Two chiropractors founded the Center for Research into Automotive Safety and Health (CRASH) to gather data on low- and high-speed collisions using human subjects

One of the most compelling types of care provided by doctors of chiropractic is the treatment of automobile injuries. Although many studies have been performed to determine the mechanics of injury in automobile crashes, there have been few or none that use human subjects to determine the degree of injury in low and high speed collisions.

Arthur C. Croft, DC, MS, MPH, FACO, Spring Valley, Calif, and Michael T. Haneline, DC, FICR, El Cajon, Calif, took on this challenge by performing human crash studies under the umbrella of their testing organization, the Center for Research into Automotive Safety and Health (CRASH). I spoke with Croft and Haneline to find out more about this organization and how it affects the chiropractic profession.

Martin: What is CRASH, and when was it founded?
Haneline: CRASH is a nonprofit 501(c)(3) public benefit corporation that organized in August 2000, with the purpose of investigating motor vehicle crash-related trauma and its sequelae. In particular, we are concerned with the alarming societal cost of injuries and disabilities resulting from relatively low speed crash injuries. We plan on conducting extensive low speed crash testing and then publishing the results. We anticipate that this will exert pressure on manufacturers to improve the low speed crashworthiness of passenger vehicles. We also anticipate that it will put increasing pressure on insurers whose current modus operandi, in terms of compensation and medical cost reimbursement for these injuries, is one of denial and dissimulation.

Another goal is to investigate the clinical side of crash injury—to look at outcomes and compare therapy modalities and practice methods to determine the best practice parameters. These results will be widely publicized.

Martin: Why was CRASH started?
Croft: After 20 years of researching, writing, and teaching about cervical spine trauma, we found that it is clear that chiropractic offers whiplash victims the best opportunity for full recovery. On the other hand, it is also clear that our voice is not as authoritative as it should be. We have seen a steady encroachment by big business to limit patient access to our care. Chiropractic is viewed as a luxury rather than as a necessity. Individually, we are helpless to alter this course, but collectively, we have tremendous untapped power and potential, and this is where CRASH comes in. The time has come to move away from the putting-out-fires approach we have traditionally followed when faced with difficult challenges, and begin looking toward the future with preemptive and long-term strategies.

The National Highway and Traffic Safety Administration (NHTSA) and the Insurance Institute for Highway Safety (IIHS)—a consortium of auto insurers, and automobile manufacturers—are groups we currently have to rely on for data. Do manufacturers know how their cars perform in low speed crashes? Yes. Are they required to divulge that data to the public? No, it is proprietary. Does the IIHS test cars in low speed crashes? Yes, but only to determine the cost of repairing bumpers. Quantifying an occupant risk in low speed crashes would be counterproductive for a consortium of insurers. And does the NHTSA conduct low-speed crashes? No.

The only other groups that have done human subject crash testing (besides the Spine Research Institute of San Diego) generally work under grants from insurers and, not coincidentally, later become the key experts for these insurers in lawsuits. This is a hugely profitable business often based on a handful of crash tests.

Martin: What are CRASH’s objectives?
Croft: Our primary goals are to:
1) develop a viable low speed crash test protocol and a valid neck injury criterion;
2) crash test representatives from the current fleet of passenger cars;
3) develop a low speed star rating system; and
4) make our data available to the public so that they can make informed decisions about purchasing cars on the basis of safety and crashworthiness in low speed crashes from which, paradoxically, most chronic pain and monetary expenditures stem.

Other goals will be to make the public aware of the enormity of this health problem called whiplash. The misinformation foisted on the public from industrial-inspired junk science and highly biased television programs over the years, has left in its wake a populace that largely believes whiplash is either benign or nonexistent. We also plan, through rigorous scientific research, to define optimal treatment methods and protocols.

One [underfunded] area of research is the question of effectiveness of chiropractic care for acute whiplash patients. As a profession, we must take up the challenge of whiplash research, and we must do it now. Even more important is that chiropractic will have taken a leading role in a worthy, public health-minded action like never before. Eventually, we will establish chiropractic in this field of research, positioning it as the de facto standard in research, and not merely as a group of alternative practitioners providing expendable, luxury treatment. Chiropractic should be to whiplash as dentists are to teeth. CRASH is one way to establish that relationship.

Martin: Do you expect to compete with the NHTSA and IIHS?
Croft: Not at all. In fact, we have already [established] a working relationship with both organizations and expect to work cooperatively with them in the future. More importantly, there is no overlap in our research goals. That is also true of the manufacturers. Last year, we conducted cooperative work with General Motors here in San Diego. They told us they were tired of crashing cars into rigid barriers and were intrigued by the idea of crashing cars into other cars, as we do, and having live volunteers in the cars so that we can actually see real occupant kinematic reactions and record actual acceleration-time histories rather than estimating them. This aided in the development of new event data recorders capable of recording crash data. Most of the live volunteers are members of the Spine Research Institute of San Diego crash test crew. The crash tests are set up to produce responses that we believe will be within the boundaries of human tolerance. We have never produced anything more than a minor, temporary injury.

In England, Thatcham’s—our sister group—work resulted in insurers offering premium discounts to owners of cars deemed more crashworthy in low speed rear impact crash tests based on their results. So car owners are not the only ones who benefit from this kind of research. When manufacturers see consumers purchasing cars based on these new standards, they, too, will be less reluctant to tackle design issues that are not currently defined in the Federal Motor Vehicle Safety Standards. The important point is that there will be less room for the kind of wildly unscientific speculation that currently pollutes the medico-legal system.

This unscientific speculation primarily is that one cannot be injured in low-speed crashes, or thatif one is injured, one will virtually always recover in 6 to 12 weeks. This overtly sanguine estimation has been foisted on the public by insurers keen to inculcate jurors and indemnify themselves in lawsuits. Their experts write papers attesting to these “truths,” which are rarely founded by real science. These papers are then used as proof in court that such injuires cannot be real. All of this also affects safety in a negative manner, because the manufacturers [use this as an excuse] not to develop better, safer cars in low-speed crashes.

Martin: What fundraising efforts are currently taking place?
Haneline: Until now, our primary funding has come from tax deductible, charitable donations from organizations and individuals. After 9 months of fundraising efforts, we have raised about $60,000 through donations. Several chiropractic suppliers have made donations, including Anabolic Laboratories, Irvine, Calif, which gives a portion from the sale of every Whiplash Recovery System sold. Now that we have surpassed the $50,000 mark, we anticipate other companies to follow suit.

Martin: In what kind of research is CRASH currently involved?
Croft: We cosponsored a crash test with the Spine Research Institute of San Diego and Texas A&M University, College Station, Tex, last year, which dovetails with earlier research by both groups. A dozen papers for publication in clinical and automotive safety journals resulted from this research. One paper in Accident Analysis and Prevention deals with the new neck injury criterion (NIC) and, although the journal has not yet been published, it can be viewed on the Internet (www.elsevier.com). Another was published in the Association for the Advancement of Automotive Medicine Proceedings in 2000.

Another looks at the disparity in occupant kinematics and acceleration between front impact crashes and rear impact crashes using human subject crash testing. This is, to our knowledge, the first time such a study has been done. We found that occupants in rear impact crashes experience markedly higher forces to their head and neck, and also undergo more complex kinematics. This may eventually enable doctors to explain why the person in the struck car can be injured, while the person in the striking car often is not.

We also have another paper looking at a method of auto crash reconstruction in press, and we presented those, one on roller coaster injuries, and an Internet survey headed up by Chris Centeno, MD, Colorado private clinic psychiatrist, at an International Conference on Whiplash in Switzerland last spring.

While we have performed some pioneering work in the crash testing arena, we want to increase the frequency of our crash tests, and get away from dependence on human volunteers. Right now, our goal is to purchase a state-of-the-art crash test dummy and all of the necessary crash data recording equipment. CP

Kenneth Martin, DC, has been in practice for 27 years in Temple City, Calif. He can be reached via email: bacdoc@earthlink.net,   or website: www.bacdoc.web.com. 

Arthur C. Croft, DC, MS, MPH, FACO, and Michael T. Haneline, DC, FICR, can be reached at the Spine Research Institute of San Diego. For more information on CRASH, please call 800-423-9860 or 619-660-8802.