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.
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.
Much as I admire your general approach to woo, I think you have missed the point in your post. It’s very good of you to point out the incestuous relationship between various bodies and various protagonists of chiropractic but the following question is the most important.
Does it work or is it effective?
Apart from lower back pain, the answer seems to be no. And even in the the above case, exercise and analgesics appear equally effective.
I’ve just re-read my own contribution and realised it sounds more condemning than I meaned it to.
My comment above is more about the emphasis of your post than the content, I do realise you question the effectiveness of these woo merchants and it is of value to point out they just reinforce themselves in different contexts.
IMO, the UK chiropractic regulatory body, the General Chiropractic Council (GCC), is little more than a self-interest group, not least because it has, as part of its remit, a duty to “promote the profession”. In essence, that would appear to mean that it is committed to pushing an expensive (and sometimes dangerous) woo-laden therapy that offers about the same benefit to its back pain patients as would be derived from taking a couple of paracetamols:
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf
It’s also worth noting that [1] although the GCC requires that “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”. See page 7 here…
http://www.gcc-uk.org/files/page_file/FITNESS_TO_PRACTISE_REPORT_2007_FINAL_FOR_WEBSITE.pdf
and that [2] although section A2.3 of its Standard of Proficiency requires that “chiropractors’ provision of care must be evidence-based”…
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf
…the GCC appears to (intentionally?) confuse the public by failing to make clear on its website – and elsewhere – the essential differences between scientific manual therapy and chiropractic subluxation-based philosophy. It also seems to make no attempt to specify the common chiropractic techniques and practices which it does not consider legitimate:
http://www.gcc-uk.org/page.cfm?page_id=6
How that can be reconciled with its other statutory duties to “protect patients” and “set standards” is beyond me.
Acleron – ‘Does it work?’ is not the only interesting question about alternative medicine. Indeed, the answers to that question are largely in, but this appears to make no difference to the amount of alt med in society.
I hope I am raising other interesting questions here. Essentially, ‘Given that alt med does not work (largely), how did we get here and how does it persist?’ There are lots of intersting answers to that question.
An update. The General Chiropractic Council (GCC) has just published its Annual Report on its website, and the Chairman’s foreword states the following:
Quote:
“With effect from July 2008, our duty to promote the profession has been removed. This implements one of the recommendations of the White Paper ‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’, that health regulators should have a more consistent statutory purpose – that of protecting the public by setting and maintaining
professional standards.”
http://www.gcc-uk.org/files/page_file/ANNUAL_REPORT_2007_FINAL.pdf
Well, let’s hope this sees the GCC setting some meaningful standards. It would get off to a good start if it (1) denounced subluxation-based and other pseudoscientific chiropractic practices such as applied kinesiology and craniosacral therapy, (2) admitted that the frequency of serious injuries following chiropractic spinal manipulation is currently not known, and (3) implemented an independent reporting system for patients who experience adverse events following chiropractic treatment.
It would also be good to see on its website, and in its Patient Information Leaflet, what Simon Singh and Professor Edzard propose (on p.285 of their book ‘Trick or Treatment? Alternative Medicine on Trial’) that all chiropractors be compelled by law to disclose to their patients about chiropractic therapy:
Quote:
“WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”
The warning reminded me of an acquantance of mine who had chiropractic manipulation of his neck and suffered a neurological injury as a result. Fortunately the symptoms resolved over the next day or so.
After a bit of prompting from me, he decided to write to the chiropractor to inform him of what had occurred – so that others would not be harmed. When I asked him about it later, he said he decided to just forget about that sorry incident. He never did contact that chiropractor.
I’m wodering how widespread that result would be that the chiropractor never finds out that he paralysed or nearly paralysed his patient.
“…the chiropractor never finds out that he paralysed or nearly paralysed his patient.”
Aha… And if he finds out it, then he will sue against his patient like BCA against Simon Singh, eh? 🙁
What an outrage! 🙁
Did you know that the sympathetic chain ganglion comes off anteriorly to the segmental spinal nerve roots or are you just blowing smoke up the preverbial?
I think you need an adjustment!
A neurological "injury" which resolved in 1 day? Hmm, not really. An "insult" to neurological structure, by either a good adjustment, freeing up a fixation or narrowing, or a bad adjustment doing the opposite, is more likely…but that's not an injury.
Christina Cunliffe only became a GCC council member long after the college had put in a couple of years of work producing a new, longer (5 year) programme against the newest and highest GCC standards.
In any case, the educational review teams from the GCC are made up of people from RIVAL colleges.
Actually i'm not sure what the value is picking your article apart as it's all a bit hyperbolic and lacking in facts.
Talking of lacking in facts, yes, Chiropractic needs to raise its game with research and effectiveness. Any sensible chiro would agree. Certainly beware those that speak about magic. 🙂 Saying it's based on pseudoscientific principles though is a bit redundnant. Modern medicine was founded on pseudoscience.
As far as I'm concerned, a well educated modern chiropractor (in the UK, that's certainly anyone in the last decade), is a primary physician specialising in musculo-skeletal and neurological disorders, including the early diagnosis and treatment thereof.
I'm still a student but I know several qualified chiropractors who regularly see GP's, even just for checkups, and NOT just LBP. These are well-qualified, informed patients, who in spite of the low numbers of gold-standard studies, still see considerable benefit themselves.
You’ll never be able to prescribe medication for spinal injuries for a REASON. And the licensing authorities recognize that and don’t allow it. If you want to know about your spine, you can pretty much ask a nurse. They’ve got a better education in neurology and can identify when a medication is safe or dangerous to use based upon an assessment. Chiropractic “physicians” can’t do that, again for a REASON.
Well Rob, it looks like your trainers are indoctrinating you well. Welcome to the cult of chiropractic. I hope the money you spend on your course is worthwhile!
McTimoney does not represent main stream chiropractic, so why has the analysis of chiropractic education been based on that college? Would using the AECC or Glamorgan not back up your arguments sufficiently? Perhaps due to the level of the quality of education, based on applying the principles of EBM to chiropractic taught at these establishments. (EBM being the use of best available current research, patient choice and clinical experience NOT just RCTs!!!!!). The level of uninformed argument around the issue of chiropractic is insulting to the good, conscientious, caring and well educated chiropractors!
Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Chiropractors’ attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment.
Just like any industry there are good guys and bad guys. While there are those who try to encourage lifelong treatments, the good ones treat what is necessary (yes sometimes this takes more than a couple of treatments) and send their clients on there way beter than when they came in.
[edited to remove spammy link]
To reiterate Janine’s comment, the McTimoney College is very different to the other two universities that train chiropractic in the UK. If you wish to see what the reality of chiropractic education is please look in to the AECC or glamorgan, since they are where the bulk of chiropractors graduate from.
Also TIAs last for 24-72 hours and are neurological injuries, but there is no more a link between chiropractic and stroke as there is between general practitioners and stroke. It is much more likely the patient presents with neck pain as a symptom before the stroke occurs (Cassidy et al, 2008).
Please back up future arguments with evidence, not subjective opinion.
I always wondered: When chiropractors become evidence-based and throw out all the energy flow and subluxation B/S… What, then, is the difference between them and physiotherapists?
I have asked this question many times. I have never received a sensible answer.
The only answer I get is that if it is delivered by a chiropractor then it is chiropractic. It’s a closed self-referential loop.
I was amused recently while listening to the audiobook of Carl Hiaasen’s Double Whammy when one character asks a chiropractor, “Tell me. What’s the difference between this and a massage?” And the chiro replies, “I’m a Doctor. That’s the difference.”
It was written in 1987.
“The only answer I get is that if it is delivered by a chiropractor then it is chiropractic.”
And, of course, anything treated by a chiropractor is a subluxation.
Therapists possess a higher degree of skill and training when working with actual medical-based injury and disease. Physiotherapists (Physical Therapists in the U.S.) deal with real diseases and injuries, not made-up catch-all phrases such as sub-luxations.
Obviously, physios aren’t trained to detect minor displacements in the spine, merely owing to muscles being imbalanced and therefore exerting more pressure on one side. The term subluxation is used to denote not a dislocation but something much more minor which can still interfere with nerve pathways. Shame some of these people are so bigoted since a severe subluxation can often be seen and certainly felt by even an untrained person. You do good work with stroke patients though, so don’t give up the day job.
Why is it that we quote the risk of Chiropractic with maybe 30 non conclusive deaths in 30 years after Millions of manipulations delivered, and no one looks at the deaths one conventional therapy like NSAID (anti inflammatory drugs) have caused in the years. Serious toxicity (leading to hospitalization or death) from NSAID use occurs for an estimated 100,000 to 200,000 people per year. Moreover, it is estimated that approximately 10,000 to 20,000 DEATHS per year are related to NSAID use.
Iatrogenic death is well-studied.
What you forget is that we are dealing with a ratio
Risk:Benefit
Chiropractic benefit for non-spinal conditions is somewhere between nothing and sod all, so the ratio tends to infinity.
For spinal conditions it is, at best, no better than a range of other modalities.
Simply because, for example, maybe one person in a hundred visits a chiropractor while perhaps 50 out of a hundred visit a physician? And the FDA approved nsaids for OTC use and purchase by anyone with the money. And chiropractic is available to anyone without basic research skills.
I know, keep taking pain medication to relieve you symptoms and forget about the cause. If people are getting relief whats the problem? Also I don’t understand why the location of the McTimoney College matters so much to you. Have you seen some of the school locations in central London? I am not one to usually comment on internet posts, as most of the time they are produced by people who only hide behind thier monitor with the use of a key board. Joseph very clever post.
The more comments I read on the defence of chiropractic, the more I value my 60s school science classes that taught me scientific method. It is impossible to engage in reasonable discussion with people who are not rational in the first place. I class belief in chiropractic as something akin to dolphin worship, which involves raising money to send sick kids to the USA to rub up against these creatures.