Original Report; Jensen V GCC, scope of chiropractic practice.

May 1, 2002
By

This is the initial report I prepared in relation to the initial 65 pages of GCC charges against Jesper Jenson which were written by GCC “expert” Dafid Byfield in an effeort to define GCC scope of practice. Having read my report the GCC decided to change the charges against Jensen and focus on 21 specific claims on the website rather than the general scope of chiropractic practice.

As the GCC changed the charges, little of this material was referred to in the hearing. The report is about 100 pages long and outlines the two main philosophical approaches to chiropractic and the areas the GCC took issue with Dr Jenson’s Web site.

I submit this report as an expert witness:

1 INTRODUCTION
1.1 The purpose of this report is to address the allegations made under Sections 8.4, and 8.5 of the GCC Code of Practice against Dr Jensen’s website “How a Chiropractor can help you” on www.parkerclinic.co.uk (the “Website”). This report addresses the allegations raised in Dr Byfield’s Report (the “Report”) at pages 15-52.

2. QUALIFICATIONS
2.1 I am the principal chiropractor at the Family Chiropractic Centre, Kingston-upon- Thames, Surrey, graduating from the Anglo European College of Chiropractic (“AECC”) in 1996.

2.2 In the late seventies I spent 3 years studying to be a PE teacher, moving to Denmark in 1979 to play professional football. In 1981, after a serious knee injury, I became interested in rehabilitation and I studied the methods used in the Soviet Union and USA. I opened the first Aerobic Centre in Denmark in 1982, which, by 1987, was the largest fitness centre in Scandinavia. We employed chiropractors and physiotherapists and I supervised the fitness training programmes for Denmark’s elite sportsmen for the Los Angles and Seoul Olympic games through their main sponsors “Team Danmark”. In 1991 I decided to move to England and study chiropractic at the AECC to expand my approach to rehabilitation.

2.3 During my time at AECC I was student president for two years and also sat on the college executive and the Board of Governors, which gave me a useful insight in to the politics and the decision making process of the chiropractic profession in the UK. I organised and chaired possibly the largest meeting discussing registration with Tony Metcalf and Ian Hutchinson at AECC in 1994. I was AECC chief Delegate at three World Congresses of Chiropractic Students and have visited seven US colleges: four British, two Australian, one French and one Danish college.

2.4 I have been a member of the British Chiropractic Association (“BCA”) since 1996; I have also been a member of the United Chiropractic Association (“UCA”) executive. I have been an associate member of the International Chiropractic Association (“ICA”), and McTimoney Association. The President of the Scottish Chiropractic Association (“SCA”), Graeme Wight, is a close colleague. I am in my final year doing a MSc. in Health Promotion at Brunel University and I have taken twelve modules in the chiropractic neurology diplomat course.

2.5 Twice a year I go to Cuba to do chiropractic voluntary work in a hospital there, this year I took three students from The Welsh Institute of Chiropractic with me. I maintain contact with the student body at AECC and students often seek my help regarding problems they encounter at college. I recently represented a student at a major disciplinary hearing at AECC and the charges were dismissed.

2.6 I am a business partner of Dr Ole Wesung DC and was involved in setting up the largest chiropractic occupational health programmes in Europe for the 5000 employees of Lego in Denmark in 2000.

2.7 My practice clients vary from a 97-year-old lady to Premiership footballers. Earlier this year my clinic was featured on News Room South East television programme because the player who scored the goal that insured Kingstonian Football Club was the last remaining non-league club in the FA cup, was a client of mine.

2.8 I recently wrote a script and featured in a health and safety video for Scania Trucks, alerting them of the benefits of chiropractic care for their drivers. They are now considering donating money towards chiropractic research.

2.9 I have written many articles for newspapers, have been a guest lecturer at AECC, and have given many lectures on the politics of health. I am also the European distributor for Koren Publications and run two websites, familychiropractic.co.uk and vaccination.co.uk.

3 MATERIALS USED IN THIS REPORT?
3.1 I have read the Website and have compared it to the Report prepared by Dr David Byfield. I have referenced many articles and books in the text and where possible I have appendixed them to my report. The materials include the General Chiropractic Council Standard of Proficiency required for the competent and safe practice of chiropractic and the General Chiropractic Council Code of Practice.

3.2 In compiling this report. I have drawn extensively from certain books: Rethinking Health Promotion – A Global Approach by Theodore MacDonald published by Routledge 1998; Culture, Health and Illness by Cecil Helman published by Butterworth and Heinemann 2000; Chiropractic Manipulative Skills by David Byfield published by Butterworth and Heinemann 1996, Foundation of Chiropractic/Subluxation by Meridel Gatterman published by Mossby 1995, Chiropractic and Spinal Research by Tedd Koren published by Koren Publications 2000 [appendix 1], Somatovisceral Aspects of Chiropractic – An Evidence-Based Approach by Charles S Masarsky and Marion Todres-Masarsky published by Churchill and Livingstone 2001; and The Chiropractic Report July 2001 [appendix 2]. I have used current BCA leaflets [appendix 3], and Koren Leaflets from which Dr Jensen got much of his material for the Website [appendix 4]. The leaflets are presented as examples of typical promotion materials used by chiropractors in the UK.

4 GENERAL COMMENTS ON THE WEBSITE

4.1 In my opinion the Website does not contradict any of the aims of the GCC to protect the public and raise standards, ensuring chiropractors practice in a safe competent manner. Dr Jensen fully endorses the search for evidence of the efficacy of chiropractic, to be used as a guide in the care of chiropractic clients.

4.2 The information contained in the Website, though not acceptable for publication in a peer reviewed journal, is such as would normally be contained in information leaflets and promotional material used by the chiropractic profession worldwide, including the BCA. The text was derived from a number of different sources and presented in a similar way as information in BCA leaflets.

4.3 As some of the claims which are considered untruthful and misleading by the report are also on GCC and BCA public information materials. In my opinion Dr Jensen had no reason to think statements derived from these sources and Palmer College, the highly regarded chiropractic college where he studied, would be considered to be dishonest, untruthful, or misleading.

4.4 In my view it is possible to rebut the comments made by Dr Byfield on each section of the Website (pages 28-84). There are also 35 instances where the Report has been misquoted or misinterpreted in sections: [1v,vi,vii,viii. 2i. 3ii,iv. 5i,ii,ii,v,viii,ix. 6i. 6biii. 7i,iii,iv,v. 8i. 10vi. 11i. 12i,iv. 13ii,iii,iv,v. 15v. 16ii,iv. 17viii.]

4.5 In my opinion, the Website reflects the broad scope of practice of the profession, and asks questions of the bio-medical health paradigm that one would expect informed consumers to be aware of. The Website presents a point of view that is exemplified by the Association of Chiropractic Colleges (“ACC”) chiropractic paradigm, which is generally considered mainstream chiropractic.

4.6 Nobody would dispute the Report’s assertion that most of the evidence for the efficacy of chiropractic is in the treatment of back and neck pain, and that most people visit chiropractors for the treatment of pain syndromes. However, the point of websites like Dr Jensen’s is to explain how chiropractic could help people with a variety of other conditions, because of a relationship between the spine, the nervous system and the symptoms people experience daily yet get very little relief from allopathic therapy. However, the Website does not claim to treat or cure any condition mentioned therein.

4.7 Health is a natural phenomenon; the body is in a constant dynamic flux between health and disease. The body’s ability to adapt to chemical, emotional and physical stress enable it to maintain a state of health. The goal of the traditional chiropractor is to facilitate the body’s natural healing and regulatory systems so the individual has the potential to achieve optimal well-being. The Website attempts to help the public understand the difference between health care and disease care. In my opinion, chiropractic care is preferable to invasive treatments at port of entry in a progressive health service, something that is repeated throughout the Website.

4.8 Regarding treatment, the GCC Standard of Proficiency Required for the Competent and Safe Practice of Chiropractic Care states at section 5.1 [appendix 10] :-
“A chiropractor must be competent to select the appropriate treatment for the individual patient and be proficient in its delivery. A chiropractor should be competent to recognise the risk or contra-indications associated with any treatments. A chiropractor should also know and understand the theories underlying such treatments.”
Dr Jensen has explained the theory behind correcting the vertebral subluxation complex “VSC” throughout the Website in simple language that members of the public can understand. It was not intended for peer review.

4.9 The Report at the end of the paragraph on page 12 suggests that it is wrong for Dr Jensen to promote his practice as anything but a “typical chiropractic practice”. There is no requirement on Dr Jensen to market his practice as a “typical chiropractic practice”. The GCC Code of Practice at Section 8.9 states that [appendix 10]:-
“A chiropractor may indicate that a practice is wholly or mainly devoted to particular types of treatment.”

4.10 As mentioned above, many of the criticisms in the Report directed at the Website are because of an apparent lack of evidence to support the claims and the omission of referencing. These criticisms apply right across the health spectrum for reasons that will become obvious, they apply to most of the BCA promotional leaflets [appendix 3]. The assumption that all orthodox medicine is evidence based and the gold standard for chiropractic is incorrect according to David Eddy only a small percent of medical practice is evidence based (BMJ 1994) [appendix 5]. A recent joint statement from the International Committee of Medical Journal Editors [appendix 5b] questioned the integrity of the “evidence” being produced from clinical trials. “The use of clinical trials primarily for marketing, in our view makes a mockery of clinical investigation….” They are now reviewing the inclusion criteria for their journals. Promotional material in GP’s surgeries is often inaccurate, out of date and biased, according to a Kings Fund report in 1999 [appendix 6].

4.11 Dr Jensen is also criticised for not referring to the complications of manipulation. I am not aware of an independent study that has demonstrated a significant risk from a chiropractic adjustment. To complicate this kind of research further, there are many variables which need to be considered, particularly different techniques, some gentle, others more forceful. “Is chiropractic treatment safe”? asks BCA leaflet “A Helping Hand”, “Chiropractic is remarkably safe” even after surgery, is the answer. [appendix 3], again the BCA leaflet on Sports Injuries states, “As chiropractic does not involve drugs or surgery, there is none of the risks of side-effects associated with these treatments”. It is only this year the BCA has produced a leaflet acknowledging slight “risk” from chiropractic treatment.

4.12 There is no obligation on chiropractors to reference all their publicity material, and it is not normal practice. Section 8.10 of the GCC Code of Practice states that “The publicity materials of chiropractors may refer to clinical research material published by them or others”. The Report states that it should be required. In response to this request, Dr Jensen has now added references to the Website for clarity, these are accurate and clearly identified at the end of the article “How Chiropractic Can Help you.”

4.13 The GCC Code of Practice 8.14 states: “No publicity shall employ any words, phrases or illustrations which suggest a guarantee that any condition would be cured”. There are many instances in the Website where Dr Jensen repeatedly states chiropractic is not a treatment for a given condition, specifically to avoid misleading the public. The Website does state conditions may be helped by a spinal adjustment if the condition is related to a vertebral subluxation and nerve interference. The rationale he has used to justify this claim is the neurological relationships with the Vertebral Subluxation Complex “VSC” and the many symptoms people present with. There is much scientific evidence and case studies to support his rationale, not least from Dr Byfield’s own book ‘Chiropractic Manipulation Skills’

5 DIFFERENT SCHOOLS OF THOUGHT ON CHIROPRACTIC CARE
5.1 There are 60,000 chiropractors practising around the world and their training is of a similar standard. There are two major schools of thought in the chiropractic profession. The first considers chiropractic to be a limited biomedical speciality for the treatment of certain musculoskeletal disorders. The second school sees chiropractic as a separate and distinct discipline in the healing arts, focusing on removing interference to the body’s innate healing ability. These equally honourable approaches to healthcare can be traced back to Hygea and Panacea in ancient Greece.

5.2 Asklepios the god of healing had two daughters, Hygea and Panacaea. Hygea was the guardian of health who symbolised the belief that men could remain well if they lived according to reason. Panacaea achieved fame, not by teaching wisdom, but by mastering the use of the knife and the knowledge of the curative virtues of plants. As medicine has developed through history, this division in approach has been preserved with dominance afforded to intervention rather than well-being. The ‘myths’ of Hygea and Panacea symbolise the never-ending oscillation between the two different points of view.

5.3 Due to the political difficulties caused by one profession having such diametrically opposed views, The World Federation of Chiropractic (“WFC”) adopted in May 2001 the consensus definition of chiropractic that was developed by The Association of Chiropractic Colleges, the ACC chiropractic paradigm [appendix 2]. This was supported by the vast majority of national associations worldwide at the congress, and has the support of all the Chiropractic Associations on The Joint Chiropractic Committee JCC in the UK.
5.4 The ACC paradigm defines chiropractic as:-
“A health care discipline that emphasises the inherent recuperative power of the body to heal itself without the use of drugs or surgery. The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health.

In addition, doctors of chiropractic recognise the value and responsibility of working in cooperation with other health care practitioners when in the best interest of the patient. The Association of Chiropractic Colleges continues to foster a unique, distinct chiropractic profession that serves as a health care discipline for all. The ACC advocates a profession that generates, develops, and utilises that highest level of evidence possible in the provision of effective, prudent, and cost-conscious patient evaluation and care.”

5.5 The ACC paradigm is what constitutes “mainstream” chiropractic worldwide including the UK. There are, of course, some on the fringes of the chiropractic profession who do not subscribe to this consensus view; they are represented by small associations like The National Association of Chiropractic Medicine, in the US, and The Canadian Association of Orthopractic Manual Therapists, [appendix 7]

5.6 A survey of chiropractors by Dr Francis Wilson DC, demonstrated the broad scope of practice of most chiropractors [appendix 8]. He presented his results at the BCA and McTimoney conferences in October 2001, stating that “the majority of British chiropractors considered the management of musculoskeletal conditions, the management of organic or visceral conditions, and the management of children to be within the remit of chiropractic care”.

5.7 The broad diversity of chiropractic practice has always been recognised by the European Chiropractic Union “ECU”. The ECU consensus document (1998) states “Despite the lack of adequate scientific evidence, consensus by peer groups might support a recommendation to become a guideline. Therefore the gold standard is not the weight of scientific evidence, but a play off between what practitioners experience in clinical practice and the consensus process. The triangulation between the available evidence, discussion by practitioners of particular aspects of their work and the recommendations which are produced, makes informed debate”.

5.8 The spirit of consensus was highlighted in a letter to the profession by Dr Peter Dixon, former President of the BCA and now President of the European Chiropractic Union [appendix 9].
“One of our great strengths as a profession is the diversity that is Chiropractic. It is not possible to absolutely define what it is to be a Chiropractor, and we must all accept that there are differences in the way we were educated, the way we choose to interpret that knowledge and the way we then handle our practices as a result. None of us has the right to criticise another’s style, unless there is the potential for injury to the patients being treated”. He went on to say “People are not idiots, and surely they would not continue to generate referrals to any practice if they were not experiencing benefits”. I am sure this also applies to the Parker Clinic.

5.9 The Report attempts to define the scope of chiropractic practice. However, the Standard of Proficiency Required for the Competent and Safe Practice of Chiropractic states at Section 1 paragraph 1 [Appendix 10] that:-.
“Chiropractic is an independent primary health care profession. In common with other such professions, the law does not attempt to define precisely what is the scope of chiropractic”.

5.10 The Report states on page 9 that “claims regarding the benefits of spinal manipulative therapy must be limited to the known evidence for musculoskeletal symptom patterns”. This approach may well help integrate chiropractic into the NHS, but if the welfare of the patient is to be paramount, then the principal objective should be helping the individual who presents at the chiropractic clinic.

5.11 The chiropractic profession has limited funds for research and has tended to focus its research on mechanical back, neck pain and headache as stated in the Report. It goes on to say that less than 5% of the people visiting a chiropractic clinic have non-neuromusculoskeletal complaints. Therefore there is a greater need to concentrate on this area of chiropractic care when marketing chiropractic, to increase public awareness that chiropractic is more than just a treatment for back and neck pain.

5.12 If through clinical experience a chiropractor thinks he or she may be able to help a condition even though academics have not produced data for “peer review” publications. In my opinion there is an ethical duty for the chiropractor to offer chiropractic care and explain the theory behind it. The alternative is to wait for the evidence and as recognised by the Report “inadvertently excluding useful therapeutic options that may otherwise benefit patient well being”. (According to scientists in the US it is theoretically impossible to hit a baseball at 90 mph, yet it happens all the time [appendix 11]) science does not have all the answers. In my opinion the solution for both points of view within the chiropractic profession is to embrace the principles of consensus outlined by the ACC Paradigm.

5.13 The ACC Paradigm [appendix 2]
Considering the ACC paradigm in greater detail:
The ACC is committed to greater public service through reaching consensus on the following issues, which are important to the chiropractic profession.
· Continued enhancement of educational curricula;
· Strengthening chiropractic research;
· Participating and providing leadership in the development of health care policy;
· Fostering relationships with other health care providers;
· Affirming professional confidence and conduct;
· Increasing public awareness regarding the benefits of chiropractic care.

5.14 The consensus statement represents the broad diversity of chiropractic college missions in the United States and the UK with the possible exception of the Welsh Institute who focus on an evidence based best practice paradigm.

5.15 The Chiropractic Paradigm is as follows:
PURPOSE. The purpose of chiropractic is to optimise health.
PRINCIPLE. The body’s innate recuperative power is affected by and
integrated through the nervous system.
PRACTICE. The practice of chiropractic includes establishing a diagnosis, facilitating neurological and biomechanical integrity through appropriate chiropractic case management, and promoting health.
FOUNDATION. The foundation of chiropractic includes philosophy, science, art, knowledge, and clinical experience.
IMPACTS. The chiropractic paradigm directly influences the following: education; research; health care policy and leadership; relationships with other health care providers; professional stature; public awareness and perceptions; and patient health through quality care.

5.16 The Subluxation is explained within the ACC paradigm as follows: –
“Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.”

5.17 To survive, neurons need activation and fuel. Mechanoreceptors in the spinal joints need to be active. Lack of activation will eventually result in trans neural degeneration which affects the function of neurons. The homologous relationship of the neurons in the spinal cord means any pathway to the brain can be affected by dysfunction. This is the mechanism to explain how DD Palmer, the founder of chiropractic, improved the hearing of Harvey Lilard with a spinal adjustment. Thinking DD Palmer had discovered a cure for deafness, deaf people came to him to have their hearing restored. It was not a cure for deafness but it helped other conditions, their headaches, their dizziness, their neck pain and so a profession was founded over a hundred years ago.

5.18 In the Report, Dr Byfield criticises the use of the word “subluxation” in the Website throughout, (specifically at pages 9,10,16 at, section 7 paragraph 1(vi), and 6(iii). However, the term can be found in most Chiropractic textbooks, including ‘Chiropractic Manipulative Skills’ which was edited by Dr Byfield in 1996. Dr Byfield states on pages 26-27: –
"For chiropractors however, segmental instability is but one clinical entity that we may encounter. Closer to home is the spinal fixation, subluxation, dysarthrosis or biomechanical dysfunction, that we locate in almost all our patients. Call it what you will, what it represents is a perceived reduction in relative segmental motion"[emphasis added]

5.19 In the Website Dr Jensen chooses to call it a vertebral subluxation. In the Report Dr. Byfield views the VSC as a clinical myth. A view shared with The Orthopractic Manual Therapy Association of Canada [appendix 7]. Dr Byfield’s new book appears to be directed at manual therapists generally rather than chiropractors.

5.20 According to Meridel Gatterman, in her book Subluxation – Foundations of chiropractic (1996), more than one hundred synonyms have been used for subluxation [appendix 12]. Gatterman describes the subluxation complex or VSC as a “theoretical model of motion segment dysfunction that incorporates the complex interactions of pathologic changes in nerve, muscle, ligamentous, vascular, and connective tissues” [appendix 13]. She goes on to say that the VSC supports DD Palmer’s original hypothesis that the neurological component of the subluxation is the cornerstone of chiropractic theory. The subluxation complex provides a structure for better understanding the foundation of chiropractic theory and provides a paradigm for chiropractic education and research.

5.21 The subluxation has been adopted as the “chiropractic lesion” by the World Federation of Chiropractic Congress in Paris in May 2001 and the vast majority of its member associations. Although the BCA abstained from the vote to allow time for discussion among its members. In my opinion The BCA will endorse the paradigm at the Special General Meeting being arranged to vote on it, George Carruthers the BCA president has recommended it to the members. McTimoney Association; Scottish Chiropractic Association; and The United Chiropractic Association, all endorse the ACC paradigm.

5.22 In his book Dr Byfield would appear to agree with many of the theories regarding the effects of segmental dysfunction or subluxation, on a wide variety of conditions. These claims are in line with the subluxation theory as presented on Dr Jensen’s Website. Dr Byfield states in his book: on Pages 206-207
“Mechanical dysfunction of the cervical spine has been reported to be an important aetiological factor in the presentation of certain types of headache, migraine, acceleration/deceleration syndrome, shoulder and arm pain, tinnitus, autonomic nervous system disturbance, including disorders of equilibrium, cervical migraine, vertigo and cervical angina.

“The importance of the cervical spine in maintaining postural equilibrium and coordinating head and eye movements has been well established and documented. Furthermore it is almost impossible for all other systems of the nervous system to function normally when their is lack of stability, coordination and purposeful movement patterns at the cervical level of the body. This suggests that restoration of mechanical function of the cervical spine should be considered an element in all rehabilitation programmes as a result of the overall neurological implications on the entire body”.
"Manipulation of the cervical spine has a significant effect on the tone on lumbopelvic musculature therefore the normal mechanical function of the cervical spine becomes an important consideration in the restoration of total body movement and posture".

Page 176 “Thoracic manipulation takes an additional importance from a neurological perspective, with its relationship to the sympathetic ganglion chain”.

5.23 To gain an insight into the matrix of ideology, politics and philosophy of health, out of which the broad scope of practice referred to in the Website is based, I will address the concept in the context of contemporary health promotion and the parallels with chiropractic as defined by the ACC paradigm should become apparent.

5.24 The Report states on page 19 “Chiropractors claim to have a role in health promotion, but typically this role is attributed to patient education and advice rather than to spinal manipulation”. This statement demonstrates the reductionist philosophy that the report also applies to subluxation-based chiropractic. In my opinion, subluxation based chiropractors could have a major role to play in health promotion.

5.25 In his book “Rethinking Health Promotion” Professor Theo MacDonald (1998) explained that health promotion should not be seen as a “separate” discipline, rather a symbiotic relationship between different approaches to health “to effectively support the empowerment of individuals and communities”.

5.26 The most common definition of health promotion comes from the Ottawa Charter for Health Promotion (1987). It stated that “health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and be able to change or cope with their environment”.

5.27 Health is seen as a positive concept, emphasising psychosocial factors as well as the physical capabilities reaching an equilibrium of physical, social and environmental factors which contribute to the optimum well being of the individual. This concept of health integrates ideas of community and individual contributions to health promotion by focusing on empowering individuals, by the development of their self-esteem so that they assume control over their health.

5.28 According to MacDonald “health promotion claims a distinct intellectual territory for itself in the following respects”. Health enhancement should include many approaches that do not rely on medical targeting of disease. Health education is the transparent communication of health information. Health empowerment encourages individuals to assert their own autonomy and have the self-confidence to assert their own health care agendas. Health is social as much as individual.
5.29 The philosophy of health care Dr Jensen describes in the Website recognises illness as multifactorial and the need for a holistic approach to health care. The health care provider is seen as an educator, a facilitator of optimal well-being using the least intervention possible. The emphasis is on caring as opposed to treatment of symptoms. According to Jameson in “Topics in Clinical Chiropractic” (1996) health can be promoted by creating an environment where well-being is optimally expressed. While the environment that permits expression of optimum health is unique to each individual, there are general principals that can be universally applied – clean water, safe food, a supportive network of personal relationships and effective coping skills that contribute to optimal well being.

Philosophical Approach
5.30 Dr Byfield represents the modernist/biomechanical/musculoskeletal school of thought and Dr Jensen belongs to the philosophical/holistic/vitalist school. This distinction is central to an understanding of the information contained in the Website and it is in line with progressive thinking on health. That is not to say that chiropractors belonging to the philosophical school see it as an alternative or substitute for medical care. Medicine’s role is in the treatment of disease. Heart attacks, operable tumours or life threatening accidents, for these conditions medical care is paramount, nevertheless medical practitioners need to understand when the application of medical care is appropriate and acknowledge that prescription of medicine is not a cure, and sometimes even harms the patient [appendix 24, 25, 26, 26b]. In my opinion wellness should be the goal of all health care professionals.

5.31 A growing number of scientists claim that we are in the midst of a scientific revolution, a major paradigm shift with tremendous implications for how we deal with health and disease, according to eminent neuroscientist, Candace Pert who wrote “Molecules of Emotion” (1999). She states: –
“Reductionism Cartesian thought is now in the process of adding something very new and exciting – and holistic – emotions, the connection of mind, body and spirit” (page 18)

5.32 She refers to body/mind intelligence, an intelligence to seek wellness, one that can potentially keep us disease-free without the modern high tech medical intervention we now rely on.

5.33 Dr David St George a consultant in public health medicine and a senior lecturer in Clinical Epidemiology at the Royal Free Hospital, echoed this view at a Wessex CPD lecture for chiropractors two years ago. Dr St George also stated in “The Homeopath” in 1994 [appendix 24] “the time has come for complementary medicine to turn away from the need to obtain legitimacy from orthodox medicine by adopting its paradigm and research methods.

5.34 Chiropractic is based upon a philosophical premise that there is universal intelligence in all matter, which accounts for all of its atomic properties and activities, thus maintaining it in existence (Ralph Stevenson 1926: Chiropractic text book). Living matter on the other hand consists of molecules that are bonded together in an organised pattern, existing not as independent units but as part of a co-ordinated structure.

5.35 Most health professions accept the concept of an inborn wisdom, which runs and heals the body. But acknowledging it and making it a fundamental tenet of the philosophy and practise are entirely different. History reveals the philosophical underpinnings upon which chiropractic and medicine respectively rest. Throughout history the pendulum of acceptance and power has swung between them, with mechanism’s recent domination (in the form of allopathy).

5.36 Chiropractic’s vitalist assumptions are outlined by Tedd Koren in his article in Science & Medicine Sep 1999 [appendix 14 page 42] they include:
· The body is intelligent and behaves in a purposive way. There is something inside living creatures which causes them to respond and learn things, that a mere collection of chemicals can never do. To mechanists the body is a collection of chemicals obeying general laws of chemistry, physics and mechanics.
· Illness is seen as a reactive, curative response and symptoms as beneficial phenomena which should not be suppressed or eliminated. To mechanists the symptom is intrinsically harmful and must be removed or combated.
· Vitalist therapeutics seek to strengthen the patient’s powers of resistance and compensate for the predisposition to become ill. Mechanism is far less interested in the body’s resistance or predisposition, in general, mechanism is more concerned with treating the “disease” than with the host organism.

5.37 Chiropractic, as a vitalist healing philosophy, science and art is not limited to patients with certain conditions, but instead to all individuals, no matter what their presenting symptoms, who have vertebral subluxation complex (VSC), spinal distortions which interfere with the function of the nervous system. If chiropractic is to have a role in health promotion the most effective method by which to judge this art should be determined. Chiropractors have long noticed that spinal adjustments affect people in many ways, so how may we best evaluate such an intervention.

5.38 If the purpose of the spinal adjustment is the correction of the VSC and not the treatment of named conditions, then chiropractic, along with other vitalist healing arts, may not be amenable to the same testing procedures of the (medical/pharmaceutical) randomised controlled clinical trial. Outcome studies hold promise because they highlight the holistic approach in caring for the person who may or may not have a named disease rather than the “disease entity” which is a mechanistic approach. Some studies that have been done to support the holistic claims of chiropractic and referred to by Tedd Koren in his article [appendix 15].

6 General Comments on the Report
6.1 I am of the opinion that the Report represents an extremely narrow account of part of broad scope of practice that most chiropractors adhere to in the UK and the rest of the world.

The Report does not recognise the need for flexibility in defining the chiropractic paradigm, and how attitudes to patient empowerment are changing among healthcare professionals as stated by the BMJ in August [appendix 16]. “Healthcare professionals must recognise that they do not hold a privileged position from which they alone recognise all medical truths. Medical paradigms come and go, and medicine often develops new paradigms to support the continuation of certain practices when faced with conflicting data.”

6.2 The Report states that it is “not a complete systematic review of the available literature for all subject areas but mainly to provide a representative sample of the more recent literature pertaining to neuromusculoskeletal medicine.” In other words a representative sample chosen by Dr Byfield, The NHS Centre for Reviews and Dissemination (CRD) 1996 describes a systematic review as “ the process of systematically locating, appraising and synthesising evidence from scientific literature in order to obtain a reliable overview.” They differ from traditional reviews by having a scientific design therefore reducing bias and systematic error and promoting reliability.

6.3 The Report does not seem to recognise that “the rigid insistence on controlled trials as the sole source evidence on effectiveness that characterised the beginnings of the evidence based healthcare movement is fading”. [appendix 17]

6.4 There are 35 instances where the Report has misquoted or misinterpreted the Website: 1v,vi,vii,viii. 2i. 3ii,iv. 5i,ii,ii,v,viii,ix. 6i. 6biii. 7i,iii,iv,v. 8i. 10vi. 11i. 12i,iv. 13ii,iii,iv,v. 15v. 16ii,iv. 17viii.

6.5 Regarding treatment, the GCC Standard of Proficiency Required for the Competent and Safe Practice of Chiropractic Care states at section 5.1 [appendix 10]: –
“A chiropractor must be competent to select the appropriate treatment for the individual patient and be proficient in its delivery. A chiropractor should be competent to recognise the risk or contra-indications associated with any treatments. A chiropractor should also know and understand the theories underlying such treatments.”
Dr Jensen has explained the theory behind correcting the VSC throughout the Website in basic language that members of the public can understand. The Website was not intended for peer review.

6.6 Many of the criticisms directed at the Website also apply to most of the BCA promotional leaflets, and all the other UK chiropractic associations and websites and promotional material in most GP surgeries [Appendix 6].
7. Specific Comments on the Website
The numbering used in this section adopts the numbering used in the Report.
1. Shoulder, arm & hand problems
i) Frozen Shoulder There is no requirement to describe “the typical clinical presentation of frozen shoulder”. The Website states “problems with the neck, shoulder and arm are often called different things by patients” and a number of generic terms for painful shoulder are listed. These terms are normally used by members of the public and the list helps the public’s understanding of the problems being referred to. It is not misleading, or inaccurate. Adhesive capsulitis is not a term generally used by members of the public so it was not on the list. The site does not imply anything sinister about frozen shoulder as suggested. This is not misleading.
ii) Old age The Website states some people may blame their shoulder problems on old age even though their other shoulder, which doesn’t have any problems is just as old. This is a rhetorical question. This section is not misleading or exploiting the public.

iii) Other Conditions Dr Byfield states in the Report at paragraph 1)iii) page 15 that the sections on plexus, brachial plexus, brachial plexus injury and results of brachial plexus injury as “reasonably informative” and not misleading or exploitative, then criticises connecting these to “unrelated conditions” at paragraph 1 iv page 16. This section should be taken in the context of the title “Shoulder Arm and Hand”, their neurological pathways which eventually summate in the brain and their relationship to the vertebral subluxation complex , therfore this section is not misleading

The Report states there is no evidence to support the fact that cervical spine damage can cause low back pain. If research has not proved something, this does not mean it does not happen [appendix 11]. However, this particular example of the lack of relationship between the cervical spine and low back is odd considering Dr Byfield in his book gives an example of how manipulation of the cervical spine can affect the lumbar pelvic musculature on page 206. The Report also criticises the Website for not reporting information published in 2001 on shoulder pain. This information had not been published at the time of the complaint against Dr Jensen in December 2000. Dr Jensen may wish to update the Website to include 2001 published articles in his references.

v The Chiropractic Approach
This is the first example of the Report misinterpreting or taking the Website out of context. “The chiropractic approach to a person’s health problem is very different from the medical approach. Rather than treat the condition a patient has, the chiropractor concentrates on the health of the patient”. Anyone who reads the newspapers will be aware that GPs have not been getting a good press in recent years [appendix 19] and have a major problem with complaints [appendix 18] a principal reason for this is the time GPs get to spend with their patients due to lack of funding.

The Government White Paper, The Health Plan 2000, recognises the need for 2,000 new GPs. To achieve the Government targets for the NHS the BMA estimate they in fact need 10,000 more GPs [appendix 20]. The fact is GPs do not have time to deal with the broader issues affecting the health of their patients. They have approximately five minutes per patient. In my view Dr Byfield has clearly misinterpreted the above statement as “medicine as a whole is not interested in the health of their patients”. To my mind, Dr Jensen’s comments are not misleading, inaccurate or exploitative.

vi) Vertebral Subluxation
The Report states “chiropractic is not devoted entirely to correcting vertebral subluxations.” The word “entirely” has been added. What is stated in the Website is “chiropractic is devoted to correcting abnormal spinal structural conditions called vertebral subluxations or spinal nerve stress which cause abnormal spine and joint motion and nervous system stress”. This is very much in line with the description Dr Byfield gave in his book “spinal fixation, subluxation, dysarthrosis or biomechanical dysfunction, that we locate in almost all our patients. Call it what you will, what it represents is a perceived reduction in relative segmental motion" (page 27)

The Report refers to the statement “uncorrected vertebral subluxations can cause many health conditions and prevent or interfere with the normal healing process”, and describes this as being misleading. The Website actually states “subluxations can cause or contribute to many health conditions”. “Can” and “contribute” are the operative words here. By leaving out “contribute” the Report has the effect of implying that the Website is suggesting a definite cause and effect from the subluxation which, in my opinion, it is not.

I see no reason why chiropractors should not speculate on the effects of the vertebral subluxation complex on general health. Numerous examples of the effects of somatic (muscles) or visceral (organs) sensations on visceral function mediated and regulated by the autonomic nervous system can be cited [appendix 21]. The medical profession is also looking at the connection [appendix 21a] unfortunately in many instances the neurophysiologic mechanisms are poorly understood. Nevertheless, according to Meridel Gaterman, therapeutic intervention that alters somatic or visceral function may have effects in body systems apparently remote from the site of the applied therapy. A growing body of evidence suggests that there exists a close correlation between somatic functions and visceral functions.

Currently it is not possible to determine exact systemic consequences of the vertebral subluxation complex. What we do know is that spinal manipulation, which is used by chiropractors to correct subluxations, elicits some very specific effects involved in immune responses and other physiologic roles as well A study by Banks et al (1997), on quality of life and well-being, a self reported retrospective characterisation of 2818 patients under chiropractic care revealed that chiropractic recipients reported significant improvement in overall quality of life [appendix 22]. The reported outcomes reflected a large positive clinical effect in every health-related domain investigated: physical state, mental/emotional state, stress and life enjoyment. Moreover, patients who had been under care the longest time reported greatest perceived improvement in wellness. The “Textbook of Clinical Chiropractic” edited by Gregory Plaugher presents an algorithm for the chiropractic management of a patient with visceral concomitant [appendix 22a].

Other studies are referred to in the Tedd Koren article on chiropractic [appendix 15] on page 45. In one of them Coulter et al (1996) investigated the value of chiropractic care in persons 75 years and over. Out of a population of 414, a small sub population of 23 (5.65%) reported receiving chiropractic care. Those under chiropractic care had better overall health and a higher quality of life compared to non-chiropractic users. The chiropractic users were less likely to have been hospitalised, less likely to have used a nursing home, more likely to report a better health status, had fewer chronic conditions, were more likely to exercise vigorously, more likely to be mobile in the community, and less likely to use prescription drugs than non-chiropractic users. In addition, 87% of chiropractic users described their health status as good to excellent, compared with 67.8% of non-chiropractic patients.

Physiotherapists are now also exploring the neurophysiological effects following spinal manipulative therapy [appendix 22b].

vii) Your Inner Healer The Website states “The chiropractor specialises in analysing your spinal column for vertebral subluxations and correcting them when found”. This “helps restore healthy nerve impulses between the brain and body parts.” The Report states that this suggests “that a chiropractor’s only task is to find subluxations, correct them and restore health”. Dr Byfield has added “only” and left out “helps”. This has been done twice in this section. The Report then states “this implies that the cause of all ill health is the subluxation.” Dr Jensen has not implied this. Dr Byfield claims that he is confused by the notion that a chiropractor “helps” restore a healthy flow of nerve impulses between the brain and body parts. I would again refer him to his own book, which states: -

“ restoration of mechanical function of the cervical spine should be considered an element in all rehabilitation programmes as a result of the overall neurological implications on the entire body”.
"manipulation of the cervical spine has a significant effect on the tone on lumbopelvic musculature therefore the normal mechanical function of the cervical spine becomes an important consideration in the restoration of total body movement and posture". Pages 206-207
"thoracic manipulation takes an additional importance from a neurological perspective, with its relationship to the sympathetic ganglion chain "Page 176.

The Report then introduces Psychoneuroimmunology (PNI), which is not relevant to the point the Report is trying to make. The Report states “what has become clear is that the body’s primary communication system in PNI is mainly hormonal. Therefore chiropractors must accept that any interventions and results will be non-specific unpredictable non-neurological and most likely placebo-based”. I am not familiar with the study referred to but the only non-neurological intervention that I can think of that has been studied, is the effect of prayer on peoples well-being by Larry Dossey in 1994 this is not mentioned on the Website.

This raises a question of the Reports understanding of the term “Psychoneuroimmunology”, which like the term vertebral subluxation complex, are holistic concepts involving many physiological systems, “a network hook-up of multisystems of the human organism” described by Candace Pert one of the principal neuroscientists studying PNI, she states in her book Molecules of Emotion (1997):

“the Cartesian era, as western philosophical thought since Descartes has been known, has been dominated by reductionist methodology, which attempts to understand life by examining the tiniest pieces of it, and then extrapolating from those pieces to overarching surmises about the whole. Reductionist Cartesian thought is now in the process of becoming holistic”.

What this means in relationship to Dr Byfield’s understanding of PNI is that it is not “mainly hormonal”, it is not mainly the brain and the nervous system, or the immune system, but all of the systems working together, like a triangle, each system using peptides and their receptors to form a body wide communication system. Since 1983 scientists have known that the immune system is physically linked to the nervous system [appendix 23 and 23b]. This section is not misleading.

viii) Should you see a medical doctor or a chiropractor?
The Report quotes Dr Jensen as having stated “that as a general rule drugs and surgery are extreme routes and that people get the run around if they seek medical care,” What the Website actually stated was “As a general rule it is wisest to explore drugless, non surgical methods of healing before having to undergo more extreme routes of drugs and surgery”. Error and side the effects of prescribed drugs have been well documented [ Appendix 24 and 25]. As many as 20,000 people are addicted to over the counter medications in the UK [appendix 26]. The limitations of medicine have been well documented in the report by the “Bristol Inquiry” [appendix 26b] and in my opinion, if the condition is not life threatening I would always advise non-invasive interventions as a first choice. This is in line with a statement made by the GCC Registrar, Margaret Coats, in a press statement in July 2001 “…chiropractic treatment is safe. Risks are much less than for other forms of treatment for example, surgery or anti-inflammatory drugs”.

In respect to the term “run around” which has been used, the Website actually states “In actual practice many people go to chiropractors after they have gone through the medical run around and they are fed up and tired of the drugs they have been taking.” Many people are being given painkillers etc. which are not in their best interests [appendix27]. It is my opinion people go to their GP first because its free, and then go to the chiropractor because they are not satisfied with the GP. This would be in line with a study in the BMJ that assumed that “back pain got better by itself. When the study was followed up 12 months later they found that 91% of the patients were still suffering or had gone some-where else. They had not bothered to return to their GP one could presume because they felt they were being given “the run around.”

Two years ago I did a survey of all 62 GP clinics in the Kingston and Richmond area requesting “the advice they would give to a patient with back pain”. This was inspired by the Kings Fund study which said the information available in GPs surgeries was inaccurate, misleading and often out of date in relation to back pain. My findings with a 94% response were similar to the Kings Fund; all the surgeries except one advised bed rest and painkillers, which was not in accordance with their own RCGP guidelines.

I presented this information as an agenda question at an open forum meeting at the Kingston and Richmond Primary Care Group. The question and subsequent discussion was ignored in the subsequent minutes of the meeting. When I went back and objected and told them they were obliged to include my questions in the minutes, they did and sent a reminder to all GPs of the guidelines. Because of this I had two local chiropractors call me in private correspondence asking me to cease my activities as the GPs were stopping referring to them. Dr Byfield points out this kind of attitude is “argumentative and extremely controversial”. It may well be, but in my opinion it is in the public best interest.

Dr Byfield completely ignored the final line in his interpretation of this section of the Website. Dr Jensen stated “it is sometimes necessary to use drugs and even surgery, but one must be prudent about such extreme therapies”. This section is not misleading or untruthful.
ix) Prevention
Dr Jensen is criticised in the Report for using the word “prevention”, stating “problems caused by an unhealthy spinal column can be corrected and even prevented before they become serious”. Prevention is presented in the Report as “very misleading, inaccurate and may exploit the public’s lack of general knowledge in healthcare and chiropractic service”, and therefore an infringement of codes 8.4 and 8.5. The BCA uses the term frequently in its literature including “Chiropractic – a helping hand for you and your patients”, which it gives out to GPs [appendix 28]. Dr Byfield referred earlier in the Report (paragraph 1 vi page 16) to how the GCC defined chiropractic as “a health profession concerned with the diagnosis, treatment and prevention of the musculoskeletal system and the effects of these disorders on the nervous system and general health”. If website is misleading here, so is the entire chiropractic profession on this issue.

2) Lower back, hip and leg problems
i) Help for hip, sacroiliac and leg problems
It is David Byfield’s opinion that “joint clicks, foot flaring and leg length inequalities are normal, and do not require therapeutic intervention”. Applying the same logic one could also say headaches and backaches are normal and that it is “misleading and exploitative” to suggest these common benign conditions require therapeutic intervention as Dr Byfield states elsewhere in the Report.
Dr Byfield then states it is “very misleading to suggest that chiropractic is a common treatment intervention for a wide range of conditions other than musculoskeletal” when what Dr Jensen actually said is “…people with such problems have found relief through chiropractic. Chiropractic is not a treatment for disease but a method of unleashing your natural healing ability.” In a GCC press release dated 10th July 2001 Margaret Coats states “Chiropractors treat disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health.” I would imply from this that “large numbers have found relief”, as suggested by Dr Jensen and this statement is not misleading and inaccurate and is supported by many studies as stated earlier.
ii) Lower back, buttock and thigh pain
I agree with Dr Byfield that it is not entirely clear what condition Dr Jensen is referring to as “an unbalanced hip” but stating its medical terminology of a sacroiliac joint dysfunction would not make it any clearer to a member of the public.

The organs mentioned in this section of the Website all have a nerve supply that enters the spinal column. Joint dysfunction (in the spinal column) as Dr Byfield has stated in his book, can affect the autonomic nervous system. It is difficult therefore to understand how Dr Jensen “misinforms the reader and is highly inaccurate” when he says, “vertebral subluxation complex in the pelvis or lumbar area can be related to non-musculoskeletal conditions”. I would specifically refer to the study by Kokjohn et al 1992 [appendix 29], which concluded from a randomised pilot study concluded that spinal manipulative therapy may be an effective and safe non-pharmacological alternative for relieving the pain and distress of primary dysmenorrhea. Another article by Walsh et al 1999 supports the hypothesis that the symptoms associated with PMS can generally be reduced by chiropractic treatment consisting of adjustments and soft tissue therapy, both published in JMPT. Many other studies support these conclusions.

iii) Leg length inequality (LLI)
The rationale behind leg length inequality (LLI) is taught at AECC and most colleges throughout the world. The Report states, “there is considerable debate within the profession regarding the clinical significance of LLI”. Therefore it is a matter of opinion whether “ this section misleads the public by promoting inaccurate and outdated information,” as there is a major school of opinion supporting LLI, it is not inaccurate information.

iv) Chiropractic effectiveness
The Website claims “that 90% of patients with sacroiliac problems returned to normal activities after 2-3 weeks”. The Report does not disagree with this, only the quality of the study from which this statement was taken. The Website further states “also after chiropractic, cases of gynaecological problems, constipation, urinary, kidney…have been reported relieved.” There are many case studies to support the effect of chiropractic [appendix 29] based on the principle that there is a relationship between the spine and the autonomic nervous system, as referred to in Dr Byfield’s book. Therefore, these statements are not misleading, inaccurate or exploitative.

v) Pregnancy
The Website states that, “During pregnancy there is increased flexibility and instability of the hip joints”. Whilst the Report states “There is no evidence that hip joints become more flexible and unstable during pregnancy” it continues that “There is however good evidence that the pelvic ligaments become more lax during the last trimester of pregnancy”. In my opinion, each of these statements would mean more or less the same to a lay person. Indeed, the BCA leaflet states that pregnancy “can make the spine and pelvis unstable through the relaxation of the ligaments” [appendix 30]. This is not misleading

The Website states that “A properly aligned SI joint, hip and spine will help ensure a more comfortable pregnancy…”. Similarly, the BCA leaflet states that “Chiropractic can help maintain spinal balance, as well as ensuring that the pelvis is correctly aligned – both before and after your baby is born.” The BCA sold 50,000 leaflets last year to chiropractors for distribution to their patients.

The Report states that “There is no data to support that a properly aligned sacroiliac joint will ensure a safer and easier delivery.” Nevertheless, chiropractors are making this claim every day based on their own clinical experience. In his book on page 130 Dr. Byfield advises chiropractors that they have a professional responsibility to learn and execute manipulation on the sacroiliac joint in a highly skilful manner despite the “lack of compelling data supporting any specific treatment approach as of yet”.

A small study by the American Medical Association (records released in 1987 during a trial in the US District Court Northern Illinois Eastern Division, No. 6C 3777) showed that pregnant women who received chiropractic adjustments in their third trimester were able to carry to term and deliver children with more comfort. A further study by the American Medical Association also released in the above trial indicated that in pregnant women receiving chiropractic treatments the need for painkillers during delivery was reduced by half. These studies are referred to in The Tedd Koren Research book [appendix 1]. Therefore, in my view these statements made in the Website are not misleading, inaccurate or exploitative.

3) Infants & babies
i) Healthier infants & babies
The Report states there is no evidence that a “chiropractic spinal check up can ensure a healthier baby with higher resistance and better nervous system”. This is taken out of context because it is stated earlier in this section of the Website, that advice would be given on diet, avoiding drugs, cigarettes and alcohol, childbirth classes “so you may have a natural, drug-free birth”. Mothers would be encouraged to breastfeed “knowing that it is a superior form of nutrition”; a parent should do everything they can to make sure their baby is healthy, including checking the spine. In my opinion, this holistic approach is what ensures a healthier baby.

ii) Birth trauma – the first subluxation
The Report states that the Website claims that “birth process is a traumatic, crippling event, is ludicrous at best”. Again, I would agree with Dr Byfield’s assessment here. However, that is not what Dr Jenson has stated in the Website. The Website states “The birth process is potentially a traumatic, crippling event”, which it could be. Some mothers labour for many hours and then there is the traumatic experience of forceps in some deliveries”[appendix 30a]. One could give extreme examples of birth trauma causing Erb’s and Klumpke’s palsy, and the less traumatic examples, of the vertebral subluxation complex. BCA leaflet also refers to trauma at birth and benefit of chiropractic care to babies. This is not misleading.
iii) Research
I would accept Dr Byfield’s conclusion that subluxation in this context on the Website is the medical definition. It still supports the claim that the birth process is traumatic for 80% of babies, which Dr Byfield suggests Dr Jensen has exaggerated. The conclusion in the Website that an “unhealthy spine causes many clinical conditions” and may possibly benefit from chiropractic care, is a reasonable theory and is supported by many clinicians. For example Neil Davies in Chiropractic Pediatrics (2000) on page 8 and other authors [appendix 31]. This is not misleading.

iv) Shaken Baby Syndrome: In this section Dr Jensen is obviously trying to demonstrate how easy it is to damage a child’s nervous system. The examples given, “mild to moderate shaking of a child”, “playfully throwing the child up in the air and catching him/her” and “being spanked” (which many loving British parents believe in), this is described as rough behaviour and the Website recommends that children should have their spine checked. One assumes people looking for information on child health care are loving parents, rather than child abusers. Dr Byfield has interpreted this section as Dr Jensen thinking that “abused children or children subjected to potentially violent behaviour need a spinal check up by a chiropractor rather than being referred to the appropriate authorities,” which is clearly preposterous. This section has been completely misinterpreted. The differences in the type of condition Dr Jensen is referring to and Dr Byfield’s case scenario are obviously very different [appendix 32 and 33]. The points being made by Dr Jensen can be seen in the abstract of the study by Wrightson et al. (1995) [appendix 34].

v) When does a baby need a spinal check up?
The section is looking at normal developmental stages in the curvature of the child’s spine and recommends having the spine checked at these points. The BCA leaflets also recommend having the child’s spine checked. I would suggest there is a certain logic to the time frame suggested by the Website and is not misleading.
vi) Conclusion
The Report states that the Website implied “that in order to ensure a healthy baby, they need to have their spine checked”. What the Website actually says is to have a healthy baby you want childbirth without trauma, breastfeeding, avoidance of drugs and medical procedures (except in emergencies) and then the Website asks why not have the baby’s spine checked as you would their eyes, heart and hearing? There is no statement in this section stating “childbirth is violent and medical procedures should be avoided”, as claimed by the Report.

4) Babies & Colic
i) Relief from Colic – Colic makes Life Miserable
The Report states “the definition of infantile colic is incorrect. It is commonly accepted that a diagnosis of colic is made via the four times three rule. The most accepted definition is unexplainable and uncontrolled crying in babies from 0 to 3 months old, over 3 hours per day, more than 3 days per week, for three weeks or more”. The key word here is “unexplainable” The Website states ….. “baby, just a few weeks old, begins to cry, and cry and cry.”…. “No one is sure what colic is……doctors use it to explain crying and screaming that they can’t explain. Therefore one would hope that any hypothesis presented would be looked at with an open mind. This is not misleading

ii) Chiropractic & colicky babies
The Report states this section is inaccurate. Dr Byfield states “there is a significant change in the frequency and duration of crying and discomfort for those receiving chiropractic manipulation” and cited Wiberg 2001. Dr Jensen states “Chiropractic care appears to have an especially dramatic effect on colicky babies”. I am left to conclude that in Dr Byfield’s view because Dr Jensen has not cited the Danish study his statement is invalid and a violation of code 8.5 which it is not.

iii) Are Infant Adjustments Safe?
According to the Website a “child should barely notice a properly performed chiropractic adjustment. Children should never cry or feel discomfort……A sleeping child will often sleep right through an adjustment. All children with colic should have their spines checked for the vertebral subluxation complex”. However, the Report concludes from this information “In the best practice evidence clinical paradigm this is just not acceptable particularly when the risks v benefits are considered.” According to a BCA Sports Injuries leaflet.[appendix 35] “As chiropractic does not involve drugs or surgery there is no risk of the side-effects associated with these treatments” The BCA has only recently introduced guidelines for chiropractors on advising patients of the risks associated with spinal manipulation prior to treatment. This is not misleading.

However a study by Pistolese in 1998 { abstract: appendix 36] looked at the risk assessment of neurological and /or vertebrobasiliar complications in the paediatric chiropractic patient and concluded that there would be a chance of approximately one in 250 million paediatric visits that a neurological or vertebrobasiliar complication would result. While some pre-existing conditions may pre-dispose a paediatric patient to a higher incidence of such complications, the estimates derived in the above study were considered applicable to the general paediatric population. The estimates derived in this study are intended to be an initial risk assessment since very few reports exist relative to the incidence of neurological and /or vertebrobasiliar complications in children.

5) Children
i) Healthier Children with Chiropractic
These are views expressed throughout mainstream chiropractic and are reflected in BCA leaflets, and I am baffled why Dr Byfield thinks having your child’s teeth, hearing, eyes, ears and spine checked sends the wrong message and is misleading. Nowhere in the text does it say a “spinal check up is capable of assessing the overall integrity of the spinal cord”, as implied by the Report.

ii) Blockage of Nerves of the Spine
The Report states that the word “dis-ease is not a commonly used word, without a clarifying definition the term is invalidated”. Again, Dr Byfield has failed to read the website properly. The Website states “dis-ease is a term that chiropractors and others have long used to describe a state of disharmony in the body”. Page 30 “Bringing out the Best in You” [appendix 37].

iii) The First Subluxation
According to Dr Byfield, it is a common medical term, despite the fact it is not in the index of the Merck manual or the Oxford Dictionary of Clinical Speciality. As stated earlier Dr Byfield has used the term subluxation in his own book to describe what chiropractors correct. Dr Byfield states, “there is no supportive evidence that health problems early in infancy can be traced back to difficult delivery”. As stated previously there are many common recognised side effects to the birth process.

iv) Whiplash Shake Syndrome
This section is confusing simply because it has been put in the wrong section and misnamed. It should have been put in the vaccination section where cases of vaccine damage to the brain have been noted and it has been misdiagnosed as shaken baby syndrome by doctors who tend not to be looking for side effects to vaccines. D D Palmer, one of the founders of chiropractic, was one of the first to raise this contentious issue in his book “The Chiropractic Adjuster” 91 years ago [appendix 38]. Palmer questioned mandatory smallpox vaccination programmes and its effect on the brain years before anyone thought there might be a problem with side effects from vaccines.

v) Childhood
Dr Jensen states in the Website “Childhood is a very physical time. Jumping and running, falls and accidents are all part of normal childhood and yet they can cause spinal misalignments and nerve damage – with serious consequences It would be wise for all parents to have their children’s spines checked periodically”. Dr Byfield states in the Report, “there is, to the best of my knowledge no evidence to suggest that normal childhood playing can cause spinal misalignments and serious nerve damage.” There is evidence [appendix 39]. The use of “serious” in front of nerve is Dr Byfield’s. The point in the Website was that nerve damage can become serious; one could also argue a child breaking their neck would suffer serious nerve damage. That however was not the point being made by the Website. I would say common sense tells you that children hurt themselves when they fall and it is advisable for them to have their spines checked.

vi) Research
Dr Byfield states on page 27 of the Report that the Van Breda “study had a number of methodological flaws and inappropriate conclusions were made based upon biased results”. Dr Byfields assessment is possibly correct however that is the whole problem of evidence-based research being presented as truth and this charge is being made about research right across the health spectrum with major Medical Journals having to review their inclusion criteria for publication in their journals [appendix 5b]. This raises questions about the reliability of the paradigm shift to evidence based practice which Dr Byfield believes is “of fundamental importance in the delivery of a quality and effective health care in the modern world”. To dismiss The Van Breda study completely is to throw the baby out with the bath water. The variables that can be manipulated in health care are enormous and no one should assume evidence is the same as truth, it is merely a guide to better understanding.

Another problem is the peer review process [appendix 40]. It is also inconceivable, that the chiropractic profession would fund and produce research that did not show chiropractors were good at treating back pain or that chiropractic was unsafe [appendix 41].

vii) Psychological Studies
The Report says to mention the results of two pilot studies conducted over twenty-five years ago regarding the benefits of spinal adjustment on musculoskeletal conditions is inappropriate in an evidence based best practice health care paradigm. It is Dr Byfield’s opinion that chiropractors should restrict themselves to this paradigm, that is his choice. How chiropractic can effect emotional problems brain function, and a wide range of disorders is explained by Dr Frederick Carrick in [appendix 42]

viii) Spinal Checkups are Vital
Dr Byfield states, “this section may mislead the public into thinking that chiropractic treats all these conditions”. What Dr Jensen says is that, “it is essential to have his/her spine checked for vertebral subluxations; not because the doctor of chiropractic is treating your child for these conditions but because all children, especially if they are ill, need healthy spines”. After listing the conditions which have been helped by chiropractic, of which there is clinical evidence in the form of case studies, Dr Jensen repeats the message, “chiropractic is a different approach to health care, it is not a treatment for disease or conditions.” This is not misleading.

ix) Warning signs
The warning signs that there may be something wrong are: chronic fatigue; skin conditions; one hip or shoulder higher than the other; a foot turned in or out; joint aches; shoulder blades flared out; can’t stand still; hyperactivity; neck tilt; frequent falling; one leg shorter; “noisy bones”; nervousness. Dr Byfield’s comment is, “these are normal conditions seen within the population”. In my opinion these are common conditions rather than normal. In his book “Talking back to Ritalin”, Dr Peter Breggin estimated that up to 2.5 million American children are taking ritalin as a treatment for hyperactivity. Dr Byfield may consider this a normal condition in the community as do many medical doctors. It is also being seen as a classic example of medicalisation of a common behavioural condition which is relatively new and may be linked to a lack of mechanical sensory stimulation of brain. Nowhere in this section does Dr Jensen say, “therapeutic intervention (an adjustment) is required for these conditions”, simply the Website is recommending that children with these conditions should have their spine checked for subluxations.

6) Children & Bed Wetting
i) The Chiropractic Approach
The Report claims that Dr Jensen stated “chiropractors completely cure bedwetting by spinal manipulation”. The statements in the Website are, “for years parents have told their chiropractors that soon after their child’s spine was adjusted their bedwetting was often eliminated or improved…….. In many of these cases, the bedwetting problem was alleviated if not completely cured following chiropractic spinal adjustments”. Dr Jensen has explained “the possible mechanism” of this theory due to the neurological relationship between bladder and spine; there are many published case studies to support this theory especially in Masarsky’s “Somatovisceral Aspects of chiropractic” (2001) page 204. Dr Jensen has also mentioned other non-chiropractic procedures that may help bed-wetters, therefore he is not implying that the vertebral subluxation complex is the only cause of bedwetting. This section is not misleading.

ii) Why Not Keep Your Child’s Spine Healthy?
There is no charge relating to this section but Dr Byfield’s comment is not consistent with other comments made in the Report. The Website states: “The chiropractic approach to health care is quite different from any other approach. It is a full body approach – ensure that your child’s spine is healthy; that there is no nerve stress or spinal blockage to the internal organs, including the bladder; and to the brain and spinal nerves in general. This benefits your child’s overall health, no matter what condition they may have”. Dr Byfield’s comment on this section is. “This section suggests that spinal health may benefit an overall child’s health. This is a reasonable statement to make regarding child health”.

6b) Pregnancy
(i) Pregnancy & Chiropractic – Your Body, Your Baby
Dr Byfield states in the Report that the Website is misleading in that it states that “pregnant women require chiropractic care more than any other group.” The Website states “chiropractic care is one of the best things that you can do if you are pregnant”. This is not misleading because it is based mainly on case studies within the chiropractic profession. They are referenced in the Koren leaflet “Pregnancy” and the BCA leaflet advising pregnant women to get chiropractic care (appendices 30 and 43 ). Dr Byfield also states that this may exploit people’s lack of knowledge regarding health matters. In the Website Dr Jensen assumes that the people reading it are informed and read much about the health of their babies: “pregnant women are taking more responsibility for their bodies; reading more, asking more questions, eating better, exercising more and exploring ways of optimising health”. This is not misleading.

ii) Chiropractic For Your Body and Your Baby
The Report states that there is a lack of scientific evidence for the subluxation. Given that most chiropractic researchers are from the mechanistic school of thought that should not be surprising. Nevertheless, there is, there is a whole chapter by Howard Vernon on the basic scientific evidence for the chiropractic subluxation in Gatterman’s book “Foundations of Chiropractic: Subluxation” (1995) [appendix 44], Vernon has presented eighteen studies. At the time of writing that chapter Howard Vernon was director at the Centre for the Study of Spinal Health Research Department in Canadian Memorial Chiropractic College, where Dr Byfield trained. The Website states “vertebral subluxations damage the nervous system and affects the workings of the entire body.” This is a holistic concept based on the idea that the nervous system “blankets” your entire body and interference to its function could affect anything including the developing foetus.

iii) Drugless Health Care
Again, the Website is conveying the idea of optimal function naturally. It states that “there is no such thing as a safe drug”. Thomas J. Moore in his book “Prescription from Disaster” 1998, states in chapter 6 “more than thirty years after the thalidomide tragedy every new prescription drug today is in some fashion assessed for its dangers to pregnant women. The results of this testing should be of serious concern. Of the 3,200 approved prescription drugs only six are reported safe for pregnant women on the basis of evidence from human studies. Five are thyroid hormone replacement drugs and the sixth is a form of folic acid.”

Beeson and McDermott in 1971 concluded in the Cecil-Loeb textbook of medicine “it is virtually impossible to specify any drug that will not result in an increased frequency of congenital malformations when administered in a certain dose to a sufficiently large panel of different laboratory animals.” Bearing in mind it is unthinkable to recruit pregnant women to test the safety of drugs, we are forced to make assumptions from this data, i.e. “there is no such thing as a safe drug for pregnant women”. I would therefore conclude that this statement is not inaccurate and misleading.

The over use of X-ray is a controversial topic within the chiropractic profession, similarly, there is also controversy surrounding diagnostic ultrasound linking it to miscarriage in a small percentage of woman. There are risks associated with C-section and other invasive obstetrical interventions. Lynne McTaggart covers many of the dangers in chapter 2 of “What Doctors Don’t Tell You”. The Website simply states, “invasive diagnostic procedures also have the potential to cause harm and should be avoided if possible”. However, Dr Byfield misinterprets this as the Website “categorically stating that ‘all pregnant women should stay away from x-rays, diagnostic ultrasound… and every other form of dangerous obstetrical intervention’”.

v) Pregnant Women Have Special Concerns
The Website has not claimed that there are any studies that demonstrate that “chiropractic care can help women become pregnant, control vomiting, deliver full-term infants with ease… ”The Website points out that is merely “experience of many professionals” that has shown that chiropractic care can help these conditions. I and many other chiropractors can testify to that fact. A chiropractor on the GCC council once reported to me a case of a woman with back pain who had waited years to have a baby and conceived during her treatment for back pain. One year later she returned to the chiropractor symptom-free but wanted him to adjust her spine so she could have another baby. He agreed to do the adjustment and she successfully went on to have another baby. Millions of healthy babies are born without chiropractic care, and there are no statements in the Website suggesting otherwise.
.
vi) Spinal Adjustments
The Report states that claims in the Website regarding the correction of breech presentation is “anecdotal at best”. The Webster breech technique was taught on the CPD approved Chiropractic Paediatric Certification Programme in Modules 2 and 5. [appendix 45]. Dr James Thompson DC teaches that Dr Larry Webster developed this technique and he reported that it is effective in turning the baby in 94% of breech presentations. Dr Thompson reported on 19th May 2001 in Solihull that the International Chiropractic Paediatric Association is involved in doing a major study on this and preliminary results are very encouraging and reflect the findings of Dr Webster, other studies are mentioned in the Koren Spinal Research book [appendix 1]. I have been successful three out of three times. There is no suggestion in the Website that “chiropractors are experts when it comes to obstetrical conditions” merely that chiropractic has been shown to be effective in turning breech babies to facilitate natural delivery. This is not misleading.

vi) Common Questions and Answers Regarding Chiropractic & Pregnancy
A report by Peterson in the Journal of the American Obstetric Association 1975 Vol 74 page 957 stated that “postpartum depression is a rarity in patients receiving manipulative therapy.” The Website reflects the views expressed in this report and is not inaccurate and therefore misleading as stated by the Report. A positive outcome with depressed patients could simply be due to the fact, as stated by Dr Byfield in the Report, patients are generally satisfied with chiropractic care. There is also data supporting the positive role of chiropractic in helping mentally ill patients in the 30’s [appendix 46].

7) PMS & Menopause
i) Help for Menstrual Discomfort, PMS & Menopause
The Report states that the Website claims that “millions of women with PMS have visited chiropractors.” However, the Website simply states that “millions of women with these conditions [menstrual discomfort, PMS and menopause] have visited chiropractors.” It is repeated later in the section “Spinal Care” how women who go to the chiropractor with back and neck pain may get relief from other conditions at the same time as their back pain. Throughout the world, it is reasonable to assume that millions of women suffering from these conditions have benefited from chiropractic care and therefore I would not consider this statement to be untruthful, inaccurate or misleading. Many studies have been carried out on the effect of chiropractic care on primary dysmenorrhoea and pre-menstrual syndrome and are referred to at pages 197-198 in Somatovisceral Aspects of Chiropractic: An Evidence-based Approach by Charles S. Masarsky and Marion Todres-Masarsky (2001)(appendix 47) .
ii) The Chiropractic Approach:
The Website clearly states “chiropractic is not a treatment for gynaecological problems” but goes onto explain how the chiropractic approach could help people with these conditions. It does not imply that the vertebral subluxation is the direct cause of the patient’s symptoms. The Vertebral Subluxation Complex affects nerve transmission, in doing so it can cause or contribute to many conditions as stated previously on page 16. This does not contradict the role of the chiropractor as a primary care profession or his responsibility for assessing the health status of a patient and making an appropriate clinical impression/diagnosis to select the appropriate management plan.

iii) “The Hysterectomy Hoax”
This is a huge subject area in the sociology of health and to a certain degree has become a major feminist issue raised first as such by Germaine Greer in her book “The Change” (1991). This book is highly acclaimed and well referenced. One of the chapters is titled “Medical Ignorance”. Germaine Greer states at page 183 “the menopause muddle is part of the general fog of incomprehension about the health status of the middle-aged woman. It is complicated by the availability of an expensive panacea [hysterectomy] which seems to obviate the necessity for further expensive long-term studies. Indeed it looks very much as if researchers will run out of untreated women to study long before they will have reached any firm conclusions. Already studies are complicated by the presence in the study population of a large proportion of hysterectomized women … The practitioners who deny that there is too much that they don’t know are the most dangerous…If your (young male) doctor is doctrinaire, change him…Taking responsibility for your own health if the first step towards ‘coping with menopause’.”

Greer also refers to an article by Professor John Studd which advocated that healthy women should elect to have a hysterectomy when their families are completre at forty five. Greer, using similar language which has been criticised by the report, states the progressive woman of the future will be expected to “undergo devastating major surgery to mutilate themselves in order to acquire synthetic sexuality courtesy of the major pharmaceutical multi-nationals.”

The Website also points out how hysterectomy can affect posture “often resulting in lower back, hip and knee pain”. It does not imply, as stated by the Report, that “chiropractors are more knowledgeable and skilled than a consultant gynaecologist.” Therefore in my view this section is not misleading.

iv) Hysterectomy Damage
The Report claims that the Website states that “only a few doctors warn their patients about the side effects of hysterectomy”. However, the Website actually claims “too few doctors warn their patients about these too common side effects.” I would state that unless all doctors warn their patients about the side effects of a hysterectomy it is “too few” doctors that do so. The statement on the Website does not imply, as suggested in the Report, that all doctors are professionally negligent. Rodney Ledward, the doctor who was recently struck off the General Medical Council Register, or Richard Neale another disgraced gynaecologist are examples of doctors who were found to be professionally negligent in performing hysterectomies. The Observer newspaper described them as “Butchers” [appendix 48].

v) The Dark Ages?
The Report states that the Website claims that “most women are subject to unnecessary hysterectomy”. The Website states that “most women who are told that they need a hysterectomy may not”, and that “hysterectomy may be necessary in the case of severe infection of the reproductive organs, necrotic tissue in the uterus and cancer….” Germaine Greer’s “The Change” reports from a study by Riphagen et al in 1988 “hysterectomy is the most frequently performed surgical procedure in the United States. For every five hysterectomies performed in the US, where 30% of women aged between forty-five and forty-nine had had their wombs removed only one is performed in Sweden.” Lynne McTaggart on page 272 of “What Doctors Don’t Tell You” states “hysterectomy outranks all others, when it comes to the most unnecessary of surgical procedures”

vi) Menopause
The Report states that “there is no documentation to support the claim that many doctors consider menopause to be a disease and not a normal physiological state”, Helman provides many examples in his book, “Culture Health and Illness on pages 116 –117. One study by Kaufert et al. “Women menopause and medicalisation” (1986) noted that the biomedical definition of menopause as primarily an endocrine disorder. Helman goes on to say that once “defined as a disease it can only be diagnosed by a physician, treatment can only be prescribed by a physician and thus it often becomes a a permanent condition to be permanently managed by the medical system” Helman argues that in the case of both premenstrual syndrome and menopause, that two of the most natural physiological events in a women’s lives have been redefined by some clinicians as endocrine disorders or diseases. This “medicalisation” means that some women have become more dependent on the medical system and its treatments than their mothers ever were. This supports the opinion expressed in the Website and is not inaccurate and professionally misleading.

viii) Spinal Care & Conclusion
The point here is if the women who found relief from menstrual cramps had only done so because they had received treatment for back pain. Women who do not have back pain may be missing out on help because the common perception of chiropractors is that they are only “backache doctors”. This is supported by Dr Byfield when he acknowledges that there is a plausible theory to explain this due to the neuroanatomical connections between the spine and related structures. . Therefore this is not dishonest or misleading and is supported by BCA leaflets.

8) Whiplash Injuries
i) Whiplash and the Chiropractic Lifestyle
The Website states “injuries to the neck caused by the sudden movement of the head, backward, forward, or sideways, are referred to as whiplash”. Dr Byfield states this section is incorrect, and explains the correct description in language lay people do not understand. “global physiological range of motion…….This in vitro investigation has been replicated in vivo……local intersegmental instability…the neutral zone” The BCA again uses simple language to explain whiplash in their leaflets [appendix 49] “Whiplash is a general term used to describe any injury where the neck has gone sudden acceleration and deceleration”. Dr Jensen does not state the he will “manipulate unstable joints” or “introduce an adjustment to torn soft tissue” as implied by the Report. Dr Jensen actually states that the goal of the chiropractor is to “help restore proper motion and position of spinal bones”. He will perform a “thorough case history and examination”. The person is advised that with whiplash they will probably need a series of visits. Dr Jensen’s approach is to use a specific chiropractic adjustment to help return spinal function. This is not misleading.

At this point it is important to differentiate between manipulation, as performed by manual therapists and chiropractors as described by Dr Byfield in this example, and a chiropractic adjustment. Gatterman 1995 in Chapter 1 [appendix 50] describes manipulation as a “manual procedure that involves a directed thrust to move a joint past the physiologic range of motion without exceeding the anatomic limit.” An adjustment on the other hand is described by Gatterman as “any chiropractic therapeutic procedure that uses controlled force, leverage, direction, amplitude, and velocity directed at specific joints or anatomic regions. Chiropractors commonly use such procedures to influence joint and neurophysiologic function”.

9) Headaches
i) Migraine, Cluster Headache & Chiropractic & Cluster Headache not misleading.

ii) Can Chiropractic Help?
This section has been badly written. It states “Millions of headache sufferers are turning to the natural drugless, chiropractic approach to health”. Nevertheless having referred earlier (Headaches; i) to the millions who get occasional headaches, in my opinion the public is unlikely to think that they have all turned to chiropractic. While this section is inaccurately expressed, in my view it is hardly an attempt to mislead the public.

Describing the vertebral subluxation as the “Silent Killer” seems overly dramatic taken in the context that it is presented, but in my opinion it is not misleading. Subluxations often have no symptoms and neurons can die as a result of subluxations. According to Fitzgerald in Neuroanatomy – basic and clinical: (1990) pages 53-54, when nerves are damaged they experience wallarian degeneration, if they do not regenerate they die. The effects of subluxation and lack of stimulation of connecting neurons manifests itself in the form of trans neural degeneration. How this affects the brain, is the basic neurological principal that Dr Carrick applies to his course [appendix 51]. Dr Carrick teaches chiropractors how to optimise the function of the nervous system without exceeding the metabolic rate of neurons, and how to observe these effects clinically and apply these observations to chiropractic care.

Even though medical professionals may sometimes use the term subluxation, as stated earlier here, it is not commonly used term by MD’s, and its usage is far more common in the chiropractic profession. If there is an argument for not using a word in chiropractic it would be to “manipulate”, according to Chambers dictionary manipulate can also mean to give a false appearance or to turn to one own advantage. Complaints were made to the BCA about a medical doctor Peter May who used the Chambers definition to describe the chiropractic profession on Radio 5, two years ago.

iii) The Chiropractic Check-up
As stated earlier in this report, the Francis Wilson study [appendix 8] stated that “most British Chiropractors consider the management of visceral conditions to be within the remit of chiropractic care”. Improving spinal function facilitates healing restoring the body to a greater level of health and wholeness as stated in this section of the Website. It is Dr Byfields opinion that this is an “outdated unproven chiropractic philosophical tenet”. Whilst he is of course entitled to his opinion most chiropractors disagree [appendix 2]. This section is not misleading or exploitative.
10) Chronic Pain
i) Pain & Chronic Pain:
The Report states that “there is very good evidence that patients are very satisfied with chiropractic care in general”. BCA leaflets and a WFC position paper on the use of prescription drugs by chiropractors [appendix 52] states “the practice of chiropractic does not include the use of prescription drugs”. It is not misleading therefore to extrapolate from this, that “millions of people have hailed chiropractic as their drugless salvation from pain” A Tedd Koren leaflet on Pain [appendix 53] reported a Louis Harris Survey in 1985 that stated “Millions of people experience more than 100 days of pain a year.

ii) Early Warning System & Painkillers: Is not misleading

iii) Types of Pain: Is not misleading

iv) Emotional Factors: Is not misleading

v) The Standard Medical Approach to Pain
The Report states the second paragraph “makes a number of unsupported a statements”. The statements come from the Koren leaflet on Pain in which Tedd Koren refers to an article by John Liebeskind in 1989 “Conquering Pain” where he states “I don’t think there is a medical school in the world where more than four hours out of four years are spent teaching students to diagnose and treat pain problems. That’s a primary reason why most pain problems are mismanaged or ignored with tragic and, unnecessary consequences.” From the same article Blaine Nashold, MD, is quoted as saying, “Too often the medical approach merely helps the patient to learn to live with the pain”. In my view, therefore, the Website is not being misleading.

vi) “Learn to Live With It”
This section continues from the quote by Dr Blaine Nashold at the end of the previous section. One could speculate from this quote, that there is often a reluctance from medical doctors to refer patients to other complementary therapists. Perhaps that is why they would say to a patient “learn to live with it”. The Website does not assign the cause of all misdiagnoses on to the medical profession and is not misleading.

vii) The Chiropractic Approach
The Website again refers to the Tedd Koren Leaflet on Pain and a statement by Dr J Mannheimer in the Conquering pain article referred to earlier. “Bad posture and body mechanics are the most overlooked causes of musculoskeletal pain” this is not inaccurate and misleading.

11) Sciatica
i) Sciatica and the Chiropractic Lifestyle
The Website does not say “VSC is the only cause of sciatica” as stated in the Report. The Website states VSC is one of the most common causes of sciatic leg pain. Gatterman on page 281 of Foundations of Chiropractic Subluxation, presents a neurobiologic explanatory hypotheses of sciatica which relates to the VSC. The Website describes the commonest medical interventions for sciatica and the chiropractic approach. It is accurate, balanced and not misleading as described by the Report.

12) Carpal Tunnel Syndrome (CTS)
i) Help for Carpal Tunnel Syndrome
The Website does not imply or state in this instance that “millions of people are seeking chiropractic care for carpal tunnel syndrome” as the Report states. The Website states “Millions of people now suffer from CTS and increasing numbers of them are seeking chiropractic care”. Studies by Bonebrake et al in 1990 and published in JMPT, showed chiropractic to be an effective treatment for CTS. Later a study by Davis and Hulbert et al in 1998 and also published in JMPT, showed significant improvement in the group under chiropractic care, and though not significant over conservative medical care it would make chiropractic care the choice for people who did not want to take drugs as part of the management of the condition. Accordingly the Website is not misleading.
ii) Where is the Carpal Tunnel, Who Gets CTS? & The Medical Approach: Is not misleading

iii) The Chiropractic Approach & Your Spine and Carpal Tunnel Syndrome: Is not misleading

iii) Conclusion:
Nowhere in this section as claimed by the Report, is the question asked “which would you rather have, a chiropractic spinal adjustment, or spinal surgery”. However the Website does state (based on the information presented in the entire carpal tunnel part of the Website), “A chiropractic adjustment may make the difference between a pain free wrist or spinal surgery”. This is not misleading.

13) Digestive Health
i) Your Digestive System: Your Oesophagus and Stomach; Dyspepsia and Ulcers & Heartburn/Gastritis/Pyloric Stenosis Is not misleading.

ii) The Medical Approach
The Website does not state “medical doctors only treat symptoms”. The Website does however state “medical care is often directed at treating symptoms with drugs….” The Website does not state it is always best to avoid medical drug therapy and investigate natural forms of health care”. The Website does state “As a general rule it is always best to avoid medical drug therapy and surgery as much as possible and investigate first and foremost more natural forms of health care”.

Cecil Helman on page 67 of “Culture Health and Illness” (2000) reports “Biomedicines iatrogenic effects are now widely known to the public via the media”. He also cites a study of over 30,000 hospital records in New York in the 1980’s which showed that adverse effects occurred in 3.7 per cent of them. Bearing these facts in mind the last statement in this section is not misleading [appendix 24].

iii) The Chiropractic Approach & Correction of the Subluxation
The Website does not state The Vertebral Subluxation Complex (VSC) theory is “the view held by the entire profession” as claimed in the Report. Nevertheless, as stated earlier in this report, according to Francis Wilson the majority of UK chiropractors subscribe to this neurological theory, they may not use the tem subluxation but they subscribe to the theory. This is not misleading.

iv) Research
The Report states there is absolutely no documentation to support claims of a link with subluxation and digestive problems. This is not correct, Tedd Koren in his leaflet Digestive health [appendix 54] has listed eight studies where spinal manipulative therapy has helped the listed conditions on the Website and Masarsky [appendix 55a] lists others. Consequently, this is not misleading.

v) In Conclusion
The Report has taken the statement “the chiropractic spinal adjustment is what your body needs” out of context and claimed it is misleading. The statement is made in the context of the bodies nerves being compromised by the VSC and therefore needing an adjustment. This preceded the quoted statement but was ignored by the report.

14) Ear Infections
i) Acute Otitis Media; Antibiotics and Surgery; Tubes in the Ear
It is well documented in the medical literature that the use of antibiotics in ear infections is questionable. A double blind study by Van Buchen et al. 1981 published in the Lancet compared the treatment of 171 children with otitis media. The children were divided into four groups, one group was treated with surgery, a second group was given antibiotics, in the third group, both surgery and antibiotics were given. The fourth group received no treatment at all. The findings showed there was no significant difference in pain, temperature, duration of discharge, otoscopic appearance, or recurrence between the groups. Many more studies supporting these statements in the Website are reported in the book “Healing Childhood Ear Infections” (1996) by Dr Michael Schmidt. This section is not misleading.

ii) Cause of Ear Infections
One of the main causes of ear infection is compromised immune function according to Dr Michael Schmidt. Many studies support the view that vaccinations, while helping reduce the incidence of the disease being vaccinated against, can also compromises the function of the immune system in dealing with other illness. In his book “Vaccination Social Violence and Criminality- the Medical Assault on the American Brain” (1990), Harris Coulter makes the case linking the increase in ear infections, allergies, asthma, hyperactivity and attention deficit disorders, with mandatory vaccination programmes. This report goes into vaccination in more detail in part 18:Immunisations. This section is not misleading.

iii) The Chiropractic Approach
Dr Michael Schmidt reports a number of studies which report that spinal manipulation benefits ear infection. On page 87 of Schmidt’s book he refers to a study by Manual therapist Gottfried Gutmann MD who has reported on spinal manipulation treatment of more than 1,000 infants and children. The study states that increased susceptibility to infection of the ear, nose and throat is one of the most common consequences of upper cervical problems. Other studies reported support these claims. The textbook: “Chiropractic Pediatrics” (2000) by Neil Davis, who spoke at the BCA conference last year on the VSC, has a section of his book devoted to chiropractic management of acute otitis media (page 178). This section of the Website is not misleading or untruthful.

iv) In Conclusion
Based on the information presented in the Website, it is reasonable to recommend chiropractic care for people suffering from a wide variety of conditions. The Report states that there is no data indicating the benefits of spinal care, “check ups for subluxation,” or “spinal adjustments to avoid drugs, with all their side effect”. These claims have been dealt with earlier in this part of the Website and data presented. The vast majority of chiropractors do not prescribe drugs, and drugs have side effects, which is well documented. In regards to the relative safety of chiropractic, I would again refer to the study by Pistoles et al, which stated “there would be a chance of approximately 1 in 250 million paediatric visits to a chiropractor that a neurological or vertebrobasilar complications would arise”. In my view this section is not misleading.

15) Sinus Trouble – Help For Sinus Trouble
i) Chronic Sinus Trouble; What is Mucus; Symptoms; Causes of Sinusitis and Rhinitis: Not misleading

ii) The Orthodox Medical Approach
This section is reporting an article written by an American osteopath Robert Ivker in 1989 titled Sinus Survival, and statements made by Charles Lebo medical editor of the self help tape “The truth about sinusitis” 1994, describing the medical approach to sinus problems These articles have been quoted by Tedd Koren in his leaflet “Sinus Trouble” [appendix 55]

iii) The Chiropractic Approach
At the beginning of this section the Website states clearly “Chiropractic is not a treatment for sinus conditions, yet sufferers often find relief after chiropractic care”, the section then goes on to explain the theory behind this claim. Tedd Koren’s book “Chiropractic and Spinal Research (2000) has a number of case studies and references, to the benefits of spinal care on sinus and respiratory infections [appendix 1]. There are also a number of case studies demonstrating the benefits of spinal manipulation in the book “Dr Gallagher’s guide to 21st century medicine” (1997) pages 141-143.This section is not misleading. Masarsky, and Gregory Plaugher in his textbook “Clinical Chiropractic” also make reference to the benefits subluxation correction has had on sinus problems.
iv) Can Chiropractic Help Your Immune System?
The Website states “ many studies have shown the beneficial effect of chiropractic care on the nervous and immune system” Thirteen studies are referred to in Chiropractic and Spinal Research (2000) on page 123 [appendix 1]. Other case studies are presented in Dr Gallagher’s and Dr Massarsky’s book. The Website also states that the relationship between the nervous system and the immune system appears to be more extensive than ever before realised. In 1983 David Felton made the discovery that nerve fibres physically link the nervous system and the immune system [appendix 23]. This discovery opened up a whole new are of study previously mentioned in this report in relationship to chiropractic and psychoneuroimmunology. This section of the Website is not misleading

v) Chiropractic for Sinus Sufferers
The Website states “chiropractic care is not a treatment for sinusitis, rhinitis”etc………yet anyone suffering from these conditions should receive chiropractic care “Spinal care can help your body function better, improve your resistance to disease and enhance your well being”. The Website does not say people with sinusitis etc “would benefit from chiropractic spinal care”, as stated in the Report, which implies a guarantee. This section of the Website is not misleading.

16) TMJ Dysfunction
i) Help for TMJ Sufferers; TMJ Dysfunction or Syndrome
The Report states it is not acceptable for the Website to “relate a whole host of unrelated and unsubstantiated clinical symptoms” to TMJ. These symptoms are listed in the book “TMJ” – The self help program (1990), by dentist John Taddey, and in another study by Gilespie et al. Diagnosis and treatment of TMJ, head and asthma symptoms in children, which was published in the American journal; The Journal of Practice in October 1990 pages 342-350. This section of the Website is not misleading.

ii) Who Gets TMJ?
The Report states that there is some doubt regarding the accuracy of the information in this section of the web site. The Report states 85-90% of the population exhibit some form of TMJ dysfunction throughout their lifetime. The Website states that up to 78%, of the population have some amount of TMJ, it could have been made clearer that it was lifetime prevalence being referred to here.

iii) Causes of TMJ? not misleading.

iv) The Standard Dental/Medical Approach:
The Report states “a clinical procedure should not be discouraged by a health care professional whose expertise lies outside a particular discipline, until all the reasonable therapeutic options for a particular condition have been reviewed and discussed fully with the appropriate professionals”, the Report implies that the Website disagree with this statement.

After describing some of the other treatments, the Website states “in severe cases surgery has been performed to enter the joint and end the discomfort, yet this drastic step should only be taken after more conservative approaches have failed”. Surgery should not be done until chiropractic and proper dental support has been tried, with the exception of cases of “tumour, fracture or serious joint pathology”.

In my opinion this is good advice. A person who does not have a serious TMJ problem and is waiting for surgery has little to lose by trying a more conservative approach to the condition and much to gain from this advice. These decisions should be made in consultation with the appropriate members of the health care team, as stated by the Report The question is whether the patient is an active informed participant in this process or a passive recipient of prescribed treatment. This section of the Website is not misleading

v) The Chiropractic Approach: Is not misleading.
17) Prostate & Impotency
i) Prostate, Impotency and Chiropractic
The Website describes the prostate gland anatomically and functionally. The connection to chiropractic has been made throughout the Website in connection to visceral nerve supply. This is not misleading.

ii) Enlarged Prostate or Benign Prostate Hyperplasis (BPH): is not misleading

iii) Non-medical, Natural Remedies: is not misleading

iv) Prostate Cancer: is not misleading

v) The Medical Approach: is not misleading

vi) Impotence: is not misleading

vii) Medication Induced Impotence: is not misleading

viii) Chiropractic and the Prostate
There are many studies demonstrating the effect of spinal manipulation on the cardiovascular system in Tedd Korens Spinal Research book [appendix1]. Pain is as much an emotional experience as physical so it should not be unreasonable to assume, that if some one has less pain, their emotional well-being improves.

The Website does not say holism strengthens the body, it states “A holistic person based approach directed at strengthening the body has been attracting many men suffering from this condition”. The concept of holism is a very progressive approach to contemporary health care because it is moving away from a reductionist approach that the whole can be explained by the sum of the parts, each part has a role to play in the functioning whole. This section is not misleading.

viii) In Conclusion
The Website begins by saying “chiropractic is not a treatment for prostate conditions or impotence”. It goes on to say that “anyone with such problems definitely needs chiropractic care to ensure that their body is functioning without vertebral subluxations”. Based on the data available that is a reasonable assumption. “The Cerebral Dysfunction Theory” which was proposed by two medical practitioners [Appendix 56] Eric Milne a GP with an interest in spinal manipulation, and Frank Gorman an ophthalmologist with an interest in migraine, makes a case for the subluxation to be “health destroying”.

According to Gatterman (1996), Milne and Gorman noted that “after spinal manipulation for headache, patients often commented that some other health complaint was relieved as well”. With time the list of conditions benefiting from spinal manipulation enlarged, (for example, lethargy, depression, irritability, hyperkinesia in children, problems with memories, dizziness, learning disability, clumsiness, changes in visual acuity, auditory difficulty). The mechanism proposed to explain these post manipulation effects was that increased cerebral blood flow resulted in hibernating areas of the brain as a result of spinal manipulation, and the brain becomes functional again. [appendix 56]. In Dr Byfield’s opinion there is no “proof” to support this view, I disagree and this section is not misleading or inaccurate.

18) Immunisation
i) Immunisation and Chiropractic:

ii) The Critics
The Website States “Many Doctors” urge parents to reject all inoculations. Dr Jane Donegan, a South London GP, is often reported in the media regarding her opposition to vaccination. Dr Robert Mendelsohn voiced this opinion in his book. “How to bring up a healthy child in spite of your doctor”. Dr Peter Mansfield who was recently charged by the GMC with giving single measles vaccine, is opposed to mandatory vaccination policy [appendix 57]. Many other medical doctors are now questioning the wisdom of this approach to children’s health [appendix 58]. Many Doctors of Chiropractic, many Doctors of Philosophy have presented their views in opposition to vaccination in the many books that have been published on the subject [appendix 58a]. Vaccinations are legal and in many instances the have abused children as stated on the Website. Vaccine damage has cost the US government over $1,000,000,000 in the 90s.The British Government has recently increased the funds available for vaccine damaged children. In my opinion it is only a matter of time before there is a public inquiry into vaccination programmes in the UK and the US [appendix 59].

iii) “Vaccines are killing” The Website states “Vaccines are killing” The Compiled Vaccine Adverse Event Reporting System (VAERS) for Diphtheria, Pertussis, and Tetanus vaccines (DPT) 1990-1999. [appendix 60]. On page 2, Lot 0C21045 from the Connaught Labs, listed 70 adverse events, 19 were brought to the ER, 13 died, for five others it was life threatening, four were disabled. VAERS lists many other children who have died from this one vaccine. It is not possible to provide “the percentages comparing successful and failed inoculations” as requested by the Report, because the ratios are not available under the US “freedom on information act”, because corporate rivals could benefit from such information (see VAERS introduction). The Report is correct in stating “the public needs to hear a balanced debate which provides useful information from all angles in order that patients and parents can make the most informed choice”. This is not happening in doctors’ surgeries, the Website is providing some balance to the debate, however somewhat emotive the choice of words to articulate this opinion probably detracts from the message. Some would argue you have to present it this way to get attention. This section is not misleading.

iv) Do Vaccines Work? Is not misleading.

v) What Vaccines are made of: Is not misleading.

vi) Links with other Diseases
Vaccinations have been linked to many diseases [appendix 62,63,64,65 and 66], for example It has been reported in the media that the only case of polio in the UK last year and Ireland this year were caused by a polio vaccine. Research has been done by Andrew Wakefield suggesting a link between MMR and crohns disease and autism. As the Reports states these are not common diseases nevertheless, there is an enormous amount of evidence which suggests a link to autoimmune diseases like asthma. There is not space here to present the case in detail, I have included in the appendix the arguments for and against vaccination in a social science essay I have written [appendix 61]. The arguments presented by the Website help give balance to this debate, it is not inaccurate or misleading.

vii) Chiropractic: Creating Natural Immunity
The Website states chiropractors have traditionally opposed immunisation [appendix 38], promoting instead a good diet, natural childbirth, breastfeeding and spinal checkups. The first chiropractor D D Palmer in his book The Chiropractors Adjuster written in 1910 outlines his opposition to vaccination on pages 52, 164, 432, 448, 854, 877 and 908. Traditionally chiropractors focused “on the body’s innate recuperative power and how this is affected by and integrated through the nervous system in achieving optimal well-being” (ACC Paradigm) without using drugs. This debate is as controversial within the chiropractic profession as in the general public. In personal communication I have been informed that a recent study by a student at Glamorgan University showed a significant percentage of chiropractors opposed vaccination in the UK. A study by Rose-Aymon et al. stated that children under chiropractic care were less likely to get these childhood illnesses that people vaccinate against [appendix 66a]. This section is not misleading.

8. Summary of the Parker Clinic Website Overview
8.1 I would say the Website is a reasonable representative view of subluxation-based chiropractic, which is covered by the ACC paradigm. While I do not regularly use the word subluxation in my practice to my patients (only because it is a mouthful for lay people), the principle and theory behind it represents the scope of practice of the vast majority of chiropractors worldwide. Some of the issues raised by the Website are controversial and the language could have been articulated better, nevertheless the most important consideration is whether the information provided is in the patient’s best interest. Simply because some of these issues are controversial is not a good enough reason for avoiding them.

8.2 When Robert Mendelson MD first questioned the overuse of antibiotics or Linus Pauling emphasised the importance of vitamin C, these were all extremely controversial views at the time. One hundred scientists signed a letter saying Einstein’s theory of relativity was rubbish. These views are only controversial to those who would disagree with them or have another agenda. That is not the majority of chiropractors. Unfortunately the lack of respect to towards opposing viewpoints has been very damaging historically to the chiropractic profession.

8.3 The problem within the chiropractic profession has been that two schools of thought have completely different ideas on how the profession should progress. For years musculoskeletal pain relief has been seen as the coin “of the realm” in its quest for legitimacy. According to Masarsky 2001, narrowing the professions focus to musculoskeletal pain made licensure possible in Canada’s Ontairo province. In Australia, intense pressure has been placed on practitioners who mention non-musculoskeletal pain in their advertising, despite supportive research findings and the widely held belief among the nation’s practitioners that chiropractic care can improve visceral function.

8.4 In the landmark 1979 report on chiropractic in New Zealand, the Commission of Inquiry noted that much of the medical opposition to chiropractic had to do with claims that adjustments could influence the course of systemic visceral (type O) disorders.

8.5 There is no doubt the mechanical approach has elevated the profile of chiropractic in Europe. At the same time the biomedical model has been subject to much criticism for it’s claims regarding “scientific proof” where commercial interests were involved. Health is not like mathematics, the variables are so many there can be no absolute truth or proof. Health care practitioners must treat their patients as individuals and respect their ability to make informed choices about their health. The key to a better health service is empowering individuals to make those decisions. As Peter Dickson DC, President of the ECU said “the public is not stupid.” People are not going to go to chiropractors if they are not being helped or chiropractors are making claims to cure all disease.

8.6 A patient does not ask for proof of what a chiropractor does. Can the chiropractor prove that he cures back pain, heals headaches, fix damaged necks? No he cannot. What the average patient wants to know is can the chiropractor help. The chiropractor cannot treat cancer but could chiropractic help someone with cancer? A mechanist practitioner will probably say no. A holist practitioner will advise the client to follow the best outcome prediction for the tumour, equally important, optimise the health potential of the individual to prevent cancer cells spreading to other organs, and improve the quality of life of the individual. This is the way health care is moving as health professions recognise the limits of the biomedical approach.

8.7 Of course science is important as is mechanism particularly in the area of emergency medicine. Some chiropractors may choose to play a role in the development of a branch of manual medicine within the NHS. They should be respected for it as should chiropractors who want to help optimise the health of their communities as The Parker Clinic is doing, by asking legitimate questions of the biomedical health paradigm. The Website is also encouraging people to explore a non-invasive approach to health care rather than being subjected to more extreme interventions as a first option.

8.8 The chiropractic world the Report envisages has a role in the biomedical model of health care. However chiropractors have a choice as to whether they wish to participate. In my opinion it is not possible to force a profession as diverse as chiropractic to embrace this model against their will, the consensus in the ACC paradigm is the only way forward. In conclusion, to support this point of view I present the definitions of chiropractic in the current leaflets of the four major chiropractic associations in the UK. There are no references accompanying these claims on the respective leaflets and the Website is in complete harmony with these views.

The Scottish Chiropractic Association [appendix 67]
“Chiropractic relates to the fact that the nervous system controls all organs, tissues and cells of the body. When vital nerve communication pathways are interfered with, as can occur with a variety of structural/functional problems in the spine, pain and ill health can be the result. Research both within and outside the chiropractic profession now provides support for this concept.

Chiropractors locate areas of altered spinal function which may be causing nervous system interference and are particularly interested in a specific problem affecting the spine called, the vertebral subluxation”. (A Guide to Chiropractic)

The British Chiropractic Association [appendix 70]
“Chiropractic specialises in the diagnosis, treatment and prevention of conditions which are due to mechanical dysfunction of the joints and their effects upon the nervous system. Your chiropractor effects an improvement in your joint’s mobility, as well as nerve and muscle function. Your body’s own healing processes will then be able to continue the task of restoring your health.

Less obvious complaints can also result (from nerve irritation) such as migraines, fatigue, chest pain, infantile colic, chest and period pain. Your chiropractor has the training and experience to treat people with these conditions”. (Chirocheck; your personal assessment)

McTimoney Chiropractic Association [appendix 68]
“Chiropractic aims to correct the alignment of the bones of the spine and other joints of the body, to restore nerve function, to alleviate pain, to promote natural health. All organs and cells require nerve information to function correctly, and much nerve information is passed through the spinal cord, protected within the spinal column. Any impediment to the normal nerve supply caused by slight misalignments or malfunction of the vertebrae can therefore be the cause of the pain, discomfort and even disease, and the correction of vertebral function is thus of paramount importance”. (A Gentle Way With Back Pain)

United Chiropractic Association [appendix 69]
The nervous system has a central role in regulating, coordinating and integrating the functions of the entire organism. We recognise that interference to innate intelligence (subluxation) diminishes healing capacity, with an alteration in the dynamic interrelationship between mental, physical and social aspects of the whole person. The art of chiropractic encourages optimal expression of health by the detection, removal (adjustment) and prevention of nervous system interference. Chiropractors use drugless, minimally invasive techniques to adjust identified subluxations throughout an individual’s lifetime”. (UCA Newsletter No 1)

This report has been produced by Dr Richard Lanigan DC, BSc

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