Editor's note: You may recall our March 12, 1993, front page story on Dr. Cassidy's appointment as research director in the department of orthopedics at the University of Saskatchewan.
DC: Could you give us some background on your interest in whiplash and how the grant came about?
Dr. Cassidy: I got interested in whiplash over the last few years by being a member of a government task force. Years ago, the Quebec government created a task force on spinal disorders and published it as a supplement in the journal Spine. They looked at all treatments for low back pain and came up with recommendations based on a scientific review of the literature.
A second task force, the Quebec Task Force on Whiplash Injuries, was formed about three years ago, sponsored by the Quebec SAAQ; the equivalent of the government insurance system that pays for whiplash-injured patients. This international task force was funded by SAAQ and chaired by Dr. Walter Spitzer, head of the Department of Epidemiology and Biostatistics at McGill University. He had chaired the previous task force on low back problems. We have been looking at the literature on whiplash to try to make some scientific recommendations on treatment and risk factors, etc. We all began to realize that there is very little known about whiplash and there is a real need for research in that area.
Among the international notables on this task force is Ake Nygren, MD, PhD, a professor of accident prevention at Karolinska Institute in Stockholm, who has been researching whiplash for a number of years. Dr. Nygren and I began discussing the kind of whiplash research that needed to be done. I also began talking about whiplash research with Professor Ken Yong-Hing, head of the department of orthopedics here at the Royal University Hospital.
Dr. Nygren and I decided to go to the Saskatchewan Government Insurance (SGI) to ask if they would fund a long-term research project into the natural history and prognostic variables that affect the outcome of whiplash injuries in Saskatchewan. SGI was interested in funding research for several reasons: They were aware of the Quebec Task Force, and we had made them aware that there is a need for research in this area. Secondly, SGI had spent about $87 million dollars on whiplash injuries in Saskatchewan in 1993 - a sizable amount of money for a small Canadian province.
Because SGI would like to prevent chronicity and disability after whiplash injuries, they were very interested in working with us. They eventually gave us a grant to study whiplash injuries over the next five years.
We are in the process of setting up a whiplash assessment unit at the Royal University Hospital. We will be conducting a large, population-based cohort study on whiplash injuries. We are particularly interested in the natural history of, and the prognostic variables for, disability and whiplash.
DC: On what specific areas of whiplash are you hoping to shed some light?
Dr. Cassidy: To date, we really don't know about the epidemiology of whiplash. For example, we don't know what percentage of whiplash patients will recover quickly and how many will go on to have disability. There have been several studies on this, but most of them suffer from sample-selection bias and really don't give us good information. Since we will be doing a population-based study, we should have good information on recovery after whiplash. Secondly, probably most people who have whiplash don't need treatment, because most of them recover in a very short time. Therefore, what we want to do is find out who is at risk of having trouble after whiplash so that we can target treatment towards those people. There are few studies on treatment outcomes for whiplash. We want to look at the efficacy of all treatments for whiplash injury patients.
DC: Is this the first time this kind of money has been put towards a Canadian study with a chiropractor as the primary investigator?
Dr. Cassidy: I'm not sure, but probably. I think part of the appeal for SGI is our multidisciplines: Ken Yong-Hing is an orthopedic surgeon, and I'm a chiropractor and PhD/researcher. SGI appreciates us because we cover orthopedics, chiropractic and science. I think the grant wasn't given to me just as a chiropractor. It was given to me as a chiropractor and a research scientist.
DC: There is an increasing amount of funding from nonchiropractic institutions going toward studies on chiropractic. Drs. Cherkin and Deyo got nearly $1 million dollars from the Agency for Health Care Policy and Research to compare chiropractic and physical therapy treatment for low back pain; the US Congress funded $1.75 million for chiropractic demonstration/training projects; and now your grant. As a researcher, what is your reaction?
Dr. Cassidy: I think it's good. The only thing that troubles me is that most of the large grants are going to people working outside of chiropractic colleges. The major problem in the chiropractic profession is that our colleges are private colleges and are not part of the university system. I don't think the chiropractic colleges will get big grants until they're aligned with the universities. I firmly and strongly believe that the next important step for the profession is to get the chiropractic colleges into the university systems. Once that happens, the colleges will enjoy larger grants because they will have more resources.
DC: Some people may characterize the recent funding of chiropractic research as "tokenism," suggesting that the different agencies and governments are not really seriously looking at chiropractic. How would you respond to that?
Dr. Cassidy: Again, I think they will seriously look at chiropractic when chiropractors get serious about research. You can't be really serious about research unless you're in a university, because you just don't have the resources, including equipment and people, to do real, big time, expensive research. I know that government agencies look at things like that. They look at the resources of the institutions that they grant money to. I don't see the chiropractic colleges being competitive until they are part of the university system.
DC: When can we look for something published on your work? Will you be doing some preliminary publishing or will we have to wait five years?
Dr. Cassidy: I think it will be a few years. It takes a couple of years to collect the data and write it up, and we are just starting this month. We have to run a pilot project first, that will probably take the better part of a year and then we will be into a data collection phase about a year from now.
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