As most readers would be aware, two days ago the president-elect of the Chiropractors’ Association of Australia, Helen Alevaki, resigned her position after her presence on the CAA National board became untenable. Alevaki was investigated by AHPRA and was required to agree to undertakings by the Chiropractic Board of Australia.
Alevaki was investigated and sanctioned for her admissions that she had breached the Code of Conduct for Chiropractors by treating patients in hospitals without permission. This came about because of a blog post I published in September 2013: Australian chiropractors sneaking into hospital wards to manipulate patients.
Thanks to a tip-off from a reader I can now reveal that a further six chiropractors from that September 2013 blog post have been investigated and sanctioned.
1. Catherine Langford (CAA member) of South Australia has undertakings on her registration:
1. To successfully complete the following education with a registered chiropractor who has been approved by the Board.
a. obtain the Board’s approval of the educator prior to the commencement of the education The educator is required to:
i. hold general registration as a registered health practitioner for a period of not less than seven (7) years
ii.not be in a close collegiate, social or financial relationship with Dr Langford, and
iii. have experience in the various regulatory, legislative and other requirements governing practice as a chiropractor.
b. provide the educator with a copy of this undertaking prior to the commencement of the education and to advise the Board in writing that a copy of this undertaking has been provided to the educator within 14 days of doing so.
3. To meet on at least two occasions over a three month period for a minimum of two hours each occasion for education on the following issues:
a. the ethics of practice as a chiropractor in maintaining the integrity and trustworthiness of the profession, with particular reference to the Board’s Code of Conduct for Chiropractors
b. use of social media, with particular reference to the Board’s Social Media Policy, and
c. the blog posted by ‘Reasonablehank’ which will be provided by the Australian Health Practitioner Regulation Agency (AHPRA), in light of subparagraphs 4a and 4b hereof.
4. To ensure the following reports are forwarded to AHPRA’s Compliance Team within two weeks of completing the above education:
a. A report from the educator, stating the dates the education occurred, what the education comprised of, and whether or not I have, in the opinion of the educator, satisfactorily participated in and understood the contents of the education.
b. A report written by me demonstrating a written summary of the outcomes/lessons learnt from the education sessions, and a written summary of how I intend to apply this knowledge to my practice.
5. I acknowledge that:
a. The above reports and statements will be relied upon by the Board when determining whether I have complied with the terms of the undertaking.
b. That AHPRA may communicate with the educator in relation to my compliance with these undertaking.
c. If the Board is not satisfied that the reports demonstrate that I have benefited from the education, I may be required to provide a further report and/or undergo further education as determined by the Board.
d. I am responsible for all the costs associated with this undertaking, including the costs of reports by the educator.
6. This undertaking will be reviewed in six months.
7. In the event that I change my principal place of practice to New South Wales, then the appropriate review body for this undertaking is the Chiropractic Council of New South Wales.
Langford had posted this evidence on her Facebook page:
2. Jenny Roppola (former CAA National board member) has conditions on her registration:
1. Dr Roppola is required to successfully complete the following education with a registered chiropractor who has been approved by the Chiropractic Board of Australia (the Board).
2. Dr Roppola is required to meet with the educator, in person, or via video or tele conference, for a minimum of two hours on at least two occasions over a three month period (review period).
3. Dr Roppola is required:
a. to obtain the Board’s approval of the educator prior to the commencement of the education.
The educator is required to:
i. hold general registration as a registered health practitioner for a period of not less than seven (7) years.
ii. not be in a close collegiate, social or financial relationship with Dr Roppola.
iii. have experience in the various regulatory, legislative and other requirements governing practice as a chiropractor.
b. to obtain the Board’s approval of the education program prior to the commencement of the education.
c. to provide the educator with a copy of this undertaking prior to the commencement of the education and to advise AHPRA in writing that a copy of the undertaking has been provided to the educator within 14 days of doing so.
4. The educator is to review the blog posted by ‘Reasonablehank’ and Dr Roppola’s response to the investigation, which will be provided to the educator by AHPRA, and discuss the following with Dr Roppola:
a. the ethics of practice as a chiropractor in maintaining the integrity and trustworthiness of the profession, with particular reference to the Board’s Code of Conduct for Chiropractors.
b. use of social media, with particular reference to the Board’s Social Media Policy.
c. her understanding about working within her scope of practice.
d. her understanding about how to work as a member of a collaborative, multidisciplinary team and the need for proper coordination of care.
e. her obligations as a registered professional to comply with the requirements of registration, focusing on maintaining proper indemnity insurance, with particular reference to the Board’s registration guidelines.
f. Record keeping practices in relation to informal and formal chiropractic treatment, focusing on the importance of recording investigations, findings, working hypothesis and treatment provided for every attendance.
g. provide feedback to the Practitioner about her general practice as a chiropractor and the requirements on a registered health professional to maintain the trust and confidence of the community in the profession.
5. Dr Roppola will ensure the following reports are forwarded to Australian Health Practitioner Regulation Agency (AHPRA) Compliance Team within two weeks of completing the above education.
a. a report from the educator, stating:
i. the dates the education occurred, and
ii. what the education comprised of, and
iii. whether or not Dr Roppola has, in the opinion of the educator, satisfactorily participated in and understood the contents of the education.
b. A report written by Dr Roppola demonstrating:
i. a written summary of the outcomes/lessons learnt from the education sessions.
ii. a written summary of how Dr Roppola intends to apply this knowledge to their practice.
6. Dr Roppola acknowledges that:
a. The above reports and statements will be relied upon by the Board when determining whether she has complied with the terms of the undertaking.
b. That AHPRA may communicate with the educator in relation to her compliance with this undertaking.
c. If the Board is not satisfied that the reports demonstrate that the practitioner has benefited from the education, she may be required to provide a further report and/or undergo further education as determined by the Board.
d. The practitioner is responsible for all the costs associated with these conditions, including the costs of reports by the educator.
Roppola had made these comments about her hospital breaches:
Adjusted my daughter (14 weeks prem) in NICU as soon as I was allowed to touch/hold her. Did sacral work SOT style…. Never said a word…. Then when she got bigger and I was able to breastfeed behind screens, a colleague came in to work on her…. Nurses even commented on how we had the best behaved baby in there…. Told nurses later, especially after her ‘colic’ settled so well and quickly.
I’ve done sacral SOT type work on a few preggers and post-partum women. Use the curtains when you visit your brother and get creative….. (That doesn’t sound so good……). :/
3. Olivia Gleeson (CAA member) of Western Australia has conditions on her registration (as per above).
Gleeson made these startling admissions about her hospital breaches:
I have adjusted lots of bubs in hospital, I just go in do my work and then go home. :)
Ali adjusted Tom in the Nicu a couple of hours after birth and the nurse wasn’t happy but my hubby said we are doing it anyway
4. Stephanie Le Coz (CAA member) formerly of New South Wales; now of Western Australia has conditions on her registration.
Le Coz made this admission about her hsopital breaches:
Have adjusted my mother and my CA post surgery . Do not worry and go for it xxx
5. Katelyn McGregor (CAA unknown as yet) of Victoria has undertakings on her registration (as per above).
McGregor made these alarming admissions regarding her sneaky hospital breaches:
U don’t need to broadcast it but it’ll be fine. Ditto to being in there often, all good. Go at visiting time when their’s lots of people around and wack the curtain around. I visited my mum in neuro wards of lots of hospitals. No biggie… And ur right , he needs adjusting. Get well to him x
6. Tom Dawson (CAA member) formerly of Victoria; now Indonesia has undertakings on his registration.
Dawson’s comments are nothing short of bizarre in the clear threat to patient safety he demonstrates to have undertaken:
If the PT wants you to, you can do it, simple as that, I actually lifted a man in Albury off a guerney in the base hospital there 17 years ago, put him in the car and drove him over to Wodonga( Vic licence only) as the medicos said they couldn’t help him anymore and just left him there. I offered to take him back but he walked out and went home. Saw him and his family last week. Nowadays I just set up and go for it whenever asked.
It should be noted that three of the six chiropractors included above have been members of the disreputable anti-vaccination organisation, the Australian Vaccination Network, or have featured in my anti-vaccine chiropractors series.
I note that there were a few more chiropractors who featured in my original September 2013 blog post who have escaped sanction. In reality some of them did not make the clear admissions of wrongdoing that those above have made. Fair enough. There are two anti-vaccine chiropractors who were featured in that post whose admissions, I must say, to me, were damning. They have escaped sanction at this point it seems.
1. Tim Shakespeare (former CAA NSW board member), of NSW. Shakespeare – now the proprietor of Life Rebel Chiropractic in Newcastle – has featured in this blog, a lot, for his anti-vaccinationism as well as his repeated examples of bringing the chiropractic profession into disrepute.
Shakespeare makes this extraordinarily arrogant admission:
Why should they care? They think its next to useless anyway…
I adjusted my niece with a CWD (Chiropractic World Domination) t-shirt on.
2. Bryce Fleming (CAA member) of NSW still works at Shakespeare’s former haunt, Healing Wave Chiropractic in Newcastle. Fleming, too, has featured in this blog for his anti-vaccinationism. Really, who can forget his jolly japes with Shakespeare who joked of “shit[ting] on the doorstep” of a medical practice who was offering influenza immunisations?
Fleming made this admission of his own hospital breaches:
I have adjusted a few peeps in hospital too. The more confident you are being there, the less questions get asked
So, we’ll see what happens with Shakespeare and Fleming. To me their breaches appear to be clear cut. The CBA might think differently.
It took almost two years and, who knows, it might not be over yet; but, congratulations to the Chiropractic Board of Australia for taking some action against these chiropractors. Even better, the sanctions are recorded on the public register of practitioners so the public can also see some regulation happening.
Update July 27 2015
Article – including audio – from ABC Radio’s PM program. Elise Worthington reporting:
Peak body for chiropractors to review membership obligations after president-elect Dr Helen Alevaki resigns
Australia’s peak chiropractic body has vowed to overhaul membership policies in the wake of the resignation of its president-elect.
Dr Helen Alevaki, who was also its board director, stood down last week after admitting on social media to sneaking into a maternity ward to perform a spinal alignment on a newborn baby.
The Australian Health Practitioners Regulation Agency (AHPRA) has confirmed a further six chiropractors have had conditions placed on their registration.
It is understood several were part of the closed Facebook group where the comments by Dr Alevaki were made and some also admitted to similar practices on social media.
It is the latest in a string of controversies for the booming spinal adjustment industry which is estimated to be worth around $1 billion a year in Australia […more]
MARK COLVIN (audio intro): The national health watchdog has sanctioned a further six chiropractors for sneaking into hospitals to treat newborn babies. The president elect of the national body has already resigned after admitting to ‘sneaky’ visits to a maternity ward to perform a so-called spinal alignment last week.
Update July 28 2015
Article from Australian Doctor. Serkan Ozturk reporting:
More chiros sanctioned over social media boasts
Six more chiropractors around Australia have been sanctioned over their use of social media to promote visits inside hospitals and maternity wards, it can be revealed.
The chiropractors had used social media to discuss various strategies on how to clandestinely enter hospitals and perform chiropractic work on patients — including babies and infants — with at least one also posting photos while inside hospital wards.
Confirmation of the sanctions follows on the heels of a similar ruling handed down in April to the former president-elect of the Chiropractors’ Association of Australia (CAA), Helen Alevaki.
Ms Alevaki was instructed to undertake further education on professionalism and social media use after admitting to having used Facebook to post about her “sneaky” visits to the maternity wards of hospitals.
The six chiropractors, who were investigated by the Chiropractic Board of Australia, also have to undergo further education on professional standards, ethics, record-keeping and use of social media.
The practitioners are:
Katelyn McGregor (Victoria)
Jenny Roppola (ACT)
Olivia Gleeson (WA)
Catherine Langford (SA)
Stephanie Le Coz (formerly of NSW, now in WA)
Thomas Dawson (formerly of Victoria, now in Indonesia)
In an unusual move, the chiropractic board has also directed all the sanctioned chiropractors to review writings by public health blogger Reasonable Hank — widely considered a nemesis of subluxationist chiropractors within the profession.
It was a blog post on Reasonable Hank’s website in September 2013 that first brought the alleged activities of the six sanctioned chiropractors and others into public light.
The sanctions on the chiropractors were imposed separately from September 2014 to February of this year, the chiropractic board has confirmed.
The latest sanctions have led to calls for the chiropractic board to be more transparent in its investigation of rogue elements within the industry.
Associate Professor Rod Bonello, the president of the newly formed national lobby group Chiropractic Australia — which stresses evidence-based approaches to the practice — said the actions of Ms Alevaki and the other six sanctioned chiropractors had brought a stain upon the profession.
“This sort of behaviour is indefensible,” he said. “Our group … doesn’t and won’t accept people as members who continue to do this kind of thing.”
Professor Bonello added: “It’s well and good for the Chiropractic Board of Australia to react to complaints but I think the profession needs to be proactive in stamping out this form of conduct.
“The vast majority of chiropractors do the right thing, with complaints against chiropractors relatively uncommon compared to other health professionals.
“But the actions of a few miscreants are giving the profession a continued bad reputation.”
The chiropractic board continued to protect the public and manage potential risks to public safety from chiropractors, a board spokesperson said.
Ms Alevaki resigned her position as president-elect earlier this month amid claims from CAA members that her admitted actions had brought disrepute upon the organisation.
Article from Sydney Morning Herald. Harriet Alexander reporting:
President-elect resigns from peak chiropractors group over ‘sneaky’ hospital visits
Already bent out of shape and weathering trauma from external forces, the peak body for chiropractors has now lost its head.
Helen Alevaki, the president-elect of the Chiropractors Association of Australia, has resigned from the board three months after she was reprimanded by the regulator for making unauthorised visits to maternity hospitals […]
Ms Alevaki had flagged in another closed Facebook group that under her leadership the CAA would renew its interest in subluxation, a controversial theory that claims spinal manipulation can cure almost all human conditions.
Her resignation has also reinvigorated disgruntlement with the CAA board for accepting her as a candidate for president only a year after her excursions into maternity hospitals were discovered.
Joe Ierano, who ran against Ms Alevaki in the 2014 campaign, said the CAA should not condone the bad behaviour of its members.
“Helen stepped up, but it’s up to the board to determine whether a candidate is suitable,” said Mr Ierano, the former president of the CAA NSW […]
“I think it’s fair to say that people looking at any prospective candidacy will be asked to ensure that there’s no potential breach of the constitution,” Mr Fisher said.
Mr Fisher was recently embarrassed after he penned a criticism of Chiropractic Australia on the ReasonableHank medical blog and was praised by two respondents, one of whom said chiropractic “had made a real difference in my life” and the other who said Mr Fisher’s insight made the person “proud to be a chiropractor”.
Both respondents were later revealed to have used the same IP address as Mr Fisher.
Mr Fisher said both comments were made by legitimate sources, who had sent them into CAA’s Penrith office where a staff member had posted them to the site.
The staff member had been counselled.
Update July 29 2015
Article from Medical Observer. Flynn Murphy reporting:
Calls for inquiry after chiros sneak into hospitals
RE-EMERGING claims that chiropractors snuck into hospitals to treat and in some cases adjust newborn babies have sparked calls for a Senate inquiry.
The controversy resurfaced when the Chiropractors’ Association of Australia (CAA) president-elect Dr Helen Alevaki, who first admitted to sneaking into a maternity ward in a Facebook post in 2013, resigned this month.
Sceptical health blogger Peter Tierney, who captured the 2013 post, revisited it on his Reasonable Hank blog this month after Dr Alevaki was named incoming president of the peak body.
Mr Tierney said contrary to media reports, Dr Alevaki had boasted about “checking” babies, not “adjusting” them. He said in any case she had breached the Code of Conduct for Chiropractors.
AHPRA has confirmed that in the past nine months, six chiropractors have been sanctioned for sneaking into hospitals.
They are: Katelyn McGregor (12.12.14), Catherine Langford (20.2.15), Jenny Roppola (16.10.14), Olivia Gleeson (19.9.14), Stephanie Le Coz (19.9.14) and Tom Dawson (12.12.14).
At least four of the practitioners sanctioned are members of the Australian Chiropractic Philosophy Society Facebook group, where members have shared tips on how to sneak into hospitals.
One, Katelyn McGregor, advised to: “Go at visiting time when their’s [sic] lots of people around and whack the curtain around. I visited my mum in neuro wards of lots of hospitals. No biggie…”
Mr John Cunningham, an orthopaedic spinal surgeon practising in Melbourne, says the incidents speak to the “hubris of many chiropractors”.
He says chiropractic has no evidence base and no place in hospitals, and risks breaking a newborn’s neck.
He has backed calls for an inquiry.
“Anything in medicine is based on the balance of risks and benefits,” Mr Cunningham told MO. “We know there’s risks of chiropractic manipulation and so far no benefit. There have been a few poorly performed studies. I don’t see there’s any benefit.”
Murdoch University Associate Professor Rodney Bonello disagrees. In June, he launched a new chiropractic lobby group Chiropractic Australia (CA) in response to a perceived failure by the legacy body – the Chiropractors’ Association of Australia (CAA) – to “keep its members in line”.
It is “completely wrong and indefensible” for chiropractors to sneak into hospitals, Professor Bonello said.
But he rejected Mr Cunningham’s “sweeping statement” that there was there was no evidence for the use of chiropractic treatment in babies.
“The fact is there’s very little scientific evidence that validates this, but there are some mechanical problems that babies and infants do get that chiropractors can help with,” he said.
“I’m thinking of something like infantile torticollis, or wry neck… sometimes it’s spastic, and the muscles need to be worked on and stretched and released.”
Professor Bonello said other chiropractic treatments that there was “even less evidence for” should be properly investigated, and that chiropractors should be in hospital teams.
“The evidence is thin – and a lot of it is anecdotal… but we don’t slam the door on new areas of technique because we don’t have the evidence. We look for the evidence,” he said, rejecting calls for an inquiry.
Stop the AVN spokesman Ken McLeod said Greens leader Dr Richard Di Natale, who has links with the sceptics group, has indicated he was “receptive” to the idea of an inquiry.
“I would suggest the terms of reference be quite simple – is there any evidence for what chiropractors practice today?” Mr McLeod said.
“And should there be taxpayer subsidies for private health insurance that includes chiropractic and other unproven practices?”
The Greens’ leader, who is on a study tour in Portugal, was not immediately available for comment.
Article from Kidspot. Rebel Wylie reporting:
Warning to parents: Chiropractics and babies don’t mix. It’s dangerous and unproven
To date, legitimate properly-controlled studies have failed to support the claims of chiropractors who treat children. The risks of paediatric spinal-adjustment are too frightening to consider, and the benefits? Pure fiction. So why are parents sneaking chiropractors into hospital wards to secretly treat their newborns?
“Chiropractors caught sneaking into hospitals to adjust newborns’ spines” was the news headline on ABC Radio earlier this week – and it sounded a whole lot of alarm bells. Should newborns, just out of their cosy, watery home and with all their rubbery and soft bones and ligaments be subjected to such treatments? Are there any proven benefits? And most importantly, is it safe?
Kidspot has rounded up experts including an orthopaedic surgeon and a chiropractor – and also a confused new mum who was advised to seek chiropractic treatment to treat a breastfeeding issue.
What has become clear to me in my extensive research and discussions for this story is that the information available to parents is confusing at best. But there is one comment from an expert, orthopaedic surgeon John Cunningham, that needs to take pride of place right up the top of this story:
“Your baby’s spine is mostly cartilage at that age. There is no problem that spinal manipulation can fix – it is never justified.” […]
The Chiropractors Association of Australia has been left red-faced by these allegations
Australia’s peak chiropractic body, The Chiropractors Association of Australia (CAA), is in utter turmoil after the resignation of its board director and president-elect, Dr Helen Alevaki, over an unauthorised hospital visit to treat a baby that has seen her sanctioned by health watchdog, The Australian Health Practitioners Regulation Agency (AHPRA).
It was back in 2013, when Aussie blogger Reasonable Hank first shone the torch on the Australian chiropractors operating outside of reasonable expectations. That post is where you will find the screenshots of Dr Alevaki’s bold brags of conducting the sneaky visits. Reasonable Hank also looked at the behaviours of other board members of the CAA who too boasted of sneaking into hospital wards – including, astonishingly, neonatal intensive care units – without the permission of the hospital or any treating physicians, nursing, or allied health staff. Not only conducting unnecessary and dangerous spinal-adjustments, but conveying an anti-vaccination message that they have no medical authority to discuss.
AHPRA has since confirmed a further six chiropractors – four of whom are also members of the CAA – have also been sanctioned and have had conditions placed on their registration.
The CAA has also been criticised for allowing chiropractors who take an anti-vaccination stance to be members – more detailed information around that can be found later in this post […more of this highly recommended, wonderfully researched article]
Update August 6 2015
Article from Australian Doctor. Serkan Ozturk reporting:
Chiros’ kids care comes in for criticism
Questions over whether chiropractic procedures should be performed on young children are being raised again following the sanctioning of six more chiropractors.
The chiropractors have received sanctions from the Chiropractic Board of Australia to undertake further education on professionalism and ethics over comments they had made on social media sites about how best to clandestinely enter hospital wards to treat patients.
A similar ruling was handed down in April to the former president-elect of the Chiropractors’ Association of Australia (CAA), Helen Alevaki, who admitted to “sneaky” visits of a maternity ward.
While it is unclear whether all the chiropractors were treating babies and children, the revelations of the visits has led the AMA to reiterate calls for an end to chiropractors performing spinal and neck manipulations on children due to a lack of evidence on their worth.
Many chiropractic clinics that treat children suggest the technique can assist with a variety of health problems such as bedwetting, colic, diarrhoea and ear infections.
“Adjusting babies is so safe and so relaxing that many newborns will fall asleep,” reads the website of Health in the Bay clinic, in Neutral Bay, Sydney.
Australian Doctor contacted several chiropractors who advertise their services treating babies and young children, with each refusing to comment.
Another Sydney chiropractor said the issue was “too political at the moment”.
The CAA’s CEO, Dr Matthew Fisher (PhD), says the association welcomes the recent sanctions upon its members as there should be “no circumstance” for chiropractors to enter hospitals without appropriate permission.
He said that some chiropractors were perhaps spooked by the “debate that’s been going on through different media outlets”.
Dr Fisher (pictured) said while knowledge about the possible dangers associated with procedures on children could be “significantly enhanced by ongoing rigorous clinical research”, there was already plenty of anecdotal and other evidence for their benefit.
“If a variety of evidence … goes to show that a modality of treatment either has or hasn’t got benefits, then that would be put to the profession for them to incorporate into their practice,” he said.
The CAA has commissioned the University of Technology Sydney to examine longitudinal health outcomes of chiropractic care.
Update August 7 2015
Article from Medical Observer. Flynn Murphy reporting:
Chiro chief condemns covert baby visitors
THE Chiropractors’ Association of Australia (CAA) has distanced itself from members who sneaked into hospitals to secretly treat newborn babies, describing the practice as “unprofessional”.
Speaking to MO, chief executive Matthew Fisher rejected criticism that the CAA attracts members with fringe views on medical evidence and vaccination.
He said at least one chiropractor had been expelled because of his criticism of childhood vaccination and several others had resigned because their views conflicted with the CAA, which supports vaccination.
Stories of chiropractors bragging about sneaking into hospital maternity wards to treat and adjust newborns sparked calls last week for a Senate inquiry. Their re-emergence followed the resignation of CAA president-elect
Dr Helen Alevaki, who admitted to the practice, a breach of the Code of Conduct for Chiropractors, in a Facebook post in 2013.
Sceptical health blogger Peter Tierney, who captured Dr Alevaki’s 2013 post, sparked a media storm for the group when he revisited it on his Reasonable Hank site after Dr Alevaki was named incoming president of the peak body last month.
AHPRA has confirmed that in the past nine months six chiropractors have been sanctioned for sneaking into hospitals. They are Katelyn McGregor, Catherine Langford, Jenny Roppola, Olivia Gleeson, Stephanie Le Coz and Tom Dawson.
Dr McGregor advised others on Facebook to “go at visiting time when their’s [sic] lots of people around and whack the curtain around. I visited my mum in neuro wards of lots of hospitals. No biggie…”
Mr Fisher stopped short of committing to expel from his association chiropractors who sneak into hospitals, saying that was a matter for state branches.
Mr John Cunningham, a Melbourne orthopaedic surgeon, says the incidents speak to the “hubris of many chiropractors”. Chiropractic has no evidence base and no place in hospitals, and risks breaking a newborn’s neck, he says, backing calls for an inquiry.
Murdoch University Associate Professor Rodney Bonello, who launched a new chiropractic lobby group, Chiropractic Australia, in response to a perceived failure by the CAA to “keep its members in line”, rejected Mr Cunningham’s “sweeping statement”.
Admitting evidence supporting the chiropractic treatment of newborns was “thin” and “anecdotal”, he said “we don’t slam the door on new areas of technique because we don’t have the evidence. We look for the evidence.”