President's Report

Peter Werth
As we again approach the lead up to the festive season it seems that the year has passed by at an all too alarming rate. We have had a busy few months with the recent national conference in Sydney providing an opportunity to hear Drs Triano, McGregor and Ferrance provide an excellent view of contemporary practice (see related articles).

We also had our AGM during the course of the weekend. This saw our Executive remain fairly stable. All Executive members were re-elected apart from Drs. Robert Hennessey and Peter Chapman whose outside commitments have seen them step down for the time being. Also Dr Paul Martin resigned earlier in the year, again due to his increasing commitments. On behalf of the Executive and members I would like to thank all three for their contribution to the College over the past few years.

The AGM also saw the admission of Drs Bruce Walker and John Reggars into life membership of the College, which is an acknowledgement of their enormous contribution to the development and advancement of the College over many years.

Since my last report to you John Jannese, our Executive Director and I have met with representatives from the CAA to discuss areas of interest and potential for future co-operation particularly in areas of mutual concerns. It is hoped that where possible the two groups can work together for the benefit of the chiropractic profession. We also hope to work with other associations and related organisations where appropriate particularly with respect to professional and vocational matters.

In the June issue of COCA News, I expressed a view regarding COCA’s position on the care of paediatric patients and COCA’s related media release. This was in response to a current affairs program on television where a chiropractor made a number of dogmatic unsupportable claims. Since then there have been a few letters and emails relating to this position statement, some of which were published in the September issue and some are in this issue of COCA News.

I believe that there is room for considerable debate on this topic, especially with many members of the professions having very diverse opinions on this topic. However, I am concerned that COCA’s statement has been both misinterpreted and misrepresented by some.

I therefore wish to clarify our position on this for the record. What was said was that there is no sound scientific evidence that justifies the regular or continued manipulation of the spines of infants. This is to say that practitioners offering ongoing spinal treatment to children without a need (as opposed to a clearly defined need, treatment plan and regime) are not, in our view offering appropriate care.

COCA has not stated that treatment should not be provided to children, but we are of the opinion that when there is no evidence of benefit, or where the evidence is equivocal, parents should be informed of this, and the treating practitioner should offer appropriate advice as to what the possible outcomes may be.

In respect to the issue of consulting a GP first, having now heard Dr Randy Ferrance (a chiropractor and medical practitioner trained as a paediatrician) speak on paediatric diagnosis and care of children it confirmed my view that there is a void in the knowledge-base of a chiropractor and/or osteopath regarding the diagnosis and treatment of many paediatric conditions in comparison to that of a GP. This is particularly so in respect to conditions that may potentially evolve into life-threatening situations.

It would seem a common-sense approach to (where possible) work in conjunction with the GP to exclude serious pathology or conditions that would fall outside our scope of practice. If you liaise with the GP in an appropriate fashion then most reasonable GP’s would, I think, see you as acting in the patient’s interests which should foster a rapport and achieve a better outcome for your mutual patient. COCA is not against the treatment of children by chiropractors. But, it is time to debate the issue and perhaps develop specific policy on it.

The approach to this issue and “Type O” conditions in general has been outlined in the COCA Code of Conduct since the early 1990’s. This policy reflects the recommendations of the New Zealand Government inquiry into chiropractic released in 1979. It still remains a valid approach to patient management of Type O conditions in light of the current available evidence.

The matter of “Type O” conditions was debated healthily at the national conference with the prevailing view from all speakers being, if we don’t know if or how it works…. say so. This is not to be dismissive of the treatment of Type O conditions, but rather if you do choose to manage patients for Type O conditions, treat patients in a responsible and honest manner, while the research is being conducted to see how the cards fall. But above all, give the patient all of the known evidence so that they can make up their mind in an informed way.

A criticism that has been levelled at COCA previously and highlighted by the above issue is that in promoting an evidence-based approach we can be seen to advocate only the use of interventions that have passed through the hoops of multiple randomised controlled trials. This is not the case. We all know that if this was the situation, then much of what we do and much of what is done in medicine and other areas of health-care would not be acceptable.

Practising in an evidence-based way means to gain an appreciation as to the process of accumulating and appraising the best available evidence, and adopting where indicated the outcomes of well-conducted research, taking into account your own clinical experience and the preferences of the patient. If there is no evidence for an intervention, acknowledge this and keep it in context when treating patients.

In the situation where there is good scientific evidence to change the way in which you practise, then it would be reasonable to adopt this change. The key to this is identifying good evidence. Discussion of this in more detail can be seen in the article in this edition by Simon French, Henry Pollard and Bruce Walker. All are well qualified to discuss this issue in further detail. Hence, when you read an article (in COCA News or elsewhere) that challenges your views, you may be well advised to give it due consideration to see if it stacks up.

You may at times read articles in COCA News that appear negative, or not pro-chiropractic/osteopathy and/or manipulation. The reason for this is simple, our role is to report what the literature is saying about what we do. You can choose to ignore it, denigrate it, and see it as being critical of the professions that you have made your career and life, or you can see it in a constructive light, take it on board if it is sound, and move forward to try and better manage your patients, which is what it is all about……isn’t it?

It is worthy of note that the COCA Executive often spend considerable time debating these questions and others like it. There is a diversity of views whenever we sit down at meetings. However, we nearly always reach consensus even on the curliest of questions. I am personally pleased to lead and work with such a well qualified and intellectually stimulating group. The COCA Executive is comprised of some the professions’ great thinkers, whom I believe have offered on-going leadership, stimulating growth and maturity for the professions in this country.

I hope that members continue to feel as proud as I do to belong to a College that shows this sort of leadership. A College that is dedicated to science, ethics and the vocational advancement for all within the professions of chiropractic and osteopathy.

Have a safe and happy festive season. I look forward to serving you in 2004.