Chiropractors tired of scrutiny. Bless.

IT was good to see the Chiropractic Board of Australia last week issue its strongest statement yet on misleading claims in advertising by the profession it regulates.

“The Board is concerned about a number of practitioners who are making claims in advertising that there is a relationship between manual therapy (e.g. manipulation) for spinal problems and achieving general wellness or treating various organic diseases and infections; or that spinal problems may have a direct role in various organic diseases and infections,” the statement said.

“There is insufficient scientific evidence to support these claims.”

Well, yes.

The Board expressed particular concern at claims of benefit in a wide range of infant and child health problems, including developmental and behavioural disorders, attention deficit hyperactivity disorder, autism spectrum disorders, asthma, infantile colic, bedwetting, ear infections, digestive problems, and pre-birth correction of breech presentations.

Chiropractors should not provide anti-vaccination materials and advice or make public comments discouraging vaccination, the statement said.

Some chiropractic waiting rooms and websites have in recent years become recruiting grounds for the anti-vaccination movement, according to an article in the Sydney Morning Herald last year.

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It beggars belief that the wilder claims made by some chiropractors have been allowed to continue for so long. It’s not as though it’s a new problem.

In a communique issued on 29 August 2010, the Chiropractic Board asked all practitioners to review their advertising, including their websites, “as a priority” to ensure they conformed with advertising guidelines applicable to all health professions regulated by the Australian Health Practitioner Regulation Agency (AHPRA).

Those guidelines are based on the National Law on health practitioner regulation, which states chiropractors, like doctors and other health professionals, must not engage in “false, misleading or deceptive” advertising, must not use testimonials or purported testimonials, and must not create an unreasonable expectation of beneficial treatment.

Did that call to action stamp out the more outrageous claims made by some in the profession? Hardly.

Nearly 4 years on, I found a number of Australian chiropractic clinics claiming beneficial outcomes in a range of non-musculoskeletal conditions, including asthma, colic, ear infections … and the list goes on.

Some websites seem to have slightly shifted their advertising approach since then, moving away from explicit claims of clinical benefit to simply listing the conditions people might choose to see a chiropractor for.

That might help them to avoid being in breach of the letter of the law, though the list would probably still create an expectation of clinical benefit in the average health consumer.

The indefatigable public health campaigner, Dr Ken Harvey, has recently documented apparent advertising breaches on more than 200 chiropractic websites, as he revealed in MJA Insight earlier this year, and has made a number of formal complaints to AHPRA.

There are, as Dr Harvey points out, penalties available for breaches of the legal requirements and guidelines, including court-imposed fines and disciplinary action by the relevant professional board.

So far, though, there seems to have been a singular reluctance by any of the regulatory bodies to impose those kinds of sanctions.

It seems even less likely we’ll see genuine attempts to rein in the misinformation being provided by chiropractic groups that provide “information” rather than clinical services.

The Australian Spinal Research Foundation says its mission is “to facilitate research and disseminate knowledge that furthers the understanding, development and effectiveness of chiropractic care”.

Fair enough, though a warning bell might be sounded by the follow-up statement that this mission is fulfilled by facilitating research “in support of chiropractic”.

Because that’s how research works, right? First, you decide what you want it to show and then you make sure it does just that.

In a page headed “Autism and the Case for Chiropractic”, the Foundation cites a case study in a 3-year-old child with autism that showed “marked improvements in her condition following subluxation-based care”.

While acknowledging that – “encouraging as that case may be” – further research is needed, the site goes on to suggest chiropractors might be able to help children with autism through potential effects on brain plasticity, neurological function and gut health.

The Foundation, which is listed as an associated organisation on the Chiropractors’ Association of Australia website , also makes claims about the ability of chiropractic to treat babies for breathing problems, breastfeeding difficulties, allergic reactions and chronic infections.

“Perhaps, just perhaps, the grey cloud of scrutiny is finally lifting off the area of paediatric chiropractic care,” the Foundation says.

Applying scrutiny to non-evidence-based treatment of infants and children? The “naysayers”, as this website describes them, really will stop at nothing.

Jane McCredie is a Sydney-based science and health writer.