Informed consent, duty of disclosure and chiropractic: where are we?

Background The COVID-19 pandemic has seen the emergence of unsubstantiated claims by vertebral subluxation-based chiropractors that spinal manipulative therapy has a role to play in prevention by enhancing the body’s immune function. We contend that these claims are unprofessional and demonstrate a disturbing lack of insight into the doctrine of informed consent. As such it is timely to review how informed consent has evolved and continues to do so and also to discuss the attendant implications for contemporary health practitioner practice. We review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered. The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. We discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending “inhouse” products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings. Conclusion Ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.

Spinal stabilisation using a polyvinilidine (Lubra) plate in a pot-bellied pig

A three-month-old pot-bellied pig presented for acute paraplegia following a presumptive fall. CT examination identified a vertebral subluxation of L1–L2 with a comminuted fracture of the L1 vertebra. Spinal stabilisation was performed with polyvinilidine (Lubra) plates. The pig improved neurologically and regained the ability to walk. Spinal radiographs six weeks following surgery revealed partial failure of the plates in the caudal aspect of the vertebral column and suspected pressure atrophy of spinous processes. Eighteen months later, the plates were piercing through the skin, so they were removed surgically and the pig did well from then on. This case report describes the feasibility of spinal stabilisation in a pot-bellied pig associated with a good outcome, but also reveals potential complications and spinal changes that can be observed after use of polyvinilidine plates in this species.

The “subluxation” issue: an analysis of chiropractic clinic websites

Background Vertebral subluxation theories are controversial in chiropractic. Divisions are evident in the chiropractic community among those who align their practices to subluxation theories and those who do not. This study investigated how many clinics offering chiropractic in the Canadian province of Alberta promote a theory of subluxation, which health ailments or improvements were linked to subluxation, and whether the subluxation discourse was used to promote chiropractic for particular demographics. Methods Using the search engine on the Canadian Chiropractic Associations’ website, we made a list of all clinics in Alberta. We then used Google searches to obtain a URL for each clinic with a website, totalling 324 URLs for 369 clinics. We then searched on each website for “subluxation” and performed content analysis on the related content. Results One hundred twenty-one clinics’ websites (33%) presented a theory of vertebral subluxation. The health ailments and improvements discussed in relation to subluxation were wide-ranging. An observed trend was the marketing of chiropractic for children, which was observed on 29 clinic websites (8%). Conclusions Based on the controversy surrounding vertebral subluxation, the substantial number of clinic websites aligning their practice with vertebral subluxation should cause concern for regulatory bodies.

Intra-abdominal granulomas caused by Clostridium tertium in an American Fuzzy Lop rabbit

ABSTRACT: A 6-year-old Fuzzy Lop rabbit was referred to a veterinary hospital with a complaint of lameness. In addition to a vertebral subluxation, two radiopaque and well-defined structures were revealed by radiographic evaluation. Ultrasonographically, the masses were characterized as parenchymal structures with diffuse mineralization and formation of reverberation artifacts, suggesting presence of gas. These two structures were excised during a laparotomy and Clostridium tertium was isolated. To the best of our knowledge, this is the first report of C. tertium infection in a pet animal.