The Role of UK Universities in Chiropractic
Friday, August 29, 2008
The decision by the British Chiropractic Association to sue Simon Singh will undoubtedly bring increased scrutiny of chiropractic. I would like to start with a first look at the education of chiropractors in the UK. This is also timely as Universities have recently been criticised for teaching quackery, resulting in a homeopathy degree being dropped by the University of Central Lancashire.Chiropractic is going to be quite different from homeopathy though. Anyone can call themselves a homeopath. Having a diploma behind you helps in joining the various homeopathic pretend regulatory bodies. Have a BSc and you will be vastly overqualified by far to dish out sugar pills. Chiropractors, however, need to be registered with the General Chiropractic Council. Chiropractic is capable of causing injury to patients, sometimes even death. To be registered, you need to have studied chiropractic for at least four years to degree level including one year of clinical supervision. That is the law.
There are three approved chiropractic schools in the UK: the Anglo-European College of Chiropractic, the McTimoney College of Chiropractic and the Welsh Institute of Chiropractic. The three Universities that accredit these degrees in chiropractic are, respectively, Bournemouth Universty, the University of Wales and the University of Glamorgan.
Let's look at one college: the McTimoney College where you can gain a BSc (Hons) Chiropractic degree validated by the University of Wales. The first surprise that new students may get is that the college is in the very un-Welsh market town of Abingdon, a few miles south of Oxford on the river Thames. You are a very long way from the Valleys now, boyo. No male voice choirs and Brains bitter here. Abingdon is an attractive town, but the college happens to be situated on a peripheral industrial estate near the A34, between B&Q and Furniture Village.
McTimoney chiropractic is one of the many denominations of the original chiropractic ideas and appears to stick quite closely to the founding ideas. This 'usually painless' technique twists and pulls sharply on the spine, sacrum, pelvis and the cranium whilst allowing them to spring back 'naturally' - the 'toggle-torque-recoil' technique. Students can follow up their BSc by seeing how their 'toggle-torque-recoil' techniques can be applied to small mammals (MSc Chiropractic (Small Animals)) and children (MSc Chiropractic (Paediatrics)).
One of the recurrent criticisms of chiropractic is that it is founded in mystical ideas and has a very poor evidence base for the efficacy of any of its treatments. The McTimony Chiropractic Association, based a few miles from Abingdon in Wallingford, sheds little light on the evidence for the efficacy or superiority of their chiropractic variations on thier web site. The philosophy of McTimony is given as
McTimoney taught, as DD Palmer had before him, that health depends on healthy nerve messages, that subluxations of the vertebrae or other joints interfere with these, and that such subluxations can affect not only joints and muscles, but every cell and organ in the body. He also stressed what would one day be called holism: that human beings are not purely physical but mental, emotional and spiritual beings as well, and that treating the whole body restores health to all these aspects of the patient.
This looks like pretty fundamental chiropractic with their mysterious and unproven 'subluxations' being the cause of illness - and not just bad backs, but the health of all 'cells and organs'. The college appears to adopt this worldview. Its prospectus states,
The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.
Another common criticism of chiropractic is the practice of developing dependent relationships with customers and encouraging them to have regular chiropractic sessions as a preventative or 'wellness' service. The evidence for the benefits of such prolonged and expensive intervention does not appear to be sound. The McTimoney school prospectus tells us that,
Chiropractors consider that the body benefits from having periodic chiropractic treatments on a preventative basis so that incipient problems may be avoided.
Given that the practice of chiropractic is founded on pseudoscientific ideas it would appear to be imperative to ensure that any BSc offered by a college maintained appropriate and modern academic standards. Some chiropractors have abandoned the dubious aspects of the trade and limit their work to that they can be confident works - almost exclusively lower back pain. Does the college in Abingdon do this? Who inspects them? Many aspects of the prospectus and web site worry me. They say in their description of chiropractic,
A chiropractor will examine by hand (palpate) the bones and joints of the body to check for imbalance, however slight. Any problems found are corrected with various adjustments, which are effective and safe. The bones are never forced into place, but by adjusting with a very rapid thrust and immediate release, the bone 'toggles' towards its correct position.
Chiropractic aims to restore nerve function in order to promote natural health. This involves re-educating the patient’s muscle and bones into better alignment. It is also preventative treatment and can greatly improve overall health and well-being. Regular check ups are recommended to ensure that the body maintains a healthy balance.
Sounding just like homeopaths, they say,
Chiropractic is a drugless and non-surgical form of health care that aims to treat causes rather than symptoms.
Now the problem as far as I see it is that the General Chiropractic Council is responsible by law for recognising courses as meeting its standards so that graduates can call themselves chiropractors, don their white coat, put their brass plaque up, and title themselves 'Dr'. The GCC makes inspection visits to colleges and issues reports as you can view on their web site. This must surely create a conflict of interest. As there are only three colleges that provide chiropractic degrees, there would be severe repercussions for the profession as a whole if one of them was found to be offering substandard education. This potential conflict of interest is exacerbated by the fact that the principle of the McTimony Chiropractic college in Abingdon, Christina Cunliffe, is also a council member of the GCC. The GCC does ask its council members to declare interests, but questions can surely be asked about how independent the GCC can be in assessing the quality and appropriateness of education provided by the colleges.
Given the nature of chiropractic, there is surely a case to be made to separate the professional representation and regulation of chiropractors from the educational validation of their training. What role does the University of Wales play in this? That is a question we should find out.
Labels: chiropractors
posted by Le Canard Noir at
12:01 AM
8 Comments:
Much as I admire your general approach to woo, I think you have missed the point in your post. It's very good of you to point out the incestuous relationship between various bodies and various protagonists of chiropractic but the following question is the most important.
Does it work or is it effective?
Apart from lower back pain, the answer seems to be no. And even in the the above case, exercise and analgesics appear equally effective.
I've just re-read my own contribution and realised it sounds more condemning than I meaned it to.
My comment above is more about the emphasis of your post than the content, I do realise you question the effectiveness of these woo merchants and it is of value to point out they just reinforce themselves in different contexts.
IMO, the UK chiropractic regulatory body, the General Chiropractic Council (GCC), is little more than a self-interest group, not least because it has, as part of its remit, a duty to “promote the profession”. In essence, that would appear to mean that it is committed to pushing an expensive (and sometimes dangerous) woo-laden therapy that offers about the same benefit to its back pain patients as would be derived from taking a couple of paracetamols:
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf
It’s also worth noting that [1] although the GCC requires that “all chiropractors must ensure that all the information they provide, or authorise others to provide on their behalf is factual and verifiable, is not misleading or inaccurate in any way, does not abuse the trust of members of the public in any way, nor exploit their lack of experience or knowledge about either health or chiropractic matters”, and “does not put pressure on people to use chiropractic, for example by arousing ill-founded fear for their future health or suggesting that chiropractic can cure serious disease”. See page 7 here…
http://www.gcc-uk.org/files/page_file/FITNESS_TO_PRACTISE_REPORT_2007_FINAL_FOR_WEBSITE.pdf
and that [2] although section A2.3 of its Standard of Proficiency requires that “chiropractors’ provision of care must be evidence-based”…
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf
…the GCC appears to (intentionally?) confuse the public by failing to make clear on its website - and elsewhere - the essential differences between scientific manual therapy and chiropractic subluxation-based philosophy. It also seems to make no attempt to specify the common chiropractic techniques and practices which it does not consider legitimate:
http://www.gcc-uk.org/page.cfm?page_id=6
How that can be reconciled with its other statutory duties to “protect patients” and “set standards” is beyond me.
Acleron - 'Does it work?' is not the only interesting question about alternative medicine. Indeed, the answers to that question are largely in, but this appears to make no difference to the amount of alt med in society.
I hope I am raising other interesting questions here. Essentially, 'Given that alt med does not work (largely), how did we get here and how does it persist?' There are lots of intersting answers to that question.
An update. The General Chiropractic Council (GCC) has just published its Annual Report on its website, and the Chairman’s foreword states the following:
Quote:
“With effect from July 2008, our duty to promote the profession has been removed. This implements one of the recommendations of the White Paper ‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’, that health regulators should have a more consistent statutory purpose – that of protecting the public by setting and maintaining
professional standards.”
http://www.gcc-uk.org/files/page_file/ANNUAL_REPORT_2007_FINAL.pdf
Well, let’s hope this sees the GCC setting some meaningful standards. It would get off to a good start if it (1) denounced subluxation-based and other pseudoscientific chiropractic practices such as applied kinesiology and craniosacral therapy, (2) admitted that the frequency of serious injuries following chiropractic spinal manipulation is currently not known, and (3) implemented an independent reporting system for patients who experience adverse events following chiropractic treatment.
It would also be good to see on its website, and in its Patient Information Leaflet, what Simon Singh and Professor Edzard propose (on p.285 of their book ‘Trick or Treatment? Alternative Medicine on Trial’) that all chiropractors be compelled by law to disclose to their patients about chiropractic therapy:
Quote:
“WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”
The warning reminded me of an acquantance of mine who had chiropractic manipulation of his neck and suffered a neurological injury as a result. Fortunately the symptoms resolved over the next day or so.
After a bit of prompting from me, he decided to write to the chiropractor to inform him of what had occurred - so that others would not be harmed. When I asked him about it later, he said he decided to just forget about that sorry incident. He never did contact that chiropractor.
I'm wodering how widespread that result would be that the chiropractor never finds out that he paralysed or nearly paralysed his patient.
"...the chiropractor never finds out that he paralysed or nearly paralysed his patient."
Aha... And if he finds out it, then he will sue against his patient like BCA against Simon Singh, eh? :(
What an outrage! :(
Did you know that the sympathetic chain ganglion comes off anteriorly to the segmental spinal nerve roots or are you just blowing smoke up the preverbial?
I think you need an adjustment!
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