Zeno's Blog

Posts Tagged ‘Advertising Standards Authority (ASA)’

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.

Note: there was a problem with Internet Explorer not showing all of the post – it’s  now fixed, so you can read it right to the end!

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

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

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

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

Meantime, the GCC:

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

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

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

Read the rest of this entry »

Following on from Skeptic Barista’s tenacious questioning of the GCC over the lack of evidence for the chiropractic subluxation, and my obituary of it, the GCC have announced that it is no more than ‘an historical concept’ to be consigned to the rubbish bin of a bygone, pre-scientific, evidence-free history.

The final nail in the coffin for the subluxation is their guidance for chiropractors, issued today:

GUIDANCE ON CLAIMS MADE FOR THE CHIROPRACTIC VERTEBRAL SUBLUXATION COMPLEX
The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. 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.

Chiropractors are reminded that

• they must make sure their own beliefs and values do not prejudice the patients’ care (GCC Code of Practice section A3)
• they must provide evidence based care, which is 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 (GCC Standard of Proficiency section A2.3 and the glossary)
• any advertised claims for chiropractic care must be based only on best research of the highest standard (GCC Guidance on Advertising issued March 2010)

Bogus

This is interesting because of their statement about beliefs. They clearly see a chiropractor’s belief in subluxations as unfounded and irrelevant and indeed possibly prejudicial to the best interests of their customers.

However, it’s not so much a ‘theoretical model’ of anything: it’s never been any more than an hypotheses and one that has never had any evidence base. It was a notion that the quack D D Palmer invented to ‘explain’ to the unsuspecting why he was charging them money to crack their backs. As I’ve said before, there has never been any good evidence for either the subluxation nor its supposed effects on nerves.

The way they’ve phrased their second sentence is also interesting:

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 seems to me that this was carefully written so that it included all conditions — anything at all that might be considered a ‘health concern’ is covered whether that is some actual condition such as back pain, or some more esoteric chiropractic condition like ‘feeding problems’. This should prevent them claiming that anything at all is caused by the mythical subluxation and stop them blinding their customers with sciency-sounding words.

All change again

This is a good time to be  a web designer. Just think of all those websites that will need to be changed — again — to remove yet more misleading claims.

Of course, it might not be that simple. As Blue Wode has pointed out, there are a plethora of terms used by chiropractors instead of the bogus S word. The GCC’s guidance doesn’t say anything about any of these, and I suspect that some website changes may amount to no more than substituting a few new words. The GCC will need to keep on its toes if they really want to protect the public from misleading claims.

Applying appropriate care

The second bullet point in the guidance cites part of clause A2.3 of the GCC’s Standard of Proficiency. Although in the same document as the Code of Practice, it’s not really been relevant to my complaints, so I’ve not mentioned it before.

However, in full, the clause is:

A2.3 Applying appropriate care
Chiropractors must be knowledgeable about the underlying theories of the care they provide and be competent to apply that form of care in practice. Chiropractors’ provision of care must be evidence-based and appropriate to the patient’s health and health needs. The patient must have consented to the form of care. Chiropractors must care for patients in a way that minimises risk to that patient.

With the ‘theory’ of subluxations finally declared a mere historical artefact, what ‘underlying theories’ of chiropractic are left?

How are they going to explain to a customer why they think a good back crack will make any difference to their cervicogenic dizziness, their migraines or their chronic back pain?

How are they going to explain to a customer that they need to keep coming back for ‘wellness’ or ‘maintenance’ care to stop those nasty subluxations from causing you future health problems?

How indeed.

Spirit

So whilst this new guidance by the GCC is a welcome step in the direction of evidence-based chiropractic (whatever that is), they may find some abiding by the letter of the guidance but not the spirit. Not dissimilar to the lip-service many have paid to the ASA guidance they are mandated to abide by.

Inspired by the atheist bus campaign and this bus advert that Skeptic Barista happened across:

It is with no sadness whatsoever, that the death of the chiropractic subluxation at the ripe old age of 115 has finally been declared.

The long-anticipated demise was announced this evening by Skeptic Barista and, indeed, there are grounds for believing that he played a very significant part in that death. It is rumoured that he will be helping the ASA with their enquiries, although he maintains there is not a jot of evidence to support those bogus allegations.

It died on Wednesday 12 May during a meeting of the General Chiropractic Council after suffering numerous assaults, particularly over the past 12 months and despite a rigorous wellness maintenance program.

All in vain, it seems.

Read the rest of this entry »

Time to take a closer look at some of the conclusions of the Bronfort report.

Otitis Media is, to the average parent, an ear infection — of the middle ear, to be precise. This can affect children and can be very painful and disturbing to both infant and parents. About one in five chiropractors I complained about made claims about ear or similar infections. It was also one of the childhood ailments that Simon Singh mentioned in the Guardian article the BCA had a hissy fit about.

Because of my complaints and because there appeared to be no definitive list (other than the ASA’s list of acceptable claims, of course) of what conditions were backed by robust evidence, the GCC commissioned five US chiropractic researchers to review the good evidence for all the conditions I complained about. I’ve already said something about the kinds of evidence Bronfort et al. decided should be included in the report: they were interested in only relying on quality evidence.

Read the rest of this entry »

The GCC’s Bronfort report is starting to have an effect. And not before time.

The British Chiropractic Association removed their Happy Families leaflet from their website last year, but it is still on the websites of some chiropractors (for example Weston Chiropractic Clinic here (cached).

Over the intervening months, various chiropractors have removed loads of claims from their websites, with one of them even asking Skeptic Barista if he could check they had made the appropriate changes!

As part of the ongoing complaint process, I have received observations on my complaints from 290 chiropractors (so far) and some have included ‘before and after’ screenshots of their websites, showing what they have removed or changed. (Don’t worry, I intend to write about what’s been happening and what the current position of my complaints is very soon.)

Now, presumably as a result of the Bronfort report, the BCA have removed various statements from their website over the last few days.

Read the rest of this entry »

In November last year, there was specualtion that the ASA’s remit might be extended to cover claims on advertisers’ own websites, rather than just third-party online adverts (the so-called digital remit).

In launching their new Code of Advertising Practice today (which comes into force on 1 September 2010), the ASA/CAP have given more details:

Read the rest of this entry »

The first few pages of Bronfort et al. certainly talk the right talk:

EBH [Evidence-Based Healthcare] is about doing the right things for the right people at the right time. It does so by promoting the examination of best available clinical research evidence as the preferred process of decision making where higher quality evidence is available. This reduces the emphasis on unsystematic clinical experience and pathophysiological rationale alone while increasing the likelihood of improving clinical outcomes. The fact that randomized clinical trial (RCT) derived evidence of potentially effective interventions in population studies may not be translated in a straight forward manner to the management of individual cases is widely recognized. However, RCTs comprise the body of information best able to meet existing standards for claims of benefit from care delivery. The evidence provided by RCTs constitutes the first line of recommended action for patients and contributes, along with informed patient preference, in guiding care. (page 4)

Read the rest of this entry »

The first photo was taken in East Kilbride shopping centre on 16 August 2009. The second was taken this morning.

Spot the difference:

Answer: Today’s advert has the claims for “Children with colic & ear infections” covered up.

The removal of these claims may have been due to the GCC’s recently released Bronfort report, or perhaps they’ve now read the ASA guidance they’re supposed to follow. Who knows.

The claims left are for: “headaches and migraines, neck, back and shoulder pains, sciatica or disc injuries, sports or accident injuries, pins and needles in arms and legs”.

A step in the right direction, but a long way to go yet.

Czego mogę się spodziewać podczas wizyty u kręgarza?

If your Polish isn’t up to scratch, this roughly translates as: What can I expect when visiting a chiropractor?

Ah! I hear you say. Is it just a coincidence that this is suspiciously close to What can I expect when I see a chiropractor?

No, of course it isn’t. That was the title of the GCC’s leaflet that Simon Perry (Adventures in Nonsense, Leicester Skeptics in the Pub and skeptical columnist for the Leicester Mercury) complained to the Advertising Standards Authority about last year. Read the rest of this entry »