Our article, "Australian Medical Association Taken to Task" (Jan. 26 issue) prompted a letter of clarification from J. Keith Simpson,DC, chairman of the Trade Practices Committee of the Chiropractors' Association of Australia ("We Get Letters," Feb. 8 issue). That letter, Dr. Simpson tells us, is "still at odds with the facts."
As a final clarification, we are printing Dr. Simpson's article written for the upcoming issue of the newsletter of the Chiropractors' Association of Australia.
The first informal meeting of the Chiropractors' Association of Australia (CAA) with the Australian Competition and Consumer Commission (ACCC) took place in December 1992. There have since been numerous meetings and teleconferences involving officials from the CAA and the ACCC. These dialogues, along with a significant change in the application of the Trade Practices Act (TPA), culminated in an article, "The AMA and Chiropractic: a Trade Practices Viewpoint" (Aug. 1998 issue of ACCC Journal), authored by Alan Ducret, ACCC regional director, Brisbane.
The purpose of this writing is to bring readers up to date on the current position of the Australian Medical Association (AMA) with regard to the TPA and chiropractors.
Initially, the ACCC had to be convinced that the policies and activities of the medical profession in Australia toward the chiropractic profession could be viewed as anticompetitive. The simplest way of doing this was to make clear to the ACCC the findings and outcomes of the Wilk case in the U.S. and then to draw parallels to the activities of the Australian Medical Association. Very briefly, Wilk v AMA confirmed that the American Medical Association had breached U.S. anti-trust laws by declaring it unethical for medical practitioners to have professional dealings with unscientific practitioners, and then labelling chiropractic as an unscientific cult. The purpose of this boycott was to eliminate chiropractors as competitors in the U.S. health care system.
The ACCC was convinced that the policies of the Australian Medical Association were sufficiently similar to warrant further investigation. Specifically, the ACCC felt that the AMA's 1977 policy on chiropractic was effectively boycotting chiropractors and others. The 1977 policy stated: "The Australian Medical Association does not recognise any exclusive dogma such as homeopathy, osteopathy, chiropractic and naturopathy. It is unethical for doctors to associate professionally with practitioners of such dogmas."
In 1981 the AMA Federal Assembly modified this policy to read:
"The Australian Medical Association does not recognise any exclusive dogma such as homeopathy, osteopathy, chiropractic and naturopathy or any other practices which are not based on sound scientific principles."
Even though the 1981, modification removed the overt boycott, it would appear that the general AMA membership (and indeed the state branches) were unaware of the subtle change. For example, in 1982 the Victorian branch rule 36 stated that it was unethical for a member of its branch to have professional dealings with chiropractors. In 1997, the Victorian AMA branch president stated publicly that it was unethical for AMA members to refer patients to chiropractors.
Until July 1996, none of these policy changes really had much meaning as far as the ACCC was concerned because professional organizations were effectively exempt from the TPA. This changed, however, with the passage of the State and Territory Competition Policy Reform Acts of 1995, which applied the competitive conduct rules to the Australian professions, including the medical profession. With these changes came a commitment from the ACCC to assess the AMA position to determine if it was in breach of the TPA. To this end the ACCC contacted the federal, state and territory branches to ascertain if any of those bodies engaged in activities that could be construed as prohibiting interprofessional relations between chiropractors and medics. According to the AMA branches, individual members of the AMA are free to decide whether or not they form a professional association or alliance with chiropractors.
The AMA confirmed to the ACCC that individual medical practitioners are free to: communicate professionally with chiropractors; refer certain patients to chiropractors; establish a multidisciplinary practice which includes chiropractors; share premises with chiropractors; and engage in research projects with chiropractors.
The AMA also will not take action to discourage or prevent chiropractors working in public hospitals, or discourage the offering of courses or research through universities. Additionally, neither the AMA nor its affiliates will seek to exclude chiropractors from participating fully in the Australian health care system.
While this is exciting news, it must be stated that this does not constitute an AMA endorsement of chiropractic. Indeed, as an active professional organization, the AMA retains the right to market its member services and to question all forms of health care. The AMA retains its right to remain a vigorous opponent of health services it believes are ineffective or dangerous.
The bottom line is that the AMA has publicly stated it is up to doctors to individually decide whether to deal with chiropractors. Should an instance arise where doctors jointly agree not to deal with chiropractors, or where the AMA gets involved, a report should be made to the CAA. It must be emphasised that it is pointless reporting instances where an individual doctor simply decides not to deal with a chiropractor. The TPA is about collusive activity, and should the ACCC become aware of such activity, it will act swiftly to apply the appropriate legal remedies.
The CAA acknowledges and thanks Mr. Alan Ducret, ACCC regional director, Brisbane, for his tireless efforts over the past six years. Without his persistence, the public statements made by the AMA would never have come about. Now it is up to both professions to proceed responsibly into the future. Copies of Mr. Ducret's article, "The AMA and chiropractic: a trade practices viewpoint," are available through CAA national headquarters.
J. Keith Simpson, DC
Chair, Trade Practices Committee
Chiropractors' Association of Australia (National) Limited
P.O. Box 241 Springwood, NSW 2777
Australia
fax: 61-247-515856
cca_nat@pnc.com.au
