Journal of Society of Preventive Korean Medicine (대한예방한의학회지)

Society of Preventive Korean Medicine (대한예방한의학회)
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A Study on the Current Status of Complementary and Alternative Medicine in Canada

캐나다의 보완대체의학 현황에 대한 연구

  • Kiyong Lee (Department of Korean Medicine, School of Korean Medicine, Pusan National University) ;
  • Hyunjin Nam (Department of Korean Medicine, School of Korean Medicine, Pusan National University) ;
  • Jieun Yu (Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University) ;
  • Byungmook Lim (Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University)
  • 이기용 (부산대학교 한의학전문대학원 한의학과) ;
  • 남현진 (부산대학교 한의학전문대학원 한의학과) ;
  • 유지은 (부산대학교 한의학전문대학원 인문사회의학부) ;
  • 임병묵 (부산대학교 한의학전문대학원 인문사회의학부)
  • Received : 2024.04.24
  • Accepted : 2024.08.13
  • Published : 2024.08.31
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Abstract

Objectives : The purpose of this study is to review the current status of Complementary and Alternative medicine (CAM) in Canada, and derive its implications for Korean Medicine (KM). Methods : In order to understand the current status of CAM in Canada, a literature survey was conducted using academic databases such as PubMed, OASIS, RISS, and Google Scholar, and CAM regulations were identified through each state's legal website. Official documents provided on the Canadian government were referenced, and publications and official information were searched on the websites of related organizations. Results : In Canada, accredited CAM therapies include acupuncture, traditional Chinese medicine, natural therapy, massage therapy, homeopathy, and chiropractic. Regulations on these therapies vary from state to state in Canada, but all have laws, and education, licenses, organizations, and insurance systems are also regulated. In particular, the education and licensing system for natural therapy and chiropractic are relatively strict, and as a result, therapists can use the name of a doctor. The authority of CAM therapists is based on education. Conclusions : CAM therapies authorized in Canada have systematic regulation, and therapists have also been legally granted expertise. It may be surmised that the accumulation of policy and clinical evidence is important as one of the ways to maintain the expertise of KM.

Keywords

References

  1. JH Lee. World traditional medicine and Korean Medicine. Healthcare Technology Trend. Korea Health Industry Development Institute. 2015;45:2-6.
  2. WHO. The Regional Strategy for Traditional Medicine in the Western Pacific (2011-2020). 2010.
  3. KH Kim, YT Oh, YM Ko, et al. Survey on Overseas National Health Insurance System of Traditional Medicine. Korea Institute of Oriental Medicine. 2020.
  4. Cao Ben Bao Qi. Current status and future prospects of acupuncture and traditional Chinese medicine in Canada. Chinese Journal of Integrative Medicine. 2015;21(3):166-172. https://doi.org/10.1007/s11655-014-1962-8
  5. Esmail N. Complementary and alternative medicine. Fraser Institute. 2017.
  6. MarketResearch.biz. Global Complementary And Alternative Medicine Market. 2020.
  7. Ministry of Health and Welfare, Korea Institute of Oriental Medicine. Guidebook of overseas advance for Korean Medicine doctor. 2016
  8. JY Ng. The regulation of complementary and alternative medicine professions in Ontario, Canada. Integrative Medicine Research. 2020;9(1):12-16. https://doi.org/10.1016/j.imr.2020.01.001
  9. JS Hong, CH han, YS Kang. Current Status on Education and Evaluation of Acupuncture and TCM in Canada. The Journal of Korean Medical History. 2016;29(2):107-115.
  10. K Leslie, J Moore, C Robertson, D Bilton, K Hirschkorn, MH Langelier, IL Bourgeault. Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK. Human Resources for Health. 2021;19(1):15
  11. Govornment of Ontario. Regulated health professions. Available at : https://www.ontario.ca/page/regulated-health-professions. Accessed on 08 Jan 2024.
  12. Cao, B.B.Q. Current status and future prospects of acupuncture and traditional Chinese medicine in Canada. Chin J Integr Med. 2015;21(3):166-172. https://doi.org/10.1007/s11655-014-1962-8
  13. P Xue, T Zhan, G Yang, GM Farella, et al. Comparison of Chinese medicine higher education programs in China and five Western countries. Journal of Traditional Chinese Medical Sciences. 2015;2(4):227-234. https://doi.org/10.1016/j.jtcms.2016.01.010
  14. MPP Consultation Group on Traditional Chinese Medicine and Acupuncture. Traditional Chinese Medicine and Acupuncture in Ontario; Report to the Minister of Health and LongTer Care. 2005.
  15. Government of Ontario. Traditional Chinese Medicine Act, 2006, S.O. 2006, c. 27.
  16. Government of Quebec. A-5.1 - Loi sur l'acupuncture.
  17. Government of British Columbia. Health Professions Act, Traditional Chinese Medicine Practitioners and Acupuncturists Regulation. Reg. 290/2008.
  18. Government of Alberta. Health Professions Act, Acupuncturists Professions Regulation. Alberta Reg. 255/2020.
  19. Government of Newfoundland and Labrador. Acupuncturists Regulations under the Health Professions Act. Newfoundland and Labrador Reg. 75/12.
  20. Government of Canada. National Occupational Classification. Career Handbook : Acupuncturists. Available at : https://noc.esdc.gc.ca/CareerHandbook/ChProfile?objectid=J%2BFAp61mg3eH5PfIJgdG%2BVsiQY2tZRetRemxX8uHNjc%3D Accessed on 08 Jan 2024.
  21. Government of Ontario. O. Reg. 27/13: Registration under Traditional Chinese Medicine Act, 2006, S.O. 2006, c. 27.
  22. J. Hong, C. Han, Y. Kang. Current Status on Education and Evaluation of Acupuncture and TCM in Canada. The Journal of Korean Medical History. 2016;29(2):107-115. https://doi.org/10.15521/JKMH.2016.29.2.107
  23. CARB-TCMPA. Candidate Handbook Pan-Canadian Entry-Level Examinations in Traditional Chinese Medicine (TCM) and Acupuncture. 2023.
  24. College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario : Pan-Canadian National Results. Available at: https://www.ctcmpao.on.ca/applicant/pan-canadian/national-results/ Accessed on 28 Jan 2024.
  25. CMAAC : History of CMAAC. Available at: https://cmaac.ca/history-of-cmaac Accessed on 28 Jan 2024.
  26. British Columbia. Medical Services Plan. Available at : https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp/bc-residents/benefits/services-covered-by-msp/supplementary-benefits Accessed on 15 Jan 2024.
  27. Government of Canada. National Occupational Classification. Career Handbook : Traditional Chinese medical practitioners. Available at : https://noc.esdc.gc.ca/CareerHandbook/ChProfile?objectid=J%2BFAp61mg3eH5PfIJgdG%2BaFw6T%2FwV1Spm3WJVJrUx%2FU%3D Accessed on 08 Jan 2024.
  28. College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia. Examinations. Available at : https://www.ctcma.bc.ca/applicants/examinations/ Accessed on 15 Jan 2024.
  29. The College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (CTCMA). Doctor of Traditional Chinese Medicine Examination Candidate Handbook. 2024.
  30. Traditional Chinese Medicine Ontario. More TCMO Benefits. Available at : https://www.tcmo.ca/for-your-practice/start-your-practice/ Accessed on 28 Jan 2024.
  31. Coburn D, Biggs CL. Limits to Medical Dominance : The Case of Chiropractic. Social Science &Medicine. 1986;22(10):1035-1046. https://doi.org/10.1016/0277-9536(86)90204-2
  32. Canadian Chiropractic Association. About Canadian Chiropractors. Available at : https://chiropractic.ca/about-canadian-chiropractors/ Accessed on 08 Jan 2024.
  33. Government of Quebec. Professional Code c C-26.
  34. Manitoba Laws. The Chiropractic Act.
  35. Ontario Chiropractic Association. How Do You Become a Chiropractor? Available at : https://chiropractic.on.ca/chiropractic-care/about-chiropractic-care/education-regulations/ Accessed on 15 Jan 2024.
  36. The Federation of Canadian Chiropractic. Specialty Colleges. Available at : https://chirofed.ca/specialty-colleges/ Accessed on 18 Feb 2024.
  37. CCEB. Examination Eligibility Policy.
  38. CCEB Examinations Candidate Handbook.
  39. Canadian Chiropractic Association. Provincial Associations and Regulatory Bodies. Available at: https://chiropractic.ca/provincialassociations-and-regulatory-bodies/ Accessed on 15 Jan 2024.
  40. Canadian Chiropractic Association. Strategic Plan. Available at : https://chiropractic.ca/strategic-plan/ Accessed on 18 Feb 2024.
  41. College of Chiropractors of Ontario. Available at : https://cco.on.ca/about-cco/whatis-cco/ Accessed on 08 Jan 2024.
  42. Ontario Chiropractic Association. Available at : https://chiropractic.on.ca/about-oca/who-weare/what-oca-does/ Accessed on 08 Jan 2024.
  43. Government of Manitoba. Manitoba Health. Available at : https://www.gov.mb.ca/health/mhsip/healthcoverage.html#section-one Accessed on 15 Jan 2024.
  44. Government of Ontario. Fact Sheet - Ministry of Health and Long-Term Care. Available at : https://www.health.gov.on.ca/en/public/publications/ohip/docs/chiropractic.pdf Accessed on 08 Jan 2024.
  45. Canadian Association of Naturopathic Doctors. Common Questions - About Naturopathic Medicine. Available at : https://www.cand.ca/common-questions-about-naturopathicmedicine/ Accessed on 18 Feb 2024.
  46. Canadian Association of Naturopathic Doctors. About Naturopathic Medicine. Available at : https://staging.cand.ca/history-of-naturopathic-medicine/ Accessed on 18 Feb 2024.
  47. Drugless Practitioners Act, R.S.O. 1990, c. D. 18.
  48. Canadian College of Naturopathic Medicine. Academic Calendar 2023-2024. 83-84.
  49. Government of Northwest Territories. Health and Social Services Professions Act. Available at : https://www.hss.gov.nt.ca/en/services/health-and-social-services-professions-act
  50. College of Naturopaths of Ontario. Standard Acupuncture. Available at : https://www.collegeofnaturopaths.on.ca/resource-library/standard-acupuncture/ Accessed on 08 Jan 2024.
  51. Government of Ontario. O. Reg. 168/15: GENERAL.
  52. The Manitoba Naturopathic Association. Policies & Standards. Available at : https://www.cndmb.org/copy-of-member-resources Accessed on 08 Jan 2024.
  53. Saskatchewan Association of Naturopathic Practitioners. SANP Legislation, Bylaws And Policies. Available at : https://www.sanp.ca/sanp-legislation-bylaws-and-policies.html Accessed on 08 Jan 2024.
  54. College of Naturopathic Doctors of Alberta. Code of Ethics, Standards of Practice & Bylaws. Available at : https://www.cnda.net/standards Accessed on 08 Jan 2024.
  55. College of Naturopathic Physicians of British Columbia. Certifications. Available at : https://cnpbc.bc.ca/certifications/ Accessed on 08 Jan 2024.
  56. Canadian Association of Naturopathic Doctors. Common Questions - Education and Regulation. Available at : https://www.cand.ca/common-questions-education-and-regulation/ Accessed on 08 Jan 2024.
  57. Council on Naturopathic Medical Education. Accredited Schools Overview. Available at : https://cnme.org/accredited-programs/ Accessed on 08 Jan 2024.
  58. Canadian College of Naturopathic Medicine. Academic Calendar 2023-2024. 65-66, 97-99.
  59. Association of Accredited Naturopathic Medical Colleges. The Difference Between a Licensed Naturopathic Doctor and a Traditional Naturopath in North America. Available at : https://aanmc.org/featured-articles/difference-between-traditional-naturopath-and-licensed-naturopathic-doctor/ Accessed on 08 Jan 2024.
  60. D Snow. A Survey of Regulated Naturopathic Doctors in Canada: Demographics, Governance, and Public Understanding. Health Law in Canada. 2021.
  61. The North American Board of Naturopathic Examiners. Eligibility Requirements. Available at : https://nabne.org/eligibility-requirements/ Accessed on 08 Jan 2024.
  62. Canadian Information Centre for International Credentials. Occupational profile. Available at : https://www.cicic.ca/938/occupational_profile.canada?&id=673 Accessed on 08 Jan 2024.
  63. I Loudon. A brief history of homeopathy. JR Soc Med. 2008;99(12):607-610.
  64. Government of Canada. Information on Homeopathisc Products. Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/information-homeopathic-products.html#a1 Accessed on 08 Jan 2024.
  65. A Parker. Ontario Homeopathic Practitioner Survey. Are homeopaths prepared to be regulated?. University of Toronto. 2013.
  66. College of Homeopaths of Ontario. Governing Legislation. Available at : https://www.collegeofhomeopaths.com/governing-legislation-and-bylaws.html Accessed on 08 Jan 2024.
  67. Health Force Ontario. Homeopaths. Available at : https://www.healthforceontario.ca/en/Home/Health_Providers/Homeopaths Accessed on 08 Jan 2024.
  68. Government of Ontario. Homeopathy Act, 2007, S.O. 2007, c. 10, Sched. Q.
  69. College of Homeopaths of Ontario. Homeopathic Scope of Practice. Standard. 2013 : 3. Available at : https://collegeofhomeopaths.com/uploads/1/2/4/8/124811910/standard_15_scope_of_practice_[final].pdf Accessed on 22 Apr 2024.
  70. College of Homeopaths of Ontario. Homeopathic Scope of Practice. Standard. 2013 : 16. Available at : https://collegeofhomeopaths.com/uploads/1/2/4/8/124811910/standard_15_scope_of_practice_[final].pdf Accessed on 22 Apr 2024.
  71. College of Homeopaths of Ontario. Homeopathic Scope of Practice. Standard. 2013 : 9. Available at : https://collegeofhomeopaths.com/uploads/1/2/4/8/124811910/standard_15_scope_of_practice_[final].pdf Accessed on 22 Apr 2024.
  72. Government of Canada. Information on Homeopathisc Products. Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescri ption/regulation/information-homeopathicproducts.html#a1 Accessed on 08 Jan 2024.
  73. Government of Canada. Evidence for homeopathic medicines. Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/legislation-guidelines/guidance-documents/evidence-homeopathic-medicines.html#a1 Accessed on 08 Jan 2024.
  74. Government of Canada. Drug Identification Number (DIN). Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/fact-sheets/drug-identification-number.html Accessed on 08 Jan 2024.
  75. Government of Canada. Information on Homeopathic Products. Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/information-homeopathic-products.html#a1 Accessed on 08 Jan 2024.
  76. Government of Canada. Evidence for homeopathic medicines. Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/legislation-guidelines/guidance-documents/evidence-homeopathic-medicines.html#a1 Accessed on 08 Jan 2024.
  77. Government of Canada. General Questions. Regulation of Natural Health Products. Available at : https://www.canada.ca/en/healthcanada/services/drugs-health-products/natural-non-prescription/frequently-asked-questions/general-questions-regulation.html Accessed on 08 Jan 2024
  78. College of Homeopaths of Ontario. How to Determine Eligibility to Register. Available at : https://www.collegeofhomeopaths.com/registration-eligibility.html Accessed on 08 Jan 2024
  79. Canadian College of Homeopathic Medicine. Accredited In North America. Available at : https://homeopathycanada.com/collections/north-american-programs Accessed on 08 Jan 2024
  80. Canadian College of Homeopathic Medicine. All Programs. Available at https://homeopathycanada.com/collections/all-products Accessed on 08 Jan 2024
  81. Ontario College of Homeopathic Medicine. Blended Intensive Diploma Program. Available at : https://ochm.ca/blended-intensive-diploma-program/ Accessed on 08 Jan 2024
  82. Canadian College of Homeopathic Medicine. North American Accreditation. Available at : https://homeopathycanada.com/pages/accreditation Accessed on 08 Jan 2024
  83. Accreditation Commission for Homeopathic Education in North America: Accredited and Candidate School/Program Directory. Available at : https://achena.org/refresh/resources/accredited-school-directory/ Accessed on 08 Jan 2024
  84. College of Homeopaths of Ontario: A protected health profession title. Available at : https://www.collegeofhomeopaths.com/about-homeopathy.html Accessed on 08 Jan 2024
  85. College of Homeopaths of Ontario. Title And Credential - Guideline. 2013. Available at : https://collegeofhomeopaths.com/uploads/1/2/4/8/124811910/guideline_4_title_v2_2018_[final].pdf Accessed on 22 Apr 2024
  86. College of Homeopaths of Ontario. Annual Report 2022 - 2023. Available at : https://www.collegeofhomeopaths.com/uploads/1/2/4/8/124811910/cho_annual_report_and_financial_statements_2022-2023.pdf Accessed on 22 Apr 2024
  87. College of Homeopaths of Ontario. How to Determine Eligibility to Register. Available at : https://collegeofhomeopaths.com/registration-eligibility.html Accessed on 08 Jan 2024
  88. Canadian College of Homeopathic Medicine. CHC. Available at : https://homeopathycanada.com/pages/accreditation Accessed on 08 Jan 2024
  89. Council for Homeopathic Certification. Eligibility Requirements. Available at : https://homeopathcertification.org/get-certified/eligibility-requirements/ Accessed on 10 Jan 2024
  90. Canadian Information Centre for International Credentials. Occupational profile. Available at : https://www.cicic.ca/938/occupational_profile.canada?&id=680 Accessed on 10 Jan 2024.
  91. College of Massage Therapists of Ontario. Celebrating 100 Years of Massage Therapy Regulation. Available at : https://www.cmto.com/wp-content/uploads/2021/12/Article-No.-4-Winter-Spring-2019-1.pdf Accessed on 10 Jan 2024.
  92. Natural Health Practitioners of Canada. Current Status of Massage Therapy Regulation. Available at : https://www.nhpcanada.org/massage-therapy-regulation/saskatchewan Accessed on 10 Jan 2024.
  93. Canadian Council of Massage Therapy Schools. About Us. Available at : http://www.ccmts.ca/ Accessed on 10 Jan 2024.
  94. Federation of Massage Therapy Regulatory Authorities of Canada. About. Available at : https://www.fomtrac.ca/about/ Accessed on 10 Jan 2024.
  95. A Baskwill, B Sumpton, S Shipwright, et al. A Canadian Massage Therapy Education Environmental Scan. Int J Ther Massage Bodywork. 2020 : 13(4) : 12-24. https://doi.org/10.3822/ijtmb.v13i4.453
  96. Government of British Columbia. Massage Therapy. Available at : https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/professional-regulation/massage-therapy Accessed on 10 Jan 2024.
  97. Canadian Massage & Manual Osteopathic Therapists Association. History of Regulation in Newfoundland & Labrador. Available at : https://cmmota.com/wp-content/uploads/2020/04/Newfoundland-and-Labrador-Regulation-Landing-Page.pdf Accessed on 15 Jan 2024.
  98. Canadian Massage & Manual Osteopathic Therapists Association. History of Regulation in New Brunswick. Available at : https://cmmota.com/wp-content/uploads/2020/04/New-Brunswick-Regulation-Landing-Page.pdf Accessed on 12 Jan 2024
  99. College of Massage Therapists of Prince Edward Island. Massage Therapy in PEI. Available at : https://www.cmtpei.ca/about-massage-therapy Accessed on 15 Jan 2024
  100. Government of Saskatchewan. The Massage Therapy Act, SS 2021, c 18.
  101. Canadian Massage Therapy Council for Accreditation. Accredited Programs. Available at : https://www.cmtca.ca/accreditedprograms Accessed on 11 Jan 2024.
  102. Canadian Massage Therapist Association. RMT FACTS. Available at : https://crmta.ca/project-rmtact/rmt-facts/there-are-over23000-registered-massage-therapists-incanada/ Accessed on 12 Jan 2024.
  103. College of Massage Therapists of Ontario. Certification Examinations. Available at : https://www.cmto.com/become-an-rmt/applyfor-registration/certification-examinations/ Accessed on 12 Jan 2024.
  104. College of Massage Therapists of Newfoundland and Labrador. Certification Examinations Candidate Handbook 2024. Available at : https://www.cmtnl.ca/wp-content/uploads/2024/01/2024-Certification-ExaminationsCandidate-Handbook-2024.pdf Accessed on 12 Jan 2024
  105. College of Massage Therapist of New Brunswick. Candidate Handbook 2024 Certification Examinations. Available at : https://www.cmtnb.ca/wp-content/uploads/2024/01/CandidateHandbook-CertificationExaminations2024-01-27.pdf Accessed on 12 Jan 2024
  106. College of Massage Therapists of British Columbia : Exam Components. Available at : https://www.cmtbc.ca/applicants/registration-examination/exam-components/ Accessed on 12 Jan 2024
  107. College of Massage Therapists of Prince Edward Island: Education Requirements. Available at : https://www.cmtpei.ca/education-requirements#jurisprudence Accessed on 12 Jan 2024
  108. BM Lim. Policies on Complementary and Alternative Medicine in the United States - Focusing on Licensing and Insurance. Journal of Society of Preventive Korean Medicine. 2010;14(1):137-149.
  109. D Sibbritt, et al. How are complementary health professions regulated in Australia? An examination of complementary health professions in the national registration and accreditation scheme. Complementary Therapies in Medicine. 2018;37:6-12. https://doi.org/10.1016/j.ctim.2017.12.012
  110. Gallup - Palmer College of Chiropractic Inaugural Report. American's Perceptions of Chiropractic. 2015.
  111. M Chang. The Chiropractic Scope of Practice in the United States. A Cross-Sectional Survey. J. Manip. Physiol. Ther. 2017;37(6):363-376. https://doi.org/10.1016/j.jmpt.2014.05.003
  112. Health Caanda, Drugs and health products. Pathway for Licensing Natural Health Products used as Traditional Medicines. Available at : https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-nonprescription/legislation-guidelines/guidance-documents/pathway-licensing-traditional-medicines.html. Accessed on 18 Feb 2024.
  113. D Coburn. Legitimacy at the expense of narrowing of scope of practice. chiropractic in Canada. J Manipulative Physiol Ther. 1991
  114. Chris Baggoley AO. Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance. Natural Therapies Review Advisory Committee, Department of Health. 2015.
  115. S Gavura. Australian review finds no benefit to 17 natural therapies. Science-Based Medicine. 2015.11.19. https://sciencebasedmedicine.org/australian-review-finds-no-benefit-to-17-natural-therapies/ Accessed on 28 Mar 2024.
  116. Wikipedia. 'Naturopathy'. Available at : https://en.wikipedia.org/wiki/Naturopathy Accessed on 28 Mar 2024.
  117. MJ Leach, M Aucoin, K Cooley. Canadian Naturopathic Doctor Engagement, Preparedness, and Perceptions of Evidence-Based Practice. A National Cross-Sectional Study. J Integr Complement Med. 2022;28(12):955-964. https://doi.org/10.1089/jicm.2022.0637
  118. M Aucoin, G Newton, M Leach, K Cooley. Co-Design of an Evidence-Based Practice Continuing Education Course for Canadian Naturopathic Doctors. J Integr Complement Med. 2023;29(9):592-601. https://doi.org/10.1089/jicm.2022.0730
  119. DS Kim, BM Lim, IH Park, and YJ Lee. A case study on benefit coverage of complementary medicine in public health insurance by the referendum in Switzerland. Journal of Society of Preventive Korean Medicine. 2017;21(3):29-42. https://doi.org/10.25153/spkom.2017.21.3.004
  120. Jenkins, H.J., Downie, A.S., Moore, C.S. et al. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap. 2018;26:48.