The Quackometer

Criticising quackery and pseudoscience has its risks. Write a newspaper article or blog criticising someones scientific and medical ideas and you are likely to enter into sharp debate about evidence and its interpretation. Criticise a quack and you can be sure they will be thinking of ways to shut you up - maybe with lawyers. Vested interests and money are strong factors and there are none of the usual safety valves in quackery for critical debate - peer review is near non existent and membership regulatory bodies are broken at root. Inherent in much quack thinking is the mantra that evidence and the scientific method cannot be trusted or is entirely inappropriate for their 'special' art. There are no accepted objective mechanisms by which disputes, internal or external, about practice, philosophy and ethics can be resolved. Quacks have locked themselves away from critical debate for so long that they have no idea how to re-engage, and if they did, they would have a mountain to climb with so much garbage accumulated over years of dogma dominated discourse . Thus, to defend their trades and protect their income, the legal route appears to be the only route.

Simon Singh MBE is one of Britain's best science writers. He is now locked in legal proceedings with the British Chiropractic Association after he wrote in the Guardian about the lack of evidence for chiropractic practice and the dangers associated with spinal manipulation. It has been some months now and it appears that both claim forms from the BCA and a defense from Simon Singh have been filed with the courts. The legal blogger Jack of Kent has done an excellent job of explaining what these documents mean so that non legal numpties like me can understand. Jack of Kent explains that the chiropractors are objecting (as we thought) to Singh saying that there is 'not a jot of evidence' for chiropractors claiming that they can cure 'colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying'. Singh calls such treatments 'bogus'.

The defense has done two main things. It has said that Article 10 of the European Convention on Human Rights provides a right to freedom of expression. Writing as a science writer in a quality newspaper about a matter of public health regarding children should surely not be subject to legal intimidation because some people object to it. And secondly, the defense wants to show that the meaning of the alleged defamatory words is justified because the meaning put forward is factually justified and fair comment. I urge you to read Jack of Kent's analysis in full.

In short, it would appear that Simon Singh wants to put the evidence base for chiropractic in the dock. This is quite stunning and I am sure there are very many chiropractors who are now very nervous about this development. My feeling is that this was inevitable. Chiropractors, no doubt, believe that they do have evidence that their bone crunching can work miracles like curing frequent ear infections. Undoubtedly they will have countless testimonials.

But what is interesting here is the likelihood that chiropractors will have to defend what is appropriate evidence for believing that a medical intervention can treat particular illnesses. This is fascinating for me as I constantly hear about how much evidence there is for highly implausible treatments such as homeopathy. When examined though, the evidence is terrible and utterly unconvincing given how implausible homeopathy is. Homeopaths tend to argue as if evidence is all or nothing. They find some evidence for their claims and then act as if there can be no further doubt.

But evidence exists on a scale. Depending on the quality of the evidence, how far it is along the scale, our estimate for the truth of various propositions can change. Science is never certain about anything. Science is provisional in its nature. All theories are subject to change, although some are much less likely to change than others given the enormous amount of high quality evidence available. We can find poor evidence for all sorts of weird propositions. We might say that the round holes we see on the Moon are evidence that it is made of cheese. We might suggest that the reduction in back pain experienced after chiropractic treatment as evidence for its success. But we could also be mistaken too. Back pain does get better on its own (I can testify to that). Children's ear infections do subside on their own. Children get over their sleeping and feeding problems and occasionally stop crying. Mere testimony is not really evidence but quacks love this sort of stuff. As I have said before,

Healing fools. The seemingly miraculous ability of our bodies to naturally fight and recover from illness, and our inquisitive brains that are eager to seek out causative patterns in all things, means that we all too readily attribute our healing moments to whatever magic beans we were rubbing at the time. Some are so impressed by their own healing stories that they start to make businesses selecting the appropriate beans for others' healing. And the rest of us listen to the tales of the healing fools, as a sincerely told story appears to hold such power over us. Without care, we all risk becoming healing fools.

If we are to accept evidence for chiropractic efficacy we need a little more than stories. It is also worth pointing out that chiropractic treatment for anything that is not to do with muscles and bones is implausible in the extreme. Chiropractors believe they can cure many other things because the trade was founded on the idea that subluxations (chiropractors mysterious bodily malfunctions) were the cause of most (if not all) illness. Thus, by crunching bones you can clear subluxations and get the 'vital forces' moving again. Yes, chiropractic is founded on pre-scientific views of biology and medicine and thus any claims it makes must be subject to the highest forms of evidence. (Amazingly, some UK Universities, like the University of Wales, still underwrite such pseudoscientific gibberish.)

In discussing the nature of homeopathic evidence I have previously said,

Scientific medicine takes into account the scientific context of the evidence and says that we should interpret that evidence in light of what we know about the world. It forbids us from casually accepting light evidence for treatments that are not plausible from what we know about physics, chemistry and biology.

Chiropractors will need to demonstrate a high degree of plausibility before we can casually accept any light evidence from testimonials and other poor forms of evidence. They do not have that plausibility. They have a hard task ahead of them.

This task is made worse by the medical literature. The most recent review of the effectiveness of techniques such as chiropractic concluded,

Sixteen papers were included relating to the following conditions: back pain (n=3), neck pain (n=2), lower back pain and neck pain (n=1), headache (n=3), non-spinal pain (n=1), primary and secondary dysmenorrhoea (n=1), infantile colic (n=1), asthma (n=1), allergy (n=1), cervicogenic dizziness (n=1), and any medical problem (n=1). The conclusions of these reviews were largely negative, except for back pain where spinal manipulation was considered superior to sham manipulation but not better than conventional treatments. CONCLUSIONS: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

It looks like the Chiropractors are on a hiding to nothing. That does not mean that I think Singh will automatically win. The legal courtroom is not the place to decide scientific issues: it decides legal ones, and we all know that the law, at times, can be perverse. Rather, we have a game of high stakes now where, if the chiropractors go ahead, we are going to see lots of arguments like the above and the evidence for chiropractic put in the spotlight. Even if by some freak, the chiropractors win, they may well suffer many humiliations in the process. The world is watching, the press is watching and it is going to be a show.

That is unless, the BCA see some sense and decide to try to slink away from this one.

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Labels: chiropractors