Editor's Note: Part 1 of this article appeared in the November 2006 issue of Acupuncture Today.
The Role of Research
Research plays a huge role in the medical community as the "gold standard" or the ground rules, if you want to play the game. It's important to understand academics and history in order for our profession to survive as a medical specialty. Academics in mainstream universities and colleges are slow to change. This is evident with academic research trailing clinical practice. Nonetheless, it's still the framework with which we have to work to gain acceptance identified through historical evidence.
Understanding this basic component as to why research is necessary also has historical significance. Osteopathic research tended to be sporadic. An early document describes experiments taking place in 1898-1899 on the effects of spinal stimulation and inhibition of anesthetized dogs.11 Early studies, with some exceptions, tended toward the idea of proving osteopathic theories. Gradually, the emphasis shifted toward an impartial search for general scientific knowledge. In large measure, the shift in research emphasis paralleled the growth in osteopathic medical education.12
Osteopathic research funding originally was provided by the schools or by the individuals doing the work. Support then came through the American Osteopathic Association (AOA) or one of its philanthropic affiliates, in combination with the schools. Currently, funding comes from all the usual support sources for biomedical research. Research topics now encompass a broad range of interest. Researchers report both at the usual scientific meetings for their fields and at an annual conference sponsored by the AOA. Research funded from within the osteopathic profession itself concentrates on questions distinctive to doctors of osteopathy.7,12
The chiropractic profession also did research and gained funding in the same manner as osteopaths − through the unity and open communication between associations, schools and sponsorship of donors, all financially contributing for the same cause, regardless of interprofessional squabbles.12,13 Historically, most of the research relied on case studies rather than double-blind studies. Scientific evidence, referred to as "evidence-based," should be used to assess patient health outcomes. At the time, there were two major systems of belief within the chiropractic profession: (see chart).
The 1998 Manga Report supported the scientific efficacy, safety, validity and cost-effectiveness of chiropractic care for low-back pain and stated, "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."14 In 1989, a survey by Cherkin, et al., identified that patients belonging to HMOs in the state of Washington were three times as likely to report satisfaction from their chiropractic care verses medical doctors. These patients also mentioned they believed the chiropractor cared more about the patient.15
In dealing with evidence-based research, the number-one hindrance to moving forward in academia is professional egos. Another historical lesson, more recently identified and publicly announced in 2000, was the Human Genome Project, identifying base pairs in DNA of the human species. This was a 13-year endeavor that was not only global, but also involved collaboration between both the university and the private sector. The importance to us in our current dilemma in jockeying for professional acceptance is that it took the integration of sharing information. In academics, information is not shared. It tends to be undisclosed until published and predisposes the delay of advancements in science. Sharing information and working together to achieve one common goal was a monumental concept. This, in the biological sciences, is huge and now documented. This reflects the foundation of Oriental medicine and many of the CAM therapies' basic belief systems. This evidence-based research validates the importance of working together for the advancement of a common cause.
Today, historical relevance can teach us many key patterns that can benefit our profession as a whole. The ground rules have not changed, only the medical specialty. Those that have gone before us have paved the way, as seen with the National Institutes of Health, in which CAM gained an office in 1991. What we as a profession can learn from this cyclical historical pattern reflects the following ground rules:
Oriental medicine is like geometry: There are many different theorems with the exact same outcome. Every theory is correct, providing the philosophy upon which the individual theory is based. The key to bridging communication is to use verbiage that is understandable. As an educator, if I talked over your head, you would not understand what I was saying. However, if I were able to bring that information to you in a way you understood, I could bridge that communication gap, as well as provide a frame of reference for your understanding.
In summary, many of these health care disciplines were practiced in ancient medicine and have been documented as part of the traditional medicine within ayurvedic, Chinese and European cultures. Medicine, as presented historically in the United States since the 17th century, started in this exact same manner with the same mentality seen today from trade schools to academic ivory towers. Historically, the chiropractic profession was faced with the same dilemma our profession currently are facing as perceived by the "established medical community" belief system at the time:
"...referenced the flow of 'life forces' which heal the body and/or to 'bio-energetic synchronization,' although according to the philosophy of these chiropractors this was correct, this jargon did not contribute to the advancement of the discipline into mainstream medicine. Likewise, to state that germ theory is wrong, a common chiropractic claim, did little to make chiropractors seem like advanced medical practitioners. To ignore bacteria and viruses or to underestimate the role of microbes in infections created more road blocks and again, did not advance their cause. During the 18th and 19th centuries, every misdiagnosis or mistreatment by a chiropractor undermines the whole profession, rather than only the individual malpractitioner, because of the contentious nature of the theory of subluxations"8
This issue was not about being right or wrong; it was about being wise enough to understand each academic discipline's perspective in order to communicate on the level of their understanding. Historically, everyone was right, until something better came along. Public health issues created collaboration between osteopaths and allopathic doctors. Regardless of the time period, advancement is inevitable. It's just a matter of time. Although more sophisticated jargon and techniques have been developed there currently there is a lineage that really dates back to antiquity.
I would like to thank all involved, past and present, who have paved the way for me to present this information. My gratitude for all your hard work, persistence and perseverance as organized professions and individual beliefs are what enabled me to write this article.
References
11. Gevitz N. The DOs: Osteopathic Medicine in America, 2nd ed. Baltimore: Johns Hopkins University Press. 2004.
12. McCrory DC, Penzien DB, Hasselblad V, Gray RN. Evidence Report: Behavioral and Physical Treatments for Tension-Type and Cervicogenic Headache. Durham, NC: Duke University Evidence-Based Practice Center, 2001. Available at: www.madisonchiro.com/hss.pdf.
13. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med 2005;11(1):42-9.
14. Manga P, Angus D. Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services. Ottawa, ON, Canada: Ontario Chiropractic Association, 1998. Available at: www.chiropractic.on.ca/ExecSummary.html.
15. Cherkin CD, MacCornack FA, Berg AO. Managing low back pain. A comparison of the beliefs and behaviours of family physicians and chiropractors. West J Med 1988;149(4):475-80.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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