Health Insights Today
Mar/Apr 2013, Volume 6, Number 2
Next Steps in Chiropractic Research
Interview with Christine Goertz, DC, PhD
Interview by Daniel Redwood, DC
Christine Goertz DC, PhD is the Vice-Chancellor for Research and Health Policy at Palmer College of Chiropractic. She received her doctor of chiropractic degree from Northwestern Health Sciences University and her PhD in Health Services Research, Policy and Administration from the University of Minnesota.
Dr. Goertz spent four years as an independent scientist and in research administration positions of increasing responsibility at the Samueli Institute. Before that Dr. Goertz was a Program Officer at the NIH National Center for Complementary and Alternative Medicine (NCCAM), managing a $50 million portfolio focused on musculoskeletal disease, pain, and health services research.
Her research interests are primarily focused on CAM treatments for cardiovascular disease and pain syndromes. She currently serves as a member of the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors, and as chair of PCORI’s Program Development Committee. She is also chair of the American Chiropractic Association Performance Measurement Workgroup, and a member of the American Medical Association’s Measures Implementation and Evaluation Advisory Committee, Physician Consortium for Performance Improvement.
In this Health Insights Today interview Dr. Goertz describes the dramatic changes in chiropractic research over the past generation and then puts forth a vision for how the profession’s research agenda can most effectively meet the needs of the patients it serves.
Looking back over the past 20-25 years, what do you consider the most significant developments and trends in research related to chiropractic?
First of all, the fact that we get federal funding.
I graduated with my DC degree 22 years ago. At that time, aside from the Meade study [which found chiropractic care markedly superior to standard medical care for low back pain] in British Medical Journal and Dr. Bob Kane’s in Lancet in the 1970s, very little was published in the peer reviewed literature. But what’s happened in the last 20-25 years is we’ve developed a research agenda and we have a growing number of scientists committed to doing research in the area of chiropractic.
So here are the significant developments: we’ve gone from virtually no federal funding, no research agenda, very few published articles and very few scientists who are interested in and capable of conducting the research, to having a growing cadre of scientists interested in this topic, chiropractors with advanced degrees, funding opportunities, and to having our work published in higher level journals.
Aside from federal funding for clinical trials and other research, part of the federal funding also went into physical infrastructure.
It did. Palmer received a matching facilities grant in order to remodel the research center that we’re using today, as well as four developmental center grants from NIH over the last 12 years or so that have allowed us to build a remarkable infrastructure.
Research infrastructure at any of the colleges serves the profession as a whole. What do you believe should be the top priorities for a chiropractic research agenda in the near future?
I think we need to look more at translational research, at collaborative care models, and nail down some of the issues related to cost.
Translating Research into Practice
For readers who may not be familiar with the term, what is translational research?
The Institute of Medicine [part of the National Academy of Sciences] has defined two different phases of translational research. One is when you’re translating basic science into clinical research and the other is when you’re translating clinical research findings into clinical practice.
So the great value of research is not just intellectual understanding, but translating this into actual practice so that patients are helped.
That’s exactly right. Because here’s the thing; a group of scientists can design the most exquisite project in the entire world and get their results published in the New England Journal of Medicine, but their job is not close to being done unless those findings are translated into helping healthcare practitioners take care of the patients they serve.
Along those lines, it seems to me that a great deal of chiropractic research over the past generation — understandably and for many good reasons — has focused on demonstrating the effectiveness of spinal manipulation or chiropractic care for particular conditions. That enhances the credibility of the chiropractic profession. What about research that might help chiropractic clinicians to change the ways they practice based on research findings? We don’t seem to do very much of that.
I am committed to the concept of doing research that helps clinicians take better care of patients. This would include things such as technique comparisons. We’re doing a study right now that started with cadavers. We looked at flexion-distraction in the neck, how disc pressures change when chiropractors administer certain forces. We took the data gathered there, and are now doing a randomized clinical trial where we’re going to look at different forces applied by the doctor of chiropractic, to see if it impacts patient outcomes.
The Patient-Centered Outcomes Research Institute (PCORI)
You were appointed by the U.S. Office of the Inspector General to serve on the Board of Governors of the Patient-Centered Outcomes Research Institute (PCORI). What is PCORI, what needs is it designed to meet, and how is it funded?
PCORI was formed as part of the health care reform act but it is not part of the federal government. It is an independent organization that, when we become fully funded in 2014, will have a budget of approximately $500 million per year.
That sounds like real money.
It is, although it’s much less than the billions a year that NIH spends. It is certainly enough to make a significant impact towards our mission, which is to help people make better-informed healthcare decisions and improve healthcare delivery and outcomes by producing and promoting high-integrity evidence-based information that comes from research guided by patients, caregivers and the broader healthcare community.
PCORI focuses on comparative effectiveness research. What is CER and why is it important?
NIH defines CER as “the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions. The purpose of this research is to inform patients, providers, and decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.” CER is important because if focuses on what’s best for the patient.
Research That Meets Needs Identified by Patients
How is PCORI interpreting the “patient-centered” part of its mission? Are patients involved in some way other than just being the people whose responses to treatment are studied in this research?
As we say at PCORI, the patient is our North Star. So we are looking at a different kind of science, a science that really incorporates the patient perspective in the questions that we ask, in the design of our studies, in the interpretation of results and the dissemination of those results.
Can you give an example of that? How are patients involved, so that we’re seeing direct patient input into this research rather than patients’ needs interpreted by doctors and other experts?
I think that a place you could go to see the extent to which we incorporate that would be our funding announcements, where we’re telling people what kind of science we’re interested in funding. We specify, for example, that applicants for PCORI funds must have a research team that includes not only the researchers but patients and/or caregivers, as well as clinicians, health systems managers and other potential end users of the study’s findings.
Would it be correct to say that this approach has not been typical in research and research funding in the past?
It has not. There are four questions that really guide our research definition. The first is, “Given my personal characteristics, conditions and preferences, what should I expect will happen to me?” The second is, “What are the options and potential benefits and harms of those options?” Then, “What can I do to prove the outcomes that are most important to me?” And finally, “How can clinicians and the care delivery system they work in help me make the best decisions about my health and healthcare?”
Is it your hope that this sort of new direction in health sciences research will spread beyond PCORI-funded projects to influence research endeavors more broadly in the United States and elsewhere?
I hope that PCORI is the beginning of a cultural shift toward a healthcare system that pays a lot more attention to patients and the four questions that are at the cornerstone of our patient-centered mission.
You’ve recently been named as the chair of PCORI’s Program Development Committee. What does this involve and is it unusual for a chiropractor to be asked to serve in such a role?
I am very excited and honored to have the opportunity to chair PCORI’s Program Development Committee (PDC) over the next two years. PDC is the committee on PCORI that makes recommendations to the entire board regarding our scientific program.
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