Since the Web Archive can not be searched, things there can not be found. So we take this find into the publicly viewable archive:
xhttp://www.chirovictims.org.uk/images/AVC_JANUARY_2007_COMMENTARY[3]_CORRECTED_VERSION[2].doc
_CORRECTED_VERSION[2].doc]http://web.archive.org/web/20070207223548/http://www.chirovictims.org.uk/images/AVC_JANUARY_2007_COMMENTARY[3]_CORRECTED_VERSION[2].docxhttp://web.archive.org/web/20070207223548/http://www.chirovictims.org.uk/images/AVC_JANUARY_2007_COMMENTARY[3]_CORRECTED_VERSION[2].doc
[Das idiotische Skript fälscht die URL. Man muß die URL von Hand mit dem Browser nehmen und dann das "x" am Anfang löschen. Das funktioniert. Thymian]
(spidered on 7th. February 2007)
[*quote*]
Action for Victims of Chiropractic (AVC)It is Six years since we started this campaign, we detail below where we see the state of Chiropractic in the UK with special emphasis on Chiropractic Neck Manipulation. These are the opinions and views of AVC and should not be relied on for any decisions for treatment or making a complaint. Always seek advice from your GP for medical treatment and a Solicitor for any complaint regarding Chiropractic treatment.
Mrs Frances Denoon
January 2007
Introduction: Is it safe? Do they tell us all the facts? Is the GCC working for the public good?
You the patient can only make fully informed choices about your health care if you have access to factual and accurate information that is clearly worded and unambiguous. In our view this quality of information has always been lacking with regard to the practice of Chiropractic in the UK.
Action for Victims of Chiropractic (AVC) has written several times to the UK regulatory body, the General Chiropractic Council (GCC), in an effort to obtain clarification on a number of serious Chiropractic issues. Almost invariably, the GCC’s responses have been vague and evasive, serving only to strengthen AVC’s belief that the protection of the public is not what really lies at the heart of chiropractic regulation.
Drawing on AVC’s correspondence with the GCC, this six year review will look at much of the confusion that surrounds Chiropractic and offer some suggestions as to how the public might be better served by the profession.
The General Chiropractic Council (GCC): Working for the public good?
In 1999, two years prior to its regulatory powers coming fully into force, the GCC issued a press release in which it made clear that it was determined to be an effective and transparent regulatory body. [1] This ambitious policy of openness, undoubtedly designed to inspire public confidence, implied that the GCC could perform its statutory role without reproach. However, the last six years have indicated that its original aspirations have been largely unworkable, not least due to a significant incompatibility in its remit.
In attempting to fulfil the first two of its three main duties - (1) protecting the public, and (2) setting standards of chiropractic education, conduct and practice - the GCC has simultaneously been actively attending to its third main duty, that of “promoting the profession”. [2] In executing this duty, not only has it been remarkably reticent to inform the public that the origins of chiropractic are rooted in pseudoscience, but it has also been persistently reluctant to acknowledge that chiropractic has yet to demonstrate that it is a safe therapy.
Chiropractic Subluxation Theory: What is it? Does anyone know?
Chiropractic was founded by Daniel David Palmer in the United States in 1895. DD Palmer, as he is more commonly known, was a grocer and magnetic healer who had a deep interest in spiritualism and had come to believe, erroneously, that most diseases were the result of 'nerve interference' caused by misaligned vertebrae (‘subluxations’ – as defined by chiropractors), and that health could be restored and maintained by the administration of spinal ‘adjustments’ to correct these misalignments. He hypothesised that such adjustments would help a patient to achieve optimal health or ‘wellness’ by allowing the spinal cord to express its 'innate intelligence' (a metaphysical, non-measurable entity, sometimes known as the 'vital force').
However, this vitalistic philosophy, which is exclusive to chiropractic, has never stood up to scientific scrutiny. It has been shown to be anatomically impossible for misaligned vertebrae to interfere with the autonomic (involuntary) nervous system and no one has ever been able to demonstrate that subluxations exist or cause disease by theoretically compromising neural integrity. [3]
Put simply, Chiropractic subluxation theory is false.
So why would a “transparent” regulatory body omit such crucial historical information from its two main public information resources? [2] [4]
Subluxation-based chiropractic practices: Where is the evidence?
Based on the GCC’s claim that "the term subluxation is not fundamental to the overall practice of chiropractic in the UK", [5] it would be reasonable to assume that the omission is due to subluxation-based practices being rare in the UK. However, on closer inspection there are several indications that the concept of subluxation, even when unstated or denied, is very much fundamental to the practices of many UK chiropractors.
To illustrate this point one needs to look no further than the UK’s four main chiropractic organisations. Three of them blatantly support the subluxation theory [6] [7] [8] and the fourth, although seemingly trying to distance itself from it by making little reference to it, does say that “subluxation” may indirectly cause people to be unable to shake off some illnesses. [9] Although the GCC might say that these organisations are autonomous and that it cannot be responsible for the content of their external websites, the issues raised by them cannot be ignored.
What many people do not seem to appreciate is that chiropractors’ reasons for using spinal manipulation can be very different from those used by evidence-based manual therapists. [10]
On more than one occasion AVC has asked the GCC to produce reliable scientific evidence in support of chiropractors’ claims that they can identify and correct “subluxations” and that such corrective treatment leads to improved health outcomes. But rather than admit that here is no scientific evidence for chiropractic subluxation theory and insist that UK chiropractors abandon their ingrained beliefs about it, and discard their associated manipulation-based treatment approaches (specific spinal adjustments), the GCC has instead offered up complex and incomprehensible explanations for it in an apparent desperate attempt to validate it. [5] [11]
Particularly misleading has been its claim that “There is confusion over the term ‘subluxation’, because it has different meanings for different people. There is, however, scientific evidence for many of the interpretations of the word”. [12] The fact is that there are only two definitions for it: (1) The evidence-based medical definition (i.e. an incomplete or partial dislocation of a joint – frequently the result of trauma, it is a more severe abnormality which tends to occur in areas other than the spine and, as such, is rarely treated by chiropractors), and (2) the scientifically unproven chiropractic definition.
In view of the above, AVC is forced to conclude that any chiropractor who claims to correct chiropractic “subluxations” and who offers ongoing treatment to correct these alleged lesions (often under the guise of wellness care, family wellness care, or preventative maintenance care), is not only misrepresenting a patient’s condition and the therapeutic effects of treatment, but is also needlessly subjecting patients to the risks associated with chiropractic treatment. As the GCC has stated very clearly to AVC that “unnecessary chiropractic treatment should not be provided to any patient”, [13] such practices must surely be indefensible.
So why does the GCC seem to be tolerating these practices instead of outlawing them? Could the philosophical leanings of the GCC’s own members have something to do with this? It would certainly seem so.
GCC Committees: Who makes the decisions and are they working together?
As at least half of the chiropractors who currently sit on the GCC’s committees are members of chiropractic organisations that support chiropractic subluxation theory, it would seem that a fragile political unity is all that is binding the GCC together. Moreover, with the number of ‘vitalist’ chiropractors in the UK increasing, and with the next GCC elections due to be held in June 2007, the practice styles of all 10 chiropractors who will be sitting on the GCC’s committees between June 2007 and June 2012 could be a cause for even greater concern. [14]
So are the contrasting outlooks of the GCC’s current chiropractic committee members responsible for its apparent focus on opinion rather than evidence? [15] And how does the current regulatory set-up impact on the GCC’s duty to develop the profession using a model of continuous model improvement in practice amongst its registrants?
Standards: Who’s checking on who? Are chiropractors checked enough?
In gaining the political credence required to achieve statutory self regulation, the GCC was required to develop and publish a Code of Practice and Standard of Proficiency [16] that would contain binding requirements on chiropractors. These “set out for patients the quality of care they are entitled to receive from chiropractors” and in discharging its duties the GCC seems to rely heavily on chiropractors adhering to, and patients reading, all the requirements embedded in them. [5][11][12][13][17]
But as the scope of chiropractic is not defined by law in the UK, [5] are either of these two documents of any real value to patients?
For example, the GCC claims that its fundamental concern is that neither the advertising nor the application of treatment approaches, which it has acknowledged would include the following -
• adjustment of the atlas and axis (high neck manipulation) to optimise health
• free screenings of asymptomatic infants, children and adults to detect and correct “subluxations”
• regular maintenance/wellness care involving the detecting and correction of “subluxations”
• craniosacral therapy
• applied kinesiology
- should be used to “alarm the public/patients, exaggerate the benefits of chiropractic care, or exploit the lack of understanding of the public/patients”.
However, it claims that “appropriate use” of screenings and maintenance/wellness care “are acceptable aspects of the prevention of musculoskeletal disorders and (where they occur) reducing the impact they have on the health and wellbeing of patients”. [11] This is plagued by confusion since neither the GCC nor the Code of Practice and Standard of Proficiency defines the term “appropriate use”.
In view of this, how can the GCC expect such vague terminology to be understood by patients and the public? This also begs the question, how good is the quality of care that patients are entitled to receive from chiropractors?
Benefits of chiropractic: Are there any? How much evidence do we need to believe?
Section A2.3 of the Standard of Proficiency states clearly that "Chiropractors' provision of care must be evidence based", and Section B2.7 of the Code of Practice requires that chiropractors “must offer enough information to patients for them to take the decision to consent or not. If the patient is not offered as much information as they reasonably need to make their decision, and in a form they can understand, their consent may not be valid”. A related footnote explains that this would include “information on the benefits and risks of the proposed method of assessment or care and any alternative methods”. [16]
Subluxation-based practices notwithstanding, this requirement means that patients who are suffering from low back pain or neck pain will have to be told that the most up-to-date scientific evidence shows that spinal manipulation for these conditions is no better than conventional therapies, [18] [19] [20] some of which are apparently safer, more convenient and more cost-effective. For most other conditions, including migraine, asthma, infantile colic and menstrual pains, they will have to be told that there is no compelling evidence for either spinal manipulation [21][22][23][24] or ‘chiropractic’. [25][26]27][28]
In spite of this, the GCC’s current definition of chiropractic remains very broad and claims to treat a range of conditions. [4] It has even dared to stretch its very strange definition of evidence-based care (which incorporates the “expertise” of chiropractors) to include applied kinesiology and craniosacral therapy [11] despite there being no scientific evidence whatsoever for either of these treatment approaches. But, conversely, it appears to make an allowance for this in its claim that "No health profession limits its approach to treatments for which there is evidence, because for most interventions in healthcare there simply is not yet good evidence”. [12] Although there is some truth in this, it should never be abused by healthcare professionals to serve their own interests. Certainly, it should not be twisted to allow irrational beliefs to override scientific evidence and ignore known risks.
So what are the risks of chiropractic treatment and what is the GCC’s attitude to patient safety?
Risks: Just what are the real dangers? Does anyone know? Should we find out?
As there have been several case reports of serious complications associated with chiropractic treatment (including stroke, paralysis and death), [29][30] it would be more than reasonable to assume that regulatory transparency in this regard would be imperative. However, in view of the GCC’s persistent claims that “there is no evidence that neck manipulation causes stroke”, it would appear that it is very keen to reduce the significance of such reports. [5][12] [13]. It has even gone as far as to assert that "Associating spinal manipulation with ‘stroke and death’ is not supported by research evidence as a causal relationship, but is put forward by alarmist journalism only”. [31]
Nevertheless, the fact remains that serious adverse events associated with spinal manipulation are on record and their frequency is currently not known. [32] Indeed, the risk estimates which are required to be divulged by chiropractors to their patients prior to treatment could actually be very much higher than currently estimated due to under-reporting. [33] This would also include the under-reporting of adverse events experienced by children following chiropractic treatment. [34]
So does the GCC’s stance on this issue convey a genuine concern for patient safety?
Safe practice: Advising potential alternatives would reduce their fees of course.
With regard to neck pain (a non-life-threatening condition which is often treated by chiropractors), it is an inescapable fact that the best evidence available today shows that exercise rather than spinal manipulation is the best treatment for it. [20]
However, rather than acknowledge this responsible risk-benefit assessment by issuing a public statement in support of it, the GCC currently passes off neck manipulation as being one of several treatment “options” available for chiropractors to include in their provision of care. [11]
As all health practitioners should always use the therapy that has the least potential to cause serious side effects, why isn’t the GCC instructing chiropractors to err on the side of caution and to stop using neck manipulation until its safety profile is better understood? Or is the potential for neck manipulation to wreck lives by causing serious injuries - including devastating brain injuries - not to be taken seriously?
With most chiropractors in the UK being self-employed, AVC suspects that the GCC’s current overall position could be directly related to a conflict of interest, i.e. the disclosure of the risks associated with chiropractic treatment having the potential to work against the financial interests of chiropractors by deterring patients from proceeding with treatment. This is underscored by the fact that the GCC’s Patient Information Leaflet doesn’t mention serious risks, [4] and that the GCC has never established a reporting scheme for patients who have experienced complications associated with chiropractic treatment.
Further underscoring AVC’s suspicions is the GCC’s insistence that it doesn’t prevent patients from undertaking their own assessment of the risks of chiropractic treatment. [11]
If that is true, then why wasn’t it prepared to make a strong public statement regarding the clinically unnecessary practices of ‘upper cervical specialists’?
Upper cervical specialists: Of course the GCC say there is little risk!!
It is very possible that a considerable number of patients will, unwittingly, be receiving treatment from chiropractors who consider themselves to be 'upper cervical specialists'. These chiropractors use a technique known as ‘a hole-in-one treatment’. The hole is the top of the spine where the brain stem forms the spinal cord, which then passes through the skull and top two vertebrae to enter the vertebral column. In keeping with original chiropractic philosophy, some chiropractors believe that there is some sort of ‘innate intelligence’ existing in the spinal cord and that highest neck manipulation will release it. One well-respected American chiropractor has this to say on the subject:
"Some chiropractors believe that most human ailments are the result of misalignment of the atlas and axis and that every patient they see needs neck manipulation. Unnecessary manipulation of the atlas, in the area where manipulation is most dangerous, is not uncommon in chiropractic offices. You should refuse treatment by any type of chiropractic 'upper cervical specialist'." [35]
As this technique has no scientific merit, AVC asked the GCC to declare its position on it in the hope of receiving an assurance that it was forbidden in the UK. But rather than condemning it, the GCC would only comment “The GCC does not have a position on a style of practice. The Standard of Proficiency requires that chiropractors select care that is safe and appropriate for the patient concerned, their health and their health needs (section A2.2)”. [17]
With no other government body in the UK to which the public and patients can turn for advice on the risks and benefits of chiropractic treatment, the GCC’s responses thus far could easily be viewed as detrimental to the public that it is duty-bound to protect.
So how does the GCC’s apparent playing down of the risks associated with chiropractic relate to its duty to ensure that chiropractors follow correct informed consent procedures?
Informed consent: It is just not happening. Would you walk out if told all the risks?
In order to obtain informed consent from patients it is a fundamental legal and ethical requirement for chiropractors to provide full information to their patients on proposed treatments. However, a recent survey suggested that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors. [36] As only 23% of survey respondents reported always discussing serious risks of treatments, it is evident that many UK chiropractors have been contravening the requirements set out in the Code of Practice and Standard of Proficiency.
When AVC confronted the GCC with the survey results, the GCC would only comment that it had “embedded the requirement” for chiropractors to provide full information to their patients on proposed treatments in its Code of Practice; that it investigated all complaints against chiropractors; and that it published “learning points for the profession” that arose from all cases that proceeded to hearings by its Professional Conduct and Health Committees. It also said that Fitness to Practice reports were distributed directly to all chiropractors and these were also published on its website. [11]
But are these strategies realistic? Is it really possible for the GCC to effectively enforce its requirement for chiropractors to be “honest and trustworthy” ? [17]
Protection of patients: Much more yet to do.
As already pointed out, one of the GCC’s primary duties is to protect the public with regard to the regulation and practice of chiropractic and with a few disciplinary actions having been taken against UK chiropractors during the past six years it would appear that, on the surface, the GCC has been diligently executing its duty in this area. To the public, this is bound to look very reassuring. But is it? Whilst such disciplinary actions are commendable and should encourage patients (and others) to continue to make complaints, there is a danger that these cases are somewhat isolated and, as such, might be giving a false impression to the public.
With the GCC not having an inspectorate role, and with most of the UK’s 2,000+ chiropractors working unmonitored in private practice, in many cases dealing with patients who have sought chiropractic treatment independent of a GP referral, patients are constantly placed in a potentially vulnerable situation. This situation is compounded by the fact that unless patients have been formally referred to them, there is no compulsion on chiropractors to communicate with their patients' GPs [13] or other healthcare professionals. These circumstances give chiropractors an enormous advantage over their patients since most patients wouldn't be able to distinguish between reasonable therapeutic claims and implausible pseudoscientific theories.
For example, how would patients be able to determine when treatments were being appropriately used and when they might not be valid? How would they know when they might be becoming dependent on particular forms of care? How would they be able to recognise when chiropractors were being dishonest and untrustworthy? Bearing in mind that most patients would find it difficult not to comply with the recommendations of a figure of authority, especially one who holds the title of doctor*, it is worth noting some remarks made by one student of chiropractic history and philosophy in a criticism of the philosophical constructs of the profession:
"The trick to evading accountability, and yet keeping patients coming, is to imply a lot of benefits without saying anything specific.....There are few outcome measures by which patients can judge their progress..... When a patient begins to balk at further care, they can be frightened into continuing care by dire predictions of the 'devastating effects of subluxation degeneration.'" [37]
With regard to current professional standards, it seems that chiropractic is just about anything that chiropractors want it to be. It is all very well having a regulatory body in place to deal with any problems that patients may have, but as long as patients are being deprived of a factual, accurate, and evidence-based resource that would equip them with enough information to recognise problems such as inappropriate treatment, or deceptive or unethical behaviour, then it follows that many of them will remain unprotected and the chiropractors treating them will evade accountability.
* Although chiropractors are legitimately known as 'Doctors of Chiropractic’, it is important that their ‘doctor’ title is not confused with that of medical doctors. A degree in chiropractic does not command the same depth and quality of training as a degree in medicine.
Summary:
With chiropractic being promoted as suitable for people of all ages with acute or chronic conditions, apparently including those who are symptom-free, the modern day reality of chiropractic in the UK seems to be that almost any members of the public could be scared into believing that they require chiropractic care.
Those who do decide to seek chiropractic care will almost certainly be left with the following question to answer for themselves: Is chiropractic about the regular adjustment of scientifically unproven “subluxations” which allegedly prevent a patient from achieving optimal overall health, or is it one of a handful of manipulative professions that can help to alleviate pain and discomfort arising from a limited number of recognised neuro-musculoskeletal conditions? Even a few UK chiropractors have gone as far as to acknowledge this dilemma. The following comments were published in a recent GCC survey:
“13 respondents called for the GCC to differentiate between the various styles of chiropractic. The reasons given for this were that when asked by patients what the differences are they are not sure what they can say and this leads to confusion. It was also said that some GPs will not refer patients to chiropractors because they do not understand the difference between the styles of practice.” [38]
Clarifying the confusion
As one of the GCC’s main duties is to “promote the profession of chiropractic so that its contribution to the health of the nation is understood and recognised” [2] the very least that it could do is to produce a very detailed, clearly worded, and easily accessible resource explaining the essential differences in chiropractic styles, along with reliable scientific evidence to substantiate them and a list of the individual practice styles of UK chiropractors. In doing so it should also provide a list of common chiropractic techniques and practices which it does not consider legitimate and an accurate risk-benefit profile for those which it does consider legitimate.
Hopefully, such a resource would also include a very precise description of the two different meanings of the term “subluxation”, as well as an explanation of the manner in which evidence-based chiropractic care differs from services currently being provided by other manual therapists. For example, if it is not duplicating services already being provided by physiotherapists, what extra services is it offering (apart from more rapid access for patients due to the profession’s primary care status)?
Not only would such a resource reflect the GCC’s determination “to be an effective and transparent regulatory body”, [1] but it would also be in keeping with Section 5.14 of The House of Lords Select Committee Report on Complementary and Alternative Medicine which states that a feature of effective regulation is:
"…to understand and advertise areas of competence, including limits of competence within each therapy." [39]
It would also be helpful if the GCC would define its understanding of the word 'competence' and how it relates to those chiropractors who follow vitalistic subluxation-based practices styles as well as other pseudoscientific or potentially dangerous approaches to patient care.
Reform
It is probably fair to say that much of the current situation regarding the practice of chiropractic in the UK represents a microcosm of the way in which chiropractic is practiced elsewhere in the world.
Fortunately, as with other countries, the UK does appear to have a small number of reformist chiropractors
who limit their practices to the conservative treatment of neuro-musculoskeletal conditions and reject chiropractic's subluxation theory and other pseudoscientific procedures.
It is more than likely that these reformists were among the 11 respondents who, in the recent GCC survey, commented that ‘wellness care’ and the recommendation to patients that they required on-going care to prevent any disorder occurring was “unethical and must be stopped”. [38] As these chiropractors obviously have the courage to address the profession's shortcomings by speaking out, it would be helpful if they made themselves known, perhaps by forming their own association, and thereby allowing the public to have easier access to chiropractors who prefer to administer treatments only for which there is a reliable scientific base.
In the meantime, the rest of the profession might like to heed some words which were written over 10 years ago but which, in many cases, would still appear to be applicable to the practice of chiropractic today.
On the issue of informed choice for patients:
"If relevant information is withheld (a covert lie), or if false information is supplied (an overt lie), there is deception. Under such conditions, treatment is administered under false pretences. Deceived patients are not able to choose freely. Only an informed choice is a free choice. Chiropractors who pre-empt their patients' ability to choose betray their trust and set them up for possible physical and psychological catastrophe." [40]
And regarding the profession itself:
"Perhaps they will reflect on the origin of their profession or reconsider the importance of a scientific attitude and methodology in helping to ensure that their treatment is safe and effective. Only a scientific foundation can elicit the widespread acceptance and respect they desire." [41]
The message is clear. But will it ever get through?
[17th January 2007]
REFERENCES
1. GCC Press Release, ‘General Chiropractic Council takes the lead’, 17th December 1999
http://www.gcc-uk.org/files/link_file/Press_GCCTakesLead_171299.pdf2. General Chiropractic Council, ‘What is the GCC?’
http://www.gcc-uk.org/page.cfm?page_id=73. Crelin E. A Scientific Test of Chiropractic’s Subluxation Theory. American Scientist 61:574-580, 1973
http://www.chirobase.org/02Research/crelin.html4. GCC Patient Information Leaflet ‘What can I expect when I see a chiropractor?’, 2005
http://www.gcc-uk.org/files/link_file/WhatCanIExpect.pdf5. General Chiropractic Council letter to Action for Victims of Chiropractic, 14th October 2004
http://www.chirovictims.org.uk/images/AVC%20Letter%20to%20GCC%20with%20response%20extracted%20in%20red..rtf6. United Chiropractic Association
http://www.united-chiropractic.org/modules/content/index.php?id=47. McTimoney Chiropractic Association
http://www.mctimoney-chiropractic.org/mca.htm8. Scottish Chiropractic Association
http://www.sca-chiropractic.org/index2.htm9. British Chiropractic Association ‘Servicing your spine’
http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Servicing%20your%20spine.pdf10. Homola S. Can Chiropractors and Evidence-Based Manual Therapists Work Together?
The Journal of Manual & Manipulative Therapy; Vol.14 No.2 (2006), E14-E18
http://jmmtonline.com/documents/HomolaV14N2E.pdf11. General Chiropractic Council letter to Action for Victims of Chiropractic, 17th November 2006
(Page 1)
http://www.chirovictims.org.uk/images/GCC%20Letter%20to%20AVC%2017.11.06%20-%20Page%201%200f%203.jpg (Page 2)
http://www.chirovictims.org.uk/images/GCC%20letter%20to%20AVC%2017.11.06%20page%202%200f%203.jpg (Page 3)
http://www.chirovictims.org.uk/images/GCC%20letter%20to%20AVC%2017.11.06%20page%203%20of%203.jpg12. General Chiropractic Council letter to Action for Victims of Chiropractic, 17th June 2004
(Page 1)
http://www.chirovictims.org.uk/images/GCC%20Letter%20Page%201%2017%20June%202004.pdf (Page 2)
http://www.chirovictims.org.uk/images/GCC%20letter%20Page%202%2017%20June%202004.pdf13. General Chiropractic Council letter to Action for Victims of Chiropractic, 8th April 2004
http://www.chirovictims.org.uk/images/Letter%20from%20GCC%208.4.04.doc14. Wight JLG. GCC elections in the UK. Chiropractic Choice 2002;Sept:18
http://www.thechiropracticchoice.com/edition_pdf/sep_2002_18.pdf15. Action for Victims of Chiropractic letter to the General Chiropractic Council, 22nd October 2006
http://www.chirovictims.org.uk/images/Letter%20to%20GCC%2023.10.06.doc16. General Chiropractic Council, Code of Practice and Standard of Proficiency
http://www.gcc-uk.org/files/link_file/Standards_COPSOP_240504.pdf17. General Chiropractic Council letter to Action for Victims of Chiropractic, 15th August 2005
http://www.chirovictims.org.uk/images/Lettert%20to%20GCC%2018.07.05%20(with%20response).doc18. Assendelft WJJ, Morton SC, Yu EI et al. Spinal manipulative therapy for low back pain.
Cochrane Database Syst Rev 2004; 1 CD00047
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000447/frame.html19. Gross AR, Hoving JL, Haines TA et al. Cervical overview group. Manipulation and mobilisation for
mechanical neck disorders. Cochrane Database Syst Rev 2004; 3:CD004249
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004249/frame.html20. Ernst E., Chiropractic spinal manipulation for neck pain - a systematic review. J Pain 2003; 4: 417-42
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14622659&dopt=Abstract21. Hondras MA, Linde K, Jones AP. Manual therapy for asthma.
Cochrane Database Syst Rev 2005;2:CD001002
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001002/frame.html22. Spinal Manipulation for Infantile Colic, CCOHTA, November 2003
http://www.chirobase.org/02Research/chirocolic.pdf23. Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal Manipulation for primary and secondary
dysmenorrhoea. Cochrane Database Syst Rev 2001; 4: CD002119
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002119/frame.html24. Ernst E, Canter PH. A systematic review of systematic reviews of spinal manipulation. JR Soc Med.
2006;99:192–196
http://www.jrsm.org/cgi/content/full/99/4/19225. Bandolier Extra – Migraine Special Issue
http://www.jr2.ox.ac.uk/bandolier/Extraforbando/migspec.pdf26. Balon J et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment
for childhood asthma. New England Journal of Medicine 1998;339:1013-1020
http://content.nejm.org/cgi/content/abstract/339/15/101327. Olafsdottir E, Forshei S, Fluge G, Markestad T, Randomized controlled trial of infantile colic treated
with chiropractic spinal manipulation. Arch Dis Child 2001;84:138-141
http://adc.bmjjournals.com/cgi/content/full/archdischild%3b84/2/138?ijkey=5c02b02767eb5c85cf40ea76aa005172ea29394d28. Ernst E. Chiropractic manipulation for non-spinal pain: a systematic review.
New Zealand Medical Journal 2003;116(1179):U539
http://www.nzma.org.nz/journal/116-1179/539/29. Ernst E. Manipulation of the cervical spine: a systematic review of case reports of serious adverse
events, 1995–2001. Med J Aust 2002; 176: 376–80.
http://www.mja.com.au/public/issues/176_08_150402/ern10520_fm.html30. Neck911USA.com – Victims (10 pages)
http://www.neck911usa.com/vict_deta.htm?id=2585751.5609490731. Coats M., Letter to Editor of Health Service Journal, 26th July 2004
http://www.gcc-uk.org/files/link_file/Press_HSJ_260704.pdf32. Ernst E. Cerebrovascular complications associated with spinal manipulation.
Phys Ther Rev 2004; 9: 5–15.
http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art0000233. Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation.
J R Soc Med 2001; 94: 107–10
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11285788&dopt=Abstract34. Vohra S, Johnston BC, Cramer K, Humphreys K., Adverse Events Associated With Pediatric Spinal
Manipulation: A Systematic Review, Pediatrics, Vol. 119 No. 1 January 2007, pp.275-283
http://pediatrics.aappublications.org:80/cgi/content/abstract/peds.2006-1392v135. Homola, S., (DC), Inside Chiropractic: A Patient’s Guide, p.86
http://www.chirobase.org/03Edu/C/homola.html36. Langworthy JM, le Fleming, C, Consent or Submission? The practice of consent within UK
chiropractic, Journal of Manipulative and Physiological Therapeutics, 2005 Jan;28(1):15-24
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1572603137. Donahue, J. H., (DC) The trouble with Innate and the trouble that causes,
Philosophical Constructs for the Chiropractic Profession, 2(1):21-25 (1992)
38. General Chiropractic Council, A survey of UK chiropractors, 2004
http://www.gcc-uk.org/files/link_file/UK_ChiroSurvey20041.pdf39. The United Kingdom Parliament Select Committee on Science and Technology, Sixth Report,
Complementary and Alternative Medicine, Chapter 5: Regulation
http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12307.htm40. Magner, G., Chiropractic: The Victim’s Perspective, p.178
http://www.quackwatch.org/04ConsumerEducation/BookContents/cv.html41. Magner, G., Chiropractic: The Victim’s Perspective, p.200
http://www.quackwatch.org/04ConsumerEducation/BookContents/cv.html[*/quote*]
[Skriptfehler behoben, Thymian]