The dodgy posters in Leicester Highcross TCM shop

I went into the Traditional Chinese Medicine place in Leicester's Highcross centre today and took photos of all the posters on display. In total there are 20 photos of 31 posters or signs.

See if you can count how many of these 31 posters are not breaking the Consumer Protection Regulations.

If you can't read the text, click on the image for higher resolution.

A

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The public isn't interested in why the GCC is trying to mislead Trading Standards

I received the GCC's response to my Freedom of Information Act Inquiry yesterday evening. The GCC avoided responding to almost every point. You can read the full text of their response here and here.

Two points stand out. Firstly, I was very clear in asking for all previous versions of the document, yet they only returned the final version without specifically stating that it was the only version.

Secondly, and more interesting is their response to my request for copies of internal communications discussing the content of the letter.

The emails are considered to be exempt under S36 of the FOIA because the disclosure of the information would, or would be likely to, inhibit the free and frank exchange of views for the purposes of deliberation. The GCC considers it is important that an exchange of views can take place between relevant parties to allow for proper space for deliberation without the exchange being made public. Additionally, the GCC needs to be able to think through the implications of particular options and consider how to properly approach the trading standards offices. Consequently, the public interest test has been applied by the "qualified person" at the GCC and the decision was that the public interest in withholding the information outweighed the public interest in disclosure and therefore it was considered appropriate to rely on FOIA s36 in this case.

Now the only way I can see this inhibiting the free exchange of ideas is if those ideas are not in the public interest. If those ideas included strategies for deliberately misleading trading standards by misrepresenting evidence, then you'd expect that the free exchange of those ideas may be inhibited. But then I'd have thought that inhibiting those ideas was very strongly in the public interest.

But if the ideas exchanged were how best to represent the evidence and how important it is to be honest with trading standards, then it is important that these ideas are not inhibited. But then honest ideas that are genuinely intended to help the public are not likely to inhibited by the prospect of them being made public.

Now I am willing to accept that some of the GCC's staff may have been less than complimentary when referring to me in their internal communications. And I don't have a problem with that.

Paul Ghuman of the GCC, I make you an offer to protect your staff from embarrassment. Pop those communications over to your lawyers at Capsticks and let them know what you want to remove. Then ask them to send the censored copy to me, declaring that nothing material to the decision making process was removed.

If you'd prefer not to do this, I'll ask my MP to send the next request for information. He has been very helpful before when I have been campaigning against quackery.

His next open bureaux is at 5pm on the 18th September.

Quick Update on the Chiropractic Stuff

Just a quick post to keep you up to date. Firstly, thank you to everyone who signed the letter to Trading Standards. Once I got to 500 signatories I sent it off, reporting 56 chiropractor practices. The sites have started to change. 12 have completely removed the claims, and another 5 have diluted what they are claiming - not ideal, but I'm not sure we can do much better right now.

So we're looking at 39 remaining. Not bad when we started with 160.

I'm still keeping an eye on these complaints, but for now my focus has changed the GCC. The organisation has done nothing to make sure its members are not practicing quackery. It promotes chiropractic for babies with colic and asthma in its patient information leaflet, and it has been actively defending its members from the Trading Standards complaints I've been making.

Having received a copy of their leaflet, I have now reported the GCC to the Advertising Standards Authority. The complaint has been slightly stalled when they questioned if I should be submitting the complaint as coming from Skeptics in the Pub. I'm not sure why that is relevant - and Skeptics in the Pub doesn't even exist as a legal entity, but I'm sure we'll work out the details soon. The ASA have made some very good decisions recently so I'm looking forward to seeing them deal with this.

My letter is below.

New Complaints

Advertising Standards Authority

Mid City Place

71 High Holborn

London

WC1V 6QT

To Whom It May Concern:

I have attached a copy of a leaflet entitled “What can I expect when I see a chiropractor?”. This leaflet is published by the General Chiropractic Council and used to promote the chiropractic profession. The GGC’s address is:

General Chiropractic Council

44 Wicklow Street

London

WC1X 9HL

020 7713 5155

My complaint is that this leaflet breaches the following ASA standards:

3.1 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove all claims, whether direct or implied, that are capable of objective substantiation. Relevant evidence should be sent without delay if requested by the ASA or CAP. The adequacy of evidence will be judged on whether it supports both the detailed claims and the overall impression created by the marketing communication. The full name and geographical business address of marketers should be provided without delay if requested by the ASA or CAP.

The claims I would like to focus on in this leaflet are as follows:

There is some evidence, though more research is needed, that you may see an improvement in some types of:

• asthma

• headaches, including migraine and

• infant colic

First I would like to focus on asthma. The statement “There is some evidence, though more research is needed, that you may see an improvement” is misleading. The evidence from trials quoted by the GCC themselves in a letter they recently wrote to trading standards (available at http://www.dcscience.net/gcc-response-to-TS-050609.pdf), they cited the following:

Brønfort concluded in 1997 that there is moderate evidence (Level B) that SMT is a non-efficacious therapy for chronic to moderately severe asthma in adults. There was insufficient data (Level D) to draw conclusions about the efficacy of spinal manipulative therapy (SMT) for other respiratory diseases (including childhood asthma)

I was not actually able to find this paper. However, you can see from the above that the GCC acknowledge that the conclusion of this paper is that the treatment was ineffective.

In 2001, Brønfort et al ( see c. below) concluded that after three months of combining chiropractic SMT with optimal medical management for childhood asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. The observed improvements were thought unlikely to be as a result of the specific effects of chiropractic SMT alone, but other aspects of the clinical encounter that should not be dismissed readily.

This is a misrepresentation of the study’s findings to make it appear that the outcome was positive (study is attached with this letter - Bronfort2001 asthma.pdf). In fact, the study also concludes that there were “no important changes in lung function or hyperresponsiveness at any time.” In addition, the patient rated outcomes were not even compared between the control and treatment groups. Even the GCC admits in their abstract above “The observed improvements were thought unlikely to be as a result of the specific effects of chiropractic SMT alone”. My conclusion from this evidence is that if you go for a chiropractor for asthma then you might think you’ve got better, but (a) if you had received the sham treatment you may have thought that too, and (b) objective measures will show you wouldn’t have got any better.

In their letter, they also list the following studies:

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

(see Nielsen1995.pdf)

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

(see Balon1998.pdf)

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

(Bronfort2001 asthma.pdf)

These studies all come to the conclusion that this treatment does not work.

Study (a) concludes:

The results do not support the hypothesis that chiropractic spinal manipulative therapy is superior to sham spinal manipulation in the management of pharmaceutically controlled chronic asthma in adults when administered twice weekly for 4 weeks.

And study (b):

In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.

I have already described study (c).

I have also attached “Spinal manipulation for asthma: A systematic review

of randomised clinical trials, E. Ersnt, 2009.” (09-000 SM4Asthma.pdf). Which states within its conclusion:

Systematic reviews often conclude that ‘‘more evidence is needed’’. In this particular instance, however, I am not convinced that more studies of spinal manipulation should be funded with public money. The current evidence is clearly not positive, not even encouraging. If clinicians or organisations nevertheless imply (as they do) that spinal manipulation is an effective therapy for asthma, the onus is on them to fund, conduct and publish rigorous trials that demonstrate this claim to be true.

By making the statement “There is some evidence, though more research is needed” I believe that the GCC is being misleading. This statement implies that there is a mixture of positive and negative findings and we don’t really if it works or not. In reality, the evidence from RCTs overwhelmingly suggests that this treatment is ineffective.

I have also attached “Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials, E. Ernst, 2009” (09-000 SM4InfantColic.pdf). As you can see from the text, the best evidence studying the use of chiropractic in the treatment of colic is also negative.

I would like to confirm that I have no commercial interest in the outcome of this investigation.

Yours sincerely,

Simon Perry.