Holford Watch: Patrick Holford, nutritionism and bad science

Hot on the heels of the recent action involving Professor Frank Frizelle and the New Zealand Medical Association’s journal v. the New Zealand Chiropractors’ Association we now learn about the British Chiropractic Association issuing a legal writ against Simon Singh: Doctors Take Simon Singh to Court.

Simon Singh expected to arouse controversy when he claimed that chiropracters knowingly promoted bogus treatments for illnesses including asthma and ear infections. The bestselling author and Bafta-winning broadcaster did not, however, expect to have a High Court writ issued against him.

At the time of writing the British Chiropractic Association’s website does not carry any stories about this legal action. However, this does answer the questions raised on UK Sceptics since July 3rd about where Simon Singh’s article had disappeared to from the Guardian. It seems that the Guardian piece about Singh And Professor Ernst’s book and written to mark National Chiropractic Week is the cause of contention between Singh and the British Chiropractic Association. Update: Gimpy has managed to track down a copy of the article and has posted it: The ‘libellous’ Simon Singh article on chiropractors.

This ill-judged and peevish action can only produce more publicity for Trick or Treatment? Alternative medicine on trial which is the source of the claims that have so outraged british chiropractors.

“I will contest this action vigorously,” says Singh, who was awarded an MBE in 2003 for services to science. “There is an important issue of freedom of speech at stake. Sadly, I cannot speak about it at this early stage because I have already engaged lawyers.”

It’s a shame that nobody thought to ask Professor Frizelle or Professor David Colquhoun for their comments – particularly about the title of ‘doctors’ used to refer to chiropractors in the Telegraph headline.

It has been said many times before but it is impossible to lampoon obvious targets because they so frequently indulge in activities that seem self-parodic. It is entirely possible that the British Chiropractic Association believes that this sounds sweetly reasonable:

“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.”

Dr Jakubowski…adds: “It’s a terrible shame he made those comments and he has been given a full opportunity to take them back. However, he hasn’t.”

However, to onlookers it sounds like hurt feelings and an over-reaction. As Professor Frizelle might have said, “Let’s hear more about your evidence and less about your legal muscle”.

The way that things are going, any month now you should expect to see a benefit announced to raise legal fees. Professor David Colquhoun and Dr Simon Singh will perform Brothers in Arms. Dr Andy Lewis has yet to reveal his packed programme with his backing band Five Thousand Defamatory Bloggers but inside sources report that it is diverse and ethically maverick. Just like Live Aid, maybe there will even be an international event in tandem. Professor Frank Frizelle Fries the Easily Affronted…And don’t despair of even more ethereal contributions: being dead didn’t stop Hettie from getting membership of the American Association of Nutritional Consultants.

Update: Quackometer has a strong opinion on the matter: Chiropractors Try to Silence Simon Singh.

There is nothing here that cannot be defended by evidence or is fair opinion…
This is a disgrace and I hope it backfires massively and is the start of the end of this massive fraud on the public.

Quite.
JREF forum has an interesting thread: British Chiropractic Association v Simon Singh.
Gimpy takes issue with the BCA: Chiropractors sue Simon Singh – prefer legal action to evidence.

These claims are expounded on in Dr Singh’s and Professor Ernst’s book ‘Trick or Treatment‘ that devotes a whole chapter to chiropractic therapy. The discussion and conclusions in this chapter are evidence based, something which does not bode well for the BCAs legal action

The decision to conduct arguments under the cloak of libel threats and silence evidence based arguments using legal muscle is a damning indictment of quack therapies.

Gimpy has managed to track down a copy of the article and has posted it: The ‘libellous’ Simon Singh article on chiropractors. Gimpy has also added in additional commentary on the claims and instances when it seems that the BCA has made similar claims to the ones that are now under discussion.

Mr Hunnybun comments both on the BCA v. Simon Singh action and British Chiropractic Association and that:

lamentable Pharmaceutical Journal contains a letter from the Superintendent Pharmacist of the Royal London Homeopathic Hospital. Guess what, she thinks homeopathy works. What a shocker! She also suggests that there is solid evidence that it works.

Jack of Kent discusses some of the free speech and other aspects of this news: On Simon Singh Against the Chiropractors.

Dr* T is experiencing a bout of deja vu: Another Back-Cracking Quack Attack – The Sequel.

jdc observes: British Chiropractic Association: Afraid of Criticism.

Skeptinet deplores what seems to be a growing trend: Litigation Instead of Evidence.

Litigation is becoming an alarming trend with practitioners of pseudo-science and quackery. If you can’t win with the evidence, win by bullying your opponents until they sit silent. I imagine their choice to sue an Simon Singh personally and not the paper is no accident. By suing the individual they are discouraging future article writers from writing critical articles because they too could be sued personally and, presumably, the Chiropractic Association has a much bigger war chest.

Skepchick considers the BCA action to be ill-judged: Pseudoscientists Sue Simon Singh.

If you’ve read Simon’s book Trick or Treatment (and you should, it’s brilliant), you’ll know that he’s actually quite fair to the chiropractic industry, admitting where it may have some benefit while cautioning patients against the dangerous practices that have no benefits at all…Hence, a frivolous libel lawsuit designed to squash valid criticism and free speech.

The Welsh Pharmacist has an enquiry: Any Chiropractors Want to Sue Me As Well?

It would be fair to say that Twoniblankblank has greeted the news of the BCA’s action with some exasperation, declaring it “lolworthy”: Oh FFS- British Chiropractic Association issues writ against Simon Singh. In keeping with that spirit, there is a video of ducks, a piano and some pithy lyrics accompanied by periodic quacks and much quackery. Quacks and sinister ducks behaving badly.

Norbury lends support to the blogosphere coverage: More idiocy from chiropractors.

Update Aug 19: Casting Out Nines muses on the matter of Simon Singh versus the chiropractors.

[D]on’t these chiropractors realize that going after Singh in such a public way is only going to increase the propagation of his article and ideas exponentially (witness this blog post)?

There is coverage on the Think Humanism forum.

Podblack includes the coverage in a news round-up: Bloggers Behind Simon Singh – Where The News Is At.

There is a discussion thread on Australia’s ABC Science Forum: British Chiropractors Association suing critic.

Daniel Cressey covers the matter for Nature’s blog: Chiropractors get litigious, again.

A Right to Think wonders whether: Anyone else see the problem with the headline?

I look forward to this case – although UK libel law places the burden of proof on the defendant, Singh has already gathered his evidence in Trick Or Treatment, so won’t have to look around too hard to lay his hands on the necessary papers. This could well backfire vigorously in the face of the BCA, and that will be fun to watch!

Some Canadian Skeptic says: Doc, it hurts when my chiropractor does *THIS*. His message is:

Good luck Simon, free speech and rationality stands with you!

Dougal at Looking Out To Sea might echo that sentiment. He has a punchy summary of the chiropractors’ tactics (or those of their associations): If you don’t have anything nice to say, say it on lawyer’s headed notepaper.

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.

We are seeking clarity as to whether the patient in the cat chiropractic clinic is merely deeply relaxed or something more serious has happened (see Dougal’s illustration).

August 20: Ministry of Truth has some interesting observations as to why chiropractic associations might be anxious to stifle criticism for the present: Can you libel woo?

…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…

Some useful additional commentary on this topic at the Bad Science Forum.

Unity’s insights seem very plausible. This might happen, particularly in the light of Get Well UK’s ’successful’ pilot programme in NI.

Jonathan Hearsey comments on: ‘Self-destructing chiropractors’.

I get the feeling that chiropractors have missed a golden opportunity here. Instead of demonstrating their legal might they should have used what little evidence there to parry the criticism plus given the scientific community the assurance that they would fund further research.

The Hysterical Shrieking Grief is unimpressed by the BCA’s action: Bone-cracking Quacks. NRG comments illustrate just why the BCA’s action might backfire if this action gains any traction in the mainstream media and more people learn about chiropractic:

I for one was completely unaware just how totally full of shit it was until the above posts started appearing, there had been the odd mention of it on bad science blogs before but I’d never really looked into it. The ‘offending’ article is a fantastic introduction to just how batshit-insane this stuff really is.

Science Forums have a discussion thread that has some participation from someone who appears to accept chiropractic: Chiropractors sue Simon Singh.

Several of the forum threads continue to be interesting and good discussions; in particular the JREF Forum. Blue Wode makes some slightly chilling observations about the success rate of previous letters from the UK’s chiropractic organisations when complaining about press coverage.

Jack of Kent has an interim update: COMING UP: The Ten Questions British Chiropractic Association Members Should Now Be Asking the BCA.

Aug 21: Homo Economicus lends support: Simon Singh sued by The British Chiropractic Association.

The Guardian has an article about low-back pain and the Alexander Technique that includes a section about chiropractic and how it is more than crunching and clicking bones and joints.

Professor David Colquhoun has published a letter from Jonathan Bleier: An ex-chiropractor speaks out.

David, thank you for having the courage to speak out and oppose this. Historically (and in your case), chiropractors fight their battles through litigation so it takes personal courage and integrity to do so.

The indefatigable Blue Wode comments on that piece and quotes from the results of a survey of UK chiropractors that sought their views on their scope of practice.

Jonathan Hearsey mentions the chiropractors’ action in:‘The Plausibility of CAM on the NHS’.

Dr Aust has been able to collect his resources together and resist the cute distractions of the most recent addition to the Aust family to swell the ranks of those covering this issue in a wide-ranging discussion: Back crack quack attack – it’s a legal matter, baby. Jack of Kent says that Dr Aust’s piece “carries the legal analysis forward significantly” and characterises it as a “must read”.

August 22: the fabulously named Geoglyph Entropy of Geoglyph’s Ramblings has joined the fray: Chiropractors versus Simon Singh.

August 25: the Wikipedia entry on Simon Singh is now carrying news of the BCA action.

HealthWatcher UK is offering a round-up of some links that cover the Singh v. BCA story.

August 28: Jim Lippard reproduces Singh’s offending article: Simon Singh sued and silenced; Svetlana and Steinberg’s speech surmounts suppression . He also comments on the need for reformation of the UK libel law and recounts an anecdote of his first suspicions that chiropractic manipulation may sometimes result in nerve damage, in this case related to blindness.

Update 1 Sept: Margaret Coats of the General Chiropractic Council complains about an opinion piece by David Colquhoun: Safe chiropractice. Professor Colquhoun mentioned chiropractic in passing in his Regulating quack medicine.

The Government’s answer to the problem is, as always, to set up more expensive quangos to regulate alternative medicine. That might work if the regulation was effective, but experience has shown it isn’t. It makes no sense to regulate placebos, especially if you don’t admit that is what they are. The Government should be warned by the case of chiropractors about the dangers of granting official recognition before the evidence is available. The General Chiropractic Council already has a status similar to that of the General Medical Council, despite it being based on the quasi-religious idea of “subluxations” that nobody can see or define. Recent research has shown it to be no more effective, and less safe, than conventional treatments that are much cheaper.

Related Reading

Professor David Colquhoun: Doctor Who? Deception by Chiropractors
Chiropractors Resort to Legal Intimidation.
Samuel Homola, a retired chiropractor comments that the majority of chiropractors believe that “spinal adjustment should not be limited to treatment of musculoskeletal problems” although “there appears to be little evidence to support the value of spinal manipulation for nonmusculoskeletal conditions”: Chiropractic: A Profession Seeking Identity.
Bruce Thyer and Gary Whittenberger investigated the willingness of chiropractors’ representatives to agree to consider treating hypertension and arthritis: A Skeptical Consumer’s Look at Chiropractic Claims: Flimflam in Florida?
jdc offers A Beginner’s Guide to Chiropractic. We would also add Dr Mark Crislip’s analysis of a paper on chiropractic and stroke; Dr Harriet Hall on Chiropractic and stroke and the sad case of Sandra Nette who is now living in locked-in syndrome following chiropractic treatment that went badly awry and Dr Steve Novella’s account of Sandra Nette and chiropractic.

This is a good overview of chiropractic: Chiropractic – a study by Mahlon Wagner, PhD. It contains a classic quotation: chiropractic, “the only legally recognized and licensed superstition in the United States today”.

Interesting exchange of letters in Arch Fam Med: Chiropractic: A Fantasy and Delusion.

It is worth noting that in Wilk v. American Medical Association, the AMA lost in some regards (relating to federal anti-trust laws). However, the upside is that the judge took a very robust attitude.

The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study… No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.

Although not about chiropractic, we would recommend these glimpses into Alt.Reality ™ and Alt.Science by Dr Aust and Gaylard. One alternative reality please. No – make that several and Publish and be damned.

Jack of Kent has posted a fascinating discussion of the legal aspects of this case: On English Libel Law: A Brief Guide for the Perplexed. He says that he will provide further commentary -so I hope that some more information is forthcoming soon so that we can learn more. On the same topic, Duncan Campbell has a fine discussion concerning british law: British libel laws violate human rights, says UN.

Britain’s libel laws have come under attack from the United Nations committee on human rights for discouraging coverage of matters of major public interest…

The intervention by the UN comes in the wake of international disquiet over the use of British courts for “libel tourism”, whereby wealthy plaintiffs can sue in the high court in London over articles that would not warrant an action in their own country…The committee warns that the British libel laws have “served to discourage critical media reporting on matters of serious public interest, adversely affecting the ability of scholars and journalists to publish their work, including through the phenomenon known as libel tourism”.

Earlier this year Rachel Donadio wrote up a fine summary of the libel tourism issue: Libel without borders.

The case is fanning widespread concern that English libel law is stifling writers far beyond the borders of the United Kingdom. Today, any book bought online in England, even one published exclusively in another country, can ostensibly be subject to English libel law. As a result, publishers and booksellers are increasingly concerned about “libel tourism”: foreigners suing other foreigners in England or elsewhere, and using those judgments to intimidate authors in other countries, including the United States. Last year, the Association of American Publishers, Amazon.com, the American Society of Newspaper Editors and others filed an amicus brief in New York, arguing that such litigation “constitutes a clear threat to the ability of the U.S. press to vigorously investigate and publish news and information about the most crucial issues before the U.S. public.”

Update August 22: The scope of chiropractic practice: A survey of chiropractors in the UK.
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 has lent his considerable expertise to researching and compiling: The Ten Questions British Chiropractic Association Members Should Now Be Asking .

The answers to these questions may indicate to BCA members whether a sound decision was made or not…

These questions are also intended to be the sort of questions which any professional should ask of his or her representative body in these circumstances.

Update 25 August: NYT examines the issue of whether
chiropractic neck manipulation can lead to stroke: the review concludes, “Forceful neck manipulation seems to carry a small risk of arterial tears”.

BPSDB