The Quackometer

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

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 Simon Singh/BCA libel case is having the unintended consequence of the media being full of reports of the strange beliefs of chiropractors. They are a cult like body of people and are demonstrating that they are unwilling to discuss matters of evidence but very happy to call their lawyers to get at their critics. In this way they show behaviour more readily expected from scientologists than a responsible health profession.

Another unintended consequence of the BCA decision to sue Simon Singh is that an army of bloggers, scientists and sceptics have been scouring leaflets, advertising and web sites of chiropractors resulting in hundreds of complaints being made to the Advertising Standards Authority, Trading Standards and directly to the General Chiropractic Council. What was once considered a strength of Chiropractic – Statutory Regulation – is now being turned back on them as the GCC is obliged by law to investigate every complaint made to them. They are now sitting on a huge pile of letters. The ASA has recently ruled on one claim by a Dr Carl Irwin that he should not call himself ‘Dr’ or claim he can treat things like babies colic. Hundreds of chiropractors make similar claims. The GCC will be busy.

This sort of mass complaint would be powerless against homeopaths. It is now well established that the homeopath’s regulatory bodies, such as the Society of Homeopaths, do not upkeep their own code of conduct and ethics. They are under no obligation to do so by law. But Chiropractors now have to suffer from their own status.

Statutory Regulation of chiropractic makes a number of demands on the trade. Importantly, their education must be from one of three approved schools that provide a degree level education. One school stands out here: the McTimoney College based in Abingdon, Oxfordshire, where the degrees are underwritten by the University of Wales. McTimoney Chiropractic is a sect within the bigger cult. It has its own ideas about how hard you should hit the body when it is ill. According to the McTimoney Chiropractic Association, the School was set up in Oxfordshire by John McTimoney who believed that “health depends on healthy nerve messages, subluxations of the vertebrae or other joints interfere with these, and that such subluxations can affect not only joints and muscles, but every cell and organ in the body.” McTimoney Chiropractors do not rely on X-rays to ‘diagnose’ problems, but use their hands to ‘feel’ for things to ‘correct’. Their Latin motto, In Manu Vis Medendi, means 'in the hands is the power of healing'.

These sort of beliefs would appear to be the root of the sort of claims that Simon Singh was disputing. Whilst there is some plausibility that a chiropractic back massage may help back pain, there is no good evidence that chiropractic subluxations exist and that correcting them allows general health conditions to be treated.

The McTimoney Association is quite explicit in its beliefs. Singh was questioning the role of chiropractic in children. McTimoney’s believe that the act of birth harms children and that chiropractic can correct birth problems:

Birth is probably one of the toughest events we undergo as humans. A baby's head has to squeeze through a small birth canal to be born. In doing so the baby's head in particular will absorb much of the shock, and the soft bones will yield slightly allowing it to travel down the birth canal. This is called 'moulding'. After birth the baby's head will gradually revert to a more normal shape. However, if this 'unmoulding' doesn't take place completely, the baby can be left in some discomfort which they are unable to communicate.

Most babies cope extremely well with the process and emerge contented, happy, able to feed, sleep, and grow normally. However, for some, the recovery can take longer, especially those who had a particularly difficult entry into the world and these babies may show some, all, or a combination of the following signs:

• Irritability, fractiousness
• Feeding problems
• Continuous crying
• Sleeps little, difficult to settle
• Colic, sickness and wind

All of these could indicate that there is a misalignment in the baby's skeletal system and that the baby is uncomfortable as a result.

Evidence for this is of course lacking. It’s nonsense.

Of course birth is not the only problem, but growing children also suffer “simple bumps and tumbles associated with growing up can often cause misalignments of the skeleton”. Naturally, only chiropractors appear to be able to detect these problems. There appears to be few childhood conditions that a good bone rub can’t help:

There is also a range of problems which cannot necessarily be associated with a bump or fall, but which may nonetheless be due to bony misalignment and the subsequent interference with nerves. There are many recorded incidences where treatment has been beneficial for the following symptoms:

• Some childhood asthma
• Learning difficulties and behavioural problems including:
  • Poor concentration and inattentiveness
  • Fidgeting and difficulty sitting still
  • Hyperactivity
• Vunerability [sic] to infections including:
  • Ear infections
  • Repetitive colds
  • Sinus and dental problems
  • Clumsiness or poor co-ordination

It would appear that a huge source of bogus* chiropractic claims come straight from the (undoubtedly sincerely held) beliefs of the McTimoney’s.

Amazingly, the McTimoney School offers a MSc in Chiropractic Paediatrics. This postgraduate degree is underwritten by the University of Wales. You can also gain a similar MSc in crunching the bones of animals as well as babies. The University validates these degrees and presumably passes them as meeting acceptable standards. What these standards are though must surely exclude having a sound scientific basis. It is the GCC that assesses the content of the courses. We may not expect the GCC to be too harsh in assessment – its own survival depends on the survival of the college. It may also be worth noting that the McTimoney College Principal, Christina Cunliffe, is on the Education Committee and General Council of the GCC.

Without the degree awarding body of the University of Wales endorsement of these courses, students could not join the GCC and subsequently practice as Chiropractors. By underwriting the claims that chiropractic can treat colic, the University has allowed this whole affair to happen.

Recently, Universities have been attacked for offering bogus* science degrees in pseudoscientific subjects, such as homeopathy. Many courses have closed as a result. This does not harm homeopaths too much; most learn their trade from private unaccredited schools.

Somehow, the Chiropractic degrees have escaped this scrutiny. I do not think that will last. And if similar decisions are made in places like the University of Wales as has happened elsewhere, the very future of chiropractic in the UK will be severely threatened.

Chiropractic statutory regulation has given this form of quackery* great strength. But that strength may well be turned against itself and be the undoing in the long run.

* Deliberate deception not implied.

Labels: chiropractors, qualifications, Simon Singh

“The law has no place in scientific disputes”

Simon Singh is to appeal the absurd and astonishingly illiberal ruling made by Sir David Eady in the libel case brought about by the British Chiropractic Association. This is a brave decision by Simon, but an important one as there are issues at stake that go well beyond one case.

Today, the charity Sense about Science is launching a campaign to highlight the issues raised by the Simon Singh libel case. I am very please to support this campaign and be one of the first signatories to the following statement:

We the undersigned believe that it is inappropriate to use the English libel laws to silence critical discussion of medical practice and scientific evidence.

The British Chiropractic Association has sued Simon Singh for libel. The scientific community would have preferred that it had defended its position about chiropractic for various children's ailments through an open discussion of the peer reviewed medical literature or through debate in the mainstream media.

Singh holds that chiropractic treatments for asthma, ear infections and other infant conditions are not evidence-based. Where medical claims to cure or treat do not appear to be supported by evidence, we should be able to criticise assertions robustly and the public should have access to these views.

English libel law, though, can serve to punish this kind of scrutiny and can severely curtail the right to free speech on a matter of public interest. It is already widely recognised that the law is weighted heavily against writers: among other things, the costs are so high that few defendants can afford to make their case. The ease and success of bringing cases under the English law, including against overseas writers, has led to London being viewed as the “libel capital” of the world.

Freedom to criticise and question in strong terms and without malice is the cornerstone of scientific argument and debate, whether in peer-reviewed journals, on websites or in newspapers, which have a right of reply for complainants. However, the libel laws and cases such as BCA v Singh have a chilling effect, which deters scientists, journalists and science writers from engaging in important disputes about the evidential base supporting products and practices. The libel laws discourage argument and debate and merely encourage the use of the courts to silence critics.

The English law of libel has no place in scientific disputes about evidence; the BCA should discuss the evidence. Moreover, the BCA v Singh case shows a wider problem: we urgently need a full review of the way that English libel law affects discussions about scientific and medical evidence.

Please visit the campaign web site at http://www.senseaboutscience.org.uk/freedebate and give your own support. As you can see, there are one or two names on the list who are even more eminent and famous than me. Every one from the Poet Laureate to Harry Hill has signed. (I believe that Harry has suggested there is only one way to settle this – FIGHT!)

Sign the Support Statement.

Also, download the campaign button and add it to your website.

The Quackometer wishes Simon Singh all the best in his appeal. He may still yet lose. The legal shenanigans involved are tough. What is quite clear though, in that appealing, the absurdity of the chiropractic position will be made public, and the injustice of the law brought to the full attention of the media. The BCA could still do the best thing and back down. At the very least they could publish the scientific evidence that they believe they have to support their position. Their silence on the matter of evidence is damning.

Good luck and here’s to greater public awareness of chiropractic absurdity and even a change in the law.

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What some people have said about this:

Stephen Fry, Broadcaster and Author:

“It may seem like a small thing to some when claims are made without evidence, but there are those of us who take this kind of thing very seriously because we believe that repeatable evidence-based science is the very foundation of our civilisation. Freedom in politics, in thought and in speech followed the rise of empirical science which refused to take anything on trust, on faith, on hope or even on reason. The simplicity and purity of evidence is all that stands between us and the wildest kinds of tyranny, superstition and fraudulent nonsense. When a powerful organisation tries to silence a man of Simon Singh's reputation then anyone who believes in science, fairness and the truth should rise in indignation. All we ask for is proof. Reasoned proof according to the established protocols of medicine and science everywhere. It is not science that is arrogant: science can be defined as ‘humility before the facts’ — it is those who refuse to submit to testing and make unsubstantiated claims that are arrogant. Arrogant and unjust.”

Professor Richard Dawkins, FRS, University of Oxford:

“This splendid manifesto hits so many bullseyes, I feel like adding my signature to every line of it. The English libel laws are ridiculed as an international charter for litigious mountebanks, and the effects are especially pernicious where science is concerned.”

Jonathan Heawood, Director, English PEN:

“You know there's something badly wrong with the libel law when a serious scientific writer is dragged through the courts for something he didn't even mean to say! Simon Singh's only mistake was not to distinguish clearly enough between ineffective and fraudulent treatments - both of which might equally be termed 'bogus'. The real culprit here is the rich English language and the arcane law of libel.”

Professor Richard Wiseman, Professor of the Public Understanding of Psychology, University of Hertfordshire, and author:

“England's strict libel laws can deter individuals from speaking out against bad science, even when they have strong evidence for their argument.  Simon's campaign deserves the support of everyone who cares about fighting pseudoscience.”

Diana Garnham, Chief Executive, The Science Council:

“Delivery of professional health care should be based on science, not libel laws.  It goes without saying that all professional health care scientists must be expected to base their professional practice on scientific methodology, encompassing both a rigorous evidence base and open peer review.”

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An Impressive List of Signatories:

Science

Professor Jim Al-Khalili OBE Professor of Physics and of Public Engagement in Science, University of Surrey

Dr Sabine Bahn Cambridge Centre for Neuropsychiatric Research, University of Cambridge

Harriet Ball Voice of Young Science network

Professor Michael Baum MB FRCS ChM MD FRCR Emeritus Professor of Surgery and Visiting Professor of Medical Humanities, University College London

Professor Jocelyn Bell Burnell FRS University of Oxford and President, The Institute of Physics

Willem Betz Emeritus Professor, Vrije Universiteit Brussel and Chair, SKEPP

Susan Blackmore Visiting Professor, School of Psychology, University of Plymouth

Professor Colin Blakemore FRS University of Oxford

Sir Tom Blundell FRS University of Cambridge and President, The Biochemical Society

Jean Bricmont Professor of Theoretical Physics, University of Louvain and Honorary President, Association Francaise pour l'Information Scientifique

Tracey Brown Managing Director, Sense About Science

Professor David Colquhoun FRS University College London

Professor David Cope

Professor Brian Cox University of Manchester

Dr Tim Crayford MB BS MSc FFPH FRSA Former President, Association of Directors of Public Health

Professor Richard Dawkins FRS University of Oxford

Professor Edzard Ernst MD PhD FRCP FRCP (Edin) Peninsula Medical School, Exeter University

Professor Elizabeth Fisher FMedSci Institute of Neurology, University College London

Dr Ron Fraser Chief Executive, The Society for General Microbiology

Carlos Frenk Ogden Professor of Fundamental Physics, Durham University

Diana Garnham Chief Executive, The Science Council

John Garrow MD PhD FRCP FRCP (Edin) Emeritus Professor of Clinical Nutrition, University of London and Former Chairman, HealthWatch

Professor David Gordon President, Association of Medical Schools in Europe

Professor Hugh Griffiths FREng University College London and Chairman and on behalf of The Campaign for Science and Engineering in the UK

Dr John Haigh Former Reader in Mathematics, University of Sussex

Professor Martin Humphries University of Manchester and Chair, The Biochemical Society

Sir Tim Hunt FRS Cancer Research UK

Roland Jackson Chief Executive, The British Science Association

Professor Steve Jones University College London

Dr Stephen Keevil King’s College London

Professor Sir David King FRS Former Chief Scientific Adviser to the UK Government and Director, Smith School of Enterprise and the Environment, University of Oxford

Dr Chris Kirk Chief Executive, The Biochemical Society

Professor Sir Peter Lachmann FRS FMedSci University of Cambridge and Founder President, Academy of Medical Sciences

Jennifer Lardge Voice of Young Science network

Armand Leroi Professor of Evolutionary Developmental Biology, Imperial College London

Dr Robin Lovell-Badge FRS FMedSci MRC National Institute for Medical Research

Daniella Muallem Voice of Young Science network

Professor Dame Bridget Ogilvie FRS FMedSci Former Director, Wellcome Trust

Professor Clive Orchard University of Bristol and President, The Physiological Society

Professor Ole H Petersen CBE University of Liverpool

Lord Rees Professor of Cosmology and Astrophysics, University of Cambridge

Les Rose Clinical Science Consultant

Dame Nancy Rothwell FRS MRC Research Professor and President, Biosciences Federation

Alan Sokal Professor of Physics, New York University and Professor of Mathematics, University College London

Professor Beda Stadler University of Bern, Switzerland

Dr John Stevens DMS President and on behalf of The Institute of Biomedical Science

Professor Ian Stewart FRS Mathematician and Science Writer

Professor Raymond Tallis FMedSci Emeritus Professor of Geriatric Medicine, University of Manchester

Lord Taverne Chair, Sense About Science

Hazel Thornton Independent Advocate for Quality in Research and Healthcare

Sir Mark Walport Director, The Wellcome Trust

Professor Robin A Weiss FRS University College London and President, The Society for General Microbiology

Tom Wells Voice of Young Science network

Robin Wilson Professor of Pure Mathematics, Open University

Richard Wiseman Professor of the Public Understanding of Psychology, University of Hertfordshire and Author

Journalism and Publishing

David Aaronovitch Columnist, The Times and Author

Yasmin Alibhai-Brown Journalist and Columnist

Wendy Barnaby Editor, People and Society

Rosie Boycott Former Editor, The Independent and Independent on Sunday

Geoffrey Carr Science Editor, The Economist

Duncan Campbell Journalist

Dr Philip Campbell Editor-in-Chief, Nature

Sir Iain Chalmers Editor, The James Lind Library

Nick Cohen Columnist, The Observer

Clive Cookson Science Editor, Financial Times

Nick Davies Journalist and Author of Flat Earth News

Kendrick Frazier Editor, Skeptical Inquirer

Professor Christopher C French Head, The Anomalistic Psychology Research Unit, Goldsmiths University and Editor, The Skeptic Magazine

James Gleick Science Writer and Journalist

Dr Ben Goldacre Writer, Broadcaster and Medical Doctor

Nigel Hawkes Director, Straight Statistics and Former Health Editor, The Times

Mark Henderson Science Editor, The Times

Roger Highfield Editor, New Scientist

Dr Richard Horton FRS FMedSci Editor, The Lancet

Alok Jha Science and Environment Correspondent, The Guardian

Rohit Jaggi Columnist, Financial Times

Barry Karr Skeptical Inquirer and Committee for Skeptical Inquiry

Dr Karl Kruszelnicki Author, Broadcaster and Scientist

Sam Lister Health Editor, The Times

Brenda Maddox Journalist and Biographer

Dr Margaret McCartney Columnist, Financial Times and GP

Robin McKie Science Correspondent, The Observer

George Monbiot Journalist

Andrew Mueller Journalist and Author

Steven Novella Editor, Science-Based Medicine; Director of General Neurology, Yale University School of Medicine and Author

Vivienne Parry Science Writer and Broadcaster

John Rennie Former Editor-in-Chief, Scientific American

Nick Ross Journalist and Broadcaster

Ian Sample Science Correspondent, The Guardian

Ariane Sherine Comedy, Writer and Journalist

Michael Shermer Publisher, Skeptic Magazine; Columnist Scientific American and Author of Why People Believe Weird Things

Rebecca Smith Medical Editor, The Daily Telegraph

Bill Thompson Technology Journalist

Arts, Humanities and Entertainment

Martin Amis Novelist

Joan Bakewell Broadcaster and Journalist

Antony Beevor Historian

Jo Brand Performer

Derren Brown Psychological Illusionist

Alain de Botton Author

Carol Ann Duffy Poet Laureate

Peter Florence Director of The Guardian Hay Festival

Stephen Fry Broadcaster and Author

Ricky Gervais Writer and Performer

Anthony Grayling Professor of Philosophy, Birkbeck College University of London

Dave Gorman Writer and Performer

Harry Hill Performer

Robin Ince Performer

Tim Minchin Performer

Dara O'Briain Performer

Penn Jillette Illusionist, Juggler and Libertarian

Libby Purves Broadcaster, Journalist and Author

David Starkey Historian

Teller Illusionist, Juggler and Libertarian

Sandi Toksvig Broadcaster, Comedian and Author

Dr Richard Vranch Performer and Ex-physicist

Skeptics and Campaign Groups

Australian Council Against Health Fraud

Australian Skeptics Inc

Peter Bowditch Editor, www.ratbags.com

Neil Denny Little Atoms podcast

Rachael Dunlop Reporter, Skeptic Zone podcast

Jonathan Heawood Director, English PEN

Narisetti Innaiah Chairman, Center for Inquiry, India

Andy Lewis Blogger, quackometer.net

Ronald A Lindsay President and CEO, Center for Inquiry, USA

Simon Perry Founder, Skeptics in the Pub (Leicester)

Dr Philip Plait President, James Randi Educational Foundation, USA

James Randi CEO, James Randi Educational Foundation, USA

Padraig Reidy Index on Censorship

Sid Rodrigues Chairman, Skeptics in the Pub (London)

Amardeo Sarma Chairman, German Skeptics (GWUP)

Eran Segev President, Australian Skeptics Inc

Law

David Allen Green Solicitor

Jonathan Morgan Fellow in Law, University of Cambridge

Baroness Helena Kennedy QC Barrister and Labour Member of the House of Lords

Labels: chiropractors, Simon Singh, the law

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.

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* 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

William Alderson, a homeopath, has produced a 142 page response to the book that attempts to show that the book has “has no validity as a scientific examination of alternative medicine”. Entitled, Halloween Science, the critique is a collection of misunderstandings, quibbles, strawmen and just plain daftness.

The approach that Alderson is taking here is to produce so many half baked critiques that to debunk the whole work would take 500 pages or more. Even if I was to show that the first few pages contained nothing but nonsense, the charge could be made that the rest of the book must contain some well targeted criticism. The whole book is destined to become an exemplar of the Dunning-Kruger effect.

Nonetheless, given that I have a life, I have no choice but to pick out a few examples and display their total inadequacy to you. The rest I shall leave as an exercise to the reader. No doubt, as with any work, there may well be weaknesses in Trick or Treatment and Alderson may well stumble over a few of them. Whether this undermines the main argument of the book though is a different matter. In that regard, Alderson fails to plant any fatal punches.

For the easily bored, or for those with delicate foreheads (for you will be sure to be banging yours on the desk if you attempt to read the full tome), Alderson gracefully produces a précis of his magnum opus.

So, a quick example: early on in Trick or Treatment, Ernst and Singh show how early versions of clinical trials established effective treatments for sailors’ scurvy. By trialling different proposed remedies and comparing outcomes, the British Navy was able to eradicate the curse of scurvy by allowing sailors access to lemons and oranges, a good source of vitamin C.

Alderson contends that in doing so the authors are “confusing two types of intervention”.

In fact, we need to be clear that the condition which lemons, oranges or vitamin C are actually curing is the absence of vitamin C in the diet. In other words the treatment in this case is actually the ending of a harmful intervention (deprivation of vitamin C), and this harmful intervention is the one and only cause of the illness. In this respect dietary deficiency diseases and poisonings are totally different from infections or chronic diseases, where there are multiple causes. The point can be illustrated by reference to another of Ernst and Singh’s examples: loss of blood as a result of bloodletting simply requires one to stop depriving the patient of blood, whereas a haemorrhage requires an active intervention to be initiated to solve the problem. Nobody would call the former action a ‘cure’, yet that is precisely what Ernst and Singh are doing in the case of scurvy.

You might want to read that again, because, yes Alderson is really saying what you thought he did.

Before I highlight his error here, it is worth noting Alderson’s misplaced obsession with theory in medical treatments. He claims that Ernst and Singh ignore theory when they say that “by experimenting and observing, [we] can determine whether or not a particular therapy is effective.” Alderson contends that “Ernst and Singh [believe] the scientific method is about “experimenting and observing”, not about experimenting, observing and theory.” The observant might notice the Alderson is attacking an argument that the authors do not make. Ernst and Singh do not attempt to define science as being about “experimenting and observing” but that we can determine what facts are true about the world by such processes. We can understand if an intervention has an effect on a disease without having a theoretical understanding of the diseases nature. That may well come later.

Alderson obsesses about theory because, like a lot of homeopaths, he delights that homeopathy provides a theory of disease – imbalances in vital forces (or something) and a theory of cure – ‘like cures like’. Like all homeopaths, he does not understand that you cannot have a theory until you have a set of observations that need explaining by a theory. No such observations exist for homeopathy. In two hundred years, homeopaths have failed to produce a similar demonstration of efficacy as this primitive trial with lemons.

So, back to our scurvy problem. What Alderson is missing is that when citrus fruits were proposed as a cure for scurvy, that this was not based on any theory of disease. Indeed, it was completely unknown what caused the terrible disease amongst sailors. It could have been an infection or diet; some though the disease was caused by sailor’s laziness and so made sick sailors work harder. Physicians at the time had no knowledge of vitamins and the book makes this clear. The sailors’ trials tried different suggested remedies including cider, sulphuric acid, vinegar, sea water, garlic paste and, of course, oranges and lemons on twelve afflicted patients. The two given fruit recovered very quickly, the cider drinkers somewhat and the rest made no progress. As trials go, it is pretty primitive, but understandably compelling.

Even with this result, it would take a long time to establish that that the reason lemons worked was because of a dietary deficiency. Alderson is quite wrong to suggest that somehow the trial only worked because of the nature of the cause. In fact, the nature of the trial makes no assumptions about the cause of the illness; it merely seeks to determine what intervention has an effect on the illness. The trial has about as much need of theory as a ruler does of General Relativity. Alderson fails to state why this so called failure or ‘confusion’ had any bearing on this or any other trial.

The rest of Halloween Science is riddled with the same error and similar misunderstandings. What is unforgivable is that that Ernst and Singh go to some six pages explaining very carefully the same point I have made above. William Alderson does not, or chooses not to, understand.

Of course, the whole Alderson book is a mere fig-leaf. Its clumsy rhetoric and lengthy nitpicking is a disguise of the embarrassment that homeopaths have over the fact that they cannot produce any reliable evidence for the efficacy of their treatments and the validity of their hypotheses (not theories). This pamphlet may well please the homeopaths who continue to avoid acknowledging the genuine and urgent criticisms of their shabby trade (such as their refusal to condemn the practices of their colleagues who dish out sugar pills in Africa in order to 'prevent’ malaria or treat HIV infection). More competent readers will not be impressed.

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UPDATE

It is probably worth mentioning the section in Halloween Science that discusses the attempts by the Society Homeopaths to sue my internet service provider when I dared to criticise them.

William Alderson, a member of that society continues to misrepresent what happened in the most shocking way.

Ernst and Singh said in their book,

Worse still, when the Society of Homeopaths, based in Britain, was criticized for not taking a firm stand against inappropriate use of homeopathy, it decided to suppress criticism rather than to address the central issue. Andy Lewis, who runs a sceptical and satirical website (www.quackometer.net), had written about the Society and the issue of homeopathic malaria treatments, which resulted in the Society asking the company that hosts his website to remove the offending page. In our opinion, the Society needs to improve in three ways. First, it ought to police its practitioners more thoroughly. Second, it ought to act publicly and promptly when serious complaints are made. Third, it should listen to its critics rather than silence them.

You can read my criticism here. It is harsh – but the issue was very important.

At its most basic level, the Society fail to uphold their own code of conduct, never censor anyone for clear breaches and allow their members to offer dangerously misleading advice to the public. (Example here)Those charges demand a serious response. The Society have never done so.

Alderson responds to this rather serious charge by just quoting the Society asserting what good eggs they are. He then repeats the lie that the Society could not take action against any members as no information had been given to them. This is simple untrue as you can read here. To say that the society had nothing to “police” is an utter distortion. The Society is riddled with members who either support or who actively engage in immoral and dangerous uses of homeopathy on Africans with malaria or AIDS.

Alderson then claims that the Society was justified in calling in their lawyers because my remarks were not criticism but defamatory. I wrote to Paula Ross asking for an explanation. None was ever forthcoming. They simply wanted to silence me.

And the Society and their members made no meaningful attempt to stamp out dangerous practices. Indeed, they went on to host a conference on treating AIDS with sugar pills and have been financially supporting members experimenting on Africans with AIDS. Let me now defame them: despicable scum.

Labels: edzard ernst, homeopathy, Simon Singh

Chiropractors have achieved a status amongst practitioners of alternative medicine that is almost unrivalled. In the UK, they have achieved a level of mainstream acceptance, regulation and recognition that must be the envy of homeopaths and herbalists. Such is their standing that I suspect that many people would not even consider them as part of the alternative medicine scene. Chiropractors, like their close cousins the Osteopaths, are statutorily regulated in the UK, and this means that they have 'protected title' and other rights not afforded to lesser practices.

The Professional Conduct Committee has seen that treatment plans are exploitative when they are constructed around a diagnosis that leads patients to believe they are more seriously ill than they are, with the intention to promote undue dependence on chiropractic care. Some treatment plans, as shown by the evidence heard by the Professional Conduct Committee, were formulated without any adequate assessment or reassessment of patients’ needs. Going hand in hand with this approach was the routine X-ray of patients without justification. The images were used as sales tools further to pressurise patients to accept treatment.

They speak of a few cases:

This year the Professional Conduct Committee heard evidence in one case that also demonstrated a blatant disregard for patients’ safety and wellbeing. Amongst other things, patients, including a child, were exposed to ionising radiation for no other reason than to use X-rays to pressurise patients to sign up to long contracts of care. The individual concerned showed no insight, understanding or remorse for what
he had done and was removed from the Register.

During another Professional Conduct Committee hearing, a respondent chiropractor admitted that he had routinely X-rayed nine out of 10 adult patients. Upon considering an audit of nine patient records, the Professional Conduct Committee was of the view that there was no justification for those patients to have been exposed to ionising radiation.

Table 33. & 34. X-rays

Chiropractors were asked:

a) For what percentage of your patients is an x-ray justified?
b) Do you take x-rays of your patients?
c) Do you refer patients direct for imaging?
d) Do you refer patients for imaging via GPs?
e) Do you interpret the x-rays?

Table 33. a) X-ray justified?
Number of Range chiropractors

0%	9	1%
1-20%	525	61%
21-40%	99	12%
41-60%	51	6%
61-80%	47	6%
81-100%	34	4%
Didn’t specify	89	10%

 
Table 34. b, c, d, e) X-rays

	B	C	D	E
Yes	294 (34.43%)	499 (58.43%)	568 (66.51%)	593 (69.44%)
No	542 (63.47%)	306 (35.83%)	246 (28.81%)	241 (28.22%)
Didn’t specify	18 (2.1%)	49 (5.74%)	40 (4.68%)	20 (2.34%)

Clearly, the majority of Chiropractors are X-raying fairly regularly and some are performing it routinely. There are undoubtedly practitioners out there that believe wholeheartedly in the concepts of subluxations and use X-rays to try to find their mysterious problems.  One comment in the Survey noted this 'fundamntalist' approach to their art,

Labels: chiropractors, regulation, Simon Singh

Labels: British Chiropractic Association, chiropractors, Simon Singh