The random thoughts of a sceptical activist

Monthly Archives: June 2010

The beginning of the end?

The first decisions of the GCC’s Investigating Committee (IC) on my complaints fell with a thud onto my doormat a few days ago.

I received copies of 43 letters sent to 43 of the chiropractors I complained about. All were notifications that the IC (which consists of eight chiropractors and four lay members) had decided — for various reasons — that there was no case to answer and that, therefore, no further action would be taken against them.

Eight of them were thrown out (leaving 35), the IC reasoning:

The extracts from the website, submitted in support of the complaint against you, related to a time you had ceased working at the clinic in question and therefore at a time when you were not responsible for the website content. For this reason the Investigating Committee has concluded that there is no case to answer in respect of the complaint against you.

I’ll leave it to you to tease out the issues I might have with that.

I’ll be saying more about the details of the other letters later, but I thought I’d share some of the gems to be found within them.

The law

After some preamble, they get off to a good start, citing the relevant clause of their Code of Practice that chiropractors are bound to comply with:

C1.6 of the Code of Practice states that chiropractors –

‘may publicise their practices or permit another person to do so consistent with the law…”

All well and good. Except…that’s not all C1.6 says. It continues:

…and the guidance issued by the Advertising Standards Authority.

And indeed, that’s what my complaint was all about: that they were making claims that I believed went against guidance issued by the ASA.

So why cut it short? Why ignore whether or not the claims complied with ASA guidance? Do they think that requirement is somehow null and void; something to be ignored without justification? Publicity has to comply with both requirements not just one.

More questions needing an answer.

However, they go on to say:

In the context of the relevant law (The Consumer Protection from Unfair Trading Regulations 2008) advertised claims for chiropractic care must be based on best research of the highest standard. This will almost certainly mean randomised controlled trials that produce high or moderate positive evidence. (Link added)

Now we know what law they think is relevant. At least they mention ‘the best research of the highest standard’ and that this (almost certainly) means RCTs that give good evidence.

Expertise and preferences

But what about the Code of Practice whose glossary defines evidence-based care, cited by many chiropractors in their observations, as:

clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners (including the individual chiropractor her/himself).

All the 35 letters stated the following:

The other elements of evidence based care as it relates to clinical practice (the preferences of the patient and the expertise of practitioners (including the individual chiropractor her/himself)) are, of themselves, insufficient to support advertised claims.

No matter what a chiropractor might think; no matter what a chiropractor might have seen with his or her very own eyes; no matter what he or she believes might work; no matter what a customer might prefer — none of these are sufficient to back up claims in any publicity. All claims must be supported by robust evidence, and that severely limits what many chiropractors can now get away with claiming.

About time too.

There is, of course, a subtle difference between what a chiropractor is allowed to advertise and what he or she actually tells customers and what they do in their clinics. My complaints were about what they were advertising; what they were using to pull in new customers. I have no idea what goes on within the four walls of the clinics, although Skepticat has first hand experience of one.

However, it would be utterly perverse if what they were allowed — tacitly or otherwise — to practice was in any way different to what they were allowed to tell people they were allowed to practice.

What about the kids?

Many of the letters mentioned that the chiropractor had said something on his or her website about children and babies. One example:

The Investigating Committee did note the reference to ‘Paediatric care’. The Investigating Committee considered that this could give a member of the public reading the webpage the impression that you provide treatment to babies.

Other letters mentioned similar claims about children. Despite the fact that Bronfort found that there was no good evidence that chiropractic worked for children or babies for any condition, the GCC have taken the opportunity to remind all the chiropractors:

It was mindful that there is no high or moderate positive evidence from randomised controlled trials that would support a claim to treat children using manual therapy. In the absence of such evidence, it concluded that it could be inappropriate to make such an advertised claim.

An odd choice of phrase, ‘could be inappropriate’, but the meaning is all too clear: there is no evidence for treating children with chiropractic. Not a jot. Not for colic; not for bed wetting; not for hyperactivity; not for feeding problems; not for sleeping problems. Not for any condition.

Chiropractors should therefore not be making any claims for children.

But isn’t it odd that they managed to decide that unsupported claims were being made, but still found no case to answer?

Good advice

In addition to the specific guidance offered to the 35, the GCC chose to deliver the following message to all 43 chiropractors — the ones they’ve decided have no case to answer:

The Investigating Committee recommends that you carefully consider the guidance issued to the chiropractic profession by the General Chiropractic Council in February/March 2010 and that you ensure that any advertisement of your services complies with C1.6 of the Code of Practice. (the GCC’s underlining)

Taken individually and together, these are welcome steps in the right direction.

But there is much more to come.

The Cracklash begins

It’s not just the evidence for chiropractic that’s a bit shaky these days.

For a long time, there has been an uneasy truce between the different chiropractic factions in the UK, all believing different things and each with different rituals.

It seems that they all came together when statutory regulation was first mooted and the carrot of respectability that that offered overcame those fundamental differences — temporarily at least.

Since the GCC was set up, the trade bodies representing the different factions (‘straights’, ‘mixers’, etc) appear to have been reluctant bedfellows, and there seems to have been various fallings out and lots of jostling for position and power.

But they trundled along and put a brave face on things for the sake of the profe$$ion.

After the BCA’s misconceived attack on Simon Singh, sceptical eyes were focused on chiropractic and the claims made by its followers. After being disgusted by the claims we saw being made by a large number of chiropractors on their websites, Simon Perry and I independently poked the GCC with a somewhat sharp stick.

What a hornet’s nest we stirred up, with the GCC eventually acknowledging that chiropractic had to be based on proper evidence and not on wishful thinking.

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Standing up for science and evidence

Science and evidence frequently have a hard time surviving in the seat of our democracy, but it seems it is going to become even more difficult in this new session, particularly where health is concerned.

David Tredinnick (Conservative, Bosworth) — he of astrology software expenses fame — put down four Early Day Motions about homeopathy a few days ago. They are unbelievably ignorant of science and Julian Huppert (LibDem, Cambridge) tabled amendments to correct Tredinnick’s misaprehensions and misunderstandings.

EDMs don’t really change much, but it is sometimes important to put a marker down. And, given Tredinnick’s and Nadine Dorries‘ recent appointments to the Health Select Committee, this is even more important. So I have just emailed my MP, Barry Gardiner, urging him to support Julian’s amendments:

Barry

We strongly urge you to support Julian Huppert’s amendments to EDM 284, 285, 286 and 287 originally laid by David Tredinnick. We hope we don’t have to explain the woolly thinking and utter disregard for evidence that is embedded in the original motions.

Julian’s amendments correct that nonsense: it is important that a marker is put down that Parliament will not support such ignorant notions and that it is made clear that homeopathy is dangerous pseudo scientific quackery.

With the astonishing appointment of David Tredinnick and Nadine Dorries to the Health Select Committee, we can see many battles looming ahead and we need to ensure that health decisions and funding are based on facts, not fantasy.

Two articles in today’s Guardian are worth reading if you are not familiar with Tredinnick and Dorries’ views on science:

Conservatives put Dumb and Dumber on the Health Select Committee by Martin Robbins

Health select committee lunacy by Adam Rutherford

We look forward to receiving your reply and your support

Thanks and best regards.

I’ll post any reply I get and urge others to write to their MPs asking them to stand up for science and evidence.

The Long and Winding Road

It’s been a while since I blogged about the progress of my complaints to the GCC and it’s time for an update.

In fact, it’s been a full 12 months — to the day — since I submitted my complaints. How time flies.

I’m sure no one is interested in all the minutiae of this, so here’s a brief summary:

  • Hundreds of emails and letters have been received and sent;
  • I’ve had two meetings with GCC’s two firms of lawyers;
  • I’ve received 11 lever arch files of paper copies of chiropractors’ websites;
  • I’ve been sent 290 sets of chiropractors’ observations on my complaints, sometimes at the rate of 40 a day: the postie complained.

Meantime, the GCC:

  • have had to get their rules changed by the Privy Council to allow them to survive financially;
  • have had to employ six new staff (admins and paralegals) to cope with the workload;
  • have commissioned a review into the evidence for chiropractic — the Bronfort report;
  • have held lots of meetings with the Department of Health, a QC and their lawyers.

But they have barely started to even consider the first of my complaints.

So, what’s taken all this time, what are the 290 envelopes all about and when will it all be over and done with?

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