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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I

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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.

Sara Stevens and the Ultra-Woo Allergy Test

I visited Sara Stevens of "The Complementary Health Team" in Blaby back in May. I've been incredibly slow to blog this, but just realised that blogging my letter of complaint in full would be much better than writing anything new.

Enjoy!

Dear Ms Stevens,

I visited your premises in Blaby on the 7th May 2009 around 5pm for what was sold to me as an “allergy test”.

Having thought about the tests I received, I have got quite suspicious of the methods used and am not convinced that they could work.

To summarise your methods:

• You took a homeopathic preparation of an allergen and put it into my left hand.
• I held it close to my stomach and outstretched my arm.
• You pushed my arm down.
• If my arm moved easily you deduced that I was allergic or sensitive to the preparation from which the homeopathic remedy was made. If not, you deduced that I was not allergic or sensitive.

The problems I am having difficulty overcoming are as follows:

• Homeopathic solutions are typically dissolved to the point where there is none of the original substance remaining. With no substance remaining, I see no difference whatsoever between the 35 preparations you presented me with. How could this work without a chemical difference between the solutions?
• With the preparations contained within glass phials, my body did not even come into contact with the pills. How could my body produce a reaction against a chemical it did not come into contact with?
• I can find no reliable evidence to suggest that coming into contact with an allergen near your stomach reduces your strength in a different part of your body.
• You merely pushed my arm down to subjectively measure the force. This is obviously a completely inaccurate way of measuring resistive force.

To summarise, you attempted to test me for an allergy by pushing my arm down while I didn’t touch a preparation that probably contained no trace whatsoever of an allergen. What evidence do you have to demonstrate that this test actually works?

Following the allergy test, you then gave me two further “tests”. The first, you claimed, was to assess the proportion of “bad bacteria” to “good bacteria” in my body. You did this by counting in tens (0, 10, 20 etc) up to 100 while repeatedly pushing down my arm. After assessing it was weakest between the times when you said “10” and “20”; you then pushed down my arm while counting between 10 and 20. From this, you deduced that my “Candia Level” as you called it, was 14%.

What evidence do you have to demonstrate that this second test actually works?

You then carried out a further “test” to find out what “good bacteria” I needed to buy to restore the balance. You did this by repeatedly pushing down my arm whilst pointing at descriptions of bacteria in a book. You then recommended I take “acidobifidus”.

What evidence do you have to demonstrate that this third test actually works?

I’ve read a fair bit about these tests online and opinion seems to be split. Practitioners of Applied Kinesiology appear to endorse the test, while the common consensus, including all reputable scientific studies, dismiss the practice as pseudo-science with no evidence that it produces accurate repeatable results.

If you do have good evidence that this test works, could you send it to me please? If you do not, I believe that you are operating an unfair commercial practice under the 2008 consumer protection regulations and would like a full refund.

If you do not have reliable evidence for this test, I assume you will from now on comply with the 2008 consumer protection legislation and discontinue your applied kinesiology service. Can you clarify if this is the case?

Regards,

Simon Perry

Skeptics with a "K"

Just a quick note to say I was on the Skeptics with a K podcast talking about the Chiropractic/colic campaign. This was the first time I've listened to the podcast. With the exception of my rambling, those Merseyside skeptics have done very well. Very funny discussion of Genesis at the beginning. I will now become a regular listener.

You can download the episodes here: http://www.merseysideskeptics.org.uk/category/podcast/. My interview is on #2.

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.

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.