Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Everyone knows what bogus treatments are – or do they?

Simon Singh won his appeal of the libel decision that is summarized in that quote –

Everyone knows what bogus treatments are. – High Court judge Mr Justice Eady paragraph 7 (12)[1]

Perhaps some explanation is in order.

One of the reasons I write this blog is that not enough people know what bogus treatments are, or how to determine what treatments are bogus. I do not limit myself to EMS (Emergency Medical Services) treatments.

Simon Singh wrote an article explaining about bogus treatment, but The BCA (British Chiropractic Association) cried libel. High Court judge Mr Justice Eady demonstrated his profound ignorance by finding in favor of the frauds. A bad time for science, but do not worry, gentle reader, the truth will come out.

Perhaps High Court judge Mr Justice Eady thought he would be remembered as Justice Potter Stewart is for (the highlighting is mine) –

under the First and Fourteenth Amendments, criminal laws in this area are constitutionally limited to hard-core pornography. [n2] I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description, and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that.[2]

I agree with High Court judge Mr Justice Eady that there is little difference between bogus treatments and hard core pornography. However, High Court judge Mr Justice Eady makes it quite clear that he does not know what bogus treatments are.

The claim that Everyone knows what bogus treatments are, is itself bogus.

The way we determine what is bogus and what is not is by using scientific inquiry.

While anyone can make fantastic claims about a treatment, and a lot of bogus treatments have fantastic claims made about them, that is only a correlation. Penicillin had fantastic claims made about it. Penicillin did live up to some of those claims. Penicillin did not put an end to infectious disease, but it did have a dramatic effect death from infection. Penicillin, as with all treatments, has had problems. Penicillin has plenty of research to show when it is an appropriate treatment. Penicillin did not just rely on fantastic claims. Penicillin is still used, because of doctors putting aside the fantastic claims and looking at the research. That is real medicine.

How does High Court judge Mr Justice Eady know what a bogus treatment is?

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. – High Court judge Mr Justice Eady paragraph 7 (12)[1]

Allow me to rewrite that for High Court judge Mr Justice Eady.

Everyone knows what bogus treatments are after these treatments repeatedly fail to demonstrate superiority to placebo in valid scientific studies.

They are not merely treatments which have proved less effective than they were at first thought claimed to be, or which have been shown by the subsequent acquisition of more detailed scientific knowledge to be ineffective never been shown to be effective.

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. A perfect example is that, 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.[1] As Simon Singh stated in the alleged libelous article.

There have been some developments since the original libel complaint. One was the release by BCA of a plethora of evidence supporting the claims that chiropractic can successfully treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying. The Lay Scientist addresses the 29 studies in a post that found the plethora to be less than a jot of evidence.[3] Many other bloggers did likewise.

Following this public humiliation of the BCA, and the suggestion that they should change the name to the Bogus Chiropractic Association, a separate group (McTimoney Chiropractic Association) sent an emergency letter to its members essentially telling them that the claims they have been making may land them in jail. It seems that they are beginning to understand that the research they have used as the basis for treatment is worthless. Actually much less than worthless, since it will cost them money, reputation, and possible jail time. They had to have this explained to them by bloggers more literate in research than any of these chiropractic doctors. I wish I could claim that I had been one of them, but I did not write much on the topic, and I did not review any of the research on my blog, since it was done so swiftly and completely elsewhere.

If you have a website, take it down NOW.[4]

REMOVE all the blue MCA patient information leaflets, or any patient information leaflets of your own that state you treat whiplash, colic or other childhood problems in your clinic or at any other site where they might be displayed with your contact details on them. DO NOT USE them until further notice. The MCA are working on an interim replacement leaflet which will be sent to you shortly.[4]

If you use business cards or other stationery using the ‘doctor’ title and it does not clearly state that you are a doctor of chiropractic or that you are not a registered medical practitioner, STOP USING THEM immediately.[4]

IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.[4]

Most importantly, this email and all correspondence from the MCA is confidential advice to MCA members alone, and should not be shared with anyone else.[4]

Yes, I have selected parts of this letter that are more incriminating than others. However, they are making this clear, they believe the way they have been advertising is illegal. They need to change things in order to abide by the law. In other words, they assert that Simon Singh was completely accurate in his article.

Here is the most ironic part –

Be wary of ‘mystery shopper’ phone calls and ‘drop ins’ to your practice, especially if they start asking about your care of children, or whiplash, or your evidence base for practice.[4]

Imagine if any professional organization told a group of its members, at least if they are real medical professionals, You do not know enough to answer questions from patients about the evidence supporting the treatments they use regularly.

In essence, this is what they are saying –

We screwed up. We need to make up another story.

Until further notice we advise you to –

Change the subject.

Make counter accusations.

Stonewall.

Without our advice, you will continue to break the law.

And don’t call yourself a doctor, let’s get real about the trade school you attended.

What did High Court judge Mr Justice Eady write?

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. – High Court judge Mr Justice Eady paragraph 7 (12)[1]

McTimoney Chiropractic Association seems to be making it quite clear that High Court judge Mr Justice Eady is describing the actions of McTimoney Chiropractic Association. They don’t like it, but they can’t charge him with libel, he is the libel judge defending chiropractic quackery. They may even need to see real doctors for treatment of their apoplexy.

Back to the ruling of the Court of Appeals.

What “evidence” signifies depends heavily on context. To a literalist, any primary fact – for example, that following chiropractic intervention a patient’s condition improved – may be evidence of a secondary fact, here that chiropractic works. To anyone (and not only a scientist) concerned with the establishment of dependable generalisations about cause and effect, such primary information is as worthless as evidence of the secondary fact as its converse would be. The same may equally well be true of data considerably more complex than in the facile example we have given: whether it is or not is what scientific opinion is there to debate. If in the course of the debate the view is expressed that there is not a jot of evidence for one deduction or another, the natural meaning is that there is no worthwhile or reliable evidence for it. That is as much a value judgment as a contrary viewpoint would be. – Court of Appeals paragraph 26[1]

It appears that not all judges are as easily or willfully fooled as High Court judge Mr Justice Eady.

If in the course of the debate the view is expressed that there is not a jot of evidence for one deduction or another, the natural meaning is that there is no worthwhile or reliable evidence for it.

It is now nearly two years since the publication of the offending article. It seems unlikely that anyone would dare repeat the opinions expressed by Dr Singh for fear of a writ. Accordingly this litigation has almost certainly had a chilling effect on public debate which might otherwise have assisted potential patients to make informed choices about the possible use of chiropractic. If so, quite apart from any public interest in issues of legal principle which arise in the present proceedings, the questions raised by Dr Singh, which have a direct resonance for patients, are unresolved. This would be a surprising consequence of laws designed to protect reputation. – Court of Appeals paragraph 11[1]

Accordingly this litigation has almost certainly had a chilling effect on public debate which might otherwise have assisted potential patients to make informed choices about the possible use of chiropractic.

When you hear someone claiming that a statement is libel (or slander) think about this.

Is the claim of libel an attempt to silence debate or to encourage healthy debate?

A more thorough review of the legal aspects can be found at Jack of Kent. He has a post about this, but promises to examine this decision in more depth over the weekend.[5]

A more thorough review of the scientific aspects can be found at The Guardian in an article by Dr. Ben Goldacre. He examines the history and concludes with this.

a ragged band of bloggers from all walks of life has, to my mind, done a better job of subjecting an entire industry’s claims to meaningful, public, scientific scrutiny than the media, the industry itself, and even its own regulator. [6]

Footnotes:

^ 1 British Chiropractic Association v Singh [2010] EWCA Civ 350 (01 April 2010)
England and Wales Court of Appeal (Civil Division) Decisions
Free Full Text of Decision

^ 2 Jacobellis v. Ohio (No. 11)
173 Ohio St. 22, 179 N.E.2d 777, reversed.

Concurring Opinion of Justice potter Stewart
Free Full Text with links to other sections of the decision

^ 3 A Review of The BCA’s Evidence for Chiropractic
The Lay Scientist
Post

^ 4 McTimoney Chiropractors told to take down their web sites
The Quackometer
A copy of the McTimoney Chiropractic Association letter is posted in full.
Post

^ 5 BCA v Singh: An Astonishingly Liberal Judgment
Jack of Kent
Post

^ 6 An intrepid, ragged band of bloggers
The Guardian
by Dr. Ben Goldacre
Article

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