The Quackometer

This afternoon, Richard Dawkins will speak about the insidious nature of English Libel Laws as a guest speaker at the Liberal Democrats Conference in Bournemouth.

Professor Dawkins (along with me, coughs) was one of the first signatories to the campaign to keep libel laws out of science. This campaign was inspired by the rather shocking story of how science writer Simon Singh is being sued by the British Chiropractic Association after he wrote in the Guardian that the BCA were promoting chiropractic for common childhood complaints when there was no good evidence that these treatments were effective.

There is now a very compelling case that English libel laws are a fundamental threat to free speech in Britain and even the world. This is not just about science, although science might be hit particularly hard by these unjust laws.These laws prevent writers, whether in the mainstream media or eve non blogs, from voicing concerns and opinions where vested interests may want those opinions suppressed.

Richard Dawkins will say,

The effects of England’s libel laws are especially pernicious where science is concerned” and that action must be taken to stop the law being “ridiculed as an international charter for litigious mountebanks. I urge the Liberal Democrats to support the call for reform, and hope that Labour and the Conservatives will follow, so that we can get cross-party support on this vital issue.

The fundamental problem here is that a claimant in a libel case has a massive advantage. It does not matter if the writer has been thoroughly careful in checking what they have written and that what they write is demonstrably true. Even if they win the case, it can cost a huge amount of money to the defendant. If they lose, they will be financially ruined, even if the nature of the damages are small.

The government appear to be taking notice, but as Dawkins points out, cross party support for changes is important given that we can expect a general election soon. The case for change is overwhelming, but the best we can see at present is some preliminary discussion of changing the way that libel law can apply to online publications. In general, there is a time limit of a year for bringing a case after publication. However, each fresh ‘click’ or download is counted as a new publication effectively meaning there is no limit for liability for online publication.  This is an important concern, but minor compared with the gross injustice of the libel system. The system is fundamentally flawed and tinkering will not work.

Libel reform is important. Singh is being persecuted for daring to discuss matters of public health. The BCA could have simply published their own account and defended their actions in print. Instead, they chose to attempt to financially ruin a writer for criticising the approach to health. Far more worrying is how oil company Trafigura have tried to cover up an African pollution disaster by threatening any publication that dared to write about their business. They have now offered to pay compensation to 31,000 African people affected by their illegal dumping activities. People died and many more made ill. And anyone who wrote about it was threatened with legal action. The BBC reports,

It has until now denied compensation claims, and its lawyers repeatedly threatened anyone worldwide who sought to contradict its version. It launched a libel case against BBC Newsnight, forced an alleged correction from the Times, demanded the Guardian delete articles, and yesterday tried to gag journalists in the Netherlands and Norway with legal threats.

These threats tend to work in most cases.

The government have a chance to turn this around and make Britain a safe place to have full and frank debate about all manner of important issues, no matter what vested interests may be harmed. Instead, Britain can be viewed as a willing collaborator with rogues and charlatans, polluters and criminals, the rich and connected, against the writer and journalist, the activist and campaigner, the blogger and even twitterer. Free speech is reduced to a meaningless freedom as long as it does not effect business interests, political ambitions and dogmatic beliefs.

It is time for a change. It is time for us to be free from fear when voicing our concerns.

*****************************************

In the next day or so, I will be writing about how a UK healer has been threatening bloggers with claims for writing about them and the impact this has on honest debate.

Labels: British Chiropractic Association, the law

The Dutch sceptics group, Vereniging tegen de Kwakzalverij (VtdK - The Society against Quackery) have managed to overturn a important court ruling that was preventing them calling quacks quacks. In a remarkable case, that in many ways closely parallels the BCA vs. Simon Singh case in the UK, a judge has decided that using a narrow definition of the word ‘Quack’ that a previous ruling was forcing the group to defend in a libel case, was incompatible with Article 10 of the European Convention of Human Rights.

The Society against Quackery claims to be the world’s oldest sceptics group. Its first newsletter was published in 1881 (Google translation) and has campaigned ever since against the misleading claims of alternative medicine.

In 2000, their magazine published an article “Quacks of the 20th Century” that looked back over the last 100 years and wanted to ‘preserve the history’ of the characters that had dominated, in their view, the world of quackery. They published a score card of how they had arrived at the top twenty quacks and stated that this list was “not meant to belligerently settle scores” but provide ‘insight into the personality of the healers of this period”.

In publishing their top 20 list, the Society were quite careful to explicitly define what they meant by the word ‘quack’. They said, (Google translation)

‘Quackery is:
(a) any professional act and/or the extending of advice or assistance related to the state of health of either man or animal;
(b) which is not founded on contemporary and/or empirically tenable hypotheses and theories;
(c) which is actively propagated among the public (“over-promotion”);
(d) which has not been tested on efficacy and safety within the professional group;
(e) which is (usually) performed without consultation of fellow practitioners.’

Now, you may not agree with this definition. And that is fine. But it is important to note that this is what the Society explicitly said about the meaning of the word. The Society also made it quite clear about what they thought about the honesty of such people:

As has been made clear by the Society & co, being labelled a ‘quack’ does not in the least imply bad faith or fraud: in practice, it is hardly possible to establish this. Therefore, nominees on the “long list” need not feel they are accused of immoral behaviour; the only thing they are accused of is quackery and nothing else!

I quite agree with this. In my explorations with the Quackometer, I can say that one of my biggest discovered undertsandings is that there are very few people out there practicing alternative medicine that fit into a simple categorisation of ‘fraud’. Most people sincerely believe that what they practice is genuine and are sincerely trying to help people. They are not deliberately misleading people, they are just mistaken in their beliefs. And why they are mistaken is much more fascinating and insightful into human behaviour than mere trickery and con-artistry. And when I do suspect genuine fraud, it is impossible (bar a few exceptions) to prove that this is the case. As the Dutch Society make clear, “it is hardly possible to establish this”.

At number seven on the list was a doctor by the name of Maria Sickesz (Google translation) who claims to be a “doctor of Orthomanual Therapy”. Sickesz believes that she has “developed a unique method to correct misalignments of the spine and the pelvis. She pays attention to the individual misalignment of each vertebra and noticed that they followed specific patterns.”

Misalignments of the bones in the back can be responsible or add to all sorts of diseases according to her. She claims to be able to treat “syndromes such as lung and digestive disorders, problems with the menstrual cycle, ADHD, autism, multiple sclerosis, Parkinsonism”. According to the VtdK, she has claimed to be able to treat “anorexia, asthma, autism, bipolar disorder, dementia, depression, diarrhea, eczema, palpitations, high blood pressure, fever, stomach pain, menstrual complaints , migraine, neck pain, tinnitus, psychosomatic stomach, schizophrenia” all by manipulation and hammering of the spine. She says that “The connection between these seemingly unrelated conditions and the spine is that the nerves, which serve all areas of the body, can be irritated directly or indirectly by spinal disorders.”

Yes. Sickesz has developed hew own brand of chiropractic or osteopathy. Indeed, a paper by her describes her subluxation based theory of why children develop colic. It is pretty indistinguishable from the sort of nonsense promoted by British chiropractors.

Displaying what we now know to be a typical chiropractic response to criticism, she decided to sue the VtdK for calling her a quack. An initial ruling by a district court said that the Society had not acted unlawfully and rejected Sickesz’ claim to prohibit the society from calling her a quack. However, on appeal, this decision was overturned and the Society was told not to repeat the claim and to issue an apology in De Telegraaf, a popular daily newspaper. It would appear that the main reason was that a major Dutch dictionary, “Van Dale, Groot Woordenboek der Nederlandse Taal” described quackery as follows: “

Someone who applies useless remedies to cure some disease or other or claims knowledge of remedies for all kinds of diseases, and/or someone who offers such remedies for sale, usually with a lot of noise; - unqualified practitioner of medicine, (fig) someone who wants to take the public for a ride, syn. cheap swindler, fraud, trickster.

This is a far more negative definition that the one offered by the Society in their article and the court decided that it is this meaning that the ‘ordinary’ man would ascribe to their article despite the Society being explicit about what they meant.

The Society decided to appeal this decision as it had far wider implications than just this case. Indeed, it would make it very difficult to talk about quackery in the Netherlands at all if courts were to take it as fact that an accusation of quackery meant that the Society were calling someone a “cheap swindler, fraud [and] trickster.” Fortunately, at appeal last May, this decision was overturned by the Supreme Court of the Netherlands. A number of very interesting things were said.

The Society claimed they had a duty and a right to warn the public about medical treatments that claim to be effective but are not supported by science. They believed there was no scientific evidence to back up Sickesz' claims. They claimed the treatments met with fierce criticism from academic circles and that the treatments could even be dangerous,

Five experts in the fields of neurology, internal medicine, lung diseases and psychiatry, when asked for their scientific opinion, said: ‘the answers not only show that there is not a jot of scientific backing in serious medical literature for the opinions of Sickesz, but also that experts cannot even imagine that OMM could have any efficacy for their professions.’ The Society & co also have concerns about the safety of the manipulations. They have placed Sickesz on the list not just because of her claims concerning neck and back complaints, but mainly because of her other claims.

The court looked at the case from the perspective of the European Convention on Human Rights. They had to balance Article 8 that gave Sickesz a right to personal privacy against Article 10 that gave the Society a right to free expression. The court had to decide between a “colliding of fundamental interests interests in determining what level of carefulness should be practiced in society towards one’s fellow man.”

The Supreme court found in favour of the Society against Quackery. The court decided that the definition of ‘quack’ must follow the Societies own definition if it is to protect its right to free expression. That an average reader might not have the same definition cannot be blamed on the Society. Furthermore, there was substantial important public interest in the publications of the Society and so the publication of the list with Sickesz name on it cannot be “unlawful or grievous towards her”.

No justice is done to this freedom when no attention is being paid to the content that the Society & co themselves have given to the term and the context in which the term is used. The [previous] court has also failed to take into account that the publication with the list of quacks comes from a society with a serious character and a serious aim and the circumstance that in the medical world a treatment is considered quackery when it is claimed that it can cure something while there is no scientific evidence to support this claim.

It was also noted that the publication did not say anything about Sickesz private life but only discussed aspects that were matters of public interest and should as a matter of principle be part of a public debate. As such, the court said that “there must be sufficient room for freedom of expression in situations like these”.

This freedom of expression was characterized by the European Convention of Human Rights as 'one of the essential foundations of a democratic society and one of the basic conditions for its progress and for each individual's self-fulfilment' and consequently: ‘must be narrowly interpreted and the necessity for any restrictions must be convincingly established.’

This court hearing only overturns a decision by a previous court that the Society should defend itself on the basis of the dictionary definition rather than their own definition. My understanding is that the full case is yet to be heard.

What does this mean for the current British Chiropractic Association vs. Simon Singh case in the UK? I present this here simply as a parallel and a reflection on how other countries might view such cases. Simon Singh is in quite a different situation at the moment.

The Dutch case has very much depended on the court allowing decisions to be appealed. Simon has of yet no such luxury and must defend his article on the definition of the word ‘bogus’ handed to him by Justice Eady – and that definition is that ‘bogus’ implies dishonesty. As Simon made his own meaning of the word bogus quite clear in his article as referring to chiropractic’s lack of evidence, he has to defend his position on a basis that quite obviously he himself does not believe.

Simon also has currently no platform to defend his case on European Human Rights grounds. But it is worth noting that the laws considered by Dutch judges are also applicable in the UK. Whether, a similar conclusion can be come to in this British case I will leave to better qualified commentators although my amateurish perspective would suggest that Simon would have very similar grounds to appeal.

Simon Singh must decide this week how best to move forward either with an oral appeal or some other route. This decision will undoubtedly rest not just on the apparent injustice being done but also on the financial and emotional drain placed on Simon (Defending English libel law may cost a hundred times more than most European proceedings, plus Simon has to defend his article on his own.)

My own commentary would be this:

Science is so successful because of one central feature: its self correcting nature. Ideas in science get better over time. Ideas that do not match reality are discarded and those that do survive testing are refined and become more useful. The Dutch sceptics are in the fortunate situation they find themselves because the legal decisions so far have been subjected to several bouts of scrutiny and refinement. Everyone in the Netherlands should have confidence that those decisions have got better with each legal iteration.

Simon Singh has not been so fortunate. He has been refused permission to subject the current ‘bogus’ ruling to any scrutiny under an appeals process. He is currently subjected to the tyranny of the man on the Clapham omnibus where the meanings of the words he has written has been decided by one man who appears to believes he can have definitive and infallible insight into the mind of the ‘common man’. There is currently no mechanism to question that ruling and so Simon is being forced to defend his words in the terms of a definition that is quite arbitrary, at the extreme of possible interpretations and in contradiction with Simon’s own stated definition.

And even if Justice Eady’s is right (and many doubt it is), then what the Dutch decision shows us is that by forcing Simon to accept an opinion about quackery that Simon would himself believe to be ill informed and ignorant of the true nature of alternative medicine then he is being denied a legitimate right to free expression about an issue of important public health. The ordinary man on the Clapham omnibus may indeed view quackery as simple fraud, but it is vital for public health for people to appreciate that it may be a little more complicated than that. And laws that force Simon to accept this situation are fundamentally unjust and oppressive according to rights that are now enshrined in European law.

The more I look at how English libel law operates the more convinced I am that such laws are an anachronism. Born in an age where a gentleman needed his honour protected against the tittle-tattle of the popular press, they now serve as a source of oppression where the powerful, the wealthy, the corrupt and the vested interest can close down democratic discussion. We now live in an age where we are all publishers, not just the press. The law is out of step and if the BCA vs Singh case causes fresh thinking about how we mediate the various rights involved in free speech then a great good will have been done.

With thanks to Cees Renckens (pictured) of Vereniging tegen de Kwakzalverij and to Jo van Ringen for translating the court papers (my Dutch is limited to ordering a beer at the bar). I must add that the opinions and interpretations discussed are mine alone.

Labels: British Chiropractic Association, chiropractors, Simon Singh, the law

This is an open letter to all homeopaths in the UK.

It has been a bit of a surprise to me to learn that the Society of Homeopaths is wanting to lobby the Health Professions Council to include homeopathy within its regulation remit. As such, you will receive protected title (only registered homeopaths will be able to call themselves that) and be held against a code of standards and ethics.

Why do you want to do this? I can guess some of the reasons.

Homeopathy has always battled to be recognised – both as a science and as a healing profession. Deep within the homeopathic mindset is a belief that you hold a valuable principle of healing, if not the fundamental theory of healing. Over two centuries you have battled to gain acceptance and validation against what you see as a hostile (even conspiratorial) medical profession. You call the medical profession allopaths and define yourselves in opposition to your own picture of them.

Undoubtedly, you see that statutory regulation will put yourself at least on a par with doctors. You will no longer legally be invisible in the healing professions. But there are other more economic reasons too. Being statutorily registered will make it easier to gain referrals from the huge source of cash that is the NHS. It will also make it easier to get payments from private health insurers. You won’t have to pay VAT, although I doubt many of you make enough to have to worry about that. Universities have recently said that they will not teach BSc courses to train homeopathic practitioners unless they achieve statutory regulation.

So, the prize appears to be huge. Recognition, financial gain and the secured future of your profession through accredited education. The Society of Homeopaths can free itself of the tedious burden of having to pretend to regulate you and instead become something like the BCA and concentrate more on trying to sue its critics.

But what of the cost? Such rewards will come at a price – and I am amazed that the Society of Homeopaths believes you will wish to pay that price.

First, before we look at what this might all mean for homeopathy, I would suggest that the path to Statutory regulation will not be easy. I am sure you are aware that there are many people who think such a step would be absurd, myself included. Homeopathy has failed in two hundred years to make any progression in showing that it is nothing other than a inert treatment based on pre-scientific and magical thinking. The basic science to show that your principles are true is not there. My own simple challenge to homeopaths to demonstrate their fundamental propositions has not been taken up in 85 weeks. More damningly, in the two hundred years since homeopathy was invented, our scientific understanding of medicine, chemistry and physics has moved on enormously and it clearly shows that homeopathy is not just implausible but is utterly contradicted by everything we know about the world. Homeopathy lies outside of reason and science. It is a pseudo-medicine and is just a placebo therapy. It is just not tenable to hold any other position.

To gain statutory regulation, you will have to demonstrate that it is indeed possible to have meaningful standards in education and training for a pseudoscientific subject. That is not impossible – the current government has on the whole failed to see the problem with regulating absurd treatments. It is funding Ofquack, the Prince Charles backed Complementary and Natural Healthcare Council, as a voluntary regulator for a rag bag of quack practitioners. The government does not appear to see that upholding such people to high degrees of training and competence is problematic when such people believe in absurdities. I would suggest though that the HPC may well be tougher judges than Prince Charles.

So, onto the costs. In order to appreciate what such regulation might mean for homeopaths it is worth looking at what it has done for other statutorily regulated alternative medicines. Chiropractic would be a good example.

The regulation of chiropractic was not without its controversy. The Society of Homeopaths claim that 65% of its members support the route to such regulation. The Society of Homeopaths only represents 65% of homeopaths, so we can only be sure that 42% of homeopaths support such a route. Even then, this survey was taken in 2006 and a lot has changed since then. I would be very surprised if this support has grown. Are the majority of you in favour of this move? Chiropractors were also split when the Chiropractic Act was brought in. Many saw it as an attempt to control their practice and restrict what they could do. Chiropractic philosophy appears to embrace a libertarian stance and many resented passing control of their work to people who may not share their beliefs and views. Some were worried that the move had conspiratorial overtones of the medical community trying to suppress an alternative to them. There were quite a few who refused to be registered and had to cease calling themselves chiropractors and instead called themselves simply spinal manipulators or even the grand sounding osteomyologists.

Over a decade later, the political infighting still continues. Many resent that the McTimoney Chiropractors were let into the exclusive regulated club. McTimoney is seen as a chiropractic heresy where bones are not cracked so violently and training takes place through part-time courses. It is not seen as being real chiropractic and the practitioners as being undertrained – through cheaper courses. It represents a threat to the chiropractors who will have invested well over £40,000 in fees for their training at one of the other two ‘real’ chiropractic colleges.

The General Chiropractic Council, the regulatory body, appears to be popularly despised by the ordinary chiropractor. It is seen as heavy handed in its regulation, costly and not in tune with chiropractors’ needs (to be left alone). It has no duty to promote chiropractic but only to protect the public and enforce its code of conduct. It is also increasingly dominated by lay representatives – chiropractors are getting a smaller voice in its running. Much of this resentment has been well documented on the chiropractic blog chiropracticlive.com.

When the British Chiropractic Association decided to sue Simon Singh for criticising the lack of evidence base for the treatments it was promoting, I doubt they understood the difficulty they would be putting their members in because of the very fact that they were statutory regulated. The ensuing debate has exposed the non existent foundations of much of chiropractic care and this has led to an unprecedented number of complaints being made to the GCC about chiropractors misleading the public on their websites for the effectiveness of the treatments they offered. There are now perhaps 20-30% of the entire chiropractic profession undergoing statutory complaints procedures which could result in the loss of their registration and their ability to practice.

The mistake the government and chiropractors made in accepting statutory regulation was allowing it to go ahead before chiropractors could demonstrate that they were not simply a vestigial remnant of Victorian back cracking quackery. Now, chiropractors find themselves being held to the highest forms of professionalism and practice without an evidence base for pretty much anything they do. It is now possible that chiropractic in the UK will not survive the current onslaught of professional complaints and trading standards investigations being pursued against them. What will come out the other side is pretty much anyone's guess, but I am pretty sure it is not a situation that the majority of chiropractors would have wished for in their quest for recognition.

And this is what I find extraordinary about the attempt by homeopaths to join the HPC. At present, the nightmare that is happening to chiropractors cannot happen to homeopaths. Despite what you say, you have had the freedom of living without any form of genuine regulation. The Society of Homeopaths has never ruled against a homeopath for the way they practice when when faced with clear breaches of the code of ethics. Homeopaths have been free to indulge in whatever delusions they fancy without fear of sanction. You have claimed to treat malaria and AIDS and have done so without a single voice of censure from within the lay homeopathic trade. You have no idea what it is like to be regulated and to be subject to a real code of ethics and practice. I suggest you pop along to your nearest chiropractor to find out what it is like.

And I must say that chiropractors have it fairly easy. Their treatments (at least for lower back pain) have an air of plausibility and some evidence for effectiveness. Homeopaths lack these luxuries of plausibility and reliable evidence for anything. What makes your situation worse is that your belief set is acutely in conflict with those who will become your statutory medical colleagues. You regularly undermine public healthcare messages about childhood inoculation and believe your sugar pills are an alternative. You show no sense of boundaries for what you can reasonably hope to achieve and make claims to be a superior treatment for everything from asthma and swine flu to autism and cancer. Do you really believe you could continue with your alternative beliefs in a statutory world? And they are alternative. Whilst you denounce the side effects of real medicine as being avoidable by homeopathy you pitch yourself against the medical world. And I doubt that a regulated profession could last long with such rhetoric.

Homeopaths. You have never had it so good. And you do not realise it. You are pretty much free from any constraint on what you say and do. You may moan about the continuous criticism you get from people like me – but that is the worst you have to suffer at the moment – criticism. If by some fluke you do manage to achieve full regulation, expect your cosy world to come crashing down very fast. Your quest for regulatory recognition will be hubris. It took over fifteen years for the chiropractors to realise they had been practising on borrowed time. Your regulatory nemesis will come much quicker.

Labels: British Chiropractic Association, chiropractors, CNHC, Complementary and Natural Healthcare Council, homeopathy, regulation, Society of Homeopaths, SoH, the law

The following is a reprint of an article by Simon Singh that appeared in the Guardian last year. It is highly critical of significant aspects of chiropractic. As a result the British Chiropractic Association decided to sue Simon Singh.

The article is being posted and reprinted today on many blogs and in magazines as a sign of solidarity with Simon as he fights this misconceived libel case. His lawyers have edited several sections that are at the heart of the BCA claim. As you can see, the substantive article remains – that chiropractors lack evidence for their treatments. I believe it is in the public interest that such criticism is not allowed to be stifled by the legal actions of vested interests.

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, 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.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

Labels: British Chiropractic Association, chiropractors, Simon Singh

The BMJ has today published an exchange between the British Chiropractic Association and Professor Edzard Ernst examining the claims of the BCA that chiropractic is effective in treating childhood ailments such as asthma and colic. The editorial of the BMJ has come down firmly supporting the assessment of Ernst. The editorial says,

His demolition of the 18 references is, to my mind, complete.

This would look like it is now the definitive assessment of these claims and buries any suggestion that the BCA can defend its claims on the strength of evidence.

Meanwhile, the BCA continues to pursue science writer Simon Singh through the courts for an alleged libel when Singh wrote in the Guardian that these treatments were ‘bogus’ and that the BCA were ‘happily promoting’ them. Despite the BMJ clearly showing that there is little evidence to support the BCA claims, they could still win against Singh as the trial judge, Eady, has ruled that the meaning of ‘bogus’ suggests that the BCA were being ‘deliberately dishonest’ in promoting these claims. Singh has since contended that what he meant was that the BCA were simply wrong in their assessment of evidence.

So, Richard Brown of the BCA kicks off by defending the chiropractors position. He starts by saying,

It is quite remarkable that scientists should expect themselves to become exempted from the laws of the land for publishing defamatory comments, be they about an individual or an organisation.

Brown shows his total misunderstanding of the situation in his first statement. It is not that scientists want to be seen as exceptions to the libel laws; rather, that science is hindered by the presence of English libel laws and their application in disputes of evidence is completely inappropriate.

The insidious thing about English libel law is that all you need to do to bring an action is to suggest that you have been defamed; that in some way your reputation has been lowered. But in science, by criticising ideas, it is inevitable that some degree of defamation will occur – that by showing someone's ideas are unsubstantiated and unsupportable their reputation may well be diminished in the eyes of their peers. The rules of the game in science are that this ‘defamation’ takes place in the open – most often in journals and conferences and public debate – not in the courtroom. Science is a tough calling. It is full of knock-about and direct challenge. In scientific medicine, the ethical demand is that public health is more important than any particular reputation. The BCA’s reputation is completely disposable if it means that people get better medical advice and treatments.

Brown then goes on – “there is in fact substantial evidence for the BCA to have made claims that chiropractors can help various childhood conditions.” This claim is then totally demolished in the following BMJ article that looks at Brown’s references and pulls the weak evidence apart and shows it to be completely lacking. Damningly, the review shows that the BCA have cherry picked their evidence and ignored high quality trials that suggest chiropractic is not effective for treating the named conditions.

And then in a bombshell, Ernst suggests that.

The omissions are all the more curious as the Association apparently knew of these [ignored] articles.

And then goes on to explain why. This would suggest that the BCA were deliberately ignoring pertinent negative evidence in their justification of their stance. Ernst concluded that,

The association’s evidence is neither complete nor, in my view, “substantial.”

This allegation would suggest that even if Singh were unable to overturn Eady’s decision that he must defend his article on the basis that the BCA were deliberately misleading in their statement, that it might be possible to prove that this is indeed the case.

So, what should the BCA do next? A few months ago, they must have been feeling rather pleased with themselves that the trial was going their way and I am sure they would have thought that Simon Singh would have folded his cards. That is not so true now. Indeed, Simon is fighting on and looks like he is prepared to go all the way. It is now clear that the BCA cannot defend their position on the basis of scientific evidence. They must now hope that it cannot be proven that they have deliberately deceived. However, cracks are now appearing even in this defence. Even if they were to win, the only conclusion that someone like myself can come to is that they may not have been deceiving, but that they are incompetent in their assessment of evidence. There does not look like a way the BCA can now ‘win’ in any moral sense.

And what this means is that the chiropractic profession is taking a battering like it has never seen before.

What is ironic is that if the BCA had written this article a year ago, as the Guardian had offered them the space to do so, all this would have been now forgotten. Chiropractic would have continued to thrive under their cloak of intellectual obscurity. But to pursue Simon through legal means only was their own decision, despite their claim that “The British Chiropractic Association (BCA) neither wished nor intended this matter to end up in the courtroom.” That is clearly not the case as they had alternatives presented to them and, indeed, they have belatedly taken up the alternatives in the pages of the BMJ.

And so, after some thought, several weeks ago, I have made a complaint to the GCC about the officers of the BCA for presenting misleading information to the public about the effectiveness of chiropractic in children. If they had written this article a year ago, I would not have done so. But if they feel happy that they do not have to defend their evidence in court now, perhaps they might be less happy that they now have to defend their position to their professional regulator. Their code of conduct is quite clear:

If chiropractors, or others on their behalf, do publicise, the information used must be factual and verifiable. The information must not be misleading or inaccurate in any way. It must not, in any way, abuse the trust of members of the public nor exploit
their lack of experience or knowledge about either health or chiropractic matters.

If you want to be treated like a regulated profession, then expect to be held against high standards.

Labels: British Chiropractic Association, chiropractors, edzard ernst, Simon Singh

This letter has been issued from the McTimoney Association to all its members…

Date: 8 June 2009 09:12:18 BDT

Subject: FURTHER URGENT ACTION REQUIRED!

Dear Member

If you are reading this, we assume you have also read the urgent email we sent you last Friday. If you did not read it, READ IT VERY CAREFULLY NOW and - this is most important – ACT ON IT. This is not scaremongering. We judge this to be a real threat to you and your practice.

Because of what we consider to be a witch hunt against chiropractors, we are now issuing the following advice:

The target of the campaigners is now any claims for treatment that cannot be substantiated with chiropractic research. The safest thing for everyone to do is as follows.

1. If you have a website, take it down NOW.

When you have done that, please let us know preferably by email or by phone. This will save our valuable time chasing you to see whether it has been done.

1. REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them. DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.

1. If you have not done so already, enter your name followed by the word ‘chiropractor’ into a search engine such as Google (e.g. Joe Bloggs chiropractor) and you will be able to ascertain what information about you is in the public domain e.g. where you might be listed using the Doctor title or where you might be linked with a website which might implicate you. We have found that even if you do not have a website yourself you may still have been linked inadvertently to a website listing you or your services.

CHECK ALL ENTRIES CAREFULLY AND IF IN DOUBT, CONTACT THE RELEVANT PROVIDER TO REMOVE YOUR INFORMATION.

CHECK OUR PREVIOUS EMAILS FOR SPECIFIC ADVICE AND KEY WORDS TO AVOID.

KEEP A LOG OF YOUR ACTIONS.

1. If you use business cards or other stationery using the ‘doctor’ title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.

5. Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice.

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.

IF YOU DO NOT FOLLOW THIS ADVICE, THE MCA MAY NOT BE ABLE TO ASSIST YOU WITH ANY PROCEEDINGS.

Although this advice may seem extreme or alarmist, its purpose is to protect you. The campaigners have a target of making a complaint against every chiropractor in the UK who they perceive to be in breach of the GCC’s CoP, the Advertising Standards Code and/or Trading Standards. We have discovered that complaints against more than 500 individual chiropractors have been sent to the GCC in the last 24 hours.

Whatever you do, do not ignore this email and make yourself one of the victims. Some of our members have not followed our earlier advice and now have complaints made against them. We do not want that to happen to you.

Even if you do not have a website, you are still at risk. Our latest information suggests that this group are now going through Yellow Pages entries. Be in no doubt, their intention is to scrutinise every single chiropractor in the UK.

The MCA Executive has worked tirelessly over the last week keeping abreast of development and contacting at risk members. We have decided that this is our best course of action to protect you and the Association at this time of heightened tension. This advice is given to you solely to protect you from what we believe is a concerted campaign, and does not imply any wrongdoing on your part or the part of the Association. We believe that our best course of action is simply to withdraw from the battleground until this latest wave of targeting is over.

Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond.

Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.

Please be aware that the office phone lines are likely to be busy, so, if you need our help, please send an email to the office and we will get back to you as soon as we can.

Yours,

Berni Martin

MCA Chair.

Best wishes,

Nicki

The McTimoney web site itself now just reads:

For all enquiries regarding McTimoney chiropractic, please contact :

McTimoney Chiropractic Association
Crowmarsh Gifford
Wallingford OX10 8DJ
admin@mctimoney-chiropractic.org
Tel : 01491 829494

The most stunning admission is that Chiropractors are told:

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.

****************************************************************************************************

Update:

All the missing websites have been archived here: http://yaxu.org/tmp/chiros.html

Smashing job yaxu

PS Dont forget to sign the Simon Singh support campaign.

http://www.senseaboutscience.org.uk/index.php/site/project/333/

Labels: British Chiropractic Association, chiropractors, McTimoney, Simon Singh

The British Chiropractic Association do not appear to be too hot on evidence. Given that they are suing Simon Singh, a science writer, for saying that they promoted treatments for children's ailments, such as asthma and colic, when there was no good evidence, you would have thought that they would have been quick to publish any evidence that existed. In fact, despite the BCA telling us that there is a plethora of evidence for the chiropractic treatment of these conditions, they have still failed to make their case public. Strangely, they have made that alleged evidence available to the court. Some of us are beginning to doubt that the evidence will stand up to much scrutiny.

Two of the central criticisms of chiropractic are that they promote improperly evidenced treatments and that they attempt to enrol customers on lengthy, expensive and unnecessary treatment plans. Furthermore, they market themselves as ‘wellness’ therapists where you should attend your chiropractor even when you feel fine for ‘corrective’ adjustments. My investigations of the BCA reveal that they are deliberately targeting children with an unevidenced chiropractic message.

Every year the BCA hold a Chiropractic Awareness Week. For the past few years, they have been promoting themselves with a campaign called “Straighten Up UK”. The idea of this campaign is to suggest to people that they should be performing a daily exercise programme “to help strengthen the spine and improve posture.” They are specifically targeting children by introducing a couple of cartoon characters, Abbey and Jake, and suggesting some exercises that kids can do to keep them in shape.

The exercises are divided into three parts and given kid friendly names - ‘stars’, ‘flying friends’ and ‘core balance’. The idea is that children can do a simple three minutes that can be incorporated into their ‘daily routine’ – whatever that means for kids. You can look at the video of the exercise here.

Now, anything that helps kids lead active lives ought to be good. But the campaign is not just about getting kids to bend and stretch – it is closely linked to the idea that chiropractic for kids is a ‘good thing’. Some chiropractors advertise that they would like you to “visit your chiropractor as you would your dentist”. There is no evidence to suggest this is necessary or beneficial. The BCA say in their Straighten Up UK (SUUK) campaign,

As children grow, chiropractic can help not only with the strains caused by the rough and tumble of life but also with some of the problems that children can suffer in their first years:

A BCA chiropractor will carry out a full examination and take a thorough history before advising an appropriate treatment programme for you or your children. Treatment consists of specific adjustments done by hand to free stiff joints and remove spinal nerve irritation.

We have previously seen how chiropractors are taught that birth introduced trauma to the bones of children can be corrected by manipulation. Again, there is no decent evidence for this.

So, where did this campaign come from and where is the evidence that their exercise programme benefits children?

Well, a PR Company looks like it is taking the credit. Publicasity, who describe themselves as ‘brand alchemists, have the BCA as a case study. Publicasity take the credit for creating the “three minute exercise called “Straighten Up UK” and using it is a tool for creating “clear ROI” for the BCA. (For my gentle readers not engaged in marketing activities, ROI is ‘Return on Investment’).

Publicasity also undertook some ‘research’ by conducting a survey to look at “ who was suffering from back pain and attitudes towards bad posture”. Dutifully, the market research showed that “50% of 16-24 year olds were currently suffering back pain and that the UK was indeed a nation of ‘Slouch Potatoes’.” Press releases were then issued and obediently picked up by Jenny Hope and Sarah Stacey of the Daily Mail for verbatim publication.

Indeed, in the Daily Mail, we are given a quote,

Mr Hutchful [Tim Hutchful, BCA spokesperson] said the BCA has launched a three-minute exercise programme called Straighten Up UK, which is designed to help strengthen the spine and improve posture.

It gives instructions for three quick sets of movements designed to warm up muscles, and advice on posture care and balance.

He said that although chiropractors can assist in diagnosis and treatment of painful joints, ligaments and the spine, they are more concerned with prevention.

"It's like looking after your teeth," he said. "It doesn't take long to brush your teeth every day but it pays dividends for life.

"We want people to take that amount of time to care for their backs."

PR job done.

Well, not quite. A ‘call to action’ is also important in marketing terms. Being ‘with it’ Publicasity made sure there were some ‘flash events’ and ‘stunts’ in ‘high footfall’ locations (English translation: train stations and shopping centres). They also made sure they interfered with Fern and Phil on ITV’s This Morning. Publicasity also made sure that ‘press toolkits’ were available to BCA chiropractor members so that they could get people into their premises for ‘free posture check ups’.

Joy.

A pretty slick operation. Publicasity state they had a reach of 53,998,551 people. I think that figure pretty much sums up their attitude to relevance, accuracy and precision.

And what does this say about the BCA? Well, they like their stunts. This is typical of the ‘cash for’ stories that Ben Goldacre documents so well. We may expect cheap PR stunts from a fish oil pill peddler or a fluff headed shampoo maker, but a regulated health profession?

True colours are shining through.

Labels: British Chiropractic Association, chiropractors, publicasity

One of the side effects of the BCA vs Chiropractic libel case is that there are a growing number of people who now realise that Chiropractic is bogus*. Even though Simon Singh may well have suffered a set back from a judge who according to the law can define words as he sees fit, we are now seeing increasing exposure to the bogus* practices of the chiropractic trade.

One way to show the ridiculousness of the legal decision and of chiropractic would be to have a little blog carnival on the bogus* nature of chiropractic claims and practices, and so I suggest that sceptical bloggers and writers help out by doing the following…

1. Find a chiropractic claim from an association or practitioner and examine the evidence for it critically. Look at Cochrane reviews (if they exist), papers and the basic science behind the claims. Write to the claimant involved and ask them for their evidence for their claims.

2. If the evidence for effectiveness is lacking, call it a bogus* treatment.

3. Let me know what you have written and I will do a round up in a few weeks. Email me or twitter me @lecanardnoir.

4. Spread the word. Twitter like crazy.

I am on hols at the mo, so can I suggest all entries are emailed to me (see my ‘about’ pages) so that the carnival will appear y June 5th.

I think with not much effort we could turn the chiropractic google space into  a web of critical articles. That would be a small step in the right direction.

********************************************************************************************************

* deliberate deception not implied.

Labels: British Chiropractic Association, chiropractors, Simon Singh

The University of Oxford recent completed a report into the comparative costs of defamation proceedings across Europe. Its conclusions were that the costs of libel proceedings in England and Wales are about 140 times higher on average than those found across Europe. The reasons for this boil down the large number of lawyers that get involved, the length of the proceedings, the adversarial nature of English law, and the take up of Conditional Fee Arrangements (CFAs), “no win no fee”.

The result of this is that the legal costs involved are likely to be hugely disproportionate to any potential damage done. Defending a case of libel, even if the damages only amount to a few thousand pounds, could result in the losing party facing legal bills of six or seven figures.

The specifics of English libel law make the situation even worse. The entry costs to make a libel claim can be very low. Conditional Fee Arrangements allow a lawyer to take on a case where they will only receive payment if they win. And because of the risks involved their fees may well be double that if there were no CFA. There is also a double whammy in that the legal barriers to starting libel proceedings are very low. All the complainant has to do is show that they have some sort of reputation worth defending and that the accused party has made a statement that has defamed them. There is no requirement to show that this statement is untrue or not fair comment. Nor indeed is there indeed any requirement to show that you have suffered any loss.

The effect of this is that English libel law can be easily used to silence criticism. The complaining party essentially has to take no risk of costs and take on no burden to prove their case. The huge risks and burdens of proof are passed almost entirely to the defendant. So what should someone do when faced with a libel claim against you? A game theory approach might suggest that, since you can never be certain of success, no matter how well justified you might believe yourself to be, there can only be downsides by defending yourself and that you should seek to apologise and settle as soon as possible, regardless of the strength of your case. Defendants may well end up having to pay large amounts of money no matter if they win or lose.

This Oxford report talks about how such a situation has serious free speech issues in the British press. Newspapers are heavily dissuaded from defending libel claims, regardless of their merit. This undermines the role of the press and results in self-censorship where articles criticising wealthy or powerful interests may be dropped or watered down. Our libel laws were essentially created to enable the powerful and the elite to preserve their reputations against the tittle-tattle of the press. As the press grew more powerful, CFAs were brought in to allow ordinary people to take on the press when they do not have access to large amounts of money.

In 1995 Lord Woolf, identified three problems with libel law,

a. litigation is so expensive that the majority of the public cannot afford it unless they receive financial assistance;
b. the costs incurred in the course of litigation are out of proportion to the issues involved; and
c. the costs are uncertain in amount so that the parties have difficulty in predicting what their ultimate liability might be if the action is lost.

CFAs were brought into address point a. However, it would appear that they have also exacerbated the other problems. Whilst CFAs have allowed the less powerful to take on the more powerful, they have then, in the conclusion of the report, denied justice to the defending side.

The report suggests that CFAs and the libel law are not compatible with Article 6 – Access to Justice - and Article 10 – Freedom of Expression -  of the European Human Rights declaration. It states,

Based on those findings it is therefore reasonable to develop the following hypothesis: The CFA scheme increases access to justice for litigants bringing CFA-based defamation claims while eliminating financial incentives and thereby denying access to justice to media outlets, which leads to an interference with the right to freedom of expression. Such a hypothesis must be considered in terms of the ECHR’s Article 6 regarding the right to access justice and Article 10 regarding freedom of expression.

The huge and disproportionate costs of defending libel, the unpredictability of outcome and the burden of defence have all hit hard upon one of Britain’s best science writers. This week we have seen Simon Singh having been placed in a rather kafkaesque position where he is now unable to defend himself against a libel charge as he has been told he must prove something that he clearly does not believe to be true. Libel law hinges around the defamatory meanings of words and the judge in this case has decided that the word ‘bogus’ can only mean ‘fraudulent’. Due to the strict requirements of the pre-trial hearings, Simon will now not be able to defend what he wrote under any reasonable terms. Simon has made it quite clear, and the article made it clear too, what he meant by ‘bogus’. But he will not be able to put that case forward to the judge because of the humpty dumpty nature of the courtroom.

The British Chiropractic Association brought the charge of defamation against Simon Singh after an article appeared in the Guardian criticising the lack of evidence for many chiropractic practices and how the BCA continue to promote such treatments when the scientific evidence appears to be so low. Of course the BCA may well have some evidence that is not readily available, they may be unaware of the lack of evidence, but the judge has ruled that Simon meant they are being fraudulent in promoting these ‘bogus’ treatments.

Already the BCA have succeeded in that the discussion now going on is about the various meanings of the word ‘bogus’ and not about the effectiveness of chiropractic treatment. If Simon decides to appeal then we could see many more months of wondering what ‘bogus’ means to the man on the street. Costs will escalate rapidly.

With such a blatantly unjust set of laws, those who seek to bring defamation cases against individuals must surely already be on the losing side of morality.  The costs for the defendant can only be crippling for the average person. And libel is about reputation, and the clearing of reputations if they have been defamed. Libel laws should not be about exacting revenge, huge cash awards and legal fees, and the silencing of criticism – and that is exactly what they are in the UK. Of course there is a need for defamation laws. But when there are straightforward alternatives to the lumbering and unpredictable giant of the courtroom, then these should be taken. Clarifications, debate, discussions of evidence are still available to the BCA.

And let us remember what this libel claim is about. It is not about claims that some MP or businessman had their fingers in the till. Nor is it about a footballer allegedly seen coming out of a nightclub with someone other than their WAG. This is about a award winning science writer penning a comment piece in a respectable paper about a matter of public health. It is questioning the amount of evidence for an alternative and doubtful practice and highlighting the unspoken dangers of such treatments on children. It is exactly the sort of article that our papers ought to printing and is undoubtedly an important matter of public interest. The central point of the article is that chiropractors promote their trade for children’s ailments, such as asthma, when there is no plausibility that their techniques work, poor evidence that they do, and all with significant risks of harm. That is a charge that a responsible profession would answer.

Simon Singh may well have made an unfortunate choice of words or may well have been unlucky with the trial judge. The article he wrote could have easily been slightly edited to get around the current problems and the substantive criticism he made of the chiropractic trade could have remained. And this highlights how unjust this whole process may be. If the BCA want to clarify that they are not fraudulently promoting treatments and that they believe they work (for whatever reason) then they could have written a letter to the paper. Even better, they could have presented scientific evidence of their efficacy – if it exists. But by pursuing Simon Singh, they are using unjust laws to potentially financially cripple a critic.

Simon will be deciding over the coming days if he wishes to appeal. The logic of current English libel law would suggest he should not. But I know that Simon is a principled man and that the principles involved here are well worth fighting for. The libel law is a serious threat to free speech and it is a serious deterrent to engage in debate where vested interests may wish you to remain quiet. My guess is that in the end this will have to be decided by Europe. The UK government appears to be slow to act. One reason may well be that the main victims of this injustice appear to be the press and correcting this may well not be in the best interests of politicians. One only has to look at the news today to see how the press and MPs are not the cuddliest of friends. Also, so many MPs come from a legal background, and lawyers are the major winner in this mess.  However, it is an injustice that effects us all and it may well take a lone and principled campaigner to do something about it. Perhaps Dr Simon Singh is that man.

Labels: British Chiropractic Association, chiropractors, Simon Singh, the law

Labels: British Chiropractic Association, chiropractors, Simon Singh