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

When Christopher Lehmann of Innisfil, Ont., was nine years old, his mother, Sandy Hart-Lehmann, took him to a chiropractor who claimed treatments could 'correct' his autism. The family spent at least $5,000 before Christopher called a halt to the treatments. 'Honestly, I felt I was – I hate to say it – duped,' Ms. Hart-Lehmann says.

Michelle Siu/The Globe and Mail

Canadian chiropractor Dr. Clifford Hardick paces in front of an auditorium full of Life University chiropractic students in Marietta, Ga. He energetically tells the students about the power of “the subluxation” and how it is the root of all disease. “One cause, one cure,” he booms into the crowd.

A chiropractor for more than 50 years, the London, Ont.-based practitioner says in other speeches and interviews that spinal adjustments can release the body’s healing powers and correct all manner of disorders, including attention deficit hyperactive disorder, attention deficit disorder, asthma and lupus. Those beliefs make Dr. Hardick a “vitalist” chiropractor. Vitalists contend that subluxations, or nerve impingements in the spine, can block the healing force they call "innate energy.” Many vitalists also advocate against vaccination.

The problem? There’s no evidence subluxations exist. There’s no evidence innate energy flows through the body. And no evidence-based health-care profession believes any of this.

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But Clifford Hardick isn’t an outlier on the fringes of the profession. He is a council member and a former president of the College of Chiropractors of Ontario, the body that regulates practitioners in the province.

For a decade or more, the college has been influenced, if not outright controlled, by vitalists such as Dr. Hardick, according to a Globe and Mail analysis.

Although most provinces no longer cover chiropractic services, private insurance plans still do.

Four of the Ontario regulator’s current nine chiropractic members espouse unscientific views, according to an extensive review of these leaders’ published writings and online speeches, interviews, podcasts, social-media feeds, book reviews and conference presentations for evidence of support for vitalist chiropractic.

“The daily practice and application of the Laws of Life and Vitalistic Universal Principles distinguish Chiropractic within the field of healthcare,” writes Dr. Elizabeth Anderson-Peacock in her recently published book Pearls of Wisdom – Pure & Powerful. She is the vice-president of the regulator.

Dr. Peter Amlinger, a former four-term president, said in a 2014 interview: “Within each and every one of us is infinite potential which we call innate intelligence that expresses itself over our nervous system. And, if we live fully connected to this intelligence all possibilities are within our reach … healing on any level is possible if we can release this intelligence and keep it flowing without interference.”

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Dr. Dennis Mizel served as the regulator’s president in 2008, vice-president from 2009 to 2013 and president again in 2014. The St. Catharines, Ont.-based chiropractor states on his website that “physical, chemical and emotional stress is the underlying cause of subluxations.” He promotes a book on innate energy and subluxation, Healing Satori, saying it “Should be read by every Chiropractor, Chiropractic Student and Chiropractic Patient.” Though educated in Canada, Dr. Mizel made a $25,000 legacy donation to Life University, an Atlanta-based chiropractic college that says it is “at the forefront of the vitalistic health revolution.”

And Dr. Keith Thomson, a Kawartha-area chiropractor who served as the regulator’s president in 2004, echoes similar views. “In short, because the body’s innate recuperative powers are affected by and integrated through the nervous system, correcting spinal abnormalities which irritate the nervous system can lead to a number of favourable results in patients suffering from various, seemingly non-spinal health conditions.”

None of these chiropractic leaders agreed to be interviewed.

The College of Chiropractors of Ontario has been led by presidents who have espoused subluxation-based chiropractic beliefs in nine of the past 10 years.

As a result, the regulator has a record of tolerating unscientific claims and unproven practices – including anti-vaccine statements and the treatment of babies, children and adults for non-musculoskeletal conditions – instead of protecting the public from them. The Globe reviewed 60 patient-complaint decisions made by the regulator in the past decade. Because the college does not typically make these decisions public, The Globe was able to review only those that were challenged by the complainant and further reviewed by the Health Professions Appeal and Review Board, a body that oversees regulated health professionals in Ontario.

The regulator, according to the analysis, is diligent in disciplining chiropractors for unprofessionalism, sexually inappropriate behaviour or questionable business practices. However, The Globe found a consistent pattern that when the regulator’s inquiries, complaints and reports committee is presented with evidence from patients that chiropractors are making unscientific claims, engaging in scare tactics or promoting unproven treatments for ailments that have nothing to do with the spine, it takes no action.

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The complaints include treating patients with autism and acquired brain injury, claiming that “subluxations” would dramatically shorten a child’s life; making anti-vaccine claims; and billing a 76-year-old woman for year-long “corrective” treatment to improve general wellness. None of these vitalist treatments was supported by medical evidence, according to the complaints.

Of the 60 cases, the board confirmed the decision of the regulator in all but five.

This pits the regulator against a faction within chiropractic urging a shift to evidence-based musculoskeletal treatments and a curbing of unscientific claims and treatment.

Marc Bronson, a Kirkland Lake, Ont., chiropractor, said news stories about “outlandish claims made by vitalistic chiropractors” are tarnishing the profession’s reputation. “Most of us are not like that, but that’s what makes the headlines.”

Dr. Bronson, 40, has been outspoken about the vitalistic beliefs of the regulator’s leadership, calling out specific council members in a posting to a closed Facebook group he started for evidence-based chiropractors. He is also critical of the regulator’s reluctance to be pro-active about curbing non-scientific claims made by chiropractors.

“I am tired of being associated with these kind of chiropractors,” he said in an interview with The Globe. “I think it poses a public-health risk with some of these chiropractors who hold these anti-vaccination views or practise outside of scope.”

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The Canadian Chiropractic Association says it is urging provincial regulators to be more pro-active against misleading advertising and unscientific claims. This association acts as a national chiropractic advocate and has no regulatory powers.

The College of Chiropractors of Ontario declined multiple requests for an interview, but provided a letter stating, in part: “The CCO does not endorse any specific style of practice, but rather requires that all members practise within the chiropractic Scope of Practice and in accordance with the legislation governing the CCO, Standards of Practice, policies and guidelines.”


The front door of the Toronto office of the College of Chiropractors of Ontario, which regulates practitioners in the province.

Melissa Tait/The Globe and Mail

HOW THE SCHISM BEGAN

The schism in chiropractic is rooted in the origins of the profession. In the late 19th century, D.D. Palmer was a “medicineless healer” in Davenport, Iowa. Born in Port Perry, Ont., he was a religious man taken by spiritualism and magnetic healing. Mr. Palmer came to believe the spine was a sort of lightning rod for God’s healing power – what he called “innate energy.”

The father of chiropractic believed that adjusting the spine could remove subluxations, letting the body heal itself. But in repeated scientific trials published in peer-reviewed journals over decades, chiropractors have been unable to consistently detect subluxations or diagnose disorders as a result of them.

However, through intense political lobbying and public promotion, chiropractors moved from the fringes of medical science to being seen as legitimate health-care professionals nearly three decades ago.

In 1991, Ontario’s Regulated Health Professions Act gave chiropractors the title of “Dr.” and granted them self-regulation like medical doctors and dentists. Other provinces followed suit, with Newfoundland being the last to grant self-regulated status in 2009.

But regulation didn’t guarantee provincial health coverage. The British Columbia government stopped paying for chiropractic in 2002. Ontario followed suit in 2004, Alberta in 2009 and Saskatchewan in 2010. No Atlantic provincial plan covers chiropractic. Manitoba reduced paid coverage in 2018.

Despite reduced coverage by provincial health-care plans, it remains a billion-dollar-a-year industry in Canada, most of it picked up by private insurance or paid for directly by patients.

Mr. Palmer’s beliefs about the power of chiropractic continue to inform practitioners today. Research conducted by University of Western Ontario PhD student Anton Ninkov and Paul Benedetti last year analyzed 800 Ontario chiropractor websites. Roughly one-third of the sites mentioned “subluxation”; more than half make reference to asthma; nearly one-third mention colic.

Another recent study, co-authored by Prof. Timothy Caulfield, a Canada Research Chair, reviewed websites of 80 commercial chiropractic clinics across the country and found similar numbers. Some of the conditions treated with chiropractic, according to the study: attention deficit hyperactivity disorder and attention deficit disorder (37.5 per cent); allergies (37.5 per cent); premenstrual syndrome (32.5 per cent); and bed-wetting (30 per cent). There is no credible evidence to support such treatments.

Today, Ontario is home to more than half of Canada’s 8,400 chiropractors. Some of them are members of the Guelph, Ont.-based group the Alliance for Chiropractic. It was founded in 1998 to ensure that the college introduced regulations and bylaws supporting “a healthier practice for the subluxation-based chiropractors.”

In early June, the alliance held a conference at a Toronto airport hotel, where the regulator’s vice-president, Elizabeth Anderson-Peacock, and Peter Amlinger attended. Dr. Amlinger won a lifetime achievement award at the event’s gala, in part, for his leadership in supporting vitalist, subluxation-based chiropractic.

His achievements include serving the Ontario regulator as a former president and current board member, as well as practising at the Mississauga-based Amlinger Family Chiropractic. In November, 2015, a Facebook post by the clinic showed a flyer linking the flu shot to Alzheimer’s. Dr. Amlinger comments, “How about a chiropractic adjustment instead?”

Dr. Amlinger told The Globe the posting was put up without his permission by an associate no longer with the practice.

In other provinces, even among its leadership, chiropractic is still informed by vitalistic beliefs.

In May, Dr. Avtar Jassal, the vice-chair of British Columbia’s College of Chiropractors, resigned after the CBC discovered he had posted an anti-vaccine video on Facebook.

The president of the Nova Scotia College of Chiropractors, Dr. Chad Mykietiuk, is also co-owner of Wellness Media, a chiropractic promotional materials company. In July, his company promoted a poster on Facebook classifying vaccines as stressors that can lead to subluxations and illness in toddlers and teens.

After The Globe inquired about the posting with the province’s college of chiropractors, it was removed. Dr. Mykietiuk did not respond to a request for comment.

Postings like these, despite coming from Canadian chiropractic leaders, contravene an edict from the Canadian Chiropractic Association, which states: “Vaccination is not within the scope of chiropractic practice." The association recommends patients consult public-health authorities about immunization.

And these pseudo-scientific ideas stand in contrast to the relatively recent, evidence-based direction of the Canadian Memorial Chiropractic College (CMCC), Canada’s largest chiropractic teaching institute located in Toronto. Though CMCC officials declined to be interviewed, they provided a letter stating their “curriculum emphasizes the science and best-practices of today, not our past. An emphasis on evidence-based practice has replaced dogma and unfounded vitalistic concepts from a century ago.”

A 2011 study in Chiropractic & Manual Therapies of the curriculums of 16 North American chiropractic colleges found that CMCC was one of only three colleges that made no mention of subluxation in their academic catalogues.

But that leaves the college at odds with the vitalistic beliefs of about half the Ontario regulator’s leadership.


SIGNS OF CHANGE

The new head of the regulator, Dr. David Starmer, is considered an evidence-based chiropractor. Dr. Starmer is the education co-ordinator for the CMCC simulation lab. He did not respond to requests for an interview.

Some chiropractors consider his appointment a welcome sign of change. “There has never been an evidence-based chiropractor at the helm of the board since I first started practice 12 years ago,” Dr. Bronson said.

Five years ago, Dr. Bronson, who graduated from CMCC in 2006, launched a Facebook group for science-based colleagues. He says it now has a worldwide membership of more than 8,000, including about 2,000 Canadian chiropractors.

“It has brought a silent majority together who are not really happy being silent any more,” he said.

Dr. Bronson believes his profession is making strides in research and evidence-based treatment. He sees chiropractors being integrated into health-care teams as spinal-pain specialists. “There is a transformation happening,” he said.


Ryan Amstrong of London, Ont., has been strongly critical of the chiropractors' regulatory body.

GEOFF ROBINS/The Globe and Mail

PERSISTENT CLAIMS

Like Dr. Bronson, London, Ont.-based information specialist Ryan Armstrong wants to see chiropractic reformation and has been critical of regulator’s leadership.

In 2016, Mr. Armstrong was finishing up his PhD in biomedical engineering at Western when he was given a pamphlet about a public lecture by local chiropractor Dr. B.J. Hardick on a book called The Cancer Killers. Intrigued, about a year later, on Feb. 2, 2017, Mr. Armstrong attended a lecture at a London church where Dr. Hardick made numerous claims including that chiropractic could reduce heart arrhythmias, improve cholesterol and lower blood pressure.

The lecture led the young engineer to probe Dr. Hardick’s online claims about cancer, the link between vaccines and autism, and chiropractic manipulation for newborns. Mr. Armstrong began to blog about these “outrageous” claims.

B.J. Hardick is the son of Clifford Hardick who, at that time, was the president of the regulator. Clifford Hardick became the executive chair of Maximized Living, a practice management, development and education firm for chiropractors, in early 2017.

Maximized Living (now rebranded MaxLiving) is a Florida-based company that provides marketing programs for subluxation-based vitalist chiropractors.

The company provides sample recruitment scripts: “If you have subluxations, this condition is not just causing your pain – it is destroying your body, causing disease and early death.”

Later in 2017, Mr. Armstrong listened online to what he described as an “evangelical” chiropractic speech by Clifford Hardick, who was then president of the Ontario regulator.

In the speech to chiropractic students at Life University in Atlanta in June, Dr. Hardick said he adjusted barely verbal autistic children, who within weeks started to speak whole sentences. “That’s what chiropractic is!” he tells the cheering crowd.

Mr. Armstrong, 29, said, “It was astonishing to me and I felt confused that he could be the head of the regulatory agency.”

He filed a complaint with the College of Chiropractors of Ontario about Dr. Hardick on Dec. 3, 2017. Mr. Armstrong alleged Clifford Hardick claimed to treat disorders such as verbal ataxia, attention deficit disorder, attention deficit hyperactivity disorder, asthma, infertility, diabetes and “made public statements that illustrate a profound disrespect for medicine and public health.”

He followed up with additional complaints against nine Ontario chiropractors for a variety of alleged infractions, including practising beyond the scope of practice and making false and misleading advertising claims.

Mr. Armstrong’s initial complaint against Clifford Hardick remains before the regulator.

In a response letter filed to the regulator and obtained by The Globe and Mail, Dr. Hardick’s lawyers told the complaints committee their client was not diagnosing ADHD or autism, but rather using chiropractic adjustments to address the symptoms of those disorders, which they argued was within the scope of practice.

The defence has worked in the past. Seven years earlier, the regulator’s complaints committee accepted exactly the same argument and vouched for it to the Ministry of Health.

In 2011, Ontario family physician Dr. Terry Polevoy, complained to the regulator about two Ottawa-area chiropractors using the “Turner method” to treat children with ADD, ADHD and autism. The regulator ruled these disorders were “within the scope of chiropractic practice” and that chiropractors were “not treating autism or ADHD, but were treating the symptoms of these disorders by removing spinal or cranial subluxations that interfere with the optimal functioning of the body.”

The Turner method, named for Barrie, Ont.-based chiropractor Dr. Roger Turner, is a chiropractic technique for manipulating the joints of the skull to affect a variety of disorders. Dr. Turner claims he has taught his method to 1,000 chiropractors around the world.

Dr. Polevoy thought the regulator’s decision was nonsense. He appealed it to Health Professions Appeal and Review Board.

The board accepted the regulator’s argument that, “the traditional chiropractic perspective is that the removal of vertebral or cranial subluxations contributes to the optimal functioning of the body as a whole.” They wrote, “the Board finds this to be a reasonable conclusion given the expertise and experience of the members of the Complaints Committee.”

In legal documents filed to the regulator in April by Henein Hutchison, Dr. Hardick’s lawyers are referencing this 2011 ruling by the regulator as part of their defence of him.

The problem? The regulator and board rulings are based on bunk, says Sam Homola, a retired Florida-based chiropractor and author of Inside Chiropractic: A Patient’s Guide.

“There is no evidence to support the idea that manipulating cranial bones to free restricted movement is an effective treatment for brain disorders or special needs children,” Dr. Homola wrote in an e-mail. “Toleration of such nonsense by chiropractic regulatory boards is tantamount to endorsement of nonsense.”

That ruling allows Dr. Turner to continue to treat children with neurological disorders, cerebral palsy and, in what he calls a “personal research project,” Down’s syndrome.

That angers Sandy Hart-Lehmann. In 2010, she took her nine-year-old son Christopher to see Dr. Turner, who claimed to “correct” autism and make silent children verbal.

Dr. Turner told Ms. Hart-Lehmann the treatments would take six months. Each session cost about $50. Instead of six months, the Hart-Lehmanns saw Dr. Turner for a year and a half until Christopher himself refused therapy. By then, the family had spent at least $5,000.

The Innisfil, Ont., mother never filed a complaint with the regulator. She said at the time she was trying everything possible to help her son, acting out of, “sheer, terrifying desperation.”

“Honestly, I felt I was – I hate to say it – duped,” Ms. Hart-Lehmann, now 58, said.

Sandy Hart-Lehmann and Stephen Lehmann sit beside their son in his room. Ms. Hart-Lehmann feels she brought Christopher to chiropractic treatment out of desperation.

Michelle Siu/The Globe and Mail

Christopher Lehmann shows off his collection of monster trucks. His mother has not filed a complaint with the CCO about the chiropractic treatment he received.

Michelle Siu/The Globe and Mail

Dr. Turner, 73, defended his practice in an interview with The Globe.

“We’re there to help the kids. Unfortunately, we don’t get 100 per cent results with everybody. Nobody does,” he said. “If we can make a change by positioning the bones of the skull, then that’s for the kid, that’s for the parents.”

Dr. Turner said he’s been using the Turner method for 26 years, treating 4,000 to 5,000 children. “I have 92 non-verbal kids that speak after our treatment,” he said.

Autism experts say there is no evidence to connect the bones in the skull with any aspect of the disorder. Dr. Turner has published no scientific research to back his claims; nor has anyone else.

“My first reaction is, it’s quackery,” said Margaret Spoelstra, the executive director of Autism Ontario.

Stelios Georgiades, the co-director of the McMaster Autism Research Team and a world leader in autism treatment, said what Dr. Turner is doing is “unfair and unethical” and lacks scientific evidence.

But he is not the only chiropractor making unscientific claims about the treatment of children and autism. Treating children has been especially controversial.

In May, after a National Post report cited concern among pediatricians who were questioning chiropractic treatments, Dr. David Peeace, the chairman of the Canadian Chiropractic Association, came out publicly to defend the practice.

Shortly after, however, Dr. Peeace sent an urgent internal directive, obtained by The Globe and Mail, to all association members exhorting them to stop publicly talking about anti-vaccination and treating children for ADHD, autism and asthma.

“There has been a noticeable increase in public scrutiny and criticism on the claims made by some chiropractors online. Issues raised in the National Post article are speaking to our most vulnerable group of patients – children. This patient group is also one where there is the least amount of evidence-based research,” he wrote.

Dr. Peeace urged chiropractors to review their websites for claims that “can be used by chiropractic skeptics and critics to disparage the entire profession and negatively affect our profession’s reputation.”

In a statement to The Globe, the CCA said it is urging all provincial regulators to be pro-active in limiting misleading claims about chiropractic treatment.

“We respect the role of the regulator which is currently a complaint-driven process. We are currently advocating to the Federation [a national federation of chiropractic regulators] for modernization of the regulatory process. This would include changes to make our regulatory processes more proactive and more consistent. For example, we would like to see the regulators proactively addressing misleading advertising and claims that are inconsistent with our scope of practice.”

According to the CCA, the organization met with Canadian Chiropractic Federation leadership on July 25 to do just that. And a national meeting with provincial regulatory bodies, the leadership of the federation and the national professional association took place on Oct. 19.

“What is interesting is that the CCA is almost de facto becoming the regulatory board,” Dr. Bronson said. “The concern I have with the CCO is that in some instances, it seems like some of the regulatory stances are designed to protect the vitalistic chiropractors instead of the public.”

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.

Melissa Tait/The Globe and Mail

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