Posts Tagged ‘General Chiropractic Council (GCC)’
The beginning of the end?
The first decisions of the GCC’s Investigating Committee (IC) on my complaints fell with a thud onto my doormat a few days ago.
I received copies of 43 letters sent to 43 of the chiropractors I complained about. All were notifications that the IC (which consists of eight chiropractors and four lay members) had decided — for various reasons — that there was no case to answer and that, therefore, no further action would be taken against them.
Eight of them were thrown out (leaving 35), the IC reasoning:
The extracts from the website, submitted in support of the complaint against you, related to a time you had ceased working at the clinic in question and therefore at a time when you were not responsible for the website content. For this reason the Investigating Committee has concluded that there is no case to answer in respect of the complaint against you.
I’ll leave it to you to tease out the issues I might have with that.
I’ll be saying more about the details of the other letters later, but I thought I’d share some of the gems to be found within them.
The law
After some preamble, they get off to a good start, citing the relevant clause of their Code of Practice that chiropractors are bound to comply with:
C1.6 of the Code of Practice states that chiropractors -
‘may publicise their practices or permit another person to do so consistent with the law…”
All well and good. Except…that’s not all C1.6 says. It continues:
…and the guidance issued by the Advertising Standards Authority.
And indeed, that’s what my complaint was all about: that they were making claims that I believed went against guidance issued by the ASA.
So why cut it short? Why ignore whether or not the claims complied with ASA guidance? Do they think that requirement is somehow null and void; something to be ignored without justification? Publicity has to comply with both requirements not just one.
More questions needing an answer.
However, they go on to say:
In the context of the relevant law (The Consumer Protection from Unfair Trading Regulations 2008) advertised claims for chiropractic care must be based on best research of the highest standard. This will almost certainly mean randomised controlled trials that produce high or moderate positive evidence. (Link added)
Now we know what law they think is relevant. At least they mention ‘the best research of the highest standard’ and that this (almost certainly) means RCTs that give good evidence.
Expertise and preferences
But what about the Code of Practice whose glossary defines evidence-based care, cited by many chiropractors in their observations, as:
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).
All the 35 letters stated the following:
The other elements of evidence based care as it relates to clinical practice (the preferences of the patient and the expertise of practitioners (including the individual chiropractor her/himself)) are, of themselves, insufficient to support advertised claims.
No matter what a chiropractor might think; no matter what a chiropractor might have seen with his or her very own eyes; no matter what he or she believes might work; no matter what a customer might prefer — none of these are sufficient to back up claims in any publicity. All claims must be supported by robust evidence, and that severely limits what many chiropractors can now get away with claiming.
About time too.
There is, of course, a subtle difference between what a chiropractor is allowed to advertise and what he or she actually tells customers and what they do in their clinics. My complaints were about what they were advertising; what they were using to pull in new customers. I have no idea what goes on within the four walls of the clinics, although Skepticat has first hand experience of one.
However, it would be utterly perverse if what they were allowed — tacitly or otherwise — to practice was in any way different to what they were allowed to tell people they were allowed to practice.
What about the kids?
Many of the letters mentioned that the chiropractor had said something on his or her website about children and babies. One example:
The Investigating Committee did note the reference to ‘Paediatric care’. The Investigating Committee considered that this could give a member of the public reading the webpage the impression that you provide treatment to babies.
Other letters mentioned similar claims about children. Despite the fact that Bronfort found that there was no good evidence that chiropractic worked for children or babies for any condition, the GCC have taken the opportunity to remind all the chiropractors:
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.
An odd choice of phrase, ‘could be inappropriate’, but the meaning is all too clear: there is no evidence for treating children with chiropractic. Not a jot. Not for colic; not for bed wetting; not for hyperactivity; not for feeding problems; not for sleeping problems. Not for any condition.
Chiropractors should therefore not be making any claims for children.
But isn’t it odd that they managed to decide that unsupported claims were being made, but still found no case to answer?
Good advice
In addition to the specific guidance offered to the 35, the GCC chose to deliver the following message to all 43 chiropractors — the ones they’ve decided have no case to answer:
The Investigating Committee recommends that you carefully consider the guidance issued to the chiropractic profession by the General Chiropractic Council in February/March 2010 and that you ensure that any advertisement of your services complies with C1.6 of the Code of Practice. (the GCC’s underlining)
Taken individually and together, these are welcome steps in the right direction.
But there is much more to come.
The Cracklash begins
It’s not just the evidence for chiropractic that’s a bit shaky these days.
For a long time, there has been an uneasy truce between the different chiropractic factions in the UK, all believing different things and each with different rituals.
It seems that they all came together when statutory regulation was first mooted and the carrot of respectability that that offered overcame those fundamental differences — temporarily at least.
Since the GCC was set up, the trade bodies representing the different factions (‘straights’, ‘mixers’, etc) appear to have been reluctant bedfellows, and there seems to have been various fallings out and lots of jostling for position and power.
But they trundled along and put a brave face on things for the sake of the profe$$ion.
After the BCA’s misconceived attack on Simon Singh, sceptical eyes were focused on chiropractic and the claims made by its followers. After being disgusted by the claims we saw being made by a large number of chiropractors on their websites, Simon Perry and I independently poked the GCC with a somewhat sharp stick.
What a hornet’s nest we stirred up, with the GCC eventually acknowledging that chiropractic had to be based on proper evidence and not on wishful thinking.
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.
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.
NHS Choices
The NHS Choices website has the tag line “Your health, your choices” and aims to inform the public:
NHS Choices is the online ‘front door’ to the NHS. It is the country’s biggest health website and gives all the information you need to make choices about your health.
They provide first-rate information about your health, illnesses, careers, etc as well as helping you find a local GP or other NHS services.
They also have some pages on alternative therapies such as homeopathy. On the page for homeopathy, they say:
Homeopathy is a type of complementary and alternative medicine (CAM). CAMs are treatments that are not based on conventional scientific theories. Other CAMS include:
- acupuncture – where needles are placed in certain parts of the body,
- chiropractic – where physical manipulation of the spine and joints is used to try to relieve symptoms, and
- faith healing.
It’s good to see them place chiropractic firmly along side homeopathy, acupuncture and faith healing.
All change!
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.
Talking the talk
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)
Spot the difference
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.
What’s Polish for ‘chiropractor’?
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 »
