The random thoughts of a sceptical activist

All change!

The GCC’s Bronfort report is starting to have an effect. And not before time.

The British Chiropractic Association removed their Happy Families leaflet from their website last year, but it is still on the websites of some chiropractors (for example Weston Chiropractic Clinic here (cached).

Over the intervening months, various chiropractors have removed loads of claims from their websites, with one of them even asking Skeptic Barista if he could check they had made the appropriate changes!

As part of the ongoing complaint process, I have received observations on my complaints from 290 chiropractors (so far) and some have included ‘before and after’ screenshots of their websites, showing what they have removed or changed. (Don’t worry, I intend to write about what’s been happening and what the current position of my complaints is very soon.)

Now, presumably as a result of the Bronfort report, the BCA have removed various statements from their website over the last few days.

This is odd.

The GCC have already told Martin Robbins that they only regulate individual chiropractors, not associations or clinics, so it would seem they can say whatever they like (even though anything claimed could be seen to be claims made on behalf of the BCA’s office bearers, if not the entire membership they claim to represent).

Anyway, what have the BCA removed?

Firstly, there is their page for health-care professionals. The bit that is now missing is a link to a pdf titled Chiropractic – Information for Healthcare Professionals, which included the text:

Chiropractors treat patients from newborn to the elderly and conditions suitable for chiropractic treatment include:

  • Neck pain due to posterior joint and ligament strain with referred pain or paraesthesia. This might involve nerve root irritation which could be discogenic or related to degenerative spondylosis.
  • Migraine of cervicogenic origin.
  • Tension headaches due to dysfunction of the upper cervical spine and muscle spasm.
  • Thoracic spine pain with involvement of the costo-vertebral joints which might also affect other body systems.
  • Disc herniation with nerve root involvement, tension signs and even mild neurological deficits.
  • Low back pain due to facet and sacro-iliac irritation, muscle strain, ligament sprains with associated muscle spasm and referred pain which might also affect other body systems.
  • Nerve root irritation due to lateral spinal canal stenosis with degenerative changes, and even when there are signs of neurogenic claudication.
  • Peripheral joint problems such as shoulder capsulitis and rotator cuff tendonitis, medial/lateral epicondylitis and carpal tunnel syndrome. These conditions present as local problems but can involve the cervical spine and may benefit from treatment of both areas.
  • Knee ligament sprains and mild meniscal tears.
  • Ankle injuries.
  • Dysfunction of the joints of the hands and feet.

The pdf also listed a very small plethora of ‘evidence’ to support these — just eleven references, including a couple of reports and an odd trial.

Secondly, on their What is Chiropractic? page, a link to the same pdf and the following text have disappeared:

The conditions which chiropractors treat range from low back pain, with or without nerve root irritation, to posterior joint strains in the neck which might also involve the nerve roots if there are spondylotic changes or disc protrustion. Also tension headaches and benign transient positional vertigo or dizziness due to an upset of proprioception in the posterior joints of the cervical spine. Rib strains and various peripheral joint disorders – adhesive capsulitis, rotator cuff tendinitis and lateral epicondylitis as well as problems with the joints of the hands and feet.

As they say, it is left as an exercise for the reader to compare these conditions with the conclusions of the (albeit flawed) Bronfort report.

It’ll be interesting to see if they make any further deletions or replace the pdf.

No improvement

But they might also like to take account of what the ASA have to say about chiropractic claims — after all, it’s the ASA’s guidance chiropractors have to be consistent with.

The What is Chiropractic? page I mentioned earlier still says the following:

Chiropractors treat problems with joints, bones and muscles, and the effects they have on the nervous system. Working on all the joints of the body, concentrating particularly on the spine, they use their hands to make often gentle, specific adjustments (the chiropractic word for manipulation) to improve the efficiency of the nervous system and release the body’s natural healing ability.

This would appear not to be consistent with ASA guidance. In my complaint about an advert by Discover Chiropractic, the ASA stated:

This also applies to the claim that chiropractic is able to improve the function of the spine and nervous system, so we would expect the advertisers to also remove this claim.

So why then are they making a virtually identical claim? Have they not checked with the ASA’s Copy Advice Team?

Finally, it’s worth repeating: Bronfort conducted no new trials. All he and his team did was to review evidence that was already out there and that is something that could — and should — have been done a long time ago.

48 Responses to All change!

  • Very interesting post, Zeno. You are impressively sharp-eyed.

    Bearing in mind that most chiropractors in the UK work in private practice, IMO, the reason for there not being a review of the evidence until now is pretty obvious. Indeed, Stephen Barrett, MD, sums it up rather succinctly in the ‘Spine Salesmen’ chapter of the book, ‘The Health Robbers: A Close Look At Quackery In America’:

    Quote
    “If a chiropractor limited his practice to musculoskeletal conditions such as simple backaches, if he were able to determine which patients are appropriate for him to treat, if he consulted and referred to medical doctors when he couldn’t handle a problem, if he were not overly vigorous in his manipulations, if he minimized the use of x-rays, and if he encouraged the use of proven public health measures, his patients would be relatively safe. But he might not be able to earn a living.”

    The entire chapter can be read here:
    http://www.chirobase.org/12Hx/hr76.html

    It’s well worth a read.

  • Great work.

    I know (because I asked them) that the BCA issued some “condition specific” guidance to its members on 10 March 2010 with regards to the findings of the Bronfort report. I don’t know what they said, but I can only assume that they believe their website & literature conforms to their own advice!

    The UCA & SCA have also issued advice to their members, not sure about McTimoney, as they didn’t reply.

    I’ve had a number of chiropractors who have removed claims recently (blog update sortly), including a second one who asked if I’m happy with the changes:

    “As a result of the recent guidelines being released and your email we have removed all symptoms relating to children off our website. At this stage we have no intention of placing any childhood symptoms back on the website in the near future. I assume this was what the enquiry was regarding and our response has been satisfactory for you. Would be great to hear back from you to make sure that you are satisfied with our response.”

    What a U-Turn, this is a chiro that successfully defended the same claims to their local TS!

    However, some have totally ignored my letter and continue to make claims for colic, asthma etc leaving themselves wide open to complaints!

  • This gets more interesting by the minute. You discount the brontfort report as having covered no new evidence and yet on your wife’s blog she defends prof ernst’s conclusions with regards hypnotherapy, for doing exactly the same. Once again confirmation of your concept of ‘one rule for what you believe on and a different rule for the ‘opposition’. So I ask again, fair and reasonable behaviour based on facts or bigotry. Sadly your actions and on fact the postings on this blog do not support the former.

    Before you discount my opinions, try and look at what you and your wife’s postings and tell me that they follow a reasonable pattern of though, communicated to the world on a reasonable manner.

    Currently, your wife is trying to appease a hypnotherapist by attempting to be nice, what I mean by that is that there is a full paragraph without the usual abuse, in the hope that he discontinues his attack on prof Ernst. Reasonable approach on it’s own right but her history shows it for what it is.

  • I really don’t know if you are unwilling — or simply unable — to read and understand what’s been written.

    However, it is obvious that discussing anything with you is a waste of time; time, I’m sure, you’d be happier I spent dealing with other nonsense.

  • It’s pretty obvious to me that this Bruce guy has some kind of learning difficulty. I commend both of you for your patience but his comments are unfailingly ill-informed, obnoxious and – dare I say it – bigoted and it’s a mystery to me why you continue to tolerate him.

  • Blue Wode said: “Bearing in mind that most chiropractors in the UK work in private practice, IMO, the reason for there not being a review of the evidence until now is pretty obvious.”

    And what reason would that be, Blue Wode? If I’m not mistaken, that sounds like a character slur against chiropractors. Please elucidate.

    Blue Wode said: “Stephen Barrett, MD, sums it up rather succinctly in the ‘Spine Salesmen’ chapter of the book, ‘The Health Robbers: A Close Look At Quackery In America’:

    Quote
    “If a chiropractor limited his practice to musculoskeletal conditions such as simple backaches, if he were able to determine which patients are appropriate for him to treat, if he consulted and referred to medical doctors when he couldn’t handle a problem, if he were not overly vigorous in his manipulations, if he minimized the use of x-rays, and if he encouraged the use of proven public health measures, his patients would be relatively safe. But he might not be able to earn a living.” ”

    Interestingly, for the quarter-century that I have been practising chiropractic, my practice has been based on treating musculoskeletal conditions, primarily, but not exclusively, spinal pain. My training has given me the knowledge and skills to determine the most appropriate treatment for a patient, whether that be from me or another healthcare professional, and I have a good working relationship with my local GPs and Consultants so we cross-refer patients in order that they receive the best care.

    Thankfully, through practising safe, effective, evidence-based, patient-centred chiropractic care, I have managed a reasonable standard of living, employing several staff, contibuting to my local community and affording my children a good education and a leg-up in life. All without any advertising, becasue our patients come by recommendation, either from other heatlhcare professionals, or satisfied patients.

  • @ Artemis

    I’m glad to see that you’ve managed to overcome your feeling of intimidation and bring yourself to post a comment or two. You must have had some very effective therapy to have become so much bolder so quickly.

    http://www.zenosblog.com/2010/03/curbing-the-quacks-protecting-the-public/comment-page-1/#comment-4102

  • David wrote: “Interestingly, for the quarter-century that I have been practising chiropractic, my practice has been based on treating musculoskeletal conditions, primarily, but not exclusively, spinal pain. My training has given me the knowledge and skills to determine the most appropriate treatment for a patient, whether that be from me or another healthcare professional, and I have a good working relationship with my local GPs and Consultants so we cross-refer patients in order that they receive the best care. Thankfully, through practising safe, effective, evidence-based, patient-centred chiropractic care, I have managed a reasonable standard of living, employing several staff, contibuting to my local community and affording my children a good education and a leg-up in life. All without any advertising, becasue our patients come by recommendation, either from other heatlhcare professionals, or satisfied patients.”

    As has been said elsewhere, that could quite easily be a case of GPs unloading intractable, self-limiting cases on chiropractors for placebo treatments. If so, then that’s not really an endorsement of chiropractic as much as an acknowledgment that chiropractic clinics are repositories for people who really need no treatment (with the hope they will not be harmed).

    BTW, you may be interested to know that the BCA is featured in a new song:
    http://www.youtube.com/watch?v=l5tZKCcLLWs

  • Blue Wode wrote: “As has been said elsewhere, that could quite easily be a case of GPs unloading intractable, self-limiting cases on chiropractors for placebo treatments. If so, then that’s not really an endorsement of chiropractic as much as an acknowledgment that chiropractic clinics are repositories for people who really need no treatment (with the hope they will not be harmed).”

    I’d be interested to see a case that was both intractable and self-limiting, but we’ll ignore that for now.

    You seem to be suggesting that GPs refer patients for a treatment that you have previously described as ineffective and *dangerous*, simply in order to offload them.

    That cannot be classed as ethical practice. If you believed it, surely you would be behoven to complain to the General Medical Council about the hundreds of GPs and Consultants who refer patients to chiropractors every week.

  • @ David.
    I think the problem is that GPs and consultants need to be better informed about the slim evidence base for chiropractic and its apparent unfavourable risk/benefit profile.

    Also, unlike chiropractors, I am not bound by statute to report on GPs’ failings. It’s interesting to note, however, that chiropractors *must* (according to the following clauses of their Code of Practice – p.21 in the pdf, p.18 of the actual document) report on the following:

    Quote
    E1: Chiropractors must act quickly if either their own, or another healthcare worker’s conduct, health or performance may place patients or colleagues at risk. Specifically chiropractors…

    E1.3: Must protect patients when they believe that the conduct, competence or health of another regulated healthcare practitioner (including a chiropractor) is a threat to patients. Before taking action, a chiropractor should do his/her best to verify the facts on which this belief is based. Then, if necessary, the chiropractor should report honestly to the practice principal/work colleagues of the other regulated healthcare practitioner (if s/he works with others) any concern about the conduct, competence or health of that healthcare practitioner. If the other person is a sole practitioner, or the practice principal/work colleagues of that other person have refused to take action, then a chiropractor must report his/her concerns to the relevant regulatory body.

    http://www.gcc-uk.org/files/link_file/COPSOP_Dec05_WEB(with_glossary)07Jan09.pdf

    In view of the above I’m surprised that the hundreds of subluxation-based chiropractors in the UK continue to ply their trade unchallenged.

  • @ Blue Wode

    It is precisely because of the knowledge and experiences of our local GPs and Consultants that they refer to us.

    As for the rest of your post, it only goes to demonstrate how rigorous and demanding the regulations governing chiropractic in the UK are.

    I note that you have not denied you were making a slur against chiropractors in your earlier post. What was all that talk about ad hominems before and during my absence….?

  • @David “As for the rest of your post, it only goes to demonstrate how rigorous and demanding the regulations governing chiropractic in the UK are.”

    LOL! You’re havin’ a laff aren’t you? There is no doubt the GCC have done some things to keep chiros in check, but whether or not you think all of zenos complaints are valid, what he has done is shake them up and make loads of them withdraw claims they just did not have the evidence to make. These are the claims that have been for years misleading their customers and breaking their COP yet the GCC has done nothing about! Fit for purpose? Don’t think so.

  • David wrote: “It is precisely because of the knowledge and experiences of our local GPs and Consultants that they refer to us.”

    And it could be that those GPs and Consultants know from experience that referring patients to chiropractic clinics will get them off their backs until the tincture of time sees their ailments either improved or resolved.

    David wrote: “As for the rest of your post, it only goes to demonstrate how rigorous and demanding the regulations governing chiropractic in the UK are.”

    And, I would venture, how ineffective many of them seem to be.

    David wrote: “I note that you have not denied you were making a slur against chiropractors in your earlier post.”

    That is correct. Keeping in mind the Bronfort review (which didn’t include any new studies), the current unfavourable risk/benefit profile for chiropractic, and the fact that most chiropractors in the UK work in private practice, my comments were based, primarily, on the observations of a former Chair of the GCC:

    Quote
    “In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.”

    Michael C. Copland-Griffiths, former Chairman of the General Chiropractic Council (European Journal of Oriental Medicine, Vol.2 No.6)
    http://web.archive.org/web/20060924183943/www.ejom.co.uk/backissues/vol2no6/feature1.html

  • @David

    Still making snide comments I see. As I said before, your unpleasant manner towards others here have prevented me from getting involved in the discussions and it still does. Kudos to those who are prepared to spend their time on thoughtful, well-argued and civil posts only to have to put up with rudeness from you. After seeing how you have conducted your ‘arguments’, there’s no way I’m going to engage with you about anything that matters.

    I don’t consider my comments on objectionable remarks by others to be discussion or debate and if you or Bruce are going to continue making them I will continue to comment on them. Hope that clarifies.

    Thank you for the link to your comment saying you were “out of here”. It seems you just can’t keep away…

  • @IainD

    “what he has done is shake them up and make loads of them withdraw claims they just did not have the evidence to make.”

    Exactly! At the libel reform benefit gig recently, Simon Singh drew the attention of the thousands of people there to this post http://www.zenosblog.com/2010/03/spot-the-difference as a very public illustration of the difference Zeno has made. Power to your elbow, Z!

  • @IainD

    Because the GCC is statutorily bound to investigate all complaints it receives, Zeno’s bulk submission is being given a great deal of time and attention. It remains to be seen how serious the GCC feels these complaints are and what punishments they will merit.

    Remember, the GCC no longer has the responsibility of promoting the profession. It’s responsibilites are to protect the public, set standards of education, conduct and practice and ensure the development of the profession.

    It has no choice, and no desire, but to take these responsibilities seriously and no doubt will mete out appropriate and proportionate punishments to those who have contravened the Code of Practice.

    As each complaint carries as much weight as any other, one complaint would have been taken as seriously as 500. There is, therefore, no doubt that the money and resources required to deal with Zeno’s bid for glory are out of proportion with the severity of the complaints made.

  • @ Blue Wode

    Blue Wode said: “David wrote: “It is precisely because of the knowledge and experiences of our local GPs and Consultants that they refer to us.”

    And it could be that those GPs and Consultants know from experience that referring patients to chiropractic clinics will get them off their backs until the tincture of time sees their ailments either improved or resolved.”

    You have spent many posts trying to convince readers that chiropractic is unsafe, expensive and ineffective. Now you are trying to argue that GPs and Consultants refer to us just to get patients “off their backs”.

    Are you really accusing these medics of the unethical practice of referring patients for unsafe, expensive and ineffective treatment for problems that they know will resolve spontaneously? Any right-minded reader here will see that you’re making a false argument, again.

    As for your quote from Michael Copland-Griffiths, I would urge readers to read the article in full and they will then see that you have, again, cherry-picked a quote to make a cheap point.
    http://web.archive.org/web/20060924183943/www.ejom.co.uk/backissues/vol2no6/feature1.html

  • @ Artemis

    Artemis said: “I don’t consider my comments on objectionable remarks by others to be discussion or debate and if you or Bruce are going to continue making them I will continue to comment on them. Hope that clarifies.”

    You won’t mind if I point out the hypocrisy of your snide remarks then. Clear?

    Artemis said: “Thank you for the link to your comment saying you were “out of here”. It seems you just can’t keep away…”

    If you had read my earlier post, you would have seen that I said I would be away for a week. I didn’t say I wasn’t coming back!

  • David wrote: “You have spent many posts trying to convince readers that chiropractic is unsafe, expensive and ineffective. Now you are trying to argue that GPs and Consultants refer to us just to get patients “off their backs”. Are you really accusing these medics of the unethical practice of referring patients for unsafe, expensive and ineffective treatment for problems that they know will resolve spontaneously?”

    As I said in a previous post, I think that many medics are unaware of the slim evidence base for chiropractic and its apparent unfavourable risk/benefit profile. For example, if NICE can get it so wrong, what hope is there for GPs and consultants (not to mention self-referring members of the public)?

    For readers who may not be up to speed on the controversial new NICE guidelines for low back pain, it’s worth noting that the recommendation for spinal manipulation was not specific to chiropractic and therefore cannot be cited as evidence for the effectiveness of chiropractic for lower back pain. It’s also worth noting the following very pertinent points which were made by Professor Edzard Ernst in a recent critique of the guidelines:

    Quote
    “The risk of mild to moderate adverse effects is undisputed even by chiropractors: about 50% (!) of all patients suffer from such adverse effect after spinal manipulations. These effects (mostly local or referred pain) are usually gone after 1-2 days but, considering the very moderate benefit, they might already be enough to tilt the risk-benefit balance in the wrong direction.
    In addition, several hundred (I estimate 700) cases are on record of dramatic complications after spinal manipulation. Most frequently they are because of vertebral arterial dissection. Considering these adverse events, the risk-benefit balance would almost certainly fail to be positive. It is true, however, that the evidence as to a causal relationship is not entirely uniform. Yet applying the cautionary principle, one ought to err on the safe side and view these complications at least as possibly caused by spinal manipulations.
    So why were these risks not considered more seriously? The guideline gives the following reason: ‘The review focused on evidence relevant to the treatment of low back pain, hence cervical manipulation was outside our inclusion criteria’. It is true that serious complications occur mostly (not exclusively) after upper spinal manipulation. So the guideline authors felt that they could be excluded. This assumes that a patient with lower back pain will not receive manipulations of the upper spine. This is clearly not always the case.
    Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them. And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment of spinal manipulation for back pain.”

    [Ref: Ernst, E. Spinal manipulation for the early management of persistent non-specific low back pain ? a critique of the recent NICE guidelines. Int J Clin Prac, Vol 63, No10, Oct 2009, pp.1419-1420]

    In support of the moderate benefits for chiropractic mentioned by Edzard Ernst in the above quote, it’s worth noting some comments that were made by three chiropractic staff members at the University of Glamorgan. They appeared in a chiropractic trade magazine not so long ago and are as follows:

    Quote
    “…it has [also] been shown that patients are very pleased and satisfied with chiropractic care whether they get better or not….Furthermore, it has been said that chiropractic’s greatest contribution to health care has been the development of a solid doctor-patient relationship. So, let’s not kid ourselves. It may not be what we say…..but simply the way in which we say it that stimulates some measurable change in patient’s general health care status. Some studies support this view.”

    http://web.archive.org/web/20041215180456/www.familychiropractic.co.uk/news/Articles/article3.htm

    David wrote; “As for your quote from Michael Copland-Griffiths, I would urge readers to read the article in full and they will then see that you have, again, cherry-picked a quote to make a cheap point.”

    I don’t agree that the point was cheap. Although chiropractors have recently welcomed the new NICE guidelines – which should see a substantial increase in NHS referrals for them – a fairly recent (prize-winning) survey indicated that most chiropractors in the UK want to remain working in private practice:

    Quote
    “Ninety-five percent were interested in future arrangements [with NHS patients] but on a part-time basis and in a way that most closely resembled private practice.”

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11898015

    Why would that be?

  • David,

    What hypocrisy? Please go right ahead and point it out.

    And yes I did read that you would be absent for a week but you followed that up with a new comment ‘don’t bother banning me, I’m out of here’. As you are unable to keep away, I assume the warning you were issued with still stands.

  • Can we have a cessation of hostilities now please? It’s getting boring. At least David is honest about the fact that he’s a chiropractor.

    David said, “Are you really accusing these medics of the unethical practice of referring patients for unsafe, expensive and ineffective treatment for problems that they know will resolve spontaneously?”

    Isn’t it widely recognised and admitted that GPs sometimes dole out useless meds like antibiotics for viral infections or refer people to chiros and homeopaths because they don’t know what else to do with them?

  • Yeah, OK, sorry. To borrow a phrase from David, I’m out of here.

  • Plethora of evidence? You want a plethora of evidence????? I’ll give you a plethora of evidence!!!! Check it out here: http://www.chiropractic.org.nz/research-literature

    The New Zealand Chiropractic Association do at least admit that it is a selection. Given that one might expect by chance alone to find a paper with Professor Ernst’s name on it in a random selection of this size, one can assume it’s not a random selection but a selective selection. A very selective selection. Can’t seem to find any Cochrane reports either.

  • Blue Wode said: “For readers who may not be up to speed on the controversial new NICE guidelines for low back pain, it’s worth noting that the recommendation for spinal manipulation was not specific to chiropractic and therefore cannot be cited as evidence for the effectiveness of chiropractic for lower back pain.”

    Quite true, the recommendation that NICE made for the management of low back pain was spinal manipulation, not specifically chiropractic. However, the anti-chiro lobby complained at the time that, because chiropractors are the profession who supply the majority of manipulation available today, NICE was in effect specifically advocating chiropractic. Now, Blue Wode is trying to distract from that endorsement.

    What NICE said was that “Manipulation can be performed by chiropractors and osteopaths, as well as by doctors and physiotherapists who have undergone specialist postgraduate training in manipulation.”

    Note that doctors and physiotherapists providing the manipulation must have undergone “specialist post graduate training”. This is because the skills required are not quickly or easily learnt, which is why the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic run courses over a minimum of four years to train chiropractors before they are awarded their MSc.

    Blue Wode said: “Professor Edzard Ernst in a recent critique of the [NICE] guidelines [noted]:
    Quote
    “The risk of mild to moderate adverse effects is undisputed even by chiropractors: about 50% (!) of all patients suffer from such adverse effect after spinal manipulations.”

    This comment has been roundly dealt with many times already. The adverse effects he is making so much of, amount largely to mild soreness which passes off quickly. Bear in mind that because patients are generally consulting chiropractors with something that is already sore, this might well be expected.

    As has been noted elsewhere, this mild soreness equates to the post-exercise muscle ache you might feel after visiting the gym, or to seeing a small amount of blood when you spit out the toothpaste after cleaning your teeth. If Professor Ernst’s assessment of the risk/benefit ratio for chiropractic were applied generally, none of us should go to the gym, or indeed brush our teeth.

    Blue Wode’s quote from Ernst continues:”In addition, several hundred (I estimate 700) cases are on record of dramatic complications after spinal manipulation. Most frequently they are because of vertebral arterial dissection.”

    Again, this matter has been dealt with many times already. There are NO cases, as far as I am aware, where a manipulation delivered by a registered chiropractor anywhere in the world, let alone in the UK, has irrefutably been demonstrated to have caused a vertebral artery dissection or subsequent stroke. It is well understood and accepted that the presenting symptoms for these patients are commonly neck pain and headache, which are symptoms that the research shows chiropractic to be a very effective treatment. Sadly, it is sometimes, although thankfully very rarely, the case that the diagnosis is missed, not only by chiropractors but by many medics as well. I have had a tragic experience myself which I relayed before: http://www.zenosblog.com/2010/01/discover-chiropractic/comment-page-1/#comment-3190

    It is well known that Edzard Ernst seems to find it impossible to be rational about complementary and alternative medicine and I had a very interesting conversation with a doctor I met last week. He works for an organisation that provides advice to doctors and they publish a monthly magazine. They asked Ernst to write an article for them but when he produced it, they had to send it back because the tone was so rabid that they considered it unprintable. Ernst refused to tone it down and they didn’t use it. This doctor had no prior knowledge of the battle between Ernst and the the CAM world, but was left with a clear impression of the state of mind of the “professor”. Decorum prevents me from repeating the actual words he used to describe the man.

    Never mind, I’m sure that Edzard Ernst and Blue Wode are much better sources of good medical advice than NICE, or the local GPs and Consultants who act on the knowledge and experience they have gained from years in practice.

  • To the lurkers with back-pain out there:
    See a physiotherapist rather than a chiropractic wizard.
    It is cheaper, as effective, and less dangerous.

  • Michael Kingsford Gray said: “To the lurkers with back-pain out there:
    See a physiotherapist rather than a chiropractic wizard.
    It is cheaper, as effective, and less dangerous.”

    Tell that to the numerous physiotherapists I know who have gone on to train as chiropractors becasue they wanted the extra skills to manage their patients.

    Then tell it to the physiotherapists I treat for their musculoskeletal problems.

    Then tell it to the countless patients we have seen who have already had courses of physiotherapy before settling with us.

    No disrespect to physios, I have many good friends who are physios, but credit where credit’s dus: chiropractors know a thing or two about backs.

  • As this thread is about the British Chiropractic Association (BCA), it’s worth posting this morning’s news about the BCA v. Simon Singh libel case:

    Quote
    “In a judgment [PDF 73KB] handed down at 9.30 this morning, the Lord Chief Justice ruled that Singh’s contention that the BCA promoted “bogus” treatments was “a statement of opinion, and one backed by reasons”. Singh may now pursue a defence of “fair comment”.

    The judgment criticised the BCA, saying its action had created an “unhappy impression” that the case was “an endeavour by the BCA to silence one of its critics”.

    The judge added: “if that is where the current law of defamation takes us, we must apply it.”

    Addressing the effect of lengthy, costly libel trials on public debate and medicine, the judge commented: “It is now nearly two years since the publication of the offending article. It seems unlikely that anyone would dare repeat the opinions expressed by Dr Singh for fear of a writ. Accordingly this litigation has almost certainly had a chilling effect on public debate which might otherwise have assisted potential patients to make informed choices about the possible use of chiropractic.””

    http://www.indexoncensorship.org/2010/04/simon-singh-bca-libel-ruling/

    The full text of the judgment is included in the link.

  • @ Blue Wode

    The ruling today does not exonerate Simon Singh from making his libellous remarks in the Guardian newspaper.

    In fact, all it has done is allow Singh to defend his remarks as “comment” rather than a statement of “fact”. This is the premise on which Singh has defended himself; that what he said was not fact, only comment.

    Draw your own conclusions.

  • David wrote: “…the anti-chiro lobby complained at the time that, because chiropractors are the profession who supply the majority of manipulation available today, NICE was in effect specifically advocating chiropractic.”

    I don’t recall that. Would you please supply links to support that statement. What I do recall is rational thinkers raising the issue of the ‘bait and switch’ of unscientific medicine with regard to chiropractors’ beliefs in mythical lesions like ‘subluxations’:
    http://www.dcscience.net/?p=1516

    David wrote: “What NICE said was that “Manipulation can be performed by chiropractors and osteopaths, as well as by doctors and physiotherapists who have undergone specialist postgraduate training in manipulation.” Note that doctors and physiotherapists providing the manipulation must have undergone “specialist post graduate training”. This is because the skills required are not quickly or easily learnt, which is why the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic run courses over a minimum of four years to train chiropractors before they are awarded their MSc.”

    I’m not sure what your point is. Are you saying that post graduate training in spinal manipulation has to be for four years for it to be of any value?

    David wrote: “There are NO cases, as far as I am aware, where a manipulation delivered by a registered chiropractor anywhere in the world, let alone in the UK, has irrefutably been demonstrated to have caused a vertebral artery dissection or subsequent stroke.”

    Then allow me to enlighten you about one that was caused by a ‘leading’ chiropractic researcher, David Cassidy, DC:

    Quote
    “…Principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as “all of the study’s authors conclusions are completely invalidated by their methods”. David Cassidy, before he was dismissed from the University of Saskatchewan, was called as an “expert” witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest. In the Globe and Mail article
    co-author David Cassidy is quoted “Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office”. Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome.”

    http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

  • David wrote: “The ruling today does not exonerate Simon Singh from making his libellous remarks in the Guardian newspaper.”

    I never said that it did. Indeed, the first paragraph of the quote I posted said this:

    Quote
    “In a judgment [PDF 73KB] handed down at 9.30 this morning, the Lord Chief Justice ruled that Singh’s contention that the BCA promoted “bogus” treatments was “a statement of opinion, and one backed by reasons”. Singh may now pursue a defence of “fair comment”.”

    David wrote: “In fact, all it has done is allow Singh to defend his remarks as “comment” rather than a statement of “fact”. This is the premise on which Singh has defended himself; that what he said was not fact, only comment.”

    Yes, that is *all* it has done. However, I would remind you about the following which the BCA said in a statement at the end of last year:

    Quote
    “The BCA remains confident that once in possession of all the facts the presiding judges will refuse the appeal.”

    http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Singh/BCA%20Statement%2015%2010%2009.pdf

    I wonder how confident the BCA is feeling now.

  • @David

    “all it has done is allow Singh to defend his remarks as “comment” rather than a statement of “fact”.”

    Actually what it does is give Simon the opportunity to do exactly what he has wanted to do all along: to defend in court what he actually wrote rather than have to defend the BCA’s interpretation of what he wrote, an interpretation he has rejected from the outset. I was at the press conference after the hearing today and heard Simon say he “relished” the prospect of being able to do exactly that. He was grinning from ear to ear and seemed barely able to contain his excitement at the idea that he might finally get his day in court to wipe the floor with the BCA, which is what they deserve for resorting to legal bullying to try to settle a scientific dispute.

    @Blue Wode

    “I wonder how confident the BCA is feeling now.”

    Judging by their weaselly statement, which blames it all on their lawyers, I’d say not very. In fact, I’d say they are paving the way for a public climb-down. If they do go to court, they will surely have to produce evidence for their claims and we all know by now that they have none. :-)

    http://www.skepticat.org/2010/04/up-yours-bca/

  • “David” said:
    “Tell that to the numerous physiotherapists I know who have gone on to train as chiropractors becasue they wanted the extra skills to manage their patients.”

    I shall. You can post me the list of contacts here, or in private to my email address. When can I expect such a list?

    “Then tell it to the physiotherapists I treat for their musculoskeletal problems.”

    I shall. Again, I cannot so do without contact details.

    “Then tell it to the countless patients we have seen who have already had courses of physiotherapy before settling with us.”

    Again. See above. I am quite happy to so do, given the appropriate contact information.

    I await your lists in response. We can arrange a private channel via Zeno, whom I trust.
    The ethical ball is in your court.

  • to Blue Wode:
    David Cassidy was not dismissed from the University of Saskatchewan.

  • Zeno:
    I wonder if you might provide us with some idea of how you might personally re-model Chiropractic. Or is it your view that there is no place for Chiropractic in any society and the ideal would be to eradicate it completely. Could you provide us with an alternative to the Bronfort report which you point out conducted no new trials. Could you also provide us with a list of the clinical trials performed by Profesor Ernst during his professorship.

  • Will

    It’s up to the chiropractic industry to ‘re-model’ itself. Chiropractors need to abide by the rules set up by their statutory regulator. It’s not rocket science – or brain surgery.

    It’s not up to me to provide alternatives to the Bronfort report. Can’t chiropractors do proper research?

    As for your question about Ernst, I have no idea why you’re expecting me to do your searching for you.

  • I note that the so-called “David” (for I have no methid of determine “his” quite cowardly bona fides, unlike my openly public persona, has not responded since what *must* have been a badly judged April Fool’s joke that backfired.
    There is no other rational explanation for “his” rather tedious rant gratuitously advising me to do what has long been my practise.

    Tell that to the numerous physiotherapists I know who have gone on to train as chiropractors becasue they wanted the extra skills to manage their patients.

    I call “BULLSHIT!!!” on this claim. You do not know any physiotherapists who have decided that they need skills in BOGUS scams. If you do: NAME THEM.

    “Then tell it to the physiotherapists I treat for their musculoskeletal problems.”
    Again: you are lying by the “skill” of plurium interrogationum.
    Clever Holmes, but not clever enough.

    “…I have many good friends who are physios…”
    Ah yes, even the neophyte philosophy students can determine under which logical fallacy tree that utterance lies.

  • Will:
    Thursday 15 April 2010 at 09:55
    Zeno:
    I wonder if you might provide us with some idea of how you might personally re-model Chiropractic.

    At the expense of riding-over Zeno’s prerogative, I can certainly answer that query.
    I should re-model chiropractic that it vapourises. The essential difference between physiotherapy and chiroquacktic is that quacktic is a bizarre religion, to whom their practice relies upon medieval superstition (at best), and outright harmful fraud (at not quite worst).
    How does that sit with you?
    Eliminate Chiroquacks, yet retain and train physios.
    OK?

  • Zeno : I merely asked you if you could provide something better than the Bronfort report because I honestly thought someone as well-read as yourself could at least point me in the direction of a better piece of research. As regards Professor Ernst, the question still stands: what clinical trials has he conducted during his Professorship? The gold standard of any efficacy in therapeutics seems to be the double blind RCT and presumably all forms of ‘alternative’ healthcare should undergo such testing. I simply asked if you knew of any such trials which have been instigated by the Professor of Complementary Medicine. I am not trying to ruffle feathers, I just want an honest answer.
    Michael Kinsford Gray : thanks for that, most illuminating.

  • My apologies for my spelling mistake.’Michael Kingsford Gray’

  • Will

    I’m sure a search of PubMed will answer all your questions.

  • Zeno: been there, done that. Not a very impressive list of RCT’s by the Professor of Complementary Medicine. But I thought such trials were the backbone of clinical therapeutic research. I’ll keep looking.

  • Come on, Will. It’s a bit of a cheek to ask a blogger to spend their time finding something you could find yourself with a couple of clicks of the mouse.

    You might be interested in this article by a retired American chiropractor.

    http://www.sciencebasedmedicine.org/?p=4068

  • I see we cross-posted, Will. What is your point? Ernst conducted reviews of clinical trials conducted by others and reviews of reviews carried out by others. You’ve probably seen this article but for anyone else:

    http://beta.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

  • Skepticat: No point at this stage, just contemplating. Thanks for the references, excellent article by the retired Chiropractor.

  • Michael Kingsford Gray wrote: ” I call “BULLSHIT!!!” on this claim. You do not know any physiotherapists who have decided that they need skills in BOGUS scams. If you do: NAME THEM.”

    You seem to be getting a bit excitable Michael. Calm down!

    You are of course right. I don’t know any physiotherapists who have felt the need to acquire skills in bogus scams. However, I do have four personal friends who have undergone a four year full-time course in chiropractic subsequent to completing their physiotherapy training in order to acquire the knowledge and skills they desired.

    I also do have several physiotherapists as patients and an untold number of other patients who have previously consulted physios before settling with us for the management of their musculoskeletal problems.

    I have in fact asked some of the above if they would like to have their name forwarded to you in order that you can point out the error of their ways. However, curiously, none has felt the need or desire to be berated by a ranter like you. They are intelligent and informed enough to make their own judgements on the evidence and their experience.

    I would just like to repeat, I have no beef with physiotherapists. I have worked closely with many physios over the years and have a great deal of time and respect for the good ones. I also count a number of physios among my good friends.

  • David: I most certainly know of physiotherapists who have trained as chiropractors.I know chiropractors who have trained to be medical doctors and I know medical doctors who trained to be chiropractors. There is a good deal of this sort of hybridization and long may it be so. But I’m not sure this actually takes us anywhere in this debate. I personally feel there is no need for three distinct physical therapy professions. There should be one all encompassing physical therapy practitioner who is a specialist in non-invasive care for musculoskeletal disorders without bullshit. The essential problem is that the three main groups present today hate each other’s guts and prefer turf warfare than rational debate. But no doubt even this observation will be treated with vitriol by some bloggers!

  • Will wrote: “David Cassidy was not dismissed from the University of Saskatchewan.”

    Thank you for that. I’ll take your word for it for the time being. BTW, more serious criticism of the Cassidy et al study has emerged, and it doesn’t show the authors’ methodology in a good light:
    http://www.chirowatch.com/Stroke/2010%20Vascular%20accidents%20after%20chiroSM%20-%20myth%20or%20reality.pdf

    It’s well worth clicking on the link and having a slow read through the paper.

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