Posts Tagged ‘Simon Singh’
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.
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.
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.
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.
