The UK regulatory body, the General Chiropractic Council (GCC), frequently expresses the view that those involved in National Health Service (NHS) healthcare commissioning should fund chiropractic care. The following links may be helpful to NHS healthcare commissioners, and others, in reaching an informed decision regarding chiropractic in the UK. NOTE: Section S3.2 of the GCC's Code of Practice and Standard of Proficiency (effective from 30th June 2010) requires that the care selected and provided by chiropractors "must be informed by the best available evidence" and minimise risks to the patient.
This page was last updated on 4th September 2013.
The concept of pursuing prescribing rights for chiropractors came about as a result of the 2002 UK Health and Social Care Act, which permitted professions allied to medicine, including chiropractic, to attain rights for limited prescribing. As a consequence, in 2009, following a vote by British Chiropractic Association (BCA) members at its AGM in 2008, the BCA undertook a postal ballot of its members to determine whether there was support for pursuing these rights, the results of which were announced on the opening day of Richard Brown's presidency. Two thirds of those eligible to vote chose not to express a view, but of those who did nearly 80% supported a proposal to further explore prescribing rights for UK chiropractors.
On the 1st September 2009 the Council of the British Chiropractic Association approached the UK chiropractic regulatory body, the General Chiropractic Council (GCC), to ask it to consider making an application to the Medicine and Healthcare Products Regulatory Agency (MHRA - part of the UK Department of Health) for limited prescribing rights for UK chiropractors. However, following some reflection and a change of opinion by Richard Brown (after continued criticism from quarters of the profession for whom the concept of drug prescription was an anathema), the BCA Council reconsidered its views at a meeting on 20th February 2013 (even although, four years on, the matter had yet to be considered by the GCC). The meeting saw the BCA Council unanimously deciding to support Richard Brown's new stance. Richard Brown explained that, whilst there were some benefits in acquiring limited prescribing rights (which the BCA welcomed as recently as July 2012), there were major issues of regulation, practicality and competence that would need to be overcome, and he believed that the BCA and its members should continue to strive to position chiropractic "in its role as the non-surgical experts in the treatment of MSK (musculoskeletal) conditions". In support of his U-turn, Richard Brown cited the New Zealand Commission of Inquiry's 1979 report, Chiropractic in New Zealand:
"25. As we have seen, much is made by chiropractors of the drugless and non-surgical nature of their therapy. But modern chiropractors do not suggest that there is only one cause of disease; they admit there are limits to their expertise; and they acknowledge the need for medical intervention and medical monitoring. They do, however, place emphasis on the body's natural functioning and its natural recuperative powers.
26. In these matters of emphasis we see some value in the contribution that the chiropractic outlook can make to healthcare generally. There cannot be any fundamental objection to an attitude to healthcare which restricts drugs to cases where they are shown to be a matter of necessity rather than a matter of mere convenience. Nor can it seriously be suggested that anyone is unreasonable to believe that it is better for the body's disorders to be relieved if possible, by natural rather than artificial or chemical means."
At a closed meeting on the 8th August 2013, the GCC finally considered the BCA's 2009 request that it approach the MHRA seeking limited prescribing rights for chiropractors. All four UK associations had submitted their thoughts on the issue, three of whom had been against seeking limited prescribing rights from the start. The GCC decided that to endorse or lead the call for limited prescribing rights for chiropractors was not the role of the regulator, and concluded that any application to the Department of Health must come from the profession as represented by the associations. In the end, the subluxation-based (vitalistic) Alliance of UK Chiropractors (AUKC), composed of the Scottish Chiropractic Association, the United Chiropractic Association, and the McTimoney Chiropractic Association, who claim to represent the majority of chiropractors in the UK, admitted on the 2nd September 2013 to playing a key role in blocking the BCA's original 2009 application. Click here and here to learn more about the AUKC.
"Some national [UK] and international guidelines advise physicians to use spinal manipulation for patients suffering from acute (and chronic) low back pain. Many experts have been concerned about the validity of this advice. Now an up-date of the Cochrane review on this subject seems to provide clarity on this rather important matter....The authors draw the following conclusion: "SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies"...In other words, guidelines that recommend SMT for acute low back pain are not based on the current best evidence. But perhaps the situation is different for chronic low back pain? The current Cochrane review of 26 RCTs is equally negative: "High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain"...This clearly begs the question why many of the current guidelines seem to mislead us. I am not sure I know the answer to this one; however I suspect that the panels writing the guidelines might have been dominated by chiropractors and osteopaths or their supporters who have not exactly made a name for themselves for being impartial. Whatever the reason, I think it is time for a re-think and for up-dating guidelines which are out of date and misleading. Similarly, it might be time to question for what conditions chiropractors and osteopaths, the two professions who use spinal manipulation/mobilisation most, do actually offer anything of real value at all. Back pain and SMT are clearly their domains; if it turns out that SMT is not evidence-based for back pain, what is left? There is no good evidence for anything else, as far as I can see. To make matters worse, there are quite undeniable risks associated with SMT. The conclusion of such considerations is, I fear, obvious: the value of and need for these two professions should be re-assessed." Edzard Ernst (29th April 2013)
A close look at how the BCA [British Chiropractic Association] appears to defend the business interests of its members by instructing them not to share with the media, public, or patients information revealing its views on the evidence for the efficacy of chiropractic and its safety. Zeno's blog (8th April 2013)
The [British Chiropractic Association's] "strictly confidential" message is intriguing in several more ways...I find the most remarkable aspect that the BCA seems to attempt to silence its own members regarding the controversy about the value of their treatments. Instead they proscribe answers (should I say doctrines?) of highly debatable accuracy for them, almost as though chiropractors were unable to speak for themselves. To me, this smells of cult-like behaviour, and is by no means indicative of a mature profession – despite their affirmations to the contrary." Edzard Ernst's blog (8th April 2013)
A few weeks ago, The College of Chiropractors, a Company Limited by guarantee, was given a royal charter...From my perspective, this begs numerous questions; here are just some of them: 1) Have UK chiropractors truly been promoting "high practice standards and certifying quality and thus securing public confidence"? I would argue that they have been doing the opposite. They made bogus therapeutic claims by the hundreds on their websites, and when Simon Singh had the courage to make this public, they sued him for libel. Call me old-fashioned, but I fail to see how this maintains "the highest possible standards of chiropractic practice for the benefit of patients" nor how this might "promote the art, science and practice of chiropractic." 2) Is it truly for the benefit of the people that so many chiropractors deny the considerable risks of spinal manipulation? I would have thought that this is a serious disservice to the people and the health of the nation and believe it reflects an irresponsible disregard of the precautionary principle in health care. 3) How can we accord the high aims of the College with the fact that UK chiropractors demonstrably violate fundamental rules of medical ethics, e.g. informed consent, and that their professional bodies must be aware of this fact, yet have so far failed to do anything about it? I think there is a discrepancy here that needs explaining. 4) Does the College truly "advance the study of and research in chiropractic?" We have shown that UK research into chiropractic has not increased but decreased since statutory regulation. This leads me to suspect that regulation is being abused as a means of gaining recognition and not as a mechanism to protect the public. Considering all this, I find that the status of the other Royal Colleges has been de-valued by the ascent of this organisation." Edzard Ernst (1st March 2013)
"The UK General Chiropractic Council has commissioned a survey of chiropractic patients' views of chiropractic...Perhaps the most remarkable finding from the report is the unwillingness of chiropractors to co-operate with the GCC which, after all, is their regulating body. To recruit only ~10% of all UK chiropractors is more than disappointing. This low response rate will inevitably impact on the validity of the results and the conclusions. It can be assumed that those practitioners who did volunteer are a self-selected sample and thus not representative of the UK chiropractic profession; they might be especially good, correct or obedient. This, in turn, also applies to the sample of patients recruited for this research. If that is so, the picture that emerged from the survey is likely to be far too positive. In any case, with a response rate of only ~10%, any survey is next to useless. I would therefore put it in the category of 'not worth the paper it is printed on'." Professor Edzard Ernst (15th February 2013)
This overview by the Vice President of the British Chiropractic Association, Matthew Bennett, reveals that, in the UK, “much of the early work” on the statutory regulation of chiropractors was done at dinner parties attended by HRH Prince Charles, among others. (20th December 2012)
“The College of Chiropractors has, indeed, been granted a Royal Charter, but it's a Royal Charter of Incorporation, granted by the Privy Council, with Nick Clegg as Lord President…The College claims it "currently has more than 1500 UK members and 2800 members worldwide." That adds up to just 4,300 members (with only 1,500 in the UK), somewhat short of the requisite 5,000. Or does that 2,800 include its 1,500 UK members? In which case, it's even further off meeting the 5,000 requirement. But why only 1,500 members in the UK? There are 3,374 chiropractors registered with the General Chiropractic Council, so the College of Chiropractors doesn't even represent half of the chiropractors in the UK. Is this further evidence to the split between the different chiro factions?...The grant of the Royal Charter on 7th November followed a letter of support from Department of Health dated 26th September 2012 to the President of the College to say the Department would be advising the Privy Council that the College’s charter application should be taken out of abeyance. So, despite the College failing to meet the requirements set out by the Privy Council, it was interference in that process by the DoH that produced the Royal Charter a mere weeks later. Once we have that letter, we'll let you know what it says. Meddling, anyone?” Zeno’s blog (26th November 2012)
“Critics of complementary and alternative medicine have condemned the Privy Council's decision to award a Royal Charter to the chiropractors' professional body. According to the website of the British Chiropractic Association (BCA), the College of Chiropractors was granted the charter by the Queen last week, following a meeting of the Privy Council…Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, described the awarding of the charter as "a serious mistake which debases the [royal] title as carried by all the other royal colleges"…David Colquhoun, professor of pharmacology at University College London, described the awarding of the Royal Charter as "a bad day for reason”.” Times Higher Education Supplement (16th November 2012)
“A new analysis of the evidence has just been published, and, in view of the news just out of a Royal Charter for the UK College of Chiropractors, it is time to dedicate some real attention to this important issue…I find many of the statements of the authors helpful and commendable, particularly considering that they are chiropractors. They seem to be aware that, when there is genuine uncertainty, we ought to err on the safe side [the precautionary principle]. Crucially, they comment on the practical implications of our existing knowledge: “Considering this uncertainty, informed consent is warranted for cervical spinal manipulative therapy that advises patients of a possible increase in the risk of a rare form of stroke…” A little later, in their discussion they write: “As the possibility of an association between cervical spinal manipulative therapy and vascular accidents cannot be ruled out, practitioners of cervical spinal manipulative therapy are obliged to take all reasonable steps that aim to minimise the potential risk of stroke. There is evidence that cervical rotation places greater stresses on vertebral arteries than other movements such as lateral flexion, and so it would seem wise to avoid techniques that involve full rotation of the head.” At this point it is, I think, important to note that UK chiropractors tend not to obtain informed consent from their patients. This is, of course, a grave breach of medical ethics. It becomes even graver, when we consider that the GCC seems to do nothing about it, even though it has been known for many years. Is this profession really worthy of a Royal Charter? This and the other question raised here require some serious consideration and discussion which, no doubt, will follow this short post.” EdzardErnst.com (13th November 2012)
“…like many authorities, the Privy Council has been fooled and cajoled. In addition to this Royal seal of approval giving legitimacy to a nonsense therapy, it also undermines the credibility of the other medical Royal Colleges. Members of these colleges may wish to express their disapproval.” Andy Lewis, Quackometer blog (13th November 2012)
(See the two links immediately below for more background.)
The UK College of Chiropractors is keen to secure a Royal Charter to become known as the 'Royal College of Chiropractors'. A body applying for a Royal Charter is normally expected to meet a number of criteria, one of which is that it should comprise members of a unique profession. However, the only unique aspect of chiropractic would appear to be its pseudoscientific underpinnings. It has been said that without their subluxation theory, chiropractors are reduced to manipulative therapists practicing a very limited modality shared by osteopaths, physiatrists, sports trainers, physical therapists and others: That without subluxation theory, chiropractic's claim that it is a unique and comprehensive 'alternative' to standard medicine is lost. Furthermore, a body applying for a Royal Charter is expected to have 5,000 or more members. In the UK, there are currently around 3,000 chiropractors.
NOTE: Formal applications for Charters are published to allow other interested individuals or organisations to comment or to lodge counter-petitions. Any proposal which is rendered controversial by a counter-petition is unlikely to succeed. Full details available from the Privy Council via this link.
"The application for the Royal Charter was unsuccessful, but the initiative is still alive and when the time is right a further application will be made."
Ref: Section C-170210-3 (v) Minutes of the General Chiropractic Council meeting held on 17 February 2010.
A critical look at the British randomised clinical trial: Meade TW, Dyer S et al 1990. Low Back Pain of Mechanical Origin. Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, BMJ 300: 1431-37; and the follow up study: Meade T W, Dyer S et al 1995. Randomised Comparison of Chiropractic and Hospital Outpatients Management for Low Back Pain Results from Extended Follow Up, BMJ 311: 349-351. Also contains critical comment on the UK BEAM trial 2004, and others.
NOTE: Chiropractors often cite these studies as proof that chiropractic is "effective, cost-effective, and safe".
“We all remember the libel case of the British Chiropractic Association (BCA) against Simon Singh, I’m sure. The BCA lost, and the chiropractic profession was left in disarray. One would have thought that chiropractors have learnt a lesson from this experience which, after all, resulted in a third of all UK chiropractors facing disciplinary proceedings. One would have thought that chiropractors had enough of their attempts to pursue others when, in fact, they themselves were clearly in the wrong. One would have thought that chiropractors would eventually focus on providing us with some sound evidence about their treatments. One would have thought that chiropractors might now try to get their act together. Yet it seems that such hopes are being sorely disappointed. In particular, chiropractors continue to attack those who have the courage to publicly criticise them. The proof for this statement is that, during the last few months, chiropractors took direct or indirect actions against me on three different occasions…” EdzardErnst.com (17th October 2012)
"While we acknowledge that there is uncertainty surrounding the causality of the association between manipulation and these events, we do not accept that the same uncertainty exists regarding the benefits…
The British Chiropractic Association has suggested that we have cherry picked low quality evidence. We believe that we have considered the key studies, but if the BCA are aware of important or more robust contradictory evidence then we would be very happy to consider it…
Dr Mann suggests that the UK BEAM trial provides evidence for the effectiveness of cervical manipulation, but since it was a trial of treatment for low back pain, this assertion is tenuous. However it is worth discussing this study as it highlights a number of important issues for manual therapists wishing to use high quality evidence rather than anecdote to inform their management of patients with neck pain. Firstly, the differences reported for the primary outcome measures were lower than the authors pre-set minimal clinically important difference. In addition, as is common to many trials of manual therapy for neck pain, the therapist, patients and the assessors were not blinded. It is likely that the already small effect sizes seen are exaggerated by the resulting biases. Most significantly in relation to the current discussion on high velocity manipulation techniques, it is important to recognise that clinicians were able to choose from a range of manual therapy techniques as well as mobilising and strengthening exercises. As is the case in many neck pain trials, effectiveness of a package of care provided by a manual therapist cannot be used to specifically endorse high velocity thrust manipulations, as they are often only part of a treatment package. It should also be noted that this package of care was designed and endorsed by the professional bodies representing osteopathy, chiropractic and physiotherapy in the UK and explicitly excluded the use of high velocity thrust techniques to the neck because of the chance of serious side effects. We also do not accept that the existing data on risks, imperfect though it is, is uninformative. The fact that not all studies have shown an effect in the over 45's most likely reflects the other causes of these events in that population clouding the picture. Indeed finding the association in a group who would not normally be expected to experience such an event (i.e. <45 yrs) arguably makes the association more convincing. While attempts to develop screening procedures is commendable, given that the association between manipulation and VAD/stroke is found in this group who are less likely to present with key vascular risk factors, it seems unlikely that screening will achieve its goal satisfactorily.
Reid and colleagues point out that in one survey , 45% of these events may have been preventable, which still leaves a rather uncomfortable 55% that may not have been. Indeed acceptance of Cassidy and colleagues argument, that there are patients receiving cervical manipulation who present with a pre-existing dissection, only further illustrates that screening is far short of being effective. We would suggest that comparisons with NSAIDs or surgical procedures are less useful. Beyond the issue of inadequate data for drawing fair comparisons and the likely underestimation of the true risks for manipulation, manual therapists might more simply ask how their own practice may be made safer
…in possession of truly informed consent, why would one choose a technique that confers no unique benefit but poses a possible unique risk?
...In the end, it remains our opinion that cervical spinal manipulation is unnecessary and inadvisable given the other options available."
Neil O'Connell et al, British Medical Journal (27th June 2012)
"Neurologists have been warning for years of growing evidence that neck manipulation carries a risk of stroke and death from trauma to the neck arteries. Chiropractors have generally denied or minimized this risk. A recent article in the BMJ (British Medical Journal) reviews this controversy and concludes that neck manipulation, based upon relative risk vs benefit, should be abandoned as a therapy…A number of recent systematic reviews of spinal manipulation in general (but including neck manipulation for headaches) have concluded that there is no evidence to support that they are effective for any indication. Looking specifically at cervical manipulation for headaches, systematic reviews are also negative. The reviews indicate that the best controlled studies are negative. The less rigorous studies are mixed. This is a familiar pattern, consistent with an ineffective treatment combined with researcher and publication bias. The BMJ article is actually more favorable, concluding that there is evidence for short term symptomatic benefit from cervical manipulation. However, the evidence shows that the benefits are no better than safer treatments, such as massage, medication, or neck mobilization (a gentler intervention favored by physical therapists)…That is a devastating assessment of any medical intervention, and certainly justifies abandoning that method…Some critics of neck manipulation argue that it should not be abandoned completely but should be reserved for highly selective cases in which there is no contraindication and the safer treatments have been tried and found to be ineffective. This too is reasonable, but is still based upon the notion that neck manipulation has a significant benefit, which has not been established by rigorous clinical evidence. The response of the chiropractic community so far has been predictable. The British Chiropractic Association is quoted by the BBC:
"The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help the people suffering from neck pain and headaches to choose the most appropriate treatment."
As is typical of CAM apologists, they are begging the question - does neck manipulation help those suffering from neck pain? The answer, in my opinion and based on published systematic reviews (the very antithesis of cherry picking) is no. Further, claiming that a reasonable and thorough assessment of risk vs benefit is needlessly alarmist says volumes about the approach of the chiropractic community to their own practice and the scientific evidence. My primary criticism of the CAM community in general, and the chiropractic profession specifically, is that they do not have a culture and philosophy of ethical science-based practice. If they did they would be practicing real medicine, not the "alternative." The issue of neck manipulation and risk of arterial dissection reflects this basic reality, and is not an isolated case but a systemic problem."
Steven Novella, MD, James Randi Educational Foundation's Senior Fellow and Director of the James Randi Educational Foundation’s Science-Based Medicine project. (9th June 2012)
“The British Chiropractic Association have an article on their website that contains a rather interesting comment regarding this BMJ article. While the BCA are happy to refer to “one report of 24 cases” and “one UK study” to support two of the various claims they make during the piece, they finish the article by complaining about the BMJ article:
"The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help the people suffering from neck pain and headaches to choose the most appropriate treatment.
If you have any concerns about your treatment, please discuss this with your chiropractor."
That’s right – the BCA have complained about somebody other than them cherry-picking poor quality research. And why wouldn’t they? Cherry-picking poor quality research is very much their territory and they presumably do not like others trespassing…In May 2009, I wrote about a ‘research’ page on the association’s website and then emailed the BCA. In the BCA’s own words, this page contained “a selection of research papers and reports of relevance and interest”. A selection. The BCA had selected certain research papers and reports. Entirely coincidentally, these papers and reports were positive with regard to chiropractic treatment. So, the research published by the BCA was variable, made up of reports, guidelines, and a small number of RCTs. All systematic reviews and meta analyses were omitted. It doesn’t look to me like the BCA selected their research by looking for the best available evidence…” Stuff and Nonsense blogspot (8th June 2012)
Professor Edzard Ernst delivers his talk ‘After the Storm’ to the 2012 International Skeptics Conference in Munich. He highlights concerns raised by the British Chiropractic Association’s unsuccessful attempt to sue the writer and broadcaster, Simon Singh, for libel. The talk is preceded by Professor Ernst’s acceptance of the Committee for Scientific Investigation’s ‘In Praise of Reason’ award. (May 2012)
The Nightingale Collaboration response to the Consultation on the Regulation of Health Care Professionals
Summary: “Our interest lies in the regulation of chiropractors and osteopaths because of the lack of a robust evidence base for chiropractic and osteopathic spinal manipulation. Statutory regulation rightly confers respectability and trustworthiness in the eyes of the public and these need to be protected to maintain that trust. For chiropractic and osteopathy, we do not believe statutory regulation is deserved or necessary and it gives a false imprimatur that misleads the public. Because of this, our overall view is that statutory regulation of chiropractors and osteopaths is not appropriate and recommend that this statutory regulation be abolished. We believe that adequate protection of the public can be achieved by existing regulations (such as The Consumer Protection from Unfair Trading Regulations 2008) as are applied to any other alternative therapies and businesses. However, we appreciate that this may not fall within the scope of the present consultation and we offer our responses regardless. We are concerned that some of the claims made by these practitioners are not founded in robust evidence and that they can therefore mislead. We are concerned that current statutory regulation is failing by not adequately protecting the public from such claims. We are aware that the situation regarding claims made on practitioners’ websites has significantly improved in the past three years, but we believe that much more still needs to be done and that the current regulatory framework is not fit for purpose in this regard. The Law Commissioners’ consultation on the reform of the legislation is a welcome opportunity to greatly improve the protection of the public and we hope that the Law Commissioners will note and act on our recommendations. We therefore restrict our views to those proposals and questions that directly affect the regulation of chiropractors and osteopaths and we make recommendations that we believe will enhance public protection.” (31st May 2012) [pdf]
“A quick email to the UCL authorities quickly determined that the claimed endorsement was not true. Attempting to access this page now leads to “page not found". The page vanished on Sunday 22nd April, and a near identical page for the Broadgate Pine and Joint Clinic had already vanished on Friday 20th April. While it is true that two surgeons from UCL’s Institute of Sports Medicine have worked in the same building, they neither use chiropractic nor endorse it. I’m assured that the alleged endorsement never happened. London Chiropractors won’t say where it came from. It seems that it was simply made up. I think that’s called a lie. I presume it is a sign of the desperation of chiropractors.” Professor David Colquhoun, DC Science (23rd April 2012)
“Who will regulate the chiropractic claims made at the Olympics?... What evidence is there that chiropractic manipulation can either prevent or treat sports injuries? Not a lot, as you might guess.” Lecanardnoir, Quackometer blogspot (16th April 2012)
“It would appear that the device appeals to chiropractors as it gives a scientific veneer to an unvalidated diagnostic. On the basis of the scan, a customer might be enrolled on a lengthy and expensive course of treatment that is both ineffective and unnecessary, but very profitable to the chiropractor…Remarkably, it looks like it is common practice for chiropractors in the UK to use some sort of discount incentive and questionable diagnostic procedure to rope customers into ‘wellness’ treatment plans…Chiropractic is a statutory regulated profession. As such, it would appear remarkable that chiropractors could get away with such practices…But if they were to stamp out dodgy practices, I would guess that there would be few chiropractors who could sustain a business. Would a regulator regulate itself out of business? If its only goal was to protect the public then is should and it could. But if it is really only protecting its own existence, then do not expect to see any action here.” Lecanardnoir, Quackometer blogspot (14th April 2012)
"...the whole system has been shown to be an utter shambles. The question now is: how are they [the General Chiropractic Council] going to extricate themselves from this fiasco?" Zeno’s blog (3rd April 2012)
“Perhaps not surprisingly, the SCA [Scottish Chiropractic Association] claims on its website that the majority of chiropractic patients present with musculoskeletal complaints such as lower back and leg pain, neck and mid-back pain, headaches, and shoulder and arm problems. It also says that chiropractic can play a ‘vital’ role in living a healthy lifestyle. Undoubtedly most visitors to its website will view these claims as innocuous and in context; however, they suggest a hidden agenda… it is paramount that the SCA’s strong leanings towards vitalistic chiropractic practices are fully understood by as many people as possible…” The Twenty First Floor blogspot (14th March 2012) [Republished at Zeno's Blog, 1st February 2013]
“Dr Richard Brown, the President of the British Chiropractic Association (BCA), has presided over the infamous BCA’s libel action against Simon Singh…Brown recently gave a lecture in which he reviews this experience 'that was ultimately to cost [the BCA] financially, reputationally and politically'1. This lecture has been published and is well worth a thorough read…'For reasons that still elude us, [Ernst] reserved his most poisonous venom for the chiropractic profession'…If, by that, Brown means that I have repeatedly criticised chiropractors, he is correct. But the reasons for my actions should not 'elude' him – in fact, he provides them himself later on: chiropractors have been shown to make 'claims… relating to everything from haemorrhoids to hair loss, chlamydia to cancer'. As it is my job to scientifically verify claims in alternative medicine, I had no choice but to criticise…Brown’s lecture contains many more noteworthy statements, some of which are not directly related to the libel action but reflect on the chiropractic profession more generally, for instance: 'It is unsurprising that new (and not-so new) graduates [of chiropractic colleges] are seeking innovative ways of making a living. Inevitably, however, innovation for some means sailing closer to the wind than ethics and professionalism permit'. Really? Inevitably? Only if ethics and professionalism of chiropractic are wanting, surely! From my perspective, the libel case had an enormous and lasting impact. The true legacy of Simon Singh’s courageous stance is that all practitioners of alternative medicine received a wake-up call telling them that standards of medical ethics must not be corrupted – and that can only be good for the quality of healthcare in the UK.” Professor Edzard Ernst, Pulse (28th February 2012)
“Brown [Richard, President of the British Chiropractic Association] seems to recognize the need for research and evidence-based practice to make chiropractic generally accepted, but his emphasis on finding out what chiropractors do and “why it works,” misses the mark. The real point of research is to figure out if treatments work. If first, then you can worry about why…He sounds partly like a reformer who sees a future of the BCA that can look back and thank [Simon] Singh for being the trigger for change. But he also talks about “clothing” chiropractic after being exposed, rather than fundamentally changing chiropractic. Chiropractic needs more than a costume change – it needs to embrace science-based practice and to rid itself of a great deal of pseudoscience and ethically dubious practices. This will require a significant cultural change within chiropractic. At this point we will just need to watch Brown and the BCA to see if they are serious, or if this was just another lame attempt at damage control.” Stephen Novella MD, NeuroLogica blog (23rd February 2012)
“The president of the British Chiropractic Council, Richard Brown, recently gave his account of the much publicised libel suit that the BCA instigated against Simon Singh. It makes fascinating reading. In the BCA's president's own words:
" … an army of scientists, sceptics and comedians was mobilised to disgrace, degrade and demolish the chiropractic profession. Cabinet ministers, BBC journalists and erstwhile Members of Parliament also joined the fray, determined to pitch in and use the case to reform what they claimed were Britain's draconian libel laws. In using the case as a powerful vehicle to promote his Sense About Science campaign, Singh's crusade mobilised a dark force of UK sceptics who suddenly found their raison d'etre, shifting their attention from the fairy tales of homeopathy to the cure-all claims of chiropractors. Following a call to action, an army of PC pilots and laptop lizards began a war which was to lead to one in three UK chiropractors facing formal disciplinary proceedings from its regulator, the General Chiropractic Council.”
And what was the outcome? Were the chiropractors who had been making unsubstantiated claims disciplined? The short answer is no. One is tempted to conclude that little has changed, but this would be wrong. It is too early to estimate the effects of the libel case on UK chiropractic.” Edzard Ernst, The Guardian (22nd February 2012)
SIMON SINGH: “There are some chiropractors who treat animals and some who don’t, there are some who believe in subluxations and some who don’t, and there are some who use precision instruments and some who don’t, and so on. After the British Chiropractic Association lost its libel action against me, there seemed to be a genuine effort to create a coherent identity that was compatible with the best available evidence. However, the more radical elements in the profession seemed to kick up a fuss, and I suspect that we are back to square one with chiropractors making all sorts of weird claims and a regulator that is unable or unwilling to take control.” The Conversation (31st January 2012)
Hands for Heroes: Ministry of Defence refuses free chiropractic care worth £4.5 million for veterans
The Ministry of Defence said that the Government was firmly committed to ethically sound evidence based therapies where there was evidence that they worked, and that such evidence was usually obtained from reports of suitably designed studies in the published peer reviewed medical literature. As chiropractic care had not been endorsed by the NHS, the Ministry of Defence considered that it was not appropriate for it to raise awareness of ‘Hands for Heroes’ amongst Serving and ex-Service personnel. [NOTE: Although the care was ‘free’, a £50 deposit was required to show “a serious commitment on the part of the veteran to wanting to improve their health” and “to prevent abuse of the valuable care being donated by not turning up for scheduled visits”.]
"Today, the University of Wales announced that it is to cease accrediting degrees at all but two colleges…the University has been accrediting the controversial McTimoney Chiropractic College in Abingdon…So, it looks like the McTimoney College will soon have its degree awarding rug pulled from under its feet. This is a very serious situation for it as their students need an accredited degree in order to register with the General Chiropractic Council and practice legally as a chiropractor…Quackery has many victims, and the first are the students who get fooled into training. We now know chiropractic is a largely useless therapy, with a history of pseudoscience and magical thinking. Many students will come to McTimoney as second careers and will not get direct funding. They will have spent tens of thousands of pounds on a four year ‘MSc’, long before this government decided that should be the norm. In order to repay that cost, students must work very hard as a chiropractor with some, no doubt, getting into the very dubious arts of ‘wellness’ chiropractic. By accrediting these degrees, Wales has been doing these young people a disservice. It has given these techniques an air of legitimacy that they do not deserve. When starting a degree, students ought to have confidence that what they are learning is based on sound principles, academic rigour and good evidence. Chiropractic lacks these vital features and so today’s announcement is good news for future students.” Quackometer blogspot (3rd October 2011)
Most consumers seem to think all alternative treatments are natural and therefore safe. I have repeatedly pointed out that this is not necessarily true. Some alternative therapies are associated with very significant risks. Chiropractic, for instance, has left many patients in wheelchairs and some have even died. Yet most chiropractors vehemently deny any responsibility. A recent article by researchers from the Anglo-European College of Chiropractic in Bournemouth started with the telling statement that "the risk associated with cervical manipulation is controversial". This is certainly true…The Bournemouth team sent questionnaires about risk-related issues to 200 randomly selected UK chiropractors and received 92 responses. Their results show, among other things, that "only 45% indicated they always discuss [the risks of cervical manipulation] with patients ... " In plain language, this means that the majority of UK chiropractors seem to violate the most basic ethical standards in healthcare. If we assume that the 92 responders were from the more ethical end of the chiropractic spectrum, it might even be the vast majority of UK chiropractors who are violating the axiom of informed consent.” Professor Edzard Ernst, The Guardian Science Blog (12th July 2011)
During 2008-2010 the British Chiropractic Association attempted to sue the well-known science writer Simon Singh for libel regarding the content of an article he wrote for the Guardian newspaper. Follow how the events unfolded via this link to the James Randi Educational Foundation. [Includes the full text of the original article.]
“There is some evidence that chiropractic is an effective treatment for lower back pain. This means that scientific trials conducted to investigate the effect of chiropractic on lower back pain found that it did have a beneficial effect. But because of disagreements over the way the trials were carried out, and over what their results mean, this evidence does not allow us to draw definite conclusions. Some scientists believe that the best fair tests show that chiropractic is not effective for lower back pain. More research is needed before firm conclusions can be drawn. NHS Choices website
42 recruiting, none of which are in the UK. NHS Choices website (December 2010)
An expose of the regulation of chiropractic in the UK: Why should a statutory body (GCC), charged with protecting the public set such low standards? Do chiropractors now have carte blanche to advertise whatever they want? Zeno’s blog (14th December 2010)
“A letter expressing no confidence in the General Chiropractic Council’s process, interpretation and proportionality in its regulation of the chiropractic profession has been written to the GCC [starts p.4]. Its signatories are the chair of the McTimoney Chiropractic Association and the Presidents of the British Chiropractic Association, Scottish Chiropractic Association and United Chiropractic Association. [link provided] It’s a long document, with 89 points of complaint to made against the GCC…But these are problems that are only to be expected of the GCC. The GCC was set up by chiropractors in order to protect their profession, rather than by members of the public seeking protection from them. The GCC only acted when they were cornered: their code of conduct states that claims must follow ASA guidelines, and the ASA clearly informed the GCC that these claims did not. They had no choice. There’s a lesson here for other quacks seeking to regulate their own quackery. You can use people from your own profession to regulate, and they’ll prove themselves incompetent. Or you can use people to regulate your industry properly - and they’ll destroy it.” Adventures in Nonsense blogspot (25th November 2010)
“…why was the Hancock et al. study (which has nothing to do with chiropractic, remember) ever considered by Bronfort? The GCC has made it abundantly clear that Hancock et al. has nothing whatsoever to do with chiropractic. Even if Bronfort was not aware of this at the time, you’d have thought someone at the GCC would have read it and noticed this irrelevant Hancock study and either asked Bronfort to remove it or issue an amendment to it. Neither has happened… if the Hancock study is to be removed from Bronfort because it had nothing to do with chiropractic manipulation, then we must also remove all the other papers that Bronfort cited that were not explicitly to do with chiropractic and chiropractic manipulation…Chiropractors can’t have it both ways: chiropractors can’t claim to be unique amongst the manual therapists because of their techniques, yet claim any evidence for their particular ‘art’ from the studies that were not about chiropractic manipulations. The GCC has made this perfectly clear. So, the GCC can’t maintain that Hancock is irrelevant because it’s not about chiropractic manipulations, yet allow their prized Bronfort Report off the hook when it cites trials mainly not about chiropractic. Once all those non-chiropractic manipulations have been removed from the Bronfort Report, what’s left? Not a jot.” Zeno’s blog (17th November 2010)
"The Statutory Regulation of Chiropractors can no longer be justified, even if it does help prevent them making bogus claims….It was a big mistake to give official state recognition and regulation to a discredited, superstitious and pseudoscientific form of medical treatment in the first place. Chiropractic theory has been shown to be nothing but mystical whimsy and the effectiveness of their special back rubs has now only been shown to be marginal for lower back pain – about as good as a few paracetamol. So, when the demands of an evidence-based regulator are brought down on a cult-like pseudomedical trade, only tears could follow. What is ironic here is that when regulation was first proposed for chiropractic, one of the conditions was that the trade should be unified and have a single voice, as is characteristic of a profession. That unified voice never really appeared and the desired agreements were a political fudge in order to gain the prize of state recognition…It is not a mature profession as it cannot even agree on what the essential nature of their profession is…were they to be de-regulated, at least they would lose their imprimatur of state recognition and probably the degree level courses underwritten by the universities.” Le Canard Noir, The Quackometer (1st November 2010)
Item C-120510-17(a) Minutes of Education Committee 17 November 2009
Members noted the content of the minutes, and in particular that as a result of the chair’s contact with the Council of Deans of Healthcare network, several institutions had expressed an interest in exploring the development of a chiropractic degree programme.
Item C-120510-17(b) Minutes of Education Committee 13 April 2010
Members noted the contents of the minutes, and in particular that representatives of two institutions in north west England had visited the Welsh Institute of Chiropractic. The purpose of the visits was to inform the early stages of their exploration of the feasibility of developing chiropractic degree programmes.
“On 17th August we met with the GCC council and presented a dossier on the Vertebral Subluxation Complex. After reviewing this document and discussions that followed at this meeting the GCC agreed that they would delete the phrase “…or health concerns” in the VSC guidance [new guidance here] and provide an explanation why it had done so…It was also agreed at this meeting that the term Subluxation would again be included in the Frequently Asked Questions (FAQs) – A definition will be discussed and agreed at the next Communications Advisory Group meeting on 10th December 2010…We surveyed the AUKC membership and over half of our members took the time to complete this online survey; the results are as follows:
- 88.2% felt that chiropractic should remain drug-free and that chiropractors should not pursue prescribing rights,
- 82.9% felt that the Vertebral Subluxation was NOT an historical concept
- 95.4% thought that Philosophy should be taught in the Chiropractic Colleges
- 90.5% had found that in their experience Chiropractic was effective for conditions outside those mentioned in the Bronfort Report
- 83.9% answered NO to the question “Do you have confidence in the GCC to regulate the profession?”
The BCA [British Chiropractic Association] approached the Alliance to work collaboratively which has culminated in a joint letter to the GCC advising them that we no longer have confidence in the ability of the GCC to regulate the profession [see p.4 for full text]. The Alliance and the BCA will be meeting with Council on 17th November 2010 to discuss this matter…We are proposing to form a Working Group to promote Chiropractic…[and a] petition for a responsible approach to advertising. There are limitations of RCT's, and good cohort studies should be acceptable evidence. A submission was made to the CAP Copy Team at the Advertising Standards Agency in April 2010 for a further 28 conditions not included in the Bronfort Report to be reviewed and accepted. We are still waiting for this documentation to be reviewed and assessed.”
During October 2010 the UK General Chiropractic Council updated its evidence on sciatica from inconclusive but favourable, to a moderate level of positive evidence when compared to sham manipulation following a review by Professor Bronfort of the Santilli et al trial which was included within a 2008 literature synthesis conducted by Lawrence et al on the chiropractic management of low back pain and low back-related leg complaints. However, the author of a well respected evidence summary maintains the following:
"There is no reliable evidence that chiropractic, osteopathy, or spinal manipulation provide any useful benefit for people with sciatica. And there is reason to believe that chiropractic may aggravate sciatica. I have a double personal interest in this issue because (i) I have sciatica, and (ii) I wrote this evidence summary. The evidence was summarised last year, but our scanning for new research has not found any new evidence since then, as you can see here. The abstract of this recent paper is consistent with what I have said, and tells you all you need to know about the evidence: there is no effective treatment other than surgery (when the sciatica is due to nerve root compression) --- and surgery has its limitations too." Michael Power (20th October 2010)
"This post is an update on my earlier discussions with the UK General Chiropractic Council on the subject of the evidence to support various claims surrounding the Chiropractic Vertebral Subluxation Complex (VSC)…
This resulted in the GCC issuing some guidance to its members. To say this new guidance was unpopular with chiropractors would be something of an understatement…
An organisation calling itself the Alliance of UK Chiropractors (AUKC) was formed and they proceeded to put pressure on the GCC to reinstate their beloved subluxation….Eventually the GCC gave way and issued an amendment to their guidance…
The GCC’s original statement was that there was no evidence to support subluxation claims, yet after this meeting the GCC changed the guidance.
If they are [now] going to allow subluxations to be linked to health concerns [indirectly through stating specifically that there is no evidence to link subluxation to 'disease' whilst omitting the words 'health concerns' ], then surely they must now have some evidence.
...on 27 Aug I wrote to the GCC asking if they could explain the reasoning behind changing the guidance and asked if they now had any evidence. My personal view was that these changes had more to do with chiropractic politics than actual evidence…”
Skeptic Barista blog (17th October 2010)
Are chiropractors in the UK primary healthcare or primary contact practitioners?: A mixed methods study
“The findings of this study suggest that chiropractors in the UK view their role as one of a primary contact healthcare practitioner and that this view is held irrespective of the country in which they were educated or the length of time in practice. Further research needs to be developed to evaluate the findings of the current study within a wider healthcare context. In particular the opinions of other healthcare professionals towards the role of chiropractors in healthcare, need to be examined in more detail… it is imperative that the profession maintains autonomy and precludes limitation of practice…” Amanda R Jones-Harris, Chiropractic & Osteopathy (October 2010)
“…the chiropractic profession doesn’t do itself any favours, particularly when it chooses to disregard the impact associated with perpetuating outdated principles conceived in the 19th century and the influence this has on its current professional standing. Embracing modern health science would be one crucial way forward to shift public opinion and our status in the health care community…Unification of the profession is as remote today as it has ever been and in some ways responsible for the lack of progress…More importantly, chiropractic undergraduate education must become integrated within the higher educational infrastructure at university level which brings access to public funds, research opportunities and staff development…The profession must move in this direction to enable student access to high quality education and minimise the excessive financial burden which may influence individual practice style and ethical behaviour following graduation.” David Byfield, Head of the Welsh Institute of Chiropractic at the University of Glamorgan, European Chiropractors’ Union President’s blog (22nd September 2010) [The article is from a lecture that David Byfield gave at the ECU Convention in London in May 2010]
Recently the GCC distanced themselves from the concept of subluxation. Now the GCC has issued a reminder to UK chiropractors that:
when practising, the care they “select and provide must be informed by the best available evidence, the preferences of the patient and the expertise of practitioners…”
- when advertising, claims for chiropractic care “…must be based on best research of the highest standard” only.
Meanwhile on 8 September it was announced that the ‘Alliance of UK Chiropractors’ is about to be founded, apparently in protest at the above actions…To make matters really exciting the BCA is apparently seeking the right for its members to prescribe drugs…It seems that UK chiropractic is heading for a division: the 'fundamentalists' are likely to adhere to the dogma of their founding fathers. Thus they might believe in the notion that 'subluxations' are the cause of all human diseases and treat them with spinal manipulation. GPs might want to think twice before referring patients to such practitioners.” Professor Edzard Ernst, Pulse (16th September 2010) [Free registration]
States that: The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease. Chiropractors are reminded that:
when practising, the care they “select and provide must be informed by the best available evidence, the preferences of the patient and the expertise of practitioners…” (GCC Code of Practice and Standard of Proficiency: effective 30 June 2010; section S3.2)
when advertising, claims for chiropractic care “…must be based on best research of the highest standard” only. (GCC Guidance on Advertising, March 2010)
However, it should be noted that the above has no bearing on chiropractors’ scope of practice.
“GPs are being prevented from putting controversial NICE guidance on low back pain into action because primary care organisations [PCOs] are refusing to fund its recommendations of acupuncture and spinal manipulation. Of 127 PCOs responding to requests under the Freedom of Information Act, half said they were currently providing no funding for spinal manipulation...The institute’s guidance on low back pain advises that patients should be offered exercise, a course of manual therapy or acupuncture as first-line treatments. The recommendation was fiercely attacked by musculoskeletal specialists, who questioned whether there was evidence the treatments were effective on top of standard care. Pulse’s investigation suggests PCOs have felt able to ignore NICE’s recommendation because of the controversy surrounding it.” Pulse (8th September 2010) [Free registration]
"So what we have is a definition of what a subluxation is (functional derangement) combined with research reviews & GCC statements that there is no evidence to support such claims. We also have confirmation from the training establishments that they do not support or teach links between the subluxation and health concerns. Clearly something has prompted the GCC to issue a revised guidance. Are the GCC in possession of updated research confirming a link, if so then this is truly a breakthrough and should be published …Or is there another reason for the U-Turn?" Investigative blogging by SkepticBarista (30th August 2010)
“…there is always the possibility that there may, indeed, be good, persuasive evidence for the subluxation. Do we need to gather the best minds in science to review all these references? Perhaps we need to call on the expertise of Prof Edzard Ernst? No. These references have already been reviewed. The General Chiropractic Council got the Anglo-European College of Chiropractic, no less, to review them. So, was this a whitewash, with chiropractors all agreeing amongst themselves about the mountain of evidence for the subluxation? Not exactly. In fact, the best evidence put forward by the straight chiropractors was pwned. Utterly. By fellow chiropractors.” Zeno’s blog (24th August 2010)
“Given the amount of bad publicity the UK chiropractic profession has been through in the past couple of years and continues to bring upon itself, you would think most of them would have taken the hint to remove claims for conditions like colic & asthma from their websites…strange then that over 5 months since this guidance was issued there are still chiropractors who continue to make these unsubstantiated claims.” SkepticBarista blog (24th August 2010)
“The GCC as an organisation has itself been riven with political infighting among the factions which make up its council structures and senior figures within the organisation have been forced to resign over what might be termed serious errors of judgement in the course of their work activities. Such problems have retarded the profession and undermined the GCC's ability to act in a fair and impartial manner. So what might be the way forward?” One suggestion put forward is to conduct a full open audit of all the GCC's activities regarding their handling of their regulatory duties since their inception 10 years ago. Your Freedom website (1st July 2010)
“It’s not just the evidence for chiropractic that’s a bit shaky these days. For a long time, there has been an uneasy truce between the different chiropractic factions in the UK, all believing different things and each with different rituals. It seems that they all came together when statutory regulation was first mooted and the carrot of respectability that that offered overcame those fundamental differences — temporarily at least.” Zeno’s blog (26th June 2010)
After searching the University of Glamorgan’s Chiropractic Course web page, and finding nothing useful, a PhD neuroscientist sent the university an email of concern. Excerpt:
“…The chiropractic course description contains the following phrase: “… training means you will understand the scientific principles relevant to chiropractic”. Is it possible to clarify what these principles are? I myself and, more importantly, the global scientific community are yet to identify any scientific principle on which the ‘efficacy’ of chiropractic may be based, with the exception of a placebo effect or possibly ‘it’s nice to have some attention and a massage’ resulting in improved sensation of well-being. My own anecdotal experience also leads me to doubt any possible link between chiropractic and science, as during my time as an anatomy technician then postgraduate neuroscientist at Cardiff University, I have been exposed to dozens of thoroughly dissected nervous systems and spinal columns (human and otherwise) and have yet to encounter anything that could be said to represent a subluxation (a miss-alignment of the joint/organ which chiropractors believe to be the cause of ill health)…If the Faculty has discovered a scientific cause for the supposed efficacy of chiropractic, would this not warrant more publicity than a casual mention on a course description? This would represent a major scientific breakthrough for the university and surely should be touted as such?... If chiropractic course does include modules that give students a grounding in health sciences and the practicalities involved, in what way do these differ from other, more general courses taught at the Faculty for Health, Sport and Science? I would be greatly interested in seeing a module description for the course in order to ascertain the necessity for the inclusion of the chiropractic element. Would this be possible?”
Science Digestive blogspot (15th June 2010)
“This is a remarkable repositioning not just on subluxation but of the UK chiropractic profession as a whole. It seems to be a clear break with the traditional philosophy of chiropractic assuming that most human conditions are caused by subluxations of the spine and are thus treatable with spinal adjustments. The existence of spinal subluxations has never been established. Thus chiropractic was built on sand. The new position seems to more or less admit that and is an attempt to render chiropractic evidence-based.” Edzard Ernst, Pulse (10th June 2010) [Free registration]
“The General Chiropractic Council, a UK-wide statutory body with regulatory powers, has just published a new position statement on the chiropractic subluxation complex: “The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.” They remind chiropractors that they must make sure their own beliefs and values do not prejudice the patient’s care, and that they must provide evidence-based care. Unfortunately, they define evidence-based care as
clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself. [emphasis added]
This effectively allows “in my experience” and “the patient likes it” to be considered along with evidence, effectively negating the whole point of evidence-based medicine.” Harriet Hall MD, Science Based Medicine (29th May 2010)
The British Chiropractic Association has finally dropped their misconceived libel action against Dr Simon Singh. Best of all, the BCA have done this in Chiropractic Awareness Week. Zeno’s blog (15th April 2010)
“In failing to achieve their aims, they have now ensured many more people do not see chiropractic as just a small branch of the medical profession that looks after backs, but as a bizarre, cult-like pseudomedical trade who make spurious healing claims with little regard to evidence. Their reputation has been trashed.” The Quackometer (15th April 2010)
Full text of the judgment of Lord Judge, Lord Chief Justice of England and Wales in which he allowed Simon Singh’s appeal against Mr Justice Eady’s preliminary ruling in the libel suit filed by the British Chiropractic Assocation.
England and Wales Court of Appeal (Civil Division) Decisions. (1st April 2010)
One in four chiropractors in Britain are under investigation as a result of campaign by Singh supporters. Article by Martin Robbins, The Guardian (1st March 2010)
“To see the harm that can result from premature statutory regulation, it is necessary only to look at the General Chiropractic Council (GCC).” Professor David Colquhoun, BMJ (2nd February 2010)
“The BCA opposes restricting the scope of practice of chiropractors, yet it recognises that there are boundaries. It actively prohibits unethical practice building or unprofessional marketing which undermines the integrity of the profession. Those limits aside, the BCA supports equality of opportunity and diversity and indeed it has been this rich diversity that has given the chiropractic profession its colour and vibrancy for nearly 85 years.” Views of Richard Brown, President of the British Chiropractic Association, The BackCare Journal (Winter 2009/10) [See page 37]
Satirical look at the British Chiropractic Association v. Simon Singh libel case by Crispian Jago. (19th December 2009)
The General Chiropractic Council is allegedly continuing to mislead the very patients it is meant to protect. Adventures in Nonsense blogspot (10th October 2009)
"Since 1994 chiropractic has been regulated by statute in the UK. Despite this air of respectability, a range of important problems continue to bedevil this profession. Professional organizations of chiropractic and their members make numerous claims which are not supported by sound evidence. Many chiropractors adhere to concepts which fly in the face of science and most seem to regularly violate important principles of ethical behaviour. The advice chiropractors give to their clients is often dangerously misleading. If chiropractic in the UK is to grow into an established health care profession, the General Chiropractic Council and its members should comply with the accepted standards of today's health care." Article by Professor Edzard Ernst, Journal of Health Services Research & Policy (3rd July 2009)
“We were pleased to see a call from Prof Alan Breen (at the Anglo-European College of Chiropractic, and on two GCC committees) for a move beyond or supplement to evidence-based medicine in order to achieve a “more democratic and inclusive…age” in “musculoskeletal practice”. However, it is unfortunate that Breen fails to follow through on the implications of his demand…We were also surprised that – given the the British Chiropractic Association is currently pursuing a libel case against the science journalist Simon Singh – Breen did not speak up for Singh’s right to speak freely. After all, surely a democratic and inclusive approach to muskuloskeletal practice must keep open the possibility of robust criticism – and robust examinations of the empirical and theoretical bases for chiropractic. Regrettably, it appears that what Breen is moving towards is not democracy and inclusivity. As Sackett et al argue, evidence-based medicine aims to integrate individual clinical expertise with the best available external clinical evidence from systematic research. Evidence-based medicine therefore draws on the experiences of patients, clinicians and patients. In contrast, Breen seems to be moving towards a privileging of the experiences of a small subset of medical professionals – chiropractors and associated practitioners – and he seems to be advocating this privileging at the expense of numerous other stakeholders: from patients to researchers. Evidence-based medicine is certainly not perfect – and there are important areas in which it should be improved, supplemented or superseded. However, compared to Breen’s approach – an odd kind of chiropractic-centric obligarchy – evidence-based medicine is a much more promising approach.” Evidence Matters (27th June 2009)
"This is an invitation to all UK chiropractors to stop the confusions, misunderstandings and animosities that arose during the recent debate about the effectiveness of chiropractic for non-spinal conditions such as asthma and otitis. I herewith invite all of you to state clearly where you stand." Edzard Ernst, New Scientist (25th June 2009)
"In quangos like the GCC, complaints don't necessarily get considered at all. First they go to an investigating committee (IC) which has to decide if there is a 'case to answer'. Now the GCC wants that criterion to be changed to 'realistic prospect of success'. Given the GCC's attitude to evidence it is hard to imagine that any complaint will have a 'realistic prospect of success'….The attitude of the GCC to evidence is amply illustrated by the fact that they have said that the rather crude myths known as craniosacral therapy and applied kinesiology fall within their definition of evidence-based care. Any organisation that can say that is clearly incompetent." Article by Professor David Colquhoun, DC Science (17th June 2009)
As reported by The Quackometer (10th June 2009)
The Quackometer (5th June 2009)
"If chiropractors are to provide a safe clinical experience for patients then a reporting procedure needs to be put in place, within the clinics and within the profession as a whole, which allows for adverse events and near misses to be shared on an anonymised basis so that we can all learn from them." Quoted from Item 7 of the Minutes of the GCC's 2nd March 2006 meeting [pdf]
NOTE: June 2009. There does not appear to be a widely publicised, efficient reporting system in place for UK chiropractors and their patients.
"Both the New Zealand and the UK governments have got themselves into an impossible position by giving official recognition to chiropractic *before* the evidence was in. Since the conventional manipulative treatments are cheaper, and may well be safer, and because they involve no quasi-religious ideas like 'subluxation' or 'innate intelligence', the only reasonable conclusion is that there is no need for chiropractic to exist at all. They do nothing they do that would not be done as well by medical practitioners and physiotherapists. What will governments do about that, I wonder?" Professor David Colquhoun, New Zealand Medical Journal (5th September 2008)
"I googled 'Chiropractic Clinics UK' (31/7/2008) and evaluated the contents of the first 10 websites of individual chiropractic clinics listed. My aim was to find out whether chiropractors adhered to their own ethical code…..[The findings] suggest that many chiropractors violate their own ethical code." Professor Edzard Ernst, New Zealand Medical Journal (5th September 2008) [pdf]
"The Government should be warned by the case of chiropractors about the dangers of granting official recognition before the evidence is available. The General Chiropractic Council already has a status similar to that of the General Medical Council, despite it being based on the quasi-religious idea of "subluxations" that nobody can see or define. Recent research has shown it to be no more effective, and less safe, than conventional treatments that are much cheaper." Professor David Colquhoun, The Times (29th August 2008)
Includes a close look at the McTimoney College of Chiropractic: "One of the recurrent criticisms of chiropractic is that it is founded in mystical ideas and has a very poor evidence base for the efficacy of any of its treatments…..[The philosophy of McTimoney] looks like pretty fundamental chiropractic with their mysterious and unproven 'subluxations' being the cause of illness — and not just bad backs, but the health of all 'cells and organs'. The college appears to adopt this worldview." The Quackometer (28th August 2008)
The Journal of Health Services Research and Policy has just published a ‘perspective’ piece by Professor Alan Breen of the Anglo-European College of Chiropractic in which he, unsurprisingly, praises Chiropractic… [Breen concludes] that, “strong ontological commitment to only part of the knowledge base seems often to be the stance taken to contest the scientiﬁc basis of Chiropractic” at the end of an argument where he neglects to mention any trials that test the efficacy of Chiropractic for any condition. Moreover, the article does not cite a single negative study or review. Instead, politicians and committees are the preferred source of authority. Again, a preference for one side of the knowledge base is seen in the author’s focus on risks that are not balanced against benefits. Having had a look for the evidence, it appears to me that in an evidence-based biopsychosocial model for the treatment of musculoskeletal complaints: Chiropractic is, at best, unnecessary.” A P Gaylard blog (3rd July 2009)
British Chiropractic Association members’ attitudes towards the Chiropractic Reporting and Learning System: A qualitative study
“Reasons identified for under-reporting included fear of retribution, being too busy and insufficient clarity on what to report…until there is greater clarity of the purpose and role of the CRLS, the system will probably remain under-utilised.” Clinical Chiropractic, Volume 11, Issue 2, Pages 63-69 (June 2008)
Click here for a critique of the Chiropractic Patient Incident Report and Learning System (CPIRLS).
UPDATE April 2011: Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS): relevance and structure “A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.”
UPDATE March 2013: The Scottish Chiropractic Association announces a decrease in its malpractice insurance premium due to a "robust risk management and reporting system" which it claims to operate and manage. The system doesn't appear to be public, and there's no indication if any of the reports it receives are added to the data in the medical literature regarding complications following chiropractic treatment.
"Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents. Statistically significant differences between chiropractors of different associations in the UK were present, particularly regarding the benefits of chiropractic treatment for non-musculoskeletal conditions…..Traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents and 63% considered subluxation to be central to chiropractic intervention." Aranka Pollentier and Jennifer M. Langworthy, Clinical Chiropractic, Volume 10, Issue 3, Pages 147-155. (September 2007) [pdf]
GCC Fitness To Practice Report 2007 (see p.13) [pdf]
According to the GCC's Fitness To Practise Report (2007) all chiropractors must ensure that all the information they provide, or authorise others to provide on their behalf, is factual and verifiable, is not misleading or inaccurate in any way, does not abuse the trust of members of the public in any way, nor exploit their lack of experience or knowledge about either health or chiropractic matters, and does not put pressure on people to use chiropractic, for example by arousing ill-founded fear for their future health or suggesting that chiropractic can cure serious disease.
Contained in this Action for Victims of Chiropractic link is correspondence with the GCC (August 2005) in which the GCC stated that it understood that the British Chiropractic Association (BCA) was in the process of establishing a national database to which UK chiropractic patients could report complications following their treatment. However, in a letter to Nature on 22nd September 2005 (in response to an article which questioned what complementary and alternative medicine [CAM] organisations were doing to monitor adverse reactions) Barry Lewis of the BCA stated that the association had, in conjunction with the Anglo-European Chiropractic College, "set up a chiropractic reporting and learning system; more than 1,200 practitioners who are members of the BCA have recently received an information pack to enable them to participate in the scheme. Resulting data will be analysed at the Anglo-European Chiropractic College and outcomes will be relayed to the profession, through our newsletter, journal and website, so practitioners may learn from the experience of others. The intention is that the scheme will, if successful, be offered to other chiropractic associations within Europe in 2006".
NOTE: No mention was made of a database to which the patients of all (approx 2,300) UK chiropractors could report complications following their treatment.
In this recent investigation which focused on approaches to consent of a small sample of practicing UK chiropractors, only 23% reported that they always discussed serious risk with their patients, and over one third did not advise patients of alternative available treatments. J. M. Langworthy and C. le Fleming, Institute of Musculoskeletal Research and Clinical Implementation, AECC, UK (Journal of Manipulative and Physiological Therapeutics, January 2005)
NOTE: As regulated health professionals, UK chiropractors are required to obtain informed consent from their patients to ensure that patients understand the principal benefits, risks and alternatives regarding their proposed treatment. Failure to do so contravenes the UK General Chiropractic Council's code of practice. It should also be noted that, should a patient experience complications, there doesn't appear to be a widely publicised, efficient reporting system in place in the UK for chiropractors and their patients to report adverse events related to chiropractic treatment. Interestingly, the UK General Chiropractic Council's current promotional literature appears to make no mention of serious risks.
A test which was designed to find out whether the regulation of the UK osteopathic and chiropractic professions had any impact on the research activity in the areas of efficacy and safety concluded that "[These] data do not support the hypothesis that regulation of a healthcare field will increase research in that area". Further comments in this editorial include "Regulation should be a step towards professionalism, which, in turn, should stimulate research activity and eventually lead to answers to the most pressing open questions… Regulating uncertainties, it seems generates regulated uncertainties rather than certainties." P. Canter and E. Ernst, 'The effect of statutory regulation of osteopathy and chiropractic on research activity in the UK', Physical Therapy (2005) [pdf]
Published in The Guardian on 2nd February 2005, both letters contained in this link fail to mention that chiropractic is based on flawed science. Regarding universities teaching chiropractic degree programmes, it has been said that the worth of a degree in a subject that cannot prove its basic tenet, the subluxation, seems rather dubious. The fact that an established university is prepared to offer such a degree may only serve to diminish the university's standing and reputation.
In the GCC's June 2005 Council Bulletin (see page 3) mention is made to correspondence that had been received from a GP seeking the view of the GCC in respect of the use by a chiropractor of a Vegatest Machine. Members of the GCC "agreed that it would not be appropriate for the GCC to comment on a commercial product". This link contains the position statement of the Scientific and Therapeutic Subcommittee of The Australian College of Allergy which was published the Medical Journal of Australia. It concludes that "Vega testing (the Vega test method) is an unorthodox method of diagnosing allergic and other diseases. It has no established scientific basis and there are no controlled trials to support its usefulness. Vega testing may lead to inappropriate treatment and expense to the patient and community".
"I was quite surprised when I went to see my chiropractor about my spinal problems that it says that chiropractic could be successful for people with hay fever." John Austin, MP, Question 64, Select Committee on Health, United Kingdom Parliament (17th June 2004)
"In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994).....Regulation for a new profession will literally 'legitimise it', establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance." Michael C. Copland-Griffiths, former Chairman of the General Chiropractic Council (European Journal of Oriental Medicine, Vol.2 No.6, 2004)
This investigation revealed that the vast majority of UK chiropractors are interested in providing their services through the NHS, but only on a part-time basis and in a way that most closely resembles private practice. Concludes that "National health care reform and the statutory self-regulation of chiropractors have brought this closer to a more widespread reality. However, to prosper in this setting, the profession may benefit from a greater understanding of the competing priorities and constraints faced by NHS purchasers, who, for their part, should be prepared to implement policy based on evidence". Investigation undertaken by the IMRCI (AECC), UK. Journal of Manipulative and Physiological Therapeutics (January 2002)
NOTE: Most chiropractors in the UK currently work in private practice.
Majority of newly elected chiropractic members to the General Chiropractic Council (UK regulatory body) reported to support a more conservative orientation, leaning away from the medically-oriented musculoskeletal definition of chiropractic to a more traditional subluxation-based orientation. The Chiropractic Choice (June 2002) [See link below for the second page of this report — pdf]
Emotional Freedom Techniques, "The Ambassador of Meridian Energy Therapies", reported to have gained CPD (Continuing Professional Development) status with both The College of Chiropractors and The McTimoney Chiropractic Association in the UK.
A website operated by a former UK chiropractor. The site contains many questionable articles about vaccination. (www.vaccination.co.uk)
An example of a chiropractic practice-building organisation. This organisation — which has held seminars in the UK — offers, among other products, a 12 Visits For Life Protocol; a handout aimed at reducing patient resistance to recommendations; a Vertebral Subluxation Complex brochure; literature to help increase referrals; postcards to help prevent patient dropout, and a brochure encouraging chiropractic care beyond symptomatic relief.
Article questioning the effectiveness of the UK General Chiropractic Council.
A vitalistic subluxation-based UK chiropractic organisation. It says that it ascribes "to the idea that all living organisms are sustained by an innate intelligence". It also says that its sub-committees are taking on "valuable work" such as "raising the profile and importance of subluxation-based wellness chiropractic in the UK". Click on its 'About Us' section to learn more about its philosophy. (Names and locations of all UK chiropractors who are members of this organisation are available via this link)
"Sometimes vertebrae can become misaligned or fixated causing interference with the mental impulses that travel between the brain and the rest of the body. Chiropractors refer to this as a vertebral subluxation. A subluxation can cause pain, imbalance, fatigue, lowered resistance to disease and a general decline in health. Doctors of Chiropractic specialise in locating and then correcting vertebral subluxations with a chiropractic spinal adjustment permitting normal nerve transmission, innate recuperative capability, and effective health and adaptation of the person." (Names and locations of all UK chiropractors who are members of this organisation are available via this link) A member of this organisation currently serves on the GCC's committees.
The McTimoney Chiropractic Association (MCA) currently claims to have around 400 members who represent at least a quarter of the UK chiropractic profession. This link to the Origin & History section of their website contains this statement : "Following his first heart attack, John McTimoney was asked to take on students in order to ensure the survival of his work…. McTimoney taught, as DD Palmer had before him, that health depends on healthy nerve messages, that subluxations of the vertebrae or other joints interfere with these, and that such subluxations can affect not only joints and muscles, but every cell and organ in the body". The Objectives section of the site states that "By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements)". NOTE: Three of the ten chiropractors who have been elected to serve of the GCC's committees between June 2007-2012 are members of this organisation. (Names and locations of all UK chiropractors who are members of this organisation are available via this link)
Section 5.14 of The House of Lords Select Committee Report on Complementary and Alternative Medicine states that a feature of effective regulation is "…to understand and advertise areas of competence, including limits of competence within each therapy".
NOTE: Why doesn't the UK chiropractic regulatory body, the General Chiropractic Council (GCC), specify the common chiropractic techniques and practices which it does not consider legitimate?
This bill was eventually passed as the Chiropractors Act 1994 and is described as follows:
"An Act to establish a body to be known as the General Chiropractic Council; to provide for the regulation of the chiropractic profession, including making provision as to the registration of chiropractors and as to their professional education and conduct; to make provision in connection with the development and promotion of the profession; to amend, and make provision in connection with, the Osteopaths Act 1993; and for connected purposes."
On his blog profile Lidington describes the passing of this bill as his "proudest political achievement", and states that "I believe that this piece of legislation has made a real difference to many people’s lives" (Skeptical Voter website)