MD, PhD, FMedSci, FSB, FRCP, FRCPEd

CBC news (Canada) reported yesterday that, more than a decade ago, the Manitoba Chiropractic Health Care Commission had been tasked to review the cost effectiveness of chiropractic services. It therefore prepared a report in 2004 for the Manitoba province and the Manitoba Chiropractors Association. Since then, this report has been kept secret. The report makes 37 recommendations, including:

  • Manitoba Health should limit its funding to “chiropractic treatment of acute lower back pain.”
  • Manitoba Health should provide “limited coverage of the treatment of neck pain.” The report called the literature around the efficacy of chiropractic care for neck pain “ambiguous or at best weakly supportive” and noted such treatment carried a “not insignificant safety risk.”
  • Manitoba Health should not fund chiropractic treatment anyone under 18 “as the literature does not unequivocally justify” the “efficacy or safety” of such treatment.

A Manitoba Ombudsman’s Office report from 2012 might shed some light on why the Manitoba Chiropractic Health Care Commission’s report was never made public. Someone had attempted to get a copy of the report, but large parts of it were redacted. “Access to this record was refused on the basis that disclosure would be harmful to a third party’s business interest,” the ombudsman report notes, “and harm the economic or financial interests or negotiating position of a public body.”

The report also challenged claims that chiropractic treatments can be address a wide variety of medical conditions. It stated that there was not enough evidence to conclude chiropractic treatments are effective in treating muscle tension, migraines, HIV, carpal tunnel syndrome, gastrointestinal problems, infertility or cancer, or as a preventive care treatment. It also said there was not enough evidence to conclude chiropractic treatments are effective for children.

The report urged Manitoba Health to establish a monitoring system to keep a closer eye on “the advertising practices of the Manitoba Chiropractors Association and its members to ensure claims regarding treatments are restricted to those for which proof of efficacy and safety exist.” It suggested the government should have regulatory powers over chiropractic ads.

A recent CBC I-Team investigation found Manitoba chiropractors advertising treatment for a wide range of conditions including Alzheimer’s, autism and pediatric services. The commission report contained sharp criticisms of previous reports that suggested funding chiropractic care could save the health-care system money. Dr. Pranlal Manga authored two widely cited reports which claim that by offering publicly funded chiropractic care, provinces can cut health-care costs. “The Manga study on Manitoba must be rejected as a guide to public policy,” the commission report states, “because its assumptions, methodology and costing of recommendations are all deeply flawed.” The reports states, “What limited evidence the Commission has suggests he [Manga] grossly exaggerates possible medical savings.” Dr. Manga did not respond to CBC’s repeated attempts to contact him.

The commission report also made recommendations around the use of X-ray machines by chiropractors. It suggested chiropractors not own and operate X-ray machines “Given the restrictive conditions under which X-rays are advisable, their poor correlation with low-back problems, their apparent limitation as a guide to appropriate treatment …[and] the apparent complete lack of monitoring [of] the use of X-ray by chiropractors.”  Instead, it recommended consulting with radiologists when imaging is deemed necessary. “The Commission is of the view that the public interest, and even chiropractic itself, would be better served if chiropractors had access to radiologists for this service, rather than perform it themselves,” the report said.

All three report authors declined comment. Calls to Dave Chomiak, who was health minister at the time the report was prepared, were not returned. In an email to CBC, Manitoba Chiropractors Association president Perry Taylor said, “I personally have never seen this 13-year-old document and [it] pre-dates my time as President. As such I have no comment on this.” The CBC I-Team offered to go through the report with Taylor but he did not respond.

MY COMMENT:

This report seems to confirm much of what we have discussed repeatedly on this blog: Chiropractic is not nearly as effective and safe as chiropractors try to make us believe. To hide this fact is certainly dishonest and unethical, but it is in some ways understandable: this knowledge would directly threaten the income of most chiropractors.

Yesterday I commented on another post: “the conflict of interest seems obvious: if homeopaths speak the truth, they are out of business. therefore, they are taught untruths from the first day of their training and eventually end up believing them. there is only one solution, as far as I can see: regulators must prevent them from making false claims. if not, this will go on for another 200 years and damage many patients’ health”. In the light of the above report, I will now re-phrase this: the conflict of interest seems obvious: if chiropractors allowed the truth to be known, they would soon be out of business. Therefore, they are taught untruths from the first day of their training and many end up believing them. There is only one solution, as far as I can see: regulators must prevent chiropractors from making false claims. If not, this abuse will go on for another 120 years and damage many patients’ health.

4 Responses to Foul play by chiropractors?

  • more on this subject (http://www.cbc.ca/news/canada/manitoba/chiropractic-subsidies-changing-manitoba-1.4078802):
    Health Minister Kelvin Goertzen is hinting that changes are coming to the province’s subsidy of chiropractic care.

    “I’ve had discussions with the chiropractors this week about the future of their funding,” said Goertzen.

    “Those discussions are ongoing but I think they are happening in a co-operative way, recognizing that we value their contribution to the system but also recognizing we have fiscal challenges in terms of making the health-care system sustainable.”

    The province currently subsidizes patients for up to 12 chiropractic visits a year for spinal and pelvic adjustments, and adjustments of the extremities.

    In 2016, the province paid out nearly $12 million for claims from more than 166,000 patients. As for whether or not the same subsidies will continue, Goertzen said an answer is coming.

    “I would expect that relatively shortly within a week or so you’ll be able to have a firm answer on that,” said Goertzen, adding “it’s respectful for them (chiropractors) to keep those conversations between us at this point.”

    Goertzen said chiropractors will have to play a role in keeping health funding manageable.

    “This is an all hands on deck effort to ensure that we have sustainability in the healthcare system today, tomorrow and into the future, he said.

    “I think chiropractors understand that, they understand that they’re part of that all hands on deck strategy. And I’ll say that they’ve been very understanding of the need to be part of the solution.”

    The current contract with chiropractors runs until 2020 but Goertzen said the government is not opening the contract without chiropractors’ consent.

    “We want to do this in a co-operative way,” Goertzen said.

    “That’s why we met with them right after the budget, had some very good discussions and not just about funding but also about their role in the healthcare system. And those are continuing on in a co-operative way.”

    Chiropractic services have been covered by Manitoba Health since 1969.

    Saskatchewan, Alberta, and British Columbia all offer some form of public coverage, but only for limited groups, such as seniors and people on social assistance.
    Ontario delisted chiropractic coverage in 2004.

  • As quoted, Health Minister Kelvin Goertzen has said (on behalf of Manitoba), about chiropractors: ” …we value their contribution to the system…”.
    Very well, but what is that value, to the health system?
    Just what are the benefits? Risks? Outcomes attributable to manipulation and or adjustment, as opposed to benefits from a caring counselling consultation (which could be, and is, offered by PTs or MDs)?

    Just what is the ‘value added’ of spinal manipulation by chiropractors? Just what are the outcomes – the value referred to by Minister Goertzen?
    The answers are in the Manitoba Chiropractic Health Care Commission’s report which Professor Ernst, and CBS News (Canada), cite.
    Has Minister Goertzen read it?
    If not, why not?
    On what evidence does he base his opinion that chiropractic has any value at all to the healthcare system?

  • Activist says Manitoba Health was ‘deceitful’ to withhold chiropractic report:

    An activist who tried for years to get a copy of a report into chiropractic care in Manitoba says the government was “deceitful” in denying her access to the report.

    “I don’t know why the government would spend taxpayers’ dollars to commission a report and and then ignore the report. Boggles my brain,” Chevrier said.

    Her interest in the report arose from her son’s experience suffering harm after receiving chiropractic treatments, she said.

    Chevrier said the government should release the report in full.

    “The public has a right to know,” she said.

    The president of the Manitoba Chiropractors Association, which regulates the profession, has declined comment.

    Chevrier and others created an informal group called the Manitoba Chiropractic Stroke Survivors and have lobbied the province on policies related to chiropractic care.

    Laura Brownson, a member of the group who was diagnosed as having suffered a stroke after a chiropractic neck manipulation, said the government’s denying access to the report was “despicable.”

    The CBC I-Team renewed calls to the Manitoba Chiropractors Association for comment. There was no response.

    More…
    http://www.cbc.ca/news/canada/manitoba/manitoba-chiropractic-report-withheld-1.4078831

    ___________________________________________________________

    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”

    Björn Geir Leifsson, MD

  • In UK we have a ‘Freedom of Information’ Act:
    “The Freedom of Information Act creates a statutory right for access to information in relation to bodies that exercise functions of a public nature, three different kinds of bodies are covered under the act. Public Authorities, publicly owned companies and designated bodies performing public functions.

    In principle, the freedom of information act applies to all “public authorities” within the United Kingdom – the Houses of Parliament, the Northern Ireland Assembly, the Welsh Assembly, the armed forces, local government bodies, National Health Service bodies, schools, colleges and universities, police authorities and Chief Officers of Police are included within this list. A few government departments are expressly excluded from the scope of the act, principally Intelligence services.” (Wikipedia).

    In Canada, the Access to Information Act allows citizens to demand records from federal bodies.

    I cannot see on what grounds this information is being witheld.
    Those who want it should get it!

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