This week in The Lawyer, Robert Dougans and David Allen Green wrote about the emerging phenomenon of ‘wiki litigation’ where there is large scale scrutiny and participation in legal proceedings using the web as a shared medium. They used the example of the British Chiropractic Association’s libel case against science writer Simon Singh. This was not just the web watching the case – but actively participating by the scrutiny of all parts of the claim, actively playing out scenarios and options for Singh, and undertaking a distributed analysis of the pertinent scientific points – the result being the demolition of the BCA’s reputation.
This mass participation turned a near hopeless case for Singh under the absurd English libel system into a victory and a total humiliation for the chiropractors. It was a great example of what Clay Shirky describes in his book Here Comes Everybody of how the internet can bring together like minded people to collaborate on creating previously unthinkable change.
It is likely that a US company called Doctor’s Data (DDI) is going to be facing similar scrutiny as it is has decided to sue the website Quackwatch for libel. Stephen Barrett has been very critical of DDI and has written that the diagnostic health tests it provides are used to defraud patients. One test in particular stood out for his criticism where patients are given a “provoking agent” that flushes out heavy metals into the urine. A urine test is then analysed by DDI and the concentration of heavy metals is compared with standards. Except the standards used are for patients who have not had the provoking agent. The levels of metals are going to be much higher than normal and this ‘elevated result’ is then used to sell expensive and unnecessary treatments. These tests are particularly popular with doctors in the US who advocate chelation for the treatment of autism. It is a bogus treatment and such laboratory tests provide an artificial sense of urgency and validation.
Doctor’s Data asked Stephen Barrett to remove his articles discussing these urine tests as they were “false, fraudulent, defamatory or otherwise not truthful”. Dr Barrett replied asking for clarification as to what specifically he had written that was not correct or fair opinion. Doctor’s Data did not respond but instead has now simply filed suit.
This is tragically familiar. When the Society of Homeopaths threatened me, I asked them to detail their concerns. I got no response. The chiropractors also asserted they had a ‘plethora’ of evidence to back up their claims when they sued Simon Singh. They withheld the plethora – and when it was finally released, it was quickly shown to be worth nothing.
Pursuing a court case rather than discussing evidence does not make Doctor’s Data look the good guys in this episode. Quackwatch would appear to have some very serious concerns about how their tests are used to mislead people into expensive and unnecessary treatments. If DDI could defend the selling of these tests against these complaints then it is surprising that they do not. Looking at their web site, Doctor’s Data would appear to be a respectable laboratory and yet they happily promote a number of bogus tests.
I can confidently label these treatments as bogus because I have researched and written about some of them before. DDI also offer Hair Analysis as a way of assessing nutritional status. This is simply not possible to do in any meaningful way. As I have explained, to measure the mineral content of hair and then draw conclusions that lead to intervention recommendations (such as supplementing with pills) is not possible given the state of knowledge we have about how hair mineral levels relate to possible deficiencies. And yet, this is precisely what nutritionists do. They use these tests to give scientific plausibility to their recommendations and their customers purchase expensive supplements ‘tailored’ to their ‘nutritional status’ as revealed by the tests.
And if we in the UK think this a peculiar US phenomenon, we should note that DDI operate in Europe too. Their testimonial page for their “comprehensive testing for the treatment of autism” offers some feedback from “luminaries in this field of medicine.”
One such “luminary” is Dr Jean Monro, MB, BS, MRCS, LRCP, FAAEM, DIBEM, MACOEM, Medical Director of the Breakspear Hospital in Hemel Hempstead.
Dr Munro is not unknown to the Quackometer. We have seen how the private hospital treats people with ‘electrosensitivity’ (a condition where people falsely attribute symptoms such as headaches to the presence of mobile phones and mains cabling) by subjecting them to strange Eastern European magnetic therapy devices and using unreliable diagnostic tests to see if things are ‘working’. I have also documented how Breakspear treats allergies with special injections on the basis of bizarre, pseodoscientific and homeopathic reasoning.
Breakspear also offers treatments for autism. Part of this expensive programme is chelation to remove supposed high levels of heavy metals. Breakspear states that it regularly tests urine during chelation to look at metal levels – precisely the sort test that is at issue here. Breakspear tell us that the test is “evaluated at independent accredited laboratories”.
In Jean Munro’s testimony on the DDI web page she says,
Breakspear Hospital and its antecedents have been practicing in the field of environmental medicine, allergy and nutritional medicine since the late 1970s. Throughout this entire period we have worked with Doctor’s Data Inc. Stool tests and investigations for heavy metals through urine tests have been the mainstays of our management of patients. The service we receive is excellent with results set out superbly and with expert advice available from Doctor’s Data’s scientific advisors whenever requested. Having had this experience and backup, we can now provide a service to any practitioner in the UK, including practitioners helping to treat children on the autistic spectrum and patients with Aspergers syndrome who will benefit from this laboratory service.
Munro does not hide the central importance of urine testing in the “management of patients”.
In 1990 Granada Television’s ‘World in Action’ programme produced a documentary that focused on the activities of Dr Monro and the Breakspear hospital. The programme alleged that the Breakspear Hospital in Hertfordshire has been “the subject of allegations of wrong diagnosis, useless treatment and a death following the failure of treatments. It is run by Dr Jean Monro who charges extortionate fees for bizarre treatments.”
The programme makers had to apologise for stating that Munro took “wrongful advantage of her patients’ vulnerability”. Their other charges stood.
The problem with many libel cases in the UK is that you are often as a defendant pushed into proving a state of mind, much as Simon Singh nearly had to. To show that Munro deliberately misleads and defrauds requires an impossible peering into her soul to understand her motives. An aggrieved party can always claim that they are honestly going about their business, even if the subsequent analysis of the science or facts may prove them wrong. Being wrong but honest is not the same as being fraudulent.
And that is the problem that Quackwatch may face, if any. Barrett has stated that these tests are used to defraud patients. But it is quite possible, and indeed we must assume for the moment, that all people involved are acting with what they believe to be honesty. The laboratory may well be offering analytical tests to the best of their ability. It is not up to the laboratory to dictate how doctors use the data. The doctors and nutritionists who use the tests may be mistakenly using them to spot deficiencies, excesses and problems that need correcting. They may well have been trained to interpret the tests in inappropriate ways. The end result, however, is indistinguishable from fraud. Patients are being falsely led to believe they have a problem that needs expensive intervention to correct. They may hand over thousands of dollars as a result of being misled.
Patients are being badly let down by regulatory authorities and governments that allow this chain of deception (intentional or otherwise) to take place.
We can see another clear UK example from the Doctor’s Data web site where. One other “luminary” is a Nutritional Therapist called Antony J. Haynes BA(Hons), Dip ION from London. Haynes says of the lab,
- In my professional opinion, Doctor’s Data, Inc. (DDI) not only offers an excellent service, but also has the finest and most up-to-date scientific laboratory assessments available anywhere. DDI’s elemental, amino acid and comprehensive stool analysis test results have proven invaluable in helping offer the most appropriate therapy to those with ASD. I’d recommend DDI to colleagues and patients alike.
Haynes appears to work for a nutritional supplement company, lectures in many undergraduate colleges and has had over 11,000 ‘patients’. He states that he is registered with the Complementary & Natural Healthcare Council (Ofquack) although I cannot find his name on their list. (Although to be fair, I have little faith in Ofquack’s IT skills). He was trained at Patrick Holford’s ION where hair mineral analysis is taught as a legitimate technique for assessing nutrient needs. Haynes is not alone. It is quite possible to find people on Ofquack’s register who do undertake such tests and then sell pills on the back of these meaningless results.
And here is where the real failure is. Ofquack does not see such misleading claims as an impairment to fitness to practice. As Simon Perry uncovered, it appears to be acceptable for such claims to be made if they have been trained to do so and that no deliberate attempt to mislead has been made. The best that the government can do in protecting people from dodgy tests is to set up a voluntary registration body that feels it cannot tell someone off if they have been told to do the tests by bigger boys and girls.
It is a failure in the US too. As Kimball Atwood puts it on the Science Based Medicine blog,
Yes, it is true that very few people or places provide the type of information that [Barrett] does. That’s why I linked to so many of his articles from my own recent post. You can’t find that kind of information on virtually any mainstream website that claims to give reliable information about “complementary and alternative medicine”: not on WebMD, not onInteliHealth, not on the NCCAM website—even though most people would probably expect to find it in those places, if they were aware of it at all. You won’t find on any of those sites, for example, that being “a CLlA-certified company in full compliance with all state and federal regulatory and CLlA standards” is no guarantee against peddling bogus diagnostic tests.
It is a scandal that Quackwatch has had to highlight these concerns nearly alone. Barrett is now paying the price of speaking out. And he is one of the few voices warning the public to be aware. Stephen Barrett deserves to be supported. You can donate here.
More importantly, let Doctor’s Data know that deciding to sue without addressing the science is not a risk free and low cost option for shutting up critics. Write about the case. Examine its merits. Blog. Tweet. Comment. These tests are a menace and largely unregulated. Perhaps DDIs actions could shine some unexpected light into this murky world, and maybe, just maybe, someone will be watching.