Fundamentalist chiropractor and career anti-vaccination activist Simon Floreani, was last week suspended from practice for six months, from 18 October 2021.

The Victorian Civil and Administrative Tribunal (VCAT) handed down the ruling [Archived] after Floreani was referred by the Chiropractic Board of Australia (the Board) in March 2019, for professional misconduct. In November 2016 Floreani featured in a video podcast interview titled Nazi Vaccination Regime in Australia. In December 2016 Floreani facilitated the screening of Andrew Wakefield’s anti-vaccine film Vaxxed: From Cover-Up to Catastrophe at his chiropractic clinic. Not surprisingly the film’s thoroughly debunked theme and content are, “contrary to the Chiropractic Board of Australia’s codes and statements”.

Floreani was initially suspended on 27 September 2017, after an Immediate Action Committee (IAC) was convened. The transcript informs [item 5]:

The IAC made that decision on the basis it formed the reasonable belief that action was necessary because Dr Floreani posed a serious risk to persons and it was necessary for it to take immediate action to protect public health and safety.

That suspension lasted around six weeks as it was stayed by the VCAT. Conditions were imposed in March 2018 [item 142], and have applied since then. The Tribunal accepts Floreani has complied with them. The matter had returned to the Tribunal, “because the Board decided it was appropriate to refer Dr Floreani so the Tribunal could consider making disciplinary determinations.” [item 8].

The conditions, designed to limit Floreani’s anti-vaccination influence when he returns to practise, will be in place for twelve months. These include a ban on anti-vaccination signage, materials, advice to practice clientele, and “public comment discouraging vaccination”. If asked about vaccination by a client, Floreani must refer them to an appropriate practitioner. These are an effective continuation of conditions imposed by VCAT in 2018 and “there is no dispute Dr Floreani has complied with them in full at all times”. There is another pre-existing condition (noted item 178) that will also continue. Floreani must display the following sign in all waiting areas.

Please be advised Dr Simon Floreani does not provide any patient with advice regarding vaccination. Any patient requesting such advice will be referred to an appropriately qualified medical practitioner

He must permit the Australian Health Practitioner Regulation Agency (AHPRA) access to waiting areas during business hours, to monitor compliance with signage. Floreani must also submit to practice inspections during which AHPRA may access appointment diaries, booking schedules and any social media accounts used in conducting his business. AHPRA will provide a minimum of 24 hours notice before these inspections, and not conduct them more frequently than once per calendar month. Despite this, they are referred to as “random practice inspections”.

One reads:

The respondent must bear his own costs of complying with the above conditions.

The videoed interview Nazi Vaccination Regime in Australia was with US based anti-vaccine conspiracy theorist and chiropractor Billy DeMoss. During the 3 November 2016 interview Floreani suggested that “they” are trying to silence screening of Vaxxed in Victoria and because people “have to have secret screenings”, it was “a nanny state”. He went on to make some extraordinary statements such as:

…we could not find one shred of evidence to show the efficacy of childhood vaccination […]

I’m, under my regulation and registration requirements, not allowed to talk about vaccination. But under the laws of this country I have to do what’s right… I have to tell people the truth, as a health practitioner, as a leader, as a father, as a community member […]

…parents are trusting their gut and saying, “I don’t want to do this. I can’t inject this poison in my baby’s body and be okay with that” […]

…the evidence is not there to suggest that people are safe and our kids are safe

Prior to 10 December 2016, Floreani was contacted by then president of the anti-vaccine pressure group, Australian Vaccination-risks Network (AVN)*, Tasha David. She requested he screen the film Vaxxed at his clinic. Floreani and his wife, anti-vaccine author and chiropractor, Jennifer Barham-Floreani are past professional members of the AVN. The screening at his clinic was one of a number the AVN had organised at the time. The event was covered in depth, including a video of the entire evening, by reasonable hank. Glaringly obvious, but important from a legal standpoint, the Tribunal has observed that prior to the screening, “Floreani was aware of the content of the film”. Indeed.

Both allegations, which are detailed in the ruling transcript, are that Floreani engaged in professional misconduct and unprofessional conduct. Both allegations note that he:

(i) failed to promote the health of the community through disease prevention and/or control; and/or 

(ii) failed to provide balanced, unbiased and evidence-based information to the public; and/or

(iii) promoted and/or provided materials, information or advice that was anti-vaccination in nature and/or made public comments discouraging vaccination.

That sounds like the Simon Floreani I’m familiar with. His transgressions in the above regard range far further afield than those covered in the Tribunal ruling. This is reflected in item 197 of the transcript:

The Board submitted the admitted conduct represented ‘repeated brazen departures from the standards expected of a registered chiropractor’.

This may be a statement about Simon Floreani. However, in that it describes his stance on vaccination, it confirms that similar views held by a large number of practicing chiropractors are therefore well removed from “standards expected of a registered chiropractor”. The problem is one inherent in chiropractic, although I rush to add it is not absolute in chiropractic nor exclusive to chiropractic. The re-emergence of vitalism in chiropractic has led to an influx of practitioners who almost certainly began the study of chiropractic with an established aversion to evidence-based medicine. Once qualified, they see themselves as representatives of a viable alternative to the medical profession if not a replacement for it. This is a problem of staggering proportions and one that the Chiropractic Board of Australia is seemingly ill equipped to address.

A unique example emerges when considering the transcript of the VCAT hearing. As noted there’s no dispute about Floreani’s compliance with conditions initially imposed in November 2017 [item 144]. As we read in item 150 the Board considered another notification about Floreani in 2019. It was received by the Board in 2017, and concerned conduct from 2016. The Board decided to investigate in May 2017, concluding on 26 July 2019. The professional conduct issue related to items published by Floreani on Facebook and his business website. He made claims about the effectiveness of chiropractic for conditions and circumstances, in the absence of any evidence. Namely [item 151]:

(a) Chiropractic care for childhood illness, colic, ADHD, autism, cerebral palsy and asthma;

(b) Chiropractic care to treat infants who are having trouble sleeping or have persistent ear infections or reflux;

(c) Suggesting homeopathy could be used in lieu of traditional vaccines; and

(d) Suggesting that conventional medicine was ‘poorly performing’.

The transcript tells us the investigation lasted twenty six months. Twenty one months in, on 20 February 2019, Floreani appeared on A Current Affair defending the actions of Andrew Arnold who was filmed the previous August performing a series of non-evidence based adjustments on a two week old infant. Floreani told ACA:

I’ve been doing this 20 years, and the proportion of paediatric patients has gone from one in 10 to three or four in 10.

The next day Arnold was put on an undertaking by the Chiropractic Board, published on his website, that he would not treat children from birth to twelve years or provide any material in support of such treatment on any internet platform. It’s inconceivable that Floreani was not aware of the Board’s ongoing investigation into his advertising. He chose to publicly defend Arnold despite the highly controversial and widely reported circumstances.

Ultimately the Board found that his 2016 performance was unsatisfactory and below the expected standard. He failed to work “within the limits of his competence and scope” and failed to comply with the Board’s Statement on Advertising. After AHPRA requested removal of the material it was removed in full. The transcript observed that this was said to demonstrate, “some level of insight and compliance by Dr Floreani in relation to his advertising”. Floreani had already been cautioned in 2014 for provision of anti-vaccine material (see below). In response to the evidence-free claims above, which are anything but unique in chiropractic advertising, the Board cautioned:

The practitioner is cautioned in relation to the publishing of advertising and other material in relation to chiropractic care that is not supported by sufficient evidence.

One should acknowledge that this is seperate from the career antivaccinationist activity Simon Floreani is known for. Perhaps the record of compliance with conditions and the evidence he gave does support him having turned a corner. Perhaps. We can get an idea of his prior and current vaccination beliefs by revisiting his comments about his wife’s book, Well Adjusted Babies, both during the DeMoss interview and when giving evidence. Item 65 contains longer responses of Floreani’s from the DeMoss interview. During these he clearly relies on the book as a source of “evidence” and “research”. He talks about working with the regulator to show them “evidence”. He tells DeMoss his wife had been snowed under and produced:

18 reams of paper worth of evidence and research around every single question they asked […]

…and you give these people what they want. When they want evidence, you know, there is – we could not find one shred of evidence to show the efficacy of childhood vaccination.

This is only twenty eight months after the Board had cautioned Floreani for providing Australian Vaccination-risks Network booklets in his waiting room. It was submitted to Tribunal by Marion Isobel, counsel for the Board, that he had done so despite being aware that the Board had that year, “released a communique requesting practitioners to remove all anti-vaccination material from their websites and clinics” [item 202]. On 22 July 2014 the Board advised of the caution. It was as follows [item 148]:

The Chiropractic Board of Australia cautions Dr Floreani that in the future he ensures that he is familiar with and complies with the Board’s guidelines for the advertising of regulated health services.

Returning to Floreani’s chat with DeMoss, the transcript includes:

And, you know, really the evidence is not there to suggest that people are safe and our kids are safe, and it’s a really – you know, my wife, God bless her, has worked tirelessly to bring the evidence together, and her next book will be – you know, we’ve got this multimedia platform where we can share the research as it becomes available, in layman’s terms, to help people actually hear the truth, not through the media but through multimedia platforms. We can share around the world exactly what the truth is, exactly what the research says and let people make informed decisions…

This confirms the level of disinformation Floreani and his wife were content to disseminate through various media. Indeed VCAT and the Chiropractic Board of Australia are limited to Floreani’s conduct as a chiropractor, or activity demonstrated to be in a professional capacity. Well Adjusted Babies was published through the group Well Adjusted Pty Ltd. Floreani and his wife are the shareholders and Floreani’s son is the director [item 64].

In evidence, Floreani confirmed he had been active in the company as a “research assistant” and currently has no role. He maintained he does not promote the book Well Adjusted Babies. Dr. Ann Koehler [item 41] gave expert evidence to the Tribunal, including the risks associated with statements made in the book’s chapter on vaccination; chapter 15. She quoted the preface to this chapter [item 70]:

Laying aside the very real possibility that various vaccines are contaminated with animal viruses and may cause serious illness later in life (multiple sclerosis, cancer, leukaemia, ‘Mad Cow’s’ disease, etc) we must consider whether the vaccines really work for the intended purpose.

Regarding his role in development of the book Floreani said he, “helped distil information into lay terms” [item 187]. Perhaps the above paragraph reflects his prior, and not his current stance on vaccination. Or, perhaps not. Giving evidence, Floreani was asked if he stood by the content of chapter 15. He referred to the book as “an evidence-based document”. Dr. Koehler stated that the content was “inaccurate, misleading and alarmist”. Floreani disagreed. In fact it wasn’t something he wanted to discuss because the Tribunal was not “workshopping the book”. Asked how he would describe the content of chapter 15:

He said again it was an evidence-based document which was ‘up for discussion’ as was all research information. He said he was not in that arena and did not deal with that kind of material and was not prepared to ‘walk down that path’.

When asked if he still held the same views on vaccination but had agreed to not make public statements, Floreani replied that he was “a researcher at heart and a critical thinker” [item 189].

He said he would appraise any information and he was not fixed in his views. He said he was ‘very prepared to take [his] medicine’. He then stated that he understood that, in the whole area of vaccination, there were ‘diverse opinions’.

In addition, Floreani’s current curriculum vitae lists him as a “contributor” to Well Adjusted Babies 2005, Well Adjusted Babies Revised Edition 2006, Well Adjusted Babies 2^nd Edition 2009 Vitality Productions and Well Adjusted Babies Practitioner Guide 2009 Vitality Productions [item 166]. The antivaccinationist in Simon Floreani is an ingrained part of his identity. His C.V. reflects that he is not only happy to be seen as having promoted anti-vaccination views but is proud of it.

Reading the transcript, it’s tempting to accept he is motivated to keep an anti-vaccine image out of his professional life. Yet even this purported change isn’t something that evolved. He has been forced into this position after repeated breaches of the Chiropractic Code and/or Statement. To use his own words he feels he has been “bludgeoned about the head” [item 185].

He was no doubt also motivated to avoid a suspension and, having already been suspended in 2017 by the IAC for the same matter, was aware the Board would seek another. Reading through the transcript it isn’t surprising that the Tribunal agreed one was warranted. Particularly in light of his entrenched views outlined above, which is reflected in item 14:

However we remained concerned that his statements to us showed he has not fully absorbed relevant Code obligations and he appeared to maintain a level of scepticism about vaccination.

Under Dr Floreani’s submissions on determinations, the transcript noted via his counsel, Mr. Shaun Maloney, that Floreani agreed a reprimand was an appropriate order [item 204]. Also, that written submissions “contended that a suspension was wholly unsustainable in this case and was in fact a punishment” [item 205]. It’s further contended that suspensions are reserved for protection of the public and to ensure the practitioner gains insight and ‘the message’. “None of those matters are present here”, it was submitted.

Other noteworthy points from submissions include [item 205]:

Dr Floreani has full insight. […] He is apologetic and has recanted. […] The risk of repetition is non-existent. […] This is a health practitioner who has committed isolated error for which he is truly sorry… […] …the only possible justification for a suspension is as a matter of general deterrence. […] It is illusory to suggest that general deterrence is necessary here… […] …seen in the light of that which it truly is, being an isolated act, made in error through a transitory erroneous opinion… […] Accordingly, any period of suspension is not warranted for protection of the public, either for specific deterrence or for general deterrence.

Clearly the Tribunal did not accept the argument from submissions. I also found the source and content of references for Floreani compelling [item 168]. Not one referee stated a clear purpose for the reference nor indicated they were aware of the VCAT proceedings or Floreani’s involvement with the Board. One name leaps out immediately. That of Canadian chiropractor Elizabeth Anderson-Peacock, who in 2019 lost re-election for her seat on the executive of the College of Chiropractors of Ontario (CCO). The National Post reported this was in the wake of speaking at a conference that also hosted Del Bigtree. Earlier that year she had endorsed Vaxxed – the same movie Floreani now faced disciplinary action for permitting to be screened at his clinic. The reference was dated 22 June 2021.

The Tribunal didn’t refer to this thumbing of the nose at proceedings from Floreani, but did provide a quoted section from Anderson-Peacock’s reference which they were “very concerned by”. It included in part [item 172]:

On occasion that [ensuring clients can make a fully informed decision] sometimes includes inconvenient or alternative viewpoints from mainstream allopathy. Dr Floreani encourages people to do their own research and think.

Another, dated 7 June 2021, referee is Mr Giles A. La Marche, Vice President of University Advancement and Enrolment, Life University Canada. On 13 April 2020 BuzzFeed News published Chiropractors Are Feeding Their Patients Fake Information About The Coronavirus. A paragraph was devoted to La Marche who, on April 10, had then shared a conspiracy video about Bill Gates’ plan to depopulate the planet with COVID-19 and articles on how Fauci was planning to profit from a COVID-19 vaccine. On 21 May 2021 La Marche featured in The Atlanta Journal-Constitution after posting a story from the antivax disinformation mill Children’s Health Defense on a purported COVID-19 vaccine death.

More recently on 27 September this year La Marche posted a video on his Facebook page, Canadian doctors destroy the COVID-19 fear narrative. On 7 September he shared “important info” on “jaw dropping mask and vaccine failures”. He’s also just bought Robert F. Kennedy, Jr.’s book, The Real Anthony Fauci. On 30 August he wished someone a happy birthday. Smiling from the accompanying photo is one Billy DeMoss who hosted the Nazi Vaccination Regime in Australia podcast – the same podcast Floreani now faced disciplinary action for airing his anti-vaccination laundry on.

Eric Russell, past president of the New Zealand college of chiropractic is devoted to the promotion of vitalism in chiropractic and “subluxation-based research”. He has spoken of chiropractors going into the world to help humanity and the chiropractic philosophy. In 2009 he was inducted into Palmer College of Chiropractic’s Great Hall of Philosophers. At last year’s Parker seminar he spoke about chiropractic philosophy and how this shapes Wellness past, present and future.

In an undated reference chiropractor Kimberlie Furness praised Floreani, having been impressed by him almost twenty years ago. He had worked on infants, toddlers and children. The transcript observed [item 174]:

She referred to his practice being evidence-based, combining the ‘best available research evidence with clinical judgement and patient preference’.

The Tribunal observed it’s often inappropriate to present references from clients “given the uneven power dynamic between practitioner and patient” [item 171]. However they did note that Ms. Andrea Pavleka “senior executive, legal practitioner” [item 168], was positive about professional treatment received and personal qualities of Floreani.

Looking at these references it is far from surprising that the Tribunal observed:

Taken as a whole, the references did not show the authors were aware of the content of the Allegations or the nature of the Tribunal proceeding. Some appeared to support chiropractic care which might well fall outside the Code and Statement [item 222].

It’s equally unsurprising that submissions arguing against a suspension included.

His references are excellent. They reveal a respected and trustworthy health practitioner.

The underlying story of the references is a reflection of Floreani’s entire defence. It’s a story of going through the motions, keeping within the lines. Indeed Simon Floreani doesn’t have to think like a health professional, but merely act like one. Ultimately that’s all that is required and it underscores the problem with chiropractic today and the Board’s inability to initiate serious change.

More so, as a chiropractor, Floreani need not be educated as an effective health professional nor maintain and update an evidence-based skill set. Despite his rhetoric, evident in the transcript, of him being a “critical thinker”, referring to “evidence” and “research”, vitalistic chiropractic deals in anything but. Floreani just won’t admit that his disdain for the sciences important to public health, is what keeps leading to disciplinary action. From item 184:

Dr Floreani was asked about his past disciplinary history. He agreed a caution was an important regulatory tool for practitioners who ‘misunderstood’ what they were doing consciously or unconsciously.

As mentioned, Floreani reinforced his anti-vaccination views by defending Well Adjusted Babies. He contended the content was “up for discussion” and thinks it is “research information”. This is what defines Floreani and his wife, Jennifer Barham-Floreani. These problems and others, did not escape the Tribunal as evidenced by item 220. It included:

While the content of that book is not strictly before us, Dr Floreani’s comments raised questions in our mind about whether he has absorbed the fact that the profession of chiropractic does not have adequate training or expertise in the science supporting vaccination. His reference to the ‘political climate’ being a factor in the discussion about the safety of vaccines was worrying.

The Board should be worried. Consider the disparity between assurances Floreani gives to regulators, and his wife’s response to a 2013 crackdown by the Board on anti-vaxxers.

Chiropractors will certainly be working towards making sure that the information that they convey to parents is the latest, up-to-date information that presents both sides of the vaccination debate. I think it would be very rare that there would be chiropractors giving only one side of the argument.

Which brings us back to the problem the Board faces. Whether it’s anti-vaccination beliefs, advertising claims void of evidence (if not plausibility) or the motions carried out on infants and in the name of “maintenance”, pseudoscience is endemic in vitalistic chiropractic. It’s an ideology that is enormously profitable and it exudes a trendy energy that continues to be disturbingly popular with an unsuspecting, cashed-up public. One gets the feeling the horse has bolted in reading item 234, in which the Tribunal comment on discourse arising from Floreani’s support of Vaxxed.

The underlying scepticism towards science continues to be potentially damaging and likely to bring the profession into disrepute.

The Tribunal was aware Floreani presented himself as a leader in his field [item 236]. It didn’t help him. Rather it contributed to the decision to enforce a suspension. It was seen as:

…an aggravating factor because it is inconsistent with the standards of the profession for such a person to promote the anti-vaccination cause and to provide unbalanced, biased and non-evidence-based information to the public.

This is as it should be. Any perceived success of Floreani should add to the suspension’s value in deterring others. Floreani had held a number of influential positions with the Chiropractors’ Association of Australia (CAA), now the Australian Chiropractors’ Association, including president from 2009-2012 [item 162]. Under his direction and authority, pseudoscience gained firm traction. His supporters were delighted when Floreani decided to run for the 2017 CAA presidential election. Then they were crushed when his short suspension (for the same reasons that led to this hearing), threatened his chances. At the time reasonable hank published Suspended chiropractor’s supporters liken themselves to Jews and AHPRA to Nazi Germany.

It’s an essential read and very much a case of in their own words. In pleading Floreani’s case they apply the very same offensive allusion to Nazism that has led in part to his suspension. For our purposes note the familiar theme we have come to hear almost daily during the COVID-19 pandemic. Often from chiropractors, one of whom was a referee for Floreani in this very hearing. Namely that when vaccination is attacked, those who defend the high standards of evidence-based health care and the science it relies upon are as the fascists of Nazi Germany. Those who wish to do what they want regardless of the harm it may cause others, are as the persecuted Jews whose very nature was unjustly targeted.

Which for the very last time brings us back to the problems faced by the Chiropractic Board of Australia. Problems that are ingrained in fundamentalist elements in chiropractic, in all countries in which they thrive. Australians have the right to ask how this came about. How can a movement that seemingly regards accepted evidence and regulatory standards as almost anathema, hold the position it does? How can chiropractors, be highly regarded by colleagues and rise to positions of influence, whilst spreading harmful disinformation?

Floreani’s referee Liz Anderson-Peacock was, in fact, one of three senior members of the council of the College of Chiropractors of Ontario to endorse anti-vaccination views. At the time she was vice-president of the CCO, report the National Post. There are similarities to Australia. The CCO is not unlike the CAA under Floreani’s influence. Jonathon Jarry is a science communicator at the Office for Science and Society at Canada’s McGill University. He noted that anti-vaccination views are “innate to a certain persistent strain of chiropractic”. With respect to the three members of the CCO, he had a winning comment:

If a professional regulator is allowed to be so wrong about a basic building block of public health, the public should demand change for its own protection. Swift action is needed to correct this dangerous misfire.

The answer to our questions then, is in appreciating that chiropractic here is often modelled on the already tarnished international movement that resurrected the unscientific beliefs of D.D. Palmer and now passes them off as health care. In fairness to Palmer, who got the idea from a deceased doctor’s ghost, he stated in 1911 that chiropractic should be regarded as a religion and he, its founder. The 126th anniversary of his first “adjustment” was recently observed on Facebook by Floreani’s referee, Gilles La Marche.

By necessity, Australia must at times internalise scientific trends from overseas. This is particularly true for evidence-based medicine. By definition then, we should firmly resist the influence of vitalistic chiropractic. The challenge for the Chiropractic Board of Australia and indeed for AHPRA is to do just that. A proactive regulatory process is needed. It should not be the responsibility of advocates for evidence-based public health to ensure reckless, dangerous actors are brought to account.

Simon Floreani has for years actively promoted disinformation and misinformation related to vaccination whilst attacking evidence-based medicine. He has given no indication that he has changed his views. Were he to have genuinely changed he would be a rarity in fundamentalist chiropractic. More so, he only need refrain from being overtly anti-vaccination in a professional sense. The problem with this, is that he never need be motivated to give sound advice on the topic.

A six month suspension is an undoubtedly insufficient sanction. Yet given the current scope of regulatory power it is an understandably appropriate response. The real problem is that Simon Floreani and other chiropractors like him should never have been practising in the first place.

That is the problem that must be managed.

* The Australian Vaccination-risks Network was at the time the Australian Vaccination-skeptics Network, and before that the Australian Vaccination Network. They are referred to in the ruling transcript as the Anti-Vaccination Network.

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