As numerous of my posts have demonstrated, chiropractic manipulations can cause severe adverse effects, including deaths. Several hundred have been documented in the medical literature. When discussing this fact with chiropractors, we either see denial or we hear the argument that such events are but extreme rarities. To the latter, I usually respond that, in the absence of a monitoring system, nobody can tell how often serious adverse events happen. The resply often is this:
You are mistaken because the Royal College of Chiropractors’ UK-based Chiropractic Patient Incident Reporting and Learning System (CPiRLS) monitors such events adequately.
I have heard this so often that it is time, I feel, to have a look at CPiRLS. Here is what it says on the website:
CPiRLS is a secure website which allows chiropractors to view, submit and comment on patient safety incidents.
Access to CPiRLS
CPiRLS is currently open to all UK-based chiropractors, all ECU members and members of the Chiropractic and Osteopathic College of Australasia. To access the secure area of the CPiRLS website, please click the icon below and insert the relevant CPiRLS username and password when prompted.
In the UK, these can normally be found on your Royal College of Chiropractors’ membership card unless the details are changed mid-year. Alternatively, email [email protected] from your usual email address and we will forward the details.
Alternatively, in the UK and overseas, secure access details can be obtained from your professional association.
National associations and organisations wishing to use CPiRLS, or obtain trial access to the full site for evaluation purposes, should contact The Royal College of Chiropractors at [email protected]
Please click the icon below to visit the CPiRLS site.
Yes, you understood correctly. The public cannot access CPiRLS! When I click on the icon, I get this:
Welcome to CPiRLS
CPiRLS, The Chiropractic Patient Incident Reporting and Learning System – is an online reporting and learning forum that enables chiropractors to share and comment on patient safety incidents.
The essential details of submitted reports are published on this website for all chiropractors to view and add comments. A CPiRLS team identifies trends among submitted reports in order to provide feedback for the profession. Sharing information in this way helps to ensure the whole profession learns from the collective experience in the interests of patients.
All chiropractors are encouraged to adopt incident reporting as part of a blame-free culture of safety, and a routine risk management tool.
CPiRLS is secure and anonymous. There is no known way that anyone reporting can be identified, nor do those running the system seek to identify you. For this security to be effective, you require a password to participate.
Please note that reporting to CPiRLS is NOT a substitute for the reporting of patient safety incidents to your professional association and/or indemnity insurers.
So, how useful is CPiRLS?
Can we get any information from CPiRLS about the incidence of adverse effects?
No!
Do we know how many strokes or deaths have been reported?
No!
Can chiropractors get reliable information from CPiRLS about the incidence of adverse effects?
No, because reporting is not mandatory and the number of reports cannot relate to incidence.
Are chiropractors likely to report adverse effects?
No, because they have no incentive and might even feel that it would give their profession a bad name.
Is CPiRLS transparent?
No!
Is CPiRLS akin to postmarketing surveillance as it exists in conventional medicine?
No!
How useful is CPiRLS?
I think I let my readers answer this question.
23 Responses to The ‘Chiropractic Patient Incident Reporting and Learning System’ (CPiRLS)
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Whilst I am aware that there is mandatory reporting in NHS hospitals and for adverse drug reactions what is the situation with other professions in private practice such as physiotherapy, osteopathy etc and how does incident reporting in general medical practice work?
Orthodox medicine uses “Serious Complications and Harmful Therapy/Untoward Matters” reporting.
SCHTUM.
But then, no un-evidenced claims are made (except when conducting ethical research).
I think what Ernst means is: it’s not useful to him.
… nor to the public!
an overview of findings is available to the public.
what a joke!
@DC
Well, he has made a career out of the subject matter for several decades – just not in the way that the alternative community liked to see. In my book, that sounds pretty useful.
Well, anyone but a meatball chiropractor sees that this CPiRLS basket has no bottom.
That said and since you apparently do see value in CPiRLS, you shouldn’t have any trouble telling those like Ernst who has pointed out the holes in the basket’s bottom, the many ways CPiRLS is of value to you and your colleagues professionally.
~TEO.
A 10 year analysis of the data has indicated that 51.9% of patient harms were classified as avoidable and 62% were due to clinicians action/inaction. Around 86.4% of harms were classified as low to moderate which mirrors published research.
There are no official schemes for reporting of adverse events from non-pharmaceutical treatments or therapies in the UK.
There is currently a campaign running to get one instated.
https://www.change.org/p/department-of-health-and-social-care-we-demand-the-creation-of-a-new-mechanism-to-report-non-pharmaceutical-treatment-harms?redirect=false
https://en.wikipedia.org/wiki/Yellow_Card_Scheme#:~:text=The%20Yellow%20Card%20Scheme%20is%20the%20United%20Kingdom%27s,that%20are%20on%20the%20market%20to%20be%20monitored.
EE the link you provided is for adverse drug reactions. What mandated reporting systems exist for private practice such as GP services, physiotherapist, osteopathy, chiropodist etc? You seem to be avoiding this question!
Nothing and nowhere to report for harm from CBT or any other psychological treatments.
Have I got this right? There is no mandatory reporting of serious adverse events in the chiropractic industry? And there is no penalty for failing to report? And the reporting ‘system’ is run by the industry? And there is no independent oversight of adverse events by regulators? And the public can’t submit reports to the ‘system’? And the system, without mandatory reporting, will not deliver reliable statistics on events and trend? And without reliable statistics on adverse events and trends there can’t be proper management and oversight?
What a joke.
Contrast this with the systems for reporting accidents and incidents in the shipping and aviation industries, where all of the above is implemented. See https://www.atsb.gov.au/about_atsb/legislation/enforcement-policy/ and https://www.atsb.gov.au/mandatory/asair-form/
“Often, there is a lot of concern over MedWatch’s voluntary reporting, as opposed to implementing a mandatory adverse event reporting provision. The challenge would be enforcing such a provision. For a program to be mandatory there would have to be a penalty involved with noncompliance, the the FDA is concerned that penalizing individuals might deter participation rather than increase it.”
http://rx-wiki.org/index.php?title=MedWatch
MedWatch, 1996
“Reporting by individual healthcare providers is essentially voluntary.”
https://www.supremecourt.gov/opinions/URLs_Cited/OT2010/09-1156/09-1156-2.PDF
You’re all looking in the wrong place for reporting of non-pharmaceutical incidents, which is found in health and safety law. EVERY incident of every sort should be reported and the yellow card scheme is in addition to this.
For example the accident book is mandatory:
https://www.hse.gov.uk/pubns/books/accident-book.htm
Employers are also required by law to have risk assessments and risk management in place, part of which is incident reporting.
If people don’t know this it reflects poorly on workplace culture, not the systems that are in place.
John you are quite correct and many thanks for pointing this out. When I worked in the NHS I was required to use their incident reporting sysytem and similarly in private practice my emloyer was responsible for incident reports. This is part of HSE law and private practitioners (from all professions) need to comply with this, and they do. These incident reporting systems are not available for public scrutiny but would be available at HSE inspections. The CiPRLS incident reporting system is primarlly for learning across a profession. Many of the other health care professions do not have anything equivalent, though some do. Rather than criticise the chiropractic profession it should be praised for at least trying to collate incidents in this way. The other aspect of reporting is covered by Duty of Care and Duty of Candour which again is relevant to all regulated health care professions. So chiropractors will be required to report incidents by their employer and in addition the profession has it own incident and learning system in place. EE is aware of this and it is somewhat disingenuos of him to compare CiPRLS with the yellow card scheme which is designed for drug adverse incidents.
Andy wrote: “Rather than criticise the chiropractic profession it should be praised for at least trying to collate incidents in this way.”
But is the CPIRLS being used properly? For example, we already know that its usefulness is questionable within the chiropractic industry:
https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1888-british-chiropractic-association-members-attitudes-towards-the-chiropractic-reporting-and-learning-system-a-qualitative-study.html
And even if the CPIRLS was being used properly, it looks like its purpose would be a drop on the ocean when compared to the dire situation in the U.S. where the vast majority of chiropractors practice:
https://www.ebm-first.com/chiropractic/risks/1842-letter-from-britt-harwe-president-chiropractic-stroke-awareness-group-csag.html
Andy wrote: “The other aspect of reporting is covered by Duty of Care and Duty of Candour which again is relevant to all regulated health care professions.”
But how meaningful is that given that chiropractors seem to have far less integrity than medical doctors? See item 7 here: https://tinyurl.com/yh8swxzx
Compared to medical doctors, chiropractors are:
•2x more likely to be involved in malpractice
•9x more likely to be practicing fraud
•2x more likely to transgress sexual boundaries
Another damning example of chiropractors’ behaviour can be found here:
https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1179-consent-or-submission-the-practice-of-consent-within-uk-chiropractic.html
It’s hardly a reassuring picture.
Compared to medical doctors, chiropractors are:
•2x more likely to be involved in malpractice
•9x more likely to be practicing fraud
•2x more likely to transgress sexual boundaries
No, that doesn’t properly reflect what the paper actually looked at or found.
Be a good little skeptic and inform us of the limitations of that 2004 study done in one state.
@ DC
I think the following is all readers require to make their own minds up… https://www.researchgate.net/publication/8326290_Chiropractors_Disciplined_by_a_State_Chiropractic_Board_and_a_Comparison_with_Disciplined_Medical_Physicians
…along with this comment:
https://edzardernst.com/2021/07/fraud-and-sex-offences-by-chiropractors/#comment-132504
So you can’t or won’t share what you found as limitations of the paper, unlike a true skeptic.
John, the link you provide is for workers and workplace accidents, not for patients reporting adverse events from therapy.
So, far from there being a yellow card system for SCAM to get annoyed about, there is no yellow card system for any non-drug therapy in mainstream medicine.