by Mal Vickers
Back in June 2012, a letter was sent to the Chiropractors’ Association of Australia (CAA). The text of this letter is reproduced below. The letter was signed by representatives of the Australian Skeptics and the Tinnitus Association of Victoria.
Att: Dr Laurie Tassell
President of the Chiropractors’ Association of Australia (National) Limited
Date: 19 June 2012
Dear Dr Tassell,
We request that your organisation takes action by removing misleading claims regarding the treatment of medical conditions via chiropractic. It appears to be a practice of a small number of your members to advertise that they can treat conditions for which there is little or no scientific evidence that chiropractic is effective.
We appeal for action for the protection of Australian consumers.
A ‘Google Advanced’ search using the words ‘chiropractor’ and ‘asthma’ shows more than 80,000 results with the search limited to the ‘.au’ (Australian) domain.
You may confirm this result by typing this short link into any internet browser:
Whilst not all search ‘hits’ are relevant, it does highlight a problem. Some Australian chiropractors are claiming to be able to treat asthma and other conditions where the scientific evidence appears to be lacking. Further investigation and use of your association’s ‘Find a Local Chiropractor’ website search, suggests that some are Chiropractors’ Association of Australia members.
We would also like to bring to your attention the findings of the Bronfort Report (2010). The Bronfort Report was commissioned by UK’s General Chiropractic Council (GCC). The Bronfort Report appears to be the most wide-ranging and recent study of the evidence in support of chiropractic in one document, thus it is a useful reference.
From the Bronfort Report, it is clear that a reasonable person would regard it as misleading to claim to be able to use chiropractic to treat the following;
Asthma, colic, ear infections (otitis media), bed-wetting (nocturnal enuresis), ADHD, allergies, tinnitus, sinusitis, sciatica, coccydynia, temporomandibular joint disorders, fibromyalgia, pneumonia, pregnancy pains, menstrual pain and many others.
It appears that some of your Association’s members claim on their websites to be able to treat conditions included in the above list. Internet searches also find claims that chiropractic can ‘improve your immune system’. There is little or no scientific evidence supporting those claims.
We appreciate and acknowledge some criticisms of the Bronfort Report. Notably that the search for evidence only included the scientific literature written in English, and that the researchers did not clearly distinguish between chiropractic treatments and other treatments, such as osteopathy. We note that the Bronfort Report was written by chiropractors and if it is to be criticised for its bias, it is biased in favour of the practice of chiropractic.
Despite those limitations, we think the findings of the Bronfort Report are broadly valuable as a reference. The findings of the Bronfort Report suggest that chiropractic is scientifically efficacious for a small number of conditions. The conclusions of the Bronfort Report are attached in Appendix A. You can find a full copy of the Bronfort Report at:
http://chiromt.com/content/18/1/3
In addition, we would like to draw your attention to a number of Cochrane Reviews, which generally corroborate the findings of the Bronfort Report. These are included in Appendix B.
The Cochrane Review findings are in the following areas of research:
Chiropractic and Asthma, Chiropractic and Dysmenorrhoea (Period Pain), Chiropractic and Nocturnal Enuresis (Bed Wetting)
Our understanding is that as a result of hundreds of complaints about chiropractic advertising in the UK and the subsequent release of the Bronfort Report, the GCC issued advertising guidelines to UK chiropractors stating;
“You are urged in the strongest terms to use the Report [Bronfort] and its evidence summary tables to review the content of your printed advertisements, practice leaflets and any website that publicises your practice….”
Please note the difficulties experienced by the UK regulator in relation to hundreds of complaints submitted by the Nightingale Collaboration about chiropractic advertising in the UK. Our information is that it took almost two and a half years not to mention the significant expense to resolve these complaints.
We suggest that communication with your membership would be a far simpler and cost effective way to deal with advertising that is not in line with current scientific research.
Note that we are not suggesting that scientific research into chiropractic should cease.
We believe that this request is in accordance with the Code of Conduct for Chiropractors developed by the Chiropractic Board of Australia which states:
2.2. Good care:
(h) “Providing treatment/care options based on the best available information”
(o) “Practising in an evidence informed context including clinical outcomes”
9.8 Giving evidence:
(d) “Making clear the limits of a chiropractor’s knowledge and not giving opinion beyond those limits when providing evidence”
There appears to be a limited number of chiropractors providing misleading information. However, we wish the majority that do not make unreasonable claims, continued success.
Those signing this letter politely request an acknowledgment of this correspondence within one month. We would be pleased to receive a reply before that time; otherwise we think it would be reasonable to assume that no reply is forthcoming. We trust you will receive this request with the spirit of respect with which it was sent.
Yours sincerely
(signed) Terry Kelly, Australian Skeptics (Victorian Branch), President
(signed) Eran Segev, Australian Skeptics, President
(signed) Ross McKeown, Tinnitus Association of Victoria, President
Appendix A
The Conclusions of the Bronfort Report (2010)
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.
Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.
Appendix B
Cochrane Review: Chiropractic and Asthma
Authors’ conclusions:
There is insufficient evidence to support the use of manual therapies for patients with asthma. There is a need to conduct adequately-sized RCTs that examine the effects of manual therapies on clinically relevant outcomes. Future trials should maintain observer blinding for outcome assessments, and report on the costs of care and adverse events. Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma.
Cochrane Review: Chiropractic and Dysmenorrhoea (Period Pain)
Authors’ conclusions:
There is no evidence to suggest that spinal manipulation is effective in the treatment of dysmenorrhoea. In the one trial reporting on adverse effects there was no greater risk of such events with spinal compared with sham manipulation.
Cochrane Review: Chiropractic and Nocturnal Enuresis (Bed Wetting)
Authors’ conclusions:
There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects clearly reported.
The CAA’s Response:
The CAA replied on the 27 July 2012, noting that their Chairman had been away for some time. None of the issues in the Australian Skeptics/Tinnitus Association letter were addressed.
In October 2012 another letter was sent to the CAA asking if they had any problem with the publication of the original letter. More than two months ago the CAA replied, asking for an electronic copy of the letter, which they were sent.
No further contact has been received from the CAA.
Chiropractic Services Advertised on Australian Websites:
I have a challenge for the chiropractors who offer patients a “free check up” of their spinal health. Please send me ONE confirmed instance of a customer who was told by a chiropractor: “GO AWAY. THERE IS NOTHING WRONG WITH YOU”.
Perhaps the ACCC is the next step?
I went to one in a shopping centre, I was told i had great posture and did not need any treatment. But i could come for any advice etc.. George i think you need to seek mental help?
Thank you Tony. You are the first person who has every been cleared of any problems by a chiropractor in the many years I have asked this question. Please send me her name. Meantime it appears you conclude I have a mental problem because I asked what should be a reasonable question. It says more about you than me.
I perceive a deep seated problem with the majority of CAM practitioners in that the practitioner diagnoses the problem and supplies the treatment, which is wide open to abuse by over servicing and lacks any checks and balances.
In contrast a medical doctor will refer you to a specialist or supply a prescription which you fulfil at the pharmacy of your choice.