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The UK regulatory body, the General Chiropractic Council (GCC), frequently expresses the view that those involved in National Health Service (NHS) healthcare commissioning should fund chiropractic care. The following links may be helpful to NHS healthcare commissioners, and others, in reaching an informed decision regarding chiropractic in the UK. NOTE: Section S3.2 of the GCC's Code of Practice and Standard of Proficiency (effective from 30th June 2010) requires that the care selected and provided by chiropractors ""must be informed by the best available evidence"" and minimise risks to the patient.
“It would appear that the device appeals to chiropractors as it gives a scientific veneer to an unvalidated diagnostic. On the basis of the scan, a customer might be enrolled on a lengthy and expensive course of treatment that is both ineffective and unnecessary, but very profitable to the chiropractor…Remarkably, it looks like it is common practice for chiropractors in the UK to use some sort of discount incentive and questionable diagnostic procedure to rope customers into ‘wellness’ treatment plans…Chiropractic is a statutory regulated profession. As such, it would appear remarkable that chiropractors could get away with such practices…But if they were to stamp out dodgy practices, I would guess that there would be few chiropractors who could sustain a business. Would a regulator regulate itself out of business? If its only goal was to protect the public then is should and it could. But if it is really only protecting its own existence, then do not expect to see any action here.” Lecanardnoir, Quackometer blogspot (14th April 2012)
"...the whole system has been shown to be an utter shambles. The question now is: how are they [the General Chiropractic Council] going to extricate themselves from this fiasco?" Zeno’s blog (3rd April 2012)
“Perhaps not surprisingly, the SCA [Scottish Chiropractic Association] claims on its website that the majority of chiropractic patients present with musculoskeletal complaints such as lower back and leg pain, neck and mid-back pain, headaches, and shoulder and arm problems. It also says that chiropractic can play a ‘vital’ role in living a healthy lifestyle. Undoubtedly most visitors to its website will view these claims as innocuous and in context; however, they suggest a hidden agenda… it is paramount that the SCA’s strong leanings towards vitalistic chiropractic practices are fully understood by as many people as possible…” The Twenty First Floor blogspot (14th March 2012) [Republished at Zeno's Blog, 1st February 2013]
“Dr Richard Brown, the President of the British Chiropractic Association (BCA), has presided over the infamous BCA’s libel action against Simon Singh…Brown recently gave a lecture in which he reviews this experience 'that was ultimately to cost [the BCA] financially, reputationally and politically'1. This lecture has been published and is well worth a thorough read…'For reasons that still elude us, [Ernst] reserved his most poisonous venom for the chiropractic profession'…If, by that, Brown means that I have repeatedly criticised chiropractors, he is correct. But the reasons for my actions should not 'elude' him – in fact, he provides them himself later on: chiropractors have been shown to make 'claims… relating to everything from haemorrhoids to hair loss, chlamydia to cancer'. As it is my job to scientifically verify claims in alternative medicine, I had no choice but to criticise…Brown’s lecture contains many more noteworthy statements, some of which are not directly related to the libel action but reflect on the chiropractic profession more generally, for instance: 'It is unsurprising that new (and not-so new) graduates [of chiropractic colleges] are seeking innovative ways of making a living. Inevitably, however, innovation for some means sailing closer to the wind than ethics and professionalism permit'. Really? Inevitably? Only if ethics and professionalism of chiropractic are wanting, surely! From my perspective, the libel case had an enormous and lasting impact. The true legacy of Simon Singh’s courageous stance is that all practitioners of alternative medicine received a wake-up call telling them that standards of medical ethics must not be corrupted – and that can only be good for the quality of healthcare in the UK.” Professor Edzard Ernst, Pulse (28th February 2012)
“Brown [Richard, President of the British Chiropractic Association] seems to recognize the need for research and evidence-based practice to make chiropractic generally accepted, but his emphasis on finding out what chiropractors do and “why it works,” misses the mark. The real point of research is to figure out if treatments work. If first, then you can worry about why…He sounds partly like a reformer who sees a future of the BCA that can look back and thank [Simon] Singh for being the trigger for change. But he also talks about “clothing” chiropractic after being exposed, rather than fundamentally changing chiropractic. Chiropractic needs more than a costume change – it needs to embrace science-based practice and to rid itself of a great deal of pseudoscience and ethically dubious practices. This will require a significant cultural change within chiropractic. At this point we will just need to watch Brown and the BCA to see if they are serious, or if this was just another lame attempt at damage control.” Stephen Novella MD, NeuroLogica blog (23rd February 2012)
“The president of the British Chiropractic Council, Richard Brown, recently gave his account of the much publicised libel suit that the BCA instigated against Simon Singh. It makes fascinating reading. In the BCA's president's own words:
" … an army of scientists, sceptics and comedians was mobilised to disgrace, degrade and demolish the chiropractic profession. Cabinet ministers, BBC journalists and erstwhile Members of Parliament also joined the fray, determined to pitch in and use the case to reform what they claimed were Britain's draconian libel laws. In using the case as a powerful vehicle to promote his Sense About Science campaign, Singh's crusade mobilised a dark force of UK sceptics who suddenly found their raison d'etre, shifting their attention from the fairy tales of homeopathy to the cure-all claims of chiropractors. Following a call to action, an army of PC pilots and laptop lizards began a war which was to lead to one in three UK chiropractors facing formal disciplinary proceedings from its regulator, the General Chiropractic Council.”
And what was the outcome? Were the chiropractors who had been making unsubstantiated claims disciplined? The short answer is no. One is tempted to conclude that little has changed, but this would be wrong. It is too early to estimate the effects of the libel case on UK chiropractic.” Edzard Ernst, The Guardian (22nd February 2012)
SIMON SINGH: “There are some chiropractors who treat animals and some who don’t, there are some who believe in subluxations and some who don’t, and there are some who use precision instruments and some who don’t, and so on. After the British Chiropractic Association lost its libel action against me, there seemed to be a genuine effort to create a coherent identity that was compatible with the best available evidence. However, the more radical elements in the profession seemed to kick up a fuss, and I suspect that we are back to square one with chiropractors making all sorts of weird claims and a regulator that is unable or unwilling to take control.” The Conversation (31st January 2012)
The Ministry of Defence said that the Government was firmly committed to ethically sound evidence based therapies where there was evidence that they worked, and that such evidence was usually obtained from reports of suitably designed studies in the published peer reviewed medical literature. As chiropractic care had not been endorsed by the NHS, the Ministry of Defence considered that it was not appropriate for it to raise awareness of ‘Hands for Heroes’ amongst Serving and ex-Service personnel. [NOTE: Although the care was ‘free’, a £50 deposit was required to show “a serious commitment on the part of the veteran to wanting to improve their health” and “to prevent abuse of the valuable care being donated by not turning up for scheduled visits”.]
"Today, the University of Wales announced that it is to cease accrediting degrees at all but two colleges…the University has been accrediting the controversial McTimoney Chiropractic College in Abingdon…So, it looks like the McTimoney College will soon have its degree awarding rug pulled from under its feet. This is a very serious situation for it as their students need an accredited degree in order to register with the General Chiropractic Council and practice legally as a chiropractor…Quackery has many victims, and the first are the students who get fooled into training. We now know chiropractic is a largely useless therapy, with a history of pseudoscience and magical thinking. Many students will come to McTimoney as second careers and will not get direct funding. They will have spent tens of thousands of pounds on a four year ‘MSc’, long before this government decided that should be the norm. In order to repay that cost, students must work very hard as a chiropractor with some, no doubt, getting into the very dubious arts of ‘wellness’ chiropractic. By accrediting these degrees, Wales has been doing these young people a disservice. It has given these techniques an air of legitimacy that they do not deserve. When starting a degree, students ought to have confidence that what they are learning is based on sound principles, academic rigour and good evidence. Chiropractic lacks these vital features and so today’s announcement is good news for future students.” Quackometer blogspot (3rd October 2011)
Most consumers seem to think all alternative treatments are natural and therefore safe. I have repeatedly pointed out that this is not necessarily true. Some alternative therapies are associated with very significant risks. Chiropractic, for instance, has left many patients in wheelchairs and some have even died. Yet most chiropractors vehemently deny any responsibility. A recent article by researchers from the Anglo-European College of Chiropractic in Bournemouth started with the telling statement that "the risk associated with cervical manipulation is controversial". This is certainly true…The Bournemouth team sent questionnaires about risk-related issues to 200 randomly selected UK chiropractors and received 92 responses. Their results show, among other things, that "only 45% indicated they always discuss [the risks of cervical manipulation] with patients ... " In plain language, this means that the majority of UK chiropractors seem to violate the most basic ethical standards in healthcare. If we assume that the 92 responders were from the more ethical end of the chiropractic spectrum, it might even be the vast majority of UK chiropractors who are violating the axiom of informed consent.” Professor Edzard Ernst, The Guardian Science Blog (12th July 2011)
“We were pleased to see a call from Prof Alan Breen (at the Anglo-European College of Chiropractic, and on two GCC committees) for a move beyond or supplement to evidence-based medicine in order to achieve a “more democratic and inclusive…age” in “musculoskeletal practice”. However, it is unfortunate that Breen fails to follow through on the implications of his demand…We were also surprised that – given the the British Chiropractic Association is currently pursuing a libel case against the science journalist Simon Singh – Breen did not speak up for Singh’s right to speak freely. After all, surely a democratic and inclusive approach to muskuloskeletal practice must keep open the possibility of robust criticism – and robust examinations of the empirical and theoretical bases for chiropractic. Regrettably, it appears that what Breen is moving towards is not democracy and inclusivity. As Sackett et al argue, evidence-based medicine aims to integrate individual clinical expertise with the best available external clinical evidence from systematic research. Evidence-based medicine therefore draws on the experiences of patients, clinicians and patients. In contrast, Breen seems to be moving towards a privileging of the experiences of a small subset of medical professionals – chiropractors and associated practitioners – and he seems to be advocating this privileging at the expense of numerous other stakeholders: from patients to researchers. Evidence-based medicine is certainly not perfect – and there are important areas in which it should be improved, supplemented or superseded. However, compared to Breen’s approach – an odd kind of chiropractic-centric obligarchy – evidence-based medicine is a much more promising approach.” Evidence Matters (27th June 2009)
“Reasons identified for under-reporting included fear of retribution, being too busy and insufficient clarity on what to report…until there is greater clarity of the purpose and role of the CRLS, the system will probably remain under-utilised.” Clinical Chiropractic, Volume 11, Issue 2, Pages 63-69 (June 2008)
Click here for a critique of the Chiropractic Patient Incident Report and Learning System (CPIRLS).
UPDATE April 2011: Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS): relevance and structure “A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.”
UPDATE March 2013: The Scottish Chiropractic Association announces a decrease in its malpractice insurance premium due to a "robust risk management and reporting system" which it claims to operate and manage. The system doesn't appear to be public, and there's no indication if any of the reports it receives are added to the data in the medical literature regarding complications following chiropractic treatment.
An expose of the regulation of chiropractic in the UK: Why should a statutory body (GCC), charged with protecting the public set such low standards? Do chiropractors now have carte blanche to advertise whatever they want? Zeno’s blog (14th December 2010)
42 recruiting, none of which are in the UK. NHS Choices website (December 2010)
“A letter expressing no confidence in the General Chiropractic Council’s process, interpretation and proportionality in its regulation of the chiropractic profession has been written to the GCC [starts p.4]. Its signatories are the chair of the McTimoney Chiropractic Association and the Presidents of the British Chiropractic Association, Scottish Chiropractic Association and United Chiropractic Association. [link provided] It’s a long document, with 89 points of complaint to made against the GCC…But these are problems that are only to be expected of the GCC. The GCC was set up by chiropractors in order to protect their profession, rather than by members of the public seeking protection from them. The GCC only acted when they were cornered: their code of conduct states that claims must follow ASA guidelines, and the ASA clearly informed the GCC that these claims did not. They had no choice. There’s a lesson here for other quacks seeking to regulate their own quackery. You can use people from your own profession to regulate, and they’ll prove themselves incompetent. Or you can use people to regulate your industry properly - and they’ll destroy it.” Adventures in Nonsense blogspot (25th November 2010)
“…why was the Hancock et al. study (which has nothing to do with chiropractic, remember) ever considered by Bronfort? The GCC has made it abundantly clear that Hancock et al. has nothing whatsoever to do with chiropractic. Even if Bronfort was not aware of this at the time, you’d have thought someone at the GCC would have read it and noticed this irrelevant Hancock study and either asked Bronfort to remove it or issue an amendment to it. Neither has happened… if the Hancock study is to be removed from Bronfort because it had nothing to do with chiropractic manipulation, then we must also remove all the other papers that Bronfort cited that were not explicitly to do with chiropractic and chiropractic manipulation…Chiropractors can’t have it both ways: chiropractors can’t claim to be unique amongst the manual therapists because of their techniques, yet claim any evidence for their particular ‘art’ from the studies that were not about chiropractic manipulations. The GCC has made this perfectly clear. So, the GCC can’t maintain that Hancock is irrelevant because it’s not about chiropractic manipulations, yet allow their prized Bronfort Report off the hook when it cites trials mainly not about chiropractic. Once all those non-chiropractic manipulations have been removed from the Bronfort Report, what’s left? Not a jot.” Zeno’s blog (17th November 2010)
"The Statutory Regulation of Chiropractors can no longer be justified, even if it does help prevent them making bogus claims….It was a big mistake to give official state recognition and regulation to a discredited, superstitious and pseudoscientific form of medical treatment in the first place. Chiropractic theory has been shown to be nothing but mystical whimsy and the effectiveness of their special back rubs has now only been shown to be marginal for lower back pain – about as good as a few paracetamol. So, when the demands of an evidence-based regulator are brought down on a cult-like pseudomedical trade, only tears could follow. What is ironic here is that when regulation was first proposed for chiropractic, one of the conditions was that the trade should be unified and have a single voice, as is characteristic of a profession. That unified voice never really appeared and the desired agreements were a political fudge in order to gain the prize of state recognition…It is not a mature profession as it cannot even agree on what the essential nature of their profession is…were they to be de-regulated, at least they would lose their imprimatur of state recognition and probably the degree level courses underwritten by the universities.” Le Canard Noir, The Quackometer (1st November 2010)
“On 17th August we met with the GCC council and presented a dossier on the Vertebral Subluxation Complex. After reviewing this document and discussions that followed at this meeting the GCC agreed that they would delete the phrase “…or health concerns” in the VSC guidance [new guidance here] and provide an explanation why it had done so…It was also agreed at this meeting that the term Subluxation would again be included in the Frequently Asked Questions (FAQs) – A definition will be discussed and agreed at the next Communications Advisory Group meeting on 10th December 2010…We surveyed the AUKC membership and over half of our members took the time to complete this online survey; the results are as follows:
- 88.2% felt that chiropractic should remain drug-free and that chiropractors should not pursue prescribing rights,
- 82.9% felt that the Vertebral Subluxation was NOT an historical concept
- 95.4% thought that Philosophy should be taught in the Chiropractic Colleges
- 90.5% had found that in their experience Chiropractic was effective for conditions outside those mentioned in the Bronfort Report
- 83.9% answered NO to the question “Do you have confidence in the GCC to regulate the profession?”
The BCA [British Chiropractic Association] approached the Alliance to work collaboratively which has culminated in a joint letter to the GCC advising them that we no longer have confidence in the ability of the GCC to regulate the profession [see p.4 for full text]. The Alliance and the BCA will be meeting with Council on 17th November 2010 to discuss this matter…We are proposing to form a Working Group to promote Chiropractic…[and a] petition for a responsible approach to advertising. There are limitations of RCT's, and good cohort studies should be acceptable evidence. A submission was made to the CAP Copy Team at the Advertising Standards Agency in April 2010 for a further 28 conditions not included in the Bronfort Report to be reviewed and accepted. We are still waiting for this documentation to be reviewed and assessed.”
During October 2010 the UK General Chiropractic Council updated its evidence on sciatica from inconclusive but favourable, to a moderate level of positive evidence when compared to sham manipulation following a review by Professor Bronfort of the Santilli et al trial which was included within a 2008 literature synthesis conducted by Lawrence et al on the chiropractic management of low back pain and low back-related leg complaints. However, the author of a well respected evidence summary maintains the following:
"There is no reliable evidence that chiropractic, osteopathy, or spinal manipulation provide any useful benefit for people with sciatica. And there is reason to believe that chiropractic may aggravate sciatica. I have a double personal interest in this issue because (i) I have sciatica, and (ii) I wrote this evidence summary. The evidence was summarised last year, but our scanning for new research has not found any new evidence since then, as you can see here. The abstract of this recent paper is consistent with what I have said, and tells you all you need to know about the evidence: there is no effective treatment other than surgery (when the sciatica is due to nerve root compression) --- and surgery has its limitations too." Michael Power (20th October 2010)