GCC extends complaints to cover all dubious claims

My complaints to the BCA focussed on claims to treat colic. I chose to just complain about colic claims for reasons of simplicity. It was easy to search the pages for one word and gather the evidence. When you’re submitting 55 complaints, it makes sense to go for the easiest method possible.

The GCC has now sent me copies of the responses to my complaints. What's interesting is that it appears that the GCC’s investigating committee has gone further than asked. They have manually gone through the Chiropractor's web pages looking for other claims.

Where they existed, the chiropractor will be investigated for those claims too.

I’m not sure of the GCC’s motivation is to make life easier for themselves in the knowledge that they will soon be needing to deal with Zeno’s 500+ complaints, or if this is a genuine attempt to properly regulate the profession. Either way, this is a positive step from the GCC and should be applauded.

A copy of one of the letters is below.

The GCC Is Avoiding FOIA Requests

On the 6th October 2009, I sent two Freedom of Information Act Inquiries to the General Chiropractic Council. At this point in time, the GCC had just finished its resolution with the Adverting Standards Agency and as a result of this it became known to me that the GCC had commissioned a review of the evidence for the use of chiropractic in the treatment of various diseases that were not related to the spine.

The first request asked them to hand over all communications between the GCC and the ASA.

My second request simply asked:

• Has the GCC commissioned a review of evidence concerning the effectiveness of chiropractic in the treatment of colic or other diseases?
• If so, please provide me with copies of all communications surrounding the commissioning of this review.
• Please provide the final specification detailing how the review is to be performed.

The GCC’s previous behaviour, and especially their response to questions from Trading Standards officers, has clearly demonstrated that they are not interested in regulating the profession of chiropractic, but instead of protecting the interest of practitioners.

I was obviously interested in how they were planning to perform this review, for instance had they agreed the criteria for inclusion and perhaps more interestingly if there had been an attempt to sway the outcome of the trial during the commissioning phase.

I received a reply from Paul Ghuman the next day confirming receipt and asking me to confirm if my request for communications between the GCC and the ASA related to my complaint made about the GCC’s Patient Information Leaflet. I quickly clarified that this was the case.

It took until the 2nd November until I received a response. They were more than happy to respond to the first request, but the second was completely avoided. They acknowledged that they had commissioned a review, but gave no details.

2. Please note that the current request needs to be defined more clearly in the respect of the information required. For example, it could be that the request is for who approved/agreed the final specification or who made the decision on reviewers. I need more clarification in respect of what information it is that is being requested.

Now they could have asked for this on the 7th October when they responded to my first FOIA request. Why did they wait until the 2nd November to ask this question? If I am not being clear enough, that should be obvious enough from the first time they tried to find the information.

I replied to clarify:

To clarify on (2), I assume the GCC has outsourced the evidence review to a scientist, group of scientists, research group or elsewhere. I also assume that in order to find a supplier for the research you may have contacted several organisations/people.

I am looking for copies of all communications to and from those organisations/people that are relevant to the review - both those that were commissioned and those that were considered.

Is that clear? Any questions just ask.

Since I replied, now 2½ weeks ago, I have emailed Paul Ghuman to chase up, phoned him twice and left a message and emailed Margaret Coats.

No response.

The GCC is acting very much like they’ve got something to hide.

The General Chiropractic Council is knowingly and deliberately violating its own code of practice

The General Chiropractic Council is knowingly and deliberately violating its own code of practice and continuing to mislead the very patients it is meant to protect.

My previous post detailed how the General Chiropractic Council resolved my Advertising Standards Authority complaint against them informally. I also noted that as yet, the GCC has not removed their Patient Information Leaflet from their web site.

About a week after the informal resolution was made (but before it was published), I spoke to the ASA on the telephone about the fact that they were continuing to make these unsubstantiated claims. A concerned ASA voice told me:

"We would have hoped they would have taken this down by now."

So on the 6th October I emailed the GCC to ask their intentions:

"I notice that despite your informal resolution with the ASA, that the text still appears on your patient information leaflet here: http://www.gcc-uk.org/files/link_file/WhatCanI_142_5(Web-Version).pdf

Are you intending to take down or change this leaflet?"

And on the 8th, I received a reply in the post:

I emailed the ASA by email to get their take on this:

"I contacted the GCC following my finding that they had not removed the Patient Information Leaflet from their web site. I had a rather surprising reply from them this morning. They said that they will take it down in reasonable time - and suggested that this would happen once they had taken the time to re-write the document and translate it into several languages.

This is shocking. Surely it makes sense for them to take it down now if it breaches ASA standards - or not at all if it doesn't. Surely while they are re-printing they should not be continuing to distribute the material?

Can you clarify the ASA's position on this?"

And the ASA's reply was fairly clear:

"We’d normally expect an advertiser to implement the changes as soon as is 'reasonably practicable' (bearing in mind the time involved in printing new leaflets).

However, if it’s a leaflet on a website then it should be taken down as soon as possible."

So the ASA (rather unsurprisingly) agrees with me that it is unreasonable to continue to make unsubstantiated claims solely on the grounds that you haven't got around to writing and translating anything honest yet.

Based on the informal resolution and the above text from letters and emails, I can't draw any conclusion other than:

• The Chief Executive of the GCC is fully aware that its Patient Information Leaflet violates ASA guidelines.
• The Chief Executive of the GCC is aware that this leaflet is continuing to be made available on their web site.
• The Chief Executive of the GCC is in no rush to do anything about it.

How can the GCC be expected to regulate the chiropractic profession when it knowingly and deliberately violates the very guidelines it is meant to be enforcing?

I think it's time for a complaint against the GCC itself.

Hopefully they'll take my complaint seriously, clean up the regulatory body, start properly regulating the chiropractors and move towards a future of evidence-based chiropractic.

Then I can get back to my game of World of Warcraft.

General Chiropractic Council to Change Patient Information Leaflet

My complaint to the Advertising Standards Authority about the General Chiropractic Council’s Patient Information Leaflet has now gone through the ASA’s process.

The ASA has managed to deal with my complaint as an “Informally Resolved Complaint” rather than pushing it through to a formal adjudication.

This is a very interesting outcome.

What this means is that the General Chiropractic Council has withdrawn the claims as soon as they were approached and asked the ASA’s guidance in how they can make their advertising comply. There is an important point to note here: if the General Chiropractic Council believed they had the evidence to back up the efficacy of using chiropractic as a treatment for asthma, headaches, migraine and infant colic – then they simply could have produced it.

The ASA would have assessed this for them free of charge and either upheld the complaint asking them to remove the advertising, or not upheld the complaint. There is only one reason for backing off from the complaints: the GCC must have appreciated that that they simply do not currently have the evidence.

This is a significant change, and has huge implications for the circa 600 complaints currently being handled by the GCC.

By backing off and removing their claims before the ASA investigates, the GCC is acknowledging that even their loosely worded, slightly ambiguous leaflet (text below) is in breach of ASA guidelines.

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.

If the GCC believes this loosely worded text to be in breach of ASA guidelines, then they must also believe that every complaint made to the GCC surrounding this subject is valid.

Am I being too optimistic in anticipating a vast number of guilty verdicts against chiropractors in the forthcoming months?

It also brings up a second potentially interesting outcome. If you’ve been following this blog, you will be aware of the letter that the GCC sent to Trading Standards in defence of their members. The advice given in that letter includes the exact text within the patient information leaflet that I complained about.

Will the GCC now follow that letter up with another saying that they are now withdrawing that claim? I will be putting that question to them.

Perhaps I'm being a bit optimistic – especially considering that more than a week after agreeing to informally resolve the complaint, the patient information leaflet remains on their website in its original form.

I am now beginning work on my second ASA complaint about the same Patient Information Leaflet.

While you're in the mood for chiro woo, I highly recommend Zeno's post on his recent ASA complaint - published at the same time.

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.

The Quest for “Dr” Paul Homoky’s Secret Evidence

Following my previous post about how Edinburgh City Council now has secret evidence that Chiropractic is an effective treatment for colic, I have been pursuing two different routes to try and get at it. The importance of this evidence – like any evidence of clinical efficacy - cannot be overestimated.

Firstly, I sent the following FoI request to Edinburgh city council:

Hi Lynsey,

I am really quite confused about what has happened over my complaint, and really want to get to the bottom of it. Hence this FoI.

1. What are City of Edinburgh Council Trading Standards' criteria for sufficient evidence when assessing a claim to be able to treat disease?

2. Would City of Edinburgh Council Trading Standards accept simple case histories as adequate evidence when assessing the efficacy of a treatment to treat a self-limiting disease?

3. Would City of Edinburgh Council Trading Standards accept unpublished studies as adequate evidence when assessing the efficacy of a treatment?

4. What training do City of Edinburgh Council Trading Standards' Enforcement Officers receive to ensure they can adequately assess the validity of studies testing the efficacy of a medical treatment?

5. What is City of Edinburgh Council Trading Standards' policy for dealing with trading standards complaints where an assessment of the evidence falls outside the expertise of the enforcement officers?

Many thanks,

Simon Perry

I also contacted “Dr” Paul Homoky, asking for this evidence (see last post). I have now received his reply:

Dear Simon,

Thank you for your email. I’m afraid I won’t be sending you any information. I am far too busy helping patients to improve their health through natural, safe techniques and to help educate the public regarding prevention and lifestyle management. You and your colleagues have already sent an unreasonable complaint to the Edinburgh council and General Chiropractic Council without having even met or talked with me and discussed our approach. If you had done so, or even examined my website properly, you would have learned that we do not treat colic, nor do we claim to treat it on our website or in the clinic. We deal with spine and nervous system complaints, the treatment of which sometimes has a positive effect on other conditions too.

We are a reputable clinic with great success and happy clients. I do not have anything to prove to your sceptics society. Our mode of therapy is chosen specifically because it is safe and effective. I wonder if you have applied the same rigorous analysis to a wide range of medical treatments which are provided by medical doctors on a daily basis—many of which are proven to be ineffective, unnecessary and/or carry a high risk of negative outcome.

My new wife and I have had our first baby, and we would like to enjoy his beautiful entry into the world. Please do not send any further emails to me. I was happy to provide details to the Edinburgh Council as they requested, but this is, quite frankly, our business and not yours. I have taken the time to write this email to you because I believe you deserve a response. If you have any further questions regarding chiropractic care of the spine and any of its researched effects, please direct them to the British Chiropractic Association.

I wish you and your sceptics society well. I am a sceptic too—we have much in common.

Best wishes,

Paul Homoky, B.Sc., D.C.

Chiropractor

I don't think it is correct to say that he does not claim to treat colic. From what I can make out of the wording, he seems to say they don't treat colic, but colic is caused by misalignment of the spine and they treat misalignment of the spine. That would seem to imply that they treat colic, even if indirectly. The text on his site is as follows:

But chiropractic isn’t a treatment for colic! If vertebral subluxation is present, interfering with the proper function of any part of the body, restoring proper nervous system control allows the body to heal. This can happen regardless of age and regardless of what the symptoms are called.

So “Dr” Paul Homoky has decided to keep the evidence secret. All UK chiropractors are bound by the GCC’s code of conduct, which includes:

E1.4 must avoid conduct which may undermine public confidence in the

chiropractic profession or bring the profession into disrepute, whether

or not such conduct is directly concerned with professional practice.32

Now publicising irrelevant evidence, or evidence that has already been publicly debunked, is likely undermine public confidence in the chiropractic profession so it may be that this is his reason for not providing it. However, should the evidence be strong, it would of course undermine public confidence in the profession if he refused to provide it.

I will take up “Dr” Paul Homoky’s suggestion and ask the BCA if they are aware of this new evidence.

After my last post, Felix_the_Mac commented on why I had not asked Edinburgh City Council to provide the evidence for a second time within my FoI request. In reality, this might work. But I don’t think that’s the best approach. Once I finally get hold of the evidence, it’s likely to make for one amusing blog post and die away.

But in all likelihood I’ll get refusal after refusal. And that means I can drag this out for months.

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