MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

We have discussed the tragic case of John Lawler before. Today, the Mail carries a long article about it. Here I merely want to summarise the sequence of events and highlight the role of the GCC.

  • In 2017, Mr Lawler, aged 79 at the time, has a history of back problems, including back surgery with metal implants and suffers from pain in his leg.
  • His GP recommends to consult a physiotherapist.
  • As waiting lists are too long, Mr Lawler sees a chiropractor shortly after his 80th birthday who calls herself ‘doctor’ and who he assumes to be a medic specialising in back pain.
  • The chiropractor uses a spinal manipulation of the neck with the drop table.
  • There is no evidence that this treatment is effective for pain in the leg.
  • No informed consent is obtained from the patient.
  • This is acutely painful and brakes the calcified ligaments of Mr Lawler’s upper spine.
  • Mr Lawler is immediately paraplegic.
  • The chiropractor who had no training in resuscitation is panicked tries mouth to mouth.
  • Bending the patient’s neck backwards the chiropractor further compresses his spinal cord.
  • When ambulance arrives, the chiropractor misleads the paramedics telling them nothing about a forceful neck manipulation with the drop and suspecting a stroke.
  • Thus the paramedics do not stabilise the patient’s neck which could have saved his life.
  • Mr Lawler dies the next day in hospital.
  • The chiropractor is arrested immediately by the police but then released on bail.
  • The expert advising the police is a prominent chiropractor.
  • One bail condition is not to practise, pending a hearing by the GCC.
  • The GCC decide not to take any action.
  • The police therefore release the bail conditions and she goes back to practising.
  • The interim suspension hearing of the GCC is being held in September 2017.
  • The deceased’s son wants to attend but is not allowed to be present at the hearing even though such events are normally public.
  • The coroner’s inquest starts in 2019.
  • In November 2019, a coroner rules that Mr Lawler died of respiratory depression.
  • The coroner also calls on the GCC to bring in pre-treatment imaging to protect vulnerable patients.
  • The GCC announce that they will now continue their inquiry to determine whether or not chiropractor will be struck off the register.

The son of the deceased is today quoted stating that the GCC “seems to be a little self-regulatory chiropractic bubble where chiropractors regulate chiropractors.”

I sympathise with this statement. On this blog, I have repeatedly voiced my concerns about the GCC – see here, for instance – which I therefore do not need to repeat. My opinion of the GCC is also coloured by a personal experience which I will quickly recount now:

A long time ago (I estimate 10 – 15 years), the GCC invited me to give a lecture and I accepted. I do not remember the exact subject they had given me, but I clearly recall elaborating on the risks of spinal manipulation. This was not too well received. When I had finished, a discussion ensued in which I was accused of not knowing my subject and aggressed for daring to ctiticise chiropractic. I had, of couse, given the lecture assuming they wanted to hear my criticism. In the end, I left with the impression that this assumption was wrong and that they really just wanted to lecture, humiliate and punish me for having been a long-term critic of their trade.

I therefore can fully understand of David Lawler’s opinion about the GCC. To me, they certainly behaved as though their aim was not to protect the public, but to defend chiropractors from criticism.

29 Responses to The GCC “seems to be a little self-regulatory chiropractic bubble where chiropractors regulate chiropractors.”

  • I can fully understand David Lawler’s opinion about the GCC too.

    For example, regarding Prof. Ernst’s comment: “A long time ago (I estimate 10 – 15 years), the GCC invited me to give a lecture and I accepted. I do not remember the exact subject they had given me, but I clearly recall elaborating on the risks of spinal manipulation. This was not too well received. When I had finished, a discussion ensued in which I was accused of not knowing my subject and aggressed for daring to ctiticise chiropractic. I had, of couse, given the lecture assuming they wanted to hear my criticism. In the end, I left with the impression that this assumption was wrong and that they really just wanted to lecture, humiliate and punish me for having been a long-term critic of their trade.”

    I recall that meeting being mentioned by the GCC at the time and later commented on it (in 2010) on the Quackometer blog:

    QUOTE
    “FYI, Professor Ernst attended one of the GCC’s meetings in August 2005, and the following is what the GCC chose to write about his visit in its open minutes of that meeting:

    [GCC] A copy of Professor Ernst’s presentation is attached as Appendix A to these Minutes. Questions to Professor Ernst in the subsequent debate included:

    • Are you familiar with the work of Herzog et al regarding the physical characteristics of cervical spine manipulation and its effect on the vertebral artery?
    • How do you rationalise your view of the chiropractic profession as responsible for most serious adverse affects when osteopaths, some physiotherapists and other professionals also engage on a global basis in manipulation of the cervical spine?
    • Why do you say that osteopaths use mobilisation, which is inherently safer and chiropractors only manipulate, which carries more risk?
    • Where is your evidence of “serious adverse events, such as stroke (sometimes fatal) are regularly reported”? [/GCC]

    Ref http://www.gcc-uk.org/files/link_file/C-040805-Open1.pdf *

    What is particularly interesting about this meeting is that Appendix A, and the minutes of the ensuing debate, seem to be for chiropractors’ eyes only. Considering that the GCC prides itself on being a transparent and helpful regulatory body, what reasons could it have for not publishing such important information?

    It’s worth noting that at the time of that meeting one of the GCC’s main duties (now withdrawn) was to promote** the profession of chiropractic. Perhaps publishing Ernst’s input would have shown chiropractic in too negative a light – in which case it is unlikely that the AECC and BCA would manage to be impartial.”

    Ref: http://www.quackometer.net/blog/2010/11/chiropractors-at-war-with-their-regulator-the-gcc.html#comment-6944

    *It’s now a dead link, but you can still read the minutes here: https://tinyurl.com/ufbznrq NB. Currently, for agendas, papers or minutes prior to 2015, you have to contact the GCC:
    https://www.gcc-uk.org/about-us/how-we-work/council

    ** The GCC’s remit now gives it the power to ‘develop’ the chiropractic profession in the UK. Some might view that as promoting it by another name.

  • “a discussion ensued in which I was accused of not knowing my subject”

    That is a possibility.

    • @ DC

      Prof. Ernst has a thorough understanding of chiropractic. In addition to that, he was Professor in Physical Medicine and Rehabilitation (PMR) at Hannover Medical School (Germany) and Head of the PMR Department at the University of Vienna (Austria). I also understand that he’s been trained in spinal manipulation.

      IMO, it’s understandable that the GCC would try to intimidate him and scare him off. For example, just look at what the Chairman of the General Chiropractic Council wrote in 2004:

      QUOTE
      “In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.” Michael C. Copland-Griffiths, former Chairman of the General Chiropractic Council (European Journal of Oriental Medicine, Vol.2 No.6, 2004)

      Ref: https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1437-statutory-regulation-the-chiropractic-experience.html

      Pretty damning stuff.

    • yes, that’s a possibility.
      but I think that, if the chiro in this case, had had half the knowledge of mine, Mr Lawler would be still alive today.

      • DC wrote: “I have seen him [Prof. Ernst] make three errors in the past few weeks alone. I pointed them out. Errors from someone who ‘understands chiropractic’ would not have made.”

        @ DC

        Prof. Ernst’s understanding of chiropractic has long been thorough. Indeed, it has been comprehensive enough for him to know not to become one. You can learn why from this display of some of his chiropractic knowledge: https://edzardernst.com/2019/01/evidence-based-chiropractic-education-would-mean-that-students-cannot-become-chiropractors/

        Further, I agree with his comment above that if the chiropractor in the Lawler case, Arleen Scholten, had had half of his knowledge, then Mr Lawler would still be alive today.

        Returning to the topic of this post, DC, do you agree that it looks like the General Chiropractic Council’s aim is not to protect the public, but to defend chiropractors from criticism?

        • @Blue Wode

          “Further, I agree with his comment above that if the chiropractor in the Lawler case, Arleen Scholten, had had half of his knowledge, then Mr Lawler would still be alive today.”

          You make me laugh.
          While death by homeopaths are publicized and scrutinized one by one, the deaths from SBB blankets thousand at a time in many a category. If you were concerned about death by medical … you would be focusing in on deaths due to SBM
          I’ve pointed this out here many times, but the drum beat continues to condemn those whom do not have the precious license issued by the state … to KILL

        • He is still making errors. Perhaps his understanding is just outdated.

          I have no insight on GCC motives.

  • This case, and Mrs Arleen Scholten will be considered by the GCC, again.
    It is important, as the role of the GCC is to protect the public so that “patients can be confident that when they go to see a chiropractor they will receive quality care and will be protected from harm.” (GCC Code of conduct). The Code requires chiropractors to:

    • Put the health interest of patients first
    • Act with honesty and integrity, and maintain the highest standards of professional and personal conduct
    • Provide a good standard of clinical care and practice
    • Establish and maintain a clear professional relationship with patients
    • Obtain informed consent for all aspects of patient care
    • Communicate properly and effectively with patients, colleagues and other healthcare professionals
    • Maintain, develop and work within their professional knowledge and skills.

    In this case the GCC will have to determine:
    (i) whether the use by Mrs Scholten of the title ‘Dr’ misled Mr Lawler (and other patients), was intended to do so (what other reason could there be?) and was inherently dishonest – demonstrating a consistent inability to act with integrity (as evidenced by her website and claims in other literature).
    (ii) Whether such behaviour represents ‘the highest standards of professional and personal conduct’.
    (iii) Whether it was a good standard of chiropractic care to manipulate the spine of an 80 year old who almost certainly had spondylolisthesis. He had had surgery to stabilise his lumbar spine – no new X-ray was needed.
    (iv) Whether she established a clear professional relationship with Mr Lawler (he did not realise she was not a doctor).
    (v) Whether Mr Lawler gave informed consent for all aspects of his care (clearly, he did not).
    Mrs Scholten did not explain that chiropractic was founded by D.D. Palmer “as a different system to medicine” and that the consensus of scientific and medical opinion is that subluxations do not exist and therefore, do not need adjusting –that is the unique opinion of chiropractors.
    Chiropractic opinion is not based on evidence nor motivated by scientific altruistic integrity, but by commercial self-interest. What other reasons could there be?
    (vi) Whether Mrs Scholten worked with her professional knowledge and skills.
    If the GCC determines she did, patients and the public must be properly informed as to the standards accepted by the GCC – and associated risks.

    The biggest problem in this matter is that whilst the GMC has a majority of lay members, the GCC’s membership is 50:50. And quite why any knowledgeable lay person would want to regulate a system based on erroneous understanding of anatomy and pathology escapes me. Do they share the faith? The public should be told.
    And why did Mrs Scholten qualify in chiropractic in the first place, and not physiotherapy, osteopathy, or medicine? What were her intentions?

    Effectively, the GCC is on trial.

  • The AMA is doctors regulating doctors. The same occurs in every state in the USA. That is the case in most professions. The ultimate protection being mal-practice lawsuits and the threat thereof.

    • regulating yes, but not protecting wrong-doers

    • The GCC has a statutory duty to protect the public and set standards for the chiropractic profession. While the GCC’s investigations remain based on evidence from ‘expert’ chiropractors on what chiropractors think and do, it is unable to competently fulfil its brief.

      (The expert chiropractor in this case persuaded the GCC’s Interim Suspension Panel that “Whereas there is a temporal coincidence between the onset of Patient B’s respiratory problems and the treatment provided by Dr Scholten there is in my opinion, no biomechanically plausible mechanism that could result in causative injury in regard to the treatment provided. Dr Scholten appears to have not only discharged her professional obligations but acted in an exemplary fashion in her immediate identification of a medical emergency and in taking the appropriate medical action in summoning an ambulance and providing first aid to address Patient B ‘s respiratory distress.”)

      The threat and use of civil litigation is not to regulate, but to compensate for losses. The concept of punitive damages does not really exist in the UK, and in a loser-pays-all-the-costs system, negligence lawsuits will continue to perform an entirely different role from that of regulation designed to ensure high standards of care.

      • It’s interesting that there is “no biomechanically plausible mechanism that could result in causative injury” but we are being told by (?some part of) the chiropractic community that supposed subluxations of the spine are the cause of nearly all known disease.

        Is this having your having your cake and eating it too?

    • I know nothing of the governance of the AMA – which is irrelevant in considering the UK’s GCC.

      Chiropractic is a faith based on anachronistic concepts, should have moved on, has not done so and its schools still seek students who cannot or will not study and qualify in medicine or physiotherapy.

      Patients must be properly informed. Not all read the Daily Mail. The GCC must do better.

      The ‘expert’ was wrong when advising the GCC – on balance of probabilities

      • “Chiropractic is a faith based on anachronistic concepts, should have moved on, has not done so and its schools still seek students who cannot or will not study and qualify in medicine or physiotherapy.”.
        Time to move on, read the research, change your faith based anachronistic concepts an get up to date Richard.
        You are stuck in the past with the subluxationists. 😉

        • @ Critical_Chiro

          Dr Richard Rawlins is correct. Chiropractic has not moved on, unless you have any better data than these https://edzardernst.com/2016/10/top-model-died-as-a-result-of-visiting-a-chiropractor/#comment-83306

          Also, see item 5.14 in the final link here (Performance review – GCC 2015-16) https://www.professionalstandards.org.uk/news-and-blog/latest-news/detail/2017/03/06/the-authority-publishes-its-review-of-the-general-chiropractic-council's-performance-for-2015-16

          QUOTE
          “In May 2015, we had noted concerns expressed by the Alliance of UK Chiropractors (AUKC, representative of over 1,000 registrants) in a letter to the GCC about the revised TOC (Test of Competence). The AUKC expressed no confidence in the TOC based on its view that the procedure was prejudicial and flawed.”

          NB. The AUKC is an affiliation of UK professional organisations. Its vision is “to create a vitalistic, chicopractic model of health and well-being for families in the UK by providing the distinct elements offered by Chiropractic as a healthcare profession predicated upon its philosophy, science and art.”
          Ref: https://www.facebook.com/pg/Alliance-of-UK-Chiropractors-151897244826008/about/?ref=page_internal

          • @BW
            You think Blogs are data?
            Above you cite a blog citing a…………. you guessed it……. a blog.
            You need to move out of your vitalistic bubble (that you ironically inhabit with the vitalists) and start reading/citing research.
            As the research presents itself I change the way I practice.
            The regulars here have devoted so much time, effort and made so many public statements on one point of view that they are incapable of change.
            Once you have made a public statement you have to defend it no matter what evidence is presented.
            It’s human nature.
            Are you capable of moving on Blue?

        • since the 1960’s there has a known association between viscera and paraspinal muscles. Granted, chiros may be confused on correlation vs causation, but nonetheless, there appears to be an association.

          example…

          “Stimulation of abdominal viscera provokes reflex contractions of the paravertebral muscles. The reflex contractions change in intensity and in number of segments involved with variations in degree of stimulus.”

          American Journal of Physiology
          Volume 198 Issue 2
          February 1960
          Pages 429-433

          • do you know many parts of the body that are not associated?
            mostly meaningless in terms of therapy.

          • It’s part of the “anachronistic concepts”.

            There is more than one concept, not all of them are therapy related, but since you have a though understanding of chiropractic you should know that…or not.

          • “since the 1960’s there has a known association between viscera and paraspinal muscles. Granted, chiros may be confused on correlation vs causation, but nonetheless, there appears to be an association.”

            So what? How does this contribute, in any way, to a useful and efficacious treatment for anything (except for fattening of your wallet at the expense of the gullible)?

          • Frank, Richard didn’t limit his comment to treatment.

          • I’ve been diligently looking for some well-established, well publicized, substantial scientific-advance, or scientific-discovery by the chiroquackery-profession since 1960 (just picked an arbitrary date).
            So far, like their patients I keep coming up empty. Though I’ve not had a stroke or a broken neck in my pursuit….2 things the profession CAN lay claim to promulgating, if not actually discovering.
            Seems to me a profession of “doctors” should be able to point to at least ONE scientific advance THEY and their underlying “science” have contributed to human knowledge and understanding in the last 60 years. Perhaps as someone with a normal IQ I’m expecting too much from these greed-based, self-aggrandizing dogmatic apologists. My conclusion: without the resurrection there can be no Christianity…without the subluxation there can be no Chiropractic…the problem is they’re both myths.

  • Critical_Chiro wrote on Tuesday 26 November 2019 at 04:52 : “As the research presents itself I change the way I practice.”

    @ Critical_Chiro

    In that case, you are practicing a very limited modality shared by osteopaths, physiatrists, sports trainers, physical therapists and others whilst being a member of a ‘profession’ that totally confuses the public https://sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

    NB. Blogs are handy for pointing this out, because chiropractor regulators seem very reluctant to do so.

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