Tag: fracture

The Outraged CAA and Other Outages.

Before I go on, please do not read this as a criticism of all chiropractors.  You need to understand that there are two bodies that represent chiropractors within Australia.  There is the Chiropractic and Osteopathic College of Australasia (COCA), and the Chiropractors’ Association of Australia (CAA).  I believe that anybody practicing in the health professions should always employ evidence-based techniques and treatment regimes, myself included.  If you want a chiropractor who practices based on evidence, you’ll be more likely to find one within the ranks of the COCA than you will in the ranks of the CAA though.  For example, of the fifty chiropractors openly expressing anti-vaccination lies on their websites documented here, most of them are members of the CAA.  None are members of COCA.

recent article in The Age, by Julia Medew and Amy Corderoy, has outraged chiropractors, or more specifically, the CAA.  If you want to know how much it has outraged them, you only need to read this press release by the CAA, and see the report on their outrage here.  The Age hasn’t even acknowledged their outrage, which must add disappointment to their already overflowing cup of emotion.

Why?

The article was startling for several reasons.  Firstly, it described the case of a four-month old baby treated by a chiropractor with a fractured neck.  Yep – a fractured neck.  Did the chiropractor cause it?  We don’t know, but suffice to say that it appears from the information available, that the parents took the baby to a hospital ED after an “adjustment” by a chiropractor, and the baby was found to have a fracture in his or her cervical spine.  I was not and am not part of the treating team.  Maybe the fracture occurred before the adjustment.  In that case the chiropractor possibly missed the signs and symptoms of a fractured neck – disappointing for someone who’s had “five years of university training” as we keep hearing.  The other option is that the chiropractor caused the fracture.  Either way, it’s not a shining endorsement.

The other startling aspect of the story was the claim that chiropractors visit hospitals and provide adjustments without the hospital’s permission.  More can be read on those allegations here.

So what is the reaction of the CAA?  Outrage.  Take a read of the media release.  They appear to know in great detail the results of the investigation of the case by AHPRA, despite those results being confidential.  Yet, they know.  And they tell us that The Age article “smeared the Chiropractor” – despite the name of the chiropractor not being mentioned.  Kinda hard to smear someone when you don’t name them.  This sort of confusion occurs when you are outraged.

Then we get to,

“National President of the CAA, Dr Laurie Tassell said, “It remains the case that not a single serious adverse event has been recorded in the medical literature (world-wide) involving a qualified Chiropractor treating a child since 1992.”

This Claim is obviously part of the gift pack you receive when you join the CAA, as it’s the same Claim made by Tony Croke on Catalyst.  The CAA lodged a complaint against Catalyst for criticising this Claim, and the complaint was only today dismissed by an independent investigator.  More outrage.  Lots of it.

So what of the Claim?  I contacted Bevan Lisle, Communications Director of the CAA today about the claim, and his response was, well, less than satisfactory in my opinion.  You see, The Claim, as we shall refer to it as, has several weak points.  Firstly, a health practitioner who claims to have no adverse events is someone who does not practice.  Secondly, as they have no systematic method of compiling adverse events, they simply aren’t looking for them.  It’s like claiming there’s no stars out while you’re down a mine shaft.  Thirdly, by Claiming that there has never been even a single adverse event, the documentation of just one is enough to falsify the Claim.  Lastly, the word “involving”, or as Bevan put it, “associated with”, doesn’t mean they caused the event – it just means the chiropractic treatment was “connected” with the event.  So how does the Claim stand up?

It doesn’t.

As defined by the FDA, a Serious Adverse Event (SAE) can be of several types. One is

Disability or Permanent Damage: Report if the adverse event resulted in a substantial disruption of a person’s ability to conduct normal life functions, i.e., the adverse event resulted in a significant, persistent or permanent change, impairment, damage or disruption in the patient’s body function/structure, physical activities and/or quality of life.
I had to help Bevan today with his definition of SAE, so let’s be clear in case anyone else doesn’t know it.
A slipped capital femoral epiphysis is a serious event, and a delayed diagnosis meets the criteria of a SAE.  The paper here describes 12 delayed diagnoses because of attendance at either a physiotherapist or a chiropractor.  Remember, we only need one case “associated” with chiropractic care after 1992 to disprove the Claim.  Hence, the Claim is apparently false.
This paper also describes fractured ribs associated with chiropractic care.  Published after 1992, associated with chiropractic care.  The Claim is therefore false.  Surely?
This paper also describes a litany of SAE’s associated with chiropractic care.  The events were all in 1992 or before, so technically lie outside the Claim, but still make for shocking reading.
The CAA, when asked for comment, stands by the Claim.  It’s like a mantra.  Even in the face of the investigation of the four-month old baby, they still repeat the Claim.  It happened after 1992, was associated with chiropractic care, and is a SAE.  Time to retract the Claim?
Instead of expressing outrage at one of their members, the CAA prefers to express outrage at journalists, and probably now myself, at what they see as a smear against an unnamed chiropractor.  In fact, in a brilliant example of double talk…

CAA president Dr Laurie Tassell (Chiro) said there was no doubt the baby had a hangman’s fracture.  “The official report made it quite clear that the chiropractor did not cause the injury but unless AHPRA releases the report we can’t use those findings,” he told Medical Observer.

See what he did there?  He can’t use the findings, but here they are anyway.  But he can’t use them, OK?

And we’re meant to believe him.  We’re meant to trust the CAA to have the public’s interest in mind.  We’re meant to see them as a peak representative body whilst they repeat the apparently false Claim, talk in double talk, and rather than express sympathy or even a whim of accountability, prefer to express their own outrage.

Here’s my message to the CAA: instead of expressing outrage, why don’t you start behaving like professionals, start regulating yourselves, start looking for adverse events and start reporting them openly like other medical professionals do, stop tolerating anti-vaccination garbage, encourage evidence based care, and for once, take responsibility.

John