British chiropractors defend treatment

London: A recent UK medical report which cast doubt on the benefits of spinal manipulation for back problems has been criticised as biased from the outset by the British Chiropractic Association (BCA).

In a statement the BCA says it is outraged by the recent claims made by Professor Ernst in a study* published in the Journal of the Royal Society of Medicine. The BCA believes that the study was created using carefully selected, negative articles, in support of a pre-determinedconclusion, and that this research was biased from the outset. The BCA strongly maintains that chiropractic is a safe and effective formof treatment and finds numerous faults with ErnstÂ’s latest attack on the well-established chiropractic community.

The study was flawed for a number of reasons: In the main, the co-author (Ernst) only selected 16 research studies, out of a possible 60-70. A quarter (25%) of these selected studies were by the reportÂ’s own author, adding even more bias to the results Elements of ‘spinÂ’ exist within the context of the research – making reference to ‘no evidence that SM is superior to other standard treatmentsÂ’
can actually be translated, as SM is just as effective as other standard treatments.

The study cited that 16,000 chiropractors were practising in the UK, in fact there are just 2,200 chiropractors in the UK, all of whom are regulated by the General Chiropractic Council.

The original reviews were not reported in full, leaving a great deal to the authorsÂ’ own interpretation. A report prepared for the NHS National electronic Library for Health (NeLH) by the Centre for Reviews and Dissemination, based at the University of York, has already stated, “The reliability of the authors’ conclusions cannot be fully assessed” because “insufficient details of the methodological robustness of the reviews included in the systematic review were provided. In addition, few details relating to the quality or the results of the primary studies included in the original reviews were reported”.

Chiropractic is a mature profession, and numerous studies exist which clearly demonstrate that chiropractic treatment, including manipulative and spinal adjustment, is both safe and effective. The profession has always adopted a responsible attitude to research, and has never laid claims that manipulation is the cure for conditions such as asthma and colic but there have been instances where these conditions appear to have benefited from chiropractic treatment. More so chiropractors should be congratulated for carrying out studies, which actively explore the scope of the treatment for such conditions.

In recent years, there have been three Medical Research Council funded research projects with results published in the BMJ. All clearly demonstrate the efficacy and cost effectiveness of the chiropractic management of back pain.

Barry Lewis, BCA President comments: “The vast majority of chiropractic patients are suffering from lower back pain or neck pain. When it comes to back pain, there is no single treatment that has been researched more than chiropractic. No other treatment methodology has come under as much scrutiny, and the recent UK BEAM trial demonstrates that the ‘package of care’ chiropractic offers compares more than favourably with GP ‘best practice’.”

Existing research which Ernst failed to include within the ‘systematicreview’ include: UK Beam Trial; Back pain, exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.
2004 Medical Research Council; ‘Low Back pain of mechanical origin: randomised comparison of Chiropractic from hospital outpatient treatment’; Meade et al. 1990 Medical Research Council (Follow-up-study) Trial ‘Randomised comparison of Chiropractic and hospital outpatient management for low back pain; results from extended follow up’; Meade et al. 1995 RCGP – Clinical Guidelines for the Management of Acute Low Back Pain (1996, 1999, 2001) Clinical Standards Advisory Group; Backpain Report 1994. Acute Back Pain – Primary Care Project; The Wiltshire and Bath Health Commission. Carter JT, Birrell LN (Editors) 2000. Occupational health guidelines for the management of low back pain at work – principal recommendations. Chiropractic Treatment in Workers with Musculoskeletal Complaints; Mark P Blokland DC et al;Journal of the Neuromusculoskeletal System House of Lords Select Committee on Science and Technology report on Complementary and Alternative Medicine November 2000

BCA chiropractors see tens of thousands of patients each day and they provide a safe and effective form of treatment that keeps people of all
ages healthy and happy: Ex England star and rugby player, Austin Healey: “I am aware of recent claims that manipulation doesn’t work. I couldn’t disagree more.
Chiropractic treatment plays an important part in keeping me at the top of
my game.”

Paul Clifton, BBC correspondent “I had a longstanding back injury and I have not the slightest doubt that chiropractic has enabled me to lead a normal life. As a cameraman and correspondent, carrying heavy equipment and travelling are part of my day to day life, without chiropractic treatment I certainly could not do the job I do.”

Professor Ernst has a track record of disparaging not only the chiropractic
profession but also other similarly regulated healthcare professions. Ernst and Canter have carefully selected negative articles in support of their conclusion that manipulation cannot be recommended as a treatment when national clinical practice guidelines, based on much more and better research than the studies this article has selected, has come to exactly the opposite conclusion.

*A systematic review of systematic reviews of spinal manipulation. Ernst E, Canter PH. Journal of the Royal Society of Medicine Vol 20 April 2006, pp189-193.