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.
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)
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?
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.