Is the Chiropractic Board of Australia doing enough to protect consumers from pseudoscience?

Michael Vagg, Barwon Health

In this column two and a half years ago, I took the Chiropractic Board of Australia (CBA) to task for abdicating its responsibility to keep the public safe by waving through questionable activities that some chiropractors have taken part in. It drew this response from the Board, which I thought was a bit lukewarm at the time.

I resolved to wait and see whether they lived up to their public commitment. Maybe they would surprise me with their rigorous approach to protecting the public from the so-called “fringe” elements of the profession. I say “so-called” because some of the views that cause concern emanate from positions of considerable influence with chiropractic ranks.

I have not been the only one with these frustrations. An article by A/Prof Ken Harvey in the MJA Insight publication last year highlights some more direct action he has undertaken in an effort to drag chiropractors kicking and squealing into line with the same professional standards that seem so routine to other groups.

When followed up some months later it is clear little effective action has taken place. More than half of the misleading claims were still present in the complained-of websites. Only one of the ten clinic websites reported to CBA had removed the claims. The misleading and unprofessional claims that the CBA is tasked with regulating are still there, five years after it was first highlighted to them, and seven months after the CBA announced its intention to start getting serious.

The CBA Communique from its June 2015 meeting says:

The Board holds ongoing concerns about advertising by the profession that may be seen as misleading and deceptive. In particular, there have been a number of concerns raised about chiropractors’ advertising that indicates that there may be a lack of understanding of evidence and evidence-based practice.

Worryingly, the CBA’s credibility problem goes beyond advertising regulations. By continuing to lend its gravitas to some of the continuing professional development (CPD) activities that attract approved hours, I would suggest the CBA itself may end up looking like it has problems understanding the concept of evidence-based practice.

Here is an example of an activity approved by the CBA via their delegated authority to the Chiropractors Association of Australia (CAA). It specifically says on the website offering these online modules:

The Paediatric CPD Program is approved in Australia (by the CAA on behalf of AHPRA).

One of the modules on offer in this program is on Craniosacral Therapy. Craniosacral Therapy is an entirely made up and ineffective pseudo-therapy based on what “evidence” exists in the literature. It is implausible and has no credible reason for being promoted as a treatment for anything. To allow practitioners to offer it is entirely inconsistent with a commitment to evidence-based practice.

Here is another howler CBA might rather forget. Obtained by the medical media website 6minutes.com.au, it shows the CAA National approving CPD hours on behalf of CBA for chiropractor Tim O’Shea’s visit to Australia a couple of years ago. Note that CAA specifically pointed out that they were happy for him to use the Board’s imprimatur in his marketing.

CBA subsequently overturned the approval for claimable CPD hours after an investigation prompted by outrage from the more science-based chiropractic community and negative media coverage.

The CBA’s previous inability to professionally manage an investigation of an injured child has not been forgotten either. The failings of that case, including inappropriate public discussion of the highly confidential AHPRA report I have detailed previously.

Just have a look at the slap-downs being handed out by the other AHPRA Boards. Bear in mind also that the chiropractors disciplined by the Board so far have only been disciplined for advertising code breaches. The inappropriate treatment that they actually may be providing, if their advertising is anything to go by, has received little attention.

These ongoing frustrations within the profession have resulted in the formation of a new professional organisation based on professionally progressive ideals. The early signs are positive that this organisation may provide leadership and representation that is more in alignment with what the rest of the scientific health-care community expects from their colleagues in the 21st century. Whether Chiropractic Australia can influence the Board to take a similarly progressive stance against pseudoscience in their profession remains to be seen. It is a daunting and perhaps forlorn task but I wish them well in their efforts.

So after five years of hollow threats and effete regulatory action, the Chiropractic Board of Australia has “written to every chiropractor registered in Australia via the newsletter to remind them what is legal, and what the Board expects” according to the current Chair in a media release. They have also set out at length in their newsletter the standard to which they wish to hold their profession.

I guess it’s just too bad for the public if average chiros treat this latest “campaign” by their supine regulator with the same unresponsiveness they have shown for the last five years. Reform-minded chiropractors might prefer to see a few outrageously unprofessional colleagues temporarily put out of practice pour encourager les autres.

I think when one looks at the efforts of the CBA over the last couple of years, it’s hard to be confident that the public’s interests are being adequately protected. The reluctance of the fractured chiropractic profession to go along with even the most basic self-regulation standards seems intractable with a light touch. The strongest enforcements by the CBA have been brought about by public shaming from the media or within their own profession. As it stands they are the Caspar Milquetoast of regulators.

They could at least have a go.

Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Barwon Health

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

 

Trust me, I’m a doctor… of sorts

Rachael Sharman, University of the Sunshine Coast

Qualifications and their associated titles allow for quick identification of appropriately trained or recognised experts within a given field. They bestow legitimacy on the information provided to people looking for expert advice.

But how does the average person decide who to reasonably trust when it seems anyone can call themselves a doctor?

Traditionally, the title doctor was reserved for medical doctors, or scholars who’d completed postgraduate training to a doctoral level, and were recognised by their peers as an expert in their field.

Indeed, a number of dictionary definitions appear to support these two categories.

Free for all

But doctor creepage has been hastening with extraordinary stealth over the last few years, particularly within health care.

I can clearly remember assuming as an adolescent that chiropractors were doctors who specialised in a particular medical domain (back care) because the title Dr preceded their name.

It wasn’t until much later that I realised that Dr Chiropractor or Dr Osteopath or Dr Vet were all equally deceptive for implying that people using the title are either medical doctors, or substantially more qualified than an undergraduate degree.

To be fair, most medical doctors also have an undergraduate degree, but that involves six or seven years of tertiary training, similar to that undertaken in total by a doctor of philosophy degree.

And I’m not suggesting that members of the aforementioned professions haven’t undergone university training suited to their practice (I’ll come to that substantially more serious problem later), but there appears to be no legal impediment to a number of bachelor degree graduates using the title doctor.

In fact, I couldn’t easily find the answer to the question of whether there’s any legal reason why plumbers, hairdressers or retired beekeepers can’t use the title!

Surely this situation is confusing because most people would assume a particular type of training (medical), or level of training (recognised expert in their field) goes hand-in-hand with this title.

Training and expertise

But there’s an even more serious related problem here, and that involves the questionable practice of representing certain kinds of “tertiary training” as comparable to university-level qualifications.

This practice is also becoming increasingly rampant in the health-care field.

Representing certain kinds of ‘tertiary training’ as comparable to university-level qualifications has become rampant in health care. Truthout.org/Flickr

I was intrigued recently by a workshop reported by the press as being run by a “world renowned expert” allegedly “recognised as one of the foremost experts in the biochemistry of ADHD and ASD” (attention deficit hyperactivity disorder and autism spectrum disorders).

I wanted to discover more about this presenter, whose name was followed by the letters CNC.

After consulting the individual’s website, I discovered that CNC stood for Certified Nutrition Consultant, a qualification I had not previously heard.

And here’s a tip from that experience for punters: if you type the name of a qualification into Google, and the first site in the list is Quackwatch, you’re probably justified in being suspicions about the validity of that certification.

In this case, I was unable to find any mention that the person in question had engaged in any university-level education whatsoever. Although, to be fair, perhaps she has but chooses not to clearly advertise her education on her website.

While this particular CNC-qualified expert has written a couple of books and frequently appeared in the media, I couldn’t find any trace of her authoring a published study, review, or even having presented a basic scientific overview of her “research” in any kind of peer-reviewed journal.

When I tried to find out how one obtains registration as a CNC, I eventually found myself at its supposed credentialing website, which appeared to have some sort of requirement for tertiary training, but not necessarily at university-level.

Are you qualified?

This brings me to my final point: a number of qualifications in complementary medicine cannot be obtained from a public university because, quite frankly, these institutions won’t touch them.*

Indeed, training in a number of alternative health domains is not even vaguely scientific or evidence-based, despite the pretence of being so. This has led to a variety of colleges popping up offering all sorts of questionable “qualifications”.

Now, I’m not suggesting that there’s anything wrong with people seeking alternative health options. But I dare say there’s very deliberate confusion being created by credentialing practices by these colleges, that attempt to mimic traditional markers of university-level training or expertise, presumably for personal or professional gain.

For those seeking a specific type or level of recognised expertise, the inflation of qualifications via the appropriation of the title Dr is at best unhelpful, and, at worst, deliberately disingenuous.

And those seeking a particular basis of advice (alternative versus scientific, for instance) have the unhappy task of navigating a conflation of scientific and alternative health qualifications from questionable tertiary training colleges.

Apart from the confusion this creates, it suggests level of insecurity among some health-care practitioners who may be attempting to establish their legitimacy through stealth and deceit.

* This article has been edited to remove an incorrect claim that Australian public universities do not offer bachelor’s degrees in naturopathy. Students can undertake a three-year Bachelor in Clinical Sciences at Southern Cross University with a double major in naturopathy and complementary medicine. There is also a three-year Bachelor of Applied Science in naturopathic studies at the University of Western Sydney.

Rachael Sharman is Lecturer in Psychology at University of the Sunshine Coast.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.