Posted by: Chris Cole | May 16, 2009

Lawyers and the scientifically retarded join forces…

I suppose by now I should really stop being surprised by the degree of obtuseness and idiocy displayed on a regular basis by some of my fellow human beings, but sometimes… well… you just have to sit back and admire the spectacle of a complete and utter lack of rationality and logic when it’s elevated to levels one might have hoped were simply unattainable. And this week, via the works of the good people of the British Chiropractic Association and aided and abetted by the legal machinations of the English civil tort system, we are afforded ringside seats to a travesty of natural justice, and an insult to the sane and sensible everywhere.

Simon Singh, a mathematician and well-known UK author (Fermat’s Last Theorem, The Code Book, Big Bang, the list goes on) and television documentary producer, is currently being sued for libel by the British Chiropractic Association (BCA) because… well, because he truthfully stated in a newspaper article that claims the BCA had made regarding the use of chiropractic to treat certain medical conditions in children were utter crap, and the BCA were not very happy about it. To be somewhat more accurate, Simon Singh actually called the claims “bogus” and was generally far more polite than I would have been, and indeed intend, shortly, to be. Rather than just get all grumpy, take their bat and ball and storm off home, the BCA decided to go next door to their uncle the lawyer, and bring him back to the site of the dispute, armed with a much bigger cricket bat and a not-at-all veiled threat about using it, if Simon didn’t publicly retract the terrible things he had said about their precious quackery… er, delusions… um, preying on the gullible… oh, “profession”… yes, that must have been the word I was looking for.

Simon’s article can be found here: http://svetlana14s.narod.ru/Simon_Singhs_silenced_paper.html

The BCA brochure in question is here:
http://web.archive.org/web/20070206003656/http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Happy+families.pdf

Ignoring the more nebulous waffle found in the brochure, let’s focus on two of the specific claims made therein, namely that there is evidence that chiropractic is effective in treating asthma, and recurrent infections, especially otitis media (middle ear infections) in children. Demonstrating that their knowledge of the law regarding false advertising far outstrips their knowledge of science, medicine or pathophysiology, the BCA is careful to word their claim as “There is evidence to show that chiropractic care has helped children with…” these conditions. From a legal perspective this could be construed to mean anything from say a third hand story that one child somewhere, who happens to have asthma, burped less often one day in twenty and had been subjected to a chiropractic treatment at some point… to something more robust such as that a large randomised controlled trial has shown that a specific chiropractic intervention cures asthma as measured by objective lung function tests in a certain percentage of children. (I leave the reader to guess for themselves towards which end of this spectrum of possibilities the truth lies). It is important to realise the wording is loose enough to allow a lot of latitude in one’s interpretation of the statement. There is no assertion about the quality of evidence involved, the existence or not of conflicting evidence, or that the non-quantified or even qualitatively described “help” had anything to do with the illness in question. Cleverly constructed legalese aside, however, does anyone of reasonable intelligence doubt for a second that the implied meaning of the sentence is essentially “We have evidence that chiropractic is an effective treatment for…” these conditions??

So why would Simon Singh suggest that such claims are bogus, unfounded and generally just plain not true? Because he’s right. Such claims are, by any reasonable standard, patently false. Chiropractic suffers, like many so-called alternative therapies, from the fact that there is very little good quality research done in their field, and that what decent research is done consistently fails to support their most treasured claims. A recent systematic review, published in one of their own journals, concludes that the quality of evidence for the role of chiropractic treatments in all paediatric conditions in which it is purported to work, is extremely poor; essentially that there is no good evidence that chiropractic intervention is of any benefit to children for any illness. The full article is here: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2553791.

So what about the evidence for chiropractic helping kids with asthma? Searching the relevant medical literature (something real doctors do quite often) turns up only two well-designed studies that might help answer this question. One, a randomised controlled trial, examined the difference between “real” chiropractic treatment versus “sham” chiropractic treatment (to eliminate the placebo effect) in treating kids with asthma. There was no difference between the two groups. The second study looked at the use of chiropractic as an adjunct or “add-on” therapy for kids with mild to moderate asthma who were already receiving normal (that is, evidence based) medical treatment for their asthma. The conclusion? There was no additional benefit in adding chiropractic to standard medical therapy. These articles can be found here: http://www.ncbi.nlm.nih.gov/pubmed/7728627 and here:  http://www.ncbi.nlm.nih.gov/pubmed/9761802.

What about the wonderful benefits of chiropractic in treating or preventing recurrent ear infections? There exists one decent article in the medical literature relevant to this. Its authors were enthusiastic, and were studying, both together and independently, the effects of echinacea and of chiropractic manipulation on the risk and frequency of recurrence of otitis media in children. Echinacea actually showed a small tendency to make matters worse, and the chiropractic treatments had no significant effect at all. The article can be found here: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2573879.  The one reference cited in the BCA brochure as supporting the effectivness of chiropractic for treating otitis media is for an article which has not yet been published, and there is no indication as to what type of study it is, or if it is an experimental study at all; it could simply be an opinion piece for all we know. The fact that the principal author has some affiliation with Harvard University probably got them all excited about the prospect of respect by association.

I should take pains at this point to stipulate that all of the above is merely my opinion, for what it’s worth, as a traditionally trained western scientist and medical doctor. I point this out because, despite the fact that practically no-one will ever read this, the voicing of opinion is generally not permitted to be the subject of a libel action. Under British law, one is open to being sued for libel if one presents such statements as fact, rather than mere opinion. Interestingly, by the weird and wonderful convolutions of the legal system, though I may be on the far side of the world, anything published in the English language which can be expected to be read by anyone in the UK, and which can be construed to damage the reputation of a legal person in the UK (this includes corporations, bodies such as the BCA, and so on) can be the basis of a libel action before a British court. Certain jurisdictions have done the sensible thing in light of such madness, and passed their own specific laws negating this possibility (New York state is one example).

However, proving defamation generally requires that the allegedly damaging statement is, in fact, false. Thus, in support of Dr Singh, and rational people everywhere, I submit that the following statements are factual and true:

  • There is no credible evidence of reasonable scientific standard that chiropractic intervention is of any benefit whatsoever in the treatment of asthma in children.
  • There is no credible evidence of reasonable scientific standard that chiropractic intervention is of any benefit whatsoever in the treatment of recurrent otitis media in children.
  • Untreated children with asthma have a higher risk of adverse outcomes, including death, than do children with asthma who are treated appropriately with proven medical interventions.
  • Reliance upon chiropractic intervention, for which there is no evidence of benefit, in place of proven medical treatment for asthma in children therefore increases the risk of adverse outcomes in such children, including death.

If these facts upset people such as the BCA, that’s just too damn bad. You do not have the right to not be offended. If you feel these facts are not true, then the solution is very, very simple: provide the evidence which shows these assertions are false. It’s what you should have done in response to Simon Singh’s article, but you did not, because such evidence simply does not exist. Instead, you appeal to heavy-handed legal maneuvers in an effort to win a battle of attrition by making it both less irritating and less costly to simply give up, retract such statements, and walk away. Such tactics are cowardly, wasteful, and reflect a pitiable inability or unwillingness to admit that the tenets of your so-called profession have little if any basis in verifiable reality. It is unfortunate indeed that the current legal system allows such abuse of process and harrassment of those who, unlike you, strive to provide bona fide evidence-based information to a public all too susceptible to your quackery.

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Responses

  1. As one of the mere handful of people in the UK who might read this article, I feel obliged to defend chiropractic by sueing you, on the other side of the world, for defamation in a British civil court.

    But if I were to actually do that, of course, it would make me something of a twat.

    For what it’s worth, the more we Brits hear about the abuses of our unjust libel laws, the more we want to see them changed. I had the pleasure of hearing Simon Singh speak recently, and while he was obviously obliged to avoid public comment on the case, his fellow speakers took the opportunity to rip into the BCA and the law mercilessly. Not only was it an educational and entertaining evening, I also have the great satisfaction of knowing that part of the cost of my ticket will go towards helping Simon defend this attack on his good name.

  2. Well, I read this ;-), and thought it was spot-on.


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