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.

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