DELIVERING THE RESEARCH MESSAGE EFFECTIVELY

In its 57-year history, FCER has prided itself upon the provision of more than $10M for both research and postgraduate study in order to document the theory and practice of chiropractic healthcare. In just 10 years from a point in which federal funding was deemed virtually nonexistent,¹ chiropractic research now can claim the National Institutes of Health, Health Resources and Services Administration, and the Agency for Health-care Research and Quality as among its supporters. As a result of research, spinal manipulation is considered to be a viable and advantageous alternative for managing back pain according to clinical guidelines from no less than 7 countries [United States, New Zealand, Finland, United Kingdom, Switzerland, Denmark and Sweden].²

So what has happened? Utilization rates of chiropractic services within the U.S. have crept up to an annual rate of 11-15%,^3,4 but denials and limited scopes of practice allowed by third-party payers continue to abound. To coin a popular phrase, why haven't the results of chiropractic research gained further "traction" with the key decision-makers? Weighing the effectiveness of any intervention is partly laboratory science, partly experiential, partly clinical judgment, partly an art, and [unfortunately] partly political--as shown by the recent efforts of such lobby groups as the American Physical Therapy Association or the American Osteopathic Association to mobilize opposition to the first-contact privileges granted to chiropractors in the VA legislation passed by the U.S. House of Representatives but then taken up for debate within the Senate.

It is true that much of the published clinical research supporting spinal manipulation continues to be of extremely high or superior quality;^5-7 in fact, it has achieved this status despite the fact that it has done so with only a minute fraction of funds compared to the amounts disbursed by either the NIH or pharmaceutical companies for medical research. What appears to be lacking is an integrated approach by which the media are more cognizant of the results of our research efforts. Furthermore, there continues to be an egregious lack of cost-effectiveness data; in fact, there are virtually none at the present for the treatment of conditions outside of the low back.

In addition to the admirable efforts of Manga^8-10 and Stano,^11-13 we should take note of cost comparisons of different treatment which take into account such indirect costs as treatment failures [iatrogenesis], which can only be expected to increase the cost advantages of such conservative interventions as spinal manipulation. We need to take note of such groundbreaking studies as Burton's investigations of disc herniations, in which it was shown that patients undergoing a common medical intervention incurred 4 times the costs of patients undergoing spinal manipulation for their condition AND the cost of 300 British pounds for treating therapeutic failures. No such costs were experienced by chiropractic patients.¹⁴ Research results such as this need to be emulated and broadcast far more forcefully, as it will most likely be bottom-line issues in addition to patient satisfaction and outcomes that will deliver the coup de grace to convince key decision-makers of the viability of chiropractic management in today's healthcare system.

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