The Quackometer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In the meantime, if you care about what is going on here, you can keep up to date on this facebook group...


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Labels: chiropractors

 

The decision by the British Chiropractic Association to sue Simon Singh will undoubtedly bring increased scrutiny of chiropractic. I would like to start with a first look at the education of chiropractors in the UK. This is also timely as Universities have recently been criticised for teaching quackery, resulting in a homeopathy degree being dropped by the University of Central Lancashire.

Chiropractic is going to be quite different from homeopathy though. Anyone can call themselves a homeopath. Having a diploma behind you helps in joining the various homeopathic pretend regulatory bodies. Have a BSc and you will be vastly overqualified by far to dish out sugar pills. Chiropractors, however, need to be registered with the General Chiropractic Council. Chiropractic is capable of causing injury to patients, sometimes even death. To be registered, you need to have studied chiropractic for at least four years to degree level including one year of clinical supervision. That is the law.

Labels: chiropractors

 

Hot on the heals of New Zealand Chiropractors trying to silence David Colquhoun and the The New Zealand Medical Journal, we learn today in the Telegraph that the British Chiropractic Association has issued a writ against Simon Singh for an article he wrote in the Guardian entitled Beware the Spinal Trap. 'Dr' Antoni Jakubowski of the BCA said that this was not a decision they were taking lightly. If justice is forthcoming, it will be a decision they regret.

The original article is no loner available on the Guardian site, but here are some excerpts that so offended the chiropractors.

Labels: chiropractors

 

Chiropractors have an air of respectability about them. They style themselves, 'Doctor'. They wear white coats and have brass plaques outside their offices with lots of letters after their name. My friends look at be puzzled when I say they are quacks. But that is what the evidence says. Their practice is founded on strange ideas about mysterious things called 'subluxions' and pseudoscientific beliefs in 'inate intelligence' running through our nerves and bones. We think of chiropractors as being for bad backs, but their founding beliefs state that cracking bones can be a panacea. You will still find chiropractors claiming treatments for all sorts of weird and wonderful things.

The evidence for the effectiveness of chiropractic is not good. What evidence does exist suggests it is just another placebo treatment. It might work for lower back pain - but probably no more than a couple of paracetamol. And the risks of bone cracking can be quite severe with deaths reported by stroke. More minor adverse reactions appear to be quite common.

In the UK, chiropractors can thank their regulated status for much of their standing and freedom from ridicule that other quackery attracts - like homeopathy. Chiropractors are statutorily regulated. You need to be registered to call yourself one. You can even call yourself Doctor as long as you do not imply that you are medically trained - but that is hard. Brass plaques. White coats. X-ray machines. My best guess is that most people think of chiropractic as a branch of medicine. It is not. It is quackery and a business.

Some times though we see them for their true colours. The New Zealand Medical Journal has just been threatened by a law suite for publishing research into how chiropractors (mis)represent themselves to the public by using the title 'Dr'. Professor David Colquhoun wrote an editorial that put chiropractic deception into a wider context of their education and business practices. The response of the New Zealand Chiropractic Association was to get their lawyer to threaten to sue. The Medical Association has responded admirably by calling their bluff and asking for their evidence that what was being said is not true. "Let’s hear your evidence not your legal muscle."

That is how it should be. As Ben Goldacre has responded, the real medical world is full of self-criticism - often very harsh. The way to respond is with science and argument - not with lawyers. Legal threats are a business technique, not the actions of medical practitioners. They expose their true self by calling their lawyers.

As Professor Colquhoun notes, since the invention of chiropractic, their business acumen has been sharper than their scientific and medical expertise. Consultancies on how to grow your bone crunching businesses are rife in the US. As Rose Shapiro notes, its all about building "high-volume, subluxation-based, cash-driven, lifetime family wellness practices."

In the UK, we have similar chiropractors-turned-business gurus too. 'Dr' Terry Chimes, ex drummer with the Clash, is perhaps the highest profile. This year he has launched his 'Chiropractic Heaven' consultancy. Chimes promises to tell you the 'The Secrets of the World's Most Successful Chiropractors'. He does this over 120 weekly modules - all brimming with 'golden nuggets of wisdom '. And he claims to be able to 'Quadruple Your Practice in a Matter of Months. . . Ethically'.

Not all chiropractic business skills could claim to be ethical. Occasionally, the General Chiropractic Council of the UK is embarrassed enough to step in. In one case, a chiropractor was found to have "abused the trust of his patients, and coercing them, through alarmist scare tactics, into excessively protracted and unjustified treatment plans". Chiropractic lends itself to such approaches: it deals with long term chronic conditions, such as back ache, uses mysterious and unverifiable X-ray diagnostic techniques to alarm customers, and recommends long courses of treatments. The chiropractor in question was accused of using unjustified courses of X-rays and misrepresented the gravity of the customer's condition. The chiropractor was removed from the chiropractic register, but simply re-invented himself as a 'osteomyologist' - a sort of renegade and unregulated chiropractor in all but name.

It is amazing that all chiropractors cannot be charged with using unjustified X-rays. Since, their bone crunching cannot be showed to be medically effective, X-rays cannot be medically justified, and so applications of X-rays are in direct contravention of IR(ME)R regulations which demands medical justification for all exposures. One has to wonder how chiropractors get away with X-raying patients. One factor must be is that statutory regulation of chiropractors directly lead to their inclusion in the list of health workers who were allowed to refer for X-ray. Not that means that their referral is likely to be justified.

Such are the perils of regulating nonsense.

Labels: BPSDB, chiropractors