Chiropractic: Evidence, claims and a willingness to change …

Posted on March 14, 2010


The GCC commissioned report entitled ‘Effectiveness of manual therapies: the UK evidence report’ was published on 25 Feb 2010.  When it was commissioned (June 2009) it was tasked with assessing the evidence base for every condition and symptom listed on any website for which the  GCC has had a complaint relating to treatment claims.

I asked the GCC some questions to get a little clarification on a few things (  the end result is that the GCC’s current view to its members is:

The GCC’s guidance to the profession mirrors that of the Committee of Advertising Practice Copy Advice Team ie that any claims for chiropractic must be based on best research of the highest quality. This will almost certainly mean randomised controlled trials that produce high or moderate quality positive evidence.

(No RCT = No evidence = No claim)

The above statement, viewed alongside the evidence tables in the report show that many of the treatment claims that can be found of some chiropractors websites can no longer be justified and chiropractors need to change the services they offer.  They also need to be aware that the conditions listed in the report are the ONLY ones where a relevant RCT could be found to assess the evidence.

Significantly, page 6 of the report states:

Perhaps most critical is the clinician’s willingness to change the way they practice when high quality scientific evidence becomes available. It requires flexibility born of intellectual honesty that recognizes one’s current clinical practices may not really be in the best interests of the patient. In some cases this will require the abandonment of treatment and diagnostic approaches once believed to be helpful.

A quick internet search soon showed up a number of sites that were still making claims like colic, asthma, ear infections (otitis media) and bedwetting.

The GCC are not planning to issue any direct advice, feeling that the report is clear enough in its message.  I did ask the GCC what would be the best course of action to take for any websites that did not implement any changes (given a suitable amount of time), but they didn’t seem interested in answering that one.

So I thought I’d take the most reasonable option and contact the chiropractors directly by sending them a letter, I simply let them know that I’d been in touch with the GCC and asked them:

A recent viewing of your website shows that you continue to make claims regarding one or more of the conditions that has been reported as having Negative or Inconclusive evidence.

I realise that it can take time to review the report and have websites updated accordingly, therefore in the first instance this letter being is sent to confirm that you are aware of the content of the report and establish your intentions for removing these unsubstantiated claims from your website.

So far I’ve sent out 22 letters (by email) and have about another 10 to go in the post.

Currently 12 chiropractors have responded, here’s a small selection:

Most of the replies have been along these lines:

We have reviewed the GCC report and are complying with their findings. We have instructed our web team to remove the link relating to asthma claims. This may take one to two weeks.

Some were a little less happy:

I am currently reviewing my website and will make the changes that I am forced to make.  Sorry but I don’t recognise your name. Who are you exactly?

Others took a while to think it through:

(8 March) I have received your letter, which I have forwarded on to my professional association, who will be in touch with you regarding this letter in due course.

(11 March) I have a copy of the new Chiropractic & Osteopathy Bronfort research review from end of February, which is referred to in your letter. As the GCC are now supporting this, I am reviewing the contents of my website and advising my webmaster of any changes that are in order as a result.

Some were almost too eager:

I have now changed the articles you pointed out to me and apologise for missing them earlier. May I ask you if you could check to see if you are happy that my web site is now in accordance with the ASA guidelines as it is sometimes difficult to assess your own work.

Some changes have already taken place and claims are being removed.  Not everyone has replied yet, but of those that have NONE have tried to defend their claims and NONE have openly questioned the reports findings.

I’m sure there are more and I’ll contact them as I find them.  Others who have the ability to run scripts to automatically sniff out any remaining claims will hopefully catch the rest!!

I’m going to recheck all the websites in early April and see what is still being claimed, that’ll be about 8 weeks after the publication of the report and adequate time to make any changes.

There will no doubt be those who don’t want to respond or are unwilling to make any changes.  At least two of the chiropractors I’ve contacted have had previous Trading Standards complaints submitted about these claims and have managed to convince TS that their claims were justified, that’ll be much harder to do now!

Posted in: Chiropractic