For some time, chiropractic has managed to get away with being the acceptable face of alternative medicine. With some evidence to show that it helps with lower back pain, and many chiropractors only using the therapy for this purpose, it was seen by many as a legitimate therapy and largely escaped criticism from sceptics.
That all changed when the BCA decided to sue Simon Singh for libel. In a fine example of the Streisand effect, all the energy usually reserved for criticising homeopaths and reiki healers was redirected straight at those chiropractors making wild and outlandish claims to treat colic, asthma and a host of other problems unrelated to the spine.
With the BCA attempting to stifle debate over the bogus* claims pointed out by Simon Singh, I was determined to do something.
The BCA web site lists all it's 1029 members online, including for many of them, about 400 web site URLs. I wrote a quick computer program to download the member details, record them in a database and then download the individual web sites. I then searched the data for the word "colic" and then manually checked each site to verify that the chiropractors were either claiming to treat colic, or implying that chiropractic was an efficacious treatment for it. I found 160 practices in total, with around 500 individual chiropractors.
Using their postcodes, I then found their local Trading Standards office using the Trading Standards web site.
The final piece in the puzzle was a simple mail-merge. Not wanting to simultaneously report several quacks to the same Trading Standards office, I limited the mail-merge to one per authority and sent out 84 letters. I told a couple of friends about what I was doing and they asked to write letters too. In total, we sent out around 240 complaints. The first batch went out on the 25th May. I don't think there could be a better use of £75 worth of stamps.
To whom it may concern:I am writing to complain about the unfair commercial practices of [practice name].[practice name] makes express reference to the treatment of colic on this web site:[practice web site URL].This appears to be in breach of the unfair commercial practice regulations and other consumer protection legislation. In particular, consumers will, or will be likely to, enter into transactions they would not do so if they were aware of the correct situation in respect of the treatment of colic by chiropractic treatments.The Advertising Standards Authority recently ruled against a chiropractor making similar claims, including on the bases of truthfulness and substantiation - about using Chiropractic as a treatment for colic, with the assessment concluding:“We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.”Unless this trader can show such evidence, it should not be appropriate for it to continue to refer to colic on its website.The trader in question is operating at the following address:[address]I look forward to your response.Best regards,
Replies were mixed. Some authorities were extremely helpful, going straight to the chiropractor and advising them to remove the claims. Here is an example from the Borough of Poole's Trading Standards department.
"I have checked the adjudication on the ASA web site and seen the claims made by Amethyst Chiropractic Clinic on their website. I agree the adjudication can be applied to Amethyst and the company should not claim to treat colic and irritable bowel syndrome. I will contact the company and ask them to amend their website and I anticipate you will be able to see the changes in the near future".
Perhaps the most helpful was the London Borough of Hounslow. I spoke on the telephone to an extremely enthusiastic officer who was genuinely concerned about the claims made. During the conversation, I admitted to making a number of complaints and she asked for the full list of 174 practices and with around 500 chiropractors, which I happily sent her to put on the Trading Standards national database. Two other boroughs have since received the same list.
Some of the Trading Standards offices wasted time and money by writing to inform me that they'd forwarded the complaint to my local Trading Standards office, who promptly checked the claims and wrote to me informing me that they'd referred it back. I suppose they managed to avoid doing any work for a full week while this went on.
Next step was the GCC (General Chiropractic Council). On the 30th May, I reported approximately 500 chiropractors at 174 practices. The GCC responded informing me that I could not submit a list, but needed to complain individually. The GCC will only accept complaints about chiropractors, not practices. I therefore trimmed down the database to those practices who only listed one chiropractor and submitted 56** individual complaints, including archives of the offending web pages.
I wish to make a complaint about «quackNames». This chiropractor is operating at the following address:
«companyName»
«tblQuacksaddress»
I believe this to be the only chiropractor operating at this practice. I also believe this chiropractor to be making unsubstantiated claims on their web site «web» regarding the treatment of colic.
I wish to emphasise that I do not believe this to be fraudulent behaviour. The chiropractor may simply be mistaken about the quality of evidence.
I copied and pasted the following text from their web site «web» on the 30th May 2009:
«summary»
To my knowledge, there is no reliable evidence to indicate that chiropractic is an effective treatment for colic. The most quoted research I could find was 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 simply found 316 babies who were being treated for colic using chiropractic and watched if they got better over a number of weeks.
As colic is not a condition that lasts very long, it is entirely expected that the patients would improve over a number of weeks in the vast majority of cases whether they were receiving chiropractic or not. Without a control group, this study was simply incapable of establish any kind of a link whatsoever between chiropractic treatment and improvement in the symptoms of colic.
I believe this chiropractor to be breaking the GCC codes of practice in the following ways:
B2.2 should always assume adults to be competent unless demonstrated otherwise. If a chiropractor has doubts about the adult’s competence, s/he should ask him/herself the question “can this patient understand and weigh up the information needed to make this decision?” Unexpected decisions do not prove the patient is incompetent, but may
indicate a need for further information or explanation.
B2.7 must offer enough information to patients for them to take the decision to consent or not.17 If the patient is not offered as much information as they reasonably need to make their decision, and in a form they can understand, their consent may not be valid.
By claiming to treat colic, the chiropractor is abusing the customer’s inability to weigh up the evidence to make the decision whether to use chiropractic to treat colic. If the patient had (a) an understanding of the methods of clinical trials, and (b) an understanding of the current evidence for treatment of colic, they are significantly less likely to make the decision to treat colic with chiropractic.
C2.4 must act in the patient’s best interests when making or receiving referrals, providing or arranging assessment or care, or offering products to patients.
In order to act in the patient’s best interests, the chiropractor must advise based upon a fair assessment of the evidence for a particular procedure’s efficacy. By claiming to treat colic with chiropractic, the chiropractor is not giving a fair assessment of the evidence and therefore is not acting in their patients best interests.
C3 Chiropractors must recommend the use of particular products or services only on the basis of clinical judgment and not commercial gain.
By claiming to treat colic, I believe the chiropractor to be demonstrating poor clinical judgement. The chiropractor is making commercial gain by recommending their service for the treatment of colic.
D1 Chiropractors must recognise and work within the limits of their knowledge, skills and experience.
By treating a condition for which chiropractic has not been shown to be effective, this chiropractor is operating outside the limits of their knowledge, skills and experience.
A1.7 Clinical decision making
A1.7b b) the benefits and risks of providing care for the patient, including any contra-indications
By advertising to treat colic with chiropractic, the practitioner failed to properly assess the benefits of treatment.
A2.2 Selecting appropriate care
Chiropractors must select care that is safe and appropriate for the patient concerned, their health and their health needs.
A treatment for which there is no credible evidence for efficacy is inappropriate for the health of the patient.
C1.1 Information on assessment and care
* the outcomes of assessments and care
The communications on the web site of the practitioner clearly indicate chiropractic is an effective treatment for colic. This clearly communicates a positive outcome for which there is no evidence.
C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.
The Advertising Standards Authority has recently ruled against Dr Carl Irwin & Associates for making similar claims:
We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.
On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).
Although the Advertising Standards Authority does not cover claims made on the web, the claims themselves are obviously of the exact same type ruled against by the ASA.
In addition, advertising chiropractic as a treatment for colic is a clear abuse of the trust of members of the public, exploiting the fact that the public is unlikely to independently verify these claims and also exploiting the public’s lack of experience and knowledge in dealing with health based evidence.
I look forward to your response.
Finally, I also sent the entire list to the Office of Fair Trading.
On the 8th June, I was surprised to find out that someone else was doing almost exactly the same thing - allthough they hadn't got as far as the submission yet.
And on the 10th, the science blogs went wild when Le Canard Noir published a very amusing email from the McTimoney Chiropractic Association, advising their members to take down their web site.
It didn't matter, I had copies of all the web sites.
* Not intended to mean deliberately misleading.
** I later withdrew one complaint as there was a problem with the web page archive and I could not be sure if an offence had been committed.
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