British Chiropractic Association v Simon Singh

Asolepius said:
Edzard Ernst includes some relevant comments in his latest BMJ Rapid Response.
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UK homeopaths are currently engaging in an elaborate campaign of multiple letter writing, repeatedly invoking the Freedom of Information Act to harass and silence me. The present letter shows that they have failed.
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I was unaware that Ernst was being harassed. It shows the moral bankruptcy of some homeopaths. The link you provided is titled "Treating evidence with contempt", of course if you have no evidence on your side you are reduced to these underhand tactics.
 
Acleron said:
I was unaware that Ernst was being harassed. It shows the moral bankruptcy of some homeopaths. The link you provided is titled "Treating evidence with contempt", of course if you have no evidence on your side you are reduced to these underhand tactics.
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Yes, it’s really quite appalling what Edzard Ernst is having to endure from some of the CAM brigade. Indeed, in his editorial in last month’s issue of Focus on Alternative and Complementary Therapies (FACT) he gave readers a glimpse of the “bombardment of insults” that he’s received from CAM evangelists in the wake of Trick or Treatment? going on sale in the UK back in April:
A few weeks ago, ‘Trick or Treatment? Alternative Medicine on Trial’, a book I co-wrote with Simon Singh, was published.

-snip-

It goes without saying that some treatments do not come out smelling of roses, but the book is clearly not a book opposing CAM, but is a book emphatically in favour of reliable evidence.

The launch of the book was marked by a range of promotional activities that were (mostly) enjoyable. Nothing had prepared me, however, for the bombardment of insults I received from CAM evangelists. To give you a flavour, here are some quotes (in no particular order or preference):

  • Edzard Ernst is a Fake (title of a website)
  • …your pathetic battle against complementary medicine… (e-mail)
  • Prof Ernst must know how bad, how unscientific, is much of the literature on which he relies. After all he wrote some of it (press release from Alliance for Natural Health)
  • …you… make a profit from joining the quack buster movement… (e-mail)
  • …you show arrogance and a lack of respect of humanity in general (e-mail)
  • …unfairly biased in favour of the pharmaceutical industry (e-mail)
  • Prof Ernst’s activities have been brought before the General Medical Council on countless occasions… (e-mail to my publisher)
  • …prejudiced twaddle… (e-mail)
  • I really do wish that I could find evidence of just how much the pharmaceutical industry is paying you… (e-mail)
  • You and your cronies are completely misleading the public with your pseudoscience… (e-mail)
  • …promotion… at the expense of many vulnerable people… (e-mail)
  • You’re just another lackey of the pharmaceutical industry, with no more real regard for the truth than they have (website).

More…
http://www.medicinescomplete.com/journals/fact/current/fact1303a02t01.htm
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On another matter, it’s worth updating this thread with NICE’s draft guidelines for low back pain and its recommendation of referral for spinal manipulation as a first line treatment:
http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4120823&c=2

A consultation on the draft guidelines is open until the 26th November 2008. Full details can be found here…
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=42249

…and David Colquhoun has been quick of the mark to send in his comments:
The inclusion of chiropractic spinal manipulation in the recommendations seems to be to be without foundation. The evidence is surely now rather strong that chiropractic is no more effective than other sorts of manipulation, but it has three disadvantages that should preclude its recommendation

(1) The (admittedly small) risk of stroke (which has resulted in legal action in several countries)

(2) The excessive use of X-rays to search for purely imaginary “subluxations”.

(3) The fact that it is based on mystical, indeed quasi-religious, “principles”. If it is recommended that carries the consequence that its practitioners are required to be ‘educated’ in anti-scientific nonsense.

Since it has no demonstrated advantage over other approaches, these three reasons are surely sufficient for it to be not recommended. In my view NICE should go further and recommend AGAINST use of chiropractic.

http://dcscience.net/?p=258#comment-3663
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For the benefit of drive-by readers, here’s why his point (3) is particularly pertinent:
Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.

-snip-

Traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents and 63% considered subluxation to be central to chiropractic intervention.


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, pp147-155.
http://www.cam-research-group.co.uk...linical Chiropractic 2007 10 3 pg 147-155.pdf
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For more discussion on the draft guidelines, including the questionable involvement of the Chairman of the General Chiropractic Council, Peter Dixon, see here:
http://www.internationalskeptics.com/forums/showthread.php?t=125791
 
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Physiotherapist said:
Myofascial Release is nothing like Chiropractic whatsoever. It is a technique that is very similar in nature to Soft Tissue Release.
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Umm, one set of people 'manipulate' soft tissue and claim it cures EVERYTHING, one set of people 'manipulate' bones and claim it cures EVERYTHING.

How dissimilar in principle could it be?

Yeah, different in practice. Scatter chicken blood instead of wave chicken feathers here, chant "Oomboogey" instead of "Ungahbunga" there, but it's all the same crap.

Right down to suing any vocal detractors of the quackery.
 
pingnak said:
Umm, one set of people 'manipulate' soft tissue and claim it cures EVERYTHING, one set of people 'manipulate' bones and claim it cures EVERYTHING.

How dissimilar in principle could it be?

Yeah, different in practice. Scatter chicken blood instead of wave chicken feathers here, chant "Oomboogey" instead of "Ungahbunga" there, but it's all the same crap.

Right down to suing any vocal detractors of the quackery.
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Wow. Now just hang on a minute. Firstly, you seem to have made a sweeping generalisation here about MFR and secondly, this thread is about Chiropractic and was never about MFR, so how about you stick on the topic in hand, rather than trying to derail it.

People who use MFR do not claim that it is cure all. If you understand anything about it, then you should understand that it is one of a range of techniques that can be used to achieve muscular balance, along with such things as Soft Tissue Release/Active Release Technique and others.

I read your other post where you stated that someone said that Myofasical Release of the feet can cure blindness? You actually need to understand that Myofascial Release is NOT the same as reflexology. That is not what is happening and I don't think that I have heard anyone say that MFR can cure blindness.

Unfortunately, you cannot tar all with the same brush and I will say again as I said before, Myofascial Release is not the same as Chiropractic. There is no philosophy behind it in the same way as there is Chiropractic - nothing about subluxations. As I said, it is one of a few treatments that can help restore muscular balance in the body, by helping to release short tight muscles and strengthen weak ones.

Now perhaps you could resort to posting about Chiropractic, which this thread was originally about, rather than trying to high jack it by posting something that is totally irrelevant.
 
Sorry, one quack looks quite the same as the next to me. Be it bones, muscles, 'subluxations', 'piezoelectric signals' or 'chi', it's the same nonsense with different pseudoscience labels.

OK, I'm out of this topic. This is old news. Quacks suing people who point out that they're, well, QUACKS is a fine tradition going back for decades. If it's not medical-sounding quacks, it's psychic-healing morons. No difference at all.
 
pingnak said:
Sorry, one quack looks quite the same as the next to me. Be it bones, muscles, 'subluxations', 'piezoelectric signals' or 'chi', it's the same nonsense with different pseudoscience labels.

OK, I'm out of this topic. This is old news. Quacks suing people who point out that they're, well, QUACKS is a fine tradition going back for decades. If it's not medical-sounding quacks, it's psychic-healing morons. No difference at all.
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Well, not it's not all the same, which is why I said in the first place that you can't tar everyone and everything with the same brush. As I also explained, there are no pseudoscientific labels attached to it and it is one of a range of techniques that can be used to achieve muscular balance in the body, so not the same as chiropractic at all.

What you need to understand is that posture and lifestyle generally can leave you with short tight muscles in some parts of your body and MFR is a technique like Soft Tissue Release that can help to lengthen these short tight muscles. STR is where the practitioner locks into the painful part of the muscle and lengthens it by asking a client to make the movement. MFR works on the same principle, except it is working with the myofascia rather than just the muscles and the practitioner moves with the tissue as well as the client.

Anyway, I am extremely pleased that you won't be posting any more, as you have not contributed anything of use to this topic, except a very biased opinion that comes from a base of absolutely no knowledge of the subject matter whatsoever. It is also totally irrelevant to the topic in hand, which is Chiropractic.
 
I searched on sciencedirect.com for "myofascial release" and found lots of hits to the Journal of Bodywork and Movement Therapies (mainly due to their listing of abstracts from the First International Fascia Research Congress) including Myofascial release; an evidence based treatment concept? which concludes:

The prerequisites for myofascial pain are present. However, there are no published reliability studies documenting that the diagnostic method is reproducible and valid.

We strongly recommend performance of reliability studies on diagnostic tests used for myofascial dysfunction, in order to perform efficacy studies based on a more solid diagnostic foundation.
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I also note that Journal of Bodywork and Movement Therapies recently published Perspective: Assume a spherical cow: The role of free or mobile electrons in bodywork, energetic and movement therapies.
 
I have been guilty of going off topic as much as anyone. However, in this case I think it is especially important to keep this thread free for news from the UK that the rest of us won't see in a timely fashion.
 
Another consultation document

Just to get this thread back on topic whilst we await developments in the BCA v. Simon Singh case, another chiropractic-related consultation document has just been published. This time it’s from the General Chiropractic Council (GCC) which is inviting comments on the review of the profession’s Code of Practice and Standard of Proficiency (COPSOP):
The General Chiropractic Council (GCC) welcomes any comments you wish to make that will help us improve the content and clarity of this Code and Standard, whether you are a chiropractor, a chiropractic patient or a member of the wider public.

The closing date for this consultation is Friday 28 November 2008. You may email your comments to lindsay.m@btclick.com or post them to the GCC at
44 Wicklow Street
LONDON
WC1X 9HL

Full document here:
http://www.gcc-uk.org/files/page_file/Consultation_document_on_website.doc
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For those wishing to make a contribution, this thread is full of ideas for ways in which the current COPSOP could be improved.

For drive-by readers, here’s a reminder of the other consultation document - NICE’s draft guidelines for low back pain and its recommendation for referral for spinal manipulation as a first line treatment. The consultation on the draft guidelines is open until the 26th November 2008. Full details can be found here…
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=42249

…and, once again, here is what David Colquhoun has sent in:
The inclusion of chiropractic spinal manipulation in the recommendations seems to be to be without foundation. The evidence is surely now rather strong that chiropractic is no more effective than other sorts of manipulation, but it has three disadvantages that should preclude its recommendation

(1) The (admittedly small) risk of stroke (which has resulted in legal action in several countries)

(2) The excessive use of X-rays to search for purely imaginary “subluxations”.

(3) The fact that it is based on mystical, indeed quasi-religious, “principles”. If it is recommended that carries the consequence that its practitioners are required to be ‘educated’ in anti-scientific nonsense.

Since it has no demonstrated advantage over other approaches, these three reasons are surely sufficient for it to be not recommended. In my view NICE should go further and recommend AGAINST use of chiropractic.

http://dcscience.net/?p=258#comment-3663
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And here’s why his point (3) is particularly pertinent:
Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.

-snip-

Traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents and 63% considered subluxation to be central to chiropractic intervention.


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, pp147-155.

http://www.cam-research-group.co.uk...linical Chiropractic 2007 10 3 pg 147-155.pdf
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BTW, Peter Dixon, Chairman of the GCC, continues to assert that neck manipulation does not cause stroke. Last week he wrote to Dr Miriam Stoppard at the Daily Mirror highlighting the following in bold…
There is no evidence that examination or manipulation of the neck causes stroke.

http://www.gcc-uk.org/files/page_file/Letter_Miriam_Stoppard6Oct08.pdf
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It should be noted that Peter Dixon serves on NICE’s Guideline Development Group (GDG). To learn more about him, scroll down the following link until you come to ‘Edzard Ernst again challenges chiropractors in UK’:
http://www.healthwatcher.net/chirowatch.com/cw-cervical.html

Further reading:
http://www.ministryoftruth.me.uk/2008/08/19/can-you-libel-woo/
 
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The case is still ongoing.

In a few days, I will be posting on my blog (and copied here) about what I understand are the recent developments in this case.
 
Jack of Kent said:
I set out in some detail Simon Singh's defence to the BCA case on my Blog, see:

http://jackofkent.blogspot.com/2008/11/on-putting-chiropractic-on-trial.html


In view of its length, I will not copy it here (unless requested).

However, I can answer any questions on it...

Best wishes, Jack
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Excellent post. Hopefully it answers one worry about the phrase 'even though there is not a jot of evidence'. It would have been difficult if not impossible for Singh to prove that while the BCA does not have to produce proof that it is untrue. It now seems that Singh's team have greater latitude in arguing the merits of chiropractic. Good news indeed.
 
Jack,

I notice that in a couple places you have typed "in effective: " when you mean "ineffective". The meaning is obvious but I find it jarring to the eye when read.

On a more serious note about a decade ago some major chiropractors in North America published a study that slammed the practices of the majority of chiropractors and chiropractic schools. The study was reported on by at least some of the press including the National Post here in Canada. I seem to remember finding a copy of the study on the internet and still have at least a bookmark to the National Post article. The link now does not work and I cannot find even a reference to the study via Google. I might be very worthwhile to track it down and it supports Mr Singh's case. This was chiropractors saying that it does not work.
 
Gord_in_Toronto said:
Jack,

I notice that in a couple places you have typed "in effective: " when you mean "ineffective". The meaning is obvious but I find it jarring to the eye when read.

On a more serious note about a decade ago some major chiropractors in North America published a study that slammed the practices of the majority of chiropractors and chiropractic schools. The study was reported on by at least some of the press including the National Post here in Canada. I seem to remember finding a copy of the study on the internet and still have at least a bookmark to the National Post article. The link now does not work and I cannot find even a reference to the study via Google. I might be very worthwhile to track it down and it supports Mr Singh's case. This was chiropractors saying that it does not work.
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Typo fixed, thanks. (More of a annoying glitch in the field I typed into, but now rectified!) Have also corrected a couple of other actual typos.

Thanks also for the tip. It would be interesting item to dig up!
 
Acleron said:
Excellent post. Hopefully it answers one worry about the phrase 'even though there is not a jot of evidence'. It would have been difficult if not impossible for Singh to prove that while the BCA does not have to produce proof that it is untrue. It now seems that Singh's team have greater latitude in arguing the merits of chiropractic. Good news indeed.
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Many thanks indeed. It is clear a lot of hard work went into the Defence.

It is also clear from the article as a whole that Simon Singh means evidence sufficient to the task it was being put (ie, scientific/clinical purposes), when he says that there is "not a jot" of evidence. The BCA's case is misconceived; I suspect they litigated without thinking it all through first.

It is commendable that Simon Singh is not backing down in the face of such legalistic intimidation.
 
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Yes, of course this puts chiropractic on trial. But even more importantly, if it goes to court, it will set the precedent of what constitutes evidence for effectiveness of health care inteventions of any kind. Who knows, we may find this case cited wherever scientific evidence is disputed. I must say the `evidence' cited by BCA is staggeringly pathetic, and certainly qualifies to my mind for the definition of `not a jot'. Now I suppose we sit and wait for months while the BCA decides what to do. Jack - how long have they got?
 
Jack of Kent said:
The BCA's case is misconceived; I suspect they litigated without thinking it all through first.
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Yes, you have to wonder what their definition of “a lot of thought” is:
"It wasn't a decision taken lightly," says Dr Antoni Jakubowski, a member of the association's governing council. "I know that a lot of thought went into this."

http://www.telegraph.co.uk/news/newstopics/mandrake/2570744/Doctors-take-Simon-Singh-to-court.html
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Gord in Toronto, this might be the study you're looking for:
The Unsubstantiated Web Site Claims of Chiropractic Colleges in Canada and the United States
David M. Sikorski, D.C., Southern California University of Health Sciences, and Jaroslaw P. Grod, D.C., F.C.C.S.(C), Canadian Memorial Chiropractic College

Objective: To determine the prevalence of claims by chiropractic colleges for the clinical art which are not currently justified by available scientific evidence, or which are intrinsically untestable.

Design: A survey of chiropractic college Web sites in Canada and the United States.

Method: Chiropractic college Web sites were examined for presence or absence of unsubstantiated claims related to the theory and practice of chiropractic.

Results: Of the 16 chiropractic college Web sites examined, eight made at least one claim for chiropractic theory and practice which is not known to have been scientifically validated, or is not experimentally testable. These eight Web sites represent 10 (55%) of the 18 English-speaking chiropractic colleges in Canada and the United States.

Conclusion: More than half of the chiropractic colleges in Canada and the United States make unsubstantiated claims for clinical theories or methods on their Web sites. This behavior likely reflects what is taught in the schools. Chiropractors’ quest for greater legitimacy and cultural authority is retarded by this tendency. (The Journal of Chiropractic Education 17(2): 113–119, 2003)

Key words: chiropractic, education, marketing, quackery

Full text:
http://www.journalchiroed.com/2003/JCEFall2003Sikorski.pdf
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BTW, here’s a close look at how some UK chiropractors are educated...
http://www.quackometer.net/blog/2008/08/role-of-uk-universities-in-chiropractic.html

…and how many of them appear to be violating their ethical code:
http://dcscience.net/nzmj-ernst-reply-050908.pdf
 
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