Friday, November 14, 2008

Simon Singh sued by the British Chiropractic Association

Alternative medicine calls in the lawyers

Science author Simon Singh (who is speaking at the CFI London Science and Religion event in April) is being sued by the British Chiropractic Association (BCA).

The action is being taken over a passage in an article Singh wrote for the Guardian about the BCA.

The case was reported here by the Telegraph.

The excellent Jack of Kent sets out the alleged libel here.

This case is important because if the BCA wins there is a host of other alternative medical practitioners (homeopaths, etc.) who will probably also sue if it's suggested there's no evidence their treatment works.

If the case goes ahead, we'll see the evidence for and against the efficacy of chiropractice as a treatment for various ailments set out in court - which will be interesting!

11 comments:

Brian said...

Next the religions will sue if someone complains that they don't have evidence. Oh wait, it appears the UNHRC has been coopted for just that purpose.

jeremy said...

Ultimately, I suppose this case will stand or fall on the judge's opinion of the state of chiropractic evidence.

This worries me a little, since it is often very difficult for non-scientists to properly evaluate the quality of scientific trials.

No one could argue that chiropractic has been adequately evaluated. I find this rather frustrating, since in principle it is no harder to design a tight study with chiropractic than it is with, say, paracetamol.

Nonetheless:

(i) The onus is on the British Chiropractic Association (BCA) to produce evidence of adequate quality. Simon Singh didn't say that the evidence goes against them, he simply said there wasn't any (adequate) evidence.

(ii) To the best of my understanding, there is sufficient evidence for chiropractic's success for musculoskeletal problems, like lower back pain. However, it is no more effective (and possibly less effective) than traditional methods, like physiotherapy. However, there is NO strong evidence that is effective in treating the sorts of things that got Simon Singh into trouble for mentioning, like "colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying".

(iii) More seriously, it is in principle implausible that chiropractic works for these conditions. There is simply no known way for ear infections, say, to be caused by slightly malaligned vertebrae!

An analogy: say you are told by someone that his lucky crystal can predict the weather. A few people do rather bad trials (like asking his customers whether or not the man's predictions worked for them) and the result is, at best, ambiguous. Should you be allowed to say that this his claims are unfounded? Yes, I believe you should.

jeremy said...

...especially considering the downside: good money and time expended, rare direct dangers (like strokes), and frequent indirect dangers (like not taking your sick child to someone who knows what the hell they're doing with ear infections).

Jackie said...

What's the proper pronunciation of "Singh"?

"We've plenty of hearsay and conjecture. Those are kinds of evidence." - Lionel Hutz, The Simpsons

According to Jack of Kent, the BCA's case rests on whether "not a jot of evidence" means no scientific evidence (Singh's probable meaning) or no evidence whatsoever, the BCA's interpretation. By making that distinction, aren't they admitting that they have no scientific basis for their treatment of infants? If the BCA wins, I hope it's on condition that they stop claiming to be medical professionals.

Kyle P. said...

Shall we send over the Amazing Randy to put this to rest? :)

Tony Lloyd said...

M'lud. Conjecture and hearsay are banned from even the most minor court case. We do not make decisions about speeding tickets or dodged bus-fares on the basis of conjecture and hearsay. If conjecture and hearsay do not provide evidence to enable us to license a betting shop they do not provide evidence for the treatment of serious illness in children.

I don't think Simon Singh needs to prove that "evidence" meant "scientific evidence". He would just need to show that it meant, well....evidence in the general everyday way we use it: in law, at the workplace etc. The bar would need to be very, very, low indeed to admit the type of "evidence" the woo-brigade put forward,

Big Bad Bob said...

Asthma is defined as a condition which is relieved by the use of bronchiodilators. It seems then by definition that nothing could be effective against asthma except a bronchiodilator - so unless the bac show that chiropractice is a bronchodilator they will never have an effective treatment.

It is rather obvious there are fundamental problems when the methods of alternative medicine converge with the established proceedures of conventional medicine. These can be examined or ignored. Unfortunately the BAC do neither.

In short , The BCA or similar bodies such as the BAC since they present themselves in the clothes and confidence of established medicine without the evidence to match. If they could articulate an alternative method of enquiry to match their supposed alternative findings I would have respect for them. I will listen to anyone who articulates a challenge to the all too fallible practice of conventional medicine.

I would also respect them if they simply said screw you to the medical profession and refused to engage in its language - mental landscape and methods of investigation - if they sold their product as alternative - citing perhaps customer satisfaction and holistic efficacy. Stick to mymop scores and personal testimony.

Unfortunately they do neither - they hover in the worst realms of pseudo-science - conducting themselves as professionals they refuse to accept the dialogue of the established medical professions. They trumpet out wishful thinking on the legal ground that their treatments "may" help with anything they can think of.

A personal anecdote to close - The BAC - british acupuncture council was in uproar in recent years because they were told not to induce births. The BAC in its proud and wooly language fought back pulling out all the stops with formal letters to newspapers - collecting its most respected members as "we the undersigned". The debate raged back and forth. The only slight problem is there is no scientific evidence that acupuncture can induce labour. This minor detail was never raised. Perhaps it was fear of litigation :)

jeremy said...

Hi Big Bad Bob,

Two points:
1. To define asthma as "a condition relieved by bronchodilators" isn't sufficient - other conditions are too. Also, even if this definition were accurate, it still wouldn't preclude OTHER things from relieving asthma in addition.

2. I'm not sure I would "respect" chiropracters who decided to shun the scientific method in evaluating their claims (if this is what you're saying). Surely ANY treatment should be subject to the highest possible level of scrutiny with regards to efficacy and side-effects, etc. before foisting it on the public?

Big Bad Bob said...

Jeremy .

Breathlessness relieved by bronchiodilators is to my knowledge is the accepted working definition of asthma - see ballinger and pratchett or the NICE guideliness. I am only pointing out how medical definitions can invoke their treatements and how difficult it can be separate them from conventional practice . I may be picking holes but Im trying to intimate how hard it can be to even begin to build a dialogue between alternative and conventional medicine.

As for respect for chiropractors - I am saying that until they articulate themselves in a way which is even vaguely comprehensible to the medical profession - they should at least be honest with their claims. They should stick to clinical audits - or customer feedback - examples such that patients during a course of treatments showed improvement on pain scales etc. Such holistic reports could exclude them from a reductionist analysis, and could still show evident safety

Unfortunately we don't even hear observational evidence. I'd let them off with saying what exactly explains how their techniques work. But they dont even seem interested in that. All we hear is the same old rubbish about "treating the whole person" even if nothing is being treated. We hear "may help" with syndrome x rather than has been shown to help.

Hope that makes a bit more sense. Asthma incidently isnt relieved by acupuncture - see the cochrane database. But do traditional acupunturists even such suggest some stuttering objection such as the definitions in the study are wrong - no they just blindly ignore the findings and say more research is needed !

Stu said...

Seems the comments went downhill here over time, didn't they?
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