Chiropractic professional ethics

Various organizations of practicing chiropractors have outlined formal codes of professional ethics. Actual practice has revealed a wide range of behaviors which may or may not conform to these standards.

## Contents

* 1 Official positions
* 2 Reports of actual practice
* 3 Tenets
* 4 See also
* 5 References
* 6 External links

## Official positions

The American Chiropractic Association (ACA) has a "Code of Ethics"[1] "based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient." The smaller International Chiropractor's Association (ICA) also has a detailed set of professional canons.[2]

## Reports of actual practice

Various situations have occurred in which the ethics of chiropractors and chiropractic organizations have been called into question.

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians.[3]

Gleberzon et al. identify "deliberate fraud" as a notably harmful element of the chiropractic profession, finding that dubious practice techniques can translate into "outlandish billing and utilization rates".[4] Those at the "fringe of ethical behavior" present the profession with a challenge, they believe, and must be weeded out.[4]

A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for medical doctors, and the incident rate for fraud was nine times greater among chiropractors (1.99 per 1000 chiropractors per year) than among medical doctors (0.20).[5] According to a 2006 Gallup poll of U.S. adults, when asked how they would "rate the honesty and ethical standards of people in these different fields", chiropractic compared unfavorably with mainstream medicine. When chiropractic was rated, it "rated dead last amongst healthcare professions". While 84% of respondents considered nurses' ethics "very high" or "high," only 36% felt that way about chiropractors. Other healthcare professions ranged from 38% for psychiatrists, to 62% for dentists, 69% for medical doctors, 71% for veterinarians, and 73% for druggists or pharmacists.[3][6][7][8] Similar results were found in the 2003 Gallup Poll.[9]

In 2001, the largest chiropractic associations in the U.S. and Canada were reported to have distributed patient brochures which contained unsubstantiated claims.[10] Chiropractors, especially in America, have a reputation for unnecessarily treating patients. In many circumstances the focus seems to be put on economics instead of health care.[11][12] Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could possibly present a risk to patients.[13] Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[13] A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, while 28% of chiropractic websites advocate lower back pain care, which has some sound evidence.[14]

Although in the vast majority of US States chiropractors are considered physicians pursuant to statute (exceptions are inter alia, New York and California). The Joint Commission recognizes chiropractors as physicians as well.[15] In some jurisdictions, like New Zealand, chiropractors appeared to have used the title 'doctor' in a New Zealand yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true.[16] In New Zealand, chiropractors are allowed to use the title 'doctor' when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board states that entries in the yellow pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified.[17] If a chiropractor is not a registered medical practitioner, then the misuse of the title 'doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.[16]

UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous.[18] In 2009, a backlash to the libel suit filed by the British Chiropractic Association (BCA) against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24-hour period,[19][20] prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."[19] An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[21] The libel case ended with the BCA withdrawing its suit in 2010.[22][23]

## Tenets

* ACA's Page on Ethical Practice
* ICA Ethics.

## See also

* Chiropractic

## References

1. ↑ Staff. "Code of Ethics". American Chiropractic Association. http://www.acatoday.org/content_css.cfm?CID=719.
2. ↑ Staff. "ICA code of Ethics". International Chiropractor's Association. Archived from the original on 2014-04-05. https://web.archive.org/web/20140405120410/http://www.chiropractic.org/ica/ethics.htm.
3. ↑ 3.0 3.1 Murphy, DR; Schneider, MJ; Seaman, DR; Perle, SM; Nelson, CF (Aug 2008). "How can chiropractic become a respected mainstream profession? The example of podiatry". Chiropractic & Osteopathy 16: 10. doi:10.1186/1746-1340-16-10. PMID 18759966.
4. ↑ 4.0 4.1 Gleberzon, Brian J.; Cooperstein, Robert; Perle, Stephen M. (2005). "Can chiropractic survive its chimerical nature?". Journal of the Canadian Chiropractic Association 49 (2): 69–73. PMID 17549192.
5. ↑ "Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians". J Manipulative Physiol Ther 27 (7): 472–7. September 2004. doi:10.1016/j.jmpt.2004.06.006. PMID 15389179.
6. ↑ "Gallup Poll: Americans have low opinion of chiropractors' honesty and ethics". Dynamic Chiropractic 25 (3). 29 January 2007. http://dynamicchiropractic.com/mpacms/dc/article.php?id=52038.
7. ↑ "USA TODAY/Gallup poll". USA Today. 11 December 2006. http://usatoday.com/news/polls/tables/live/2006-12-11-ethics.htm.
8. ↑ Inc., Gallup (14 December 2006). "Honesty/Ethics in Professions". http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx.
9. ↑ "Public Rates Nursing as Most Honest and Ethical Profession." Gallup Poll, 2003
10. ↑ "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther 24 (8): 514–9. October 2001. doi:10.1067/mmt.2001.118205. PMID 11677551.
11. ↑ "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. 2008. pp. 145–90. ISBN 978-0-393-06661-6.
12. ↑ Samsonov, Mike. "Chiropractic Therapy As a Method of Treatment". http://www.betterhealthbeauty.com/2017/03/04/chiropractic-therapy-as-a-method-of-treatment/.
13. ↑ 13.0 13.1 Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
14. ↑ Ernst, E; Gilbey, A (2010). "Chiropractic claims in the English-speaking world". The New Zealand Medical Journal 123 (1312): 36–44. PMID 20389316.
15. ↑ "The Joint Commission Now Recognizes Chiropractors as Physicians". Joint Commission Perspectives. http://www.acatoday.org/content_css.cfm?CID=4038. Retrieved 2014-04-05.
16. ↑ 16.0 16.1 Gilbey A (July 2008). "Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy". N. Z. Med. J. 121 (1278): 15–20. PMID 18670471.
17. ↑ Bale K (August 2008). "Chiropractic Board New Zealand response to "Dr Who?" editorial". N. Z. Med. J. 121 (1280): 78–9. PMID 18791634.
18. ↑ Ernst E (July 2009). "UK chiropractic: regulated but unruly". J Health Serv Res Policy 14 (3): 186–7. doi:10.1258/jhsrp.2009.008183. PMID 19541879.
19. ↑ 19.0 19.1 Lucas Laursen. "The Great Beyond: Chiropractic group advises members to 'withdraw from the battleground'". Nature.com. http://blogs.nature.com/news/thegreatbeyond/2009/06/chiropractic_group_advises_mem_1.html. Retrieved 20 June 2009.
20. ↑ Lucas Laursen. "The Great Beyond: Complaints converge on chiropractors". Nature.com. http://blogs.nature.com/news/thegreatbeyond/2009/06/chiropractic_complainers_ident.html. Retrieved 20 June 2009.
21. ↑ "Unjust burdens of proof". Nature 459 (7248): 751. June 2009. doi:10.1038/459751a. PMID 19516290. Bibcode: 2009Natur.459Q.751..
22. ↑ Pallab Ghosh (2010-04-15). "Case dropped against Simon Singh". BBC News. http://news.bbc.co.uk/1/hi/sci/tech/8621880.stm.
23. ↑ Mark Henderson (2010-04-16). "Science writer Simon Singh wins bitter libel battle". London: Times Online. https://business.timesonline.co.uk/tol/business/law/article7098157.ece.

## External links

* Institute for Chiropractic Ethics
* ICA Canons of Ethics

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