Moving the goalposts (Part Two)
It’s very clear what standard of substantiation is required for claims made by chiropractors. It is in black and white in the General Chiropractic Council’s Code of Practice. Paragraph C1.6 of the CoP states that any information published by chiropractors or on their behalf, must be ‘consistent with the law and the guidance issued by the Advertising Standards Authority’ (ASA). More on this can be found in my previous post and in my complaint letter. The ASA guidance clearly says that only scientific evidence is acceptable.
However, in another bizarre statement from the GCC, it looks as if they are trying to change the meaning of the word ‘evidence':
It does seem, however, that there may be some misunderstanding about what constitutes the practice of a reasonable chiropractor in the context of accepted modern healthcare practice.
GCC is directing its attention, therefore, to what underpins evidence based care for a variety of conditions. In line with the work of Sackett, D (2000), this will focus on “The integration of best research evidence with clinical expertise and patient values” in anticipation that we will be able to expand the information we provide to patients and the wider public.
No! It’s not about ‘what constitutes the practice of a reasonable chiropractor in the context of accepted modern healthcare practice’! It’s not the practice, it’s all about what claims can be substantiated to the level required by the chiropractors’ Code of Practice. Perhaps the GCC would be better spending their resources in ensuring their chiropractors abide by the CoP – but that’s entirely up to them.
Anyway, behind this smokescreen of trying to look as if they are doing something, they will look at the ‘best research evidence’ (although no definition of ‘best’). But why do they go and spoil it all by talking about ‘clinical experience’ and ‘patient values’? That wouldn’t be a cynical attempt to smother the scientific evidence for the lack of efficacy for chiropractic with the results of customer satisfaction surveys, would it?
They can do all that if they want, but it is a diversion from the main ‘problem’ here: that the current level of substantiation is a tad higher than customer satisfaction and chiropractors biased experiences.
As I write this, the BCA have released their ‘plethora’ of evidence for chiropractic. As can be expected, this will be taken apart in the coming days with the usual critical eye.
While this goes on, I note the first item they offer in ‘evidence’ m’lud is the entry in the GCC’s glossary for ‘evidence-based care':
clinical practice that incorporates the best evidence from research, the preferences of the patient and the expertise of practitioners (including the individual her/himself).
Not entirely dissimilar to the GCC’s pronouncement.
However, given that they choose to quote from the GCC’s CoP, I wonder why they missed out this bit:
C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.
Or the ASA guidance the CoP refers to:
Medical and scientific claims made about beauty and health-related products should be backed by evidence … Substantiation will be assessed by the ASA on the basis of the available scientific knowledge.
Or this bit:
Marketers should hold robust evidence for all claims.
Or this bit:
To date, the only serious medical condition to which CAP and the ASA accept chiropractors may refer is migraine (not headaches).
Or this bit:
But CAP has accepted in the past that chiropractors may claim to help: aches and pains, arthritic pain, backache, back pain, circulatory problems, cramp, digestion problems, joint pains, lumbago, muscle spasms, neuralgia, fibromyalgia, inability to relax, rheumatic pain, rheumatism, minor sports injuries and tension (see General List in the Help Note on Health, Beauty and Slimming Marketing Communications that Refers to Medical Conditions).
Practitioners claiming to treat such conditions would be expected to hold evidence.
Now, they’re not cherry-picking, are they?