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Dr Who – DC's Improbable Science

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Shortly after I published my editorial in the New Zealand Medical Journal, Dr Who?, I was delighted to get a letter from someone who had trained in chiropractic and seen it all from the inside.

Sadly this wonderful letter had to be removed within a few weeks of posting it because its author was threatened and bullied by chiropractors. Its author is too young and too vulnerable to risk his future career. As a result of this shameful and vindictive treatment, I was asked to remove the letter and did so immediately.  Other copies on the web have now vanished too.

The experiences described in the letter justified much of what I said in the editorial, and in some ways went further.  This letter doubtless contributed to dropping of the threatened legal action by chiropractors against the Journal and against me.  The letter was posted originally on 21 August 2008, with the permission of its author.  See also the follow-up in Chiropractic wars. Part 3: internecine conflict.

Now I have been sent a much more anonymous version, and it is a great pleasure to post this inside information.

David

I must begin by stating my background in relation to chiropractic.  I am a graduate of a chiropractic college and have practiced for several years. I have elected not to register or practice again and have returned to study to begin a new career.  Prior to studying chiropractic, I gained undergraduate and postgraduate qualifications in science.

First I would like to address your comment about the validity of a qualification from a private chiropractic college, especially in relation to the difference between studying there and studying at a university.

A major difference is the education and experience of faculty.  At the time I was there, most of the faculty at my college had only undergraduate qualifications (I would suggest that the American DC degree is of undergraduate level as it is the primary qualifying degree for chiropractic in the US and Canada -it is not the equivalent of a doctorate in a British or Australasian university) and have not published in peer-reviewed journals.  This is quite different to my experience of universities where the all of the faculty usually have at least a PhD and are actively involved in research.

The content of the chiropractic curriculum was voluminous.  It included basic sciences, chiropractic subjects and social sciences. The college I attended did not have any laboratory facilities so the experience of learning science from a textbook was quite different to the way I had been taught at university, where each subject had a significant laboratory program that had to be passed separately to pass the subject.

As chiropractic is a clinical discipline, the course contained subjects in common with a medical degree. Sadly, the attitude towards medicine and the medical profession was not always the most constructive.  For example, I can recall a noticeboard where newspaper clippings of media reports of medical misadventure and adverse effects of pharmaceuticals were posted regularly.

Clinical experience was gained by a 2 year internship in the school health centre concurrent with the last 2 years of academic study; so it was not a full-time internship.  The requirements for passing this component of the course were complex but centred around seeing a number of patients, a number of visits, performing a number of various kinds of x-rays and reading a number of x-ray films.  Every student was responsible for finding all of their own patients to meet the requirements.  The result of this was a clinical experience that was quite narrow for most people.  This would seem to be quite different to the hospital internship of a medical degree, the clinical internship of a dental degree or the range of placements in a physiotherapy degree in terms of the breadth of experience of different kinds of patients of different ages and states of health.

For people who are not aware, there are a range of ideas within chiropractic about what it is and what it is for.  The “wellness”, subluxation-based kind of chiropractic is taught by a minority of schools and is what chiropractors call a “philosophical view”.  It advocates that chiropractic care be independent from symptoms or treatment and be a regular part of peoples’ lives.  The expectation is that healthy, asymptomatic people will be “adjusted” on a regular basis to keep them free from “vertebral subluxation”. To that end, the training at schools that teach this approach is adequate (and probably even excessive).

The issue that you wrote about related to the use of the title “doctor” by chiropractors in New Zealand. In licensing chiropractors and allowing them the use of the title “Dr” in front of their names (provided that the title is qualified by the word “chiropractor”) governments have awarded chiropractors with recognition and prestige that has usually been associated with a level of academic achievement or with a medical qualification. It indicates that the bearer of the title can be trusted to give credible advice within their area of expertise.

The issue may seem benign, but in allowing chiropractors to use the title, people who would not normally feel safe to submit to the treatment of an alternative health practitioner, choose to try chiropractic. I make this point because at its core, chiropractic is quite different to medicine, dentistry and physiotherapy.

A chiropractic office often looks like a lot like a doctor’s surgery.  The layout is similar (with waiting rooms and consultation rooms; there are things like stethoscopes and x-ray machines and there are often informative and education posters and brochures.  In many cases, the title “doctor” is used in
the office to describe the chiropractor.

I have found that some people believe chiropractors are medical doctors.  Some even believe that chiropractic is a kind of medical speciality. I have seen patients who choose chiropractic as their primary health care and come to a chiropractic office as their first port of call when they are unwell.  I
have seen offices where this behaviour is encouraged by the chiropractor. Equally, some of the most “philosophical” chiropractors are adamant that chiropractic does not treat anything. They maintain that it is simply something that everyone should do regularly, at all stages of life, to ensure they stay healthy. These chiropractors sometimes refuse to use the title “doctor” altogether.

Two practices are of particular concern in some chiropractic offices and in my view; these alone should be sufficient reason to prevent chiropractors from calling themselves “doctor”.   The first is the systematic and deliberate erosion of a person’s confidence in the medical system.  Many offices have anti medical literature in their libraries.  Chiropractors are sometimes taught practices to subvert medical credibility.  See http://chirobase.org/20PB/top7.html for an example.

The second is a subset of the first but is particularly damaging.  It is active opposition to vaccination.  At chiropractic school, I was taught anti-vaccination information in my paediatrics course.  I have seen books written by chiropractors opposing vaccination and I have seen many offices with anti vaccination leaflets and books in abundance.  Now I am all for informed choice but this type of material is rarely accurate or balanced.  People are being encouraged not to vaccinate their children by professionals who they believe to be a reliable and prestigious source of information.

Although it may sound paternalistic to people who have not had the privilege of clinical practice (albeit in a profession I no longer agree with), it made me realise several things. The first is that people who are unwell are vulnerable.  The second is that there are people who trust “medical” advice unquestioningly.

I believe we should be very careful about who we title as a credible source of advice about health care. Legislation treads a fine line between limiting personal freedom and protecting people from harm.

Aside from the qualification being inconsistent with the academic level that is usually required to use the title “Doctor”, the greatest danger, in my opinion, is that the legal recognition and permission to use the title has allowed chiropractors to assume the mantle of a doctor.  In the guise of this respectability, some chiropractors are deliberately eroding confidence in doctors and denying children (and possibly populations) the protection of vaccination.

David, thank you for having the courage to question the use of the title “doctor” by chiropractors. Historically (and in your case), chiropractors fight their battles through litigation so it takes personal courage and integrity to do so.


All I can say is, don’t thank me. It doesn’t take much courage at my age.  It takes a lot at yours and the world should be grateful to you.

Replies from chiropractors in the NZMJ

The New Zealand Medical Journal, very properly, allowed right of reply to chiropractore. This week’s issue contains three letters, one of which is from Paul Kelly. It is signed “Dr Brian Kelly B App Sci (Chiro), President, New Zealand College of Chiropractic”. This is not quite the same as appears on his College’s web site which shows the president’s welcome.

It seems that Kelly has not been quite so careful about use of his title on the web site because (as of 21 August) the signature on his address looks like this.

Dr Brian Kelly, President”. That does seem a bit careless, given that his usage of “Dr” was pointed out in my original editorial, published on 25th July.

Replies to these letters appeared in the September 5th issue of NZMJ.