Bassett Chiropractic Reply

May 29, 2009 at 9:39 pm (Alternative Medicine, Chiropractic) (Bassett Chiropractic Clinics, BCA, BCC, British Chiropractic Association)

Here is the email I sent requesting further information on the evidence for whiplash, followed by the response from Bassett Chiropractic Clinics (BCC – the have clinics called St Albans Chiropractic Clinic, The Hertford Chiropractic Clinic, Watford Chiropractic Clinic, and Kings Langley Chiropractic Clinic):

Thank you for responding. I would like to concentrate in this email on your claim to help with whiplash injury.

I note that the GCC state in their guidelines (Code of Practice, C1.6)[1] that “[Chiropractors] may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority.” I wondered if you were aware that the Advertising Standards Authority ruled against BritChiro[2] due to a claim they made to be able to help with whiplash. The ASA stated that they “instructed an independent expert to assess the evidence BritChiro submitted in support of the treatment of whiplash and arthritis. Our expert concluded however that the studies were not sufficient to support efficacy claims for either condition.”

I further note that a review[3] of the evidence for chiropractic and other treatments in treating whiplash associated disorders found that there were no randomised controlled trials for treatment of whiplash with chiropractic. The authors concluded that “Future research should be directed toward clarifying the role of exercise and manipulation in the treatment of WAD” and did not recommend chiropractic as a treatment for whiplash.

I acknowledge your reference to studies by “Forman and Croft , Dan Murphy and Johnny Cook” and I would like further information – please could you pass on the citations for these papers in order that I might read them? I assume the Johnny Cook paper is the 1996 retrospective study that called for randomised controlled trials to be conducted?

Regards,

James.

[1]http://www.gcc-uk.org/files/link_file/COPSOP_Dec05_WEB%28with_glossary%2907Jan09.pdf

[2]http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_44999.htm

[3]http://www.ncbi.nlm.nih.gov/pubmed/15782244

And now for the Bassett Chiropractic response:

You will, I am sure, realise that whiplash is a colloquial name for a collection of signs and symptoms that usually arise from a motor vehicle accident.In such accidents a number of structures can be involved, including (but not restricted to) joints, muscles, ligaments, tendons and nervous tissue. Most commonly the term whiplash is used where the above-named tissues are sprained or strained. These injuries fall into the category of musculoskeletal or mechanical injuries.

Chiropractors regularly treat neck pain arising from motor vehicle accidents. Having undergone a minimum of four years full-time training, they are qualified to assess, diagnose, manage and treat such injuries. Contrary to popular belief, chiropractic is not a treatment, but a profession which utilises a range of treatment techniques to help its patients. Although chiropractors are highly skilled at spinal manipulation it would be incorrect to assume that every patient is manipulated.[1] Exercise prescription, reassurance, patient education, supervised rehabilitation, massage and mobilisation and spinal rehabilitation are all used to treat whiplash associated disorders (WAD). This approach was suported by the Quebec Task Force Study (see http://www.ciap.health.nsw.gov.au/downloads/specialty/gdl_mngmnt_whiplash.pdf).

You refer to the ASA Code of Practice. You will no doubt have read it thoroughly. The Code explicitly sets out the remit within which it operates. The Code is more concerned with paper advertising and does not extend to material posted on members’ websites.[2] This was the case with the BritChiro case and hence the reason why the ASA got involved. In it, the ASA’s expert is believed to have been Edzard Ernst.

I note that in your email of 19 May you appear to challenge the claim that chiropractic can help in the treatment of headaches. You do not repeat this in your email of 22 May, presumably because you had by then read the ASA adjudication in which event you will have noted that the ASA is satisfied that chiropractic was effective in the treatment of ‘migraine'[3]

I’ve noted three points in their email that I wish to respond to and I have a further couple of requests for them – to provide the citations I asked for seven days ago and comment on the paper I cited in my email to them. Here’s my next email to the BCC:

[1] Thank you for clarifying this point. I’d be interested to learn what proportion of patients are treated with manipulation by Bassett Chiropractic. Is this information available to members of the public?

[2] I find it interesting that rather than defend the claims you have made on your website, you seem to prefer to rely on the ASA’s inability to police websites due to their remit not extending to that medium. Do you consider it acceptable to make claims that are inconsistent with ASA guidance on the basis that it is done so on a website and they therefore are unable to challenge your claims?

The GCC code of practice (C1.6) states that members are allowed to “publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority”. This does not seem to me to mean simply that chiropractors should abide by ASA judgements on paper advertising, but rather seems to indicate that any publicity of a chiropractic practice should be consistent with ASA guidance. Your website is clearly publicising your practice and is certainly not doing so consistent with ASA guidance. It seems to me that you are in breach of the GCC code of practice (as I have interpreted it). Is your interpretation of C1.6 different to mine? I think the GCC should be able to clarify this point and I would suggest that you or I contact them to obtain this clarification.

[3] Actually, I decided it would be better to deal with the conditions separately. “Migraines” and “headaches” are not synonymous (in fact, your website clearly promotes chiropractic for each of these conditions) and I will be requesting the evidence that backs up your claim to be able to help with headaches in a future email.

[4] I note that, despite my request for proper citations of the papers you claimed supported chiropractic for headaches and whiplash, no citations have been forthcoming. If you are relying on these papers to back up your claims to be able to help with headaches and chiropractic then I would expect you to have the papers to hand – or at least be able to pass on the relevant citations within the 6 days since my email.

[5] I also note that you have yet to comment on the systematic review I cited in my previous email. Should I expect comment from you regarding this paper? [http://www.ncbi.nlm.nih.gov/pubmed/15782244]

I will, of course, keep you up to date if and when I receive a further response from BCC. (Ditto the British Chiropractic Association.)

More

The Simon Singh case roundup may be of interest: godknowswhat.wordpress.com; as might the Lay Science post on what chiropractors can’t say.