Simon Singh
Beware the spinal spin
Finding a document on the website of the British Chiropractic Association titled ”CONFIDENTIAL FOR BCA MEMBERS ONLY” is an open invitation…
Perusing the BCA’s website usually finds extremely useful advice on schoolbags, gardening, bras, shopping, Bank Holidays, baking, gadgets, sitting and, of course, Christmas.
This time, however, I was bravely looking for what they said about the differences between chiropractic and osteopathy after a comment by a chiro on Prof Edzard Ernst’s blog:
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.
Their own search facility brings up very few mentions of osteopathy, so I tried a Google Site Search as this frequently gives more results. This returned these search results (cached):
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.
It is still available on the BCA’s website for any member of the public to read — no login, password or any special privileges required — but is cached here just in case it disappears.
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…
And it doesn’t look like this dire state of affairs is going to improve any time soon — there may even be more chiropractic surveys conducted than solid, basic and essential new research trials!
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.
Related articles
Professor Edzard Ernst’s take on the BCA document
“Strictly confidential”- for chiropractors only
Other related articles by Prof Ernst
Spinal manipulation: a treatment to die for?
Research in chiropractic seems in a dismal state
More dismal chiropractic research
Criticism of the NICE guidance on lower back pain
NICE fiasco, part 2. Rawlins should withdraw guidance and start again
The NICE fiasco, Part 3. Too many vested interests, not enough honesty
Simon Singh’s article on chiropractic in the Guardian
Demolition of the the BCA’s ‘plethora’ of evidence
British Chiropractic Association produces its plethora of evidence
My complaints to the General Chiropractic Council
Omnibus Complaint to the General Chiropractic Council
Other blog posts on the General Chiropractic Council and the British Chiropractic Association
The BCA’s libel action against Simon Singh and the subsequent libel reform campaign
The Scottish Chiropractic Association: Attempting to ‘manipulate’ the entire Scottish population?
Guest post by Blue Wode. Originally published on The Twenty First Floor on 14 March 2012.
Introduction
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.
Chiro regulator admits systemic failures
I have never been 100% sure of the exact numbers of complaints of mine the General Chiropractic Council had to deal with.
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?
Out with the old…
When I submitted my complaints about claims made on chiropractic websites in June 2008, a fundamental requirement regulating what chiropractors could claim — firmly embedded in their Code of Practice — was that they only advertise consistent with guidance issued by the Advertising Standards Authority (ASA).
At that time, the General Chiropractic Council‘s Code of Practice that was in effect was the 8 December 2005 version and the relevant clause was C1.6. Let’s put it fully in context:
Chiropractors must justify public trust and confidence by being honest and trustworthy.
C1 Chiropractors must act with integrity and never abuse their professional standing.
Specifically chiropractors:
…
C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.29
______________________
29 For example, by arousing ill-founded fear for their future health.
This clearly mandates chiropractors to ensure any advertising complies with ASA guidance, remembering that ASA guidance includes the CAP Code, other guidance and their adjudications.
In prosecuting my complaints, the GCC inexplicably forgot all about the requirement to be consistent with ASA guidance and came up with some arbitrary standard of evidence for compliance. The Professional Conduct Committee begged to differ even with that and effectively allowed any old evidence to be used to substantiate chiropractors’ claims. To understand the whole story, see Humpty Dumpty regulation.
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.
Where the evidence leads
Google Alerts is a very useful tool for skeptics. It sends you an email whenever the word or phrase you’ve asked for crops up in their searches of news, blogs or other websites. They are excellent for keeping tabs on what’s going on by helping you track new stories and hits.
Naturally, I have one set up for the General Chiropractic Council (GCC), just to see where they crop up on web sites and in the news.
A few days ago, I received a Google Alert about a page that had been recently updated, although the mention of the GCC was from some time ago. It linked to a decision by the Press Complaints Commission (PCC) about complaints made by the GCC against the Daily Telegraph, the Daily Mail and the Guardian about articles published on 9 November 2007.
According to the GCC, the articles said:
- Chiropractors ‘are waste [sic] of money’, Daily Telegraph, Rebecca Smith
- Chiropractors ‘are a waste of time’, Daily Mail, Jenny Hope
- ‘Chiropractors may be no use in treating back pain, study says’, The Guardian, Alok Jha
Nothing new there, then.
The Mass Libel Reform Blog – Fight for Free Speech!
This week is the first anniversary of the report Free Speech is Not for Sale, which highlighted the oppressive nature of English libel law. In short, the law is extremely hostile to writers, while being unreasonably friendly towards powerful corporations and individuals who want to silence critics.
The English libel law is particularly dangerous for bloggers, who are generally not backed by publishers, and who can end up being sued in London regardless of where the blog was posted. The internet allows bloggers to reach a global audience, but it also allows the High Court in London to have a global reach.
You can read more about the peculiar and grossly unfair nature of English libel law at the website of the Libel Reform Campaign. You will see that the campaign is not calling for the removal of libel law, but for a libel law that is fair and which would allow writers a reasonable opportunity to express their opinion and then defend it.
The good news is that the British Government has made a commitment to draft a bill that will reform libel, but it is essential that bloggers and their readers send a strong signal to politicians so that they follow through on this promise. You can do this by joining me and over 50,000 others who have signed the libel reform petition.
Remember, you can sign the petition whatever your nationality and wherever you live. Indeed, signatories from overseas remind British politicians that the English libel law is out of step with the rest of the free world.
If you have already signed the petition, then please encourage friends, family and colleagues to sign up. Moreover, if you have your own blog, you can join hundreds of other bloggers by posting this blog on your own site. There is a real chance that bloggers could help change the most censorious libel law in the democratic world.
We must speak out to defend free speech. Please sign the petition for libel reform.
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!
Chiro evidence for subluxations pwned — by chiros!
When the British Chiropractic Association published its ‘plethora‘ of 29 references they thought supported chiropractic for childhood conditions, it took just 24 hours for it to be utterly demolished by scientists and skeptics. Only 18 of these were relevant to chiropractic and childhood conditions.
Shortly after that, Fiona Godlee, Editor on the BMJ, commenting on an article by Prof Edzard Ernst, said:
But in response to our recent editorial by Evan Harris (doi:10.1136/bmj.b2254), the vice president of the BCA, Richard Brown, has now presented the evidence (doi:10.1136/bmj.b2782). He writes, “There is in fact substantial evidence for the BCA to have made claims that chiropractic can help various childhood conditions” and lists 18 references. Readers can decide for themselves whether or not they are convinced. Edzard Ernst is not (doi:10.1136/bmj.b2766). His demolition of the 18 references is, to my mind, complete.
This, presumably, was the best evidence the BCA could muster and it was left in tatters by those more knowledgeable about science and robust trials.
The beginning of the end? Part three
It’s only taken 433 days to get this far.
On Saturday, I received three batches of letters from the General Chiropractic Council (GCC), sent Recorded Delivery.
These letters are the formal notices that a complaint against a chiropractor has been considered by the Investigating Committee, that they have decided that there is a case to answer and that the complaint will go before their Professional Conduct Committee (PCC).
The letters consist of the formal notice, the Notice of Allegation and some of the website pages that contained the claims I complained of and where they were using the title ‘Dr’. The Notices of Allegation are all very similar to this redacted one; straight and to the point. (There’s lots to be said about the documents and I’ll cover that in a separate blog post.)
I have so far received these formal notices for 93 chiropractors.
There will be far more to follow.
