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Chiropractors in the Spotlight

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Last year the British science journalist Dr Simon Singh was accused of libel by the British Chiropractic Association because he had written an article in the Guardian newspaper saying that chiropractors had been “happily promoting” “bogus” treatments. Singh pointed to the inadequacy of evidence supporting claims that chiropractic could treat childhood colic and asthma.

Earlier this year, Justice Eady ruled on the meaning of the word “bogus” and argued that Dr Singh was accusing the BCA of being deliberately dishonest, which was explicitly not what Singh’s article was saying.

It was clear to those reading the article that Singh was deploring the poor quality of the evidence offered, arguing that the claims were unjustified. He was criticising the BCA for defending those members who were making what he saw as unjustified claims.

The response of the BCA in launching a lawsuit was, at best, using a hammer to crack a nut. The obvious recourse would have been to openly evaluate the available evidence, invite those members who were offering treatment of colic and asthma to submit their best evidence, and then organise a panel to evaluate it. At the end of such an evaluation, it would have been reasonably clear whether there was any convincing evidence to support the claim. An open look at the evidence would have resolved, or at least clarified, the issue.

Once it became clear that Simon Singh was going to be dragged into court, very many scientists and eminent people from around the world gathered in support of his right to subject medical claims to criticism and evaluation. A petition was sent to the UK parliament, and open letters were published in the press.

The previous year, Dr Singh and Professor Edzard Ernst (a UK professor of Complementary Medicine) had written a book called Trick Or Treatment, in which they extensively evaluated the evidence for alternative medicine. In their chapter on chiropractic they concluded that there was no evidence for it being effective anywhere except for relief of lower back pain, and even there the evidence was poor, with conventional physiotherapy both more effective and less risky. They also found no evidence for the so-called subluxations, misalignments of the spine which are supposed to provide a diagnostic method for identifying illnesses in the organs of the body.

Once the BCA had launched the libel case, and Justice Eady had ruled on the meaning of “bogus”, the onus was on Dr Singh to prove his innocence. In contrast to the usual principles of justice, instead of being innocent until found guilty, UK libel laws are amongst the most draconian in the world, assuming guilt until the accused can prove his innocence.

It is vastly more expensive to defend a libel action in the UK than anywhere else in the world, which means that without extensive financial backing, anyone accused is almost always forced to settle out of court, paying damages even if innocent. This has prompted moves in the US to limit the applicability of UK libel law in the States because it hampers free speech. Simon Singh was at risk of potential bankruptcy.

But the supporters of Singh were not simply passive. In the UK, there is legislation to ensure that chiropractors have to register with a professional association, and members are bound by a code of practice, part of which says they shouldn’t make unjustified claims. There is also consumer protection legislation which provides recourse for those contesting false advertising claims.

Within a couple of days, more than 500 chiropractors who had advertised that they could treat childhood colic, asthma, and a variety of other illnesses were subject to complaints about unsubstantiated claims. The General Chiropractic Council was legally obliged to investigate each claim. In addition, the Advertising Standards Authority started dealing with the complaints as well, and told many chiropractors to remove the unsubstantiated claims from their websites.

The response was a mixture of panic and farce amongst the chiropractors. The McTimony Association sent out a letter to its members advising them to take down their websites pending further advice, and it was clear that for the first time, many chiropractors were having to think about the evidence behind their marketing claims.

As is the way with the British justice system, Simon Singh had to ask for permission to appeal the earlier ruling by Justice Eady on the meaning of the word “bogus”, and yesterday he had his chance. In court again, the aptly named Lord Justice Laws ruled that not only had Justice Eady’s ruling been “legally erroneous” but that there was no question of Simon Singh acting in good faith. He was now free to appeal the case.

What happens now is anyone’s guess. The BCA has issued a defiant press release (PDF) with potentially questionable content. Simon Singh will be back in court some time next year. If the BCA had any sense in this matter, it would let it drop rather than further embarrass its members.

But in all this legal hullabaloo, we shouldn’t lose sight of the importance of the issue. If someone makes questionable claims, which are abundant in the land of Woo, science journalists and others should have the right to challenge them, to question the evidence, and where those claims are seen to be unfounded, to say so openly. It is in the public interest. It is an unacceptable encroachment on free speech to use the libel laws to gag journalists and others seeking to expose questionable therapies.

There is now a coordinated campaign in the UK to get the libel laws amended so that science journalists and others are not attacked the moment they question therapies that are inadequately supported by evidence. This particular case only came up because the chiropractors are regulated by law and have to be answerable to the General Chiropractic Council. The British Chiropractic Association decided to go to court to attack the journalist who was questioning the practices of its members.

There are vast areas of alternative medicine where the most fanciful therapies are marketed on the basis of bizarre theories without even a passing glance at the notion of evidence. This is a massive business sector and few governments have the courage to put it under the spotlight. Journalists such as Simon Singh deserve our thanks for having the courage to investigate, and where appropriate, expose them.

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About Bob Lloyd

  • As a writer, I completely agree with you that journalists should not have to fear legal punishment for asking questions or questioning official claims of cures or solutions — whether made by doctors, politicians, or anyone else.

    And as someone who respects science and the scientific method, I can appreciate your concern about unproven claims in the arenas of medicine and science in general.

    However, I got the distinct impression from this article that one of your additional aims here was to discredit chiropractic across the board.

    I’m well familiar with traditional medicine’s disdain for chiropractic; this particular battle is older than I am. And I won’t bore you with the irrelevant anecdotal evidence of how much help chiropractic has been to me, other members of my family, and many others I know.

    But what I’m wondering, Bob, is: is it your mission in your articles in general to debunk everything that doesn’t conform to the standards, judgment and methods of traditional, conventional, Western medicine and science? Do you truly consign everything else to what you view as the junk heap of “Woo” medicine and ideas?

    If so, I think that makes you a poor champion of your cause. Scientists more than anyone should be open to new ideas, and not dismiss all discussion with the fact that if something hasn’t been proven by traditional scientific method, it’s worthless. I contend that some things can’t be proven and some things are indeed proven by different means.

    I commend you for wanting to protect your readers from scams and dangerous deviations from the establishment that may do much more harm than good. But unless I’m completely misreading you, you seem to regard any and all deviation from the establishment as dangerous by its very nature.

    I think that’s unfortunate, unscientific in the true spirit of curiosity and open-mindedness that are an essential part of scientific inquiry, and…dull. “My way or the highway” is an ill-advised attitude towards anything.

  • Jeanne, chiropractic does not have a track record of good quality scientific evidence to support it. It is based on the claim by D.D.Palmer in the 1890s that 95% of human illnesses are caused by misalignment (subluxations) in the human spine. The claim is that alignment of the spine affects the organs in the rest of the body. This is an unsubstantiated claim. Subluxations cannot be detected – each practitioner detects different ones, exactly as you’d expect if the detection mechanism didn’t work.

    The claim that the alignment of the spine is essential for the functioning of the organs of the body is disproved easily by considering transplanted kidneys which have no connection with the spine, yet they work perfectly well.

    Chiropractors in their advertising often make grandiose claims to be able to treat a wide variety of illnesses, some including childhood colic and asthma. When the evidence cited is examined, we find that the trials were not double-blind (and are therefore inevitably subject to bias), not controlled (and therefore cannot show anything, and not randomised (which leads to being able to guess the intended results).

    When the BMJ examined the offered evidence, it said there was no credible evidence. Even the Cochrane Collaboration, which carries out meta-analyses of all the known clinical trials, concluded that other than some help with back pain, chiropractic doesn’t do anything beyond the placebo effect.

    Anecdotal evidence just isn’t enough to count as real evidence. It is inevitably subjected to bias and those who have spent money on it, inevitably defend their decision. That’s why we have clinical trials in the first place.

    As to my “agenda”, it’s quite invidious to imply I have some “establishment” point of view. If medicine works, it is medicine regardless of where it comes from. If eastern medicine works, then it’s medicine. You are quite right that some things can’t be proven and that’s why Woo therapies depend on belief rather than evidence. That includes acupuncture, chiropractic, homeopathy, ayurvedic medicine, and so on.

    But if someone is making a claim to be able to offer a therapy to alleviate or cure conditions, surely they should have good reason for saying so, some evidence that shows it works. Simply as a consumer, you’d expect the seller to be acting in good faith, with reliable evidence that their product works. You wouldn’t buy a TV that worked on some undetectable new energy source (you’d want a factual demonstration and an explanation), yet people are expected to buy a therapy based on it.

    Saying “you seem to regard any and all deviation from the establishment as dangerous by its very nature” is utterly insulting. What I am actually saying, and I don’t know why you can’t see it, is that before selling therapy and treatment, the seller has a duty to show evidence, good reason, and justifiable cause, for the claim. Homeopathy, consisting of sugar pills, are harmless, but in my view it’s a fraudulent sale of a non-treatment.

    We should in the true spirit of science, be open-minded, and that means investigating and finding out if these therapies actually work. It is not at all in the spirit of enquiry to blindly accept any old Woo story about fanciful claims and non-functioning products. That’s being closed-minded, credulous, and gullible.

  • the only actual provable benifit of chiropractors is their massaging muscles which releases painkillers and happy chemicals while making the muscles looser.

    basically, they should just be masuses, and drop the fancy name

  • Sorry, Bob, I truly didn’t mean to be invidious or utterly insulting. What’s clear to me from this exchange is that you view your opinions as scientific fact as validated by testing, and my opinions as delusional, since they’re based (in some cases) on nothing more than personal experience or a belief in something that can’t be scientifically proven. We are who we are, we stand where we stand, and further dialogue between us in this area is not likely to be enlightening to either of us or anyone else.

  • “you view your opinions as scientific fact as validated by testing”

    Again Jeanne, you are not reading what I actually wrote. I distinguish very clearly between opinion and fact. What is fact is fact independent of anyone’s opinion about it. Our opinions might be right, or not. The question is how to do we check? We do that by testing the theories against the real world.

    The position of saying that we stand by our opinions regardless of the facts, isn’t a defence of individuality but a refusal to check and change our opinions which is the opposite of being open-minded.