Chiropractor Dr Carl Irwin is wrong to call himself ‘Dr’ and makes untruthful claims say ASA

The Advertising Standards Agency (ASA) have passed judgement on an advertising claim by chiropractor business Dr Carl Irwin and Associates.  Dr Carl made the following claim in his advertising:

Dr Carl Irwin and Associates CHIROPRACTORS. Back, Neck, Shoulder, Arm and Leg Pain, Sports Injury, Joint Problems, IBS, Colic, Learning Difficulties, Cranial Treatment for Mothers and Babies. To discuss any area of your health with our Doctors, call for a FREE Consultation.

This claim was challenged on two points:

1. Dr. Carl Irwin and Associates could substantiate the implied claim that their therapies could successfully treat some of the conditions mentioned, in particular IBS, colic and learning difficulties;

2. the references to “Doctors” and “Dr” misleadingly implied that the chiropractors held general medical qualifications.

Also of interest is the reference to colic as the article by Simon Singh, which he was sued for libel over by the British Chiropractic Association (BCA) claimed that

even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

Carl Irwin is a member of the BCA, both the BCA and Carl think that colic can be treated by a chiropractor.  The ASA think not:

1. Upheld
The ASA acknowledged that manipulative therapies used by suitably qualified practitioners had been shown to be effective in treating back and joint pain and minor sports injuries. We noted the journal abstracts, conference paper reports and article references provided by Dr. Carl in support of the claim to treat IBS, colic and learning difficulties. In relation to the chiropractic treatment of IBS we noted the evidence provided included a 2007 randomised controlled pilot study relating to osteopathy and another randomised controlled study where results involving the treatment of IBS with osteopathy were described as “promising”; we noted, however, that those studies referred to osteopathy, not chiropractic. In relation to the chiropractic treatment of colic, we noted a number of reported un-controlled individual case studies where infants had been treated with chiropractic. We also noted several larger studies, one of which was a  “prospective case study”, another of which was based on “a retrospective uncontrolled questionnaire”, another which was a “pilot study” presented at a conference and a fourth which was a blinded randomised controlled trial that measured the “short-term effect” of spinal manipulation on infantile colic. In relation to the chiropractic treatment of learning difficulties we noted a 2007 literature review of the effects of chiropractic on individuals with learning disabilities and dyslexia in which the reviewers considered that none of the studies met all of their pre-defined methodological criteria.

We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).

The ASA also upheld part 2 of the complaint:

2. Upheld
We welcomed Dr. Carl’s assurance that the practice would no longer refer to its chiropractors as doctors in their future advertising to avoid misleading readers.

On this point the ad breached CAP Code clause 7.1 (Truthfulness).

and concluded:

The ad must not appear again in its current form. We told Dr. Carl not to refer to the treatment of IBS, colic and learning difficulties in future.

Now the ASA are to be applauded in their judgement and willingness to analyse the evidence submitted as well as their criticism of claims that some may describe as bogus but sadly their remit only extends to advertising not websites or professional claims.  Not a medical doctor Carl describes himself as a Doctor on his website and promotes chiropractic for the treatment of colic.  Given the ASA ruling I think it is fair to say that Carl Irwin is potentially misleading people into thinking he has general medical qualifications and making claims unsupported by clinical evidence.  Also Carl Irwin is promoting homeopathy on his website, a therapy I would argue is incontrovertibly bogus, having no plausible mechanism of action and having being robustly proven not to be better than a placebo.

Carl Irwin is a respectable Chiropractor and BCA member who is promoting bogus treatments. With respect to The Quackometer’s challenge I think I may be getting in touch with Mr Irwin about some of his other claims.

*update*

JackofKent has a skeptical lawyer’s brain point of view on this ruling in which he makes the point that the GCC demand that their members work within ASA guidelines.  He concludes with this point:

[...]it would render odd that the British Chiropractic Association still wishes to litigate in respect of its promotion of chiropractic for the treatment of colic when such a promotion by its members would now seemingly be a breach of their professional obligations…

I suspects the BCA and GCC will use the get out clause that the ruling only applies to one chiropractor and one advert, not the wider chiropractic community.  No professional organisation worth its salt would allow a independent body with no stated professional expertise in chiropracty (IMHO the ASA demonstrate a professional approach to evidence) to pass rulings that would have wide implications for the whole profession without some kind of get out clause.  I hope I’m wrong and that this ruling does have implications for Simon Singh and Judge Eady’s ruling, but I’m assuming a default position of pessimism for now.

However, I would encourage readers of this blog to submit ASA complaints about chiropractors making dubious claims referring to this ruling and the ASA guidelines on chiropractic.  The profession as a whole may be resistant to the ASA, individually I suspect they are not.

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General Chiropractic Council admit chiropractors may be ‘bogus’

You may be aware that Simon Singh, the science writer and broadcaster, has been a victim of Britain’s odd libel laws and Judge Eady’s creative interpretation of the word bogus over an article he wrote for The Guardian.  Outstanding legal pillar of the sceptical community and blogger JackofKent describes Eady’s interpretation of bogus as follows:

The word “bogus” meant deliberate and targeted dishonesty. So it did not mean that chiropractic for the six named children’s ailments (including asthma) was simply wrong, or that it was contrary to established medical practice or research, or even that it completely lacked evidence.

“Bogus” meant a lot more. The judge held that by the mere use of the word “bogus” Simon Singh was stating that, as a matter of fact, the [British Chiropractic Association] BCA were being consciously dishonest in promoting chiropractic for those children’s ailments.

JackofKent continues:

The ruling means that, as it stands, Simon Singh would have to prove at full trial that the BCA were being deliberately dishonest. This is not only extremely difficult but it was undoubtedly not Simon Singh’s view in the first place. The BCA, as with many CAM practitioners, may well be deluded, irresponsible, and sometimes rather dangerous; but calling their promoted treatments “bogus” was not an express statement of their conscious dishonesty.

Interestingly it appears the General Chiropractic Council (GCC), regulators of the profession, have used the word bogus to describe some practitioners, their 2003/4 report begins:

The General Chiropractic Council (GCC) has spent a year working hard,maintaining momentum and keeping focused. Like all health regulators the GCC has a statutory duty to set standards of education,conduct and practice and maintain a register of appropriately qualified and experienced practitioners. It is,in part,through regulatory mechanisms that the public is protected from the bogus,the incompetent,the dangerous and the unprincipled health practitioner. Even though such individuals crop up relatively rarely we must identify and deal with them promptly,openly and firmly.

We can argue over the precise definition of the word bogus and the context the GCC used it in but it is certainly a term chiropractors have used self-critically, thus acknowledging its validity as a descriptive term for at least some chiropractors.

So how many bogus chiropractors are out there?  Well thanks to the Quackometer on the 5th of June we may just find out, so if you know a bogus chiropractor then tell the Quackometer.  After all the GCC admit they exist.

*update*

Posted something on an ASA judgment on a chiropractor’s claims today.

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Health at every size – comfortable eating and comfortable lies

In recent weeks I have become aware of the beginings of a popular movement asserting that obesity is not a healthcare problem.  This article will be the first in a likely irregular series looking at some aspects of this movement.

Last week the Guardian ran an opinion piece by a dietician by the name of Lucy Aphramor.  Ms Aphramor was promoting the Health At Every Size (HAES) philosophy;

HAES promotes tested and achievable ways to optimise health for individuals and populations. It does this at an individual level by focusing on eating, activity and body acceptance. Of course, food and exercise are old targets in the health promoter’s arsenal, and psychological factors influencing dieting behaviours are well-known. So what’s new? The crucial difference is that HAES emphasises the benefits of sound nutrition, active living and body confidence as ends in themselves, not as a route to weight management.

There does not seem to be anything controversial about this statement, bit wishy washy maybe, bit idealistic, ’sound nutrition’ may be a shibboleth of the alternative health world but its use here may be coincidental, nothing here to challenge conventional health notions.  But things begin to take a turn to the strange as the article continues:

Adopting a HAES approach may or may not result in a weight change, but that’s not the point. The point is that HAES improves health outcomes long-term and dieting doesn’t. That makes HAES the ethical, effective choice.

The evidence for favouring HAES over weight-loss interventions is strong. First, as has been documented in detail in several books, including The Diet Myth by Paul Campos and The Obesity Epidemic by Michael Gard and Jan Wright, the common obesity scaremongering in the media greatly exaggerates the risks.

It is hard to find a review of The Diet Myth, written by a law professor, by a suitably qualified health professional but The Obesity Epidemic has been criticised by Morgan Downey of the American Obesity Association:

It isn’t hard to find researchers who offer global prescriptions to control body weight; it isn’t hard to find press accounts which hype this or that discovery or new information and it isn’t hard to find dubious or misguided policy prescriptions. But the authors’ real target is science itself. They feel that overweight and obesity just can’t be viewed as a science at all and that biology, physics, have not been helpful and will not be helpful in the future. A big part of their gripe is the energy in/energy out formula just doesn’t seem to work consistently in obesity studies.

In fact, a number of the authors’ insights and observations should cause some serious thinking. But it is curious to note that, although the authors are university professors and although they must cite close to a thousand studies, there is not, as I can read it, one reference to the discovery of leptin, much less the influences of the host of neuropeptides, hormones and other neuroendocrine effects of adipose tissue. One must ask, “In all this research, did they never come across the information about grehlin, PYY 3-36, and other such influencers? If they did come across them, why not reference all that is going on? Where is any analysis, or even mention, of the effects of bariatric surgery on the understanding of the disease process we call obesity?

It seems, judging by the amazon blurbs and reviews, these books offer a sociological analysis of obesity that either ignores science or regards it as irrelevant.  I haven’t read these books and don’t intend to critique them here, however, when an argument is presented to public opinion, without academic references and apparently anti-science, by non-experts it should be regarded as weak evidence in any argument. Unfortunately Ms Aphramor seems to regard it as being fairly robust.  The next part of her article does confirm that she might not be approaching the evidence base impartially:

whatever the risks of a particular weight, the scientific evidence is clear: for the vast majority of people, there is no known safe way to obtain significant weight changes and maintain them in the long-term. Dieting puts bodies in emergency starvation mode and, just as it is difficult to hold your breath for a long time, it is difficult to willingly undereat; your body will make you eat, just as it will make you breathe, in order to survive. The evidence shows that weight lost from dieting is almost always regained within a few years, often accompanied by a few more pounds. Weight loss pills (at least, those that haven’t been found unsafe yet) result in a few pounds lost, but only while you continue them. Even those who undergo the risks of weight-loss surgery find that much of the weight lost is regained in the long term. On the other hand, many naturally thin people cannot manage to gain weight for sustained periods either, no matter how much they try to eat.

This is a rather controversial statement and provoked this response from hospitaldietician in the comments to the Guardian article:

Firstly, all weight loss results in loss of both body fat and lean body mass, predominantly muscle, as the remodelled habitus requires less muscle mass, and energy expended, to move. As muscle tissue has a high metabolic demand, preservation also helps offset some of the reduction in energy expenditure associated wth its loss. Research shows that including exercise from 6-8 weeks into a diet (lets not embrace everything at once, if we want sustained acceptance) helps preserve muscle bulk and expend more energy for its duration – a double whammy of benefit for long term weight control.

We Dietitians must take care not to misrepresent the real issues related to obesity – namely its social, economic, psychological and physiological aspects. Yes, Aphramor is correct to say perhaps we are too obsessed with the ideal BMI and that lifestyle, or indeed waist size, may give us more sophisticated assessment of the impact of extra avoirdupois – in approximately 10-20 years or so when our current diet + lifestyle declares itself.

But current knowledge demonstrates that the percentage of the population with diabetes, hypercholesterolaemia, and hypertension increase with incremental increases in BMI.

[...]

Yes, there is great controversy as to whether a BMI of 27 should be an acceptable cut-off point for health risk rather than the current value of 25. However, to imply that it is possible to have good health pushing a BMI of , say, 40, to appease those who throw in a bit of walking and broccoli with their 3000kcal diet is clinically irrational – and not one that should be entertained by dietitians whose clients are in denial about their weight and health risk. Obesity ostracises its carriers, serving as a visual indicator to others of an individuals dietary habits, and perpetuates low self-esteem.

What is important, especially for the morbidly obese, is to root out the cause of ‘whats eating them’. Inability to address the psychological reasons for such extreme body habitus will of course lead to Aphamor’s self-fulfilling prophecy of the ultimate failure of any weight reducing diet.

Finally, longstanding weight loss requires constant vigilance, but the powerful improvement in self-esteem is sufficient for many to maintain their new shape – despite Aphamor’s assertions. The National Weight Control Registry (http://www.nwcr.ws/Research/default.htm) describes a common theme for those with successful long term weight loss that can be summarised thus: a modest calorie diet (usually around 1400kcal a day) and regular, modest exercise (up to an hour a day of walking etc).

For some obese individuals, focussing on a ‘healthy lifestyle’ may be the single step that starts the journey towards a healthier weight and lifestyle. To suggest that this single step is enough for a morbidly obese individual to achieve health is wrong – clinically and morally.
Empathy should not deter us from presenting the clinical evidence of health risks to our clients.

This comment is consistent with the advice and references provided by the British Dietetic Association (BDA) on weight loss.  While it is interesting that a BDA regulated dietician, Ms Aphramor, can feel compelled to offer advice that apparently goes against the scientific consensus and who may be in breach of the HPC proficiency standards* and standards of conduct** for dieticians that is not my biggest concern.  Ms Aphramor has set up a NHS social enterprise, in conjunction with HAES UK, to promote her ideas.  NHS social enterprises are defined as “organisations that are run along business lines, but where any profits are reinvested into the community or into service developments.  Encouraging social enterprise in health and social care is a key part of the patient led reforms.”.

It appears that these reforms have led to a dietician prepared to step outside of her evidence base to create an enterprise offering easy but wrong solutions to vulnerable people.  Presumably the government did not intend ‘patient led reforms’ to lead to easy but inaccurate answers to hard questions and allow populist anti-evidence enterprises but in this case that seems to have happened.

In my next post on this issue I will take a more in depth look at the HAES movement and how they present their ideas to the public.

Thanks to hospitaldietician for their comments.

*

2.2b

- be able to choose the most appropriate strategy to influence nutritional behaviour and choice
- be able to undertake and explain dietetic treatment having regard to current knowledge and evidence based practice

**You must act in the best interests of service users

You are personally responsible for making sure that you promote and protect the best interests of your service users. You must respect and take account of these factors when providing care or
a service‘ and must not abuse the relationship you have with a service user. You must not allow your views about a service users sex‘ age‘ colour‘ race‘ disability‘ sexuality‘ social or economic status‘ lifestyle‘ culture‘ religion or beliefs to affect the way you treat them or the professional advice you give. You must treat service users with respect and dignity. If you are providing care‘ you must work in partnership with your service users and involve them in their care as appropriate.
You must not do anything‘ or allow someone else to do anything‘ that you have good reason to believe will put the health or safety of a service user in danger. This includes both your own actions and those of other people. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk‘ including following national and local policies.
You are responsible for your professional conduct‘ any care or advice you provide‘ and any failure to act. You are responsible for the appropriateness of your decision to delegate a task. You must be able to justify your decisions if asked to.
You must protect service users if you believe that any situation puts them in danger. This includes the conduct‘ performance or health of a colleague. The safety of service users must come before any personal or professional loyalties at all times. As soon as you become aware of a situation that puts a service user in danger‘ you should discuss the matter with a senior colleague or another appropriate person.

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The latest deceit from Jeremy Sherr

Jeremy Sherr, the homeopath conducting unethical treatments in Tanzania, made the claim on his blog that:

When I was in South Africa 5 years ago, we had designed a very complex trial together with the Nelson Mandela hospital in Durban.

Well blogger Warhelmet, whose comments here are always appreciated, has contacted the Nelson Mandela hospital and obtained this reply:

Please note that Mr Jeremy Sherr has no association with the University of KwaZulu-Natal and that its Nelson R Mandela School of Medicine has not conducted any research with Mr Sherr.

Looks like another lie to add to the litany of Mr Sherr’s misdeeds.  In summary Mr Sherr has:

1. claimed the support of the Muhumbili University of Health Sciences in Dar Es Salaam, Tanzania.  This is not true.
2. claimed the support of the Department of Integrative Medicine at the University of Maryland, USA. This is not true.
3. shown disregard for established notions of medical ethics.
4. may be in breach of Tanzanian law
5. caused the Society of Homeopaths (SoH) to lie on his behalf

The Homeopathic Action Trust (HAT), the SoH affiliated charity and Sherr’s funders, have had concerns about Mr Sherr put to them.  They refused to take action.

Mr Sherr remains fairly blase about all the allegations raised against him, dismissing all concerns as the activities of “a close group of the bloggers’ friends swimming around in their own swill“.

It is worth remembering that Mr Sherr is a highly respected homeopath whose teaching are admired by many other homeopaths and whose Dynamis school teaches many students.  In many ways Mr Sherr is one of the most respected members of his profession.  No homeopath has criticised Mr Sherr on this blog, they endorse what he does.  Mr Sherr’s failings are the failings of the homeopathic profession.

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