British Chiropractic Association presents their evidence – do you think it supports their claim for chiropractic treatment of children?
June 19th, 2009
You may remember my recent blog on the case of science journalist Simon Singh who was sued for libel by the British Chiropractic Association (BCA) following a piece Singh wrote about treatment of childhood ailments with chiropractic.
One of the criticisms those working in healthcare and science have made of the BCA hinges on their claim to base their practices on evidence without making it clear what this evidence is.
On Wednesday (17 June) the BCA circulated a third update on their case against Simon Singh which you can read here. Within this document the BCA included a list of 29 publications which they claim represent ‘good’ (but not overwhelmingly conclusive) evidence on the “effectiveness and safety of chiropractic treatment in children”.
So the BCA have now produced the evidence they feel enables them to make decisions about chiropractic treatment of infants. This allows the wider scientific community, healthcare professionals and anyone else with an interest in this topic to interrogate the studies listed.
Many bloggers have been quick off the mark and produced some excellent critiques on the evidence promoted by the BCA. Highlights include:
Jack of Kent’s blog BCA’s worst day (also contains links to some other fantastic blogs on this topic)
Holford Watch’s BCA demonstrates what Evidence Based Medicine isn’t
David Colquhoun reviews the papers on colic presented by the BCA
Ministry of Truth’s analysis of the supplied evidence
along with a further excellent critique from God Knows What
also covered in depth by The Lay Scientist
Since the BCA don’t clearly explain their search strategy or appraisal of this evidence it is difficult to know why they selected these particular papers. It’s also unclear how said evidence is used. We don’t know if these papers are recommended reading for all chiropractors, for example. I have emailed the BCA to ask them for their search strategy, key terms used to identify papers, papers included/excluded in their search, how they appraised the papers finally selected, and how they use these papers to directly inform their treatment of infants.
What does seem immediately obvious (and is clearly outlined in the blogs linked above) is the evidence produced by the BCA does not seem to support their assertions for the success of chiropractic treatment on infants. Indeed, it would be worrying to think these papers have underpinned any practice. Also of concern is the BCA’s assertion they are using evidence based approaches and yet do not appear to demonstrate this fully in the papers they have cited. Not least because they have failed to contextualise how they searched for, selected, and interpreted these publications.
The blogs listed above have all done their bit to critique and summarise the evidence presented by the BCA. What the BCA makes of this remains to be seen. No doubt supporters of the BCA will argue those who’ve already blogged about the BCA’s evidence are biased and were deliberately negative in their reviews.
To counter this claim, as an exercise in good science practice, and a learning opportunity I would advocate that anyone who wants to evaluate the BCAs evidence should have a go themselves. Those of you teaching/researching within the health/social sciences may want to use this as a teaching activity.
I have archived all the papers cited by the BCA that are available electronically. If you’d like to see them, please email me.
Here are some additional resources to help you carry out a critical appraisal of said papers.
[I'll be adding a downloadable table to help you appraise the papers shortly]
Trisha Greenhalgh’s excellent book ‘How to read a paper: the basics of evidence based medicine’ provides detailed instructions on how to critically appraise research using a variety of methods (RCTs, qualitative studies, questionnaires etc).
University of Sheffield’s School of Health and Related Research department have an easy to follow introduction to Critical Appraisal and Searching the Literature which guides you through the process of finding papers and making sense of them.
The Centre for Evidence Based Medicine has a slew of free tools to help you understand evidence and carry out research.
The National Collaborating Centre for Methods and Tools has an equally helpful stepwise guide to the process of collating and interpreting evidence that might improve/inform practice (includes some great links to tools to help with all areas of appraisal).
Surgical Tutor has a stepwise guide to appraising a paper (it focused more on quantitative research, but gives an idea on how to get started). This open access paper from Nature is similarly biased towards assessing quantitative studies, but it’s 10 steps for critical appraisal is still a helpful guide on finding your way around a paper.
Trent R&D have a fantastic resource pack with worked examples that takes you through how to search the literature, find papers, make sense of them, and apply them to your practice.
For a more reflective account on the whole process of understanding evidence, how we do it, and why it’s important I’d recommend reading ‘Just the Facts Ma’am’ courtesy of Canada’s National Coordinating Group on Health Care Reform and Women, which is written from a women’s health perspective but covers in lay terms the kind of questions you ought to be asking about research.
Learning to search the literature and appraise papers isn’t always easy, but is really just a matter of practice. The reason it’s important to use evidence to inform practice is to make sure whatever we recommend for patients/the public is safe and effective.
This is important whoever you are working with, but particularly important if your patients are children.
With that in mind I’d invite you to look again at the list of papers recommended by the BCA and see if you think what they’ve presented justifies chiropractic treatment on children.Tweet