The random thoughts of a sceptical activist

A bitter PIL to swallow

You couldn’t make it up!

That’s almost become a overused exclamation in the blogosphere these days, particularly when yet more idiotic woo claims are uncovered. But it also applies to the shenanigans over the General Chiropractic Council‘s Patient Information Leaflet (PIL).

At the start of this year, on their website, the GCC had a leaflet (What can I expect when I see a chiropractor?) dated September 2007 that informed visitors all about chiropractic. The opening words of the leaflet told us:

Why might I go to a chiropractor?

Even though the first thing that may spring to mind is that ‘chiropractors treat backs’ – which they certainly do very successfully – today’s  chiropractors also diagnose and treat other musculoskeletal disorders as well as a number of other conditions.

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

After the searing scrutiny of expert bloggers on the claims for childhood conditions made by the British Chiropractic Association (published on 17 June 2009) and the immediate demolition (within 24 hours) of their best evidence, the GCC decided they had better amend their PIL, just in case it was misleading the public into thinking chiropractic had a robust evidence base for the treatment of these childhood ailments.

All change

And so their June 2009 version was published. This completely re-wrote the above first paragraphs:

Why might I go to a chiropractor?

The first thing that may spring to mind is that ‘chiropractors treat backs’. But chiropractors do much more than this: they are concerned with the framework of bones and muscles that support the body (the musculoskeletal system).

So, even though they do treat backs – and very successfully – today’s chiropractors also diagnose and treat other musculoskeletal problems as well as a number of other conditions.

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

Well, not really that much different.

All this revision did was add in some Woolly Weasel Words™ that still implied to the casual reader that chiropractic was effective for these conditions whilst making them look as if they were concerned that some research was missing to support those claims.

It fools no one who has even a passing awareness of the paucity of evidence for chiropractic.

Published only on their website, this cannot be touched by a complaint to the Advertising Standards Authority. They only deal with claims made on things like leaflets, adverts in newspapers, etc, not content on the advertiser’s own website.

However, Simon Perry, in a stroke of genius, simply asked the GCC for a paper copy of their leaflet — and they happily obliged. It was in the hands of the ASA quicker than you could say “Quacklash”!

Last week, the ASA published their notification of the informal adjudication against the GCC. Simon blogged about this: General Chiropractic Council to Change Patient Information Leaflet. (I won a similar complaint on the same day, but only against a chiropractor, not their statutory regulator.)

Having the ASA rule against their leaflet must have been a very bitter PIL to swallow!

Once they have ruled against an advert, the ASA expects that advert to be withdrawn immediately, particularly those on websites, which can be removed in seconds.

However, the GCC decided not to remove their website leaflet. Whether or not they withdrew paper leaflets — almost certainly available at chiropractic clinics up and down the country — we can’t say. But the GCC’s tardiness in withdrawing it from their own website has been noted.

Ignoring the fact that there has never been a jot of robust evidence for chiropractic for these conditions, the GCC was left in an untenable position where, if chiropractors, who must statutorily be registered with the GCC and abide by their Code of Practice, made the claims the GCC have made in their PIL, they would be breaking the very CoP supposedly enforced by the GCC!

If there had been any doubt before the ASA ruling, there can be absolutely no doubt now that the ASA has not seen any robust evidence to substantiate those claims.

What an unbelievable situation! You just couldn’t make it up. You’d have thought a statutory regulator would have been acting with the highest probity and setting a good example to those it is supposed to be regulating.

All change. Again.

However, nearly a week after the ASA published their decision, the GCC have today decided, not to withdraw their leaflet, but simply to modify it.

The offending bit of their leaflet now says:

A review is being carried out of the evidence as to whether chiropractic may ease some of the symptoms of some types of:

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

It’s good to see that someone is carrying out a review of the evidence — better late than never. Reviewing evidence is what scientists do all the time: it shouldn’t take a crisis to prompt it.

All the GCC have done is remove the bit about more research being needed with a bit about them reviewing the evidence. Do they now think there is no need for new research?

But surely they are wasting their time? Unless they have evidence over and above what the BCA published, all the reviews necessary have already been carried out. The result? Not a jot.

If the GCC wants to review the evidence for themselves, then so be it. But the starting point has to be to address the criticisms and concerns highlighted by all those sceptical bloggers and scientists who have demolished the BCA’s ‘evidence’.

I won’t be holding my breath. They’ve got one hell of a job ahead of them.

In the words of the editor of the British Medical Journal, Fiona Godlee, speaking of Edzard Ernst’s article on the BCA’s plethora of evidence for the chiropractic treatment of childhood ailments:

His demolition of the 18 references is, to my mind, complete.

Fiona GodleeFiona Godlee

21 Responses to A bitter PIL to swallow

  • They certainly have chutzpah!

    In the mean time “a review” is being carried of the evidence that the BCC happily promoted bogus treatments.

  • Obviously it now becomes relevant to ask them, on the record, who is carrying out the review, when will it be reported, what evidence will be included, particularly will it cover the same evidence that the BCA introduced into the debate in defence of their position and which was measured and found to amount to less than a jot.

    FOI request? I’m not very familiar with the niceties of the rules governing such things.

  • The GCC appear to be now under intollerable pressure. They are a state sanctioned regulator of a pseudomedical cult that believes in magical and irrational healing claims. The GCC have to keep up the pretence that what they are doing is real, but reality is now hammering hard on its door.

    It is difficult to predict where this will go, but the seismic forces are now pressing hard on major fault lines and some give is innevitable.

    Will the GCC stick to what appears to be its obstinacy in pretending that chiropractic is evidence based? (However they define it?) This can only result in a massive and prolonged assault on it by its critics.

    Or will it try to usher in a new order of low key chiropractic that operates almost exclusively on management of lower back pain? This would tear the profession to bits and require a complete re-evaluation of chiropractic regulation and training. (Does it really need a 4 years honours degree to do a bit of limited massage?)

    The chiropractors may kick and scream at this second option but will be totally constrained by legislation as to what they can do. Implosion would be innevitable.

    My guess is that the GCC will try to bluster this out and hope that a) their critics lose steam and b) the CHRE/HPC are themselves incompetent and rubber stamp the tattered remains of the GCC’s credibility. That would be a disaster for the public.

  • Andy

    Let me think for a nano second about your option a). Nope. Don’t think so!

  • (Does it really need a 4 years honours degree to do a bit of limited massage?)
    Arrogant twat. Does it really take a know nothing self important idiot to post such drivel.
    This INTOLLERABLE PRESSURE you call it, is a handfull of bloggers with nothing better to do. “sigh” You won’t alter the GCC or the publics view on Chiropractic. You are not up to it. 2400 chiropractors helping thousands of people every week and you think this blogg and the other 2 or 3 will make a difference?
    Get a LIFE.

  • I think they will make a difference. Already the GCC has employed several more staff to deal with these issues and the eyes of many people are on them.

    Maybe you would also like to substantiate your assertion that I am an ‘arrogant twat’ and a ‘self important idiot’ by providing some evidence that chiropractic is nothing other than a bit of a back rub.

    I sense desperation…

  • To Fed Up

    I honestly wouldn’t bother replying to these bloggers. I have been following them on and off ove rthe last few months. If a chiropractor makes a valid point they either ignore it, or say that we are not sticking to the issue or they insult us by calling us loads of names.

    We both know how good our syllabus was when we studied in college and why we studied it -I was personally taught by neurologists and GP’s when I studied.

    We all know what are patients tell us every week regarding the work we do.

    The minute you called a blogger he was an arrogant twat he wanted you to substantiate the reasons.

    However these bloggers over the past few months are telling the world that we are glorified massage therapists,that we manipulate necks unsafely as compared to osteos and physios, we are fleecing the nation of their money etc, we all live in mansion and we are quacks and endless other insults which have not been substantiated. They are not interested in including the fact that osteopaths claim to treat colic etc nor are they interested that physios treat people suffering whiplash, asthma etc. They claim they do not have time.

    They are not interested in debate, they loathe chiropractors and nothing we say will ever change their attitude. They would argue with you that the earth wasn’t flat and the grass wasn’t green if it suited their argument.

    I’m sure I will be subject to a witty reply by them – not really fussed either way.

  • Just another thought – can you substantiate the 4 years honours degree to do a bit of limited massage. What is limited massage, are we so low down the chain that we can only perform limited massage -

    On that note I must be really thick as my course was 5 years and what is limited massage – limited to one part of the body – limited to one muscle – limited in time.

    Those massage therapists are really lucky there allowed to undertake unlimited massage unlike our training in limited massage.

    Note – the most common complaint presented to a chiro clinicis low back pain – in my clinic at least 80% of patients suffer back pain – so treating low back pain isn’t really that low key
    Oops I probably need to substantiate that. Oh and I am not sticking to the issue of colic.

    If we will ever be restricted to treating just low back pain because there is no evidence for treating anything else
    then all the other practitioners who treat neck pain and other joint ailments will also be affected because surely they will need evidence.

    If a physio or osteo can treat more than low back pain than so would we – because we also use similar techniques mobilisation, stretching, exercise etc not just manipulation. The reason we are different is the methodology of the way we apply the stretches and trigger point releases and the combination in which we do it. Do I need to substantiate?

  • I have just sent the following to the GCC, lets see what happens.

    Dear Sir,

    On page 2 of your leaflet “What can I expect when I see a chiropractor?” available from your website via Publications/Patient Information Leaflet you state

    “A review is being carried out of the evidence as to whether chiropractic may ease some of the symptoms of some types of:

    asthma
    headaches, including migraine and
    infant colic.”

    Under the Freedom Of Information Act 2000 please provide me with the following:

    a) a list of the reviewers for the evidence and there qualifications to make such a review;

    b) a list of the papers to be included;

    c) the expected timescales for the review;

    d) the maximum time you will allow for the review.

    Yours faithfully,

    Bender

  • Dear “Whatever”, the osteos and physios may deserve some time in the spotlight, but they do not suffer from from the delusion that supposed spinal subluxations cause all disease. Chiros do suffer from that delusion and from that false base advise against vaccination. This makes them a danger to public health

  • Thanks, Bender, please let us know what happens

  • I think you’re reading a bit too much into this and I would cution against getting too excited about your ‘success” in scoring another “victory” against chiropractic just yet.

    Remember, the GCC is currently dealing with at least a 1500% increase in workload at the moment, as a result of one individual irresponsibly simultaneously submitting approximately 600 vexatious complaints.

    I suspect that, rather than committing unnecessary time and money to dealing with the pranks of a few troublemakers, the GCC has chosen to take the easier route of simply changing the wording of this leaflet until more time can be given to considering the matter fully.

  • whatever said, “However these bloggers over the past few months are telling the world that we are glorified massage therapists,that we manipulate necks unsafely as compared to osteos and physios, we are fleecing the nation of their money etc, we all live in mansion and we are quacks…”

    Goodness! I think it’s very unfair of anyone to suggest you all live in mansions.

  • David

    Can you explain why you think it was an irresponsible and vexatious prank?

    Do you think it is OK for chiropractors to break their own Code of Practice with impunity?

  • How will the ASA rule on the new wording?
    “A review is being carried out of the evidence…” seems to imply there is grounds to support the treatment. Once the status of the “review” is known, the ASA can rule on a) whether “A review is being carried out” was true and b) whether the overall impression given by this page of the leaflet is that chiropractic can help with asthma, migraine and colic.
    I’m not in the U.K. so I can’t sibmit the complaint.

  • “On that note I must be really thick as my course was 5 years”

    Well, if the cap fits (and this one has bells on it), wear it.

  • More seriously, how can it take 5 years to learn to crack backs when operating in an evidence-free vacuum?

    Lecturer: [Spouts random theory based on mythical subluxations] Whack the patient here.

    Student: [Whacks patient]

    Both drink coffee for 4 years, 11 months, 30 days, 23 hrs, 50mins.

  • The anonymous COWARD “whatever” asks:
    “Do I need to substantiate?”
    Yes, you do.
    With a verifiable identity, no less.
    As for ‘fed up’, if your contribution is the standard of education and literacy amongst your fellow slavish brain-dead acolytes of the chiropractic religion, then it is little wonder that these back-quacks are buckling faster than an thin glass egg in the Mariana Trench.

  • After 7 days and one reminder I have finally received an acknowledgment of my FoIA request to the GCC. (See post 10 for details)

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