British Chiropractic Association v Simon Singh

[tolman]

I think it was suggested that the BCA's income comes from membership subscriptions and damage to its reputation could reduce its ability to recruit members, and thus potentially cause financial damage.

But surely, that could only easily happen in a direct way if chiropractors agreed with what Singh wrote, or at least suspected he was right.

Indirectly, it is possible that members might be annoyed with their promotional body failing to defend itself by means of legal action, and so leave.
However, even if the BCA wins the case, I'd imagine that quite a few members might think it would have been rather better if it *hadn't* gone down the legal route, and had instead done nothing, or taken the cheap and simple option of writing a rebuttal to be published.

[dizzyblonde2]

But surely, that could only easily happen in a direct way if chiropractors agreed with what Singh wrote, or at least suspected he was right.

Indirectly, it is possible that members might be annoyed with their promotional body failing to defend itself by means of legal action, and so leave.
However, even if the BCA wins the case, I'd imagine that quite a few members might think it would have been rather better if it *hadn't* gone down the legal route, and had instead done nothing, or taken the cheap and simple option of writing a rebuttal to be published.

Think of the BCA as a trade union. Members can choose to join or leave at any time. There are other associations they could join or choose to save the £600-£700 per year BCA members pay in subscriptions. This on top of the £1000 registration fee per annum to the GCC plus insurance premiums of around £500.

GCC renewals are done annually en bloc for the calendar year and one cannot be a member of the BCA if one is not registered with the GCC (otherwise one is not a chiroractor).

If even 10% of BCA members decide to hang up their queen's purcussors and stethoscopes, their income will fall substancially. Remember, the 611 complaints received at the GCC caused a financial headache until some bright spark came up with the idea of changing the rules and forcing those under investigation to continue paying their £1000 registration fee. Interestingly this rule change has been enacted through the privy council just in time for the end of year renewals process. There maybe 500+ BCA members who are thinking very carefully about the costs, financial and otherwise of being a chiropractor in the aftermath of the decision by their directors to sue the pants off Simon Singh.

NO BCA member is under any obligation to stay with the BCA. Indeed, there may be some who consider the Laningan Gambit of resigning from the GCC register and the BCA in a grand gesture and forgoing the use of the title Chiropractor. A saving of £1700 might look very appealing in the current financial climate and just having Trading Standards, the ASA and the occaisional watchdog journo to deal with could possibly be less stressful and time consuming.

[tolman]

There maybe 500+ BCA members who are thinking very carefully about the costs, financial and otherwise of being a chiropractor in the aftermath of the decision by their directors to sue the pants off Simon Singh.

But the BCA can't blame Singh for costs resulting from their ill-judged reaction to his article - the only costs they can morally claim he's responsible for are the costs they might reasonably have incurred if they hadn't taken legal action, but done something brighter (or nothing) instead.

If a neighbour's cat was scratching away at someone's flower bed, and the victim decided to use artillery in an attempt to scare or kill the cat, they could hardly blame their neighbour for the resulting craters.

[Blue Wode]

Interesting that Jack says that the following can be written perfectly safely about the General Chiropractic Council:

...I can type the following about a particular statutory corporation without any fear whatsoever:-

The General Chiropractic Council happily promotes (and regulates) bogus treatments for which there is not a jot of evidence.

http://jackofkent.blogspot.com/2009/...t-is-bcas.html

BTW, Jack has another new - and equally interesting - blog post up today in which he has published a copy of his FOI request to the General Chiropractic Council:

I would like to make a freedom of information request to the GCC.

Please disclose to me all information which is held by the GCC in respect of the Happy Families leaflet issued and then withdrawn by the British Chiropractic Association. This information can include internal documents, correspondence with the BCA, and all metadata and other electronic information. The period for this information should date back to the GCC's first awareness of the leaflet.

In case you wrongly construe my request narrowly, I would like to remind you of your duty to assist under freedom of information legislation.

I would wish to make representations on the public interest in disclosure, in the event that any qualified exemption applies requiring a public interest balancing exercise. It is denied that there could be any public interest in non-disclosure should any qualified exemption apply, which is also denied.

-snip-

My reason in making this request is that it is appropriate - and indeed imperative - that the GCC now places into the public domain all information which it holds relating to this controversial leaflet, especially information about the BCA's promotion and withdraw of the leaflet.

http://jackofkent.blogspot.com/2009/09/my-foi-request-to-gcc.html

[Blue Wode]

The following letter from Professor Edzard Ernst, which has great relevancy to this topic, is lifted from last month’s International Journal of Clinical Practice:

Re: Chiropractic for otitis?

Sir,

Many professional organisations of chiropractic such as the British Chiropractic Association (1), the Chiropractic Association of Ireland (2) or the American Chiropractic Association (3) state or imply that chiropractic is an effective treatment for ear infections. A recent survey furthermore demonstrates that 54% of UK chiropractors subscribe to this idea (4). So is there any evidence that it is true?

In an attempt to find all clinical trials on the subject, I conducted electronic literature searches in the following databases: Medline, Embase, Cinhal and AMED (September 2008). No language or time restrictions were imposed. To get included, an article needed to refer to a controlled clinical trial of chiropractic for ear infection (otitis). Case reports, case series and uncontrolled or feasibility studies were excluded.

These searches generated 35 hits. After removing duplicates, 27 articles were read. None of them met the inclusion criteria. Previous research has shown that professional chiropractic organisations ‘make claims for the clinical art of chiropractic that are not currently available scientific evidence…’ (5). The claim to effectively treat otitis seems to be one of them. It is time now, I think, that chiropractors either produce the evidence or abandon the claim.

E. Ernst
Complementary Medicine,
Peninsula Medical School,
25 Victoria Park Road,
Exeter EX2 4NT
UK

References

1. British Chiropractic association, 2009. http://www.chiropractic-uk.co.uk (accessed January 2009).
2. Chiropractic Association of Ireland, 2008. http://www.chiropractic.ie (accessed January 2009).
3. American Chiropractic Association, 2009, http://www.amerchiro.org (accessed January 2009).
4. Pollentier A, Langworthy JM. The scope of chiropractic practice: a survey of chiropractors in the UK. Clin Chiropractic 2007; 10: 147-55.
5. Grod JP, Sikorski D, Keating JC. Unsubstantiated claims in patient brochures from the largest State, Provincial, and National Chiropractic Associations and Research Agencies. J Man Phys Ther 2001; 24: 514-9.

Chiropractic for otitis? Int J Clin Pract, September 2009;63(9):1392-1393

Also relevant to this topic is the following blog post about a chiropractor who has lodged a complaint against the Australian Skeptics Group:
http://www.skeptics.com.au/latest/announcements/chiropractor-lodges-complaint-against-australian-skeptics/

The Australian Skeptics’ excellent reply can be read here:
http://www.skeptics.com.au/latest/announcements/chiropractor-lodges-complaint-against-australian-skeptics/

[Blue Wode]

Some more updates.

The full text of Edzard Ernst's recent paper 'Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials' is now available online:

In conclusion, the current evidence from RCTs does not show that chiropractic spinal manipulation is an effective treatment for infant colic. Further rigorous studies may be warranted.

http://www3.interscience.wiley.com/c...TRY=1&SRETRY=0

And two interesting new blog posts have just been produced concerning the General Chiropractic Council and the Adversting Standards Authority:

General Chiropractic Council to change patient leaflet
http://adventuresinnonsense.blogspot...change_06.html

I get anonymous chiropractic mail, I do!
http://www.zenosblog.com/2009/10/i-g...tic-mail-i-do/

It's all becoming very intriguing.

[Trinoc]

I expect Ernst's conclusions are right, but I wonder ... if the study had come up with the opposite conclusion (chiropractic treatments are effective), would he still have published it?

[Matt]

I expect Ernst's conclusions are right, but I wonder ... if the study had come up with the opposite conclusion (chiropractic treatments are effective), would he still have published it?

I don't see why not, he's published when he's found herbal remedies to be effective e.g. topically applied capsaicin for neuropathic and neuralgic pain, P hybridus for seasonal allergic rhinitis, Sinupret and bromelain as adjunctive treatments in acute rhinosinusitis.

A pubmed search "(herbalism) AND (Ernst E[Auth])" found 104 results. These examples were swiftly scanned from the abstracts of just the first page.

[Trinoc]

I don't see why not, he's published when he's found herbal remedies to be effective e.g. topically applied capsaicin for neuropathic and neuralgic pain, P hybridus for seasonal allergic rhinitis, Sinupret and bromelain as adjunctive treatments in acute rhinosinusitis.

A pubmed search "(herbalism) AND (Ernst E[Auth])" found 104 results. These examples were swiftly scanned from the abstracts of just the first page.

Ernst is well known to be a supporter of herbal medicine. The same can not be said of chiropractic.

[Croydon Bob]

Ernst is well known to be a supporter of herbal medicine. The same can not be said of chiropractic.

Ernst's postion on various practices and substances is based on evidence, not on what he "supports". He has found evidence that some herbs do some things, he reported it; he's found no evidence to support chiropractic for anything other than back pain and has reported it.

You seem incapable of grasping a very simple process that is part of basic science and medicine. Instead you are suggesting, as the believers do, that there are two sides and that Ernst is biased against chiropractic in the same way that they are biased against facts.

[Blue Wode]

Ernst is well known to be a supporter of herbal medicine. The same can not be said of chiropractic.

Ernst has conceded that there may be some evidence for spinal manipulation (which is not 'chiropractic') for the relief of pain in a sub-group of low back pain sufferers, but even then it is no better than cheaper, equally effective options. It's worth noting that in addition to some herbal medicines, Ernst is also a supporter of biofeedback for hypertension, hypnosis for labour pain, acupoint stimulation for nausea and vomiting induced by chemotherapy, and acupuncture for osteoarthritis:
http://www.pulsetoday.co.uk/story.as...de=4123323&c=1

Along with most chiropractic interventions, Ernst also does not support many other CAM interventions including Bach Flower Remedies, Chelation Therapy, Colonic Irrigation, Craniosacral Therapy/Cranial Osteopathy, Crystal Therapy, Cupping, Detox, Ear Candling, Magnet Therapy, Reflexology, Reiki, Shiatsu and Spiritual Healing. [Ref: Trick or Treatment? Alternative Medicine on Trial, pp.301-328] You can also safely add homeopathy to that list.

What reasons would he have to be biased?

[Matt]

Ernst is well known to be a supporter of herbal medicine. The same can not be said of chiropractic.

My suggestion is that he follows the evidence rather than the other way round. Didn't he used to be a well known supporter (and indeed practitioner) of other alternative modalities including homeopathy before he found the evidence for efficacy was lacking?

[Trinoc]

OK, let's step back from Edzard Ernst a bit. Let's imagine one of the skeptics here came across compelling evidence that some of the apparently nonsense claims of chiropractic were true. Would they be happy to post on here saying "Look, I was wrong all along ... here is the evidence"? If so, what sort of reaction would they receive from others? I think Croydon Bob's reaction to me in the post above would be mild by comparison.

So, getting back to Ernst ... suppose he did publish something saying chiropractic worked (other than for LBP) ... would skeptics (a) start to take chiropractic seriously, or (b) reject Ernst as a false skeptic?

Given that I suspect the answer is (b), would he not therefore be more inclined to go back and try to find something wrong with his data, rather than "publish and be damned"?

[Blue Wode]

OK, let's step back from Edzard Ernst a bit. Let's imagine one of the skeptics here came across compelling evidence that some of the apparently nonsense claims of chiropractic were true. Would they be happy to post on here saying "Look, I was wrong all along ... here is the evidence"? If so, what sort of reaction would they receive from others? I think Croydon Bob's reaction to me in the post above would be mild by comparison.

So, getting back to Ernst ... suppose he did publish something saying chiropractic worked (other than for LBP) ... would skeptics (a) start to take chiropractic seriously, or (b) reject Ernst as a false skeptic?

Given that I suspect the answer is (b), would he not therefore be more inclined to go back and try to find something wrong with his data, rather than "publish and be damned"?

IMO, no, Ernst wouldn't "be inclined to go back and try to find something wrong with his data". For example, see his paper on acupuncture in 2007:

Acupuncture: its evidence-base is changing

The effectiveness of acupuncture remains a controversial issue. The aim of this article is to evaluate trends over time in the development of the evidence-base of acupuncture. A comparison of two series of systematic reviews was conducted. The first related to the evidence-base in 2000, the second related to 2005. Both employed virtually the same methodology and criteria for evaluation. The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.

http://www.ncbi.nlm.nih.gov/pubmed/17265547

[Croydon Bob]

OK, let's step back from Edzard Ernst a bit. Let's imagine one of the skeptics here came across compelling evidence that some of the apparently nonsense claims of chiropractic were true. Would they be happy to post on here saying "Look, I was wrong all along ... here is the evidence"? If so, what sort of reaction would they receive from others? I think Croydon Bob's reaction to me in the post above would be mild by comparison.

So, getting back to Ernst ... suppose he did publish something saying chiropractic worked (other than for LBP) ... would skeptics (a) start to take chiropractic seriously, or (b) reject Ernst as a false skeptic?

Given that I suspect the answer is (b), would he not therefore be more inclined to go back and try to find something wrong with his data, rather than "publish and be damned"?

That's just a big pile of false assumptions, straw men, etc. Did you take stupid pills this morning?

Just to be clear: If Ernst found evidence to support chiropractic then I would neither believe nor disbelieve. I would look at the evidence. That's what makes me a skeptic. You've suddenly decided today that skeptics are irrational idiots and that skepticism is a religion. You are wrong.