I am, of course, playing devils advocate. And no I'm not thick.

I don't think Chiropractors try and deliberately mislead people into thinking they are medical doctors. More they are trying to claim their professional education is deserving of the title like GPs, Dentists, Vets etc – a subtle but important difference.

If you want to say it doesn't, and in this country you could argue that as the standard of student is inferior for a start, I would say you have a better case.

I wonder…are you a bit thick or just being deliberately obtuse?

No, I wouldn't think a chiropractic who puts me on a bench and uses spinal manipulation is difficult to distinguish from a GP, nor did I suggest any such thing.

But if someone calls themself 'Dr' and claims to be able to treat a range of medical conditions some of which are not even muscular-skeletal,then I don't think I'd be the only one to assume that they are doctors of medicine rather than doctors of chiropractic and chiroquacks know this. That's why to do so is to be deliberately misleading.

Got it now?

"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 you had, you would have known that the CoP mandates all claims made by chirpractors to be compliant with ASA guidelines. That is not ASA rules, but the GCC's.

It is not up to the ASA to hold evidence for an advertiser's claims: it is the advertiser who must hold that evidence before he/she makes that claim.

The vexatios nature of your complaint is clear to see.

The chiropractors have not broken ASA rules as ASA rules do not apply to websites. With copy advertising the ASA will assist and advise on the advert in question. This is not the case with web sites as they are not regarded as advertising. If they have not broken ASA guidelines then they are not in breach of GCC cop providing they can substantiate their claims.

ASA guidelines relate to all independent practitioners- I have contacted the ASA to ask about claims made by physiotherapists and osteopaths and the ASA relpied that they did not hold evidence to support some of their claims.

ASA guidelines are out of date-if we consider whiplash and arthrits this has now been covered by recent research papers and guidelines endorsing manipulation. Clearly Ernst had an influence on the ASA guidelines. His objectivity has been discussed above but now ASA guidelines are at odds with national guidelines and best available evidence.

Review conclusions by Ernst and Canter regarding spinal
manipulation refuted
Gert Bronfort*1, Mitchell Haas2, David Moher3, Lex Bouter4, Maurits van
Tulder4, John Triano5, Willem JJ Assendelft6, Roni Evans1, Simon Dagenais3
and Anthony Rosner

The conclusions by Ernst and Canter were definitely not
based on an acceptable quality review of systematic
reviews and should be interpreted very critically by the scientific
community, clinicians, patients, and health policy
makers. Their conclusions are certainly not valid enough
to discredit the large body of professionals utilizing spinal
manipulation.

Evidence for manipulation is stronger than that for most orthodox medical treatments
British Medical Journal , Jan 23, 1999 by Gordon Waddell

As one of the coauthors of the Clinical Standards Advisory Group's report on back pain[1] and the Royal College of General Practitioners' guidelines on acute low back pain,[2] I am disappointed by Ernst and Assendelft's editorial on chiropractic.[3] The authors present a critical view of chiropractic under the guise of scientific objectivity, but I had hoped that we had got beyond that stage of interprofessional confrontation.
Burton and I recently reviewed international guidelines for low back pain, and none of them specifically recommend chiropractic.[4] What they do all say, and what all recent reviews conclude to varying degrees, is that considerable evidence now exists that manipulation is an effective treatment for low back pain. Indeed, there is stronger evidence for manipulation than for most orthodox medical treatments. The guidelines also advise that manipulation should be performed by a trained professional but that there is no clear evidence whether it is better performed by a chiropractor, an osteopath, a physiotherapist, or a doctor with special training.
Ernst and Assendelft's review of the risks of manipulation is particularly biased. Although the subject of this editorial is low back pain, they concentrate on the admittedly higher risks of cervical manipulation. Even then, orthodox medicine has a long way to go to reduce the rate of serious complications of most of our investigations and treatments to the order of 1:0.2-1 million. The adverse reactions to which the authors refer are temporary aggravations of symptoms or minor subjective reactions; in a personal series, that rate is comparable to figures for every other orthodox treatment for back pain. What matters is the balance of effectiveness versus risk, and that is strongly in favour of manipulation. The politics and costs of any NHS provision of a service are a completely separate and more relevant debate.
None of us have a good answer for low back pain–orthodox medicine, professors, and methodologists least of all. Chiropractic is not the magic answer for back pain, and it should and can stand up to fair criticism, but orthodox medicine could potentially also learn a lot from chiropractic.[5] The needs of patients with back pain should override our professional dignities, and the real need is for us all to work together. That cooperation is not likely to be helped by this kind of editorial.
[1] Clinical Standards Advisory Group. Report on back pain. London: HMSO, 1994.
[2] Royal College of General Practitioners. Clinical guidelines for the management of acute low back pain. London: RCGP, 1996.
[3] Ernst E, Assendelft WJJ. Chiropractic for low back pain. BMJ 1998;317:160. (18 July.)
[4] Burton AK, Waddell G. Clinical guidelines in the management of low back pain. In: Nordin M, ed. New approaches to the low back pain patient. London: Bailliere Tindall, 1998:17-35. (Bailliere's clinical rheumatology.)
[5] Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.
Gordon Waddell Orthopaedic surgeon
Glasgow Nuffield Hospital, Glasgow G12 0PJ