Singh the blues

By Phil Plait | June 3, 2009 5:17 pm

[Pardon this lengthy post, but this is an issue central to science and skepticism, and is thus very important. I ask my readers to please read the whole thing. I am not exaggerating when I say this issue has profound ramifications.]

Simon Singh is a journalist in the UK; he writes for the Guardian. Moreover, he’s a science journalist, and a good one who, like so many of us, prefers reality the way it is.

The British Chiropractic Association, however, prefers reality to bend to their will. They’ve been making some outrageous claims lately about the efficacy of their "treatment", things that are clearly wrong. Simon wrote about this in a column, saying,

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 organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

Unsurprisingly, the BCA took a dim view of this. So of course they produced copious variable-controlled double blind studies with statistically significant testing procedures to back up their claim.

HAHAHAHAHAHAhahahahahaha! No, that would be silly! Of course they didn’t do that. They sued him instead.

In the US that would be a dumb thing to do, as our libel laws put the burden of proof on the claimant (in this case, the BCA), as things should be. However, the UK is very different: when party A sues party B for libel, it’s up to party B to prove their innocence.

The ramifications of this are obvious: a chilling effect on dissent in the media against, well, anything. If you call someone on the carpet for making fallacious claims, they can basically shut you up by suing you. Not surprisingly, there are many people dissatisfied with this approach to libel, but it’s what Simon is dealing with currently.

Worse, in Simon’s case, a judge ruling in the preliminary hearing agreed with the BCA, citing Simon’s use of the word "bogus" to mean that the BCA knowingly is perpetrating fraud. The judge is obviously wrong here; Simon went to some pains to indicate in that very article that his use of bogus did not mean intentional fraud, but instead to mean wrong, as in chiropractic techniques cannot be used to cure the ills the BCA claims.

To understand this breathtaking lack of judicial wisdom on the part of the judge, one need only read Jack of Kent’s entry on the ruling.

Certainly, one could say that Jack of Kent may be biased, and didn’t give a fair account of the case. However, Jack also posted the actual official ruling in the case, and I draw your attention to sections 12 and 13:

What [Singh's] 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.

Emphasis mine.

This clearly comes down to the definition of the word "bogus". Merriam-Webster calls it "not genuine : counterfeit, sham". Of those three, only sham denotes knowledge on the part of the person involved; something can be not genuine or counterfeit, yet presented honestly if mistakenly.

It seems to me that this is a very narrow ruling based on the use of the word bogus to mean knowingly fraudulent, but Simon meant it to mean wrong and useless. That does not mean the BCA was aware of the treatment being wrong and useless. After all, they may honestly be peddling quack medicine.

So the judge is wrong, and Simon is doing the right thing: he’s appealing.

This is an extremely important decision on his part. If he can appeal this ruling, he stands a chance of at least easing the libel laws somewhat, if only as a precedent when a judge makes a bad call.

Keep Libel Laws out of Science

There’s a lot of support for him. I personally support him, as is clear from this post. Sense about Science, a group supporting science education in the UK, has started a campaign called Keep the Libel Laws out of Science. If you are a blogger or web site owner they have a button you can download to put on your site. I have mine in the sidebar now.

There was a support meeting for Simon recently, and a lot of great people showed up (he was introduced by my friend Professor Brian Cox). James Randi and I issued a statement which was read there:

We at the JREF support Simon in his quest for justice. It’s clear from his writing that his intent was not to claim that the BCA knowingly commits acts of fraud, but that the BCA is nonetheless incorrect in their claims of the efficacy of chiropractic. Simon is, of course, correct. Furthermore, the ruling, as it stands, would produce a chilling effect on the ability of journalists to question the claims of anyone, including pseudoscientists. Whatever path Simon chooses over this issue, the JREF will be there, and to the best of our ability we’ll have his back.

We are thrilled Simon is appealing this frankly incorrect ruling, and you can bet we’ll be watching the proceedings carefully. I will continue to post more information as I find it, and you can also check in on Sense about Science and Jack of Kent for more as well.

Comments (130)

Links to this Post

  1. Supporting science speech : Stochastic Scribbles | June 3, 2009
  2. Oh, you bleeding hearts… « Tankebrott | June 4, 2009
  3. Simon Singh is charming! Er, appealing! « Cubik’s Rube | June 4, 2009
  4. Simon Singh v. The Chiropractors! - Religious Education Forum | June 4, 2009
  5. Simon Singh Case Response Roundup « God knows what… | June 4, 2009
  6. Simon Singh V. British Chiropratic Association (BCA) « IBY’s Island Universe | June 4, 2009
  7. Simon says… Appeal! « God knows what… | June 5, 2009
  8. The British Chiropractic Association: Quack, Quack « Software Musings | June 5, 2009
  9. Keep Libel Laws Out of Science | June 5, 2009
  10. Sense About Science « The Crystal Conundrum | June 8, 2009
  11. Chiropocalypse | Bad Astronomy | Discover Magazine | June 10, 2009
  12. 11 June 2009: Prior to the Road… « blueollie | June 11, 2009
  13. I sue in your general direction | Bad Astronomy | Discover Magazine | June 13, 2009
  14. “Keep libel laws out of science” | June 14, 2009
  15. Chiropocalypse – panicked retreat by chiropractors in UK free speech war | reasonWeekly | June 14, 2009
  16. ScienceBlogs Channel : Medicine & Health | BlogCABLE.COM | June 20, 2009
  17. So what next? « Thinkers’ Podium | July 11, 2009
  18. The article the British Chiropractic Association hopes you will not read « Millard Fillmore’s Bathtub | July 31, 2009
  19. The Peculiar Case of Simon Singh | Bad Astronomy | Discover Magazine | August 4, 2009
  20. when the laws aren’t there for your protection « weird things | October 18, 2009
  21. Review: The Code Book – the most entertaining book on cryptography you’ll ever read | Philosophical Geek | November 3, 2009
  22. Preparing for Childbirth, Part III: Thoughts on Surgery | Thoughts | August 24, 2010
  1. truthspeaker

    See, I respect the intent of libel laws. People should not be able to make defamatory claims they cannot back up. That’s why I always stress that it is not absolutely certain that Mr. Justice Eady accepted a large bribe from the BCA in exchange for his ruling.

  2. It seems to me the UK system is set up to encourage a lot of frivolous suits based on just hurt feelings as opposed to genuine libel. Keep us up to date on this Dr Plait, we appreciate it.

  3. Travis

    I first heard about the UK’s weird libel laws when I heard about a case involving a Holocaust denier. I sure hope it gets reformed, we certainly don’t need science being decided in courtrooms.

  4. Damon

    Darn, too bad about this… as a sufferer of borderline scoliosis I can personally attest to the profound healing power of Chiropractic– cured my headaches, bodyaches, psoriasis, improved my mood and sexual health, made it so I could swallow food again, not to mention eliminated most pain involving my neck and lower back– but indeed, the profession itself is full of some pretty nutty people. My own Chiropractor feels the need to oversimplify his practice into a series of obnoxious rants about “the healing power of god”, but I let it go because I know deep down he knows the real medical reasons behind the usefulness of his treatments (Chiropractors are trained doctors, after all.)

    I think what a lot people are confused about is that Chiropractic doesn’t cure cancer or heart-disease, but if initiated early enough it certainly can prevent it; that’s the key word here, preventative. By removing subluxations and strengthening nerve connections from your spine to the rest of your organs, the immune system is freed up to focus on preventing the invasion and spread of foreign-induced illnesses. The problem is, most people are suffering from some sort of ailment that could be either cured or prevented by Chiropractic adjustments…

    I firmly believe that if everyone received Chiropractic care, the world would be a much better place. (And it sure beats the hell out of pill-popping for the rest of your life.)

  5. Aline
  6. Crystal

    While I know Singh must (and should!) appeal, the real battle isn’t over the definition of a word – it’s that regardless of the outcome of Singh’s appeal, scientists will continue to be sued and put under pressure in Britain until this libel law is changed. It’s silly and hinders the entire idea of scientific criticism.

  7. truthspeaker

    3. Damon Says:
    June 3rd, 2009 at 5:46 pm
    Darn, too bad about this… as a sufferer of borderline scoliosis I can personally attest to the profound healing power of Chiropractic– cured my headaches, bodyaches, psoriasis, improved my mood and sexual health, made it so I could swallow food again, not to mention eliminated most pain involving my neck and lower back– but indeed, the profession itself is full of some pretty nutty people. My own Chiropractor feels the need to oversimplify his practice into a series of obnoxious rants about “the healing power of god”, but I let it go because I know deep down he knows the real medical reasons behind the usefulness of his treatments (Chiropractors are trained doctors, after all.)

    No, they aren’t.

    I think what a lot people are confused about is that Chiropractic doesn’t cure cancer or heart-disease, but if initiated early enough it certainly can prevent it; that’s the key word here, preventative. By removing subluxations and strengthening nerve connections from your spine to the rest of your organs, the immune system is freed up to focus on preventing the invasion and spread of foreign-induced illnesses.

    There is no evidence that is the case. There is not even evidence that “subluxations” exist.

  8. #3 Damon,
    “(Chiropractors are trained doctors, after all.)”

    Oh really? What country would this be in? Or, by “Doctors”, do you mean “Chiropractic” doctors? They are most certainly NOT trained medical doctors, that have gone through seven years of medical school, done residency, and held a private practice. They certainly cannot prescribe drugs.

    Here in Canada, there have been numerous wrongful death suits filed against chiropractors because patients, who have had that head turning, neck cracking move done on them have died of a stroke shortly after. Strokes have been directly attributed to that procedure.

    While some people may get a benefit from an occasional adjustment, what Phil and others are talking about here are the claims that chiropractic practitioners can heal a host of ailments without conventional medical aid. Sorry, but anecdotal evidence does not count.

    We have a TV spot that runs here in British Columbia, showing a guy out on the golf course. He states that a short while ago, he couldn’t do this, and was scheduled for back surgery. He thought it was a good idea to get a second opinion from… wait for it… A Doctor of the BC Chiropractic Association! And, lo and behold, his chiropractor cured him! Now he can enjoy lazy sunny days on some of the best golf courses in the world! All the while encouraging people with serious back problems to go see their chiropractor!

    Of course, this is a TV commercial, and the guy on the golf course is an actor. No real, verifiable proof is ever offered to back up any claims.

  9. @Damon – the point is that there is absolutely no evidence that Chiropractic has any effect on the immune system at all, and certainly can’t prevent cancer. It can ease back pain, which may in turn ease stress (which might explain your psoriasis and headache improvements), but that’s about it. And it is quite a shame that it makes all those claims, as they tend to trivialize where it actually does help.

  10. Greg the Goofy Antiscience Guy

    Phil wrote:

    “This clearly comes down to the definition of the word “bogus”. Merriam-Webster calls it “not genuine : counterfeit, sham”. Of those three, only sham denotes knowledge on the part of the person involved; something can be not genuine or counterfeit, yet presented honestly if mistakenly.”

    Uh, I think this line of reasoning is best left unexplored. “Counterfeit” also has pretty much the same definition (“made in exact imitation of something valuable with the intention to deceive or defraud.”). Seems that in this case, Singh made a really bad choice of word. The argument should perhaps instead centre on what “promotes” means – I think that removes them one step from the actual ‘counterfeiting’, and so perhaps doesn’t therefore suggest that they are the ones knowingly deceiving.

    I think what needs to be acknowledged though is that you can “Keep the Libel Laws Out of Science” simply by presenting the science, rather than saying things like “happily promotes bogus treatments”. Singh is British, he’s a high-profile media skeptic – he should have had a pretty good understanding of the law before writing a controversial column. There needs to be a little ownership here of a mistake made, and acknowledgement that libel laws can’t be used against you if you’re just presenting solid science. I’m cringing a bit at the way in which this is being mischaracterised as the legal system silencing science.

    My additional query would be that surely Singh had the opportunity to withdraw the remark before legal action was taken? Why did he not just withdraw the remark “bogus” and present some science?

    Having said that, I fully support Singh in his appeal. I have a strong dislike of of anything but essential use of libel laws, and as a publisher I fully understand the difficulties in screening all of your text for every definition and nuance. I also enjoy healthy debate and dislike those that resort to petty rebuttals to the larger topic at hand.

  11. Ender

    Our system of libel in the UK is appalling. What’s worse it it’s spreading abroad. Book publishers in the US who release books only in the US are being sued in the UK for libel because one or two books were sold on eBay and imported into the UK, and thus (apparently) are subject to UK libel laws.

    May I suggest that you Americans declare that UK libel suits against US citizens and corporations are a violation of first amendment rights, and refuse to pay any alleged damages imposed by UK libel courts.

  12. truthspeaker

    Singh doesn’t need to acknowledge making a mistake, because he didn’t make one. Members of the BCA do, in fact, happily promote bogus treatments.

    There is nothing in that sentence that would imply to any native speaker of English (other than Mr. Justice Eady, who may or may not have been blackmailed by the BCA after photographs surfaced of him in a compromising position with Jacqui Smith in a taxpayer-funded second home) that they knowingly promote bogus treatments.

    But even on the “knowingly” non-issue, it seems like Mr. Justice Eady (about whose alleged cocaine addiction there is NO firm evidence at this time) would benefit from reading William K. Clifford’s story about the willfully ignorant shipowner from The Ethics of Belief. We can’t prove that the members of the BCA know their treatments are bogus. But we can prove that they should have known they were bogus. The data about the inefficacy of chiropractic care are readily available.

  13. @Michal L – to add to your comment, York University recently declined an affiliation with Memorial Chiropractic College because of unscientific claims. A DC (Doctor of Chiropractic) is granted only by chiropractic colleges, not universities. Physiotherapy is offered in universities, Massage Therapy is offered in specialized colleges, but not universities. Chiropractic is somewhere in between, though neither MT’s or Physio’s are doctors. But then, you can be a “doctor” of naturopathic medicine or homeopathic medicine too. Unfortunately “doctor” is not a regulated designation…

  14. We’ve always been given the impression here in the UK that suing is far easier over in the States than it is here. It’s sort of a relief to think that here is worse – that at least it doesn’t (over with you, anyway) get sillier than this.

    Suing is just another form of legitimised attack, and the sue-ee, like so many types of victim, so often gets the stigma and blame.

    GO SINGH!!!! You sue them, mate, and put them in the victim position. And would Ben Goldacre come and help?

  15. truthspeaker

    15. Alice Says:
    June 3rd, 2009 at 6:45 pm
    We’ve always been given the impression here in the UK that suing is far easier over in the States than it is here.

    That’s probably true for personal injury cases, especially in California, where having your feelings hurt (“emotional distress”) is considered an injury. It’s just libel and slander where the England is a legal laughingstock.

    I just edited this comment to replace “UK” with “England”. My understanding is that it’s only England that has these crazy laws. In Scotland they are more sensible. I don’t know about NI or Wales.

  16. sailor

    “We can’t prove that the members of the BCA know their treatments are bogus. But we can prove that they should have known they were bogus.” Truthspeaker.
    Yes this is a good point. Anyone practicing some form of healing art today should know if it works and how effective it is. Ignorance in this case should not be an excuse. If Singh can prove that where he calls Chiropractic bogus, there is absolutely no evidence that chiropractic works for those symptoms, then if the chiropractors are ignorant of this, they would, it seems to me, be criminally negligent.

  17. Damon

    No proof that Chiropractic works, eh? Nevermind the hundreds of thousands of satisfied customers. Nevermind the existence of Chiropractic degrees and clinics. But that all falls under the definition of “anecdotal” evidence, so it doesn’t count, huh? That’s some great logic there. So I guess we can write off rapes as anecdotal as well then?

    Yes, Chiropractors are doctors. Not the kind of doctor that blows seven years and hundreds of thousands of dollars in tuition to write prescriptions for placebos or memorize extensive internal anatomy charts to impress their friends at Jeopardy, but the kind of doctor who prevents us from needing those kinds of people in the first place– probably the real reason Chiropractic is under attack. Somebody is losing money.

    Medical Doctors are a dime-a-dozen– like police, useful in an emergency, but ultimately disposable. They claim to be men of science, but I get a different answer for the same ailment out of them every single time. I get a kick out of their frustrated reactions when I ask them to recommend me a decent Chiropractor or refuse their invasive treatments.

    The only viable criticism I’m seeing here is towards the unfortunate side-effects of Chiropractic such as strokes, but those aren’t the fault of the Chiropractor; they simply exposed a pre-existing condition that probably would have killed the person in a short time, any way. If you disagree with that logic, too bad; it doesn’t discredit the 99% of satisfied customers of Chiropractic.

    But, please, go on ignoring all of the positive data. Go on insisting that subluxations don’t exist. I certainly wasn’t aware it was possible to fake an X-Ray.

  18. Pardon this lengthy post, but this is an issue central to science and skepticism, and is thus very important. I ask my readers to please read the whole thing

    Dood, have you been to oracs blog? This was but a mere haiku compared.

  19. Its actually rather funny that Damon is espousing his love for expensive placebo on a post about chiropractic. Singh wrote extensively about it (and why it is nonsense) in his book. you should pick it up, its called Trick Or Treatment. Funny part is that one of the dangers of chiropractic as it is commonly practiced is the heavy use of x-rays, particularly without radiological education.

    Appeals to popularity and “Science doesn’t know everything” will get you nowhere.

  20. Why are people so weird about English libel law? The burden of proof is just the same as in a criminal trial: the victim doesn’t have to prove a negative, i.e. that they didn’t do what they were accused of.

    Suppose you’re a celebrity, and a newspaper article claims that you sleep with prostitutes, for example: under the English system it’s the newspaper that has to provide some proof of their allegation; under the US system you’re faced with the daunting–if not impossible–task of proving that you don’t in fact sleep with prostitutes.

    There are cases in which the English system is fairer and ones in which the US system is fairer, but for some reason the English system gets an almost universally negative reception.

  21. Alex

    @truthspeaker

    With the exception of a very few Welsh only acts of Parliament the legal systems of Wales & England are unified, due to a series of acts in the 16th century. You might think it similar to the way that the DC compares to the states, with a few DC only laws, plus lots of ‘every state’ laws.

    There is also the Welsh Assembly, who have powers to secondary legislation, such as deciding on fees, and how funds should be spent, but cannot create laws without the permission from Westminster.

    This is very different to the Scottish & Northern Ireland situations, where they have always had separate legal systems, and therefore the Scottish Parliament and the Northern Ireland Assembly can pass primary legislation.

  22. Steve Morrison

    The well-known linguistics blog Language Log had an entry last month about this case; it pretty much shreds the idea that the word “bogus” automatically implies conscious fraud.

  23. Brian

    I had been under the impression, until Singh’s case arose, that the England was going to improve their guilty-till-proven-innocent libel laws, as part of an effort to bring themselves more in harmony with the EU. Apparently I was completely wrong….

    Singh’s decision to appeal is a relief for the rest of us, of course, but he must realize he could be taking on a huge amount of effort and expense in the coming months. I hope it pays off in the end.

  24. Alex

    @Daemon

    If the strokes were a pre-existing condition rather than due to the manipulation then you would expect the occurrence rate to be the same for people who have had it compared to controls who have not.

    However, a scientific study found the exact opposite, you were 5 times more likely to have a stroke within 1 week of manipulation.

    Another study looked at the victims, and found that there was no reason to suspect that they would suffer from strokes, and in particular that there were no predisposing vascular lesions.

    Given both of these studies (And many more on similar subjects, the risk has been known since at least the late 70′s), it is clear that manipulation is dangerous.

    Of course, strokes are only one possible adverse reaction, there are many others, eg Epidural hematoma, which can cause paralysis.

  25. OK, I’ve read both of Damon’s comments twice, and I still can’t decide if he’s being satirical or not.

  26. Daniel J. Andrews

    Damon said, “Nevermind the existence of Chiropractic degrees and clinics. But that all falls under the definition of “anecdotal” evidence, so it doesn’t count, huh? That’s some great logic there. So I guess we can write off rapes as anecdotal as well then?”

    1. There are numerous degrees/clinics for amazing cancer cures too. How do degrees and clinics provide proof that chiropractic works?

    2. Anecdotes for evidence are subject to human bias and recreation of memories. Educate yourself on this. Start with this 9 minute youtube clip.
    http://www.youtube.com/watch?v=NPqerbz8KDc

    3. Do not trivialize rapes and use them in an attempt to support your point. You should well know the difference (physical trauma, DNA transference confirm rape). What were you thinking when you used this example?

    Points 1 and 3 demonstrate your idea of “some great logic there”. Point 2 demonstrates lack of knowledge. And your whole post did not have a single bit of evidence to support any of your contentions. As well it is obvious you don’t really know much about doctors and their training.

    I bet you’re just making things up, aren’t you? If you say you aren’t, you can bet people are going to ask you to provide evidence for subluxations showing on x-rays, that subluxations even exist, and that people who died after neck manipulation would have probably died soon anyway.

    heh.10 second Google search–
    http://www.quackwatch.com/01QuackeryRelatedTopics/chirosub.html

    Apparently even chiropractors are divided on whether or not you can see subluxations on x-rays. That should only take 5 minutes to see if this claim is true or not. Go to it, Damon. Find the evidence to refute this claim. Maybe you’ll find evidence for your other statements too?

    @Paul: Oops, you may be right. We might have been Poe’d. His posts were very stereotypical and with just a few word changes could have belonged to any antiscience or conspiracy group, couldn’t they? Dang.

  27. DC

    The ignorance of most posters here is prevalent. Those who claim to know the science of manipulation medicine really don’t know much, if anything at all. Let’s stick to the science, shall we?

    First: The evolution of chiropractic medicine in Canada

    http://www.thestar.com/article/642057

    The bottom line is that ANY health professional or layman that does not respect the skills of a chiropractic doctor in the field of NEUROMUSCULOSKELETAL medicine is outrageous. DCs are primarily NMS specialists who are experts in spinal and joint manipulation. Joint dysfunction, segmental dysfunction, somatic dysfunction? Synonyms for subluxation. It’s a non-functional joint.

    Furthermore, there has been no single mode of therapy MORE studied than chiropractic spinal manipulation for spinal pain syndromes, and no BETTER therapy than spinal manipulation for both acute and chronic low back pain. There is also NO better therapy than spinal manipulation/chiropractic adjustment for mechanical neck pain grades 1-2 (read the WHO Bone and Joint TaskForce 2008 document if you haven’t already).

    The bottom line is that chiropractic medicine has a growing body of evidence for non-musculoskeletal complaints, the most recently done by Hawk et al. in 2008. Read up on it first before you discard it. As for truthspeaker, techskeptic and others, you have no clue what you’re talking about and clearly do not have the research, practical or clinical skills in musculoskeletal medicine. Why don’t you let the REAL professionals and researchers debate this properly as opposed to your grandstanding?

  28. #18, Damon

    So, when you have a heart problem, are you going to call your chiropractor instead of a cardiologist?

    How about cancer?

    Stroke?

    Brain Injury?

    Diabetes?

    Pneumonia?

    Swine Flu?

    Bird Flu?

    Regular Flu?

    Interestingly enough, I have had experiences with chiropractors. One thing I could never understand, is why I needed to continue to see the “good doctor” week after week, if his “treatment” was supposed to work? When I go to the “regular, dime-a-dozen doctor” for a prescription of a “so-called” placebo, it generally clears up whatever problem I have.

    Oh, the reason my chiropractor gave? Weekly maintenance!

    You also stated:
    “The only viable criticism I’m seeing here is towards the unfortunate side-effects of Chiropractic such as strokes, but those aren’t the fault of the Chiropractor; they simply exposed a pre-existing condition that probably would have killed the person in a short time, any way. If you disagree with that logic, too bad; it doesn’t discredit the 99% of satisfied customers of Chiropractic.”

    WRONG!

    Many of these individuals were healthy young, fit adults and adolescents with absolutely NO pre-existing conditions:

    “Researchers representing the Canadian Stroke Consortium have reported on 98 cases in which external trauma ranging from ‘trivial’ to ‘severe’ was identified as the trigger of strokes caused by blood clots formed in the arteries supplying the brain. Chiropractic-style neck manipulation was the apparent cause of 38 of the cases; 30 involved vertebral artery dissection and 8 involved carotid artery dissection. Other Canadian statistics indicate that the incidence of ischaemic strokes in people under 45 is about 750 a year. The researchers believe that their data indicate that 20% are caused by neck manipulation, so there may be ‘gross under reporting’ of chiropractic manipulation as a cause of stroke.

    Paper presented by V Beletsky at the American Stroke Association’s 27th International Stroke Conference, San Antonio, Texas, USA, 7–8 February 2002.”

    How about this study from California in 1995:

    “Lee KP, Carlini WG, McCormick GF, Albers GW.

    Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Palo Alto, CA 94304-1705, USA.

    To obtain an estimate of how often practicing neurologists in California encounter unexpected strokes, myelopathies, or radiculopathies following chiropractic manipulation, we surveyed each member of the American Academy of Neurology in California and inquired about the number of patients evaluated over the preceding 2 years who suffered a neurologic complication within 24 hours of chiropractic manipulation. Four hundred eighty-six neurologists were surveyed, 177 responded; 55 strokes, 16 myelopathies, and 30 radiculopathies were reported. Patients were between the ages of 21 and 60, and the majority experienced complications following cervical manipulation. Most of the patients continued to have persistent neurologic deficits 3 months after the onset, and about one-half had marked or severe deficits. Nearly all of the strokes involved the posterior circulation and almost one-half were angiographically proven. Patients, physicians, and chiropractors should be aware of the risk of neurologic complications associated with chiropractic manipulation.

    PMID: 7783892 [PubMed - indexed for MEDLINE]”

    Before you whine about “cut and paste” jobs, at least I actually took the time to dig a little to find evidence to back up what I am saying. Now, would you like to respond in kind?

    (Sorry other BAblogees, if it’s difficult to read who is saying what, I haven’t figured out how to bold and italicize things yet!)

  29. For those on Facebook, there is also the group “For Simon Singh and Free Speech – Against the BCA Libel Claim”.

    http://www.facebook.com/group.php?gid=33457048634

  30. DC

    Michael L

    Quoting outdated research does not do this discussion any good, especially if there is more current research that is SPECIFIC to chiropractors and not just anybody perform SMT.

    The main gist is that VB stroke is UNPREDICTABLE and occurs at the same relative frequency in MDs and DCs offices

    Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.

    Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.
    Centre of Research Expertise for Improved Disability Outcomes, University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, ON, Canada. dcassidy@uhnresearch.ca
    STUDY DESIGN: Population-based, case-control and case-crossover study. OBJECTIVE: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke. SUMMARY OF BACKGROUND DATA: Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke. METHODS: Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls. RESULTS: There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke. CONCLUSION: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

    Also, strokes rates have increased despite DECREASED chiropractic utilization in 2 Canadian provinces.

    Examining vertebrobasilar artery stroke in two Canadian provinces.

    Boyle E, Côté P, Grier AR, Cassidy JD.
    Centre of Research Expertise for Improved Disability Outcomes, University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Ontario, Canada. eboyle@uhnresearch.ca

    TUDY DESIGN: Ecological study. OBJECTIVES: To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization. SUMMARY OF BACKGROUND DATA: Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level. METHODS: All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates. RESULTS: The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period. CONCLUSION: In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

    Michael L is talking and PROMOTING the fringe while completely neglecting the evidence-based wing of the profession. He is using straw men arguments with outdated data. Perhaps Michael L is familiar with the risks/benefits research regarding neck manipulation and CHIROPRACTIC care (it is specific to chiropractors and not others who do not have the expertise in spinal manipulative therapy)

  31. Geoff

    Britains laws go too far as Singh was not only demonstrably correct but the judge put too much weight on a single word. But I don’t agree with the American view of Libel laws either.

    If I were to punch someone in the face, it is me who should be held responsible for my actions.

    If I call someone a child molester, it is also me who should be held responsible for my actions.

    Speech is an act in of itself and there are consequences and one should be held responsible for it.

    It works both ways too. US laws protect anti-vaccers who say irresponsible things about doctors and medicine and cause harm. I don’t think that’s any more just.

    Bottom line. Don’t make fallacious claims against someone. Back up with evidence and be prepared to fight.

    I think that’s the way it should be.

  32. DC

    Singh:

    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 organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

    From practice-based (real world) research done by pediatric DCs published no less in EDZARDS ERNST’s FACT perdiodical.

    http://www.medicinescomplete.com/journals/fact/current/fact1205a13a01.htm

    There is SOME research which is beginning to come out, but one must understand that there have been numerous POLITICAL barriers to get funding to do chiropractic-related research for many reasons that go beyond the scope here. Singh used language that was too harsh and critical, left himself open to a lawsuit, and by the time this goes to appeals there are I believe 3-4 studies on colic, otitis media and asthma that suggest that manual interventions used by DCs improves objective outcome measures. So, yeah, it’s OK to be skeptical (in fact in science it’s required) however most of these posters here have crossed the skeptical line into a hardline ideological dogma against chiropractic medicine.

  33. Andy

    Chiropractic manipulation is a crock, they might as well put up signs that say witch doctor. British libel laws are also a crock.

  34. DC

    Andy

    Research says chiro manipulation is the best for back pain. You are being anti-scientific at this point.

  35. Zombie

    The worst part of Singh’s case is that a judge has basically chosen an interpretation of his own that Singh is forced to defend even though that isn’t even what he said. British libel law would be bad enough defending against reasonable things one might say without such arbitrariness.

    As to chiropractic (to DC of #36), there is apparently a small amount of research saying adjustments work about as well some other physical interventions like massage for temporary relief of a subjective symptom. That implies absolutely nothing about any other application of chiropractic, and certainly nothing about magical subluxations. There are chiropracters, and they aren’t some whacko minority, who claim one can discard all of science-based medicine for chiropractic treatment. The difference between evidence and claim is like building a sandcastle and thinking you’ve conquered all of Europe.

  36. @ Damon,

    I think what a lot people are confused about is that Chiropractic doesn’t cure cancer or heart-disease, but if initiated early enough it certainly can prevent it; that’s the key word here, preventative.

    Though I’m sure, after reading your further comments, that you’re a Poe trying to make chiropractic appear even sillier than many here already think it is, I’ll play along and ask how, without large blinded trials, does someone who doesn’t get cancer determine what it was that made them not get it?

    I, for example, like to whistle occasionally and, though I’m nearing 50, have never suffered a heart problem. Does this prove whistling prevents heart disease? Should I write a book about my new hypothesis? Would you buy it?

    My cartoon and summary can be found here.

  37. TS

    @Damon:
    Are you really cured? or do you have to see a chiropractor on a regular basis?
    If you still have to go for treatments, you are not cured but have become a regular source of income for a chiropractor.

    There a places that can help you deal with Scoliosis on an earthly basis, where they will teach you exercises to build your muscles to compensate for your spine problems. But first you should see a real doctor to get a proper assessment of how serious your problem is.
    A member of my family suffers from Scoliosis and as an alternative to spinal fusion (which is what serious cases might require) she had a week of training that targeted her particular case. It turned her life around, she still have to do about half an hours worth of muscle exercises every day, but she feels much better (and she’s got a well toned body on top of that).

  38. Charon

    @Rob Miller (21): What? The burden of proof for libel in England is completely backwards from criminal trials. If you are accused in a criminal trial, you are assumed _innocent_ until the prosecution can _prove_ you guilty. So in libel, the person accused of libel should be assumed innocent until proven guilty, i.e. the burden of proof is on the prosecution.

    Well, innocent until proven guilty is basic in the US. I know that’s not the case in every country, but I would have thought it was the same in England, since we share a common-law background.

    Update: on rereading your comment, I think you are under the misapprehension that the person accused of libeling is in fact the prosecution, because they accused the other person of something. This is bizarre, because one is a legal accusation in a court of law and other is a public remark.

  39. Charon

    To those who believe chiropractic works: read Singh and Ernst’s book. Chiropractic probably does work, for some things, like back pain. Many chiropractors know these limitations. The problem is many others who don’t, and think they can do things that are completely crazy, like, well, prevent cancer.

    If you are going to have a debate on a scientific subject, you must first realize one thing: your personal experiences in uncontrolled situations are not evidence, and neither are anyone else’s. They are great places to get ideas to test, but they are not tests themselves. If you can’t admit this, there’s no point talking.

  40. #34. DC says that I am:

    “Michael L is talking and PROMOTING the fringe while completely neglecting the evidence-based wing of the profession.”

    Um, really? I’m promoting the fringe??? Funny, I do not remember that!

    When I was seeing a chiropractor, before a spinal cord injury, I was NEVER made aware of the risks of neck manipulation. Those risks are clearly known and understood by chiropractors. If I had known the risks, I would have had the opportunity to decline the procedure.

    Incidentally, after my injury, in which I learned that I have a tethered spinal cord (look it up, I’m not going to bother explaining it), I was told by the neurosurgeon that operated on me, twice, that even though he has no problem with chiropractors, he warned me that in my case, spinal manipulation could lead to permanent paralysis because of the tethering. Now, who am I going to believe? One of the top neurosurgeons in Canada, out of the U of A Hospital, that has had 14 years of medical training, plus over 25 years of practical experience, OR, the local chiropractor that has acquired his ‘doctorate’ in 3 or 4 years from a college that is not recognized by the established medical community?

    As far as out-dated data, the data is still relevant. Those cases cited were shown to be a result of spinal/neck manipulation!

  41. foolfodder

    An organisation honestly promoting bogus treatments would try to show that their treatments work. Instead the BCA chose to sue. That indicates to me that they know, or at least suspect, that their treatments are bogus.

    To me, the fact that they are suing invalidates their case.

  42. Alex

    #32 DC

    Have you actually read the paper you quoted? It says that you’re 3 times more likely to have visited a chiropractor. In other words, the rate is NOT the same.

  43. Funkopolis

    We should all just refer to the BCA as the Bogus Chiropractic Association all the time, everywhere. They can’t sue everyone. 09f91102…

  44. Sili

    *sigh*

    I kept waiting for the reveil while reading Damon’s post – and then it turned out not to be satire.

  45. ethanol

    Funkopolis- Yes!, that is the way to make them regret trying to silence criticism. But you do it first…
    Does anyone know if the judge for the appeals case gets to issue a new ruling on what Singh “meant” or does he have to utilize the previous ruling?

  46. @Funkopolis

    I agree if every scientific publication and blog article that caries Simon’s story called the claims the BCA makes Bogus as well.. it would be hard to sue everyone, in fact the view would be a consensus (and no longer defamatory).

    They should change the button text to inlcude “BCA claims are bogus, keep the libel laws out of science”! Esp since the claims regarding paediatric asthma, colic etc are so clearly bogus.

  47. Between medical errors, pharmacuetical errors, and normal pharmaceutical drugs about 200,000 people a year die in the U.S. And you guys want to bash chiropractic which keeps people healthy? Can someone please explain to me their understanding of the relationship of the spine and nervous system to the rest of the body?

    We chiropractors know what we do works. We see it everyday in the benefits our patients receive. If you choose not to go to a chiropractor and prefer an MD, that’s fine with me, but why the need to bash something you clearly don’t understand?

    Chiropractic research is far behind medical research for several reasons; mainly lack of funding, political obstructions, and difficulty in performing sham adjustments as a control in the study. (Have you heard of the small but remarkable study by an MD at the University of Chicago Med School? They found a technique whereby a patient can’t tell if they got the real treatment or not. The subjects all had HBP and all who got the real treatment experienced a marked decrease in BP equal to several meds over the course of several week/months. All who received the sham treatment experienced no change.) There is, however, a growing body of legit research in our field. If you’re honest and open-minded you’ll check it out.

    Chiropractic training is very similar to medical training. The MDs get more pharmacolgy and toxicology and the chiros get more anatomy and physiology. I had every -ology course you could name, gross anatomy for 8 months, took physical diagnosis and pathology courses, had 9 radiology courses, learned EMR from the Red Cross, even learned how to do phlebotomy, had a year and half of clinical work under a staff doctor, and took a four part National Board to earn my doctorate. If you stil think I’m not a “real” doctor that’s OK with me. By all means you’re free to go to the “real” doctor. You just won’t experience what I have to offer. My patients would strongly disagree with you.

    I have a lot of interactions with MDs and ask about their training. We value the information we each have to offer and we use that info to better the health of our patients.

    Chiropractors are the experts in the spine and chiropractic neurologists (a 3 year post grad dilpomate degree) are experts in the brain and nervous system.

    So guys, you can keep on with your negative and quite ignorant rants, but see if you can be just a bit open-minded and check ALL the most recent research. Would you even know where to look? See if you can come up with a relationship between the brain, spine, joints, muscles, and the rest of the body. Tell me how joint mechanoreceptor function plays a role in one’s health. Explain to me how having fixated joints would cause a global decrease in function. Tell me about the relationship between structure and function. I could ask for much more but I’ll leave that as your HW for now.

    Be honest. Keep it positive. Be informed.

    Dr. Reuven M. Rosenberg
    Chiropractor

  48. piratebrido

    The Libel laws over here stink. I am not sure if Scottish law differs from English and Welsh law regarding libel, but it is a shocking situation. I was at a Skeptics in the Pub meeting in Edinburgh which Simon was the speaker and he really chewed over his decision – it clearly wasn’t easy for him. He has an practically impossible case to win, so he really does require everyones support. He personally has put huge amounts in the line by appealing the decision. I have huge respect for Simon Singh.

  49. Nigel Depledge

    Damon said:

    Darn, too bad about this… as a sufferer of borderline scoliosis I can personally attest to the profound healing power of Chiropractic– cured my headaches, bodyaches, psoriasis, improved my mood and sexual health, made it so I could swallow food again, not to mention eliminated most pain involving my neck and lower back

    No. Because the two things coincide in time does not prove a causative link. How can you ever know that your condition would not have improved anyway? How can you know that it was not simply the placebo effect (which has been demonstrated to be especially powerful with regard to pain relief)? Without a randomised, double-blind, controlled trial, you cannot know.

    – but indeed, the profession itself is full of some pretty nutty people.

    True.

    My own Chiropractor feels the need to oversimplify his practice into a series of obnoxious rants about “the healing power of god”, but I let it go because I know deep down he knows the real medical reasons behind the usefulness of his treatments (Chiropractors are trained doctors, after all.)

    I’m not so sure about that last bit. I have not heard or read anywhere else that chiropractors have to be doctors first. What is your source for that?

    I think what a lot people are confused about is that Chiropractic doesn’t cure cancer or heart-disease, but if initiated early enough it certainly can prevent it; that’s the key word here, preventative. By removing subluxations and strengthening nerve connections from your spine to the rest of your organs, the immune system is freed up to focus on preventing the invasion and spread of foreign-induced illnesses.

    OK, this is a load of nonsense. Whether it works or not (and, for most conditions, there really isn’t any evidence that it does), the terminology used by chiropractors does not illuminate, it obscures.

    The problem is, most people are suffering from some sort of ailment that could be either cured or prevented by Chiropractic adjustments…

    Again, this claim is not supported by any evidence.

    I firmly believe that if everyone received Chiropractic care, the world would be a much better place. (And it sure beats the hell out of pill-popping for the rest of your life.)

    Actually, I think the opposite is true.

    Chiropractic may have a place in treating certain kinds of muscular or joint problems, but the current evidence shows that it has no better effect than a placebo when treating other ailments.

  50. Nigel Depledge

    Crystal said:

    While I know Singh must (and should!) appeal, the real battle isn’t over the definition of a word – it’s that regardless of the outcome of Singh’s appeal, scientists will continue to be sued and put under pressure in Britain until this libel law is changed. It’s silly and hinders the entire idea of scientific criticism.

    Agreed.

    Furthermore, I think any organisation (such as the BCA) making a claim in order to sell something (in this case, chiropractic in general) should have to supply proof when asked for it. Sadly, the Advertising Standards Agency is a toothless puppet of the industry it is supposed to regulate.

    However, the UK has never claimed to be a genuinely free country. Freedom of speech has never been enshrined in a constitution as it is in the USA.

  51. Moose

    At its best, chiropractic is nothing more than untrained, unlicensed, and unregulated physiotherapy. At worst, it’s a great way to induce a stroke.

  52. Nigel Depledge

    Truthspeaker said:

    Singh doesn’t need to acknowledge making a mistake, because he didn’t make one. Members of the BCA do, in fact, happily promote bogus treatments.

    There is nothing in that sentence that would imply to any native speaker of English (other than Mr. Justice Eady, who may or may not have been blackmailed by the BCA after photographs surfaced of him in a compromising position with Jacqui Smith in a taxpayer-funded second home) that they knowingly promote bogus treatments.

    But even on the “knowingly” non-issue, it seems like Mr. Justice Eady (about whose alleged cocaine addiction there is NO firm evidence at this time) would benefit from reading William K. Clifford’s story about the willfully ignorant shipowner from The Ethics of Belief. We can’t prove that the members of the BCA know their treatments are bogus. But we can prove that they should have known they were bogus. The data about the inefficacy of chiropractic care are readily available.

    Agreed.

    In a similar vein, it is possible to innocently use a counterfeit banknote, if you are ignorant of how to distinguish it from the real thing. The crime is in making the counterfeit note, and in knowingly attempting to use a fake in place of the real thing. Average Joe Public cannot be expected to tell a good fake from a genuine note, but in the case of the BCA, they most certainly have a duty to be aware that what they promote does not do what they claim it does.

  53. Nigel Depledge

    Damon said:

    No proof that Chiropractic works, eh? Never[ ]mind the hundreds of thousands of satisfied customers.

    Never mind the fact that “never mind” is two words.

    Any number of “satisfied customers” can be wrong. After all, what qualifies them to judge the efficacy of a medical intervention?

    Never[ ]mind the existence of Chiropractic degrees and clinics.

    None offered by reputable universities – and I think you may agree that chiropractic colleges have a vested interest in selling their product as if it were reliable.

    But that all falls under the definition of “anecdotal” evidence, so it doesn’t count, huh? That’s some great logic there.

    No, it is anecdotal evidence (not “anecdotal”, because it actually is mere anecdote). The logic is sound. Without some form of experimental control, the outcome means precisely nothing.

    Do you have any idea how medical science works?

    So I guess we can write off rapes as anecdotal as well then?

    What? This is an utter non-sequitur.

    The reasons that anecdotal evidence cannot tell us anything about medical interventions are several. Here are a few, in brief:

    (1) With no control, it is logically impossible to establish a causal link.
    (2) Without statistical significance for the exact same intervention, establishing a causal link is not reliable.
    (3) Regression to the mean (people tend to seek treatment when their symptoms are at their worst, and they may simply have got better without intervention).
    (4) The placebo effect.

    Yes, Chiropractors are doctors.

    If they do not have training and a degree from a reputable university medical school, they are not doctors.

    Not the kind of doctor that blows seven years and hundreds of thousands of dollars in tuition to write prescriptions for placebos or memorize extensive internal anatomy charts to impress their friends at Jeopardy, but the kind of doctor who prevents us from needing those kinds of people in the first place

    Aha, I see you are now using the Making Stuff Up debating tactic. Why do you wish to prove to us that you do not believe that you have an argument to present?

    – probably the real reason Chiropractic is under attack. Somebody is losing money.

    Chiropractic is “under attack” for several reasons:

    (1) It is largely a pack of lies (vis, your “subluxations” comment earlier).
    (2) It does not do what the BCA claims it can do.
    (3) It can cause patients who need to seek proper medical treatment to not do so.
    (4) It can kill people, but chiropractors do not explain the risks to their customers, and neither do they seek informed consent.

    Medical Doctors are a dime-a-dozen– like police, useful in an emergency, but ultimately disposable.

    And thus the ignoramus dismisses years of hard-won expertise. If you really have such a low opinion of the medical profession, simply don’t visit them. Ever.

    They claim to be men of science, but I get a different answer for the same ailment out of them every single time.

    Ah, so you do make use of their expertise after all. Hypocrite.

    There could be any number of reasons you get different answers for what seems to you to be the same thing. Here are some possibilities:
    (1) They actually know more about it than you do, and it is not the same ailment no matter how it seems to you.
    (2) Doctors are human beings and thus fallible.
    (3) There may be several equally efficacious treatments for the same ailment.
    (4) Different treatments have different efficacies in different patients. It may be that you doctor or doctors are exploring what might work best for you.
    (5) It may be that medical science is, y’know, advancing and that is why you perceive treatments changing.

    I get a kick out of their frustrated reactions when I ask them to recommend me a decent Chiropractor or refuse their invasive treatments.

    You get a kick out of preventing an expert from helping you? How twisted and perverse.

    The only viable criticism I’m seeing here is towards the unfortunate side-effects of Chiropractic such as strokes, but those aren’t the fault of the Chiropractor;

    Actually, the link has been demonstrated. It is the fault of chiropractic.

    they simply exposed a pre-existing condition that probably would have killed the person in a short time, any way.

    There is no evidence to support this view. You have simply made it up (or parroted the words of someone else who made them up) to defend chiropractic.

    Your logic is virtually non-existent.

    If you disagree with that logic, too bad;

    No, it’s not “too bad”, it’s proof that chiropractic, in many situations, does more harm than good.

    it doesn’t discredit the 99% of satisfied customers of Chiropractic.

    Not by itself. However, coupled with the fact that there is no evidence of chiropractic having any benefit for 95% of the conditions it is alleged to treat, that does discredit the personal, subjective opinions of people who are not qualified to judge the efficacy of a medical intervention.

    But, please, go on ignoring all of the positive data.

    It’s not data – there is no control. It could merely be coincidence, or the placebo effect.

    Go on insisting that subluxations don’t exist.

    Certainly, until there is some evidence to suggest that they are more than a mere delusion to sell a fake service, I will adopt Ockham’s razor.

    I certainly wasn’t aware it was possible to fake an X-Ray.

    Well, it is, but that may not be relevant. What are you trying to claim here?

  54. ndt

    On strokes, my understanding is that it’s one specific type of neck manipulation that can cause strokes, so it’s possible to administer chiropractic treatment that doesn’t entail a risk of stroke.

  55. DLC

    First, let me say that I am not the person who posted As “DC” above.
    Second: Phil, I am in complete agreement regarding Simon Singh and his appeal.
    I would wish him the best of luck, but I don’t actually believe in luck in the traditional sense, so I’ll say that I hope he has a favorable outcome and an appellate judge who has a bit more on the ball than the original.

  56. RL

    This story make me glad (among other reasons) that I live in the US. Our system may not be perfect but its much more preferable to most other places. Its not to hard to imagine that if the US had the same kinds of libel laws, then Jenny McCarthy would be having a field day with this site and others.

    My own view is that Europe has been going backwards in recent years regarding free speech issues. This reinforces that view.

  57. Geek Goddess

    @Greg the Goofy Antiscience Guy Says – Why doesn’t Singh withdraw the remark or present solid science?

    He has presented the science – he coauthored an entire book reviewing the science. which has been on a best seller list.

  58. RL

    After looking at the Senseaboutscience website, I have to ask this question. Why would anyone in England care if an American doesn’t like their libel laws? While I’m sympathetic and thinks its good if people want to help finance Singh’s fight, I wouldn’t give any weight to a persons opinion on a country’s laws who doesn’t actually live in that country. Wouldn’t it be more appropriate for me, an American, to urge my Congress to make British libel laws unenforceable here? (That would seem to send a very loud message). And let the UK sort out its own laws?

  59. Rob

    @ Geoff (33) — Geoff, you are correct in stating that if you punched someone in the face you would be held accountable, but you would be presumed to be innocent until you were proven guilty, and it would be the prosecution’s job to prove to the jury that you are guilty. You surely would need to defend yourself against them to prove them wrong, but at the end of the day, the burden of proof is on the prosecution and not you. If there were a shadow of a doubt that you were not guilty of punching someone in the face, then you would not be convicted.

    The way British libel laws seem to work, the assumption is that the defendant (Singh, in this case) is guilty, and needs to prove his innocence, ie, the burden of proof has been put on him to prove that the statement was not libelous, which is absolutely an abortion of justice and has an extremely profound chilling effect on free speech. The difference is very plain and it is astonishing that you cannot see it.

    As for that Damon character, methinks I smell a troll. There certainly are people out there of that level of ignorance, but I find it very doubtful that too many of them read science blogs on a regular basis.

  60. Nigel Depledge

    Rob Miller said:

    Why are people so weird about English libel law? The burden of proof is just the same as in a criminal trial: the victim doesn’t have to prove a negative, i.e. that they didn’t do what they were accused of.

    Suppose you’re a celebrity, and a newspaper article claims that you sleep with prostitutes, for example: under the English system it’s the newspaper that has to provide some proof of their allegation; under the US system you’re faced with the daunting–if not impossible–task of proving that you don’t in fact sleep with prostitutes.

    There are cases in which the English system is fairer and ones in which the US system is fairer, but for some reason the English system gets an almost universally negative reception.

    You raise a good point.

    The tricky bit is that the system is open to abuse, as in the present case, where an organisation is trying to stifle legitimate criticism.

    I think that, if the judge had not taken such a narrow definition of the word bogus, Singh would indeed have been able to prove that he was correct.

    One thing is clear to me, however – that the judge has misapplied the law. This law is intended to protect people and organisations from defamation, not information. The BCA knows full well that there is no real evidence for the efficacy of chiropractic as a treatment for most of the conditions for which they recommend it. So, whether Singh intended the word bogus to mean merely “wrong” or fully “fraudulent”, I think he has a point. Here’s hoping for a triumph of reason over marketing.

  61. Patimus

    That’s all we need is people cracking babies’ backs. Great! The chiropractors should have to prove they’re right, which would take years, so they’ll just cause the writer problems to discourage any future dissent. Here’s hoping he wins and establishes a precedent.

    If they’re right, then maybe, just maybe, Jesus was a chiropractor and everyone just assumed he was a carpenter, because they didn’t want to ask what a chiropractor was. “I think he said he was a car-pen-ter?”

  62. RL

    While I’m very skeptical of chiropractors, I do know a lot of people who swear by them and claim to have their ailments remedied. Most of the fixes involve mechanical issues, nothing like sore throats and the like. Its hard to tell them that it doesn’t work. But I also had a friend who worked at a chiropractic office (receptionist or something) and that person told me some outrageous stuff about what the doctor said he could heal. I have trouble reconciling all of the data on this one. I suspect that its a mixed bag of some useful techniques and a lot of questionable claims and techniques.

  63. @ RL (comment 60):

    The problem is – it’s likely that you could also find a lot of people who swear by homeopathy, crystal healing, faith healing, etc. As others have pointed out, you can’t trust a person’s testimonial – even a bunch of people’s testimonials – that the technique works. It’s merely anecdotal.

  64. Nick W

    I felt like putting up some evidence to counter DC’s arguments. I am not an expert in chiropractic medicine. I know some people that swear by it helping their headaches or back pain.

    I found some interesting articles. Including one 1990 article by the “Journal of the Canadian Chiropractic Association”.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2484626

    The article suggests that chiropractors should move to a science-based practice. They even put ‘science’ in quotation marks in the article’s abstract. Although this is a great sentiment, it sounds like deciding on the conclusion before even starting the research. What if the science-based research (is there any other kind?) they do find chiropractic medicine is not effective? Will the association close it’s doors? This also shows that the efficacy of chiropractice medicine in scientific trials has only been recently addressed.

    I found a pretty good review article from 2008 in the “Journal of Pain and Symptom Management”.

    http://download.journals.elsevierhealth.com/pdfs/journals/0885-3924/PIIS088539240700783X.pdf

    According to this review, the original basis of chiropractic medicine was not based on science. The original basis has been thoroughly disproven. There is some evidence for the treatment of back pain, but it seems the reasons for this are unclear and there are conflicting reports. Table 3 on pg 552 has a good summary of many studies showing efficacy. Some studies are conflicting, which puts some doubt in my mind whether there is something there. It turns out a lot of people pick and choose what studies they show. Since science is based on repeatability of results, you need multiple studies that come to the same conclusion to prove a point. There seem to be a lot of “No evidence” under the efficacy column.

    I think the conclusion of that paper is fair:

    “Chiropractors’ belief in the ‘innate,’ subluxation, or spinal manipulation is not rational. Current chiropractic practice raises numerous concerns. The effectiveness, safety, and cost of spinal manipulation are uncertain.
    More and better quality studies are, therefore, required. Until convincing data are available, we might question the value of this popular approach to health care.”

  65. Ian

    Unfortunately the Judge in the case will take the definition of the word ‘bogus’ from Black’s Law Dictionary an American tome, but nevertheless, used globally in the Courts.

    The word bogus is defined as, ‘Counterfeit, sham, imitation’, and, although Mr Singh didn’t know you can bet that the BCA’s Barrister did.

  66. Pieter Kok

    Since this is an English case, let’s look at the OED, instead of Merriam-Webster:
    bogus
    A. (noun) An apparatus for making counterfeit coins; a counterfeit coin.
    B. (adjective) 1. Spurious, sham, ficticious. 2. Very displeasing or inferior, bad. US slang.

    It seems that even though the origin of the word had to do with fraud, this is not so much the case for the adjective.

  67. Double post (done after the edit time was up) – I dunno what happened there, I could have sworn RL’s post was #60, not #64. I must be going crazy (too much coffee?)

  68. Crystal

    It is irrelevant, really, if you think chiropractors do what many claim they can do – which is, in my mind, similar to the preacher who lays his hands on a man and claims God has healed him. There’s no shred of evidence, save the “patient” believing he has been cured, which can merely be a placebo as so many others have pointed out.

    It is also irrelevant if you believe you yourself have been healed by chiropractors for various ailments or been protected from others. Many people believe in “treatments” which have unsupported evidence, but the fact is: there must be controlled tests that can prove these claims, which must be peer reviewed then replicated in order for these claims to hold water in the scientific community. As there have been controlled tests performed in the past which did NOT support the claims of so many chiropractors and their patients, all “evidence” is purely anecdotal and written off as placebo or coincidental.

    That’s how science works.

    As I said before, the problem is this law and how the BCA is abusing the system. I disagree with RL’s statement that we should not hold offense to the business of other countries. That’s just silly. Say, hypothetically, Phil posted a ruling from a judicial court outside the United States which had ruled in favor of a family who claimed a doctor caused their child to get autism through the administering of vaccines. Of course people would be outraged, regardless of what country they live in. Not only would the ruling be ridiculous, but it would have global implications.

    Similarly, the Singh case can and will have serious effects on the scientific community, which is a global community. Denying scientific opinion, which has scientific evidence to back up its claims, and calling it “defamatory” is obnoxious on its own, but going so far as to file a libel suit against the scientist is cause for the global scientific community to worry. Once scientific opinion and criticism are under attack, what is to prevent others from jumping on the bandwagon?

    Most importantly – science cannot advance without opinion and criticism. In fact, it will become overshadowed by anti-science rhetoric which cannot be criticized without fear of retribution in the courts.

    This is why this case is important. Not just because anti-science has struck a blow, but because of the rippling effect it will cause. All it takes is a crack in the dam.

  69. RL

    @Chris Owen (comment 61)

    Anecdote or not, if I personally know 5 people who have the same experience that doing something worked for them and thru talking to them understand the details of what happened, I think I can conclude that something may have remedied their ailment. In the cases I’m referring to, what was done sounded like a form of physical therapy (as someone above may have alluded to). I think it would be unreasonable to equate what I’ve observed with homeopathy, crystals and the like. I haven’t performed a controlled study to verify the long term effectiveness, etc, but I have witnessed people with a physical limitation restored to full function. (By the way, thats why I use words like suspect, think, seem, may…instead of know)

    As I said, I’m very skeptical of the claims of chiropractors (I’d rather see a sports medicine physician thru I have had very good anecdotall success with), but I also think its incorrect to always assume that EVERYTHING associated with a particular field is woo even when that field may be inundated with it. (Thats not to say that the field in question is thereby validated or that there aren’t fields without redeeming truths- homeopathy and astrology come to mind).

  70. RL

    @Chris Owen

    You’re not crazy, it was post 60. But I guess some moderated posts came to life.

  71. Cheyenne

    Chiropractors are quacks. Feels great to live in a nation where I can say that and not get sued over it.

  72. @Damon,

    That’s some great logic there. So I guess we can write off rapes as anecdotal as well then?

    Way to jump into obnoxiousness and trivialize rape at the same time! Are you going to talk about how we’re exactly like Hitler? Because really, there aren’t enough people on the internet drawing false comparisons to real tragic events whose victims may not want anything to do with the argument.

    @RL,

    I wouldn’t give any weight to a persons opinion on a country’s laws who doesn’t actually live in that country.

    I don’t want to make this more political than it already, but as an American living IN America, I absolutely give weight to the opinions of people who despise our NEWTM LEGALTM TORTURETM. Why not? Are people in other countries not human beings, incapable of compassion, and devoid of the ability to make valid evaluations of fallible human systems? Not giving weight to the opinions of people perhaps best equipped to see past the cultural paradigms that hinder your ethical evaluations would be Stupid (with a capital “S”). [Just to be clear, I'm not calling RL stupid]

    @ Rob Miller

    Why are people so weird about English libel law? The burden of proof is just the same as in a criminal trial: the victim doesn’t have to prove a negative, i.e. that they didn’t do what they were accused of.

    Suppose you’re a celebrity, and a newspaper article claims that you sleep with prostitutes, for example: under the English system it’s the newspaper that has to provide some proof of their allegation; under the US system you’re faced with the daunting–if not impossible–task of proving that you don’t in fact sleep with prostitutes.

    There are cases in which the English system is fairer and ones in which the US system is fairer, but for some reason the English system gets an almost universally negative reception.

    Actually, and IANAL, but I’m pretty sure you have the English and US system exactly backwards.

    [Edited to add: Just a random observation, but isn't it telling that people on the internet talk "@" each other and not "to" each other? Just a random thought.]

  73. RL

    @The Chemist

    We’ll have to disgree on this topic. If I don’t live in a place, I do not expect, nor should I expect that the people who do live there give me a say in what their laws are. And it goes the other way too. If I’m going to decide what kind of state/country I want to live in (or leader), its up to me and the other residents to determine not an outsider. It has nothing to do with my or other peoples value as a human being. It has to do with running your own country the way that you see fit without interference. If what a country does affects another (like some application of this law to people in the US) then government action here can be used to remedy and things can be taken up at the state department level.

    If the people of the UK like their libel laws, then they should keep them. Or THEY should change them. I can add my name to a list, but I suspect that if I’m not a citizen, I’ll be ignored.

    Please keep in mind that the discussion is about libel laws. Not torture. Or war.

    Slow day here at work.

  74. I’ve signed :)

    @truthspeaker:

    Thanks :) England and Wales aren’t particularly separate, though some laws are different (for instance here in Wales all prescription medicines are free! Yay!). I haven’t heard of suing being worse in England specifically, though I wouldn’t be surprised.

    @RL: Sorry, I haven’t read your whole conversation, but I just thought I’d put in a Brit’s view if you’re interested. I think it’s outrageous that libel laws put the onus on the sue-ee, and I’m happy to hear from citizens of other countries about better ways of doing things. For foreigners to suggest and explain their ways is great; to order us to do something, at that point yes I’d get annoyed and might stop listening. If that makes sense.

    And also, science is an international thing now. Foreigners might well need treatment when they’re coming here, and they need access to scientific evidence for treatment which works, just like us Brits do. And of course this treatment probably exists in other countries . . .

    Phil: I hope you like this little blog entry, admittedly thrown together in 5 minutes while I have 1000000 other things to do, but hopefully it will http://aliceingalaxyland.blogspot.com/2009/06/sense-about-science.html

  75. @ RL (Comment 73):

    “Anecdote or not, if I personally know 5 people who have the same experience that doing something worked for them and thru talking to them understand the details of what happened, I think I can conclude that something may have remedied their ailment.”

    But that’s the point of my comment – that “something” may have been the placebo affect at work. Perhaps they were healed at the clinic – I’m not claiming they weren’t – but we know that simply asking them if they feel better is a poor indicator of whether the treatment worked or not.

    “I think it would be unreasonable to equate what I’ve observed with homeopathy, crystals and the like.”

    I didn’t equate the treatments – I equated the method with which you used to judge their effectivness. Like I said, you could find a group of people willing to give testimonial that crystal healing or homeopothay healed their aliments, much like how you’ve already got a group of people willing to give testimonial that chiropractors worked. If you had both groups as described, how would you discern between which treatments were useful and which ones were not? Is a group of people claiming that homeopothy healed their back pain disceranbly different to a group of people claiming that a chiropractor healed their back pain?

    “I haven’t performed a controlled study to verify the long term effectiveness, etc, but I have witnessed people with a physical limitation restored to full function.”

    That sounds more reasonable. I’m not entirely certain to what degree the placebo affect operates (though, I’m under the impression that it can be quite strong), though I’d imagine that you might be able to start making at least some sort of judgment if you had a group of friends with sever leg pains healed by a chiropractor – as in, they were unable to walk one day, then able to walk the next, or something similiar. Though again, that’s far from rigorous (as you suggested) and I’d still suggest that you might still want to hold back any solid conclusions. Though, as you say, you’re already maintaining your skepticism of said practice.

    “(By the way, thats why I use words like suspect, think, seem, may…instead of know)”

    Yeah, I caught that. None of my comments have meant to suggest that you were rashly jumping on any bandwagons or anything.

  76. Jason H

    If I have a massage I usually feel pretty good afterward too, even if I have the flu. That might just be because I get the same sensation when my girlfriend strokes my hair. Physical contact produces plenty of endorphines.

    Evidence of ‘feeling better’ does not equate to ‘being better’. You can cover up symptoms, but as far as I’m aware, chiropractic medicine usually equates to lifelong ‘treatments’ and there is a very, very good reason as to why many health insurance companies simply do not cover it.

  77. rob

    animals are bio-chemo-mechanical machines.

    there is no magical vitalistic energy or chi that responds to poking with pins, re-alignment of spines, or extremely dilute preparations.

    if your car is not starting, do you let a mechanic tap on the hood to realign the alternator to expel the bad demons, allowing the car to heal itself?

    if your computer is not booting, do you let the tech drive nails into the cpu to redirect the turingal energies along alternate interconnects?

    if your drain is clogged, do you let the plumber pour really really really really really dilute eye-of-newt down the drain to realign the quantum aura magneto-crapto field of the clump of gunk to coerce it into taking it’s pre-ordained trip to the septic tank?

    no. no. no.

    then why let practitioners of pseudo-scientific gobbly-gook do the same to your body?

  78. Gazz

    Here’s a copy of an email I just sent to the British Chiropractic Association. I suggest everyone bombards them with their views on the subject of silencing someone instead of proving claims with evidence.

    “I just wanted to let you know that me and my friends were not sure if chiropractic was a really effective treatment or just a useless pseudoscience. Your suing of Simon Singh has now resolved this dilemma for us. If you really had any good scientific evidence it worked you would have presented it, but just silencing someone with legal action proves to me (and will do with many others) that chiropractic is a quackpot pseduoscience and I’ll make sure everyone I encounter knows to avoid it like the plague.”

  79. Andrew

    Any analogy between criminal law and libel tort is ridiculous, in criminal law you are trying to establish what happened. Whether someone, in fact, took a certain action. In libel cases you know what happened. It’s not a question of whether someone did something or not. You already know that someone said something that defamed someone else. From their you try to establish if the statement were true or not.(igoring the other possible defences in a libel suit for the moment) It’s not a questions of being guilty or innocent, it’s not a person that’s on trail. It’s the statement that is made that’s on trail. If you start by presuming this statement is true you give people free reign to make false, defaming, statements as long as they know that it would be impossible for anyone to show that those statements are false. This is dumb. British tort law, and the tort law of several other common wealth countries, has it right.

    The thing that surprises me about this case is that he wasn’t able to get defeat the suit on the grounds of either fair comment, or privilege.

  80. slavdude

    There is always osteopathic medicine, which involves real medical training without the woo of chiropractic medicine, at least in the U.S. Elsewhere, YMMV.

  81. ndt

    Gazz, that’s a good letter, but it’s “my friends and I”. Good grammar usually makes for a more effective letter.

  82. Lawyer

    Dear Simon,
    Next time you publish something critical of a UK org, publish it on a US website. We love free speech here, and view critique as the very essential nourishment for democracy (and truth!) and the prevention of totalitarianism.
    Spread the critique! its makes everyone better.

  83. skeptickle

    @Rob Miller

    Rob Miller said:
    “Why are people so weird about English libel law? The burden of proof is just the same as in a criminal trial: the victim doesn’t have to prove a negative, i.e. that they didn’t do what they were accused of.

    Suppose you’re a celebrity, and a newspaper article claims that you sleep with prostitutes, for example: under the English system it’s the newspaper that has to provide some proof of their allegation; under the US system you’re faced with the daunting–if not impossible–task of proving that you don’t in fact sleep with prostitutes.”

    Nope, that’s not how it works. The problem with the libel laws here in the UK is that the truth doesn’t matter. Simon Singh doesn’t have to prove his allegation was correct – it is irrelevant, rather he has to prove that his allegation WASN’T LIBELOUS! Very tricky.

  84. Nigel Depledge

    DC said:

    Furthermore, there has been no single mode of therapy MORE studied than chiropractic spinal manipulation for spinal pain syndromes, and no BETTER therapy than spinal manipulation for both acute and chronic low back pain. There is also NO better therapy than spinal manipulation/chiropractic adjustment for mechanical neck pain grades 1-2 (read the WHO Bone and Joint TaskForce 2008 document if you haven’t already).

    This is not at issue, DC.

    Several of us already accept that there is a potential benefit from chiropractic for back and joint problems.

    The real issue is twofold:
    (1), that the BCA has claimed that chiropractic is a beneficial treatment for all sorts of things for which there is no evidence of any benefit;
    (2), that chiropractors do not inform their customers about the increased risk of stroke from certain types of manipulation.

  85. Nigel Depledge

    DC said:

    Quoting outdated research does not do this discussion any good, especially if there is more current research that is SPECIFIC to chiropractors and not just anybody perform SMT.

    The main gist is that VB stroke is UNPREDICTABLE and occurs at the same relative frequency in MDs and DCs offices

    So, first off, are you claiming that chiropractors have changed the way in which they manipulate the neck in order to reduce the risk of stroke?

    Second, while those strokes are indeed unpredictable (with or without all-caps), cervical manipulation is a clear and proven risk factor.

  86. Nigel Depledge

    @ DC (32) -

    I notice that the studies you quote from have not been published in a peer-reviewed journal. Is that because there is no peer-reviewed research that supports your position, or is it because you could not be bothered to find any? Either way, I will take Michael L’s “outdated” but peer-reviewed articles as substantially more convincing than your (undated but allegedly up-to-date) quotations.

    DC said:

    Also, strokes rates have increased despite DECREASED chiropractic utilization in 2 Canadian provinces.

    Just because chiropractic is not the only risk factor for stroke does not change the fact that it is a risk factor, and one that is not disclosed to the customers of most chiropractors.

  87. Nigel Depledge

    DC said:

    There is SOME research which is beginning to come out, but one must understand that there have been numerous POLITICAL barriers to get funding to do chiropractic-related research for many reasons that go beyond the scope here.

    Well, it seems pretty damn simple to me: chiropractors have, for most of the last 15 years or so, been claiming that chiropractic fixes all sorts of things without the slightest shred of evidence to support their claims. If they had done the research before making the claims, I daresay funding would have been forthcoming at the time (assuming the grant applications were able to compete with all the other demands for medical research funding).

    If nothing else, the BCA should be (and should have been for some time) funding independent research into the efficacy (or otherwise) of chiropractic as a treatment for specific disorders.

    Singh used language that was too harsh and critical,

    But nonetheless true.

    left himself open to a lawsuit,

    I’m sure that was not his intention! In fact, telling the truth should not leave one open to a libel lawsuit – in this case, the BCA is deliberately attempting to abuse the law.

    and by the time this goes to appeals there are I believe 3-4 studies on colic, otitis media and asthma that suggest that manual interventions used by DCs improves objective outcome measures.

    Nevertheless, the BCA has been making the claims that Singh has criticised for some time, without any evidence to support them. Whether evidence subsequently proves them right is irrelevant.

    So, yeah, it’s OK to be skeptical (in fact in science it’s required) however most of these posters here have crossed the skeptical line into a hardline ideological dogma against chiropractic medicine.

    Perhaps some have. Your defence of chiropractic as a profession has been passionate and articulate. However, of the key issues, you have failed to address one and your answer to the other is not convincing:
    (1) That the BCA (and many individual chiropractors) make claims about chiropractic that are supported by no evidence at all; and
    (2) That chiropractic carries a risk of stroke that is rarely, if ever, disclosed to patients before manipulations are performed.

  88. Nigel Depledge

    Zombie said:

    The difference between evidence and claim is like building a sandcastle and thinking you’ve conquered all of Europe.

    Oh, man!

    You mean I didn’t conquer the whole of Europe at the beach last weekend? Dammit! ;-)

  89. Nigel Depledge

    Dr Rosenberg said:

    Between medical errors, pharmacuetical errors, and normal pharmaceutical drugs about 200,000 people a year die in the U.S.

    Out of how many who receive treatment?

    And of those 200,000 (assuming your figure to be correct), how many haven’t been told that there is some kind of risk?

    And you guys want to bash chiropractic which keeps people healthy?

    That’s a very bold claim.

    Please cite the peer-reviewed, double-blind trials that demonstrate that chiropractic “keeps people healthy”.

    If you cannot or will not, why should anyone here pay you any mind at all?

    Can someone please explain to me their understanding of the relationship of the spine and nervous system to the rest of the body?

    No time here – how about you look in Grey’s Anatomy?

    We chiropractors know what we do works. We see it everyday in the benefits our patients receive.

    But without a randomised, double-blind trial, how the hell can you tell that your intervention does anything at all?

    And I’m not talking about back and joint problems here, I’m talking about all of the other stuff that the BCA claims chiropractic can do.

    If you choose not to go to a chiropractor and prefer an MD, that’s fine with me, but why the need to bash something you clearly don’t understand?

    Because you don’t understand it either.

    All the rubbish about subluxations is just so much snake oil.

    To my mind, the principal danger posed by chiropractic is that it may make people choose not to seek treatment from a proper doctor.

    Chiropractic research is far behind medical research for several reasons; mainly lack of funding, political obstructions, and difficulty in performing sham adjustments as a control in the study.

    The BCA seems not to care – they have been making their wild claims for some time without any evidence. Perhaps you should be criticising them for making chiropractic appear as ludicrous to the sceptical as crystal healing

    (Have you heard of the small but remarkable study by an MD at the University of Chicago Med School? They found a technique whereby a patient can’t tell if they got the real treatment or not. The subjects all had HBP and all who got the real treatment experienced a marked decrease in BP equal to several meds over the course of several week/months. All who received the sham treatment experienced no change.) There is, however, a growing body of legit research in our field. If you’re honest and open-minded you’ll check it out.

    And if you’re honest and open-minded, you’ll reserve making any claims until you have the evidence to suopport them.

    If chiropractic genuinely has the potential to do all that is claimed for it, then by all means get out there and do the research. But don’t go selling a treatment until you can prove that it works.

  90. Nigel Depledge

    RL said:

    While I’m very skeptical of chiropractors, I do know a lot of people who swear by them and claim to have their ailments remedied. Most of the fixes involve mechanical issues, nothing like sore throats and the like. Its hard to tell them that it doesn’t work. But I also had a friend who worked at a chiropractic office (receptionist or something) and that person told me some outrageous stuff about what the doctor said he could heal. I have trouble reconciling all of the data on this one. I suspect that its a mixed bag of some useful techniques and a lot of questionable claims and techniques.

    Satisfied customers are no measure of efficacy. Without a double-blind, controlled trial, there is no way to establish a genuine link between a change in someon’s condition and a specific medical intervention.

    Having said that, there does seem to be some evidence that chiropractic is useful in treating back and joint problems. It’s like a type of physiotherapy. But the claims of many chiropractors go way beyond what the current evidence will support.

  91. Nigel Depledge

    RL (73) said:

    Anecdote or not, if I personally know 5 people who have the same experience that doing something worked for them and thru talking to them understand the details of what happened, I think I can conclude that something may have remedied their ailment.

    Actually, this illustrates quite an important point.

    First, no, you cannot conclude that “something” may have remedied their ailment. It is possible that they were improving anyway, but in subtle ways that they did not perceive until after the treatment.

    Second, even if we can soundly conclude that “something” remedied their ailment, we cannot know what that something was without a controlled study. Preferably one that is large enough to have some statistical power.

  92. Nigel Depledge

    RL said:

    If I don’t live in a place, I do not expect, nor should I expect that the people who do live there give me a say in what their laws are.

    What? Haven’t you heard of the EU?

  93. My, my! All this huffing and puffing! Let’s look at this evidence: not ONE chiropractor has EVER applied to win the million dollars that the James Randi Educational Foundation has had on offer for more than ten years now. Of course this doesn’t prove that chiropractic is bogus, but it sure makes you wonder why none of the practitioners have shown any interest in winning an easy million… Secondly, years ago, when I did my radio show out of NYC, I approached two different chiropractors, one of whom had appeared on my show and assured me that he could diagnose any problems, the other was a former president of the New Jersey Chiropractic Association. I saw them separately, and both diagnosed that I had a short leg. They prescribed a wedge for insertion into a shoe, to even me up. Only problem was that they chose different shoes… I could have gained half an inch of height! But the big failure was that neither of them found — from the X-Rays I provided — the two compression fractures that showed there very plainly…

  94. rrt

    You nailed a point I was going to make, Nigel, but I think it bears repeating: Rosenberg is ADMITTEDLY defending the practice, for generations, of medical treatments that have no supporting evidence while claiming they work. He somehow thinks that because (so he believes) evidence is just NOW coming to light to support those methods, that justifies generations of unethical medical malpractice.

    Of course he’ll deny that by citing his anecdotes. But that helps nothing but his conscience. As another commenter said, when it comes to woo, if the claimant refuses to understand the futility of anecdotes then there’s really no point in continuing the conversation.

  95. I’m with the people who claim that those on Singh’s side here should not focus on the word “bogus”. IMO, one should be free to speak claims that can be justified. If there’s reasonable doubt over the efficacy of a purported treatment for a given condition, someone should be able to say so without fear of suit. This is where I would have our friends across the ocean try to get their laws to state. (I’m Canadian and so have no direct means to challenge UK law.) Moreover, simply stating something false should not be grounds for libel either – people make *mistakes* after all.

  96. PhD

    DrR said
    “We chiropractors know what we do works. We see it everyday in the benefits our patients receive.”

    The problem is that you chiropractors don’t understand why we scientists consider your evidence to be useless. What about the patient in pain who comes to a DC, receives no benefit (perhaps some harm) and just never returns? You don’t see them everyday but they still exist, you just ignore them. How many of your patients belong to that group who claim great benefit but have to return for treatment on a regular basis? Interesting psychology there but hardly evidence for any “cures” from the treatment.

  97. Nigel Depledge, rrt, & PhD:

    You are cherry picking some of my statements and ignoring others. You are making presumptions based upon your opinions and biases.

    I never used the word “subluxation” in my post and I don’t use that word with my patients. Surprised? You have to understand that there are very different types of chiropractors today. There is the group I suspect you are ranting against. They are against research and anything medical. There is a smaller but growing group who are very interested in research and validating how what we do works. We can’t make up for the lack of research. We can only move forward and in the last 10-15 years we have made great strides in this area. There have already been major studies done that validate chiropractic care but you seem to ignore them for some reason. If you think they’re “useless” please point to a specific study and explain what exactly is “useless” about it. Until then you’re just stating a groundless opinion with nothing to back it up. This is truly “unscientific”.

    I stated that I have good working relationships with respected MDs in the community. For five years I specialized in pain management with a team of physicians. I don’t expect to see patients forever and don’t want them to be “addicted” to me. I don’t sell long term care plans. I stated that chiropractic research is lacking and why, but that it has been gaining ground in the last 10-15 years because we recognize the need for it. I compared chiropractic with medical training and how similar they are today.

    Most importantly I asked you guys to explain to me your understanding of some basic anatomy, neurology, and physiology but you conveniently ignore that. Until you can answer these questions I have nothing more to discuss with you. Here goes again:

    See if you can come up with a relationship between the brain, spine, joints, muscles, and the rest of the body. Tell me how joint mechanoreceptor function plays a role in one’s health. Explain to me how having fixated joints would cause a global decrease in function. Tell me about the relationship between structure and function.

    Be honest. Keep it positive. Be informed.

    Dr. Rosenberg :)

  98. DrRosenberg

    James Randi said:

    Let’s look at this evidence: not ONE chiropractor has EVER applied to win the million dollars that the James Randi Educational Foundation has had on offer for more than ten years now.

    Could be that chiropractors don’t claim “paranormal, supernatural, or occult power”s as you state on your webpage, http://www.randi.org/site/index.php/1m-challenge.html

  99. PhD

    Dr.Rosenberg

    ummm,the brain, spine, joints, muscles, and the rest of the body are clonally derived from pluripotent embryonic stem cells, that’s one relationship. How about the CNS (brain and spinal cord) directs the PNS (nerves outside CNS) to contract muscles which cause bones to pivot on joints and move the body. I’ve a degree in biochemistry and a decade as an academic neuroscientist so I can list some more if you wish. I also know enough to call BS when someone claims that chiropractic manipulations can remove subluxations to increase nerve connections thereby freeing up the immune system to attack invaders, to paraphrase another poster here.

    As my old enzymology professor Dr. Chan used to say, “Structure is function”. For your other questions, please specify which mechanoreceptor(s) and a ‘global decrease in function’ of what?

    I agree with your assertion that mainstream chiropractors are against research and anything medical. A minority have at least some understanding of the need for proper research and you appear to be in the group. The ‘useless’ data comment was based on your claim that you knew it worked based on your personal observations rather than controlled scientific analysis. Yes, I am assuming that most chiropractors do not have a system in place for long term follow-up or controlled studies. You did suggest that you’ve heard about a “small but remarkable study” that supports your contentions, but no reference was provided.

    When you complain about a lack of funding for research you start to sound like all the other apologists for the multibillion dollar ‘alternative’ health industry. Get every chiropractor to chip in $100 and you would have enough for a first class trial. Try some fund raising.

    “There have already been major studies done that validate chiropractic care but you seem to ignore them for some reason.”

    Yes, some temporary pain relief can result from some chiropractic manipulations. That does not validate most of the outrageous claims that are common in the field. Or are you saying that studies have validated the notion that chiropractic care can prevent cancer? I know where to look and I haven’t read that!

    Also, when a patient feels better after a manipulation that does not mean the your particular explanation of the underlying mechanism is correct. You understand that don’t you? Physical contact with a member of your species is very therapeutic in a number of settings. Google ‘Robert Sapolsky’ if you want to learn more.

  100. Howard Boos

    What I think is interesting is that many published peer reviewed studies have demonstrated that well over 50% of medical practices are not supported by scientific evidence. And, yet it appears that many in the public are demanding that the chiropractic profession supply 100% scientific proof. I have family members that have been saved from surgery thanks to “unscientific, bogus” chiropractic care. Is it “scientific” for the drug Vioxx to have killed over 25,000 people? Why hasn’t Singh thrown stones at the medical profession who annually performs 2.4 million unnecessary surgeries at the cost of 11,900 lives? It’s much easier to pick on a small profession perhaps.

  101. Nigel Depledge

    Dr Rosenberg, seemingly not recognising when (s)he has backed a loser, said:

    You are cherry picking some of my statements and ignoring others.

    Not true. I addressed the larger proportion of your post.

    You are making presumptions based upon your opinions and biases.

    Also not true. This is, in fact, what you have been doing.

    The key point here, my dear Dr Rosenberg, is that (for the most part) chiropractic is not supported by evidence. Now, as several people will readily acknowledge, there is some evidence that chiropractic may be of benefit in treating back and jointy issues. However, the BCA, which is the official body of chiropractic in the UK, has supported all sorts of wild claims about chiropractic, without the slightest bit of evidence to support it.

    I never used the word “subluxation” in my post and I don’t use that word with my patients.

    I never said you did – but many other chiropractors do use that word, and the BCA supports its use. Many chiropractors use it as a term to “explain” how what they do is supposed to fix problems. But it is merely a cover for ignorance.

    Surprised?

    Not really.

    You have to understand that there are very different types of chiropractors today.

    I understand that there is no standard chiropractic, but I am not familiar with its sub-types. However, the BCA is the professional organisation for all chiropractors in the UK. If any chiropractor has a problem with how their profession is viewed by the public, the BCA is largely responsible.

    There is the group I suspect you are ranting against. They are against research and anything medical. There is a smaller but growing group who are very interested in research and validating how what we do works.

    Well, in that case you guys really need to get your house in order.

    In the meantime, I suggest you write to the BCA and tell them exactly what you think of the unsupported claims thay make for chiropractic.

    We can’t make up for the lack of research.

    Agreed.

    We can only move forward and in the last 10-15 years we have made great strides in this area. There have already been major studies done that validate chiropractic care but you seem to ignore them for some reason. If you think they’re “useless” please point to a specific study and explain what exactly is “useless” about it. Until then you’re just stating a groundless opinion with nothing to back it up.

    Please cite where these studies have been published in peer-reviewed journals.

    This is truly “unscientific”.

    Well, it would be if I were wrong.

    However, I have never seen any defender of chiropractic able to cite a controlled double-blind trial that shows a benefit from chiropractic exepct in cases of back or joint problems.

    Are you going to be the first?

    I stated that I have good working relationships with respected MDs in the community. For five years I specialized in pain management with a team of physicians. I don’t expect to see patients forever and don’t want them to be “addicted” to me. I don’t sell long term care plans. I stated that chiropractic research is lacking and why, but that it has been gaining ground in the last 10-15 years because we recognize the need for it. I compared chiropractic with medical training and how similar they are today.

    Again, you seem to be demonstrating that you are the exception among chiropractors.

    Most importantly I asked you guys to explain to me your understanding of some basic anatomy, neurology, and physiology but you conveniently ignore that.

    Seriously, there is not time or space here for me to discuss my understanding of such things. And they are entirely OT anyhow.

    However, if you are trying to say that chiropractors shouldn’t be expected to understand how what they do works, you are wrong. Even if I cannot explain connections between chiropractic manipulations and supposed changes in symptoms, I don’t need to because I’m not trying to sell a treatment. As a person selling medical intervention, you should either have evidence that it works, or at the very least a sound theoretical basis for how and why it should work. You seem to have neither.

    Furthermore, if you wish to complain about us ignoring your questions, perhaps yuou can set an example by not ignoring questions asked of you . . . ?

    Failing that, did you want to be the pot, or the kettle?

    Until you can answer these questions I have nothing more to discuss with you. Here goes again:

    See if you can come up with a relationship between the brain, spine, joints, muscles, and the rest of the body. Tell me how joint mechanoreceptor function plays a role in one’s health. Explain to me how having fixated joints would cause a global decrease in function. Tell me about the relationship between structure and function.

    This is all irrelavnt. I don’t offer any kind of medical intervention for a fee.

    The real issue is twofold:
    (1) That the BCA touts chiropractic as a cure for many ills where there is no evidence of it having any benefit whatever;
    (2) That many chiropractors do not inform their customers of the risk of stroke associated with certain kinds of cervical manipulation.

    Be honest. Keep it positive. Be informed.

    Perhaps you should be honest with yourself, too. There are many things claimed by chiropractors with no evidentiary support at all. No-one here is criticising you specifically; rather the criticism is levelled at chiropractors in general and the BCA in particular.

    However, you defence of chiropractic in general has been unconvincing. You have not cited evidence that chiropractic is a successful treatment for (for instance) colic. You have not expounded a sound theoretical basis for chiropractic. While you point out that you do not use the term “subluxation”, neither have you denounced its use among chiropractors in general.

    Additionally, you have claimed that your anecdotes are the equivalent of real evidence, which indicates a lack of understanding of the standards of evidence required in modern medicine. Without an experimental control, your anecdotes are no more than post hoc ergo propter hoc.

  102. Nigel Depledge

    Howard Boos said:

    What I think is interesting is that many published peer reviewed studies have demonstrated that well over 50% of medical practices are not supported by scientific evidence.

    OK, first off, this is unconvincing without some citations.

    However, you do raise an important point: how much of current mainstream medical practice is supported by actual data? 30 years ago, I might have believed your figure of 50%. Now, not so much.

    I do not know if you are old enough to have heard of thalidomide (but I’m sure Wikipedia can help you out there), but all new medical procedures and treatments introduced to the market since about 1960 have required trials to demonstrate three things:
    (1) Safety;
    (2) Efficacy;
    (3) That they are at least as good as the current treatment (e.g. just as effective but with fewer side effects, or the same side effects but more effective, or whatever – it depends on the treatment).

    So, in 2009, I would guess that most of the treatments carried out as part of mainstream medical practice do have a basis in actual evidence.

    And, yet it appears that many in the public are demanding that the chiropractic profession supply 100% scientific proof.

    Not 100%. Just proof that it does what they claim. Some hard evidence would be better than what they have now.

    I have family members that have been saved from surgery thanks to “unscientific, bogus” chiropractic care.

    Too little detail. What were the actual conditions involved here?

    And remember, there actually is some evidence that chiropractic can treat back and joint problems.

    Is it “scientific” for the drug Vioxx to have killed over 25,000 people?

    What a bizarre question.

    The big pharma company that made Vioxx has been demonstrated to have behaved unethically in their promotion of that drug. (This affair is discussed in Ben Goldacre’s Bad Science.) It does not exemplify correct modern medical practice.

    Why hasn’t Singh thrown stones at the medical profession who annually performs 2.4 million unnecessary surgeries at the cost of 11,900 lives?

    Erm … well, maybe he does. Have you tried looking up his articles?

    And, again, without a citation your figures could have been plucked from the air.

    It’s much easier to pick on a small profession perhaps.

    This does not make him wrong about the BCA.

    The BCA promotes chiropractic as a treatment for various conditions for which there is no evidence whether it works or not. The BCA, as the professional, organised figurehead of chiropractic in the UK, has a duty of care to know whether what they promote actually does what they claim. IN short, Singh was right about them.

  103. Michael Kenward

    This is the first place that I remember seeing any mention of the phrase “evidence-based” medicine in relation to BCA vs Singh.

    It raises an important issue.

    The whole notion of evidence-based medicine is relatively new. Track back references to the term and you will find that it rarely appeared more than 20 years ago.

    This really reflects that fact that that much medicine practiced before then really did not come with the full scientific evidence that we now demand.

    In other words, medicine is a latecomer to real science, with its demands for peer review and do on.

    What we see now is a bunch of medics finally realising that they purveyed bogus remedies for years. (Leeches anyone?) They are now rounding on the quacks who now use the same approach that was once central to conventional medicine.

    Maybe the BCA is just a few years behind the medics in demanding evidence for treatments. Unfortunately, the late conversion of “reputable” medicine to scientific evidence makes it hard to take them as seriously as their case deserves. There is still a lot of stuff coming out of the likes of the BMA that makes not much scientific sense.

    Think of all those doctors who refuse to wash their hands enough to stem the onslaught of MRSA. Evidence based medicine is irrefutable. But the sawbones are still too lazy of arrogant to pay attention.

  104. Christian

    Not to defend the BCA… I think they are out of line.

    I can only share my experience.
    Several years ago I experienced a loss of sensation and motor control in my left arm over a period of several months. I went to my primary care physician, who examined me, prescribed some anti-inflammatories, and said if the situation didn’t resolve itself he’d consider exploratory surgery on my shoulder. My response was “No way are you doing EXPLORATORY surgery anywhere NEAR my neck!”

    On the recommendation of a friend, I went to her chiropractor the next day and explained the situation. He examined me, probing my neck, spine, shoulder and arm with hands and other tools. He then took a couple of x-rays and another type of scan (something to measure muscle tension, IIRC), then told me “Let me look at these. Come back tomorrow morning and we’ll talk.” He made no promises of a remedy.
    I whimpered in pain, and he said to take whatever pain-killer and anti-inflammatory I needed, but he wouldn’t do anything until he’d reviewed the scans.
    I was back the following morning, and my left arm was almost useless. I could barely move it, and couldn’t feel light sensations.
    The chiropractor showed me the x-rays and pointed out 3 items, the primary one being the C5 vertebrae. It was clearly not in line with the rest of my neck, and appeared to be pinching the nerve controlling my left arm. The muscle scans appeared to back this up, with the muscles around the area showing significantly more tension than elsewhere.
    The chiropractor then explained what he planned to do, and the results he expected. I concurred, and gave him permission to manipulate the vertebrae back into alignment. He then proceeded to gently pull and twist my neck, at the same time pushing on the vertebrae with his thumbs. After about 30 seconds, there was a very brief, sharp, pain in my neck, a “pop” sound, and I felt my left arm come alive and tingle as though plugged into an electrical socket. The chiropractor continued to massage and manipulate my neck and back, and much of the stress I was experiencing seemed to fade.
    I had a massage and a manipulation performed twice a day for a week, then twice a week for 2 weeks, then once a week for a month, then he said “It looks like your muscles aren’t pulling your vertebrae out of alignment any more. Come back when/if you feel out of sorts.” I didn’t go back for over a year, and I’m pretty sure C5 wouldn’t have been realigned “on its own”.

    Chiropractic isn’t for everybody. But it worked for me. YMMV. Be an informed consumer. Extraordinary claims require extraordinary proof. My chiropractor doesn’t make any claims that I consider unwarranted, and specifically tells me what it CAN’T do.

  105. Joseph

    Goodness Gracious there are a lot of posts here.
    I can not speak for all of the Chiropractors out there but my uncle Jim was an actual Doctor that practiced Chiropractics, he could and did dispense medicine.

    He would say that Chiropractics could help fix a lot of things and might be able to cure a few things but was certainly not a cure all.

    Were he alive I think he would be rather upset at the BCA’s behavior.

    Perhaps they could adjust themselves, as chiropractics may cure hysteria, insanity and stupidity.

  106. I was asked by someone to provide a reference for the chirorpactic study which lowered blood pressure. Here is a link to the WebMD article:

    http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure?page=2

    This refers back to post # 50 on this page.

  107. Ed

    A lot of this, and Simon Singh’s comments are fairly malicious. I know this is a late post, but I had to say something.

    It is WRONG to claim that chiropractic cures things that are not clinically indicated, but it is also wrong to claim that chiropractic has no evidence.

    Fact 1 – vertebral artery dissection leading to stroke is an unfortunate side effect to extension of the neck in already unwell patients, and has been proven to be just as likely to occur when going to the hairdresser or any movement invloving extension of the neck. Because of this chiropractor’s neck adjustments DO NOT involve extension of the neck. Incidence of stroke after chiropractic are about 0.01% and are due to individual chiropractors having poor technique.

    Fact 2 – Chiropractic degrees are 4 or 5 years long and go through accreditation with universities. They also include plenty of clinic training. If they use Xray, it is because they have learnt imaging as part of the course. Seriously people, if they didn’t have rules and regulations, the profession would have been destroyed a long time ago.

    Fact 3 – Chiropractic is within the NICE guidelines and is clinically indicated for GP’s to refer in a whole host of musculoskeletal conditions. These conditions have plenty of decent evidence. Other conditions for which chiropractic might be clinically indicated for in the future are very difficult to prove given the nature of treatment, and may well be proven in time. Remember that the nature of evidence is such that it includes ALL evidence availible to the practitioner ranging from RCT’s to clinical experience. Medical doctors use drugs which aren’t first line in the guidelines due to previous good experiences with said drugs.

    I won’t go into any more as many of you are far too ignorant to understand. If I can just get through to one person, maybe it will stop people being so short sighted.

    How much have you actually studied the subject from a non-biased standpoint? Looked at the research rather then just some dude’s book? He HATES chiropractors. This makes him biased.

    Rant over,
    Ed

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