Weaponized Research

Welcome to the second 33 Minutes episode in which Dr. Gerry Clum, chiropractic’s senior statesman, recaps a recent paper in which chiropractic students who understand the holistic impact of subluxation are treated as though they are a cognitive contagion that must be eliminated from the profession.

Dr. Clum then goes on to describe his recent experience at the World Federation of Chiropractic (WFC) speaking with shock, dismay and determination about the unprofessional and rogue remarks made from the stage in Berlin by members of the WFC Research Council.

See below the video interview with Dr. Clum and Dr. Jason Deitch for  the entirety of  Dr. Clum’s remarks. A complete transcript of the conversation is copied below the video. In the transcript, you will also find links to the various papers and organizations that Dr. Clum references in this interview.

 

TRANSCRIPT:

Deitch: Hi and welcome to another episode of 33 Minutes. This is Today’s Chiropractic Leadership. Welcome. I’m really glad that you’re here. I’m Dr. Jason Deitch with the pleasure, of course, [of being] with Dr. Gerry Clum. Gerry, good afternoon.

Clum: Good afternoon, sir.

Deitch: Great to be with you. I’m excited for today’s conversation. Let’s get right into it. I know last episode we talked about two different studies. There just seems to be a lot of conversation these days and that’s really what this program is all about, is making sure that practicing chiropractors and those that are affiliated with, invested in, and connected with the chiropractic profession, who want to see it thrive the way we know it should thrive. Stay up to date with the research, the politics, the leadership, what’s going on both in America and around the world. Recently, last week, we talked about a paper that came out of the French institute. Why don’t we start today’s episode, if you wouldn’t mind, for those that didn’t watch last episode, what’s the significance of that paper?

Clum: Well, thank you. First of all, it’s great to be back with you and looking forward to this conversation. There’s been a pretty disturbing trend, I would say, within the research community in chiropractic over the past couple of years in particular. And it’s really come to a head in the last couple of months. This paper that we’re going to chat about today is an example of some of the thinking that, frankly, I hope will alarm our colleagues, because I don’t think it portends well for the profession and for the chiropractors who reason as we do about the profession. The whole question was amplified by the recent meeting of the World Federation [of Chiropractic] in Berlin, where the research community, quite frankly, stopped being researchers and became politicians. And they assumed an agenda, and they advanced that agenda in a coordinated, integrated fashion through the program. They used their research and they, in my opinion, weaponized it. And they’re furthering this same kind of ultra reductionistic perspective. Let me tell you a little bit about this study that we’re talking about.

Clum: And then you might understand what I’m concerned about. The paper that I’m referring to, and I have to apologize to the gentleman; I’m meaning no disrespect, but my French pronunciation is terrible. The last name is Gonclaves…and it was published in Chiropractic and Manual Therapies… and the article is entitled “Chiropractic conservativism and the ability to determine contra indications, non-indications and indications to Chiropractic care,” [a] relatively benign discussion, from the title. Let me break it down and tell you what that article was about. It is from faculty at the French Institute in Paris and Toulouse. And they conducted essentially two processes in this study. The first was to survey the student body at both campuses about their attitudes toward subluxation, their attitude toward the adjustment, their attitude toward the body’s ability to do its own healing, things of that nature.

Clum: And they created a spectrum and graded people across that spectrum based upon the responses that they offered. Then, they provided them with a series of cases, two cases that were contra-indications, four cases that were what they referred to as non-indications, and three cases that were contraindications.* [Ed. note: Dr. Clum misspoke here; the third category was “indications”]

Deitch: Okay.

Clum: And the first set of feedback that I got is, and I think this is very, very good news is that the students at the institution were third-year students and sixth-year students, and they pretty much nailed the indications for care and the contra-indications for care, regardless of where they were on the spectrum that they had developed regarding philosophy, which I think is a really important finding – Is that the idea that…your philosophic position makes you less dangerous, more dangerous, whatever. You know, the bottom line was, the students regardless what their attitudes were, they recognized the flat out indications for care and the contraindications to care. That’s a pretty good beginning point. Where it got really squirrely is when the researchers took the non-indications of care, and by their definition, an asymptomatic patient was a non-indication of care.

Clum: And they cross referenced whether or not that student said they would adjust that sample case that…the faculty perceived to be a non-indication of care, and then they figured out where the student was on that philosophical…spectrum. And lo, and behold, quite honestly, I think you and I probably could have come up with this without the numbers, but they’ve got the numbers and the and the statistical testing behind it, so good for them. But what they came up with is, that the more philosophically oriented the student was, the more likely they were to adjust the patient in the non-indications of care category, i.e., absent symptoms.

Clum: And so, if they had left it at that, I suppose it was a nice, [it would] be interesting finding. But they went on to propose that the delivery of care to…those people in that non indications of adjusting, was in fact breaking the law and that the students were advocating the illegal practice of chiropractic. Now, they were smart enough and kind enough to include a reference to the French law, and thanks to Google translator and our good friend, Gilles Lamarche, who confirmed the translation for me, I was able to go back and to read the scope of practice provisions in the French decree, that they based these conclusions on. And quite frankly, it doesn’t come anywhere near saying anything like that.

Clum: So then I went back and I started to read it very carefully and look for key words that were there, and to look for negative connotations and negative associations in the language that was being used. Well, as you know, I’ve done a good bit of malpractice defense over the years, and one of the common ploys of plaintiffs’ attorneys is what’s called the “reptilian approach.” And in the reptilian approach, what the attorney wants to do is to approach a jury and an expert witness, for example, and begin the discussion about safety and begin to get everybody thinking about safety. Because safety is one of the most basic, oldest drives in our being, and when we start thinking in those terms, we drop back into the reptilian brain, and we hunkered down and we lose the, the logical reasoning capacity of the newer areas of the brain and we fall into this safety protection of, “Oh my God, we’ve got to get rid of this risk, et cetera, et cetera, et cetera.”

Clum: In my opinion, that’s exactly what these researchers are doing. They are attempting to develop a reptilian response on the part of the practicing chiropractic community to be fearful and to become enraged about the behavior of the students that are involved. And as an extension, of the practitioner who would take that same perspective and that same attitude, these folks go on to talk about idea that there need to be curricular changes to breed this out of these students; “we need to get this out of their brains and the reason that that they have these perspectives is that they’re just young and ideological and they’ve not seen any patients and they’re just too dumb to know better.” Now, too dumb to know better is my interpretation of their language.

Clum: They don’t say that, but in reading it, that’s exactly what it says to me. Never once, never once, did they consider that the reason that student’s in that seat in that classroom in Toulouse is because his mom had her life changed because of tahe cervical adjustment that didn’t have a damn thing to do with low back pain, didn’t have a damn thing to do with neck pain. Not once did they consider the fact – and they were kind of puzzled by the idea that the farther the student went in the curriculum, the more they adopted a, “We should adjust this non indication patient” – and that seemed to run contrary to their conclusion that well, the more that we train them, the less they’ll do that. Or. Perhaps the more they were trained, the more they were exposed, the more they talked to their colleagues, the more they realized the magnitude of the adjustment of what could be done.

Clum: And this very short sighted, ultra-reductionistic perspective that if there isn’t an RCT [randomized clinical trial] about it, you can’t talk about it. Now you and I, probably or maybe a year ago, we chatted at length about a paper that came out in [the journal] “Spine” by a fellow by name of John Adams from Sydney, Australia. And, what John Adams did was an analysis of the US National Health Interview survey that was conducted in 2012. The first set of that data that was available for analysis became available in 2017 and immediately they went after that data and they did their analysis. Admittedly, they found that the vast majority of patients initially sought chiropractic care for pain, whether it be low back pain or neck pain, but the value of the care and the reasons that they continued with the care, were far, far removed from the pain. Almost 45% of the patients surveyed said that they sought chiropractic care and continue to seek chiropractic care for their general health and wellbeing, not for pain.

Clum: They got out of pain; happy for them, that’s the way it’s supposed to work. We like that. But they also saw the benefit of the care. And 45% – almost 45% – of the folks involved in this survey said that they saw general health and wellbeing consequences to the positive, in their favor, as a result of chiropractic care. Now we’re in this moment in time where everybody wants to be patient centered. Well, I’ve been a patient; I am a patient for some people and I like patient centered. Okay. But when the voice of the patient says, 45 times out of a hundred, the reason I’m doing this is because it helps my general health and wellbeing, how can you discredit that and say, “Well, I don’t have an RCT about that, so you can’t do that and you’re breaking the law.”

Clum: You know, you would have to contort the French language of Article One of the decree beyond imagination to come up with the idea that adjusting a patient without symptoms was breaking the law. And the implication of these authors was that that would be the way it is across most countries, particularly in Europe, that have legislation. And quite frankly, it isn’t there. You know, I’ve been active in international circles for almost all of my career and very heavily the last 30 years in particular. I’ve read the texts, I understand the legal status of the profession around the world and frankly that just isn’t there. So what does this mean to you and to me and to the guy and the gal in Topeka, Kansas. Well, the bottom line is, this ultraoreductionistic thinking is crossing paths with trends in society that we dreamed about as chiropractors.

Clum: Yesterday’s [April 2] latest issue of JAMA has an article entitled Re-imagining Health, and their perspective on re-imagining health is we really shouldn’t be paying so much attention to the symptoms. Not that they’re not important. We really shouldn’t be paying that much attention to pain scales. Not that they’re not important. We really shouldn’t be paying attention to whether or not there was the patient was satisfied with the patient encounter of that that given day. We should be looking at things in a holistic fashion and we should be concerned about the flourishing capacity of the patient; their word, the “flourishing” capacity of the patient. This is exactly what John Adam talking about. This is exactly what the consumer reflected back to Adam in the survey, what they were after. Now, let me just take it out; I can’t do it from memory, so I’m going to have to pull it out and take a take a look at it here, but we’re talking about persons that are talking about how they get along better with their spouse, they concentrate better, things are better at work. They sleep better as a result of chiropractic care.

Clum: Now, if that isn’t patient centered and it isn’t about flourishing, I don’t know what is. So we’ve got this tension that exists that is… changing character from tension to outward aggression. I heard a presentation that Dr. Scott, the president of Life University made recently, and he talked about the culture of contempt. Boy, he should have been in Berlin for the presentations I heard there. The contempt was dripping. It was dripping off the words, and every time there was an opportunity to weaponize, the subject was weaponized. It was terrible in that regard. I’m sure the German food was great. I can attest to the fact that the beer was good, but the bottom line was some of the content was remarkably scary in that regard. So what do you and I need to worry about and think about in this?

Clum: The bottom line is, if we don’t counter this, we’re going to be victimized by it. Pure and simple. And the average guy or gal in practice doesn’t have the good fortune that I’ve had to be able to travel to these different conferences, participate in these things. But they still have to arm themselves with the information to be able to answer the questions that we’re talking about. This whole new world of flourishing that is being promoted in JAMA in April, 2019, is what we’re talking about as well. The role that chiropractic care can play in the flourishing of the population, the role of chiropractic care in helping your patients have the best possible life experience they want to have. Is it going to cure this? Is it going to heal that? Is it going to fix that? No. Are things better off? Well, for 45 out of a hundred patients, they said they were better off under chiropractic care.

Clum: So we need to understand that there’s another side to the story. You know, we were told by mom and dad when we were kids, you know, you can look at the glass as half full or you can look at the glass as half empty. I’m afraid our colleagues that have a tendency to look at it as half empty. I know that you and I look at a perspective of when we deliver an adjustment, we’re thrilled with what happens. You know, if it’s supported by the research, that’s wonderful. If it’s not, it’s not necessarily going to stop me from providing the care. As such, I’m providing… care for non indications. And as such, according to our French colleagues, I’m potentially breaking the law. Well, frankly, we need to counter that stuff. And the best way to do it is to arm yourself, to read, to attend conferences, and to go to the places and talk to the people that can help you look at that data set differently.

Clum: Just like this data that I’m talking about from this study at the French school, I think there’s things to be excited about. The authors glossed over it and decided to seize on something else and translated it into something perverse. So I’m suggesting that our colleagues need to take some time, need to invest themselves, probably need to invest a little bit of money and prepare themselves more fully than in the past. The day of being able to hunker down over your adjusting table and say the hell with the world and let it go by, and you just see your patients and take care of them, is not enough anymore. It may work in the short run, but in the long haul, that’s the emergence and the development of health care delivery around the world, we’ve got to be prepared with the coin of the realm and that’s the best data that’s out there. And the people in Berlin, were given one dataset, that’s for sure, that was somewhat very, very useful but tinged.

Clum: There’s a conference coming up in Paris in November with the Rubicon Group, November 15th and 16th at the Hyatt Hotel Etoail, which is just off the Champs-Élysées in the heart of Paris, a gorgeous facility, a four star property, great rate. And we’re going to be bringing the Rubicon community, as we did in 2016 in London, as we did 2017 in Melbourne, Australia, as we did 2018 in Atlanta, in Paris in 2019, we’re bringing some of the cutting edge researchers who are bringing technologies from other disciplines and other fields and other aspects of healthcare, that can help inform our understanding of the power and the magnitude of the adjustment to the conference table. To learn from them, to help them learn about us, and in the process to create a greater wealth of knowledge and understanding about what it is we do, how it works, and how powerful and important it is. So, I’m going to ask our colleagues to invest some time. If you, if you’ve got a few minutes, visit the TCL website, download this paper that I’m talking about. Read it. I hope you get angry. I hope you get upset about it and I hope you get the implications of what is being put forward in this discussion because they could be dire and we need to be prepared. The Rubicon is going to help you do it.

Deitch: Yeah, exactly. Would you spend a few moments explaining for those that may not be aware of what the Rubicon is, so they get the significance of this isn’t just another conference. The Rubicon is made up of…why does it deserve their support to be around…?

Clum: A series of educational institutions in chiropractic from the UK, from Spain, from Germany, from Australasia, the United States have been working together since 2012, and began our conferences in 2016 and the goal is to bring science, to bring the art, and to bring the philosophy of chiropractic forward; a contemporary, scientifically oriented, evidence established basis; the documents, the realities of what goes on in your office and in mine over that adjusting table, and has gone on in the tables across the planet for the last hundred and twenty years. And that’s the goal of this process. We want to give the adjustment and its correction, the importance, the dignity and the significance that it deserves in the marketplace. And we want to give you the chiropractor, the tools to be able to defend yourself against allegations such as this that non indications for adjustments is an illegal act. Crazy talk.

Deitch: Well, and you’re not one to sound fake alarm bells and you’ve always been intellectually, and I think, extremely accurate and you’ve had your finger on the pulse. But what I hear [is] an urgency in your voice that this is different. And what I hear from you is that this isn’t just another philosophical debate, you know? Yes, we should, no we shouldn’t, yes, we should, no we shouldn’t… That when they start in the literature bringing in the conversation of legal versus illegal, like you said, this goes from being science based to political action, and sitting back and being a spectator only means that their offense is going to overcome our lack of defense should we not have it, and there are consequences to not getting in the game and playing strong defense. And it sounds, y what you’re saying, of course, we can sit here and go stand here and go, this is crazy talk.

Deitch: I mean there is such a thing as off label use of prescription medications that are not illegal. In fact, I think more drugs are prescribed off label than on label from what I understand. But nonetheless, that’s not a legal or illegal conversation. It’s this subject of the trained, licensed professional. True?

Clum: Correct.

Deitch: And it would seem like that would be a standard that’s right for medicine; shouldn’t they think, so that would apply to us, too, for us to in any way imply that if you don’t have, and again, now define symptoms, right? I mean, indicators of physiology I don’t think is what they’re describing. They’re describing actual musculoskeletal pain, I’m assuming, is really about what a symptom is.

Clum: That’s right. The symptom of significance in their world is pain, period.

Deitch: So there’s no creative ability to kind of redefine what symptoms are according to the way the defining them in this paper. So, please, if you’re watching this, there’s a couple of takeaways. Number one, please go to TheRubiconGroup.org, and invite your spouse and your colleagues to join us in Paris in November. This is where amazing minds, researchers, scientists, educators, and the leaders from around the world are getting together to both defend our right, but also to promote the facts, the science, the research, that what we do as Adams says and many others is extremely effective. And that we have to both play defense and offense. And that’s really the place to be involved and do it. This is not just charismatic people coming up and giving you some tips on how to make a few bucks on Monday. This is the institutional leadership of the world getting together, to join forces, which is again, one of those data points that really is exciting, is to see this, you know, galvanization of leaders around the world coming together, to work together to support science and to support the promotion of our ability to practice in a legal and helpful a way that if we don’t, may have dire and serious consequences for your career, for our profession and, most importantly, for the people that really deserve our care, that are, I think threatened to have it being taken away from them.

Deitch: Does that all sound accurate to you?

Clum: Absolutely. And I’d like to go back to one of the points you made real quickly. You’re right. I’ve tried very hard in my career over the last years, almost 50 years, to not be very reactionary. Now, there could be some people out there laughing because they’ve seen me flame. But, the bottom line is I’ve tried to be reasoned. I was alarmed by what I encountered in Berlin, I am scared by what I encounter in the literature that we’re talking about today, not in terms of the power of the literature, but in the power of the thought behind it and how distorted it has become. If we don’t speak up and rectify it, if we don’t point out the fact that these people have just been believing their own PR too long, to the point that they think it is reality, is another story. And, we need to become active. We need to become aggressive and in order to do that, we need to have the information and the strategy and the approach to be able to engage. So, we all gotta do it.

Deitch: I just want to close up with one thing. I saw Dr. Scott’s presentation on this concept of the culture of contempt. And it’s one of the most refreshing and intellectually brilliant spot on analysis and observation of what’s going on maybe worldwide, certainly in America and most definitely in our profession. Do you want to… articulate why now needs to be different, that we can’t afford the luxury of just arguing amongst each other and bickering among our small differences about what… what do you see as the solution? How do we overcome that culture and what’s the new culture we should be looking into?

Clum: Yeah, well, that culture of contempt has caused things to become toxic. You know, it’s been annoying. It’s been irritating. It’s been a lot of things in the past. It’s downright fundamentally toxic. It’s that way in the United States. It’s that way, if you noticed in today’s newsfeeds, a serious disruption to the Canadian cabinet, in terms of resignations and things of that nature, and this is… places that don’t react are all of a sudden reacting around the world. And we’re a microcosm of that macrocosm and we need to understand that moments of great opportunity are moments of great danger and they collectively represent a crisis. This is approaching a crisis for us and we need to seize the opportunity and address the danger. And it’s very real, because we’ve always had to be concerned about the outside foe. Right now the internal foe is every bit as dangerous as the outside ever was and we need to make sure that we maintain a balance of thought. I don’t want to crush anybody. I don’t want to eliminate anybody else’s thought. I just want to live and let live and in a logical, reasonable, productive fashion. And, I don’t think that’s too much different than what most people want out of it.

Deitch: I would agree with you and that, this is happening in Europe does not divorce itself from the fact that this could cross the pond and be here in the United States relatively quickly as well. This is not “their issue.” This is very much an “our issue.” It’s just taking place geographically somewhere “up first.”

Clum: If, as a chiropractor, you haven’t figured out that geography doesn’t matter any longer, and that where something happens in the world is incidental. It’s forgotten in relationship to the fact that it did happen and it was transmitted around the globe in a nanosecond. So geography and location just simply doesn’t matter. You may think it’s “over there,” but over there’s right here.

Deitch: And the last thing we can afford to let happen, I would say, is to let a precedent like this be set in any… significant or substantial way as a result of non-reaction.

Clum: That’s right. That’s right. Passivity is not going to win. And if we just say, well, that’s just some, some person… I don’t agree with on the other side of the world and forget about it and don’t say anything, they win by your default.

Deitch: “That’s their problem, not mine,” doesn’t apply here.

Clum: That’s correct.

Deitch: Okay. Action steps. Go to TheRubiconGroup.org. Join us in Paris in November. Two: Read the research. We’ll put links down below. Educate yourself, inform yourself. It may not be a comic books and the most exciting reading, but it is the probably the most important reading you can be doing these days. And being aware of these studies, being aware of the details and significance, the devil’s in the details in many of these things. Being aware of these things just gets you, I’ll say, energized and excited enough to participate in the game.

Deitch: The exciting thing is, and I’ll sort of close by saying thank you Dr. Clum and the others, Phil McMaster, and I don’t want to leave anybody out, but the other leaders of the Rubicon Group, for the work that you’re doing, both the monitoring, the endless traveling and calls, conversations, research that goes on, to pay attention to what’s going on, because as you said, passivity isn’t an option right now. And you know, most of us, whether you’re a practicing chiropractor or just not into that conversation for the experience, I can only say thank you very much for your service and what you’re doing and keeping us aware and abreast of what’s going on. And most importantly, creating opportunities for us to be able to make a difference and both protect ourselves, keep people safe, and I think that’s ultimately the point. If we want to go reptilian, let’s go reptilian. People’s lives are at stake, and not allowing them to get adjusted because they’re not yet in enough pain to warrant. It is about the closest thing to insanity that most of us can come up with. So, I’ll say thank you very much and Dr. Clum, I’ll leave you with closing words.

Clum: It’d be foolish to try and add anything to that. You’ve been very gracious and very kind. Please do your homework and let’s keep on working on this together. And we can come out of this better off than we were before, if we manage it properly. Let’s get to work. Thank you very much.

Deitch: We’ll see you in Paris.

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