Comment and Opinion

Chiropractors' Association of Australia

Chiropractors are unhappy. How sad is that? (4/12/2010)
The November edition of Australasian Science magazine contained an article by me titled "Who has the backbone to stop this?" The Chiropractors Association of Australia was not happy and made a formal complaint to the magazine. As the magazine doesn't have a Letters to the Editor column, the CAA were advised to make any comments via the magazine's web page, but a check of the article there indicates that they weren't motivated to do that. Perhaps they felt that a letter that would not be published, and therefore not attract attention to their claims, would be sufficient. I have decided to respond, as some of the statements made in the letter do not correspond to my version of reality, although I am prepared to admit that in this postmodernist, relativistic world it is possible that chiropractors have a different form of reality. To avoid any possible accusation of misquotation on my part, you can read the original letter, including the CAA logo, here.

Chiropractors Have Their Own Backbone*

(* A response to an article by Peter Bowditch in the November 2010 issue of Australasian Science)

Chiropractors welcome critical observation when it is intelligent and well-informed but dislike re-cycled ignorant cynicism and bias.

I like to think that I write original ignorant cynicism and bias, rather than recycled. I will address the ignorance and cynicism below, but I have to admit to bias against unscientific and dangerous practices pretending to be medicine.

Scepticism is healthy and the readers of this quality magazine have every right to expect The Naked Sceptic to reflect the magazine's mission to publish world-class science. Unfortunately Peter Bowditch's article "Who Has the Backbone to Stop This" in your November 2010 issue is so overloaded with factual error that it falls well short of being world-class.

I hope that some facts are coming to correct my errors.

On the other hand it is interesting to note Bowditch state that chiropractic sits between complementary medicine and what he mistakenly calls "real, scientifically-based medicine." In my role as Chair of a Human Research Ethics Committee within a multi-campus, Government-funded health network in Melbourne I regularly lead the review of applications designed to advance our collective understanding of medicine and its practices. My many medical colleagues, as decent, caring and hard-working practitioners frequently point out that which medicine does not know, in the scientific sense.

There is much that medicine doesn't know. That is the nature of science, so to say that there are things "which medicine does not know, in the scientific sense" is meaningless.

As a chiropractor I have high regard and respect for my medical colleagues and a deep understanding of the work they do. It is particularly interesting to note that medicine in general does not hold itself out to be "real and scientifically-based" in everything it does.

I would be interested to know what part of medicine doctors do not think is real, and also which parts of medicine are not based on science. If you are referring to that old canard beloved by quacks of all persuasions that X% of medicine has not been proved effective in randomised, double-blinded clinical trials then I suggest you offer yourself to be a member of the placebo group in studies into anaesthesia for abdominal surgery, suturing for knife wounds, splinting for broken femurs, morphine for reducing the pain of third-degree burns, charcoal lavage for the treatment of poisoning and other "untested" procedures.

The same can be said of chiropractic, and this is where Bowditch makes his fundamental errors and demonstrates both his ignorance and bias. I admit I have only been a chiropractic educator since my graduation as a chiropractor some 20 years ago, but I must say we do not teach that "all dis-ease is the result of pressure on nerves."

From the CAA web site:

Chiropractic is based upon the understanding that good health depends, in part, upon a normally functioning nervous system.

Chiropractic works by helping to restore your own inborn ability to be healthy. When under the proper control of your nervous system, all the cells, tissue, and organs of your body are designed to function well and resist disease and ill health. The chiropractic approach to better health is to locate and help reduce interferences to your natural state of being healthy.

A common interference to the nervous system is the twenty four moving bones of the spinal column. A loss of normal motion or position of these bones can irritate or impair the function of the nervous system. This can disrupt the transmission of controlling nerve impulses.

Chiropractors aim to improve nervous system function primarily through chiropractic adjustments (with particular attention to the spine, skull and pelvis), to help remove any interference that may be impairing normal health

Palmer may have thought like that in the late 19th Century, at a time when medicine was either heroic or homeopathic, X-ray was a new discovery, and it would still be some 30 years before Flemming discovered the first usable antibiotic. We also teach the value of evidence-based chiropractic practice, an approach supported by the Chiropractic Board of Australia which requires chiropractors to offer evidence to support any claims of clinical outcomes. Contemporary chiropractors understand disease and illness is actually multi-modal and this principle underpins the chiropractic curriculum in Australian universities.

Chiropractors claim to treat asthma, autism and ADHD, and now seem to be moving into dentistry. Please enumerate the "modes" of these conditions with special emphasis on those amenable to chiropractic adjustment.

From the CAA's Continuing Professional Development
program for 2010

As noted in the opening sentence above, scepticism is healthy. A recurring theme in my writing is my questioning of the claims chiropractors make and how it is that we know what it is that we say we know. Chiropractors do know that the X-ray does not show subluxation.

Then one must ask why chiropractors take X-rays of the spine. If subluxations can't be detected, surely this practice exposes patients to increased risk from radiation (and increased expense, of course).

The point missed by Bowditch is that what chiropractors call subluxation for the lack of a better term is actually a functional lesion of the spine, and not one that is structural. Static plain film radiographs are quite poor at showing functional lesions, if they do at all.

So, effectively, subluxations are subjective. Or, put another way, imaginary.

His suggestion chiropractors reject the germ theory of disease is quite incorrect. Chiropractors are well trained in microbiology at university level and understand bacterial infection and viral diseases. But while respecting their role in disease we hold neither the germ nor the virus as the reason for our existence.

This is obvious. They are not even the reason for the existence of real doctors, let alone ones who think that diseases can be related to undetectable "functional lesions" in the spine.

Bowditch will be unable to explain why one person in a household falls victim to a germ or virus to which all other members of that household have been equally exposed.

Perhaps I could try. Let's see:

• As different people have different sets of life experiences, no two immune systems carry exactly the same set of antibodies
• Not all diseases are universally infectious or contagious. The Black Death and the 1918 flu epidemics didn't kill everyone. Put another way, not all infectious agents cause epidemics.
• All the members did not receive identical exposure.
• Even within a single family people are not genetically identical.

Indeed, this is one of the mysteries of public health, and in their attempt to understand it chiropractors have taken a view that there may be variable degrees of resistance in individual bodies that allow some to succumb while others remain healthy.

Which is what I said. This is not news to real doctors and is the subject of continued research.

With respect to neurological connections, your sceptic really shows his nakedness when he twice tries to denigrate a view of chiropractors by resorting to the supposed anatomical fact that there is no nerve connecting this with that.

I was quite specific. I said that there are no nerves passing through the spine that connect the brain to the ear. Please do not say that I said things that I didn't say. If I am wrong in this specific instance, please tell me the name of the nerve which passes through the spine and causes otitis media when its function is impaired by subluxation.

An hour or two of learning about convergence within the central nervous system and the interplay between its autonomic and cranial nerves and their processing of, and in return management of, the peripheral nervous system may help him better understand the way the human body functions.

I can learn it in an hour? Does that make me very smart or chiropractors very dumb? Actually, an hour seems like a long time, because I learnt kinesiology in about five minutes but according to the CAA's schedule of professional development courses for the next few months chiropractors need several days of training.

And we haven't yet touched on the homeostatic balance between the sympathetic and parasympathetic systems. All neurologists, including those chiropractors who have made it their specialty through considerable additional study, admit to living in the shadow of what remains largely unknown.

As I said above, real doctors admit that they don't know everything. That is how science works and why research is done.

Surely this magnificent part of human existence deserves more than to suffer severely limited comment based on 19th Century anatomical knowledge?

Human anatomy was quite well understood in the 19th century. What major discoveries have been made since then that implicate the spine in the range of conditions that chiropractors claim to be able to treat?

The suggestion that "attempts to reform the profession and place it on a scientific basis have been strongly resisted" is scurrilous. There are five or six funded Chairs of Chiropractic Research in Canadian Universities, none of which deliver a first-professional program in chiropractic and are thus "scientifically" independent of the profession.

So you support the continued growth and success of the US-based National Association for Chiropractic Medicine, a group based on the idea that chiropractic can be moved to a position where it can be firmly based on science. Oh, that's right, you can't, because it folded in 2009. The people who set it up finally got sick of the insults and the resistance to science in the chiropractic profession. All they were asking was that chiropractors only perform treatments and procedures for which there was good scientific evidence, but apparently that would have placed too much restriction on practitioners. It is much better to spend money researching better ways to increase the growth of the client base and how to retain patients once they are acquired than it is to try to find evidence of the elusive subluxation.

Two of the three chiropractic programs in Australia's universities are led by chiropractors with a doctorate; the third leader has relevant additional qualifications in a specialty area of practice. The Australian Spinal Research Foundation is the largest chiropractic body in the world to fund chiropractic research, and the Palmer Research Institute in Iowa is richly funded by grants from the US Federal Government.

Where are the results of this research published? I know that grants from the US National Council for Complementary Medicine require publication of even negative results (one reason that they can't give away all the budget) so there must be something somewhere. I would also like to see evidence that the findings of chiropractic research have been adopted outside the profession by specialists such as sports medicine doctors, physiotherapists and orthopaedic surgeons.

This is a commendable record of scientific performance in the absence of research dollars from the highly profitable drug companies who, in Australia, generate their income largely from public money.

Why is it admirable for chiropractic research to receive government funding but wrong for pharmaceutical companies to receive government money through sales to the PBS?

And then we come to the hoary chestnut of opposition to vaccination. One of the things this writer celebrates about his profession is the breadth of freedom of thought exhibited by its practitioners. Yes, there are chiropractors who have successfully raised their own families without vaccination and there are chiropractors, myself included, where certain vaccinations are accepted.

In the current vaccination schedule recommended by the federal Department of Health, which vaccines do you think are essential and which should not be there?

And of course, there are many in the middle. But as responsible players in Australia's public health arena we do get nervous when we see a vaccine manufacturer allegedly fail to adequately test their product on children and also allegedly fail to adequately control the quality of production.

A lot of "allegedly" there. Are you generally opposed to swine flu vaccination or just concerned, as was everyone else, about the minor problem which arose in Western Australia?

Every parent in Australia is concerned to note a nine times greater incidence of negative reaction in infants recently vaccinated with a certain "seasonal" vaccine. Again, one bought at great expense by public money and then poorly utilised to the extent there has been a gross waste of public resources.

I'm afraid that quoting from the anti-vaccination liar hymn book doesn't inspire confidence that you really don't oppose vaccination.

Do you have a comment about the fact that the CAA, the organisation you represent, were handing out anti-vaccination literature developed by US-based chiropractor Tedd Koren at a recent trade show targeting parents of young children? There is nothing ambiguous about Koren's material. It is packed with lies and is deliberately designed to discourage vaccination. It is also specifically marketed in bulk packs to chiropractors.

A poster and information pack from Tedd Koren. Note the lies
in the first two lines of the ingredient list.

Detail from a Tedd Koren brochure, containing lies that the author (and the
chiropractors he sells the brochures in bulk to) assume are uncheckable by parents.

Do you also have a comment about the award of "Hero of Chiropractic" made in 2000 by the Pediatric Council of the International Chiropractors' Association? It was made to a man who was in prison for murdering a ten-week old baby and was granted on the basis that the child had died from a vaccine reaction, not a savage beating by a vicious thug.

The use of derogatory language is also unhelpful. To infer it is a misconception to see "chiropractors ... (as) ... some sort of back pain specialist(s)" is mischievous, as any cursory review to compare the chiropractic curriculum against the medical curriculum will attest.

Why are back pain specialists treating autism, ADHD, colic and ear infections?

Bowditch may be surprised to note that it is not only the breadth of content but its depth that ensures chiropractors are the experts in non-invasive spinal care.

I met someone recently who is an expert in UFOs. His knowledge of flying saucers was both wide and deep.

He is welcome to visit my University's anatomy lab and pathology museum by arrangement; he may be surprised at the superb quality of the material that underpins the learning undertaken by registered student chiropractors. And yes, student chiropractors are registered under the new National Scheme.

And in coming back to the observation that chiropractic now sits between complementary and Western medicine

This dichotomy always amuses me. As Claire said to Elwood in The Blues Brothers: "We got both kinds here, complementary AND Western". What could be more Western than something invented in the USA? Bruce Springsteen sang a song about it.

it must be stated that the National Health Professions Regulation Act ranks chiropractic alongside medicine, dentistry, pharmacy, nursing, psychology and a number of other disciplines and applies the same rigid principles of registration. Further, the profession-specific Boards are also charged with the accreditation of educational programs and the public can take heart from the fact that Government is indeed keeping a close eye on the major health disciplines in Australia, of which chiropractic is one. The outcome of this will be a strengthening of what Bowditch recognises as "an excellent health system."

My view is that registration does nothing except allow practitioners of fringe "complementary" modes of "medicine" to assume a cloak of respectability. It is made even worse when education and registration standards are set by the very people who need to be controlled. That something like chiropractic, which contradicts almost all that is known in medicine, can be accepted as a medical profession is not just a tragedy, it is a disgrace.

Perhaps it is time for The Naked Sceptic to move on to a topic about which he actually has contemporary and factual information, instead of filling a few column inches with an old agenda revealing misinformation, ignorance and prejudice.

Yours sincerely,
Associate Professor Phillip Ebrall
Spokesperson, Chiropractors' Association of Australia

Phillip Ebrall is Associate Professor of Chiropractic Education at RMIT University Melbourne, and an Adjunct Professor in the Faculty of Medicine at the International Medical University in Kuala Lumpur.

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I'm waiting patiently (25/2/2012)
In 2006 the Chiropractors' Association of Australia came up with a Strategic Plan.

They even had some major objectives.

Unfortunately they probably have managed to influence health policy in the last few years, because chiropractors can now legally use the title "Dr" in front of their names to confuse the public about reality. We are still waiting for that "credible scientific research" though. Actually, if chiropractic was shown to be useful to treat any medical condition and this was demonstrated using properly-conducted clinical trials the appropriate term might be "incredible research". Much like hearing about successful transmutation of lead into gold, or achieving true "free energy", or maybe finding a single cure for all forms of cancer.

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Chiropractors are unhappy! Sob, sob! (13/7/2013)
Some of my friends appeared in a television show this week about chiropractic. Chiropractors are not happy, because the show wasn't a complete pander to their delusions of making a meaningful contribution to public health.

I congratulate the ABC Catalyst program for presenting a balanced view of this form of quackery. My opinion about this nonsense is well known, so I will allow the video to stand on its own for now. I will however make special mentions of Dr Mick Vagg's wonderful statement about how we don't turn to magic carpets because planes crash, and how could I resist another distribution of Mr John Cunningham's lovely facepalm.

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Chiropractic cleanout? (10/8/2013)
Everyone has been getting very excited over the last week because the government-sanctioned Chiropractic Board of Australia has announced that it is going to have a mighty crack-down on chiropractors who spread lies about vaccination. (I would have avoided the dreadful "crack-down" pun used by all media outlets reporting this, but it comes directly from the CBA. They wrote the material.) Here is the media release from the CBA.

I am far less sanguine about this than many of my friends. My prediction is that chiropractors will carry on as before opposing vaccination, sorry "advising their customers of the potential dangers of vaccines", and not a single chiropractor will be deregistered and pushed out of business by this. Oh, there might be some PR-worthy wrist-slapping but that will be all. The Board really has little influence over what chiropractors say or do, but a little lip service and window-dressing never goes astray.

The professional body of chiropractors (with about 50% of them belonging to it), the Chiropractors' Association of Australia, has already expressed disquiet at the Board's threat and suggested that the responsibility of chiropractors to provide "good" advice to customers overrides any attempt by the Board to pander to people who don't understand the value of a good neck snap.

Two things in the media release are encouraging, however.

The Chiropractic Board of Australia is cracking down on chiropractors who step outside their primary role as healthcare practitioners and provide treatment that puts the public at risk.

That should mean that neck twisting is out because of the well-known and proven danger of cerebral artery damage caused by chiropractors doing sudden and sharp manipulations of the cervical spine. Then there are the people put at risk because they go to a chiropractor instead of a doctor and therefore miss out on correct diagnosis and treatment of medical conditions, but that is a general and valid criticism of all "alternative" medicine.

"However, the Board takes a very strong view of any practitioner who makes unsubstantiated claims about treatment which is not supported within an evidence-based context," he said.

Well, there goes the whole of chiropractic. Take out the stuff that's not based on evidence and there's nothing left. Perhaps we can look forward to a coming Board meeting when they follow the example set by the gay-bashing Exodus International organisation and announce that the whole chiropractic thing is over and they apologise to all the people deceived since DD Palmer invented the scam and his son worked out how to turn it into a business.

Oh, to any chiropractors who object to my use of the word "customers" and would prefer "patients", I say "Dear Mr X, when you are a doctor, not just someone who likes to be called 'Doctor', I will use the word 'patients', but not before".

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Chiropractors in the news (28/9/2013)
Chiropractic has been getting its share of publicity lately, and to my great pleasure this attention has been focused on the uselessness and dangers of this particular form of medical charlatanism. In July Australia's premier television science show had a look inside the profession, and this week two expos's have appeared. The first is an article in the Sun Herald newspaper.

This story is disturbing for several reasons, but the title and the first three paragraphs provide a good summary.

1. Chiropractors have no business touching children of any age. (I would be happy if the minimum age for treatment by one of these quacks were to be legislated to be 120 years.) There is nothing that they can provide that can increase the well-being of infants. Adults might get a placebo effect from hearing pops from their backs but babies won't and should not be exposed to the dangers of this unregulated form of sympathetic magic.
2. I have written before about the uselessness of the Chiropractic Board of Australia, which only exists to provide a veneer of respectability to chiropractic so that its practitioners can say "See, we are just like real doctors". In a clear case of negligence and inappropriate treatment leading to severe injury the best they can (or will) do is hide the problem and tell the quack to get advice from another quack. The expression ''expert in the field of paediatric chiropractic" is precisely analogous to ''expert in the field of unicorn metabolism" or ''expert in the field of exorcising ghosts". When the discipline is meaningless expertise means nothing.
3. Real doctors and other medical staff have to jump through many hoops before they are even allowed to go near patients in hospitals, and this even applies to relatives. Nobody is allowed to treat children without undergoing police checks; nobody can treat any patient without the institution's permission and without it being part of a treatment plan (and an emergency creates its own plan); nobody can just walk in, no matter what expertise they have, and start work even if everything they might need to know is on the documentation at the end of the patient's bed. Nobody! Not doctors, not nurses, not specialist doctors, not ambulance paramedics. Nobody. Except chiropractors, who lie that they are just visiting someone.

You might think that this last point is something that happens rarely, but my friend Peter (who prefers to be called Reasonable Hank to protect his privacy and shield him from attack) has done a comprehensive analysis of chiropractors' Facebook comments and pages and has found that the practice seems to be widespread. It also seems to be condoned by the Chiropractors' Association of Australia, which is hardly surprising given that members of the various CAA committees admit to this sort of unethical behaviour.

See Reasonable Hank's article here

People have said that the Chiropractic Board of Australia should do something about this, but why would anyone expect it to do more than hand waving and platitudes. It's not there to regulate or control chiropractic, it's there to give the "profession" a professional appearance. Its response to a child with a broken neck shows what it finds acceptable. People have said that the Chiropractors' Association of Australia should do something about this, but why would anyone expect a club for charlatans to try to do anything about its members following its leaders' example.

There is only one way to fix chiropractic, make it safe and force practitioners to behave ethically. That is to close it down completely and consign it to the rubbish bin of history along with blood-letting, cauterising and the four humours. It was invented in 1897 and became obsolete three minutes later. Why is it still here?

And if you think it can't be silly as well as dangerous and useless, here is picture from a chiropractor's Facebook page showing him adjusting a turtle. Please remember that the turtle's shell is part of its spine and the plates in it are totally unmovable.

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Late breaking news (28/9/2013)
The CAA has responded. By some strange stroke of fate this media release appeared on the Facebook page of the Australian Vaccination Network.

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Chiropractors. Such fun people. (8/8/2015)
Imagine the following scenarios:

• You are in a restaurant having a meal and someone gets up from one of the tables, goes into the kitchen, and starts cooking food
• You are waiting for your car to be serviced and to fill in the time you pick up a spanner and start doing things to the engine of another car in the workshop
• You get bored waiting for your prescription to be filled because the pharmacist is busy, so you go behind the counter and assist him by filling prescriptions yourself
• A visitor to a new mother in a hospital performs a medical procedure on the newborn baby, despite having no affiliation with the hospital, or even being a doctor.

"Outrageous!", you say. "Impossible!", you say. But the last one has happened. Several times.

The President-elect of the Chiropractors Association of Australia has been forced to resign from the position because it has been revealed that she had been going into hospitals and "adjusting" new-born babies. She admitted on her Facebook page that she had done it at least once, but since this was revealed several more stories of chiropractors doing the same thing have come to light. Ms Helen Alevaki (who likes to be called "Dr" even tough she is only a chiropractor) works out of a chiropractic business named "chiro4wellness" and apparently specialises in a particular kind of quackery known as "Webster Technique" which appears on the surface to be some sort of obstetric practice which pretends to make birth easier. (Ms Alevaki had her own children at home with a midwife. Of course.) The method of gaining access to hospital patients is to come as a visitor, draw the curtains around the bed, and get cracking on the baby's spine.

If a real doctor did this to someone who was not his patient, in a hospital to which he did not have visiting credentials as a doctor, he would face severe discipline and possibly even loss of his licence to practice. The punishment for a chiropractor is to do two hours of training on record-keeping and the use of social media. And to keep on chiropractising without any further impediment. Chiropractic is, after all, a self-regulated industry, and there is that old cliché about foxes and henhouses.

What is outrageous is that chiropractors are allowed to get anywhere near babies other than the usual interaction allowed to normal parents, friends and relatives. They are not doctors, they are not pediatricians, they have no qualifications to do anything related to babies. (Or anyone else, in my opinion.) That there is an International Chiropractic Pediatric Association should be an affront to all the real doctors who treat children without the need to resort to magic. Oh, did I mention that the ICPA urges caution about vaccinations and suggests that parents ask their doctors such questions as "Where is the scientific evidence showing vaccines are safer than the disease itself? Where is the scientific evidence showing vaccines prevent these diseases?" and "Where is the balance on the pro-vaccine web sites?". The organisation that Ms Alevaki heads is a member of ICPA.

You can read a media report of Ms Alevaki's resignation from her position at CAA here.

In that article you will see mention of a group known as Chiropractic Australia. This has been presenting itself to the world as an association of chiropractors who want to practice some form of evidence-based medicine, getting away from the innate energy and subluxations of traditional chiropractic. The founder of this group has recently said that further research needs to be done into pediatric chiropractic, but until that is done it is better to err on the safe side and keep fiddling with babies' backs. Or, put another way, keep doing the things which have no evidential backing. Just like all the other chiropractors. This is a "profession" which cannot be salvaged.