Chiropractic "Research" Project Is a Marketing Tool
Stephen Barrett, M.D.
Several chiropractic Web sites are now advertising for volunteers "to help evaluate the effects of drug-free chiropractic care on overall health and wellness." The program's developer, Research & Clinical Science (RCS), has approved this television message for advertising to the public:
Do you frequently feel fatigued, run down or suffer from stress-related health problem? If so, you may be eligible to participate in a global research project conducted by an international team of scientists at RCS Research & Clinical Science. It’s estimated that 70 to 80 percent of all illnesses are cause by or made worse by stress: addictive disorders, autoimmune disorders, anxiety disorders and even some cancers. Participants in this research project will receive at no cost a full evaluation by an authorized chiropractic health care professional and a custom Vitality Wellness Index report comparing their results with the national average. No drug therapy is used in this study, and there is no obligation to accept any health care services. To participate, or for more information, call . . . . 
The ad does not mention that RCS is a practice-building program or that the "free evaluation" is likely to be followed by an invitation to pay thousands of dollars to participate in the "research."
In 2005, Research & Clinical Science (RCS) announced that it would "seek to validate the profession and position chiropractic as a scientific, evidence-based wellness practice." RCS's president is Robert Blanks, Ph.D. a professor in the Department of Biomedical Sciences at Florida Atlantic University. Its vice president is Mathew McCoy, D.C., a leading figure among subluxation-based chiropractors. McCoy is a board member of the The World Chiropractic Alliance (WCA), an organization "dedicated to promoting a subluxation-free world."  He also edits WCA's Journal of Subluxation Research and serves as research director at Life University.
Vertebral subluxation is a nebulous term that chiropractors use to describe the spinal problems they claim to detect and treat . WCA holds that "the determination of the presence of subluxation may stand as the sole rationale for care" and that "subluxation-based health care approach providing lifetime, family wellness care . . . should be available to all people, from infancy to old age, regardless of the presence or absence of symptoms." [4,5] RCS's program is consistent with these views. One of its brochures states:
. . . Recent research findings support the underlying theory that chiropractic helps the body “do its job" by correcting misalignments and abnormal movement in the spine called “subluxations.” . . .
When two or more of the bones become misaligned or stuck (subluxated), they can interfere with the normal transmission of information along the nerve path. When this happens, malfunction occurs. The result could be an impairment of function or a decrease in the health of the impacted organ or cell. Sometimes, the effect is immediate – pain, illness, or other obvious signs that a problem exists. At other times, the effect is far more subtle, with no apparent symptoms. Still, the long-term result may be chronic diseases, shortened lifespan, a decrease in quality of life, or impaired immune system. The reality is, one cannot live a life of optimal health and wellness through a nervous system that is interfered with.
The research being done by RCS is geared to pinpointing exactly what impact subluxations have on the body, and what benefits chiropractic might offer to people of various ages and health levels. The International Scientific Research Panel is using, as its working hypothesis, the proposition that “drug-free chiropractic care has a significant, positive and far-reaching impact on health and wellness for people of all ages.” 
To join the RCS program, chiropractors pay $7,384 in advance or up to $8,384 for an installment plan. In return, RCS provides the training, research technology, brochures, and other marketing materials needed to act as an "RCS Authorized Clinical Investigator." 
When training is completed, the chiropractor receives a “Fellowship in Health Outcomes Research” certificate, will be approved by an "independent institutional review board (IRB)" and can begin recruiting. The certificate, signed by Blank, McCoy, and another RCS official, attests that the chiropractor was granted fellowship "in recognition of his contribution to the advancement of knowledge in the field of chiropractic health and wellness."
Research or Marketing?
RCS flyers call for "volunteers" who are suffering from stress-related disorders, allergies, asthma, high blood pressure, "prehypertension," or who feel frequently tired and rundown. The flyers offer a free evaluation by an "authorized RCS Researcher" plus a "Customized Vitality Wellness Index report comparing the results of your wellness evaluation with those of the larger population." After that, the volunteers will be invited—as paying patients—to "commit to a 24-visit cycle, and continue coming until they reach their maximum potential." At various times, RCS's offerings to chiropractors have promised that its program will:
- Conduct the largest ongoing study of the effects of chiropractic care on human health and wellness ever carried out, and publicize the results of that study to the world
- Organize and categorize the largest body of knowledge regarding the application of chiropractic science
- Validate chiropractic care for every man, woman and child on the planet
- Promote long-term wellness and compliance among existing patients
- Create a flood of new patients while enhancing a doctor’s credibility and prestige
- Generate between 10 and 25 new patients a month
- Transform many patients into long-term chiropractic wellness supporters
- Help stop the "revolving door" syndrome (in which patients discontinue care sooner than the chiropractor advises)
- Provide the sound scientific research needed to satisfy and silence critics who claim chiropractic suffers from a lack of scientific evidence.
- Validate the standard rating systems for the severity of subluxation and integrate them into the potential for multiple levels of subluxation
- Help the chiropractor to become a published research author
- Provide the increased visibility that comes from being a community leader and health care expert.
There are obvious problems with this set-up. Because "subluxation" detection is not a valid health yardstick, most "research volunteers" are likely to be invited to waste time and money getting care they do not need. Moreover, it is not proper to promote long-term care (24 visits or more) before any data show that it actually results in a positive outcome. As two critics have noted:
This purported relationship between regular chiropractic care, subluxation and wellness is certainly a testable hypothesis or theory, but therein lays the inherent contradiction with the RCS program. In practically every advertisement and article about the program, there is no mention of this being a "testable hypothesis" with a level of uncertainty. Nor is there any discussion about the possibility that the research findings might discredit or undermine this hypothesis. Sounds biased to us. It makes you wonder how objective the researchers can be, when they appear to giving us the results of the research before the research is even performed! The promoters of the RCS program seem overly confident that their research findings can only "prove" their hypothesis. This clearly shows a lack of understanding about the fundamentals of scientific research. . . . No credible researcher would ever tout the positive impact of his or her research in advance, before the data was analyzed and the results were actually found to support the hypothesis in question .
It appears to me that RCS is inviting patients and chiropractors to join a vaguely defined research project that involves nebulous diagnoses, unspecified treatment protocols, and undefined outcome measurement using questionnaire that has not been validated. The RCS Web site has expressed hope that 15,000 chiropractors will participate. Some observers wonder whether the program's main accomplishment will be collecting money from gullible chiropractors.
- Do you suffer from stress-related disorders? Medeira Chiropractic Wellness Center video commercial. Downloaded from RCS Web site, Jan 27, 2008.
- Subluxation. WCA Web site, accessed Jan 28, 2008.
- Barrett S. Chiropractic's elusive subluxation. Chirobase, May 21, 2006.
- Position statement on vertebral subluxation as the sole rationale for care. WCA Web site, accessed Jan 28, 2008.
- About World Chiropractic Alliance (WCA): Where we stand on the issues. WCA Web site, accessed Jan 28, 2008.
- Exploring the chiropractic-wellness link. RCS Web site, 2006.
- RCS application and contract. RCS Web site, Jan 28, 2008.
- Perle S, Schneider P. The ethics of research, aka marketing. Dynamic Chiropractic 24(13):12, 2006.
This article was posted on January 28, 2008.