The beginning of the end? Part two
Last time, I said I’d have more to say on the letters I’ve received so far.
I said that seven of the 36 were dismissed because the chiropractors mentioned on the websites were no longer at that clinic and therefore — by the GCC’s reckoning anyway — were no longer responsible for claims made. My arithmetic was faulty; there were eight, leaving 35 others. I’ve corrected the previous blog post.
This post deals with why the Investigating Committee (IC) decided there was no case to answer in most of these 35.
Sciatica
The vast majority of the 35 had made claims about sciatica — it was claimed on 31% of the sites I included in my complaint. (There will be more on sciatica in a future blog post.)
The IC said:
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.
Nothing unexpected there. But the attentive reader will know by now that it may not always be that simple:
In the light of this, the Investigating Committee concluded that it could be inappropriate for you to make such an advertised claim.
It ‘could be inappropriate’ to make a claim not supported by good evidence??? When might it be appropriate???
However, having found evidence that the chiropractor had indeed made the claims I was complaining about and having decided that there was no robust evidence to substantiate that claim and that it could be ‘inappropriate’ for them to make such a claim, did they decide there was a case to answer?
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.
The key phrase here is ‘unacceptable professional conduct’.
Clause 20.—(2) of the Chiropractors Act 1999 defines this term:
In this Act conduct which falls short of the standard required of a registered chiropractor is referred to as “unacceptable professional conduct”.
So a chiropractor, making a claim for which there is no evidence is not considered to be unacceptable professional conduct and therefore has no case to answer. Such conduct does not fall short of the required standard, apparently.
This does not bode well.
When is a list of conditions not a claim to treat those conditions?
Taking one of them as an example, a chiropractor had stated on his website (cached) — and in fact, still makes exactly the same claims:
Chiropractors successfully treat a wide variety of problems such as back pain, neck pain, sciatica, trapped nerves, sports injuries, head-aches, car accident neck sprain injuries, leg or arm pain, stiff joints and wear/ tear, repetitive strain injuries (RSI’s) and muscle tension problems.
They are clearly making a claim that chiropractic treats sciatica (I’ll come to the other claims later) — and the GCC agrees.
But many websites never actually used the word ‘treat’ or ‘cure’ or anything similar. Many just had a list of conditions.
Like this clinic in Leicester. This website has been completely demolished and no longer exists, access in archive.org has been blocked, and the domain registration has just expired, but this is one of the pages I submitted to the GCC:
A list of medical conditions, but no help/treat/cure/ease/alleviate symptoms or other woolly weasel words. What message is the reader intended to take from that list?
If these chiropractors aren’t claiming they can in some way influence those particular conditions, what’s the list for? Is it a list of the conditions the chiropractors themselves suffer from, perchance?
Anyway, how did the IC deal with this one?
They said the list was a list of conditions, but decided:
…however it was not clear from the website extract provided whether you made a publicised claim to treat sciatica on your website.
Sorry? What isn’t clear, exactly?
I have little doubt that the ASA would consider such a list of conditions as a claim to treat those conditions. As I’ve pointed out before, the ASA cover implied claims as well as direct ones (clause 3.1 of the CAP Code). But then again, the IC don’t seem to be at all interested in what the ASA have to say on anything, despite the CoP mandating that chiropractors follow their guidance.
Pathetic excuse #1
Well, if the IC weren’t clear about something, it might be an idea to ask the chiropractor concerned what he/she meant.
It did cross their minds:
The Committee considered whether it should ask you to provide further information about these references as they appeared on your website,
Good (but you know there’s a ‘but’ coming):
…but was mindful that due to the passage of time that has elapsed since the complaint was submitted, it could not be certain that any web pages as they appear now would be the same as when the complaint was submitted.
Yes, it all happened a long time ago…
The Committee concluded that there is insufficient evidence available to it for it to consider this matter further.
Because it all happened a long time ago, they gave up.
Anyone spot the non sequitur: “The IC considered whether it should ask about the references as they appeared on the website, but decided not to because the current site might not be the same”?
Is that really the best excuse they can come up with?
Real reasons?
I’m open to suggestions as to why the IC made this bizarre decision, but I note the chiropractors at this particular clinic include Tim Hutchful and Colin Rose, Secretary and Director respectively of the BCA.
I also note that five of the eight chiropractors on the IC are members of the BCA.
A case to answer?
There are some legal issues to be considered around this, but, for now, I’ll simply state what the Chiropractors Act 1999 has to say about the duty of the IC at this stage. It states that the IC shall:
…consider, in the light of the information which it has been able to obtain and any observations duly made to it by the registered chiropractor concerned, whether in its opinion there is a case to answer.
The Investigating Committee Rules 2000 say little more.
Have they applied these rules in this case? The phrase ‘information which it has been able to obtain’ does imply that they have to actively do something, but have they tried hard enough to gather information? We already know they rejected my comment document, although they said
The Investigating Committee did not consider that your letter raised any points that it had not given careful consideration to when making its decision…
Whether or not they have, the rules say nothing about not bothering to ask for information just on the off chance it might be a bit out of date.
But what about the other conditions?
A very good question.
In the first example I used above, the website made claims about many other conditions. To recap:
Chiropractors successfully treat a wide variety of problems such as back pain, neck pain, sciatica, trapped nerves, sports injuries, head-aches, car accident neck sprain injuries, leg or arm pain, stiff joints and wear/ tear, repetitive strain injuries (RSI’s) and muscle tension problems.
Surely these are conditions that Bronfort either didn’t find any evidence for or found there was no good evidence for?
Again, it’s not so simple.
The IC noted references to these conditions (although, bizarrely, a slightly different list):
The Investigating Committee noted the reference to trapped nerves, sports injuries, trauma injuries, leg and arm pain, stiff joints and wear/tear, repetitive strain injuries, muscle de-conditioning problems, neck sprain injuries and muscle tension problems. It concluded that such terms are broad in nature and the pages provided do not enable the Committee to understand what is covered by the use of these terms.
So they have refused to consider these because they couldn’t understand what the chiropractor meant by them. However, they went on to repeat the nonsense about not bothering to ask the chiropractor for further information…
Because these ‘broad’ terms were not mentioned specifically by Bronfort, doesn’t that mean that there is no good evidence for them and therefore — by the GCC’s own argument — should not be being claimed by chiropractors? In their guidance on advertising, they say:
…any claims you make must be based on best research of the highest standard.
So, where’s the ‘best research of the highest standard’ for trapped nerves, RSI, neck sprains, etc, etc?
ASA guidance
As I mentioned in Part one, the IC did not, in the letters, refer to the ASA guidance their chiropractors are supposed to adhere to, and provided no explanation for this omission.
Given that guidance and their past adjudications, I am convinced that, had the IC followed ASA guidance, they could not possibly have come to these bizarre conclusions.
Robust guidance, properly and diligently applied is what is needed to properly protect the public, not the feeble excuse that “it wasn’t really a claim to treat, but anyway, we don’t really know what they meant therefore we give up”.
Did they even consider all the evidence?
The Committee carefully considered the complaint made by Mr Henness and all of the documentary evidence provided to it, as set out in Appendix 1.
Appendix 1 listed:
- Letter of complaint with enclosures
- Website extract(s) provided by the complainant
- Your observations on the complaint
What about the evidence I provided to the GCC? Have they considered that — particularly what I said about the proper application of ASA guidance? Despite promises, I strongly doubt it.
Much more to come
But don’t worry, there is more to come. Much more.
I’ve still to be told about the other 500-odd cases. Even the best whitewash might not be white enough.
Going by the 72% of Simon Perry’s complaints that have so far been passed on to the PCC, I don’t think any chiropractor should be too heartened by this first round — a round that is by no means over.
94 Responses to “The beginning of the end? Part two”
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It’s a whitewash all right and confirms that the chiropractic ‘profession’ is utterly corrupt from the top down.
I have no idea of how the IC works, but if all of the IC members have one equally weighted vote regarding whether any complaint should be upheld or even dealt with, then I guess it’s always going to be an outcome of at least 8 to 4 in support of chiropracty.
The more I read about chiropracty, the more I become convinced there is no logical reason why it should exist (apart from to provide chiropractors with a job). Providing patient choice and offering drug/surgery free alternatives? Sorry, that’s just words. As far as I understand it, the evidence is simply not that strong that basic chiropractic malarkey works, beyond simple placebo effect, for anything! I’m sure some of the things that chiropractors suggest do help, such as weight advice and exercise and stretching etc. But I fail to see how this can possibly justify how they have set themselves up as ‘health care professionals’ entitled to use the title of doctor.
I think that brilliant quote that Zeno found from Christopher Kent sums up chiropracty so well, “…are we a profession simply seeking some niche which offers access to a slice of the health care pie?” Surely this is an Emperor’s new clothes kind of question – Of flipping course they are! And they haven’t found it yet!
Zeno,
Have you any news on comment on this message that “We’re all Doomed” left on your last post:
“Just found out that the GCC, after taking legal advice, cannot go ahead with your complaints. Any conditions which they were promoting/endorsing at the time of your omnibus complaint prohibits them from disciplining those chiros that were simply following their example.”?
David
You’ll need to wait for my next blog post.
Thank you for another intriguing post, Zeno.
Even if the GCC were to keep a tight check on claims made by chiropractors by applying proper ASA guidance, patients would still not be protected from the chiropractic ‘bait and switch’: http://www.dcscience.net/?p=1516
Although we know that the GCC has recently ruled that the chiropractic vertebral subluxation complex is an historical concept and that it is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns, its definition of evidence-based care remains as follows:
Quote
“…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.”
Unfortunately, that allows for quackery such as Applied Kinesiology and Craniosacral Therapy to fall within its definition. See here:
http://jdc325.files.wordpress.com/2009/06/gcc-ak.pdf
Since the vast majority of chiropractors in the UK work in private practice, I think it’s high time that the public was told that although the GCC has influence over chiropractors’ advertising, it has no real powers to limit chiropractors’ scope of practice, and that, as a consequence, patients are in real danger of wasting their time and money on useless (and in some cases, potentially lethal) treatments.
@ Zeno,
Thank you; I shall be interested to hear what they have said.
Zeno,
This is not meant to be an argumentative or personal comment, so please don’t read it as such. It is simply a matter of relevence to the topic.
I made a comment on your last post about the contributions made by Blue Wode and I have to say that I believe it applies as much to this latest one as any of the previous ones:
“Can you see a pattern to Blue Wode’s contributions to this blog? It seems quite obvious to me that his/her sole intent is to denigrate chiropractic at any and every opportunity, shoehorning irrelevant quotes and references in wherever possible.
One really has to wonder what the motive is. Personally, I find it hard to believe that it’s public interest; it has all the hallmarks of pure malice as far as I can tell.”
David
Which bit of Blue Wode’s comment do you think is not relevant to the topic of the regulation (or otherwise) of chiropractors?
@ David
You can read the GCC letter sent to Chiropractors on Richard Lanigan’s blog
http://www.chiropracticlive.com/?p=790
The GCC do not have to punish those chiropractors who have made unsupportable claims. Simply telling them to not make such claims, and enforcing that (watching, warning, with potential punishment for repeat offenders) would be major progress.
The investigating committee seems to have failed in its role, because making unsupported claims is a breach of Advertising standards rules, and breaking Advertising standards rules is a breach of GCC code of conduct. They seem to have actually made the standard be “worth punishing” rather than “a case to answer” or even their watered down (and highly dubious) modified version of “reasonable prospect of success”.
@Davidp
the only reason for the GCC’s failure to enforce ASA rules is that it was in breach of these rules itself. Therefore enforcing these rules would mean possible litigation supported by the fact that chiropractors were only following example. As I said many times before, I really do believe that the majority of chiropractors (very few of which will actually treat for all these claims) were merely following example of list of claims from most authoritative source.
@Blue Wode
the GCC has not “ruled” that the subluxation concept is an historical concept and that it is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns. It is just stating the obvious: It’s a concept without scientific evidence. Sorry, but the way you are making the comment just sounds like you actually think the term “historical” means “without value”. As I stated to Zeno, before, it is an historical concept, always has been and always will be until the evidence emerges to support at least parts of its original theory, if it ever emerges. The rest is just emotive. Also your critique of the GCC’s definition of EBM is just obscene; take a look at the GMC’s definition, it’s quasi identical and for very good reason as any more restrictive would pretty much put all healthcare flat on its bottom and render it useless.
Lastly you comment that as a consequence of the GCC’s inability to limit scope of practice the public might be at risk of wasting their time and money on useless (and in some cases, potentially lethal) treatments. Could you please provide some references or reasoning behind this? Do you have any knowledge of success or risk stats to back this up? And would you be able to tell us all how that this has anything to do with the GCC’s scope of practice? Advertising standards and scope of practice are very different things. Some chiropractors made statements they shouldn’t have had they looked at the research available. THey didn’t they looked at the GCC-errore humanum est. The fact that research is not available for something does not mean that they have not had great success with the treatment. It just means there is no research (to support or reject I hasten to add). Which is why you will find that most of us have great reputations, great practices and the work comes to us by word of mouth rather than websites or advertisements. Helping primarily chronic back pain, at an average cost of £320 per case and a success rate of %98 doesn’t seem like “a waste of time and money on useless treatment”. That said, please do let me know if you actually have anything to back up your claims to the contrary. If you haven’t, then your opinion is as good as any chiropractor’s and you will have to agree on being equal. I on the other hand can back up my claims…
Stefaan Vossen
This is only the beginning
@ Stefaan Vossen
You wouldn’t happen to be posting as ‘rwk’ or ‘nwtk2007’ in the comments section here:
http://www.sciencebasedmedicine.org/?p=5897
It looks they are also not finding it easy to understand the points being made.
As for all your questions, you’ll find the answers to them here:
http://www.ebm-first.com/chiropractic.html
@ Blue Wode,
no, I post under my own name, always. The website you refer to spawns the usual drivel which does not answer the questions at all, but then this is not your aim after all is it?
http://www.chiropracticlive.com/?p=794
Stefaan Vossen Doctor of Chiropractic
@ Stefaan Vossen
I suggest you start with this section:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues.html
@Blue Wode
I suggest you reflect on your motives and understandings of what chiropractic is. It is customary for people to study their topic prior to critiqueing. At least if they wish to be taken seriously, otherwise, as I already observed to you, it would make you nothing more than a heckler. Could you please answer my questions to you? The information your provide does not answer the questions. If you need further clarification as to their meaning, please feel free to ask.
Stefaan
Re: Blue Wode
I refer to my last post, which can be read here: http://www.zenosblog.com/2010/07/the-beginning-of-the-end-part-two/comment-page-1/#comment-7196
@Blue Wode
or this one here:
http://www.zenosblog.com/2010/06/the-cracklash-begins/comment-page-1/#comment-6907
@Blue Wode,
on the one page you referred me to alone there are (at least) misquotes in relation to the SCA and McT, decontextualisations in relation to “allergies” and “chiroquakery” and very questionable references and unattributable quotes in relation to “vaccinations”.
Sorry, but you’re no skeptic, you’re a quack, representing yourself to be something you’re not, you are misleading the public by attributing yourself to hold the skeptical stance and should be taken through ASA for misleading the public by saying you’re a sceptic when you’re not and in the process possibly risking people wasting valuable time and money on useless treatments as they have been dissuaded to try effective and efficient chiropractic care…
Just busting some balls
Stefaan
@BW, your site is down! don’t worry I have a cached version of it if you’d like…
@ Blue wode
I’m rwk not nwtk2007. I find it easy to understand what’s going on ( SBM blog) as I’ve been in practice for 20 years. I’ve worked as a locum tenens for greater than 50 other chiropractors and
I believe I have a right to make comments on the state of everyday practice. I have not seen nor caused a stroke. I’m pretty much amazed at how many lay people there are here and other blogs
that are now experts on chiropractic because they read Trick or Treatment and a few other things.
It’s the same argument back and forth. No winners here. By the way Bronfort is going to be giving
a lecture on EBM at my alma mater,NUHS ( yes,a university with a chiropractic school) and I’ll be
sure to let him know BW,Zeno and the rest all said hiya.
Robin wrote: “I have not seen nor caused a stroke.”
You cannot know for sure that you haven’t caused a stroke…
Quote
“Sometimes the damage is immediate and the patient collapses on the chiropractor’s table. Sometimes mild symptoms start immediately and progress after the patient leaves the chiropractor’s office. Sometimes the tear is a small one and it clots over; then days later the clot breaks loose, travels to the brain and causes a delayed stroke. By this time, the patient may not connect his sudden collapse to the previous visit to the chiropractor.How often can a stroke be attributed to neck manipulation? We really don’t know. Estimates have varied from one in ten million manipulations to one in 40,000. I should clarify that only one specific type of stroke, basilar stroke, has been linked to chiropractic. It has been estimated that about 20% of all basilar strokes are due to spinal manipulations. This would work out to about 1300 a year in the U.S. But we just don’t know, because it has not been properly studied. Carotid artery strokes have also been reported after chiropractic treatments. Chiropractors do not follow up on every patient. Patients who have delayed strokes may never see their chiropractor again, so chiropractors would naturally tend to underestimate the risk. Many of these diagnoses are missed because the vertebral arteries are not typically examined on autopsy.”
http://www.sciencebasedmedicine.org/?p=94
Robin wrote: “By the way Bronfort is going to be giving a lecture on EBM at my alma mater,NUHS ( yes,a university with a chiropractic school) and I’ll be sure to let him know BW,Zeno and the rest all said hiya.”
Would that be the same Bronfort who serves on the NCCAM’s National Advisory Council for Complementary and Alternative Medicine (NACCAM)?
http://nccam.nih.gov/about/naccam/roster.htm
Because if so, the Skeptic’s Dictionary has this interesting observation to make about the NCCAM:
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.”
-snip-
News stories
$2.5 billion spent, no alternative cures found (big, government-funded studies show alternative health treatments work no better than placebos. “It’s the fox guarding the chicken coop,” said Dr. Joseph Jacobs….”This is not science, it’s ideology on the part of the advocates.”)
Critics Object to ‘Pseudoscience’ Center (“The impending national discussion about broadening access to health care, improving medical practice and saving money is giving a group of scientists an opening to make a once-unthinkable proposal: Shut down the National Center for Complementary and Alternative Medicine at the National Institutes of Health.”)
http://www.skepdic.com/NCCAM.html
Hardly reassuring, is it?
BTW, I see the NUHS (Robin’s alma mater) has a large acupuncture program:
http://www.nuhs.edu/show.asp?durki=17
That’s surprising to see when one considers that acupuncture is increasingly being shown to be little more than a theatrical placebo.
@ davidp
“The GCC do not have to punish those chiropractors who have made unsupportable claims. Simply telling them to not make such claims, and enforcing that (watching, warning, with potential punishment for repeat offenders) would be major progress.”
I agree. The GCC has got itself in a right mess. In their attempts to ensure that they are seen to be doing their job, they have bent over backwards to accommodate Mr Henness and are, at great expense, going to ridiculous lengths over this.
The trouble is that the GCC’s own procedures demanded that they deal with the complaints in this way, each and every one being examined and processed in its own right. I’m sure that Mr. Henness couldn’t believe his luck when he realised how big his impact was on the GCC. I suspect that his reason for submitting 500+ complaints was originally an effort to demonstrate the extent of the problem as he saw it and to cause as many members of the BCA to be disciplined as possible. Let’s not forget that the stimulus for the complaints was an action of support for Simon Singh’s defence of his libel of the BCA. The purpose was to discredit the BCA and it’s members.
A side effect was to potentially bring the GCC to its knees and I’m sure that there are many “sceptics” who would be pleased to see that happen, in the misguided belief that that would be some sort of victory. What they should remember though, is that without the GCC there would be no regulation of the chiropractic profession at all, returning it to the bad-old-days when anyone, with no training, qualifications, standards of proficiency or code of practice, could call themselves a chiropractor. How is that going to benefit anyone?
I believe that the GCC, having already achieved one change in the law to allow them to consider these complaints without folding, should have sought another so that they could consider all the complaints as one, which I believe is what was intended. That would have allowed a determination on the issues much sooner, to the satisfaction, or otherwise, of all concerned.
Of course, the GCC has made life more complicated for itself by not managing to follow its own guidance in relation to the conditions it has publicised the chiropractic management of. That’s embarrassing enough for me as a chiropractor, let alone for the GCC.
Unfortunately, they are now committed to pursuing this matter in the manner they have started. Some (?many/most) chiropractors will be told they have no case to answer, which will be a relief to them but described as a white-wash by the “sceptics”. Others will be disciplined, and some will deserve to be, for intentionally misleading the public, and I have no problem with that.
However, I come back to your point that the simplest, and I believe best, option would have been to consider and then clarify the situation for all chiropractors and the public, and then properly police it after that.
David wrote: “…the simplest, and I believe best, option would have been to consider and then clarify the situation for all chiropractors and the public, and then properly police it after that.”
But how is that possible for the GCC to police such a situation when it has already declared in a letter to Action for Victims of Chiropractic, on 17th June 2004, that is not an inspectorate? See here:
http://web.archive.org/web/20060924185126/http://www.chirovictims.org.uk/images/GCC+letter+Page+2+17+June+2004.pdf
The current regulatory set up appears to leave it to patients to recognise false advertising (and when their treatment might be dangerous, bogus, or unnecessary).
A new pro-active (rather than reactive), chiropractor-free, independent regulatory body appears to be what’s needed.
@ Blue Wode,
I don’t agree. Once the GCC has put its house in order with regard to its own literature and correctly advised registrants with respect to their publicity material, it can remain largely reactive. This is the manner in which the General Medical Council and the General Dental Council operate and is the proper and appropriate manner for the GCC to operate as well.
Let’s face it, there seem to be plenty of “sceptics” available, let alone patients, to report any non-compliance.
The suggestion of a chiropractor-free regulatory body is ridiculous, as you know.
Two interesting articles that have arrived in my inbox this evening:
1) “Further evidence has come to light suggesting that GlaxoSmithKline knew about an increased cardiac risk with the diabetes drug rosiglitazone (Avandia) as early as 2001 but withheld the data and that certain officials at the FDA conspired with the company to minimize the impact of later safety results”
http://www.medscape.com/viewarticle/725012?sssdmh=dm1.626649&src=nldne&uac=148070PR
2) “Physicians should not prescribe the malaria drug quinine (Qualaquin) for nocturnal leg cramps — an off-label use — because it may result in serious and life-threatening hematologic adverse effects, the US Food and Drug Administration (FDA) announced today……….. The FDA issued a similar warning in 2006, but the agency noted today that the majority of quinine used in the United States is still for the prevention or treatment of leg cramps.” http://www.medscape.com/viewarticle/724798?sssdmh=dm1.625757&src=nldne&uac=148070PR
Relevant because of the issues of regulation and compliance.
David “The suggestion of a chiropractor-free regulatory body is ridiculous, as you know.”
Why’s that ridiculous?
There are always calls for complaints about the police to be handled completely independently of the police (they can always get any necessary advice from an expert if required) and the PCC to be completely independent of the press. Why should that not be the same for chiros?
If there is a clear set of rules that have to be followed, then it doesn’t take a chiro to tell whether one of the rules has been broken. If specialist advice is needed about say xrays or whether some chiro technique technique was the right one, they can ask an expert. In fact arent the GCC in the habit already of paying chiros like Richard Brown to provide expert chiro testimony?
Which bit of “you must only advertise consistant with the law and ASA guidance” does it need a registered chiro to decide on?
Yes, David. Wow! Big Pharma and MDs aren’t perfect either and need tighter control and oversight.
Next!
@ JoeMac
“David “The suggestion of a chiropractor-free regulatory body is ridiculous, as you know.”
Why’s that ridiculous?”
Considering that every aspect of regulation of the chiropractic profession is by definition going to involve chiropractic, it makes sense for chiropractors to be present on the GCC. However, it also makes sense for there to be lay members on the GCC, which is why there are lay members on the GCC.
@ JoeMac
“Yes, David. Wow! Big Pharma and MDs aren’t perfect either and need tighter control and oversight.
Next!”
Yes Joe, my point precisely.
Chiropractors are no better, AND NO WORSE, than MDs or Dentists, or Vets, or Osteopaths etc. So, there’s no justification for this vendetta against chiropractors?
David
You seem to have completely missed my question:
“Which bit of “you must only advertise consistant with the law and ASA guidance” does it need a registered chiro to decide on?”
David
So Big Pharma and doctors are lying, cheating, killing megalomaniacs out to make money regardless of human suffering therefore it’s Ok for chiros to be as well? Don’t you want chiros to be better than the enemies so many of them despise?
@JoeMac
The GCC have got rather more to deal with than simply ensuring compliance with ASA standards, although it is currently being prevented from doing much else because of a couple of well- publicised complainants.
Are you seriously suggesting that the GMC should be a doctor-free organisation? Or, that dentists should be regulated by an organisation with no dentists involved?
@ JoeMac
“So Big Pharma and doctors are lying, cheating, killing megalomaniacs out to make money regardless of human suffering therefore it’s Ok for chiros to be as well? Don’t you want chiros to be better than the enemies so many of them despise?”
I have no idea where you got the notion that I consider doctors and drug companies in that fashion. I also have no idea why you believe that these people are my enemies. We are all working in healthcare and I hope, and believe, that the vast majority of my medical colleagues have just as much honesty, integrity and professionalism as I do.
It is absolutely clear that a good many chiropractors make claims that are not supported by evidence. This is a problem and I don’t see it being resolved anytime soon (even with the outstanding efforts made by Zeno and Simon Perry).
So how about this for an idea: Individual Chiropractors no longer be allowed to advertise their services. All they may do is have a line entry in the white pages under the heading of chiropractors. (This should not affect Stefaan as he works entirely from referral and recommendation.) The GCC or BCA simply publish a list of all registered chiropractors and state the scope of chiropractic practice, as supported by proper scientific evidence. (i.e., they may possibly be able to help with a bit of lower back pain.)
David
“The GCC have got rather more to deal with than simply ensuring compliance with ASA standards, although it is currently being prevented from doing much else because of a couple of well- publicised complainants.”
So which sections of the COP do you think can *only* be decided by a chiro?
A You must respect patients’ dignity, individuality and privacy
B You must respect patients’ rights to be involved in decisions about their healthcare
C You must justify public trust and confidence by being honest and
trustworthy
D You must provide a good standard of practice and care
E You must protect patients and colleagues from risk of harm
F You must cooperate with colleagues from your own and other professions
David
I neither know nor particularly care what you think about doctors and drug companies or whether you think you’re working in healthcare. I wasn’t talking about you specifically – I was talking about some chiros who seem to intensely dislike medical doctors and those nasty drugs that they force on people. Perhaps I’ve looked at too many US chiro websites?
As for honesty, integrity and professionalism does that include making claims about conditions for which there is not, and has never been, any good evidence?
@Blue Wode
I see I got a cut and paste regurgitation from you:
Blue_Wode on Fri, 11/20/2009 – 22:23
Title: Chris Pickard, thank you for
Chris Pickard, thank you for your comments.
You say that over the past seven years you have treated 3,000 people, “none of whom have died of a stroke after being adjusted”. How do you know that? How do you know that patients that you’ve never seen again haven’t had a stroke as the result of being “adjusted” by you? Here’s the problem:
Quote
“Sometimes the damage is immediate and the patient collapses on the chiropractor’s table. Sometimes mild symptoms start immediately and progress after the patient leaves the chiropractor’s office. Sometimes the tear is a small one and it clots over; then days later the clot breaks loose, travels to the brain and causes a delayed stroke. By this time, the patient may not connect his sudden collapse to the previous visit to the chiropractor…How often can a stroke be attributed to neck manipulation? We really don’t know. Estimates have varied from one in ten million manipulations to one in 40,000. I should clarify that only one specific type of stroke, basilar stroke, has been linked to chiropractic. It has been estimated that about 20% of all basilar strokes are due to spinal manipulations. This would work out to about 1300 a year in the U.S. But we just don’t know, because it has not been properly studied. Carotid artery strokes have also been reported after chiropractic treatments. Chiropractors do not follow up on every patient. Patients who have delayed strokes may never see their chiropractor again, so chiropractors would naturally tend to underestimate the risk. Many of these diagnoses are missed because the vertebral arteries are not typically examined on autopsy.”
Much of what you say above is not referenced by Harriet Hall who of course is a skeptic
You said,
You cannot know for sure that you haven’t caused a stroke…
Then neither can anyone who’s ever touched,examined or massaged someone else’s neck as well.
And you don’t know how I approach (or don’t) a patient’s spine.
I suggest that if it is your mission to take down chiropractic, you ought to spend some time
in several offices. Go visit Stefaan. Then after after a lengthy observation you’d have the right to an opinion worthy of publishing.
The reason I brought up Bronfort was that you skeptics look at his report to validate your opinion
of chiropractic. We’ll see what he has to say in person.
Why does the BMJ have an Acupuncture in Medicine journal if it were only a theatrical placebo?
@ Andrew Gilbey
“So how about this for an idea: Individual Chiropractors no longer be allowed to advertise their services………..”
Thankfully there are persons better qualified and postitioned than you to decide what is appropriate in terms of marketing. I’d suggest that compliance with ASA standards is amply sufficient and, now that the failure of some chiropractors to do this has been broought to the attention of the ASA and the GCC, I’m sure it’s only a matter of time before that is achieved.
@ JoeMac
You haven’t answered my question. Are you seriously suggesting that the GMC should be a doctor-free organisation? Or, that dentists should be regulated by an organisation with no dentists involved?
@ JoeMac
“I neither know nor particularly care what you think about doctors and drug companies or whether you think you’re working in healthcare. I wasn’t talking about you specifically – I was talking about some chiros who seem to intensely dislike medical doctors and those nasty drugs that they force on people. Perhaps I’ve looked at too many US chiro websites?”
It’s abunbantly clear that you don’t know what I think about doctors and drug companies, or anything else for that matter. I suspect you’re right in that you have been paying too much attention to the wrong websites.
If you don’t care what I (or any of my chiropractic colleagues) think, then that suggests that your presence here is simply to heckle rather than to debate.
Robin wrote: “@Blue Wode I see I got a cut and paste regurgitation from you”
Yes, you did, but it was lifted from here:
http://www.ebm-first.com/chiropractic/risks.html
Robin wrote: “Much of what you say above is not referenced by Harriet Hall who of course is a skeptic”
Harriet Hall is also a science-based, retired medical doctor. As for references, you’ll find plenty in the link above.
Also, it’s worth remembering what the International Chiropractic Association’s 1981 confidential malpractice alert had to say on the subject of chiropractic neck manipulation and stroke:
Quote
“In stroke patients it is common for patients to have sudden symptoms which may include occipital pain, dizziness, slurring speech, incoordination and vomiting. All or any such symptoms may occur at the time of manipulation *or later*.”
See pp42-43 here
http://www.casewatch.org/mal/nette/claim.pdf
Robin wrote: “You said, ‘You cannot know for sure that you haven’t caused a stroke…’ Then neither can anyone who’s ever touched, examined or massaged someone else’s neck as well. And you don’t know how I approach (or don’t) a patient’s spine.”
I am talking about chiropractors in general. Fig. 2 in the link below serves to demonstrate why it’s not wise for patients to let chiropractors anywhere near their necks:
http://ptjournal.apta.org/cgi/content/full/79/1/50
Robin wrote: “I suggest that if it is your mission to take down chiropractic, you ought to spend some time in several offices. Go visit Stefaan. Then after after a lengthy observation you’d have the right to an opinion worthy of publishing.”
Irrelevant.
Robin wrote: “The reason I brought up Bronfort was that you skeptics look at his report to validate your opinion of chiropractic.”
That is correct, but I would hasten to add that the report has yet to be thoroughly evaluated by impartial scientific experts. For example, there are already indications that it is seriously flawed:
Quote
“…it is 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 (1991) study 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…The review is rife with such over-enthusiastic interpretations of literature, and non-chiropractic references.”
http://forums.randi.org/showpost.php?p=5671829&postcount=32
Robin wrote: “Why does the BMJ have an Acupuncture in Medicine journal if it were only a theatrical placebo?”
Money?
Quote:
“The same motive that causes some vice-chancellors to bring their university into disrepute by awarding BSc degrees in subjects that are not only not science, but which are oftenly openly anti-science.”
http://www.dcscience.net/?p=351
@ Blue Wode
“You cannot know for sure that you haven’t caused a stroke…”
As we know, chiropractors have been wrongly blaimed for causing strokes in patients who were already in the process of a vertebral artery dissection when they consulted the chiropractor.
Remember, a close temporal relationship between events does not prove a causal relationship.
I’ll remind you of a case I had some years ago:
A 32 year old woman presented to me complaining of neck pain and headache. I won’t go into the whole history here, suffice to say that the nature of the symptoms and their onset, together with family history, past medical history and lifestyle features, led me to refer her to A&E. Unfortunately, when she was examined at A&E she was diagnosed with a migraine and discharged with analgesics.
Next day she came to see me again, desperate for help with her pain. This time I referred her to her GP whom I telephoned to express my concerns. Unfortunately, the GP was typically dismissive but I believe that the patient went to see him anyway, as a result of my insistence to her.
I’m not sure of the exact course of events that followed but I tried to contact the patient over the next couple of days and eventually spoke to her mother. Her mother told me that the patient had been admitted to hospital and had been diagnosed with a stroke. I contacted the hospital and spoke to the neurologist managing her who confirmed the situation. Tragically, the conclusion of the story is that the patient went on to suffer a further, larger stroke and died in the next few days.
Thankfully, I had not treated this woman but this is the sort of event that results in chiropractors being blamed for causing strokes.
David wrote “…chiropractors have been wrongly blaimed for causing strokes in patients who were already in the process of a vertebral artery dissection when they consulted the chiropractor.”
But the GCC claims that chiropractors are trained to watch for pre-stroke warning signs…
http://www.docstoc.com/docs/4693363/The-Letters-Editor-The-Times-Pennington-Street-LONDON-July
…so why would a chiropractor manipulate the neck of a patient who already had a vertebral artery dissection in progress?
@David
Remember, there are quite a few cases on record of patients stroking out on chiropractors’ tables after neck manipulation.
If those strokes weren’t due to neck manipulation, but were, as many chiropractors would claim, the consequence of vertebral artery dissections in progress, then why did the patients have their necks manipulated in the first place?
Chiropractors can’t have it both ways.
@ Blue Wode
Sadly, vertebral artery dissections are often not easy to recognise in their early stages. The presenting symptoms are most commonly neck pain and headache which, as we know, are problems that chiropractic is a proven and appropriate treatment.
There is no evidence that chiropractors are any less able, or less likely to diagnose these cases than medical doctors and my example is a case in point. I had already alerted the patient and therefore the A&E department to the possible diagnosis but they failed to spot it. Had the patient not re-presented to me, the diagnosis would have been further delayed.
In this case I was lucky, because I didn’t treat the patient and there could therefore not be any suggestion that I had been part of the cause. Unfortunately, there have been times when the diagnosis has been missed by the chiropractor as well as the “doctors” and the patient has received treatment before the complete picture became clear. Again, this close temporal relationship of events does not prove a causal link between the treatment and the stroke.
Thankfully, these events are very rare and chiropractic remains a safe, effective and appropriate way of managing musculoskeletal disorders, including neck pain and headache.
David wrote: “…chiropractic remains a safe, effective and appropriate way of managing musculoskeletal disorders, including neck pain and headache.”
Not so. As the hallmark intervention of chiropractice is spinal manipulation, it is apparent that chiropractors’ use of it is less judicial than other manual therapists (see Fig.2 in the link I posted in my comment above).
The bottom line is this:
Quote
“The effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905885/
David, you can argue with me all you want, but you cannot argue with the science.
@ Blue Wode
You can present as much distorted science as you like, it doesn’t make you right. The graph in your post simply relates to the fact that chiropractors perform much the most manipulation that is done. Just as well actually, given that they are the ones with the best and most extensive training in how to do it safely and effectively. You have no evidence that chiropractors make use of manipulation in a less judicious manner than anyone else, only the opinion of a physiotherapist.
As you well know, chiropractic is about a great deal more than manipulation, which is only one of many tools available to chiropractors and, when used, is combined with the other elements of best practice in the chiropractic management of musculoskeletal disorders and their effects on the patient’s health.
It appears that I do need to keep on arguing with you because you keep trying to mislead and alarm the public with unjustified anti-chiropractic propaganda. I am not arguing with the science. The only problem I have with the science, is that there isn’t enough of it yet.
David wrote: “You can present as much distorted science as you like, it doesn’t make you right.”
And which parts of the science I’ve presented to you do you think are ‘distorted’?
David wrote: “The graph in your post simply relates to the fact that chiropractors perform much the most manipulation that is done.”
But why do they do it when there are effective, safer, cheaper and more convenient options available? To me, it smacks of large-scale malpractice.
David wrote: “Just as well actually, given that they are the ones with the best and most extensive training in how to do it safely and effectively.”
Are you sure about that? The latest Cochrane review on spinal manipulative therapy for low-back pain claims the following:
Quote
“Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, *profession of manipulator*, and use of manipulation alone or in combination with other therapies *did not affect these results*.”
David wrote: “You have no evidence that chiropractors make use of manipulation in a less judicious manner than anyone else, only the opinion of a physiotherapist.”
And those of well-respected, impartial scientists, Simon Singh and Professor Edzard Ernst, who, after thoroughly examining *all* the evidence for chiropractic in their recent book, ‘Trick or Treatment? Alternative Medicine on Trial’, came to the following conclusion:
Quote
“There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper…*We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer*.”
http://tinyurl.com/3abuchf
David wrote: “As you well know, chiropractic is about a great deal more than manipulation…”
And as you well know, anything other than a chiropractic ‘adjustment’ is not chiropractic. It’s physical therapy.
David wrote: “I am not arguing with the science. The only problem I have with the science, is that there isn’t enough of it yet.”
But chiropractic has had over 100 years to produce robust scientific data. The data that are now in have almost invariably concluded that chiropractic has nothing unique to offer, and that the only intervention that chiropractors can provide – which is backed up by weak scientific evidence – is spinal manipulation for the short-lived relief of pain in a sub-group of low back pain sufferers. Even then, as we have learnt from the Cochrane Review linked to above, it has “no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school”.
As Andrew Gilbey recently commented, it makes you wonder why chiropractic needs to exist at all.
David
“You haven’t answered my question. Are you seriously suggesting that the GMC should be a doctor-free organisation? Or, that dentists should be regulated by an organisation with no dentists involved?”
I’m sorry if I wasn’t clear enough in what I said earlier (but make sure you read what I said about calling experts when required). But you still haven’t said why you think such a suggestion is ridiculous. Can you answer my question about which sections of the COP need a chiro to decide?
Are you someone perhaps who thinks that MPs should decide on their own expenses because they’re really the only ones who can possibly know what a legitimate MP’s expense is? Would you agree we need a fully independent PCC? I’d really like to know your views on that.