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

A report just published by the UK GENERAL CHIROPRACTIC COUNCIL (the regulator of chiropractors in the UK) entitled Public perceptions research Enhancing professionalism, February 2021 makes interesting reading. It is based on a consumer survey for which the national online public survey was conducted by djs research in 2020 with a nationally representative sample of 1,002 UK adults (aged 16+). From this sample, 243 UK adults had received chiropractic treatment and were surveyed on their experiences of visiting a chiropractor.

Hidden amongst intensely boring stuff, we find a heading entitled Communicating potential risks. This caught my interest. Here is the unabbreviated section:

The findings show that patients want to understand the potential risks of treatment – alongside information on cost, this is the most important factor for patients considering chiropractic care. In fact, having any risks communicated before embarking on treatment scores 83 out of 100 on a scale of importance.

Many patients report receiving this information from their chiropractor. Seventy per cent of those who have received chiropractic treatment agree that risks were communicated before treatment commenced.

What does that suggest?

  1. Patients want to know about the risks of the treatments chiropractors administer.
  2. 30% of all patients are not being given this information.

This roughly confirms what has long been known:

MANY CHIROPRACTORS DO NOT OBTAIN INFORMED CONSENT FROM THEIR PATIENTS AND THUS VIOLATE MEDICAL ETHICS.

The questions that arise from this information are these:

  1. As the GCC has long known about this situation, why have they not adequately addressed it?
  2. Now that they are reminded of this flagrant ethical violation, what are they planning to do about it?
  3. What measures will they put in place to make sure that all chiropractors observe the elementary rules of medical ethics in the future?
  4. What reprimands do they plan for members who do not comply?

20 Responses to 30% of UK patients are not informed by their chiropractor about the risks of the treatment they are about to receive

  • whilst I second your comments above, I have a further question.

    To what extent can we be certain that the 70% who have supposedly “communicated potential risks” have in fact communicated an appropriate, accurate or comprehensive level of risk of treatment to these patients? This is a very broad generalization.

    And how was this “communicated?” A notice in the waiting room? A leaflet? A specific talk through the possibilities?
    This is the important part of “informed” consent.

  • Doesn’t seem to mesh with this survey…

    Ninety-three percent said they always discuss minor risk with their patients but only 23% report always discussing serious risk.

    Journal of Manipulative and Physiological Therapeutics. Volume 28, Issue 1, January 2005, Pages 15-24

    • well spotted!
      except you overlooked that the survey you mentioned was of chiros; the one I discussed was of patients.
      who do you think is more likely to be telling the truth?

      • Let’s see

        Someone who does it everday

        Someone who saw a chiropractor maybe 5, 10 or 20 years ago?

        • @ DC

          you don’t think it’s possible that chiros might be just a little bit biased?
          people are bound to think they do things better than they actually do in self-reported surveys.
          way more than 50% of people regularly say they are better than average drivers or are of above average intelligence………only somehow that doesn’t add up.

          I think we need a fly-on-the-wall survey.
          that might help clear up what they are actually treating as well.

          • John, this report doesn’t tell us how long ago the person saw a chiropractor. Is someone going to remember the details of a conversation that happened 10 or 20 years ago?

            It’s silly to even discuss this report and reeks of desperation for someone to even share it here.

          • @ DC

            I wasn’t the one who posted the study.

            In any event I was referring to the chiro’s reported figures being inflated by bias.

            what evidence do you have that chiros are doing a better job on informed consent?

          • Well when Ernst claims they lie and you said their self reports are too biased, it’s pointless to proceed.

            But one can look at legal cases such as:

            Hannemann v Boyson 2005 in Wisconsin.

            Judge Pollock ruling in 1999 in New Jersey.

            What is taught in chiro college classes using such books as Professional Chiropractic Practice.

            How well are chiropractors truly complying with informed consent? Most likely better then 25, 50 or 75 years ago…as with MDs, PTs, etc.

            Do they need to do better…yes.

          • “Ernst claims they lie”- DID I?

          • @ DC

            fascinating.

            I note that in the case of Hannemann v Boyson 2005 in Wisconsin which you listed that the court defined Chiropractic thus:

            “In relying upon that decision, the court noted
            that a chiropractor does not treat or diagnosis disease; but rather a chiropractor’s
            practice is limited to the analysis and correction of subluxation.”

            Since the court believes that the sole purpose of Chiropractors is to search for and treat a non-existent condition I am not certain how much faith we ought to have in the US court system.
            Of course they also have a touching faith in bite mark analysis and blood spatter analysis and various other forms of pseudo forensic analysis better suited to keeping innocent people locked up than to convicting the guilty.

          • Non-existent condition?

            Perhaps you are referring to what some chiropractors attach to the condition.

            Or are PTs, DOs and MDs also addressing a non-existent condition when they do spinal manipulation?

          • @ DC

            did you not read the quote? here it is AGAIN:

            “In relying upon that decision, the court noted
            that a chiropractor does not treat or diagnosis disease; but rather a chiropractor’s
            practice is limited to the analysis and correction of subluxation.”

            “analysis and correction of subluxation.”

            Since chiros use the word “subluxation” to mean a very different thing from what MDs and PTs do when they refer to a “subluxation” and since the latter is a REAL entity which can actually be identified on an X-ray and is a relatively rare event I think it is quite obvious what I meant.

            However if my meaning escaped you I shall spell it out. The court defined your profession (if one can really call it that) as the pursuit and correction OF AN ENTIRELY IMAGINARY ENTITY since the “chiropractic subluxation” DOES NOT EXIST IN REALITY but only in the imagination of chiropractors.
            Even chiropractors as a group cannot be relied upon to agree from a set of X-rays or patients whether these same individuals have matching “subluxations.” They are highly inconsistent.
            Within the “profession” they cannot agree whether this entity exists or not.

            So that’s how the courts defined it. MDs or PTs who do spinal manipulations are not looking to correct “subluxations!”

            That the entire “profession” began with an imaginary belief system ought to be enough to make us highly dubious about anything that emanates from it. The continued association of many chiros with the belief that they can heal other organ systems by manipulating the spine is highly problematic as is the association of chiros with other forms of pseudoscience such as homeopathy, naturopathy etc and a strong association with anti-science and anti-vaccine views generally.

            Since there is no reliable means of telling whether someone might be lucky enough to consult of of the few science based chiros who just engages in evidence based manipulation therapies it must be safest to advise everyone to avoid the whole bunch entirely. And one has to ask – why see a chiro anyway? Why not just see a PT? No danger of ending up with a quack spewing misinformation and diagnosing non-existent subluxations and the possibility of harm.

            I don’t see that the “profession” has a purpose. There are all the risks and no advantages – so why bother?
            It’s just an ego trip to dress in a white uniform, call yourself Dr and crack joints.

          • John, perhaps a history lesson is in order.

            The word subluxation, as used within manual therapy, was first seen in Osteopathy in the late 1800’s. This was a variation of the use of the word by the medical profession at that time. Later, a few of DD Palmer’s students used the word in the first textbook on chiropractic. Prior to that, there is no record that DD Palmer called what he adjusted a “subluxation”. After it was printed in a textbook, of course this created some conflict between MDs and DCs as the definitions varied. DD Palmer then wrote that the chiropractic subluxation is what the MDs refer to as a sprain. It is assumed that this was an attempt to try and ease the confusion. However, by this time the word was becoming common within the chiropractic profession and eliminating its use was, shall we say, had barriers.

            Over the course of the next several decades, the definition and description changed. There are some within the profession today who hold onto some of the original definitions and description. Of course, research to date has not backed up these antiquated definitions. Thus, we are seeing a shift in the profession to consider the word “subluxation” as a historical usage.

            I have no problem leaving the word and it’s antiquated views into the history pages. However, it does appear there is a spinal lesion that may respond to spinal manipulation in some cases. Osteopaths refer to it as a somatic lesion. MDs may refer to it as a paraspinal muscle spasm. PTs, well, they tend not to call it anything, they just do “thrust joint manipulation”. I have seen some PTs call it a manipulable lesion.

            So, you have a problem with “subluxation”? OK. Take it up with those who still use and believe in it’s antiquated definitions and concepts (approximately 20% of the profession).

          • @ DC

            I have a problem?

            chiros have a problem as a group. Some individual chiros have a problem The US courts define chiros by the use of the very word. this was in the very case law that you yourself referred me to.

            It confuses clients and the general population.

            It isn’t I who have the problem.

          • Your problem is with the word subluxation and it’s definition as used by some in the profession. I understand.

  • The biggest risk is that gullible and vulnerable patients risk being misled and taken advantage of.

    The basic information that any patient contemplating treatment by a ‘chiropractor’ is:

    “‘Chiropractic’ is a proprietary term invented by a Canadian born ‘magnetic healer’ working in Iowa in 1895, who believed that blockage of ‘innate intellegence and vital magnetic energy’ could be beneficially achieved by the ‘manipulation and adjustment of subluxations’ of the spine.
    Orthodox doctors, anatomists, surgeons, physiologists, pathologists and radiologists have found no evidence such ‘intellegence’ and ‘subluxations’ exist – and chiropractic is regarded as a SCAM.”

    Any chance chiropractors will be honest about what they are up to?

    • What percentage of chiros still hold that view?

      Has the profession in general evolved or are we obligated to believe what Palmer believed?

  • This is an important point and, as you said, has been an ongoing issue for a long time. The same report highlights the fact that the public think chiropractors can treat conditions that they are not allowed to advertise to treat, such as whiplash: https://twitter.com/compandalt/status/1367765487506100229?s=20 The most obvious explanation for the public holding this incorrect understanding is that chiropractors continue to advertise for and treat these conditions. The regulator makes no mention of this in the report and doesn’t appear to have any plans to tackle it even though it is surely their duty to protect the public from being misled.

  • Keep in mind that informed consent wasn’t well received within the medical community. It came out of legal actions in the 1950s, at least in the USA.

    Yes, chiropractors need to have informed consent.

    Is a poorly presented web based report going to give us much insight, I think not.

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