Thanks to Mary’s comment and a few other sources for pointing out this interesting development in the New Zealand medical scene.
New Zealand has created a small buzz internationally with an interesting dispute based on a very well written and timely New Zealand Medical Journal editorial piece by David Colquhoun entitled “Doctor Who? Inappropriate use of titles by some alternative “medicine” practitioners.” The full editorial is available here.
Two points stood out from this editorial for me. Firstly Colquhoun states:
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.
This really hits home the problem with chiropractic “medicine”: there simply is no true indication of its efficacy as a treatment for anything, but plenty of evidence it can cause problems such as strokes. Yet they give off an aura of being a profession with equal academic backing to standard medicine.
The second point that I thought was interesting was that chiropractors who claim to be medical doctors are already breaking NZ law but the law is simply not enforced. I did a quick search and it seems the relevant legislation is the Health Practitioners Competence Assurance Act 2003, of which section 7 contains the relevant information. It seems the issue could be solved quite quickly by simply applying the law as written and this is what Colquhoun recommends. I do wonder if the penalties are severe enough though, entailing a fine not exceeding $10,000, and I also wonder about the wording – I suspect a good lawyer could wriggle a pseudo-doctor out of any fine.
What makes things interesting however is that this article was met with a rather aggressive response from the New Zealand Chiropractic Association via a letter to the NZMJ from their lawyer, Paul Radich. The NZMJ reproduced the letter (here). The claim is made that the editorial (and another paper by Dew et al) is “one of the most blatant examples of defamation that we have seen.” The letter then goes on to demand a retraction, apology, opportunity for rebuttal and costs under the Defamation act.
What has really set the world alight however is the response by the editor of the NZMJ, Frank Frizelle. In it he discusses the letter from Radich, and then concludes with:
The Journal has a responsibility to deal with all issues and not to steer clear of those issues that are difficult or contentious or carry legal threats. Let the debate continue in the evidence-based tone set by Colquhoun and others.
I encourage, as we have done previously, the chiropractors and others to join in, let’s hear your evidence not your legal muscle.
As the Holford Watch blog states, “it isn’t often that you come across a newly-minted phrase that is destined to become a classic but Professor Frank Frizelle has managed it”. I can see people quoting that last sentence for years to come, myself included. Evidence based thought rather than lawyer based thought all the way!
What I find disappointing is that the New Zealand media doesn’t seem to have picked up on this issue (if someone has heard of it on the news or radio please let me know). Without media coverage it will probably die down quite quickly which is a shame because it is a lost opportunity to raise public awareness of this important issue. Far too many people (including me until a couple of years ago) think that, as a dentist is a “tooth doctor” and an optometrist is an “eye doctor”, that a chiropractic is a “back doctor”. This is manifestly not the case even if what they do is genuinely beneficial (which in my opinion it is almost certainly not) and the general public need to realise this.
For what it is worth, my advice is that if you have back problems go and see your doctor or a physiotherapist. I have had back problems and my physio sorted it, and I have been fine since. For extensive information about chiropractors check out chirobase and for the flipside, check out the New Zealand Chiropractors Association website.
For more details and posts about the NZMJ legal “battle” check out this page which seems to be keeping up to date with posts about the issue, and Colquhoun’s own site here.