risk
The UK Chiropractic Council is inviting you to help them re-formulate their educational standards. It is an occasion, some of my readers might find interesting. I, therefore, copy the relevant part of their announcement:
… Following a scoping review in 2021, which determined that the existing Education Standards, published in 2017, required development and updating, the GCC began revising the Education Standards in January 2022.
The revision will ensure that the Education Standards:
- Provide a realistic and comprehensive set of outcomes to be met by graduates on approved qualifications, demonstrating an ability to practise in accordance with the GCC Code.
- Take into account developments within the profession, increase focus on multi-disciplinary learning and different professions working more closely together across the UK, ensuring that graduates are well placed to meet the opportunities to care for patients in different contexts.
- Remain consistent, as appropriate, with the outcomes set by other UK healthcare frameworks and standards.
Purpose: why we are consulting
This consultation sets out our draft Education Standards for providers and Learning Outcomes for students, which reflect and build on the evidence and feedback we have obtained through our scoping review.
We seek stakeholders’ views on these draft Education Standards to ensure our final proposals are future-proof and fit for purpose.
We welcome all responses to the consultation.
Documents
The draft Education Standards on which we invite comments.
The equality impact assessment of the Education Standards, with comments invited within the consultation.
The GCC Education Standards consultation document in Word format.
Ways to respond
Submissions to this consultation can be made online (see below) or by email at [email protected] (click here to download the consultation document).
It is advisable to make a copy of your submission to prevent the loss of information due to internet, portal or connectivity issues. This should be done before pressing the submit button.
Information in responses, including personal information, may need to be published or disclosed under the access to information regimes (mainly the Freedom of Information Act 2000, the General Data Protection Regulation, the Data Protection Act 2018, and the Environmental Information Regulations 2004).
The GCC is a data controller registered with the Information Commissioner’s Office. We use personal data to support our work as the regulatory body for chiropractors. We may share data with third parties to meet our statutory aims and objectives, and when using our powers and meeting our responsibilities.
Closing date
The deadline for responses to this consultation on the draft Education Standards is 16 September 2022 at noon. The consultation will be publicised and stakeholders will be invited to comment…
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Personally, I think the GCC desperately needs to improve its educational (and other) standards. They claim that, “as the regulator for chiropractors, our role is to protect the public”. The case of the late John Lawler is one of many examples to show how unfit for this purpose the GCC truly is.
So, perhaps you might want to contribute to the consultation with a view to making UK chiropractors less of a danger to the public?
Earlier this year, I started the ‘WORST PAPER OF 2022 COMPETITION’. You will ask what is there to win in this competition? I agree: a competition without a prize is no fun. Therefore, I suggest offering the winner (that is the author of the winning paper) one of my books that best fits his/her subject. I am sure this will over-joy him or her. And how do we identify the winner? I suggest that I continue blogging about nominated papers (I hope to identify about 10 in total), and towards the end of the year, I let my readers decide democratically.
In this spirit of democratic voting, let me suggest to you ENTRY No 6:
This study was to ascertain the efficacy of dry cupping therapy (DCT) and optimal cup application time duration for cervical spondylosis (CS). It was designed as a randomized clinical trial involving 45 participants with clinically diagnosed CS. The eligible subjects were randomly allocated into three groups, each having 15 participants. Each of the three groups, i.e., A, B, and C, received DCT daily for 15 days for 8 min, 10 min, and 12 min, respectively. All the participants were evaluated at the baseline, 7th, and 15th day of the trial using the neck disability index (NDI) as well as the visual analog scale (VAS).
The baseline means ± SD of NDI and VAS scores were significantly reduced in all three groups at the end of the trial. Although all three groups were statistically equal in terms of NDI, group C demonstrated greater efficacy in terms of VAS.
The authors concluded that the per-protocol analysis showed that dry cupping effectively alleviated neck pain across all treatment groups. Although this effect on neck disability index was statistically equal in all three groups, the 12-min protocol was more successful in reducing pain.
Who would design such a study and why?
- The authors claim they wanted to ascertain the efficacy of DCT. A trial is for testing, not ascertaining. And this study does certainly not test for efficacy.
- The groups were too small to generate a meaningful result of what, in fact, was an equivalence study.
- Intra-group changes in symptoms between baseline and time points during treatment are irrelevant in a controlled trial.
- The slightly better results of group C are most likely due to chance or non-specific effects (a longer application of a placebo would generate better outcomes that a shorter one).
- The study participants had cervical spondylosis, yet the conclusion is about neck pain. The two are not identical.
- The title of the paper promises that we learn something about the safety of DCT. Sadly, a trial with just 45 patients has no chance in hell to pick up adverse effects in a reliable way.
- As there is no control group, the study cannot tell us anything about possible specific effects of DCT.
The authors of the study have impressive affiliations:
- Department of Ilaj bil Tadbir, Luqman Unani Medical College Hospital and Research Center, Bijapur, India.
- Department of Ilaj bil Tadbir, National Institute of Unani Medicine, Bengaluru, India.
- Department of Moalajat, Luqman Unani Medical College Hospital and Research Center, Bijapur, India.
I would have hoped that researchers from national institutions and medical colleges should be able to design a trial that has at least a small chance to produce a meaningful finding. As it turns out, my hope was badly disappointed.
HISC (HOMEOPATHY IN THE SUSSEX COMMUNITY) was formed in 2011 and has established effective partnerships with organisations that support those in need. Projects include working with domestic and sexual violence charities as well as supporting people recovering from long-term and enduring mental health illness issues. They enable vulnerable and marginalised members of the Sussex community to access low cost treatment with highly experienced homeopaths.
On 22 July, HISC made the following announcement:
Homeopathy in the Sussex Community (HISC) has been awarded a grant from The National Lottery Community Fund to provide homeopathy to survivors of domestic abuse and sexual violence.
HISC works in partnership with Sussex-based organisations; RISE, and Survivors Network, offering long-term and low-cost homeopathic support to women who have experienced abuse and sexual violence.
This grant will fund these projects for the next year, allowing HISC to build on the valuable work already being done and reaching even more vulnerable women who want access to homeopathic support.
Society Fellow Caroline Jurdon and Registered members Michael Bird, Therese Eriksen, Tara Lavelle and Jo Magowan have all worked on the project with colleagues from the wider community. HISC received one of the Society of Homeopath’s Community Clinic awards in 2018.
HISC also offer volunteering and sitting in opportunities for students.
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The ‘National Lottery Community Fund’ make the following points on their website:
- “Our funding is public money. This means that it cannot be used to give organisations an unlawful advantage.”
- “We fund projects that support people and communities across the UK to thrive.”
I would argue that, for the following reasons, the award is misplaced:
- Public money should not be wasted. It must be invested in projects that have a reasonable chance to do more good than harm.
- A broad consensus exists today that homeopathy has no effect beyond placebo. In fact, the NHS has stopped funding homeopathy and states that “there’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.”
- Homeopathy can endanger lives. If people are misled into believing that it is effective and thus treat serious conditions with homeopathy, they needlessly prolong their suffering or, in the worst case scenario, hasten their death. Awards of the above nature can undoubtedly have this effect.
In my view, this means that the award given to HISC by the National Lottery Community Fund gives an unlawful advantage to an organisation promoting a bogus therapy. At best, it is a waste of public funds, at worst it causes serious harm.
Surely, women who have experienced abuse and sexual violence deserve better!
I have been warning the public about the indirect dangers of so-called alternative medicine (SCAM) for a very long time. It is now 25 years ago, for instance, that I published an article in the ‘European Journal of Pediatrics’ entitled “The attitude against immunisation within some branches of complementary medicine“. Here is the discussion section of this paper:
… certain groupings within COMPLEMENTARY MEDICINE (CM) may advise their patients against immunisation. Within these groupings, there is, of course, a considerable diversity of attitudes towards immunisation. Therefore
generalisations are difficult and more detailed investigations are required to clarify the issue.
The question arises whether the level of advice against immunisation as it exists today represents a real or only a potential risk. One study from the U.K. demonstrates homoeopathy to be the most prevalent reason for non-compliance with immunisation [30]. The problem may not be confined to naturopathy, chiropractic and homoeopathy. Books relating to CM in general [e.g. 19] also strongly advise against immunisation: “Vaccination may provoke the illness which it is supposed to prevent. People who are vaccinated can transmit the illness, even if they are not ill themselves. The vaccine can make the person more susceptible to the illness … The vaccinated child is a contaminated child”.
At present, our data is insufficient to de®ne which proportion of which complementary practitioners share this
attitude. The origin of this stance against vaccination is largely unknown. For instance, there is nothing in Hahnemann’s writings against immunisation [14]. It may therefore stem from a general antipathy toward modern medicine which seems to be prevalent within CM [7, 19, 23]. A more specific reason is that immunisation is viewed as detrimental, burdened with long-term side effects. It is also felt that it is not fully effective and unnecessary because
better methods of protection exist within CM [16].
Anti-immunisation activists are often unable to argue their case rationally, yet they place advertisements in the daily press warning about immunisation. In Britain, one tragic case has recently been publicised. A physician advised parents against measles vaccination for their child who was suspected of suffering from convulsions. Five years later, the child suffered severe brain damage after contracting measles. The doctor was sued by the parents and found guilty of negligence and ordered to pay £825,000 in damages [1].
In medicine we must, of course, always be vigilant about the risks of our interventions. Each form of immunisation should therefore be continuously scrutinised for its possible risks and benefits. Most forms of immunisation are clearly not entirely free of risk [e.g. 22] – in fact, no effective intervention will ever be entirely risk-free. Therefore the risks have to be discounted against the benefits. It follows that any blanket rejection of immunisation, in general, must be misleading. It endangers not only the individual patient but (if prevalent) also the herd immunity of the community at large. Such unreflected rejection of immunisation, in general, will inevitably do more harm than good.
It is concluded that the advice of some, by no means all complementary practitioners in relation to immunisation represents an area for concern, which requires further research. Complementary practitioners and patients alike should be educated about the risks and benefits of immunisation. Paediatricians should be informed about the present negative attitude of some complementary practitioners and discuss the issue openly with their patients.
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I suspect that, had we heeded my caution, researched the subject more thoroughly, and taken appropriate action, the current pandemic might have produced fewer and less vocal anti-vaxxers, and fewer patients might have died.
The US Food and Drug Administration (FDA) state that dietary supplements can help people improve or maintain their overall health. But they may also come with health risks. Whether you’re a consumer of dietary supplements or it’s your job to inform and educate, it’s important to know the facts before deciding to take any dietary supplement.
Therefore, they launched the initiative, “Supplement Your Knowledge”. It aims to help inform health care professionals, consumers, and educators about dietary supplements.
“Dietary supplements can be valuable to your health but taking some supplements can also involve health risks,” Douglas Stearn, JD, deputy director for regulatory affairs in the FDA’s Center for Food Safety and Applied Nutrition, said in a statement. “These Supplement Your Knowledge resources will help provide consumers and health care professionals with facts to make informed decisions when determining if they want to use or recommend dietary supplements.”
In collaboration with the American Medical Association, publisher of JAMA, the FDA has developed a free continuing medical education program for physicians and other health care professionals about the regulation of dietary supplements, informing patients about their use, and reporting adverse events to the agency. The program includes 3 videos and accompanying educational materials. It is available on the FDA website and the AMA Ed Hub.
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The objectives of the program are:
1. Define dietary supplements
2. Describe how dietary supplements are regulated
3. Describe how dietary supplements are labelled and the types of claims permitted
4. Review potential interactions of dietary supplements with other supplements, medications, and laboratory tests
5. Identify adverse events and how to report them to FDA
Even though some parts of the program are quite specific to the US, I think that the initiative is most laudable and an excellent resource for physicians, SCAM practitioners, consumers, and decision-makers to learn more about this important subject.
On 18/7/2022 the ‘WORLD FEDERATION OF CHIROPRACTIC’ published a statement on cervical artery dissection (CAD). Below are a few excerpts to which I have added a few numbers [in brackets] which refer to my comments below:
… On rare occasions, CAD has been reported to have occurred after a patient visited a chiropractor or other provider of manual therapy [1]. However, the best evidence available to date indicates that spinal manipulation does not stress the arteries enough to cause tearing of the arteries leading to dissection-related strokes [2]. Additional studies have concluded that patients are as likely to have consulted a primary care physician as receive spinal manipulation from a chiropractor prior to experiencing a CAD-related stroke [3]…
The provision of safe, high-quality, evidence-based, patient-centered care for these and other conditions is a priority for the chiropractic profession [4]. Rigorous research is core to the pursuit of that objective [5]. We urge caution in making claims that are in conflict with the current state of the evidence.
About the WFC
The World Federation of Chiropractic is an international, non-governmental organization whose members are the national associations of over 90 countries in seven world regions. It is a non-state actor in official relations with the World Health Organization and is the global authority for matters related to the chiropractic profession [6]…
References
Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 Apr;17(Suppl 1):176–83. Open access here.#
Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. Open access here.
Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. Open access here.
Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19. Open access here.
Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005 Jul;36(7):1575-80. Open access here.
Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. Open access here
Here are my brief comments based on the evidence discussed in dozens of posts previously published on this blog:
- As there is no post-marketing surveillance, nobody can say with any degree of confidence that CADs after chiropractic are rare.
- This is not the ‘best’ evidence. In fact, it has been refuted repeatedly.
- This study has also been refuted.
- Chiropractic is very far from being evidence-based.
- Rigorous research fails to show that chiropractic neck manipulations generate more good than harm.
- The WFC is a lobby group for chiropractic; its mission is ” to advance awareness, utilization, and integration of chiropractic internationally”. Its current director is Richard Brown who spear-headed the disaster when the BCA sued Simon Singh, lost, and caused immense reputational damage to chiropractic worldwide.
I recently looked at the list of best-sellers in homeopathy on Amazon. To my surprise, there were several books that were specifically focused on the homeopathic treatment of children. Since we had, several years ago, published a systematic review of this subject, these books interested me. Here is what Amazon tells us about them:
Homeopathic remedies are increasingly being used to treat common childhood ailments. They are safe, have no side effects or allergic reactions, are inexpensive and, above all, effective. In this guide, Dana Ullman explains what homeopathy is, how it works and how you can use it correctly to enhance your child’s health. He recommends remedies for more than 75 physical and emotional conditions, including: allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds and travel sickness
Without doubt, this is the most comprehensive book on homeopathic pediatrics. Included is a complete guide to the correct use of homeopathy, recommended remedies for the treatment of more than seventy-five common physical, emotional, and behavioral conditions, and valuable information on the essential medicines that all parents should have in their home medicine kits
Tricia Allen, a qualified homeopath, offers a host of practical advice on how to treat illness using natural, homeopathic remedies. Homeopathy differs from conventional medicine in that it does not only alleviate the individual symptoms of an illness, but treats the underlying state to ensure that the disease does not return, something which rarely occurs when using traditional remedies. This guide gives you advice on; what homeopathy is and how to use it; each stage of childhood and how to deal with the complaints that occur at that time of a child’s development; the most common childhood illnesses, how to take your own steps to treating them, which homeopathic remedies to use and when to seek medical help and first aid.
The Homeopathic Treatment of Children is indispensible at giving both a clear overall impression of the various major constitutional types, and also a detailed outline for reference at the end of each chapter. Not only does Paul Herscu draw from various sources (repertories and materia medica), he also adds indispensable original information from his successful practice.
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The fact that such books exist is perhaps not all that surprising. Yet, I do find the fact that they are among the best-selling books on homeopathy surprising – or to be more precise, I find it concerning.
Why?
Simple: children cannot give informed consent to the treatments they receive. Thus, consent is given for them by their parents or (I suspect often) not at all. This renders homeopathic treatment of children more problematic than that of fully competent adults.
Homeopathy has not been shown to be effective for any pediatric condition. I know Dana Ullman disagrees and claims it works for children’s allergies, grief, anxiety, headaches, asthma, measles, bedwetting, nappy rash, bites and stings, shock, burns, sunburn, colic, teething, coughs and colds, and travel sickness. Yet, these claims are not based on anything faintly resembling sound evidence! Our above-mentioned systematic review reached the following conclusion: “The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition.”
And what follows from this state of affairs?
I am afraid it is this:
Treating sick children with homeopathy amounts to child abuse.
The US Food and Drug Administration created the Tainted Dietary Supplement Database in 2007 to identify dietary supplements adulterated with active pharmaceutical ingredients (APIs). This article compared API adulterations in dietary supplements from the 10-year time period of 2007 through 2016 to the most recent 5-year period of 2017 through 2021. Its findings are alarming:
- From 2007 through 2021, 1068 unique products were found to be adulterated with APIs.
- Sexual enhancement and weight-loss dietary supplements are the most common products adulterated with APIs.
- Phosphodiesterase-5 inhibitors are commonly included in sexual enhancement dietary supplements.
- A single product can include up to 5 APIs.
- Sibutramine, a drug removed from the market due to cardiovascular adverse events, is the most included adulterant API in weight loss products.
- Sibutramine analogues, phenolphthalein (which was removed from the US market because of cancer risk), and fluoxetine were also included.
- Muscle-building dietary supplements were commonly adulterated before 2016, but since 2017 no additional adulterated products have been identified.
The authors concluded that the lack of disclosure of APIs in dietary supplements, circumventing the normal procedure with clinician oversight of prescription drug use, and the use of APIs that are banned by the Food and Drug Administration or used in combinations that were never studied are important health risks for consumers.
The problem of adulterated supplements is by no means new. A similar review published 4 years ago already warned that “active pharmaceuticals continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after FDA warnings. The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.”
These papers relate to the US where supplement use is highly prevalent. The harm done by adulterated products is thus huge. If we focus on Chinese or Ayurvedic supplements, the problem might even be more serious. In 2002, my own review concluded that adulteration of Chinese herbal medicines with synthetic drugs is a potentially serious problem which needs to be addressed by adequate regulatory measures. Twenty years later, we seem to be still waiting for effective regulations that protect the consumer.
Progress in medicine, they say, is made funeral by funeral!
Today, I received an email advertising a book – nothing unusual, of course. But the book and its author are both quite unusual. Here is the text:
Dr. Farokh J. Master’s birth into homeopathy was in the year 1976, when he joined Bombay homeopathic medical college, after giving up his studies at the orthodox school of medicine. Dr Master was instrumental in starting homeopathic out-patient dept in many allopathic hospitals viz. Bombay Hospital, KEM Hospital & Ruby Hall, Pune. Besides his work as a senior Homeopath of the HHC, Dr. Farokh Master is teaching homeopathy (advanced level) at the Mumbai Homeopathic Medical College, part of Mumbai university. He is also teaching at other homeopathic colleges in India and abroad. He has given seminars in various countries like Austria, Australia, India, Japan etc…
Healing Cancer: A Homoeopathic Approach
As a homeopath one should not deter oneself in dealing with any type of cases, be it cancer. But for executing that an ultimate guidance is needed. Cancer is so much prevalent and challenging medical problem of today that a trustworthy source of accurate information becomes pertinent and this work of Dr. Farokh Master immediately propels at the top of quality books for cancer. Based on Master’s 40 years of experience this book was written for students to understand the basis of oncology and for practitioners for brushing-up of their knowledge in this growing discipline. Author says that to get a grasp on cancer cases we should believe in the potential of the homeopathic treatment, that healing from cancer refers to internal process of becoming whole and feeling harmonious with yourself and your environment.To even start with handling the cases of cancer one should be aware of understanding of cancer, its cause, pathophysiology, different types, conventional treatment and their side effects, integrative medicines, social problems in the treatment, such topics are well casted by Volume 1 of the book…• A whole chapter on Cadmium salts and cancer.• 51 “lesser known remedies” are briefly quoted and their usefulness in different situations and types of cancer exposed.• A long chapter deals with the “Indian drugs”, it is important that these remedies are used mostly in tincture or low potencies, as herbal or Ayurvedic remedies or food supplements relieving the patients. • The choice and differentiation between the remedies is then helped by the “Repertory of Cancer”, very well compiled and a highly useful section. “Clinical tips from my practice” given as a sub-chapter. • It ends with recommendations on how to deal with radiation illness and the side-effects of conventional treatment, as well as the treatment of pain and help with palliative care. For fighting and curing cancer and improving the quality and quantity of life of people, knowledge of Homeopathy, both philosophically and scientifically is needed which this work of art portrays delightfully.
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It is clear that Dr. Farokh J. Master does not suggest using homeopathy in addition to conventional cancer therapies. He foremost wants to employ it as an alternative cancer cure. It is also clear that, if his concepts were generally adopted, they could kill millions.
Some defenders of homeopathy might claim that this is not what most homeopaths would advocate; they would merely recommend homeopathy as an adjunct to conventional oncology. Yet, there are many examples to the contrary, and not just from India – after all, Hahnemann, the inventor of homeopathy, insisted that homeopathy must never be combined with ‘allopathic’ medicines.
So, the next time someone claims homeopathy to be harmless, please show them this post.
Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue.
The purpose of this scoping review was to explore the issues surrounding the utilization of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence.
A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesized using a narrative approach.
In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings:
- (1) The historical integration of FLS radiography in chiropractic,
- (2) Clinical indications for FLS radiography in chiropractic,
- (3) Risks associated with FLS radiography,
- (4) Chiropractic techniques which prescribe the use of FLS radiography,
- (5) Current trends in the utilisation of FLS radiography in chiropractic.
This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence to published guidelines for spinal imaging, an absence of a reporting mechanism for the utilization of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography.
The authors concluded that this review has identified a scarcity of literature addressing the completion of chiropractor‐referred FLS X‐rays. Our review has outlined several pressing issues that warrant further investigation including a lack of quantitative measures to assess the utilisation of FLS X‐rays by chiropractors, a lack of consensus of what constitutes appropriate clinical justification for imaging and the existence of a spectrum of beliefs amongst chiropractic authors about the clinical utility and limitations of FLS radiography. This provides radiographers with a definitive opportunity to demonstrate clinical leadership in this space and seek to begin a constructive dialogue with chiropractic referrers about the risks associated with unnecessary or unjustified spinal radiography. In doing this, diagnostic radiographers as evidence‐based health practitioners can actively contribute to the conversation surrounding the issues identified by this study and can be better positioned to advocate for the interests of the discipline and the safety of their patients.
The authors of this review make a number of further relevant points:
- Between 2014 and 2015, approximately 130,000 three‐ to four‐region spinal X‐rays were performed in Australia. Most were requested by chiropractors.
- In Australia, chiropractors often request FLS X‐ray examinations by radiographers.
- A spectrum of beliefs and knowledge exists amongst chiropractic practitioners surrounding the appropriate use of FLS radiography which may not always align with the principles of evidence‐based practice.
- The risks associated with the overutilization of diagnostic imaging are well documented. Aside from the inherent risks of unnecessary exposure to ionizing radiation, increased reliance on diagnostic imaging by any practitioner in the absence of sufficient clinical justification increases economic burdens encumbered upon the health care system. As such, FLS radiography should be used judiciously to ensure risks associated with its use are minimized, thus ensuring that it remains available to chiropractors and other practitioners where its use is clinically justified.
- Imaging that is not clinically indicated also carries a risk of overdiagnosis that being the radiological diagnosis of disease which does not ultimately impact on a patient’s course of treatment.
- The use of FLS radiography by chiropractors for the detection of red flags in the absence of any significant clinical indications for imaging could be considered a practice that carries a high risk of overdiagnosis.
When I first raised the issue of chiropractic overuse of imaging in 1998, I got fiercely attacked by a gang of chiros. Each time hence that I mention the subject, chiros loudly protest, and I do, of course, understand why. Imaging gives chiros the flair of being ‘cutting edge’; more importantly, in most countries, it is an easy source of additional income.
So, I do not expect that things will be different this time. Yet, I feel that, instead of constantly trying to shoot the messenger, chiropractors might be well advised to consider the message.
