In defence of chiropractic: DUT, Casa and Prof Noakes

Organisation: Position: Deadline Date: Location:

SpineThe Durban University of Technology, the Chiropractic Association of SA, and Professor Tim Noakes respond to Dr Alastair McAlpine’s recent ‘unsubstantiated, provocative and highly defamatory’ Digital Clubbing column in MedicalBrief.

 

The Durban University of Technology:

“The Durban University of Technology has noted with concern, the opinion piece by Dr Alastair McAlpine titled: The ‘sheen of respectability’ that surrounds chiropractic which you published.

“We would like to comment that whilst we respect Dr McAlpine’s right to have an opinion – and to express himself freely, we feel that we must respond to the statement in the article that reads, ‘Chiropractic is not taught at most reputable universities – currently only the University of Johannesburg and the Durban University of Technology offer it in South Africa.’ We are insulted by the writer’s allegation that DUT is not a reputable University.

“The University feels that your readers deserve to know more about the Chiropractic programme at DUT.

“The Chiropractic Programme at the Durban University of Technology has been in existence since 1989. It is fully recognised as a Master’s Degree programme by the Department of Higher Education and Training (DHET) and the Council on Higher Education (CHE).

“In order to practice as a chiropractor in South Africa, one has to hold a Master’s qualification in the field. Our programme is internationally recognised as one that is within a Scientific-Evidence-Based-Practice paradigm. All our graduates write dissertations as part of their academic research requirements, which undergoes exactly the same scientific rigor as any other dissertation or thesis of a reputable Master’s programme anywhere in the world. The examiners of our student’s research are well known academics from respected institutions locally and internationally.

“The programme is founded in a similar manner as any other traditional medical programme with subjects including but not limited to Physics, Chemistry, Biology, Full-Body Anatomy (including dissection and histology), Microbiology, Biochemistry, Epidemiology, General and Systemic Pathology, Diagnostics, Radiography and Radiology, etc. All which form the basic medical science subjects in the formative years. Then the student branches specifically into the chiropractic field with subjects including Clinical Chiropractic, Chiropractic Principles and Practice and Clinical Biomechanics (all of which are taught with a strict Scientific-Evidence-Based-Paradigm).

“In the Master’s programme, all students conduct research and write a dissertation which is externally examined, and in some cases it goes onto being published in peer reviewed journals.

“The programme also has a fully-fledged clinic which is attended by thousands of patients annually. During clinic treatment sessions with patients, students have to reference the scientific evidence for every treatment protocol they are conducting on a patient for their specific condition.

DUT Faculty of Health Sciences, executive dean, Professor Nokuthula Sibiya said, “I wish to re-iterate that the Chiropractic Programme at DUT underwent an internal review (by the Centre for Quality Promotion and Assurance, CQPA). In April 2012, an external review was conducted by the European Council on Chiropractic Education (ECCE). There was another internal review in November 2017 by CQPA and another ECCE review in 2017. In addition, the Allied Health Professions Council of South Africa (AHPCSA) conducted a clinic review in 2016 as well. There were no concerns raised to the effect mentioned by these bodies. The documents have been published and are available on request. The ECCE review of DUT is online for public viewing.”

 

The Chiropractic Association of South Africa:

“Re: Your published article: The ‘sheen of respectability’ that surrounds chiropractic

“We, the Chiropractic Association of South Africa, have read your above-mentioned article written by Dr Alastair McAlpine (hereinafter referred to as ‘the author’) and published on 23 May 2018.

“Said article is loaded with unsubstantiated claims, is provocative and highly defamatory to the chiropractic profession.

“The chiropractic profession has evolved into a scientific evidence-based profession.
There is no longer anything suspect behind the theory of chiropractic.

“The statements surrounding the title ‘doctor’ relate to the fact that after six years of studying medical sciences, specialising in chiropractic sciences, a chiropractor graduates as a doctor of chiropractic. It is dictated by the legislation which regulates the profession. The author himself mentions that chiropractors are registered with the Allied Health Professions Council of South Africa and it is this council that also regulates the profession.

“Any profession has risks but stating that chiropractic is ‘outright dangerous’ is unsubstantiated. Chiropractic has one of the lowest malpractice insurance rates, due to the safety of the profession. In trained hands, spinal manipulative therapy is very safe. Side effects such as pain and stiffness occur after most manual therapies. It even happens after most surgeries.

“The statement about how chiropractic had its origins is correct. However, it fails to state that the profession has evolved. Is anybody still driving the first car built by Henry Ford? No. Technology has allowed things to be research, explored and improved.

“Chiropractic certainly does not base its existence on that original incident. The very word “subluxation” is no longer part of the education of chiropractors and it is certainly not the defining characteristic of the profession. Chiropractic has also moved away from the belief that only nerves cause issues in the body. The body is looked at as a whole, and not in its’ separate parts. Chiropractic manipulation does not realign a subluxation, it restores movement to a restricted joint.

“The author states that the University of Johannesburg (UJ) and the Durban University of Technology ‘are not the most reputable universities’. This is a shockingly defamatory statement towards these institutions to say the least. UJ is the only university on the African continent to belong to the Universitas 21 group of universities. They are also ranked in the top 4% of universities worldwide.

“The example quoted by the author on a baby’s neck being broken was found to be untrue by the Australian Health Practitioner Regulation Agency. In fact, to the contrary, radiological examination revealed a congenital malformation, and that there was never a fracture to the baby’s neck. (Fraser, 2013)

“The Chiropractic Association of South Africa does not align itself with any pro or anti vaccination campaigns. The domain of vaccinations does not fall within the field nor expertise of the chiropractic profession. Any chiropractor expressing an opinion either way, is expressing a personal opinion and is discouraged by the Association from doing such.

“Chiropractic is evidence-based medicine, and the statements made that it is “unproven metaphysical ideas”, “pseudoscience of the highest order” or that it “will tear your arteries” is completely defamatory. There has never been any proof of this, yet there has been a lot of evidence to prove the benefits of chiropractic treatment. (Neil M. Paige, et al., 2017) (Roger Chou, et al., 2007)

“Consulting a physiotherapist or orthopaedic surgeon is not always the solution. Surgery has a much higher risk factor. Physiotherapists do not receive the same intense training as a chiropractor in spinal manipulative therapy. Chiropractors are the specialists in spinal manipulative therapy, and the institutions around the world produce much research to substantiate this claim. (A. Qaseem, 2017)

“In South Africa, physiotherapists and chiropractors often work together to achieve the best results. There is also much acceptance by the orthopaedic and neuro surgeons to whom we do refer surgical cases.

“Chiropractic cannot cure all, and there is a time and place for drugs and/or surgery. However, part of the training of a chiropractor, is to be able to diagnose when such interventions are needed, and to refer accordingly.

“The Chiropractic Association hereby requests an apology from MedicalBrief to be published in your next publication, and to state therein that the statements made by the Author were opinions, unfounded and defamatory towards the chiropractic profession and that MedicalBrief will distance itself from further unfounded and defamatory publications towards the chiropractic profession in the future.”

References
Qaseem, TW (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Annals of Internal Medicine, 166. Retrieved from annals.org.
Fraser, A (2013, October 16). The Australian. https://www.theaustralian.com.au/news/nation/chiropractor-cleared-overbreak/newsstory/3ef77c8a56ebb1b6a8f57868df938915?sv=81db7a8ae0da0eb23e572bf83dec86 93
Neil M Paige, Isomi M Miake-Lye, Marika Suttorp Booth, Jessica M Beroes, Aram S Mardian, Paul Dougherty, Richard Branson, Baron Tang, Sally C Morton, Paul G Shekelle (2017). Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain. JAMA, 317(14), 1451 – 1460.
Roger Chou, Amir Qaseem, Vincenza Snow, Donald Casey, J Thomas Cross J, Paul Shekelle, Douglas K Owens (2007). Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine.

 

Professor Timothy Noakes:

“With respect to the recent article published in MedicalBriefs, inquisitive readers might be interested in this recent publication in the Journal of the American Medical Association.
Christine M Goertz; Cynthia R Long; Robert D Vining; Katherine A Pohlman; Joan Walter; Ian Coulter (2018) Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain A Comparative Effectiveness Clinical Trial. JAMA Network Open. 2018;1(1):e180105.

“The conclusions are the following:
Conclusions and Relevance: Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care.

“Apparently the authors find evidence for the benefits of chiropractic care ‘as a component of multidisciplinary health care for low back pain’.”

Dr Alastair Mcalpine replies:

I stand by what I wrote. Vhiropractic is pseudo-science and there is no compelling evidence to the contrary. Given its mystical elements, and decidedly un-evidence based pedigree, most reputable universities do not teach chiropractic and DUT shouldn’t be teaching it either.

The ‘regulatory’ mechanisms listed by are all done by chiropractors, or by the AHPCSA – which endorses homeopathy and reiki, among others, so is hardly a beacon of critical thinking – rendering them essentially meaningless.

My column concedes that SMT may provide mild benefit for lower back pain, but SMT is not limited to chiropractic, and that’s where the evidence ends. And even that is far from proven.

Editor of MedicalBrief replies:

The Digital Clubbing column expresses the opinion of the writer, Dr Alastair Mcalpine. It was not defamatory and there will be no retraction.

Digital Clubbing column on chiropractic

Other Digital Clubbing columns


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