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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

The risk of neck manipulation

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 falls for Bait and Switch by acupuncturists and chiropractors: it has let down the public and itself

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

Beware the spinal trap

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

Jack of Kent’s Blog

Libel Reform Resources for Defamation Bill 2012