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Canada Calls grow for outside regulation of chiropractors

The College of College of Chiropractors of Ontario office front door near Bay Street and Bloor Street in Toronto, Ont.

Melissa Tait/The Globe and Mail

Critics from inside and outside the chiropractic profession say its regulatory body in Ontario is incapable of policing its members and protecting the public from unscientific claims and treatments.

The College of Chiropractors of Ontario (CCO), they contend, is putting members' interests above those of the public and has allowed assertions, including the ability to prevent cancer, to go unchecked. Some believe that, for the sake of public health, CCO council members who hold “vitalistic” views should resign.

Vitalists say that subluxations, or nerve impingements in the spine, can block a healing force. Many vitalists also advocate against vaccination. There is no evidence that subluxations exist or that they play any role in human health or in cancer prevention.

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“I think the government should be regulating us," said Carlo Ammendolia, a leading Canadian chiropractic researcher. "There’s too much self-interest.”

The researcher was reacting to a recent investigation in The Globe and Mail that revealed that for a decade or more, the college has been influenced, if not outright controlled, by chiropractors called vitalists who support unscientific claims and unproven practices from the earliest days of chiropractic.

The early November story prompted what Dr. Ammendolia, an assistant professor at the University of Toronto and a chiropractor himself, called a “huge outcry in the profession that something needs to give and something needs to change.”

Chiropractors at a crossroads: The fight for evidence-based treatment and a profession’s reputation

Letters sent to the CCO by chiropractors, and provided to The Globe, demanded the immediate resignation or dismissal of council members who hold vitalistic beliefs or act outside the scope of practice. Some chiropractors critical of the CCO believe that the scope of chiropractic care should be limited to the evidence-based treatment of musculoskeletal problems, such as low-back pain.

“If chiropractors who are elected to the CCO are speaking, advertising on social media or on their website, practising outside the scope of practice and the standards of the CCO, they should resign,” wrote one chiropractor, whose name was redacted by the CCO.

“It is my strong opinion that these [vitalist] council members should step down from their positions immediately," wrote another chiropractor, “in order to allow the CCO to satisfy its duty to protect the public of Ontario.” He added that vitalist chiropractors are "endangering the health of the public via out-of-scope, anti-scientific and radically uninformed positions on issues like vaccination.”

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Professor Joe Schwarcz, director of McGill University’s Office for Science and Society, agrees with Dr. Ammendolia: “I think there needs to be a higher body, an outside body that should look at all of this and regulate it.”

He also says that a recent decision by the CCO allowing a chiropractor to say his treatments may prevent cancer demonstrates its inability to protect the public from fraudulent claims.

The four vitalist chiropractors, of the nine chiropractic members on the CCO council, declined to comment.

Not all the letters the CCO received were critical. About half supported the college and vitalist chiropractic and opposed evidence-based chiropractors, the Canadian Memorial Chiropractic College, which has eschewed vitalist practice, and the Globe investigation.

In general, the sentiments expressed in the letters reveal a profession divided, with chiropractors at odds over beliefs, treatments and a shared body of knowledge.

In a Nov. 19 letter to the CCO, the Ontario Chiropractic Association (OCA), an organization that advocates for the province’s chiropractors, said it also received a deluge of feedback from its members. They told the OCA that because of lax oversight by the regulator, “false advertising, out-of-scope claims, unethical business and clinical practices continue without consequences.”

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One letter said that the regulator was “supposed to be protecting the public, but is still allowing ridiculous and frankly fraudulent practices to continue…”

The Globe obtained an Oct. 31 decision by the CCO’s complaints committee in which it declined to discipline a chiropractor, based in Tecumseh, Ont., who made claims in promotions for a cancer-prevention workshop that chiropractic adjustments can help with the disease.

To advertise the event, Brian Nantais said blockage in the nervous system: “weakens the body, weakens the cells, weakens the immune system, weakens the very things that fight cancer.”

The CCO allowed Dr. Nantais to continue offering the workshops after he suggested that he add the word “may” to the promotional material. The committee found Dr. Nantais’s assertions to be reasonable and wrote: “the concept that ‘subluxations’ may contribute to visceral disorders is biologically plausible, but as yet unconfirmed. As such it would be appropriate to use the phrasing … may weaken the body, may weaken the cells, may weaken the immune system and may weaken the very things that fight cancer.”

In an e-mail, Jo-Ann Willson, the registrar and general-counsel of the CCO, said that the regulator cannot comment on specific complaints. She said that at its most recent meeting, on Nov. 29, the “Council … affirmed unequivocally that chiropractors in Ontario cannot make or advertise claims to cure or treat conditions unrelated to the chiropractic scope of practice.”

Given its judgment on the complaint against Dr. Nantais, this means that the CCO believes that chiropractors who assert that their adjustments may fight cancer are operating within its scope of practice.

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Prof. Schwarcz says the committee’s decision is “beyond belief."

"The only thing they chastised him for was not having enough weasel words in there,” said the author and science communicator. “I don’t know how any governing body, given that this guy on his website and social media was talking about chiropractic being beneficial for cancer, how they cannot just come with a sledgehammer on that. I don’t understand.”

Prof. Schwarcz said the decision failed to fulfill the college’s first mandate – to protect the public. “It protects the chiropractor against whom the complaint was launched. Treating cancer with chiropractic is fraud,” he said.

Professor Gordon Guyatt, an expert on evidence-based practice, says supporting assertions like this is, “fundamentally misleading, provides patients with false hopes, leads them to spend money unwisely, may put them at unnecessary risk, and represents a profound disservice to the public. Either the [CCO] should raise their evidentiary standards, or the government should act to force higher standards upon the profession,” Prof. Guyatt said

The CCO, like other regulated health professions, is overseen by the Health Professions Appeal and Review Board (HPARB), which is mandated, “to ensure that the health professions are regulated and co-ordinated in the public interest and to ensure that appropriate standards of practice are developed and maintained.”

The Globe provided HPARB with the college’s ruling on Dr. Nantais and requested a response. David Jensen, a spokesperson for the Ministry of Health and Long-Term Care, wrote: “Concerns related to an individual chiropractor’s practice or the scope of practice for the profession should be referred to the college.”

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Prof. Schwarcz called the response “bizarre.” He said that "It seems that the government is not taking a position on cancer quackery.”

Paul Benedetti and Wayne MacPhail are the authors of Spin Doctors: The Chiropractic Industry Under Examination. Mr. Benedetti teaches journalism at the University of Western Ontario. Mr. MacPhail is a digital media consultant.

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