The Chiropractic Board of Australia has had enough:
“We will not tolerate registered chiropractors giving misleading or unbalanced advice to patients, or providing advice or care that is not in the patient’s best interests,” chairman Phillip Donato said.
Dr Donato said chiropractors should only provide evidence-based treatment and anyone with concerns should report them. [Sydney Morning Herald August 9 2013]
Angela Hennessy manipulates customers at Sans Souci Chiropractic Centre, in Sydney. Hennessy is a member of the Chiropractors’ Association of Australia. She is also a member of the dreadfully deceptive anti-vaccination organisation, the Australian Vaccination Network. Unfortunately for the Chiropractic & Osteopathic College of Australasia, she is also a member of that organisation [edit August 29 2013: Hennessy has not been a COCA member since 2004. See comment by Dr John Reggars, below].
This screenshot taken from Hennessy’s website says enough about this salesperson:
Given Hennessy’s pride, one can only assume she would be proud to share AVN misinformation to her customers. Time for those spot checks, CBA.
Sorry, COCA. You need to get on this.
Can I just say a big “thanks” for this series? It’s quite seriously disturbing how many chiropractors are associated with the anti-vaccination movement. It’s been a real eye-opener for me. Thanks for your hard work!
Oh FFS – they can’t even spell “Australian”. Wankers.
If Chiropractors were to only give advise based on evidence and science they would have to tell their patients doesn’t work and they should go to a real medical practitioner.
Peter, that is simplistic and incorrect. Chiropractic is safe and effective for a number of musculoskeletal conditions. It is even more effective when done in correlation with an exercise regime. Modern chiropractic is not necessarily synonymous with spinal manipulative therapy, although many straights would argue against me (though they would probably insist I label it an adjustment). Modern chiropractic incorporates SMT, soft tissue modalities, EPT modalities, exercise, stretching, advice and based on recent evidence, CBT. There is still a fair amount of woo woo around within the profession, just look at the anti-vax section of the profession. But to label the whole profession in this one basket is ignorant.
Paul, I believe it’s “Strine”… innit?
Hank, this series has been an eye opener for the chiropractic profession. I wonder if there will be any action taken by either the CBA or the CAA. What are your thoughts?
Cynic that I am, I doubt a blog will make any difference to the “regulators”. It’s not like it’s been a secret for a long time that the profession has a massive anti-vax, anti-science problem. If England’s BCC saga wasn’t enough to put a rocket up Aussie chiro, I’m not sure what it will take.
The Chiropractic & Osteopathic College of Australasia (COCA) http://www.coca.com.au has checked its member records, which reveal that chiropractor Angela Hennessy is not a current member of the Chiropractic & Osteopathic College of Australasia (COCA) and has not been a member since 2004, The College will endeavor to have Dr Hennessy remove any reference to her membership of COCA as soon as practicable.
COCA acknowledges the beneficial effects of mass vaccination and has, with relevance to chiropractic and osteopathy, published a Policy Statement on this issue. http://www.coca.com.au/wp-content/uploads/2013/03/Vaccination-Policy.pdf
It is also worthy to note that COCA has been actively lobbying the Chiropractic Board of Australia for over 3 years to put in place policies and procedures which, among other things, would restrict chiropractors from promoting or providing their patients with an anti-vaccination material. http://www.chiropracticboard.gov.au/News/Past-Consultations.aspx
COCA is a not for profit member organisation dedicated to the promotion of knowledge of disorders of the musculo-skeletal system and related aspects of health care in an ethical manner and with an evidence based approach.
Dr. John W Reggars OAM, DC, MChiroSc.
CEO & Vice President
The Chiropractic & Osteopathic College of Australasia
Thanks so much for your comment Dr Reggars. I’m chuffed that you’ve found the time to comment here. I know how much flack you have copped from the types of chiropractors featured in this series, for simply demanding that chiropractic be evidence based. I wish you all the best, and hope to assist you in your endeavours. I will amend my post, above.
Thanks “Hank” for correcting the post.
Thank you, Dr Reggars, for replying. We understand that the COCA are striving to be evidence based and are trying to get some regulation into the practice.
If I may ask, does COCA have an adverse event reporting system, or if not, are there plans for one? I’m finding it very hard to accept that CAA affiliated chiropractors insist that they obtain informed consent, but cannot describe with any degree of accuracy the risks that may be associated with their treatments. If they accept there are risks at all.
My interest is a professional one as I work in the area of patient Safety &Quality of Care.
Here is the link to the RCoC’s CPiRLS facility http://www.rcc-uk.org/default.aspx?m=28&mi=277
Thank you John for representing the rational and professional view publicly. It would be great to reach a position where your standards are accepted as normal amongst the Chiro profession, and the anti-science people are left behind.
Thank you for commenting on this series. I haven’t seen a direct comment from a CAA representative with a firm statement at all in either direction. This includes the present and former board members mentioned. Thank you also for having the courage to voice your objection. I have observed other chiropractors cop flak and be discriminated against for daring to question an anti-vaccine position.
COCA has an affiliation with the UK’s Royal College of Chiropractors and 3 years ago we entered into an agreement for COCA members to be included in their excellent adverse incident reporting facility CPiRLS. To my knowledge, CPiRLS is the only self reporting system available worldwide.
Thank you again Dr Reggars, that is excellent. I also monitor a no-blame incident reporting system, and you can get good data from it as well as track actions and recommendations. I think it’s important in every profession to have systems like these so that lessons can be learnt and safety/quality enhanced.
You also have the benefit of some international benchmarking with your system 🙂
@ Dr John Reggars
FYI, the UK Royal College of Chiropractors’ Chiropractic Patient Incident Report and Learning System (CPIRLS) has been more of a failure than a success:
“Reasons identified for under-reporting included fear of retribution, being too busy and insufficient clarity on what to report…until there is greater clarity of the purpose and role of the CPIRLS, the system will probably remain under-utilised.”
Ref: Clinical Chiropractic, Volume 11, Issue 2, Pages 63-69 (June 2008)
Dear Blue Wode
I have no doubt that there is under-reporting with the CPiRLS system for the reasons outlined but some reporting is better than none. This type of self reporting system requires confidence, and for many a leap in faith. Confidence that reporting an adverse event does not result in some form of retribution or admonishment from ones peers. From my limited knowledge in this area, other self reporting systems in public hospitals suffered the same problems as CRiRLS is experiencing but over time they became a valuable tool in risk management and patient safety.
I can personally attest to the value of CPiLRLS in my role in risk management with COCA. For example there have been 2 personal injury insurance claims, I know of relating to patients falling off treatment tables. When I last looked at the literature there were no case reports or studies relating to this adverse event yet in CPiRLS another 3 were reported.
So whether there is under-reporting or not this has been a valuable risk management tool which ultimately improves the safety of chiropractic patients and as confidence and usage of this system increases also will its value in terms of patient safety.
John Reggars wrote:
“From my limited knowledge in this area, other self reporting systems in public hospitals suffered the same problems as CRiRLS is experiencing but over time they became a valuable tool in risk management and patient safety…whether there is under-reporting or not this has been a valuable risk management tool which ultimately improves the safety of chiropractic patients and as confidence and usage of this system increases also will its value in terms of patient safety.”
Thank you for your reply, however I can’t say that I share your optimisim re your prediction “as confidence and usage of this system increases”. Workers in public hospitals aren’t in the same position as chiropractors – i.e. if the risks of chiropractic were conclusively shown to outweigh the benefits (not an unrealistic prospect given that currently the only evidence for chiropractic is short-lived pain relief in a sub-group of low back pain sufferers -, and even then the outcomes may be due to non-specific effects ), then chiropractors (who work in a relatively narrow field) could ultimately be looking at losing their livelihoods. IMO, that means that they will continue to be reluctant to utilise any adverse events reporting systems.
Dear Blue Wode,
Chiropractic is not interchangeable with SMT and your attempt to judge a profession on an intervention is a strawman argument. Chiropractors apply many therapeutic interventions for which most have quite decent evidence in regards to back pain for instance exercise prescription, McKenzie protocol, soft tissue therapy, SMT, mobilisation, TENS, Dry needling, reassurance and pain education.
In terms of back pain there is still no therapy that stands apart from the rest and as such most of your comments could equally be applied to any other profession that treats back pain, we all have a stake to prove what we do works. No doubting there is under reporting under the Cpirls system but this is not unique to chiropractic but applicable to any adverse event reporting. You ask for increased reporting then shoot it down as soon as it is offered, you are impossible to be pleased. Please direct me to the system employed by private practice physiotherapists, osteopaths, massage therapists etc in Australia.
Evidence based chiropractors do not live and die on the merit of SMT as an intervention although no one doubts how popular it is, nor how central it is to our identity. I applaud John Reggars’ comments and am glad to have him representing me professionally.
@ Tom Condon
I was being generous towards evidence-based chiropractors (a tiny minority).
However, for the benefit of unenlightened readers, your description of evidence-based chiropractors above (exercise prescription, McKenzie protocol, soft tissue therapy, SMT, mobilisation, TENS, Dry needling, reassurance and pain education) is physiotherapy whereas true chiropractic (the detection and correction of ‘subluxations’ using specific adjustments – as practiced by the majority of chiropractors) is pseudoscience.
Re “most of your comments could equally be applied to any other profession that treats back pain”.
No they couldn’t. I can’t think of any other profession that resorts to this:
“Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”
[Ref: Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009)
Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and gives the reference Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.]
Re: “No doubting there is under reporting under the Cpirls system but this is not unique to chiropractic but applicable to any adverse event reporting. You ask for increased reporting then shoot it down as soon as it is offered”
Yes, I do, because it’s a drop in the ocean. For example, in U.S. – where the vast majority of chiropractors practice – there is no reporting system because of a loophole. How can the safety of chiropractic patients be improved *in any meaningful way* when the majority of chiropractors are so blasé about it? I would add that many chiropractors, as well as their regulators and professional associations, seem to find it acceptable to promote anecdotal or weak evidence where it supports chiropractic treatment, but where similar, or more robust evidence suggests that serious complications (e.g. stroke) can result from it, they are known to be quick to dismiss it, or at the very least play it down. It all looks like economic predation to me.
Dear Blue Wode,
I will not get roped into defending what is or isn’t chiropractic, I have merely defended what I and other chiropractors do in practice. Suffice to say I find it amusing that dry needling and SMT is considered physiotherapy where the origins of these therapies is acupuncture and chiropractic. An evidence based practitioner that deals with conservative spine management will naturally expand their scope of therapeutic options with the evidence regardless of profession. So you see there is no pleasing you, anyone that practices evidence based chiropractic is said to not be a chiropractor and then we are criticized by the standards set by our less evidence informed peers. As an evidence based chiropractor I share most in common with other evidence based practitioners such as physiotherapists than I do with people stuck practicing early 20th century chiropractic.
It is a text book example of strawman arguement and I must say your style of arguement is very unreasonable unlike the owner of this blog, Hank.
Tom wrote: “I will not get roped into defending what is or isn’t chiropractic.”
That’s not very helpful.
Tom wrote: “I find it amusing that dry needling and SMT is considered physiotherapy where the origins of these therapies is acupuncture and chiropractic. “
Dry needling may ultimately have to be dropped based on the scientific data coming in for acupuncture – i.e. its effects are not clinically significant (‘a theatrical placebo’ as some call it). As for SMT having its origins in chiropractic, that is not correct. It has its origins in the centuries-old practice of bonesetting:
“Spinal manipulation has actually been practiced since ancient times. A Chinese Kung Fu document, for example, describes it in China as early as 2700 BCE…In 1867, in the British Medical Journal, the respected English surgeon Sir James Paget stated that some manipulations performed by bonesetters had value.”
Ref. Homola, S. [DC], Chapter 2: From Bonesetting to “The Big Idea”, Inside Chiropractic, pp 9-15.
Tom wrote: “So you see there is no pleasing you, anyone that practices evidence based chiropractic is said to not be a chiropractor and then we are criticized by the standards set by our less evidence informed peers.”
It’s not just me…
Tom wrote: “As an evidence based chiropractor I share most in common with other evidence based practitioners such as physiotherapists than I do with people stuck practicing early 20th century chiropractic.”
Then that raises this very pertinent question: How are patients informed about the two different types of chiropractors?
Do chiropractor regulators flag the different types on their lists of registrants? Patients have a right to know if they’re risking their time, money – and even lives – on quackery.
Dear Blue Wode,
Thanks for your reply. You are correct that chiropractors were not the first group to perform SMT- but we were the driving force for it’s popularity- in any case it’s an adopted intervention by physiotherapists was the point not to get caught debating semantics about whom was first.
As for dry needling, here is a very recent RCT showing benefit over lidocaine injections and sham. http://www.ncbi.nlm.nih.gov/pubmed/23629597. I am sure you are aware of this though as it has been covered by Paul Ingraham whom is on the Science based medicine site. I am sure you will tell me why this study is not to be trusted- whether it is it’s relatively small numbers or like Paul argued that 2 points on VAS superior to placebo is not clinically significant (4 point drop on average).
In any case wether dry needling or SMT is sufficient in evidence base needs to be put perspective to other options for back pain treatment. Here are two great newspaper articles featuring Head of the Murdoch school Bruce Walker which I believe explain the schools stance on SMT as an intervention.
You do ask a good question about how do the public become informed about the two different types of chiropractors and I agree it can be difficult. Professional affiliation to COCA/CAA does somewhat sort the practitioners in a rudimental way, but in my opinion this is not enough. Ideally the CBA would enforce EBP guidelines creating only one type of chiropractor- but otherwise I think both parties have such separate goals and mindset that they are best clearly delineating themselves to go their own separate ways.
I would be interested to get Hanks, thoughts on this as he has dealt and spoken to chiropractors of both mobs. As an outsider Hank how would you recommend patients find and EBP practitioner?
If it’s CAA – stay away.
If it’s COCA – it’s kosher.
Simplistic, but, it really seems to be sorting itself out that way. I would even recommend any CAA chiros who are tired of taking hits to their integrity, change associations immediately. The CAA should be shut down. There is no place for anti-vaccinationism and magic in real health care.
Tom wrote: “You are correct that chiropractors were not the first group to perform SMT- but we were the driving force for it’s popularity”
Hmm. You said the “origin’ of the therapy was chiropractic. Do you have data which confirms that chiropractic was “the driving force” for SMT’s popularity with other MSK practitioners? For example, Still’s osteopathic SMT intervention was ahead of DD Palmer’s chiropractic discovery.
Tom wrote: “…in any case it’s an adopted intervention by physiotherapists”
Who, it has to be stressed, use it far more far judiciously than chiropractors.
Tom wrote: “You do ask a good question about how do the public become informed about the two different types of chiropractors and I agree it can be difficult…Ideally the CBA would enforce EBP guidelines creating only one type of chiropractor- but otherwise I think both parties have such separate goals and mindset that they are best clearly delineating themselves to go their own separate ways.”
Huh? Chiropractors’ livelihoods are dependent on income generated from their trusting patients. Why are patients, in the 21st century, continuing to be bamboozled by them? Why is it taking so long to enforce EBP guidelines? It seems to me to be all about fear of losing lucrative, easy incomes. I can’t think of any other reason for the reluctance to reform.
Hank wrote: “If it’s CAA – stay away. If it’s COCA – it’s kosher.”
And how many Australians know that? Also, it’s not just a problem in Australia, it’s a worldwide public health scandal.
Blue Wode wrote: “Who, it has to be stressed, use it far more far judiciously than chiropractors.”
Come on Blue, for a person who stresses the evidence, this is purely just an anecdotal claim. It might possible be correct, but it’s a stretch to say it with certainty. I’ve seen physiotherapists use SMT when there are red flags a plenty and they should have immediate medical referral.
Blue Wode wrote: “Huh? Chiropractors’ livelihoods are dependent on income generated from their trusting patients. Why are patients, in the 21st century, continuing to be bamboozled by them? Why is it taking so long to enforce EBP guidelines? It seems to me to be all about fear of losing lucrative, easy incomes. I can’t think of any other reason for the reluctance to reform.”
At this stage, I believe here in Australia that the registration board will only act if a treatment program lasts longer than 12 weeks without reassessment. Please don’t take that as gospel. If I hadn’t had a positive result before 12 weeks I’d be pretty concerned at either my clinical decision making or the patient’s condition. At present, it only seems to be if a complaint is lodged with the registration board is any action taken, rather than any self policing.
Blue Wode wrote: “And how many Australians know that? Also, it’s not just a problem in Australia, it’s a worldwide public health scandal.”
Australians would only know that if they were tracking the situation and if the practitioner advertised themselves as a member of COCA/CAA, either via their website (which as has been shown COULD be a false claim) or via a membership sticker that gets sent annually.
roguechiropractor wrote: “Come on Blue, for a person who stresses the evidence, this is purely just an anecdotal claim.”
Well, around 90% of chiropractors ‘adjust’ (manipulate) patients to ‘correct’ mythical subluxations. How many physiotherapists use manipulation based purely on quackery?
Blue Wode wrote: “Well, around 90% of chiropractors ‘adjust’ (manipulate) patients to ‘correct’ mythical subluxations. How many physiotherapists use manipulation based purely on quackery?”
I have a horrible feeling I’m going to regret asking this, but what is that claim based on? (and real evidence, not just a link to a website or blog please). Which country, when were the figures taken?
I’m not burying my head in the sand over this (because there are chiros correcting subluxations), but there is any chance that there could be a touch of hyperbole to your figures? I’m all for holding bulls#*t to account, but let’s not fight bulls#*t with more bulls#*t. Apologies for the language Hank.
A large survey of (and by) chiropractors which was carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Seminars in Integrative Medicine, 2004 V.2 No.3 92-98, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA (where well over 50% of chiropractors practice) feel that spinal manipulation should not be limited to musculoskeletal conditions – a figure which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon…
…which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge. Interestingly, the McDonald et al survey also revealed that 9 in 10 chiropractors believe in (fictitious) subluxations, 4 in 5 think they are involved in visceral illness, and 2 in 10 think they explain all of illness (so-called straight chiros).
A further indication that the majority of chiropractors are using spinal manipulation as a panacea can be found in research which the World Federation of Chiropractic gathered during its 2004-2005 consultation on ‘The Identity of the Chiropractic Profession’. It gives valuable insight into the chiropractic profession’s perceptions of itself on an international scale. For example, not only did the consultation result in the participating chiropractors’ unanimous agreement that the most appropriate public identity for the profession within healthcare was “The spinal health care experts in the health care system” – a definition which clearly allows pseudoscientific chiropractic practices to continue to flourish – it also produced a document entitled “Abstracts of Previous Relevant Research” which cited the 2003 McDonald et al study, and specifically mentioned the following in section E, No.6 (p.20):
“Approximately 9 in 10 [USA chiropractors] confirmed that the profession should retain the term “vertebral subluxation complex” (88.1%) and that the adjustment should not be limited to musculoskeletal conditions (89.8%). Subluxation is rated as a significant contributing factor in 62.1% of visceral ailments.”
In addition to that, the results of the consultation showed that 65% of all participating chiropractors thought that the general public should perceive chiropractic as “Management of vertebral subluxation an its impact on general health”.
roguechiropractor, do you have any figures which are more up to date than that? Also, please bear in mind that chiropractors responding to surveys could well be at the more ethical end of the profession, so the true figures could be a lot more grim than those highlighted above.
Thanks Blue Wode. No, the figures you have posted appear to be the most recent on the subject.