'Witch hunt' forces chiropractors to remove websites by Prof. Chris French

source: http://www.guardian.co.uk/science/2009/jun/19/chiropractic-bca-mca-singh

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'Witch hunt' forces chiropractors to remove websites | Chris French

Chris FrenchJun 20, 2009 09:58:21 GMT Share

A chiropractic association has strongly advised its members to remove websites and withdraw patient leaflets or risk prosecution

On 10 June a revealing letter from the McTimoney Chiropractic Association was published on Andy Lewis's excellent website, The Quackometer. The strongly worded letter from the MCA advises all its members to take down their websites immediately or risk prosecution. The letter refers to "a witch hunt against chiropractors" with campaigners targeting "any claims for treatment that cannot be substantiated with chiropractic research".

The use of the phrase "witch hunt" brings to mind visions of the Salem witch trials or the worst excesses of the McCarthy era, with innocent people being unjustly persecuted by those in power. Challenging unsubstantiated treatment claims does not seem to me to qualify as a witch hunt.

The letter goes on to advise members to "REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic" and, "If you use business cards or other stationery using the 'doctor' title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately."

They were also warned to "Be wary of 'mystery shopper' phone calls and 'drop ins' to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice."

The letter concludes: "Finally, we strongly suggest you do NOT discuss this with others, especially patients. Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond." It is reassuring to see that the MCA takes its ethical responsibilities so seriously.

Just in case any of its members had not got the message, the MCA letter states: "IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION."

What caused the MCA to react with such panic? As most readers will already know, the lack of good clinical evidence relating to the use of chiropractic for treating a range of disorders with no direct link to problems of the spine has come under the spotlight as never before following the decision of the British Chiropractic Association to sue science writer Simon Singh.

In an article in the Guardian last year he criticised the BCA for claiming that its members could use spinal manipulation to treat children with colic, ear infections, asthma, sleeping and feeding conditions, and prolonged crying. Singh described the treatments as "bogus" and based on insufficient evidence, and criticised the BCA for "happily promoting" them. At a preliminary hearing last month to decide the meaning of the article, a judge ruled that Singh had implied that the BCA was being consciously dishonest.

Could this explain the MCA's apocalyptic letter to its members? Apparently so. When the Guardian approached the association to check the authenticity of the leaked letter, it responded with a statement:

Following the High Court decision and in what one can only speculate was a spirit of retribution, a number of Dr Singh's supporters decided to launch, in their own words, a "blitzkrieg" against the chiropractic profession. This has centred on trawling the websites of chiropractors and one individual, Alan Henness, has made complaints against over 500 individual chiropractors to the Statutory Regulator for chiropractors, the General Chiropractic Council (GCC).

It continues:

For a chiropractor, having a complaint made against you to the GCC is a very serious matter. The process of having a complaint investigated by the GCC is a very stressful, protracted and ultimately expensive process for the chiropractor, however minor or serious the misdemeanour, regardless of the eventual outcome ... As soon as the MCA became aware of the actions of the 'skeptics', as they like to call themselves, we advised our members to withdraw their web sites as a precautionary measure in light of what was considered to be a vexatious campaign against the profession.

And in conclusion:

The MCA has nothing to hide – and it is our belief that our members have not intentionally breached any rules regarding the content of their websites. The MCA was not alone in advising such precautions; indeed at least two other chiropractic associations have given similar advice to their members.

The BCA's use of the perverse English libel laws in an attempt to silence Singh has caused outrage and concern in equal measure among scientists, journalists, and indeed anyone who values free speech and honest debate. Detailed coverage of the case can be found at Jack of Kent's superb blog.

An interesting development took place on 20 May when the Advertising Standards Authority (ASA) published its adjudication on whether chiropractors Dr Carl Irwin and Associates "could substantiate the implied claim that their therapies could successfully treat some of the conditions mentioned, in particular IBS, colic and learning difficulties". The relevant part of the adjudication reads as follows:

We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).

The ASA instructed that the offending advertisement must not appear again and that the practice must not refer to the treatment of IBS (irritable bowel syndrome), colic and learning difficulties in future. Furthermore, the chiropractors gave assurances that they would not refer to themselves as "doctors" in any future advertising to avoid giving the misleading impression to members of the public that they held general medical qualifications.

Some people were so angered by the BCA's legal assault on Singh that they decided to follow up the ASA ruling. Among them was Simon Perry, organiser of the Leicester branch of Skeptics in the Pub. Singh's own account can be found on Perry's Adventures in Nonsense blog.

Essentially, Perry downloaded from the BCA website the details and websites of 174 chiropractic practices that either claimed to treat colic or else implied that chiropractic was an effective treatment for this condition. Using their postcodes, he then found their local trading standards office using the Trading Standards Institute website. Having checked the content of each chiropractic website, he then mailed 84 letters of complaint to trading standards offices, referring to the ASA adjudication and saying he believed the practices in question to be in breach of the unfair commercial practice regulations and other consumer protection legislation.

He has posted the latest results on his Adventures in Nonsense blog. It appears that out of the 84 chiropractors he reported to trading standards with individual letters, 14 have now removed the word "colic" from all pages on their web sites. Out of 55 individual chiropractors that Perry reported to the General Chiropractic Council, 13 have removed the word from all of their web pages.

Perry kindly agreed to perform a similar mail-merge on my behalf. My letters, around 80 of them, simply pointed out that as far as I was aware there is no convincing scientific evidence that chiropractic is an effective treatment for colic.

At the time of writing, I have received some 46 replies. The vast majority of these are simply acknowledging receipt of my complaint and telling me that it will be investigated. The others display a wide range of decisions regarding my concerns.

Trading Standards Service of East Sussex County Council informed me that they had been in touch with Lushington Chiropractic to advise them of the ASA's adjudication and to ask them to remove any reference to the conditions mentioned. Interestingly, their letter to me also states that "The General Chiropractic Council have recently contacted them regarding this, and so they have already taken steps to have the statements removed from their website and literature as soon as possible."

A similar response was received from the Borough of Poole Environmental and Consumer Protection Services with regard to Amethyst Chiropractic Clinic. A few responses informed me that the practices in question appeared to have already removed any references to the treatment of colic (possibly as a result of the MCA letter?).

Other responses simply reported that the trading standards officer in question had decided not to take any action against the chiropractic practice. Some, such as the environmental protection department of Sefton Council, proclaimed that my complaint had been investigated and, in its opinion, the Back for Your Future Family Chiropractic Clinic was not contravening any of the legislation that it enforces. No justification was provided for this verdict.

Four letters were particularly worrying. The trading standards officers for Haringey Council, the City of Edinburgh Council, and the Highland Council all claimed that they could only take action against the practices if they could "prove beyond all reasonable doubt" that the claim that chiropractic can treat colic is false or misleading. There is no obligation on the part of the trader, I was informed, to establish anything.

Mark McGinty of the Highland Council informed me that "For your information, it would appear that the evidence available is inconclusive … " and Simon Keegan, the trading standards inspector employed by the Northern Ireland Trading Standards Service, told me that "there is no conclusive scientific evidence stating that chiropractic does not offer effective treatment for infantile colic."

As it happens, to the best of my knowledge, there is no conclusive scientific evidence that chewing my toe-nail clippings is not an effective cure for Aids, but I would rather hope that trading standards services would take some action against me should I ever decide to set up a business based upon this claim.

The most commonly cited paper in support of the treatment of infantile colic by chiropractic is by Klougart, Nilsson, and Jacobsen (1989). They showed that 94% of a group of 316 infants suffering from colic improved when treated with chiropractic. The appropriate response to this statistic is "So what?" As no control group was included in the study, we simply cannot know if the results might have been even better if no spinal manipulation had been employed.

A subsequent study by Olafsdottir, Forshei, Fluge, and Markestad (2001) did include a placebo control group and concluded that "Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic." This raises the question of what exactly would constitute proof "beyond all reasonable doubt", to the satisfaction of certain trading standards officers, that chiropractic is ineffective as a treatment for colic?

Overall, though, the effect of this campaign appears to have been very positive from the perspective of those who value science, free speech and open debate. The BCA has shot itself in the foot by taking the heavy-handed approach it did with respect to Simon Singh's article. By doing so, it has brought the lack of good evidence for many of chiropractors' claims right out into the bright light of day.

If you care about science and free speech, join the 12,000 people who have already signed up to support Simon Singh and keep the libel laws out of science at the Sense About Science website.

Chris French is a professor of psychology at Goldsmiths in London where he heads the Anomalistic Psychology Research Unit. He edits the [UK] Skeptic magazine

• Medical research
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• Health & wellbeing

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What you should know about chiropractic

Simon Singh is being sued by British Chiropractic Association - go to the Facebook site to support Simon and for information about the case.

BCA Press statement 29 may

and Jackofkent comments on this statement.

THURSDAY, 28 MAY 2009 BCA v Singh: The Official Ruling

source: http://jackofkent.blogspot.com/2009/05/bca-v-singh-official-ruling.html

This is the OFFICIAL text of the ruling of the English High Court on the question of meaning at the preliminary hearing of British Chiropractic Association v Simon Singh on 7 May 2009

The key paragraphs are 12 and 13 have added emphasis.

4. The words complained of were taken from the third paragraph of the article.
"The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organization is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments."

12. What the article conveys is that the BCA itself makes claims to the public as to the efficacy of chiropractic treatment for certain ailments even though there is not a jot of evidence to support those claims. That in itself would be an irresponsible way to behave and it is an allegation that is plainly defamatory of anyone identifiable as the culprit. In this case these claims are expressly attributed to the claimant. It goes further. It is said that despite its outward appearance of respectability, it is happy to promote bogus treatments. Everyone knows what bogus treatments are. They are not merely treatments which have proved less effective than they were at first thought to be, or which have been shown by the subsequent acquisition of more detailed scientific knowledge to be ineffective. Bogus treatments equate to quack remedies; that is to say they are dishonestly presented to a trusting and, in some respects perhaps, vulnerable public as having proven efficacy in the treatment of certain conditions or illnesses, when it is known that there is nothing to support such claims.

13. It is alleged that the claimant promotes the bogus treatments "happily". What that means is not that they do it naively or innocently believing in their efficacy, but rather that they are quite content and, so to speak, with their eyes open to present what are known to be bogus treatments as useful and effective. That is in my judgment the plainest allegation of dishonesty and indeed it accuses them of thoroughly disreputable conduct.

source: http://www.newscientist.com/article/mg20227101.100-what-you-should-know-about-chiropractic.html?full=true

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What you should know about chiropractic

29 May 2009 by Edzard Ernst Magazine issue 2710.

FOR many people, chiropractic appears almost mainstream. Some chiropractors even call themselves "doctor". In the UK, chiropractors are regulated by statute, and in the US they like to be seen as primary care physicians. It is therefore understandable if people hardly ever question the evidential basis on which this profession rests.

The origins of chiropractic are surprising and rather spectacular. On 18 September 1895 Daniel Palmer, a "magnetic healer" practising in the American Midwest, manipulated the spine of Harvey Lillard, a janitor who had been partially deaf since feeling "something give in his back". The manipulation apparently cured Lillard of his deafness. Palmer's second patient suffered from heart disease, and again spinal manipulation is said to have effected a cure. Within a year or so, Palmer had opened a school, the first of many, and the term he coined, "chiropractic", was well on its way to becoming a household name.

Palmer convinced himself he had discovered something fundamental about human illness and its treatment. According to Palmer, a vital force - he called it the "Innate" - enables our body to heal itself. If our vertebrae are not perfectly aligned, the flow of the Innate is blocked and we fall ill. Chiropractors speak of these misalignments as "subluxations" (in conventional medicine, a subluxation means merely a partial dislocation). The only true cure is to realign the vertebrae by manipulating the spine, and in the logic of chiropractic it follows that all human illness must be treated with spinal manipulations. Many chiropractors also assert that we need regular "maintenance care" even when we are not ill so that subluxations can be realigned before they cause a disease.

In the words of Palmer "95 per cent of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints".

All diseases are caused by 'subluxations' blocking the flow of the 'Innate' - This bit of history is important because it explains why many chiropractors treat all sorts of conditions, not just back pain. In fact, in the early days, back pain was not an issue for chiropractors at all. Today they are divided into roughly three camps. One adheres religiously to Palmer's gospel - indeed, at one stage Palmer considered establishing chiropractic as a religion. Another has moved on and now employs a range of non-drug treatments in addition to manipulations, mainly for treating back pain. The third group is situated somewhere in between these two extremes and, at least occasionally, treats many conditions other than back pain.

If you find this hard to believe, here is the evidence. A 2004 survey by the UK General Chiropractic Council revealed that most chiropractors believe they can treat asthma (57 per cent), digestive disorders (54 per cent), infant colic (63 per cent), menstrual pains (63 per cent), sport injuries (90 per cent), tension headaches (97 per cent) and migraine (91 per cent). According to a 2007 survey, 69 per cent of all UK chiropractors see themselves as more than just back specialists, and 76 per cent consider Palmer's original concepts to be "an important and integral part of chiropractic".

So, are they right? Palmer's concepts of the Innate and subluxation are pre-scientific and wacky, but that in itself needn't mean that the treatment is not helpful. We therefore need to ask, how good is chiropractic spinal manipulation in treating anything?

The answer is not clear-cut. For back pain, there is some encouraging evidence. Chiropractic manipulations have been shown in several clinical trials to be as effective as standard treatments. One needs to know, however, that standard care is not very effective for bad backs, and studies that adequately control for placebo effects tend to arrive at less positive conclusions. When my team in Exeter reviewed data from these more rigorous trials we concluded that "spinal manipulation is not associated with clinically relevant specific therapeutic effects" (Journal of Pain and Symptom Management, vol 22, p 879).

For virtually all the other conditions which chiropractors treat, where rigorous trials have been done, the evidence is weaker. In some cases, the most reliable studies have found that spinal manipulation is ineffective.

Chiropractors and many of their professional associations often claim otherwise, but a few do acknowledge this problem. In 2001, one team of chiropractors looked at this issue, and their conclusion was blunt: "The largest professional associations... make claims for the art of chiropractic that are not currently justified by available scientific evidence". Since then, several investigators have come to similar conclusions.

The issue is not just whether chiropractic treatments work. There is also the question of the safety of chiropractic spinal manipulation, a matter that few people seem to be aware of. Several big studies have shown that a large proportion of patients experience side effects after receiving chiropractic spinal manipulation. Luckily these complaints - mostly pain - are not normally very severe and are usually gone after a day or two.

There have, however, been several hundred cases of potentially very serious complications associated with this treatment. Extreme chiropractic manipulation of the neck can damage one of the two vertebral arteries that run roughly parallel to the upper spine and supply part of the brain. The consequence of such a "vascular accident" can be a stroke, and several deaths are on record. Such disastrous events are, of course, rare; this is one reason why it is difficult to investigate this phenomenon systematically and not all studies show the same result.

In the book I co-wrote with Simon Singh, Trick or Treatment? Alternative medicine on trial, we dedicate a chapter to chiropractic. After weighing all the evidence, our conclusions were not flattering: "Warning: this treatment carries the risk of stroke and death if spinal manipulation is applied to the neck. Elsewhere on the spine, therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions chiropractic therapy is ineffective except that it might act as a placebo."

Simon later wrote an article in The Guardian newspaper about chiropractic. In it, he quoted from the website of the British Chiropractic Association which, at the time, made fairly clear claims that chiropractors can effectively treat a whole range of childhood diseases, including asthma. The evidence for treatment of this condition is less than weak: no fewer than three controlled trials have found that chiropractic spinal manipulation has no beneficial effect. The best of these studies, published in The New England Journal of Medicine, concluded that "the addition of chiropractic spinal manipulation to usual medical care provided no benefit".

For alerting the public to all of this, and possibly preventing harm to unsuspecting children, Simon deserves much credit. Instead, he is being sued for libel by the British Chiropractic Association. I think this is a serious issue that raises two crucial questions. Is it acceptable that scientists and journalists are restricted in their criticism by the legal muscle of those who are being criticised? And is it acceptable that professional bodies, such as the British Chiropractic Association - or indeed any other organisation - are able to make therapeutic claims that are not supported by scientific data? I leave it to the reader to decide.

Profile Edzard Ernst is professor of complementary medicine at the Peninsula Medical School in Exeter, UK. In his investigations of alternative therapies, he has found only about 5 per cent are supported by scientific evidence; the rest are either ineffective or have not been tested properly.

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Simon Singh sued by the British Chiropractic Association

Stephen Law Source: http://stephenlaw.blogspot.com/2008/11/simon-sigh-sued-by-british-chiropractic.html says
"Alternative medicine calls in the lawyers

Science author Simon Singh (who is speaking at the CFI London Science and Religion event in April) is being sued by the British Chiropractic Association (BCA).

The action is being taken over a passage in an article Singh wrote for the Guardian about the BCA.

The case was reported here by the Telegraph.

The excellent Jack of Kent sets out the alleged libel here.

This case is important because if the BCA wins there is a host of other alternative medical practitioners (homeopaths, etc.) who will probably also sue if it's suggested there's no evidence their treatment works.

If the case goes ahead, we'll see the evidence for and against the efficacy of chiropractice as a treatment for various ailments set out in court - which will be interesting!"

Facebook Site: http://www.facebook.com/home.php#/group.php?gid=33457048634
have following key supporters:

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Nick Cohen

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Chris French (Goldsmiths)

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Simon Singh sued by the British Chiropractic Association

Alternative medicine calls in the lawyers

Science author Simon Singh (who is speaking at the CFI London Science and Religion event in April) is being sued by the British Chiropractic Association (BCA).

The action is being taken over a passage in an article Singh wrote for the Guardian about the BCA.

The case was reported here by the Telegraph.

The excellent Jack of Kent sets out the alleged libel here.

This case is important because if the BCA wins there is a host of other alternative medical practitioners (homeopaths, etc.) who will probably also sue if it's suggested there's no evidence their treatment works.

If the case goes ahead, we'll see the evidence for and against the efficacy of chiropractice as a treatment for various ailments set out in court - which will be interesting!