Government Support and the Research Challenges of Chiropractic Pediatrics
Dr. Dennis Leduc, a McGill University pediatrician recently stated that “There are no physical ailments in childhood, whether they be ear infections, asthma, or other physical problems, that have ever been shown to be amenable to chiropractic manipulation or therapy.”
The story released Friday by The Star Phoenix reports that the concern is over 5,297 chiropractic pediatric treatments at the cost of $80,921 paid in Saskatchewan this last year. [1] The Health Ministry is considering if it will continue to subsidize chiropractic pediatric care in Saskatchewan.
The key issue is the rampant misunderstanding or intentional misuse of the original concept of evidence based care. Governments and the insurance industry often view evidence based care as treatment supported only by rigorous scientific evidence.
Sackets original concept of Evidence-based treatment has three components;
- the current scientific literature, which includes more than randomized controlled clinical trials,
- the clinical expertise of the health provider, and
- the desires and needs of the patient.
Recent attempts to deny chiropractic care in the U.S. and Canada have ignored these latter two elements and focused solely on limited components of the published literature.
Dr. Leduc was the past president of the Canadian Pediatric Society. The official journal of the Society is Pediatrics and Child Health. Ironically, a 2005 a review of evidence supporting chiropractic care appeared in the 2005 issue of that very journal. [2] This was the first chiropractic paper published in the journal of the Canadian Pediatric Society. An updated review was published in 2008. [3] Both reviews attempt to harvest the available scientific literature supporting chiropractic care of children and, although the quantity and quality of research supporting chiropractic care for children is limited, there is a growing body of literature supporting such care. This literature surpasses some of the limited literature used to support reimbursement for some medical interventions.
A recent chiropractic consensus process by Hawk, et. al. used a number of experienced pediatric chiropractors. [4] The level of consensus among that group relative to key concepts of child and infant care was high (80%). These consensus processes help fill some of the gaps in current evidence and help direct future research.
The difficulty of providing high quality pediatric research is very challenging for the chiropractic profession. There are added requirements in terms of bioethics and Institutional Review Board review constraints that create challenges. As one medical group put it “excessive regulatory oversight is seriously affecting translational research and quality improvement efforts.” They have identified 5 problem areas that restrict pediatric research. The same constraints apply to chiropractic research. [5]
Two other major impediments to chiropractic research in general are
- the limited number of the profession engaged in research, and
- the very limited funding available.
There are also only a hundred or so chiropractic researchers who have extremely limited funding to conduct their work. With this backdrop, it is more incumbent upon individual chiropractors and chiropractic organizations to support pediatric research.
REFERENCES:
1. Government may stop subsidizing child chiropractic treatment
The Star Phoenix
2. Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review
Paediatr Child Health. 2005 Mar;10(3):157-61
3. Chiropractic manipulation in pediatric health conditions – an updated systematic review
Chiropr Osteopat. 2008 (Sep 12);16:11
4. Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process
J Manipulative Physiol Ther. 2009 (Oct);32(8):639-47
5. Grinding to a halt: the effects of the increasing regulatory burden on research and quality improvement efforts
Clin Infect Dis. 2009 Aug 1;49(3):328-35
Full-Text of “Grinding to a halt” is now available
Thanks to ChiroAccess for access to this material!
The future of chiropractic is in research.
AMEN!!
Top notch research requires $$$$……HMMMMM
Two great points. The future for Chiropractic is in research and we need top notch research which is going to require money. The problem I see is that as a profession we can’t pull together to make that happen as Chiropractors tend not to be team players, but individualist.
REPLY: Fortunately, we have our college systems and their research departments, doing the good work. If you follow JMPT, every issue is loaded with new studies, mostly funded by the schools.
Frank,
I am grateful that the colleges are doing research and I have been a big supporter of it. I sit on Parkers Alumni Board and sometimes wanna pull my hair out of my head trying to get people to support us. The money raised goes to support research. We are also having a huge Gala at Parker Seminars in Las Vegas. I believe 100% of the funds raised at the gala and auction will be going to research. Research will move us forward as a profession
I am a firm believer in research for the profession, but it is not going to fix all our problems. The medical words says they are scientific but we all know they are not. So why is it we have to be so perfect in ours for us to be successful? Our princple of what we do and why we do it is just as important.
RESPONSE:
I agree we are being held to a much higher standard. Women experienced much the same thing as they entered “the” workplace (the glass ceiling). We can burn our proverbial bras, or we can suck it up and do the job.
I think that the more research that is conducted, it will only validate what our profession has known for years, when people get adjusted there is improvement in their wellbeing. As painful a process and as many barriers as they put up, ultimately will only strengthen our position over time. As one D.C. said to me “Chiropractic may not be for everyone, but it has something to offer everyone.”
“Chiropractic Works” hit the nail on the head. We can not rely on government funded research grants. We need to give back to the profession that has given us so much. Support for your Chiropractic College pays dividends by moving the profession forward. It is a win-win for us all.
RESPONSE:
Everyone else relies on Federal funding for research, so there’s nothing wrong with us applying for it. The biggest problem is that we have so few researchers trained in making their way through the morass of the application process.