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A History of Chiropractic Science


'Science' and 'Research' were used in chiropractic publications, however, the ... The result was a deficit in the realm of scholarship and science ... – PowerPoint PPT presentation

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Title: A History of Chiropractic Science

A History of Chiropractic Science
  • Johnson, Greene Keating

Science? What Science?
  • 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    unpublished or non-peer reviewed cases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?
  • 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

  • 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

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

  • 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

  • Chiropractic students did not have access to
    student loans as allopathic students did
  • This created hardship on both chiropracticstudent
    s and colleges

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

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

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

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 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

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

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

Early attempts at science
  • 1938 What Chiropractic is Doing (a hard bound
  • A collection of testimonials
  • Published for marketing "chiropractic science

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

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

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

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-Aug18(6)357-78.
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
  • Patients were required to go through both to
    fight against claims of misdiagnosis

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

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

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

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

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

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
  • Lack of research submissions to the journal

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

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

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

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

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

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

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

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.

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)

CRF advertisement on page 4 of the NCAs National
Chiropractic Journal, September 1947
Times of transition
  • CRFs purpose
  • To receive monies for research purposes
  • To promote science of chiropractic
  • To promote infrastructure facilities, equipment,
  • To promote chiropractic hospitals and clinics
  • To gather and disseminate scientific information

CRF advertisement on page 41 of the NCAs
National Chiropractic Journal, February 1948
Times of transition
  • Problems with the CRF
  • Focused on marketing and fundraising not on
  • Money went more to the colleges than research
  • Lack of fundraising goals and poor public
    relations resulted in failures (often expensive

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

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

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,
  • Few colleges were non-profit to receive grant

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

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

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

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

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

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)

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

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

Times of transition
  • 1976
  • Wilk et al. case
  • The AMA was charged of violating the Sherman
    Anti-Trust act in its efforts to contain and
    eliminate the chiropractic profession

Chiropractic science
  • The birth of the modern era of chiropractic
    science was attributed to the 1975 National
    Institute of Neurological Diseases and Stroke
    (NINDS) conference on spinal manipulation
  • It was the first formal interaction between
    chiropractors and medical physicians in an
    academic forum

Chiropractic science
  • The NINDS conference was supported by the
    National Institutes of Health (NIH) and the U.S.
    Department of Health Education and Welfare
  • A multidisciplinary conference (DC, MD, and DO)
    focusing on research needs concerning

(No Transcript)
CH Suh, PhD - Biomechanical Aspects of Subluxation
Chiropractic science
  • NINDS stimulated a greater awareness of the need
    for good research and science, especially in
    regard to manipulation

Chiropractic science
  • 1978 JMPT was the first successful chiropractic
    scientific journal
  • Published by the NCC
  • Roy Hildebrant was the editor (previous
    Radiology chair from PCC)

(No Transcript)
Chiropractic science
  • JMPT had
  • Good editing methods
  • Scientific contents
  • Peer reviewers from outside and inside
  • Blinded peer review process

Chiropractic science
  • In 1982 JMPT received status in Index Medicus
    (Pub Med)
  • Indexing was essential because
  • Information that cannot be identified or
    retrieved does not exist

Chiropractic science
  • Even though JMPT was accessible and reputable,
    only a few in the profession subscribed
    (estimated 10 to 15)
  • Thus the continued struggle for the doctor in the
    field to embrace science

Chiropractic science
  • 1982 The Index to Chiropractic Literature
  • Chiropractic college librarians started an
    indexing system
  • It lacked significant funding and had limited
  • Thus not as substantial a resource as Index

Chiropractic science
  • 1985 Consortium for Chiropractic Research
  • Organized the 5 West coast chiropractic college
  • CCA donated 50,000/yr

Chiropractic science
  • Problems with the CCR
  • Colleges received the money and often put it in
    the general fund, thus the money did not go to
  • CCR died in the 1990s due to dwindling financial
    resources and a fight for control of power

Chiropractic science
  • 1986 FCER attempts an annual research conference
    at the chiropractic colleges
  • Conference was poorly attended, even by the
    faculty at those colleges, due to lack of
  • 1986 FCER President states that FCER funds went
    unspent due to lack of worthy proposals
  • Thus, skills and training still an issue

Chiropractic science
  • 1987 Judge Getzendanner orders a permanent
    injunction against the AMA on September 25th
    requiring it to publish the court's judgment in
    JAMA (follow up from the Wilk trial)

Chiropractic science
  • 1990 FCER holds the International Conference on
    Spinal Manipulation (ICSM) in Washington DC
  • ICSM is at first an annual conference, then
    becomes a biannual conference

Chiropractic science
  • 1994 Association of Chiropractic Colleges holds
    its first Educational Conference
  • All ACC Colleges were represented
  • Scholarly presentations in the field of
  • Proceedings published in the Journal of
    Chiropractic Education

Chiropractic science
  • 1996 Research Agenda Conference, first annual
    conference is held
  • Government funded conference
  • (Funding efforts began in 1994 by HRSA)
  • Purpose is to create an agenda for chiropractic
  • Speakers and workshops for training chiropractic

Health Resources and Services Administration
Chiropractic science
  • The 1990's provided the opportunities for
    foundational growth in research and science

Chiropractic science today
  • ACC, RAC and ICSM Conferences continue to grow in
    numbers of participants and quality of research
  • FCER continues to fund research fellowships for

Chiropractic science today
  • Chiropractic Peer-reviewed journals
  • JMPT
  • JCCA (Canada)
  • CJA (Australia)

  • JCE
  • JACA (USA) etc.

Chiropractic science today
Chiropractic science
  • Government money is now available for
    chiropractic research
  • National Center for Complementary and Alternative
    Medicine (NCCAM)
  • Health Resource and Services Agency (HRSA)
  • Consortial Center for Chiropractic Research
  • Funded through National Institutes of Health
    (NIH) in l997

Chiropractic science today
  • Chiropractic college research faculty more
  • More productivity from the colleges and from the

Chiropractic science today
  • Palmer's contributionsPalmer Center for
    Chiropractic Research PCC, PCCW, and PCCF
  • 2.9 million dollars
  • Largest chiropractic research center in the world
  • 16,400 net square feet in a five-floor building
  • Has received grants totaling more than 20 million

(No Transcript)
Chiropractic science today
  • In 2000, the Federal government awarded the PCCR
    a Facilities Construction grant of 1.3 million
    to renovate the research facility, the first ever
    made to a chiropractic college
  • Has allowed expansion of physical space by 60 per
    cent to 16,400 net square feet in a five-floor

Chiropractic science today
  • Experimental Research in
  • Basic sciences
  • Clinical studies
  • Historical Studies
  • Educational Studies

Chiropractic science today
  • Research in Chiropractic
  • 73 randomized controlled trials
  • 43 trials of spinal manipulation LBP
  • 30 found chiropractic effective
  • 13 found no significant difference between groups
  • 0 found chiropractic ineffective

Chiropractic science today
  • We no longer must rely on "testimonials"
  • Chiropractic manipulation is better researched
    than many medical interventions
  • We now have access to training and resources and
    the future is bright
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