Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Monday, January 24, 2005

Does science have chiropractic's back?

Jan. 23, 2005

Does science have chiropractic's back?

By Melanie Yeager

Education politics aside, opponents and proponents of Florida State University's proposed chiropractic program hinge their arguments on the issue of science.

Is there science backing chiropractic care? And is it the right kind of science or enough science to warrant FSU's starting a chiropractic school?

Dr. Ray Bellamy, a longtime Tallahassee orthopedic surgeon who teaches FSU medical students, calls chiropractic science "gobbledygook" that is based on "pseudoscience." He says a chiropractic school will destroy his alma mater's hard-earned academic reputation.

But John Triano, a chiropractor at the Texas Back Institute with a combined staff of medical doctors and chiropractors says, "We (chiropractors) have to stand up to the same criteria as everyone else when we get published," Triano said. "The notion we keep hearing that our science is somehow inferior is the hype." Triano also is a research professor in bioengineering at the University of Texas at Arlington.

Proponents believe having a chiropractic school at a public research university will accelerate efforts to validate best methods of chiropractic care.

FSU faculty members watched as both sides espoused their argument's merits earlier this month at a forum. Ross Ellington, a professor of biological science who was there, compared it to the age-old debate between those who believe in "intelligent design" and evolutionary biologists.
"Both parties walk away convinced that they're correct," he said.

Gathering research

Scientific research does exist regarding chiropractic care. Even Bellamy concedes on this point. But he says the overwhelming evidence doesn't support it.

"There are solid studies showing chiropractic is no better than the placebo effect ... for most conditions with one exception - low back pain," Bellamy said.

Spinal manipulation is the primary chiropractic treatment, chiropractic experts say. And the research for that continues to build.

"In the last 10 years, $20 million has been put into chiropractic research from the federal government and $4 (million) to $5 million from the profession itself," Triano said.

But everyone - opponents and proponents - seem to agree there still is not enough.

Walter Herzog, a professor of kinesiology at the University of Calgary in Canada, reviewed what had been studied in an attempt to develop a chiropractic paradigm - a theory to explain the beneficial effects of chiropractic treatments. What he determined was there isn't a generally accepted paradigm.

"Although many studies have described the mechanical, neuromuscular and physiologic effects produced by chiropractic treatments, a comprehensive picture has not emerged," he wrote.

Many findings still need to be independently verified, he said. And the research does not go far enough. For instance, he said, research repeatedly shows neuromuscular reflex responses during and after spinal manipulation, but more needs to be known about the origin of the responses. Also, most chiropractic research measures reported patient relief, instead of how the body changes during and after spinal manipulation.

FSU Provost Larry Abele, also a member of the biological-sciences faculty, said in his assessment about 90 percent of chiropractic research is in clinical trials, which measure patient response, and about 5-10 percent is in the basic sciences.

"And the basic sciences is very, very preliminary," he said.

The clinical trials, which have been systematically reviewed, do provide quality research, said Partap Khalsa, an associate professor and researcher in the Department of Biomedical Engineering, Neurobiology and Orthopaedics at the Stony Brook University in New York.

"For any treatment that's been devised, it's important to show it's effective," Khalsa said. But clinical trials don't usually investigate why treatment is effective. "This is where there's not good data, at this point."

Out there, but hard to find

Still, many FSU faculty members are wondering where to find this research, especially studies in basic science. Chiropractic researchers admit they also have had difficulty getting their arms around it because it's spread among different disciplines, such as neuroscience and biomechanics. And it can't always be found using "chiropractic" or "spinal manipulation" in a database search engine.

Marc Freeman, a veteran FSU professor of biology and neuroscience, hasn't seen the science.

"They say the research is out there. It seems to me it's up to the pro-chiropractic community to provide that research, to educate us, and that hasn't happened," Freeman said.

Alan Adams, the chiropractic researcher hired to help develop FSU's proposal, said he's ready to educate.

"I haven't had very many people ask me, 'Can you get me some papers on these?'" Adams said. He said the research does exist.

FSU's provost insists any new chiropractic program would be embedded in science.

"We wouldn't want to teach a theory that wasn't true or backed by strong evidence," Abele has said. "This is a real opportunity to take some very important but somewhat untested therapies ... and integrate them into rigorous academic programs."

To do that, FSU's program would need to "explicitly reject" some chiropractic methods because of a lack of scientific evidence, he said.

But many faculty wonder how FSU would ensure this. Where do you find chiropractors to teach this new program who are fully scientific in their approach? How does FSU ensure its program will be different from existing chiropractic colleges?

"I need those assurances," said David Houle, an associate professor in biological sciences. "It seems it's hard to get these assurances without starting this thing. Then how do you get those assurances? I don't know."

And for some faculty, the mere perception that FSU might be embracing a discipline not fully grounded in science is the bigger issue.

"I do not believe that the efficacy of the broad spectrum of what chiropractors do has been documented and validated carefully," Ellington said. "But again, I think that is a secondary issue. The issue is whether the university with its goals and aspirations wants to do this."

FSU continues to build its research reputation among public universities.

"This is just a terrible distraction," Ellington said.

The ongoing controversy at FSU made the Jan. 14 issue of SCIENCE magazine. Alongside the article was the fictitious map by Albert Stiegman, an FSU chemist, depicting a chiropractic medicine school and renaming science buildings with titles such as "Bigfoot Institute" and "School of UFO Abduction Studies."

FSU scientists have been fielding e-mail chuckles and concerns from their colleagues nationwide.
Abele has said the university will need to study the arguments against a chiropractic program, including the academic community's perception of FSU if it goes ahead with the program. He said FSU needs to consider whether it's stable enough in its development of its new medical school.

Chiropractic care has evolved into a health service regularly used by 15 million Americans each year, he said. And more scientific research is needed to examine the biological reasons behind Americans' great satisfaction with chiropractic care.

But should FSU be the university to take on the task?

"That's a good question," Abele said.