British Chiropractic Association v Simon Singh

[ponderingturtle]

We are getting quite speculative here, especially as we don't know the details of the BCA claim. But they are forced to resort to the evidence issue. If they choose not to do that, and instead base the claim on whether they knew the evidence was bad, they abandon all credibility for their practice.

Ah but remember this is a court room, good evidence is not relevent. That was the basis of the decision when the american chiropractors sued the AMA.

 

[Asolepius]

Ah but remember this is a court room, good evidence is not relevent. That was the basis of the decision when the american chiropractors sued the AMA.

Yes, I think I have made that point. It does worry me, as judges can be staggeringly perverse. Anyway, let's see what the claim says.

 

[JJM]

Ah but remember this is a court room, good evidence is not relevent. That was the basis of the decision when the american chiropractors sued the AMA.

I worry about what source of expertise the British courts will consult. However, Wilk vs AMA (1987?) was never about evidence, despite the AMA's best efforts. Judge Getzendamer (spelling?) acknowledged that the AMA had a compelling case for the absurdity of chiro. However, she had to decide on the laws of commerce.

Nonetheless, I do worry about the competence of the judge.

 

[Blue Wode]

Blogging from the past 24 hours…

Oh FFS – British Chiropractic Association issues write against Simon Singh
http://www.twonilblankblank.com/200...-association-issues-writ-against-simon-singh/

First Canadian blog to post the entire text of Beware the spinal trap:
http://somecanadianskeptic.blogspot.com/

And the Think Humanism forum has posted it as well:
http://www.thinkhumanism.com/phpBB3/viewtopic.php?f=14&p=37279


A round-up of previous bloggings (some of which have been updated)…

British chiropractors join the legal intimidation party
http://holfordwatch.info/2008/08/16/british-chiropractors-join-the-legal-intimidation-party/

Chiropractors try to silence Simon Singh
http://www.quackometer.net/blog/2008/08/chiropractors-try-to-silence-simon.html

Chiropractors sue Simon Singh – prefer legal action to evidence
http://gimpyblog.wordpress.com/2008...-simon-singh-prefer-legal-action-to-evidence/

The libellous Simon Singh article on chiropractors
(Gimpy again with the full text of the original Guardian article plus refs.)
http://gimpyblog.wordpress.com/2008/08/17/the-libellous-simon-singh-article-on-chiropractors/

On Simon Singh against Chiropractors
http://jackofkent.blogspot.com/2008/08/on-simon-singh-against-chiroprators.html

British Chiropractic Association suing Simon Singh!
http://www.mrhunnybun.com/2008/08/british-chiropractic-association-suing.html

Any Chiropractors Want To Sue Me As Well?
http://thewelshpharmacist.blogspot.com/2008/08/any-chiropractors-want-to-sue-me-as.html

Another Back-Cracking Quack Attack – The Sequel
http://thinking-is-dangerous.blogspot.com/2008/08/another-back-cracking-quack-attack_18.html

Pseudoscientists Sue Simon Singh
http://skepchick.org:80/blog/?p=2200

Litigation instead of evidence
http://skepti.net:80/index.php/2008/08/litigation-instead-of-evidence/

British Chiropractic Association Afraid of Criticism
http://jdc325.wordpress.com:80/2008/08/18/bca-afraid-of-criticism/

UK Skeptics thread
http://www.skeptics.org.uk/forum/showthread.php?t=2707

 

[Blue Wode]

Here’s an interesting excerpt from a new blog post by Ministry of Truth:

…the public kicking that another bunch of woo merchants - homeopaths - has gotten over the last year or so may have spooked the BCA but, casting around for information presents a rather more enticing and plausible explanation as to why they might want to prevent the publication of adverse commentary in the press and any kind of critical public debate surrounding the efficacy and risks of chiropractic…

…and to see that explanation first hand one need only take a short trip over to the website of NICE the National Institute for Clinical Evidence, where we find that one of things they’re working on is a new set of clinical guidelines for the treatement of non-specific lower back pain.

Yep, its the key to the NHS gravy train. If NICE approves the use of chiropractic manipulation as part of the treatment regime for lower back pain then the door opens to chiropractors taking referrals from the NHS under contracts in which the NHS pays their fees and before you can say ‘vested interest’ you’ve got a whole bunch of chiropractors on what is effectively the public payroll. Little wonder then that just about the last thing that the BCA want right now is science journalists asking all sorts of awkward questions like ‘is there any evidence to show that it works?’ and ‘what kind of risks might patients face when referred for a course of woo?’.

I’m speculating, of course, but the idea that this might all be motivated by nothing more than a desire to avoid adverse publicity and awkward question while the door to a taxpayer funded gravy train lies tantalising before them makes about as much sense as an explanation for the threat of legal action against Singh as anything else I can think of…

…its just a shame that no one thought to mention the Streisand Effect to the BCA before they tried it on.

http://www.ministryoftruth.me.uk/2008/08/19/can-you-libel-woo/

There might be more than a kernel of truth in the above. For example, if you look at the general information page for those NICE clinical guidelines which are currently being developed, see here…
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11645re

…you’ll see included in the Guideline Development Group (GDG) members list…
http://www.nice.org.uk/nicemedia/pdf/LowBackPainGDGMembersList270407.pdf

…a ‘Peter Dixon’ who is described as a chiropractor with “experience and working knowledge of non specific low back pain”. Well, for those not familiar with chiropractic in the UK, Peter Dixon happens to be the current Chairman of the UK chiropractic regulatory body, the General Chiropractic Council (GCC). An interesting example of his work in that capacity can be found here:
http://www.gcc-uk.org/files/link_file/DAILY MAIL 12 December 2006.pdf

His presence on that panel developing the NICE guidelines is also confirmed in this recent GCC newsletter (page 7):

In the pipeline

NICE is developing a guideline on low back pain: the acute management of patients with chronic (longer than six weeks) non-specific low back pain. The GCC’s Chairman, Peter Dixon, is a member of the guideline development group, which is Chaired by Professor Martin Underwood. Publication of the guideline is expected in May 2009.

http://www.gcc-uk.org/files/page_file/WEBSITE_GCCNews23.pdf

What troubles me is, can a man who recently insisted that “there’s no available evidence to show that manipulation of the neck by chiropractors has ever caused a stroke” be a trusted member of a clinical excellence team? To learn more about Peter Dixon, scroll down this link until you come to ‘Edzard Ernst again challenges chiropractors in UK’:
http://www.healthwatcher.net/chirowatch.com/cw-cervical.html


Back to the latest blogging:

‘Self-Destructing Chiropractors’
http://jonathanhearsey.com/?p=60

Chiropractors get litigious, again
http://blogs.nature.com/news/thegreatbeyond/2008/08/chiropractors_get_litigious_ag.html

Simon Singh versus… the chiropractors?
http://castingoutnines.wordpress.com/2008/08/19/simon-singh-versus-the-chiropractors/

Bloggers Behind Simon Singh – Where The News Is At
http://podblack.com/?p=855


And here’s a message from Simon Singh which has been lifted from his latest (e)newsletter which was sent out to subscribers earlier today - but which, unfortunately, doesn’t seem to have been published on his site yet (http://www.simonsingh.net):

Unhappy Chiropractors

As some of you may have heard, I am being sued for libel by the British Chiropractic Association. I cannot say much at the moment, but I will return to the subject in due course. In the meantime, thanks for the emails of support and the various blogs backing my position. I have not had time to reply – as you can imagine, I am fairly busy at the moment – but the support is much appreciated.

 

[godless dave]

Has the Guardian said anything about why they pulled the article? Or do they routinely pull "Comment is Free" articles after a certain time frame? Their regular news articles seem to be archived back to the beginning of the web (and you can read them for free!).

 

[Blue Wode]

Has the Guardian said anything about why they pulled the article? Or do they routinely pull "Comment is Free" articles after a certain time frame? Their regular news articles seem to be archived back to the beginning of the web (and you can read them for free!).

I wrote to the Guardian at the beginning of July asking why the article had gone missing, but they didn’t reply. As far as I know, they don’t routinely pull CiF articles - indeed, I suspect that this might be the first time that they have done so.

Also, it’s worth remembering that this isn’t the first time that the British Chiropractic Association has managed to silence a mainstream newspaper. At the end of last year it managed to have an article ('Chiropractors are a waste of money') deleted from the Daily Telegraph’s website. See page 7 here:
http://www.gcc-uk.org/files/page_file/WEBSITE_GCCNews23.pdf

In addition to that, the UK regulatory body, the General Chiropractic Council (GCC), has a habit of firing off emotive letters to newspaper editors whenever any criticism of chiropractic appears in the press. See here:
http://www.skeptics.org.uk/forum/showpost.php?p=40405&postcount=3

Suffice to say that the GCC’s behavior seems to be not too far removed from that of the British and New Zealand chiropractic associations - something which blogger Dougal Stanton so aptly describes here:

It should be pretty obvious now that these two associations have little interest in medical science or patient wellbeing. If they did then stifling criticism would not be their first reaction.

http://www.dougalstanton.net/blog/i...g-nice-to-say-say-it-on-lawyers-headed-paper/

For those interested, there’s another new blog post here,
http://yunshui.wordpress.com/2008/08/18/anyone-else-see-the-problem-with-the-headline/

although Holfordwatch probably has the best round up from the blogosphere:
http://holfordwatch.info/2008/08/16/british-chiropractors-join-the-legal-intimidation-party/

 

[Mojo]

One thing in English litigation is very different from US litigation. Over here, the loser has to pay both sides' legal costs. If this case goes to court then there will be a highly expensive legal bill for either Dr Singh or the BCA.

And presumably if it does go to court the costs are likely to be pretty high in view of the sort of involvement of experts and detailed examination of the scientific literature that is inevitably going to be involved. I would have thought the BCA would have to be pretty confident that they can prove their case to let it go that far.

Then again, CAMsters are (by definition) pretty bad at assessing the quality of evidence.

 

[Jack of Kent]

And presumably if it does go to court the costs are likely to be pretty high in view of the sort of involvement of experts and detailed examination of the scientific literature that is inevitably going to be involved. I would have thought the BCA would have to be pretty confident that they can prove their case to let it go that far.

Then again, CAMsters are (by definition) pretty bad at assessing the quality of evidence.

Given (a) the sheer cost of any English libel trial (and possible subsequent appeal), especially one which seems to inherently require extensive expert evidence, and (b) the outcome of any trial is unpredictable but the loser will pay the legal costs of both sides, then I think one of the following may apply:

1. the BCA have resourced themselves for a potential incredible financial hit over the next year or two, and are thereby confident that they can continue to provide their "services" to their members as if such a financial hit never occurs;

2. the BCA have decided that Simon Singh is bound to give in before trial and so such a financial hit will not really take place; or

3. the BCA have blundered into something which - quick quickly and in all seriousness - could turn into a total reputational and financial disaster for them and thereby their members.

If (2), they should bear in mind that such a complacent "tactic" was adopted by Equitable Life in its recent bullying litigation; and that tactic failed disasterously.

The BCA members should really hope it is (1) - or a soundly-based (2).

I would hope it would be (3), if it was not for Simon Singh having also to take the pressure as a defendant.

If it is (3), or a misconceived (2), the BCA should now start bricking themselves.

It is just so unfortunate that the BCA have chosen to deal with criticism in this way.

 

[gimpy]

Jack of Kent,

One thing has been puzzling me over this, although my puzzlement may be the result of ignorance, would a lawyer advise a client to instigate a libel case such as this where (to my untrained eye) the possibility of a win seems remote and the costs high?

 

[Jack of Kent]

Jack of Kent,

One thing has been puzzling me over this, although my puzzlement may be the result of ignorance, would a lawyer advise a client to instigate a libel case such as this where (to my untrained eye) the possibility of a win seems remote and the costs high?

Good question. My initial lawyer-ish answer: it depends!

However:-

1. It is never the decision of a lawyer to bring an action, it is the client's decision alone - and it is not unusual for a client to press on despite legal reservations.

2. The claim has still not been published, and it is difficult (and unwise) to rely on a newspaper report. It may well be that the claim is stronger than is realised.

3. That said, it would be a "brave" litigant who launched any libel action in the English courts, even with gushing legal advice.

I will blog in a day or two on what one would have expected the BCA to have thought through before launching this unfortunate action. If I were a BCA member I would want to feel that a sound and realistic decision had been made. So, to be helpful, I may suggest some questions they should be asking. After all, the BCA spokesperson did say a lot of thought went in to the decision to bring the claim.

 

[Jack of Kent]

Further to the final paragraph of my last post, see:

http://jackofkent.blogspot.com/2008/08/coming-up-ten-questions-bca-members.html

 

[shadron]

Well, I'd hate to compare the BCA (of which I know nil) to the Dover District Schools Board. but they had a case that they thought was foolproof, even though their own attorney told them not to do it. The Discovery Institute and the Thomas More Law Center though hey had a winner, until the first round of depositions and the DI got cold feet. The lawyers in the Law Center stuck it out to the disastrous end. So, yeah, 3 is a possibility, because the BCA believes they have a 1 and their lawyers are probably thinking 2.

 

[Worm]

Let's face it, in the end, the lawyers get paid whatever the outcome.

 

[Blue Wode]

Two more blogs today (the first isn’t for the faint-hearted)….

Bone-cracking Quacks
http://thehystericalshriekinggriefoftwats.blogspot.com/2008/08/bone-cracking-quacks.html

Simon Singh sued by the British Chiropractic Association
http://homoeconomicusnet.wordpress.com/

And for anyone who’s wondering what the current evidence says about chiropractic spinal manipulation, here you are:

Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion. Four Cochrane reviews of spinal manipulation are available today.

Back pain is by far the condition most frequently treated by chiropractors. The Cochrane review of spinal manipulation for back pain summarised 39 clinical trials [2004].1 The authors’ conclusions were very clear: ‘There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.’

A Cochrane review of spinal manipulation and mobilisation for mechanical neck disorders evaluated 33 clinical trials [2002].2 The authors found that, combined with exercise, these approaches were promising, but ‘the evidence did not favour manipulation and/or mobilisation done alone or in combination with various other physical medicine agents; when compared to one another, neither was superior.’2

Another Cochrane review summarised the available trials of chiropractic treatment for asthma [2005].3 The authors found only two such studies and ‘neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured.’ Finally, a Cochrane review assessed five trials of spinal manipulation for dysmenorrhoea [2001].4 The authors concluded that ‘there is no evidence to suggest that spinal manipulation is effective in the treatment’ of this condition.

The value of chiropractic
http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

A systematic review of systematic reviews of spinal manipulation (2006)

Conclusions: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

http://jrsm.rsmjournals.com/cgi/content/full/99/4/192

Adverse effects of spinal manipulation: a systematic review (2007)

Conclusions: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review (2007)

Conclusions: Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.

http://pediatrics.aappublications.org/cgi/content/full/peds.2006-1392v1

NB. The reviewers commented that despite the fact that spinal manipulation is widely used on children, paediatric safety data are virtually nonexistent.

Cost-Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review (2006)

Conclusions: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17173105

BTW, today’s Guardian has published a small chiropractic promo piece:

There's a lot more to chiropractic than crunching and clicking bones and joints, according to Tim Hutchful from the British Chiropractic Assocation.

More…
http://www.guardian.co.uk/lifeandstyle/2008/aug/21/healthandwellbeing

Yes, indeed. How about Mr Hutchful tells the public about all the quackery that helps chiropractors to stay in business:
http://www.skeptics.org.uk/forum/showpost.php?p=41640&postcount=12

 

[rjh01]

Given (a) the sheer cost of any English libel trial (and possible subsequent appeal), especially one which seems to inherently require extensive expert evidence, and (b) the outcome of any trial is unpredictable but the loser will pay the legal costs of both sides, then I think one of the following may apply:

1. the BCA have resourced themselves for a potential incredible financial hit over the next year or two, and are thereby confident that they can continue to provide their "services" to their members as if such a financial hit never occurs;

2. the BCA have decided that Simon Singh is bound to give in before trial and so such a financial hit will not really take place; or

3. the BCA have blundered into something which - quick quickly and in all seriousness - could turn into a total reputational and financial disaster for them and thereby their members.
<snip>

4. The BCA knows it is finished if it allows such criticism to be made. It must either fight and win or cease to exist and knows it. The vultures are welcome to the spoils. They will never pay costs as they do not have the money.


Edit. I have given this thread its tags.

 

[Blue Wode]

Another 24 hours, and another round of blogging. Today we have…

More idiocy from chiropractors
http://norburynewlywed.blogspot.com/2008/08/more-idiocy-from-chiropractors.html

Chiropractors versus Simon Singh
http://geoglyphs-ramblings.blogspot.com/2008/08/chiropractors-versus-simon-singh.html

Back crack quack attack - it’s a legal matter, baby
(A look at the potential legalities of the case)
http://draust.wordpress.com/2008/08/21/back-crack-quack-attack-its-a-legal-matter-baby/

An ex-chiropractor speaks out
http://dcscience.net/?p=248

The plausibility of CAM on the NHS
(Comments related to the BCA’s recent action from a skeptical osteopath)
http://jonathanhearsey.com/?p=61


Further reading:

http://www.cam-research-group.co.uk...linical Chiropractic 2007 10 3 pg 147-155.pdf

[Aranka Pollentier and Jennifer M. Langworthy, The scope of chiropractic practice: A survey of chiropractors in the UK. Clinical Chiropractic, Volume 10, Issue 3, September 2007, Pages 147-155.]

 

[Jack of Kent]

Another tip of the hat to Blue Wode for these great inventories!

I strongly recommend the blog at http://draust.wordpress.com/2008/08/21/back-crack-quack-attack-its-a-legal-matter-baby/

This is an excellent piece by a non-lawyer, and one which carries the legal analysis forward significantly. It should be read very carefully,

 

[Jack of Kent]

I will blog in a day or two on what one would have expected the BCA to have thought through before launching this unfortunate action. If I were a BCA member I would want to feel that a sound and realistic decision had been made. So, to be helpful, I may suggest some questions they should be asking. After all, the BCA spokesperson did say a lot of thought went in to the decision to bring the claim.

Now posted: see http://jackofkent.blogspot.com/2008/08/ten-questions-british-chiropractic.html

 

[Blue Wode]

Thanks for that, Jack. Very informative.

All is quiet in the blogosphere this morning, so for those interested, here’s a closer look at how chiropractic is being taught and promoted in the UK.

Bearing in mind that the Ministry of Truth suspects that UK chiropractors are desperately trying to secure referrals from the NHS under contracts…
http://www.ministryoftruth.me.uk/2008/08/19/can-you-libel-woo/

…and that Jonathan Hearsey, the skeptical osteopath, wonders if such a quest might give rise to a potential conflict of interests (whilst pointing out that there’s room for pragmatic spinal manipulators as part of multidisciplinary teams or integrated clinical assessment and treatment services on the NHS)…
http://jonathanhearsey.com/?p=61

…it’s interesting to read the following on the Anglo-European College of Chiropractic’s website…

Each student [chiropractic intern] is obliged to have seen a minimum of forty new patients during the clinical year. While a number of patients will be assigned to a student during this time on a rota basis, he/she is obliged to have at least five of this number personally referred by another source.

-snip-

Rounds are another vehicle that enhances the clinical education. Students attend rounds on a rota basis with a consultant physician at Royal Bournemouth Hospital. Each week two students accompany him and his team on ward rounds in a general medical ward. While the rounds may not be completely apropos to chiropractic, students see a wide range of medical conditions, many of them in a terminal condition. The rounds also provide a first hand opportunity to observe varying signs and symptoms of pathology that would normally be seen at an earlier stage in chiropractic practice.

-snip-

Standardised or trained simulated patients are used by the Clinic to provide realistic scenarios for the assessment of a student's skills in case history taking, physical examination procedures and patient management issues.

http://www.aecc.ac.uk/college/course_information/clinical_training.asp

…because it begs the question, is that really enough practical training to prepare chiropractors for their official role as independent primary care providers?


With regard to the promotion of chiropractic, we already know that the Chairman of the General Chiropractic Council (GCC), Peter Dixon, is currently lending his ‘expertise’ to NICE’s Low Back Pain Guideline Development Group (GDG). See the GDG members’ document here:
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11645

However, it seems unlikely that the data he’ll be presenting in support of chiropractic will be from the most recent systematic reviews which have collectively concluded that there is an extremely slim scientific evidence base for chiropractic spinal manipulation, and that its few benefits don’t seem to outweigh its risks…
http://www.internationalskeptics.com/forums/showpost.php?p=3964350&postcount=55

…because it’s apparent that the GCC prefers to ignore such reviews in favour of weaker, but more chiropractic-friendly data, which it claims show that the main treatments of chiropractic are “consistently more effective” than the treatments to which they have been compared, and that chiropractic intervention is “safe, effective and cost-effective” in reducing referral to secondary care. See here:
http://www.gcc-uk.org/files/page_file/LANCET Australian study statement9Nov07.pdf

The data in question is cited in the GCC’s January 2007 publication ‘Advice for General Practitioners, Primary Care Trusts and Local Health Boards’ and it is linked to, and critiqued, here:
http://www.skeptics.org.uk/forum/showpost.php?p=26449&postcount=203

I would also add the following to the critiques of the Meade study contained in the link above:

People familiar with clinical tests of spinal manipulative therapy (SMT) for back pain were puzzled by the outcome of the British study by Meade, et al, (Brit Med J, 300:1431-37, 1990) which found chiropractic care to be more effective in the long term than hospital management (for chronic back pain sufferers only). Studies designed to test SMT against other modalities have consistently found that although SMT may produce more rapid relief there are no differences over the long term (for a review see Clinical Orthopaedics & Related Research, 179:62-70, 1983). The Meade study did not test SMT against other modalities but merely compared hospital with chiropractic care in which a flock of modalities were employed. It did not even equalize the number of treatment sessions nor length of time under care. The most likely answer to this anomalous finding lies in patient satisfaction.

More…
http://www.ncahf.net/nl/1991/1-2.html

So, in essence, it doesn’t seem to be the interests of the public that the chiropractic profession is serving in the UK. Indeed, if chiropractors do end up gaining good access to the NHS’s patient bank, it could be bonanza time for them, not least because…

…the vast majority [95%] of UK chiropractors are interested in providing their services through the NHS, but only on a part-time basis and in a way that most closely resembles private practice.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11898015

Finally, it’s worth remembering that just because some chiropractors may appear to have dropped chiropractic’s subluxation-based nonsense, it doesn’t necessarily mean that they practice evidence-based manual therapy. They could still, quite easily, be duping patients into unnecessary or inappropriate treatment. For example, here’s what one well-known chiropractic marketing outfit offers its clients:

Chiropractic Simplified—Chiropractic described in 100 words without using the terms adjustment or subluxation. Use it in your patient conversations and see more people "get" chiropractic.

http://www.patientmedia.com/previewproducts/audio/seminar.htm

Scandalous.