Monday, 14 September 2015

SPHPM's Adjunct Associate Professor Ken Harvey on chiropractic advertising for MJA InSights

This article was initially published on MJA InSight on 7 September 2015.

The primary role of the Australian Health Practitioner Regulation Agency (AHPRA) is to protect the public by setting standards and policies that all registered health practitioners must meet.

In August 2010, the Chiropractic Board asked all chiropractors to review their advertising, including their websites, as a priority to ensure the content met the advertising requirements of the Health Practitioner Regulation National Law Act 2009 and the provisions of the Board’s guidelines for advertising.

The Act prohibits advertising that is false, misleading or deceptive, creates an unreasonable expectation of beneficial treatment, and can encourage the indiscriminate or unnecessary use of health services.

There has been ongoing concern about continuing advertising by chiropractors that breaches the Act, as well as the Chiropractic Board Code of Conduct. For example, in December 2011,Professor John Dwyer, said he was “disturbed” that chiropractors were offering “adjustments” for a wide range of childhood problems — for which there was no evidence of efficacy.

In July 2014, Choice was concerned some chiropractors were promoting themselves as alternatives to GPs for the care of babies and children.

A colleague and I presented examples of misleading chiropractic claims for specific conditions to the Australian Competition and Consumer Commission (ACCC) in September 2014. We asserted that the chiropractic businesses identified were in breach of the Competition and Consumer Act 2010, which prohibits a person, in trade or commerce, from engaging in misleading or deceptive conduct.
The ACCC passed our concerns on to representatives of AHPRA in October 2014.

In their July 2015 communique, the Chiropractic Board expressed ongoing concern about advertising by some in the profession that might be seen as misleading and deceptive. The Board noted that practitioners might lack understanding of evidence and evidence-based practice — a matter they proposed to address in their next newsletter.

Five years have passed since the Chiropractic Board first asked practitioners to ensure that their websites met legal advertising requirements.

The time for further “educative” communiques has passed — aberrant chiropractors must now be held to account for breaches of the law.

My colleague and I have provided the AHPRA with 10 representative complaints about chiropractic websites, which make claims likely to harm consumers. They include:
  • Claims to treat serious diseases such as cancer, heart disease, diabetes, hypertension and pneumonia with manipulation (for which there is no evidence of efficacy), with the likely result of delaying more evidenced-based treatment to the detriment of the patient’s health
  • Providing unnecessary services and/or encouraging indiscriminate or unnecessary use of health services by promoting regular and intensive chiropractic manipulation for “corrective care” or to prevent disease and reduce obstetric complications (for which there is no evidence of efficacy)
  • Misdiagnosing and mistreating conditions by using non-evidence-based modalities such as allergy testing, hair tissue mineral analysis, homeopathy and biomesotherapy.
We agree with the authors of research published in the New Zealand Medical Journal that “the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue”.

Serious questions must be asked about the ability of the Chiropractic Board to make timely, non-biased and transparent determinations on breaches of the law.

The recent Independent Review of the National Registration and Accreditation Scheme for health professionals noted widespread concern about delays in assessing and finalising complaints and notifications, poor communication with complainants and inadequate explanations of outcomes.
I understand that the Chiropractic Board has used just one independent peer reviewer to determine if similar complaints have breached relevant advertising standards. With the division that exists within the chiropractic profession, this is an inappropriate procedure to assess complaints.

A more appropriate course would be similar to that used by the Therapeutic Goods Advertising Complaints Resolution Panel

At the very least, the investigation of complaints submitted to the Chiropractic Board should be overseen by the AHPRA National Board.

If the Board’s process fails to change aberrant chiropractor behaviour, a more radical solution would be to consider adapting the Swedish Quackery Act to our laws.

In Sweden, only a physician is allowed to treat specific diseases such as cancer, diabetes and epilepsy, pathological conditions associated with pregnancy or childbirth, or children younger than 8 years of age. Violation of these restrictions is an offence and may be prosecuted.

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