Feb 23 2012

The British Chiropractic Association Reflects on the Simon Singh Affair

Richard Brown, president of the British Chiropractic Association (BCA), has a tough task before him.  He presided over the BCA’s libel suit against Simon Singh for an article he wrote in the Guardian in which he specifically criticized the BCA, writing that it, “happily promotes bogus treatments.” The libel suit resulted in a magnification of criticism against the BCA by orders of magnitude, and the questioning of onerous libel laws in Britain that stifle free speech. The BCA ultimately had to withdraw the suit and pay for Singh’s outrageous legal expenses.

In a recent speech Brown reflected on the Singh lawsuit, now published in the Chiropractic Report with the title, “After the Storm – What Have We Learnt?” As Edzard Ernst noted in an article about Brown’s speech, “it makes fascinating reading.” To me it reads like desperate damage control, but in it there are some interesting admissions.

Regarding the Singh affair Brown writes:

Singh claimed that the BCA ‘happily promotes bogus treatments’ even though there was ‘not a jot of evidence’. The BCA was faced with a dilemma. Did it sit by and permit an assault on its reputation and good name, or did it stand up for its members and challenge the criticism? For years, chiropractic had been castigated in a succession of critical articles, but here was a published article which had explicitly named a chiropractic association and had made defamatory comments about it.

Brown is not off to a good start with this paragraph, in which he lays out a false choice and entirely misses the point of Singh’s criticism. There were other choices other than “sit by” or “challenge the criticism.” Both of those choices contain the unstated premise that the criticism’s against the BCA were not legitimate (which was the basis of their suit against Singh).  Another option would have been to answer the criticism without suing Singh, who was specifically criticizing chiropractors for treating children for colic, bed wetting, and asthma. By suing Singh they reinforced the impression that they could not defend their practices on the scientific evidence, otherwise they just would have done so.

After the storm of criticism against the BCA they did belatedly try to defend these practices by publishing a paper summarizing the evidence base for these treatments. In a statement they wrote:

“In the spirit of wider scientific debate, and having taken appropriate professional advice, the BCA has decided that free speech would be best facilitated by releasing details of research that exists to support the claims which Dr. Singh stated were bogus. This proves that far from being “not a jot of evidence” to support the BCA’s position, there is actually a significant amount.”

I dissected their article in detail on SBM – what they actually demonstrated was how thin the evidence for chiropractic treatment of these conditions is, and further they left out studies that show that chiropractic does not work and tried to pad out their list with studies that had nothing to do with chiropractic. In my opinion their list of studies only demonstrated that they do not care what the evidence actually says and they are willing to misrepresent the evidence base in order to defend their practices. In short, the list was a massive backfire.

In addition to this third choice of addressing the scientific evidence, the BCA could have reviewed the practices that Singh criticized and then advocated a science-based position.  Imagine if they simply responded by saying – the BCA does not support chiropractic manipulation of children for colic, bed wetting, and asthma because such treatments are based upon an obsolete philosophy (subluxation “theory”) and the evidence does not support the efficacy of these treatments. Rather, like many a politician who was accused of dubious behavior, they made their situation far worse by trying to defend chiropractic pseudoscience. This fourth option (let’s call it “honesty”) apparently didn’t even make the list for the BCA.

Brown goes down from there, trying to make a side-swipe at the BCA’s critics:

“In using the case as a powerful vehicle to promote his Sense About Science campaign, Singh’s crusade mobilised a dark force of UK sceptics who suddenly found their raison d’etre, shifting their attention from the fairy tales of homeopathy to the cure-all claims of chiropractors. Following a call to action, an army of PC pilots and laptop lizards began a war which was to lead to one in three UK chiropractors facing formal disciplinary proceedings from its regulator, the General Chiropractic Council.

The “dark force of UK sceptics,” “PC pilots and laptop lizards.” One might get the impression that Brown doesn’t like skeptics very much. That’s no surprise – mobilized and effective skeptical activism is the worst nightmare of cranks, quacks, and charlatans of every type. Yes, Mr. Brown, welcome to the intertubes. It’s one of those new-fangled developments brought to you by something else you may not be very familiar with – science.

Another tidbit that caught my eye- did the president of the BCA just call homeopathy a fairy tale? That may be the most honest statement in the entire speech. It’s possible this was meant to be just the skeptics’ perspective (i.e. the scientific perspective), because he follows with “the cure-all claims of chiropractors.” However, the rest of the speech indicates that he may be serious about that characterization. Brown goes on to discuss that the Singh affair may be an opportunity to reform chiropractic as a profession, to make is more evidence-based. It makes me wonder how serious he is, and if so how much is he willing to go against his own profession in order to reform it.

He writes:

Some may say that we owe Simon Singh a debt of gratitude. His newspaper article, his confrontational stance and his defiance in standing up to UK libel law has all made us, at long last, recognise what, to be fair, many chiropractic researchers have been telling us for years. If we are ever going to get anywhere near being accepted by the wider healthcare  community – and, let’s face it, for us to move forward as a respected profession we need that acceptance – we need to know who we are, know what we do and know why it works. It is no longer good enough in 2011 for us to expect chiropractic to survive on outdated dogma.

Ooh! So close. Brown seems to recognize the need for research and evidence-based practice to make chiropractic generally accepted, but his emphasis on finding out what chiropractors do and “why it works,” misses the mark. The real point of research is to figure out if treatments work. If first, then you can worry about why. This is not a subtle point – it is at the core of SBM criticism of alternative medicine.

If one is being cynical it might seem that Brown looks at scientific research as a patina to paint over chiropractic in order to make it more acceptable to mainstream medical practice. Rather, it is a scalpel that should be used to ruthlessly carve away worthless, harmful, and pseudoscientific practices. Brown does talk about getting past the outdated ideas of chiropractic’s history, but he dances around the desperate need for major reform that is plaguing the chiropractic profession.

After reading the article I am still not sure if Brown is a serious reformer, and has a sense of the immense task before him, or if he is just paying lip service to science and evidence because he knows it is a barrier to wider acceptance. I hope it is the former, and this is just the first step in that direction. He does conclude:

“There has been much to reflect on, and in a strange way the chiropractic profession may one day look back and thank Simon Singh for making the chiropractic profession recognise its weaknesses and evolve from teenage angst into adult maturity. We have been indecently exposed and we must now seek to clothe ourselves in the respectability that modern healthcare demands of us.”

This gives me mixed signals. He sounds partly like a reformer who sees a future of the BCA that can look back and thank Singh for being the trigger for change. But he also talks about “clothing” chiropractic after being exposed, rather than fundamentally changing chiropractic. Chiropractic needs more than a costume change – it needs to embrace science-based practice and to rid itself of a great deal of pseudoscience and ethically dubious practices. This will require a significant cultural change within chiropractic.

At this point we will just need to watch Brown and the BCA to see if they are serious, or if this was just another lame attempt at damage control.

13 responses so far

13 Responses to “The British Chiropractic Association Reflects on the Simon Singh Affair”

  1. zenoon 23 Feb 2012 at 10:43 am

    In honour of being called a laptop lizard by Brown, I titled my talk to Leicester Skpetics in the Pub on Tuesday night about my 500-odd complaints about chiropractors’ websites and how that led to setting up the <a href="http://www.nightingale-collaboration.org"Nightingale Collaboration: ‘The Rise of the Laptop Wizards’.

    It’s difficult to see how Brown managed to get so much so wrong in his article:

    “Following a call to action” Nope. No one asked us to do anything – I did it because I was appalled at what was being claimed without good evidence.

    “an army of PC pilots and laptop lizards” Nope. There were just four or five of us – all unaware of each other.

    “Using a software package to highlight key words in chiropractors’ websites” Nope. All done with a browser, a spreadsheet and an awful lot of copying and pasting.

    “claims were uncovered relating to everything from haemorrhoids to hair loss, chlamydia to cancer.” Nope. Those certainly weren’t on my list of claims being made by 524 chiropractors.

    At least we can agree on homeopathy being a fairytale.

  2. daijiyobuon 23 Feb 2012 at 12:28 pm

    This kind of reminds me of attempted chiropractic ‘reforming’ published in 2008,

    “How Can Chiropractic Become a Respected Mainstream Profession? The Example of Podiatry ” (see http://www1bpt.bridgeport.edu/~perle/abstracts.htm for an abstract, http://chiromt.com/content/16/1/10 for full-text).

    I thought there were SOME honest things said, like:

    “when an individual consults a member of any of the medical[*] professions, it is reasonably expected that the advice and treatment that he or she receives is based in science, not metaphysics or pseudoscience. In addition, it is reasonably expected that the services he or she receives are being provided for the primary purpose of benefiting the patient, and not for any other reason. The financial benefit to the professional is secondary, and results from the degree of clinical benefit received by the patient. Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse or quackery. This is the social contract as it applies to chiropractic physicians[*]” — *though I wouldn’t characterize chiros as “medical” or “physicians”.

    And yet, when you go to one of the author’s school web pages touting “health science” (see http://www.bridgeport.edu/academics/healthsciences ), ISYN, he is therein, as that school engages in trade within the context of [amongst other things]

    science subset naturopathy and acupuncture.

    Talk about “mixed signals.”

    -r.c.

  3. Blue Wodeon 23 Feb 2012 at 3:24 pm

    An excellent summation of the mess that that British Chiropractic Association continues to find itself in.

    I suspect that Dr Novella is correct with his view that Richard Brown is dancing around the need for major reform in chiropractic, and that he might just paying lip service to science and evidence because he knows it is a barrier to wider acceptance.

    For example, on p.37 of the Winter 2009/10 issue of the UK publication, The Back Care Journal, Richard Brown wrote the following in an article called ‘Towards New Horizons’:

    Quote
    “The BCA opposes restricting the scope of practice of chiropractors, yet it recognises that there are boundaries. It actively prohibits unethical practice building or unprofessional marketing which undermines the integrity of the profession. Those limits aside, the BCA supports equality of opportunity and diversity and indeed it has been this rich diversity that has given the chiropractic profession its colour and vibrancy for nearly 85 years.”

    It seems to confirm that although he is well aware of the continuing serious divisions in chiropractic regarding practice styles, he’s turning a blind eye to the problem. Indeed, in the BCA’s statement on the vertebral subluxation complex which was published on 24th May 2010 (and no longer unavailable on its website) he advised the Association’s members to…

    Quote
    “…refrain from making any reference to Vertebral Subluxation Complex in media to which patients or the general public may have access”

    but added that

    Quote
    “…this advice has no bearing on scope of practice”

    IMO, the above is not just a classic example of the chiropractic bait and switch
    http://www.sciencebasedmedicine.org/index.php/the-bait-and-switch-of-unscientific-medicine/

    – but also one of weak leadership.

  4. Blue Wodeon 23 Feb 2012 at 3:27 pm

    @ daijiyobu

    I believe that the “one author” to whom you refer is Stephen Perle DC – a chiropractor educator who, IMO, seems to have become somewhat afraid of public debate with critics of chiropractic. Unlike Dr Novella, and the academics who contribute to the Science Based Medicine website, Stephen Perle banned me from engaging with him on his blog simply for being anonymous. Perhaps even worse is the photograph he chose to accompany his attempted justification of my banning. I find it wholly unprofessional and insulting:
    http://smperle.blogspot.com/2010/12/anonymous-criticism-defending-ernst.html

  5. rpotter1000on 23 Feb 2012 at 7:41 pm

    Great, thoughtful post as always. But am I the only person who finds all the cutesy names for the Internet annoying? It’s not just you, Dr. N. I hear them everywhere. Interwebs, intertubes, internets. Just one of those things that bug me for no good reason, and I needed to share my feelings on the, um, Interspace.
    Love your blog! It’s the only one I always read.
    Rob

  6. HHCon 23 Feb 2012 at 7:51 pm

    Solicitor Dougans, Associate of Bryan Cave LLP, stated his client would ultimately have out-of-pocket expenses of 20000 pounds, over $31,000 and two years’ salary.

  7. mdstudenton 23 Feb 2012 at 10:06 pm

    “It (the ECU) is committed to positioning chiropractors as the spinal health care specialists of choice, but knows that research will ultimately be the currency of the profession.”
    – After the Storm – What Have We Learnt?

    Chiropractic is doomed to remain on the fringes of conventional health care. Would-be reformists don’t seem to realize that plenty of quality research already exists demonstrating how useless it is. They also don’t seem to realize that surgeons and neurologists already have a highly detailed understanding of how the nervous and musculoskeletal systems are organized. Of course there’s still loads of room for research but I wonder if they really expect to make any kind of breakthrough validating their existence with non-controlled and non-blinded studies.

    Ultimately, if chiropractors genuinely want to become “the spinal health care specialists of choice” they’re going to have to go to med school.

  8. pious fraudon 24 Feb 2012 at 12:23 am

    “Brown looks at scientific research as a patina to paint over chiropractic in order to make it more acceptable to mainstream medical practice. Rather, it is a scalpel that should be used to ruthlessly carve away worthless, harmful, and pseudoscientific practices.”

    I really like this imagery here, it’s a great comparison. Good post!

  9. eiskrystalon 24 Feb 2012 at 4:04 am

    a war which was to lead to one in three UK chiropractors facing formal disciplinary proceedings from its regulator, the General Chiropractic Council.

    Yes, it is really terrible when people of an organisation are found guilty of failing the public so hard that the regulators have to formally discipline them. If only Singh had stayed quiet then we could have all pushed their lies and fakery under the rug and the regulators wouldn’t have had to do their job…

    …ON 1/3RD of it’s members!!!

    If anyone thinks this guy is in any way serious about reforming chiropractic then I have a bridge to sell them. Barely used. Looks like new.

  10. daedalus2uon 24 Feb 2012 at 11:16 am

    pious fraud, I like the imagery too. The usual term in a medical context is debridement, the removal of dead and necrotic flesh from an infected wound before the infection spreads to healthy tissue and kills the patient.

    “Debridement or removal of dead tissue is a cornerstone of good wound bed preparation. Slough, eschar and debris in the wound are a good food source for bacteria and must be removed to prevent or treat infection and to promote healing.”

    http://cawc.net/images/uploads/wcc/5-2-pearson-maggots.pdf

    A useful treatment modality in some cases is maggot therapy, where individual maggots seek out and remove the dead flesh. Sort of like how medical skeptics can seek out and remove quackery.

  11. pious fraudon 24 Feb 2012 at 12:27 pm

    Debridement, inserting new word into vocabulary, now. Thanks.

  12. tmac57on 24 Feb 2012 at 7:13 pm

    daedalus2u- Ever think of script writing for ‘The Walking Dead’?

    (Oh,and thanks Dr. Novella for getting me hooked on that show…I think)

  13. SimonWon 05 Mar 2012 at 3:11 am

    The problem for science based reform of Chiropractic is found in the work of Edzard Ernst where he points out that for spine problems (which I think most people agree is where it might have some utility) there is no evidence it is better than other methods of treating these conditions, and there is evidence it has safety concerns, so the correct reforming position would be to stop all non-research Chiropractic until it is found to be safer and more effective than established treatments for some condition. Since that would basically put all their members out of work I don’t think any BCA president would get support on that platform.

    Whilst as skeptics we might be happy for evidence of efficacy, as patients we expect a treatment to be effective, safe, cheap and the best of those available, not merely evidence that it might help, otherwise we’d all be boiling willow bark in saucepans, or sticking mouldy bread on our infected parts.

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