The latest newsletter from the regulator of chiropractors offers an insight into the industry’s culture problems.
In their June newsletter, the chair of the Chiropractic Board has admonished chiropractors for a discussion on how to circumvent consumer protection regulations:
At a recent chiropractic function, a presentation was given on advertising, chiropractors’ responsibilities and the Advertising Standards Authority (ASA). The information was well presented and informative however ensuing discussion revealed that the message is clearly not being heard by all. I urge you to please refer to my email of 30 August 2017 that clearly outlines your responsibilities, and reiterates very important points set out in the Board’s Advertising and Social Media Policy, and references to all other responsibilities. I was particularly disappointed in discussion among practitioners on how to best circumvent the prohibition on posting testimonials on Facebook – some very creative ideas were invented.
The Chiropractic Board published their current Advertising Policy in November 2015. It notes, correctly, that the use of health testimonials in advertising is prohibited in New Zealand by Section 58(1)(c)(iii) of the Medicines Act 1981:
A chiropractor shall not advertise any material which relates to the chiropractor’s qualifications, practices, treatment or the premises where they practice chiropractic if the material:
…
f) uses testimonials whether from patients or any other person (see section on Medicines Act);
…
This section [58 of the Medicines Act] provides further at Section 58(1)(c) that it is an offence to imply, claim, indicate or suggest that a medicine, treatment or device is a panacea or infallible for any condition or is recommended by an appropriately qualified person or had beneficially affected the health of a particular person or class of persons, whether real or fictitious.
This wording clearly prevents a health practitioner publishing testimonials.
Unfortunately, this law is widely ignored in New Zealand, particularly by promoters of dodgy health products. In my experience even when breaches are brought to the attention of the agency responsible for enforcing it – Medsafe, in this instance – nothing is likely to happen.
In 2015, my colleague at the Society for Science Based Healthcare Mark Honeychurch and I looked at how often New Zealand chiropractors were publishing health testimonials and various misleading health claims in online advertising. This was prior to the publication of the Chiropractic Board’s current advertising policy, but over 20 years after the law prohibiting the use of health testimonials in advertisements was passed. We found that just over a third of the 137 websites we looked at used health testimonials.
Thankfully, this does seem to have decreased following the introduction of the Advertising Policy, but the recent newsletter seems to imply that chiropractors are not happy about being unable to use testimonials to promote their services.
When looking at how often chiropractors use misleading claims and health testimonials in 2015, we hadn’t looked at advertising on social media. While writing this post, I have searched for “NZ chiropractic” on Facebook and clicked on the top three pages that showed up in the results – Bays Chiropractic NZ, Chiropractic Touch, and Revolution Chiropractic NZ – to have a quick look (I didn’t look through any comments or watch any videos) and see if any of them had been publishing testimonials there.
I didn’t see testimonials on the Bays Chiropractic NZ page, but I couldn’t help but notice that they shared an image in February featuring many misleading claims about chiropractic manipulation, including that it can reduce allergies, asthma, and ADHD. As the Chiropractic Board of Australia has clarified in their own Statement on Advertising in 2016, these claims are not supported by evidence:
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.
In August 2017, Chiropractic Touch posted a testimonial claiming that chiropractic manipulations had cured someone’s asthma. They used one of the “creative ideas” commonly used by chiropractors to try to circumvent the prohibition on publishing health testimonials: telling the testimonial in the context of it inspiring a chiropractor to pursue their career rather than framing it as a patient’s experience.
I didn’t see any testimonials on Revolution Chiropractic NZ’s page, but they do seem to publish a lot of posts about adrenal fatigue. Adrenal fatigue is a fake diagnosis that I’ve seen most often used by naturopaths to sell unnecessary supplements. Revolution Chiropractic NZ also shared some of the same misleading claims as Bays Chiropractic NZ, including particularly concerning misleading claims about being able to treat children and infants for conditions such as colic and ear infections.
Whatever improvements there may have been over the past few years, it seems the chiropractic industry in New Zealand is still struggling with its culture of ignoring or sidestepping patient protection regulations.
Honest Universe 
True on adrenal fatigue (Addison’s disease) but adrenal insufficiency (Addison’s disease) is a real medically diagnosed disease. And the symptoms are very similar and since you are fatigued, I think this may be a tomato potato issue. It is like your complaints about Dr Ho using Dr. I can’t address him specifically but there are doctors with medical degrees called doctors of osteopathy (DO). They may be confused with chiropractor because DOs also perform manipulations of the body. DOs and MDs are both physicians who can practice in any area of medicine including surgery. They have similar training, too – 4 years of medical school; then work as interns, residents, and for some, as fellows in their chosen field for 3-8 more years. DOs and MDs also have to pass state exams to receive a license to practice medicine. Both can practice medicine in all 50 states. Both can write prescriptions, order testing, and perform various treatment. DOs though differ from most MDs in that they work on a “whole body” approach. Osteopathic doctors get extra training in the musculoskeletal system (your muscles, bones, and joints). This knowledge helps them understand how illness or injury can affect another part of the body. DOs also learn something that MDs don’t: osteopathic manipulative treatment (OMT). They use their hands to help diagnose, treat, and prevent illness and injury. It’s a key part of their medical training. Not all DOs use OMT routinely. But when they do, they apply techniques such as gentle pressure, stretching, and resistance to help restore range of motion and encourage good health. I personally know of folks going to a DO who call them chiropractors because of the manipulations. I myself see a DO and find their approach to medical issues to be much more in depth than my other MDs.
In the US and I imagine in many countries Chiropractors get in-depth training, though it’s not the same as that of MDs and DOs. Chiropractic students get nearly 4 years of undergraduate college coursework before attending a 4- to 5-year chiropractic college. Typically, they spend at least a year of their training working with patients, though it’s not in a residency program. After graduation, they must pass a national board exam in order to get a license to practice. And they must meet continuing education requirements every year to keep their licenses. Chiropractors’ expertise is doing adjustments, recommending exercises, offering nutrition and lifestyle advice. They mainly focus on problems involving the musculoskeletal system, such as back pain, neck pain, and headaches. Chiropractors cannot prescribe medicine, nor do surgery.
Chiropractors emphasize the alignment of the spine for good health. So they often perform spinal adjustments with their hands or a small tool. DOs and chiropractors share a few similar moves. One example is high-velocity, low-amplitude (HVLA), which is a thrusting motion to the spine that’s meant to help movement. In terms of insurance, Medicare does cover medically necessary chiropractic services. According to the CMS, Medicare Part B now covers 80% of the cost for “manipulation of the spine if medically necessary to correct a subluxation.” There is no cap on the number of medically necessary visits to a chiropractor. Most insurance plans follow suit. That said, Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture. However, other insurance plans or even Medicare Advantage plans may cover additional services under supplemental benefit plans. And keep in mind, if you are willing to pay for any service 100% yourself, you can then submit a claim for reimbursement and appeal if denied. These are determined on a one-by-one case and I would imagine success is dependent on how well a case is written up by your doctor(s). As long as you are prepared and are okay with covering 100% of the cost, what do you lose by submitting a claim and possibly having it covered especially if other treatments have been tried, if the procedure works, and if it is shown to prevent covered surgical procedures, you might luck out.
That’s a very US-centric view, Rose. In other countries, the UK for example, osteopaths don’t get that sort of training and are more likely to promote quackery such as cranial osteopathy. I’m less familiar with how rigorous their training is here in New Zealand, which is why I don’t talk about them very much.
Here in New Zealand, the majority of chiropractors who advertise their services online claim, misleadingly, to be able to treat conditions such as allergies and ear infections: https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1432-1-april-2016/6856
They also get 4 years of training, but the institutions that teach them have quackery built into their syllabus. Just like how being a trained and qualified homeopath doesn’t stop someone from being a quack, the duration of training chiropractors receive shouldn’t be treated as an indicator of their reliability.