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The article below is an editorial that I was asked to write for the New Zealand Medical Journal, as a comment on article in today’s edition about the misuse of the title ‘doctor’ by chiropractors [download pdf]. Titles are not the only form of deception used by chiropractors, so the article looks at some of the others too.  For a good collection of articles that reveal chiropractic for what it is, look at Chirobase


THE NEW ZEALAND
MEDICAL JOURNAL

Journal of the New Zealand Medical Association

NZMJ 25 July 2008, Vol 121 No 1278; ISSN 1175 8716

URL: http://www.nzma.org.nz/journal/121-1278/3158/ ©NZMA

Doctor Who?
Inappropriate use of titles by some alternative “medicine” practitioners

David Colquhoun

Who should use the title ‘doctor’? The title is widely abused as shown by Gilbey1 in this issue of the NZMJ in an article entitled Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. Meanwhile, Evans and colleagues 2, also in this issue, discuss usage and attitudes to alternative treatments.

Gilbey finds that the abuse of the title doctor is widespread and that chiropractors are the main culprits. An amazing 82% of 146 chiropractics used the title Doctor, andL most of them used the title to imply falsely that they were registered medical practitioners.

Although it is illegal in New Zealand to do that, it seems clear that the law is not being enforced and it is widely flouted. This is perhaps not surprising given the history of chiropractic. It has had a strong element of ruthless salesmanship since it was started in Davenport, Iowa by D.D. Palmer (1845–1913). His son, B.J. Palmer, said that their chiropractic school was founded on “a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell” (Shapiro 2008)3 It is the same now. You can buy advice on how to build “build high-volume, subluxation-based, cash-driven, lifetime family wellness practices”

In her recent book3 , Rose Shapiro comments on the founder of chiropractic as follows.

“By the 1890s Palmer had established a magnetic healing practice in Davenport, Iowa, and was styling himself “doctor”. Not everyone was convinced, as a piece about him in an 1894 edition of the local paper, the Davenport Leader, shows.

A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious,those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method he has certainly profited by the ignorance of his victim. His increase in business shows what can be done in Davenport, even by a quack.”

D.D. Palmer was a curious mixture: grocer, spiritual healer, magnetic therapist, fairground huckster, religious cult leader—and above all, a salesman. He finally found a way to get rich by removing entirely imaginary “subluxations”.

Over 100 years later, it seems that the “weak-minded, ignorant, and superstitious” include the UK’s Department of Health, who have given chiropractics a similar status to the General Medical Council.

The intellectual standards of a 19th Century Mid-Western provincial newspaper journalist are rather better than the intellectual standards of the UK’s Department of Health, and of several university vice-chancellors in 2007.

Do the treatments work?

Neither Gilbey nor Evans et al. really grasp the nettle of judging efficacy. The first thing one wants to know about any treatment —alternative or otherwise — is whether it works. Until that is decided, all talk of qualifications, regulation, and so on is just vacuous bureaucratese. No policy can be framed sensibly until the question of efficacy has been addressed honestly.

It is one good effect of the upsurge of interest in alternative treatments that there are now quite a lot of good trials of the most popular forms of treatments (as well as many more bad trials). Some good summaries of the results are now available too. Cochrane reviews set the standard for good assessment of evidence. New Zealand’s Ministry of Health commissioned the Complementary and Alternative Medicine
website to assess the evidence, and that seems to have done a good job too. Their assessment of chiropractic treatment of low back pain is as follows:

There appears to be some evidence from one systematic review and four other studies, although not conclusive, that chiropractic treatment is as effective as other therapies but this may be due to chance. There is very little evidence that chiropractic is more effective than other therapies.

And two excellent summaries have been published as books this year. Both are by people who have had direct experience of alternative treatments, but who have no financial interest in the outcome of their assessment of evidence. The book by Singh and Ernst4 summarises the evidence on all the major alternative treatments, and the book by Bausell5 concentrates particularly on acupuncture, because the author was for 5 years involved in research in that area, Both of these books come to much the same conclusion about chiropractic. It is now really very well-established that chiropractic is (at best) no more effective than conventional treatment. But it has the disadvantage of being surrounded by gobbledygook about “subluxations” and, more importantly, it kills the occasional patient.

Long (2004)7 said “the public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45.

The chiropractors of Alberta (Canada) and the Alberta Government are now facing a class-action lawsuit8. The lead plaintiff is Sandra Nette. Formerly she was a fit 41 year old. Now she is tetraplegic. Immediately
after neck manipulation by a chiropractor she had a massive stroke as a result of a torn vertebral artery.

Acupuncture comes out of the assessments equally badly. Bausell (2007) concludes that it is no more than a theatrical placebo.

Are the qualifications even real?

It is a curious aspect of the alternative medicine industry that they often are keen to reject conventional science, yet they long for academic respectability. One aspect of this is claiming academic titles on the flimsiest of grounds. You can still be held to have misled the public into thinking you are a medical
practitioner, even if you have a real doctorate. But often pays to look into where the qualifications come from.

A celebrated case in the UK concerned the ‘lifestyle nutritionist’, TV celebrity and multi-millionaire, Dr Gillian McKeith, PhD. A reader of Ben Goldacre’s excellent blog, badscience.net did a little investigation. The results appeared in Goldacre’s Bad Science column in the Guardian9.

She claimed that her PhD came from the American College of Nutrition, but it turned out to come from a correspondence course from a non-accredited US ‘college’. McKeith also boasted of having “professional membership” of the American Association of Nutritional Consultants, for which she provided proof of her degree and three professional references.

The value of this qualification can be judged by the fact that Goldacre sent an application and $60 and as a result “My dead cat Hettie is also a “certified professional member” of the AANC. I have the certificate hanging in my loo”.

Is the solution government regulation?

In New Zealand the law about misleading the public into believing you are a medical practitioner already exists. The immediate problem would be solved if that law were taken seriously, but it seems that it is not.

It is common in both the UK and in New Zealand to suggest that some sort of official government regulation is the answer. That solution is proposed in this issue of NZMJ by Evans et al2. A similar thing has been proposed recently in the UK by a committee headed by Michael Pittilo, vice-chancellor of Robert Gordon’s University, Aberdeen.

I have written about the latter under the heading A very bad report. The Pittilo report recommends both government regulation and more degrees in alternative medicine. Given that we now know that most alternative medicine doesn’t work, the idea of giving degrees in such subjects must be quite ludicrous to any thinking person.

The magazine Nature7 recently investigated the 16 UK universities who run such degrees. In the UK, first-year students at the University of Westminster are taught that “amethysts emit high yin energy” . Their vice chancellor, Professor Geoffrey Petts, describes himself a s a geomorphologist, but he cannot be tempted to express an opinion about the curative power of amethysts.

There has been a tendency to a form of grade inflation in universities—higher degrees for less work gets bums on seats. For most of us, getting a doctorate involves at least 3 years of hard experimental research in a university. But in the USA and Canada you can get a ‘doctor of chiropractic’ degree and most chiropractic (mis)education is not even in a university but in separate colleges.

Florida State University famously turned down a large donation to start a chiropractic school because they saw, quite rightly, that to do so would damage their intellectual reputation. This map, now widely distributed on the Internet, was produced by one of their chemistry professors, and it did the trick.

Other universities have been less principled. The New Zealand College of Chiropractic [whose President styles himself “Dr Brian Kelly”,though his only qualification is B. App Sci (chiro)] is accredited by the New Zealand Qualifications Authority (NZQA). Presumably they, like their UK equivalent (the QAA), are not allowed to take into account whether what is being taught is nonsense or not. Nonsense courses are accredited by experts in nonsense. That is why much accreditation is not worth the paper it’s written on.

Of course the public needs some protection from dangerous or fraudulent practices, but that can be done better (and more cheaply) by simply enforcing existing legislation on unfair trade practices, and on false advertising. Recent changes in the law on unfair trading in the UK have made it easier to take legal action against people who make health claims that cannot be justified by evidence, and that seems the best
way to regulate medical charlatans.

Conclusion

For most forms of alternative medicine—including chiropractic and acupuncture—the evidence is now in. There is now better reason than ever before to believe that they are mostly elaborate placebos and, at best, no better than conventional treatments. It is about time that universities and governments recognised the evidence and stopped talking about regulation and accreditation.

Indeed, “falsely claiming that a product is able to cure illnesses, dysfunction, or malformations” is illegal in Europe10.

Making unjustified health claims is a particularly cruel form of unfair trading practice. It calls for prosecutions, not accreditation.

Competing interests: None.
NZMJ 25 July 2008, Vol 121 No 1278; ISSN 1175 8716
URL: http://www.nzma.org.nz/journal/121-1278/3158/ ©NZMA

Author information: David Colquhoun, Research Fellow, Dept of Pharmacology, University College London, United Kingdom (http://www.ucl.ac.uk/Pharmacology/dc.html)

Correspondence: Professor D Colquhoun, Dept of Pharmacology, University College London, Gower Street, London WC1E 6BT, United Kingdom. Fax: +44(0)20 76797298; email: d.colquhoun@ucl.ac.uk

References:

1. Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. N Z Med J. 2008;121(1278). [pdf]

2. Evans A, Duncan B, McHugh P, et al. Inpatients’ use, understanding, and attitudes towards traditional, complementary and alternative therapies at a provincial New Zealand hospital. N Z Med J. 2008;121(1278).

3 Shapiro. Rose. Suckers. How Alternative Medicine Makes Fools of Us All Random House, London 2008. (reviewed here)

4. Singh S, Ernst E. Trick or Treatment. Bantam Press; 2008 (reviewed here)

5. Bausell RB. Snake Oil Science. The Truth about Complementary and Alternative Medicine. (reviewed here)
Oxford University Press; 2007

6. Colquhoun D. Science degrees without the Science, Nature 2007;446:373–4. See also here.

7. Long PH. Stroke and spinal manipulation. J Quality Health Care. 2004;3:8–10.

8. Libin K. Chiropractors called to court. Canadian National Post; June21, 2008.

9. Goldacre B. A menace to science. London: Guardian; February 12, 2007/

10. Department for Business Enterprise & Regulatory Reform (BERR). Consumer Protection from Unfair Trading Regulations 2008. UK: Office of Fair Trading.

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40 Responses to Doctor Who? Deception by chiropractors

  • Nicely said David, it is good to see that the medics back home in NZ are worried about all the woo too.

    When it comes to chiropractic I wonder what people have against physiotherapists. Having been put back together by them on numerous occasions, including my back, I would never go anywhere else. BTW my back was dealt with in passing when I was in about my shoulders. It was free too.

  • Exactly. Physiotherapists would do as much good and be safer. It’s true that the evidence base for much of physiotherapy is pretty thin too. But at least they don’t claim to be able to cure asthma, and they don’t invent imaginary “subluxations” so they can pretend to remove them

  • Unfortunately my ‘alma mater’ haven’t bothered translating their pages on chiropractics into English, but here’s the link anyway:
    http://www.sdu.dk/Uddannelse/Fuldtidsstudier/Bachelor/Klinisk_biomekanik.aspx

    Clinical biomechanics is the area of health science where the biological, biomechanical and psychological knowledge is bound together with the illnesses that people with pains and problems in joints, muscles and bones suffer from. As a chiropractist one must be able to prevent, diagnose and treat musco-sceletal illnesses and disabilities by using the latest knowledge and technology. Thus one is never done learning chiropractics, but must expect to study for life.

    Theory and practice
    By studying CBM you’ll gain the scientific basis that’s a prerogative for your later work as a chiropractist. You’ll learn to seek out new information, treat this in a critical-analytical manner and use it in the real world among patients. You’ll also train to acquire the techical skills of chiropraxy.

    There’s more of course, but I’m not all that good a translating.

    In general my impression is that Danish chiropraxy only works of skeletal issues such as backpains and the like. I’ve never heard of anyone going to one to be treated for asthma or something similarly unrelated.

  • Great post. What incenses me is that the UK chiropractic regulatory body, the General Chiropractic Council (GCC), claims, on its website, that chiropractic is safe – and it even gives a description of that fictitious lesion, the chiropractic subluxation, in an apparent attempt to validate it:
    http://www.gcc-uk.org/page.cfm?page_id=6

    Now when you consider that two of the GCC’s main statutory duties are to protect patients and set standards, you have to wonder what chance patients and the public have when faced with such (mis)information. Presumably it exists because the other part of the GCC’s remit is to “promote the profession” – something which basically means pushing a therapy which is less safe and more expensive than many other effective conventional options. Interestingly, paragraphs 85 and 193 of Sandra Nette’s Statement of Claim describe the way in which chiropractors are currently regulated in Alberta, Canada, and it seems to very closely resemble the way in which they are regulated here in the UK:
    http://www.casewatch.org/mal/nette/claim.pdf

    With regard to chiropractors calling themselves ‘doctors’, it’s interesting to note that in May of this year the UK Advertising Standards Authority’s (ASA) published an adjudication which upheld two complaints about chiropractic advertising, one of which saw it concluding that the use of the word “Dr” could mislead and that the suggested claim “Doctors of Chiropractic”, for use in future ads, did not go far enough to remove the implication that the practitioners held general medical qualifications as well as chiropractic qualifications:
    http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_44460.htm

  • You can meet some Doctors of Chiropractic here . Asthma is one of the named conditions they claim benefits from chiropractic treatment, though predictably they fail to mention that current guidelines e.g. BTS/SIGN do not support such a claim.

    Here is another chiropractor, claiming that chiropractic can prevent/treat asthma in young children.

  • Claire, if you take a look at the General Chiropractic Council’s ‘Patient Information Leaflet’ you’ll see that it says on page 8 that “You may also see an improvement in some types of asthma”…
    http://www.gcc-uk.org/files/link_file/WhatCanIExpect_Sep07_Web.pdf

    …yet here’s what the scientific evidence tells us:

    “…Another Cochrane review summarised the available trials of chiropractic treatment for asthma.3 The authors found only two such studies and ‘neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured.’” [Ernst]
    http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

    Interestingly, the GCC requires that “all chiropractors must ensure that all the information they provide, or authorise others to provide on their behalf is factual and verifiable, is not misleading or inaccurate in any way, does not abuse the trust of members of the public in any way, nor exploit their lack of experience or knowledge about either health or chiropractic matters”, and “does not put pressure on people to use chiropractic, for example by arousing ill-founded fear for their future health or suggesting that chiropractic can cure serious disease”. See page 7 here:
    http://www.gcc-uk.org/files/page_file/FITNESS_TO_PRACTISE_REPORT_2007_FINAL_FOR_WEBSITE.pdf

    It’s also worth noting that section A2.3 of the GCC’s Standard of Proficiency requires that “chiropractors’ provision of care must be evidence-based”…
    http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf
    …although it doesn’t state what *quality* of evidence is acceptable, so presumably anecdotes and testimonials are sufficient – something which would fit in nicely with the fact that the Chiropractors Act 1994 doesn’t define the scope of practice for chiropractors in the UK.

    For chiropractic in a nutshell, you really can’t do better than Simon Singh and Edzard Ernst’s recent proposal for what all chiropractors should be compelled by law to disclose to their patients prior to treatment:

    “WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”

    [Ref. ‘Trick or Treatment? Alternative Medicine On Trial’, p.285]

  • Thanks Claire -they are both misrepresenting themselves as ‘doctors’ too.
    It’s official too,

    The British Chiropractic Association site says

    “As children grow, chiropractic can help not only with the strains caused by the rough and tumble of life but also with some of the problems that children can suffer in their first years:
    Colic – sleeping and feeding problems – frequent ear infections – asthma – prolonged crying.”

    But the Cochrane review says

    “There is not enough evidence to draw a conclusion about the effects of manual therapy by physiotherapists and chiropractors for adults or children with asthma.”

    How do they get away with it?

  • How indeed. The latest (2008 – pdf) BTS/SIGN guideline on the management of asthma puts it even more strongly [section 3.6.1 “Manual therapy including massage and spinal manipulation”]:

    “…The two trial of chiropractic suggest that there is no place for this modality of treatment in the management of asthma”

    I wonder how many chiropractors refer to the BTS/SIGN guideline?

  • Thanks to Blue Wode and Claire for some excellent links. They show the total ineffectiveness of the statutory regulation mechanisms that are in place for chiropractic. All the regulation does is to provide support for ineffective and sometimes dangerous treatment.

    That is why the suggestion of the Pittilo report, to extend “regulation” to other ineffective treatments is such dangerous nonsense.

  • I’m a physiotherapist from New Zealand and have a few thoughts about this stimulating column.

    Thought#1: The term ‘Doctor of Chiropractic’ is used in the ‘Code of Ethics’ provided by the Chiropractic Board of New Zealand (CBNZ)(http://www.chiropracticboard.org.nz/Site/code_of_ethics.aspx) – which is the regulatory body endorsed by the Ministry of Health to implement the Health Practitioner’s Competency Assurance (HPCA) Act for Chiropractors. This the SAME Act that is used to protect the use of the term ‘doctor’ for medics. So – if you have a problem with the use of this term by chiros, you will need to address its use by the regulatory body in the first instance.

    Thought#2: The ‘scope of practice’ of chiropractics in NZ according to the CBNZ, and therefore the scope of practice allowed by HPCA Act includes: “strengthening
    exercises, dietary advice, nutritional supplementation, ergonomic assessment and
    guidance, psycho-social support, physiological therapeutics (e.g. ultrasound) and other healthful living practices.” Pretty broad, eh? It also is stated that the scope of practice for chiros include the ordering of MRI, CT, and radio-isotope bone scans. For MUCH more information check out: http://www.chiropracticboard.org.nz/Site/scope_of_practice.aspx. Again, because this the scope of practice endorsed by the CBNZ, it is the scope of practice allowed under the HPCA Act in NZ.

    The Chair of the CBNZ himself states: “I have developed a holistic attitude to practise over the years and have established a health centre that includes bio resonance therapy, psychotherapy, colon hydrotherapy and connective tissue massage” (Feb 2008 CBNZ Newsletter).

    Incidentally, I myself teach an evidence-based approach to rehabilitation, so would be sceptical of many of these therapies (as I am of a number of medical and physical therapies). I’m just pointing out these practices are considered part of Chiropractics under NZ law. Where health funder are willing to pay for them is another thing!

    Thought#3: The move toward professional doctorates in on the increase – even in my profession. Aussie has introduced an ‘entry-level’ doctor of physiotherapy programme (http://www.ozdegree.com/university_profiles/bond_university/australia_s_first_doctor_of_physiotherapy) to follow the lead of PT schools in the US. Apparently Canada is likely to follow, and there is talk within my profession of the same happening here in NZ. This is a case, I believe, of degree creep. Keeping up with the Joneses.

    As someone who has recently finished a five years of study to complete a PhD (on top of a Masters and Bachelor qualifications) I am understandably reluctant for more liberal use of the term ‘doctor’ with regard to physiotherapy! But, go figure. There seems to be a strong international move in that direction.

    Thought#4: There is good evidence that physiotherapy can be used to ‘treat’ asthma – or indeed any chronic obstructive pulmonary disease. Lacasse et al. (2006) in their Cochrane Systematic review conclude: “Rehabilitation relieves dyspnea and fatigue, improves emotional function and enhances patients’ sense of control over their condition. These improvements are moderately large and clinically significant. Rehabilitation forms an important component of the management of COPD.”

    Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4

    Thought#5: Lots of thoughts – clearly this was a stimulating thread!

    Thought#6: To be devil’s advocate – there is a difference between having no evidence of effect and having evidence of no effect. The former results from having a poor research base from which to draw conclusions about efficacy of certain treatments; the latter results from having good research that clearly demonstrates a particular intervention has no effect (or is as good as or worse than a placebo). My impression of much of the CAM research (and physiotherapy research for that matter) is that is a case of the former. The response to this should be to get funding to do some good trials!

    To illustrate this point I ask the question, what evidence exists that you should regularly visit the dentist? You do do that, don’t you? Remind me how much that costs you? *grin*… Then read Beirne P, Worthington HV, Clarkson JE. Routine scale and polish for periodontal health in adults. Cochrane Database of Systematic Reviews 2007, Issue 4., which concludes “The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.”

    Anyone ready to campaign against routine dentist visits?

    Cheers,
    William Levack

  • re thought #4 (William Levack): how safe is it to extrapolate from research on COPD (the subject of the Cochrane review cited) to asthma? I am not medically qualified but understand that, although similarities exist, the two conditions are distinct in terms of disease onset, frequency of symptoms and reversibility of airway obstruction. Organisations such as the The British Lung Foundation certainly treat asthma and COPD as separate conditions.

    I am not saying that physical techniques are of no relevance in asthma: the BTS/SIGN linked to earlier includes the new recommendation that breathing techniques, e.g. Buteyko, can be considered to help with symptom control. But the same guideline does not recommend chiropractic as part of asthma management.

  • You’re right. I’m playing a little fast and dirty with that pulmonary rehabilitation reference. I was just putting a little vote of confidence out there for the evidence based underpinning respiratory physiotherapy – to demonstrate that it is not entirely ‘thin’ as was suggested. The other point I wanted to make, albeit indirectly, was that respiratory physiotherapy does not involve just manual and breathing techniques. Pulmonary rehabilitation involves little of either – it is mainly based on exercise therapy and education, which is probably best provided by a interprofessional team in fact.

    The other wee voice in my head also points out that physiotherapy is not actually referred to in the pulmonary rehabilitation review, in fact. It’s just that physiotherapists are usually involved in implementing such programmes. (That’s a metaphorical wee voice by the way.)

    I’d debate how distinct COPD and chronic asthma in fact are too – although I agree, guidelines usually suggest that should be treated differently. Pearson et al. (2006) conducted a diagnosis review of 43,203 people > 40 years with respiratory conditions in the UK, and reported that 9% in fact had a ‘mixed’ presentation of asthma and COPD. (That’s close to 4000 people in this review!) A large percentage of those reviewed were also misdiagnosed – over 50% of people with an initial diagnosis with ‘asthma’ in fact had a different respiratory condition on review (mostly like COPD or a mix of asthma and COPD). In any pulmonary rehabilitation class then, you’re going to have some people with asthma.

    But I also agree with David above – physiotherapists are unlikely to make claims to ‘curing’ asthma or any obstructive airways conditions. One of the fascinating things about pulmonary rehabilitation is that despite in positive effects on dysnpea, fatigue, exercise tolerance, mental well-being etc, it doesn’t appear to have any effect on the underlying disease itself. Lung function tests remain the same before and after pulmonary rehabilitation – it’s just that general exercise tolerance, fitness and self-management of the condition improves.

    I’ll leave the chiropractor to defend their own profession!

    Pearson M. Ayres JG. Sarno M. Massey D. Price D. Diagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997-2001

  • Whoops. That full reference is: Pearson M. Ayres JG. Sarno M. Massey D. Price D. Diagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997-2001. International Journal of COPD. 1(4):435-43, 2006. UI: 18044099

  • Hello William,

    Regarding your comments (thought #2 of your first post) that the scope of practice of chiropractic in NZ includes “strengthening exercises, dietary advice, nutritional supplementation, ergonomic assessment and guidance, psycho-social support, physiological therapeutics (e.g. ultrasound) and other healthful living practices” – as well as the ordering of MRI, CT, and radio-isotope bone scans – that’s all very well, but it’s not ‘chiropractic’ and it’s not really helpful to chiropractic patients and the public who, as far as I know, are generally not being made aware of the following crucial information:

    Quote:
    “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait – claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch – practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system…..A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are ‘chiropractic’…. But by doing so and calling it ‘chiropractic’ it legitimizes the pseudoscientific practices that are very common within the profession – like treating non-existent ‘subluxations’ in order to free up the flow of innate intelligence.”

    http://www.sciencebasedmedicine.org/?p=156

    Certainly, the above applies to the UK where the scope of chiropractic is not defined or limited by law:

    Quote:
    “Code of Practice
    Chiropractors must meet high standards of conduct and practice. The Code of
    Practice lays down the standard of personal and professional conduct that is
    required of all chiropractors. It also provides advice in relation to the practice
    of chiropractic.

    Standard of Proficiency
    Chiropractic is an independent primary healthcare profession. The law does not
    define the scope of practice for any healthcare profession. Nor is it the purpose of the Standard of Proficiency to define the scope of chiropractic. The Standard of Proficiency sets out standards for the competent and safe practice of chiropractic.”

    See page 2 here:
    http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf

    In your thought #3 it’s interesting that you say that there’s a strong international move towards professional doctorates in physiotherapy, because the well-respected veteran chiropractor, Samuel Homola, recently hinted that it could ultimately herald the demise of chiropractic:

    Quote:
    “As I warned in Bonesetting, Chiropractic and Cultism, if chiropractic fails to specialize in an appropriate manner, there may be no justification for the existence of chiropractic when there are an adequate number of physical therapists providing manipulative therapy. Many physical therapists are now using manipulation/mobilization techniques. Of the 209 physical therapy programs in the US, 111 now offer Doctor of Physical Therapy (DPT) degrees. Some of these programs have been opened to qualified chiropractors. According to the American Physical Therapy Association, “…Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services. Physical therapists will be practitioners of choice in patients’/clients’ health networks and will hold all privileges of autonomous practice…” It matters little who does spinal manipulative therapy as long as it is appropriate and evidence-based.”

    http://jmmtonline.com/documents/HomolaV14N2E.pdf

    With regard to thought #6 on the subject of CAM research and your view that more good research is required, it’s worth remembering that a fairly large amount of good evidence is already in and it’s not looking good for CAM proponents in the long run:

    Quote:
    “[R. Barker] Bausell’s book [Snake Oil: The Truth About Complementary and Alternative Medicine] gives an excellent account of how to test treatments properly, and of all the ways you can be fooled into thinking something works when it doesn’t. Bausell concludes “There is no compelling, credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo”.

    -snip-

    It can now be said with some certainty that the number of alternative treatments that have been shown to work better than placebo is very small, and quite possibly zero…”

    Integrative baloney @ Yale

    Finally, regarding the research evidence of “insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health”, that might be so, but is it really a good comparison to make with chiropractic? In other words, we all know that the Tooth Fairy isn’t real and that a scale and polish won’t kill or maim us. Chiropractic, on the other hand….

  • Re the routine scale and polish, the dental practice I attend hasn’t done this on routine check-ups for years, the reason given us patients was that there was no benefit. They do bang on about gum health though, and give a score for periodontal health. If it has deteriorated since the last check, an appointment is booked with the hygienist…she’s scary!

  • I’m enjoying this thread, and have to apologise retrospectively (and in advance) for all my typos. I blame it on the ergonomic keyboard… but I haven’t developed fibromyalgia yet, so it must be working. The keyboard also appears to be preventing the onset bubonic plague, so that’s good.

    Re: the scope of practice of chiropractics in NZ, and Blue Wode’s comment: that’s all very well, but it’s not ‘chiropractic’. The point is that because the NZ Chiropractic Board is appointed by the NZ Ministry of Health to implement the HPCA Act for chiropractors, and because THEY define the scope of chiropractics as including dietry advice, psycho-social support etc… it IS ‘chiropractic’ in NZ – by published definition! I’m certianly not saying I agree with this definition – in fact I was a little surprised to see the reference to nutritional advice and ordering of MRIs – but am merely stating that if we are talking ‘regulation’, as DC is, these practices are included as ‘chiropractics’ in NZ.

    In comparison, my own profession’s statement on ‘scope of practice’ is much more brief. The Physiotherapy Board of NZ states that “Physiotherapists are registered healthcare practitioners educated to apply scientific knowledge and clinical reasoning to assess, diagnose and manage human function. They promote mobility, health and independence; rehabilitate; and maximize potential for activity.” One could perhaps criticise this ‘scope of practice’ as being not specific enough…? But it is rather difficult to write a comprehensive list of activities that are within a scope of practice for a profession.

    One other thought: professional ‘scopes of practice’ do appear to bleed into one another over time. Physiotherapist started manipulating spines only after chiros and osteo were doing it. I understand (although can’t find a citation for this) that physiotherapy were significantly challeged by other professions when they started manipulating patients. Now it is considered mainstream practice for many musculoskeletal physios. …And everybody seems into exercise prescription nowerdays, which was originally solely the physiotherapists’ domain.

    Regarding ‘safety’, I’d be far happier to have chiropractor give me advice about eating my greens than having them snap my neck… Advice regarding water consumption, I’d take with a large grain of salt. ;-)

    Also – whoops. I stand corrected. Some physiotherapist ARE prepared to massage asthmatics into wellbeing! http://thephysiosite.com/some-physiotherapy-asthma-management-may-be-questionable.php… although the practice does not appear to be endorsed by the profession as a whole.

  • Here’s an interesting one. Bearing in mind that the practice of chiropractic in the UK is not defined or limited by law, and that the UK chiropractic regulatory body, the General Chiropractic Council (GCC), offers a vague description for the (purely imaginary) chiropractic ‘subluxation’ on its website, the Advertising Standards Authority (ASA) has just upheld a complaint from the GCC concerning claims made by a chiropractic clinic in Manchester. Apparently the clinic’s leaflet said

    Quote:

    “For A Complete Health Care Solution

    Chiropractic is the science, art and philosophy with the unique approach of looking to the CAUSE of the disease/problem and not just treatment of the symptoms.

    The Gonstead Chiropractor examines the spine, extremities and nervous system with a detailed “hands on” assessment of the verteberal column and its contiguous structures for the diagnosis of Subluxation …

    The Gonstead System of Chiropractic established in 1923 represents arguably the ultimate standard in “hands on” spinal adjusting and remains the leader in Chiropractic techniques due to the lengthy training a Gonstead Doctor receives.

    Chiropractic care goes far beyond a simple system of “putting vertebrae back in place” at the Gonstead Clinic. It is, rather, a scientific programme of carefully analysing the patient and their health problems on the basis of available information and then deciding on the proper corrective steps”.”

    http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_44788.htm

    and the GCC challenged whether the claim *The Gonstead System of Chiropractic … remains the leader in Chiropractic techniques due to the lengthy training a Gonstead Doctor receives* was misleading and could be substantiated.

    The Gonstead Clinic of Chiropractic didn’t respond to the ASA’s enquiries, so the ASA considered that the claim had not been proven and concluded that the ad was misleading and breached CAP Code clauses 2.6 (Non-response), 3.1 (Substantiation), 7.1 (Truthfulness) and 19.1 (Other comparisons). The clinic was then told by the ASA not to make similar claims in future advertising.

    Meanwhile, hundreds of UK chiropractors – and the GCC – continue to needlessly put patients at risk of serious injury with their unhampered promotion of the chiropractic ‘subluxation’ as if it were a valid entity.

    Further reading:
    http://www.chirobase.org/08Legal/nette.html

  • Thanks Blue Wode, There is huge irony in the GCC complaining about misleading advertising. Does the GCC’s own web site count as an advertisement, I wonder?

  • “Does the GCC’s own web site count as an advertisement, I wonder?”

    Regrettably, claims made on websites (other than in sales promotions and paid adverts on the page) are not within the remit of the ASA.

  • David Colquhoun wrote in post #10: “All the regulation does is to provide support for ineffective and sometimes dangerous treatment.”

    Here’s a little more evidence in support of that view.

    Margaret Coats, Chief Executive of the General Chiropractic Council, has just written a letter to the Times in which she asserts that “chiropractic is not a technique or a belief”.
    http://www.timesonline.co.uk/tol/comment/letters/article4648088.ece

    Well, bearing in mind that chiropractic was founded on the belief that health can be restored and maintained by manipulating the spine to rid it of hypothetical ‘subluxations’, it is most unlikely that she is not acutely aware of the activities of the McTimoney College of Chiropractors…

    The Role of UK Universities in Chiropractic

    …and that she hasn’t read the results of a recent survey of UK chiropractors which revealed that traditional chiropractic *beliefs* were important to 76% of respondents, with a further 63% considering the chiropractic subluxation (a fictitious lesion) to be central to chiropractic intervention. The survey is linked to here:
    http://dcscience.net/?p=248#comment-3164

    It begs the question, should Margaret Coats be allowed to remain in charge of the General Chiropractic Council?

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