In biomechanics, Ram Gudavalli is working on projects to describe, explain, and model biomechanical and manipulative forces, to basically figure out how manipulation works from an engineering point of view. He’s working on developing a better explanatory model for what goes wrong with the spine, and also to develop better training methods for teaching chiropractic students how to adjust the spine.
REDWOOD: So this research is attempting to provide a scientific explanation for why chiropractic works, which you said earlier is essential for chiropractic and other CAM approaches to clear the hurdles they face. Aside from these basic science studies, what other research are you doing?
MEEKER: We've got both clinical trial and outcome studies.
REDWOOD: For the non-scientists reading this, could you please explain the difference between the two?
MEEKER: Sure. Basically, outcome studies are experimentally less controlled, observational studies of cohorts [groups] of patients going through some [health] care process, where we're not trying to figure out cause and effect relationships between any component of the care package and the particular outcome that they have. What we’re looking for is—how did patients’ health status change as a result of going through the care process?
REDWOOD: More of a "real life care in the office" model.
MEEKER: Yes. It's a very generalizable kind of thing. In that regard, Cheryl Hawk is the director of the Palmer practice-based research program. This is a network of about 200 practicing chiropractors in the United States, Canada, and Mexico, who agree to follow standardized protocols in assessing their patients, filling out certain forms that we collect in a central location. Our office of data management then runs the stats and manages the data. We can do some fairly interesting outcome studies and descriptive studies about what goes on in chiropractic practices. For example, Cheryl recently had a paper published in the Journal of the American Geriatric Society, looking at patients in chiropractic practices who are over age 55. This had not been done before, believe it or not.
REDWOOD: What did the study find?
MEEKER: That at least half of those patients choose the chiropractor as their primary contact or primary care practitioner for those conditions. Most of those patients have multiple pain complaints; not just back or neck or head pain, for example, but back and neck and head complaints. They run the gamut from mild to severe. They only get moderately better in the first four weeks, which is all that we measured in this study, but they are highly satisfied with their care. They also get a substantial amount of recommendations on exercise, nutrition, and other health promotion approaches.
We have also looked at non-musculoskeletal complaints in chiropractic practices. We recruited doctors who said they had a high proportion of non-musculoskeletal complaints. But interestingly, even in the group that said they had a high proportion of non-musculoskeletal cases, the average was 15 percent. For the profession overall, it’s about 5 percent.
REDWOOD: I know you were in practice for a few years in the 1980s. Having made the choice to put your primary energy into research and research administration, do you miss being in practice?
MEEKER: Not any more. I did miss it sometimes, years ago. But I made a choice at the time—it was either going to be practice or academia. I don't like being bored, and I am just way more drawn to the scientific challenges. I like working in an institution. I like the group-thinking, the structure, the resources that are available, and the ability to move groups of people. Of course, I never really intended to have a career like this [no such career track existed in chiropractic until the 1990s], but there was such a vacuum. I found myself doing things that no one else was doing, and people appreciated it. I saw a real need, things that needed to be done. So I set about doing it. At this point in life, I’ve accepted that this is what I was destined to do.