The random thoughts of a sceptical activist

A claim or not a claim: that is the question

Yet more Adventures in nonsense from Simon; this time about the General Chiropractic Council (GCC) trying to persuade Trading Standards that chiropractic is effective for some conditions, whilst not actually claiming that chiropractic is effective for some conditions.

The GCC quoted their old patient information leaflet:

Chiropractors mainly treat

  • back, neck and shoulder problems
  • joint, posture and muscle problems
  • leg pain and sciatica
  • sports injuries

You may also see an improvement in some types of

  • asthma
  • headaches, including migraine; and
  • infant colic

As Simon says:

So firstly there is some confusion here. If an improvement can be the result of chiropractic care, then why don’t they use it as a treatment?

The GCC try to assert:

It is important to emphasise that the GCC doesn’t claim that chiropractors ‘treat’ asthma, headaches (including migraine) and infant colic. It is possible that chiropractic care may help to alleviate the symptoms of some of these conditions.

It is possible that powdered unicorn horn may help to alleviate some of these conditions, but are the GCC making claims or not?

Note that they say it may ‘help to alleviate the symptoms of some of these conditions’. OK. What does ‘help’ mean? What ‘symptoms’? Which ‘conditions’? And why only ‘some’ of these conditions? Can’t they be a bit more specific? There are only four conditions listed here, so why can’t they say what symptoms of these conditions they think chiropractic ‘may’ help? And what evidence they have for any of it?

The GCC changed their patient leaflet in June 2009 and the paragraph now says:

Chiropractors mainly treat:

  • back, neck and shoulder problems
  • joint, posture and muscle problems
  • leg pain and sciatica
  • sports injuries.

There is some evidence, though more research is needed, that you may see an improvement in some types of:

  • asthma
  • headaches, including migraine; and
  • infant colic

If ‘more research is needed’ then the current evidence can surely only be lacking…

Of course, it says there is some evidence, but is that evidence of the standard that would convince the Advertising Standards Authority (ASA)?

However, in adverts, the language used when making claims is the key issue here — using woolly weasel words obfuscates the issue.

We’ve seen before that the ASA have a sensible and pragmatic view on what they consider to be claims and this has been emphasised in an adjudication published yesterday.

The advert was for some nonsense magnetic device and made claims about relieving symptoms of the menopause. The ASA noted:

…that the bottom half of the pages claimed that LadyCare “may help relieve symptoms”…We considered that the bottom half of the pages also implied LadyCare would help relieve symptoms of the menopause.

The ASA decided that they were not fooled by the phrase ‘may help relieve symptoms’: this was a clear claim of efficacy. They upheld the complaint, saying:

We considered that the pages misleadingly implied adequate objective evidence existed to substantiate the claims LadyCare can contribute to relieving the symptoms of menopause. Because we had not seen evidence that demonstrated the LadyCares [sic] efficacy we considered the pages were misleading.

So when an advertiser claims ‘You may also see an improvement in…’ and ‘…may help to alleviate the symptoms of…’, the ASA would treat them as claims of efficacy and would expect the advertiser to hold and provide good scientific evidence for such claims. As we’ve already seen, chiropractors have been completely unable to come up with any good evidence for asthma and infantile colic.

Now, the GCC’s letter was to Trading Standards and does not directly affect the ASA, but remember that all chiropractors have to abide by the GCC’s Code of Conduct and it clearly states that they must only make claims that are within the guidance laid down by the ASA.

So, it would appear that the GCC is trying to make claims, which, if made by one of their registered chiropractors, would contravene their own Code of Practice!

It’s time some serious questions were asked.

10 Responses to A claim or not a claim: that is the question

  • Alan, surely you have better ways to spend your time. The wording in the GCC leaflet is clear enough for anyone reading it to understand that there is no "CLAIM" to treat these problems, but it is quite rightly mentioned that the symptoms of them may be alleviated. In the same way if you take antacids for indigestion, it is not claimed as a treatment for the problem, just a way to alleviate symptoms. SO if your arguement stands most medical products and advertising would need to overhauled.
    Lastly i would just like to ask why you seem to assume that the majority of the population are completely stupid. You attack advertising that is firstly not misleading, and if it is leave it to the ASA. And secondly last i checked we live in a free country where no one is forced to do anything they don't want to. Everyone has a choice when they are unwell as to what treatment they recieve and how much of it.

  • JB – It sounds like you're trying to defend the indefensible.

    Either there is evidence that they alleviate symptoms or their isn't. (There isn't.)

    Your analogy on antacids is a non sequitur. Antacids claim to alleviate the symptoms, nothing more. Products/therapies shouldn't claim anything there isn't evidence for. What chiropractic is doing is try to say "I'm not claiming it alleviates asthma, but it alleviates asthma except I don't claim it does".

    A humpty-Dumpty world of nonsense lies down that road.

  • That a regulator can get involved in such weasel wording brings the whole system of statutory regulation into disrepute. The ASA are showing that sensible standards can be maintained, even if they are toothless.

  • @JB. This is going to be fun.

    >Alan, surely you have better ways to spend your time.

    Excellent. If you don't have a valid argument, belittle the importance of the original argument. Ironically, use of this argument demonstrates ones own willingness to waste their time.

    >In the same way if you take antacids for indigestion, it is not claimed as a treatment for the problem, just a way to alleviate symptoms. SO if your arguement stands most medical products and advertising would need to overhauled.

    A treatment doesn't necessarily need to attack the original cause, it can work on symptoms – an antacid is a form of treatment. The difference being is that there is evidence that antacids work. Chiropractic has clearly been shown in trials to NOT work for treating asthma.

    >Lastly i would just like to ask why you seem to assume that the majority of the population are completely stupid.

    I don't think he did assume this. Much of the population does lack in-depth scientific understanding of the efficacy of chiropractic. Especially chiropractors. Lack of knowledge does not imply stupidity.

    >And secondly last i checked we live in a free country where no one is forced to do anything they don't want to.

    Nope, there are laws prohibiting people from telling untruths in order to sell their product or service.

    >Everyone has a choice when they are unwell as to what treatment they recieve and how much of it.

    Yep, and when they're sick they deserve the best knowledge and not to be preyed on by the powers of psuedo-science.

  • well said Simon.

    Your last point is particularly important. A vital aspect of a free society is that people should have the information they need to make an informed choice.

    How that choice is made must be up to them. If, however, the information they have is incomplete then they are not free, their choice has been constrained.

    To some extent all decisions are made on the basis of incomplete information. In this case, however, a group with vested interests is trying to prevent some information being generally known, by resorting to libel law. Another body is trying to obfuscate the issue by both claiming a treatment works and claiming not to be claiming any such thing. These actions are attempts to artificially warp peoples decisions by limiting access to true information and supplant it with false impressions. This is manipulative behaviour.

    Manipulative behaviour is a frequent plot line on soap operas. Everyone recognised such behaviour is wrong in a social context. Why would it be right in the private prevision of healthcare services?

  • Dr T,
    The problem is not with claims it‘s with the language. The GCC state “There is some evidence, though more research is needed, that you may see an improvement in some types of:
    • asthma
    • headaches, including migraine; and
    • infant colic”

    You say there’s no evidence for this improvement but if improvement means symptoms generally declined, which I’d say is an improvement in anyones book, then there is, if improvement means complete resolution then there isn’t. Language, you see?

    There is evidence and I freely admit it is not strong but it is not a complete disaster and certainly not in the realms of bogus. See:

    Chiropractic care for nonmusculoskeletal conditions: A systematic review with implications for whole systems research
    Hawk C et al. May 2008. The Journal of Alternative and Complimentary Medicine 2007; 13(5): 491-512. Chiropractic Guidelines and Practice Parameters (CCGPP) expert committee.
    This was a comprehensive literature search (using PubMed, Ovid, Mantis, ICL, CINAHL) which identified studies evaluating spinal manipulation and/or mobilization (both chiropractic and osteopathic) or general chiropractic management of NMSK conditions. The aims of this study were to:
    • evaluate the efficacy of chiropractic “care”, not meaning only spinal manipulation, on NMSK conditions and,
    • identify specific deficiencies in the literature in order to develop a whole systems approach to researching this topic.

    The bit covering asthma, in summary, is:

    Asthma (15 citations total):
    3 RCTs reported no adverse effects from spinal manipulative therapy (SMT) although physiological measures did not improve in any study, medication use generally declined, and symptoms were generally reported to improve

    Now, at http://www.bio-medicine.org/medicine-news/The-Adverse-Effects-Of-Asthma-Medication-2935-1/ it states that:

    “Latest research shows that a common class of drugs used for acute asthma attacks might be causing the very thing it aims to treat. Many people with asthma rely heavily on these medications, sometimes taking them several times a day.”

    So what would you do if it was you who was suffering with asthma – give it a go and see if it made “medication use generally declined, and symptoms were generally reported to improve” or press on with the drugs?

    I know what I would do and I’d be pleased if it improved.

  • Derrik,
    Good grief man what are you suggesting?

    “In this case, however, a group with vested interests is trying to prevent some information being generally known, by resorting to libel law.”

    No, no, no. Has the libel suit stopped Singh et al. from publishing the book? No. Has it stopped him from saying that all chiros are quacks? No, has it stopped him from saying that chiropractic is dangerous contrary to the scientific evidence? No. All it has done is stop him from saying that the BCA are ‘bogus’ish and even then not completely. Don’t get spun by Singh, he’s free as always to make any bogus claim he likes about any profession he likes, just not about individual organisations (and he should bloody well know that as he’s a journo and they are all scum – now, I am allowed to say that as it is the ‘profession’ I’m slagging off. I am NOT allowed to say that Singh only did it for the money and he’s a lying journo scum – see).

    You go on to say:
    “Another body is trying to obfuscate the issue by both claiming a treatment works and claiming not to be claiming any such thing. These actions are attempts to artificially warp peoples decisions by limiting access to true information and supplant it with false impressions.”
    “Limiting evidence” where’s the evidence for that crazer statement – ahh, Singh’s blog perhaps? Well I should have thought a sensible bloke would understand this as his spin. I see no attempt to limit evidence and I would challenge you to really find some. You may ‘feel’ like this is going on but it ain’t, it’s just what spin feels like. Examine the facts.

    And, the evidence is there, though not strong, but still there and above all available to anyone by searching the web. See:
    Chiropractic care for nonmusculoskeletal conditions: A systematic review with implications for whole systems research. The Journal of Alternative and Complimentary Medicine 2007; 13(5): 491-512
    for a pretty good summary.

    “Manipulative behaviour is a frequent plot line on soap operas. Everyone recognised such behaviour is wrong in a social context. Why would it be right in the private prevision of healthcare services?”
    This makes it sound like the GCC are in control – what world are you moving in, these lot of govt appointed loons have mishandled the profession in a spectacular way form their inception and couldn’t really control their breathing let alone ‘manipulate’ healthcare provision.

  • Aww come on, this isn’t a forum and unless the people you are responding to have subscribed to be notified of any new comments – which is unlikely – your posts are not going to be seen by them. I suggest you take your arguments – which are crap, by the way – to a proper forum that is set up for the purpose of discussion. e.g. http://www.badscience.net/forum.

  • Skepticat, thanks for your robust work but I do bloody hope they aren’t just beltching comments into this blog and legging it – that would seem rude.

    I’ll dash off to badscience and see if I can’t add some crap there instead.

    Keep up the spin you manky old chicken’s foot.

  • I don’t think they’re legging it, mate. As I said, this is a blog, not a forum. It’s perfectly acceptable to comment on a blog post for up to a few days after it has appeared and then forget about it and move on.

    Thank you for your kind words of encouragement. I shall indeed continue to challenge ignorance and charlatanry as when the noble cause of truth and justice dictates that I do so.

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