The Chiropractic Board of Australia, which regulates Australia’s 5000 chiropractors, has released a statement reinforcing that practitioners need to ensure their advertising complies with the requirements of the National Law, or they risk prosecution and disciplinary action.
“The statement is squarely directed at practitioners who are not toeing the line. Our position is unequivocal – false and misleading advertising is unacceptable,” said Dr Wayne Minter AM, Chair of the Chiropractic Board of Australia.
“Chiropractors must ensure they are doing the right thing in their practice and in their advertising. They must adhere to the requirements of the law and the Board’s standards, codes and guidelines. There is no place for complacency.
“We are writing to all chiropractors in Australia to make sure they are aware of this statement released today,” said Dr Minter.
The statement says that the Australian Health Practitioner Regulation Agency (AHPRA) worked closely with the Board to develop the statement, which “clearly outlines what is in and what is out when advertising chiropractic services”.
A supplementary statement gives advice on what cannot be promoted for various regulated health service areas, including vaccination, and infant and child care (see below).
Both the CBA and AHPRA have come under serious pressure of late to ensure that unsubstantiated claims from some chiropractors are investigated and, where necessary, action taken against those chiropractors. There have been suggestions that the CBA, and possibly the Board of AHPRA, should be dismissed for their lack of action in sanctioning unethical and unsubstantiated claims.
“In Australia we have a national regulatory scheme covering 14 registered professions, including chiropractic, that has keeping the public safe as its main priority. Anyone advertising regulated health services needs to understand their obligations and make sure they comply,” said AHPRA CEO Martin Fletcher.
The statement says that “the Chiropractic Board of Australia commonly takes regulatory action against practitioners for breaches of national standards, including successfully prosecuting two cases in 2014 of individuals who were not registered chiropractors but were presenting themselves as being registered; imposing conditions on the registration of 14 chiropractors; issuing 10 cautions; and cancelling/suspending the registration of one practitioner”.
While the statement touts these regulatory actions, their level of effectiveness and severity have been questioned.
Dr Ken Harvey, joint author of a major complaint about chiropractic advertising, says that “Claims made about the alleged value of routine chiropractic care for pregnant women, new-borns, babies, children and numerous medical conditions are often based on the erroneous subluxation concept. In addition, they clearly increase the practitioner’s business and bank balance.
“It’s my view that until such time as the Board and AHPRA penalise and publicise those practitioners for breaching s.133 of the National Law, little will change. Part 7 of the National Law is available to prosecute advertising offenders in the Magistrates Court (maximum penalties available for this statutory offence are $5000 for an individual and $10,000 for a body corporate). Part 8 of the National Law is available to sanction recalcitrant practitioners for repeated advertising offences. Penalties available under Part 8 include cautions, accepting undertakings, placing conditions of the practitioner’s registration or, for professional misconduct, referral to a tribunal with the power to impose additional penalties, including a fine of up to $30,000. Another advantage of using Part 7 and 8 of the National Law is that Court and Tribunal Decisions about individual practitioners are published on the AHPRA web site.”
CBA advice on advertising
In order to provide further clarity to both practitioners and the public, the Board provides the following clear advice on 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.
The Board devoted its September 2015 newsletter to providing information to practitioners on advertising-related matters and strongly encourages practitioners to review their advertising and ensure it complies with the requirements of the National Law or they risk prosecution and/or disciplinary action.
Chiropractors should not display, promote or provide materials, information or advice that is anti-vaccination in nature and should not make public comment discouraging vaccination.
The Code of conduct for chiropractors notes that all chiropractors have a responsibility to promote the health of the community through disease prevention and control, education and, where relevant, screening.
If patients request information about vaccination, they should be referred to an appropriately qualified health professional for advice.
Care of pregnant patients
Chiropractors are not trained to apply any direct treatment to an unborn child and should not deliver any treatment to the unborn child. Chiropractic care must not be represented or provided as treatment to the unborn child as an obstetric breech correction technique.