Writing to the The General Chiropractic Council

Me first:

Dear Sir/Madam

I note that your CoP contains the following entry:

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.

As you may be aware, the ASA recently declared in a ruling against Chiropractors “Dr Carl Irwin and Associates” (http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_46281.htm) that

“We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).”

It has come to my attention that Huddersfield Chiropractic (http://www.huddersfieldchiropractic.co.uk/BCAD02_Babies.asp) make the following claim on their website:

"Birth and early infancy can sometimes be a very difficult and traumatic time for both mother and baby. After the baby's head has engaged, usually during the eighth month of pregnancy, there can be a lot of stress on its head and back as it continues to move within the womb. This stress can increase further during the birth process, particularly if it is prolonged or involves breech presentation or forceps delivery. As the child grows up, and starts to walk, climb and run, the inevitable falls and bumps can affect the still-developing bones of the spine and skull. Once at school, the child carries heavy bags, sits on badly-designed chairs and participates in a variety of sporting activities.
These stresses and injuries can result in the tightening of muscles in the neck or back, so causing the bones of the spine to lose their normal motion or position. This can irritate or put stress onto the nerve roots that branch off the spinal cord to the organs and tissues of the body. In babies and young children this may lead to symptoms including:
• asthma
• colic
• hyperactivity
• bedwetting
instead of treating the symptoms with drugs, or assuming that the child will 'grow out of it', the chiropractor will gently adjust a child's spine to remove the nerve stress and return his/her body to healthy healing."

Unsurprisingly, the cited Danish research is not regarded as "robust clinical evidence" by the ASA - it would seem to fall well short of the standards applied in conventional medical research.

The claim concerning “colic” would seem to be in breach of the ASA Code. While this is not an advertisement in the sense defined by the ASA, Huddersfield are publicizing their practice and would, therefore, appear to be in breach of your code.

Please could you inform me whether you consider Huddersfield’s claims to be appropriate and whether you intend to take action against this company.

Yours faithfully


Dr* Schroedinger99

*non clinical

The first reply - which came straight back:

Dear Dr Schoedinger99,

Thank you for your email of 4 June 2009. With regard to the final sentence of your email, the Investigating Committee of the General Chiropractic Council investigates complaints relating to the fitness to practise of individual chiropractors, rather than complaints against companies or organisations. In this respect please contact us if you wish to make a complaint about a chiropractor or wish to receive a copy of our complaint information pack.

As your email refers in part to a ruling made by the ASA against a chiropractor, I have referred your email to the Chief Executive & Registrar, Margaret Coats, who will provide a separate response to your email.

Yours sincerely

XXXXX
Specialist Officer (Regulation)
General Chiropractic Council

Ths was quickly followed up by another response:

Dear Mr Schoedinger99
Your email of 4 June has been brought to my attention because it refers to the recent ASA adjudication against a chiropractor – Carl Irwin. I thought you might be interested to see that the GCC’s patient information leaflet (copy attached) includes the following statements

Chiropractors mainly treat
• back, neck and shoulder problems
• joint, posture and muscle problems
• leg pain and sciatica
• sports injuries
You may also see an improvement in some types of
• asthma
• headaches, including migraine; and
• infant colic

It’s important to emphasise that the GCC doesn’t claim that chiropractors 'treat' asthma, headaches (including migraine) and infant colic. It is possible that chiropractic care may help to alleviate the symptoms of some of these conditions. Chiropractors are trained in differential diagnosis and should refer any patient for appropriate care from another health professional when necessary. It is important that, where appropriate, there is good co-management of patient care. But the statement about the possibility of improvement has been included on the basis of the currently available evidence.

I'm not sure what level of detail to go into but as you may know there are a number of ways of measuring, or rating, evidence levels. One relevant example is Brønfort G. Efficacy of Manual Therapies of the Spine, Amsterdam: Thesis Publishers, 1997. This study rates the levels of evidence available at the time and provides a measuring tool to do it - I've cut and pasted the 'ratings table' below for your information. If there's anything that's unclear please do get back to me.

The available evidence of the efficacy of the chiropractic contribution to the management of some types of asthma, migraine headache and infant colic is inconclusive (i.e. level D in the measuring tool used by Brønfort).

Further, with regard to some types of asthma:
• Brønfort concluded in 1997 that there is moderate evidence (Level B) that SMT is a non-efficacious therapy for chronic to moderately severe asthma in adults. There was insufficient data (Level D) to draw conclusions about the efficacy of spinal manipulative therapy (SMT) for other respiratory diseases (including childhood asthma)
• In 2001, Brønfort et al ( see c. below) concluded that after three months of combining chiropractic SMT with optimal medical management for childhood asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. The observed improvements were thought unlikely to be as a result of the specific effects of chiropractic SMT alone, but other aspects of the clinical encounter that should not be dismissed readily.

So although some clinical trials had positive results there is insufficient data to make strong statements about efficacy. There is a higher level of available evidence (i.e. level B) with regard to some types of headache (such as tension-type and cervicogenic headache) and there appears to be a clinical advantage, of both SMT and exercises, both of which chiropractors use, compared to placebo and at least equivalence with commonly used therapies.

Other studies which appear to echo the evidence levels outlined in the paragraphs above are:
a. Nielsen NH, Brønfort G, Bendix T. et al 1995. Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial. Clin Exp Allergy Jan;25(1):80-8
b. Balon J, Aker PD et al 1998. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. NEJM 339 (15): 1013-1020
c. Brønfort G , Evans RL, Kubic P, Filkin P 2001. Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized pilot study. JMPT 24(6):369-77
d. Brønfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews 2004, Issue 3 Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2
e. Wiberg JMM, Nordsteen J, Nilsson N. 1999. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomised controlled clinical trial with a blinded observer, JMPT 22 (8): 517-22.
This isn’t an exhaustive list but I do hope that this level of detail is helpful.
Please don't hesitate to contact me if you have any questions.
Yours sincerely
YYYYYY
Chief Executive & Registrar

This all seemed rather irrelevant, so I worte back again:

Dear Ms YYYYYY

Thank you for your email, but I do not feel that you have addressed the complaint I raised.

To summarize:

the GCC’s CoP states that chiropractors “may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority.”

The ASA have made it clear that it is not acceptable for chiropractors to claim that they can treat infant colic – a judgement which you appear to endorse in your email to me.

Huddersfield Chiropractic claim that they can treat infant colic.

I suggest, therefore, that Huddersfield Chiropractic would seem to be in breach of your CoP and I am requesting that, in view of this, you take action against them.

Yours sincerely

Dr Schroedinger99

I then received a very polite phone call from Ms YYYYYY from which the following emerged:

1) As XXXXX indicated, the Investigating Committee of the General Chiropractic Council investigates complaints relating to the fitness to practise of individual chiropractors - not chiropractic businesses.

2) XXXXX did not pass on my complaint to YYYYY for her to deal with instead. XXXX passed on my complaint so that she could advise me on the sort of evidence the GCC use and how they assess that evidence.

3) If I wish my complaint to be considered, I shall have to resubmit it naming the individual chiropractors who work at the firm I am complaining about.

I note that the GCC seem to be very professional (unlike other "regulators" I have dealt with - e.g PhonepayPlus) and obviously take their role seriously.

I hope this helps others making complaints to the GCC about chiropractors who make bogus claims on their own websites.