Will Trading Standards now take on the General Chiropractic Council?

Sometimes the Trading Standards bodies I’ve written to get in touch with the GCC for more information. And, thanks to a trading standards officer in the Highlands, the GCC’s response is on the trading standard internal database. An officer in London who had received one of my complaints got in touch to ask about the evidence in their response.

I am extremely grateful that he did.

The GCC has been issuing a letter to Trading Standards officers considering action against Chiropractor practices. The letter appears to be deliberately designed to confuse trading standards officers and misrepresent the evidence – and it has managed to do that to great effect.

The text of this letter is available on DC Science blog.

Firstly, they include the text from their patient information leaflet:

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

So firstly there is some confusion here. If an improvement can be the result of chiropractic care, then why don’t they use it as a treatment?

“It is 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.”

What are they talking about? If chiropractic care can help to alleviate the symptoms, then it can be used as a treatment. The evidence throughout the asthma trials that they quote is clear: wherever the trials are properly blinded, it shows the treatment to be useless. I’ve been through the trials they’ve referenced for asthma: Brønfort in 1997 (note: I have not managed to find this paper – but the GCC’s letter acknowledges that this paper concludes that the treatment is ineffective), Brønfort et al 2001, Nielsen NH, Brønfort G, Bendix T. et al 1995 and Balon J, Aker PD et al 1998.

All these papers reach the same conclusion: the SMT (Spinal Manipulation Therapy) is ineffective in the treatment of asthma.

So what are they talking about when they say “You may also see an improvement”? Well the key word, I think, is “see”. While the trials they listed all reached the unanimous conclusion that SMT is ineffective in the treatment of asthma, Brønfort et al, 2001 (a pilot RCT) also found that the patients reported that their life had got better. But the paper did not compare this patient-rated outcome measure between SMT and control group. And the paper even states that “observed improvements are unlikely as a result of the specific effects of chiropractic SMT alone”.

So perhaps what they mean is that if you get chiropractic treatment for asthma, then you might think it did some good, however:

• Objective measures will show that you haven’t been helped, and
• You would have thought you’d been helped if you’d undergone a sham procedure too, and
• This information came from a pilot study and is therefore not particularly reliable.

When the GCC lists this paper as evidence, they only mention that “the children rated their quality of life substantially higher and their asthma severity substantially lower.” The GCC completely neglected to mention that this study concluded that SMT is ineffective in the treatment of asthma.

They then go on to list 3 more papers that they say “appear to echo the evidence levels outlined in the paragraphs above”:

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

But they fail to give any further information about these trials. Why? Why have they not quoted the conclusions, or sent the trial papers on along with their letter?

Why has the GCC not clearly stated that all of these papers conclude SMT to be ineffective in the treatment of asthma?

Why did the GCC list 4 papers that all concluded that SMT is ineffective in the treatment of asthma – but still state “although some clinical trials had positive results there is insufficient data to make strong statements about efficacy”?

Why has the GCC failed to reference the largest and best reported study of the use of SMT in treating infant colic?

How would the General Medical Council react if our GPs started advertising that they were willing to provide ineffective treatments for asthma?

Would they jump to the defence of those GPs?

Would they write letters deliberately designed to confuse Trading Standards?

Would they wait for a member of the public to issue a specific complaint about a specific practitioner before taking any action?

Would they publicise on their web site that “you may also see an improvement” if this ineffective treatment is used?

I think not.

The GCC is meant to be the body designed to regulate the chiropractic profession. With its actions, it has proven itself not only utterly incompetent, but it is actually protecting the very actions it should be regulating against.

The Trading Standards officer I spoke to yesterday was very much of the opinion that Trading Standards should be tackling the General Chiropractic Council directly. I am not sure if this is within their remit, but personally I am now shifting my focus in this direction.