ABC RN background briefing: Chiro wars

The latest media coverage in this long running saga.

Chiropractors are treating babies and children with conjunctivitis, bed wetting, autism and ear infections by manipulating their spines. The health regulator has told chiros to cease and desist. Ann Arnold reports:

http://www.abc.net.au/radionational/programs/backgroundbriefing/2016-04-24/7346284

See also: http://www.medreach.com.au/?p=1500

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Seminar: The Advertising of Therapeutic Good and Services, March 17, 2016

Introduction

This seminar is to be held back-to-back with World Consumer Rights Day 2016 (March 15) and the National Consumer Congress (March 16). The latter is hosted by the Australian Competition and Consumer Commission (ACCC). The 2016 Congress will discuss how to better protect and empower consumers in the lead up to the review of the Australian Consumer Law.

Our seminar’s aim is to outline current concerns that consumer (and health professional) organisations have with the advertising of therapeutic goods and services and explore ways in which the system(s) might be improved.

Organisations that have expressed concern about these matters include the Consumers Health Forum, Choice (Australian Consumers’ Association), Friends of Science in Medicine, Australian Skeptics, the Doctors Reform Society and Stop the Australian (Anti) Vaccination Network.

The seminar is organised and supported by Choice, the Foundation for Effective Markets and Governance (FEMAG), University of Sydney (Health Law Centre), Monash University (School of Public Health and Preventative Medicine) and the ACCC.

Topics to be discussed

  • The promotion of therapeutic goods to health professionals: Industry self-regulatory codes
  • The promotion of therapeutic goods to consumers
  • Promotion of therapeutic services by registered health professionals
  • Promotion of therapeutic services by unregistered health professionals

The following material is available for download:

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Chiropractic Board Media Release on Advertising, 7 March 2016

Chiropractors must ensure their advertising is within the law

The Chiropractic Board of Australia, which regulates Australia’s 5,000 chiropractors, has today released a statement reinforcing that practitioners need to ensure their advertising complies with the requirements of the National Law, or they risk prosecution and disciplinary action. More at:

http://www.chiropracticboard.gov.au/News/2016-07-03-media-release.aspx

Statement on advertising

The Board is very concerned about any chiropractors with advertising (including websites) that may not meet the required standards despite repeated guidance being provided by the Board.

In order to provide further clarity to both practitioners and the public, the Board provides the following clear advice on advertising matters. More at:

http://www.chiropracticboard.gov.au/News/2016-03-07-statement-on-advertising.aspx

Media coverage

My view: The Chiropractic Board’s “Statement on advertising” and “”Media release are welcome as far as they go.

However, there remain hundreds of chiropractor web sites that continue to make the claims identified in the “Statement” (and numerous other claims are made, equally lacking in evidence).

The last five years of “educative” communiques from the Board have had minimal impact on practitioners.  While this “Statement” is more specific than those produced in the past, it still does not identify all the non-evidenced claims complained about (see consolidated list from only ten complaints attached).

In addition, unlike the U.K. General Chiropractic Council and Chiropractic Australia, the Australian Chiropractic Board (and the Chiropractic Association of Australia) has yet to state that,

“The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease” (attached).

Claims made about the alleged value of routine chiropractic care for pregnant women, new-born, babies, children and numerous medical conditions are often based on this erroneous subluxation concept. In addition, they clearly increase the practitioner’s business and bank balance.

It’s my view that until such time as the Board and AHPRA penalise and publicise those practitioners for breaching s.133 of the National Law little will change.

Part 7, of the National Law is available to prosecute advertising offenders in the Magistrates Court (maximum penalties available for this statutory offence are $5 000 for an individual and $10 000 for a body corporate).

Part 8 of the National Law is available to sanction recalcitrant practitioners for repeated advertising offences. Penalties available under Part 8 include cautions, accepting undertakings, placing conditions of the practitioner’s registration or, for professional misconduct, referral to a tribunal with the power to impose additional penalties, including a fine of up to $30 000.

Another advantage of using Part 7 and 8 of the National Law is that Court and Tribunal Decisions about individual practitioners are published on the AHPRA web site.

I reiterate, until such time as timely and effective sanctions are employed by AHPRA and the Chiropractic Board, I doubt that significant change will occur.

For previous coverage click here.

 

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Chemmart’s myDNA test offers more than it can deliver

See: https://theconversation.com/chemmarts-mydna-test-offers-more-than-it-can-deliver-54484

Also: http://www.australiandoctor.com.au/news/latest-news/pharmacies-attacked-for-flogging-$149-dna-testing

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Victorian government crack down on dodgy health providers

The problem is that until all States & Territories introduce uniform legislation the unregistered Dr Dodgy will simply move and set up shop interstate.

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Complaints over IV infusions

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Chiropractic / AHPRA complaints

An article on this topic published in MJA InSight together with an opinion editorial in Fairfax press has attracted considerable attention (below).

More importantly, it led to a media statement by the Chiropractic Board of Australia on March 7, 2016.

The Advertiser Letters to the Editor, February 3, 2016

http://www.adelaidenow.com.au/news/opinion/the-advertiser-letters-to-the-editor-february-3/news-story/164c973c0eab9698da18c34ca497ceb3

Be accountable

MINISTER Snelling’s demand for answers from the chiropractors’ board and regulatory agency (The Advertiser, 2/2/16) is timely and welcome.

The internet has brought many benefits, but also a massive explosion in the promotion of bogus, pseudoscientific and sometimes dangerous “treatments” that are seldom, if ever, policed. Add the aggressive and overt attempts by various practitioners to make themselves the first person to be consulted by the unwell and their wholesale adoption of the title of doctor, and it is not surprising that many people are confused about what treatments may actually help them.

Friends of Science in Medicine has been advocating for years that those who profit by offering false hope and false treatments should be answerable, and Minister Snelling is to be applauded for taking up the challenge.

PROF JOHN DWYER, AO, President
PROF ROB MORRISON, OAM, Vice-President
Friends of Science in Medicine.

WE applaud Minister Snelling’s support for eliminating the false advertising of health claims in all media and particularly on the internet.

However, the various self-regulating boards of alternative therapists also need to start applying effective sanctions on their recalcitrant abusers. These boards to date have been completely ineffective in controlling nonsense therapeutic claims by their constituency, particularly in the treatment of babies, children and pregnant women.

EMERITUS PROFESSOR ALASTAIR H MacLENNAN, AO,
PROF MARCELLO COSTA,
For Friends of Science in Medicine

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Monash SPHPM Summer Vacation Scholars Program 2015

I’ve worked with two students undertaking this program over the last four weeks: Amy Yan & Ned Latham. We:

  • Reviewed the 19 recommendations of the Expert Review of Medicines and Medical Devices Regulation – Complementary Medicines (Chapter Nine) in preparation for my attendance at the Department of Health’s Stakeholder Forum held in Sydney  on December 8-9, 2015.
  • Critically appraised the promotion of Pharmacare’s Ease-a-Cold product and published an article in “The Conversation” about this, the regulatory deficiencies that allow such promotion and the views expressed at the Stakeholders Forum on the Expert Review recommendations.
  • Reviewed two Australian web sites that are promoting intravenous (IV) vitamins to the general public: iv.me hydration clinic and the hangover clinic. Complaints to AHPRA are in progress.
  • Analysed the outcome of 10 representative complaints sent to the AHPRA Chiropractors Board over 3 months ago, involving 38 chiropractors and 69 claims. A letter to the Board (and the ACCC) about the results (and the deficiencies of the complaint process) is currently being finalised.
  • Reviewed a number of websites promoting homeopathic products in the light of previous upheld determinations by the Therapeutic Goods Advertising Complaint Resolution Panel (TGACRP) and failure of the TGA to respond to additional complaints. A letter about these matters is currently being finalised with support from Friends of Science in Medicine, the Consumers Health Forum, Choice, Australian Skeptics and the Doctors Reform Society.

All the above involved the bread and butter of public health work: analysing regulatory deficiencies that allow unethical business practices, submitting complaints to highlight problems and advocating for regulatory reform.

 

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End of Life Choices

Made a presentation to the Parliament of Victoria, Legal and Social Issues Committee, Inquiry into End of Life Choices on behalf of Doctors for Voluntary Euthanasia Choice on Oct 15. 2015.

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ABC RN Interview: Does the evidence behind chiropractics stack up?

ABC RN Afternoon Program “Chiropractors under test” presented by Michael Mackenzie

Guests:

  • Dr Ken Harvey, Adjunct Associate Professor, School of Public Health and Preventive Medicine, Monash University
  • Dr Bryce Conrad, Board Member, Chiropractor’s Association of Australia
  • Professor Rodney Bonello, President, Chiropractic Australia.

There was some misinformation provided by Bryce regarding notifications to AHPRA about chiropractors and doctors. Our topic was advertising offences (not total notifications) and the following facts come from AHPRA’s 2013/14 Annual Report.

During 2013/14, AHPRA received a total of 547 advertising related complaints. Of these, 4,845 registered chiropractors accounted for 34% and 99,379 registered medical practitioners accounted for 9% of complaints. That is per 1000 chiropractors, 38.4 had an advertising complaint made against them in 2013/14 while per 1000 medical practitioners, half of one (0.5) had an advertising complaint made against them.

A total of 290 (98%) complaints were resolved when the individual or organisation complied with AHPRA’s demand to amend or remove the advertising, and required no further action. AHPRA referred six practitioners to the relevant National Board for disciplinary action.

The number of advertising complaints received about chiropractors in 2013/14 was the highest since complaints were first recorded in 2011/12.

The Board statement posted on the RN web site notes, “Managing advertising breaches is primarily complaints-driven”. Also, “The vast majority of advertisers respond to the first warning letter and amend their advertising accordingly. Any advertisers who fail to comply with the law after a second warning are considered for prosecution by AHPRA and/ or disciplinary action by the Board. This approach has proven to be a low cost and effective way of managing breaches of the National Law in relation to advertising”.

It may be low cost to AHPRA but it’s certainly not effective!

As I stated in the RN interview, working up an detailed and effective complaint is both time-consuming and unrewarding for the complainant. In my experience, a number of complaints (sent to various Boards) have been acknowledged but have then disappeared. Upon following these up I was told that an educative process was being pursued. For others, 12-24 months will elapse and then one receives a bland statement that “the matter has been resolved”. Unlike the TGACRP process, there is no public record of the complaint and its determination, no correction of misinformation by the imposition of retractions and no education of the profession about problems identified.

While this process may improve the advertising of individual chiropractors it has clearly failed to change the advertising of many others as shown by our current list of over 200 complaints (from which we have submitted a representative 10) and many more collated by Friends of Science in Medicine:

These problems continue despite, “The Board has reminded practitioners about its advertising and evidence based practice requirements in more than six publications in the past three years, including communiqués, newsletters (which are emailed to every registered chiropractor in Australia), guidelines and FAQ’s. The Board’s next newsletter to the profession, which is due for publication in coming weeks, is entirely dedicated to issues about advertising”.

The Board’s statement concludes, “We are always interested in ways to increase transparency within the requirements of the National Law and welcome suggestions to help achieve this”.

I have reiterated the need for the Board to increase its transparency (and better protect the public) by publishing the determinations made about advertising complaints and ordering chiropractors to place retractions of claims found to breach the National Law on their web sites in order to correct the misinformation promulgated.

It remains to be seen if this will happen.

 

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