The Business Ethics Blog

(By Chris MacDonald)

Chris MacDonald

Chris MacDonald
Location
Canada
Birthday
January 12
Bio
I'm a philosophy professor who specializes in business ethics. My blog (businessethicsblog.com) is about business ethics. I also blog occasionally at researchethicsblog.com, biotechethicsblog.com, and food-ethics.com.

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JUNE 10, 2009 3:05PM

British Chiropractors Retreating from Publicity

Rate: 8 Flag
This is shocking.

A chiropractic association in the UK has taken the very unusual step of contacting all of its members and recommending they take down their websites, apparently because of the risk that those websites contain unsubstantiated claims about chiropractic's ability to treat certain conditions.

This blog entry on DC’s Improbable Science blog — The McTimoney Chiropractic Association would seem to believe that chiropractic is “bogus” — has a copy of the letter. It reads, in part:
The target of the campaigners is now any claims for treatment that cannot be substantiated with chiropractic research. The safest thing for everyone to do is as follows.
  1. If you have a website, take it down NOW.

When you have done that, please let us know preferably by email or by phone. This will save our valuable time chasing you to see whether it has been done.
  1. REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them. DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.

The "campaigners" referred to in the website are individuals — mostly skeptical bloggers, from what I understand — who've taken on the task of emailing chiropractors and saying, basically, "your website says you can treat X...can you provide any credible evidence for that claim?"

Many commentators think this letter is a smoking gun, proving that chiropractors themselves know how little evidence there is that their practices are effective. (My non-expert understanding from what I've read is that there is some evidence for the effectiveness of chiropractic treatments for certain kinds of back pain, but little beyond that.) In fairness, it's worth pointing out that MCA explicitly denies that its letter is an admission of anything. Their letter says: "This advice is given to you solely to protect you from what we believe is a concerted campaign, and does not imply any wrongdoing on your part or the part of the Association. "

Now, I want to set aside entirely the debate over chiropractic in general. What interests me, here, is the move by this professional association — a kind of business association, in effect — to tell its members not to publicize the details of the services they offer. This means that all communications is now going on behind closed doors. This is clearly a dangerous move. It means that consumers now can't see in advance what ailments a various chiropractor offers to help with. It also means that (some) chiropractors are now going to be doing business in a way that's insulated from public scrutiny. That sort of behaviour is surely beneath what we expect of people who claim the title of 'health professional.'

(FYI...Here's the strikingly brief website for the McTimoney Chiropractic Association itself. Essentially, they've deleted all content. But here, thanks to the Internet Archive (which archives websites) is what the McTimoney Chiropractic Association website looked like on February 2008.)

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Please note: I will not be approving comments that try to engage the general question of evidence for/against the effectiveness of chiropractic. Please limit comments to the specific issue at hand. Thanks.

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Looks like the Wayback Machine's version of the site you mention has been blocked as well. Can behavior by the chiropractors be defended in any way?
In the past, I went to a few of these bone benders.

Their mantra is, "You need an adjustment."

What they REALLY mean is that they want you to keep bringing your checkbook back for an adjustment to your balance~~ALWAYS in the negative.
I wonder if they'll do the same for physicians in the U.K. After all, so many of their treatments do not work, even though the doctors swear up and down they do and advertise as such.

My friend just went through a grueling radiation and chemo schedule, horrific in the pain and side effects for tongue cancer. His physician assured him his cancer was "treatable and curable." Now he goes back in after the treatment and the CAT scan shows no difference at all in the tumor on his tongue and neck. He endured excruciating treatment because of the unsubstantiated claim about his Dr.'s ability to treat certain conditions. Yep, that would include lot of claims by Physician groups. But this doctor still got paid. At least someone is happy.

And when I go in for back pain, the Doctor only has one treatment for that condition: pain pills, muscle relaxants - I'll be hooked on pain pills in 2 weeks and then there starts a whole new condition for which he'll treat me.
Apparently this is all the result of a few individuals - and kudos to them - and not an effort by the government to insure that medical claims are justified (an annoying requirement that costs the pharmaceutical industry and health care researchers millions of dollars (and which system, of course, can never be perfect). In the US quack medicines were once outlawed, with, I believe, the exception of homeopathy (a homeopath helped draw up the federal regs); chiropractic gained credibility after frightening doctors with lawsuits.

Is this likely to have any legal ramifications in Britain? If so, will chiropractors be reduced to glorified masseurs? BTW, in Tennessee, chiropractors can NOT legally provide massage therapy. That is left to LEGITIMATE practitioners.
Deborah Young:

It sounds like your friend's physician was overly optimistic, perhaps culpably so.
The difference is that chemotherapy and radiation therapy actually are proven treatments for some cancers. They don't always work. But in all fairness they're not baseless. Some claims (at least) by chiropractors are made without any compelling evidentiary basis.

Chris.
If it walks like a duck it's probably a quack.
There is the placebo issue with them; maybe it works for some people, because like you say, back pain, and it can be frustrating to not be able to do anything.
It does seem bizarre to pull the whole thing down, in terms of accountability.
Surely this is connected with the chiropractors' lawsuit against Simon Singh, http://www.guardian.co.uk/science/2009/jun/04/simon-singh-libel-british-chiropractic-association-bca, where a judge ruled that 'bogus' meant they were making consciously unsupported claims, which he had not proven. He is appealing to a higher court, and the question of unsupported claims will clearly come up. They seem (unaware of the Internet Archive) to be trying to empty the playing field.
Hi Chris,
For many years I practised as a Rolfer in both Britain and the States.
I was never questioned at any time as to my claims or otherwise. I used to mainly rely on word of mouth to provide clients. My feeling was, that if I was any good I would never want for clients.

At one time in Britain physicians were not allowed to advertise. Neither was any other "ism" or "ology" except in the broadest of
terms. I think that it is a pity that this has changed. I would like to see it's return.

As far as orthodox science is concerned there are a few glaring omissions. The long term safety of maternal anaesthesia has never to my knowledge been tested. While I can understand physicians and midwifes breathing a sigh of relief when anaesthesia for childbirth was introduced, it has now been discovered that it is not as benign as has been previously thought.

It may well be imprinting our children with a propensity for becoming addicted to drugs when they hit adolescence. Plenty of recent research to check on, but no notice has been taken on this. Try Google for references for imprinting with anaesthesia at birth.
In case anyone is interested here are two research documents. There are others which can be accessed fairly easily on Professor Michel Odent's website or mine at raynergarner.com

* Jacobson, B. et al. (1988).Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynaecol. Scand., 67: 677-682.
* Jacobson, B. et al. (1990). Opiate addiction in adult offspring through possible imprinting after obstetric treatment. British Medical Journal, 301:1067-1070.
Chris, thanks for this.

I think this is a good thing. Most of the extreme/absurd claims have been made behind closed doors anyway (see "Bullshit" episode by Penn and Teller, esp. the chiro for kids, disgusting.)

But the primary reason for chiro's success is that they seem completely credible, above-board, untouchable, mainstream. If this spreads, and I hope it does, it will mean the long-overdue examination of the claims of this quack's paradise.

I don't think your concern holds up as a principle. By that definition, many things should be allowed to be promoted or claimed, like St. John's wort for heart problems...because it's somehow worse if people claim it in private? Meanwhile all heart patients who see the published claims and take wort are increasing their chances of death, since wort conflicts fatally with some heart meds.

Chiro is 94% a ripoff. But there is also the issue of violating the public trust. The claims of chiro and ALL alt meds/herbology should be subject to clinical, controlled verification, because they are health claims.
Deborah Young: "He endured excruciating treatment because of the unsubstantiated claim about his Dr.'s ability to treat certain conditions."

I think you may be missing an important part of the picture in your friend's case. Medical treatments have a statistical success rate. If the statistics are good enough to warrant using that treatment on a specific case, then it makes sense to use that treatment. It doesn't mean the treatment is guaranteed to work. Chiropractors are simply asked to provide the same sort of statistical evidence. They can't do so because there isn't any.
Greg:

I'm not advocating that Chiropractors advocate publicly things they can't support with evidence. I'm just suggesting that it's questionable for a professional body to tell members to go into hiding, rather than, say, to stop claiming to be able to do things they can't.

hughthewineguy:
The fact that some bits of mainstream medicine are not proven doesn't make it OK for other kinds of practitioners to ignore the issue of evidence. There is a massive movement to subject all aspects of mainstream medicine to rigorous assessment. Any profession not similarly committed is, I think, dangerous. At very least, one wants to ask of them, "Why do you not care to assess the usefulness of your treatments by the best methods available?"

Chris.
hugh. oh. ok.

Chiro makes claims it can't support, and it's the vast majority of them. A good starting point is several issue per year, in both Skeptic and Skeptical Inquirer. Try Searching Sci Am database.

I generally don't provide links -- i know that always sounds lame -- when it is such obvious and well-accepted materials, and especially for something that is so overwhelmingly supported by normative science, for so many who have examined it. It seems the burden is on the ones making the most extraordinary and unsupported claims. Chiro, that is.

I am impressed with your claim about how little is really studied, in quantitative ways. The list of medical procedures that can be done in an office, in one day, alone, that also can be, and are, supported by clinical evidence -- trials, double-bind studies of short- and long-term outcomes, control groups, well-designed and revisited studies altogether -- is in the many thousands.

Unless you are disputing the evidence of ALL of these, in which case you are both a polymath like no other (and my hat's off to you), AND you are sitting on even better, contrarian studies for each of those many thousands, going back decades...?

Then perhaps your assertion that "what treatments in medicine, outside of pharmaceuticals, have had the same(?) There's not a lot." is a wee but exaggerated, perhaps.

Hugh, you don't know me and haven't read my posts, to claim me "as the established, entrenched regime". We would both have a jolly good laugh at that if you truly knew me.

I don't know what your beliefs are, from your colorful but brief post, but I get the sense you are a bit of a "True Believer" about chiro? Perhaps not. Perhaps you simply have a healthy distrust of Big Pharma, Big Medicine, or Big anything. I am with you there, pal.

But the failings and abuses of corporatized science of all kinds does not extend to there being wholesale and blithe disregard of good, normative science being applied to materials and procedures regarding health. To suggest otherwise is to insult the tens of thousands of working clinicians, lab workers, docters and scientists who conduct solid science every day, who publish results, whose work can be replicated by others and thus disputed, disproven, verified, enhanced.

And is, every day.

Unlike the claims of homeopathy, chiropractic, herbal medicine, and hundreds of other "alternative" methods. Most are NOT subject to real study. When they are, "oddities" abound. The biggest is probably the complete lack of standards for what ingredients, in what amounts? what percentages? what purities? in the majority of hundreds of thousands of "remedies". But then these are the things that are allowed a special exemption, goodness knows why, and can make claims w/o proof, because they are legally "alternative".

Like Chiro. Excuse me for not being impressed with concepts like the purported "fluxous inclination alignment", whose only systematically tracked characteristics are monetary.
Chris

I must have missed that in the piece. Silly, how i get with pseudo science topics. Truly, it is a bad habit to scan and think I know when its one of my hot topic issues. I think it distorts us all, to do that, and especially i think it demeans the more generous give-and-take "middle ground" areas where flexibility and civility reside.

On re-read, I get this know. And i find I agree, on the simple point that this or any other professional org owes transparency to its members, critics, and public, but especially where health and health costs are concerned. Thanks again for catching this.

I violate your requests for sticking to the topic with my response to hugh, as well. sigh. Delete, as u like.
FYI, all: OS mirrors my external blog (http://www.businessethicsblog.com) where I *moderate* comments. I obviously don't do that here (though I guess I can delete comments, I don't have to approve them before they're posted). Anyway, the bit at the end of my blog posting about "approving" comments was intended for my non-OS audience.

Cheers,
Chris.
hughthewineguy:

Thanks for your comments.

I really didn't (and still don't) want to debate the issue of evidence. My point (again) was about a professional association telling its members to go into hiding, rather than dealing directly with the defensibility of their claims.

But 4 quick points:

1) Personal experience is in many instances a bad guide. It's very well documented that patients and those in healing professions sometimes see the results they want to see. That's why good clinical trials are done "double-blind" whenever possible.

2) The fact that a practice is old is no assurance whatsoever. For centuries, people thought prayer could bring rain. It was a very old, but entirely false, belief.

3) There may well be *some* aspects of chiropractic, etc., that's hard to test rigorously. But not all of it. And either way, it's no excuse for chiropractors not seeking to approximate, as near as they *can*, the best possible experimental proof. (To say "sorry, MY art just can't be tested" is a cop-out used by self-professed psychics who refuse to show their stuff under carefully-controlled circumstances.)

4) The quantum physics thing is a red herring. The weirdness that happens at the quantum level is not evidence that somehow science is wrong; it's a new level at which to search for hidden regularities. And besides, quantum physics is not generally held to have explanatory power at the macro level of everyday experience.

Chris.
The Consumer Health Digest recently had the following post which may have a bearing on the discussion:
Last October, the British Advertising Standards Authority (ASA)
ordered the Ideal Spine Centre in Blean, Canterbury to stop claiming
that a program of periodic spinal checkups throughout life would have
an impact on resistance to disease. [ASA Adjudication, Oct 15, 2008]
http://www.casewatch.org/foreign/asa/farthing/asa_2008(2).shtml The
clinic is run by Christian H. E. Farthing, an Australian-trained
chiropractor who began practicing in the United Kingdom in 2000.
http://www.idealspinecentre.co.uk/ During ASA's proceedings, Matthew
McCoy DC, Director of Life University, Marietta, Georgia provided a
review of "vertebral subluxation" and its application within
chiropractic. He also referenced various trials that he said showed
chiropractic and subluxation had an impact on wellness and quality of
life.The ASA's Adjudication concluded:

"The review of the purpose, principles and practice of chiropractic
provided in support of the ad did not justify the implication in the
ad that having the spine checked throughout life would have an impact
on resistance to disease. We were also concerned that the claim "If
you know someone who is regularly suffering from colds, ear
infections, chest infections or are generally run down, tell them to
get a wellness check-up by a Wellness Doctor ... start building a
healthier immune system by strengthening your spine and nervous
system ..." implied that Christian Farthing's treatment could prevent
or treat prolonged or recurrent bacterial or viral infections. We
concluded that the Ideal Spine Centre had not justified this
implication and the ad was likely to mislead."

In 2003, the UK's General Chiropractic Council, found Farthing guilty
of unprofessional conduct and suspended him from its register, which
means that he cannot legally practice as a chiropractor. Rather than
closing his clinic, however, he simply began calling himself a
"Spinal Specialist."
Hugh

I appreciate the more collegial tone.

I personally tend to distrust things that can't be found using empirical methods. Things that require "belief".

It's not that I was always this way. I have learned to respect verifiable results, to value results that can be quantified, replicated. I used to be a Believer, a yearner for magic and the unknown.

I now feel this: why does empirical somehow equal cold, sterile, un-"magic"? For example, there is no empirical reality to mind-reading, to readings of any kind. This is easily demonstrated. But what does happen -- besides the learnable cold reading techniques, the sublimely subtle ability to "read" someone's body language, tiny clues, the slightest expressions, in real time, with total strangers -- is AMAZING. Magic enough, to me at least.

There are potential, and, rarely, provable benefits to some aspects or particulars of some alternative "therapies" and "medicines". We do have wonderful techniques that can show value: well-designed, controlled studies and experiments. And when we find an ingredient in a plant, or a meditation technique, that can be even modestly effective at a human discomfort, it is great! My larger point is that the only way we have, currently,to efficiently and correctly demonstrate such efficacy is with the scientific method.

Which need not be complex or technically remote. A 12 year old girl in Colorado, about a decade ago, had a simple skepticism about, and fascination with, "healing touch". So she designed a straightforward experiment, using no equipment other than some sheets and a massage table, to see if it really worked. She used actual practitioners. When the study was controlled for fraud or bias, even unintentional, it showed conclusively that the effect was imaginary. The study was replicated by adult scientists and verified.

And yet "healing touch" still finds its way into scientific, medical training for RNs. When official professional organizations (see Chris, how I snuck that in? he he) fail to respect science, monitor there own practitioners, follow the facts, it undermines any good being attempted the handful who are sincerely trying to build real skills of real value, even in a marginal or controversial field.

Chris reveals here how this organization should be pursuing the truth, wherever it might lead, but instead opts for obfuscation, and deceit. Not good.

Wish and wish with all our might, but science levels the field. What is, is. Why isn't that good enough, something to build on? Is this astonishing planet and its improbable life not magic enough?

As to the paradigm shifts you believe in, caused by quantum physics, read deeper. Dare to comb through Skeptical Inquirer, Skeptic, Scientific American (their .coms, that is), and challenge that wishful thinking. Not one of the "new age" physics books are written by people who really understand physics. Physicists aren't saying what Alt Believers think they are saying. Spooky action at a distance is a shibboleth, at the real world scale. learn what the Planck length is, and then come up with, if you can, a mechanism for how quantum effects move "up" the scale to our reality. What happens at the quantum level, stays at the quantum level.

No baby to throw out, Hugh. There's no there there, except for stray and modest effects.

False comparison, viz the number of deaths for "iatrogenic" illness vs chiropractor. If the same array of complaints, including heart attacks, strokes, organ failure, chronic disease, etc. came daily into Chiro's doors seeking immediate relief, the number of dead and disfigured would be off the charts. Unfair to chiro to make this comparison.

Because chiro routinely does nothing much -- pressure on muscles and tendons, stretches, relaxation techniques -- to people who are not in life-threatening straits, one can reasonably expect banal outcomes. Few deaths, etc. But how does this prove anything beneficial? How is this better than home meditation and exercise, or yoga class, both much more fair comparisons?

What needs to change is universal public health care, deploying, affordably, a wide spectrum of normative, "mainstream" health care. And more oversight, of ALL who care for human bodies.

Medicine is tested, questioned, doubted, and put to the test thousands of times a day, in labs and hospital and clinics around the world. It grows, improves, evolves.

Chinese "medicine" is a western invention, cobbled together fromseveral older folk traditions less than 150 years ago. It claims to need no such testing or evolution, because...why? Because bronze age herbalists knew more than modern labs and trained scientists? If so why are there more adherents of that folk medicine and its "remedies" in California than in all of China? Why are young Chinese abandoning and ignoring it, overwhelmingly?

Because modern medicine works. And they prove it.
I don't think it's unreasonable for a chiropractic association to request that its members not make unsubstantiated claims on their websites. Not making unsubstantiated claims would seem to be a form of good behavior, and most professional associations police good behavior. Your concern that the unsubstantiated claims would then take place in private seems misplaced to me. If you can't prevent bad behavior in private, does it follow that you should welcome it in public?
Allie:

I'm not promoting the public promotion of false claims. What I'm say is that going into hiding is the wrong solution.

Chris.