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.
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.
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.
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?
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.