On July 11th 2013, the Australian Broadcasting Company’s television program Catalyst aired a segment on the chiropractic profession. In January, I was interviewed over a period of three hours by ABC TV reporter Dr Maryanne Demasi.
“MEASURED AND OBJECTIVE COVERAGE”?
Before the interview, Dr Demasi expressed surprise that members of the Australian chiropractic profession had been so open and willing to speak to her. My response was that we were tired of being misrepresented in the media by the likes of the so-called “Friends of Science in Medicine”. We were hopeful that the ABC would provide a more measured and objective coverage of the issues. So many Australians have benefitted from chiropractic care. More than 215,000 people a week come to chiropractors and our satisfaction ratings are the envy of other health professions.
Dr Demasi’s reassurance that this was indeed her aim made the finished product all the more disappointing – not just for the chiropractic profession, but for the lost opportunity for Australians to learn about a safe, effective, affordable and mainstream approach to assist in health and wellbeing.
Maryanne Demasi’s tabloid-style attempt to characterise the chiropractic profession as dangerous and baseless was nowhere near the type of programming that Australians have come to expect from their national broadcaster.
Some readers may think that I’m being overly dramatic, perhaps having a “knee-jerk reaction” to how I was presented on the segment. Others may dismiss my criticism of the segment as just plain defensive because I’m a chiropractor and the profession was presented in a negative light. Before you jump to such a conclusion, please read on.
The tone of the segment was set in the second sentence, with the suggestion that “Chiropractic therapy” is “steeped in controversy”. Ex-Professor John Dwyer’s assertion that modern chiropractic has “descended into quackery” immediately followed.
Dwyer belongs to the “Friends of Science in Medicine”, the same anti-chiropractic group as Alistair MacLennan, who, when asked about chiropractors seeing children responded with, “I absolutely believe it’s child abuse.” I’m still waiting for evidence to support such a headline-grabbing statement.
One of the most objectionable aspects of the program was the discussion of the case of an injured baby who presented to Monash Medical Centre “after allegedly having its neck broken from chiropractic therapy”. No further details were provided because of “ongoing legal action”. The nature of this legal action and the defendants involved were not mentioned.
I sit on a committee that liaises between the Chiropractors Association of Australia (CAA) and our professional indemnity insurer. At the moment, I am limited by a confidentiality agreement from commenting on this case. If and when a circumstance arises where I can make public comment on the facts, I look forward to doing so.
Similarly, I cannot comment on the specifics of the case of Lucie Snape. A population-based case-control and case-crossover study published in the European Spine Journal by Cassidy et al found “… no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care” and that any link between VBA stroke and visiting a chiropractor (or indeed a medical doctor) was “… likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke.”
“ARE THEY ALLOWED TO DO THAT?”
The Catalyst segment contained a number of omissions, inaccuracies and misquotes. Some of these are difficult to write off as innocent errors. When I discussed the program with patients this week, the most common response was, “Are they allowed to do that?”
My response to a question about chiropractic safety, taken from a paper I sent to Dr Demasi before the interview by Australian chiropractic researcher Dr Matthew Doyle, was edited to remove the words “since 1992″, therefore substantially altering the meaning of my answer:
“There was a study published in 2011 which couldn’t find a single significant adverse event in the care of children by chiropractors [since 1992]. Somewhere in the world, in the last 20-plus years, someone would’ve said something that would’ve ended up in the medical literature. At least somebody somewhere. But to have a zero result, that’s pretty decent.”
Surprisingly, an attempt to refute my comments about the chiropractic profession’s outstanding safety record in the care of children was made by Dr Michael Vagg using a 2007 paper by Vohra. If he had read the Vohra paper or the more recent Doyle paper from 2011, Vagg would know that the incidents it describes are exceedingly rare events from 1992 and before. More recent adverse events described by Vohra et al involved other professions.
Even more surprisingly, Catalyst allowed Vagg’s comments to go to air unchallenged, despite the fact that the Doyle paper I sent Dr Demasi clearly addresses the weaknesses in Vohra’s work. A little searching would have found a joint statement from the International Chiropractic Pediatrics Association and the Foundation for Chiropractic Education and Research responding emphatically to Vohra’s paper and a letter to the editor of the Journal of Manipulative and Physiological Therapeutics by Joel Alcantara of the ICPA which also addresses Vohra’s weaknesses – and at the same time reinforced the need for more research in the area of chiropractic paediatric care. The ICPA is leading the way with a practice-based research network to explore the effect of chiropractic care on the paediatric population. CAA has earmarked almost $2 million to support developing research capacity in its current budget.
This is not Michael Vagg’s first obvious factual error in his ongoing attack on the chiropractic profession. His article on a popular academic blog called The Conversation on March 12, 2013 tried to blame the death of a child after spinal manipulation by an untrained therapist on the chiropractic profession. This was picked up by other non-chiropractic readers, who posted comments about it under the article. His inclusion of a case from Cincinnati, Ohio of a child with posterior rib fractures, without evidence of causality, was similarly irresponsible. Rib fractures in this age group are usually caused by non-accidental injury and the type of chiropractic care the child received as described in the case report could not have caused such injuries without the presence of underlying pathology. The child was screened for such pathology and none was found.
When Vagg’s article from The Conversation was republished, without correction, on the MamaMia website the next week, I pointed out the same errors in a comment on that website.
One of the reasons I was moved to write this post is that Vagg gave a presentation to the Central Victorian Atheists and Free Thinkers group on July 17th, 2013, in which, according to a chiropractor who was present at the meeting:
(1) he asserted that the chiropractic profession is the only regulated health profession in Australia that does not have a Code of Conduct. In an e-mail from Dr Vagg in response to this article on July 23rd, his version of events was that he had stated that “… the CBA was the only one of the original AHPRA Boards which has not yet had it CoC ratified by the peak professional bodies.” As the CAA National Board member tasked with liaising with the Chiropractic Board of Australia during the formation of a national registration board and as a member of the consultation committee of the Chiropractic Board of Australia, I worked with a number of others to help write the Code of Conduct for Chiropractors in 2009-10. I have also been active in subsequent reviews of the document. And,
(2) he repeated my (mis)quote about chiropractic safety from Catalyst and attempted to discredit my knowledge of the topic by suggesting that the Doyle paper was published in 2010, not 2011. It was published in December 2011.
It was also particularly disappointing to see footage of my presentation of an analogy about static on a radio transmission to describe the dysafferentation model of neuro-spinal dysfunction presented as a literal assertion of the presence of “static” in the nervous system.
Fifteen years ago, Seaman and Winterstein suggested the term “dysafferentation” to describe the impact on sensory nerves caused by vertebral subluxation (or in their terms, “joint complex dysfunction”). Dysafferentation means an alteration in the central nervous system’s perception of incoming stimuli. It is clinically important, in that the distortion of nociceptive signals which may trigger the brain to feel pain and mechanoreceptive signals, which give the brain its awareness of body position and movement, can alter pain perception, body position awareness and other factors.
Haavik and others have pursued the study of dysafferentation since then, winning a number of awards and garnering interest not only in the chiropractic research community but also from the wider research community.
I hesitate to comment on the appropriateness or otherwise of John Cunningham’s response. If my comments were presented to him out of context, as it was to the viewing public, then his response could be excused. However his assertion that “There’s no nerves that control hearing that have anything to do with the neck” suggests he is unaware of the link between whiplash injury and tinnitus, or of the cervical neural structures which have been implicated in the improvement of Meniere’s disease by researchers at the University of Melbourne.
There were repeated assertions that the chiropractic profession was either unqualified or unable to safely care for childhood conditions such as colic. It was surprising that Catalyst failed to air my interview comments about the single-blinded randomized controlled trial by Miller et al that I sent to Dr Demasi on December 6th, 2012. Nor did they air comments on this paper from any other interviewees.
Dr Reggars’ statements would suggest that he may also not be up to date with Miller’s study.
Further, Reggars’ comments that:
“The nervous system is not developed, its bony structure isn’t fully developed. So I fail to see how anyone could find a problem with a one-week-old baby by touching their spine …”
demonstrates, far more eloquently than I ever could, Reggars’ lack of familiarity with neurodevelopmental paediatrics, modern chiropractic paediatric assessment and clinical intervention. Of course, it’s also possible that his comments were taken out of context too. His track record in the media would suggest otherwise.
PROTECTING THEIR TURF
The predictable assertions from the AMA about the medical doctor being the only appropriate portal of entry to the health care system don’t stack up against a large 7-year-long US study that showed “… decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine …” for people who entered the health care system through “complementary and alternative medicine” (CAM) oriented primary care providers who were mostly chiropractors. Disappointingly, even though Catalyst had also been furnished with this paper on December 6th, it was excluded from the discussion.
There are other faults in the development of the Catalyst segment, including the use of footage from a NSW chiropractor, without giving that individual an opportunity to explain the context of the footage.
I’m still hopeful that someone in the media will provide a measured, objective coverage of the chiropractic profession.
I guess the Australian public and I will just have to wait a little longer.