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Independents' Day

Are chiropractors destroying their own reputation?

British chiropractors seem bent on destroying their reputation as a credible healthcare profession. A bold statement? Maybe, but look at the evidence.

British chiropractors seem bent on destroying their reputation as a credible healthcare profession. A bold statement? Maybe, but look at the evidence.

On more than one occasion, the Advertising Standards Agency (ASA) has recently ruled against chiropractors who use a doctor title in advertisements such that patients might assume they are medical practitioners. Similarly, the ASA has also reprimanded chiropractors for making therapeutic claims which are not supported by sound evidence. According to these ASA rulings, chiropractors are no longer allowed to advertise that their interventions

• boost the immune system
• treat colic
• are the best way to treat back or neck pain
• treat irritable bowel syndrome
• treat learning difficulties
• improve resistance to disease
• treat whiplash injuries
• or treat arthritis

Neither are they permitted to claim that "chirokinetic therapy" is an effective intervention for:

• obesity
• thyroid imbalances
• anaphylaxia
• anorexia
• depression
• fertility problems
• ME
• palpitations

One might say these complaints refer to isolated cases. This may be true but I fear that the underlying problem is prevalent. The ASA only springs into action if a member of the public complains but the misleading use of the doctor title and the advertising of false claims seems very wide-spread indeed. Too common, I'd say, to be worthy of a reputable profession.

Other reputation-destroying activities of chiropractors include their adherence to wacky theories from the pre-scientific era. Almost 2/3 of UK chiropractors seem to still adhere to the idea that subluxations of the vertebrae cause all sorts of visceral diseases1. Thus professional bodies claim that chiropractic can effectively treat a wide range of non-spinal problems - asthma for instance.

41229133The truth is that all three sham-controlled trials fail to show that chiropractic spinal manipulation works for this condition. The best of these studies was published in the NEJM and concluded that "the addition of chiropractic spinal manipulation to usual medical care provided no benefit".

But the strangely self-destructive streak of chiropractic does not stop with false or misleading claims. We have shown that many UK chiropractors advise their clients not to immunise their children. Chiropractors themselves have published data which clearly demonstrate that a large proportion of UK chiropractors violate the rules of informed consent (Langworthy JM, le Fleming C. Consent or submission? The practice of consent with UK chiropractic. J Manipulative Physiol Ther 2005;28:15-24.). As a profession, chiropractors seem to be in denial regarding the considerable risks of spinal manipulation (Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manag 2008, 5: 544-562).

The worst chiropractic self-goal of the century, however, must be the decision of the British Chiropractic Association (BCA) to sue my friend and co-author (‘Trick or Treatment: Alternative Medicine on Trial') for libel. He pointed out in a newspaper commentary that the BCA's claim to effectively treat a wide range of childhood diseases, including asthma, was not based on good evidence. Now the BCA is suing Simon in a case that looks as though it will be protracted and expensive and also has important, far-reaching ramifications.

Incensed by the new trend to silence scientists and journalists with legal muscle, the British public is now beginning to speak out. About 140 leading scientists, journalists and other prominent personalities have signed a document entitled "Keep the libel laws out of science" (You can sign up by following this link). It calls "for urgent review of the English law of libel and its impact on critical debate about science and evidence. The House of Commons has issued a statement of support from senior parliamentarians. In it they state that "scientific disputes should not be resolved with libel laws…"

In the coming weeks we will see more and more that scientists don't want scientific truth decided in a court room, journalists feel that freedom of speech is in danger, and sceptics object to chiropractic mumbo jumbo. As a result, the implausibility of the basic chiropractic concepts is for the first time being exposed in a major and very public way. People who only yesterday thought that chiropractors were reasonable back specialists are therefore likely to see this profession in an entirely different light.

I have been following this case for almost a year now and have no idea how it will end. But I strongly feel that whatever the judge decides, chiropractic (as a profession) can only lose.

Even if he rules in the BCA's favour, the British public will have learnt a lot of embarrassing things about chiropractic which will severely undermine the reputation of this profession. This damage could well prove to be irreparable.

Professor Edzard Ernst Recent posts

There's no such thing as a 'negative' result 01 June 09
Percy, Pavlov and placebo in animals 26 May 09
If the evidence supports it, so will I 18 May 09
Herbal 'detox' treatments spread a poisonous message 14 May 09
CAM practitioners share some of the blame for measles epidemic 07 May 09
Homeopaths ride to swine flu rescue 06 May 09
Just because a patient gets better, doesn't mean their treatment worked 28 April 09
Homeopathy for cancer is nothing more than placebo 23 April 09
Do complementary and alternative therapies do more harm than good? 20 April 09
Don't let your practice become an evidence-free zone 15 April 09
Natural doesn't mean safe. And CAM is neither 06 April 09

So-called 'integrated medicine' is disturbing nonsense 30 March 09

Why 'belief' in complementary medicine is misguided 23 March 09

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