Please sign the letter to Trading Standards

UPDATE: We've now got 500 signatories and I'm preparing the letter to send off. Thank you for all your support.

You can sign the letter by filling out this form.

If you've visited this blog for the first time, here's a lightning-speed explanation: the evidence suggests that Chiropractic doesn't work as a treatment for colic, I made several complaints to trading standards about Chiropractors who were making this claim. Most trading standards offices have taken action, a few chiropractors are holding out. This last letter is to get those last few businesses to stop making unscientific claims about important issues of health. It will be mail-merged the details and claims made by approx 50 chiropractors.

While the names of signatories will of course need to be printed on the letters to Trading Standards, they will otherwise be kept private.

Please sign the letter.

The full text is below.

To Whom it May Concern,

We are writing to complain about [company name]. While it is up to you to establish whether this company is breaking the law, we wish to bring a possible infringement of The Consumer Protection from Unfair Trading Regulations 2008 to your attention.

This company makes the following claims on their web site [web site url to be inserted here]:

[copied & pasted claim]

This text clearly implies that the company in question is willing to use chiropractic to treat infant colic. There is no reliable evidence to support the belief that colic is caused by a problem with the spine, nor that chiropractic is effective in treating it. In addition, there is reliable evidence from a controlled trial that clearly shows chiropractic to be no more effective than placebo.

Below are listed the studies typically cited by chiropractors to show that chiropractic is an effective treatment for colic. We have included an explanation of the trial and the conclusion that can be drawn from it. The final study in the list is generally ignored by chiropractors making this claim; however, it clearly shows the treatment to be ineffective.

Study	Summary	Conclusion
1. Klougart N, Nilsson N and Jacobsen J (1989) Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases, J Manip Physiol Ther,12:281-288.	This study tracked 316 children with symptoms of colic during chiropractic treatment and showed that there was improvement in 94% of cases. However, this study failed to provide any evidence for or against the efficacy of chiropractic in the treatment of colic for the following reason: all children with colic improve over time. If all children improve from colic anyway, then showing that they improve after a certain treatment is unhelpful unless there is a control group not receiving treatment with which to compare them. This study contained no such group.	This is irrelevant. It is irrelevant because it cannot demonstrate that treatment improves recovery from the condition.
2. Mercer, C. and Nook, B. in the Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999)	This doesn't seem to have been published, so was not peer reviewed. As it seems to be almost impossible to get hold of the paper, there is very little that can be said. From the summary provided by the BCA, however, it appears that this was a simple observational study like the one above with no control group.	This is irrelevant. It is irrelevant because it cannot demonstrate that treatment improves recovery from the condition.
3. Wiberg J, Nordsteen J, Nilsson N. The short term effect of spinal manipulation in the treatment of infantile colic. A randomised controlled trial with a blinded observer. J Manipulative Physiol Ther (1999) 22:517-522.	This study was a randomised controlled trial comparing chiropractic with dimethicone in the treatment of colic. Without blinding between the two groups, it is likely that the placebo effect could play a major part in the outcome. The placebo effect is likely to be more pronounced with the chiropractic treatment as it is a more dramatic intervention. In addition, the system of measurement (asking parents to record crying hours) adds another potential bias. The parents who were keeping the diaries were were not blinded. Wiberg and Nilsson appear to concede this point themselves here: http://adc.bmj.com/cgi/eletters/84/2/138#124	This is inconclusive at best due to the lack of blinding, with the effects shown likely to be due to placebo and bias in record keeping.
4. Hayden & Mullinger (2006) Complementary Therapies in Clinical Practice (2006) 12, 83–90.	This study did not investigate chiropractic, but cranial osteopathy. Even so, this was a preliminary trial. Preliminary trials are of too small a scale to reach a conclusion. They are used only to see if it might be worth performing a proper trial.	This is irrelevant. It is irrelevant because it does not study chiropractic.
5. Hipperson AJ (2004) Clinical Chiropractic 11, 122 – 129.	This was merely a report of two case studies. This is irrelevant for the same reason as Klougart N, Nilsson N and Jacobsen J, but with only two subjects.	This is irrelevant. It is irrelevant for the same reason as the first study.
6. Browning M. Miller, J. Clinical Chiropractic (2008) 11, 122—129	This study compared two different forms of chiropractic in the treatment of colic. Maybe they both work, maybe neither work. This study did not attempt to answer that question.	This is irrelevant. It is irrelevant because it did not test if the treatment worked. It merely compared two different types of chiropractic treatment. This outcome would be expected if neither method worked.
7. Leach RA (2002) J Manip Physiol Ther, 25, 58 -62.	Simply another two case studies as Hipperson AJ (2004) above.	This is irrelevant. It is irrelevant for the same reason as the first study.
8. Miller J (2007) Clinical Chiropractic 10, 139—146 Cry babies: A framework for chiropractic care.	This is not a study at all, we are not sure why it has been quoted by the BCA.	This is irrelevant, as it is not a study of any kind.
9. Nilsson N. 1985 Eur J Chiropr 33, 264 – 255 Infantile colic and chiropractic.	This is merely a survey of parents who have had their child gone through chiropractic treatment for colic. No parents who did not take their children to chiropractors were questioned, making this study even more poorly designed than Klougart N, Nilsson N and Jacobsen J.	This is irrelevant. It is irrelevant for the same reason as the first study.
10. Olafsdottir E, Forshei S, Fluge G, Markestad T (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation.	AIMS: To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic. METHODS: One hundred infants with typical colicky pain were recruited to a randomised, blinded, placebo controlled clinical trial. RESULTS: Nine infants were excluded because inclusion criteria were not met, and five dropped out, leaving 86 who completed the study. There was no significant effect of chiropractic spinal manipulation. Thirty two of 46 infants in the treatment group (69.9%), and 24 of 40 in the control group (60.0%), showed some degree of improvement. CONCLUSION: Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic. This is the only properly conducted trial comparing chiropractic against placebo for the treatment of colic. The conclusion is that it simply does not work.	This is highly relevant, and clearly shows that chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.

Part 2, Section 5 of the regulations list misleading actions as below. You can see from the text below that a trader is in breach if they present information in a way that is misleading even if it is factually accurate. For instance, a trader presenting a testimonial from a client promoting efficacy or even just stating "some parents have found chiropractic useful in treating colic" or a trader citing a poorly conducted trial as evidence without informing the potential customer of a well conducted trial showing the opposite outcome is therefore performing a misleading action under the regulations.

Misleading actions
5.—(1) A commercial practice is a misleading action if it satisfies the conditions in either paragraph (2) or paragraph (3).
(2) A commercial practice satisfies the conditions of this paragraph—
(a)if it contains false information and is therefore untruthful in relation to any of the matters in paragraph (4) or if it or its overall presentation in any way deceives or is likely to deceive the average consumer in relation to any of the matters in that paragraph, even if the information is factually correct; and
(b)it causes or is likely to cause the average consumer to take a transactional decision he would not have taken otherwise.

According to The Consumer Protection from Unfair Trading Regulations 2008, the onus of evidence relating to any factual claim is on the company making the claim. So it is not a requirement that a prosecutor proves that the claims are factually incorrect, rather it is a requirement that the company must be able to show that their claims are backed by adequate evidence. Section 27 of the regulations state:

(1) This section applies where an application for an enforcement order or for an interim enforcement order is made in respect of a Community infringement involving a contravention of Directive 2005/29/EC of the European Parliament and of the Council of 11 May 2005 concerning unfair business-to-consumer commercial practices in the internal market.
(2) For the purposes of considering the application the court may require the person named in the application to provide evidence as to the accuracy of any factual claim made as part of a commercial practice of that person if, taking into account the legitimate interests of that person and any other party to the proceedings, it appears appropriate in the circumstances.
(3) If, having been required under subsection (2) to provide evidence as to the accuracy of a factual claim, a person—
(a) fails to provide such evidence, or
(b) provides evidence as to the accuracy of the factual claim that the court considers inadequate,
the court may consider that the factual claim is inaccurate

As an enforcement authority, you also have the right to demand any documentation, such as their evidence for the claim, from the company. Section 21 (b) states "if he has reasonable cause to suspect that a breach of these Regulations has been committed, he may, for the purpose of ascertaining whether it has been committed, require any trader to produce any documents relating to his business and may take copies of, or of any entry in, any such document;"

So, to summarise the points above:

• The consumer protection regulations cover the overall impression given by the trader and the trader may be in breech even if the actual claims are factually accurate.
• The consumer protection regulations require the trader to provide evidence for any claims they make, rather than the prosecutor needing to prove those claims to be false.
• The evidence we have found from chiropractic organisations so far appears not to be relevant to the question of efficacy in all but one study. In the one study where it is relevant it appears to be inconclusive, with a complete lack of blinding.
• The only properly conducted trial of the use of chiropractic in treating colic shows this treatment to be no more effective than placebo.
• While prosecution can proceed solely on the grounds that the company provides no evidence, or inadequate evidence; your position is much stronger: the best evidence available clearly shows this treatment to be ineffective.

We have only checked the claims on this company's web site. They may also be making similar claims in leaflets within their practice, or their advice to their customers. We hope you will be able to visit the practice to ensure compliance with the law.

While we have focused on colic for the purposes of this letter, we have also found some practices also claiming to treat children for sleeping and feeding problems, ear infections, asthma and prolonged crying. The evidence for chiropractic's efficacy for these treatments is similar to that for colic above. We sincerely hope you will take similar action against any such claims.

Yours faithfully,

[list of names, titles etc]

You can sign the letter by filling out this form.

56 Chiropractor Practices Still Holding Out With Colic Claims

The vast majority of BCA chiropractors have now removed their claims to treat colic as a result of my previous letters and the campaign by Zeno.

But still 56 practices still hold out, with the claims still available on their web site. I have listed the text of these claims below. It's a bit of a risk to actually list the practice names online. I will be putting the final revision of the letter online soon, once it's been checked by the legal folk.

In the meantime, please join the Facebook group so I will alert you when the letter is ready and we can begin accepting signatories.

			Summary of Web Site
			There is some evidence, though more research is needed, that you may see improvements in some types of: Asthma Headaches, including migraine Infant colic
			The use of these Specialist Techniques allows us to diagnose and treat a diverse spectrum of conditions. These range from headaches, sciatica and back pain to those conditions that people many not realise Chiropractic could help such as feeding and sleeping difficulties in babies, colic and dyspraxia. We are also able to treat conditions that affect women in pregnancy.
			Here are some conditions and injuries we regularly treat: Neck-, shoulder-, arm pain, Back-, hip-, thigh-, knee and lower leg pain, Sciatica, Pain in the wrists, hands and fingers, Pain in the ankles, feet and toes, Headache and Migraine, Face and Jaw pain (TMJ), Ear ache (Otitis media), Dizziness and Vertigo, Disc herniation (slipped discs), Joint sprains, Muscle strains, RSI, Tendinitis, Tenosynovitis, Bursitis, Coccydynia, Colic, Bedwetting (Nocturnal enuresis), Scoliosis, Tennis and Golfers Elbow, Sports injuries, Posture, Postural problems, Muscle Imbalances, Torticollis, Facet joint sprains, Sacroiliac joint sprains, Pelvic Dysfunction, Frozen Shoulder, Rotator Cuff Tendonitis, Achilles Tendon Problems, Hamstring Problems, Thoracic Outlet Syndrome, Rib Pain, Lumbago, Ankylosing Spondylitis (AS), Rheumatism, Spondylosis, Fibrositis, Osteoarthrits, Joint and Muscle pain
			Many chiropractors regularly report success in treating babies with colic, cases of asthma and high blood pressure, digestive complaints, period pain and many other conditions which are not directly related to the spine and joints. As a result, researchers all over the world, including the Anglo European College of Chiropractic and the British College of Chiropractic are also investigating the effect chiropractic has on pain and disease in the organs of the body.
			Although a natural process, birth is sometimes traumatic for both mother and baby, Chiropractic may help you and your baby recover from any birth trauma. Treatment aims to relieve the stress that can affect your baby's neck and head, especially if forceps or other medical assistance was involved, or if it was a breech birth. There is evidence to show that chiropractic care has helped children with the following symptoms: Asthma Bedwetting Breathing difficulties Colic Frequent infections, especially in the ears Hyperactivity Prolonged crying Sleep and feeding problems
			Chiropractic care can help children with asthma colic prolonged crying sleeping and feeding problems breathing difficulties hyperactivity bedwetting frequent infections especially in the ears
			Who should I consider recommending to a chiropractor? There is strong research evidence in the literature for the benefit of chiropractic for: Lower back pain Neck pain Whiplash type trauma in the absence of frank tissue damage. Tension headaches There is weaker evidence of benefit in: Asthma Digestive disorders Migraine Infantile colic Menstrual pains
			There is some evidence, though more research is needed, that you may see an improvement in some types of: asthma infant colic
			Other Conditions also treated Asthma Digestive disorders Migraine Infant Colic Menstrual Pains Glue-ear
			Because the aim of chiropractic treatment is to help your nervous system (that controls everything in your body including your immune system) to function properly, chiropractic treatment results in many positive effects througout your body. Chiropractic is certainly not a cure-all: instead it assists your body's own healing systems to do their job of keeping you healthy. So as well as being great for back pain, chiropractic treatment has been shown to be effective at improving many problems including: Back pain Neck pain Headaches and migraines Pain in hips, buttocks & legs (sciatica pain) Tennis elbow Whiplash Degenerative arthritis pain Disc degeneration Herniated disc Poor posture Foot pain Curvature of the spine (scoliosis) Carpal tunnel syndrome Sports injuries Tendonitis Golfers elbow Shoulder pain Elbow, wrist, hand and finger pain Fibromyalgia Breathing problems Ear infections Colic Back ache during pregnancy Menstrual cramps Workplace injuries Breathing problems Spondylosis
			Many chiropractors regularly report success in treating babies with colic, cases of asthma and high blood pressure, digestive complaints, period pain and many other conditions which are not directly related to the spine and joints.
			Many chiropractors regularly report success in treating cases of asthma, high blood pressure, digestive complaints, period pain, babies with colic and many other conditions, which may not be directly related to the spine and joints.
			All ages can benefit from Chiropractic care - from infants just a couple of weeks old - suffering from colic - to people well into their nineties.
			If your baby suffers from colic, there are a few things that you can do to help: Seek regular chiropractic care, especially during the first four months.
			There is some evidence, though more research is needed, that you may see improvements in some types of: Asthma Headaches, including migraine Infant colic
			...chiropractic adjustments. Even so-called "natural" birthing methods can stress a still-developing spine. The resulting irritation to the nervous system can be the cause of many newborn health complaints. Colic, unexplained crying, poor appetite, breathing problems, and allergic reactions can often be traced to nervous system dysfunction caused by a malfunctioning spine. Head support, followed by crawling, and a baby's first few steps should be followed by chiropractic checkups. If neglected, the bumps and falls during this period of rapid growth may lead to serious spinal deformities later in life. This can set the stage for scoliosis, "growing pains," and a weakened immune system response. Chiropractic adjusting techniques are modified to fit a child's size, weight, and unique spinal problem. Parents often report that their children seem healthier than other kids their age. Many spinal problems seen in adults begin in childhood. Proper spinal hygiene is an important key to better health. Do you know a child who could benefit from chiropractic care?
			Why would a newborn get adjusted? Even today’s “natural” childbirth methods can affect an infant’s spine. Colic, unusual crying, poor appetite or erratic sleeping habits can be signs of spinal distress. Adjustments are gentle. Knowing exactly where to adjust, no more pressure than you’d use to test the ripeness of a tomato is involved.
			' Patients commonly present to chiropractors with conditions such as back and neck pain, sciatica, 'slipped discs', headaches and migraine, whiplash associated disorders, repetitive strain injuries (RSI), leg, arm or general joint pain etc. Other conditions that patients seek treatment for include asthma, digestive disorders (including infant colic), menstrual pains, sleeping problems etc. If in doubt about your particular condition, give me a call for a no obligation chat.'
			What can chiropractic treat ? There seems to be some confusion about exactly what chiropractic is and what it can do. Basically the aim is to balance and rectify the loss of normal function that has occurred to the spine or any other joint as a result of some form of trauma or prolonged bad posture. Many complaints can be linked to working at the computer, driving a car or even spending all day on the telephone not to mention bad lifting technique and back injuries brought on by lifting and twisting type actions. Many symptoms can occur as a result: Headache - Shoulder Pain - Arm Pain - Tightness across the top of the Shoulders Reduced Neck Motion - Low Back Pain - Leg Pain - Reduced Trunk Flexibility - Infantile Colic – Cystitis. If the spine cannot function properly it will start to cause pain and then the body has to adapt to function as best as it can.
			Chiropractic care is suitable for all ages. Babies as young as a few days old can benefit from very gentle adjustments to help with colic and many other child related conditions. As we get older we need to retain our mobility and chiropractic care can help with this.
			Is Chiropractic helpful and safe for the newborn baby? Chiropractic is very safe and effective in treating the newborn baby. Conditions successfully treated are: colic, restlessness, enuresis, difficulty passing stool, and sleeping problems.
			Many research projects show chiropractic care to be helpful for colic, ear infections, erratic sleeping habits, bedwetting, growing pains and many other common childhood health complaints.
			Nina is completing her Post Graduate Master in Advanced Chiropractic Pediatrics and has successfully treated many common conditions from infantile colic to sleep disorders. She employs a 'utilization' approach to the uniqueness of each individual.
			Why would a newborn get adjusted? Even today’s “natural” childbirth methods can affect an infant’s spine. Colic, unusual crying, poor appetite or erratic sleeping habits can be signs of spinal distress. Adjustments are gentle. Knowing exactly where to adjust, no more pressure than you’d use to test the ripeness of a tomato is involved.
			If your baby suffers from colic, there are a few things that you can do to help: Seek regular chiropractic care, especially during the first four months.
			Chiropractic treatment can help patients suffering from back pain, neck pain, headaches, disc injuries, trapped nerves, hip pain, shoulder pain, arm pain, sciatica, infantile colic, pregnancy related back pain, arthritis, scoliosis, sports injuries and many other painful conditions.
			There is some evidence, though more research is needed, that you may see improvements in some types of: Asthma Headaches, including migraine Infant colic
			hiropractic is well known for the treatment of back, pelvic and leg complaints. It is less well known for the treatment of problems that arise in the shoulder and arms, like rotator cuff injuries, tennis elbow or carpal tunnel syndrome. Chiropractors also often treat childhood conditions like colic, and those that are colloquially called 'growing pains' by some other medical clinicians.
			We specialise in the diagnosis and treatment of nerve, muscle and joint problems particularly relating to the spine and its effect on the nervous system. Which means that the symptoms can be very varied. The most common symptoms include back pain, sciatica, neck pain, headache and infantile colic, to mention a few.
			Initially, I visited the Islington Chiropractic Clinic to have treatment for lower back pain which I suffered with during pregnancy. Since then, my children have also received treatment for various problems such as colic and sports injury. I can highly recommend the clinic as the reception staff are always polite, friendly and helpful. Also the Chiropractors have consistently provided us with a high level of care.
			ITRM Chiropractic Clinic also likes to emphasize the importance of family care. Pregnant women, new born babies, and children will find great benefits from chiropractic care. In some cases chiropractic care has been shown to allow for an easier birth, lessen infantile colic and reduce bed wetting. Come along and enjoy our “Kids Zone” and convenient Baby Changing facilities.
			Many chiropractors regularly report success in treating cases of asthma, high blood pressure, digestive complaints, period pain, babies with colic and many other conditions which may not be directly related to the spine and joints.
			As an infant Marcus showed signs of what is often termed ‘colic’. He would cry and scream for hours, sometimes arching his back and neck and clenching his fists. Then during childhood Marcus suffered from severe headaches and neck pain. “I can still remember suffering with headaches and neck pain, I must have only been about seven years old. I would often be told off for constantly pushing on my head, trying to relieve my pain by myself!” His father sought the advice and care of his own chiropractor, Dr Sidney Hudson-Cook, who explained that much of the damage to Marcus’ spine and head had been a result of his forceps delivery at birth. The chiropractic treatment was extremely effective, giving him continual relief. This left a lasting impression on Marcus inspiring him to pursue his studies.
			Moulded Baby' due to intra-uterine constraint by Tone Tellefsen Hughes DC, BSc, FCC (paeds). October 2006 Some babies appear to be born distressed. These babies are often brought into the Chiropractic office by worried and tired parents who, suspects a diagnosis of infantile colic and are looking for a magical cure.
			What Can Chiropractic Help? Millions have been helped with chiropractic. Chiropractors have always had great results with muscle, joint and nerve problems throughout the body, including serious injuries like whiplash type pain, slipped discs, trapped nerves and arthritis. However, chiropractic is more than just a great painkiller. As well as pain relief, many patients enjoy a greater sense of wellbeing with this common sense approach to healthcare. This long established approach of working with the body can have widespread benefits ranging from easing colic in babies to period pains and irritable bowel symptoms in adults.
			Why would a newborn get adjusted? Even today’s “natural” childbirth methods can affect an infant’s spine. Colic, unusual crying, poor appetite or erratic sleeping habits can be signs of spinal distress. Adjustments are gentle. Knowing exactly where to adjust, no more pressure than you’d use to test the ripeness of a tomato is involved.
			Colic is a very disturbing and frustrating problem for many young babies (and their parents!). It is often linked to a neck and upper back problem and seems more common in babies where delivery was long or difficult or involved forceps. Colic babies often tend to turn their head to one side whenever they lie or sit in the car seat, and may only seem to feed well from one side. Research suggest a better than 90% success rate with chiropractic treatment, which usually occurs within 3-4 treatments. The babies often enjoy being treated and having their neck massaged - and the parents enjoy getting a good night's sleep.
			All kinds of problems can be helped by correcting spinal subluxations; back and leg pain, neck and arm pain, headaches and migraines, during pregnancy, babies with colic, children with ear infections, asthma, the list is long.
			Rachel graduated for the AECC with a First class honours degree in chiropractic medicine. She has attended many soft tissue courses and her area of interest is in treating babies and children as well as pregnant women for back pain. Colic, ADHD and a whole host of childhood related conditions have been successfully dealt with by this exemplary practitioner. Rachel spent 7 years in practice in Greater London before joining the team here.
			chiropractic adjustments. Even so-called "natural" birthing methods can stress a still-developing spine. The resulting irritation to the nervous system can be the cause of many newborn health complaints. Colic, unexplained crying, poor appetite, breathing problems, and allergic reactions can often be traced to nervous system dysfunction caused by a malfunctioning spine. Head support, followed by crawling, and a baby's first few steps should be followed by chiropractic checkups. If neglected, the bumps and falls during this period of rapid growth may lead to serious spinal deformities later in life. This can set the stage for scoliosis, "growing pains," and a weakened immune system response. Chiropractic adjusting techniques are modified to fit a child's size, weight, and unique spinal problem. Parents often report that their children seem healthier than other kids their age. Many spinal problems seen in adults begin in childhood. Proper spinal hygiene is an important key to better health. Do you know a child who could benefit from chiropractic care?
			Many Chiropractors regularly report success in treating babies with colic, cases of asthma and high blood pressure, digestive complaints, period pains and many other conditions which are not directly related to the spine and joints.
			We specialise in the diagnosis and treatment of nerve, muscle and joint problems particularly relating to the spine and its effect on the nervous system. Which means that the symptoms can be very varied. The most common symptoms include back pain, sciatica, neck pain, headache and infantile colic, to mention a few.
			Why would a newborn get adjusted? Even today’s “natural” childbirth methods can affect an infant’s spine. Colic, unusual crying, poor appetite or erratic sleeping habits can be signs of spinal distress. Adjustments are gentle. Knowing exactly where to adjust, no more pressure than you’d use to test the ripeness of a tomato is involved.
			If your baby suffers from colic, there are a few things that you can do to help: Seek regular chiropractic care, especially during the first four months.
			A great deal of problems can be corrected (and prevented) at an early age!! Unfortunately, what many family health workers don't know is that many problems can be dealt with by a chiropractor early on in a child's life to help prevent complications developing in the future. If all babies and older children had their spines checked while they were still growing, there would be so many problems which would just never arise in later life. Chiropractors have a great deal of success with babies who suffer from colic and persistent crying.
			If your baby suffers from colic, there are a few things that you can do to help: Seek regular chiropractic care, especially during the first four months.
			Why would a newborn get adjusted? Even today’s “natural” childbirth methods can affect an infant’s spine. Colic, unusual crying, poor appetite or erratic sleeping habits can be signs of spinal distress. Adjustments are gentle. Knowing exactly where to adjust, no more pressure than you’d use to test the ripeness of a tomato is involved
			Is chiropractic suitable for children and infants? Yes. We use gentle techniques on our younger patients to treat conditions such as colic, sleep and feeding problems, hyperactivity disorders and asthma.
			Many of our patients arrive at the clinic with back pain, but you might be surprised to know that we can also help with many other conditions, such as irritable bowel syndrome, menstrual pain, asthma, migraine, arthritis, and even colic in babies.
			Chiropractic care can help solve a host of childhood problems such as; asthma sleep and feeding problems breathing difficulties hyperacticty bedwetting frequent infections Infantile colic
			Chiropractic is a non-invasive profession that looks to encourage the bodys natural ability to heal. It does not involve the use of medication or surgery while acknowledging there are situations where this may be ultimately necessary. In this way it is appropriate care for aches and pains in pregnancy, for infantile problems such as colic and problems sleeping, and those stubborn niggles that have become constant pain with advancing age.
			Chiropractors treat many conditions which at first may not appear to relate to the spine. These include: Headaches Dizziness Shoulder/arm pain Hand/wrist pain Carpal tunnel syndrome Repetitive strain injury (R.S.I.) Hip pain Knee pain Foot/ankle pain Sciatica Slipped disc Pins and needles and numbness Sports injuries Whiplash Colic/unexplained crying/poor sleep patterns in babies
			There is some evidence, though more research is needed, that you may see improvements in some types of: Asthma Headaches, including migraine Infant colic
			Dear Paul, We would like to thank you for the treatment you gave our baby daughter, Rebekah. We brought her to your Clinic when she was just six weeks old. She had suffered form terrible colic since birth and would cry constantly each night for at least three hours and there was absolutely nothing we could do to help her. We tried medicines recommended by the doctor and we tried lying her in certain positions but nothing worked. When a friend suggested that we take Rebekah to a Chiropractic Clinic we were unsure what to do. However, after six weeks of torture (for Rebekah and us!) we thought that anything was worth a try. After the first treatment we saw favourable results almost immediately. After just three treatments the colic had gone. Our only regret is that we didn't bring our son to you when he was a baby as he also suffered badly with colic. We will definitely recommend your Clinic to any parents who are going through the same difficulties we faced a few weeks ago.
			Why would a newborn get adjusted? Even today’s “natural” childbirth methods can affect an infant’s spine. Colic, unusual crying, poor appetite or erratic sleeping habits can be signs of spinal distress. Adjustments are gentle. Knowing exactly where to adjust, no more pressure than you’d use to test the ripeness of a tomato is involved.
			New research now also suggests that other seemingly unrelated ailments can respond well to Chiropractic treatment including headaches, migraine, infantile colic, heartburn and dyspepsia.

Complaint to Trading Standards over unsubstantiated claims made by Chiropractors

I figure it probably makes more sense to post the letter text here than to link to the Google Document. If you wish to be one of the signatories, please join the Facebook Group.

The letter is quite lengthy, but I think all the points are necessary. They are designed to combat the excuses that various Trading Standards offices have used for inaction.

To Whom it May Concern,

We are writing to complain about [company name].

This company makes the following claims on their web site [web site domain name]:

[copied & pasted claim]

We believe this text clearly implies that the company in question is willing to use chiropractic to treat infant colic. We believe there to be no reliable evidence to support the belief that colic is caused by a problem with the spine, nor that chiropractic is effective in treating it. In addition, results from the only controlled trial to date indicate that it is no more effective than placebo treatment.

Below are listed the studies typically cited by chiropractors to show that chiropractic is an effective treatment for colic. We have included an explanation of the trial and the conclusion that can be drawn from it. The final study in the list is generally ignored by chiropractors making this claim; however, it clearly shows the treatment to be ineffective.

Study	Summary	Conclusion
1. Klougart N, Nilsson N and Jacobsen J (1989) Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases, J Manip Physiol Ther,12:281-288.	This study tracked 316 children with symptoms of colic during chiropractic treatment and showed that there was improvement in 94% of cases. However, this study failed to provide any evidence for or against the efficacy of chiropractic in the treatment of colic for the following reason: all children with colic improve over time. If all children improve from colic anyway, then showing that they improve after a certain treatment is unhelpful unless there is a control group not receiving treatment with which to compare them. This study contained no such group.	This is irrelevant. It is irrelevant because it cannot demonstrate that treatment improves recovery from the condition.
2. Mercer, C. and Nook, B. in the Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999)	This doesn't seem to have been published, so was not peer reviewed. As it seems to be almost impossible to get hold of the paper, there is very little that can be said. From the summary provided by the BCA, however, it appears that this was a simple observational study like the one above with no control group.	This is irrelevant. It is irrelevant because it cannot demonstrate that treatment improves recovery from the condition.
3. Wilbery J, Nordsteen J, Nilsson N. The short term effect of spinal manipulation in the treatment of infantile colic. A randomised controlled trial with a blinded observer. J Manipulative Physiol Ther (1999) 22:517-522.	This study showed that chiropractic was equally as effective as dimethicone in treating colic. That could mean that both dimethicone and chiropractic are effective, or it could mean that neither are effective. There is very little evidence demonstrating dimethicone is an effective treatment. The only evidence we could find was a single, small scale trial involving less than 50 children. Showing something to be equal in effectiveness to something with unproven effectiveness is unhelpful. Also, without proper blinding between the two groups, it is likely that the placebo effect could play a major part in the outcome. The placebo effect is likely to be more pronounced with the chiropractic treatment as it is a more dramatic intervention.	This is inconclusive at best, with the conclusion drawn by the chiropractors being dependent on two trials both being properly carried out, both with relatively small sample sizes, neither having been repeated and one lacking adequate controls against placebo effect.
4. Hayden & Mullinger (2006) Complementary Therapies in Clinical Practice (2006) 12, 83–90.	This study did not investigate chiropractic, but cranial osteopathy. Even so, this was a preliminary trial. Preliminary trials are of too small a scale to reach a conclusion. They are used only to see if it might be worth performing a proper trial.	This is irrelevant. It is irrelevant because it does not study chiropractic.
5. Hipperson AJ (2004) Clinical Chiropractic 11, 122 – 129.	This was merely a report of two case studies. This is irrelevant for the same reason as Klougart N, Nilsson N and Jacobsen J, but with only two subjects.	This is irrelevant. It is irrelevant for the same reason as the first study.
6. Browning M. Miller, J. Clinical Chiropractic (2008) 11, 122—129	This study compared two different forms of chiropractic in the treatment of colic. Maybe they both work, maybe neither work. This study did not attempt to answer that question.	This is irrelevant. It is irrelevant because it did not test if the treatment worked. It merely compared two different types of chiropractic treatment that may or may not have worked.
7. Leach RA (2002) J Manip Physiol Ther, 25, 58 -62.	Simply another two case studies as Hipperson AJ (2004) above.	This is irrelevant. It is irrelevant for the same reason as the first study.
8. Miller J (2007) Clinical Chiropractic 10, 139—146 Cry babies: A framework for chiropractic care.	This is not a study at all, we are not sure why it is quoted.	This is irrelevant.
9. Nilsson N. 1985 Eur J Chiropr 33, 264 – 255 Infantile colic and chiropractic.	This is merely a survey of parents who have had their child gone through chiropractic treatment for colic. No parents who did not take their children to chiropractors were questioned, making this study even more irrelevant than Klougart N, Nilsson N and Jacobsen J.	This is irrelevant. It is irrelevant for the same reason as the first study.
10. Olafsdottir E, Forshei S, Fluge G, Markestad T (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation.	AIMS: To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic. METHODS: One hundred infants with typical colicky pain were recruited to a randomised, blinded, placebo controlled clinical trial. RESULTS: Nine infants were excluded because inclusion criteria were not met, and five dropped out, leaving 86 who completed the study. There was no significant effect of chiropractic spinal manipulation. Thirty two of 46 infants in the treatment group (69.9%), and 24 of 40 in the control group (60.0%), showed some degree of improvement. CONCLUSION: Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic. This is the only properly conducted trial comparing chiropractic against placebo for the treatment of colic. The conclusion is that it simply does not work.	Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.

We believe that this trader is operating an unfair commercial practice under the consumer protection regulations. It is Trading Standards' legal responsibility to enforce these regulations. 19.—(1) of the act stated "It shall be the duty of every enforcement authority to enforce these Regulations."

Part 2, Section 5 of the regulations list misleading actions as below. You can see from the text below that a trader is in breech if they present information in a way that is misleading even if it is factually accurate. We believe that a trader presenting a testimonial from a client promoting efficacy or even just stating "some parents have found chiropractic useful in treating colic" is therefore performing a misleading action under the regulations.

Misleading actions
5.—(1) A commercial practice is a misleading action if it satisfies the conditions in either paragraph (2) or paragraph (3).
(2) A commercial practice satisfies the conditions of this paragraph—
(a)if it contains false information and is therefore untruthful in relation to any of the matters in paragraph (4) or if it or its overall presentation in any way deceives or is likely to deceive the average consumer in relation to any of the matters in that paragraph, even if the information is factually correct; and
(b)it causes or is likely to cause the average consumer to take a transactional decision he would not have taken otherwise.

According to The Consumer Protection from Unfair Trading Regulations 2008, the onus of evidence relating to any factual claim is on the company making the claim. So it is not a requirement that a prosecutor proves that the claims are factually incorrect, rather it is a requirement that the company must be able to show that their claims are backed by adequate evidence. Section 27 of the regulations state:

(1) This section applies where an application for an enforcement order or for an interim enforcement order is made in respect of a Community infringement involving a contravention of Directive 2005/29/EC of the European Parliament and of the Council of 11 May 2005 concerning unfair business-to-consumer commercial practices in the internal market.
(2) For the purposes of considering the application the court may require the person named in the application to provide evidence as to the accuracy of any factual claim made as part of a commercial practice of that person if, taking into account the legitimate interests of that person and any other party to the proceedings, it appears appropriate in the circumstances.
(3) If, having been required under subsection (2) to provide evidence as to the accuracy of a factual claim, a person—
(a) fails to provide such evidence, or
(b) provides evidence as to the accuracy of the factual claim that the court considers inadequate,
the court may consider that the factual claim is inaccurate

As an enforcement authority, you also have the right to demand any documentation, such as their evidence for the claim, from the company. Section 21 (b) states "if he has reasonable cause to suspect that a breach of these Regulations has been committed, he may, for the purpose of ascertaining whether it has been committed, require any trader to produce any documents relating to his business and may take copies of, or of any entry in, any such document;"

So, to summarise the points above:

• The consumer protection regulations cover the overall impression given by the trader and the trader may be in breech even if the actual claims are factually accurate.
• The consumer protection regulations require the trader to provide evidence for any claims they make, rather than the prosecutor needing to prove those claims to be false.
• The evidence we have found from chiropractic organisations so far appears not to be relevant to the question of efficacy, and where it is relevant it appears to be inconclusive.
• The only properly conducted trial of the use of chiropractic in treating colic shows this treatment to be no more effective than placebo.
• While prosecution can proceed solely on the grounds that the company provides no evidence, or inadequate evidence; your position is much stronger: the best evidence available clearly shows this treatment to be ineffective.

We have only checked the claims on this company's web site. They may also be making similar claims in leaflets within their practice, or their advice to their customers. We hope you will be able to visit the practice to ensure compliance with the law.

While we have focused on colic for the purposes of this letter, we have also found some practices also claiming to treat children for sleeping and feeding problems, ear infections, asthma and prolonged crying. The evidence for chiropractic's efficacy for these treatments is similar to that for colic above. We sincerely hope you will take similar action against any such claims.

Yours faithfully,

[list of names, titles etc]

Over half of chiropractor colic web pages slashed & burnt

The chiropractor web site slash and burn reached a milestone today. Over half of the web pages I originally found containing the word "colic" have either been deleted, or have had the word removed.

When I originally ran the search, I found 619 pages on the web sites of BCA members. We're now down to just 273. That means a whopping 57% of pages have been changed or removed.

This shows just how much of a difference just a few people can make. This disorganised campaign has involved only 5 people. One person (I'm not sure who) submitted the original ASA complaint. Then myself and Zeno both checked chiropractor web sites for unsubstantiated claims (without each of us knowing what the other was up to). Prof Chris French, myself and another chap wrote a trading standards complaint and mail-merged it, and finally both Zeno and I submitted mass complaints to the GCC.

I've got another letter ready to go to Trading Standards about the remaining web sites. But while the slash & burn continues I think I'll hold off for another week or so. I'm hoping to get a large number of signatories.

If you wish to sign the letter, please join this Facebook group. I'll message all members once the letter is ready to go, of course allowing you to read it before getting final confirmation for your name to be added.

If just 5 people signing letters can make this much difference, think how much difference hundreds can make. Please join the Facebook group.

The current version of the letter is available to view here: http://docs.google.com/Doc?id=df7dstxw_13h5mxjwcf&invite=1199211655