“specialized” exercise programs, dis-proven passive physical therapy mo-dalities and/or virtually any other non-chiropractic SMT/adjustment interventions while too often rejecting or downplaying the evidence regard-ing the effectiveness and safety of chiropractic SMT/adjustment. Obviously it is neither scientifically valid nor logical nor ethical to reject SMT due to a “lack of evidence” while accepting, promoting, and utilizing other interventions with less evidence than SMT. The standard of evidence regarding effectiveness, cost-effective-ness, and safety must be equally ap-plied to all interventions. If it is not, then the terms “evidence-based” and “evidence-informed” simply turn into marketing terms, or a way to disguise personal bias or opinion, rather than unbiased movements to improve healthcare. Is your own stance scientific and evidence-based or biased and dog-matic? Do you accept the different clinical experience and decisions of other DCs as equal to you and your peers, or do you have a dogmatic bias in favour of your own experience and opinions? Do you have any valid evi-dence that your clinical protocols based on your experience and opinions elicit greater patient outcomes? Of course not. If you did, your clinical protocols would be classified as evidence-based in the peer-reviewed literature. Do you criticize others for making false claims based on testimonials or case reports while you do the same? Do you judge unsubstantiated claims of benefit or clinical superiority for soft-tissue or taping techniques, “spe-cialized” exercise programs, or modal-ities more harshly than such claims regarding SMT/adjustment? Do you judge a testimonial from an athlete as more or less scientifically valid than one from a child or parent? Do you judge a case report on chiro-practic adjustment as more or less sci-entifically valid than a case report on a soft-tissue technique? Do you judge a case report about pain as implicitly more or less valid than a case report regarding a non-neuromusculoskeletal complaint? Do you judge “special” back exercise programs or athletic taping protocols that lack valid evidence of www.canadianchiropractor.ca effectiveness from randomized place-bo-controlled trials as more or less evi-dence-based or scientific just because such interventions do or do not match your clinical preference? Do you interpret the fact that pre-ventative, wellness, and/or salu-togenenic paradigms of healthcare make perfect biological and clinical sense as synonymous with the idea that there is valid clinical evidence that chiropractic adjustment/SMT pre-vents illness, increases wellness, or improves health? Is an unsubstantiated, never tested claim that chiropractic adjustment/ SMT takes pressure off a nerve to an organ less troubling to you than an unsubstantiated never tested claim that a soft-tissue technique breaks up Journal, 2010): “Multiple studies have demonstrated a poor correlation be-tween what primary health-care pro-viders think is an effective treatment and what has actually been shown to be an effective treatment.” What all professions don’t suffer from, is public vitriolic infighting and accusations of malfeasance based on different clinical experience and opin-ion masked as differences in levels of evidence. It’s time we stopped allow-ing dogmatic, extreme factions to de-fine and divide us and started adhering to the guiding principles of evi-dence-based/informed care in an at-mosphere of dignity and respect re-garding our differences, while we continue to conduct research. It’s time we stopped interpreting differences in “We must never demand a higher level of evidence from others than we demand from ourselves.” scar tissue or that an athletic taping technique improves athletic perfor-mance or prevents injury? Nobody who is dogmatic and lacks evidence likes to have to answer ques-tions regarding evidence for what they do. They only like to pose such ques-tions regarding what others do. To me this is the litmus test for unscientific dogma and unethical bias. If we are honest, we all have our confirmation biases regarding our own clinical re-sults based on the biases of our chiro-practic college, our professional peer group, and our clinical experience. This is exactly what the evidence-based movement was intended to address. The peer-reviewed literature clearly points out that all healthcare profes-sionals suffer from a lack of knowledge regarding which interventions are ev-idence-based, and clinicians in all professions often differ amongst them-selves in how they manage patients. According to Bishop et al. (The Spine clinical experience and opinion as differences in ethics, intellect, clinical effectiveness, and patient satisfaction when so such evidence exists. In the end, the only ethical goal is to provide the best possible care that elicits the best possible benefit:harm ratio, for the least possible expense, for any given patient. We must do our best to remove all unethical, false claims, but we must do this in an ethical, unbiased, evi-dence-based way, and never demand a higher level of evidence from others than we demand from ourselves. When there is clear evidence available then this can and should be used to create standards of practice. When there is no clear evidence available, which is more often the case than not in all as-pects of healthcare, then ethics demand that we don’t allow the vocal, vitriolic, biased, dogmatic voices from either extreme to influence standards of prac-tice or regulatory decision-making. April 2020 Canadian Chiropractor 27
Chiropractic + Naturopathic Doctor April 2020: Page 27
