It seems to have come as news to some, but the Vertebral Subluxation Complex (VSC) has been regarded as a historical concept by the BCA and the chiropractic academic institutions for many years. When I was at the AECC 1989 -93 I was taught it as such.
I’ve reproduced the response from the BCA below regarding the GCC statement but there are some who think that the GCC or the BCA rejecting this concept is the death knell for chiropractic. Everyone is entitled to their opinion and I respect those who are willing to put their name to one. I just happen to think the opposite. Not rejecting it would be.
I have been looking into the situation in Denmark, where chiropractors are covered by the health service and have “cultural authority” as specialists in the non-surgical management of spinal healthcare. Patients with back pain can access a chiropractor directly, without requirement for referral from their GP.
How did they get there? Well, they took many important and sometimes very difficult steps. One of the first was that in 1992 the president of the Danish Chiropractic Association (DKF) made a public statement that they were rejecting all historical concepts (subluxation) associated with chiropractic and that chiropractors in Denmark treated musculoskeletal conditions. (Btw, if anyone can get that statement, I would love to see it).
This followed, by accounts I have heard, an extremely emotional SGM where many were making the same arguments as we are hearing now, that without subluxation chiropractic has no identity etc, etc Well, at that SGM they voted to become a profession that treated musculoskeletal problems.
Their identity doesn’t seem to have suffered too much.
I’ll blog later on what other steps they took in Denmark, and how we could learn from them. But for now I’ll reproduce the definition on chiropractic from their association website:
“A chiropractor is a licensed health care professional dealing with investigation, diagnosis, prevention and treatment of pain conditions and reduced function of the musculoskeletal system.”
“BCA Statement on Vertebral Subluxation Complex
The BCA welcomes today’s statement from the General Chiropractic Council (GCC) on Vertebral Subluxation Complex, which appears here http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf
As a responsible organisation, the BCA understands the need to ensure that the public is properly informed about the evidence base for chiropractic treatment so that it is able to make informed choices about the care it receives. For many years, the BCA has not supported the concept of the Vertebral Subluxation Complex in the light of the absence of evidence supporting claims made it can be the cause of disease and serious illness. It also notes that no provider of UK undergraduate chiropractic education teaches Vertebral Subluxation Complex theory in the context of modern healthcare delivery.
The BCA supports and encourages the inclusion of chiropractic in mainstream healthcare provision in the UK. To facilitate the integration of chiropractic, unsubstantiated historical concepts and ambiguous terminology must be discarded in favour of an emphasis on delivering an evidence-based care model that is easily understood by other members of the healthcare team.
The BCA reminds members of their obligations under the GCC Code of Practice and Standard of Proficiency. In ensuring compliance, they should refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access. This advice has no bearing on scope of practice, which is not defined in the Chiropractors Act, but all chiropractors are required to adopt the practice of a reasonable and competent chiropractor.
Chiropractors are the leaders in non-surgical spinal healthcare. There is strong evidence to support the inclusion of chiropractic in musculoskeletal healthcare initiatives, most recently contained in the NICE Guidelines http://guidance.nice.org.uk/CG88 Chiropractors have specific expertise in the assessment, treatment and management of spinal and joint pain syndromes, and are well placed to deliver cost-effective services within the mainstream UK healthcare framework.
Notes to the above statement:
The issue from which this advice stems is that a member of the public has requested information from the GCC about its view on the strength of the research evidence supporting the contention that the VSC is the cause of disease, many health conditions and in some cases, premature death.
The enquiry was made in the context that outcome 4(a) in the current version of the GCC’s Criteria for Recognition of Degrees in Chiropractic, requires that students must “understand the history, theory and principles of chiropractic in a contemporary context” is accompanied by guidance that includes reference to “vertebral subluxation-centred models”.
The GCC’s Education Committee sought observations on the following from the three recognised UK providers of undergraduate chiropractic degree programmes (AECC, MCC and WIOC): –
- How the chiropractic vertebral subluxation complex is covered in the detailed curriculum; and
- What relevant research they draw from.
The detailed responses from each of the institutions can be read in the paper which was considered by the GCC at its meeting on 12 May 2010
The GCC’s Education Committee provided the following advice to the GCC which it accepted at its meeting on 12 May 2010 : –
- The chiropractic vertebral subluxation complex is taught only as an historical concept.
- There is no clinical research base to support the belief that it is the cause of disease or health concerns.
The GCC did consult all of the professional associations and the College of Chiropractors prior to its meeting, and has had further dialogue with representatives at the end of last week. This guidance relates to marketing materials and websites and is not an attempt to define the scope of chiropractic practice.
The GCC’s Guidance is as follows:-
The chiropractic Vertebral Subluxation Concept is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns. Chiropractors are reminded that they must make sure their own beliefs and values do not prejudice the patient’s care – GCC Code of Practice Section 8.3. They must provide evidence based care which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners including the individual chiropractor her/himself – GCC Standard of Proficiency Section A2.3 and the Glossary refer. Any advertised claims for chiropractic care must be based only on best research of the highest standard – GCC Guidance on Advertising – issued March 2010 refers.
Any members referring to the VSC on their websites, are recommended to review the context of the wording used as a matter of urgency to ensure compliance with the GCC’s Code of Practice and Standard of Proficiency and thus prevent the possibility of a complaint being made to the GCC about the use of the terminology.
Please contact BCA Head Office if you require any clarification.
Richard Brown DC, LL.M, FCC, FBCA, FEAC
President, British Chiropractic Association 24th May 2010″