Guest post by Blue Wode
What have the Scots ever done for us? The answer is a candid ‘quite a lot‘. Over the last few centuries we have been indebted to many remarkable, but often unsung, Scottish scientists and innovators for improving the quality of our lives.
By comparison, what have chiropractors ever done for us? Perhaps not surprisingly, they have failed to offer anything of unique value to science. Indeed, much of chiropractic involves blatant quackery, including a strong belief in the bogus notion of vitalism (an immeasurable and un-observable force), and cult-like references to chiropracTIC and vitalisTIC, which refer to the philosophy of chiropractic that has at its centre the principle that life is intelligent. Moreover, increasingly the effects of chiropractic’s main intervention, spinal manipulation, are being shown to be non-specific and not without risks.
However, despite such unfavourable evidence emerging over the last decade or so, the chiropractic profession in the UK continues to enjoy the automatic respect and benefits lent to it by statutory regulation and a Royal Charter that was awarded to its foremost professional membership body despite that body failing to fully comply with the requirements set out by the UK Government’s Privy Council. As if such spurious legitimacy wasn’t enough, it now looks like a further storey is about to be added to this healthcare house-of-cards in the form of the ‘Scotland College of Chiropractic’.
Unlike all the other UK chiropractic colleges — the Anglo European College of Chiropractic (AECC), the Welsh Institute of Chiropractic (see also here) — and the McTimoney College of Chiropractic, the Scotland College of Chiropractic does not hold a .ac.uk domain. In fact, it has two domains, the other being Life Scotland, a name that indicates that it has a strong affiliation with the controversial ‘Life University’ in Marietta, Georgia, USA.
The Italian Job
Life University has already been negotiating a partnership with the Italian Chiropractic Association in Rome, Italy, with the purpose of offering a Doctor of Chiropractic degree. As a branch campus of Life University in Italy, offering an identical curriculum, its accreditation (recognition) would be through the U.S. Council of Chiropractic Education and the Southern Association of Colleges and Schools. This set up would allow Life University students to study for their degrees in Italy while continuing to have access to US federal financial benefits. According to the 2015 Fall edition of Life University’s Your Extraordinary LIFE magazine, the Italian campus is scheduled to open in 2018. In the interim, having confessed that it is “barely graduating enough DCs (Doctors of Chiropractic) to replace those retiring or passing away”, Life University is busy forging other partnerships which, like the new campus in Italy, appear to fall under its Global Initiatives programme, which harvests educational institutions “that recognize the value and vision of building sustainable partnerships around the world”. These partnerships are based “on the Vitalistic paradigm that drives the entire University“, and will benefit from ‘Presidential International Initiative Scholarships’ that are “awarded in key areas of the world where recipients must return to their home country to further develop our partnership goals in order to promote chiropractic philosophy internationally”. Notably, a trade body, the Scottish Chiropractic Association, already offers Life University scholarships, no doubt in full knowledge that chiropractors who have graduated from Life University who wish to work as chiropractors in the UK need only pass a Test of Competence to achieve registration with the UK statutory regulatory body, the General Chiropractic Council. But more about the Test of Competence later.
The General Chiropractic Council
As the statutory body for chiropractors in the UK, the General Chiropractic Council (GCC) is responsible for setting the standards of any educational organisation in the UK that trains anyone who wants to be called a chiropractor. Essentially, it decides whether these establishments are entitled to issue chiropractic degrees (see Section 14.—(1) of the Chiropractors Act 1994). On page 19 of the GCC’s current Degree Recognition criteria (up for review this year) it says that “the course must be at the minimum at the level of an honours degree or integrated masters degree validated by a UK-recognised higher education institution”. Currently, the GCC accredits (recognises) the Chiropractic Degree Program at the University of South Wales (the first university in the UK to offer a fully integrated undergraduate Masters chiropractic degree), the academic programmes at the AECC (validated by Bournemouth University), and the McTimoney College of Chiropractic, which has its Integrated Masters in Chiropractic (MChiro) programme, and its postgraduate programmes, validated by the BPP University (which is a private university, owned by the U.S. Apollo Global Education Network). This raises the question, how will the Scotland College of Chiropractic, with its vitalistic Life University tie-in, meet the GCC’s accreditation standards? Perhaps more to the point is, will it need to?
Scenario 1: Escaping UK jurisdiction?
It could be that the Scotland College of Chiropractic is hoping to circumvent the need for GCC accreditation via its association with Life University. This is because, in the UK, if a course is not validated by any recognised body, it can be offered by a foreign university:
Foreign universities may offer degrees in the UK provided they make it clear that they are not UK degrees. The UK authorities cannot advise on the quality of these courses. It is up to you to check what recognition arrangements exist in the country of origin for any degree course you undertake in the UK.
However, it carries this caveat:
It is an offence in the UK for any organisation to offer a degree qualification which could be taken to be that of a UK institution unless the body making the offer is recognised by the UK authorities. The relevant legislation in this area is section 214 of the Education Reform Act 1988. Organisations suspected of committing an offence under this Act will be reported to the appropriate local Trading Standards Department for investigation. This could lead to prosecution.
It is not an offence for overseas organisations to offer their own awards in the UK, as long as they make it clear that they are not qualifications from a UK institution and that accreditation is from overseas. However, the UK authorities are unable to vouch for the quality of these qualifications, many of which may involve no formal study. UK employers are familiar with bona fide UK universities and colleges and will easily detect a bogus degree.
As with the SCA scholarships mentioned above, it’s likely that if the Scotland College of Chiropractic graduated students from the UK (as well as US students), they would only have to pass the GCC’s Test of Competence if they wished to work in the UK. (Looking further to the future, if Scotland eventually voted for independence it’s very possible that Scottish chiropractors would lobby the Scottish Government to create a sympathetic Scottish chiropractic regulatory body, the foundations for which may have been laid already.)
Scenario 2: Recognising nonsense?
But what if it isn’t permissible for the Scotland College of Chiropractic to be validated by Life University? As we already know, a UK chiropractic educational body awarding a qualification must have its programmes validated by a UK-recognised higher education institution, and then have the GCC accredit it. In this scenario, would there be a UK university prepared to validate an educational establishment with such unscientific leanings? The answer seems to be yes. Using its current Degree Recognition Criteria,the GCC has seen fit to accredit the controversial, BPP University validated McTimoney College of Chiropractic, even although the college is far from science-friendly.
Conflicting views on chiropractic standards in Europe
Ironically, however, one chiropractic standard-setting organisation, the European Council on Chiropractic Education (ECCE), an autonomous organisation established by chiropractors and with no statutory powers, has been hesitant to accept the philosophy-based chiropractic element into its ranks. In 2015, it refused a request for accreditation from the McTimoney College of Chiropractic, condemning the college’s philosophical orientation and questionable techniques and approaches to evidence in a 39-page report. McTimoney students fired back with a 17-page open letter to the ECCE in which they:
- questioned “the role of any organisation that singles out philosophies, techniques and/or approaches”
- questioned “the right of the ECCE to exclude accreditation based on philosophical preference” especially when its legal accreditor, the GCC, had approved them “with high levels of commendation” in its 2013 inspection
- questioned the rationale behind the ECCE’s comment (see 4.2.2a of the ECCE report) that the ‘scientific level of staff does not appear to be at an appropriate level for the school to teach the principles of logic (biological plausibility) and evidence of clinical practice’
- freely admitted that the McTimoney College of Chiropractic was set up “to teach traditional (Palmer style) chiropractic with a more traditional style philosophy”, with an approach “developed organically…in the belief that more specific adjustments…enabled the practitioner to use less force to achieve similar goals”, although it remained “something that is considered fluid, even if it taught with a degree of ordering”
- declared that “a weakness based on our philosophy is hugely disrespectful”
- stated that the ECCE appeared “to be questioning the authority of statutory powers”
The fear behind the McTimoney students’ defensive response almost certainly originates in well-founded suspicions that the ECCE wants to have chiropractic fully accepted by conventional medicine by outlawing (arguably less arduous) pseudoscientific practices.
Around the same time that the ECCE refused to accredit the McTimoney College of Chiropractic, it also denied accreditation to the Barcelona College of Chiropractic. Once again, this was due to issues regarding lack of adherence to evidence-based practice, as well as because it referred to its patients as “practice members”. However, unlike the McTimoney College of Chiropractic, the Barcelona College of Chiropractic, on reflection, accepted that its programme of study would “benefit from being more evidence-based”. This is quite a volte-face considering that, in the past, the Barcelona College of Chiropractic has been accused of “taking five years of time and a substantial financial investment from students, promising them chiropractic wings, lying to them about their chiropractic futures…taking their fledglings to a literal cliff edge and yelling, “jump”.”(It’s also worth mentioning here that there is a new private chiropractic school with a vitalistic approach being secretly developed in South Australia by a handful of well-organised mavericks. They have put their faith in a chiropractor called Marc Hudson who is a self-proclaimed Shaman, chiropractic coach and ‘ingenious gentleman fundraiser of Barcelona’ who has odd beliefs about chiropractors being Shamen and Shawomen.)
Bringing the above ECCE accreditation issues up to date, in December 2015 the McTimoney College of Chiropractic learned that an appeal that it had launched against the ECCE’s refusal to accredit it had been successful on the grounds of:
- failure to be fair and accurate
- failure to be objective; and bias or apparent bias
The Appeal Panel’s report has now been sent to the ECCE’s Commission on Accreditation for them to review their decision in the light of the Appeal Panel’s findings. If the ECCE’s accreditation commission does ultimately approve accreditation for the McTimoney College of Chiropractic, it will serve to further condone chiropractic quackery that is already rife in Europe. It remains to be seen if the ECCE will accredit the Scotland College of Chiropractic, but the current ECCE status of the McTimoney College of Chiropractic and the Barcelona College of Chiropractic can be monitored here.
Registered UK chiropractors, vested interests, and influencing an amenable regulator
Returning to the subject of the GCC and its apparent leniency in recognising the education standards of a chiropractic college with a traditional ‘philosophical preference’, why might this be? Evidently, it’s because it doesn’t have a sound knowledge of chiropractic — ie its early history, chronic in-fighting, and very shaky evidence base. For instance, its legislative framework doesn’t cover the scope of chiropractic practice and, in 2015, it admitted to having no detailed information (p.14) about the make up of the UK chiropractic profession and its registrant base. Due to this ignorance, it would seem that UK chiropractors have managed, entirely unimpeded, to always elect a good proportion of subluxationist chiropractors (i.e. chiropractors who don’t seem to have a problem with vitalistic dogma) as serving members on the GCC’s committees. The most prominent of these chiropractors has been Christina Cunliffe, a graduate of the McTimoney College of Chiropractic, who is now Principal of it, and who has served on the GCC’s Education Committee. You can learn more about her style of chiropractic here where, in an unflattering investigation, it is described as ‘a cult within a cult’.
Holding similar philosophies to Christina Cunliffe is the founder of the Scotland College of Chiropractic, Ross McDonald, who graduated from this UK chiropractic college, and who appears to have been influencing the GCC for some time through a variety of channels:
- He and his chiropractor wife own a family ‘wellness’ practice in Edinburgh, Scotland, and together they founded The Edinburgh Lectures, “a vitalistic conference designed to educate, empower and inspire chiropractors and their staff”. In the past, the lectures have featured anti-vaccination speakers .
- He has been President of the subluxation-based Scottish Chiropractic Association since 2007.
- He was Chair and co-author of the dossier, The Vertebral Subluxation Complex – The History, Science, Evolution and Current Quantum Thinking on a Chiropractic Tenet, which, in August 2010, resulted in the withdrawal of GCC legislative guidance that had previously forbidden chiropractic ‘subluxations’ to be linked to health concerns. The GCC’s public explanation for this was that it had decided to do so after ‘a Council meeting’ and ‘on reflection’.
- He is one of the leaders of the several hundred-strong Alliance of UK Chiropractors (AUKC), the largest vitalistic body of chiropractors in the UK, comprising members of the McTimoney Chiropractic Association, the Scottish Chiropractic Association, and the United Chiropractic Association.
Talking the ToC
As an executive of the AUKC, one of Ross McDonald’s most recent attempts to influence the GCC was in a letter to it from the AUKC (see pages 11-15) that he co-signed. The letter informed the GCC of the AUKC’s vote of no-confidence in its new Test of Competence (ToC) process which, as previously mentioned, is the route to GCC registration for chiropractors who haven’t been trained via a GCC-accredited establishment in the UK. Indeed, the letter clearly shows the AUKC to be deeply agitated about the new ToC’s evidence-based line of questioning. But that’s understandable, not least because Ross McDonald might want to lessen the need for his future students to swot up on non-vitalistic educational materials in order to pass the ToC. Of particular concern is item 7 in the AUKC’s letter that takes exception to the GCC examining panel’s cautious views on taking x-rays in clinical practice. The AUKC claim:
One of the indications for requiring radiographic examination is the presence of neurological signs or symptoms. A subluxation (or any other name they wish to call it) by nature has a neurological component. Presence is an indication for x-rays (amongst other reasons).
In response to the AUKC’s letter (see C-180615-4, page 5), the Chair of the GCC’s Education Committee said that the Committee was “of the view that the new ToC system was proportionate and reflective of other regulators’ approaches”, and confirmed that there would be an internal review of the ToC at the end of one year, and an external review at the end of three years. Unfortunately, the Chair made no reference to chiropractic ‘subluxations’, which, as we already know, the GCC links to ‘health concerns’ (albeit indirectly). With this in mind, the outcome of the internal and external reviews of the GCC’s ToC will make for interesting reading. (NB. In 2007, the GCC reported (p.13) that one of its expert witnesses claimed that chiropractic ‘subluxations’ were “commonplace to the point of universality in patients”.)
Bumbling bureaucrats and bogus treatments
With the GCC taking an apologist stance on the subject of chiropractic subluxations, it should come as no surprise that its Chief Executive Officer and Registrar, David Howell, seems to have been caught up in the vitalistic chiropractic agenda that’s gathering steam in Scotland. For instance, he attended the Scottish Chiropractic Association’s AGM in October 2015. Ostensibly, his presence there was to update the Scottish Chiropractic Association’s members on the General Chiropractic Council’s activities. However, a ‘Dr’ Tim O’Shea, one of two American vitalistic chiropractors who were guest presenters at the event, blogged enthusiastically about his thoughts on it, revealing that it descended into a late night, whisky-fuelled affair in which David Howell’s loquaciousness had left him with the distinct impression that the GCC’s highest office “did not require a detailed knowledge of the profession that it regulated”. Others feel much the same.
In view of Scotland’s fine reputation for medical advancement, it’s disappointing that the Scotland College of Chiropractic seems intent on helping to compromise those hard-won achievements by dragging healthcare back to a time when, in a hopeless attempt to resolve health problems, superstition and religious ritual were the order of the day. Only robust regulation can stop a pernicious slide towards a culture that’s indifferent to quackery. It will mean ensuring that relevant legislators are thoroughly acquainted with The Scientific Method. Most crucially, in order for patients and the public to be truly protected, not only will transparency have to be paramount, but the inevitable backlash from chiropractors whose livelihoods will have to be earned under a defined, evidence-based scope of practice will have to be met with a persistent and conscionable resistance that firmly conveys an intolerance of double standards.
Meanwhile, the Scotland College of Chiropractic, a registered charity whose statement of purpose is “the advancement of education“, continues to evolve. Its Trust was signed recently, with its Official Witness, Michael B. Dibley, declaring that
The VitalisTIC ChiropracTIC Movement is NOW bigger than ever. Get on The Quantum Train or Hang out at the Educated Station.
There is, of course, not a jot of scientific evidence for chiropracTIC, but no doubt chiropractors who aren’t dedicated to the realities of science will be more than happy to place their trust in the Scotland College of Chiropractic and its associates. However, potential students should seriously consider doing the exact opposite. They need to ask themselves if there’s a good chance that they would be wasting their time and money, and risking harm to themselves, and others, in pursuing a career in which they could find out too late that spines aren’t the only things that can be manipulated for a fee.
Finding a document on the website of the British Chiropractic Association titled “CONFIDENTIAL FOR BCA MEMBERS ONLY” is an open invitation…
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?
Guest post by Blue Wode. Originally published on The Twenty First Floor on 14 March 2012.
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.
Jubilation in the chiropractic world! But, as usual, all is not what it might first seem…
Chiropractors granted Royal Charter:
The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. In doing so, Chiropractors become the first complementary health specialty to be awarded a Royal Charter. It is great news for Chiropractors and the development of the chiropractic profession in general.
Royal Charters have traditionally been awarded to specialty areas of Medicine such as the Royal College of Surgeons or Royal College of Dentists. It recognises the value of the College of Chiropractors unique position as a leader in the profession. (Source)
College of Chiropractors receives Royal Charter. Feels great to now be part of The Royal College of Chiropractors (Source)
The College of Chiropractors have been granted Royal Charter. Congratulations to the Royal College of Chiropractors! (Source)
The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. (Source)
One chiro was quick to update their website (or maybe he always thought it was a Royal College?) with this new imprimatur:
College of Chiropractors granted Royal Charter
Dated: 12 November 2012
At a meeting of the Privy Council on Wednesday, the Queen approved the grant of a Royal Charter to the College of Chiropractors, the first Royal Charter to be granted to a complementary medicine organisation in the UK.
The College is an academic, professional membership body, established along the lines of the Medical Royal Colleges, which over the past 13 years has sought to ensure quality, safety and excellence are at the forefront of chiropractic practice in the public interest.
Chiropractic is regulated by statute and although chiropractors provide their services largely within the private sector, NHS funding for chiropractic treatment is now emerging region by region under the Department of Health’s new commissioning arrangements. Chiropractors specialise in the diagnosis and treatment of problems affecting the joints, muscles and nerves and are probably best known for treating low back pain, a condition which costs the equivalent of between 1% and 2% of the UK GDP and has a significant impact on people’s lives.
Rarely granted, a Royal Charter signals permanence and stability and, in the College of Chiropractors’ case, a clear indication to others of the leadership value and innovative approach the College brings to the development of the chiropractic profession. The Royal Charter essentially formalises the College’s position as a unique, apolitical, consultative body, recognising its role in promoting high practice standards and certifying quality and thus securing public confidence.
Tim Jay, President of the College, said, “The College of Chiropractors’ Royal Charter emphasises to the public and other health bodies that chiropractic is a healthcare profession with parity in the field of musculoskeletal health, providing a viable and recognised option for patients.”
All the usual spin, of course.
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?
But there is an occasional interesting item or two.
The ASA Committee of Advertising Practice (CAP) – the debate goes on
The latest issue we’ve flagged up to the team at CAP relates to claims to treat minor sports injuries.
Its AdviceOnline in respect of osteopathy and physiotherapy states that CAP has accepted that they may claim to help minor sports injuries, but there is no mention of this for chiropractic. In respect of physiotherapy, CAP goes on to state that
“At the present time, CAP is unlikely to ask to see evidence for the treatment of minor conditions.”
We’ve asked CAP to confirm that it would take the same approach to any claims made by chiropractors about minor sports injuries. As ever, we’ll keep the profession in touch with progress.
We have the situation where the GCC — the statutory regulator for chiropractors, who frequently claim to be a primary health-care profession — is asking the ASA — the voluntary advertising regulator, funded through a levy on advertising spend — to add minor sports injuries back onto their list so their registered chiropractors can make claims about it!
Let’s see if we can help answer the GCC’s query.
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).
Chiropractors must justify public trust and confidence by being honest and trustworthy.
C1 Chiropractors must act with integrity and never abuse their professional standing.
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.
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).
‘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.
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.