I emailed the GCC to ask for clarification on a point that relates to my correspondence with Bassett Chiropractic Clinics, of St Albans Chiropractic Clinic, The Hertford Chiropractic Clinic, Watford Chiropractic Clinic, and Kings Langley Chiropractic Clinic (Bassett Chiropractic Clinics are members of the British Chiropractic Association – the organisation suing Simon Singh, who co-authored the excellent Trick or Treatment with Edzard Ernst). Here is my email, followed by their reply, and my follow-up email:
I am writing to you in order to clarify whether chiropractors are allowed to publicise their clinics by making claims that are inconsistent with ASA guidance. I note that C1.6 in the GCC code of practice 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”. I further note that Advertising Standards Authority ruled against BritChiro due to a claim they made to be able to help with whiplash. Finally, I note that Bassett Chiropractic Clinics claim on their website to be able to help with whiplash.
Note that my email begins “I am writing to you in order to clarify whether chiropractors are allowed to publicise their clinics by making claims that are inconsistent with ASA guidance.” I thought that this sentence was quite clear and made obvious that my purpose in writing to the GCC was to clarify whether or not chiropractors were allowed to publicise their clinics by making claims that are inconsistent with ASA guidance. I even referenced the appropriate section of the GCC code. Apparently, though, I was mistaken:
Dear Mr Cole
Evidence for chiropractic management of whiplash-associated disorders
Many thanks for your email, which my colleague has forwarded to me for reply. First, I should explain that I am not a chiropractor, or researcher, and so I have sought the advice of members of General Council who have the necessary knowledge and experience.
You mention an ASA adjudication; the ASA takes the view that it will not disclose details of the evidence it considers in relation to any adjudication. The GCC is, however, aware of the studies summarised in the paragraphs below.
The Bone & Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders, funded by the World Health Organisation, published a series of studies in the journal Spine in 2008.
The Task Force concluded that for people suffering from whiplash-associated disorders (WAD) ‘a number of nonsurgical treatments appeared to be more beneficial than usual care, sham, or alternative interventions but none of the active treatments were clearly superior to any other in the short or long term. Educational videos, mobilization, manual therapy, and perhaps acupuncture appeared to have some benefit. For both WAD and other neck pain with radicular symptoms, interventions that focused on regaining function and returning to work as soon as possible were relatively more effective than interventions that did not have such a focus.’
Haldeman S et al, Executive Summary, SPINE Volume 33, Number 45, pp 55-57
A key component of the Task Force’s recommendations is a new four level classification system for neck pain:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy (“pinched nerve” – pain, weakness and/or numbness in the arm)
Grade 4: neck pain with serious pathology, such as tumour, fracture, infection or systemic disease.
The Task Force found that a majority of patients fall into Grades 1 and 2 categories and do not need extensive tests or invasive treatments. If pain is interfering with a patient’s daily activities (Grade 2), some type of early treatment is recommended to prevent long-term disability.
The Task Force recommends that neck manipulation, acupuncture and massage are better choices for managing most common neck pain. Other useful approaches are exercises, education, neck mobilisation, low level laser therapy and pain relievers.
An article summarising the Task Force’s recommendations was published by the GCC in its newsletter (GCC News 23) in March 2008 and which you may find of interest:
I hope you find this information of help. Please don’t hesitate to contact me if you have any questions.
Executive Officer (Communications)
General Chiropractic Council
I have now responded to this email:
I thank you for your response. I am afraid, however, that I don’t see how your email answers my original query (whether chiropractors are allowed to publicise their clinics by making claims that are inconsistent with ASA guidance). This is rather a straightforward question and I would have thought it was one which could be easily answered. In fact, I don’t see why a simple “yes” or “no” answer to this question would be impractical. I shall rephrase my question: Are chiropractors allowed to publicise their clinics on their own website by making claims that are inconsistent with ASA guidance? The GCC code of conduct suggests not. Your email fails to clarify this one way or the other. In fact, the response that you have sent to me does not once refer to the GCC code of conduct. I understand that you are neither a researcher nor a chiropractor but I would appreciate a clarification of this point regarding the GCC’s own code of conduct from yourself or another member of the GCC.
PS: I should also point out that the PDF linked to in the GCC email doesn’t load. My browser tells me that the address was “not found” and the website “down for everyone or just for me” assures me that it is not just me – perhaps you have inadvertently supplied an incorrect url?
I’m afraid my latest email is a trifle more blunt than I had intended, but I have to confess that my patience is running out. I asked what I thought was a perfectly straightforward question and the GCC seem to have sidestepped this question and answered a question that I did not ask – namely “can you please send me some task force guidelines on treatment of whiplash”. If you can find this question in my original email then I would be grateful if you could point out to me, in the comments section below, where I asked this question and I shall apologise to the GCC. It seems to me that it has taken six days, and the input of “members of General Council who have the necessary knowledge and experience” in order for the GCC to answer the wrong question.