Careful, BCA, you might slip a disk!

By Phil Plait | June 18, 2009 11:30 am

The British Chiropractic Association may need to hire a chiropractor to work on themselves: they’re shoveling so hard they’re likely to hurt their backs.

Fifteen month ago, the BCA sued journalist Simon Singh for libel after he called some of their claims "bogus". Mind you, they didn’t say, "He’s wrong and here’s the stack of scientific tests that have been performed to show just how chiropractic works". They simply sued. In the UK, libel laws are such that defending yourself against them is time-consuming and very costly, a fact the BCA could not help but understand when they sued Singh. One might almost call this action "spineless".

After an uproar on the internet as well as in the media — with some predictable results — the BCA is now, over a year later, suddenly claiming there is evidence to back them up, and issued a press release about it. I read it with some amusement, as even to my non-medical eye I could see that many of the references were totally ridiculous. A study of colic in children with no control cases? Colic tends to go away after time on its own, so without a control group how do you know manipulating their spines is what did it? Why did the BCA reference its own code of practice as evidence chiropractic works? And why did so many of the references talk about osteopathy, which is different than chiropractic (though laden with its own share of dubious claims)?

I didn’t write anything yesterday when this came up because I figured others with more experience would, and would be able to give more details than I could. And that’s just what happened: chiming in are The Ministry of Truth, Zeno’s blog, DC’s Improbable Science, and of course the awesome Jack of Kent.

The BCA is struggling mightily here to make itself look like the victim, but it’s hard to see it any other way than them trying to bully a member of the free press into silence, and creating an atmosphere where other critics would be afraid to speak. Whether they were hoping to silence the media or not, what they’ve really done is let millions of people know just how thin their "supporting evidence" is, and set themselves up for a PR disaster.

I will reiterate my support of Simon, and for the right of journalists to freely investigate claims made by anyone without having to wonder if they are going to be sued frivolously or otherwise. And in this case, the claims are about not just the health of adults but of a questionable practice being applied to babies. I think the least we can do is ask for the usual standard of evidence to support those claims, and in fact they should be held to an even higher standard. The list given by the BCA… well, to be polite it leaves much to be desired.

Simon’s not backing down, nor should he. A lot is riding on this, so we need to keep shining a light on what the BCA is doing. Keep your browsers pointed to Sense About Science to stay on top of the latest news.

Comments (60)

  1. Steve Jeffers

    The point in law, I think, is that there’s a difference between knowingly defrauding someone and simply not realizing you’re wrong. It’s not a legal case about the validity of the scientific claims, it’s about the characters of the people making those claims.

    The chiropractors clearly think their mumbo-jumbo works. They are idiotic, but honest.

    Don’t get me wrong, I’d like all the money every chiropractor has ever ‘earned’ returned to the people that paid it, with interest, then to hang them all from a tree.

    But they do have a case in law. If you accept that Singh went beyond calling them wrong to calling them conmen (that’s only a slight stretch), they probably would have a case under American libel laws, too.

  2. Except that Singh didn’t say anything about them other than their claims were bogus.

    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.

    He’s calling the treatments bogus. They can be honestly promoting what they think are real cures, but if they don’t have the science/studies/evidence to back up their claims then they really are bogus. It was quite telling that, instead of countering with their evidence and a demand for Singh to retract his statements, they filed suit and only came up with some dubious “evidence” after a backlash formed.

  3. Please don’t forget my review of all the papers, in which their dishonest quote-mining is demonstrated:
    http://layscience.net/node/598

  4. Jeremy

    @Steve Jeffers

    “The chiropractors clearly think their mumbo-jumbo works.”

    Then why did they put out that call to “cleanse” chiropractic websites of unsupportable medical claims? There’s an overall pattern of behavior in relation to this case that makes it pretty clear that even THEY know they’re full of crap.

  5. @Martin

    Nice review of their “evidence”.

    @Jeremy

    The BCA did not put out that call. That was the McTimoney Chiropractic Association.

  6. I’m really hoping that Singh’s case sets a new precedent for libel laws in the UK. Libel laws in general are quickly becoming archaic and have little place in a free and open society. It is one thing when an untrue statement is made and then perpetuated to the extent that a specific person is harmed for something they are not guilty of, but evaluating a skill set, or arguing that a certain profession is “bogus” and unnecessary should be considered protected speech in all instances regardless of whether or not a profession is harmed by it. If I want to say that auto repair shops are unnecessary because a person should be able to perform all repairs themselves, and say it’s a rip-off and “bogus”, then the law should make me absolutely untouchable in stating that opinion. (Of course I don’t actually think that’s the case for auto repair shops, it’s just the first thing to pop into my head)

    I fully support Simon Singh. I didn’t know who he was at the time I saw it, but I can easily credit his documentary Fermat’s Last Theorem with helping me resurrect a liking for mathematics that got crushed by my high school math classes.

  7. ndt

    The only way BCA members can believe their mumbo-jumbo works is by wilfully ignoring readily available data. Just as George W. Bush wilfully ignored the evidence that the Iraq WMD intelligence was wrong and so was not “technically” lying, the BCA’s only defense against an accusation of lying is that they were criminally negligent.

  8. Torbjörn Larsson, OM

    Martin, that was quite a review.

    I’m constantly amazed when denialists quote-mine out of context to fabricate lies. They use their Morton Demon filter naturally and it works for them. But it is so stupidly obvious for the general public.

    In this case you caught them doing the type of outright dishonesty that creationists excel in, pasting together sentence fragments to not only leave out the context but leave out the supposed quote. I’m not sure what to call it. Lie-mine?

  9. jasonB

    @ndt

    He’s out of office. Just breath deeply and repeat to yourself, “He’s gone.”

    Regards

  10. John

    This is really a question of whether simon was questioning particular bogus claims or appearing to write off the entire practice.

    If he can show it’s the former, then his chances are very good, because the evidence is in his favour.

    If he was silly enough to say, for example “if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market”

    Then he’s in trouble, because he’s attacking claims about its efficacy with regards to back pain and spinal problems, and the evidence is against him.

    I predict he’ll retract that particualr statement and stick to his guns about the rest.

    I am a huge fan of his and I’m behind him regardless.

  11. Thanny

    Osteopathy is pretty much chiropractic. The latter is just more focused on the spine.

    It shouldn’t be confused with osteopathic medicine in the US, which has roots in osteopathy, but is now much closer to normal mainstream medicine (practitioners have actual medical training, unlike chiropractors).

    In common parlance, an osteopath is just what people in the UK call a chiropractor.

  12. l

    “I will reiterate my support of Simon, and for the right of journalists to freely investigate claims made by anyone without having to wonder if they are going to be sued frivolously or otherwise.”

    Wait, people shouldn’t have to worry about being sued non-frivolously?

  13. John

    Thanks for that, I wasn’t sure.

    Anyway, can’t he counter sue the BCA for claiming his claims are bogus?

  14. Chris

    I applaud the outbreak of common sense with regard to chiropractic ‘treatment’.

    Now, when do we get to turn the same scrutiny on the endless claims of miraculous healing from the likes of Benny Hinn? They need putting a stop to just as badly.

    Check out just about any broadcast to see what he claims is being accomplished by his ministry:

    http://www.bennyhinn.org/default.cfm

  15. Chiropractors and osteopaths come from different roots and have different (if similar) incorrect theories of illness. Though they both focus on the spine, osteopaths are concerned with blood flow, where chiropractors consider the nerves to be the thing.

    You might call a chiropractor an osteopath, but that just makes you wrong.

    Meanwhile, chiropractic and osteopathic techniques have been incorporated into some forms of physical therapy.

  16. Lawyer

    US Libel laws are generally weaker than UK (guilty until proven innocent I hear!). Free speech is a paramount and generally every US libel law has TRUTH as a valid defense, although you may need to defend against some crap lawsuits.

    So, generally I would say to Simon, be critical, but do so in US internet space (on a US server).

  17. Daffy

    JasonB,

    The damage he did will take decades to undo, if ever.

  18. Chiropractic belief is caused by very old adaptions of the brain. We are wired by surviving in the jungle for millions of years to save energy and stay alive. Jungles will make you dead quick if you take the time for proper science. Tigers don’t understand double blind studies.

    This is also people making a living or justifying their beliefs which is also related to survival. This is little different than guarding a fruit tree so that your family can survive.

    Look at chiropractic like cattle farmers burning down the rain forest. You won’t get them to stop burning unless you give them alternatives. You also have to convince the farmers that burning is bad and the alternative is better. But even here there are many people involve. The farmer that burns the forest is selling cattle into the rest of the system which relies on the cattle. People sell and consume the meat. It is an ecosystem that has strategies to defend itself to survive and will protect each link in the chain.

    Chiropractic is an ecosystem too. Chiropractic schools rely on the existence of chiropractic clinics. The lawyer of a chiropractor (or his association) relies on the chiropractor as does the owner of the building he practices in, the suppliers of equipment and so on. Even the patient that believes in chiropractic has a dependency and will not shift unless the benefit is greater than the embarrassment and cost of re-believing in something else. It is an ecosystem.

    Ok, let’s talk ecosystems some more. I hate flies and roaches. Flies sort of have a good niche in the web of life and I am sure there are some legitimate niches for the humble roach. But I hate these pests and they have no value in the local area I inhabit. Sure, if I keel over dead, maybe they have a part in the web O’ life, but not while my girlfriend is still there to shuffle me off for proper disposal.

    I hate flies. I hate roaches too. They are stupid adaptations of nature. Calling them stupid isn’t going to help solve the existence of flies and roaches. As far as I know, short of a laser defense system under every leaf, stone, or the junk in my house, calling them names is not going to eliminate nature’s process of adaption that allows these pests to be very successful at being pests.

    Calling chiropractic stupid is just as stupid as calling flies et al stupid. Got a solution to eliminate and repurpose flies or chiropractic? Didn’t think so.

    Got a way to convince someone with a strong belief in something unsupported by pure science? Didn’t think so.

    Got a way to educate every man woman and child in the practice of critical thinking and enforce its application? Didn’t think so.

    These pseudoscience bigots need to stop ignoring the other side of science and how we make decisions. The human brain is purpose built to believe in crap because that is efficient. The only way you are going to change some of these people is to just show them how their brains came to these beliefs and the aforementioned alternate reality where unscientific hokum is real.

    Pseudoscience needs to be rebranded as the study of how people believe and even thrive on bad data, poor logic, and their strong beliefs. Pseudoscience hate speech needs to be banned.

  19. WetChet

    As a beneficiary of chiropractic for over 20 years, I can say that it can help — for BACK problems. I choose to ignore the ridiculous, unsupported claims, and just get my back fixed.

  20. nunix

    Unrelated to the topic! But since your email’s probably pretty spammed I figured this would be the best way to ask.

    I’m thinking of getting a telescope, but I really have no idea where to go for information on what’s right for me and so on. Any chance of devoting a post or two to an amateur’s-first(or-second)-telescope?

  21. Hell, all this hullabaloo might help Singh in another way…the dictionary definition of “bogus” strongly suggests knowingly fraudulent, with the BCA objecting to the “knowing” implication.

    Well, with them pulling claims off of websites left and right, citing shoddy research in their own defense…doesn’t this constitute material proof that it sure as heck is KNOWING at this point?

    Hey, Phil, I heard on the Naked Scientists podcast that Betelgeuse might be getting set to go supernova? Tell us about that!!!

  22. John

    @Daniel Brookshier

    You seem to be trying to understand why people believe certain things instead of simply vilifying their beliefs.

    Good work.

  23. Ginger Yellow

    “So, generally I would say to Simon, be critical, but do so in US internet space (on a US server).”

    Wouldn’t do him any good. Anything on the internet and accessible in England is considered to have been published in England for the purposes of English libel law.

  24. wright

    @ Daniel Brookshier:

    Some decent points. If you read some of Phil’s other posts on pseudoscience, you’ll find he’s much in agreement with you on why people believe irrational things even when presented with evidence to the contrary. It’s more comfortable to follow our intuition, our familiar prejudices, than exercise critical thinking a lot of the time.

    Getting people to critically evaluate, say, the more dubious claims of chiropractors (or acupuncture, or reiki) is an ongoing process. Sure, belief in pseudoscience is not going to vanish overnight. But pointing out the fallacies and dangers in that belief is still a worthwhile endeavor.

    You seem to be disagreeing with the often heated tone of skeptics like Phil. Well then, what is your alternative? Banning “pseudoscience hate speech” ? That seems much too close to what the BCA is attempting.

  25. Nigel Depledge

    Steve Jeffers said:

    The point in law, I think, is that there’s a difference between knowingly defrauding someone and simply not realizing you’re wrong. It’s not a legal case about the validity of the scientific claims, it’s about the characters of the people making those claims.

    The chiropractors clearly think their mumbo-jumbo works. They are idiotic, but honest.

    You may be right.

    I think, though, that the point you make is not relevant. What I think is more important is whether or not the BCA, as the professional body representing UK chiropractors, has a moral duty to its customers to ensure that the “helathcare” that it promotes actually works. To my mind, that’s the second key point in this case (the first being about freedom to criticise unsupported claims).

    If they have no such duty, then they can claim they honestly believed it works and therefore Singh’s use of the word “bogus” was libellous. I dread to think what will ensue with this as a precedent. It is truly sad that their entire case rests on one word.

    If, OTOH, they do have such a duty, then whether they knew it or not, Singh is correct to call them bogus and he should win the case.

  26. John

    My inbox this morning:

    Ritalin causing sudden death in infants:
    http://www.medicalnewstoday.com/articles/154341.php

    Trepanation being considered for treatment against alzheimers:
    http://www.newscientist.com/article/mg20227121.400-like-a-hole-in-the-head-the-return-of-trepanation.html

    Could someone from the “alternative medicine bad, conventional medicine good” flock care to comment?

  27. Nigel Depledge

    Todd W said:

    The BCA did not put out that call. That was the McTimoney Chiropractic Association.

    I spoke to a member of the MCA recently, and he seemed quite happy with the concept of being careful to claim only what can be supported by evidence. He emphasised that what he does is a purely mechnical treatment, and that it may help with some other conditions (e.g. by removing pressure from nerves) but that he claims nothing for his treatment beyond that it helps to realign the spine and get the back muscles working correctly. I believe there actually is evidence to support the use of chiropractic in treating back problems.

  28. Robert Carnegie

    That’s just physiotherapy. Mind you, my physiotherapist suggested I could try acupuncture too. I think I politely turned her down.

  29. Steve Jeffers

    (I’ll stress this again, right at the outset: I think chiropractors are, as a best case scenario, completely mistaken)

    ‘I think, though, that the point you make is not relevant.’

    It’s relevant in law, and that’s the thing. Morally, yes, the BCA have duties they don’t meet, but legally, in the UK, anyone can set themselves up as an ‘alternative health’ guru.

    Their case is simply that the line ‘This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments’ is a statement that the BCA believe the treatments to be bogus, but promote them anyway.

    I think that’s a huge stretch, to be honest, and it’s well within normal English usage for the sentence to mean ‘happily promotes [what I consider] bogus treatments’, particularly in context.

    That said … they’re a trade organization, their job is to defend the good name of their profession. If someone had said ‘dockworkers all happily take stuff from containers’, the dockworkers’ unions would have had something to say about it.

    This is legal hairsplitting. The correct response, surely, is to say ‘OK … let’s discuss this further, let’s see you explain what chiropractors are and believe’. I think most people think it’s either a legitimate therapy or some kind of special massage technique – let’s get them talking about ‘subluxations’ and energy fields and the rest of that cargo cult nonsense. Most people think homeopathy, for example, is herbs and essential oils and stuff – confront them with the fact they’re paying twenty dollars for a thimble of tapwater and they see it’s a con and immediately reject it. Let’s do the same for chiropractors.

  30. BillyJoe

    “I believe there actually is evidence to support the use of chiropractic in treating back problems.’

    Not if the control is a good back massage.
    In that case Chiropractic is no better than placebo.

  31. Nigel Depledge

    Steve Jeffers (33) said:

    That said … they’re a trade organization, their job is to defend the good name of their profession. If someone had said ‘dockworkers all happily take stuff from containers’, the dockworkers’ unions would have had something to say about it.

    This, I agree with.

    Although, the more responsible way to protect the reputation of your profession is to encourage your members to be honest. In the case of chiropractic, that would be to encourage chiropractors to only advertise and apply treatments for which there is some evidence of benefit (as in back problems). In the hypothetical case of dockworkers, it would be to encourage them to not take stuff from containers.

    This way, the organisation can quite legitimately support whatever it claims.

    Hmmm, curiously, this is what some chiropractors (e.g. the MCA, as mentioned above) have started doing after the backlash against the BCA’s lawsuit aginst Singh.

  32. TheBlackCat

    That said … they’re a trade organization, their job is to defend the good name of their profession. If someone had said ‘dockworkers all happily take stuff from containers’, the dockworkers’ unions would have had something to say about it.

    Yes, unless it was true in which case it would not be libel and any attempts to silence the person who said it would simply be an attempt to muzzle a whistleblower. It shouldn’t be libel if it is true.

    Hmmm, curiously, this is what some chiropractors (e.g. the MCA, as mentioned above) have started doing after the backlash against the BCA’s lawsuit aginst Singh.

    Technically, what the MCA did was asked its members to take down anything in print dealing with unsupported treatments until the recent wave of complaints to regulatory bodies stopped. They never said anything about taking them down permanently, nor did they say anything about not telling their patients about bogus treatments in person, they just wanted anything in print hidden until the storm blows over. They also said to not tell people things over the phone, presumably because they could be taped, and to be wary of strangers. They made no pretense about mending their ways, it was all about laying low until things settle down.

  33. John Wiens

    Did you even bother to read the list of articles cited? Spine, the Journal of the American Osteopathic Association, the Journal of Manipulative and Physiological Therapeutics and the Archives of Pediatrics & Adolescent Medicine are all peer reviewed journals. Non-medical eye indeed. Do a search instead of perpetuating an agenda.

    Extremists are dangerous on any side. They cannot be reasoned with and are unlikely to change their mind even when presented with new evidence. Take a look in the mirror.

  34. TheBlackCat

    @ John: Did you even bother to read the links Phil posted? They looked at every article. Not one provided anything remotely resembling valid scientific evidence. Many had nothing to do whatsoever with the efficacy of chiropractic treatments, many of those that did were simply letters to the editor, and the remaining ones weren’t double blind and had other serious flaws. Just having something published in a peer-reviewed journal does not automatically make it true or make it valid scientific evidence. That is only the first step.

  35. John Wiens

    @TheBlackCat: Well, I had a look at those links (presumably you meant the links to the blogs) and I have a couple of problems with them. I’m new to reading blogs and I found it very difficult to discover who was actually writing the opinion piece. Perhaps I simply wasn’t looking hard enough, however, in research papers it’s clear who wrote the article and what their qualifications are. I did manage to find Phil’s bio. Does credibility come from writing “12 bazillion blog articles”?

    The second problem is the inflammatory tone in some of these articles. DC, whoever he/she might be, writes…”It is a sign of the pathetic standard of research in chiropractic.” and misleading statements… “Most are in obscure alternative medicine journals, not easily available,..” That’s incorrect. To be honest, it all sounds a bit Bill O’Reillyish to me. Is this what passes for scholarly journalism on the net these days?

  36. Damon

    Lots of unabashed fear-mongering in this post, Phil. Way to go. “Oh no, not the BABIES!”

    Seriously. My personal Chiropractor and his wife just had a baby, and in the true, honest, communal sense of Chiropractic he shared this miracle with the entire clinic, going so far as to invite everyone to be present for the baby’s first adjustment, which went smoothly.

    This was a year ago. The baby is doing just fine. I wish someone had performed Chiropractic on me since birth; maybe then I wouldn’t have some of the health problems I suffer from now.

    He and I often joke about performing Chiropractic on animals; I worry about my little Doxy after all. Dogs, like most pets, already sponge up enough of out paychecks any way :p and according to him, “they just don’t sit still.”

    Get off the anti-chiro bandwagon and get back to scrutinizing gas balls in other galaxies, Philbert.

  37. Mary Parsons

    John Wiens, if you had clicked through to the home page you would have seen that DC is Professor David Colquhoun who has a hyperlink attached to his name that tells you about him and his current research and his distinguished history as a research scientist.

    The blog to which Phil links is DC’s more informal blog – he would never say that it is scholarly journalism, more a place for informal and candid comment on matters that catch his interest.

    By the by – do you always know who writes the leaders in newspapers? You will rarely (if ever) know who writes most of the articles for the much-esteemed Economist.

    There are very detailed analyses of the BCA’s papers available – amongst others, on the topics of asthma and bed-wetting.

    Dr Petra Boynton has an excellent summary of how to assess a paper with many readable links – she is a research academic in addition to her other activities and is aware of the need to be able to evaluate research in an appropriately critical manner.

    Ironically, of course, we have no idea of the name or qualifications of the people who prepared the BCA’s summary of evidence and judged those links to be papers that represent “good evidence”.

    Judge the evidence – it is frequently more important than the writer in cases such as this.

  38. TheBlackCat

    @ John Wiens: The person’s credentials are meaningless. What matters is the quality of the evidence. You can verify whether their complaints are valid by looking at the articles yourself.

  39. Senua

    Been going to a chiropractor for over a year now as suffer from backaches caused by my scoliosis. It helps a lot. To be honest I didn’t believe it would work but it does for me. In fact it was my GP who recommended I go to a chiropractor in the first place.

  40. Howard Boos

    Dear Folks,
    I respect everyone’s commitment on this blog to providing care to help the sick and suffering. That’s what this whole discussion is about, right?
    I hope so.
    I have practiced chiropractic for 30 years. I am just a man in an office caring for spines. Admittedly, I rarely review the current literature to find out if the care I am offering is considered “scientific”. I do frequently attend chiropractic seminars to find out from fellow chiropractors what they have found to work. Certainly not at all what you would consider a “scientific” approach. I just know that I have seen countless cases over the years as parents have brought in their children between “scientific” visits to the hospital because they were suffering from an asthma attack. Hospital visits that sometimes last 5 to 7 days while their son or daughter is given massive doses of “scientific” steroids. During those visits the child will generally lose 5% of their body weight. The parents and child will all come in to my office looking worn out. The child’s obviously worn out because it’s extremely difficult to sleep when they have to fight just to breath; the parents looking equally worn out because it’s extremely hard to sleep knowing your child is suffering. And, when these parents entrust me with the care of their I child, and I gently adjust the vertebra of the mid-thoracic spine, releasing the incredible tension the child carries, it eases. They relax. They smile. The parents smile. I then adjust the segments of the upper cervical spine because I believe (whether it’s passes what you would consider a double blind study or not) that segments are interfering with the child’s nerve system and then we all watch as the child gets better. Not once, or twice, but over and over again, I see suffering children respond and get better in my office. Does every child respond? No, but the vast majority in my office do. Does the asthma ever return? Yes. Do the asthma attacks return at the same frequency? No, most of the time they don’t. Most of the time they no longer require the use of steroids. I’ve seen this. I know this from direct experience. Yes, I know this is “merely anecdotal”. But, knowing what I know, I won’t and can’t refuse care to those children that suffer until some type of study can be done so I can get the rest of the world’s approval. I would rather see them respond “anecdotally” than suffer “scientifically”. What’s odd is that what I do is considered “bogus” for those that I’ve helped, while the “scientific” community can prescribe all the antibiotics and surgically implant countless tubes in the ears of children that fail a vast majority of the time. The bottom line is that if the practice of “scientific” medicine held all the answers parents wouldn’t continue to carry their children into my office for care. So, until then, I want to use my time in helping the sick and suffering.
    Again, I respect your intentions of providing what you believe the best health care to humanity. I would appreciate, but after 30 years I don’t anticipate, that same respect. We have evolved as a society to where we know it’s wrong to libel someone because of their skin color, but it’s still fine to libel someone because of they see a different approach to health care.
    Sincerely & regretfully,
    Dr. Howard Boos
    Tulsa, OK

  41. Steve Jeffers

    Dr Boos,

    Thanks for posting here.

    There are, as I’m sure you know, many different types of chiropractor. I’d like to ask a question: if your child was sick, would you be happy for, say, this person -

    http://www.reconnect-and-heal.com/origin.html

    - to treat them? Do your patients hear voices and see angels? Do you?

    You put speech marks around ‘scientific’ every time you use the word. What I would mean by scientific is simply that it makes claims that can be replicated. Can what a chiropractor do be replicated?

    Spine injuries are, as you no doubt know better than I do, common and can be devastating. They cost millions every year to treat, it’s a chronic condition. If chiropractice works reliably, why is it ‘alternative medicine’? Why isn’t it just medicine, used by every hospital?

    Hospitals carefully monitor all their procedures, and can provide detailed data about every patient, the treatments given and the outcomes. They could give you a breakdown of the results of using, say, a particular drug or form of treatment on a spinal problem. Are your clinic’s records as thorough? Clearly, some patients who come to see you see their condition improve – how do you measure that, what’s the typical result?

  42. Dr Aust

    Re. John Wiens’ comment #42 about Prof David “DC” Colquhoun.

    To add a little to Mary Parsons’ comment #44 for anyone who can’t be bothered to check the links:

    David Colquhoun is a very distinguished research scientist, former head of the UK’s most famous (and by common consent best) Department of Pharmacology. Colquhoun is a Fellow of the Royal Society, the British National Academy of Science. This makes him a “scientists’ scientist”.

    Colquhoun is well-known for his expertise on biological applications of statistical and mathematical methods (and is the author of a statistics textbook for scientists), and this is one of the contexts where his background is relevant to looking at studies in alternative medicine. Much of the work published by Alt Med folks (and the papers the BCA quote are typical examples) is riddled by flaws in study design, grand claims that are not backed by the actual result statistics in the papers, etc. etc. In the past Colquhoun has pointed out a number of examples where the CAM people had simply done the stats wrong, and hence claimed effects that were not actually there.

    Incidentally, in the case of chiropractic for infant colic, even a review co-authored by a prominent chiropractor and chiropractic researcher concluded that

    “The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic.”

    Surprise surprise, this reference does not feature in the BCA’s “plethora of evidence”. I wonder why.

  43. Oops – forgot to leave blog address. As I never like to miss an opportunity to plug it, now included. You can read my last thoughts on BCA vs. Singh (now a bit out of date) here:

    BCA say they want scientific debate. Bears eschew woods for proper flush toilets and soft toilet paper

  44. Nigel Depledge

    John Wiens said:

    Well, I had a look at those links (presumably you meant the links to the blogs) and I have a couple of problems with them. I’m new to reading blogs and I found it very difficult to discover who was actually writing the opinion piece. Perhaps I simply wasn’t looking hard enough, however, in research papers it’s clear who wrote the article and what their qualifications are. I did manage to find Phil’s bio. Does credibility come from writing “12 bazillion blog articles”?

    Interesting. Do you ever judge an argument on its own merits, or do you always rely on putting your trust in someone who can convince you to do so?

    When I used to read scientific literature on a weekly basis, I rarely bothered finding out what else the authors had done – I mostly tried to concentrate on the data and conclusions they presented.

  45. Nigel Depledge

    Damon said:

    Lots of unabashed fear-mongering in this post, Phil

    It ain’t fear-mongering if it’s true.

    … The baby is doing just fine. I wish someone had performed Chiropractic on me since birth; maybe then I wouldn’t have some of the health problems I suffer from now.

    Maybe. And maybe not. The fact is that with the current state of evidence available for chirporactic, you have no way of telling and neither does anyone else.

    Does it not occur to you to wonder if the baby could be doing even better or exactly as well if it hadn’t had the chiropractic treatment? No, of course it didn’t.

    The fact that you seem unable to recognise is that these anecdotes of yours mean absolutely nothing. They are not evidence.

    Get off the anti-chiro bandwagon and get back to scrutinizing gas balls in other galaxies, Philbert.

    It may have escaped your notice, but Phil is president of JREF, a foundation that supports critical thinking in all things. Chiropractors make a great many claims about their work, and you seem to have believed every last one. However, only very few of these claims are supported by any real evidence. And by “evidence”, I mean a controlled experiment or trial.

  46. Nigel Depledge

    Howard Boos said:

    I would rather see them respond “anecdotally” than suffer “scientifically”.

    So, how about you suggest that your fellow chiropractors should put their profession on the basis of some solid controlled evidence, hmm? If it is as good as you say it is, then it should be easy to demonstrate that benefit in a controlled study, right?

    What’s odd is that what I do is considered “bogus” for those that I’ve helped, while the “scientific” community can prescribe all the antibiotics and surgically implant countless tubes in the ears of children that fail a vast majority of the time.

    Actually, the treatments performed in the hospital are obliged to have passed clinical trials that they are (a) better than the previous treatment, and (b) more beneficial than harmful. Typically, a medical treatment for something as widespread as asthma will not be in the marketplace for long unless it works more often than not.

    The bottom line is that if the practice of “scientific” medicine held all the answers parents wouldn’t continue to carry their children into my office for care. So, until then, I want to use my time in helping the sick and suffering.

    I find it interesting that you describe these cases in the following way:

    (1) Child is sick;
    (2) Parents take child to hospital for treatment;
    (3) Child is released from hospital;
    (4) Parents take the child to you while said child is still exhausted from a sequence of severe asthma attacks;
    (5) You treat the child;
    (6) The child’s condition improves;

    and you conclude that chiropractic is what has helped the child. What if it actually was the steroids, but that their main benefit was delayed by a few days? How can you tell?

    If people will pay you to apply the post hoc ergo propter hoc logical fallacy to their child, well, there you go.

    If you are so convinced of the benefits of chiropractic for treating asthma, why are you not screaming for your professional organisations to organise some proper trials and prove it? Some real evidence would no only bring chiropractic into mainstream healthcare, it would erase the doubts and would at least double the number of customers that chiropractors get. How could that be a bad thing? And why are so few chiropractors advocating the acquisition of real evidence?

  47. Steve Jeffers

    >Howard Boos said:

    > I would rather see them respond “anecdotally” than suffer “scientifically”.

    I absolutely agree that responding to treatment is better than suffering. That’s obvious. But you’d agree that the best of all possible worlds would be that they respond scientifically?

  48. Dr. D

    Having been a close observer in not one, but two, attempts by the chiropractic profession to develop its research arm, I can state categorically that the reason chiropractic has weak research, is because chiropractic is systematically excluded from science academia and biomedical research funding.

    The first series of events occured in the late 1980′s through the early 1990′s, when the Foundation for Chiropractic Education and Research funded a series of fellowships to financially assist Masters-degree-holding scientists to achieve their PhD, with their research foci on chiropractic. The concept was to achieve a “critical mass” of credible researchers so that chiropractic-focused research centers could be founded. What happened instead was, after writing chiropractic-oriented dissertations, the fledgling chiropractic researchers found that they could not get hired, published, or funded if any aspect of their applications or papers referenced chiropractic in any way, and that they were socially ostracized in academia if they discussed their interest in chiropractic. Unsurprisingly, all these researchers are working in other areas now.

    The second experience was at Florida State University, which has a well-established reputation for biomedical research. FSU established a College of Medicine in 2000, one of whose stated missions was to improve training of young physicians in alternative medicine. The Florida Chiropractic Association raised $1M in “seed money” from its membership and lobbied heavily until money was budgeted by the legislature to include a College of Chiropractic at FSU. This looked set to proceed in 2003-2004.
    At that time, the medical school’s final accreditation was pending, and suddenly the medical school’s clinical director, an irascible orthopedist who hates chiropractors virulently, announced that he would resign if a chiropractic school were founded at FSU. He arm-twisted approximately 1/3 of the medical staff of the school to go along with him. An administrative hearing was held; the Florida Medical Association and the American Medical Association both spent hundreds of thousands of dollars getting career “experts” in “quackery” to testify.

    So, chiropractic is not scientific because it doesn’t have large-scale, university-based research to back it up. But, it has lower quality research because it is “not scientific” enough to be the subject of serious academic research.

    Olafdottir’s study does bring into question the effectiveness of chiropractic intervention for colic, which prior studies such as Nillson’s had supported. It is, however, underpowered, as calculation of confidence intervals compared to the p values shows. The real solution would be for a study utilizing thousands of infants treated by dozens of pediatric-board-certified chiropractors at multiple centers to be designed, funded, and performed. This would cost about 1/10th of 1% of the funding allocated by the US government to conduct one typical series of trials on one drug.

    Lastly, if you had bothered to read Nilsson et. al., you would know that dimethicone drops are used precisely because they are no better than placebo, as a control group for the study, and that the study includes references to research on the natural history of colic which shows that both control and placebo groups did better than the normal progression of the untreated condition.

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