Tuesday, May 12, 2009

Two Things (Part B)

I've split what was one post with two subjects... into two separate posts. Revisionism! Yes. That's right. Good isn't it? Only I wasn't expecting it to garner quite so much attention. But if people are linking to this because of what I've written about the Simon Singh case, I figured it would be easier if that was all they found when they got here.

So... here's that bit:

There's a science writer. His name is Simon Singh. He writes great books about science (one of which inspired a stand-up routine of mine a while back) and writes articles that I think successfully convey the beauty of science and maths to people whether or not they have a sciencey background. I like Simon Singh. He's a good man.

Now... I'm going to tread as carefully as I can here because I'm discussing a legal case. Now, while chiropractors can help with some problems there is, as far as I'm aware, no medical evidence to suggest that they can deal with certain other things... like children suffering from colic or asthma. But the British Chiropractic Association were (and might still be) making claims that their members could help deal with these and other problems.

This seems to me to be an interesting area for discussion and certainly something that a science writer (especially one who has, with the world's first professor of complementary medicine, co-authored a book on the subject) should be writing about. It's important that people know what can and can't be treated in what way. Some complementary treatments have their place in the world but they're harmed if there is obfuscation and/or misinformation about them which if nothing else only helps to bolster the view of cynics who then might overlook the genuine good than can come from other parts of what they do.

Now - I hope I'm treading carefully enough - Simon wrote about this. As I read it he was careful to define his terms. If I was the BCA and I wanted to challenge him about it I'd bring forward the evidence supporting my claims. After all, that's what should be debated. Can they help a child with colic? Are there tests that say they can? If not, why not? Etc.

Instead they have sued him for libel. Which seems like a heavy handed way of silencing a critic. And the preliminary hearing - which helps to define the nature of the case - does not appear to have gone well. It seems the judge has decided what Simon meant when he used the word 'bogus' - even though the judge's view of the word's meaning is a) different to the dictionary definition and b) different to the definition contextualised by Simon in the article. But because the judge has decided that his version of the word is what Simon meant... the case now has to proceed on that basis. Lawks.

One wonders what hope there is for journalism when a science writer cannot describe as bogus, something for which there is no scientific evidence. I mean... we'll end up with nobody able to question anything... and isn't questioning things what both science and journalism are sort of about? I mean, really?

Anyway... I fear I haven't explained this very well. There's a far better explanation of it on the brilliant Jack of Kent blog. As well as taking in that particular entry, I'm going to be using Jack of Kent to help me follow the case as it progresses. It's a free-speech thing. Worrying times.

33 comments:

Anonymous said...

no you explained it very well.
bek yip

Damien said...

Isn't 'free-speech' getting more and more expensive of late...
Disappointing to see the 'sue first - ask questions later' mentality has found its way to the UK.

Dr Evan Harris said...

Thanks for the post about Simon Singh, Dave.

I am an MP who campaigns for science, evidence-nased pollcy and free speech so this case is pulling all my levers.

I met Simon earlier this week and I am pleased he has decided to fight this.

It is vital that this case is not lost because it will chill scientists, journalists, writers and even comedians from criticising the work of others which is vital component of the scientific method. It will also embolden the non-evidence-based (so called "alterntive") health care industry to threaten any critic of their apporoach, work or claims. It will also add credibility to the claims of these organisations.

Some of Simon's friends and supporters will be organising a campaign around these issues. Please watch out for news of it and get involved.

Evan Harris

Dave Gorman said...

Thanks Evan. I couldn't agree more about the importance of the case and the wider implications.

I'm attending a public meeting on Monday to do with this. If you are there also I'll look forward to meeting you there.

To others who read this: if you want to know more, I think the Jack of Kent blog linked to above is probably the best conduit for information.

Twaza said...

Chiropractic is becoming libel-based medicine.

Ginger Yellow said...

Unfortunately for freedom of speech, English libel law doesn't care what the author meant. It cares what a reasonable person would understand the allegedly defamatory statement to mean based on the "natural and ordinary meaning" of the words. To be honest, I think the sentence as a whole is defamatory whether or not "bogus" is taken to imply deceit. I also happen to think it's true, which is a defence. But it's going to be very hard for Singh to prove that it's true under Eady's definition.

masseyis said...

"isn't questioning things what both science and journalism are sort of about"

I'm not sure that chiropracty (is that the word?) is particularly interested in science. I don't believe it applies the type of evidence-based practice that HPC recognised health professions do. So I think the unfortunate situation is that a science writer is assuming that a scientific approach would be appreciated by a profession that isn't part of the scientific community. That's not to say that it doesn't work, just that it doesn't apply the scientific method.

Anonymous said...

Ah, libel law: the last refuge of scoundrels. As far as the Hon. Mr. Justice is concerned, here are some facts:

- His libel rulings have caused an international fracas, prompting the state of New York to pass legislation protecting NY residents from what the governor called court actions "inconsistent with [American] First Amendment rights;" the New York Times warned that British libel law could "infect this country and diminish our proud tradition of freedom of expression;" and legendary Manhattan District Attorney Robert Morgenthau publicly attacked the ruling's effects on American citizens.

- In private practice, he represented Lee Kuan Yew in his libel suits against opposition figure JB Jeyaretnam. In 2002, the IPU said of these suits, "the sequence and timing of the defamation and bankruptcy proceedings brought against Mr. Jeyaretnam suggest a clear intention to target him for the purpose of making him a bankrupt and thereby removing him from Parliament."

In a bitterly amusing aside, the appellate court upheld the damages against Jeyaretname, saying that the damages (including accrual of interest) were in-line with the penalties affixed in "recent defamation cases," citing only Lee Kuan Yew v. Seow Khee Leng and Lee Kuan Yew v. Derek Gwyn Davies. "Mr. Eady ... conceded that in England interest has never been awarded in a defamation action, but drew our attention to the case of Lee Kuan Yew v. Derek Gwyn Davies ... where interest was also awarded." It's tempting to conclude that "Lee Kuan Yew libel law" constitutes its own branch of jurisprudence in Singapore.

Well. Even without a judge without the Hon. Mr. Justice's background, defending a libel case under UK law is bagai anjing menyalak di ekor gajah, as the famous Malay proverb goes: like a dog barking at the tail of an elephant. Best of luck to Mr. Singh, who's certainly on the side of the scientifically-accurate angels.

More cheerfully, Dr. Harris is a genuinely good and great man, and I feel myself entitled to some envy on the far side of the ocean that Oxford West and Abingdon should be so well represented in Parliament. I don't believe his predecessor should have lost his libel case, either, but it is refreshing that a science-based LibDem succeeded the odious Patten, who once issued a paper warning teachers of potential criminal liability in the discussion of contraception in sex-ed classes, and in 1992 warned that, "Dwindling belief in redemption and damnation has led to a loss of fear of the eternal consequences of goodness and badness." Sometimes the good guys win out after all.

Dave Gorman said...

@masseyis: "That's not to say that it doesn't work, just that it doesn't apply the scientific method."I'm afraid this seems a wholly ridiculous statement. The "scientific method" simply means testing things to see if they work or not. It's not a belief system. If a treatment is effective it will stand up to scrutiny and be shown to be effective.

If not believing in the scientific method is a get-out clause I might as well claim that reading this blog can cure colour blindness. If you tell me that I'm happily promoting a bogus treatment I'll sue you for libel. The argument that there is no scientific evidence to suggest my claim is true is irrelevant to me because I simply do not believe in the scientific method.

Sheesh.

masseyis said...

@Dave: "'That's not to say that it doesn't work, just that it doesn't apply the scientific method.'I'm afraid this seems a wholly ridiculous statement"

It's not wholly ridiculous. If it hasn't been tested, then one can make no statement either way. It is just as unscientific to say something doesn't work just because it hasn't been tested. The best one can say is that we don't have any evidence to make a judgment. So I can't say that it doesn't work. I can't say it does, either.

P.S. I believe we've had a 'heated' discussion in person when you visited Imperial as part of the Carling Ice tour about 11 years ago and I heckled you. Glad things don't change...

Dave Gorman said...

@masseyis: If you want to sell a drug that cures colic you have to test it. I see no reason why any other treatment should be offered without being subject to the same tests. Especially one that is potentially harmful - which chiropractic treatments are.

Besides, what research has been done -and despite your assertion that they don't apply the scientific method, there has been some - doesn't support these claims. Edzard Ernst is the world's first professor of complementary medicine. He practised Chiropractic techniques and thought there was a need for critical evaluation. So he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

(I know this from the original Simon Singh article - now removed from the Guardian's website.)

Like I say, the scientific method isn't a belief system. It exists. It shows that chiropractic treatments are not an effective way of treating problems unrelated to the back.

Chiropractors can help with problems relating to the back, though. But there are dangers involved and I wouldn't recommend anyone undertake such treatment without first understanding the risks. Of course to do that you'd have to apply more of that pesky scientific method. Grrr.

masseyis said...

But again, you're making claims that I don't believe are supportable. You say that a chiropractor can help with back problems, but since I don't believe that has undergone scientific study (I haven't done the legwork to check), I don't think that claim is supportable.

Particularly when you take into account that Chiropractor isn't a protected profession, so anyone can practice as one with no qualifications. So it would be hard to define 'chiropractic technique', no?

Personally, I would only ever want to be treated by an HPC registered profession (like a physio) that has to be evidence based.

Dave Gorman said...

@masseyis: then we agree on something. I also wouldn't want to be treated by a chiropractor.

I'm not defending chiropractic treatment at all. I'm just saying it should be subject to scientific scrutiny like any other kind of medicine.

Your initial post - suggesting that they weren't interested in the scientific method - read to me as a defence of them... as if you were suggesting that as they weren't interested in it, it wasn't actually applicable to them and Simon was wrong to have tried to do so.

Twaza said...

masseyis said...

"You say that a chiropractor can help with back problems, but since I don't believe that has undergone scientific study (I haven't done the legwork to check), I don't think that claim is supportable."

NICE (the National Institute for Health and Clinical Excellence) has done the legwork and recommends in their draft guideline on Chronic Low back pain: "Consider offering a course of manual therapy including spinal manipulation of up to 9 sessions over up to 12 weeks"

See http://www.nice.org.uk/nicemedia/pdf/LowBackPainNICEGuidelineConsultation.pdf

Spinal manipulation can be provided by a chiropractor, physiotherapist, etc. They do the same things but give different reasons why they do them.

NICE reviewed evidence on effectiveness. It did not review evidence on how spinal manipulation might work. So, the (draft) guideline cannot be used as an evidence overview on the explanations that chiropractors give for their treatments. It may be that the explanations are right. Or, it may be that the explanations are wrong, but the method is as effective for chronic low back pain as other (slightly) effective treatments.

masseyis said...

@Dave: Quite the opposite - I think that you can expect defensive reactions such as libel claims from a non-scientific community. Even more so from pseudo-scientific communities. If a group of people isn't scientifically based, they will almost certainly not appreciate the criticism that comes from scientific rigor. Even many that are supposed to be, don't appreciate it. For e.g. the advice around breastfeeding is considered sacrasanct and studies suggesting otherwise are attacked almost as if through a witch hunt.

@Twaza: "Spinal manipulation can be provided by a chiropractor, physiotherapist, etc. They do the same things but give different reasons why they do them."

If a profession is unregulated, how can you say they're doing the same things?

Mojo said...

masseyis wrote,

"@Twaza: "Spinal manipulation can be provided by a chiropractor, physiotherapist, etc. They do the same things but give different reasons why they do them."

If a profession is unregulated, how can you say they're doing the same things?"

Chiropractic and physiotherapy are both regulated in the UK.

Stefaan Vossen said...

Hi Dave,
1.there is plenty good quality evidence to refute Mr. Singh's claims
2.Mr. Singh was invited to enter in proper scientific debate (where evidence and their respective values are assessed)
3.Mr. Singh refused to enter in scientific debate
4. Neither Mr. Singh or Prof. Ernst have any expertise in the field of chiropractic or osteopathy, making study of these subjects quite difficult
5.the chiropractic professions (in particular the BCA) is saddened that it needed to use libel laws to protect its name
6. not protecting its name would have been tantamount to being fair game for future, similarly unfounded assaults
7. Prof Ernst has a well-documented history of delivering his own brand of revisionist science which has led to both his discreditation and repeated apologies.
In conclusion; these are not bad people, I believe. They are just misguided in their confusing world of conflicting agendas.

http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Singh/BCA%20Statement%20170609.pdf

Regards,
Stefaan Vossen

Twaza said...

Stefaan

Could you show us the evidence you referred to?

Was the libel writ served on Simon Singh an invitation "to enter in proper scientific debate"? If not, could you show us the invitation?

Could you explain why you need to be a chiropractor to assess the evidence provided by a scientific trial of chiropractic treatment?

Why do you think that Edzard Ernst does not have the training to understand chiropractic? Have you looked at his CV?

Could you show us where and when Edzard Ernst has apologized for what?

Just curious

Thanks

Stefaan Vossen said...

ps. Chiropractors don't evade the scientific debate. In fact, for a profession with only short off 3000 practitioners in the UK and a treatment form as complex as chiropractic care (which by the way is not the same as spinal manipulation therapy-smt is a very small part of our tool kit) they are as a profession one of the relatively speaking most scientifically prolific healthcare professions.
The chiropractic profession, as was pointed out earlier is regulated, and to train as a chiropractor takes 5 years at BSc and MSc level followed with the possibility for PhD and continued professional development. Bascially everything you would expect from a profession that deals with patients who haven't seen their GP for years and may indeed present with serious pathology (and trust me they do).
If you bear in mind that we train not only in orthopaedics, neurology, pathology, microbiology, anatomy, neurophysiology but also in radiography, are licensed to take and read X-rays, refer for MRI or CT scans and know a thing or three about drug interactions and adviseable surgical procedures, your back would be very much in good hands with chiropractors.
And the best thing is; the GP's, the surgeons, the clinicians who deal day in day out with this stuff get it, and maybe it is time for certain people to just realise they don't really know that much about it and maybe should start asking questions rather than make bold unfounded statements.
"the scientific process is not one of become more right, just of becoming less wrong"
Stefaan

masseyis said...

Stefaan, is it no longer the case, then, that Chiropractic is founded on the belief that all conditions of the human body are treatable through treatment of the CNS, particularly through manipulation. (I believe osteopathy says the same about bones, homeopathy about diluted solutions). I'd love to be corrected if I'm wrong. But if that is the case, how can a Chiropractor fit in with a modern medical system with specialist doctors and professionals for specialist treatments?

Stefaan Vossen said...

Hi Twaza,
Mr. Singh was invited to participate in debate as soon as his comments were published.
He refused to participate or to retract his statements when the vidence to the contrary was published. For a respectable list of studies, please look at the internet link provided which includes the BCA statement of 17.06
You don't need to be a chiropractor to assess the scientific validity of the research, you need to look at it in the right context. An unwillingness to look at the data in the right context blinds you to their meaning and their relative validity (basic course in statistical analysis will show you this succinctly)
Edzard Ernst has a most impresisve cv, I am well aware of it. Impressive cv not maketh impressive man. His self proclaimed status is an invention of the university of Exeter, which I have no doubt is well intentioned, but as stated in my previous blog spinal manipulation is not chiropractic care, it is one of the tools which form a package which is built around a patient, this lack of a uniform package makes assessing "treatment" difficult, however not impossible. There are far better qualified people who do comment in respectable manner and who are open to debate and who are actively helping the profession grow as opposed to making their book-sales grow.
Edzard Ernst's comments have been retracted and news papers have printed apologies on numerous occasions.
Stefaan

Stefaan Vossen said...

Hi masseyis,
thank you for your question.
the short answer to it is "no" they don't believe that anymore. More correctly I should state that chiropractors as they got more and more educated came to realise that it is not a simple mono-causal relationship. The original simplificatin has cost us a lot of time developing the profession. We are now at the dawn of developing the analytical structures to look efficiently at poly-causal dysfunction and it is exciting times for the scientific community at large. The best example I can give you is that if a person has back pain I must look at their gait, their core-stability, their weight, their smoking, their drinking and their psychological state. If it so happens that the only aspect of the person's complaint is spinal, then all I need to do is adjust them. If on the other hand they are also obese, dehydrated, smokers then you can adjust that spine as much as you like it will be unstable and this person needs and must address these issues. The point you are referring to about the impact of the CNS is one that has now received the added nuance of "to what degree it is likely to be a factor". One factor, of potentially many.
I hope that clarifies why it is hard to assess "chiropractic care" and why it is important to understand what it is (i.e. not spinal manipulation in isolation)
For a good example look for the Milan lab, a real-time analytical outfit at AC Milan which basically assess all factors which they can realistically measure to predict injury and optimal performance, effectively ensuring longevity and performance of the players. this lab was invented and designed by a chiropractor.
As I said, we are at the very beginning of understanding polycausal dysfunction. (it's hard for us because past population studies tended to record minimal patient data making it impossible to use them effectively) Am I happy with where we are at today? Certainly not, but then that is what makes a profession grow, right?
Regards,
Stefaan

masseyis said...

Stefaan, then why have Chiropractors at all? Physiotherapists, Orthopedic and Neurologic doctors seem to cover all those bases, without the hang up of having come from what sounds like a slightly superstitious foundation. My suspicion is that Chiropractors live by the old adage that "When all you have is a hammer, everything looks like a nail"

Twaza said...

Stefaan

How did the invitation to Simon Singh to participate in debate read? What were the exact words? I am curious because I haven't seen them. What I know is that he was sued for libel.

I understand that you "need to look at it [research] in the right context".

A lot of people have tried to look at the "plethora" of evidence produced by the BCA in the right context. There is a summary and links here:

http://godknowswhat.wordpress.com/2009/06/19/revenge-of-the-singh/

If they are not looking at the research in the right context, please can you explain where they have gone wrong.

Thanks

Stefaan Vossen said...

Masseyis,
fair comment, why have them? No real need if it weren't that Orthopaedic and Neurological doctors are very good at what they do and that tends to be surgery, and when you're not a "surgical case" you can't go there. Also they tend to be quite pricey and secondary care is sought (by the NHS) to be avoided where possible. I refer regularly to them even if the patient is actively seeking to avoid surgery. Time and a place.
The point about physiotherapists is a very good one, and quite frankly if the physiotherapists I have worked with are anything to go by, we might very well be out of a job. But there are still some practical differences, mainly in the treatment protocols which are prescribed. The NHS's system is not conducive to treating chonic dysfunction and these people end up falling between categories. We just fill a gap. Quite a large gap, but a gap nevertheless. It would also be good for physiotherapy training to be more extensive so as to give more weight behind the treatment rationale and a better position as a primary care phycisian, but that is a question only the physiotherapeutic profession can answer in whether they are looking to work their way up the ladder or not. Professions at the end of the day are populated by people. Some will want to develop, some will want to stay where they are, some want th easy life. Depending on how many people of each category there are in a profession, it (as a profession) will go up, down or stay where it is.
Regards,
Stefaan

Stefaan Vossen said...

Hi Twaza,
interesting link. "Revenge of the Singh" Really?
Anyway, firstly the link you sent me confuses sense about science (excellent effort) for mr. Singh's right to spout (not so excellent effort) were Mr Singh a "scientist, as I pointed out on some other blog he could just have said that "according to his research, and based on the literature he chose to look at he came to the conclusion that there is no evidence to support the use of spinal manipulation in infants with colic" He didn't. He said the BCA promotes bogus treatment. Not quite the same ring to it.
ps. I wonder why you wouldn't have been aware of the... maybe it doesn't quite serve the cause so well?

Stefaan Vossen said...

ps. your link, which I managed to scan through now, makes some very valid points... we know it though. No-one is arguing that there is massive positive evidence based on gold standard RCT's. You go and try to design one for fun...
The point is simply that there is evidence, however weak, and that there is no evidence to say that it conclusively does not, just no strongest evidence that it does. Shades of grey, my friend, get lost in the heat of the battle.
Regards
Stefaan

Twaza said...

Thanks stefaan

I am still curious about one thing though. Could you explain if Simon Singh was invited to participate in a scientific debate, or if he was threatened with legal action if he did not withdraw his remark about bogus treatments?

Thanks

Stefaan Vossen said...

Simon Singh was sent a bouquet of flowers, with a bottle of champagne with "youtheman" written on the card with kind regards from the BCA thanking him for bringing to their attention their failings as an association and set up a meeting at the Jumeirah Palm hotel where he would be flown to by private jet with accompaniment of scantily clad ladies... surprisingly he didn't accept it.
Come on Twaza, these things have to be taken for read. He was invited to retract his statements and it was made clear that the BCA interpreted them to be defamatory (giving reason as to why he might want to retract it as he probably, one reasonably expects, did not intend it in that (defamatory) way, thereby offering him a very serious chance to rectify the ring of his statement without having to do as much as invalidate his statement. As said before, non-one took umbrage with the fact he was saying something, just that it was not the correct way of going about it.
Regards,
Stefaan

Twaza said...

Stefaan

Thanks for clarifying that he was invited to retract his remark about bogus treatment, or face legal action.

The sensible thing to do would have been to invite him to participate in a scientific debate on the merits of the evidence.

Stefaan Vossen said...

No Twaza, I did not clarify that "he should retract his statement or face legal action" I clarified that "he was asked to retract his statement and clarify it in a more apporpriate manner, befitting a scolar with access to popular media, as the statements as presented in said popular media were taken to be defamatory, which was taken to probably not be the manner in which he intended it.
You just seem adamant that the BCA must be a heavy-handed, litigation savvy bunch. They aren't. They have done everything possible to help Simon Singh enhance the validity of his intended statement, including invite scientific debate. Both, sadly were rejected by him,therefore not leaving the BCA with any other recourse than to inform Mr. Singh that they had no other option than to sue for libel. Which they did. And won. For good reasons.
This is not about freedom of speach, it is about protecting individuals' and organisation's rights to defend their reputation.
Tell me, why did he choose the BCA? Why not "the chiropractic profession" they couldn't have been libeled. It was a poor choice of actions with consequence he was forewarned of. And I feel for him. Sense for science is great, freedom of speach is pivotal. So is decency and common courtesy .
Regards,
Stefaan

Twaza said...

Thanks Stefaan

At least we agree that decency and common courtesy are desirable.

Stefaan Vossen said...

Both of which were extended to Mr. Singh. Both of which were not returned by Mr. Singh.
Both of which have been lost in the confusion surrounding the topical switcheroo that happened when it was clear that Mr. Singh's rationale for his actions would not sustain him through a libel case and instead opting for an entirely unrelated freedom of speach debate.
Regards,
Stefaan