A History of Chiropractic Science

1. A History of Chiropractic Science Johnson, Greene & Keating

2. In the 1920's through the 1960's there were many unpublished or non-peer reviewed cases "Science" and "Research" were used in chiropractic publications, however, the scientific method was either poorly adhered to or not used at all Science? What Science?

3. Science? What Science? • Money for science? • Not when you need to stay alive! • Money that was available in chiropractic was focused on ensuring the survival of the profession

4. Survival • Money was needed for: • Legally pursuing licensing laws • Defending chiropractors who had been jailed for practicing medicine without a license • Keeping the chiropractic colleges afloat through the Great Depression and World Wars

5. Survival • The Universal Chiropractic Association was created to help fight for the legalization of chiropractic • Money was needed for legal, not research, purposes

6. Survival • Chiropractors suffered persecution under licensing laws • Many chiropractors suffered the stigma of going to jail rather than paying the fine • The monies would have been used to further persecute chiropractic

7. Survival • Chiropractic students did not have access to student loans as allopathic students did • This created hardship on both chiropracticstudents and colleges

8. Survival • Named techniques were fighting for the practitioner's dollar • Any funding that did occur came from the private practitioner • Government funding for research was non-existent

9. Survival • For chiropractic, money was directed to the most vital items at the time • No money was left for supporting scientific research efforts

10. Science resource crisis • Most chiropractic students were not educated enough to appreciate reading the literature, let alone, contribute to it • Practitioners were trained neither to read nor to contribute to the efforts of science and research

11. Science resource crisis • This left a heavy load upon an already taxed source, the chiropractic faculty • The result was a deficit in the realm of scholarship and science • There was a desire, but no infrastructure • Much criticism came from outside and inside the profession with a call to increase chiropractic science

12. Science resource crisis • Many had high hopes to do “real research,” but few had the skills and infrastructure to complete the task • The burden fell on the for-profit collegeswho were ill-equipped to carry out the task • The resources were not available

13. Early attempts at science • 1925 Chiropractic Statistics (a pamphlet) • descriptive data for 110 diseases • 99,976 patients • 412 treating chiropractors • 84.59% recovered, 14.96% unchanged, 0.85% died

14. Early attempts at science • Problems with Chiropractic Statistics : • No valid measurements • Poor methodology • Not a reproducible study • Data not published in a scientific journal

15. Early attempts at science • 1938 What Chiropractic is Doing (a hard bound book): • A collection of testimonials • Published for marketing "chiropractic science“

16. Early attempts at science • Problems with What Chiropractic is Doing: • Not experimental nor sound observational studies • No outcome measures • Created a false sense of security for doctors in the field, they thought that this was “good enough”

17. Early attempts at science • 1932 Lillard Marshall, D.C. (President and founder of the NCA) published a pamphlet: • Case series • Several hundred adolescent inmates 10-20 yrs old • Volunteer doctors provided chiropractic care

18. Early attempts at science • Problems with Marshall's pamphlet: • Poor study methods • No detailed records • Type of care and outcomes not described • Due to these problems, the “study” was poorly received by the government and health care community thus did not reflect well on chiropractic

19. Marshall's findings Keating JC Jr, Green BN, Johnson CD. "Research" and "science" in the first half of the chiropractic century.J Manipulative Physiol Ther. 1995 Jul-Aug;18(6):357-78.

20. Early attempts at science • 1935 - 1961 B.J. Palmer Chiropractic Clinic: • Two divisions: a medical side for diagnosis only and a chiropractic side for diagnosis and treatment • Patients were required to go through both to fight against claims of misdiagnosis

21. Early attempts at science • B.J. Palmer Chiropractic Clinic collected a significant amount of data • Millions of dollars were spent (in today's equivalent)

22. Early attempts at science • Problems with B.J. Palmer Chiropractic Clinic: • No controlled studies • Little critical thought in study design • Although a lot of data was collected, nothing was done with it • Information was not collected in a scientific way to evaluate a theory, but instead to “prove that chiropractic works” • No publication in scientific journals

23. Early attempts at science • Problems in chiropractic science existed in the mid 1900's because: • Resources were scarce • Attempts were made without appropriate resources or skills • Chiropractors did not possess the skills in the scientific method

24. Another call to arms • C.O. Watkins (a Palmer graduate) • Watkins viewed clinical research as the missing link in chiropractic's scientific development

25. Another call to arms • Started the American Chiropractic Journal • Although short lived, it provided a model for scholarly publishing in the profession • “Our principle aim is to assemble, correlate and disseminate scientific material for educational purposes to the chiropractic profession” 1941 C.O. Watkins

26. Another call to arms • In 1942 the American Chiropractic Journal died • It is speculated that the journal failed due to: • Lack of interest in reading from the profession (subscriptions) • Lack of research submissions to the journal

27. Another call to arms • Watkins proposed the creation of the Committee on Education (the forerunner of today's CCE) • He proposed that educational standards be set for the chiropractic colleges

28. Another call to arms • Watkins described chiropractic science 1940's • Clinical research is severely lacking • Basic science from medical literature is not enough to found the profession on • Chiropractic cults are a reaction to lack of clinical foundation in science • The average DC is not interested in or qualified to do basic science research

29. Another call to arms • Watkins description cont. • Chiropractic does not have “scientific facts” to base practice on • Chiropractic does not have “scientific facts” to give to the public and its agencies • Chiropractic has too much reliance on and expects the public to accept chiropractic solely on the basis of philosophy and theory

30. Another call to arms • Watkins description cont. • Chiropractic lacked • Skills and training in research and science • Professional organization and a common goal

31. Times of transition • Attacks from outside the profession... • Post WWII medical research and randomized controlled trials on insulin and penicillin created increased criticism of chiropractic as an “unscientific cult” • Medicine used the science gap to further the attack on chiropractic

32. Times of transition • The American Medical Association reinvigorated the attack to eliminate non-allopathic professions

33. Times of transition • Undermining from within the profession... • In the 40's and 50's B.J.'s “followers” in California would: • “Object to any investigations that could challenge the truth of their fundamentalist beliefs about subluxation and adjusting.” • More cult-like chiropractic sprang up

34. Times of transition • “Cultism is like a weed in science for it saps the effort which should be used to advance the science, produces nothing of value, and a small amount of it in higher circles causes the rest of society to suspect that it exists generally throughout chiropractic. In other words, the actions of a few discredit all.” 1944 C.O. Watkins

35. Times of transition • In 1944 Watkins left the NCA • He then inspired the creation of the Chiropractic Research Foundation (CRF) • Today's Foundation for Chiropractic Education and Research (FCER)

36. CRF advertisement on page 4 of the NCA’s National Chiropractic Journal, September 1947

37. Times of transition • CRFs purpose • To receive monies for research purposes • To promote science of chiropractic • To promote infrastructure: facilities, equipment, etc. • To promote chiropractic hospitals and clinics • To gather and disseminate scientific information

38. CRF advertisement on page 41 of the NCA’s National Chiropractic Journal, February 1948

39. Times of transition • Problems with the CRF • Focused on marketing and fundraising not on research • Money went more to the colleges than research • Lack of fundraising goals and poor public relations resulted in failures (often expensive ones)

40. Times of transition • Gains from the CRF • Consolidation of small for-profit colleges into bigger non-profit colleges (e.g., SCCC and LACC) • Creation of an endowment to support the Spears Hospital

41. Times of transition • 1949 good intentions to increase research from the NCA Council On Education • Assigned research projects to faculty members at chiropractic colleges

42. Times of transition • NCAs good intentions of 1949 failed • Faculty had few skills in science and research • No training was provided • Chiropractic colleges were in a poverty state • No resources were available (equipment, labs, etc.) • Few colleges were non-profit to receive grant money

43. Times of transition • 1953 good intentions from Henry Higley, M.A., D.C. who organized the NCA to: • Create a research center • A center intended to collect data gathered by students observing in practitioners’ offices

44. Times of transition • 1953 good intentions failed • Poor participation from students and colleges • Lack of training • Lack of funding

45. Times of transition • 1960's • NCA becomes the ACA • National Board of Chiropractic Examiners is established (1963) • FCER focuses money on training faculty in science and research

46. Times of transition • 1960's • 1963 AMA states its objective was “. . . the complete elimination of the chiropractic profession” • Formation of the AMA's Committee on Quackery

47. Times of transition • 1964 Committee on Quackery • Primary goal of the committee: to contain and eliminate chiropractic (evidence from the Wilk trial 1976)

48. Times of transition • 1967 Committee on Quackery established that it was unethical for a medical physician: • To associate professionally with a chiropractor • To make referrals to a chiropractor • To teach a chiropractor • To practice with a chiropractor (published in the 1969 Opinions and Reports of the Judicial Council of the AMA, evidence from the Wilk trial 1976)

49. Times of transition • 1970's • FCER focuses money on training faculty in science and research • Scott Haldeman, Reed Phillips, John Triano • These chiropractic scientists go on to make a significant impact in the profession through publication and research

50. Times of transition • 1970's. • National College gets regional accreditation (1971) • US Office of Education recognizes the CCE Now students can get federal fundingto attend chiropractic college