FEATURE PROFESSION UNITING AROUND THE EVIDENCE, PART 3 Being evidence-based, patient-centric and ethical BY DR. JAMES L. CHESTNUT R egarding what is taught at chiropractic college and what is within the scope of chiropractic practice, when we move away from the spine and/or away from chiropractic SMT and general spinal and overall fitness exercises, we move away from evi-dence-based care and we move toward evidence-informed intervention proto-cols based on individual subjective clinical experience and/or patient preference. Subjective clinical experience and patient preference are inherently bi-ased; they are highly prone to self-ful-filling prophecy based on confirmation bias. However, the guiding principle of evidence-informed care includes a tacit acceptance of the validity of clinical judgement and patient preference and such tacit acceptance is universal in all healthcare fields. Still, it must be remembered that NO protocol based on clinical experience or patient preference, nor any testimo-nial or case study describing any such protocol, represents valid evidence of a cause and effect relationship between intervention and outcome. Thus, scientifically, logically, and ethically, we must never claim that our clinical ex-perience/judgement is better, more evidence-based, more scientific, or more valid than anyone else’s. If we do, we become hypocritical, dogmatic, and dishonest; we announce to the world that we lack both sound scientific judgement and ethics. For the above reasons, I focus on evidence-based interventions for pa-tients with non-cancerous, non-infec-tious, non-traumatic instability neuro-musculospinal health issues [uncomplicated spinal health issues] for “unifying around the evidence”. Of all the available interventions for uncomplicated spinal health issues, which is/are the most evidence-based with respect to effectiveness, cost-effec-tiveness, and safety? This very question was asked and answered by Professor Pran Manga in the infamous 1993 Manga Report which evaluated, com-pared, and contrasted the level of evi-dence regarding effectiveness, cost-ef-fectiveness, and safety of chiropractic SMT/adjustment, usual medical care, physical therapy, and surgical interven-tions for patients with low back pain. Manga’s conclusions were earth DR. JAMES CHESNUT B.Ed, M.Sc, DC, C.C.W.P., recently developed the Evidence-Based Chiropractic and Lifestyle Clinical Protocols which include evidence-based spinal health exams, reports, and patient education. He also developed, wrote the texts, and still teaches the Evidence-Based Chiropractic and Lifestyle post-graduate certification program accredited through the International Chiropractors Association (ICA). 24 Chiropractic and Naturopathic Doctor June 2020 shaking to say the least. “On the evi-dence, particularly the most scientifi-cally valid clinical studies, spinal ma-nipulation applied by chiropractors is shown to be more effective than alter-native treatments [drugs, surgery, physical therapy] for low back pain. Many medical therapies are of ques-tionable validity or are clearly inade-quate.” “What the literature revealed to us is the much greater need for clinical evidence of the validity of medical management of low back pain.” “Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain.” “Taking a global view of the ev-idence in this and the previous chap-ters, there seems to be a comprehensive body of evidence, which can fairly be described as overwhelming, for the cost-effectiveness of chiropractic over medical management of patients with low-back pain.”(1) Why would I choose to cite a report written almost 30 years ago? To make the point that so little has changed in terms of available evidence-based in-terventions for uncomplicated spinal health issues, or, sadly, the blatant bias for usual medical care and against chiropractic SMT/adjustment. What new, evidence-based interven-tions have been added to usual medical care education or practice since 1993? None that are evidence-based. In fact, www.Cndoctor.ca
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