Chiropractic - False Advertising

[fls]

A chiropractic couple has been practicing in my home town for several years. And they offer a full and complete range of chiroquackery. I just got off the phone with my mother who had to vent about the latest edition. They have been running full page ads aimed at pregnant women - promoting manipulation of the woman and eventually manipulation of the newborn - with lots of warnings about subluxations caused by the trauma of birth (present in 80% of newborns apparently) and predictions of dire consequences unless chiropractic care is sought.

It seems to me that there must be regulations about truth-in-advertising that would make it possible to get these ads stopped. Does anyone have any advice about where and when complaints can be made? This is in Alberta, Canada. I have suggested sending a letter of complaint to the newspaper in which the ads were placed, the College of Chiropractors of Alberta, and Advertising Standards of Canada. Any other suggestions? The provinical Health Minister?

TIA,
Linda

 

[blutoski]

A chiropractic couple has been practicing in my home town for several years. And they offer a full and complete range of chiroquackery. I just got off the phone with my mother who had to vent about the latest edition. They have been running full page ads aimed at pregnant women - promoting manipulation of the woman and eventually manipulation of the newborn - with lots of warnings about subluxations caused by the trauma of birth (present in 80% of newborns apparently) and predictions of dire consequences unless chiropractic care is sought.

It seems to me that there must be regulations about truth-in-advertising that would make it possible to get these ads stopped. Does anyone have any advice about where and when complaints can be made? This is in Alberta, Canada. I have suggested sending a letter of complaint to the newspaper in which the ads were placed, the College of Chiropractors of Alberta, and Advertising Standards of Canada. Any other suggestions? The provinical Health Minister?

TIA,
Linda

I think you'll have to be specific about what, exactly, you think they have done that is dishonest... If the practitioners are licenced chiropractors, this falls within their scope of treatment. The fact that chiropractic is legal in Alberta is because the licencing standards have accepted the claim about subluxations and connection with health. If they can produce a study that shows 80% of newborns have subluxations, there's no evidence that they're intentionally lying.

Basically, you're running up against a bigger problem than this ad: Chiropractic is perfectly legal in Alberta.

The way to get ads pulled is to demonstrate one of the following:
a) that the claims are outside the scope of chiropractic
b) that the advertisers are not licenced chiropractors
c) that the advertisement is part of a bait-and-switch operation


There was a fellow in BC (I'm in BC) who was upset about a set of chiropractic advertising in his community and wrote to his MP... well, his MP was James Lunney!

What I'm saying is: good luck with that.

 

[fls]

I think you'll have to be specific about what, exactly, you think they have done that is dishonest... If the practitioners are licenced chiropractors, this falls within their scope of treatment. The fact that chiropractic is legal in Alberta is because the licencing standards have accepted the claim about subluxations and connection with health. If they can produce a study that shows 80% of newborns have subluxations, there's no evidence that they're intentionally lying.

I understand that the complaint will have to be specific. The problem is that they are over-reaching and promoting treatments which are not supported by any reasonable evidence, not that they are chiropractors. I couldn't find the word "subluxation" anywhere on the College of Chiropractors of Alberta website. And the College only refers to specific evidence-based treatments (a handful of conditions related only to the spine), which suggests that they (the chiropractors that my complaint is directed at) do not have the support of their regulatory body for their claims.

It seems to me that this would fall under "Both in principle and practice, all advertising claims and representations must be supportable. If the support on which an advertised claim or representation depends is test or survey data, such data must be reasonably competent and reliable, reflecting
accepted principles of research design and execution that characterize the current state of the art." which is part of the Code of Advertising Standards Canada.

Basically, you're running up against a bigger problem than this ad: Chiropractic is perfectly legal in Alberta.

The way to get ads pulled is to demonstrate one of the following:
a) that the claims are outside the scope of chiropractic
b) that the advertisers are not licenced chiropractors
c) that the advertisement is part of a bait-and-switch operation

What I'm saying is: good luck with that.

It looks like the claims are outside the scope of the evidence-based practice of chiropractic.

Linda

 

[blutoski]

I understand that the complaint will have to be specific. The problem is that they are over-reaching and promoting treatments which are not supported by any reasonable evidence, not that they are chiropractors. I couldn't find the word "subluxation" anywhere on the College of Chiropractors of Alberta website. And the College only refers to specific evidence-based treatments (a handful of conditions related only to the spine), which suggests that they (the chiropractors that my complaint is directed at) do not have the support of their regulatory body for their claims.

It seems to me that this would fall under "Both in principle and practice, all advertising claims and representations must be supportable. If the support on which an advertised claim or representation depends is test or survey data, such data must be reasonably competent and reliable, reflecting
accepted principles of research design and execution that characterize the current state of the art." which is part of the Code of Advertising Standards Canada.



It looks like the claims are outside the scope of the evidence-based practice of chiropractic.

Linda

I'm very intersted in how this turns out, as similar attempts in BC have been futile. "Subluxation" has many euphemisms: "structural misalignments" is the one they appear to endorse on the College's website. They do refer to the care as an "adjustment" to the spine. I predict they will find subluxations compatible with their approved treatment modalities.

Action from Chiropractic Colleges is very inconsistent: there is a current situation in the US where misrepresentations of the DRX9000 are being actioned by the Oregon board.

However, at the same time, Dr. Harriett Hall has had to re-submit her complaint about a different set of fraudulent claims (about applied kineseology) to the same body three times - each time, it was closed as AK is a diagnostic technique rather than a treatment. Complaining to the Chiro College is probably your first step, but be prepared for an exercise in futility.

 

[Blue Wode]

[small derail]

Here in the UK, where chiropractic is not defined by law, there seems to be a problem with the regulators’ definition of evidence-based care.

Section A 2.3 of the General Chiropractic Council’s Standard of Proficiency requires that “chiropractors’ provision of care must be evidence based”.

Unbelievably, the Council is claiming that subluxation-based practices, Applied Kinesiology and Craniosacral Therapy all fall within that definition.

See the November 2006 news item here:
http://www.chirovictims.org.uk/victims/news.html

[/small derail]

 

[Skeptic Ginger]

Don't expect anyone to call a spade a spade when it comes to challenging false advertising that chiropractic treatments do whatever it is claimed that they do. If there were any legal requirements of real scientific evidence before claiming chiropractic treatments actually provided any benefit beyond placebo relief for back pain, you wouldn't have licenses and third party reimbursement for chiropractors. Not only are many politicians as fooled as many members of the public, it seems we legislate proper medicine rather than using science to determine the best care. 'Believers' have managed to get legislation mandating insurance carriers cover chiropractic care along with a lot of other bunk medicine.

We have a few judges that can see when people are trying to weasel religion into science classes, but there is no equivalent check that medicine is using science to make its claims. That leaves a lot to hit and miss. You have to prove your claim in order to advertise a drug. But you can go pretty far on a claim a supplement provides a benefit without having to prove a thing. You couldn't get away easily with practicing medicine without a license or performing fake treatments like the quackery of old. But acupuncture and chiropractic treatments are not only allowed despite having no evidence to support the claims, laws have been passed requiring HMOs and medical insurance companies to cover the expenses.

We are indeed a schizophrenic country.

 

[Katana]

What surprises me is that they're advertising to pregnant women. Expectant moms are usually a "hot potato" group because of the medicolegal issues that can arise. Imagine what would happen if the chiro did his/her manipulations, and the woman went into preterm labor or aborted later that day. The likelihood of cause and effect there? Slim to none, but that wouldn't stop a lawsuit...in this country anyway. I don't know what the malpractice situation is like for chiros in Canada.

 

[Gord_in_Toronto]

A chiropractic couple has been practicing in my home town for several years. And they offer a full and complete range of chiroquackery. I just got off the phone with my mother who had to vent about the latest edition. They have been running full page ads aimed at pregnant women - promoting manipulation of the woman and eventually manipulation of the newborn - with lots of warnings about subluxations caused by the trauma of birth (present in 80% of newborns apparently) and predictions of dire consequences unless chiropractic care is sought.

It seems to me that there must be regulations about truth-in-advertising that would make it possible to get these ads stopped. Does anyone have any advice about where and when complaints can be made? This is in Alberta, Canada. I have suggested sending a letter of complaint to the newspaper in which the ads were placed, the College of Chiropractors of Alberta, and Advertising Standards of Canada. Any other suggestions? The provinical Health Minister?

TIA,
Linda

If you want some support from inside the chiropractic community that much of what is claimed is unproven, take a look at:
http://www.chirobase.org/04Ads/brochures.html
that references a study by three chiropractic "doctors".

I read an article in the National Post (on-line, I've only once or twice in my life actually purchased the paper) about the study shortly after it appeared but the url no longer works. I did save a text copy, however.

If you end up in discussion with the "authorities", this is useful evidence to bring forward as it is not based on "evil allopathic doctors and big pharm" doing the debunking.

 

[fls]

The Canadian Chiropractic Association and the College of Chiropractors of Alberta don't seem to endorse subluxation-based practice, so I was hoping that maybe there were limits placed on the wording of advertisements (like with physicians). But I'm getting the impression that that is not the case, so this would be more like a test case to force the issue. And I don't think my mom (or I) is prepared for that degree of involvement.

Katana it also surprises me that they target pregnant woman, but it seems just as surprising to target newborns. You would think that the potential for lawsuits would be large in both of those populations. The Canadian Chiropractic Protection Association (CCPA) covers 80% of practising chiropractors (according to their website) - a sort of self-insuring body similar to the CMPA for physicians. The CCPA may provide a source of reform since money talks. They have to settle cases when the care provided is not supported by evidence, which drives up the insurance costs for the rest. An unwillingness to pay for others' quackery could lead to limitations on insurance coverage and withdrawal of support for subluxation-based practices.

I had the same idea, Gord - that any support should come from chiropractic, rather than medical references.

Thank you all for your help.

Linda

 

[Skeptic Ginger]

What surprises me is that they're advertising to pregnant women. Expectant moms are usually a "hot potato" group because of the medicolegal issues that can arise. Imagine what would happen if the chiro did his/her manipulations, and the woman went into preterm labor or aborted later that day. The likelihood of cause and effect there? Slim to none, but that wouldn't stop a lawsuit...in this country anyway. I don't know what the malpractice situation is like for chiros in Canada.

I wonder just what would happen if you sued over bad advice. You might have an illness that was treatable and the chiropractor discouraged you from going elsewhere. Or perhaps someone should sue for false claims.

It would make an interesting trial.

 

[Skeptic Ginger]

Chirobase, if it is the people I chatted with before, claim they don't buy into subluxation and all the bogus stuff. They claim modern chiropractors are into relieving back pain and a few other limited disorders. And in some of those cases they do have outcomes as good as some regular treatments. They claim to give the patient relief without drugs.

One reason the research actually backs some of those claims up is the alternative regular medicine does so poorly. Both regular and chiro fare about as well as placebo.

But when I looked at all the schools of chiropractic, everyone of them included subluxation in the curriculum. The folks claiming to be modern chiropractors could not address this issue with any credible response. There may be a group of chiropractors that have branched off from the woo and want to join the evidence based med community. But it hasn't yet filtered into the schools and become official.

 

[JJM]

Chirobase, if it is the people I chatted with before, claim they don't buy into subluxation and all the bogus stuff. They claim modern chiropractors are into relieving back pain and a few other limited disorders. And in some of those cases they do have outcomes as good as some regular treatments. They claim to give the patient relief without drugs.

One reason the research actually backs some of those claims up is the alternative regular medicine does so poorly. Both regular and chiro fare about as well as placebo.

But when I looked at all the schools of chiropractic, everyone of them included subluxation in the curriculum. The folks claiming to be modern chiropractors could not address this issue with any credible response. There may be a group of chiropractors that have branched off from the woo and want to join the evidence based med community. But it hasn't yet filtered into the schools and become official.

Chirobase is a branch of Quackwatch. A chiropractor who practices to their recommended (non-subluxation) standard is little more than a masseur/masseuse. That is why chiropractic colleges can’t abandon that fiction. And too few chiropractors follow the “modern” model.

There is a medical subluxation (a dislocated joint), and chiros originally claimed that is what they were diagnosing and correcting in the spine. In the 1960s and early 70s, They were forced to admit they were wrong about that. Instead of changing their practices; in good, cult fashion they redefined their subluxation.
Association of Chiropractic Colleges: http://www.chirocolleges.org/paradigm_scopet.html

A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.

In plain English: “Whatever I can pretend to fix and bill you for.”

Moreover, the chiro sublux wasn’t merely a spinal problem- they claimed it influenced the health of visceral organs. This is what leads to the inflated claims of efficacy that inspired this thread. They claim (for example) they can subtly influence kidney function with a spinal “adjustment.” The fact that transplanted kidneys (and hearts, and livers …) work fine with no connection to the spine hasn’t influenced their “thinking.”

 

[Cuddles]

The Canadian Chiropractic Association and the College of Chiropractors of Alberta don't seem to endorse subluxation-based practice, so I was hoping that maybe there were limits placed on the wording of advertisements (like with physicians). But I'm getting the impression that that is not the case, so this would be more like a test case to force the issue. And I don't think my mom (or I) is prepared for that degree of involvement.

This seems rather surprising. The fundamental basis for chiropratic is that subluxations cause all illness by disrupting nerve signals. Having looked at the CCA it seems you are right that there is no mention of either subluxations or curing anything other than musculo-skeletal conditions. In fact, their description of what they do is

Chiropractors are experts trained in the neuromusculoskeletal system. They diagnose and treat disorders of the spine and other body joints by adjusting the spinal column or through other corrective manipulation. Chiropractors provide conservative management of neuromusculoskeletal disorders including, but not limited to, back, neck and head pain (over 90 percent of conditions treated). They also advise patients on corrective exercises, lifestyle and nutrition.

The simple fact is they are not chiropracters, they are physiotherapists (in the UK, I think they are called physical therpists in the US). This is the same as calling mixed herbal medicines homeopathy, it is just not true. It would be interesting to find out how many of them actually believe all the rubbish that is chiropractic and just don't publicise it, and how many simply don't understand that what they are doing is evidence based physiotherapy.

 

[fls]

It would be interesting to find out how many of them actually believe all the rubbish that is chiropractic and just don't publicise it, and how many simply don't understand that what they are doing is evidence based physiotherapy.

I think that the professional chiropractic organizations represent a movement from within similar to what we see on chirobase - towards evidence-based physiotherapy. I don't think it represents the standard practice, though. Surveys of chiropractors and of their practice show that the majority (~80% - this is off the top of my head but I could dig up more exact information if necessary) practice subluxation-based chiropractic. And as you pointed out, the colleges still teach subluxation-based theory. So it remains to be seen whether or not attempts at reform will take hold.

I think that those who are honest with themselves do recognize that it is evidence-based physiotherapy, which is why you see them expanding into areas like counselling on exercise, nutrition and lifestyle. And that these services are already provided by other healthcare professions may make it difficult for them to justify any particular role in the healthcare field. So you can see why reform will be difficult and why there is a strong cognitive bias away from an objective look at chiropractic. They may end up reforming themselves out of a job.

However, chiropractors have been given the leeway to self-regulate, which means that their professional organizations are under pressure to show that they can do a credible job (else that privilege may be taken away). And I think the insurance industry (both as payers for services and for malpractice insurance) may also help force the reform as they are not interested in losing money.

Linda

 

[fuelair]

Chiropractic - False Advertising

Why yes, yes it is!! The real question is why governments have allowed it and allowed degrees in it.

 

[JJM]

I think that the professional chiropractic organizations represent a movement from within similar to what we see on chirobase - towards evidence-based physiotherapy. ...

There are several chiro organizations. Many say they think chiro is, or should be, evidence-based; but none will abandon the cult features of the "profession."

Surveys of chiropractors and of their practice show that the majority (~80% - this is off the top of my head but I could dig up more exact information if necessary) practice subluxation-based chiropractic. ...

That is right. There was a large survey of chiros by chiros: McDonald, P. et al Seminars in Integrative Medicine (2004) 2:3 pp. 92-8. They found >75% believe in subluxation as a major contributor to visceral ailments. Only 1.5% completely discount subluxations.

I think that those who are honest with themselves do recognize that it is evidence-based physiotherapy, which is why you see them expanding into areas like counselling on exercise, nutrition and lifestyle. And that these services are already provided by other healthcare professions may make it difficult for them to justify any particular role in the healthcare field. So you can see why reform will be difficult and why there is a strong cognitive bias away from an objective look at chiropractic. They may end up reforming themselves out of a job.

But chiro education falls short of that of physical therapists and registered dieticians. So their advice is apt to be wrong. The difference between a rational chiro and a large pizza is- a large pizza can feed a family of four.

However, chiropractors have been given the leeway to self-regulate, which means that their professional organizations are under pressure to show that they can do a credible job (else that privilege may be taken away). And I think the insurance industry (both as payers for services and for malpractice insurance) may also help force the reform as they are not interested in losing money.

I wish you were right. They are unlikely to be delicensed, because they have a lot of money (i.e., political clout) and many vocal backers among their customers. As for insurance, there is little pressure on those companies. Most folks who see chiros are not very ill, and unlikely to be harmed (other than financially) by the procedures. We do know that chiro neck manipulation causes stroke. But, the frequency of this is low-enough that it doesn't significantly affect the insuror's bottom line. Of course, it is devastating to the victims.

As for direct payments for chiro treatment. That is slippery- the cost per visit is often lower than for a real, health professional. So, if the insuror limits the number of visits, it is advantageous. There is evidence that a few visits to a chiro is as effective as visiting a masseur for acute, low back pain. Chiro can be expensive for insurors if they pay for regular, maintenance treatment.

 

[fls]

I wish you were right.

I wish I was right, too. <g>

They are unlikely to be delicensed, because they have a lot of money (i.e., political clout) and many vocal backers among their customers. As for insurance, there is little pressure on those companies. Most folks who see chiros are not very ill, and unlikely to be harmed (other than financially) by the procedures. We do know that chiro neck manipulation causes stroke. But, the frequency of this is low-enough that it doesn't significantly affect the insuror's bottom line. Of course, it is devastating to the victims.

I was thinking of bad advice that leads to harm - like a child that dies from haemophilus influenzae type B meningitis after his/her parents forego vaccinations on the advice of the child's chiropractor.

As for direct payments for chiro treatment. That is slippery- the cost per visit is often lower than for a real, health professional. So, if the insuror limits the number of visits, it is advantageous. There is evidence that a few visits to a chiro is as effective as visiting a masseur for acute, low back pain. Chiro can be expensive for insurors if they pay for regular, maintenance treatment.

It would be cost-effective for payers if chiropractic treatment was a reasonable substitute for some other, more expensive, care (this may be the case for acute, low back pain). But I would expect the payers to want some sort of evidence that that would be the case for a broader range of conditions. If it's a poor substitute, then the insurers will end up paying more to cover bad outcomes.

Except, I think coverage of chiropractic is partly a PR gimmick, and as long as it doesn't get too expensive, insurers will pay for it.

Linda

 

[ponderingturtle]

But chiro education falls short of that of physical therapists and registered dieticians. So their advice is apt to be wrong. The difference between a rational chiro and a large pizza is- a large pizza can feed a family of four.

I would like to see your evidence that there is not good money in chiro

 

[JJM]

I would like to see your evidence that there is not good money in chiro

I don't have numbers. I cited rational chiros who don't administer to imaginary conditions as not doing well. Of course, many chiros get rich- especially via "Practice Buliding" procedures. See:
http://www.chirobase.org/

What is your point?

 

[Cuddles]

We do know that chiro neck manipulation causes stroke. But, the frequency of this is low-enough that it doesn't significantly affect the insuror's bottom line. Of course, it is devastating to the victims.

I have wondered about this. From what I have read it seems that while a few strokes have been identified as caused by chiropractic, the actual risk is so low that it can't even be calculated properly. I can't help feeling that arguments along these lines are simply used for their emotional value and not because they are actual based on good evidence. While I am obviously against chiropractic, we have to criticise it for what it is, and not fall into the trap of using arguments simply because we want them to be true. Does anyone have any good data on the actual risks?