"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)

“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doesn’t do itself any favours, particularly when it chooses to disregard the impact associated with perpetuating outdated principles conceived in the 19th century and the influence this has on its current professional standing.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]

“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 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)

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. 

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]

Read the original article

“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)

"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)

“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)

“…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)

“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]

“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)

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)

“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