Then, in 1997, we had the advent of the Consortial Center for Chiropractic Research, funded by the National Institutes of Health. That was a historic milestone.
REDWOOD: Up to that time, had it been challenging for the chiropractic profession to move forward without the kind of federal financial help that was available to the medical profession?
MEEKER: Absolutely challenging, for a variety of reasons. There were a number of barriers to doing any kind of science in a profession and in institutions that were (and mostly still are) free-standing, tuition-dependent, private institutions with no history or track record dealing with federal funding mechanisms. There also was very little of the kind of scientific tradition that exists in other health professions, in terms of mentors, graduate students, and the whole scientific apprenticeship model. We had very few people with the proper training. There was little or no collaboration with any established scientific centers or institutions of higher learning. There were also some anti-scientific attitudes out there in the profession. And, there was simply a lack of money, too, a lack of financial resources to spend on these things. So it was a challenge, and still is.
REDWOOD: Why is research important, from the perspective of doctors, patients, and policy makers? Why should a profession like chiropractic (or acupuncture, massage, or medicine, for that matter) put resources into research?
MEEKER: I think the basic answer is cultural, that true professions control their own knowledge. They control the means by which they develop their own data base, the process by which they evolve and improve their methods. To the extent that chiropractic can control its knowledge base and discipline and its own special methods of investigation, and to the extent that it can develop its own scientifically valid knowledge that improves human health, then it is a credible, evolving profession. To the extent that it can't do that, then it's something less. So it’s professional control of our own destiny that is the issue.
Secondly, if research is simply looked at as a way to obtain the best possible information on how to make decisions, then research is a way to improve chiropractic practice. So that's good for individual chiropractors and, obviously, for patients. For the profession as a whole, if we control our information, that gives us credibility and legitimacy in the eyes of policy makers, third party payers, and the whole health care delivery system. So they work hand in hand.
REDWOOD: How would you summarize the current state of clinical research on chiropractic?
MEEKER: At this point there are about 50 randomized controlled trials on spinal manipulation for head, neck, and back pain. Then there's something like a dozen for all other conditions.
REDWOOD: Overall, what have those studies shown?
MEEKER: About two-thirds of those trials have demonstrated that manipulation was better than whatever it was compared with. There has not been a single trial that showed that manipulation was poorer than what it was compared with, although there have been some that showed it to be the same. When we look at the various meta-analyses, reviews, and consensus processes that have evaluated this body of research, we can say it is highly likely that manipulation is effective for patients with acute and chronic low back pain, as long as we’re talking about short-term outcomes. By short-term, I mean three weeks or a month.