GPs and chiropractic – mind the credibility gap
For many months there have been half-page adverts in the British Journal of General Practice (BJGP) by the General Chiropractic Council (GCC).
Why refer patients to Chiropractors?
Because Chiropractors manage back pain effectively and use methods recommended in current evidence reviews
The problem that chiropractic now has is one of credibility. And let’s make no mistake about it the chiropractic profession wants, indeed craves, the credibility.
One article in Chiropractic & Osteopathy in August 2008 asks this very question: How can chiropractic become a mainstream respected profession? The example of podiatry.
Objective: To present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority.
Well, my first piece of advice would be not to refer to us mainstream practitioners with the pejorative term ‘allopathic’. That aside, I have always felt that there are plenty of chiropractors out there who try to practise evidence-based interventions and who look askance at evidence for chiropractic in a variety of medical conditions. And this is the point the authors make in this paper when considering the original chiropractic concept of ‘innate intelligence’:
These concepts are lacking in a scientific foundation and should not be permitted to be taught at our chiropractic institutions as part of the standard curriculum. Much of what is passed off as “chiropractic philosophy” is simply dogma, or untested (and, in some cases, untestable) theories which have no place in an institution of higher learning, except perhaps in an historical context.
Fundamentally, there exists a gap between this approach and the reality. This is presumably why the GCC are directly targeting general practitioners and advertising in the BJGP. The debacle with Simon Singh is only serving to widen the gap and it is has the potential to set chiropractors’ professional position back years. This paper suggests that chiropractic drops any pretence to treat any other condition and sets out their stall as the market leaders in spine care. Nothing else; pretty much just bad backs. Very sensible and I could envisage the future for chiropractic they set out:
But, most importantly, it means becoming experts in patient management, i.e., helping patients overcome spinal pain, whether that means providing adjustments, exercise, short-term medication use and/or education regarding the issues related to LBP provided in a cognitive-behavioral context. Currently, there is no profession that adequately fills that role, although as we noted earlier, the physical therapy profession is moving quickly in this direction. The opportunity is there for us to correct our mistakes, but we must act now. The only question is whether the chiropractic profession has the integrity, vision and self reflection required to make the necessary changes. Time will tell.
‘Integrity, vision and self-reflection’ eh? The authors must be hanging their head in despair at the current situation. Their claims for efficacy in conditions such as asthma, colic, chronic ear infections etc are being subject to the closest scrutiny and concerns regarding safety are being highlighted.
Prof Edzard Ernst has come to this conclusion.
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.
If I was minded to follow the new NICE guidance on low back pain I can’t see how I can recommend chiropractic to my patients. If anyone is going to do spinal manipulation then I’ll send them to the local physioterrorist who is perfectly capable of all the interventions that chiropractors offer. Many GPs will be even more reticent about referring to chiropractors. The credibility gap is simply too great.
Murphy, D., Schneider, M., Seaman, D., Perle, S., & Nelson, C. (2008). How can chiropractic become a respected mainstream profession? The example of podiatry Chiropractic & Osteopathy, 16 (1) DOI: 10.1186/1746-1340-16-10
It’s surprising that you say that there have been half-page adverts placed by the GCC in the British Journal of General Practice “for many months”. According to the foreward in the GCC’s most recent annual report (published last summer), its duty to promote the chiropractic profession was removed in July 2008:
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
Interesting. The logo and slogan the GCC use is:
It couldn’t be clearer.
Blue Wode: Thanks for finding that. I too had assumed they were still in the business of promoting chiropractic.
However, can a White Paper do that if the Chiropractors Act 1994 still seems to say (IIRC) that it is one of their duties? More research required, as they say.
On their website, the logo no longer has “Promoting the profession”.
I suggest that removing this will make their message more credible to the general public.
Chronic musculoskeletal problems (such as back pain, neck pain, headaches, migraines, sciatica, carpal tunnel syndrome, herniated discs, and injuries resulting from motor vehicle accidents, slips & falls, sports traumas and work related injuries) account for a large percentage of doctor’s office visits and emergency room visits. The ways these conditions are managed typically involve one drug after another. But are there better and safer alternatives than drugs?
Chiropractor was the easiest way to remove any pain on you back. The chiropractor today is one of the most common therapies that have been using to cure back pains.