On their website, the ASA yesterday published a statement about chiropractic. It outlines which claims UK chiropractors are allowed to make and which are likely to get them into conflict with the ASA. Here are a few excerpts (my comments are added in bold):
Chiropractic is a healthcare profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, with special emphasis on the spine. It emphasises manual therapy including spinal manipulation and other joint and soft-tissue manipulation, and includes exercises, and health and lifestyle counselling…
Why not say as it is: more than 90% of patients consulting a chiropractor will receive spinal manipulations. Therefore the best way to define chiropractic is by its hallmark intervention. Using vague language like ‘manual therapy… exercises, and health and lifestyle counselling’ creates big problems and opens the door to all sorts of therapeutic claims (see below).
In 2017 the ASA carried out an evidence review on the use of multi-modal approaches used in Chiropractic in treating sciatica, whiplash and sports injuries as well as the treatment of babies, children and pregnant women as specific patient groups. The subsequent ASA Guidance explains in more detail the types of claims (including phraseology) that are likely to be acceptable for chiropractors to make in their advertising and those which are not. We recommend chiropractors consider this CAP advice and the ASA Guidance together when making treatment claims in advertising.
Based on all evidence submitted and reviewed to date, the ASA and CAP accept that chiropractors may claim to treat the following conditions:
- Ankle sprain (short term management)
- Elbow pain and tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
- Headache arising from the neck (cervicogenic)
- Inability to relax
- Joint pains
- Joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
- General, acute & chronic backache, back pain (not arising from injury or accident)
- Generalised aches and pains
- Mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)
- Migraine prevention
- Minor sports injuries and tensions
- Muscle spasms
- Plantar fasciitis (short term management)
- Rotator cuff injuries, disease or disorders
- Shoulder complaints (dysfunction, disorders and pain)
- Soft tissue disorders of the shoulder
I am puzzled by this list; for most indications, there is no good evidence at all – unless, of course, we consider chiropractic to consist of ‘manual therapy… exercises, and health and lifestyle counselling’ (see above). But, in this case, the list is still very odd because it would then need to include practically all conditions that can affect humans. Or does anyone know of many diseases that cannot benefit from ‘health and lifestyle counselling’?
…As regulated health professionals, chiropractors may refer to treating specific population groups such as pregnant women, children and babies. However, at present there is a limited or negative evidence base for the effectiveness of chiropractic (here the ASA use the term ‘chiropractic’ not as defined above but as a type of therapy which I think is correct but most chiros object to) in treating conditions specific to those groups, such as colic or morning sickness.
Consequently, references to treatment for symptoms and conditions that are likely to be understood to be specific to babies, children or pregnant women are unlikely to be acceptable unless the marketer holds a robust body of evidence…
And why should this be? Is ‘health and lifestyle counselling’ not effective for these conditions? Clearly it is! So this restriction is illogical.
I think, the ASA got themselves into a major muddle here. The only way to sort it out is to define chiropractic by its main therapy, spinal manipulation, and judge it by the proven risks and benefits of this intervention. (A surgeon will also often give ‘health and lifestyle counselling’, but this does not mean that surgery is indicated for migraine, common cold, asthma etc.)
And if we follow this approach, we instantly see that the ASA list of allowed claims makes no sense whatsoever!