[bpsdb] Recently, the Advertising Standards Agency adjudicated against Dr. Carl Irwin and associates, noting that their claims that chiropractic was an effective treatment for colic could not be substantiated. Thanks to some excellent work by Alan Henness of Think Humanism, we now know that the General Chiropractic Council (GCC) guidelines, which every UK practitioner must apply by, state 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.
In this post, I'm going to look in the ASA archives to see to what extent this could apply to the BCA statements criticised by Singh, and to other chiropractors that we might wish to target.
Jack of Kent has an excellent blog entry covering the legal implications of the latest ruling with regard to the Singh vs. BCA libel case. I'm going to leave the legal aspects to him, although I would note that it seems absurd that the BCA can be regarded as being defamed when they were criticised for promoting something which their own professional guidelines state they are not allowed to promoted.
Instead, I'm going to look at previous ASA rulings on Chiropractic, to see what they can and can't promote, in the hopes of prompting some of you to start a Blitzkrieg of complaints against some of the quacks out there.
In the last five years that archives are available, the ASA have filed 13 adjudications on chiropractic which chiropractors must abide by under GCC rules, and informally resolved a further 11 complaints. All of these cases are listed here.
Since we have no further information on the complaints, and as they probably don't apply to the GCC rules, we'll look at the 13 adjudications. I'm going to list them, and state what they prohibit chiropractors from saying. At the end, I'll list all of the conditions that GCC guidelines prohibit them from promoting treatments for.
David Stevens t/a Vital Body Clinic - 15th September 2004
"ASA told the advertiser to remove references to those serious conditions that the complainants had challenged ["ANAPHYLAXIA", "ANOREXIA", "DEPRESSION", "FERTILITY", "M.E [sic]" and "PALPITATIONS"] and also the references to the serious conditions of arthritis, migraine, obesity and thyroid imbalance."Optimum Health Centres - 19th December 2007
"We considered that the four articles and the text of other abstracts supplied were insufficient to support the claim or to show that spinal therapy had a stimulating effect on the immune system."Spinal Health Centre - 9th January 2008
No relevant ruling.Ideal Spine Centre - 20th February 2008
"We had, however, recently seen evidence from another chiropractor that satisfied us that chiropractors could treat migraine."Atlas Wellness Centre - 20th February 2008
"...the evidence provided did not support the claim that spinal manipulation affected the immune system, and that, even if effects were proven, the matter would be open to further debate and research to determine whether that translated into beneficial clinical effects on the health of patients or healthy people."Gonstead Clinic of Chiropractic - 6th August 2008
No relevant ruling.BritChiro Clinics Ltd - 17th September 2008
"We considered that the evidence submitted about migraine supported the efficacy of chiropractic in treating that condition. We therefore considered that BritChiro could continue to refer to the treatment of 'migraine' in future ads."
"We instructed an independent expert to assess the evidence BritChiro submitted in support of the treatment of whiplash and arthritis. Our expert concluded however that the studies were not sufficient to support efficacy claims for either condition."Optimum Health Centres - 17th September 2008
No relevant ruling (case involves "osteomylogy", which is a whole other blog post).BritChiro Clinics Ltd - 15th October 2008
No relevant ruling.Ideal Spine Centre - 15th October 2008
"We considered that the review of the purpose, principles and practice of chiropractic provided in support of the ad did not justify the implication in the ad that having the spine checked throughout life would have an impact on resistance to disease."Wigan Family Chiropractic Clinic - 25th February 2009
"The ASA considered that an abstract of a research study was not sufficient evidence to substantiate the claim that chiropractic was the best way to treat most spinal problems causing neck and back pain. We also noted that the conclusion of the abstract stated that "chiropractic ... may be effective for reducing levels of disability and perceived pain ...", not that chiropractic was better than all other treatment methods."
Homeo Home - 25th March 2009
No relevant ruling.Dr. Carl Irwin and Associates - 20th May 2009
"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."
There are a couple of points that need to be made regarding these cases. Firstly, those adjudications where there was no relevant ruling nearly all involve cases of misrepresenting qualifications. Secondly, most of the chiropractors involved were practising things like spinal manipulation that of course aren't chiropractic treatments, rather treatments that chiropractics often use.
Nonetheless, while the ASA allowed migraine claims to continue, their rulings and therefore the policy of the GCC must apply to the following claims:
- that spinal therapy boosts the immune system;
- that chiropractic can treat colic, IBS, learning difficulties, whiplash, arthritis;
- that chiropractic is the best way to treat back and neck pain;
- that chiropractic improves resistance to disease;
- that "chirokinetic therapy" (which as far as I can see is the same thing as chiropractic) can treat obesity, thyroid imbalance, anaphylaxia, anorexia, depression, fertility problems, ME or palpitations.
At this point it's worth going back to Simon Singh's now infamous "defamatory" paragraph:
"The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments."
The ASA rulings described here specifically prevent the promotion of chiropractic for both colic and the frequent ear infections. I would argue that between the ruling on CKT and on learning difficulties, claims for the treatment of problems with sleeping, feeding and crying are either very near, at, or beyond the limits imposed by the ASA.
The rationalist in me believes that this should completely undermine the BCA's case. After all, how can they claim their reputation has suffered when they are barred by their own professional code from making some of these claims? The cynic however suspects that it will change nothing in Eady's eyes, as he will still regard Singh as accusing them of lying, and the ASA rulings say nothing about that.
Still, for the BCA to promote the use of chiropractic to treat colic they must have been either deluded, ignorant, or liars. The travesty is that justice doesn't seem to care about the first two scenarios.
Still, the ASA and GCC between them have given us a handy rod to apply to the backs of chiropractors around the UK. If you see one making the claims listed above, you know what to do.
http://layscience.net/trackback/571
Nice one, was going to do a version of this myself but you've saved me the bother :)
Did you notice how many ASA complaints the GCC have made regarding 'osteomyologists' calling themselves doctors?
But, regarding your argument that these ASA rulings have wider implications, I suspect the BCA and GCC will use the get out clause that the rulings only apply to one chiropractor and one advert, not the wider chiropractic community. No professional organisation worth its salt would allow a independent body with no stated professional expertise in chiropracty (IMHO the ASA demonstrate a professional approach to evidence) to pass rulings that would have wide implications for the whole profession without some kind of get out clause. I hope I’m wrong and that these rulings do have implications for Simon Singh and Judge Eady’s ruling, but I’m assuming a default position of pessimism for now.
Excellent, Martin - and thanks for the plug!
There is more. See also my posts http://www.thinkhumanism.com/phpBB3/viewtopic.php?f=14&p=54756#p54756, which details the relevant sections of the ASA's CAP and in particular http://www.thinkhumanism.com/phpBB3/viewtopic.php?f=14&p=54769#p54769, which quotes from the ASA's specific guidance on what is and isn't acceptable.
Gimpy: you may be right about the wisdom of the GCC accepting carte blanche the guidelines of another body, but the GCC CoP seems very clear and there is no immediately obvious loophole for the chiroquacktors to escape through.
For those who have access, it may also be worthwhile reading what I've said on the Bad Science forum about this and where we go from here.
Gimpy: you may be right about the wisdom of the GCC accepting carte blanche the guidelines of another body, but the GCC CoP seems very clear and there is no immediately obvious loophole for the chiroquacktors to escape through.
Yeah, they'll come up with one though. Bitter experience from studying the homeopaths I'm afraid. No matter how clever you are in your arguments the quacks will always find a way of lying to get out of it...
A great idea to review these cases - very informative and interesting. Thank you!
From what I've read recently about the GCC's code of conduct and what they say in their hearing documents, they seem to be reasonably serious about enforcing the CoP - at least once someone complains. The GCC themselves have also been pursuing some of their members via the ASA (although why they don't do that themselves, I don't know). We will have to wait and see.
Can't see OfQuack being so diligent, though.
I think if there is a "Smoking gun" here it is that many of these claims that chiropractors make or have made may be traceable to BCA materials. As I have pointed out with the "Happy Families" leaflet, it appears from the concordancy of wording that many BCA member chiropractors cut 'n' paste BCA materials onto their own websites. Some even say flatly "information courtesy of the BCA".
Thus if the claims on individual practitioners' sites and in their advertising are found wanting, then claims made by the BCA that are a plausible source of origin of the claims might also be (in effect) in breach of the GCC code.
Now, I do not know whether an association like the BCA could be found formally in breach of a professional code of conduct that is designed to apply to individual practitioners. Perhaps not. But I would think that if one could argue that the BCA's materials breached, or had breached, the GCC's rules in a way exactly analogous to what the GCC itself had judged "unacceptable" for individual practitioners, the BCA's reputation would be left looking.. er.. shaky, to say the very least.
Great post - many thanks for putting that information out there!
In case it's useful to people, you can complain to the ASA online at http://www.asa.org.uk/asa/how_to_complain/complaints_form/ A very straightforward process.
Very useful, thanks :)
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So evidence is evidence is evidence? If only that were the case - it seems to depend upon where in the world you live!
Anyway, not widely known for the orginality of my ideas, I thought I'd use the UK ASA complaints (the ones that were upheld) as templates for my own complaints about a few NZ chiropractor advertisments to the NZ equivalent of the ASA. Although one complaint has still to be adjudicated, I suspect none will be upheld (because a letter of complaint - a good old ad-hominum special - from Dr James Burt of the NZCA to my Vice Chancellor, boasted as much). So it seems NZ chiropractors can call themselves doctors (although the Royal commision into chiropractic unequivocably said they should not!) and claim to do things that then magically help relieve things such as asthma. And infertility. Although they didn't promise it would help those conditions.
Although on a positive note, a complaint I made about magnet blankets was upheld.
Amusing. A few question for the Phd theorist:
1. What is Chiropractics?? Did you coin / invent this word? Are we going to describe what Dentists do as Dentics? The correct description is Chiropractor, practising Chiropractic.
2. You appear to be an expert on what Chiropractors do, treat and treatment technique. Very Scientific of you to make bold and unfounded statements and assumptions, I quote :"Secondly, most of the chiropractors involved were practising things like spinal manipulation that of course aren't chiropractic treatments, rather treatments that chiropractics often use."
What exactly are these 'Chiropractic treatments' you refer to?
For a 'man of science' and a PHd major, you certainly do not practice what you preach. I see you also delve into the legal aspect of things too...what a great education you must have.....a Phd student, a Legal expert and a Chiropractic expert....where do you find the time....
Good luck when you get out into the real world and discover that theory and hypothesis is only part of the answer.....
Phd student eh? Thus a mini-expert in your particular field of study, presuming you pass of course. Best stick to your field.
Many thanks for spotting the typo. I would have addressed the substantive scientific points that you raised, except that there weren't any. Also, please don't double-comment - it's painfully obvious when two comments are from the same person as I can see your IP address.
To answer your questions: a) If you're not sure what chiropractic is, then you can get a reasonable layperson's introduction from Wikipedia (http://en.wikipedia.org/wiki/Chiropractic ) ; and b) no I'm not a Ph.D. student, not that it makes any difference to what I write here.
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Please don’t link chirokinetic therapy with chiropractic. If someone advertises that they are a chiropractor then they have to be registered with the GCC and abide by the code of practice and other regulations.
If some advertises that they are a chirokinetic therapist then they are not a chiropractor.
Just because they start with the same five letters doesn't mean it has any links. e.g. chiropractic and chiropody!
Its same with other therapist who manipulate the spine as part of the treatment e.g osteomyologists etc. they also have nothing to do with chiropractic and chiropractors.
The GCC rather disagree with you - http://www.asa.org.uk/asa/adjudications/non_broadcast/Adjudication+Detai...
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This David Stevens guys isn't on the GCC register so he isn't a chiropractor!
Actually many of the ASA rulings relate to osteomyologists, chiropractors removed from the register, a chirokinetic therapist (not a chiropractor) and even a homeopath. You are misinforming your audience, why?- very poor research!
In actuality, 2 studies have been done on chiropractic treatment for infantile colic. Both found that spinal manipulation had a positive effect on colic. On the strength of the findings from the second study Danish health authorities instructed Danish public health nurses to recommend chiropractic care for children suffering from colic.
Jesper et al. The short term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. JMPT 1999; 22 (8).
and
Klougart et al. Infantile colic treated by chiropractors; a prospective study of 316 cases. JMPT 1989; 12 (4)
Perhaps doing some research BEFORE you post things would be better policy for the future.
@Anonymous 1
I've clearly indicated the chirokinetic practitioner above. Regarding the chiropractors, that they have been removed from the register is irrelevent - the point is that the ASA (and therefore the GCC) have ruled that the claims are unacceptable.
@Anonymous 2
Doing research before you post things is a great policy, and if you had followed it you'd know that I have already dealt with both studies.
Klougart et al fail to include any form of control group (it was study #2 dealt with here - http://layscience.net/node/598), while the
The Jesper study was raised by Dr. Mike here: http://layscience.net/node/594#comment-40077 , and as I pointed out at the time, the trial uses dimethicone as a control group, which is a bit silly.
I'd love to know why you think these are good trials?
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I'm going to look at previous ASA rulings on Chiropractic, to see what they can and can't Online degree - promote, in the hopes of prompting some of you to start a Blitzkrieg of complaints against some of the quacks out there.online degree school | Bachelors degrees
The short term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer.Masters degrees | online associate Degree