Tuesday, May 19, 2009

Chiro-Bullies

The Simon Singh meeting last night was strangely enjoyable. I say 'strangely' because while it obviously would have been far better if it hadn't been necessary the event was simultaneously informative, funny, heart-warming and energising. When a large crowd turns out for something like that, if nothing else, it confirms that you're not mad for thinking the way you do.

If you're interested there's a decent summary of the evening on the New Humanist website and the New Scientist piece ("there was a sense last night that we are at the start of something important") is good also. I was, inevitably, far and away the least informed of the speakers. Nick Cohen, Dr. Evan Harris MP. and Simon Singh were all fantastic in different ways. This really isn't about one case - Simon just happens to be the unfortunate soul at the centre of this particular whirlwind - there's a far wider issue at work and for freedom of speech to prevail both here and abroad it's obvious that Britain's libel laws need to be changed.

I'm tempted to write up everything I learned last night but it would turn into a 100,000 word dissertation if I'm not careful and there are bound to be far better sources of information out there for things like this. Suffice to say that when an Icelandic bank can bully a Danish newspaper into silence by using English courts something is clearly wrong with our system. Google the phrase 'libel tourism' if you really want to see how bad it is or read this article from the Times for a snapshot of the frankly embarrassing situation we're in.

Anyway... I don't think I expressed myself as clearly as I'd have liked last night and with the benefit of some sleep I thought it would be worth clarifying what I think about the situation in specific and general terms. (That said Jack of Kent remains the best source of information for this case - go and subscribe.)

Here's a thing. A couple of weeks ago I genuinely didn't know that chiropractic was a form of alternative medicine. I just thought it was another word for - or a distinct branch of - physiotherapy. I really did. I mean, they help your bad back by manipulating your bad back don't they? Don't they? If you've read America Unchained you'll know that my first director, Stef, was forced to leave the film because of a bad back. You'll also know that before her health forced her to leave, we were forced to take some not-really desirable detours so that she could visit a succession of chiropractors. Well at the time, I genuinely believed she was seeing what I would call 'proper-doctors.' I'm embarrassed by this gap in my knowledge.

Now I'm not suggesting that alternative therapy doesn't work at all. If it floats your boat that's great. My personal belief is that half an hour of kindness has a greater placebo effect than 7 minutes with your GP... and oddly, I reckon paying for it, increases the effect even more. But that's only really applicable to illnesses of the basic will-sort-themselves-out-eventually variety.

I think it's hugely concerning that the British Chiropractic Association produced a leaflet suggesting that chiropractic treatments were an appropriate way of dealing with colic or childhood asthma. I mean... if you're treating colic you're talking about treating babies. And if you're talking about manipulating the spine and/or joints of babies I think it's natural to be concerned. It makes me wince just thinking about the manipulation of a fully grown adult's, developed spine... but a baby's? Seriously? (Maybe there's some other chiropractic treatment that doesn't involve that sort of thing, in which case some clarification would be great. As would a new definition of chiropractic.)

Anyway, I only know about this leaflet having been produced (I believe it has since been withdrawn) because of this law suit and the attention it has brought to the case. If they hadn't sued Simon for libel, I wouldn't know anything about this. I'd still be under the more positive impression that they were 'proper-doctors-for-when-you-have-a-bad-back'. More fool them.

Of course there are other ways they could have reacted. Now, I'm not a doctor or a chiropractor or a baby so I don't know whether chiropractic offers a genuine treatment for these childhood complaints. I know what my gut instinct (and basic, layman's knowledge of how the body works) tells me... but putting that aside and entertaining both possibilities... here's how I think a reasonable organisation should behave:

1) If there is evidence for chiropractic being an effective treatment for colic and/or childhood asthma: Put the evidence forward and engage in a debate on the subject. No matter what side of the debate you fall on I can't honestly see an argument against this course of action. If you wholeheartedly believe that chiropractic offers an effective treatment how could you want less investigation of its efficacy? Who would possibly argue for less enquiry into something that involves manipulating babies' bones? More research = More information = Better treatment.

2) If the evidence suggests it isn't an effective treatment for colic and/or childhood asthma: Then surely you have to withdraw the leaflet and apologise. When a supermarket sells something that has the potential to be dangerous - say, a faulty kettle - they don't just stop selling it, they also make best efforts to ensure that anyone who's bought one returns it. This normally involves some pretty big adverts in national newspapers. If I was responsible for advertising a medical treatment that I later realised wasn't proven and could be dangerous I'd feel a huge responsibility to publicise and correct any misinformation that might be out there.

As far as I know, the BCA haven't taken either of these steps. (As I said above, I believe that the leaflet has been withdrawn but I have no idea if that is as a consequence of anything having been written about it or for some other reason.)

What they have done is sue a science writer who wrote an article offering his opinion on such practices. In doing so, they don't just intimidate one man, the message they send is that they do not welcome critical investigation of what they do. Which seems ridiculous to me because a) critical investigation of things is how science and medicine move forward and b) surely anything relating to medical treatment - especially treatment of children - should be open to scrutiny as a matter of public interest.

Who are chiropractors? What do you think they think? I imagine them to largely be of the caring, woolly, liberal type. (All adjectives I'd be happy to carry myself.) I think that's certainly the image they would choose to project. Which, to me, makes the BCA's decision to sue for defamation a mistake. It has changed the way I feel not just about what they do but also who they are.

No matter what you think about chiropractic, whether you dismiss the entirety of it as hogwash, believe it can sort out your bad back or believe it can cure 95% of illnesses in men, women and children alike, I simply can't see an argument for trying to silence its critics. It seems to me that an organisation that would best represent its members by encouraging debate has done them all a huge disservice by instead resorting to libel law; the blunt weapon of the bully.






EDIT: to add that Nick Cohen has since blogged on the subject also:
http://nickcohen.net/2009/05/20/simon-singh-and-the-battle-for-free-speech/

47 comments:

chris-coltrane said...

Your opening speech last night was absolutely spot on, and filled the room with positive feelings and confidence. Fantastic work.

Tina Mammoser said...

Thanks for that. :) I'm in two minds. The main me is a terrible sceptic and generally dismisses most natural remedy type things without any evidence.

Yet I see a chiropractor because at one point my back got so bad I could hardly stand and a friend recommended him. At that point I was willing to try anything.

But my chiro has always explained things to me and he has helped me with muscle and tendon problems as well as manipulating my back. Twice I've been seriously injured and his diagnosis and advice were exactly the same as my GP but he also was able to give some relief. I'm sure in many cases the manipulation is equivalent to massage - and has the same benefit. I think your comparison of honest kindness vs. 7 minutes at GP rings true. (oh, and my back almost never has problems anymore, if it does it's stress or sport injury) Perhaps I'm lucky and just have an excellent chiro who has physio knowledge beyond the chiropractor training - it's the only explanation I have for my positive anecdotal evidence.

So I agree wholeheartedly about the BCA. Bullies definitely. Dishonest, possibly. As you say they seem to want to take no action to back up their claims so how can we do anything but judge them sceptically?

sorry, I tend to ramble.

carmenego said...

I thoroughly enjoyed your spat yesterday, I was also inspired by your words to set up my own blog today *yay* that I will send out to all my woolly CAM family members and lovely sceptical friends.

Incidentally, I've been trying to find blogs or comment pieces written by those in support of the BCA and am finding it rather difficult. Are there any? I'd really love to hear the other side of the argument.

Thank you for shaking my hand yesterday, my friend Dave was suitably jealous and I got to lord it over him for about 4 minutes, it was a small but priceless victory.

Carmen x

Crispian Jago said...

Great to see (and hear) you at the Penderels Oak last night adding your support to Simon’s case.

Like you, until I saw an episode of Penn & Teller’s “Bullshit” on Chiropractors a couple of years ago, I was under the impression that chiropractors came under the banner of “medicine” as opposed to “alternative medicine”. I therefore assumed that they provided scientifically tested and proven techniques for spinal injuries and didn’t realise they made claims on treating other seemingly non related ailments.

You make some valid suggestions in your post, but I’m sure if the chiropractors had firm evidence (or optimism of producing firm evidence) to support their claims of its effectiveness for treating the likes of colic and asthma, they would be trumpeting it to the rafters. I’m also sure that Simon and all other genuine scientists would be prepared to change their opinions if such indisputable evidence were to come to light. However, I suspect there is little chance of the BCA following the steps you outline because they feel safer abusing the poor English libel laws to attempt to suppress free speech and uphold their reputation rather than actually providing solid evidence for their claims.

Until the English Libel laws are repealed I thought about practicing some alternative medicine myself. Here are my treatments:
http://crispian-jago.blogspot.com/2009/05/trick-or-treatment-2-more-alternative.html

John Braine said...

I'm extremely suspicious of chiropracters. I went to one for while and he screwed me for every penny he could. At one stage I had lsot my job and told him I couldn't afford it anymore and he somehow convinced me to do one last spinal scan or whatever it was. Another 80 quid.

Prior to that, the practice had 'an open day', which in hindsight I can't believe we fell for. It was just an exercise to try and rope more people in. I picked up my chart one day following the open day while he was out of the room and it had something like "brought possible candidate to open day... girlfriend or wife?".

For all I could see it was nothing more than a money making scam with no real care for the patient at all.

On top of that I can do eveything that they do myself. The neck is easy but you can do all the other bits too - a physio showed me.

I'll never being going back to a chirporacter and - definitely not with the extortionate fees they charge for the little they do.

Anonymous said...

I think the thing about the practice of chiropractic is that it overlaps with normal physiotherapy and can make people with musculo-skeletal problems feel better.

Read lots about it here: http://www.chirobase.org/

However, the theory behind chiropractic contains a great deal of mumbo-jumbo and the claims of many chiropractors go way beyond anything for which there is hard evidence.

All that aside, we ought to be free to discuss the efficacy of things like chiropractic without fear of being sued.

I think this will backfire for the BCA because the public's atttention will be drawn to the hocus-pocus side of chiropractic.

@Schroedinger99

bob said...

When my daughter was a baby, after months of suffering colic, and us suffering the screaming, my wife took her to a chirpractor. We all had a lovely night's sleep that very night.

Completey unscientific and anectodal.

I have absolutely no idea if this was cause and effect or simply coincidence. My gut tells me that it was coincidence.

From my wife's description of the session, in hindsight, I think there was some cold reading involved.

I also thought the same at the time, that chiropractors were legitimate medical professionals. Even though it may have helped us, and even though I've mentioned this to people in the past as something they might try, I've not done so for a while now. I would counsel against it. It's scary that I let my daughter's baby spine be manipulated by someone as qualified in healthcare as DrGillian McKeith.

Tim Minchin nails it in a verse of his beat poem, Storm:

And try as hard as I like,
A small crack appears
In my diplomacy-dike.
“By definition”, I begin
“Alternative Medicine”, I continue
“Has either not been proved to work,
Or been proved not to work.
You know what they call “alternative medicine”
That’s been proved to work?
Medicine.

Phil said...

I was there last night (I was the one who wished you well on your ride) and thank you very much for your contribution. This case needs as much support as possible from high-profile contributors, although for various reasons it's being underreported (sub judice or just editors running scared?)

There's a Skeptics in the pub meeting tomorrow, in the same venue (Penderel's Oak, Holborn), whose topic is Alternative Medicine on Trial, hosted by Singh's collaborator Edzard Ernst. Your readers interested in this topic are encouraged to go along.

Claire said...

I'm studying complimentary medicine (not alternative, never alternative) albeit not to be a chiropractor (I also had no idea it was classed as CAM). All I wanted to say in response to some of these comments was that we aren't all nutters. Do you really think if someone comes to see me and they have gangrene and their foot is falling off the first thing I'll do is ask them about their relationship with their mother? I'm in it because when I had Chronic Fatigue Syndrome I was told there was nothing more anyone could do with me and I had to live with it. So I tried complementary medicine and it worked. But that doesn't stop me referring people to doctors or telling them to stop taking their asthma medication and it never will. It will never be an alternative medicine for me, it will always be complimentary.

And I certainly don't screw people for all that I can get. I know only too well what it's like to have no money. I would love to specialise in helping people with CFS and providing it at a low cost.

I am concerned though that what EBM misses in it's serach for the double blind randomised controlled trials are valid observations. The parachute has never, according to the British Medical Journal (do a search for parachutes) had an RCT done on it but it still appears to work.

Dave I enjoyed reading your blog. Thank you :) Very valid points.

My turn to ramble. I never get involved in these debates because I'm not articulate enough. But I was feeling brave.

Anonymous said...

I saw a chiropactor twice a week for chronic back pain for 9 months - if I missed an appointment my pain came back with a vengance.

A friend recommended a local physiotherapist so I went for a visit barely able to walk and four visits later was cured - no problems since.

Probably says it all really - the chiro chap was very friendly but it didn't really do me any good!

Dave Gorman said...

@Claire: the fact that we have differing opinions about what complimentary medicine can do is fine because I suspect that we'll agree that more research helps rather than hinders the debate.

I don't know what branch of complimentary medicine you're in or whether it has an association equivalent to the BCA. If it does, I hope you would want them to engage in debate and offer up evidence rather than to try and bully people as the BCA are doing.

I disagree with you wholeheartedly about the validity of observations made outside of double blind randomised controlled trials. RCTs are the best way of removing anecdote and bias - which is surely a good thing.

I'm not sure your analogy with the parachute works. There is a huge difference between an invention that can be explained by known physical laws and a medical intervention that has no such rational explanation.

That said, over time I suspect enough people have had the misfortune to fall from great heights without parachutes to build as strong an experimental case for the parachute as is needed.

Any treatment that could demonstrate a cure rate as high as the survival rate for parachutists would, I'm sure, be welcomed by scientists of all stripes.

bob said...

I heard to day that Switzerland have had a referendum and voted 68% in favour of providing Homeopathy on their equivalent of the NHS. How utterly bonkers is that ?

At the end of this article on biometric passports. I can see how there would be a debate with pros and cons on biometric passports, but homeopathy ? That's just bonkers.

Marianne said...

Very much appreciated everyone's words on the subject last night.

Thank you so much for standing in front of the camera with me yesterday - I know it's horribly cheesey and it's the first time I've had enough respect for a famous person to ask!! Made my evening.

Anyway.
I have long been angered by the pseudoscientific rubbish that's all over television (often in adverts) and poor journalism around scientific issues (BBC being a regular culprit).

This crosses so many lines, though, as you say, Simon's case is not the only one. It's fantastic that he has the means to fight this ruling and hopefully together we can all bring about a productive shift towards fairness and sensibility in the law (is it such an unattainable dream?!).

I hope as the year progresses we see some positive developments. Fingers crossed.

Dr Aust said...

Dave

The leaflet in question may be gone from the BCA's website but it lives on on the websites of some of their members - either in (PDF) leaflet form or in the form of large chunks of adapted / cut 'n' pasted text. See here for a couple of examples.

The sort of claims made, including the stuff about chiropractors being able to treat just about anything you like in tiny babies, are bog standard stuff for UK chiropractors. Anyone in doubt should just check some websites.

Anonymous said...

When I had back and shoulder pain I went to an ostiopath - six half hour sessions really did the trick, the pain hasn't recurred. But can someone explain the difference between an ostiopath and a chiropractor? Thanks. Murray

Michael Gray said...

"Slack back-crack-quack hack attack flak"Are you able to insert this phrase of mine into your comedy routine? ;)
It's yours for the asking!

Anonymous said...

I have read a lot of journal articles by Edzard Ersnt as well as some by Simon Singh. I cannot help but wonder if the "bogus" word was the penmanship of Ernst rather than Singh and that Singh has now been caught up in Ernsts' adgenda, rather than his own independent analysis of the chiropractic profession.
If one was to look at the peer review literature into the "medical" treatment of conditions such as enuresis, colic and asthma, one would see that the efficacy of "medicine" is no better than chiropractic. In fact some of the drugs and treatments are downright dangerous. I would imagine many medical practitioners cringing at the idea of having to give evidence in court as to the "scientific" validity of some of the care they give. Clinically it may work, but the reasons may not be known.
The chiropractic profession was scrutinized in 1979 with the New Zealand Commission if Inquiry. Evidence was provided by the chiropractic profession, Medical profession and the physiotherapists as well as other interested parties. It was unbiased, yet came out in favour of chiropractic. This extensive report has yet to be "bettered" or superseded by anything equivalent.
Perhaps there should be an Inquiry into the validity of the treatment of neuro-musculo-skeletal conditions by physiotherapists, osteopaths, orthopaedic surgeons and "medical manipulators". As an example, the use of therapeutic ultra-sound has been proven to be useless. Yet it is still extensively used by physiotherapists. Is this scientific?, Is this good health care? The use of the anti-inflammatory Vioxx causes 38,000 deaths and 88,000 patients heart problems in the five years it was on the market. In New Zealand 13% of all hospital admissions are due to iatrogenic (physician, irrespective of profession) complications, reported in the New Zealand Herald last week.
Even homeopathy, the "soft"target of all the skeptics is a lot safer that anti-inflammatories. It may do you no good, but at least it will not do you harm. It will not kill you, and it even may help, even if it does rely totally upon the placebo effect for its action. The same cannot be said for a lot of the treatments available from the pharmaceutical industry.
These are just a few of the inconsistencies I see in the arguments raised by some of the bloggers. In other words, what we are seeing is "selective information dispersal", with no real balance.

BaldySlaphead said...

Thanks for the write up, Dave. I wasn't in a position to attend the meeting but what you've written here seems eminantly sensible and fair.

Guy Herbert said...

Trouble with the supermarket (or kettle-company) withdrawal notice comparison is this: They are selling lots of things, and they can always sell you a kettle that does work, because a kettle is a generic thing that doesn't depend for its market on their endorsement. An association of alternative practitioners is only selling the impression that their members are doing something useful. They can't very well withdraw that, regardless of whether they are right or wrong in fact.

Dave Gorman said...

@Guy Herbert: The thing is this whole situation leaves us unclear as to what the BCA think about treating these specific childhood (and baby) illnesses with chiropractic. They produced a leaflet but withdrawn it. They've also filed a suit against someone who criticised it. So I have no idea whether or not they stand by it or not.

Given that manipulating a babies spine seems like an inherently dangerous thing to me - it would be good to know whether they stand by the leaflet or not.

If they think that chiropractic is not an appropriate treatment for children with asthma or babies with colic, I think it's important that they actually say so. It's not enough to simply stop producing the leaflet that says it can help.

Of course that's if they think it isn't an appropriate treatment. Like I say, these events rather leave us guessing as to what they think about this.

If they think it is an appropriate treatment, I think it's reasonable to accept that learned, educated, men of science think it might be harmful - which suggests more research is necessary.

If they think it isn't appropriate I think they have a moral duty to say so. Loudly.

Angus Walker said...

Facetious comment: it is not 'complimentary' medicine (i.e. free) - that's what you get on the NHS. CAM practitioners are at the other end of that scale! It is 'complementary' medicine (i.e. filling in missing bits).

More seriously, I hope this is a pyrrhic victory for the BCA and that their own actions tarnish their image rather than Simon Singh's. Why don't we all email the BCA (enquiries@chiropractic-uk.co.uk) to ask disingenously or directly whether their practitioners can treat childhood asthma etc?

On the comment about the Advertising Standards Agency, frustratingly they don't uphold complaints about cosmetic companies' claims (e.g. 86% firmer skin, although at least they now have to mention they cheated with lash inserts on mascara adverts). This is because, apparently, no-one believes the claims anyway and they are just 'puff'. Still don't see why they should get away with it.

Dave Gorman said...

@Angus Walker: that's not facetious - that's good copy-reading of a too-hastily typed comment.

Re the pyrrhic victory... well, the initial ruling seems to have gone their way but things aren't over yet so it might not be a victory at all. But yes, whatever happens, their behaviour should embarrass them. It shows that they're not prepared to debate and instead behave like bullies

The ASA might not act on the claims of the cosmetic companies... but at least their products have to be tested to show that they're safe. (Don't they?)

Single Track said...

Well Dave, what can I add to this? Nothing I don't think though I've been trying to make sense of it (speech, freedoms, Web 2.0 in general) on my own blog

http://singletrackroads.blogspot.com/2009/05/web-20-jedi-or-sith.html

and it seems sometimes like the world can be a scary place. Like you said in your post "When a large crowd turns out for something like that, if nothing else, it confirms that you're not mad for thinking the way you do."

Keep up the good work.

Skepticat said...

It was a great evening, thanks for your contribution and your excellent post, Dave.

My own review of the evening is here:

http://skepticat.wordpress.com/2009/05/19/the-bca-v-simon-singh-pt-2-the-nerds-are-revolting

Claire said...

@ Dave @ Angus

It's wasn't hastily typed. I simply have dyslexic fingers (possibly not helped by missing four years of school due to CFS). But thanks for pointing that out. Immensely helpful. That said, I do and will continue to do complimentary medicine (for free) as well as complementary medicine. Just never alternative.

@Angus You can't generalise to all CAM practitioners being at the other end of the scale. I'm not. I'm not in it for the money as I previously stated. I'll be lucky to break even. Or be out of debt anytime in the next 30 years.

@ Dave The analogy with the parachute wasn’t mine it can be read in full here:

http://www.bmj.com/cgi/content/abstract/327/7429/1459?

I assumed that as it was peer reviewed it was valid? If that sounds facetious it honestly isn’t meant to be.

Of course I agree that research helps rather than hinders. And bullying is abhorrent in any form.

Dave Gorman said...

@Claire: don't worry, when I said it was "hastily typed" I was referring to my own comment not yours. I assumed Angus's self styled facetious comment was aimed, kindly, at me.

Angus Walker said...

@Claire

Point taken about some CAM practitioners offering cheap or free treatments, and good on you for aiming to do so. The 'cranial osteopathy' place that was in Cavendish Square, London (don't know if it's still there) also does so. I would also be interested to know which branch of complementary medicine helped with your chronic fatigue syndrome.

Re complimentary/complementary, I appear to have touched a raw nerve and anything I say will probably inflame the situation (so I'm not about to become a physiotherapist - or a chiropractor). I am just a sad pedant.

Think Logic said...

Thank you for an entertaining and informative speach on Monday. I will be blogging about this, as you suggested, as soon as I get the time.

I've already taken the lazy option and facebook-posted it.

Mind you, that will reach a larger audience than my blog will :)

I didn't think the guys who spoke after you were as funny, but that short chap had a couple of good lines about politicians.

Mojo said...

"If there is evidence for chiropractic being an effective treatment for colic and/or childhood asthma: Put the evidence forward..."

Actually, the ASA recently asked a chiropractor and member of the BCA to put forward their evidence that chiropractic is an effective treatment for colic (among other conditions). The result can be seen here:

http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_46281.htm

Dave Gorman said...

@Mojo: that link is fantastic. I had no idea. I recommend you follow it, but for those too lazy to do so, it shows that a complaint against an individual chiropractor's advertisement was upheld by the Advertising Standards Authority.

"We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).

2. Upheld
We welcomed Dr. Carl's assurance that the practice would no longer refer to its chiropractors as doctors in their future advertising to avoid misleading readers.

On this point the ad breached CAP Code clause 7.1 (Truthfulness).

Action
The ad must not appear again in its current form. We told Dr. Carl not to refer to the treatment of IBS, colic and learning difficulties in future."

Nash said...

@Murrey
The difference between Osteopaths and Chiropractors is that Osteopathy is actually more evidence based. Also an Osteopath uses gentle manipulation rather than violent cracking movements and Osteopaths don't do the Chiroprators neck twist (a movement very similiar to how a commando would break an enemy sentry's neck)

Aiken Drum said...

Whatever the outcome of the libel action, I fear the perception of chiropractic in the minds of the general public will be mostly unchanged. A few scientifically or skeptically minded people will follow Simon's case and curse and shout and blog amongst themselves but millions will ignore it unless it is thrust under their noses.
What can we do to make this story top of the news? Does anyone know why I can't find a single mention of this on the BBC's website?

Lewis said...

Thanks for the post Dave and for hopefully raising public awareness of this issue. I like your approach here, you don't really need to engage in the debate of whether Chiropractic works or not to make the argument that they should not resort to intimidating legal action.
I've never really thought about the English libel laws much and was frankly shocked to read about this and discover that Simon was being put in the position of defending something he didn't actually say(depending on your interpretation). It's a ridiculous ruling.
Like you I used to view Chiropractic in a kind of physiotherapy/osteopathy way, though learned a while ago that's not so. I think this may be a fairly common gap in public knowledge, hopefully this trial will bring attention to both Chiropractic and the libel laws. You're doing your bit so thanks.

pvandck said...

John Braine said...
For all I could see it was nothing more than a money making scam with no real care for the patient at all.Don't you think that description fits much of the rest of CAM, particularly homeopathy, which is why some of us refer to it as sCAM (so-called Complementary and Alternative Medicine). And homeos have been pretty keen on the legal threats front in recent times too rather than reveal the evidence; with pretty disastrous results thankfully.
But the whole issue of resorting to legal process and abusing the libel laws does prompt the question that all sCAMmers should be required to answer - that is, if there is evidence why not produce it? Why resort to the law when the evidence would silence the critics for good?

One can only point to the obvious conclusion that there is precious little if any evidence.

Olle K. said...

I have posted this email to the BCA:
Sirs,
Thank you very much for sueing Mr. Singh for libel. Your action has helped opening my eyelids at last: From believing that chiropractors were serious health professionals, I now see a behaviour that, sadly, reminds me more of a religious sect than of a scientific association. I realize that you most likely have no factual data to prove that Mr. Singh was wrong in whatever he may have said, because then you would have showed it. And whatever opinion he may have expressed, your own behaviour is the most revealing and the most defamatory to yourselves. So whether you win or lose the legal case, you have lost in the real world. Sincerely, Olle (etc. Full name, professional title and address, Sweden)

Rob Shorrock said...

It is so interesting that many people I know who have used chiropractice as a treatment and profess to its benefits are appalled and shocked at what the BCA are doing and some have even raised it with their own chiropractors who are equally astounded.

The real problem is a deep defensiveness in the alternative medicine world against rational investigation of methods. They do themselves a real disservice by not opening themselves up to real scientific scrutiny. The reason for this is that the priority is not really about advancing scientific understanding of human biology, but about protecting commercial interests. As we discover more an more about the power of placebo - which the alternative therapists are well aware off - it shatters some of their so called unique techniques and with it their investment.

Anonymous said...

Why has no-one decided to comment on the BCA's reply which sets out a number of studies and papers in support of chiropractors claims?
Perhaps if SS had chosen his words more carefully or put his allegations to the BCA for comment prior publishing or even apologised for his article since, he might not staring down the barrel that he is now.

Dave Gorman said...

@Anonymous: the question should surely be why the BCA didn't feel able to put this 'evidence' forward in a counter article, commentary on the original article or in some other public debate instead of filing a defamation case.

The problem now is that the case has nothing to do with whether or not chiropractic is an appropriate treatment for colic etc. but all about whether or not they believed it to be so.

I would have expected a responsible organisation to be more concerned with the search for truth than with the more trivial matter of whether they were deliberately misleading people.

Whatever the outcome of the case it will do nothing to prove - or disprove their claims because it's simply not what the case is about. And surely - as a matter of public health - that would be the thing worth looking at.

Anonymous said...

Where is the BCA statement which they claim refutes Simon's statement.

They claim to have presented 28 papers he "should have read", but they omit to mention which 28 they were. Cut and paste obviously challenging at the BCA.

Anonymous said...

The consequences of this action will be that no Health Care Provider, including pharmaceutical companies will be able to list the conditions that may benefit from treatments, unless peer review and randomised controlled trials have been done. There is a big problem with this, which is probably why at least 80% of allopathic medicine is essentially unproven. For example, how do you run an RCT for the treatment of appendicitis. Who wants to be in the group that gets no treatment?. Over the counter medications such as Paracetemol will be unable to list symptoms of PMT, migraine, etc. as those RCT's have not been done for these treatments.
Singh admits to having no expertise in chiropractic or complementary medicine, and Ernst, a former specialist in physical medicine and rehabilitation has long demonstrated extreme bias against chiropractic. His writings fall well short of peer-review. Writing in the BMJ in 1999, Dr Gordon Waddell, a leading UK orthopaedic surgeon and back pain auhority, described Ernst as offering “inter-professional confrontation under the guise of scientific objectivity.”
I wonder who really wrote the "bogus" article, It has the penmanship of Ernst, not Singh.

Anonymous said...

For a very good understanding of the efforts people like Stephen Barrett and Edzard Ernst go to discredit the chiropractic profession, follow the following link.
http://www.chiro.org/LINKS/New_Zealand_Report.shtml
Under oath Dr. Murray Katz was found to be unrelaible, and Barrett's organisation was totally discredited.

Palinurus said...

@Anonymous "For example, how do you run an RCT for the treatment of appendicitis. Who wants to be in the group that gets no treatment?"

Controlled clinical trails can be and are conducted for surgery. The standard practice is, I believe, to compare two existing treatments or to compare a new treatment against an old treatment.

You can also look at less rigorously controlled studies for evidence of effectiveness. For example, you can compare people who have not had surgery for some reason (e.g., no access to hospitals) to individuals who have (trying to match for possible confounding variables). Such studies are useful even if they aren't considered as good as RCTs.

There are lots of treatments that haven't been evaluated in this way and should be. There are limited budgets to do the studies. This is why more research is needed and it is important that the research as high a quality as possible (to avoid wasting those resources).

DrH said...

@Claire:

That parachute RCT you keep banging on about was in the well-know Christmas Edition of BMJ. It was a joke. Or meant to be, it's what passes for humour in medical circles. The entire Christmas edition is full of silly articles. Unfortunately, many CAM practitioners just don't get the joke and keep citing it seriously.

Stefaan Vossen said...

Dr.H, the parachute RCT was not a joke, it was food for thought. Food for thought about the fact that as a clinician you are exposed to uncertainty, risk, a chronic lack of absolute knowledge and the fact that you have to make educated decisions regardless of all of the above. That you can't freeze in the face of lack of evidence based practice, but that you must let common sense prevail. Not so very funny really is it?
Some of the people here think that being a clinician is an easy job and although chiropractors don't save lives they regularly stop them from being lost (5 life-threatening, undiagnosed conditions last year in my case alone) something they have to be well-trained to do. I was trained first as a physiotherapist, then specialised in neurological rehab and then trained as a chiropractor. My cousin was a GP (7 years in Belgium) and retrained as a chiropractor. Trust me, if you are in any doubt that chiropractors are well-trained I would advise you look at the curriculum. My father is a GP and is in awe about what I know about backs. One of the main referrers to my practice is the neurosurgery department at a local hospital (testimonials to be read on my website). I am saddened by the fact that some people here seem to pick on one thing, then the next, then the next and at every angle we are supposed to prove ourselves worthy. You will find chiropractors who do bad things to good people as you will find in all professions, but that doesn't make the profession bad. And you will find chiropractors who do good things for people and that, in itself, does not make the profession good either, it just makes the care they received, from that particular person good. That they happen to be a chiropractor is really quite unexciting in itself. But obviously this lack of excitement won't shift books neither will it enable spitting of gall. Clinical practice is not about excitement it is about a special brand of stoicism, where humility and knowing that you don't know are interlaced with a sense of servitude to the patient. That some people make claims, behave unprofessionally and show poor ethos is really only testimony of their own standing, not that of a profession, or are all GP now to be considered serial murderers?
Stefaan Vossen

richard lanigan said...

As luck would have it, I answered your first question on colic in April 2010 as a challenge to Simon and skeptics generally. My question was what would they do if their child had properly diagnosed colic.This is a child who cries constantly every day and does not stop when picked up by the parents (the placebo) http://www.chiropracticlive.com/if-your-infant-has-colic-why-not-try-spinal-care-dare-i-say-chiropractic/

Your choices are limited, let the child suffer, or find somebody who might help. Possibly the best evidence out there for helping colic is chiropractic, not a lot of money being invested into this kind of research and so students do much of it.

Although the research evidence is not conclusive, most of whats out there out there is chiropractic. As a chiropractor I have supported Simons right to write his article from day one as I would anybody with a nose or an opinion. However one should keep in mind where Simon's expertise is, its not anatomy, physiology, or clinical science. I would be more than happy to go on a platform and debate clinical science and chiropractic with any skeptic.

Most chiropractors are a bit scared of you lot and see skeptics as the bullies, however there are some of us would relish the opportunity of public debate rather than twitter debate, simply because skeptics( which I realise include some medical doctors) understanding of "evidence based medicine" is so limited, that it is laughable. Perhaps Dave you could outline your understanding of evidence in a clinical setting?

Dave Gorman said...

@Richard Lanigan: well, I would be a bit scared of letting someone manipulate my child's spine if there wasn't good evidence for both the efficacy of the treatment and their training in it.

Your willingness to debate chiropractic with skeptics is great. If all chiropractors felt the same, maybe there'd be a willingness to do proper trials.

Unfortunately the actions of the BCA suggested that they didn't want to have to justify their treatments, they just wanted to silence their critics. That's no way for anyone seeking authenticity in a medical field.

Things are improved by scrutiny. What all fields of 'alternative medicine' should be doing is the research required to be, y'know, just medicine.

Everyone wants people to be better. Everyone wants a child with colic to stop crying. Do proper RCTs. Get a proper body of evidence together. Demonstrate to people that it works.

richard Lanigan said...

Hi Dave,
First point you dont manipulate an infants spine the way you would an adult, the cervical spine of an infant is the size of my little finger, you use very little force. In paeds you are relying on the experience of the practitioner rather than "published evidence". Some people will have heard good things about me and bring their child, they see I have four very healthy children who have never had any kind of medication. They may decide to try it,they may not, its a matter of choice, which many skeptics dont want people to have, because of prejudices, not evidence. The evidence base for most child interventions is sparse for obvious reasons. Would you allow researchers to experiment on your child.When this happens you end up with the Bristol heart scenario. Do you think GPs are well trained in Paeds? Who messed up many childrens immunity by over prescribing antibiotics for conditions like otis media. Do you have evidence that chiropractic is harmful to children?I would not manipulate my children or anybody elses if thought I was likely to hurt them, would any parent.

I am not a BCA member, however in 2007 I was elected on to the GCC to regulate the profession and was thrown off after 9 months, (wasnt because I refused to wear a suit and tie at meetings). Lets face it chiropractic politicians are as incompetent as any other politician. GCC spent over £100,000, High Court orders, and charges of defamation have been used in an effort to shut down my blog, and I did not have a book to sell, nevertheless I was very supportive of Simons right to express his opinion of chiropractic.

The irony in all this is both the BCA and GCC basically agreed with Simon Singh but were afraid of the loss of membership revenue for saying it, so being very litigious, what started as sabre rattling to please BCA members escalated out of their control.

Research costs money and the chiropractic profession spends the little they have, where the money is in back pain, not paeds conditions.There are about 3,000 chiropractors practicing in the UK 80,000 in the US possibly 100,000 worldwide and we dont have a pharmceutical industry doing research for us

What percentage of NHS interventions do you believe are supported by RCTs 100%, 50% 20%. Then you have the problems when an intervention looks good on the healthy research subjects used in the RCT and you dont get the same response when people have underlying problems as happened with Vioxx.A drug intervention does not have any variables that could confound results, Manipulation is very dificult to control for because its entirely dependent on the skill of the individual delivering the manipulation. Thats why Sackett attached importance to patient values and the role of experienced practitioners in his model of Evidenced Based Practice.