Customized software was commissioned by the CCBC to provide internet analytics of their registrants and was delivered to the College in 2018 (Compliance Verification Tools, Vancouver, British Columbia, Canada). This software, known as the Marketing Review Tool (MRT), scans websites and social media activity of all chiropractors in British Columbia. The software specifically searches for pre-defined words from a target list approved and maintained by the CCBC. Using this target list, searches performed by the MRT are made twice per month for websites, daily for social media and on demand as required. Following a search, the software returns cases where a word from the target list is identified. The CCBC then manually categorizes these cases into A) acceptable use of the target word (e.g. “our office is closed during the COVID crisis”) and B) unacceptable use (e.g. "chiropractic can boost immunity). For any case deemed unacceptable, the chiropractor(s) registered with the website or social media account is sent a notice to remediate the questionable material immediately (e.g. deletion of content). A MRT scan can then be performed multiple times to determine the rate at which compliance is achieved. When the stated deadline for mandatory compliance is reached, a follow up scan can then be performed and final compliance determined. Any non-compliant activity is then dealt with by the CCBC who forwards these cases to its inquiry committee.
MRT use with specific conditions (October 2018)
The MRT was first used by the CCBC to review the internet activity of their registrants in relation to specific health conditions not permitted to be promoted or treated by registrants. These conditions were made known to registrants on October 3, 2018 with mandatory compliance to occur by November 1, 2018. The regulation providing the targeted words states:
As stated in section 14(1)(f) of the CCBC’s Professional Conduct Handbook (“PCH”), chiropractors must not advertise health benefits of their services when there is no acceptable evidence that those benefits can be achieved. See Appendix “N” to the Handbook and the Efficacy Claims Policy for additional information.
The Board is concerned registrants may be making claims in marketing or directly to patients that chiropractic care has beneficial effects on some diseases, disorders and conditions when there is no acceptable evidence for those claims. This policy identifies efficacy claims that are not supported by acceptable evidence, and therefore, must not be made.
Due to the absence of acceptable evidence supporting such claims, registrants must NOT represent to patients or the public that chiropractic: (a) can be used to treat diseases, disorders or conditions such as: Alzheimer’s disease, cancer, diabetes, infections, infertility, or Tourette’s syndrome, or (b) has any beneficial effect on childhood diseases, disorders or conditions such as: ADHD (or ADD), autism spectrum disorders including Asperger syndrome, cerebral palsy, Down syndrome, fetal alcohol syndrome, or developmental and speech disorders.
A scan of registrant internet analytics was then performed by the MRT in October, before the compliance deadline. Registrants associated with inappropriate messaging were notified before the compliance deadline so they could take corrective action. A subsequent scan was then performed on the compliance date and noncompliant cases were notified and forwarded to the CCBC inquiry committee.
MRT use with pregnancy conditions (December 2019)
On December 23, 2019, the CCBC released amendments to the Professional Conduct Handbook and the Efficacy Claims Policy regarding pregnancy. The regulation can be found here (https://www.chirobc.com/amendments-to-the-professional-conduct-handbook-and-efficacy-claims-policy-webster-technique-and-pregnancy-related-conditions/) and states:
Due to the absence of acceptable evidence supporting such claims, registrants must NOT represent to patients or the public that chiropractic: (a) has any beneficial effect on fetal development or position such as: breech/breech turning or position and intrauterine/in utero constraint. (b) has any beneficial effect on labour or birth such as: easier or shorter labour, preventing the need for medical interventions and preventing premature or traumatic birth. (c) has any beneficial effect on hormone function or postpartum depression.
After the adoption of this policy and subsequent notification of registrants, internet analytics based on selected pregnancy target words were generated from the MRT on December 23, 2019 prior to the compliance deadline of January 30, 2020. Registrants associated with inappropriate messaging were notified before the compliance deadline so they could take corrective action. A subsequent scan was then performed on the compliance date and noncompliant cases were notified and forwarded to the CCBC inquiry committee.
MRT use with COVID-19 (march 2020)
On March 13, 2020, target words were added to the MRT system in response to the COVID pandemic with the expected date of compliance set to the same day. Adding these words to the target list did not require new regulations be passed by the CCBC as claims related to infectious disease were already disallowed through existing regulations.
The PCH states: 9.5 The prevention and treatment of infectious disease is not within the scope of chiropractic practice.
The CCBC also released an announcement to the public that claims promoting treatment or supplements to improve immunity were inappropriate. (https://www.chirobc.com/novel-coronavirus-covid-19/) A surveillance scan was performed on March 18, 2020 for words such as COVID, corona, and immune and derivative words. Noncompliant cases were notified to take immediate corrective action. Further scans were then performed and noncompliant cases were notified and forwarded to the CCBC inquiry committee by March 31, 2020.
In all three applications of the MRT, our research team was provided with anonymized, aggregated data from the CCBC beginning March 24, 2020 and ending March 31, 2020. This anonymized data (provided by the CCBC with permission given for analysis) consisted solely of numerical totals and dates for all three MRT applications: estimates of the number of websites/social media accounts reviewed by MRT, subsequent cases of potentially inappropriate or non-compliant word use, estimates of the number of registrants and the number of non-compliant cases. Approval for this project was provided by the University of Alberta Human Research Ethics Board (Pro00099878).