CRITICAL CONSUMER Pat Sidley
THE medical profession is likely soon to have one of its long-standing restrictive practices curtailed. Doctors registered with the Medical and Dental Council presently may not co-operate with any of the alternative medicine professions, such as chiropractic, osteopathy or homeopathy. This restriction has over the years engendered distrust, ignorance and protectionism.
However, it is likely to come to an end later this year and the timing suggests that if it comes about by a decision of the council, it will have more to do with the new governments desire to bring traditional medicine and healing into the mainstream than with chiropractors or homeopaths. But chiropractors have been chipping away at this block for some time — they would like the co- operation and cross-pollination with doctors so far denied them.
It would be foolhardy for doctors to back away from what seems to be a healthy and progressive move. Since so few doctors actually know anything about chiropractic or have dealt with its practioners this Critical Consumer believes they are on shaky ground when they criticise it.
In the United States, the courts have ruled that the medical profession had engaged in a long- standing campaign to contain and eliminate chiropractic, holding that this was contrary to the US anti-trust laws. South Africa may soon have to contend with similar laws.
There are some 130 chiropractors in South Africa. They are all registered with the Chiropractors and Homeopaths and Allied Health Services Council which, like the Medical and Dental Council, is a statutory body. This means that chiropractors are by law required to undergo a minimum training period, practice according to certain ethical and practical guidelines, and must subject themselves to the discipline of the council when they step out of line.
Most did their training either in the US or the United Kingdom, though in the past few years training courses have started at the Natal and Witwatersrand technikons. Some medical aid schemes will pay for treatment by chiropractors.
A full-page advertisement in the New York Times recently stated that chiropractic is for more than just back pain. According to the US journal of the Consumers Union, Consumer Reports, this was part of the chiropractors century-old effort to win widespread acceptance — and to position themselves as Americas family doctors.
Consumer Reports, in a largely critical investigation of the discipline, cites a study by a reputable California thinktank (Rand Corporation) which concluded that people with low-back pain might benefit from spinal manipulation — the chiropractors primary form of treatment. The journal then says: Manipulation is a widely accepted therapy. But chiropractic is not just a set of techniques for manipulating the spine; it is a belief system that credits the spine with a major role in health and disease.
Chiropractors tend to see themselves as primary health care providers — a view held by the chairman of the South African Chiropractic Association, Dr Jeff Tasker, though apparently not shared by the councils official Pim van der Veen.
This split reflects a widespread divergence in the profession between those who will make a more medical diagnosis, co-operate (where they can) with doctors and add other therapies like ultrasound or massage. The other grouping sticks more closely to correcting spiral misalignments, in the belief that the body will heal itself from the adjustments.
Chiropractors, including Tasker, tend to quote a Canadian study done last year by the Ontario Ministry of Health about the value of chiropractic management of low-back pain. Known as the Manga Report which states that chiropractic manipulation is safer, more effective, and more cost-effective than medical management of low-back pain.
But Consumer Reports suggests that if chiropractors confined themselves to treating back pain and other musculo-skeletal problems, they may win more acceptance from the medical profession.
Alarm bells ring, however, even among members of the profession when some chiropractors claim to be able to cure everything from asthma to cancers.
Other claims need questioning too. Both Van der Veen and Tasker told this Critical Consumer that the training given to chiropractors is as comprehensive and thorough as that given to medical practitioners.
Consumer Reports states that many of the teaching staff in the US institutions are not as well qualified as those who teach would-be medical practitioners. This should be of some concern here, as a large number of chiropractors have been trained in the US; and it probably holds good here, too, as the courses offered are at technikon and not university level.
Probably the most serious accusation flung at the profession by Consumer Reports is the notion that chiropractors are against immunisation. Van der Veen is unequivocal that the regular, normal immunisations and vaccinations which young children are given in this country are supported by the profession. Tasker is less sure: he is not so certain about innoculations given for many viruses, he says, like flu.
Ultimately, there is a leap of faith involved in deciding to see a chiropractor. Some commonsense moves include:
* Question any treatment regime set over a long period and involving many treatments.
* Question the frequent use of X-rays. Overtreatment is frowned on by the council.
* If a chiropractor sells nutritional supplements himself in large quantities at high costs, ask if you can get them elsewhere — this may reduce the impulse to make a profit out of the patient.
* Ethical guidelines are similar to that of doctors, so if a chiropractor solicits patients from within your family or circle of friends question this.
* Never accept anything from either a chiropractor or a doctor without questioning what side-effects there may be.
* Ask if the chiropractor will co-operate with your doctor if need be. (The chances are that he will, but that your doctor wont).
* Watch out for any sweeping claims about magic cures and perpetual good health — they have to be nonsense.
* Watch out for sweeping claims by your doctor about chiropractic — he probably knows nothing about the discipline and while he may be right, question his basis for his claims.