The random thoughts of a sceptical activist

Murky waters

In The beginning of the end? Part two, I mentioned there was going to be more on sciatica.

I have already described how the GCC have dealt with chiropractors making claims about sciatica, even though the GCC admits that:

…there is no high or moderate positive evidence from randomised controlled trials that would support an advertised claim regarding sciatica using manual therapy. In the light of this, the Investigating Committee concluded that it could be inappropriate for you to make such an advertised claim.

Despite this damning statement, the chiropractors I’ve been told about so far have all been let off for making claims about sciatica.

However, it appears that there is more to this than first meets the eye.

The GCC’s Chief Executive and Registrar, Margaret Coats, appears to have sent the following letter (cached) to registered chiropractors:

GCC APPROACH TO PRESENTATION OF CASES RELATED TO CLAIMS MADE ON CHIROPRACTORS’ WEBSITES

Once the GCC statutory Investigating Committee, acting on legal advice, has come to its independent decision to refer a complaint to the Professional Conduct Committee, the relevant GCC officer works with our solicitors to decide how to proceed with the presentation of the case.

In respect of the case concerned with claims made on chiropractors’ websites the GCC, in its case presentation role, has given very careful consideration to the fact that throughout the period October 2003 to March 2010 the patient information leaflet published by the GCC contained reference to sciatica, asthma and infant colic.

GCC officers have been advised that the reasonable course of action in respect of the case presentation is to accept that chiropractors were entitled to rely on information published by the regulator about these conditions.

In light of that advice, the GCC in its case presentation role will not be proceeding in respect of any claim that chiropractic can treat sciatica, asthma or infant colic as listed in the particulars and/or any schedule to an allegation.

Margeret [sic] Coates [sic]

Chief Executive & Registrar

June 2010

(I asked for confirmation from the GCC that this is accurate. I have not had a satisfactory reply and have submitted an FOIA request for a copy of that letter; I’m still waiting for an acknowledgement.)

I find this letter astonishing.

What the PILs say

I’ve already looked at the changing claims made in the GCC’s Patient Information Leaflet. That covered the September 2007 version, the revised June 2009 version and the October 2009 version. I don’t have a copy of the 2006 version (do you?), but here’s what other versions had to say:

October 2003

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 primarily treat:

  • Spine neck and shoulder problems
  • Joint, posture and muscle problems
  • Sciatica
  • Sports injuries
  • Tension headaches

Benefit may also be seen for some types of:

  • Asthma
  • Digestive disorders
  • Migraine
  • Infant colic

April 2005

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:

  • spine 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
  • Menstrual pains

September 2007

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

June 2009

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

October 2009

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.

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.

March 2010

.

No, I didn’t miss anything out of that last one. This is the latest version and they are now not making any specific claims for chiropractic.

Sciatica disappeared in October 2009, as a result of a complaint to the ASA by Simon Perry. Asthma and infant colic persisted until after the Bronfort Report was published.

But that doesn’t quite accord with what the GCC said in their letter (see above). They said:

In respect of the case concerned with claims made on chiropractors’ websites the GCC, in its case presentation role, has given very careful consideration to the fact that throughout the period October 2003 to March 2010 the patient information leaflet published by the GCC contained reference to sciatica, asthma and infant colic.

It may have been up to March this year for asthma and infant colic, but it was October last year for sciatica.

Deeper

Such inaccuracies are annoying, but there is a bigger issue here.

If the letter above is correct, the GCC have told their chiropractors:

GCC officers have been advised that the reasonable course of action in respect of the case presentation is to accept that chiropractors were entitled to rely on information published by the regulator about these conditions.

In light of that advice, the GCC in its case presentation role will not be proceeding in respect of any claim that chiropractic can treat sciatica, asthma or infant colic as listed in the particulars and/or any schedule to an allegation.

However, the GCC told the chiropractors who had made claims about sciatica:

The [Investigating] Committee noted from the [Bronfort] report that there is no high or moderate positive evidence from randomised controlled trials that would support an advertised claim regarding sciatica using manual therapy. In the light of this, the Investigating Committee concluded that it could be inappropriate for you to make such an advertised claim.

While the website pages provided contain a claim to be able to treat a condition where there is no high or moderate positive evidence from randomised controlled trials that would support such a claim…the Committee considered that the website pages provided do not, in its view, raise any other areas of concern.

In these circumstances, and having taken all the information before it into consideration, the Investigating Committee has concluded that the facts of this complaint, taken at their highest, would not be capable of amounting to unacceptable professional conduct and therefore there is no case to answer.

So which is it? They can’t have it both ways. What is the real reason they’ve dismissed complaints about sciatica?

…and deeper

Now we get into even deeper — and murkier — waters.

I complained that some chiropractors were making claims that I didn’t think were backed up by the high standard of scientific evidence required by their CoP, including ASA guidance. However, instead of referring to that ASA guidance, the GCC invoked The Consumer Protection from Unfair Trading Regulations 2008 and ignored the ASA guidance.

Nevertheless, what they say is that the advertiser must hold robust scientific evidence for those claims and a patient information leaflet does not — by any stretch of the imagination — amount to robust scientific evidence.

But since the GCC have already dismissed complaints about sciatica, all we can do — for the time being — is speculate.

What if…?

What if the GCC had decided to pursue complaints about claims for sciatica? When a complaint comes before the PCC, the GCC takes it over and they prosecute the chiropractor on behalf of the original complainant.

If accused of claiming to treat sciatica, a chiropractor defending him or herself could simply have said that they thought it was OK to make that claim because the GCC — their statutory regulator — said that’s what chiropractors treat. Indeed, many of them have already tried that gambit in their observations on my complaint.

But that would put the GCC in an untenable position; one that might leave them open to legal action, particularly if the PCC found the chiropractor guilty.

Have the GCC tried to circumvent that little problem by concocting some new rules?

They’d be getting into very murky and dangerous waters if they did.

9 Responses to Murky waters

  • Another excellent and well researched blog post, thanks.

  • I realise this is slightly off topic (apologies for that), but I’d value thoughts of any readers. Basically, does this site constitute an advertisment for chirorpactic?: http://www.bayschiro.co.nz/ My feeling is that it does (I complained to the NZASA, as it refers to infantile colic), but the New Zealand ASA’s opinion is that it is a website not an advert and theefore my complaint will not be considered

  • Poor Baby. Like a mosquito,can’t someone please swat Andrew and put us out of our misery.

  • William

    Can I remind you of the rules of this blog, particularly number 6?

    If you can’t contribute to the comments without resorting to personal abuse, don’t.

  • 1,000 pardons m’liege. I hope I hath not offended thee or Andy.

  • Well colour me surprised!

    If making unsupported claims does not amount to professional missconduct (it’s only a few little white lies that harm no-one after all) in the eyes of chiros, I would be curious to discover what does.

    I suppose this will all end up in the high court where a judge will end up deciding what “professional” conduct actually means. Hopefully it will eventually turn out to mean something more than “I charge money”.

    Count me in for (small:) financial support when it is required.

    By the way, this might be of passing interest to some.
    The flying chiro:-
    http://www.dailymail.co.uk/news/article-1300009/Angry-car-owner-jailed-grabbing-helicopter-tried-off.html
    Don’t forget that search engine thing.
    A Jetranger seems to be about £500 an hour to hire.

    Sorry but I don’t like shrunk URLs due to the security concerns they present.

  • James Jones

    You can create links in a comment using the HTML a tag – see this page.

    So your Daily Mail link could look like this without using a URL-shrinking facility. Some URL-shortening websites also allow you to give a preview of the page before visiting it.

  • Is the above irrelevant link abuse of your topic Zeno?

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