By Mal Vickers
Dr Ken Harvey, a friend of the Vic Skeptics was recently interviewed on ABC Radio National. (play the interview below)
The subject up for discussion was advertising by chiropractic businesses. The interview was prompted by an article Dr Ken Harvey recently authored for the MJA (Australian Medical Journal).
In the article, Ken expresses his concerns that not much has changed in the last five years since the regulator, AHPRA (incorporating the Chiropractic Board of Australia, CBA), issued a warning via a newsletter for chiropractors to clean up their advertising.
The Board asks all chiropractors to review their advertising including their websites as a priority to ensure that the content meets the advertising requirements of the National Law and the provisions of the Guidelines on Advertising. There are criminal penalties for breaching section 133 of the National Law, which is set out in the attachment to this communiqué.
AHPRA newsletter, Aug. 2010
Since then, a CBA statement has also reminded chiropractors about their advertising obligations “in more than six publications in the past three years…”
Dr Harvey noted in the interview that some advertising had improved in the last five years but some hadn’t.
There are around 4800 registered chiropractors in Australia.
It appears to me that although most chiropractors advertise in an ethical manner, it only takes a small percentage of the total number of chiropractors doing the wrong thing to cause a significant problem for a regulator and hundreds of advertising websites that are in need of editing.
I helped Dr Ken Harvey with some of the research supporting his recent complaints to AHPRA. Consequently I’ve read a LOT of online advertising by Australian chiropractors. Again, I must stress that it’s not all chiropractors who are doing the wrong thing; but for those that are it’s quite disturbing reading.
I’ve read claims to treat health conditions unrelated to the back or the spine. Many such claims are also clearly aimed at treating children and babies. I’ve seen these health conditions discussed in a positive ‘I can help’ kind of way on chiropractic websites; colic, asthma, ear infection, cancer, diabetes, tinnitus, pneumonia, bedwetting and so on. I’ve also read suggestions that chiropractic treatment can, somehow, boost or improve your immune system. How? Don’t ask me!
In the same ABC interview, Bryce Conrad, a Queensland chiropractor and Professor Rodney Bonello, president of Chiropractic Australia offered their perspectives on the problem of chiropractic advertising.
I thought I’d have a go at rebutting a few of the points that were made on-air.
Is it only chiropractors?
Much of the discussion was about comparing different professions, that is, why single out chiropractors for dubious advertising?
AHPRA provides details of the numbers of complaints made about the various professions they regulate in their annual report. The most recent AHPRA annual report is the 2013/14 report published in January 2015.
For reasons unknown to me, AHPRA looks at complaints about advertising separately from complaints about professional conduct. Advertising complaints are referred to the ‘Statutory Offences Unit’ of AHPRA. This unit received 547 complaints about advertising in 2013/14.
Dental practitioners were the worst performing in terms of totals, with 222 advertising complaints received. However chiropractors were not far behind with 186 complaints received. Further down the list were medical practitioners with 48 complaints. It’s worth putting these numbers into perspective in terms of complaints per person.
These are the totals of AHPRA registered professionals in these three fields recorded at 30 June 2014.
20,707 dental practitioners
99,379 medical practitioners
Crunching the numbers, per 1000 dental practitioners, 10.7 will have had an advertising complaint made against them in 2013/14.
Per 1000 chiropractors, 38.4 will have had an advertising complaint made against them in 2013/14.
Per 1000 medical practitioners, half of one (0.5) will have had an advertising complaint made against them.
The numbers show that it’s not just chiropractors with a problem in this area. However chiropractors are attracting complaints at approximately 3.5 times the rate of dental practitioners. Dr Ken Harvey also noted the difficult, closed and unsatisfactory process that AHPRA has for making complaints.
Are Chiropractors Primary Health Care Professionals or Not?
There was some discussion as to whether chiropractors were ‘Primary Health Care Professionals’ or not. Whilst these words might hold different meanings for different people, I think what is meant is that anyone who puts themselves forward as a ‘Primary Health Care Professional’ will be able to deal reasonably well with anyone who arrives at a practice with any health condition. They will have sufficient skills to diagnose many common health conditions. They will have a good idea when to refer a patient to another specialist as well as a good range of on the spot options, particularly evidence-based treatments – all in the best interests of a patient (that’s my interpretation).
During the ABC segment, there was some suggestion that the idea of chiropractors thinking of themselves as ‘primary healthcare practitioners’ was out of date.
The Spinal Research Foundation, (the research arm of the CAA) made the following visionary statement in a newsletter in 2010.
“to achieve a fundamental paradigm shift in healthcare direction where chiropractic is recognised as the most cost efficient and effective health regime of 1st choice that is readily accessible to all people.”
“1st choice” that’s quite bold. Well okay, 2010 is going back a little. What about more recent statements?
RMIT University puts itself forward as the leading teaching institution for chiropractors in Australia. It says the following in part of their curriculum guide which is currently online and I assume are up to date with their recent AHPRA approved teaching practice. They state:
– situate the chiropractor as a primary health care professional within the context of the Australian Health Care System.
It’s not a really clear statement but at least a part indication that chiropractors are being encouraged to put themselves forward as the first point of call for patients.
I wonder if this is a moot point; you don’t need a referral to see a chiropractor for treatment, as such they are the first port of call by choice for some people. Shouldn’t that mean they must be high quality and evidence-based?
Anyway, have a listen to the ABC Radio National segment – enjoy.
I’m off to get my spine’s innate intelligence aligned to my subluxations – or something.