I came across this statement prominently displayed on the label of a bottle of vitamin C tablets. What struck me most about the comment was its boldness: "Enhances the immune system and promotes antioxidant activity." Was this the first time I'd read such a claim? It could have been on the last bottle I purchased, but what's important is not whether I'd seen it before, but that the makers believed they had sufficient evidence to make such a claim and get it past the usual agencies that monitor the truthfulness of such claims.
In this issue of Dynamic Chiropractic, we are introduced to a paradox.
On the other hand, we have a study suggesting that chiropractic manipulation of the same region has a greater likelihood of "adverse reactions."2 And while there are a number of criticisms you might be tempted to make regarding this study (limited sample size, limited survey response, survey response bias, etc.), the results should still be reviewed and discussed.
According to the study, the vast majority of these adverse reactions amounted to nothing more than a sore or stiff neck. But given the possibility that some people could be inherently at risk when receiving spinal manipulations, we have a responsibility to identify who those people are, screen them in the office, and adapt our care so they too can enjoy the benefits that only chiropractic care can deliver.
At the same time, we need to spend the money required to conduct a much larger study to determine the value of chiropractic for nonmusculoskeletal ailments. This will take some time, but it will begin to demonstrate the nonmechanical side of chiropractic's effectiveness.
When considered together, these two studies encourage us to continue our pursuit of a deeper understanding of chiropractic. They ask us to look at the need to personalize care in order to respect those patients who may need a different approach when it comes to neck manipulation. They also encourage us to remember that there is a nonmusculoskeletal component to chiropractic that can impact certain ailments like nothing else.
Forty-plus years ago, my father began giving me vitamin C whenever he could see a cold coming on. There were no promises on the bottles back then. In fact, most people called vitamins a waste of time. Taking vitamins certainly was not the trend it is now. But we kept on taking vitamin C, long before science gave the vitamin makers the authority to say what they can say now. We knew the results before the public would accept the claims.
Chiropractic is in much the same place. There are many patients who know what chiropractic has done for them, both mechanically and vitally. But today's health care marketplace demands research before you can make your claims. It also requires you to be responsive to research results, in order to maintain your credibility. This is the two-edged sword that governs our world.
But with the right research, it is possible for us to make similar statements as the one I noticed on that vitamin C bottle; statements that would cause people to look at chiropractic more completely. Sometime in the future, you could very well be advertising chiropractic in your community as:
"Enhances the Immune System and Effective for Many Nonmusculoskeletal Ailments"
Chiropractic's foundational philosophies remain intact, even as we refine our clinical approach. Good research calls us to refine our thinking about how we apply chiropractic to our patients. Understanding why we do what we do clinically is just as important as knowing the effect it can have. There is a dynamic tension between our art, science and philosophy that will always challenge us.
References
- Leboeuf-Yde C, Pedersen EN, Bryner P, et al. Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey. J Manipulative Physiol Ther 2005;28:294-302.
- Hurwitz EL, Morgenstern H, Vassilaki M, Chaing LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA Neck Pain Study. Spine 2005;30(13):1477-1484.
DMP Jr.
Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.