Incompetence and The General Chiropractic Council

June 9, 2009 at 5:13 pm (Alternative Medicine, Chiropractic) (Applied Kinesiology, Craniosacral Therapy, GCC, General Chiropractic Council)

According to a recent article in Pulse, the GCC were apparently described by the CHRE (Council for Healthcare Regulatory Excellence) as follows: “[The GCC] takes its role seriously and aspires to, and often maintains, excellence.” Sadly, I have some examples of the GCC’s failure to maintain excellence. I shall leave the most damning example until last. (I think it’s worth the wait. But feel free to scroll down if you’re busy.)

I have recently communicated with the GCC and my experience is that they are incapable of (a) understanding and responding to a simple question and (b) correctly linking to documents on their own website.

Apparently, they are incapable of answering my question “Are chiropractors allowed to publicise their clinics on their own website by making claims that are inconsistent with ASA guidance?” and can only refer me to the relevant legislation. Which I’ve already read. And I know that they are aware that I have read it, because I quoted it to them in a previous email. The very reason I asked the question in the first place is because I wanted clarification of the legislation that they are now quoting back to me. If I wanted guidance on a Statutory Instrument from, say, the Food Standards Agency or the MHRA then (a) there would likely be guidance notes already available and (b) these agencies would be happy to clarify anything I found unclear and to provide guidance where necessary. I can safely assert that this is the case, because I have had experience of corresponding with the FSA and MHRA and they have kindly clarified for me points relating to legislation and regulation. Why the GCC is unable to do likewise is beyond me. Perhaps I need to make a formal complaint to the GCC about a specific chiropractor (or specific chiropractors). If my complaint is successful then I will know that chiropractors are not allowed to publicise their clinics on their own website by making claims that are inconsistent with ASA guidance. If my complaint is unsuccessful, then I will know that the reverse is true and that the GCC Code of Practice and Standard of Proficiency is worthless. Though why they can’t simply indicate which is true is rather baffling.

With regards the failure of the GCC to correctly link to documents on their own website: I find that copying and pasting the url from my browser into an email is an almost idiot-proof way of providing the correct url. I wouldn’t think to type it out by hand partly because it would take longer and partly because it would give more opportunity for human error to introduce a mistake. If it were my own website then I would be rather embarrassed not to be able to provide the correct domain name to an interested party. If I were an employee of a regulatory body for a healthcare profession rather than an amateur blogger, I imagine that my embarrassment would be even greater. For any employees of the GCC reading this, I would like to point out that your web address is as follows: http://www.gcc-uk.org/. Having pointed out the incorrect url, an employee of the GCC informed me that “I don’t understand why it doesn’t work for you, I’ve tested it and everything seems to be in order.” They clearly did not test the url from the email they sent me, because it did not and still does not work. Rather than testing the broken url in the email they sent me, they tested the correct url. They apparently have not compared the correct url with the url they sent me, or they might have noticed the difference between the two.

Finally, my attention has been drawn to these claims by the GCC in a letter to Action for Victims of Chiropractic in response to questions 4 and 5 of the PDF I link to below the quoted claims:

1. The definition of evidence-based care that has been published by the GCC is as follows
“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”.
This is why the GCC feels able to include in the Standard of Proficiency the requirement that all provision of chiropractic care must be evidence based.

2. The definition mirrors that which is promoted within the medical profession. [Points 1 & 2 here are in response to question 4]

1. Adjustment of the atlas, craniosacral therapy and applied kinesiology all fall within the above definition of evidence-based care. [My bold.]

GCC AK

I was staggered to read the claim that applied kinesiology fell within the GCC’s definition of “evidence-based care”. Their definition seems to me to be so lax that pretty much anything you can think of could fall within it. The best available evidence from research does not support applied kinesiology (or craniosacral therapy, come to that). Clearly, the GCC’s definition allows practitioners to choose which of the elements of evidence-based care to take note of. They must allow chiropractors to incorporate the preferences of the patient and the expertise of practitioners including the individual chiropractor, while ignoring the best available evidence from research. That, or the GCC has no idea what constitutes “the best available evidence from research”. Either way, the GCC seems to be unskilled when it comes to providing definitions of evidence-based care or when it comes to appraising evidence. I can only assume that they are unaware of their lack of skill because, surely, if they were aware of their own incompetence, they would take remedial steps.

Craniosacral therapy: “The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury […] This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy.” http://tinyurl.com/gcc-cst

Applied kinesiology: “When manual muscle testing as used in Applied Kinesiology is disentangled from standard orthopedic/neurological muscle testing, the few studies evaluating specific AK procedures either refute or cannot support the validity of AK procedures as diagnostic tests. In particular, the use of MMT for the diagnosis of organic disease or putative pre/subclinical conditions is insupportable.” http://www.chiroandosteo.com/content/15/1/11

More

There are a few letters on the Action for Chiropractic Victims website that you may find interesting: http://www.chirovictims.org.uk/victims/news.html

[Note: the following links go to PDFs.]

Unskilled and unaware: Kruger and Dunning’s 1999 paper*, Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments; Ehrlinger et al’s 2008 paper, Why the unskilled are unaware: Further explorations of (absent) self-insight among the incompetent. Alternative link for Ehrlinger: Ehrlinger_et_al_2008. A couple of papers from researchers that asked questions of Kruger and Dunning: Krueger and Mueller, bursonlarrickklayman. (These questions were answered in the Ehrlinger et al paper.)

Recommended reading for chiropractors: my blog post; recommendation number 3 of which may be particularly useful for the GCC: Evidence based medicine: what it is and what it isn’t. Although, having said that, perhaps recommendations number 1 and number 3 2** may also be of use: How to critically appraise an article; How to read a paper.

*Much like Kruger and Dunning did in the concluding remarks of their 1999 paper, I would like to assure readers that to the extent this article is imperfect, it is not a sin I have committed knowingly. If there are errors contained in this piece then please feel free to let me know in the comments section below. **Error #1 is the incorrect numbering of reading recommendation number 2 as recommendation number 3. Thanks are due to AndyD for pointing this out in the comments section below. Further errors will be corrected and acknowledged as and when I am notified.