International Chiropractors Association

ICA Takes Action, Offers Assistance on Recent Developments Regarding Chiropractic Safety and Professional Conduct in Indonesia

The International Chiropractors Association (ICA) has responded to developments in Indonesia in which a doctor of chiropractic has allegedly been performing professional services outside the established rules for such procedures and in violation of visa and other requirements and that, in the course of such activities, a young patient has died following the administration of care by this individual.
In a formal statement released to public officials and the media in Indonesia, the ICA also has sought to emphasize the value of specific professional recognition and licensure of the chiropractic practitioner and the chiropractic profession and stands ready to serve and assist any nation or jurisdiction seeking to develop appropriate and effective regulatory rules and procedures. 
The ICA has extended its deepest sympathy to the family of the deceased.  ICA also wishes to state its strong commitment to the strictest adherence of all chiropractic professionals to all rules and regulations the various jurisdictions around the world have in place for the provision of health care services.  ICA also believes in accountability and responsibility and believes that any and all charges against an allegedly errant practitioner should be answered in person, through established judicial or other regulatory procedures. 
The ICA has, however, cautioned against unfairly projecting the possible inappropriate behavior of one individual or any adverse outcome in one specific case onto the entire chiropractic profession.  On February 8, 2016, the ICA delivered a letter to the Indonesian Ambassador to the United States asking for the opportunity to meet with him and-or his designated staff to explain the facts and enormous research record behind the science and practice of chiroipractic as well as chiropractic’s unprecedented safety record.  ICA has also provided extensive background materials and pub lications  in an effort to counter some of the outrageous statements about chiropractic being made by the media and by some public officials in that nation.  In its letter the ICA told the Ambassador:

Regrettably, much of the information being presented in the media and in statements by some public officials is simply incorrect and is only serving to confuse the public and damage the reputation those doctors of chiropractic who are practicing within the laws and rules and providing a sound and much needed public health service… The ICA respectfully requests the opportunity to meet to present additional information and resources to assist public officials in your great nation in better understanding chiropractic science and practice.  We feel that this is a time for truly objective consideration of all aspects of the current situation and we look forward to making a positive contribution to a meaningful resolution.
Throughout its nearly one-hundred years of continuous operation, the ICA has sought to obtain objective, science-based consideration of all public policy questions related to chiropractic art, science, philosophy and practice.  It is ICA’s hope that it is, indeed, objectivity and a factual, responsible consideration of all aspects of any such question that will determine the final outcome of any public policy decision in any jurisdiction.
The ICA maintains a vigilant watch on safety and clinical effectiveness issues and conducts an on-going evaluation of all health care literature related to issues of safety and relative risk.  The findings of those efforts are widely disseminated throughout the chiropractic profession and are well understood by chiropractic practitioners.  It is certainly within the interests of the chiropractic profession to honestly and immediately address any valid risk factor.  We believe this responsibility is incumbent on all health care professionals.
ICA fully recognizes that any health care delivery system is not without risk and that all consumers must explore to their personal satisfaction and understanding the risks and dangers associated with any and all health care surgical procedures, treatments, chemical interventions, etc., both diagnostic and therapeutic.[i]  The safety record of the chiropractic profession is demonstrably exceptional and stands as one of the primary outcome elements that distinguishes chiropractic procedures from the medical model. 
All health care professionals must make consumer and patient safety a paramount concern.  When the level of risk is quantifiable and significant, providers have a responsibility to offer that data to patients and potential patients.  What constitutes a significant level of risk is open to a diverse range of opinions and interpretations; however, to pinpoint risk requires that exact data on causality needs to be present.   That causality factor is simply not present and even the coincidental occurrence of injury from procedures applied by chiropractors is exceptionally rare, perhaps no more than one per 3 million neck adjustments. 
In many health care situations, a casual, coincidental relationship between a procedure and an adverse event can and is easily mistaken for causality.  ICA believes that the research record indicates that there are, indeed, cases where an individual suffers from an adverse event in conjunction with, but not caused by a chiropractic intervention and even these cases are rare.  If the evaluation of the current case in Indonesia identifies chiropractic causality, then there must be full accountability on the part of the practitioner involved.  It is our sincere hope, however, that this case be objectively evaluated and that only true and objective findings be applied to the resolution of the clearly emotional issues this case contains.
The ICA continues to work to assist the chiropractic community as well as individual DCs in Indonesia and continues to work to educate and accurately inform the authorities of that nation during this time of unprecedented crisis.  
[i] Starfield B. Is US health really the best in the world? Journal of the American Medical Association (JAMA) 2000 Jul 26;284(4):483-5. Starfield B. Deficiencies in US medical care. JAMA. 2000 Nov 1;284(17):2184-5.
Gurwitz, J.H., Field, T.S., Harrold, L.S., et al, “Incidence and preventability of adverse drug events among elderly persons in the ambulatory setting,” Journal of the American Medical Association (JAMA) 2003;289(9) 1107-1116.
Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute of Medicine (2000). To Err is Human. Washington, DC: National Academy Press.
Bad Medicine, Daily Policy Digest, Health Issues, National Center for Policy Analysis, March 25, 2008, Dallas, Texas.
"ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS - NEVER EVENTS" CMS Office of Public Affairs, US Department of Health and Human Services, May 16, 2006.