Issue 16 / 2 May 2016

A VIDEO of a Melbourne chiropractor “adjusting” the spine of a 4-day-old premature infant in a bid to cure it of colic has prompted calls for the end of GPs referring children to chiropractors.

“It’s time to make a stand,” Dr Evan Ackermann, chair of the Royal Australian College of General Practitioners (RACGP) Expert Committee — Quality Care, told MJA InSight.

The video of Ian Rossborough, known as “Dr Ian”, was highlighted on an episode of the ABC’s Background Briefing radio program on 22 April, and has received over a million hits.

It prompted the RACGP, through Dr Ackermann, to call for an end to referring children to chiropractors and for GPs to “seriously reconsider” referring any patients to chiropractors.

“This is a public safety issue,” Dr Ackermann told MJA InSight. “[Situations like the one in the video] are an accident waiting to happen, and the medical profession has condoned it with our silence.”

Both the Chiropractic Board of Australia (CBA), and the Chiropractors’ Association of Australia (CAA) had failed to act on complaints of misleading advertising, Dr Ackermann said.

“They say there’s going to be a reform, but those complaints remain largely unresolved.

“The Chiropractic Board cannot address the scope of practice issues, and that leaves them with no credibility.”

Late last week the president of Chiropractic Australia (CA) — a moderate splinter group formed last year in reaction to numerous controversies plaguing the CAA — said the RACGP stance was doing chiropractors “an injustice”.

In an interview published in Australian Doctor, Professor Rod Bonello said: “It’s entirely reasonable to be very frustrated with the behaviour of individual practitioners who do the wrong thing, but to recommend that doctors do not refer to chiropractors is an inappropriate response.”

He said he did not condone the practices shown in Ian Rossborough’s video, saying that “if all chiropractors behaved in that manner, then the RACGP would be right”.

“But they’ve done an injustice to the doctors’ patients by denying them the opportunity of chiropractic care when it is indicated.”

Dr Ackermann disagreed that the RACGP had “denied” anyone any opportunities.

“We asked doctors to seriously reconsider referring patients to chiropractors,” he said. “We stopped short of saying stop.”

However, he did not rule out the RACGP taking that final step in the future.

“I think the Health Minister and AHPRA [the Australian Health Practitioner Regulation Agency] should be wondering if it has been a mistake registering chiropractors,” Dr Ackermann said.

“By doing so we’ve leant credos to them, their scope of practice and also to the anti-vaccination lobby.”

Ian Rossborough uploaded a new video last week in response to the outrage his original video prompted.

In “Dr Ian explains why we adjust children” he used his own newborn daughter to show the technique he uses on his infant patients.

“The reason we adjust the baby is because the parents bring them to us. They’ve usually already been to the medical doctors, they’ve usually already been to hospital … and they come to us in desperation.”

A spokesperson for the CAA referred MJA InSight to a written statement which, in part, reads: “Patients who engage chiropractors are highly satisfied and this is achieved through a patient-centric approach and an informed consent process.

“Chiropractors bring the entire continuum of evidence to their practice. This includes evidence-informed practice, practitioner experience and patient outcome.

“If the same lens and bar was applied to all health professions that is being focused on chiropractors, the public discussion would shift and people would be asking questions of interest and balance of all health interventions not just chiropractic … If the current focus of levels of evidence in intervention is applied equitably to all health professions, then there will be concerns with the role or treatments that some health professions have in the ongoing care of the public.

“As in all professions, there are some practitioners who may not practice at the standard required and CAA works with the regulatory bodies to ensure this is minimised.”

Bernard Rupasinghe, policy manager for the CAA, said that over the past 12 months, the CAA had “significantly strengthened the professional development components of our ongoing education for members”.

“This has actively focused on ensuring members comply with their responsibilities as health practitioners, as regards advertising and social media. This education has been disseminated to members via numerous platforms including written publications, such as our member magazine The Australian Chiropractor, regular email updates and through social media channels,” he told MJA InSight.

Dr John Cunningham, a Melbourne spinal surgeon, said he was surprised it had taken so long for the RACGP to speak out.

“With the exception of acute lower back pain, there is no condition which a chiropractor can treat in any way better than a medical practitioner,” Dr Cunningham told MJA InSight.

“In the case of acute lower back pain, yes, chiropractors can get their patients back to work a few hours earlier than analgesics, but that’s it.

“Referring children to chiropractors is a waste of time and money, and it is potentially dangerous,” he said. “You risk missing a legitimate diagnosis by leaving a child with a chiropractor for too long.”

Dr Cunningham agreed that registration with AHPRA had added legitimacy “they potentially don’t deserve”.

“It’s time to call a spade, a spade.”

A spokesperson from the CBA told MJA InSight: “The Board doesn’t make comment on behalf of the profession as its role is to protect the public (it has no role in representing or furthering the profession).

“Whether practitioners in one profession refer to another profession or not, only becomes a regulatory issue if practitioners are not referring when their Code of Conduct would require them to. This applies to all 14 regulated professions.”


Poll

Will you reconsider referring patients to a chiropractor?
  • I certainly won't refer children (42%, 139 Votes)
  • Yes (42%, 138 Votes)
  • No, I've seen positive outcomes for my patients (16%, 52 Votes)

Total Voters: 329

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