The random thoughts of a sceptical activist

Advertising Standards Authority (ASA)

Humpty Dumpty regulation

The phrase Humpty Dumpty chiropractic cropped up in a Google Alert a few days ago. It was the fitting title of an editorial (cached) in the December 2010 issue of Clinical Chiropractic, which discussed the slippery and nebulous meaning of vertebral subluxation complex (VSC).

For those who don’t remember their childhood, in Lewis Carroll’s Through the Looking Glass, Humpty Dumpty is discussing the meaning of words with Alice. HD remonstrates:

‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

Such equivocation is typical of on-line conversations with chiropractic supporters discussing the VSC, but it applies elsewhere as well.

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Getting their nappies in a twist

It had never occurred to me that one of the important design parameters of a nappy would be how little noise it makes when flexed.

However, this seems to be a USP for some manufacturers and they want to tell prospective customers all about it.

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Credit where credit’s due

I’m insulted. I’m miffed. My good name…

How could anyone possibly think that I would complain to the Advertising Standards Authority about misleading claims for AltMed?

Someone objected to claims being made by the Craniosacral Therapy Association (CSTA) in one of their leaflets.

It wasn’t me!

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Another weapon in the skeptic’s arsenal

Mooted nearly a year ago, the Advertising Standards Authority (ASA) have today announced that their digital remit is to be extended to cover:

  • Advertisers’ own marketing communications on their own websites and;
  • Marketing communications in other non-paid-for space under their control, such as social networking sites like Facebook and Twitter.

Starting on 1 March 2011, this landmark agreement means that claims made on a seller’s website will be subject to the ASA’s Committee of Advertising Practice Code (the CAP Code), just like adverts in newspapers, magazines, and paid-for online advertising.

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Murky waters

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

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

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

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

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

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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.

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The Long and Winding Road

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?

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In Memoriam

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 (cached) 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:

Obituary: The death of the subluxation

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.

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Bronfort on: Ear Infections

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.

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