Publicly funded chiropractic care should have strict limits, leaked report says

Chiropractic services funded by the province should have strict limits and patients under 18 should not be funded, according to a reportwhich was never made publicbut was recently obtained by CBC.

The report was also critical of previous reports that suggested chiropractic treatments were cheaper than medical care for some conditions.

The Manitoba Chiropractic Health Care Commission was tasked with reviewing the cost effectiveness of publicly funded chiropractic services. It prepared a report in 2004 for the province and the Manitoba Chiropractors Association but it has been kept under wraps since.

Currently, the province covers a maximum of 12 visits a year for Manitoba residents for spinal and pelvic adjustments as well as adjustments of the extremities.

• Manitoba chiropractors need proactive oversight over members, says health lawyer

The report, verified by the CBC I-Team, has 37 recommendations, including:

• Manitoba Health should limit its funding to "chiropractic treatment of acute lower back pain."
• Manitoba Health should provide "limited coverage of the treatment of neck pain." The report called the literature around the efficacy of chiropractic care for neck pain "ambiguous or at best weakly supportive" and noted such treatment carried a "not insignificant safety risk."
• Manitoba Health should not fund chiropractic treatment anyone under 18 "as the literature does not unequivocally justify" the"efficacy or safety" of such treatment.

At present, there are no age restrictions on publicly funded visits to the chiropractor.

Report challenges claims about treatment

A Manitoba Ombudsman's Office report from 2012 might shed some light on why the Manitoba Chiropractic Health Care Commission's report was never made public. Someone had attempted to get a copy of the report, but large parts of it were redacted.

"Access to this record was refused on the basis that disclosure would be harmful to a third party's business interest," the ombudsman report notes, "and harm the economic or financial interests or negotiating position of a public body."

The report also challenged claims that chiropractic treatmentscan be address a wide variety of medical conditions.

It stated that there was not enough evidence to conclude chiropractic treatments are effective in treating muscle tension, migraines, HIV, carpal tunnel syndrome, gastrointestinal problems, infertility or cancer, or as a preventive care treatment. It also saidthere was not enough evidence to conclude chiropractic treatments are effective for children.

• Advertising by some Manitoba chiropractors undermines public health, expert says
• Too early to say if disciplinary action needed for questionable ads: chiropractors association

The report urged Manitoba Health to establish a monitoring system to keep a closer eye on "the advertising practices of the Manitoba Chiropractors Association and its members to ensure claims regarding treatments are restricted to those for which proof of efficacy and safety exist."

It suggested the government should have regulatory powers over chiropractic ads.

A recent CBC I-Team investigation found Manitoba chiropractors advertising treatment for a wide range of conditions including Alzheimer's, autism and pediatric services.

'Grossly exaggerates possible medical savings'

The commission report contained sharp criticisms of previous reports that suggested funding chiropractic care could save the health-care system money.

Dr. Pranlal Manga authored two widely cited reports which claim that by offering publicly funded chiropractic care, provinces can cut health-care costs.

"The Manga study on Manitoba must be rejected as a guide to public policy," the commission report states, "because its assumptions, methodology and costing of recommendations are all deeply flawed."

The reports states, "What limited evidence the Commission has suggests he [Manga] grossly exaggerates possible medical savings."

Dr. Manga did not respond to CBC's repeated attempts to contact him.

Use of X-ray machines questioned

The commission report also made recommendations around the use of X-ray machinesby chiropractors.

The report suggested chiropractors not own and operate X-ray machines "Given the restrictive conditions under which X-rays are advisable, their poor correlation with low-back problems, their apparent limitation as a guide to appropriate treatment [and]the apparent complete lack of monitoring [of] the use of X-ray by chiropractors."

Instead, it recommended consulting with radiologists when imaging is deemed necessary.

"The Commission is of the view that the public interest, and even chiropractic itself, would be better served if chiropractors had access to radiologists for this service, rather than perform it themselves," the report said.

It also suggested the province make funds available for "research into those areas of chiropractic in which important questions remain unanswered," and even try integrating chiropractors into interdisciplinary teams in community clinics and hospitals.

All three report authors declined comment. Calls to Dave Chomiak, who was health minister at the time the report was prepared, were not returned.

In an emailto CBC, Manitoba Chiropractors Association president Perry Taylor said, "I personally have never seen this 13-year-old document and [it] pre-dates my time as President. As such I have no comment on this."

The CBC I-Team offered to go through the report with Taylor but he did not respond.

Full coverage of health cuts in Manitoba

Got a tip for the CBC I-Team? Email iteam@cbc.ca or call the confidential tip line at 204-788-3744.