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| Journal of the New Zealand Medical Association,
25-July-2008, Vol 121 No 1278
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Doctor Who? Inappropriate use of titles by some
alternative “medicine” practitioners
David Colquhoun
Who should use the title ‘doctor’? The title is
widely abused as shown by Gilbey1 in this issue
of the NZMJ in an article entitled Use of inappropriate titles by
New Zealand practitioners of acupuncture, chiropractic, and osteopathy.
Meanwhile, Evans and colleagues,2 also in this
issue, discuss usage and attitudes to alternative treatments.
Gilbey finds that the abuse of the title doctor is
widespread and that chiropractors are the main culprits. An amazing 82% of 146
chiropractics used the title Doctor, and most of them used the title to imply
falsely that they were registered medical practitioners. Although it is illegal
in New Zealand to do that, it seems clear that the law is not being enforced and
it is widely flouted.
This is perhaps not surprising given the history of
chiropractic. It has had a strong element of ruthless salesmanship since it was
started in Davenport, Iowa by DD Palmer (1845–1913). His son, BJ
Palmer, said that their chiropractic school was founded on “...a
business, not a professional basis. We manufacture chiropractors. We teach them
the idea and then we show them how to sell it” (Shapiro 2008).
It is the same now. You can buy advice on how to build
“build high-volume, subluxation-based, cash-driven, lifetime family
wellness practices” http://www.teamwlp.com/about-wlp/index.html
In her recent book, Rose Shapiro comments on the founder of
chiropractic as follows:
...By the 1890s Palmer had established a magnetic healing
practice in Davenport, Iowa, and was styling himself ‘doctor’. Not
everyone was convinced, as a piece about him in an 1894 edition of the local
paper, the Davenport Leader, shows...
A crank on magnetism has a
crazy notion hat he can cure the sick and crippled with his magnetic hands. His
victims are the weak-minded, ignorant and superstitious, those foolish people
who have been sick for years and have become tired of the regular physician and
want health by the short-cut method...he has certainly profited by the ignorance
of his victims...His increase in business shows what can be done in Davenport,
even by a quack
DD Palmer was a curious mixture: grocer, spiritual healer,
magnetic therapist, fairground huckster, religious cult leader—and above
all, a salesman. He finally found a way to get rich by removing entirely
imaginary ’subluxations’. Over 100 years later, it seems that the
“weak-minded, ignorant, and superstitious” include the UK’s
Department of Health, who have given chiropractics a similar status to the
General Medical Council.
The intellectual standards of a 19th Century Mid-Western
provincial newspaper leader writer are rather better than the intellectual
standards of the UK’s Department of Health, and of several university
vice-chancellors in 2007.
Do the treatments work?Neither Gilbey nor Evans et al really grasp the nettle of
judging efficacy. The first thing one wants to know about any
treatment—alternative or otherwise—is whether it works. Until that
is decided, all talk of qualifications, regulation, and so on is just vacuous
bureaucratese. No policy can be framed sensibly until the question of efficacy
has been addressed honestly.
It is one good effect of the upsurge of interest in
alternative treatments that there are now quite a lot of good trials of the most
popular forms of treatments (as well as many more bad trials). Some good
summaries of the results are now available too.
Cochrane reviews set the standard for good assessment of
evidence. New Zealand’s Ministry of Health commissioned the Complementary
and Alternative Medicine website to assess the evidence, and that seems to have
done a good job too. Their assessment of chiropractic treatment of low back pain
is as follows:
There appears to be some
evidence from one systematic review and four other studies, although not
conclusive, that chiropractic treatment is as effective as other therapies but
this may be due to chance. There is very little evidence that chiropractic is
more effective than other therapies.
And two excellent summaries have been published as books
this year, both by people who have had direct experience of alternative
treatments, but who have no financial interest in the outcome of their
assessment of evidence. The book by Singh and
Ernst3 summarises the evidence on all the major
alternative treatments, and the book by
Bausell4 concentrates particularly on
acupuncture, because the author was for 5 years involved in research in that
area,
Both of these books come to much the same conclusion about
chiropractic. It is now really very well-established that chiropractic is (at
best) no more effective than conventional treatment. But it has the disadvantage
of being surrounded by gobbledygook about “subluxations” and, more
importantly, it kills the occasional patient. Long
(2004)6 said “the public should be
informed that chiropractic manipulation is the number one reason for people
suffering stroke under the age of 45.”
The chiropractors of Alberta (Canada) and the Alberta
Government are now facing a class-action
lawsuit.7 The lead plaintiff is Sandra Nette.
Formerly she was a fit 41 year old. Now she is tetraplegic. Immediately after
neck manipulation by a chiropractor she had a massive stroke as a result of a
torn vertebral artery.
Acupuncture comes out of the assessments equally badly.
Bausell (2007) concludes that it is no more than a theatrical placebo.
Are the qualifications even real?It is a curious aspect of the alternative medicine industry
that they often are keen to reject conventional science, yet they long for
academic respectability. One aspect of this is claiming academic titles on the
flimsiest of grounds. You can still be held to have misled the public into
thinking you are a medical practitioner, even if you have a real doctorate. But
often pays to look into where the qualifications come from.
A celebrated case in the UK concerned the ‘lifestyle
nutritionist’, TV celebrity and multi-millionaire, Dr Gillian McKeith,
PhD. A reader of Ben Goldacre’s excellent blog (http://www.badscience.net) did a little
investigation. The results appeared in Goldacre’s Bad Science column in
the Guardian.8
She claimed that her PhD came from the American College of
Nutrition, but it turned out to come from a correspondence course from a
non-accredited US ‘college’. McKeith also boasted of having
“professional membership” of the American Association of Nutritional
Consultants, for which she provided proof of her degree and three professional
references.
The value of this qualification can be judged by the fact
that at Goldacre sent an application and $60 and as a result “My dead
cat Hettie is also a "certified professional member" of the AANC. I have the
certificate hanging in my loo”.
Is the solution government regulation?In New Zealand the law about misleading the public into
believing you are a medical practitioner already exists. The immediate problem
would be solved if that law were taken seriously, but it seems that it is not.
It is common in both the UK and in New Zealand to suggest
that some sort of official government regulation is the answer. That solution is
proposed in this issue of NZMJ by Evans et al. A similar thing has been
proposed recently in the UK by a committee headed by Michael Pittilo,
vice-chancellor of Robert Gordon’s University, Aberdeen.
I have written about the latter under the heading A very
bad report (http://dcscience.net/?p=235). The Pittilo
report recommends both government regulation and more degrees in alternative
medicine. Given that we now know that most alternative medicine doesn’t
work, the idea of giving degrees in such subjects must be quite ludicrous to any
thinking person.
The magazine
Nature5 recently investigated the 16
UK universities who run such degrees. In the UK, first-year students at the
University of Westminster are taught that “amethysts emit high yin
energy” http://dcscience.net/?p=227. Their vice
chancellor, Professor Geoffrey Petts, describes himself a s a geomorphologist,
but he cannot be tempted to express an opinion about the curative power of
amethysts.
There has been a tendency to a form of grade inflation in
universities—higher degrees for less work gets bums on seats. For most of
us, getting a doctorate involves at least 3 years of hard experimental research
in a university. But in the USA and Canada you can get a ‘doctor of
chiropractic’ degree and most chiropractic (mis)education is not even in a
university but in separate colleges.
Florida State University famously turned down a large
donation to start a chiropractic school because they saw, quite rightly, that to
do so would damage their intellectual reputation (http://dcscience.net/?p=231#fsu).
This map, now widely distributed on the Internet, was produced by one of their
chemistry professors, and it did the trick.
 Other universities have been less principled. The New
Zealand College of Chiropractic [President “Dr Brian Kelly”, B. App
Sci (chiro)] (http://www.nzchiro.co.nz)
is accredited by the New Zealand Qualifications Authority (NZQA). Presumably
they, like their UK equivalent (the QAA), are not allowed to take into account
whether what is being taught is nonsense or not. Nonsense courses are accredited
by experts in nonsense. That is why much accreditation is not worth the paper
it’s written on.
Of course the public needs some protection from dangerous or
fraudulent practices, but that can be done better (and more cheaply) by simply
enforcing existing legislation on unfair trade practices, and on false
advertising. Recent changes in the law on unfair trading in the UK have made it
easier to take legal action against people who make health claims that cannot be
justified by evidence, and that seems the best way to regulate medical
charlatans.
ConclusionFor most forms of alternative medicine—including
chiropractic and acupuncture—the evidence is now in. There is now better
reason than ever before to believe that they are mostly elaborate placebos and,
at best, no better than conventional treatments. It is about time that
universities and governments recognised the evidence and stopped talking about
regulation and accreditation.
Indeed, “falsely claiming that a product is able to
cure illnesses, dysfunction, or malformations” is illegal in
Europe.9
Making unjustified health claims is a particularly cruel
form of unfair trading practice. It calls for prosecutions, not accreditation.
Competing interests: None.
Author information: David Colquhoun,
Research Fellow, Dept of Pharmacology, University College London, United Kingdom
(http://www.ucl.ac.uk/Pharmacology/dc.html)
Correspondence: Professor D Colquhoun, Dept
of Pharmacology, University College London, Gower Street, London WC1E 6BT,
United Kingdom. Fax: +44 (0)20 76797298; email: d.colquhoun@ucl.ac.uk
References:
This paper was corrected on 11 September 2009 as per
the Erratum at http://www.nzmj.com/journal/122-1302/3783
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