Sunday, 20 June 2010

Back to Back Chiropractic Clinic: "Specialists" in RSI


Every week when I flick through the Luton News I come across a smug Back to Back Chiropractic Clinic advert, insolently staring back at me.

UPDATE, 22nd September: The advertiser has agreed to withdraw their claim to treat RSI, and therefore the complaint has been marked as "informally resolved".

UPDATE, 22nd June: As well as complaining to the ASA, I've also submitted a complaint to the General Chiropractic Council (scroll to the bottom). Just for the lulz, you understand.

The Clinic's chiropractors, by the way, are members of the BCA, which stands for...


Earlier this week I realised that Chiropractors may not be allowed to claim they can "treat" Repetitive Strain Injury (RSI).

(The 2010 Brontfort Report, commissioned by the General Chiropractic Council, makes no mention of it, and neither does the ASA's Copy Advice service.)


Sounds like a test case for the ASA, then, because the Back to Back clinic claim to be "specialists" in "treatment and diagnosis" of RSI!

"I write to complain about an advert which appears in the "Luton News" newspaper (June 16 2010, p32).

The advert, for the Back to Back Chiropractic Clinic (Luton), promotes chiropractic treatments for Repetitive Strain Injury (RSI).

I suspect that the advert may be in breach of one section of the British Code of Advertising, Sales Promotion and Direct Marketing (CAP) code. I can provide an original copy of the advert by post, if required.

1. This complaint is not related to my April 2010 complaint against the same advertisers, which I believe is still under your consideration.

2. The advert which is the subject of this complaint claims the Back to Back Clinic are "Specialists [in] treatment & Diagnosis of: ...Repetitive strain (injury)"

3. I can find little evidence attesting to the efficacy of chiropractic in treating RSI. A 2001 systematic review [1] stated (in its abstract):

"Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness... With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that ...spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living... In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed."

4. The 2010 "Brontfort Report" [2], commissioned by the General Chiropractic Council to "provide a succinct but comprehensive summary of the scientific
evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions", does not refer to any spinal manipulation treatments for RSI.

5. CAP's Copy Advice website [3] lists a number of conditions to which it accepts chiropractors may refer, but RSI is not among them.

6. Under Sections 3.1 and 50.1 of the CAP Code, I challenge whether the advertiser holds documentary evidence to prove the following claims, and I challenge whether the claims are backed by evidence, where appropriate consisting of clinical trials conducted on people:

(i) The Back to Back Chiropractic Clinic are specialists in the diagnosis and treatment of RSI
(ii) The Back to Back Chiropractic Clinic are able to treat RSI

7. I confirm that I have no connections with the advertiser, the newspaper or the alternative medicine industry in general. I confirm that I am not involved in legal proceedings with the advertiser or the newspaper.

Footnotes:
[1] Konijnenberg HS, de Wilde NS, Gerritsen AA, van Tulder MW, de Vet HC, "Conservative treatment for repetitive strain injury", MW, de Vet HC.
Scand J Work Environ Health. 2001 Oct;27(5):299-310. Review.PMID: 11712610
[2] http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf
[3] http://copyadvice.co.uk/Ad-Advice/Advice-Online-Database/Therapies-Chiropractic.aspx
"

Here is my GCC complaint about the same two adverts.

"Dear Sir/Madam,

I write to make a formal complaint about advertisements promoting the "Back to Back Chiropractic Clinic" (Luton).

The essence of my complaint is that the advertisements may breach the General Chiropractic Council (GCC) Code of Practice (2005) and the Advertising Standards Authority (ASA) Committee of Advertising Practice (CAP) Code.

1. The Back to Back Chiropractic Clinic (268 Crawley Green Road, Luton LU2 0SJ) employs two GCC registered chiropractors, David Leu (reg. no. 00503) and Paula Garcia (reg. no. 02516).

2. My complaint concerns two adverts. The first ("Advert 1") has been running weekly in local newspapers for several months. I enclose two copies of this advert. The first was taken from the "Luton News" newspaper of Wednesday, June 16 2010. For comparison, I have included a copy of an (identical) advert taken from the Luton News of March 31 2010.

3. The second ("Advert 2") appeared just once - in the Luton News on Wednesday, April 14 2010 - as part of "Chiropractic Awareness Week".

4. Advert 1 includes the following text:
"Specialists [in] treatment & Diagnosis of: ...Repetitive strain (injury)"

5. The GCC's "Code of Practice (2005)", Section C1.6, states:

"[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. If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters..."

6. The ASA's CAP Code, Section 7.1, states:

"No marketing communication should mislead, or be likely to mislead, by inaccuracy, ambiguity, exaggeration, omission or otherwise."

7. Section 6.1 states:

"Marketers should not exploit the credulity, lack of knowledge or inexperience of consumers."

8. Section 3.1 states:

"Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove all claims, whether direct or implied, that are capable of objective substantiation."

9. Section 50.1 states:

"Medical and scientific claims made about beauty and health-related products should be backed by evidence, where appropriate consisting of trials conducted on people... Substantiation will be assessed by the ASA on the basis of the available scientific knowledge."

10. CAP's Copy Advice website [1] lists a number of conditions to which it accepts chiropractors may refer. Repetitive Strain Injury (RSI) is not among them.

11. I can find little clinical evidence attesting to the efficacy of chiropractic in treating RSI. A 2001 systematic review [2] stated (in its abstract):

"Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness... With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that ...spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living... In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed."

12. The 2010 "Bronfort Report" [3], commissioned by the GCC to "provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions", does not refer to any spinal manipulation treatments for RSI.

13. I complain that Advert 1 may be in breach of the ASA's CAP Code, Sections 3.1, 6.1, 7.1 and 50.1, in that:

(i) given the Bronfort Report and the other sources I have referenced, the advertisers are unlikely to hold sufficient documentary evidence to support their claim of a chiropractic treatment for RSI (3.1 & 50.1),

(ii) the advertisers may be misleading consumers by claiming to treat RSI with chiropractic (7.1),

(iii) the advertisers may be exploiting the "credulity, lack of knowledge or inexperience of consumers" by claiming to treat RSI with chiropractic (6.1).

14. As a a consequence, I further complain that Advert 1 may be in breach of the GCC's Code of Practice, Section C1.6.

15. The GCC's Code of Practice, Section C1.9, states:

"[chiropractors] must not make claims to being a specialist or an expert in a field of chiropractic although chiropractors may indicate that their practice is wholly or mainly devoted to particular types of care."

16. Advert 1 contains the following text:

"Specialists [in] treatment & Diagnosis of: ...Repetitive strain (injury)"

17. Therefore I complain that Advert 1 may be in breach of the GCC's Code of Practice, Section C1.9.

18. Advert 2 contains the following text:

"Chiropractic focuses on the diagnosis, treatment and prevention of disorders of the nervous system, joints, bones and muscles and the effects that these disorders have on your health. It is a hands on [sic] treatment using specific techniques to improve the function of the joints in the body. This helps to alleviate pain, reduce muscle spasm, improve movement and encourage the efficiency of the nervous system and the bodys [sic] ability to heal itself..."

19. CAP's Copy Advice website lists a number of conditions to which it accepts chiropractors may refer. Neither "encourag[ing] the efficiency of the nervous system" nor "encourag[ing]...the bodys [sic] ability to heal itself" are among them.

20. I can find no clinical evidence attesting to the efficacy of chiropractic in "encourag[ing] the efficiency of the nervous system". Similarly, I can find no clinical evidence attesting to the efficacy of chiropractic in "encourag[ing]...the bodys [sic] ability to heal itself".

21. The 2010 Bronfort Report does not refer to any spinal manipulation treatments for "encourag[ing] the efficiency of the nervous system". (The nervous system is mentioned indirectly in discussions of nocturnal enuresis and vertigo.)

22. Likewise, the Bronfort Report does not refer to any spinal manipulation treatments for "encourag[ing] the bodys [sic] ability to heal itself".

23. I complain that Advert 2 may be in breach of the ASA's CAP Code, Sections 3.1, 6.1, 7.1 and 50.1, in that:

(i) given the Bronfort Report and the other sources I have referenced, the advertisers are unlikely to hold sufficient documentary evidence to support their claim that chiropractic can encourage the nervous system and the body's ability to heal itself (3.1 & 50.1),

(ii) the advertisers may be misleading consumers by claiming chiropractic treatments have these effects (7.1),

(iii) the advertisers may be exploiting the "credulity, lack of knowledge or inexperience of consumers" by claiming chiropractic treatments have these effects (6.1).

24. As a a consequence, I further complain that Advert 2 may be in breach of the GCC's Code of Practice, Section C1.6.

25. I enclose copies of the three advertisements to which I have referred. I can provide the original advertisements, if you deem it necessary.

Yours faithfully,

Footnotes:

[1] http://copyadvice.co.uk/Ad-Advice/Advice-Online-Database/Therapies-Chiropractic.aspx

[2] Konijnenberg HS, de Wilde NS, Gerritsen AA, van Tulder MW, de Vet HC, "Conservative treatment for repetitive strain injury", Scand J Work Environ Health. 2001 Oct;27(5):299-310. Review. PMID: 11712610
[3] http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf
"

9 comments:

  1. Whoever you are you must have an extremely miserable and boring existence. The reason you can find no evidence is because you are ignorant of research methods and clearly havent read any research from participants who have benefited from these treatments. Have you had any personal experience of any of these treatments you deem "Quack". Before you continue this useless crusade, familiarise yourself with research and debates on research and issues around creating evidence bases. There are great evidence bases for the tablets doctors dish out that cure nothing but create side effects which we then give the fancy term "Iatragenic". Go and educate yourself through your own experience. My back problems and yes STRAIN have been CURED by chiropractors.

    ReplyDelete
  2. It sounds to me as though you have a psychological problem - not sure of the diagnosis but theres some great medics at the Maudsley hospital who can help your mental state. Good Luck!!!

    ReplyDelete
  3. Dear Anonymous,

    You're right! I haven't read any "research from [sic] participants who have benefited from [chiropractic] treatments".

    The reason is, of course, that no-one has yet published any such research.

    Still, fingers crossed, eh?

    ReplyDelete
  4. There is ample research if only idiots like you knew where to look as they say "Only a fool leans upon his own misunderstanding"

    ReplyDelete
  5. Please provide citations of the "ample research" you mention.

    ReplyDelete
  6. A second major consideration is the doctor's philosophy and approach to patient management.

    Chiropractic

    ReplyDelete
  7. Re: "Ample research" -- Why would any professional body make this alleged research so hard to find? It'd be in their interest to make any such research as widely available as possible. This is one of the most important things a professional body's remit: to raise the profile of their profession and benefit its practitioners. So the only reasonable conclusion is that no such research exists.

    However, I'm willing to be proved wrong, so please could you direct us to any papers that support your case.

    ReplyDelete
  8. I have used chiropractic treatment for an AC joint injury sustained 2 years ago playing Rugby.
    My collarbone was out of place, and the delightful NHS left it that way saying it's the best they could do. 2 years later, I went to chiropractor on a friends recommendation, fixed it and I feel straighter and better posture than I had for years previously.

    Don't knock it till you've tried it.
    Dick.

    ReplyDelete
  9. Looks like you've got yourself a chronic dose of the placebo effect there. But don't worry! It's not permanent, indeed, it rubs off pretty quickly for most people.

    By the way, is "Dick" an abbreviation of "Nigel", or are you trying to hurt my feelings?

    ReplyDelete

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