Tuesday, May 19, 2009

Chiropractic - totally bogus, dude?

The word 'bogus' is back in vogue - and not before time. It's been 18 years since Bill & Ted's Bogus Journey hit the big screen and had all teh kidz talking like west coast surfer dudes.

The word 'bogus' has been thrust back into the limelight for a much more serious reason - just over a year ago, Simon Singh wrote a piece for the Guardian entitled "Beware of the Spinal Trap" (you can read the full article on Gimpy's excellent website here) which contained the line:
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.
In the usual manner of Complementary & Alternative Medicine, the BCA decided to sue for libel rather than entering into a rational discourse regarding evidence or the lack thereof. At the time, it wasn't apparent what the offending part of the article was, just that it was happening, hot on the heels of another legal chill from New Zealand Chiropractors to David Colquhoun.

Blogger and legal eagle, Jack of Kent has been following this story meticulously - his round up of the preliminary hearing (which was on 7th May 2009) can be found here. From Jack of Kent's site:
[The Judge continued that] The word "bogus" meant deliberate and targeted dishonesty. So it did not mean that chiropractic for the six named children's ailments (including asthma) was simply wrong, or that it was contrary to established medical practice or research, or even that it completely lacked evidence. "Bogus" meant a lot more. The judge held that by the mere use of the word "bogus" Simon Singh was stating that, as a matter of fact, the BCA were being consciously dishonest in promoting chiropractic for those children's ailments.
[...]The ruling means that, as it stands, Simon Singh would have to prove at full trial that the BCA were being deliberately dishonest. This is not only extremely difficult but it was undoubtedly not Simon Singh's view in the first place. The BCA, as with many CAM practitioners, may well be deluded, irresponsible, and sometimes rather dangerous; but calling their promoted treatments "bogus" was not an express statement of their conscious dishonesty.
(My bold).

A Facebook site has been set up and on Monday 18th May in London, there was a collective show of support for Simon Singh, with Dave Gorman, Evan Harris MP, Nick Cohen and Brian Cox all speaking, as well as Simon himself. The Quackometer is setting up a Carnival of Bogus* Chiropractic to promote the fact that there really is little evidence for chiropractic at all, never mind the more exotic claims of colic, athsma and others.

So then, are chiropractics claiming all manner of curatives without the evidence to back it up? If so, then it's difficult to see how they aren't being consciously dishonest. Gimpy has already shown that the General Chiropractic Council appear to admit there may be bogus chiropractors. I suppose chiros could be deluded, well-meaning, possibly ignorant of the evidence, but I'm not sure how likely that is. I looked at one in the Wiltshire area at random to see what came up:

Step up Healthcare 2000 in Trowbridge and Chippenham - this is a one-stop shop for alternative quack-like things - clicking on the 'Select Treatment' icon downloads a pdf document which states the following:
This section lists alphabetically a number of conditions that may be alleviated by the therapeutic specialities shown. Many complementary therapies are not condition specific but treat the “whole person”, making it difficult to accurately list conditions alongside a therapeutic approach in this way.
Fairly weaselly - could be written as "by claiming a holistic approach, we can claim to help any disease in the whole wide world". And here is a list of the ones they claim chiropractic can 'alleviate' (I've put beside a few of them a link to a relevant Cochrane review if available and the conclusion from that review.)

Asthma - Various therapists use [...] chiropractic. The review found there is not enough evidence from trials to show whether any of these therapies can improve asthma symptoms, and more research is needed.
Bedwetting (childhood) - Complementary treatments such [...]chiropractic may help, but the evidence was weak.
Cancer (with a disclaimer that it may ease symptoms and enhance well-being)
Chronic Colds
Colic in infants - still at Protocol stage
Glue Ear
Hay Fever
Pregancy (well being during)

Remember this is chiropractic - mainly spine manipulation. Despite claiming all these diseases can be alleviated with chiropractic, there are few Cochrane reviews to confirm their claims and the ones that are available are not very positive.

How can Healthcare 2000 claim this? They must have some idea of evidence to show efficacy, I mean they wouldn't just make it up, not knowingly anyway, because that would mean their claims are bogus (according to Justice Eady).

This business with the BCA will undoubtedly have the same effect (known as the Streisand Effect) which is to blast the news round the world via the internets that BCA want to silence dissent about chiropractic. This will in turn shine a skeptic-ninja searchlight on the chiropractic industry and show that the evidence for any of it is weak to non-existant.

Roll on the Carnival!

* - deliberate deception not implied.

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