Zeno's Blog

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.

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.

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 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

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.

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?

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.

The British Chiropractic Association has finally dropped their misconceived libel action against Dr Simon Singh.

Best of all, the BCA have done this in Chiropractic Awareness Week.

The first announcement of it was from the Chambers of one

Do you know who your MP is?

If you don’t, you can find him or her on the excellent They Work for You website.

Why is this important? Well, in case you’ve been hibernating all winter (and who could blame you), there’s going to be a General Election fairly soon and there’s no better time to lobby your MP and find out what his/her views are on important issues.

In case you’re struggling to think of something to ask your MP, here’s a suggestion:

Libel law.

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)