COLUMNIST OPINION Bias is omnipresent I A response to “Uniting around the evidence, part 1” BY DR. JOE GHORAYEB n review of Dr. James Chestnut’s highly rhetorical and presump-tive opinion piece on how best to unite the chiropractic profession around research evidence, (“Uniting around the evidence, part 1” – Canadian Chiropractor April 2020) I feel compelled to opine on Dr. Chestnut’s various personal beliefs, disguised as facts, and to reiterate a logical approach to establishing pro-fessional unity. Dr. Chestnut begins by referencing a principle of evidence-informed man-agement for chronic low back pain as described in an editorial (Haldeman and Dagenais 2008) and proclaims that only when chiropractors “ethi-cally and objectively apply this guiding principle will we unite, express our potential, and earn the cultural au-thority, interprofessional respect, re-ferrals, inclusivity, and reimbursement that the evidence clearly indicates we deserve.” What is meant by the term “cultural authority”? Gaining public trust and acceptance through full integration as part of mainstream medicine? Or to remain peripheral and part of CAM, thereby imposing public trust and acceptance? The notion of inclusivity, again, is a rather vague and abstract idea. Without clarification, I will take the liberty to assume that he means for chiropractic to be included in main-stream healthcare. In order for this to occur, a precondition stipulates that the profession, as a whole, assimilates with the greater scientific community to better demonstrate that its members are evidence-based practitioners. Dr. Chestnut appropriately high-lights a key impediment in chiropractic progress when describing the beliefs physical rehabilitation. and attitudes of vitalistic chiropractors, must first think about how we deliver but mistakenly paints evidence-based healthcare and what care we deliver. DCs with the same brush, noting: Throughout the opinion piece, the “The other extreme tends to exagger-author mistakenly uses the terms evi-ate and blindly accept the validity of dence-based practice (EBP) and evi-unproven soft-tissue therapies, ‘spe-dence-informed practice (EIP) inter-cialized’ exercise programs...while too changeably. For clarity, the concept of often rejecting and/or downplaying the EIP encourages practitioners “to be evidence regarding the effectiveness, knowledgeable about findings coming cost-effectiveness, and safety of chiro-from all types of studies and to use practic SMT/adjustment.” them in their work in an integrative Simply referring to oneself as an manner, taking into consideration “evidence-based chiropractor” does clinical experience and judgment, not make one so. Evidence-based clients’ preferences and values, and chiropractors, in the truest sense, do context of the intervention.” 1 EBP was initially defined as “the not blindly accept or advocate for any “specialized” exercise programs, as it conscientious, explicit and judicious is well understood that all forms of use of current evidence in making exercise and physical activity are ben-decisions about care of individual pa-eficial to health (Warburton et al. tients,” 2 and later broadened to in-2006). Evidence-based chiropractors clude a life-long problem-solving ap-also reject the false narratives that may proach to the delivery of care that be attached to all forms of manual and integrates the best evidence from passive therapies with the same level well-designed studies and evi-of enthusiasm. So much so, that chi-dence-based theories with a clinician’s ropractic students have recently made expertise, which includes internal evi-a call to action against unsubstantiated dence gathered from a thorough pa-tient assessment and patient data, and claims (Plener et al. 2020). Bias is omnipresent, and we would a patient’s preferences and values. 3 Dr. Chestnut’s misinterpre-do well to acknowledge this and take appropriate steps to Bias is omni-tation continues as he miscon-debias ourselves when faced present, and strues both what it means to with dilemmas. At the same we would do be “evidence-based” (Djulbe-govic et al. 2009) and the time, effective communica-well to tion, updated knowledge ac-acknowledge utility of “biological plausibil-quisition and dissemination, this and take ity” (Fedak et al. 2015). As a and joint collaboration are appropriate result, he slides down a slip-tried-and-true methods of steps to debias pery slope, committing several other common logical fallacies evoking positive change. ourselves. along the way. Conversely, Dr. Chestnut’s If Dr. Chestnut is truly interested proposal: to amputate the “gangrenous arms that need to be removed,” is a in promoting unity within the chiro-rather unique and illogical approach to practic profession, all he has to do is promote unity . In my view, in order to consult the literature, as it appears unite the profession moving forward, we that the majority of chiropractors hold favourable attitudes and beliefs JOE GHORAYEB DC, MHA has been in clinical practice since 2003 with a special interest in toward EBP (Bussières et al. 2016). June 2020 Chiropractic and Naturopathic Doctor 11 www.Cndoctor.ca
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