Mark Hanna and I wrote a letter to the New Zealand Medical Journal about research we had completed showing that the majority of chiropractors break the Chiropractic Board policy on advertising. The policy states:
"All advertising must... be presented in a manner that is accurate, balanced, and not misleading;"
"A chiropractor shall not advertise... if the material... uses testimonials whether from patients or any other person"
54% of the websites claim that at least one of ADHD, Allergies, Asthma, Bed Wetting, Colic or Ear Infections could be treated or improved by chiropractic manipulation, and 35% of the websites contained testimonials.
When asked about these claims, the Chiropractic Association said that these issues had been addressed, saying that the research was "not really current now". However, I re-checked all the websites we visited and found that:
4 had stopped making the claims we looked for
4 had closed their websites, and possibly gone out of business
2 had claims that we had missed on the previous check
5 had added claims since our last check
The Chiropractic Board has reminded chiropractors to not make misleading claims:
The Board would like to remind all practitioners that you are personally responsible for ensuring you are abiding by and practising within all Board policies.
The Board's primary responsibility is the protection of public health and safety; advertising that is seen to be misleading, sensational or relies on improper sources such as testimonials does not ensure public safety and is in breach of several policies and laws.
The Board implores all practitioners to review the Advertising Policy and then closely asses all of your advertising materials- website, Facebook, flyers, handouts, print such as newspaper advertising, media advertising and business cards.
We have offered to share our data with the chiropractic board, but have not been contacted by them yet.
We will be revisiting these sites periodically to see if things improve. If not, we'll be submitting complaints to the board.
Here is the full text of the letter:
In March 2016, the Chiropractic Board of Australia—the Australian regulator of chiropractors—published a Statement on advertising relating to unsubstantiated claims made by many Australian chiropractors:
“Claims suggesting that manual therapy for spinal problems can assist with general wellness and/or benefit a variety of paediatric syndromes and organic conditions are not supported by satisfactory evidence. This includes claims relating to developmental and behavioural disorders, ADHD, autistic spectrum disorders, asthma, infantile colic, bedwetting, ear infections and digestive problems.”
The phenomenon of chiropractors making claims that are not supported by evidence is not new, nor is it restricted to Australia. In 2010, Ernst and Gilbey evaluated 200 websites advertising chiropractors based in Australia, Canada, New Zealand, the UK, and the US, and found that 190 of them made unsubstantiated claims regarding one or more of the specific conditions they were looking for.
In 2015, we systematically evaluated 137 websites for chiropractic clinics based in New Zealand, taken from the first 30 pages of Google search results for “Chiropractor New Zealand”. We looked for claims that chiropractic manipulation can treat or improve ADHD, allergies, bed wetting, colic, or ear infections, as well as for any health testimonials used to promote their services.
These conditions were chosen because we had previously observed chiropractors failing, when challenged via complaints to the Advertising Standards Authority, to provide evidence to substantiate claims that these conditions can be treated with chiropractic. Our own review of the literature also failed to find satisfactory evidence to substantiate any of these claims.
There is regulation in place to prevent misleading and unsubstantiated claims being made in advertisements. Both the Fair Trading Act 1986 and the Advertising Standards Authority’s Codes of practice have clauses prohibiting misleading and unsubstantiated claims. The New Zealand Chiropractic Board’s Advertising Policy also requires that:
“All advertising must… be presented in a manner that is accurate, balanced, and not misleading”
Health testimonials were included in the search, as they can be both very convincing and very misleading. They are prohibited in this context by the Medicines Act 1981 Section 58(1)(c)(iii), as noted in the New Zealand Chiropractic Board’s Advertising Policy:
“A chiropractor shall not advertise any material which relates to the chiropractor’s qualifications, practices, treatment or the premises where they practice chiropractic if the material…uses testimonials whether from patients or any other person (see section on Medicines Act)”
Interestingly, the Medical Council of New Zealand, whose role as the statutory regulator of medical professionals is equivalent to the New Zealand Chiropractic Board, notes in its recent proposal to amend their statement on advertising that:
“Council is proposing to prohibit the use of testimonials in medical advertising because they can be unreliable and misleading” [emphasis ours]
Claim Quantity Proportion ADHD 34 25% Allergies 48 35% Asthma 54 39% Bed Wetting 43 31% Colic 59 43% Ear Infections 55 40% Any condition 74 54% Testimonials 48 35% Any condition or testimonials 96 70% Total 137 100%
We found that 54% of the websites claim that at least one of the conditions could be treated or improved by chiropractic manipulation, and 35% of the websites contained health testimonials.
At least in their online advertising, the majority of New Zealand chiropractors make therapeutic claims that are not substantiated by the available evidence, and many have ignored the regulations surrounding the use of health testimonials. Of the chiropractor websites we surveyed, fewer than a third of them were free from both testimonials and claims of being able to treat the conditions we checked for.
Although, technically, chiropractors are regulated in New Zealand under the Health Practitioners Competence Assurance Act, our findings indicate that the regulations to ensure chiropractors in New Zealand behave ethically and legally are inadequate.
Chiropractors making unsubstantiated claims when advertising their treatments is an established problem. There are regulations in place that should address this issue, but these regulations appear to have not been effective. In our opinion, the Chiropractic Board’s hands-off regulation leaves New Zealanders wide open to potentially harmful misinformation.
In the interests of public safety, the New Zealand Chiropractic Board needs to follow the example set recently by the Chiropractic Board of Australia. The board should make a public statement giving clear direction to chiropractors to remove testimonials in their advertising, as well as claims to help any health condition where rigorous evidence of the efficacy of chiropractic treatment is lacking. The board should then follow through with sanctions, up to and including deregistration, for chiropractors who ignore the board’s direction.
Chiropractic Board of Australia - Statement on advertising [Internet]. Chiropracticboard.gov.au. 2016 [updated 7 Match 2016; cited 13 March 2016]. Available from: http://www.chiropracticboard.gov.au/News/2016-03-07-statement-on-advertising.aspx ↩︎
Fair Trading Act 1986 No 121 (as at 01 March 2016), Public Act – New Zealand Legislation [Internet]. Legislation.govt.nz. 2016 [cited 15 March 2016]. Available from: http://www.legislation.govt.nz/act/public/1986/0121/latest/whole.html ↩︎
New Zealand Chiropractic Board Advertising Policy [Internet]. Chiropracticboard.org.nz. 2016 [cited 13 March 2016]. Available from: http://www.chiropracticboard.org.nz/Portals/12/Advertising%20Policy%20%20-%20Approved%20Nov%202015.pdf?ver=2015-12-15-104320-983 ↩︎
Medicines Act 1981 No 118 (as at 01 March 2016), Public Act – New Zealand Legislation [Internet]. Legislation.govt.nz. 2016 [updated 1 March 2016; cited 13 March 2016]. Available from: http://www.legislation.govt.nz/act/public/1981/0118/latest/whole.html#DLM56046 ↩︎
Amendment to the Medical Council’s Statement on advertising in relation to the use of testimonials [Internet]. Mcnz.org.nz. 2016 [updated 8 March 2016; cited 13 March 2016]. Available from: http://www.mcnz.org.nz/assets/News-and-Publications/Consultations/Consultation-document-Revised-statement-on-advertsing-March-2016.pdf ↩︎