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Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
March, 2016, Vol. 16, Issue 03
Becoming an Informed Consumer of Research: Basic Considerations
By Martha Brown Menard, PhD, LMT
Research is a fundamental aspect of every health care discipline. It supports the theoretical foundation of any discipline and helps to distinguish useful treatments and practices from those that offer no benefit or prove harmful. In addition, integrative health care therapies such as massage therapy, chiropractic and acupuncture have developed a sizable body of research to support their use. Research on the effectiveness of these therapies has helped facilitate their acceptance by conventional health care and the general public, and is a cornerstone of the shift towards evidence-informed practice across health care more generally.
Key to this acceptance is the effort to reduce language barriers between conventional health care and more person-centered, integrative approaches to health. As integrative practitioners are usually still in the minority within the larger health care system, it is particularly important that we be able to explain our work in terms that others can grasp. Understanding research greatly improves our ability to communicate effectively with other health professionals through a shared frame of reference and a common language. In addition to this general trend, there is also an increased tendency for massage therapists, acupuncturists, chiropractors, yoga therapists, and other practitioners to work in conventional health care settings as part of a team, or to become involved in multidisciplinary practices. With the growing trend towards interdisciplinary health care, the ability to communicate across disciplines will continue to assume greater importance.
Being able to locate and critically evaluate research in one's field is essential to providing the best possible care for clients. Evidence-informed practice is here to stay as the new standard across health care, and complementary and integrative therapies are being held to it. Because news about recent research is often reported in the popular media, clients or other health care providers may approach practitioners with questions about what implications a new study might have. It is incumbent upon practitioners to be able to discuss questions that arise from research in their field. Understanding how to evaluate research findings helps one to do this knowledgeably, with ease and confidence.
Research evidence has also assumed a major role in influencing health care policy on a national and international level. Policy decisions regarding what treatments are considered "best practices" and which will be reimbursed are increasingly based on research. Cost and consumer satisfaction have also become important study outcomes of interest. I believe that reading health care research offers every complementary practitioner a valuable tool for improving the quality of care you are able to offer your clients, and for ensuring that you and your loved ones receive the best possible health care. Understanding research is vital to the continued development of complementary therapies. And there is another yet important reason to become an informed consumer of research.
Science as a Social Activity
In evaluating the merit of any particular study, it's important to remember that science takes place via human interaction, through informal communication among colleagues with similar interests, more formal presentations and discussions at conferences, and publication of completed research findings in peer-reviewed journals. Knowledge-building is a social process just as much as it is a scientific one.
Because human beings are fallible, the social norms of science help to minimize the presence and/or influence of personal bias in the processes through which speculation becomes knowledge. These norms include an expectation of integrity in the design, conduct, interpretation, and publication of research studies. Peer review serves as an additional structure to maintain integrity. Journals do however have a tendency to prefer publishing studies with positive results. This tendency has been demonstrated and is known as "publication bias."
At the same time, as the number of university tenure-track jobs and the availability of grant funding decreases, there is increasing pressure for scientists to publish positive results. The blog Retraction Watch with support from the Center for Open Science has chronicled the rise in the number of scientific retractions since 2010 and maintains a database to document these. In the end, though, both honest mistakes and deliberate scientific fraud are eventually uncovered through peer review and the nature of how knowledge-building works. Knowledge-building is always provisional — in science, new information can always displace what we thought we knew previously.
Another example of scientific integrity is the practice among peer-reviewed journals of requiring disclosure of all sources of financial support for a study, so that readers can judge the extent to which the study could be biased because of who funded the research. As an example, a study concluding that smoking poses no substantial health risks in spite of numerous contradictory studies would be viewed even more suspiciously if it were funded by the Tobacco Institute. By the same token, research on herbs and dietary supplements has sometimes been viewed more critically when funded by companies that manufacture these products.
The philosopher of science, Thomas Kuhn, articulated the idea that scientific world views or paradigms define the kinds of research questions that may legitimately be asked. What is thought to be "legitimate" can vary according to the social norms and assumptions of a culture and what is considered within that culture to be useful or important knowledge. Historians of science have detailed the ways in which the practice of science has sometimes been distorted by dominant cultural biases, such as the infamous Tuskegee study.
Ethics in Health Care Research
It is also important to define how research may legitimately be conducted, a subject that has been influenced by social norms and cultural bias as well. Present-day scientists involved in health care research have a code of ethical principles that must be applied to both human and animal research. With respect to human subjects, two of the most basic principles of ethical clinical research are to:
Experimental studies are especially susceptible to ethical concerns because they involve direct intervention by the researcher in the lives or health of the participants. For this reason, the researcher is expected to make every effort to protect the human rights and well-being of the study's participants. Current standards for research ethics have been formalized since World War II. In the U.S., the Nuremberg Code (1947) and the Declaration of Helsinki (1964, revised in 1975) became the foundation for the formation of the National Commission for Protection of Human Subjects and Behavioral Research. This commission produced a document known as the Belmont Report.
The Belmont Report proposes that three core values should underlie all research endeavors: respect for persons, beneficence, and justice. The practical implications of each value are:
An outgrowth of the Belmont Report was the development of U.S. government regulations requiring the establishment of Institutional Review Boards (IRBs), to act as ethics committees to safeguard the rights of study participants. IRBs consider the scientific merit of proposed projects in light of the study's potential risks and benefits, and assess the procedures for selecting and recruiting participants, for ensuring appropriate informed consent, and for maintaining confidentiality of private health care information disclosed during the study. The IRB approves the proposed design of the study only if its benefits outweigh its risks, and then monitors the conduct of the study as it progresses. It is standard practice now for journals to require a statement from authors describing how ethical standards for the study were met when submitting a manuscript for publication.
Understanding the background concepts that underlie how scientific research is developed, carried out and reported can enhance our ability to be informed consumers of research. Just as it's important to not believe everything you read on the Internet, it's important to think critically when we read research.
Martha Brown Menard, PhD, LMT, is the director of the Crocker Institute and a licensed massage therapist in Kiawah Island, SC. She is the author of Making Sense of Research (available here). Martha is also the co-executive director of ACCAHC.
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