One hundred and thirty of chiropractic's brightest and best minds met in Seattle, Washington, March 2-3, 1990, and came to a nearly unanimous agreement. At the Consensus Conference on Validation of Chiropractic Methods sponsored by the ACA Council on Technic, the Consortium of Chiropractic Research, and the Washington Chiropractic Association, key representatives of the research, academic, and entrepreneur communities of chiropractic identified a means to determine the appropriateness of chiropractic procedures.
All chiropractic procedures should be submitted to standardized scientific validation processes. This process should include consensus methods and clinical research.
This motion was followed by a second:
The sponsoring agencies of this conference will move forward to plan future efforts including a plenary meeting within three years.
These motions were enthusiastically supported by all but a half-dozen conference attendees.
While a cursory reading of these motions might lead the reader to determine the results of the conference to be insipid, a more careful consideration of the events of the weekend led participants to a far different conclusion.
Representatives of the research community came to the conference anticipating that their presentations of scientific methods would be rejected. Representatives of the academic community came to the conference expecting hostility and discord with the entrepreneur community. Representatives of the technique development community came to the conference highly skeptical of the value of the interchange of ideas. All went away from the conference with a heightened awareness of the urgent need to validate the entire spectrum of chiropractic procedures.
It was noted that while the intense scrutiny of all health care by third-party payers as a result of spiraling costs may have triggered the Consensus Conference, the acknowledged impetus for validating chiropractic procedures is really the ethical need to defend, with rational and scientific evidence, the effectiveness of chiropractic practices and procedures. The thoroughness with which the assembled chiropractic leaders accepted this principle was unanticipated and exceeded expectations of the organizers of the conference.
On the first day of the conference, speakers from chiropractic, medicine, public health, law and social science delivered compelling presentations on the lack of reliable information available documenting the efficacy of chiropractic. These speakers described an array of models for validating chiropractic methods, identifying both appropriate and inappropriate ones. They pleaded, harangued, and persuaded listeners to come to agreement on a method for validating chiropractic procedures. They were unanimous in their message that chiropractic could no longer rely on a purely emotional appeal to health care providers and purchasers.
On the second day the participants split into two groups. One round table, chaired by Reed Phillips, D.C., Ph.D., discussed how analytical methods and devices can be positioned into mainstream chiropractic care. The other round table, chaired by Charles Sawyer, D.C., analyzed how the same can be determined for chiropractic techniques, devices, and methods. The following conclusions were reached.
The round table which investigated chiropractic analytical methods and devices identified four steps which need to be taken:
1. Publication of research findings in refereed, indexed journals is a primary goal. Publication in refereed, non-indexed journals is next in succession.
a. Develop ethical guidelines for publication.
b. Develop publication standards (i.e., Vancouver style).
2. The process begins with consensus of broad-based investigation in all components of the profession.
3. Replication of studies by independent investigators is necessary for all techniques.
4. The scientific method should be adopted for the validation process.
The round table which investigated chiropractic techniques, devices, and methods identified five steps which need to be accomplished:
- Investigate the Kaminski, et al., model and emphasize the dynamic and inclusive nature of scientific methodology, profession-wide consensus, an emphasis on wellness, and therapeutic claims.
- Develop and adopt a standard battery of clinical outcome measures including function, economic, biomechanical, and patient satisfaction. There should be an emphasis on clinically and socially relevant issues.
- Identify sources of funding.
- Identify who should serve as validators.
- Monitor social implication ramifications and demand scientific implementation by social agencies.
At lunch, Dr. Louis Sportelli, chairman of the board of the ACA, commended the conference attenders for their efforts and urged them to proceed with zeal. He noted that the political arm of the profession was weak without access to strong research which could be used to influence the legislative and administrative branches of government and the purchasers and providers of health care.
After lunch, the participants gathered together in the final round table to see if they could reach a consensus on a "state of the art" investigation and validation of chiropractic methods. Chairman David Chapman-Smith, L.L.B., made the following proposals as a starting point:
- There needs to be a "consensus validation method" adopted.
- What "methods" need to be used?
- Who should be in that consensus group?
- There needs to be an oversight authority -- steering committee.
- Priorities need to be developed for future meetings:
a. Outcomes consensus groups.
b. Entry into the Kaminski model.
c. Identification of common language/terminology for procedures which may be unestablished, have provisional acceptance, or full acceptance.
6. Identify priorities for subjects of research.
7. Plan another major conference in two to three years.
By the time these proposals were made, the day was late. Attenders were reeling with the information they had received and the decisions they had already made. While they were unable to act upon all seven of the proposals made by David Chapman-Smith, they were able to reach consensus on the proposal recorded at the beginning of this article. The enthusiasm for continuing the effort fairly radiated throughout the room.
There was another unspoken consensus reached at this historic conference. There was an awareness that for the first time ever in chiropractic history, the political leaders, the top academicians, the key researchers, and the leading technique developers had met together and gained a better appreciation of each other's roles in the development and future of the chiropractic profession.
While participants had anticipated conflict and hostility, they experienced cooperation and a mounting sense of excitement about the task at hand. All factions left the conference wanting to be part of the validation process, ready to network with the other communities represented.
A great deal of work needs to be done. Everyone can participate at some level. The researchers need to continue their laborious, time consuming, double-blind studies of chiropractic procedures. The academicians need to validate the techniques and procedures being taught in the colleges, as well as teach chiropractic students the scientific methods necessary to continue scientific research in the clinical practice. The technique developers need to submit their techniques to the scientific validation process carried out both by their own research teams and independent investigators. The clinical doctor can document and publish case studies which are the heartbeat of much scientific research. The political arm of the profession can use this validated research to provide a long-term niche for chiropractic in the overall health care delivery system of our nation.
And it all started with a vision of a consensus conference on the validation of chiropractic methods in the mind of conference originator, Daniel T. Hansen, D.C., F.I.C.C., on a quiet evening in his clinic office in Olympia, Washington. From such humble beginnings come great events.
Note: The proceedings of this conference were recorded and tapes are available for $225. Contact:
Washington Chiropractic Association
1420 Maple Avenue S.W.,
Suite 203A
Renton, Washington 98055
or call:
(206) 235 4428
Marcia Holland
Executive Director,
Washington Chiropractic Association
Renton, Washington
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