Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics Page 1 of 11 The following chiropractors are listed on the Barham Clinic web site (http://barhamchiro.com.au/) and presumably are collectively responsible for its content: Dr Chris Barham CHI0001358745 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 222 Herries St, Toowoomba QLD 4350, Dr Daniel Barham CHI0001952680 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 16 Herbert St, Goondiwindi QLD 4390 Ms Emma Barham CHI0001683259 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 55 North St, Gatton QLD 4343 & 16 Herbert St, Goondiwindi QLD 4390 & 222 Herries St, Toowoomba QLD 4350, Dr Mary Lou Barham CHI0001389508 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 222 Herries St, Toowoomba QLD 4350, Brent Von Blankensee CHI0000955965 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 222 Herries St, Toowoomba QLD 4350 Dr Doug Clarke CHI0000957536 Registered at: KINGAROY QLD 4610 Practice at: 221 Haly St, Kingaroy QLD 4610 Dr Gavin Crouch CHI0001399023 Registered at: WAVELL HEIGHTS QLD 4012 Practice at: 225 Shaw Rd, Wavell Heights QLD 4012 No longer works there Dr Laura Harding CHI0001875973 Registered at: KINGAROY QLD 4610 Practice at: 221 Haly St, Kingaroy QLD 4610 Dr Shaka Hatcher CHI0000971772 Registered at: MOOLOOLABA QLD 4557 Practice at: 1/168 Brisbane Rd, Mooloolaba QLD 4557 Ms Alexandra Skjervheim CHI0001957948 Registered at: ALBANY CREEK QLD 4035 Practice at: 2/717 Albany Creek Road Mr Matt Wild CHI0001954335 Registered at: WAVELL HEIGHTS QLD 4012 Practice at: 225 Shaw Rd, Wavell Heights QLD 4012 Dr James Winyard CHI0000952772 Registered at WISHART QLD 4122 Practice at: 15/590 Mt Gravatt Capalaba Road, Wishart QLD 4122 We allege that certain claims made by the above chiropractors on their web site breach Section 133 of the National Law that prohibits advertising that: • is false, misleading or deceptive or is likely to be so; • creates an unreasonable expectation of beneficial treatment, and • encourages the indiscriminate or unnecessary use of health services.
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Complaint to Chiropractic Board of Australia about Barham Chiropractic …€¦ · In May 2010 the General Chiropractic Counc il, the statutory regulatory body for chiropractors in
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Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
Page 1 of 11
The following chiropractors are listed on the Barham Clinic web site (http://barhamchiro.com.au/) and presumably are collectively responsible for its content:
Dr Chris Barham CHI0001358745 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 222 Herries St, Toowoomba QLD 4350,
Dr Daniel Barham CHI0001952680 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 16 Herbert St, Goondiwindi QLD 4390
Ms Emma Barham CHI0001683259 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 55 North St, Gatton QLD 4343 & 16 Herbert St, Goondiwindi QLD 4390 & 222 Herries St, Toowoomba QLD 4350,
Dr Mary Lou Barham CHI0001389508 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 222 Herries St, Toowoomba QLD 4350,
Brent Von Blankensee CHI0000955965 Registered at: TOOWOOMBA CITY QLD 4350 Practice at: 222 Herries St, Toowoomba QLD 4350
Dr Doug Clarke CHI0000957536 Registered at: KINGAROY QLD 4610 Practice at: 221 Haly St, Kingaroy QLD 4610
Dr Gavin Crouch CHI0001399023 Registered at: WAVELL HEIGHTS QLD 4012 Practice at: 225 Shaw Rd, Wavell Heights QLD 4012
No longer works there
Dr Laura Harding CHI0001875973 Registered at: KINGAROY QLD 4610 Practice at: 221 Haly St, Kingaroy QLD 4610
Dr Shaka Hatcher CHI0000971772 Registered at: MOOLOOLABA QLD 4557 Practice at: 1/168 Brisbane Rd, Mooloolaba QLD 4557
Ms Alexandra Skjervheim CHI0001957948 Registered at: ALBANY CREEK QLD 4035 Practice at: 2/717 Albany Creek Road
Mr Matt Wild CHI0001954335 Registered at: WAVELL HEIGHTS QLD 4012 Practice at: 225 Shaw Rd, Wavell Heights QLD 4012
Dr James Winyard CHI0000952772 Registered at WISHART QLD 4122 Practice at: 15/590 Mt Gravatt Capalaba Road, Wishart QLD 4122
We allege that certain claims made by the above chiropractors on their web site breach Section 133 of the National Law that prohibits advertising that:
• is false, misleading or deceptive or is likely to be so;• creates an unreasonable expectation of beneficial treatment, and• encourages the indiscriminate or unnecessary use of health services.
Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
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We also believe that the claims documented below are not in accord with the Chiropractic Board of Australia, Code of Conduct, (March 2014):
• s.2.2 (g): providing treatment/care options based on the best available information and practising in an evidence-based context and not being influenced by financial gain or incentives;
• s.2.4 (d): investigating and treating patients on the basis of clinical need and the effectiveness of the proposed investigations or treatment/care, providing necessary services and not providing unnecessary services or encouraging the indiscriminate or unnecessary use of health services, and
• s.9.6 (a): complying with the National Board’s Guidelines on advertising regulated health services, (the Advertising guidelines) and relevant state and territory legislation and Commonwealth law;
• s.9.6 (b) making sure that any information published about services is factual and verifiable.
Comment: We are unaware of any good scientific evidence that supports this claim which appears to promote routine chiropractic examination and manipulation in the absence of patient symptoms.
Conclusion Claim 1: “Everybody, from a newborn baby to the very elderly, can benefit from having their spine checked and adjusted to ensure their body functions at its best” lacks substantiation and thus is in breach of s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
The above marketing video comes from: http://www.educhiro.com/ and is also found on a number of other chiropractor web sites
The following transcript starts at 01.45 min.
“If the spine is not moving freely it's referred to as a vertebral subluxation complex or for short a subluxation. This is where two or more vertebrae have lost their normal motion and or position. This can cause interruption to the normal nerve flow and interfere with the communication from the brain to the body and from the body back to the brain.
So what happens when you have a subluxation? That area can start to degenerate in as little as two weeks. This degeneration causes scar tissue to develop which leads to more scar tissue. This degenerative process can continue as long as the immobilisation is present. And this type of degeneration is preventable.
Subluxations can interfere with normal communication between the brain and the body. So, for example, the nerve supply from your neck goes to the immune system, pituitary gland, sinuses, face, middle and inner ear, eyes, tonsils, neck teeth and shoulder muscles...”
Comment: In 2005 in an article titled, “Subluxation: dogma or science?” Keating JC, et al,1 said:
“The dogma of subluxation is perhaps the greatest single barrier to professional development for chiropractors. It skews the practice of the art in directions that bring ridicule from the scientific community and uncertainty among the public. Failure to challenge subluxation dogma perpetuates a marketing tradition that inevitably prompts charges of quackery. Subluxation dogma leads to legal and political strategies that may amount to a house of cards and warp the profession's sense of self and of mission. Commitment to this dogma undermines the motivation for scientific investigation of subluxation as hypothesis, and so perpetuates the cycle.”
Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
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In May 2010 the General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, issued guidance for chiropractors stating that the chiropractic vertebral subluxation complex "is an historical concept" and "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease.2 Chiropractors were also reminded that, when advertising, claims for chiropractic care “must be based on best research of the highest standard” only. (GCC Guidance on Advertising, March 2010) In addition, we are unaware of any scientific evidence that supports “degeneration” and “scar tissue” caused by a “vertebral subluxation complex” as shown graphically in the video and stated in the commentary.
An additional inaccuracy in this video is the statement that “the nerve supply from your neck goes to the”……“pituitary gland, sinuses, face, middle and inner ear, eyes, etc.” In fact, these areas are innervated by cranial nerves, not spinal nerves that emerge through the vertebrae.
Conclusion Claim 2: we assert that statements concerning the “vertebral subluxation complex” alleged to cause “degeneration” and “scar tissue” and the details of the “nerve supply from your neck” lack substantiation and thus are in breach of s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
Comment: The N.Z report cited appears to be: “Chiropractic in New Zealand: Report of the Commission of Inquiry. (1979). Hasselberg PD, Government Printer, Wellington, New Zealand”.3
However, in 2002, sixty-two Canadian Neurologists issued a warning to the Canadian public and provincial governments about the dangers of neck manipulation.4 They noted that stroke and death due to neck manipulation has been reported in the scientific literature for over 50 years and that manipulation is one of the leading causes of stroke in the under 45-age group.
A 2007 literature review5 titled, “Adverse events associated with pediatric spinal manipulation: a systematic review” concluded that,
“Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the
Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
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possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients”.
This review was updated in 20106 and the author concluded,
“There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self-limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing adverse events and pediatric manual therapy is needed”.
A 2012 literature review7 titled, “Adverse events from spinal manipulation in the pregnant and postpartum periods” recorded 4 cases of stroke following cervical manipulation (2 performed by chiropractors, 1 by a physiotherapist and one by a GP). It was concluded that while it was possible that such injuries are relatively rare, future research into efficacy of this treatment for these populations and the rates of occurrence of adverse events is necessary to determine whether or not this is true.
In 2014, Dr Laurie Tassell, president of the Chiropractors’ Association of Australia (CAA), reported that his association was working towards implementing an adverse events reporting system but, to-date, we have no information on whether this project has been implemented.8
A 2014 review, “Adverse Events of Massage Therapy in Pain-Related Conditions: A Systematic Review”9 noted,
“The real serious incidence of AEs [adverse events] has been estimated to be ranging from 5 strokes in 100,000 manipulations to 1.46 case series in 10 million manipulations, and a rate of 2.68 deaths in 10 million manipulations has been reported. The Danish insurance industry claimed data support a risk of stroke as 1 per 2 million manipulations. 99% of all chiropractors practicing in Denmark completed a survey; they estimated that one case of cerebrovascular accident occurred for every 1.3 million cervical treatment sessions. The occurrence increased to 1 in every 900,000 treatment sessions for upper cervical manipulations, and they noted that techniques using rotational thrusts were overrepresented in the frequency of injury”.
Another 2014 review, “Cervical Arterial Dissections and Association with Cervical Manipulative Therapy” (Oct 2014)10 concluded:
“Cervical artery dissections (CD) is an important cause of ischemic stroke in young and middle-aged patients. CD is most prevalent in the upper cervical spine and can involve the internal carotid artery or vertebral artery. Although current biomechanical evidence is insufficient to establish the claim that cervical manipulative therapy (CMT) causes CD, clinical reports suggest that mechanical forces play a role in a considerable number of CDs and most population controlled studies have found an association between CMT and vertebral artery dissection (VAD) stroke in young patients. Although the incidence of CMT-
Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
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associated CD in patients who have previously received CMT is not well established, and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine”.
In the light of the above we believe that merely citing an undated N.Z. government report that stated (in 1979) chiropractic care is “remarkably safe” is misleading &/or deceptive.
The claim that, “Studies have shown that, in relation to the treatment of neck and back pain, a course of chiropractic care is 250 times safer than a course of anti-inflammatory drugs” appears to be based on a 1995 literature review, “A Risk Assessment of Cervical Manipulation vs NSAIDs for the Treatment of Neck Pain”.11 The abstract noted:
Although there are a small number of well-performed trials of cervical manipulation for neck pain, we were unable to locate even a single randomized, controlled trial examining NSAID use specifically for neck pain.
A search of PubMed12 failed to find any additional studies on the comparative safety of chiropractic manipulation compared to NSAIDS for the treatment of either neck or back pain.
It is accepted that NSAID’s have a number of potentially serious side-effects (especially when used long-term)13 However, we do not believe that the 1995 review cited justifies the statement, “Studies have shown that, in relation to the treatment of neck and back pain, a course of chiropractic care is 250 times safer than a course of anti-inflammatory drugs”.
Conclusion Claims 3 & 4: we argue that:
• citing a 1979 (undated) New Zealand government study that found that adjustments and chiropractic care is “remarkably safe” without warning of the uncommon association between cervical manipulation and cervical artery dissections and stoke, and
• stating that “a course of chiropractic care is 250 times safer than a course of anti-inflammatory drugs”,
breach s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
Comment: We are unaware of any good scientific evidence that supports these claims which appear to promote unnecessary chiropractic examination and manipulation of the newborn.
A 2010 review titled, “Effectiveness of manual therapies: the UK evidence report”14 (authored by Chiropractors) concluded that spinal manipulation is not effective for infantile colic.
Furthermore, a 2012 Cochrane review titled, “Manipulative therapies for infantile colic”15 concluded there was no evidence that manipulative therapies improved infant colic when they only included studies where the parents did not know if their child had received the treatment or not.
We could not find any good evidence to support the claim that, spinal distress in babies can include, but not be limited to colic, unusual crying, poor appetite or erratic sleeping habits.
Conclusion Claims 5&6: the statements:
• “it’s a good idea to get your newborn checked as early as possible for any spinal health problems” and
• “Signs of spinal distress in babies can include, but not be limited to colic, unusual crying, poor appetite or erratic sleeping habits”,
breach s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
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Claims 7-9 (from http://barhamchiro.com.au/faq/)
Comment: We are unaware of any good scientific evidence that supports the claim that regular chiropractic “check-ups” may avoid (unspecified) health complaints seen later in adults.
A search of PubMed for Nilsson [auth] AND ("chiropractic"[MeSH Terms] OR "chiropractic"[All Fields]) produced a number of studies with Nilsson as a co-author. However we were unable to identify a study that reported that:
Children under chiropractic care are healthier than other children, miss less school, are more attentive and have less need for drugs.
We did find a study with Nilsson as a co-author16 that concluded that:
Spinal manipulation is effective in relieving infantile colic. However, the number of patients studied was small, (control (dmiethicone) n=25, intervention (chiropractic) n=25); the parents who recorded symptoms were aware of the different treatments (they were not blinded) and 9 patients dropped out of the dmiethicone group. As noted above, a 2012 Cochrane review concluded there was no evidence that manipulative therapies improved infant colic when they only included studies where the parents did not know if their child had received the treatment or not.
Furthermore, a 2010 review titled, “Effectiveness of manual therapies: the UK evidence report”17 concluded that,
In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.
Complaint to Chiropractic Board of Australia about Barham Chiropractic Clinics
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Conclusion Claims 7-9: we argue that the statements,
• “Regular chiropractic checkups with us … may help avoid some of the (unspecified) health complaints seen later in adults”,
• “Children under chiropractic care are healthier than other children, miss less school, are more attentive and have less need for drugs” and
• “Children with conditions such as earaches, colic, bed wetting, scoliosis, “growing pains” and asthma generally respond wonderfully to chiropractic care”
breach s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
Claim 10: (from http://barhamchiro.com.au/faq/)
Comment: A search of http://www.ncbi.nlm.nih.gov/pubmed/?term=chiropractic+pregnancy failed to find any scientific evidence to substantiate this statement.
Conclusion Claim 10: we assert that the statement,
• “[chiropractic manipulations] often gives babies in a breech position more room to move into the correct head-down position, reducing the need for a caesarean birth”,
breaches s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
Comment: We are unaware of any good scientific evidence that supports the claim that regular chiropractic manipulation results in patients dealing with stress more effectively or suffer less from re-occurring symptoms like indigestion, sinus problems, stress, etc.
Conclusion Claim 11: we assert that the statement, “Research … show us that people who participate in a regular program of chiropractic care suffer less from re-occurring symptoms like indigestion, sinus problems, stress, etc.”, breaches s.6.2 of the AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014) and also the Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), ss2.4 (d) and s.9.6 (a) & (b).
In conclusion, the Chiropractors involved in the Barham Chiropractic Clinics make a number of therapeutic claims that are not supported by sound evidence. We agree with Ernst and Gilbey (article appended) that these unsubstantiated claims constitute both an ethical and public health issue.
We ask the Chiropractic Board of Australia to determine if Barham Chiropractic Clinics and the chiropractors involved have breached both:
• AHPRA Advertising Guidelines for Registered Health Practitioners (March 2014), s.6.2 & the • Chiropractic Board of Australia Code of Conduct (March 2014), s.2.2 (g), s.2.4 (d) and s.9.6
(a) & (b)
If so, we ask that the chiropractors involved be ordered to retract the offending claims and the determinations made in this case be published as a deterrent to others.
Cc Mr Scott Gregson Executive General Manager, Consumer Enforcement Australian Competition & Consumer Commission Level 3, 23 Marcus Clarke St, Canberra, ACT, 2601 23 August 2015