The British Chiropractic Association do not appear to be too hot on evidence. Given that they are suing Simon Singh, a science writer, for saying that they promoted treatments for children’s ailments, such as asthma and colic, when there was no good evidence, you would have thought that they would have been quick to publish any evidence that existed. In fact, despite the BCA telling us that there is a plethora of evidence for the chiropractic treatment of these conditions, they have still failed to make their case public. Strangely, they have made that alleged evidence available to the court. Some of us are beginning to doubt that the evidence will stand up to much scrutiny.
Two of the central criticisms of chiropractic are that they promote improperly evidenced treatments and that they attempt to enrol customers on lengthy, expensive and unnecessary treatment plans. Furthermore, they market themselves as ‘wellness’ therapists where you should attend your chiropractor even when you feel fine for ‘corrective’ adjustments. My investigations of the BCA reveal that they are deliberately targeting children with an unevidenced chiropractic message.
Every year the BCA hold a Chiropractic Awareness Week. For the past few years, they have been promoting themselves with a campaign called “Straighten Up UK”. The idea of this campaign is to suggest to people that they should be performing a daily exercise programme “to help strengthen the spine and improve posture.” They are specifically targeting children by introducing a couple of cartoon characters, Abbey and Jake, and suggesting some exercises that kids can do to keep them in shape.
The exercises are divided into three parts and given kid friendly names – ‘stars’, ‘flying friends’ and ‘core balance’. The idea is that children can do a simple three minutes that can be incorporated into their ‘daily routine’ – whatever that means for kids. You can look at the video of the exercise here.
Now, anything that helps kids lead active lives ought to be good. But the campaign is not just about getting kids to bend and stretch – it is closely linked to the idea that chiropractic for kids is a ‘good thing’. Some chiropractors advertise that they would like you to “visit your chiropractor as you would your dentist”. There is no evidence to suggest this is necessary or beneficial. The BCA say in their Straighten Up UK (SUUK) campaign,
As children grow, chiropractic can help not only with the strains caused by the rough and tumble of life but also with some of the problems that children can suffer in their first years:
A BCA chiropractor will carry out a full examination and take a thorough history before advising an appropriate treatment programme for you or your children. Treatment consists of specific adjustments done by hand to free stiff joints and remove spinal nerve irritation.
We have previously seen how chiropractors are taught that birth introduced trauma to the bones of children can be corrected by manipulation. Again, there is no decent evidence for this.
So, where did this campaign come from and where is the evidence that their exercise programme benefits children?
Well, a PR Company looks like it is taking the credit. Publicasity, who describe themselves as ‘brand alchemists, have the BCA as a case study. Publicasity take the credit for creating the “three minute exercise called “Straighten Up UK” and using it is a tool for creating “clear ROI” for the BCA. (For my gentle readers not engaged in marketing activities, ROI is ‘Return on Investment’).
Publicasity also undertook some ‘research’ by conducting a survey to look at “ who was suffering from back pain and attitudes towards bad posture”. Dutifully, the market research showed that “50% of 16-24 year olds were currently suffering back pain and that the UK was indeed a nation of ‘Slouch Potatoes’.” Press releases were then issued and obediently picked up by Jenny Hope and Sarah Stacey of the Daily Mail for verbatim publication.
Indeed, in the Daily Mail, we are given a quote,
Mr Hutchful [Tim Hutchful, BCA spokesperson] said the BCA has launched a three-minute exercise programme called Straighten Up UK, which is designed to help strengthen the spine and improve posture.
It gives instructions for three quick sets of movements designed to warm up muscles, and advice on posture care and balance.
He said that although chiropractors can assist in diagnosis and treatment of painful joints, ligaments and the spine, they are more concerned with prevention.
“It’s like looking after your teeth,” he said. “It doesn’t take long to brush your teeth every day but it pays dividends for life.
“We want people to take that amount of time to care for their backs.”
PR job done.
Well, not quite. A ‘call to action’ is also important in marketing terms. Being ‘with it’ Publicasity made sure there were some ‘flash events’ and ‘stunts’ in ‘high footfall’ locations (English translation: train stations and shopping centres). They also made sure they interfered with Fern and Phil on ITV’s This Morning. Publicasity also made sure that ‘press toolkits’ were available to BCA chiropractor members so that they could get people into their premises for ‘free posture check ups’.
A pretty slick operation. Publicasity state they had a reach of 53,998,551 people. I think that figure pretty much sums up their attitude to relevance, accuracy and precision.
And what does this say about the BCA? Well, they like their stunts. This is typical of the ‘cash for’ stories that Ben Goldacre documents so well. We may expect cheap PR stunts from a fish oil pill peddler or a fluff headed shampoo maker, but a regulated health profession?
True colours are shining through.
"Publicasity state they had a reach of 53,998,551 people. I think that figure pretty much sums up their attitude to relevance, accuracy and precision."
LOL! I bet they paid their PR company more for market research that they spent on their 'plethora'!
Ignorance is bliss my friends. The author of this article obviously has needs to do more research to find that chiropractic has actually been proven as an effective therapy option for certain neuromusculoskeletal conditions, in people of all ages. Despite what some antagonists would hope for, the regulated health profession of Chiropractic is here to stay and is gaining more acceptance and legitimacy by the day. 🙂
Anonymous obviously needs to learn to read. I am happy accept that chiropractic can help with lower back pain – but just as physio, moderate excercise or paracetamol might.
It cannot help with the children's conditions being talked about here which are not neuromusculoskeletal in origin. The BCA claim they have a 'plethora' of evidence to support such claims. They have not published it. Perhaps Anonymous could do better.
I would also like to see what evidence Anonymous has for making the statement that chiropractic is "gaining more acceptance and legitimacy by the day". I would suggest the BCAs actions are ensuring the exact opposite is true? More unevidenced assertion from the supporters of chiropractic?
"Ignorance is bliss my friends"
If by bliss you mean a rough massage and a lighter wallet then Anonymous might be right.
Why is it that I find the phrase "my friends" so irritating coming from someone who utters such bilge. I'm not your friend. You have no friends. Nobody likes you.
It is also interesting that Anonymous has given us no indications of their expertise or any connections with chiropractic. For the record I have spent my scientific career studying muscle development in normal and mutation situations. So if you have any evidence for appropriate developmental aberrations in growing humans I would be pleased to assess it. Bring it on.
" Despite what some antagonists would hope for, the regulated health profession of Chiropractic is here to stay and is gaining more acceptance and legitimacy by the day. :-)"
Is that the kind of legitimacy that is garnered by one of the chiro's clubs demanding its members all take down their websites and takes down its own website while concealing the reason for doing so from their patients?
Having just finished reading 'The Retreat of Reason', by the experienced and well-respected Anthony Browne (available on-line to read) on the intellectual fear and abandonment of factual debate and truth-seeking due to the insidious oppression of political correctness – chiropractic cults fit perfectly, along with homeopathy and other fantasy measures.
The degree to which a gullible public, fuelled by politically correct, non-scientific, emotional artifice, will, on parting with cash up front, become the perfect victims of deception and extortion. If customers want to fritter their cash on chiropractic twiddling OK – but they ought to be under no illusion that this twiddling is no more than a fraudulent money extraction business purporting to be based on evidence (WHAT evidence). I would also be concerned by the potential for physical injury as a result of any direct chiropractic intervention or x-ray exposure – especially when not carried out on a proven scientific basis or expert clinical basis – almost an assault on the person?
I suggest that chiropractic is based on the illusion and impotence of political correctness – endangered with a little 'knowledge'.
They are just copping a feel while playing doctor. Chiropractors should harden up and produce some evidence or stop pretneding they know anything about science-based health care
"Staighten Up UK" was actually not produced by Publicasity or the BCA for that matter, rather it is based directly on a program called "Staigthen Up America" which obviously originated from the states. This program was indeed headed up by a chiropractor Ron Kirk in the summer of 2004, but along with a five-person expert seed panel and a diversely comprised Delphi review panel of approximately 100 health care providers and fitness experts. This program made up part of the United States Bone and Joint Decade research and educational initiative. See: http://www.straightenupamerica.org/
Due to the success of the program, it went global, and was taken on and adapted by the BCA to help promote spinal health.
This should help to highlight the ignorance and the blinkered approach with which you bloggers go about your business. Please get your facts straight before you go attacking a profession with half truths and even complete fabrications designed to make the profession look inferior to other medical/health care professions.
Hi there 'bloggers suck'. You sound a little angry.
Fistly, you could be right that the campaign was first developed outside the UK. But you provide no evidence. You say 'obviously' but it is not cleat why this should be. If you could, that would be useful. I do note that the campaign is used in other countries now.
Secondly, I do provide sources for my own claims. Note that publicasity do actually take credit for this campaign. Now, this may or may not be true. But I would suggest you post better evidence.
Thirdly, none of this adds to my belief that almost all chiropractic is evidenced nonsense. No matter who made up this sorry bit of PR that charge will not go away.
PC Gone Mad?
What does political correctness have to do with quackery, BCA cherry-picking evidence or 'science' being led by a PR company?
I feel you all need to be a little more open to Chiropractic and other complimentary health care, you all sound like a bunch of allopathic yuppies, the philosophy behind it makes total sense….nervous system: 45% of which innervates the viscera…..if there are many variables adding to a problem/pathology then REMOVE one to help the body!! With asthma, increase the thoracic expansion to help breathing etc…still not make sense?
I happen to love Chiropractic and why is everyone getting a bee in their bonnet because people are taking charge of their health and refusing to pop pills all the time….Hippocrates- 'for health…look to the spine' Why is that soooo out there? It developed first- notochord and all that!!
One word: idiot.
The notochord does not develop first, but as one component from the mesoderm which develops alongside the ectoderm and the endoderm – the basic layering which gives rise to all body systems.
Just one element of so many wrong things in so few words.
Amazing how polarised people get about health and children, being a father of two myself I can quite understand. Here's something I wrote about chiropractic and chhildren – I welcome constructive comments well argued.
Guttman G. Blocked atlantal nerve syndrome in babies and infants. Manuelle Medizin. 1987, 25
Reports on the examination and adjustment of more than 1000 infants with ‘atlas blockage’ or as chiropractors would call it – subluxation.
The symptoms of ‘atlas blockage’ ranged from, “central motor impairment and development through diencephalic impairments of vegetative regulatory systems to lowered resistance to infections, especially to ear, nose and throat infections.”
Also mentions the work of a colleague, Frymann, who examined 1250 new born babies. 211 suffered vomiting, hyperactivity and sleeplessness. Examination revealed ‘cervical strain’ in 95% of this symptomatic group. Manipulation then , “frequently resulted in immediate cessation of crying, muscular relaxation and sleepiness”.
Conclusions: 80% of children are not in autonomic balance, that the upper cervical spine should be examined and, if required, treated with specific manipulation, because, “the success of adjustment overshadows every other type of treatment.”
Biedermann H. Kinematic imbalances due to suboccipital strain in newborns. Manuel Medicine 1992; 6
600 babies with a variety of problems including postural asymmetries, motor problems (including torticollis) , loss of appetite, neck sensitivity, fevers of unknown origin and other central nervous system disorders.
Results, “All but one of our little patients treated only with manipulation of the upper cervical spine developed satisfactorily.” No complications.
“The immense pathogenic potential of the proprioceptive afferents of the suboccipital region has until now been widely underestimated.”
Jesper et al. The short term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. JMPT 1999; 22 (8)
This, and an earlier study in 1989 found, specific, finger tip adjustments to the spine relieved colic symptoms.
The Danish health authorities, already being familiar with the safety and effectiveness of chiropractic for adults, picked up on this study and instructed nurses to recommend chiropractic care for babies suffering from colic.
(As an aside, Denmark’s progressive implementation of chiropractic and a rehabilitation program have lead it to be the ONLY country to be successfully managing chronic low back pain)
You want constructive comments?
I sincerely hope you are not going to use this sort of evidence from chiropractic fanzines in a defense with the GCC of misleading patients about colic.
What's the problem with the evidence?
Well, at this time of night – let us just start with Jesper – a study that used dimethicone as an unblinded control. Dimethicone is not regarded as an effective treatment – and chiro was as good as this drug. Not very convincing.
Then why did it pursuade the Danes? And what of the other studies?
I am not sure who the Danes were that were 'pursuaded', but it is quite clear now that the Jesper study is deeply flawed. Again, are you willing to bet your career that this is a sound result?
I will not here go through your papers for you – I would suggets you do some critical appraisal of your own and look at the papers and see how well blinded they were, what controls were used and assess whether or not you want to bet your career on them.
You might want to learn from a recent BMJ cooment article on this very problem: http://www.bmj.com/cgi/content/full/339/jul08_4/b2766
Can’t we just kill off these horrendous people called Chiropractors. They earn a living through dangerous techniques(neck adjustments), have little evidence they do any good and con the general public out of their hard earned cash.
We need a revolution in this country to bring back common sense and informed opinion.
Who’s with me?