The random thoughts of a sceptical activist

What’s Polish for ‘chiropractor’?

Czego mogę się spodziewać podczas wizyty u kręgarza?

If your Polish isn’t up to scratch, this roughly translates as: What can I expect when visiting a chiropractor?

Ah! I hear you say. Is it just a coincidence that this is suspiciously close to What can I expect when I see a chiropractor?

No, of course it isn’t. That was the title of the GCC’s leaflet that Simon Perry (Adventures in Nonsense, Leicester Skeptics in the Pub and skeptical columnist for the Leicester Mercury) complained to the Advertising Standards Authority about last year.

In his blogposts Quick Update on the Chiropractic Stuff, General Chiropractic Council to Change Patient Information Leaflet, The General Chiropractic Council is knowingly and deliberately violating its own code of practice, he tells the story of his complaint to the ASA about this leaflet and how, even after it was ‘informally resolved’ with the GCC, they didn’t immediately withdraw the electronic copy from their website. When Simon queried this, the GCC said:

Thank you for your enquiry of 6 October regarding the text of the GCC’s patient  information leaflet, which is published in nine languages plus Braille.

Following informal resolution of a complaint made to the Advertising Standards Authority, an amended version of the leaflet will be published as soon as reasonably practicable. including publication on our website.

You can read more about this in my post The trouble with leaflets, but it was discovered that the GCC had informed its members that, while corrective inserts would be available, there wasn’t a problem with any member using up stocks of the old leaflet (but if they really wanted the insert, they only had to ask).

Meanwhile, the GCC were re-writing the offending words in the leaflet and having it translated — presumably into all nine languages and Braille. The ASA do appreciate that re-printing leaflets takes some time:

We’d normally expect an advertiser to implement the changes as soon as is ‘reasonably practicable’ (bearing in mind the time involved in printing new leaflets).

But the GCC didn’t remove the old (misleading) leaflet from their website — something they could easily have done immediately, contrary to the ASA’s expectations:

However, if it’s a leaflet on a website then it should be taken down as soon as possible.

Anyway, they did eventually replace the downloadable leaflet. Meantime, they were presumably getting the new words translated so they could get them re-printed. How long should that take? It’s only one sentence that’s different, after all.

That was all at the beginning of October last year.

Over three months later, a GCC leaflet fell into my hands, obtained from a chiropractor who is a BCA member, and, yes, it was in Polish!

I don’t understand a word of the language, but it’s easy to get a rough translation of it with Google Translate. Much of it is similar to the English version of the leaflet, but one of the interesting bits is:

Można również osiągnać poprawę przy niektórych typach:

* astmy
* bólów glowy, w tym migreny; oraz
* kolki niemowlęcej

which translates as:

There may also be an improvement with certain types of:

* asthma
* headaches, including migraines, and
* infant colic

This is the old, old wording: the pre June 2009 English leaflet, written in 2007. It’s certainly not the words that were acceptable to the ASA. And there was no insert, giving the correct words, not even in English.

So why is this leaflet still being used by GCC members — particularly without an insert that corrects the misleading claims made?

The leaflet was soon winging its way to the ASA, who responded:

The ad makes reference to a number of serious medical conditions that our Code does not allow claims for.

They said that there was little point in adjudicating on the claims made in the leaflet because they had already done so:

The ad makes reference to a number of serious medical conditions that our Code does not allow claims for.  We have therefore decided to refer it to our Compliance team for further action.  Please note that they do not report back to complainants or publish the results of their work, but please rest assured that they will do their best to achieve a satisfactory outcome.

So, their Compliance Monitoring section would contact the GCC and have a few words with them:

Compliance take follow-up action when we have previously deemed a claim to be in breach of our Code.  For example, in the past we have investigated many similar claims for chiropractic and as we have no evidence that the claims (such as that asthma, sciatica and headaches can be treated) can be substantiated the Compliance team will approach the advertiser with evidence of our previous cases to show them why they cannot make such claims.  The advertiser is then required to give an assurance to the Compliance team.  If they persist in producing problematic ads, they can be referred to the OFT.  This system avoids us duplicating work that has been done by our Investigations team in the past when we already know that a claim cannot be substantiated.

Evidence, evidence, evidence

Just a few more words on the GCC’s newly-published Effectiveness of manual therapies: the UK evidence report (Bronfort et al.).

Many chiropractors seemed to think there was, indeed, good evidence for all sorts of medical conditions and proudly said so on their websites. However, it is clear that when the totality of evidence is examined there is a lot less evidence than many would like. Even the report, commissioned by the GCC and written by five chiropractors in the US, concluded that there was no evidence for conditions like colic and asthma. They were less sure about conditions such as ear infections, bed wetting and mid-back pain and declared the evidence to be ‘inconclusive’.

Remember, Bronfort et al. has done no new research — they simply reviewed what was already out there. But it remains to be seen whether their conclusions survive the spotlight of sceptical scrutiny.

Meantime, chiropractors are left with a dilemma: what about the conditions where Bronfort et al. concluded the evidence for the efficacy of ‘manipulation/mobilization’ was ‘inconclusive‘ (eg mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders and that old chiropractic favourite, fibromyalgia)?

Certainly, the ASA are considering Bronfort et al. but it will take some time before they make changes — if any — to their guidance. Meantime, why is the GCC leaving the decision to their members about whether claims for these conditions are acceptable? Each chiropractor has to now decide for his/herself and it is a foregone conclusion that there will be different interpretations of ‘inconclusive’!

While we all wait for the ASA, perhaps the GCC  — as an organisation who are supposed to protect the public — should take the lead?

But of course, the extreme irony of all this is that we have a consumer advertising watchdog, with no statutory regulatory powers and funded by a voluntary levy on the marketing spend of ad agencies and companies — and not the statutory regulator — who is regulating the clinical claims of chiropractors who apparently see themselves as primary healthcare professionals.

(In case you haven’t worked it out and desperately need to know, the Polish for ‘chiropractor’ is ‘kręgarz’.)

  • mid back pain;
  • sciatica;
  • tension-type headache;
  • coccydynia;
  • temporomandibular joint disorders;
  • fibromyalgia;

9 Responses to What’s Polish for ‘chiropractor’?

  • Thanks for another great post. With regard to the ‘Effectiveness of manual therapies: the UK evidence report’ by Bronfort et al., one wonders about its impartiality. It’s worth noting that Gert Bronfort serves on NCCAM’s National Advisory Council for Complementary and Alternative Medicine (NACCAM): http://nccam.nih.gov/about/naccam/roster.htm

    For those not up to speed with NCCAM, this is what the Skeptics Dictionary recently had to say about it:

    Quote
    “We’ve been waiting for 16 years for the NIH to announce some major breakthrough in health care that has emerged from NCCAM. Unfortunately, most of the “alternative” research is driven by faith, hope, and ideology rather than science. As Dr. Wallace Sampson noted: the NCCAM “is the only entity in the NIH [among some 27 institutes and centers] devoted to an ideological approach to health”….. $2.5 billion spent, no alternative cures found…”
    http://www.skepdic.com/NCCAM.html

    This is also interesting:

    Quote
    “Dr. Bronfort was recently commissioned by the British General Chiropractic Council to report on the evidence for chiropractic care. The Council and the British Chiropractic Association (BCA) has come under intense public scrutiny and pending litigation due to a large number of false-advertising claims filed against field practitioners. The purpose of the report was to help sort out what can and cannot be claimed about the effectiveness of chiropractic care, particularly manual therapies. The report is expected to be published in a peer-review journal in late 2009 or early 2010.

    Drs. Bronfort and Evans [Roni, a co-author of the GCC’s Evidence Report] were keynote speakers at the British Chiropractic Association Conference held in Wales, England, in October 2009.”
    http://www.nwhealth.edu/nwtoday/research1109.html

    Tell your friends.

  • BTW, a few more interesting comments on the Bronfort et al review can be found on this JREF thread:
    http://forums.randi.org/showthread.php?t=155947

  • I am particularly unimpressed by the ASA’s policy of not informing a complainant of the outcome of a case referred to the compliance team. I have tried in vain to get them to come clean, and they persistently refuse. The same perverse logic seems to be permeating Consumer Direct – or Consumer Indirect as it should be called. It is now impossible to contact Trading Standards dirdectly, as all calls are diverted to call centres, where poorly trained people tell me not to expect to hear anything further.

  • The review is not about chiropractic, it is about “manipulation” done by anybody (masseurs, PTs etc.). Although it is difficult to sort through all the original sources, it is also clear that what counts for favorable evidence does not pass muster in scientific circles.

    For example, they claim the evidence for chiro treatment of enuresis (bed wetting) is inconclusive but favorable. That is their summary of two papers:

    Reed WR, Beavers S, Reddy SK, Kern G: Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther 1994, 17: 596-600.

    Leboeuf C, Brown P, Herman A, Leembruggen K, Walton D, Crisp TC: Chiropractic care of children with nocturnal enuresis: a prospective outcome study. J Manipulative Physiol Ther 1991, 14: 110-115.

    The latter study (1991) was un-blinded and uncontrolled, and concluded that chiro did not work. The former (1994) was tiny, and the treatment and control groups were not closely matched; and the treatment and control groups were not statistically different after treatment. Can someone explain how this is interpreted as “inconclusive” and “favorable?”

    The review is rife with such over-enthusiastic interpretations of literature, and non-chiropractic references. Aside from low-back pain, there is little support for chiropractic.

  • Actually the Polish for ‘chiropractor’ is ‘kręgarz’. The extra ‘a’ at the end is because it’s in genitive case in this sentence.

  • Thanks Mchl – I’ve made the change!

  • Glad I could help ;)

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