When Dr Amy Haas’s latest paper dropped last month, it did so with an immense amount of anticipation. With the backing of the Foundation for Vertebral Subluxation, it had taken on one of the most contentious issues in chiropractic – could we influence immunity and neuroendocrine function, and could this all be tackled through a salutogenic and systems biology lens?
You could argue there was no better person for the job. Dr Amy Haas cut her teeth on a PhD in Biochemistry, and then moved into her field of expertise in metabolic biochemistry and molecular biology. Yet, the pull of innate intelligence wasn’t done, and Dr Amy turned to chiropractic. Recently, she authored a mammoth paper on chiropractic’s impact on the neuroendocrine and immune systems (which you can read up on here). But the topic of how chiropractic research gets done is always interesting. We caught up with her to ask about the process and impetus behind this extraordinarily significant paper.
The first big question was this: what was the motivation behind taking all of this on? The answer for Dr Amy was simple. “My personal philosophy is this: I stand for a world of possibility over a world of limitation. One of the things that has drawn me deeper into the Chiropractic profession over the years is the possibility that it holds. What can change not just in a person’s health, but also in their experience of life, if they are clear of Vertebral subluxation?”
Dr Haas says that her own personal experience in practice has shown her the power of this possibility time and time again. “It’s spectacularly beautiful to watch this unfold – when a person naïve to Chiropractic gets adjusted for the first time and you, as a healthcare provider, get to see what happens,” says Dr Amy. “I know from both my own personal experience and from my professional experience that the effects of the adjustment are indeed far-reaching – often farther-reaching than we can at first imagine. The nervous system is the instrument through which we perceive our world and, therefore, literally dictates our experience. What happens when the tone of the nervous system is stressed? Through what lens would we experience life?”
Dr Amy has a tale or two to tell on this issue. For those who follow her adventures, with her two dogs alongside, she often hikes and takes on the heights of the beautiful countryside where she lives when she isn’t caring for her patients. While the philosophy of subluxation is something that allows for the full expression of life, it is also something that has helped her bounce back from Post Concussion Syndrome.
So what is this Vertebral Subluxation Amy speaks of, beyond being something that chiropractors check and adjust? “Vertebral Subluxation (VS) impacts the tone of the autonomic nervous system. We know this because, very reproducibly when someone is adjusted to correct VS, we observe the normalisation of various autonomic, adaptive outcomes. This is certainly not unique to the Chiropractic field. Other professions have clearly elucidated the connection between the autonomic system, tone and behaviour/mental illness/psychosocial dysfunction. We need look no further than polyvagal theory to see all we need to know there. (ask Dr Mo Andrews about that). So when we adjust to correct for VS, restoring normal tone, balance, ease, and adaptability/flux to the nervous system, logically, we will impact how a person experiences their world.
Conversely, is it possible that a person with uncorrected, unmitigated VS will literally have a hampered experience of life? “That’s it in nutshell,” says Dr Amy. “That’s the possibility that Chiropractic care holds for this world. And we have a responsibility to stand in our truth and offer the Chiropractic adjustment because we are the only people that do exactly what we do.”
That was the big motivation behind writing the paper, titled “Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System.” But it came from a big crisis – one that is likely to tie up conversations for a long time, making the recent paper vitally important: “Certain folks in our profession want to limit chiropractic care to musculoskeletal or pain based only. Again, to repeat myself… I stand for a world of possibility over a world of limitation. So, right off the bat, logically, what these folks are trying to do doesn’t work for me! And having experienced what I have in Chiropractic, that’s a limitation I won’t stand for – it literally deprives humanity of potential betterment.”
“The war cry that is often used by some of these folks is “there is no evidence that…” which, if you ask me, is actually a fairly disingenuous statement,” says Dr. Amy. “First, it’s blatantly untrue. Second, even if they were to try to put that forth, from a scientific standpoint, it is extraordinarily difficult to actually prove the null hypothesis in order to make a conclusively negative statement. Because of that, I can only surmise that making any statement along the lines of “there is no evidence that” is political or agenda-based rather than fact-based.”
“So really, all that needed to be done to negate the claim that “there is no evidence that” is to disprove the null hypothesis, Which others have done in beautiful ways. But somehow those have not shifted the tide.”
That’s why Dr Amy and her supporting team and co-authors from the Foundation for Vertebral Subluxation stepped up to the plate. “We chose to embark upon this project with the vision that if our evidence were strung together in a particular way, backed up by multiple fields in a web of evidence that is enough to form a cloth, we might solidify and codify the foundation that we stand upon as vitalistic chiropractors, in order to protect our end of the profession from negation by those with an agenda. To literally protect the possibility of chiropractic care for everyone who wishes to access it.”
Purely from a process standpoint, there were some questions on our minds. We asked Dr Amy about the depth and breadth of the data she was processing and whether there were points at which she wondered if the paper would come out so positive for chiropractic.
“There were one or two points I didn’t think the paper would come out at all, actually! It’s a good thing I’m stubborn as hell, I guess?” Dr Amy laughs. “Like most monstrous projects, this has been extraordinarily difficult and has been through a few different iterations in order to achieve the final product.”
She concedes that she can’t control how the papers land, despite the academic rigour of going through hundreds and hundreds of papers and analysing them against chiropractic philosophy, science and evidence. “Some may find the perspective in this paper skewed. I can’t control how people perceive it. I just wrote what I found,” she says.
So, were there any things in this process or in the papers investigated that surprised the author? Can you still be surprised by chiropractic after years of research and practice?
Again, the answer is affirmative. ”A few of the realisations regarding research methods errors smacked me right between the eyes, like the presupposition of VS as a clinical entity with no attempt to isolate, address, or otherwise control for said variable. But what was really fun was the last section of the discussion, where we outlined research methods concerns. I began with three or four, I think. Our five peer reviewers added some really striking and valuable points. I kind of really enjoyed that I seem to have made my point clearly enough that the peer reviewers actually took the next step forward for me.”
The resultant paper showed exactly how chiropractic could indeed impact multiple systems, in a way that creates and builds health. The next big question for us is this: Where does chiropractic need to go in terms of further research?
On this, Dr Amy is emphatic. “We need to think carefully about when we design a study or write up a study, or actually just do basic chiropractic care. A few years ago at a Mile High conference, Dave Russell pulled me aside in the hallway and said (with his trademark humour and insight), ‘Hey, by the way, I’m gonna throw you into the bus for something!’ And I absolutely love him for that. I’m so grateful that he always held me to a higher standard and helped point out my blind spots. Anyway, he proceeded to point out that in my HRV paper, and in many people’s papers, there was not an adequate description of objective findings after the adjustment, supporting the contention that vertebral subluxation had indeed been reduced or corrected.
And he was absolutely right. The paper that I did more recently, and sleep and anxiety, I took that next step and corrected the oversight. I think for VS research, if we are going to make a statement that correction of VS yielded X result, we should take that extra minute to confirm that …we did indeed correct VS. This isn’t just in research. This is also in daily practice. Practitioners should post-check every patient to make sure their findings are cleared. Rescan, re-palpate, leg length, gait analysis, muscle testing, you name it. There are plenty of ways to post-check. How many actually do it? Newsflash: if, in the absence of confirmation, they don’t know whether they cleared out VS, was what they delivered actually a spinal manipulation? Dave threw me under the bus, and with what I just offered, I hereby throw all of you under another bus. Check your Chiropractic integrity. Do you do exactly as you say? As measured by what?”
“So that’s a foundational thing. I think we all need to work on and incorporate unilaterally into our methods, particularly starting with our chiro students. If everyone confirms correction or production of VS with every adjustment via post check, we will be standing at a very different place to draw the conclusions that we offer both in practice and then research.”
It’s an inspiring endpoint for a big undertaking. For Amy, it is confirmation – “That we really, truly have something unique and beautiful with the specific Chiropractic adjustment, and that if we don’t put our foot down and defend the sacred trust of Chiropractic care as it was intended to be, it will be a loss for us and for humanity both.”
Make sure you check out the paper, and our previous blog article covering its findings. You can find both of them here!
We would like to thank the wonderful Dr Amy Haas for chatting with us about her amazing work.
The ASRF would like acknowledge the valuable work of the Foundation for Vertebral Subluxation, as contributing significantly to the research around the role of chiropractic in immune function, and to the project discussed in this article.
