Journal of the New Zealand Medical Association, 05-September-2008, Vol 121 No 1281
The ethics of chiropractic
The recent article by Gilbey1 inspired me to monitor the ethical behaviour of UK chiropractors.
I googled “Chiropractic Clinics UK” (31/07/2008) and evaluated the contents of the first 10 websites of individual chiropractic clinics listed. My aim was to find out whether chiropractors adhered to their own ethical code2: it states, amongst other things, that “chiropractors must not use any title or qualification in such a way that the public may be misled as to its meaning or significance. In particular, chiropractors who use the title ‘doctor’ and who are not registered medical practitioners must ensure that they make it clear that they are registered chiropractors and not medical practitioners.” It furthermore states that “If chiropractors, or others on their behalf, do publicise the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way.”
Thus I extracted the chiropractors’ use of the title ‘doctor’ and the therapeutic claims made on the 10 websites. The claims were subsequently checked against the published evidencee.g.3,4
The results are summarised in Table 1. Six of the 10 clinic directors used the title ‘doctor’ without making it clear whether or not they are registered medical practitioners. All but one website advertised chiropractic for conditions for which there is no good evidence of the effectiveness of chiropractic manipulations e.g.3;4. Many of these conditions are unrelated to back and neck or other musculoskeletal problems.
Table 1. Data extracted from 10 websites
RSI = repetitive strain injury.
These findings add to the findings by Gilbey1 and confirm previous findings from North America.5 They suggest that many chiropractors violate their own ethical code. Langworthy et al recently showed that only 23% of UK chiropractors discuss serious risks of spinal manipulation with their patients before treating them.6 This lack of obtaining informed consent would constitute a further infringement on ethical guidelines.2
In the UK, chiropractors are independent primary healthcare professionals regulated by statute since the Chiropractors Act of 1994. The General Chiropractic Council has the duties of protecting the public, setting standards and developing the profession.2
My analysis is, of course, based on very small numbers and therefore not conclusive. Its results nevertheless suggest that these duties are performed less than optimally.
Edzard Ernst (MD, PhD, FRCP, FRCPEd)
Complementary Medicine, Peninsula Medical School
Universities of Exeter & Plymouth
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