The Quackometer

Today the US National Center for Complementary and Alternative Medicine has issued a report that shows that Americans spend $33.9 billion out-of-pocket on complementary and alternative medicine per year.

This is the figure that people spend on such things as homeopathy ($3B), yoga and qi gong ($4B) and non vitamin supplements ($15B). The report does not include purchases of vitamin and mineral supplements and estimates suggest this could triple this spend.

The NCCAM has spent nearly a billion pounds on researching CAM and has failed to demonstrate the efficacy of any complementary medicine. Yes, its all quackery and these Americans are wasting their money.

So, $34 billion is a big number. Let’s try to put that into perspective:

• Achieving the the WHO–UNICEF Global Immunization Vision and Strategy for 2006–2015 would cost US$35 billion over those years. Children throughout the world need not die of measles, diphtheria, polio and other killers.
• Putting all America 3 and 4 year old children through preschool education and thus reducing the need for remedial and special education, welfare and criminal justice services would cost $25 billion to $39 billion.
• Nearly 46 million Americans do not have health insurance and do not have the access to health care services that the rest of the civilised world enjoys. $34 billion would ensure there was cover for the uncompensated care that hospitals deliver every year. It would also provide about a third of these people with good health insurance cover.
• To reach the United Nations Development Programme Millennium Development Goals of halving the proportion of people without access to safe water or sanitation worldwide by 2015 about $30 billion needs to be spent annually.

• More than one billion people in the world could have about a 10% pay rise as they only earn a dollar a day.

• There are 7 million people in Sub Saharan African in need of antiretroviral treatment. Costs of HAART can be as much as $400 per month. Supplying this treatment would cost $35 billion per year.

• Malaria kills several million each year, the majority being children in Africa. It has been estimated that only $3 billion could bring this under control, sparing another $12 billion to remove the economic impact of lost work days, lost education and lack of development in malarial areas.

I am glad we have our priorities sorted out.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

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

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

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

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

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

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

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

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

Labels: British Chiropractic Association, chiropractors, Simon Singh

In my continuing quest to make The Quackometer the Internet’s premier resource for all your quackbusting needs, I have now taken it to Twitter.

If you don’t understand the title of this blog post, then you had better go and do something else now. Where have you been? Do you use the web? Did you know Michael Jackson is dead?

So, if you are still here then I have now made the quackometer respond to Tweets addressed to @quackometer and that have a URL in them (beginning http://…) The quackometer will go away, analyse your page for quackery and then Tweet you back with its report.

I’ve tested it a bit. It has been working-ish – please be patient. It may take a while for your tweet to get back to you.

Examples:

1) if you want to find out if that scoop the Daily Mail ran today

Medical spy ware: How Russian KGB technology is being used to spot impending disease

where we are told:

Technology developed by the Russian KGB is being used to help diagnose and predict impending illnesses, a scientist said today.

Russian-born consultant Alla Cranham has used the technique to develop the Health Detector, which measures impulses from the brain to pinpoint hidden weaknesses in other parts of the body.

We can send a quick tweet,

and then, hopefully (interweb gods willing) we will shortly get back a tweet:

Clicking on the link in the Tweet takes us to the Quackometer website where we are learn:

Could be average quack fodder. This web site has quite a bit of loosely defined terms and possibly pseudoscientific language. It is heavily using scientific jargon and may be doing this to bamboozle. It shows little or no sceptical awareness and so should be treated with caution! It also looks like this site is trying to sell stuff. Buyer Beware!

Well, that is enough to start arousing our curiousity about this story.

2) And so, we do a little more digging around and find out where this story came from. We soon land up on the site of In Vivo Health run Alla Cranham MSc ABMT, DipHTox, MBRCP, FRSPH, MBS who “practices what is known as Integrated Medicine, combining elements of conventional medicine, homeopathy and nutrition.”

Let’s Tweet this to the @quackometer…

10 Canards. What does the detailed report say?

This web site has more quackery than my village pond. It is full of scientific jargon that is out of place and probably doesn't know the meaning of any of the terms. It shows no sceptical awareness and so should be treated with a suspicious mind. It also looks like this site is trying to sell stuff. Buyer Beware!

I think that does it. And all thanks to Twitter and the quackometer.

I am sure the Daily Mail will find it very valuable to make sure they do not run such dreadful quack puff pieces like this again. We can tweet this to @pigsmightfly to see if this is true.

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So, to follow what the quackometer is up to follow at http://twitter.com/quackometer

If you want to follow my tweets about this blog and what I have for breakfast then go to http://twitter.com/lecanardnoir

Labels: quackometer

Cut free from the tethers of evidence and reason, homeopathy, as a system of thought, is free to soar into lofty heights of wild fantasy. Unrestrained by the weight of reality and the heavy ethical demands of accountability, practices and principles are able to float into almost any area that the imagination will allow. There are no maps to guide this flight of the bizarre and no compass to return the traveller to a safe base.

Despite two hundred years of existence, you will still find vigorous debates on homeopathic discussion boards about what exactly homeopathy is. There are homeopaths who will only ever give one pill. There are homeopaths that do not mind mixing pills. Some only accept remedies based on the original forms of testing, known as the ‘proving’. Others allow themselves to dream what a remedy might do. Homeopaths squabble about what is right, but can never resolve their difference because they have long ago abandoned objective means of settling disputes. An uneasy truce exists between the various schools of thought with only occasional cold war like peripheral fights breaking out, mainly in the form of a diatribe by one side denouncing heresies and calling for all homeopaths to unite under the scriptures of Hahnemann, the founder, and the One True Authority.

A few common principles bind the various factions together – the idea of similarity, that like cures like; the need to match the totality of symptoms to a remedy; and the idea of minimum dose – use the smallest amount of remedy possible. This last point means that homeopaths most often give no dose. The medicine has been so diluted away that not a single molecule remains. The beauty of homeopathy, and probably the reason that it is has done so well, is that it is a pure placebo therapy. There are no risks of side effects and the patent is quite free to allow nature to take its course and the complaint to get better on its own.

When the actual physical acts of homeopathy are completely inert and when practiced by people with no regard for critical self appraisal, the scientific method and the objective collection of data, one can expect a certain amount of arbitrary evolution of ideas and the generation of whimsical variants. The only criteria that restrain such ideas are the need to keep the treatment inert, the philosophical acceptability to the vitalist mindset of the homeopath and, most importantly, its profitability in practice.

Thus, in the UK, we have seen the former founder of the Society of Homeopath, Peter Chappell, invent the homeopathic delivery of remedies by MP3 file. Since homeopaths invent cod explanations for their work along the lines that it is an ‘energy medicine’ or a ‘vibrational medicine’ then the thinking goes that because MP3 files can encode sound vibrations, then they can also encode ‘healing vibrations’. And so, we find Chappell running a little business where people can download MP3 files and play sounds of waves crashing as they worry that they might have swine flu.

It is in India though that we must look to see some true inventiveness. The country has more homeopaths than any other and the government appears to be quite happy to support all manner of quackery in the name of political expediency.

And so, I stumbled across the works of the followers of Dr. B. Sahni who runs the Research Institute Of Sahni Drug Transmission & Homoeopathy (risdth.org). Without a hint of irony, the home page proclaims “Welcome to Medicine Free World“. The Sahni protocol is rather wonderful: a homeopathic remedy is chosen in the classical way, by matching symptoms to a remedy. The chosen pill is then dissolved in a vial and a single hair is then plucked from the customer’s head and placed in the vial with a little bit sticking out. The hair is then able to transmit the remedy back to the owner.

Naturally, there are great benefits in this method. Once the homeopath has the hair, then no further visits are required. A letter or telephone call can update the choice of remedy (“Yes, don’t worry. I am dipping your hair in the new remedy now. Can you feel that? Good.”) If a patient’s illness gets worse (as homeopaths come to expect – they call this an aggravation and this shows the remedy is working) then the hair can be removed from the vial until the aggravation passes. All marvellous stuff.

Naturally, the most wealthy homeopaths in India are not those that stick to treating customers, but those that manage somehow to take money off other homeopaths. The Sahni institute is able to train other homeopaths in the invaluable hair dipping technique for the sum of US$500 (a rather large amount in India where the annual average per capita income is under $1000).

Claims for the technique are of course high with case histories of customers with renal failure and diabetes. Online customers are invited to come forward for the treatment of cancer and multiple sclerosis, fill in a form, send in up to $300 if you are from the USA or Europe, and, of course, send in a sample of your hair.

Nice work if you can get it.

Of course, we will not see any homeopaths here in the UK condemning such practices. They will look on. Wonder if it is strictly Hahnemannian. But ultimately let a fellow homeopath do whatever they like. It does not matter how much such delusional thinking might end up hurting vulnerable people. This is an evidence free environment. A criticism void. What matters is that the Sahni Institute is finding another means to denounce ‘allopathy’.

It would be tempting to ignore and dismiss this variant of homeopathy as utterly bizarre. But it reminds us that all of homeopathy is just as equally implausible and nonsensical. What you might find in Boots the Chemist is just as daft. The NHS Royal London Homeopathic Hospital is dealing in similarly batty ideas. We become numb to the idiocy of our own local brands of quackery and heightened to exotic forms. We must remember that all forms of homeopathy are essentially forms of sympathetic magic – the idea that an object once in contact with something either good or bad can inherit those properties. The sugar pill, once associated with a healing object can retain healing properties. The hair on your head retains a connection with you and can transmit the goodness of the remedy to you. The pin stuck into a doll wrapped in the torn corner of your skirt can inflict pain in you. Its all voodoo. Let’s not kid ourselves that our NHS is beyond such superstitious thinking.

The justification for supporting homeopathy in India comes in some part from references to the old colonial power that still provides homeopathic hospitals under its National Health Service and is supported by the Royal Family. The NHS, by allowing this vestigial remnant of pre-enlightenment shamanism to remain, and keep certain aspects of the middle class and worried well happy, is responsible to helping to allow the Indian government to deprive some of the poorest people of even basic medical care.

Labels: homeopathy

I have received a letter this morning from the GCC telling me about how my complaints are going. Unsurprisingly, they are finding the sheer volume rather difficult to cope with. I complained about four officers of the BCA for misrepresenting evidence.

The GCC Indicative Sanctions Guidance notes for the Professional Conduct Committee suggests that misrepresenting evidence is not looked kindly upon:

This term is used to describe a range of misconduct from presenting misleading information in publications to dishonesty in clinical trials. Such behaviour undermines the trust that both the public and the profession have in chiropractic as a science, regardless of whether this leads to direct harm of patients. Because it has the potential to have far reaching consequences, this type of dishonesty is particularly serious.

Others have made vast ‘omnibus’ complaints about chiropractors making misleading claims on their web site.

Well, the GCC has written to all the chiropractors concerned with the following letter:

10 July 2009

Dear XXXXX

TIMESCALE FOR lNVESTIGATION OF COMPLAINT AGAINST YOU

In a letter from the GCC dated 6 July 2009, you received preliminary notification of a complaint against you. That letter was not a formal notification under the provisions of the GCC's Investigating Committee Rules (and nor is this letter).

No doubt you are aware that the GCC has received an unprecedented number of complaints in the last month or so - 590, as compared with an average of 40 per annum.

In these circumstances it will be necessary to increase our regulatory staff capacity before we issue formal notification of any complaints relating to chiropractic websites.

We anticipate that we will start issuing the relevant formal notifications in September 2009. They will not all be issued on the same date as we need to spread the workload both for staff and the Investigating Committee. I appreciate this is a stressful situation for you but I trust you will understand the reason for this timescale.

Please note that you don't need to take any action in response to this letter, it is intended for information only.

Yours sincerely

Margaret Coats
Chief Executive & Registrar

Clearly, the GCC are taking this all very seriously. I would be very surprised if they did not. The GCC are bound to do so by law and have an overriding prerogative to protect the public. Last year, the GCC dropped its commitment to promote the profession as this was seen to be in conflict with its role in regulation.

It is a shame that things are being delayed. These issues need to be cleared up. I shall write some more soon about the possible future of the Chiropractic profession in the UK as a result of these extraordinary events.

Labels: chiropractors

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