BCA vs. Simon Singh: a letter to an MP, and the responses

BCA vs. Simon Singh: a letter to an MP, and the responses

Back in June, I wrote the following letter to my MP, and received a reply, also printed below.

I encourage anyone who is concerned about the chilling effect and consequences of the BCA’s libel case against Simon Singh to contact their Member of Parliament. MPs that are aware of this case, and are made aware that it is of concern to their constituents, will be much more likely to do something about it.

Representative democracy is responsive democracy, but MPs first need something to which they can respond. So, write!

Dear [M.P.],

I write to express my deep concern regarding the recent libel case brought by the British Chiropractic Association (BCA) against Simon Singh, and the implications for English libel law.

In 2008, Simon Singh wrote a comment piece in The Guardian newspaper on the evidence for and against chiropractic. The BCA took offense at one line in particular, on the lack of evidence for the use of chiropractic in treating babies. Simon Singh had recently written in depth about the evidence for chiropractic in his book ‘Trick or Treatment?’ and so knew well of which he spoke in the comment piece. He is, as am I, a scientist, and therefore is used to the scientific method: in the face of scrutiny or disbelief from our peers, we endeavour to defend our work on its merits and on the evidence. This is how science progresses, and it is how advances in medicine are made. It is how the public good is protected. Yet the BCA, rather than provide a robust defence of their practices and claims, chose instead to sue. What was an earnest comment, written in the public interest and for the public good, was pulled by The Guardian as soon as the writ was served.

The implications are profound. You are surely aware of the concerns that many have regarding English libel law, but with this case, English libel law has taken a turn down sinister new paths. For anyone considering writing about the evidence, or lack thereof, for a treatment, the threat of a libel action will have a chilling effect on that intention. The public good is poorly served when scientists or health professionals cannot write freely about evidence and fraud in medicine, for fear of damages and costs that can run into well over 100,000 pounds just for a preliminary hearing.

In the field of public health, it should not be open for any provider or promoter of treatment to sue for defamation in respect of their provision or promotion of those treatments*. There must be a balance between the rights of the individual to protection of reputation, and the rights of the public to hear discussion of the merits of treatments provided by said individual. Defendants should be protected by qualified privilege in such cases, as are journalists under the so-called “Reynolds Defence”, or we may see further erosion of the rights to free speech and comment in England.

I note that the Commons Select Committee on Culture, Media and Sport has been considering libel law. I hope that by bringing this particular case to your attention you will be more aware of the serious and chilling directions that libel law has been taking, and will be able to offer whatever appropriate support you can toward moderating these tendencies. Additionally, the charity Sense About Science has been campaigning for a change in the law, and your colleagues Dennis MacShane, Michael Gove and Dr Evan Harris have put their names to a statement of support that you will find attached to this letter**.

Yours, [name here]

*{h/t to JoK}

** see here and here.

A few weeks later, I received the following reply.

Dear [me],

Thank you for your letter regarding the recent libel case brought by the British Chiropractic Association (BCA) against the journalist Simon Singh, and the implications for English libel law. I apologise for the short delay in responding. Your concerns about journalistic freedom of speech and the UK’s current libel law are duly noted.

Freedom of speech is essential in a functioning democracy and indeed is recognised in international and human rights law. The right to freedom of speech is particularly important to the media, which plays a special role as the bearer of the general right to freedom of expression for all.

I have therefore written to the Rt. Hon. Ben Bradshaw, Secretary of State at the Department of Culture, Media & Sport about this issue and have asked him to comment. I will let you know as soon as I receive a response.

In order to get the reply to you as quickly as possible, I may forward it to you directly. However, if there are any issues arising from the response which you wish to pursue further, please do not hesitate to let me know.

Thank you again for bringing this issue to my attention.

Best wishes,

[M.P.]

In August 2009, I received the following letter from Bridget Prentice, the Parliamentary Under Secretary of State, to my Member of Parliament. He was good enough to forward it on.

From: Bridget Prentice MP. Parliamentary Under Secretary of State.

Thank you for your letter of 26 June to Ben Bradshaw at the Department for Culture, Media and Sport, about a recent libel case brought against Mr Simon Singh. Your letter has been passed to this department and I am responding as the Minister responsible for civil justice issues.

As a Government Minister I am unable to comment on individual cases which are or have been before the courts. In that context, I understand that this case may be subject to appeal. However, it may be helpful if I begin by explaining the law in this area in general terms.

It is important that people have an effective right to redress through the law of libel where their reputation as been damaged as the result of the publication of defamatory material. Whether material is defamatory is a matter for the courts to determine based on all the relevant circumstances. The main tests established by the courts in determining whether material is defamatory are whether the words used “tend to lower the plaintiff in the estimation of right-thinking members of society generally”, “without justification or lawful excuse [are] calculated to injure the reputation of another, by exposing him to hatred, contempt, or ridicule”, or tend to make the claimant “be shunned and avoided and that without any moral discredit on [the claimant’s] part.”

Your constituent is concerned about the effects of the libel laws on freedom of speech. The Government firmly supports the right to freedom of expression, which is protected by Article 10 of the European Convention on Human Rights (ECHR). In addition, section 12 of the Human Rights Act 1998 requires courts to have particular regard to the importance of the right to freedom of expression, particularly in relation to freedom of the press. Of course, the exercise of this right carries with it duties and responsibilities that are expressly recognised in the law. It is not an absolute right, and can be restricted for a number of reasons set down by law, such as public safety, the prevention of crime, or respect for the rights or reputations of others. Often, the right to freedom of expression may need to be balanced against other rights, like the right to respect for private and family life, home and correspondence, which is protected by Article 8 of the ECHR.

As you may be aware, the Department for Culture, Media and Sport Select Committee is currently conducting an inquiry into Press Standards, Privacy and Libel and is considering a wide range of issues in this area of law. The Justice Secretary gave evidence before the committee on 19 May and the Government will consider carefully any recommendations that the Committee may wish to make in its forthcoming report.

I hope you find this information helpful, and I enclose a copy of this letter for you to forward to your constituent, should you wish to do so.

Bridget Prentice.

A chiropractor struggles to defend chiropractic

A chiropractor struggles to defend chiropractic

Lawyered up

The British Chiropractic Association took Simon Singh to court for libel. In a stunning example of the Streisand Effect, the criticism that they were trying to suppress –  that their claims that “chiropractic can be used to children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying” were unsupportable – have come under new, unprecedented scrutiny.

Richard Brown, chiropractor and Vice President of the BCA, tried to defend chiropractic in the pages of New Scientist. Here is some analysis of his unconvincing defence.

Chiropractors are so misunderstood

Brown:  Many critics – including Edzard Ernst  – hark back to the origins of chiropractic. This has the clear intention of suggesting that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases. While a tiny minority retain this view, most are aware that such claims have long since been debunked.

Let’s take a look at his first testable claim: that a tiny majority of chiropractors retain the view that “spinal misalignments are responsible for the majority of diseases”. Palmer’s original belief was that subluxations of the spine cause disease, and that correcting subluxations, therefore, will correct the disease. What do UK chiropractors believe?

A  survey of chiropractors in the UK (from 2007) found that:

Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.

Far from just a tiny minority, we can see that clear majorities of chiropractors hold the belief that asthma, GI complaints and PMS can all be treated with chiropractic. Large minorities believe chiropractic can help with hypertension, infertility, osteoporosis and obesity. Infant colic, ear infections and childhood muscular problems were believed to be treatable by chiropractic by more than 50%. A fair reading of the survey will see that it shows a majority belief that spinal misalignments play a role in at least these aforementioned, non-spinal diseases.

Of course his actual statement,  “that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases” is extreme and exclusionary, and deliberately so. A critic will find it hard to factually dispute, which succeeds in shifting the frame away from the areas of debate where chiropractic is weak, viz. the evidence and the philosophy. One must, on the evidence, accept that his statement is likely to be true, as there surely are but few chiropractors who firmly believe subluxations to be the cause of every disease. However, a majority of chiropractors do still cling to the ludicrous belief that subluxations are the cause of the aforementioned diseases, as the evidence clearly shows.

Brown also uses the rhetorical device of ‘conceding the point’. By admitting that the basic principle of chiropractic has “long since been debunked” – he even uses the language of the skeptic – he hopes to get the readership on his side. But in a scientific publication, defending chiropractic will take more than decorum. One also needs logos.

Cherry picked data

Brown: Claims that chiropractic is dangerous overlook two recent pieces of research. One found no causative association between chiropractic manipulation and stroke. The other concluded that the incidence of stroke after chiropractic was no greater than after a consultation with a general practitioner (Spine, vol 32, p 2375, and vol 33, p S176).

Here is the second testable claim: that there are two research papers that demonstrate the safety of chiropractic that the critics have overlooked. For a skeptical, scientific audience, that’s a sit up and listen moment, but as one is reading the claim and not being Gish-galloped with it in a live debate, the audience has the luxury of testing it out. There are two questions we can ask. First, what do the two papers say, and are they of good enough quality to support the idea that chiropractic does not cause stroke? Secondly, where do the papers fit into the larger body of research on the safety of chiropractic?

Spine, vol 32, p. 2375.  Safety of Chiropractic Manipulation of the Cervical Spine. A Prospective National Survey. (2007). This survey was the first national, large scale effort to poll chiropractors and estimate incidence of adverse events arising from cervical spine manipulation. The authors found that minor side effects of chiropractic manipulation were common, including neck pain, stiffness, soreness and headaches. However, no serious adverse events such as stroke or hemorrhage were reported by the chiropractors. So, no stroke, but the paper is far from a ringing endorsement for the safety of chiropractic. They report that manipulation of the neck commonly leads to headaches, a finding that is profoundly concerning. And there are other criticisms: patients were not followed up, it is not known if chiropractors under-reported adverse events, and people may not have told their chiropractor about a serious adverse event after chiropractic treatment. If they found themselves in hospital with a vertebral arterial dissection, they would have more important things on their minds. To keep things in context, a number of researchers have found that there is an association between chiropractic and stroke. A survey of chiropractors, like this one, does not invalidate all the research that preceded it.

Spine, vol 33, S176.  Risk of Vertebrobasilar Stroke and Chiropractic Care. Results of a Population-Based Case-Control and Case-Crossover Study. (2008). This paper is very popular among chiropractors, who see in it validation for their practice of manipulating the neck vertebrae. I’ll not recap it in depth, but will just say, again, that one paper does not supercede all that has preceded it, and wonder why it is that it takes a survey or an indirect population study, like this one, to identify the risks of chiropractic. It begets the question: does the profession not want to find out the risks for itself? Apparently not. For a more detailed look at what the researchers found, go here.

So, placed into context, Brown’s cherry picked citations rather reveal that there are risks associated with chiropractic, and chiropractors themselves have done little research, on their own initiative, to quantify these risks. Furthermore, there is a large body of research that shows an association between chiropractic and stroke, and Brown would do well to read up.

More to chiropractic than spine bending

Brown: Our critics also make the mistake of equating chiropractic with spinal manipulation, especially with regard to treating non-spinal conditions such as asthma. This demonstrates a lack of understanding of the fact that chiropractors utilise a range of treatments, including postural advice, reassurance and exercise.

I suppose that if one cannot defend the claim that subluxations cause asthma, one should retreat from the claim. Why argue for something that is factually indefensible? The problem with what Brown says here is that he seems to suggest that chiropractors can utilise postural advice, reassurance and exercise… to treat asthma.

It is no surprise to me that chiropractors do more than spine bending. Practice growth and financial success in the chiropractic business is not held back by the same barriers that real doctors face, like prescribing restrictions or evidence based medical practice. Take a look at a chiropractor’s office and see what they have to offer. In fact, Richard Brown, our valiant defender of chiropractic, offers all manner of wonderful woo at his clinic: aromotherapy, reflexology, ear candling and Indian Head Masssage.

So yes, there’s more to chiropractic, but not much more.

I know you are, but what am I?

Brown: Ernst and others claim that chiropractic lacks evidence, pointing to a paucity of randomised controlled trials. This overlooks the fact that many accepted medical interventions have little or no research evidence to support them.

No, it doesn’t overlook that fact, because that fact is not, in fact, relevant. What is relevant is the fact that chiropractors lack evidence in support of their claims, and ignore the evidence that disprove their claims.

Medical interventions, when found to be unsuccesful, will be discarded. Chiropractic, when found to be unsucessful, will just insist on being tested again and again until the researchers get their sums ‘right’.

Summary

The last thing the chiropractic profession wants is scrutiny, but by suing Simon Singh, that’s exactly what they got. This is a profession that chooses to sue a science writer for criticising their claims, rather than countering with the evidence. It is a profession that won’t look for evidence of harm from chiropractic unless first prodded to do so. It is a profession where the majority are adherents to a discredited, bogus 19th century pseudo-medical concept of disease. It is a profession so divorced from reality that the best they can muster in their defence is a grab bag of rhetorical tricks and diversions and the hammer of English libel law, because, as they well know, the evidence for chiropractic just isn’t there.

free debate

Write your MP about the BCA libel chill

Write your MP about the BCA libel chill

Are you concerned about the recent libel case in Britain, brought by the British Chiropractic Association against the author Simon Singh?

If you want to do something about it, I strongly recommend writing to your MP.  This is why you should.

Letters (actual, snail mail letters) get noticed. They also get answered, or they should be. Whereas an email may be deleted or overlooked, a letter is not so easily ignored. It has a physical presence in the bureaucracy.

Politicians consider a single letter to be representative of a larger body of opinion. And they are right. When an issue becomes of such concern that it prompts an individual to put pen to paper, it is worth their while to pay attention to the subject.

Letters get noticed in the system. Sustained letter writing campaigns can have a definite impact, in that enough letters can choke the civil service that has to deal with them. But even a smaller number of letters on an issue can demonstrate to an MP or minister that there is a real base of concern.

Communications in order of effectiveness from least to most effective, and with thanks to Elizabeth May for the advice:

  • Form emails (least effective)
  • Individually written emails
  • Form snail mail letters
  • Individually written snail mail letters, typed
  • Individually written snail mail letters, written by hand (most effective)

The Commons Culture, Media and Sport Committee has been considering press standards, privacy and libel. A letter to your own MP and to the committee members would be a great idea. Let them know your concerns. It doesn’t take much to demonstrate that the citizens are growing restless. It just takes a letter or two.

You can find a list of the committe members here.