Chiropractors are not allowed to advertise or claim to be medical practitioners, said Singapore's Ministry of Health (MOH).

"Chiropractors, who are not registered medical practitioners under the Medical Registration Act (MRA), cannot practice medicine as doctors," said an MOH spokesman.

This comes after queries on The Sunday Times appeared, questioning chiropractors who use "Dr." or "Doctor of Chiropractic" in their titles, which some customers claim to have misled them to assume that they are medical doctors.

"Patients and their caregivers are advised to exercise due diligence and consult appropriate healthcare practitioners for their medical problems. When in doubt, they should consult a registered medical practitioner," the MOH spokesman added.

"Doctor" title is legitimate

However, chiropractors argue and say that the "Dr" title is legitimate as 'Doctor of Chiropractic' is the degree conferred by North American Chiropractic Institutions.

It is also the honorific title used in Australia and other countries that do not confer a doctoral professional degree, according to Dr. Janet Ruth Sosna from Elder Chiropractic Clinic.

In 2011, a new law was passed to regulate allied health professionals, such as physiotherapists, but chiropractors were left out as they were considered as alternative healthcare providers, then Health Minister Khaw Boon Wan said.

The Chiropractic Association of Singapore said it would like to see the industry regulated. It is currently on a self-regulating model between its 21 members, with a code of ethics and practice. However, there are currently 80 chiropractic-related businesses registered in Singapore, according to the Accounting and Corporate Regulatory Authority.

"Singapore should follow Hong Kong, Malaysia and Thailand that have formally regulated chiropractic care in their countries. This can prevent rogues from entering Singapore to take advantage of an unregulated environment," said Mr Neil Stakes, vice-president of the association.

Large businesses pressure consumers to prepay 'packages' of treatment

Large practices employ recently graduated chiropractors in a commission earning model, and the care that is given in these practices are often without consideration of long-term best interests, Mr Stakes explains.

"Emphasis is made on completing the course of treatments so that another course can be prescribed," he added. However there have been complaints of patients being forcefully persuaded to purchase large prepaid packages before an initial course has been completed.

There is also a rising number of complaints over the years, with the Consumers Association of Singapore (Case) over chiropractic-related services - eight this year, compared to a total of seven for the three-year period from 2012 to 2014.

"The increase in the number of complaints for such services may be due to the greater interest of consumers in complementary and alternative forms of medicine such as chiropractic care and traditional Chinese medicine that can be used to supplement their health treatments," said a Case spokesman.

False advertisements and sale of large prepaid packages due to lack of regulation

Complaints are generally about unsatisfactory services, such as ineffective treatments or more injuries as a result. Consumers often have their cases resolved with Case's help - contracts terminated and money for unused sessions refunded.

The Chiropractic Association has said that it prohibited the sale of large prepaid care packages, but only individual chiropractors agree to its rules - not the clinic in which they practise.

There are also no rules to govern the advertisement of their services. The Advertising Standards Authority of Singapore (Asas) said it received a complaint last year about a chiropractic provider circulating misleading claims about its treatment - such as a high success rate in relieving pain and accelerated healing without side effects. The provider has since ceased the advertisement as it was unable to substantiate the claims. MIMS

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