Posts Tagged ‘Simon Singh’

Spinal Trap rebroadcast


On Wednesday, a large number of online and print sources showed solidarity with Simon Singh by reprinting his critique of the British Chiropractic Association. They have removed the allegedly libellous portions – I invite you to read them, then the original, and decide whether the substance is different.

Here is a list of blogs that have reproduced the article, as compiled at Sense About Science.

Although I’m late joining in, I hereby offer the same service: a reproduction of the original article. Like most others, I’m omitting the allegedly libellous lines.

Let me be clear: I do not think they are libellous. I think the BCA’s case is a cowardly attack meant to silence a critic, not a legitimate attempt to protect itself from malicious falsehoods. But I do not have the means to mount a defense should the BCA come after me. In my case, their cowardly tactics work. (That is one reason why the law must change.)

But, as I said, I think the substance of the article is unchanged by the omission (further evidence of the ridiculousness of their accusation). So here it is, as presented on the Sense About Science site:

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.


Science, skepticism, and chiropractors


In an apparent response to the great indignation stirred up by their libel suit against Simon Singh (which I have blogged about already, here and here), the British Chiropractic Association has put forth another defense of their actions (and their profession). This time, it takes the form of a letter to the British Medical Journal written by BCA vice-president Richard Brown. It is freely available on the BMJ’s website, alongside a thorough critique by Edzard Ernst (professor of complementary medicine in Exeter) and an editorial by Fiona Godlee of the BMJ.

Brown claims that the BCA didn’t want to sue Singh, but he left them no choice when he refused to retract his original article. That’s the one that claimed the BCA promoted chiropractic as a treatment for childhood conditions when there is no good evidence that it is effective. He lists several studies, claiming that they demonstrate the effectiveness of chiropractic for “various childhood conditions.” In effect, his letter suggests that they have evidence to support their medical claims, but that it is appropriate to sue someone who criticizes those claims (rather than simply presenting the evidence, as they were invited to back when Singh’s article first came out).

Ernst doesn’t address the legal or political issues at all, instead producing a thorough and easy-to-follow demolition of the studies that Brown puts forth – each of which is either irrelevant to the claims being debated or is of insufficient quality to count as substantial evidence. He also points out that “At least three relevant randomised controlled trials and two systematic reviews are missing from [Brown’s list].” That is, not only is the BCA’s evidence base of poor quality – they rely on it while ignoring good evidence that the interventions don’t work.

Godlee’s editorial provides a good summary. Remember that this is comment from an editor of one of the most prestigious medical journals around. It’s titled “Keep libel laws out of science.” (Sound familiar?) It is a masterful piece of writing, so you ought to read the whole thing. But here are some of the more delightful bits:

I hope all readers of the BMJ are signed up to organised scepticism. It’s not a blog, but it could be. It’s one of the four principles of good science as articulated by Robert Merton nearly 70 years ago.

The Guardian offered the BCA an opportunity to lay out their evidence rather than to sue him for libel. The BCA opted to sue.

Readers can decide for themselves whether or not they are convinced [by the evidence presented by Brown]. Edzard Ernst is not. His demolition of the 18 references is, to my mind, complete.

Weak science sheltered from criticism by officious laws means bad medicine.

And naturally, she echoes another medical journal editor who was faced with similar bullying recently:

And last year when chiropractors threatened to sue over an article in the New Zealand Medical Journal, its editor Frank Frizelle spoke for all of us when he asked them to provide “your evidence not your legal muscle.”

As Chris Kavanagh points out in his post on this (where I learned about this latest development), the BCA has yet again failed to vindicate themselves in any way. They have at last presented their evidence in a forum where its actual quality matters, rather than its superficial plausibility. Which is good – they should have done this in the first place, rather than stooping to the level of legal bullying. But the fact is that their evidence is poor. Very poor. The fact is that Simon Singh was right in his original article. This was bound to come out when the issue made it to a scientific journal.

I don’t know if this will have any effect on Simon’s case – after all, that is based on a fundamentally bad law, and does not (as far as I know) depend on the quality of the scientific evidence. But perhaps it will help people see through the veneer of medical respectability that chiropractors try to project.

Singh fights on


The sceptical blogosphere is abuzz with delight at the news that Simon Singh, respected science writer, will be going forward with his legal defense against the British Chiropractic Association’s accusation of libel.

For the basic story, see my earlier post or just do a web search for Simon Singh and BCA. Jack of Kent is keeping pretty detailed track of things from the legal perspective.

Also, check out the Sense About Science website. In support of Simon and to help prevent similar travesties in the future, they have begun a campaign to keep libel laws out of science.

They’re calling it “Keep Libel Laws Out of Science”. Nice title – it’s quirky, but catchy. Here’s a graphic that they’re encouraging others on the web to put up:

[link to graphic broken- sorry]

If you have a website or blog, please help promote this appeal. Also, don’t forget to sign the statement. (This is separate from the petition I linked to in my previous post.)


Science, Chiropractic, and libel laws


Scientist and author Simon Singh is in a spot of trouble. His crime is writing a strongly-worded article on the lack of evidence for several claims made by the chiropractic profession. In it, he criticizes the British Chiropractic Association’s (BCA) promotion of chiropractic treatments for certain conditions:

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.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.

Note that he’s not name-calling here. He’s making a claim – that certain treatments promoted by the BCA have no good evidence behind them – and backing it up with data. (Here’s an Amazon link for the book he mentions.)

So why is he in trouble then? Surely stronger (and less well-evidenced) claims are made in the media all the time.

Rather than try to refute his claims on scientific grounds – perhaps by submitting a counter-article – the BCA responded by crying libel. They have taken advantage of the ill-designed and internationally condemned libel laws in the UK, tying Singh up in expensive proceedings which are already going against him.

Specifically, the BCA is complaining about the word “bogus”. The judge at the preliminary hearing agreed with the BCA that the word implied that the BCA knowingly promoted unproven treatments. I’ll leave it to more savvy linguists to address the dramatic ridiculousness of this interpretation – or read Singh’s article (linked and excerpted above) to see for yourself.

Basically, the BCA’s original claims are factually wrong;, and Singh’s critique was proportionate to the evidence, with no evident desire to exaggerate the facts in order to damage the BCA’s reputation. Is he being sued only because the BCA doesn’t like to be criticized? It looks like it. As a British taxpayer, I do not think that deserves my tax dollars. The case should be thrown out, and the BCA should pay expenses to Singh, plus a penalty for wasting the court’s time.

But I’m not the judge. And even if I were, British law is skewed massively in favour of the accuser in libel cases – particularly if the accuser is rich.

Which is very worrying. Does British law value the tender feelings of professionals over free speech? Do we want honest, evidence-based criticism to be trampled on in favour of wealthy interest groups?

The judgement in the preliminary hearing feels like a blow against free speech, science-based journalism, and common sense, there is cause for hope. Check out these links for extensive roundups of the case and the coverage it has gained in the mainstream media and the blogosphere. Between the BCA’s bullying behaviour, the bad law, and the ridiculous linguistic inclinations of the judge, they are likely to end up looking even worse (and Singh even more noble and valiant) than if they’d just let the article sink into yesterday’s news.

If you live in the UK and are as disturbed as I am about how Britain’s unjust libel laws can be and are used to silence important exercises of free speech, then sign this online petition. It will be seen by MPs. In conjunction with the increasing media coverage, a petition like this might actually motivate them to reform the libel law in this country.

And, since that won’t change things in the short term, let’s make some noise in support of Simon Singh. Here are some other bloggers that are keeping an eye on the situation:

Here is a Facebook group for supporters of Simon.

I would also like to extend kudos to the Guardian newspaper, for supporting Singh in this fight (and Ben Goldacre before him). The little-guy-against-the-giant image may be inspiring, but in real life it’s good to have slightly more even odds. Good for them.