A general record of my ongoing battle with all forms of nonsense.

Wednesday, 2 September 2009

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.

14 comments:

dannyb1022 said...

Excellent stuff! Keep lighting a fire under their arses.

Although knowing the GCC they will probably shift the goal posts and cherry pick some half baked publication to substantiate their nonsense.

Zeno said...

Superb! I like the way you have effectively done the job of the ASA for them - not that they aren't capable of doing it themselves, but a helping hand doesn't go amiss. And the way you supplied them with the evidence the GCC are likely to try to submit to the ASA.

In my recent blog posts, I have been highlighting just what the ASA accept and what they do not accept as evidence. Just in case anyone wants to know...

Simon said...

@zeno, yep - I've been keeping up to date on the ASA complaints. My experience is that the ASA does a fantastic job of interpreting the evidence. Way better than Trading Standards, they really know what they're doing.

samarkeolog said...

Just found this place through Ben Goldacre's twittering. Great work. Good luck with it.

Silex said...

So how about offering some other ways of treating such disorders instead of slandering around and simply being one of those little boys who goes around pointing out everyones faults while he picks his nose. such intellectual wankery such as yours only generates a cloud of 'smug' where none can actually get around to helping people. Tragically Stupid your are.

Ronis said...

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly; who errs and comes short again and again; because there is not effort without error and shortcomings; but who does actually strive to do the deed; who knows the great enthusiasm, the great devotion, who spends himself in a worthy cause, who at the best knows in the end the triumph of high achievement and who at the worst, if he fails, at least he fails while daring greatly. So that his place shall never be with those cold and timid souls who know neither victory nor defeat.”

Simon. you are one those timid souls. wake up my furry friend

Zeno said...

Ronis

Roosevelt also said:

"No man is above the law and no man is below it; nor do we ask any man's permission when we ask him to obey it"

We could go on swapping his quotes or you could stop the ad hominens and address the substantive issue: are chiropractors abiding by the rules they have signed up to? I seek not their permission to ask them to obey their own rules - but it seems no one else is asking them either.

Silex said...

Rules? ha. Rules are there to broken. Think of them more as guidelines :-) haha. What movie is that from? Fix all the fucking subluxations and make all dem little people healthy. rules or no rules. If some rules had been broken I probably woudnt have had to spend the last 7 years in pain, tension, trauma and fatigue trying to fix a spine that couldve been fixed so easily all the way back then, with a little click in the right place when my body was fluid enough to adjust to the changes. Fuck the Rules when peoples lives, health and functionality are at stake. sorry to go Lars ulrich on the plot here. But you people are all fucking stupid. Why does Bill hicks use the F word one wonders. Well? emphasis. Fucking stupid. Rules! hahahah. play fair guys, woudnt want anyone to actually be human. Hey silent Bob! Tell me what your plight is my man. Did some chiro touch you the wrong way and you found you liked it? your stupid shit is getting in the way of healing children. Fuck YOu!

Silex said...

Humbles for passionate expression. You got the rock drummer speaking that last round. to step back into academic mode: Understanding. I don't understand you guys. Make me understand, why it is you dont understand what chiropractic can do for the human race. I am not a chiro and im not on their side. Im a musician movement artist. disease is complicated, health however is very simple. subluxation has a lot to do with the problem but so does eating healthy, focusing on breath, living stress free in the mind. having a spine so superbly beautifully functional is a human right, and chiro is the first discipline to go, 'hey guys, look at it, its kinda wonky, needs fixing. and the spine man! we are vertebrates. its what seperates us from other species. This thing is in the centre of your body orchestrating the whole thing. TONE, have any of you acualy heard the tone of your nervous system? John cage. listen to it my friends. What does it tell you? It probably says..... FIX THE FUCKING SUBLUXATIONS! oh damn, theres the artist again...thats why i make a bad bodywork practitioner. better to demonstrate your subluxations by pointing out your weaknesses on the rubber mat. see why you cant even touch me, cause your slow weak and full of subluxations. some guy could've sorted it back when you were two but idiots like simon and co ranted and raved about it. now your a weak pityfull toad of a human being. such a shame....such a shame

Silex said...

SIIIIIIIIIMON. simon simon simon simon, Where are you my furry friend? where are you hiding. hunting quack hunters is my new fav procrastination hobby. come out come out wherever you are......i can see your computer spine from your picture. got a bit subluxed neck shit going there my friend-bit of hyper lordosis. computer posture....chairs, thats spinal death if ever there was some.

Sumarize your purpose and your vision here my friend. give me the WHY???? of it all. are you just bored?

come on..say something. you had so many nice come backs when it was a gentle little girl chiro. bring some of those wonderful lines to this table.

Silex said...

"I am an author, journalist and TV producer, specialising in science and mathematics, the only two subjects I have the faintest clue about."

yeah, the body is a different thing all together my friend. Other simon in his own words. look at the way he sits in that chair hahhahhahhahaahahahahahahaha.

Fucking stupid

Silex said...

aaaaa haaa. found the source of this trouble. http://www.simonsingh.net. and what do I find..some guy who doesn't even know how to sit in a chair properly, on the front page saying how science and mathematics are the only things he has the faintest clue about. Crit Chiropractic? the body is a different animal all together my furry friend. Idiot. As if chiro's havn't had a bad enough time already. you know when you get attacked that your on to something. people don't like people that are onto things. the quest for everyone to be NOT ONNIT seems rife

Silex said...

My letter to my other furry friend:

"Some scientists claim that hydrogen, because it is so plentiful, is the basic building block of the universe. I dispute that. I say that there is plenty more stupidity than hydrogen, and that is the basic building block of the universe." Zappa

aaaaa haaa. found the source of this trouble. http://www.simonsingh.net. and what do I find..some guy who doesn't even know how to sit in a chair properly, on the front page saying how science and mathematics are the only things he has the faintest clue about. Crit Chiropractic? the body is a different animal all together my furry friend. Idiot. As if chiro's havn't had a bad enough time already. you know when you get attacked that your on to something. people don't like people that are onto things. the quest for everyone to be NOT ONIT seems rife

you sir are stupid and ignorant but clearly very intelligent. What's the problem here? such a simple notion such as subluxation. soooooooooooooooooooooo simple and you don't get it and simply want to cause a fuss. the way you sit in that chair on your website tells me you need some adjusting cause you clearly cant even hold yourself up straight. and to state that maths and science are the only subjects you know about on the front page and for you to be the source of all this chiro attack?

ha. fit of giggles you put me in my furry friend.

I liked your cartoon. that one about 'you want proof?' cause id be able to demonstrate your subluxation riddled frame with organ compromise to boot, on the rubber mat. your a mathematician scientist not a bodywork artist. this much is clear. stick to what your good at stop being a stick in the mud of progress. those kiddies need healthy functional spines so they don't end up slouching in their chairs like you my furry friend.

WAKE UP!!!!!!!!

Silex said...

Chris! hahaha. another idiot. shit. its like a found an idiots nest here. no evidence of chiropractic? tomato juice hoooooooooooooo! although bathing the baby in tomato juice sounds grand. just make sure they organic my friend :-)