The clowns at the General Chiropractic Council got it wrong on Sciatica. What a surprise!

October 22, 2010
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 ernsts-presentation Apparently its ok for chiropractors to say they treat sciatica.

After telling the profession that chiropractors were misleading the public by claiming to help people with sciatica .According to the latest bulletin on the GCC website: “Following his review of Santilli et al Professor Bronfort considered that the level of evidence for manipulation for sciatica/radiating leg pain should be changed from INCONCLUSIVE but favourable, to a moderate level of POSITIVE evidence when compared to sham manipulation”.

What is truly laughable about this piece of news is that it is not new research it has been lying  around the GCC offices since March 2006.It is rumoured it fell out of Ernsts bag after his lecture to GCC members in July 2005. Ernst and the GCC  may have conspired to hide the good stuff, in their efforts to make chiropractors look bad, which is about the only thing the GCC has done well while regulating the profession.

No doubt so obsessed were those on the GCC Education Committee with subluxation  and getting Skeptic Barista off their back, they forgot all the evidence that would help chiropractors under investigation for claiming to help people with Sciatica.

This is how the GCC explain this extraordinary oversight.

About the UK evidence report: the chronology

June 2009
The GCC commissioned a review of the evidence base for advertised claims made by chiropractors across a very wide range of conditions.

25 February 2010
The Effectiveness of manual therapies: the UK evidence report by Gert Bronfort et al was published by the journal Chiropractic & Osteopathy.

Commentaries accompanying the report by Professor Scott Haldeman and Professor Martin Underwood and published by Chiropractic & Osteopathy can be read here.

For ease of reference, the evidence summary tables can be downloaded separately here.

According to the parameters of the review, the levels of evidence for using manual therapies to treat a range of conditions are categorised as: High and Moderate quality POSITIVE evidence; INCONCLUSIVE, but favourable evidence; INCONCLUSIVE, but non-favourable evidence; and High and Moderate quality NEGATIVE evidence.

March 2010
The GCC published Advertising guidance for chiropractors. It highlights that when chiropractors advertise their services in the UK any claims must be based on best research of the highest standard. It refers to relevant UK law and the UK bodies responsible for regulating advertising. It emphasises that the GCC’s Code and Standard must be observed and urges chiropractors to use the Bronfort report, and the evidence summary tables, to review the content of their advertising materials (whatever the medium used).

UK evidence report update
It is to be expected that over time research will evolve and/or new information will come to light.

In September 2010 we asked Professor Bronfort to review the level of evidence for manipulation for sciatica/radiating leg pain in the light of the publication in 2009 of a BMJ clinical evidence review: Herniated Lumbar Disc Clinical Evidence 2009;03:1118

A chiropractic organisation had drawn our attention to a study referenced within the BMJ clinical evidence review – Santilli et al concerning the effectiveness of manipulation for sciatica.*

October 2010: Sciatica
Following his review of Santilli et al Professor Bronfort considered that the level of evidence for manipulation for sciatica/radiating leg pain should be changed from INCONCLUSIVE but favourable, to a moderate level of POSITIVE evidence when compared to sham manipulation.

Professor Bronfort considered that Santilli et al has a low risk of bias and demonstrates manipulation to be superior to sham manipulation for sciatica/radiating leg pain in the short and long term.

UK evidence review background
The Santilli trial is included within a 2008 literature synthesis conducted by Lawrence et al on the chiropractic management of low back pain and low back-related leg complaints.** The Lawrence et al literature synthesis was included in the UK evidence review.

In line with the methodology of the UK evidence review, the quality and findings of the Lawrence et al literature synthesis were not individually evaluated because its conclusions did not differ from the other similar systematic reviews.

References
*Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. [Santilli et al: Spine J. 2006 Mar-Apr;6(2):131-7. Epub 2006 Feb 3]

**Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis. [Lawrence et al J Manipulative Physiol Ther 2008 Nov-Dec;31(9):659-74].

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  • Barney

    An excellent article and it should be read by everyone in health services. A close friend, recently retired professor at a large US university medical school, told me the following:

    In America, graduate education depends almost completely on grants for study/research mostly from large pharmaceuticals or food companies.

    When he started out some forty years ago, the industry supplied the grant, the graduate student did the study and the university published the results.

    Now the industry/grantor publishes the results. Spot the difference? Negative results do not get published,

  • fed up

    “The practice of medicine is based on evidence. We need this evidence base to be complete, and of the highest quality, so that we can make the right decisions, but at present, drug companies produce most of the evidence we use. There is no doubt that these companies have a conflict of interest when they conduct trials: they want to sell their products, and so naturally they want a positive result from the trials they sponsor. But there is now good evidence from systematic reviews, meta-analyses, and case studies that this conflict of interest results in bad evidence, which distorts medical decision making and so harms patients.”

    “equally concerning is the routine grind of publication bias, where disappointing negative results on the benefits of treatments quietly disappear.”
    Or the exact opposite if you are a prof of complementary medicine.

    Good article if nobody has seen it.
    http://www.bmj.com/content/339/bmj.b4949.full

  • Barney

    Absolutely spot on Rod. Heaven forbid that we should put the patient first! And as for caring, compassion and empathy now where is the evidence……..?

  • rod macmillan

    Yep that is one take on it;

    however did you get informed consent from your kids, hanah montana the child the mother and here is the real clincher, even if the child gor better how did you record the level of discomfort?
    This sort of thing happens in the real world, in the 90% no confidence world of our buffoon regulator there is no flexibilty in records, we are there to follow a process, to the letter, not heal sick kids.

  • http://spinaljoint.com Richard Lanigan

    I had an interesting patient last week, seven years of age with severe torticollis . Woke up in the middle of the night in agony, went to AE they gave her Calpol but child could still not move her head without screaming.

    Mother carried her into the clinic my schedule was full and I told the mother I would see her between patients. Just as with the doctors in A&E the child would not let me touch her. I asked her if she liked Hannah Montana and all the other rubbish my kids watched on TV. As she talked to me I could see the tension in the neck ease and her head move slightly. I had to see another patient and lay her supine on the bench and asked her to see if she could turn her head to see the picture of my children and tell me how many children I have by the time I came back.

    I was back in 15 minutes and she could turn her head and I could examine her. The mother said I was a miracle worker. I had done nothing had not even taken a history or done a “sham adjustment” at this stage. Was that a placebo or down to years of experience.

    In my opinion experience outweighs clinical trials every time.

  • Barney

    Garland Glenn. Concur totally. I see similar numbers of sciatic patients and most benefit. As far as sham treatments are concerned my patients usually feel better before they get on the couch (there is ten to thirty minutes history/discussion/advice/etc. beforehand).

  • Garland Glenn

    How is it that GCC chirrpractors don’t often see patients with sciatica as I see at least 3-4 if not more per month? And as we learn more about the energy side of treatment, we learn that there is no such thing as a sham or neutral treatment. When two humans interact, a neutral outcome is impossible.

  • Paul

    “I would just love to have the opportunity to cross examine Zeno and Coats at a public hearing, if anyone wants me to represent them”

    Like to see this myself Richard – blood bath – could it be videoed too?

    Evidence-based balderdash [editorial] Martin Young Clinical Chiropractic Volume 13, Issue 2, Pages 141-142 (June 2010) [Clin. Chiropr. 2010 Jun;13(2):141-142]

    “Evidence-based practice has never been a hotter topic of conversation; unfortunately, much of the debate has centered around what constitutes ‘evidence’ and this has highlighted the widening chasm between researchers, who disregard anything that is not, randomized, controlled and, preferably, double-blinded, and clinicians who are far more interested in clinical outcomes for the individual patients they observe and treat every day than p-values. This problem has beset the medical profession for many years; now, it appears, chiropractors are falling into the same trap.”

  • http://spinaljoint.com Richard Lanigan

    “in the light of the publication in 2009 of a BMJ clinical evidence review: Herniated Lumbar Disc Clinical Evidence 2009;03:1118″

    I have not read the BMJ article so I am presuming they referenced the Santilli article, this gave the JMPT study from 2006 the OK as far as the GCC was concerned.

    Practicing chiropractors with good technique would not need a study to convince them they could help sciatica. GCC chiropractors obviously dont see many patients with sciatica and we can hardly blame the lay members for not knowing. It shows how ridiculous the mass complaints are. BCA Chiropractors are under threat from the GCC because the BMJ has not given its approval to the importance of spinal motion above the lumbar spine.

    I would just love to have the opportunity to cross examine Zeno and Coats at a public hearing, if anyone wants me to represent them

  • Fed up

    Just shows how evidence based medicine should only follow the rigid and inflexible outcomes of research. Lol

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