Chiropractors have doctorate or professional level
degrees which take around three years to obtain. Even so, chiropractic
therapies are polarizing and tend to elicit controversy among medical
professionals. However, I do not wish to focus on the legitimacy of chiropractic
medicine as a whole, but rather the ethical concerns of private chiropractic
practices in Denver.
There are dozens of
private chiropractic practices in Denver. The Department of Regulatory Agencies
and the Colorado State Board of Chiropractic Examiners issues rules and
regulations for practicing chiropractors in Colorado. After reading the legal
document, one stipulation resonated with me. Section 1.12 of the Colorado State
Rules and Regulations document condemns “untrue, deceptive or misleading
practices regarding unproven and/or unnecessary services” with the caveat that
such practices can be performed if “written informed consent of the patient or
the patient’s legal representative” is obtained from the patient (“Colorado state board of chiropractic examiners
rules and regulations,” 2019).
In other words, bogus practices can be performed as long as the patient signs a
paper that says they understand that it is bogus.
These regulations do
not sit well with me for several reasons. First, there are no regulations on
what the chiropractor must disclose to the patient before having them sign the
consent allowing for “untrue, deceptive, or misleading practices” to occur. In
theory, this informed consent could be lumped in with new-patient forms that
must be signed before receiving any treatment at all. Second, according to
section 1.14 of chiropractic regulations, chiropractors are allowed to
advertise these deceptive practices as long as an “adequate disclaimer”
accompanies it (“Colorado state
board of chiropractic examiners rules and regulations,” 2019). Out of curiosity for how well this rule was
being upheld, I searched through a couple of private chiropractic websites.
After 30 minutes of searching, I found a tiny tab at the bottom of the page
labeled “disclaimer.” Clicking the link routed me to an outside webpage that
stated that “[the chiropractic office] do[es] not offer advice regarding
specific treatments or health conditions,” which was a direct contradiction to
the clinic’s website that stated that they “treat childhood diseases,
including… ADD/ADHD, autism spectrum disorders, food allergies,” and more (“Services & Techniques,” 2019; “Internet
Brands,” 2019). Additionally,
practices in Denver still offer allergy therapy through the BAX-3000 Allergy
Relief System, which was condemned by the FDA, yet has no distinct disclaimer
present on any website that I visited. So not only are they not abiding by
state regulations, but they are also promoting illegitimate and condemned
practices without a specific disclaimer for the practice.
While I do not know
enough to comment on the legitimacy of all chiropractic therapies, I do know
that the regulations that chiropractors must follow are being disregarded and
are worded so loosely that individual interpretation can vary immensely. It does
not sit right with me that chiropractors can advertise and perform illegitimate
procedures with very few and very easily evaded regulations. I believe that a
person should not need a legal or medical degree to understand that they are
being taken advantage of.
References:
Department of Health, Food and Drug
Administration (2010). Warning Letter to Brad Goldstein Chief Executive Officer
of BioVeda.
Internet Brands. (2019). Retrieved from https://www.internetbrands.com/ibterms/supplementalhealthterms/index.php.
Services
& Techniques. (2019). Retrieved from http://www.rejuvenatewellnesscenter.com/about-us/services---techniques.html.
(2019) Colorado state board of chiropractic examiners rules
and regulations. Department of Regulatory Agencies: Board of Chiropractic Examiners.
3 ccr 707-1.
Kat,
ReplyDeleteVery interesting read! I know there is a stigma surrounding chiropractic care, which I have always wondered because I always felt better after visiting the chiropractor. However, I have noticed in the several chiropractors I have seen (some even at the same office), that not all care is created equal. About two weeks ago I went for an adjustment for a stiff neck and a newer "doctor of chiropractic medicine" (I'm not sure what their ending initials are) did the adjustment. It was different from all other adjustments I've ever had, and it had me thinking even before your post "why?" Some things I liked about it, and yet others really had me questioning what the heck this guy was doing, even while he was doing it! I even asked questions along the way and his answers were so bogus I hoped that I never had to encounter him again at this clinic. After reading your post and looking at this clinic's website, I see no indication of any disclaimers; one would hope that in that case they are providing a standard care for every patient based on what the patient needs.
This specific clinic though is in an area where there is a high population of non-English speakers. It makes me wonder based on my questionable experience there, how many other people are potentially being taken advantage of without even knowing it? These patients are trusting what their chiropractor is saying to them, and if they feel better then why question a good thing? Because I've seen several different chiropractors, I have an idea on what adjustments have been normal for me and which ones haven't, which is why my last adjustment had me asking a lot of questions. How can beneficence be maintained if care is not only not well understood to the patient, but wildly different each time you step in the clinic?
In 2003 Cooper and McKee wrote an article on chiropractic care in the US and its trends and issues. One of the main points was whether there is enough scientific evidence to claim that adjustments work and are effective in promoting “vitality of the spine”, much like your article states as reasons for disclaimers to be presented. One of the big findings in their article is though there isn’t much evidence to indicate that chiropractic care is actually beneficial, patients (I’m guilty of this as well), like that manual stimulation is being applied, often times with seemingly immediate effects (Cooper & McKee, 2003). Instead of allocating time to physical therapists and occupational therapists, which over time would actually make your body stronger in the hopes your pain could be managed effectively, chiropractors seem to be an easier and cheaper short term fix, even though in the long run they cost more for patients with chronic pain (Cooper & McKee, 2003). At what point do chiropractors team up with other forms of therapy to provide a holistic approach? Chiropractic websites all over claim to be “homeopathic and holistic,” but how can that be if the evidence supporting the science isn’t clear and there are other forms of therapy that can also aid in the progression of health for patients? It makes me wonder about this disclaimer of “deceptive and misleading practices” and if other healthcare settings have such disclaimers, or it’s specific to chiropractic care given there isn’t sufficient data that care across the board is equal and beneficial.
(2019) Colorado state board of chiropractic examiners rules and regulations. Department of Regulatory Agencies: Board of Chiropractic Examiners. 3 ccr 707-1.
Cooper, R., McKee, H. (2003). Chiropractic in the US. Trends and Issues. Milbank Q. 81(1). 107-138. DOI: 10.1111/1468-0009.00040
Thanks for your thoughts, Alex. I totally agree that not all chiropractors are created equal. I specifically chose not to look into the legitimacy of their techniques because regardless of their legitimacy, people seem to really like it! If procedures were harmful then that would be an issue. Also, if patients thought that by cracking their spine they would cure their cancer and experience spiritual enlightenment... thats an issue. Regardless of what people chose (because it feels good or otherwise) I think there needs to be a VERY explicit conversation that informs the patient that techniques are not proven to help or to be used in lieu of medical advice. I cannot see how someone can make an autonomous choice about a procedure if they are not given all the information, that is what makes me uncomfortable!
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