Because of the sacrifices made by Palmer and so many others through the years, chiropractors today are able to practice freely, and the profession is truly coming of age in our time. Over the past several decades, the chiropractic profession has undergone profound changes, as standards in education, research, and practice methodology have steadily risen to meet the demands of a fast-changing society. An excellent historical review, for those seeking greater detail, is contained in the book Dynamic Chiropractic Today, written by a former president of the British Chiropractors Association, Michael Copland-Griffiths, D.C.
Chiropractors are now licensed throughout the English-speaking world, and in many other nations as well. Educational standards and testing procedures are rigorous. Numerous college science courses are required prior to entering chiropractic school, and the chiropractic college curriculum extends four or more years. Highly-trained faculty fill both the basic science and clinical science departments at all chiropractic colleges, which are accredited by government-supervised agencies in the various countries.
In Australia, the first wholly government-funded chiropractic training program in the world was incorporated into a university curriculum in 1980. In Quebec, a similar program began in 1993 at the state (provincial) university. These programs are a sign of things to come, and foreshadow a far greater integration of chiropractic into the health care system of the future.
The greatest strides in the late-twentieth century have been in the area of research. No longer can chiropractors be criticized for lacking a firm base of scientific research. The tide has truly turned, as chiropractic has entered the modern era.
The early leaders of the chiropractic profession recognized the value of research. Dr. B.J. Palmer, the founderâs son, conducted numerous studies between the 1910s and the 1950s, documenting the effects of chiropractic adjustments on such physical functions as blood pressure, heart rate, respiration, and brain-wave patterns.
Unfortunately, B.J. Palmerâs studies, like other chiropractic (and medical) research from the first half of the twentieth century, do not meet the criteria demanded by the modern scientific community. In the context of their time, however, an era when medical clinical trials were just beginning, Palmerâs work marked the first serious attempt at objective measurement of the physiological effects of the chiropractic adjustment.
Through the years of Palmerâs preeminence in the chiropractic world, many other independent chiropractors and chiropractic colleges also carried the torch of research, exploring new adjusting methods and measuring their effects. Like Palmerâs studies, these too are of significant historical interest, but did not follow the rigorous scientific protocols demanded of todayâs research.
By the early 1970s, the scientific gap between chiropractic and medicine had widened, and the more far-sighted chiropractic leaders realized that it had to be closed as quickly as possible. Looking back now from the vantage point of the 1990s, it is remarkable that so much has been accomplished in such a short time.
Dr. Suh and the University of Colorado Project
Beginning in the 1970s, first with grants from the International Chiropractors Association, and later with added financial support from the American Chiropractic Association and the federal government of the United States, Chung Ha Suh, Ph.D., and his colleagues at the Biomechanics Department of the University of Colorado began a series of studies which have provided an extensive body of chiropractic-related scientific research.
It is worth noting that Dr. Suh, the first American college professor willing to stick his neck out for chiropractic research, grew up in Korea, where he had not been subjected to the same life-long anti-chiropractic bias as his American colleagues. In undertaking this research, he had to withstand intense pressure from powerful forces within the American medical and academic establishments. The AMA and cohorts condemned chiropractic for lack of scientific underpinning, while at the same time doing everything in their considerable power to prevent chiropractors from ever obtaining the funding and university connections necessary for the development of such a research base.
Time and again in American history, it has been immigrants who have brought to our land the fresh perspectives needed to move our society forward. In addition, progress has often required the courage to stand up against politically powerful forces of stagnation. Dr. C.H. Suh stands as a modern exemplar of both these traditions.
The research at the University of Colorado involved two major projects. In one, Dr. Suh developed a complex computer model of the cervical spine, which allowed a deeper understanding of spinal joint mechanics and their relationship to the chiropractic adjustment.
The second project involved studying the effects of compression on spinal nerve roots. Seth Sharpless, Ph.D., Marvin Luttges, Ph.D., and their colleagues demonstrated that minuscule amounts of pressure on a nerve root (10mm Hg, equal to a feather falling on your hand), resulted in up to a 50 percent decrease in electrical transmission down the course of the nerve supplied by that root. Chiropractors have long claimed that minimal pressure on nerves could have a significant physiological impact. This study gave credence to such claims and offered a promising path for future research.
Most of the recent interdisciplinary clinical research jointly conducted by chiropractors and medical physicians has been done outside the United States, which still remains the last, strongest bastion of the medical ancien regime. The most influential research studies of the past decade were done in Canada, Great Britain and the Netherlands.
The Canadian Study
In 1985, a landmark study was published in the Canadian Family PhysicianCanadian Family Physician  which researched the effects of chiropractic adjustments for people with severe and chronic lower back pain. The approximately 300 subjects in this study had been "totally disabled" by back pain for an average of seven years, and had gone through the full gamut of standard medical interventions.
The study found that after two to three weeks of daily chiropractic adjustments, between 79 and 93 percent of those patients without spinal stenosis (narrowed spinal cord) had good to excellent results, reporting substantially decreased pain and increased mobility. Even among those with a congenitally or developmentally narrowed spinal cord, a significant number showed substantial improvement. Remember that every single one of these people had gone through extensive, unsuccessful medical treatment prior to being allowed to participate as a research subject. After chiropractic treatment, over 70 percent of those studied were improved to the point of having no work restrictions. Moreover, follow-up a year later demonstrated that the changes were long-lasting.
These results are remarkable, but what was extraordinary about the Canadian study was the fact that it was jointly administered by Dr. J.R. Cassidy, a chiropractor, and Dr. W.H. Kirkaldy-Willis, a world-renowned orthopedic surgeon. In 1993 Dr. Cassidy became the first chiropractor to be named research director of a university orthopedics department, at the University of Saskatchewan where this research was done.
The landmark Canadian study clearly demonstrated the effectiveness of chiropractic adjustments for treating chronic lower back pain, even when standard medical interventions have been exhausted. Yet, sadly, many physicians seem unaware of this study and too few take the logical next step of referring patients with these symptoms to a chiropractor.
The British Study
In 1990, the British Medical Journal published a study called "Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment," by an orthopedic surgeon, Dr. Thomas Meade. Meadeâs research compared chiropractic manipulation with standard hospital outpatient treatment for lower back pain. The medical treatment consisted of wearing a corset and attending physical therapy sessions. Over 700 patients were involved in the study.
Dr. Meade concluded:
"For patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison to hospital outpatient management."
In a later interview with the Canadian Broadcasting Corporation, Dr. Meade said,
"Our trial showed that chiropractic is a very effective treatment, more effective than conventional hospital out-patient treatment for low-back pain [emphasis added], particularly in patients who had back pain in the past and who [developed] severe problems. So, in other words, it is most effective in precisely the group of patients that you would like to be able to treat . . . One of the unexpected findings was that the treatment difference the benefit of chiropractic over hospital treatment actually persists for the whole of that three-year period [of the study] . . . it looks as though the treatment that the chiropractors give does something that results in a very long-term benefit.
The great significance of the Meade study is that it is the first randomized study to demonstrate long-term benefits from chiropractic care. One baseless, but persistent, criticism of chiropractic has been that while it may offer short-term relief, it is of no lasting value. The Canadian and British studies, taken together, should by any reasonable standard be sufficient to lay this old falsehood to rest. Nonetheless, the criticism continues to appear in print, and needs to be answered forthrightly whenever it rears its head.
The RAND Study
In 1992, the widely respected RAND Corporation, a health care think tank, released a study on the appropriateness of spinal manipulation for lower back pain. Authored by a multidisciplinary panel headed by Paul Shekelle, M.D., the study marked the first time that representatives of this prestigious group had officially recognized spinal manipulation as an appropriate treatment for some patients with lower back pain. RANDâs procedures involved an extensive review of the scientific literature on the treatment of back pain, and a consensus process among the participants to determine areas of agreement.
The rather limited nature of RANDâs endorsement of spinal manipulation must be seen in context to be properly understood. RAND is known for its thoroughgoing critical evaluations and the great caution of its assessments, which is part of the reason that its conclusions are often taken by federal officials as something close to the final word on health matters. While its conclusions on spinal manipulation failed to go as far as many chiropractors would have liked, they nonetheless were far more favorable than RANDâs recent pronouncements on other controversial medical issues such as heart surgery.
The national media were quick to grasp the significance of the RAND report. In the weeks and months immediately following its release, high-profile news reports appeared in American newspapers, magazines and electronic media, declaring that chiropractic was finally being "accepted." Of course, millions of chiropractic patients had already accepted it happily for years, but the RAND report marked the scaling of an inner wall of the health establishment.
The Dutch Study
A Dutch study published in the British Medical Journal in 1992 compared the results of back and neck pain patients treated with physical therapy against those given chiropractic manipulation, and also compared these two methods to placebo treatment and standard medical treatment by a general practitioner.
The results were impressive, and showed that both chiropractic manipulation and physical therapy were significantly more effective than a placebo treatment or treatment by a general practitioner. In addition, those receiving manipulation showed more improvement than the physical therapy patients, in fewer visits.