badscienceblogs

The Yuletide edition of the BMJ carries a lovely article by Jeffrey Aronson, Patent medicines and secret remedies. (BMJ 2009;339:b5415).
I was delighted to be asked to write an editorial about it, In fact it proved quite hard work, because the BMJ thought it improper to be too rude about the royal family, or [...]

Recently, claims have surfaced surrounding a Belgian coma patient - Rom Houben - who spent 23 years ‘locked in’, conscious but paralysed. It was only recently discovered that he had been conscious, and efforts were made to enable him to communicate using a controversial technique called ‘Facilitated Communication’. As The Times report; “Mr Houben is now seemingly able to express himself in remarkably lucid messages while [his 'facilitator'] Mrs [Linda] Wouters guides his hand over a computer screen.” This sounds all very good, until you watch the following video, and in particular the section around 1m 17s:

Watch CBS News Videos Online

The facilitator is moving the finger at an incredible rate of knots, but Houben is not even looking at the screen, or the keypad - his eyes are firmly shut. Now, yes, I can touch-type, but try touch-typing with your eyes closed, and directing somebody else’s finger. It’s a bloody big ask.

It sounds even more unlikely when you look at the scientific evidence for facilitated communication - or rather, the lack of evidence, since - as James Randi has pointed out in a gloriously annoyed blog - the technique has about as much support as Nick Griffin at an ACLU meeting. Wikipedia note that:

The majority of peer reviewed scientific studies conclude that the typed language output attributed to the clients is directed or systematically determined by the therapists who provide facilitated assistance.

In other words, as Randi points out, FC is most likely a case of the “Clever Hans Effect“, a psychological quirk in which “a person’s or an animal’s behaviour can be influenced by subtle and unintentional cueing on the part of a questioner,” notorious for its destructive influence on poorly controlled trials of this kind. The facilitator may not be doing it consciously, but it seems far more likely that the words are coming from her mind.

The Times, one of the few papers to question the findings, notes:

The novel method of communication has not convinced all medical experts, however. “It’s Ouija board stuff. It’s been discredited time and again when people look at it. It’s usually the person who is doing the pointing who is doing the messages,” Arthur Caplan, Professor of Bioethics at the University of Pennsylvania, said after watching a video of the pair.

In a comment to Wired, Caplan has drawn attention to the unlikely language being expressed by Houben via his facilitator:

“You’re going to lie for 23 years in a hospital bed with almost no stimuli, and then sound completely coherent and cogent?” he said. “Something is wrong with that picture. The messages are almost poetic. It sounds too lucid, like someone prepared these things to say. I’m not saying it’s all a fraud, but I want to hear a lot more.”

Caplan’s disdain for Facilitated Communication (FC) is well justified. Mark Mostert published a systematic review of the literature in 2001 [1] [pdf], painting a bleak picture for proponents. Of 29 studies reviewed, 19 had one or more control procedures and refuted FC claims, 6 had one or more control procedures and supported FC claims but were often riddled with methodological problems, while 4 had no controls and supported FC claims.

Mostert concluded with a statement that should sound all too familiar to anyone who has ever read meta-studies of treatments like homeopathy or chiropractic:

The results of the review support and confirm the conclusions reached by previous reviewers of the empirical FC literature. The divide between the results of studies incorporating control procedures find very little to no support for the efficacy of FC, studies employing fewer control procedures produce mixed results, and studies ignoring control procedures almost universally find FC to be effective. In the cases of the few, tentative positive results emerging from studies reporting some form of control procedures, as in the cases of Cardinal et al. [2] and Weiss et al. [3], these results are much more likely the artifact of methodological problems than an accurate representation of persuasive evidence.

Professor Laureys, the patient’s neurologist claims to have performed a simple test to establish the truth, as The Times report:

The spectacle is so incredible that even Steven Laureys, the neurologist who discovered Mr Houben’s potential, had doubts about its authenticity. He decided to put it to the test.

“I showed him objects when I was alone with him in the room and then, later, with his aide, he was able to give the right answers,” Professor Laureys said. “It is true.”

The problem is that these claims are extraordinary, and therefore require extraordinary evidence to back up. Laureys cannot be considered an unbiased observer, given his emotional investment in the case. That isn’t an accusation of fraud or wrong-doing - it is incredibly easy to deceive yourself in such situations.

Given what we know then, Professor Laureys and other medical staff working with Houben need to back up their extraordinary claims with much more solid evidence than the anecdata presented so far. After all, if it turns out that in fact the results produced by FC aren’t real, they could be causing their patient even more stress than he has experienced so far.

And there’s a further reward on offer. The James Randi Foundation have offered a one million dollar prize to anyone who can provide a valid demonstration of facilitated communication, and Randi has told Wired that the offer “is still there.”

The gauntlet has been thrown. Will Professor Laureys be willing to put his claims to the test?

[1] Mostert MP (2001). Facilitated communication since 1995: a review of published studies. Journal of autism and developmental disorders, 31 (3), 287-313 PMID: 11518483

[2] Cardinal DN, Hanson D, & Wakeham J (1996). Investigation of authorship in facilitated communication. Mental retardation, 34 (4), 231-42 PMID: 8828342

[3] Weiss MJ, Wagner SH, & Bauman ML (1996). A validated case study of facilitated communication. Mental retardation, 34 (4), 220-30 PMID: 8828341

The paper I’m about to present was written in 2002, and in the fast-paced world of the internet may seem out of date - after all, Youtube hadn’t even been invented then, and Wikipedia and Google were shiny new businesses. But in fact, Davies et al’s study of anti-vaccination websites is as relevant today as it was then - perhaps even more so [1].

“The internet has provided antivaccinationists with unprecedented opportunities for exposure. In the USA, 55% of adults with internet access use it to seek health related information. For all its benefits, the internet has great potential to
disseminate health information that is incorrect and potentially dangerous.”

The scale of the internet in 2009 is of course orders of magnitude larger than it was seven years ago, reaching more of the population in a greater part of the world. Additionally, new ways of putting information across have been developed: in 2002, Youtube and the age of viral videos were still three years in the future, podcasts were a rarity, and mainstream blogging was still in its infancy. The scale of the problem is doubtless larger today, but what’s remarkable is how quickly anti-vaccination activists came to dominate this scene in the early days of the web.

The researchers look at a hundred anti-vaccination websites, including the tone of their content, and also looked at search results from the leading search engines of the day (back then, you could still use the plural of ’search engine’). The table below shows the number of anti-vaccination pages in the top ten search results for ‘vaccination’ for each search engine:

So while AltaVista, Yahoo and Netscape produce a couple of dodgy sites each, Google’s ’superior’ technology failed spectacularly, with all of the top ten search results for ‘vaccination’ leading to anti-vaccination sites. The situation now is improved, but even today, a search on Google.co.uk brings up whale.to and naturalnews.com in the top ten results (Wikipedia, naturally, is first).

This for me raises interesting ethical questions about the role of search engines. If a parent was five times more likely to see an anti-vaccination result on Google than searching with AltaVista, what responsibility - if any - do Google (motto: “Do No Evil”) have for the public health consequences of their abysmal rankings in 2002?

Moving on to the types of sites around, a distinct set of patterns emerged from their results that still sounds familiar today.

“Antivaccination groups sought to present themselves as legitimate authorities with scientific credibility: about one in four websites implied official status at national or international level.”

There’s an odd Cargo Cult mentality that exists in the alternative medicine and anti-science communities, in that they reject the institutions and research of modern medicine and science, yet seek to appropriate their titles, language and superficial aspects of their methodology, setting up ‘clinics’, calling each other ‘doctor’, and attempting to cite references from the literature…

“A majority of sites propounded the scientific validity of their claims by referencing from extensive literature dominated by self published works and the alternative medicine press. Allegedly damning research was often quoted, but without citation of its source. Referencing was frequently incomplete and often indiscriminate, including letters to editors of newspapers and television interviews. Research published in indexed medical journals was also quoted; however, the conclusions drawn were often inconsistent with those of the authors. Overall this produced a spectre of the existence of masses of data on the dangers of vaccination.”

This of course is the same sort of behaviour we saw with the British Chiropractic Association’s pitiful attempts to produce a ‘plethora of evidence’ for the use of chiropractic in treating childhood illnesses. But the psychology of this is complex and confusing - if you despise modern medicine, if you want to work against it, why are you so obsessed with imitating your enemy? It almost suggests a sort of authority-envy.

Over half of all sites cited rank breaking doctors speaking out against vaccination. Implied division within the medical community reinforced the notion of a debate among authorities. One third of sites promoted themselves as sources of non-partisan information on both sides of the immunisation ‘debate’. Despite these claims a mere 15% contained any information supportive of vaccination. Only a third of sites had links to such sites.

This of course is the classic ‘teach the controversy’ approach. It follows the time-honoured Tobacco company trick that if you can’t directly refute the science, you can wage a war of obfuscation that leaves the public with the impression of a scientific debate where in fact none still exists, something we’ve seen with tobacco harm, climate change, vaccination, and a dozen other areas.

The problem with all of the above is that it seems to result in a sort of cognitive dissonance. If you believe that the research is inconclusive, and that the ‘real’ picture of climate change, vaccination, smoking or whatever is not getting out to the public, then the only way to rationalize this is by inventing some sort of conspiracy. In fact, virtually all denialist beliefs seem to eventually come down to a conspiracy theory. Even when this isn’t explicitly stated, it is often implied.

“Nearly all sites referred to the antivaccination struggle as a search for truth against a background of cover up and denial. Antivaccinationists portrayed themselves as crusaders excavating hidden truths. The vaccination hoax was a vehicle for the generation of limitless profit and which would produce epidemics of chronic illness, requiring billions of dollars worth of drugs and medical care. To many groups, compulsory vaccination represented the beginning of the slippery slope towards totalitarianism.”

That ‘nearly all’ sites resorted to conspiracy theory is unsurprising then - it’s a necessary leap to make since you can’t believe that doctors are knowingly giving people dangerous vaccines without some element of conspiracy present. What’s perhaps more interesting though is the depersonalization or dehumanization of ‘the enemy’.

“Almost all sites featured the adversarial notion of ‘us versus them’ whereby parents and antivaccinationists stood against the depersonalised ‘them’ of doctors, health bodies, governments, and pharmaceutical companies. Doctors were presented as either willing conspirators cashing in on the vaccine ‘fraud’, or pawns manipulated by the shadowy vaccine combine; parents’ love and compassion whose intuition about vaccination harms was considered a stronger force than cold, analytical science.

I couldn’t have but read that and be reminded of the classic radio clash between Richard Littlejohn and Will Self, in which Self referred to Littlejohn’s characterization of John Prescott as a ‘chimp’ with the observation:

“Well he doesn’t say he’s a human being, does he? He uses the classic form of demonisation which is to say he’s a chimp, in other words he’s bestial. So he’s actually dehumanised the subject of his abuse before he even moves on to piling on the pejoratives, and I think that’s very psychologically interesting, of course we’re all familiar with the kind of people who demonise other human beings by turning them into bestiary…”

Which, while a bit strong, is interesting. Again, anti-vaccine propaganda requires that people believe doctors are behaving in an inhuman way, so this would seem to be the logical consequence of rationalizing that. The results of this dehumanization are deeply disturbing since, like the people Self alludes to, it allows people to resort to rabid abuse and attacks on those disagreeing with their ideological view. Paul Offit of course has been a target of concerted hate campaigns, and recently journalist Amy Wallace was subjected to extraordinary attacks, some involving vile misogynistic abuse, for an article she wrote in Wired.

This also seems to touch on people’s fears of doctors and science in general, and it’s unsurprising to see what follows:

“The answer to disease prevention was not the ‘artificial’ process of vaccination but the pursuit of natural lifestyle. Many sites asserted that infectious disease was a consequence of lifestyle, not microorganisms.”

[...]

“Being unnatural, vaccinations deranged the function of the immune system. The natural immunity provided by infection was considered superior. Many sites urged parents to intentionally expose their children to infectious diseases alleging health benefits.”

Yes the natural fallacy, the misguided notion that something ‘natural’ is healthier for you than something ‘artificial.’ The terrifying result of this sort of broken thinking is that parents may intentionally expose their children to infectious diseases. It begs the question, how many have fallen seriously ill or died as a result of these websites?

Overall, the picture that emerges from the 2002 survey shows that all the features of the anti-vaccine movement in 2009 were well-established several years ago, with activists rapidly seizing the opportunities presented by new technologies as they emerged.

The psychological aspects are interesting too. The anti-vaccine movement taps in to almost primal instincts and fears, dehumanizing ‘unnatural’ opponents before rabidly attacking them. On the other hand, we have this bizarre cargo-cult mentality whereby websites seek to present themselves as ‘credible’ by wrapping themselves in the language of modern science and medicine.

It would be fascinating to see this research updated for 2010. If anyone’s interested in such a project, do feel free to leave a comment or get in touch.

[1] Davies, P. (2002). Antivaccination activists on the world wide web Archives of Disease in Childhood, 87 (1), 22-25 DOI: 10.1136/adc.87.1.22

It seems very reasonable to suggest that taxpayers have an interest in knowing what is taught in universities.  The recent Pittilo report suggested that degrees should be mandatory in Acupuncture, Herbal Medicine and Traditional Chinese Medicine. So it seems natural to ask to see what is actually taught in these degrees, so one can judge whether [...]

The first of the graphs below the fold shows traffic to layscience.net for the first 16 days of October, an already high-traffic month thanks to my lovely new band of guest bloggers. It is also a graphical demonstration of the Streisand Effect in action; the phenomenon by which attempts to stifle discussion of a subject only encourage more chatter.
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Here’s a little quiz for you. Can you guess on which day Trafigura’s lawyers tried to suppress reporting of a parliamentary question? And can you guess on which day the British Chiropractic Association issued their latest ill-advised press release defaming Simon Singh? Now imagine those twin peaks, repeated across the interwebs.

In fact, you don’t have to imagine it. Below is a visualization provided by the nice folks at Trendistic showing how #Trafigura rose to become the #1 topic on Twitter, mentioned in over 1.2% of tweets.

Carter-Ruck are of course attempting to defend the reputation of Trafigura, while the BCA’s statement said that:

This claim has been brought to restore the good reputation of the BCA and that of its members.

I wonder how that’s working out for them? I’m not a lawyer or a PR expert, but if they want my advice, sometimes it’s far better to just keep quiet.

Yesterday, the British Chiropractic Association made what many believe was a serious error of judgement in a press release regarding Dr. Simon Singh’s recent appeal victory. In the release they stated that:

“However, this action is actually a simple libel claim based on the fact that the BCA was maliciously attacked by Dr. Singh in the Guardian newspaper.”

As legal expert Jack of Kent has pointed out, this is a defamatory remark which Singh could countersue over, and in Jack’s view, “the moment he chooses to do so will surely be when this case ends.”

Whoops.

And so, the virtual vultures of the interwebs are circling around BCA HQ, chanting “countersue!” and shaking their bloodied feathers in a vaguely intimidating sort of way. Which is understandable, because frankly if I were Simon Singh I’d jump at the opportunity to take advantage of the farcically dumb person at the BCA who put such a daft press release online about an ongoing legal action without running it past their lawyers first.

So the case could come to an end. But is that really what we want to see? Well, not in my opinion. Let’s look at the wider picture.

Simon Singh could have settled months ago. Indeed, some might have argued it was the sensible thing to do. But he didn’t. As Simon himself explained:

While there is still the slightest chance of defending my rights as a journalist then I am determined to continue with this legal battle. Indeed, I look forward to the opportunity to discuss the evidence for chiropractic in court.

More importantly, while this case is alive there is an opportunity to raise a whole series of arguably more important issues, particularly the appalling state of English libel laws.

Aside from the conviction that he is right and can win this case, Simon and Sense About Science have used this case as a platform from which to argue for wider libel reform, to protect the ability of science journalists to debate science, and to keep litigation out of scientific disputes.

Assuming that Jack of Kent’s assessment is correct, assuming that Singh’s team take the opportunity to countersue, and assuming that they win; this would have two side-effects.

1) In my view it risks undermining the campaign to keep libel out of scientific debates if, in the course of arguing that this dispute should be handled like a scientific debate, Simon resorts to counter-suing for libel himself. I’m sure many of you will point out that it’s not quite the same thing and I agree, but you can see how it would look to the wider world.

2) While he would force the case to be dropped, Simon wouldn’t “win” the case in any meaningful sense. The money and effort he has invested so far would not have the wider impact he wanted, and the original dispute would remain unresolved. In other words, we’d be back where we were in 2008, waiting for the next journalist to call something bogus and get sued.

Now, to be absolutely clear, I am not going to criticize Simon if he takes this route out. As I said above, I’d probably do the same. Simon has done more than enough for fellow science-writers, heroically sacrificing his time and money to bring attention to a critical issue in science journalism. I will support him whatever he does, and I suspect even if he takes this opportunity organizations like the BCA will look at this case and think twice about pursuing critics in the courts again. The BCA and the wider chiropractic industry have been comprehensively embarassed by this debacle.

But, for my own selfish reasons, and for the wider community, I hope that Simon fights on. Libel is an increasing threat to us ragged band of bloggers and writers. Ben Goldacre had to defend himself against Rath, Quackometer was temporarily shut down by legal threats, and as blogs like ours become increasingly popular and prominent it’s a question of ‘when’ rather than ‘if’ more of us are sued.

By fighting on, Simon Singh could finally rid us of that menace. Or, he could lose spectacularly. That’s why I’m glad I’m not in his shoes; and that’s why I’ll continue to admire his efforts whatever he decides to do.

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Go and follow me on Twitter! @mjrobbins

My Twitter feed has been full of tweets today regarding the Simon Singh / British Chiropractic Association case and a remarkable press release issued by the BCA, but there have also been several mentions of an MP named David Tredinnick.
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First, the BCA press release: Jack of Kent has an account of this disaster. I reproduce below the first paragraph of his post.

In an incredible press release published either yesterday or earlier today, the British Chiropractic Association made the serious and completely groundless accusation that Simon Singh had been motivated by malice in writing his original article.

Jack of Kent has contacted the BCA (and their PR company) to ask for an explanation of this extraordinary press release. Simon Singh now has a decision to make - whether to counter sue the BCA for remarks made in the statement they published. This could be the beginning of the end of the Singh-BCA case. There is a possibility that this incident could even be the undoing of the BCA.

I wonder how the BCA and their members feel about what has happened since they began their libel action. Many bloggers (and this includes me, writing at Stuff And Nonsense) have posted articles about the BCA, about claims made by chiropractors, and about the regulatory body the General Chiropractic Council (GCC). A number of chiropractors are being investigated following complaints made by bloggers such as Zeno and Simon Perry. Mainstream coverage of the case began to appear. Ben Goldacre has more details in his Guardian article about a ragged band of bloggers. The BCA released their “plethora” of evidence - which was promptly dismantled by bloggers. This Lay Science post has links to the relevant posts from the likes of Evidence Matters, Petra Boynton, and others.

And what of David Tredinnick? Well, yesterday in Parliament Tredinnick referred, in the same comment, to “negative information” regarding homeopathy and “an attack on a statutorily regulated body dealing with chiropractic.” It is interesting that he believes negative information to be a problem. If it is accurate and truthful, then so what if it is negative? If homeopathy works no better than placebo should we not be told? Should we be kept in the dark?

Well, Tredinnick believes that the negative information specific to the Royal London homeopathic is “disinformation” and presumably believes it is not truthful and accurate. He seems to make no claims as to the accuracy and truthfulness of negative statements about homeopathy, so I shall. Based on what we currently know, it is accurate and truthful to say that homeopathy probably has no benefit beyond placebo effects. It is utterly implausible, and the best evidence we have (in the form of systematic reviews) suggests that the effects of homeopathy are compatible with placebo effects.

There are, however, problems with the MP’s comments in the House of Commons other than his views on the accuracy of information about homeopathy and his characterisation of complaints about chiropractic as an “attack” - for example the following comments:

The opposition is based on what I call the SIP formula—superstition, ignorance and prejudice. It tends to be based on superstition, with scientists reacting emotionally, which is always a great irony. They are also ignorant, because they never study the subject and just say that it is all to do with what appears in the newspapers, which it is not, and they are deeply prejudiced, and racially prejudiced too, which is troubling.

It is remarkable that Tredinnick characterises scientists as reacting emotionally in response to complementary and alternative medicine - and astrology - and being ignorant “because they never study the subject” (I wonder if scientists who happen to be Professors of Complementary Medicine are excluded from this particular criticism).
It is astounding that he alleges that scientists are “deeply prejudiced, and racially prejudiced too” and I have to wonder on what basis he makes this claim.

Having read these comments, one may find it hard to be surprised by anything that is said by David Tredinnick. See if this does it:

Whatever one believes personally, the issue [of the impact of astrology and astronomy on medicine] is one that we should look into and consider. We must get away from this awful, mediaeval superstition.

I’m rather baffled as to how Tredinnick can characterise a scepticism of astrology and its effects on medical treatment as superstitious and mediaeval. I’ve noticed that I can sign up for emails whenever David Tredinnick speaks in Parliament. I have yet to decide whether to do so, as I am unsure whether the result will be a bemused fascination with his overheated rhetoric - or painful frustration.

Just after I clicked “submit” on my previous article on the Singh vs. BCA affair, I discovered via @JackOfKent that the British Chiropractic Association have released a more, er, in-depth statement on the latest ruling. You can get it at their website, or cached here for safe-keeping. I’ll reproduce the text below (since this is a press release and I am apparently a sort of press now I feel this is fair), then comment.

Dr. Simon Singh has been granted permission to appeal against the decision of Mr. Justice Eady. As the Claimant is not permitted to be represented in a hearing of this nature, the Judge of the Court of Appeal, Lord Justice Laws, did not have the benefit of being able to consider all the issues, nor indeed, has he heard any argument from the BCA.

Dr. Singh has used this case as a platform to argue that science writers should be immune from the law of libel and be free to write what they please. Ever since the Eady decision of 7th May 2009, he has engaged in a high profile media campaign to assert that the BCA’s action is a restriction of the freedom of speech. It is nothing of the sort.

The BCA supportes and would never seek to stifle legitimate open scientific debate. However, this action is actually a simple libel claim based on the fact that the BCA was maliciously attacked by Dr. Singh in the Guardian newspaper. When given the opportunity to retract his words and apologise, Dr. Singh refused. This claim has been brought to restore the good reputation of the BCA and that of its members.

Dr. Singh may now put his case before a full Court of Appeal. Here the BCA will, for the first time, have the opportunity to present its case. The BCA remains confident that once in possession of all the facts the presiding judges will refuse the Appeal.

There are several points in this bad-tempered little piece that are worth raising.

1) As Jack of Kent notes, the BCA have for the first time directly accused Simon Singh of malice, a defamatory allegation that, if intended rather than being a sloppy error, would suggest a possible new line of attack in the case.

2) The BCA state that “This claim has been brought to restore the good reputation of the BCA and that of its members.” Given that this claim has resulted in a mass attack on the profession, a high profile campaign to keep libel laws out of science, hundreds of complaints to regulators against individual chiropractors and widespread ridicule of the attempts of the BCA to provide evidence for the effectiveness of their treatments, how exactly is that going chaps?

3) It is false to claim that Justice Laws has not heard any argument from the BCA - he of course had access to the details of the original rulings which were being appealed. It is absurd to suggest that the Court of Appeal is the first opportunity for the BCA to present its case. I’m also not convinced that the BCA weren’t permitted to be represented at this hearing, but I await the comment of more qualified writers than me to clarify this point.

4) Continuing from that point, the BCA repeatedly allude to additional evidence that ‘wasn’t considered’, “once in possession of all the facts,” “did not have the benefit of being able to consider all the issues.” This raises the question: what new facts are there, and why didn’t you present them in your original case? It sounds suspiciously like appealing to ’stuff you don’t know so you can’t criticize it.’

5) The suggestion that Singh’s camp refused to compromise with the BCA is disingenuous at the very least. The Guardian offered the BCA a 500-word article in which they could exercise the right to reply, along with a comment in the corrections and clarifications column. The BCA refused the Guardian’s offer, and made it clear they were coming after Singh himself.

6) The suggestion that “Dr. Singh has used this case as a platform to argue that science writers should be immune from the law of libel and be free to write what they please” is simply nonsense. The Sense About Science campaign is very clearly focused on a campaign to keep libel laws out of scientific debates and disagreements. Their argument was that the BCA should be able to defend a challenge to the credibility of their science by presenting an argument of their own. As noted above, the BCA refused the offer of the Guardian to facilitate this, preferring instead to try and settle a scientific debate in the libel courts. Given the poor quality of their arguments, this is perhaps unsurprising.

In short it’s a very sloppy statement packed with misrepresentations which some have already suggested is legally illiterate. I’m not qualified to comment on the legal aspects, but hopefully Jack of Kent will expand on his analysis soon.

Back in 2000, when I was a lowly undergraduate, the warden in charge of our halls called all the resident students to the bar for a meeting. There, he warned us of a terrible health and safety menace. Apparently, near the student village, there lurked a large crop of magic mushrooms. On no account, he informed us, were we to go near the mushrooms located in the field at the top end of the village, nor were we to pick the white ones with the brownish tops on them.
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After the helpful meeting the field swarmed with a veritable herd of eager students. The mushroom market boomed, at least until the autumn frosts set in and the economic bubble burst, temporarily causing a mortgage crisis in a local Welsh bank; but I digress.

I mention this story because it’s been a bad month for the chiropractic profession, and Singh vs. BCA is just part of it. The British Chiropractic Association - or rather, the BCA’s lawyers - are the poor misguided wardens in this story. “Don’t write bad things about chiropractic,” they might have said, “and particularly don’t write about chiropractic regulators’ abuse of evidence,” they implied, “or we’ll defend ourselves with the shield of libel law while bopping you on the head with the mighty sword of misery,” they were no doubt tempted to add.

But of course that just made us want to do it more. They slipped, and fell, and the mighty sword of misery went straight up their arse.

The inimitable, indomitable and indignant Jack of Kent pointed out the misconceived nature of the BCA’s lawsuit many months ago, but recent events have surpassed - or perhaps underpassed - even his expectations.

The headline news is of course Singh’s victory in the battle to be allowed to appeal Justice Eady’s original ruling on meaning. It’s one small battle in the broader context of the trial; but it means that we’re back to square one, with the BCA’s lawyers once again required to make the case that Singh “had made factual statements rather than mere comment”, and that “the factual statements meant that the BCA were knowingly dishonest.”

The BCA have already issued a statement, or at least a paragraph, which is somewhat more subdued than some of their earlier press releases:

14th October 2009: The British Chiropractic Association (BCA), notes the decision of Lord Justice Laws in granting Dr. Simon Singh leave to appeal to the Court of Appeal.

It looks forward to the opportunity of presenting its case where the issues can be heard and the BCA’s position can be made clear.

Good luck with that. Of course, the British Chiropractic Association’s last attempts at presenting a case, in this case for the efficacy of chiropractic in treating a range of childhood ailments, were systematically destroyed in the space of about 24 hours by a glittering cast of disgruntled science writers, with the handsome editor of The Lay Scientist noting that the BCA had managed to misrepresent a Cochrane review by removing key words from a quote. Evidence of deliberate deception perhaps? Perhaps lawyers, perhaps.

But it’s not just the BCA that have gotten themselves into bother. The GCC, presumably envious of all the attention the BCA have received, have adopted a bizarre policy of striving to be even more stupid than their cousins at the BCA, like a sort of dim-witted monkey watching its troop leader falling off a cliff and thinking: “Hmm, that looks fun, me copy.”

They haven’t quite succeeded in this aim - yet - but my God they’re trying hard. They’ve been helped in the last week by Alan “Zeno” Henness, and Leicester SITP’s Simon Perry. Together they exposed the fact that the GCC is pushing a leaflet on its website and in paper form which makes a number of dubious claims about the benefits of chiropractic. Perry was able to obtain a copy and send it to the ASA, at which point the GCC wet their collective pants at the prospect of an ASA adjudication going against them and offered to remove the leaflet - something which would be rather embarassing since ASA compliance is part of their own Code of Practice. As Simon noted:

…if the General Chiropractic Council believed they had the evidence to back up the efficacy of using chiropractic as a treatment for asthma, headaches, migraine and infant colic – then they simply could have produced it.

They didn’t, and so once again we were able witness (eventually) the sad and pathetic sight of chiropractors frantically rewriting and withdrawing claims. Just like earlier in the year, when a mass panic developed after an onslaught of complaints to Trading Standards, regulatory bodies and the brilliant Advertising Standards Authority.

Pathetic is about the only word to describe the leadership of the chiropractic industry. Dozens of writers and activists have shone a bright, infrared spotlight on the seedy hotel bedsheets of the chiropractic industry and found stain after curious stain.

Back in June, the United Chiropractic Association whined about “a concerted campaign to discredit the profession”, but as I pointed out at the time, the simple fact is that the chiropractic profession has discredited itself, by demonstrating that it is institutionally corrupted by quackery, that many in the profession are guilty of making unsubstantiated claims about health benefits, and that regulatory bodies have failed to maintain any sort of control over the situation.

Indeed, it’s difficult to see how groups like the GCC and BCA can claim to have any credibility in chiropractic regulation when they are flirting with breaking their own codes, or engaged in misguided attempts to sue their critics. Far from protecting their interests, the interests of their members, or the interests of patients, they have engineered the worst publicity the chiropractic industry has ever seen.

Well done guys.

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Follow me on Twitter: @mjrobbins

Simon Singh is a UK science writer currently being sued for libel by the British Chiropractic Association following a critical article on chiropractic treatments published in the Guardian.

Yesterday Simon went to court to fight for his right to appeal the preliminary ruling by Judge Eady. Silé Lane of Sense About Science reports:

Dear friends

I’m very pleased to tell you that earlier today in the Royal Courts of Justice Simon was granted permission to appeal the ruling on meaning in his libel case with the BCA. Read more about the judgement here. The appeal will probably be early next year. In the meantime, we will be busy working on libel reform.

Simon said: “This is a great result, but we now have to win the appeal . and then we have to win the trial. So there is still a long battle ahead in my case and in reforming the libel laws. Thank you to everyone for all your support and please use today’s success to encourage others to sign up to supporting libel reform.”

BBC Newsnight came along to the meeting in Westminster last night and interviewed Simon and other supporters of the campaign for their report on the chilling effects of England’s laws; watch it here (the report starts 34 minutes in).

Simon, Tracey Brown and John Kampfner of Index on Censorship will be discussing today’s judgement and the chill of libel laws on free discussion of science and evidence tomorrow, Thursday 15th October, at the City University London and Association of British Science Writers debate on Science Journalism and Libel Law. For more information see here. I hope to see some of you there.

All the best

Síle

This is great news, but as Simon says, there is still a long way to go. To stay in the loop regarding the Singh case and other attacks on free speech by our abject libel laws, visit the indispensable Jack of Kent blog.

Read the comments on this post…

Yesterday, I went to a talk given by Edzard Ernst at Bradford University. The talk was based on the book he co-wrote with Simon Singh: Trick or Treatment. This is my (unsystematic) review.
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Professer Ernst began by telling us that the book has received much criticism from advocates of alternative medicine - and was met with bewilderment from some, who seemed surprised that a professor of complementary medicine would criticise CAM. To that, Ernst said that:

An uncritical scientist is a contradiction in terms.

His introductory slide included statements to the effect that:

• A large proportion of the general population uses CAM
• Patient population figures for use of CAM are much higher
• In the UK, we spend £1.6 billion on CAM each year
• Even the most fundamental questions remain unanswered

Slide number two highlighted four ways of attempting to find out if something works: plausibility; the test of time; ask the patient; do the research.

Bloodletting was used as an example for each of the first two options. Plausibility: Ernst pointed out that (at the time) bloodletting was seen as a plausible treatment because of the belief that health was affected by the status of the four humours. He then went on to point out that acupuncture (based on the principles of “yin and yang”), chiropractic (based on the idea of “subluxations”), homeopathy (based on the principle that “like cures like”), and reflexology (based on the idea that points on the foot correspond to the internal organs of the body) are utterly implausible. Although he then pointed out that implausibility doesn’t necessarily rule out a treatment being effective.

As for the test of time, Ernst noted that bloodletting was used for hundreds, if not thousands of years despite being ineffective. He then quoted Oscar Wilde: “experience is the name we give to our mistakes”, which I thought was a rather neat way to illustrate the problem with assuming that the longevity of a treatment was a reliable measure of its effectiveness.

In tackling the option ask the patient, Ernst showed a slide from Marja Verhoef that showed a hierarchy of the factors important to patients. “Gut feelings” were at the top of the pyramid, “trial-and-error” and media articles were also listed but I was unable to note all the factors or the order of importance of the factors. There is an abstract of a qualitative study conducted by Verhoef and others which lists types of evidence relied upon by cancer patients searching for information on complementary therapies.

Scientific evidence ranked very low for most patients. Anecdotal evidence was among the top types of evidence patients relied on.

Then we came to research. Ernst related the proposal made by Jan Baptist van Helmont in 1662. Thanks to the James Lind Library, I am able to reproduce the quote:

‘Let us take out of the hospitals…200 or 500 poor people, that have fevers, pleurisies. Let us divide them into halves, let us cast lots, that one halfe of them may fall to my share, and the other to yours; I will cure them without bloodletting and sensible evacuation; but you do, as ye know…We shall see how many funerals both of us shall have.’

This was perhaps the first time that an RCT had been proposed. Unfortunately, it wasn’t until 1809 and Hamilton that a trial of bloodletting is believed to have taken place. Ernst then moved on to James Lind himself and the famous trial of treatments for scurvy. The James Lind Library has a commentary of the trial here: link. Ernst informed us that one of the treatments tried was “hard labour” and explained that as one of the symptoms of scurvy was lethargy, confusion over cause and effect had led to the belief that this may be a useful treatment. His comment that hard work was believed to be a treatment for “lazy bastards” brought laughter from the audience. I had expected the talk to be rather dry, but was pleased to note several moments where humour was employed by the professor.

Acupuncture

Ernst referred to a positive trial by Berman et al that studied the use of acupuncture for osteoarthritis, then pointed out that we must beware the cherry-pickers. A single trial cannot be expected to prove the efficacy of a treatment, but systematic reviews are more reliable. While acupuncture has been touted as a panacea (cure-all), Ernst noted that it has only been shown to be effective for pain and nausea.

Chiropractic

This section of the talk began with discussion of the origins of chiropractic, which some may have been surprised to find was not invented as a treatment for back problems. A slide was shown that listed systematic reviews of chiropractic spinal manipulation for various conditions alongside percentages of chiropractors who (wrongly in most cases) believed that chiropractic was an effective treatment.

Ernst then moved on to the risks of chiropractic, noting that mild to moderate adverse effects of the treatment were not disputed - in comparison to severe adverse effects which were hotly disputed. Discussion of chiropractic ended with a slide showing a pair of scales labelled “harm” and “benefit”, with the harms being shown as heavier than the benefits.

Homeopathy

Beginning with a slide showing a homeopathic pamphlet featuring Queen Elizabeth II, we were told that the royal family were “staunch supporters” of alternative treatments such as homeopathy. Ernst went on to say that the treatment was based on the principles that “like-cures-like” and “less-is-more” - principles that are totally implausible. Ernst told us of a study he had conducted into homeopathic arnica which made him “very unpopular with British homeopaths” (who were “quite outraged” - but which was later confirmed by two independent systematic reviews.

Noting that some homeopaths complained that trials of homeopathy that did not study individualised treatment of patients, Ernst referred to a trial of individualised homeopathy for childhood asthma which provided no evidence that individualised homeopathy was superior to placebo as an adjunctive treatment. Cautioning us once more against the reliance upon single trials, Ernst then told the audience of a systematic review of systematic reviews. I believe this is the paper in question: abstract on Pubmed. Ending the section on homeopathy with reference to harm and benefit, Ernst discussed the possibility that, while an inert treatment such as homeopathy may not cause harm, homeopaths themselves might - for example by offering homeopathy as an alternative treatment for swine flu. Again, the slide showing a pair of scales with the balance tipped towards “harm” was shown.

Ernst digressed from discussion of the four complementary / alternative therapies at this point to point out that he doesn’t see himself as a “Quackbuster” - but as having to choose whether or not to tell the truth about his investigation of complementary and alternative therapies. Telling the truth seems to lead to him being labelled as a Quackbuster. Ernst then pointed to studies into St John’s Wort for depression as an example of investigation into CAM that found an effective therapy, before pointing out the risks (particularly that St John’s Wort can interact with prescription medication). Leading on from this discussion of an effective CAM treatment, Ernst moved to the last of the four therapies that were the focus of his talk.

Reflexology

Ernst points out that reflexology may be relaxing and thus beneficial for patients. While the theory behind reflexology is implausible, massage therapy can be beneficial. I have struggled to find the systematic review of massage therapy Ernst referred to, but believe that this may be it: abstract on Pubmed. On the whole, the evidence was positive (albeit there were concerns over methodology). From the abstract:

[the trials] suggest that massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue.

Summing-up

We were told that CAM is popular, used by patients, and in fact is driven by patients. Because of this, Ernst believes it is important to address the general public. He pointed out that of the research into CAM:

…you find some gems in this mess but you find a lot of disappointing results.

He then reaffirmed his stance that he is not a Quackbuster, but is a scientific investigator.

Questions

Having invited questions from the audience and promised a copy of his book for the three best efforts, the first questioner was a gentleman who had got his copy of Trick or Treatment signed by Ernst before the lecture and hence did not need a copy as a prize. He asked about the gold-standard of trials, the RCT, and whether there were problems with this approach to discovering the truth about medical therapies. Ernst stated that while there were problems with RCTs, they were the best option we had for investigating treatments. Referring to the issue that trials of this nature tell us about the group rather than individuals, Ernst reminded us that in medical science we must deal in probabilities.

A question about placebo brought a response to the effect that the placebo response can be powerful. The professor then pointed out that a genuine treatment given by a practitioner who was able to empathise with the patient would have both specific and placebo effects. CAM treatments that are no better than placebo cheat us of the specific effects that genuine treatments can offer.

A lady sitting to my left then asked about clinicians’ views (with reference to the hierarchy of patients’ views Ernst had shown us earlier). Ernst replied that clinicians often rely on experience rather than the best available evidence - and that “that is wrong” (I paraphrase here, as I cannot remember the verbatim quote).

There was also a question about the regulation of CAM (with regard to the Prince of Wales’s FIH and the CNHC, better known as OfQuack). Ernst pointed out that regulated nonsense remains nonsense and complained that CAM practitioners have no requirement to use the evidence-based medicine.

More

Unfortunately, there were many elements of the talk (and questions & answers following the talk) that I failed to note down. I hope that my scrawled notes and imperfect memory have conveyed an accurate impression of the views of Professor Ernst but I would not be surprised to find that my notes and memory of the event are both far from perfect. I have also failed to recall or to make note of the humourous moments of the talk which brought laughter from the audience.

My overall impression was that Ernst is keen to engage with the general public and to inform them about evidence-based medicine and also the pitfalls that they should avoid. For example, being misled by cherry-pickers giving single studies as proof of a treatment’s efficacy, or reliance upon inadequate evidence of other kinds - such as anecdotal evidence.

UK charity Sense About Science have been instrumental in organising support for Simon Singh, the British science writer who is being sued for libel by the British Chiropractic Association over a critical article he wrote in the Guardian.

Now it seems a BCA supporter has tried to close down this campaign. Julia Wilson reports:

Dear friends

You alerted us that someone was touting for ideas about reporting SAS to the Charity Commission. We were aware that chiropractors discussing the GCC complaints had mentioned the idea, which perhaps they saw as a way to get back at Simon and the campaign.

Well, it happened. We had a complaint against us in respect of Simon Singh and the campaign. Our board responded robustly and we received a letter pretty much by return saying that the complainant’s case has been closed. We have put this correspondence up on a link from our campaign page (see http://www.senseaboutscience.org.uk/index.php/site/about/406 ) for anyone who is interested and in the hope that it might help others (we are thinking of the Australian skeptics who’ve had a complaint against them too, albeit in a different way).

Best wishes

Julia

The letter from the Charity Commission, outlining the complaint, can be read here. Among other things, it questions whether the campaign could “impact unfavourably on the charity’s supporters”. It looks like the BCA supporter is trying to paint Singh as a pariah whom we should be embarrassed to associate with. How wrong-headed can you get?

Chairman Lord Taverne’s reply is here. He hit back:

Our campaign in support of Dr Singh is concerned with the impact of UK libel laws on public discussion about science generally and we considered that a change would be highly unlikely to impact unfavourably on our supporters. Indeed over 17,000 people have signed up in support, many giving time, money and practical assistance. It is supported by other charitable organisations. Donations from existing supporters have increased since May; while this may reflect interest in our other projects it does not suggest the campaign is having an unfavourable impact. We have inspired new volunteers and partnerships with other organisations and have reached other sections of society. All our work and activities have benefited from the publicity roused by this campaign and there has been an increased demand for our older publications.

The complaint was thrown out by the Charity Commission almost immediately.

Read the comments on this post…

Chiropractors are getting very touchy indeed, all over the world. And no wonder, because their claims are being exposed as baseless as never before, in the wake of their attempts to stifle criticism by legal action..
In March, Shaun Holt appeared on Breakfast TV in New Zealand. Holt has done a lot of good work [...]

Charity Sense About Science are running a campaign to stop libel laws silencing legitimate scientific debate in the UK. Currently producer and author Simon Singh is facing a £100,000 legal bill for an article he wrote questioning the effectiveness of chiropractic treatments. Many others like him have been forced to withdraw criticisms of pharmaceutical companies and other organisations after being threatened with legal action. Sense About Science are preparing a report on these cases, and need your help:

Hello all

As some of you will be aware we’ve had some fantastic news for our Keep Libel Laws out of Science campaign. The Liberal Democrats voted overwhelmingly in favour of libel law reform at their party conference on Sunday 20th September 2009. This was after Richard Dawkins spoke at the conference proposing an amendment to the civil liberties bill: http://www.senseaboutscience.org.uk/index.php/site/project/403/.

We’ve been getting loads of examples of the chilling effects of the libel laws on writers and we want to get these together in a report. We urgently need some extra help in the office this week to pull these together.

It should be some really interesting work and is an exciting opportunity for someone interested in the campaign. If you have any spare time in the next week please let me know and we will see if you can come in and help with this urgent project.

Best wishes

Julia

All budding science communicators - this is a good opportunity to make a difference! If you can help, email Julia at jwilson@senseaboutscience.org.

Read the comments on this post…

In July 2008 I wrote an editorial in the New Zealand Medical Journal (NZMJ), at the request of its editor.
The title was  Dr Who? deception by chiropractors.  It was not very flattering and it resulted in a letter from lawyers representing the New Zealand Chiropractic Association.  Luckily the editor of the NZMJ, Frank [...]

The King’s Fund recently published Assessing complementary practice Building consensus on appropriate research methods [or download
pdf].

It is described as being the “Report of an independent advisory group”. I guess everyone knows by now that an “expert report” can be produced to back any view whatsoever simply by choosing the right [...]

Some chiropractors now have “For Sceptics Only” pages that list supposed “myths” - but are they all really myths?

This is a guest post by British doctor DeeTee. See more by DeeTee here.

Sometimes I really wonder what planet the homeopaths live on. Recently the World Health Organisation responded to the concerns about the use of homeopathy in the developing world for serious diseases such as AIDS, malaria, tuberculosis and infant diarrhoea, all of which are diseases with a massive morbidity and mortality, and all of which can be treated with effective conventional medical therapies. I have pointed out this silliness previously.

Well it seems the Society of Homeopaths are so upset at the bad press garnered by the WHO statement that they have attempted an exercise in damage limitation. In a move that is reminiscent of the failed attempts of the British Chiropractic Association to provide a “plethora of evidence to back up their claims of evidence for chiropractic, the SoH have responded by publishing the evidence in support of homeopathy in the developing world.

This “evidence” consists of a paltry number of unreplicated studies of dubious quality looking at the use of homeopathy for infant diarrhoea in Nicaragua. Other bloggers such as Andy Lewis (le canard noir) have deconstructed this twaddle better than I could. But what intrigued me most about the SoH statement was what it didn’t say.

Does it provide any evidence for the use of homeopathy for malaria, or tuberculosis, or HIV infection? Nope, not a single word. You would imagine that the Society of Homeopaths should be able to summon at a moments notice a long list of studies demonstrating the effectiveness of homeopathy for any condition you care to mention. But not even the best cherry-picking brains in the SoH could come up with a study, not even a poor one, to justify the use of their silly nostrums for these serious diseases.

I think the conclusions are clear. Homeopathy is nothing but pseudoscientific gobbledegook and has no place in the management of real illness.

A double-blind placebo-controlled RCT of chiropractic for colic is planned. I note that subgroup analyses will be performed.

Síle Lane at Sense About Science reports:

Simon Singh announced today that he will continue the fight in his libel case with the British Chiropractic Association after his application to appeal the preliminary ruling was rejected last week. He has now has the option to try and overturn that decision at an oral appeal. If this fails his case will be tried on a meaning of a phrase he did not intend and is indefensible. This highlights the problem of narrow defences that, along with high costs and wide jurisdiction, make the English libel laws so restrictive to free speech.

Simon said today: “I can confirm today that I have applied for a hearing to ask the Court of Appeal to reconsider its recent denial of permission. A great deal has happened since my original article was published back in April 2008 and I suspect that the libel case will continue for many more months (or maybe years). While my case is ongoing, it continues to raise a whole series of arguably more important issues, particularly the appalling state of English libel laws. I am pleased that the Culture Secretary has agreed to meet with signatories of the Keep Libel Laws out of Science campaign statement to hear how the laws affect writers. We are also pursuing a meeting at the Ministry of Justice and with front benchers in other departments to lobby for a change in the law.”

British science writer and producer Simon Singh is being sued by the British Chiropractic Association for criticising their practices. You can read Simon’s full statement and more about his next steps here.

Read the comments on this post…

The much-delayed public consultation on the Pittilo report has just opened.
It is very important that as many people as possible respond to it.  It’s easy to day that the consultation is sham. It will be if it is left only to acupuncturists and Chinese medicine people to respond to it. Please write to them before [...]

This is an article about Simon Singh, but more than that about the wider issues at stake. In recent months I’ve written about the BPS, BACP, GCC, BCA, CNHC, and other unimaginative groups of letters that act as regulators or professional bodies for auxilliary health industries in Britain. Simon Singh’s battle against the BCA is one chapter in a broader story that links all these cases together. In this post, I want to take a step back, and explore that wider story.

There are four distinct but related stories that have bubbled along for months now (among many others). The CNHC (’OfQuack’) are a hapless alternative medicine “regulator” set up by an alt med charity run by Prince Charles at considerable expense to the taxpayer.

The BCA and GCC are chiropractic regulators now ‘dealing’ with intense scrutiny of an industry in which the truth is systematically distorted after the BCA’s misconceived libel action against Simon Singh.

The BPS may be new to many of you, but made themselves a target of my writing after their point-blank refusal to address concerns about psychologists “diagnosing” people in the media. Blogger Gimpy has touched on a similar story with the BACP and Derek Draper.

And finally we have the Homeopathic Action Trust and Society of Homeopaths, the target of brilliant investigative journalism by Gimpy, who have refused to deal with the reckless actions of Jeremy Sherr in Africa.

These stories all share the same elements: threats and legal shenanigans; obfuscation and deception; ineffective self-regulation; the potential endangerment of public health; and bewildering government actions. I’ll deal with these in turn.

The first thing to note is that writing about these organisations is hard, and has in fact been rather risky. The Times ended up vetoing an article I wrote for them about the BCA’s “plethora” of evidence on legal grounds. My recent piece for the Guardian about the British Psychological Society was published after considerable scrutiny by the paper’s legal team. Bloggers writing about these issues have more freedom from editors, but still risk libel, or contempt of court.

This chilling effect is largely due to the actions of the BCA, but other groups have made threats - notably the CNHC’s bizarre open letter to a “Mr. Smith”. While these threats have if anything encouraged the blogosphere to write more, they may have helped to dampen criticism of these groups in the mainstream media.

The second element is the failure of these groups to be open and honest. The BPS refused point-blank to answer my questions about psychologists flouting their guidelines; the CNHC have been almost comically inept in their backpedaling over the release of minutes from their meetings and subsequent attempts to rewrite history; the BCA took a year to release a dodgy dossier of evidence that on closer examination suggested they were either ignorant or deliberately misleading people. In each of these cases, investigation was hampered by a culture of secrecy, reluctant cooperation, and distortion of the truth.

The third is that in these cases, health workers are quite simply running amok. The chiropractic industry was thrown into chaos as soon as mass complaints were made; homeopaths are galavanting across Africa claiming to cure AIDS, psychologists are busy diagnosing celebrities in the media, and the CNHC’s version of regulation does not include any requirement that the treatments used by its members can actually be shown to work. Worse than that, the professional bodies and regulators themselves provide some of the worst examples of bad behaviour.

The one place where a line could be drawn is in government, but here we find chaos and confusion. The CNHC have sucked in hundreds of thousands of pounds of taxpayers’ money to support their struggling enterprise, with little explanation from the Department of Health to justify this outlay. The legal system is skewed heavily in favour of these groups, dampening criticism of bodies which have a critical role to play in public health. The policies of individual parties on alternative medicine regulation range from decent (LibDems) to mind-boggling insanity (Greens), but the two main parties appear to have no coherent policy on the subject at all.

I believe that the lack of any coherent, consisent policy for the regulation of alternative and complementary medicine is precisely what is allowing the present situation to continue, exacerbated by the horrendously biased legal system that journalists and writers have to contend with.

It makes no sense at all that alternative “medicine” is not subjected to the same rigorous regulation as normal medical practice. Either the treatments have a clinical effect, or they don’t. If they do, they should be dealt with like any other drug. If they don’t, they are a fraud and should be removed from sale.

Sense About Science are using current events to campaign for a reform of libel law; but while this is a worthwhile thing to do, there’s another fight to be had in Westminster. I suspect that the lack of policy in this area is simply due to the fact that MPs haven’t been made to think about this issue before. Maybe it’s about time we prompted them. And with new initiatives like the Westminster branch of Skeptics in the Pub coming in the near future, perhaps we will.

A link to my blog revealed an article promoting chiropractic care and treatment for scoliosis. It claims that, “it has been proven to be just as effective, if not more, than the existing treatment options [preventing] further progression” and also, “momentous improvement” from using chiropractic. Is this true? No.

Today, 29 July 2009, a large number of magazines and blogs will publish simultaneously Simons Singh’s article. The Guardian was forced to withdraw it, but what he said must be heard (even if the word ‘bogus’ is now missing).
This is an edited version if the article in the Guardian that resulted in the decision of [...]

Sense About Science, on behalf of the Singh campaign, have asked various bloggers around the world to take part in a mass posting of Simon Singh’s 2008 Guardian article “Beware of the Spinal Tap” - the subject of an ongoing libel case instigated by the British Chiropractic Association. Since I’m always willing to inflict more misery on the BCA - whose lawsuit has done for the chiropractic profession’s reputation what a faulty temperature dial and absent-mindedness did to my pizza earlier tonight - here it is.

BEWARE THE SPINAL TRAP

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.

We were interested to see (among a number of documents sent in response to our FOIA request to the General Chiropractic Council) that the GCC acknowledges that
The available evidence of the efficacy of the chiropractic contribution to the management of some types of asthma, migraine headache and infant colic is inconclusive
While one might argue that [...]

.The University of Central Lancashire (UCLAN) is the first place I asked to see teaching materials that were used on its homeopathy “BSc” course. The request was refused, and subsequent internal appeals were refused too, Clearly UCLAN had something to hide.

An appeal to the information commissioner took almost two years [...]

It’s good to see the BMJ joining the campaign for free speech (only a month or two behind the blogs). The suing of Simon Singh for defamation by the British Chiropractic Association has stirred up a hornet’s nest that could (one hopes) change the law of the land, and destroy chiropractic altogether. [...]