a social process just as much as it is a scientific one.
Because human beings are fallible, the social norms of science help to minimize the presence and/or influence of personal bias in the processes through which speculation becomes knowledge. These norms include an expectation of integrity in the design, conduct, interpretation and publication of research studies.
Peer review serves as an additional structure to maintain integrity. Journals do, however, have a tendency to prefer publishing studies with positive results. This tendency has been demonstrated and is known as "publication bias."
At the same time, as the number of university tenure-track jobs and the availability of grant funding decreases, there is increasing pressure for scientists to publish positive results. The blog Retraction Watch, with support from the Center for Open Science, has chronicled the rise in the number of scientific retractions since 2010 and maintains a database to document these.
In the end, though, both honest mistakes and deliberate scientific fraud are eventually uncovered through peer review and the nature of how knowledge-building works. Knowledge-building is always provisional – in science, new information can always displace what we thought we knew previously.
Another example of scientific integrity is the practice among peer-reviewed journals of requiring disclosure of all sources of financial support for a study, so readers can judge the extent to which the study could be biased because of who funded the research.
As an example, a study concluding that smoking poses no substantial health risks in spite of numerous contradictory studies would be viewed even more suspiciously if it were funded by the Tobacco Institute. By the same token, research on herbs and dietary supplements has sometimes been viewed more critically when funded by companies that manufacture these products.
Science philosopher Thomas Kuhn articulated the idea that scientific world views or paradigms define the kinds of research questions that may legitimately be asked. What is thought to be "legitimate" can vary according to the social norms and assumptions of a culture, and what is considered within that culture to be useful or important knowledge. Historians of science have detailed the ways in which the practice of science has sometimes been distorted by dominant cultural biases, such as the infamous Tuskegee study.
Ethics in Health Care Research
It is also important to define how research may legitimately be conducted, a subject that has been influenced by social norms and cultural bias as well. Present-day scientists involved in health care research have a code of ethical principles that must be applied to both human and animal research. With respect to human subjects, two of the most basic principles of ethical clinical research are to:
Experimental studies are especially susceptible to ethical concerns because they involve direct intervention by the researcher in the lives or health of the participants. For this reason, the researcher is expected to make every effort to protect the human rights and well-being of the study's participants.
Current standards for research ethics have been formalized since World War II. In the U.S., the Nuremberg Code (1947) and the Declaration of Helsinki (1964, revised in 1975) became the foundation for the formation of the National Commission for Protection of Human Subjects and Behavioral Research. This commission produced a document known as the Belmont Report.
The Belmont Report proposes that three core values should underlie all research endeavors: respect for persons, beneficence and justice. The practical implications of each value deserve discussion:
Respect for persons refers to treating people as autonomous beings, with the right to make decisions based on their own interests or preferences. This value requires that people participate in research studies voluntarily, with adequate information regarding study procedures, and has resulted in the legal protections found in informed-consent documents. People whose circumstances involve less autonomy, such as prisoners, children or mentally challenged individuals, must receive special protections because they cannot give fully informed consent. For example, children participating in research must have a parent or guardian give consent in the child's best interests.
Beneficence refers to the value of doing no harm. This concept obligates researchers to give thought to maximizing the potential benefits and minimizing the potential risks that might occur from participating in a research investigation. Researchers are required to communicate an accurate assessment of the potential risks and benefits of participation, so that prospective subjects can decide for themselves whether the possible benefits outweigh the possible risks. Beneficence underlies much public debate about exploring new areas of research, especially as new technologies expand the types of interventions that are possible.
Justice refers to the value of fairness in the distribution of the benefits and burdens associated with participation in research. In the 19th and 20th centuries, a disproportionate share of research participants came from poor, disenfranchised and/or captive populations. The exploitation of Nazi prisoners in medical experiments is a particularly flagrant example of such injustice.
The value of justice leads to the expectation that researchers will assure subjects or participants are recruited based on the requirements of the research question being asked, and that disadvantaged people are not disproportionately selected for a study because of their availability and vulnerability to exploitation.
An outgrowth of the Belmont Report was the development of U.S. government regulations requiring the establishment of Institutional Review Boards (IRBs), to act as ethics committees to safeguard the rights of study participants. IRBs consider the scientific merit of proposed projects in light of the study's potential risks and benefits; and assess the procedures for selecting and recruiting participants, for ensuring appropriate informed consent, and for maintaining confidentiality of private health care information disclosed during the study.
The IRB approves the proposed design of the study only if its benefits outweigh its risks, and then monitors the conduct of the study as it progresses. It is standard practice now for journals to require a statement from authors describing how ethical standards for the study were met when submitting a manuscript for publication.
Knowledge Is Power
Understanding the background concepts that underlie how scientific research is developed, carried out and reported can enhance our ability to be informed consumers of research. Just as it's important not to believe everything you read on the Internet, it's important to think critically when we read research.
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