The New Chiropractic

Editor-in-Chief of Chiropractic & Manual Therapies Associate Professor Bruce Walker recently published an article setting out a ten point plan for the advancement of the profession of chiropractic. Here, Dr Matt Bulman from the Chiropractic and Osteopathic College of Australasia, interviews Associate Professor Bruce Walker to find out more about his article ‘The new chiropractic’.

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1) What inspired you to write this commentary, The New Chiropractic?  

Initially the inspiration came when I was invited to give the FG Roberts memorial address and I turned my mind to what I would say. It allowed to me look back over my career of more than 40 years and reflect on what the profession has and has not achieved. I then considered the reasons for the successes and failures. Essentially the theme was the past, present and future. Pondering the future was by far the most challenging as I wanted to provide a plan that was achievable, that would generate debate and hopefully change.

2) To point 3 of your plan, you state “Some possibilities are: the further development and refinement of evidence based practice, improved posture through motor control, musculoskeletal care for the aged and elderly, improving bone density or the very important area of translating research into practice via implementation science. Whatever chosen we need to develop a special interest that sets us apart as experts in a distinctive area.” 

Do you see emerging signs of these steps in the works?  Do you care to highlight any of them?

In the article I mention the paucity of research into these areas by our profession. There is some research in all of these areas but it is very slim. There seems to be almost an obsession with paediatrics and a complete silence around elder’s health. I just don’t get this given that the older population are growing in size and they are the ones who suffer the most with MSK pain and disability.
But there are obstacles to doing research and these obstacles revolve around funding and the human resources necessary to do it. In the article I call on the profession to participate in research and to dig deep with regard to funding. The human resources to do the research is a more challenging problem and the profession globally needs to encourage chiropractors to undertake research training by providing scholarships for higher degrees by research and also insisting that chiropractic academic staff are research active. Internationally, the models in Canada and Denmark seem to be paying dividends.

3) Should the profession demand that educators have a mandatory plan towards pursuing a masters, or PhD?  Quotas for publication?  What other practical applications could we implement?  

All chiropractic staff should either have or be undertaking a higher degree by research. In Australia universities set quotas on research outputs by staff and these outputs are determined by the type of employment contract. I am unaware of any such arrangement at private chiropractic colleges in other countries. I don’t support private chiropractic programs anywhere unless there are compelling reasons for their existence. If government funded universities are unwilling to house an evidence based chiropractic program this may be cause to provide a private program. There are some very good examples of private chiropractic programs including CMCC in Canada. Their attempts to affiliate with a University were thwarted but at least they attempted it. It will come as no surprise that I do not support a vitalistic college regardless of where it is situated.

4) Regarding point 4, “Marginalisation of the nonsensical elements within the profession,” one territory this has become apparent is in social media bickering.  

Should ideas here be debated robustly?  Should an attempt towards dialogue take place with the aim to “win people over to the other side?”  Or is this a futile endeavour?  This is an area many feel very strongly about, but each side tends to further defend their position.  Do you have any comments on useful strategies?

If some chiropractors have a belief based approach that involves a religious fervour about what they think they do and why they do it then there is little hope in persuading them otherwise. This is why they should be marginalised. John Stuart Mill the 20th century philosopher said that “the silencing of discussion is an assumption of infallibility”. So yes, let’s keep talking but I wouldn’t waste too much time on those who are never likely to embrace science and evidence.

5) Regarding embracing evidence based practice the theory behind this makes sense.  It’s certainly the higher ground compared to the alternative. But is there a way for us to reward evidence based practice in a better economic model?  The reality is that evidence based practice is not rewarded equally from a financial incentive compared to, say, high volume “subluxation” care.  

Given that this is how some individuals in the profession earn a living, do you have any thoughts on the economic incentives which may translate to more pragmatic implementation of EBP?

There may be a case for both carrot and stick to achieve better practice standards. The situation you describe is not unique to chiropractic. Financial considerations drive many unscrupulous practices in health care generally. For example, 2-3 minute consultations at some corporate owned medical clinics or “up-selling” at dental clinics. But two wrongs don’t make a right and we need to concentrate on our own back yard. I was in full time practice for 30 years and made a very good living while providing sufficient time to take a history, do an examination; order tests where necessary and provide some form of therapy when warranted. Standard practice like this stacks up financially. Patient centred care is the best approach.


6) Regarding point 9, “The Profession must support research,” what are the emerging research programs that offer us hope?  What about financial models to support research?  Let’s say there are 1000 members in a society of chiropractors.  Each year, what minimum dollar amount is reasonable for a chiropractor to contribute to research limited to have a sustainable model?  And what would an ideal financial contribution from each member look like?  There are other countries, such as Denmark, that implement a percentage of each treatment towards a research fund.

Are there models that we could consider? 

A levy on all chiropractors per consultation such as we hear about in Denmark is a fabulous model. I am not up with the detail of this but on the surface it seems wonderful.  As to the quantum a pot of US$100 million dollars would sustain chiropractic research in most countries if the money was invested wisely.

7) Open access journals such as Chiropractic & Manual Therapies allows for greater access to the emerging science in the profession. Similarly, reading lists like the World Federation of Chiropractic reading list help to cull some more relevant information for chiropractors.  But regarding implementation science, and staying up to date with evidence based practice, what role does social media, podcasts, YouTube or other technologies play in this arena?

What are other pragmatic strategies that chiropractors can employ to keep up to date in a busy clinical setting?

There have been recent discussions regarding the production of good quality material to disseminate to practitioners to promote best practice. I am not directly involved in these discussions but certainly social media will play a huge role. What is important is research to determine what the most effective ways of changing practice habits are when the evidence is compelling. This research area is growing and we need to get more involved in it. It is known as TRIP or Translating Research Into Practice or Implementation Science.


Liked this article? Make sure to watch the new chiropractic author discussion on YouTube: https://www.youtube.com/watch?v=zbb23xxp2JM

 

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David Cohen

This has nothing to do with science or medicine. Chiropractic is pseudoscience based on debunked ideas.

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