Medicandus

Medicandus

A response is received from the Chiropractic Board of Australia

I was notified today that last week’s article on chiropractic care of children and the related concerns about antivax CPD activities has resulted in a response from the Chiropractic Board of Australia (CBA). Much of the response we received was reproduced from other policy documents of the Board so in the interests of space I have selectively quoted from it below. The full text can be provided upon request by email.

First up, let me say I welcome the response from the statutory regulator to my piece. I raised what were for me some very concerning issues, and I can say that their response is reassuring in many places.

I suggested that CBA should decline to recognise CPD hours for activities found to be inappropriate and it seems that this what they are planning to do. To quote their response

The Board is investigating the CPD assessment and approval process and will report on its findings. The Board will revoke the approval of any course not deemed to be within the area of practice for a chiropractor or any course that fails to meet its standards.

It’s not mentioned whether that revocation would be retrospective, but one assumes it would be if the principle at stake is to be upheld. A very reasonable measure.

With regard to my call to emphasise the public health duty of chiropractors as an AHPRA-regulated profession, it is worth quoting again from their response.

While chiropractors may hold personal views as individuals about vaccination that do not align with the Board’s position, they must not allow their personal views to interfere with the care and advice of their patients.

Since the introduction of the National Scheme in July 2010, the Board has developed the standards that chiropractors must meet, including the Code of conduct for chiropractors, which clearly states that chiropractors have a responsibility to protect and promote the health of individuals and the community, and that they are expected to practise in a patient-centred and evidence informed context.

The code also states that, ‘chiropractors have a responsibility to promote the health of the community through disease prevention and control, education and, where relevant, screening.’2 The Board investigates concerns where this is not the case.

Advice about vaccinations falls outside of the expected area of practice for chiropractors. The Board expects chiropractors to refer patient questions about vaccination to other registered health practitioners who possess such training and expertise.

Half marks for that response, in my view. On the plus side, it states quite clearly that personal antivax beliefs are not to be pushed onto patients. If you get discouraged from being immunised by a chiropractor in their practice, they are breaching their professional Code of Conduct. Fair enough.

I am disappointed by their lack of outright endorsement of immunisation. You don’t need to possess anything but the meanest of intelligence to see the upside of it. In a previous article I highlighted the extraordinary achievement of polio eradication in India. This was largely achieved by providing purposeful, culturally-sensitive education about the basic benefits of mass immunisation. They already had the medicines to achieve it, but it was only when anti-vaccination misinformation was systematically countered that public health success was possible.

Surely that’s a bandwagon CBA should jump right onto! After all, it’s not like it’s a controversial or unconventional position. Every peak body remotely concerned with public health endorses it. It’s actually bipartisan political policy and has been for decades. No organisation apart from some of the tinfoil hat variety actually thinks that there is a problem with endorsing immunisation as a public health policy. Why do they need to be coy about their support?

With regard to chiropractic care of children, I cautiously welcome the posting of a new position statement on the CBA website. A selected highlight reads thus

Chiropractors receive extensive university training, including about caring for children. Like all health practitioners, chiropractors must take particular care to gain informed consent when managing the care of children and young people. This includes keeping parents/guardians informed with clinically relevant information relevant to the chiropractic management of children.

While individual chiropractors have their own beliefs and values, the Code of conduct for chiropractors makes it clear that those values must be secondary to the wellbeing of their patients and the promotion of health in their patients and the community. The Board expects chiropractors to offer balanced, non-biased health advice to their patients. When treating children and young people, this includes parents and guardians, as appropriate.

In maintaining good practice, practitioners should consider the balance of benefit and harm in all clinical decisions. Any care options or recommendations made to patients should be based on the best available information.

Again with the university training! I must say as a humble doctor, our university training is not regarded as nearly good enough for unsupervised practice. The average GP these days has worked in supervised practice for at least 4 years (usually longer) before being let loose on the public, and some specialty groups take even longer than that once the ‘extensive university training’ is completed. In medicine, it’s not unusual to spend the better part of a decade after graduation before commencing unsupervised practice. Hence the huge importance of postgraduate CPD in this debate.

It also appears the Board is happy that the university training is good enough to enable their graduates to provide ‘care’ for infants which has no scientific credibility, but utterly inadequate to permit them to draw the blindingly obvious conclusion that vaccines are good for kids. Puzzling.

The quoted segment refers to ‘best available information’ but this falls well short of my suggestion that no recommendation should be given that allows for such flimsily conceived ideas as birth subluxations, plagiocephaly treatment by chiropractic and the whole range of fanciful claims destroyed in the BCA v Singh case to prosper.

In another press release following last week’s article the Chiropractic and Osteopathic College of Australasia (COCA), which is the second-biggest professional organisation after CAA, drew attention to their unambiguous and strong statements about these areas which were exactly the sort of clear direction to practitioners that CBA could have chosen to give.

I can understand that CBA has no desire to get involved in the details of clinical decision-making, and is only charged with statutory regulation at a strategic level within the profession. I still find that they have left considerable room for some of their more reality-challenged practitioners to continue to get away with unscientific antics under their sleepy gaze.

So let’s wait and see what the Board’s CPD investigation finds out, and what their regulatory response will be. Many within and outside the chiropractic profession are hoping it will be a strong and clear message in support of the public health of Australians.