The British Chiropractic Association v Simon Singh

Yesterday I sat in an English courtroom and and witnessed a travesty. I was in a public gallery packed with Simon Singh’s supporters for the preliminary hearing of the BCA v Simon Singh at the High Court. The BCA had objected to an article Dr Singh penned for The Guardian newspaper, which appeared during ‘Chiropractic Awareness Week’ in April 2008. The article has since been removed from the newspaper’s website but can currently still be viewed here.

The BCA were offended by this passage:

“the British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”

They had asked the author to retract the allegations, claiming these were “factually wrong, defamatory and damaging to the BCA’s reputation”, but Simon refused to do so, so the BCA sued him. Not The Guardian, him.

I’m not going to give a full account of both parties oral submissions. It wasn’t that easy to hear them and what I did hear was pretty boring. Even the judge, Sir David Eady, was seen yawning once, which was about 16 times fewer than I did. From what I could follow, Singh’s lawyers argued that the passage was an opinion — a comment — rather than a statement of fact and that this was clear from the context. In the paragraph following the offending passage, Dr Singh gives the grounds for his opinion:

“I can confidently label these treatments as bogus 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.”

A mere forty minutes into the proceedings, the judge was spotted glancing wistfully at the clock. That he wrote almost nothing down while listening to the submissions was noticed by several of us. When it was time to give his ruling he simply read out the conclusion he had aready reached and written down before he’d even entered the courtroom that morning. And an extraordinary conclusion it was too. He dismissed out of hand the suggestion that it was a comment rather than a statement of fact, which was kind of what I expected. What I didn’t expect, what nobody expected — least of all the BCA and their lawyers, I imagine — was what Mr Justice Eady said next. In his view, the word ‘bogus’ doesn’t simply mean ‘not genuine’ but implies a deliberate attempt to deceive.

This view is in accord with the one expressed by the BCA lawyers and, to be honest, I can understand it. The word ‘bogus’ is often associated with criminal behaviour e.g. the crime known formally as ‘burglary artifice’ is commonly referred to as ‘bogus callers’. (I disagree with the BCA lawyers argument about the word ‘happily’ meaning ‘knowingly’. Cobblers! It’s quite possible to ‘happily’ promote something not knowing it to be false.)

That said, I also understand why Simon Singh used it, even if he didn’t intend to imply deliberate dishonesty. It is impossible for us to know which alternative therapists are knowingly conning people and are fully aware that the remedies and treatments they prescribe are, at best, useless. Some skeptics find it impossible to believe that these people can’t be aware that their remedies lack scientific support and I have some sympathy with this view. But I think most of us believe that the vast majority of therapists are sincere in their intentions and are actually very, very deluded. What adjectives can be used to describe remedies that have no active ingredients or treatments based on completely false hypotheses — regardless of how much faith the practitioner may have in them? They are bogus therapies, are they not? Would ‘false’ be a better word? How about ‘sham’ or ‘fake’ or ‘phony’? I’d suggest that Justice Eady consult a thesaurus and let us have his suggestion.

In fact there is no word that conveys the meaning Simon obviously intended — which is that there is no good scientific evidence to support chiropractic and it doesn’t bloody work — that doesn’t have a negative connotation. There is no appropriate word that can’t be interpreted to be implying deliberate dishonesty if that’s what the reader wants to do and, obviously, the BCA did want to. They may have courted publicity by announcing it was Chiropractic Awareness Week but columns in quality newspapers by high-profile science authors exposing chiropractic for the nonsense it is, is not the kind of publicity they want or need. What else could the BCA do to keep its thousand or so members (who pay a very high annual subscription) happy but sue?

I digress. The unexpected was not Eady’s understanding of the word ‘bogus’ but in his assertion that, in using it, Simon Singh was stating in no uncertain terms that the BCA was being dishonest and that, should the case go to full trial, the onus will be on Simon to prove that the BCA were being deliberately dishonest. Yes, really. The burden of proof for something he didn’t claim or intend to imply in the first place will be on Simon Singh, the defendant.

This is likely to mean that it will be impossible to go to trial. Legal blogger Jack of Kent, who was also there yesterday, comments that,

unless there is hard evidence of dishonesty, it may not even be professionally possible for Simon Singh’s lawyers to put the required case to the court: English barristers and solicitors are prohibited from alleging fraud unless there is sound and cogent evidence before them on which to base the allegation.

Simon has three weeks in which to appeal against Eady’s extraordinary ruling. Whatever happens, the battle against batshit loopy and potentially dangerous so-called ‘therapies’ like chiropractic will continue unabated. Cases that illustrate just how dangerous chiropractic can be are viewable here.

Related posts by other bloggers

Jack of Kent: An astonishingly illiberal ruling

The Lay Scientist: The Simon Singh Verdict: British Skeptics are Under Siege

Bad Science: A characteristically amateurish and socially inappropriate approach to pitching an article

Heresy Corner: Eady’s Bogus Judgement

Bad Science Forum thread

13 thoughts on “The British Chiropractic Association v Simon Singh”

  1. Hi,

    I appreciate your bad experiences and take a lot of CAM attitudes with a pinch of salt. But i am wondering where you are coming from. Is there some utopia of ‘scientific’ medicine where all disease will be eradicated by a pill (the consensus when the nhS was founded but a little ‘bogus’ now)? If so it is a long way off. With all it’s vast research funding conventional medicine is not much further in vaildation than CAM with 85%+ of medical interventions being unproven and one in ten admissions to hospital being due to adverse drug reactions. The current model of healthcare is clearly ineffective and unsustainable.

    The ‘stalinist’ approach (as described by Prof Kucera) of evidence-based medicine fanatics (usually not clinicians it seems) is intriguing. It’s like Animal Farm, RCT good all else bad.There seems be the illogical assumption that if something hasn’t been ‘proven’ by an RCT then it doesn’t work.
    The founding fathers of EBM wanted evidence to inform practice not dictate it. Where is the evidence that practicing purely according to RCTs is of benefit to patients? Or is this of secondary importance to hegemony of ‘science’.

    CAM may not have worked for you but it does for hundreds of thousands of people who have been failed by and fobbed off by the NHS.It’ use saves the NHS millions. Even if it is all placebo the true scientific response would be not to rubbish it but to try find out what was really going on and use that to inform and improve mainstream medicine.

  2. Hi Neil

    I appreciate your bad experiences and take a lot of CAM attitudes with a pinch of salt.

    What bad experiences? I haven’t said I’ve had any bad experiences of CAM. It’s other people’s bad experiences – and deaths – at the hands of quacks that I’m concerned about. Aren’t you?

    But i am wondering where you are coming from.

    I don’t think I can make it any clearer where I am coming from than I already have on this blog.

    Is there some utopia of ‘scientific’ medicine where all disease will be eradicated by a pill (the consensus when the nhS was founded but a little ‘bogus’ now)?

    No, I’m not aware of any utopia where all diseases will be eradicated by a pill. Is there something I’ve said somewhere that impies this? If so, what?

    With all it’s vast research funding conventional medicine is not much further in vaildation than CAM with 85%+ of medical interventions being unproven and one in ten admissions to hospital being due to adverse drug reactions.

    Sources?

    The ‘stalinist’ approach (as described by Prof Kucera)

    Who?

    of evidence-based medicine fanatics (usually not clinicians it seems) is intriguing. It’s like Animal Farm, RCT good all else bad.

    I don’t recall anything in Animal Farm about promoting the scientific method for the good of public health. What chapter is it in?

    There seems be the illogical assumption that if something hasn’t been ‘proven’ by an RCT then it doesn’t work.

    Find me someone who claims that and I’ll be glad to take them on.

    The founding fathers of EBM wanted evidence to inform practice not dictate it.

    How do you know?

    Where is the evidence that practicing purely according to RCTs is of benefit to patients? Or is this of secondary importance to hegemony of ‘science’.

    As I have never suggested practising “purely according to RCTs” (and never would) this is a red herring, as is the “hegemony of science” comment.

    CAM may not have worked for you but it does for hundreds of thousands of people who have been failed by and fobbed off by the NHS.

    And your evidence is?

    It’s use saves the NHS millions.

    And that’s what matters, of course. Not people suffering and dying needlessly because of their (or their parents’) faith in quack remedies.

    Even if it is all placebo the true scientific response would be not to rubbish it but to try find out what was really going on and use that to inform and improve mainstream medicine.

    Newsflash: They’ve found out what’s going on and that’s why those of us who really care about people’s health are rubbishing it.

  3. “What bad experiences? I haven’t said I’ve had any bad experiences of CAM. It’s other people’s bad experiences – and deaths – at the hands of quacks that I’m concerned about. Aren’t you?”

    You got no benefit from the tretaments you tried – I call that a bad experience. Of course I am concerned by deaths and bad experiences at the hands of quacks. It’s just the the overwhelming majority of these are medical. See BMJ….Using this poor baby’s death in Australia as a whip to beat homoepaths is shameful especially if you ignore high morbidity rate in the NHS.

    “With all it’s vast research funding conventional medicine is not much further in vaildation than CAM with 85%+ of medical interventions being unproven and one in ten admissions to hospital being due to adverse drug reactions.

    Sources?”

    1.http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp. To summarise 13% were found beneficial, 23% likely to be beneficial,8% a trade off between benefit and harm. 6% unlikely to be beneficial, 4% likely to be harmful and 46% of unknown effectiveness

    2. BMJ 2004;329:15-19 (3 July). Sorry I over-egged this one. This study showed only(sic) 6.5% of admissions due to ADRs. At conservative estimate of 10 million admissions per year that amounts to 650,000 serious incidents requiring hospital stay of which 0.15% were fatalities – a staggering 97,500. Don’t you care about these?

    “The ’stalinist’ approach (as described by Prof Kucera)

    Who?”

    Sorry I got the name wrong, it was Prof Sikora in a letter to the Times of 3rd Feb 09 as follows:
    Complementary medicine does help patients
    The case for having more education for complementary medicine practitioners

    Sir, No doubt to the dismay of your correspondents (letter, Jan 30) complementary therapies are being used by about 60 per cent of my cancer patients. They are used by millions who suffer from long-term conditions for which, despite the efforts of scientists, there is no effective conventional treatment. Many knowledgeable and trained doctors use complementary therapies in their everyday treatment of patients where it is appropriate.

    Those of us who are faced daily by real human suffering use the best evidence available to help our patients. At the same time, patients do their best to help themselves. The ill-thought-through arguments of those who are not doctors — and so have no experience of the practice of medicine — are ridiculous.

    According to the Department of Health, about one in five adults uses complementary therapies. That means we need more education for practitioners, not less. And we certainly need better research, not the Stalinist repression that Professor Colquhoun and his colleagues demand.

    Armchair physicians are welcome to their views, but clearly patients know better.

    Professor Karol Sikora
    Professor of Cancer Medicine,
    Imperial College School of Medicine, Hammersmith Hospital

    “There seems be the illogical assumption that if something hasn’t been ‘proven’ by an RCT then it doesn’t work.

    Find me someone who claims that and I’ll be glad to take them on.”

    Then go for your heroes Drs Singh and Ernst. Singh’s suggestion that there ‘is not a jot of evidence’ would seem to prove my point.

    “The founding fathers of EBM wanted evidence to inform practice not dictate it.

    How do you know?”

    Try Sackett DL (1997)Evidence-based medicine, SeminPerinatol 21:3-5 or
    BMJ 1996;312:71-72 (13 January) BMJ editorial.

    Yours Neil

  4. Excuse me but the NHS was not responsible for that baby’s death, a homeopath was and the reason she died was because he put his faith in homeopathy instead of getting her to a hospital. There is no reason to believe that she would have died if he had done that. The reason he put his faith in homeopathy is because it is being promoted as something that works. It does not work, it cannot work and this baby’s death is a testament to its utter uselessness and its danger when in the hands of idiots. It’s your suggestion that I shouldn’t use an example of the uselessness and dangers of homeopathy to criticise homeopaths that is shameful, as is your trying to present orthodox medicine as if it is comparably useless or dangerous.

    You claimed that conventional medicine is “not much further in valdation than CAM” but the sources you quote give the lie to this. There is NO validation of alternative therapies: that’s why they remain alternative therapies. And it is not the quacks we have to thank for the ability to treat or eliminate altogether so many of the serious infectious diseases that our ancestors died from.

    I asked you to find me someone who has claimed that “if it hasn’t been ‘proven’ by an RCT then it doesn’t work”. Neither Ernst nor Singh has claimed any such thing. Singh’s assertion that there is “not a jot of evidence” referred specifically to treat the claim that chiropractors can treat “children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying”, claims for which there is not a jot of evidence.

    If you’d read all the posts on this blog you would know that I have not dismissed all complementary therapies nor have I been uniformly supportive of conventional medicine and doctors. However, this is my blog and I write about what I choose to. If you’re as obsessed with the problems of conventional medicine as you seem to be, I suggest you start your own blog.

    Good luck.

  5. I said it was shameful but it is unscientific and sensationalist. Did Dr Shipman’s murders mean that medicine is bad?

    I am not obsessed with the problems of the NHS just using them to counterpoint your ‘argument’ with published data. I am a great fan of the NHS and owe my daughter’s recovery from an accident to the skill and care of A&E staff.

    But that is the forte of the NHS – ‘heroic’ medicine – and as Prof Sikora says there are vast areas of healthcare where modern medicine is not very good and people turn to alternatives to find if they work for them. That is the evidence that is important to the patient. Indeed I am quite encouraged by the lack of ‘hard’ evidence for medical interventions. It means that that medics are ignoring the dictats of EBM and using their clinical nous.

    You confidently assert that there is no validation for alternative therapies and there is ‘not a jot of evidence’ for the chiropractors claims. All the major CAMs have extensive evidence; it’s that this ignored as not being good enough, probably because they are not RCTs, but it is evidence none the less and it is an unscientific approach to dismiss it altogether. Even Ben Goldacre, on your link, goes as far as to say that Singh got that wrong – do try and keep up if you want anyone to listen.

    As for validation the upcoming NICE guidelines for treatment of low back pain recommend manual manipulation, as pioneered by chiropractors, as the treatment of choice.

    Enough said, I don’t suppose the factual and reasoned arguments I put forward will affect you as you seem to be of probably well-meaning, but bigoted and fundamentalist disposition, just parroting slogans from others without any really knowledge or insight yourself.

    Still this is your blog and you can do what you like with. Have fun, but perhaps you should take up something like gardening.

    Yours
    Neil

  6. Neil

    If you think you’ve put forward “factual and reasoned arguments”, you are sadly deluded. What you have done is

    (1) claim that CAM works for hundreds of thousands of people, though you have not said what you mean by “work” and have not provided a shred of evidence that they do, in fact, work.

    (2) claim that there is “extensive evidence” for CAMs and, although you have not told us what this evidence is, you say it would be “unscientific to dismiss it”.

    OK, let’s see the evidence!

    Nobody is denying that some therapies make people feel better, especially people who are not very ill in the first place. What they do not do is treat serious injury or disease. Without corroborative evidence, a hundred anecdotes are no better than one.

    Anecdotes and statistically insignificant results from trials amount to the sort of “weak evidence” that Ben Goldacre refers to when he says what Simon Singh wrote was “technically a bit wrong..when there’s some weak evidence for some things”. I’m sure you know that Ben Goldacre shares Simon Singh’s views on quackery and is not suggesting that “some weak evidence” amounts to scientific support for any given quack remedy and trying to imply otherwise is pathetic, frankly.

    You have also

    (3) said some irrelevant stuff about conventional medicine in order to “counterpoint” my argument. My argument is that there is no good evidence that alternative therapies are effective except as a placebo and that putting one’s faith in alternative therapies is potentially dangerous – an argument that is supported by the many documented cases of otherwise preventable disease, injury and deaths occurring because people put their faith in alternative therapies. Pointing out problems with conventional medicine is, as I said before, a red herring. It does not make claims about the efficacy of alternative therapies any truer.

    As for whether it is fair to criticise homeopathy for the baby’s death, your analogy is plain daft. Harold Shipman intended to kill his patients. Gloria’s homeoquack father was trying to make her better. See the difference? He was trying to treat her but instead he killed her. He killed her by using useless quack remedies instead of getting her the professional treatment that would have saved her. I don’t give a fuck about your quackish sensibilities, Neil. What I care about are babies dying at the hands of people who put their faith in therapies for which there is no scientific support. Got it now?

    Love how you quackers start hurling insults when you get wound up.

  7. You started the insults, dear girl.

    To be serious, the nub is what constitutes good evidence. The illiberal tendency of you skeptics is to dismiss anything that is not an RCT as worthless ‘not a jot’. This is illogical and unscientific.

    That would fine if RCTs produced pure truth but all trials are based on assumptions. RCTs have given us Vioxx and many other medical abuses. As opined recently in the BMJ on the latter case ‘there are lies, damn lies, statistics and medical authors’.

    I wish you could find a space in your evidently caring heart for the thousands and thousands who die each year at the hands of ‘scientific’ medicine, or don’t those matter?

    Neil

  8. The problem Neil, my dear boy (you started it), is that what AltMed pushers want accepted as evidence are nothing more than anecdotes. They want to have nothing to do with anything that smacks of independence and tests designed to exclude bias – unless it happens to back up their anecdotes, that is. All sorts of excuses are then made up, usually after the fact.

    If you think anecdotes (even a good number of them) add up to decent evidence, then I’m glad proper doctors have higher standards than you. When it comes to people’s health, we need a bar set much higher than, ‘well, I’ve seen it work with my very own eyes, therefore it must work’. Such egotistical, selfish and irresponsible attitudes are highly prevalent in AltMeds and it is extremely dangerous.

    All that anecdotes tell us is that there *might* be something worth investigating. Indeed, that’s what’s happened to stuff like, say, homeopathy – it has been investigated. What’s more, it has been tested in a manner that removes personal bias as much as possible and lo and behold, homeopathy has been shown to be no better than placebo! Now there’s a surprise.

    As you’ve been told before, the efficacy of AltMed is not increased to balance any harm that may be done by proper medicine. If you want to argue for the efficacy of any particular AltMed woo, then bring on proper, unbiased evidence.

  9. I see that Neil has made a similar claim about 87% of conventional medicine being unproven on the BMJ website here:

    http://www.bmj.com/cgi/eletters/339/jul08_4/b2783

    I think it’s worth quoting in full the response from a retired physician:

    ” Predictably, proponents of chiropractic (and other CAM therapies) claim that “87% of common medical treatments that are unproven as beneficial”. This is derived from the false assumption that all the “common medical treatments” relate to conventional medical practice, but in fact they are all the 2500 treatments (both conventional and CAM)that were included in the study (see further explanation in the HealthWatch Newsletter issue 68, January 2008).

    If 13% of 2500 treatment have good evidence of efficacy that means that there are 325 proven effective treatments. How many of these 325 effective treatments were chiropractic for childhood asthma, otitis, colic, feeding problems, sleeping problems, and prolonged crying? You guess it: answer zero.

    We can extend this comparison of evidence of efficacy to all forms of CAM. How many of the 325 effective treatments are CAM treatment? I cannot do the calculation, but am confident that the proportion will be far less than 13%. I think that proponents of CAM should refrain from deriding evidence of efficacy in conventional medicine until they can show that they have a significant proportion (>13%) who have good evidence of efficacy for CAM treatments. “

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