the quackometer

The Role of UK Universities in Chiropractic

Friday, August 29, 2008

The decision by the British Chiropractic Association to sue Simon Singh will undoubtedly bring increased scrutiny of chiropractic. I would like to start with a first look at the education of chiropractors in the UK. This is also timely as Universities have recently been criticised for teaching quackery, resulting in a homeopathy degree being dropped by the University of Central Lancashire.

Chiropractic is going to be quite different from homeopathy though. Anyone can call themselves a homeopath. Having a diploma behind you helps in joining the various homeopathic pretend regulatory bodies. Have a BSc and you will be vastly overqualified by far to dish out sugar pills. Chiropractors, however, need to be registered with the General Chiropractic Council. Chiropractic is capable of causing injury to patients, sometimes even death. To be registered, you need to have studied chiropractic for at least four years to degree level including one year of clinical supervision. That is the law.

There are three approved chiropractic schools in the UK: the Anglo-European College of Chiropractic, the McTimoney College of Chiropractic and the Welsh Institute of Chiropractic. The three Universities that accredit these degrees in chiropractic are, respectively, Bournemouth Universty, the University of Wales and the University of Glamorgan.

Let's look at one college: the McTimoney College where you can gain a BSc (Hons) Chiropractic degree validated by the University of Wales. The first surprise that new students may get is that the college is in the very un-Welsh market town of Abingdon, a few miles south of Oxford on the river Thames. You are a very long way from the Valleys now, boyo. No male voice choirs and Brains bitter here. Abingdon is an attractive town, but the college happens to be situated on a peripheral industrial estate near the A34, between B&Q and Furniture Village.

McTimoney chiropractic is one of the many denominations of the original chiropractic ideas and appears to stick quite closely to the founding ideas. This 'usually painless' technique twists and pulls sharply on the spine, sacrum, pelvis and the cranium whilst allowing them to spring back 'naturally' - the 'toggle-torque-recoil' technique. Students can follow up their BSc by seeing how their 'toggle-torque-recoil' techniques can be applied to small mammals (MSc Chiropractic (Small Animals)) and children (MSc Chiropractic (Paediatrics)).

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 McTimony Chiropractic Association, based a few miles from Abingdon in Wallingford, sheds little light on the evidence for the efficacy or superiority of their chiropractic variations on thier web site. The philosophy of McTimony is given as

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. He also stressed what would one day be called holism: that human beings are not purely physical but mental, emotional and spiritual beings as well, and that treating the whole body restores health to all these aspects of the patient.

This 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. Its prospectus states,

The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.

Another common criticism of chiropractic is the practice of developing dependent relationships with customers and encouraging them to have regular chiropractic sessions as a preventative or 'wellness' service. The evidence for the benefits of such prolonged and expensive intervention does not appear to be sound. The McTimoney school prospectus tells us that,

Chiropractors consider that the body benefits from having periodic chiropractic treatments on a preventative basis so that incipient problems may be avoided.

Given that the practice of chiropractic is founded on pseudoscientific ideas it would appear to be imperative to ensure that any BSc offered by a college maintained appropriate and modern academic standards. Some chiropractors have abandoned the dubious aspects of the trade and limit their work to that they can be confident works - almost exclusively lower back pain. Does the college in Abingdon do this? Who inspects them? Many aspects of the prospectus and web site worry me. They say in their description of chiropractic,

A chiropractor will examine by hand (palpate) the bones and joints of the body to check for imbalance, however slight. Any problems found are corrected with various adjustments, which are effective and safe. The bones are never forced into place, but by adjusting with a very rapid thrust and immediate release, the bone 'toggles' towards its correct position.
Chiropractic aims to restore nerve function in order to promote natural health. This involves re-educating the patient’s muscle and bones into better alignment. It is also preventative treatment and can greatly improve overall health and well-being. Regular check ups are recommended to ensure that the body maintains a healthy balance.

Sounding just like homeopaths, they say,

Chiropractic is a drugless and non-surgical form of health care that aims to treat causes rather than symptoms.

Now the problem as far as I see it is that the General Chiropractic Council is responsible by law for recognising courses as meeting its standards so that graduates can call themselves chiropractors, don their white coat, put their brass plaque up, and title themselves 'Dr'. The GCC makes inspection visits to colleges and issues reports as you can view on their web site. This must surely create a conflict of interest. As there are only three colleges that provide chiropractic degrees, there would be severe repercussions for the profession as a whole if one of them was found to be offering substandard education. This potential conflict of interest is exacerbated by the fact that the principle of the McTimony Chiropractic college in Abingdon, Christina Cunliffe, is also a council member of the GCC. The GCC does ask its council members to declare interests, but questions can surely be asked about how independent the GCC can be in assessing the quality and appropriateness of education provided by the colleges.

Given the nature of chiropractic, there is surely a case to be made to separate the professional representation and regulation of chiropractors from the educational validation of their training. What role does the University of Wales play in this? That is a question we should find out.

Labels: chiropractors

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Chiropractors Try to Silence Simon Singh

Sunday, August 17, 2008

Hot on the heals of New Zealand Chiropractors trying to silence David Colquhoun and the The New Zealand Medical Journal, we learn today in the Telegraph that the British Chiropractic Association has issued a writ against Simon Singh for an article he wrote in the Guardian entitled Beware the Spinal Trap. 'Dr' Antoni Jakubowski of the BCA said that this was not a decision they were taking lightly. If justice is forthcoming, it will be a decision they regret.

The original article is no loner available on the Guardian site, but here are some excerpts that so offended the chiropractors.

This is Chiropractic Awareness Week. So let's be aware. How about some awareness that may prevent harm and help you make truly informed choices? Some practitioners claim it is a cure-all but research suggests chiropractic therapy can be lethal.

First, you might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that, "99% of all diseases are caused by displaced vertebrae". In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic

I will leave you with one message for Chiropractic Awareness Week - if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

There is nothing here that cannot be defended by evidence or is fair opinion. The chiropractors desperately do not want you to know that they are peddling useless therapies based on ridiculous pseudoscience and all with the risk of serious injury to you.

This is a disgrace and I hope it backfires massively and is the start of the end of this massive fraud on the public.

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This is going to be big. The story is being covered in...

HolfordWatch
Gimpy's Blog

The full original article can now be found on this Russian server (Thanks, Svetlana)

http://svetlana14s.narod.ru/Simon_Singhs_silenced_paper.html

and Gimpy's fuller analysis with references for each claim...

a day at the pharmacy blog covers it too now.

Jack of Kent

...

Dr Aust provides a superb analysis of the law and this case.

Labels: chiropractors

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They are Bone Doctors, Aren't They?

Friday, August 08, 2008

Chiropractors have an air of respectability about them. They style themselves, 'Doctor'. They wear white coats and have brass plaques outside their offices with lots of letters after their name. My friends look at be puzzled when I say they are quacks. But that is what the evidence says. Their practice is founded on strange ideas about mysterious things called 'subluxions' and pseudoscientific beliefs in 'inate intelligence' running through our nerves and bones. We think of chiropractors as being for bad backs, but their founding beliefs state that cracking bones can be a panacea. You will still find chiropractors claiming treatments for all sorts of weird and wonderful things.

The evidence for the effectiveness of chiropractic is not good. What evidence does exist suggests it is just another placebo treatment. It might work for lower back pain - but probably no more than a couple of paracetamol. And the risks of bone cracking can be quite severe with deaths reported by stroke. More minor adverse reactions appear to be quite common.

In the UK, chiropractors can thank their regulated status for much of their standing and freedom from ridicule that other quackery attracts - like homeopathy. Chiropractors are statutorily regulated. You need to be registered to call yourself one. You can even call yourself Doctor as long as you do not imply that you are medically trained - but that is hard. Brass plaques. White coats. X-ray machines. My best guess is that most people think of chiropractic as a branch of medicine. It is not. It is quackery and a business.

Some times though we see them for their true colours. The New Zealand Medical Journal has just been threatened by a law suite for publishing research into how chiropractors (mis)represent themselves to the public by using the title 'Dr'. Professor David Colquhoun wrote an editorial that put chiropractic deception into a wider context of their education and business practices. The response of the New Zealand Chiropractic Association was to get their lawyer to threaten to sue. The Medical Association has responded admirably by calling their bluff and asking for their evidence that what was being said is not true. "Let’s hear your evidence not your legal muscle."

That is how it should be. As Ben Goldacre has responded, the real medical world is full of self-criticism - often very harsh. The way to respond is with science and argument - not with lawyers. Legal threats are a business technique, not the actions of medical practitioners. They expose their true self by calling their lawyers.

As Professor Colquhoun notes, since the invention of chiropractic, their business acumen has been sharper than their scientific and medical expertise. Consultancies on how to grow your bone crunching businesses are rife in the US. As Rose Shapiro notes, its all about building "high-volume, subluxation-based, cash-driven, lifetime family wellness practices."

In the UK, we have similar chiropractors-turned-business gurus too. 'Dr' Terry Chimes, ex drummer with the Clash, is perhaps the highest profile. This year he has launched his 'Chiropractic Heaven' consultancy. Chimes promises to tell you the 'The Secrets of the World's Most Successful Chiropractors'. He does this over 120 weekly modules - all brimming with 'golden nuggets of wisdom '. And he claims to be able to 'Quadruple Your Practice in a Matter of Months. . . Ethically'.

Not all chiropractic business skills could claim to be ethical. Occasionally, the General Chiropractic Council of the UK is embarrassed enough to step in. In one case, a chiropractor was found to have "abused the trust of his patients, and coercing them, through alarmist scare tactics, into excessively protracted and unjustified treatment plans". Chiropractic lends itself to such approaches: it deals with long term chronic conditions, such as back ache, uses mysterious and unverifiable X-ray diagnostic techniques to alarm customers, and recommends long courses of treatments. The chiropractor in question was accused of using unjustified courses of X-rays and misrepresented the gravity of the customer's condition. The chiropractor was removed from the chiropractic register, but simply re-invented himself as a 'osteomyologist' - a sort of renegade and unregulated chiropractor in all but name.

It is amazing that all chiropractors cannot be charged with using unjustified X-rays. Since, their bone crunching cannot be showed to be medically effective, X-rays cannot be medically justified, and so applications of X-rays are in direct contravention of IR(ME)R regulations which demands medical justification for all exposures. One has to wonder how chiropractors get away with X-raying patients. One factor must be is that statutory regulation of chiropractors directly lead to their inclusion in the list of health workers who were allowed to refer for X-ray. Not that means that their referral is likely to be justified.

Such are the perils of regulating nonsense.

Labels: BPSDB, chiropractors