Anything to do with pseudo scientific woo quackery
Finding a document on the website of the British Chiropractic Association titled ”CONFIDENTIAL FOR BCA MEMBERS ONLY” is an open invitation…
Chiropractic and osteopathy have different origins. They are separate forms of spinal manip. Typically osteopaths use long level techniques, chiros use short lever. Both aim to achieve the same thing – spinal health.
This highlights a frequent question asked by skeptics: Are chiropractic and osteopathy substantially or even significantly different forms of healthcare?
This isn’t the time to consider whether they are even forms of healthcare at all, but it seems to me that that having different origins or whether one uses long-lever techniques and another short-lever techniques, seems an inadequate basis for requiring two entirely separate Acts of Parliament, two entirely separate statutory regulators, completely different training establishments, different trade bodies, etc.
So, what do chiros think the difference is? Some say:
In truth, the answer is probably very little, but there has been such a division historically that many people are still confused to this day.
When diagnosing patients, chiropractors and osteopaths both use observation and touch.
But then cracks begin to appear:
Chiropractors train for one extra year than osteopaths at postgraduate level and are qualified to take and diagnose from X-rays.
Because of their level of training and education, Doctors of Chiropractic are able to rely on other more diagnostic procedures, such as X-rays, MRI scans, blood tests, and nerve conduction studies. [original emphasis]
Looking for an ‘authoritative’ explanation, I searched the BCA’s website to see what they had to say.
And there, as the sixth result, is a document titled:
CONFIDENTIAL FOR BCA MEMBERS ONLY
Information for BCA members regarding an article in the Daily Mail – April 8th 2008
It was a response by the BCA to a Daily Mail article written by Prof Edzard Ernst and Dr Simon Singh to publicise their forthcoming book, Trick or Treatment. The article can be read in full here (although the title is now different): Are we being hoodwinked by alternative medicine? Two leading scientists examine the evidence
The fifth anniversary of the Daily Mail article seems a good time to bring this BCA document to wider public attention.
The BCA were presumably defending the business interests of their members. That’s their job, after all.
As we are aware that patients or potential patients of our members will be confronted with questions regarding this article, we have put together some comment and Q&As to assist you.
- Please consider this information as strictly confidential and for your use only.
- Only use this if a patient asks about these specific issues; there is nothing to be gained from releasing any information not asked for.
- Do not duplicate these patient notes and hand out direct to the patient or the media; these are designed for you to use when in direct conversation with a patient.
Why are they so adamant that these notes are not distributed? What’s in them they wouldn’t want the media, the public or their customers to see? After all, it is just what they think of the evidence for the efficacy of chiropractic and its safety, so why not be open about it? And if they thought the article was in some way inaccurate, perhaps they could have asked the DM for a chance to respond; to ‘set the record straight’ as they might see it?
Singh and Ernst’s article highlighted three aspects: what chiropractic is, the lack of evidence for its efficacy and safety concerns, particularly with neck manipulations.
Unsurprisingly, the BCA’s response attacks all three, telling their members that they need to tell their customers that chiropractic is effective, gentle and, above all, as safe as, well, a visit to your GP. Of course, an independent examination of the evidence of benefit and risks, balancing one against the other, may come to a different conclusion.
Evidence? What evidence?
We now know from the Bronfort Report, that there really is very little good evidence for chiropractic manipulations for any condition — much of the ‘evidence’ dug up by Bronfort was not for chiropractic manipulations but for osteopathic manipulations or even massage.
It seems that chiropractic is very different to osteopathy, but only sometimes…
Don’t forget the kids
One point the BCA thought their members might be asked about by an inquisitive journalist:
“The article talked about ‘claims’ of success with other problems”
There is a large and undeniable body of evidence regarding the effectiveness of chiropractic treatment for musculoskeletal problems such as back pain. There is also growing evidence that chiropractic treatment can help many patients with other problems; persistent headaches for example. There is also anecdotal evidence and positive patient experience to show that other kinds of problems have been helped by chiropractic treatment. For many of these kinds of problems, the formal research is just beginning and a chiropractor would never propose their treatment as a substitute for other, ongoing treatments.
Whether there is a credible and compelling ‘large and undeniable body of evidence regarding the effectiveness of chiropractic treatment for musculoskeletal problems’ is open to debate, but I also find it curious that they don’t mention non-musculoskeletal problems.
But what the BCA say in their document about chiropractic for children is rather odd.
Singh and Ernst said:
The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine.
The BCA interpret this as:
The article concludes by advising people not…to allow children to be treated.
To me, that’s not quite the same thing. However, it makes sense to be extremely cautious with children, particularly as there doesn’t seem to be any good basis for treating them with chiropractic. That’s not me saying that; that’s what the General Chiropractic Council told me in 2010:
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.
Is it safe?
“Is it safe for my child to be treated by a chiropractor”
It is a shame that the article so generalises the treatment provided by a chiropractor, that it makes such outrageous claims. My training in anatomy, physiology and diagnosis means that I absolutely understand the demands and needs of spines from the newborn baby to the very elderly patient. The techniques and treatments I might use on a 25 year old are not the same as those I would employ on a 5 year old. I see a lot of children as patients at this clinic and am able to offer help with a variety of problems with the back, joints and muscles. I examine every patient very thoroughly, understand their medical history and discuss my findings with them and their parents before undertaking any treatment.
Can anyone spot what could be missing from the list of conditions chiropractors might treat children for? Why is there no mention of:
colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying,
Those, of course, are the childhood conditions for which Simon Singh said there was not a jot of evidence. In his article, Beware the spinal trap, published in the Guardian just 11 days after the DM article, he described the BCA as:
…the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
It was for these statements that the BCA decided to sue Simon for libel. The rest, as they say, is history.
Professor Edzard Ernst’s take on the BCA document
Other related articles by Prof Ernst
Criticism of the NICE guidance on lower back pain
Simon Singh’s article on chiropractic in the Guardian
Demolition of the the BCA’s ‘plethora’ of evidence
My complaints to the General Chiropractic Council
The BCA’s libel action against Simon Singh and the subsequent libel reform campaign
The exposé by Prof David Colquhoun of the interference by the Department of Health — at the behest of homeopathy promoters — in the publication of impartial, scientifically-based information about homeopathy on the NHS Choices website has been covered by the Guardian and the Daily Mail this past week.
Damned by their own words, the DoH said in response to the draft submitted by the editors of NHS Choices that mentioned the House of Commons Science and Technology Committee’s comprehensive Evidence Check report on homeopathy:
Can we remove this statement? This report is really quite contentious and we may well be subject to quite a lot of challenge from the Homeopathic community if published.
The statement was removed. What NHS Choices were eventually told to publish was a biased sop to homeopathy, including a list of the main homeopathy trade bodies and a list of medical conditions homeopathy could, apparently, treat.
Andy Lewis, on his excellent website, The Quackometer, asked that we contact our MP over this to demand NHS Choices be allowed to replace this biased page with one that properly reflects the scientific consensus on homeopathy so that the public can make properly informed choices in their health care.
Below is our email to our MP. We urge all those concerned about the public being given unbiased information to write to your own MP — please feel free to use whatever you feel useful.
We are concerned to read that the Department of Health has been interfering with the content of the NHS Choices website to the detriment of the public’s ability to make informed choices about health care.
It was reported in the Guardian on 13 February (Prince’s charity lobbied government to water down homeopathy criticism) and in the Daily Mail on 15 February (Homeopathy charity run by Charles ‘cowed civil servants’ into supporting the therapy) that the NHS Choices website editor had been prevented from stating the lack of scientific evidence for homeopathy for fear of lobbying from the ‘homeopathy community’. This debacle came to light after a Freedom of Information request by Professor David Colquhoun.
As a result of this interference, the page on homeopathy as it stands now is in danger of misleading the public into thinking that homeopathy may be able to treat potentially serious medical conditions such as asthma, ear infections, high blood pressure and depression when there is no scientific evidence to suggest this is the case.
In his response to the House of Commons Science and Technology Committee’s Evidence Check report on homeopathy (which recommended removal of all NHS funding for homeopathy because of the complete lack of scientific evidence), the Secretary of State for Health stated:
10. In order for the public to make informed choices, it is therefore vitally important that the scientific evidence base for homeopathy is clearly explained and available. He will therefore engage further with the Department of Health to ensure communication to the public is addressed. His position remains that the evidence of efficacy and the scientific basis of homeopathy is highly questionable.
He also stated:
14. The Government agrees that, when looking at the evidence base for efficacy, it is important to focus on the most scientifically robust studies and evidence.
It is therefore incomprehensible and deplorable that the Department of Health believes it now acceptable to tell the public that homeopathy can be used to treat the following:
- ear infections
- hay fever
- other mental health conditions, such as stress and anxiety
- allergies, such as food allergies
- dermatitis (an allergic skin condition)
- high blood pressure
For such a highly respected, informative and authoritative source of sound medical information such as NHS Choices to have been forced by the DoH into publishing such erroneous information on homeopathy is disgraceful and unacceptable.
This can only lead to the public being mislead and potentially making ill-advised and dangerous health care decisions.
As we are sure you are aware, the Chief Medical Officer, Professor Dame Sally Davies, has recently made clear that homeopathy is ‘rubbish’. The DoH needs to heed this advice and allow NHS Choices to completely re-write the page on sound scientific and evidence-based principles.
We also note that Anna Soubry recently stated to the House:
The Department [of Health] does not maintain a position on any particular complementary or alternative medicine treatments including homeopathy.
We therefore ask you to request that the Secretary of State for Health explain these actions and that he allow NHS Choices the freedom to ensure that the public can make the informed choice that are entitled to make based on sound scientific evidence and principles and not to have that distorted by vested interests.
We look forward to receiving your reply.
Thanks and best regards.
I’ll let you know what response we get.
Guest post by Blue Wode. Originally published on The Twenty First Floor on 14 March 2012.
In recent times, the two main UK chiropractic associations, the British Chiropractic Association (BCA) and the McTimoney Chiropractic Association (MCA), have come under intense scrutiny. The BCA was brought to its knees by the misconceived libel case it brought against the science writer and broadcaster, Simon Singh, and, as a direct result of it, the MCA suffered the humiliation of having a confidential email to its members leaked online which revealed that it had urged all of them to take down their websites as they were a real threat to both them and their practices. By comparison, the Scottish Chiropractic Association (SCA) has enjoyed a relatively uncontroversial existence. Until now.
Jubilation in the chiropractic world! But, as usual, all is not what it might first seem…
Chiropractors granted Royal Charter:
The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. In doing so, Chiropractors become the first complementary health specialty to be awarded a Royal Charter. It is great news for Chiropractors and the development of the chiropractic profession in general.
Royal Charters have traditionally been awarded to specialty areas of Medicine such as the Royal College of Surgeons or Royal College of Dentists. It recognises the value of the College of Chiropractors unique position as a leader in the profession. (Source)
College of Chiropractors receives Royal Charter. Feels great to now be part of The Royal College of Chiropractors (Source)
The College of Chiropractors have been granted Royal Charter. Congratulations to the Royal College of Chiropractors! (Source)
The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. (Source)
One chiro was quick to update their website (or maybe he always thought it was a Royal College?) with this new imprimatur:
College of Chiropractors granted Royal Charter
Dated: 12 November 2012
At a meeting of the Privy Council on Wednesday, the Queen approved the grant of a Royal Charter to the College of Chiropractors, the first Royal Charter to be granted to a complementary medicine organisation in the UK.
The College is an academic, professional membership body, established along the lines of the Medical Royal Colleges, which over the past 13 years has sought to ensure quality, safety and excellence are at the forefront of chiropractic practice in the public interest.
Chiropractic is regulated by statute and although chiropractors provide their services largely within the private sector, NHS funding for chiropractic treatment is now emerging region by region under the Department of Health’s new commissioning arrangements. Chiropractors specialise in the diagnosis and treatment of problems affecting the joints, muscles and nerves and are probably best known for treating low back pain, a condition which costs the equivalent of between 1% and 2% of the UK GDP and has a significant impact on people’s lives.
Rarely granted, a Royal Charter signals permanence and stability and, in the College of Chiropractors’ case, a clear indication to others of the leadership value and innovative approach the College brings to the development of the chiropractic profession. The Royal Charter essentially formalises the College’s position as a unique, apolitical, consultative body, recognising its role in promoting high practice standards and certifying quality and thus securing public confidence.
Tim Jay, President of the College, said, “The College of Chiropractors’ Royal Charter emphasises to the public and other health bodies that chiropractic is a healthcare profession with parity in the field of musculoskeletal health, providing a viable and recognised option for patients.”
All the usual spin, of course.
In his Guardian article, Homeopaths offer to rebrand products as ‘confectionery’, Martin Robbins tells the story that, faced with being unable to sell their products as homeopathic medicines because they were unlicensed, a manufacturer offered to re-brand them as sweets. The irony of that won’t be lost on many, but what else has been going on?
…sceptics [are] posing as genuine members of the public…
Thanks to his FOIA request, we now know that the medicines regulator, the MHRA, told homeopathy manufacturers Helios and Ainsworths to discontinue the sale and supply of a number of their kits of homeopathic products because they contained homeopathic products that were not registered (under the HR scheme) or authorised (under the NR scheme) and because the names of the kits were not as had been registered with the MHRA.
McCarthy-style reporting, encouraged by the self-appointed detractors of homoeopathy…has protracted this decline [in the homeopathy industry]
These two issues are important: under the Medicines Regulations, individual homeopathic products have to be registered or authorised by the MHRA, and so do kits of these products, with the name of the kits agreed with the MHRA.
Helios and Ainsworths fell foul of the Medicines Regulations on both counts.
What does the Swiss Government really think about homeopathy?
By Sven Rudloff and Zeno
A lot has been made by homeopaths about the ‘neutral’ Swiss Government’s report and its unequivocal support of homeopathy. It’s been lauded by the luminaries of the homeopathic world as further proof — as if any was needed, of course — that homeopathic ‘medicines’ are superior in every way to those dangerous and expensive pharmaceutical drugs.
Arch proponent of homeopathy, Dana Ullman, proclaimed:
The Swiss government’s exceedingly positive report on homeopathic medicine
The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies.
In late 2011, the Swiss government’s report on homeopathic medicine represents the most comprehensive evaluation of homeopathic medicine ever written by a government and was just published in book form in English (Bornhoft and Matthiessen, 2011). This breakthrough report affirmed that homeopathic treatment is both effective and cost-effective and that homeopathic treatment should be reimbursed by Switzerland’s national health insurance program.
The provisional reimbursement for these alternative treatments ended in 2005, but as a result of this new study, the Swiss government’s health insurance program once again began to reimburse for homeopathy and select alternative treatments. (Source, cached)
The Society of Homeopaths:
Swiss scientists endorse homeopathy evidence
Report says homeopathic medicine is clinically effective
A comprehensive and authoritative research study by Swiss scientists has offered an unambiguous endorsement of the evidence base for homeopathy as a clinically effective system of medicine.
Their report, part of a Swiss government evaluation of complementary and alternative medicines, gives a massive boost to the growing body of research underpinning the therapeutic effects of homeopathic medicine. (Source, cached)
The Faculty of Homeopathy and the British Homeopathic Association:
Evidence for homeopathy builds
Long-awaited English translation of Swiss study endorses evidence for homeopathy
This important report addresses the evidence for the effectiveness of homeopathic therapy in everyday use (i.e. the real world), its safety and its cost-effectiveness.
The authors, Doctor Gudrun Bornhöft and Professor Peter Matthiessen, state: “There is sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment.”
Following on from the initial publication of this report, a public referendum in Switzerland in 2009 supported the inclusion of homeopathy and other complementary and alternative medicines in the Swiss national health insurance, with 67% of the people voting in favour. Earlier this month, the Swiss government passed legislation to enact the referendum’s conclusion. (Source, cached and source, cached)
GP and homeopath Dr Andrew Sikorski:
In 2009 a Swiss national referendum voted in favour of complementary medicine being part of the public health service which is now covered by the obligatory public health insurance system. This decision was partly informed by the findings of the 2006 Health Technology Assessment report commissioned by the Swiss Government on the effectiveness, safety and cost-effectiveness of homeopathy in general practice. (Source, cached)
Many other websites have echoed these sentiments, with many taking their lead from Ullman’s article and possibly placing far too much reliance on what he had to say, eg Swiss Government finds homeopathy effective and cost efficient (cached).
You’d think from all this that the ‘neutral’ Swiss Government had taken to homeopathy like the proverbial quacking duck to water.
Of course, to state in this context that the Swiss Government has a ’widely-respected history of neutrality’ is to conflate political neutrality with scientific objectivity.
As usual, research of truly homeopathic proportions, misrepresentation and cherry picking are the order of the day.
I certainly submitted a list of 524 names, but the number changed as the complaints were processed. Quite a few chiros were added to my initial list because they were at the same clinic as another I had complained about and some have been removed for various reasons. Then there were more than a few issues of chiros changing their names, moving clinics, moving abroad and other things that made it difficult to keep track, so I didn’t bother to keep my list absolutely up to date. There didn’t really seem any point in fretting over the minutiæ. After all, the GCC are a statutory regulator and they could be trusted to keep track because it was their statutory duty to deal with these things, couldn’t they?
Because of its content, I immediately complained to Consumer Direct (the central point for Trading Standards complaints) on 2 March who passed it on to Devon Trading Standards (TS).
There are many nutritional therapists who will give responsible, evidence and science-based advice. What is OfQuack doing to ensure their nutritional therapists don’t mislead the public? Their new ‘therapy descriptor’ needs careful analysis.
I blogged a few days ago about the investigation by the consumers’ organisation Which? that revealed nutritional therapists giving dangerous and misleading advice — most of those investigated were members of the British Association for Applied Nutrition and Nutritional Therapy (BANT).
In 2009, BANT passed any regulatory responsibilities they had on to OfQuack, aka the Complementary and Natural Healthcare Council, and they have just published a revised ‘therapy descriptor’ for nutritional therapy.
This version has been revised — and the previous one removed — after discussion with the Advertising Standards Authority. Presumably this new one is accepted as being compliant with the CAP Code — the Code all advertisers have to abide by in their advertising, whether in the media or on their own websites.
Nutritional therapists are a varied bunch and come in several ‘flavours’, with the science and evidence-based practitioners at one end of the spectrum and at the other, what @skepticstu on Twitter referred to as the ‘Supplement Salesforce’.
At this far end, some seem to think many ills — particularly chronic conditions — are due to dairy intolerance or wheat intolerance, or both or ‘toxins’, or ‘imbalances’, or ‘chemicals’, or deficiencies. And, of course, they have just the personalised detoxification or supplement for you to address the ‘underlying causes’ of your health issues. And they may make extensive use of iridology, hair mineral analysis and applied kinesiology tests to work out your own, optimum health, individualised, holistic, supplement plan. For a price. All major credit cards accepted.
Others, I am sure, give good, evidence-based diet advice without a supplement in sight. They are not the problem here.