Letter from JCS to Dr. Ken Harvey, leader of the Skeptics:
“However, let me offer my opinion that your medical bigotry against chiropractic is an erroneous and malicious view of modern spine care. You obviously are unaware of the plethora of facts supporting chiropractic care as well as the overwhelming research condemning medical spine care—opioid painkillers, epidural steroid injections and disc fusion surgery… and other causes of medical iatrogenesis. I would enjoy your response, if you have the courage to respond.”
Here is Dr. Harvey’s response:
First, I and my own colleagues are aware of the problems in mainstream medicine. Ian Harris is a supporter of “Friends of Science in Medicine” and his book, “Surgery, the ultimate placebo” is recommended to my students, both at Monash University and the University of the Third Age (U3A). I support and promote the “alltrials” campaign. I follow and support robust discussion into the safety and efficacy of conventional medicines. I’ve put in complaints (which have been upheld) about the promotion of prescription medicines and aberrant practices of medical colleagues. I’ve talked about these problems at professional conferences such as National Medicines Symposium. In short, I’m equally skeptical about aspects of mainstream medicine as I am about complementary and alternative medicine. However, mainstream medicine, despite its faults, has a track record of significant achievements in advancing health. The same cannot be said of complementary and alternative medicine (nor Chiropractic).
Chiropractic is a registered health profession in Australia, governed by the Chiropractic Board (6 of 9 members are practicing chiropractors) and the Australian Health Practitioners Regulation Agency (AHPRA). I agree with you that scientific evidence shows that chiropractic is an appropriate treatment option for low-back pain (as are other interventions).
However, the Chiropractic Board (not just Mal Vickers and I) has expressed concern about the advertising of many chiropractors that is in breach of s.133 of the Health Practitioner Regulation National Law: http://www.chiropracticboard.gov.au/News/2016-03-07-statement-on-advertising.aspx:
“Of particular concern is the number of treatment claims in advertising relating to infants and children. Claims suggesting that manual therapy for spinal problems can assist with general wellness and/or benefit a variety of paediatric syndromes and organic conditions are not supported by satisfactory evidence. This includes claims relating to developmental and behavioural disorders, ADHD, autistic spectrum disorders, asthma, infantile colic (my highlight), bedwetting, ear infections and digestive problems”.
You cited three papers that you believed showed the effectiveness of chiropractic care for colicky babies. The 2011 paper by Alcantara et al, largely depended on case reports; the 2012 paper by Miller was not a double-blind trial and the Cochrane review (which included Miller as a co-author) noted that most reviewed studies had a high risk of performance bias since the assessors (parents) were not blind to who had received the intervention. When combining only those trials with a low risk of such performance bias, the results did not reach statistical significance.
I suggest you write to the Chair of the Chiropractic Board of Australia. Wayne Minter, <Wayne.Minter@ahpra.gov.au> and ask his opinion about the evidence you have provided.
With best wishes,
Dr Ken Harvey
Adjunct Associate Professor
Department of Epidemiology and Preventive Medicine
School of Public Health and Preventive Medicine
The Alfred Centre
99 Commercial Road
Melbourne VIC 3004
Mobile: +61 419181910
Advertising regulated health services
Inappropriate claims of benefit
Patients must be adequately informed when making health care choices. Advertisers must ensure that any statements and claims made in relation to chiropractic care are not false, misleading or deceptive or create an unreasonable expectation of beneficial treatment.
The Board is concerned about a number of practitioners who are making claims in advertising that there is a relationship between manual therapy (e.g. manipulation) for spinal problems and achieving general wellness or treating various organic diseases and infections; or that spinal problems may have a direct role in various organic diseases and infections. There is insufficient scientific evidence to support these claims.
Of particular concern is the number of treatment claims in advertising relating to infants and children. Claims suggesting that manual therapy for spinal problems can assist with general wellness and/or benefit a variety of paediatric syndromes and organic conditions are not supported by satisfactory evidence. This includes claims relating to developmental and behavioural disorders, ADHD, autistic spectrum disorders, asthma, infantile colic, bedwetting, ear infections and digestive problems.
Advertising claims that are contrary to high level evidence are unacceptable. High level evidence will usually take the form of meta-analyses, systematic reviews or one or more high quality and well respected and acknowledged studies.