Singh Along

One of the nice things about the blog interface at  WordPress  is the way it flags up posts from other blogs that might be related to those on your own site. A good example is an item at a site which is quite new to me called Cubik’s Rube. This particular one alerted me to an update about the Simon Singh libel action which I’ve blogged about before, in a post that generated a great deal of debate and discussion.

If you recall, Singh is being sued for libel by the British Chiropractic Association (BCA)  for damages after he labelled some of their treatments bogus in an article written in The Guardian. The newspaper settled and withdrew the piece from its website but Singh decided to fight the action. At a pre-trial hearing the judge ruled that his use of the word bogus would be interpreted as meaning that the therapies being offered by the BCA were not only worthless, but that the BCA  knew they were worthless. To win his case Singh would have to prove both these claims were true. Simon Singh claimed he never intended that meaning and vowed to appeal. That was the situation in June 2009, at the time of my previous post.

Things moved on a bit while I was away last week. In an order sealed on 30 July 2009 the Court of Appeal has refused Singh leave to appeal, thus piling the pressure even further on him to settle the action and restricting his options even further. For a clearer explanation of the legal issues involved than I could ever manage, see the article by famous legal blogger Jack of Kent.

One side issue is worth mentioning, however, which is that it is apparently unclear from a legal point of view whether the BCA has standing to sue for defamation at all since it is a corporation without shareholders. It seems strange that such a basic issue would be unresolved. Surely there must be relevant precedents?

Meanwhile the BCA has issued a conciliatory statement, implying that it would prefer for the case to be settled out of court. This seems a bit surprising given that they would appear to hold all the cards, but the answer probably lies in the appalling public relations gaffe it has made over its presentation of alleged evidence for its therapies.

Challenged (largely by bloggers) to present evidence for the effectiveness of its therapies for certain paediatric conditions (such as asthma, infantile colic and even bed-wetting), the BCA produced a report containing a “plethora” of evidence, dated 17th June 2009. This dossier – cobbled together from 19 research papers, most of which don’t really support their case at all – turns out to have been the epitome of dodginess and over the last few weeks it has been comprehensively dissected, discredited, debunked and demolished all over the blogosphere. A recent editorial in the British Medical Journal described its own refutation of the BCA’s claims to be “complete”.

I doubt if the BCA wants to see its credibility further undermined by having its so-called evidence savaged again in open court, which probably explains why they might prefer to settle than carry on the case. Nothing said in court can be subject to the libel laws.

But it’s an amazing blunder by the BCA to have presented such a shaky collection of evidence in the first place. All it has achieved is to make them look like fools.

Anyway, it’s now a peculiar situation. It still looks like Singh can’t win the case unless he can prove the BCA are dishonest rather than merely inept. And the BCA stands to fall even lower in public esteem if it goes to trial. If Singh can afford it he could fight on regardless and hope that if he loses the damages will be bearable. Morally, though, he will have won.

But the really impressive thing to me is the way that expert bloggers have forced the BCA into a corner. I think this is probably a sign of the way science is changing through use of the internet’s ability to communicate complex things so rapidly.

29 Responses to “Singh Along”

  1. Dr. Brian Blood Says:

    The problem for the BCA may prove to be even greater than your well-considered comments imply. For too long, evidence-based medicine has ignored the dangers inherent in society’s tendency increasingly to suspend judgement when presented with the more outrageous claims of its ‘ignorance-based’ competitors. The time has come for those of us who have faith in the scientific method to demand that all these ‘tooth-fairy’ notions be put to the test and where practioners promote remedies that cannot be proved to be effective they should be forced to defend their actions before the ASA or before any other body charged with protecting the public from unsubstantiated claims whether made for pills, potions, treatments or any other other ‘quasi-medical’ treatment. Certainly if the public is to be shielded from the worst excesses of the ‘alternative medicine’ industry then the levels of proof required should be no less onerous than those demanded of ‘science-based’ medicine.

  2. Anton Garrett Says:

    Those bloggers did a good job but plenty of people have made the same points before – the point is that the world can now read them for free on the internet. I hope that this keeps going, to the BCA’s disadvantage. I always wondered about the legalities of a collective suing for libel, and it would be delicious if they can’t.
    Anton

    • telescoper Says:

      The issue of legal standing is a baffling one to me, but seems to revolve around the fact that the BCA has no shareholders so precisely who has been damaged and to what extent is unclear in law. Perhaps if a legal expert reads this they could clarify. I just wonder why it wasn’t resolved right at the outset…

      I assume the BCA thought it could bluff its way through by just talking about the evidence but now it has shown its hand it’s not going to fool anyone. I haven’t read all the papers but several of them aren’t even remotely about chiropractics. They must have been pretty desperate to have scraped together such a feeble compilation. It’s their own fault if they suffer from now on.

  3. How stupid does an argument have to be before you can assume that the person making the argument knows better? There comes a point where there is no functional difference between a stupid argument and a lie. I mean bed wetting? Can we get real here? Be honest, does anyone believe that a reasonable educated person can believe this? Wait, you can’t be honest. You can’t afford the legal cost.

    Anyway a finding that they have no standing may be the BCA’s way out of this mess. It gives them a way to let the case die while saving face.

  4. telescoper Says:

    As a non-expert I’d say that there was some level of plausibility that chiropractice might have some sort of therapeutic effect for the conditions mentioned (including bed-wetting) by aiding relaxation or for some other psychological reason. Many therapies do have unforseen side benefits. I think I’m a “reasonably educated person” and I’m prepared to have a reasonably open mind to this possibility. However, I also expect claims of such effects to be backed up by solid empirical evidence. The best evidence the BCA has been able to provide is deeply unconvincing so I agree with you that no “reasonably educated person” should believe it now.

    The UK libel laws do not apply to opinions, but do apply to statements that are presented as fact. Had Singh been simply stating an opinion the case could never have been brought.

  5. Anton Garrett Says:

    Peter: your statement that “there was some level of plausibility that chiropractice might have some sort of therapeutic effect for the conditions mentioned” is an example of what I call “double hedging” while I wear my editor’s hat – you don’t need “some level of plausibility” and “might” in the same sentence.

    Certain branches of osteopathy (Littlejohn’s) major on the role of the spine in many illnesses and involve an underlying theory I find more plausible than chiropractic’s ‘subluxations’ – but I’m not committed to this view.

    If the BCA back out now then I hope Simon Singh is able to pursue them for reimbursement of his legal fees to date.

    Anton

  6. telescoper Says:

    Anton,

    I accept your syntactical castigation.

    Peter

  7. telescoper Says:

    Ps. One of the papers belonging to the dodgy dossier put up by the BCA was in fact not about chiropractice at all, but osteopathy. I’m sure they realise that these are not the same. Perhaps they thought Joe Public wouldn’t?

  8. Thomas D Says:

    I don’t remember the exact judgement, but Singh may be able to proceed by proving (say, by cross-examination) that the BCA were merely negligent in failing to establish or even investigate the efficacy of their treatments but promoting them nonetheless.

    On the broader subject, Brian may be protesting a little too much about the scientific status of ‘conventional’ medicine. It is only recently that there has been a trend towards objectively testing the efficacy of new or established treatments, rather than trusting doctors’ informally acquired judgement and/or intuitions. And (what is much more of an issue) a lot of the ‘evidence’ is bought and paid for by pharmaceutical companies. There are perilously few organisations doing really objective and disinterested work to find which treatments really make people better.

  9. telescoper Says:

    I was wondering whether Singh might be able to win his defence if he could persuade, e.g., the President of the BMA to stand up in court and say the BCA was bogus.

  10. Dr. Brian Blood Says:

    Thomas D probably knows that ‘science-based’ treatments are so-called for a number of reasons only one of which is that the procedure or therapy has been specificially ‘tested’ in a scientific manner before its introduction into general medical practice. Many treatments persist from before the days of objective testing (although I would not go so far as to say that just because someone has a vested interest in a result their studies must necessarily be biased – although I would insist that the study should be open enough to be verified by others including those with very different interests) but they continue to be used because benefit can be demonstrated (using acceptable modern procedures) or because the ‘science-based’ understanding of the mechanisms underlying the treatment or therapy are themselves well-understood and generally accepted.

    It is certainly true that science is still advancing and present understanding may be overtaken by new discoveries or deeper understandings. Peptic ulcers and the role of the bacterium Helicobacter pylori is a particularly good example.

    The problem with ‘alternative’ ‘ignorance-based’ procedures is that they do not progress in any sense that I can establish, that they ignore or more commonly contradict well-established scientific knowledge and understanding (and in areas where we have a substantial knowledge-base) and that they have not raised, nor seem to have the capacity to raise themselves above the level of the legion of ‘snake-oil’ philosophies from the past.

    The disagreement between the scientific community and chiropractics is not so much that none of their procedures offer any benefit (Singh made clear their capacity to assist in the treatment of lower back pain) but that the ‘concepts’ that underlie their approach are basically ‘hog-wash’ and did not support the promotion of treatments aimed at children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, treatments for which their approach offer no demonstrable benefit.

    Were chiropractic a kind of religion then maybe one would just have to swallow one’s tongue and show a little respect. However chiropractic presents itself as a form of medicine and that is why it needs to be forced to show good evidence for any treatment it purports to promote.

  11. “The problem with ‘alternative’ ‘ignorance-based’ procedures is that they do not progress in any sense that I can establish, that they ignore or more commonly contradict well-established scientific knowledge and understanding (and in areas where we have a substantial knowledge-base) and that they have not raised, nor seem to have the capacity to raise themselves above the level of the legion of ’snake-oil’ philosophies from the past.”

    Yeah. Bogus.

  12. Anton Garrett Says:

    Brian: You wrote: “Were chiropractic a kind of religion then maybe one would just have to swallow one’s tongue and show a little respect.” A couple of points:

    1. I adhere to a particular religion and I don’t expect anybody to show it respect just because it’s a religion. In fact I don’t respect belief systems – I respect *people*, and their freedom to believe in whatever they like regardless of whether I agree with them.

    2. This blog, written by a secular physicist, has stated that there is strong evidence that the physical universe was designed…

    At least we agree about chiropractic!

    Anton

  13. Dr. Brian Blood Says:

    My apologies – the irony in my remark quoted above has clearly failed to make it through the ether!

  14. Anton Garrett Says:

    It did, Brian; that’s why I responded! Anton

  15. grandpa boris Says:

    Singh had the guts to say that a number chiropractic treatments are of no therapeutic value (i.e. *bogus*) and that the practitioners of the chiropractic are promoting these treatments either knowing that they are bogus or without a due diligence and reasonable level of clinical proof of effectiveness. Chiropractic’s core proposition of spinal alignment being the root cause of every physical and psychological ailment is based on the sketchy understanding of physiology at the turn of last century. At that point serious scientists still considered aether as an explanation for the physical phenomena. Why aren’t practitioners of chiropractic held to the same standards as physicists?

  16. Dr. Brian Blood Says:

    Of course if he had written what you have set out above then the whole tenor of the case would have been quite different. The judge would not have had to ‘tell’ Singh what he, Singh, had written – allegedly an accusation of fraud by the BCA. His complaint would have been unambiguous and the BCA would have found itself having to defend in court those scientifically unsupportable procedures identified by Singh and others.

    IMHO the outcome of the BCA vs. Singh case has now become pretty irrelevant to whole dispute between rational science and ‘tooth-fairy’ philosophy.

    It may prove to be more important as a trigger to changing the way the law of libel operates in England.

    I believe that the only way to control poorly or unregulated ‘alternative’ therapy is to bring them all under a single quality controlling body that will require scientific proof of efficacy, quality control of drugs, potions and pills and a proper licensing system that sweeps away all the ‘mail-order’ certified quacks, practitioners of ‘aery-faeriness’, college courses in quackology, and the like (and not one run by the self-same quacks, etc.). So goodbye homeopathy, psychic surgery, chiropractic, nutritionists (but not dietitians), etc.

    And while we are about it, and following on Ben Goodacre’s excellent piece in the Guardian, we should clean up the way the drug industry gets away with hyping its own wares and treatments through ghost written reviews.

    Finally, it should be made illegal to promote any treatment that purports to be an alternative to a medical treatment or procedure through the use of celebrities.

    • telescoper Says:

      If I understand it correctly, UK chiropractors are currently regulated by the General Chiropractic Council. They seem to have been very quiet over this, although there is a statement on their website that suggests that they are now intending to look at the evidence for certain therapies. If they haven’t done this before then what is the point of the General Chiropractic Council?

  17. Dr. Brian Blood Says:

    Well that’s what one would expect – however, the GCC appears to be an example of the situation I mentioned above (of quacks regulating quacks) – see http://www.dcscience.net/?p=1718.

  18. Anton Garrett Says:

    I’m not in favour of outlawing chiropractic, homeopathy etc even though I think they are rubbish. There are already too many laws telling people what they can and can’t do (especially with their own money), and can and can’t say. A little more freedom might encourage people to take more responsibility for themselves, in this case by informing themselves. At the moment Nanny State is morphing into Big Brother; do we really want to encourage the process?
    Anton

    • telescoper Says:

      I’m not in favour of outlawing it either, but chiropractics is available on the NHS and there should definitely be regulation of what the taxpayer pays for.

  19. Anton Garrett Says:

    Peter: I forgot that, totally agree – Anton

  20. Dr. Brian Blood Says:

    It seems to me that if we agree that alternative therapies are quite often bogus (I hope I don’t have to any more specific than that), then surely anyone who is medically trained is likely to have ethical problems choosing a non-proven treatment based on ‘tooth-fairy’ principles over a scientifically-assessed therapy of genuine benefit.

    The quacks, we can assume, have no or inadequate formal medical training and are therefore unlikely to be able to decide whether their ‘version’ of medicine provides treatment better than something a ‘science-based’ medical practioner, on the basis of his or her ‘science-based’ knowledge and/or training, would recommend.

    IMO, the solution is to have medicine practised by those who understand basic physiology, pharmacology, and so on (get rid of the ‘aery-faery philosophy’), and to have auxiliary treaments practised only by medically-trained auxiliaries (dietitians, physiotherapists, and the like).

    If people believe there is a benefit to be had from manipulation of the spine then let us train physiotherapists, people who have a thorough grounding in science-based training, to perform these treatments.

    In effect, chiropractors who want to perform manipulation will have the same training we require of a physiotherapist – and will come under the relevant regulating body.

    Similarly, nutritionists must train as dieticians and if they wish to practise they must pass the examinations and come under the regulations of the relevant body.

    I am not saying that the quacks can’t perform their magic on those gullible to pay their fees but (1) they must operate outside the NHS, (2) they will not be allowed to use the title Dr. (which in promoting themselves and their work will be reserved only to those with properly recognised medical degrees or training), (3) they will not be allow to present themselves as offering treatments of a medical nature except where those have been shown to be effective, safe and then only within those areas where this has been clearly demonstrated, (4) celebrity endorsement should be banned for any medical procedure, pill or potion.

    In my view, using celebrities to endorse medical products, pills or potions is as unethical as using sex to promote alcohol.

    This is not so much Nanny State and an injection of professionalism into a field where it has been difficult to tell the well-meaning quack from the hazardous-to-health fraud.

  21. Dr. Brian Blood Says:

    The last sentence should have read:

    This is not so much Nanny State as an injection of professionalism into a field where it has been difficult to tell the well-meaning quack from the hazardous-to-health fraud.

  22. grandpa boris Says:

    Dr. Blood, you are correct. Singh didn’t outright challenge chiropractic in general as voodoo pseudo-science and that does indeed narrow the legal case. No matter how the matter is settled, BCA seems to be doing all it can to avoid having chiropractic itself being discussed.

    “Snake Oil Science”, a recent book by Barker Bausell that examines clinical studies of alternative and “complimentary” medicine, is a good survey of the field.

  23. Anton Garrett Says:

    Feng Shui
    Is a load of hoo-ey
    But will someone get into hot water
    by saying what the libel laws think they didn’t oughta?

  24. Anton Garrett Says:

    I’d actually heard it was “Fong Shwee,” in which case:

    Feng Shui
    Is rubbish to me
    But will someone get into hot water
    by saying what the libel laws think they didn’t oughta?

  25. […] Beginning Again I keep finding old forgotten bits and pieces – especially book reviews – on my computer. This one is about five years old but I thought I might as well put it on here to save having to think of anything else for today. It’s also a little bit topical because the author, Simon Singh, has recently been the subject of much discussion on this blog (here and here). […]

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