If the results of an unusual meeting this weekend are any indication, B.C.'s chiropractors are deeply divided about the future of their profession, disagreeing on everything from false advertising to the use of routine X-rays.
Hundreds of chiropractors who attended an extraordinary general meeting of the College of Chiropractors of B.C. on Saturday were split nearly down the middle on a series of non-binding resolutions addressing actions the college has taken in recent years.
By the narrowest of margins, with at most 54 per cent support, the members voted in favour of the college's moves to limit the use of diagnostic X-rays and ban claims that aren't supported by scientific evidence.
The question that remains is who represents the bulk of the profession in B.C. — chiropractors advocating for what they describe as evidence-based practice targeting the musculoskeletal system, or "vitalists" who argue that chiropractic treatment can help with everything from immunity to brain function.
Those who spoke in favour of the college's policies described the vitalistic chiropractors fighting to overturn them as a "vocal minority" in B.C.
"It's a deliberate attempt to take over the college by a small group of chiropractors with no respect or knowledge of regulation … funded by organizations out of the province and out of the country," Victoria chiropractor Clark Konczak told the virtual meeting.
But the vitalistic faction gained close to half the vote on every one of the six resolutions discussed during the meeting.
"We are the vocal majority," Joshua Korten of Kelowna contended.
'The smoothie episode'
Konczak painted Saturday's meeting as something of a crossroads for the profession, warning chiropractors risk losing the right to self-regulation if they don't follow the science.
"We have to work hard to come across as evidence-based," he said. "We have to position ourselves to look in a responsible and patient-centred way."
At issue was a series of policies the college introduced in the wake of what Konczak called "the smoothie episode."
He was referring to a video posted on Facebook in 2017 by then-vice chair of the college's board, Avtar Jassal, in which he falsely suggested fruit smoothies are better than vaccines at preventing the flu.
That statement was in direct violation of college policy, which forbids chiropractors from making recommendations about vaccination because they are not trained in infectious diseases. But no action was taken when a member of the public complained to the college, and Jassal's video wasn't removed from Facebook until CBC News pointed it out to the Health Ministry months later.
In response, government staff began looking into "what options we have when a college is not meeting its legal obligation," according to emails obtained by CBC News through a Freedom of Information request.
Not long after, the college began cracking down on misleading advertising by chiropractors, introducing a policy banning any claims of treating conditions like Alzheimer's disease, cancer and autism because of a lack of scientific evidence.
The college has also developed a partnership with researchers at Ontario Tech University, who have performed reviews of scientific evidence on a number of issues.
That includes a review on the use of X-rays as a diagnostic tool. Earlier this year, the college introduced amendments that bar chiropractors from performing routine and repeat X-rays, saying radiography is only scientifically supported when there are red flags that something is seriously wrong.
'We risk tarnishing our reputation'
The policy change on X-rays was the flashpoint in the long-simmering tension within the profession.
A group of chiropractors have filed a petition in B.C. Supreme Court, alleging the college is preventing them from providing "safe, ethical, and effective care to their patients." Their legal action has backing from national and international vitalistic organizations.
During Saturday's meeting, a group of chiropractors argued unsuccessfully for the new X-ray policy to be tossed.
Some suggested that chiropractors who don't perform X-rays as a matter of routine are actually harming their patients.
Kelsey Bjola of Victoria alleged she has seen patients who were hurt by chiropractors adjusting parts of their spine that X-rays later revealed to be problematic.
But Victoria chiropractor Daniel Skinner described the routine use of X-ray for diagnosis as "archaic," and said by advocating for it, "We risk tarnishing our reputation amongst our colleagues."
There were also suggestions of bias and conflict of interest among members of the college's board, but a motion to launch a full examination was voted down.
Kelowna's Mark Foullong alleged that legitimate complaints filed against board members have been "intercepted" by staff rather than investigated.
"Are they above the law?" he asked.
Kristine Salmon, a Victoria chiropractor who sits on the college's inquiry committee, said those accusing the board of bias and conflict of interest have presented no evidence.
"I feel like we're asking to see Obama's birth certificate here," Salmon said, referring to racist right-wing efforts to discredit the former U.S. president.
"Tactics like this and misleading advertising are the way we're going to lose the respect of the public."
College registrar Michelle Da Roza wasn't able to provide a final number for how many chiropractors participated in Saturday's meeting, but quorum was called with about 545 in attendance, and she said "many more" joined after that. There are 1,357 fully licensed, practising chiropractors in B.C.
Another extraordinary general meeting has been called for July 20 to vote on resolutions calling for the removal of four college board members. College bylaws state these meetings must be held when requested by at least 15 per cent of registrants.