In my opinion the British Chiropractic Association is being unscientific

I have just come home from a gathering of Skeptics in the Pub in the Penderels Oak in Holborn and I am excited and dismayed.


Simon Singh – bloodied but unbowed

This was a special meeting to discuss developments in the court case being brought by the British Chiropractic Association (BCA) against the popular science author, Simon Singh. There was a packed house, a charged atmosphere and rousing, heartfelt speeches by Dave Gorman, Nick Cohen, David Colquhoun, Dr Evan Harris MP and Simon Singh himself. And rightly so: the issue goes to the very heart of our freedom to discuss science.

Science is about measurement of the world. And, perhaps more importantly, about being measured — in the sense of being steady, dignified, thoughtful, considered, deliberate, restrained. The first point about measurement goes without saying. Tonight, the second will bear some re-iteration.

Simon Singh has publicly criticised the BCA for their claim that the curative power of chiropractic extends well beyond the remedy of back pain and, for example, offers relief from childhood asthma.

How have the BCA responded to this critique? With verve and wit?

Alas, no.

With a swathe of peer-reviewed scientific papers that robustly support their claim?

Not as far as I can tell.

They have sued him for libel.

Using the UK’s dangerously lax laws on what you can and cannot write in a supposedly free press, they have brought the heavy weight of their legal muscle to bear. The BCA seems, in my view, to be more interested in their reputation than in setting the facts before the public.

And they are winning — for now — thanks to what may come to be regarded as a dubious interpretation of the word ‘bogus’ in Singh’s article. See Jack of Kent’s superlative blog for more of the back-story.

There are intricacies to this case that I do not yet understand. Ben Goldacre, though very supportive, has criticised Singh on technicalities, suggesting that the evidence in favour of the BCA’s position is weak and partial, rather than non-existent (as was claimed). But if Singh really got it scientifically wrong, are the courts the best place to settle the argument? If the BCA had a mature, serious and scientific outlook, they could have swatted Singh aside with the overwhelming mass of the evidence in their favour.

But where is this evidence? Let’s have it. As scientists, we can willingly share in the common goal to refine and improve health treatments for the population, so let’s scrutinise the data and test its quality. But I have yet to find it. Perhaps the BCA could point me in the right direction. A quick search of my own turned up a Cochrane review from 2005 on the efficacy of manual therapies for asthma (including chiropractic):

The review found there is not enough evidence from trials to show whether any of these therapies can improve asthma symptoms, and more research is needed.

I don’t think libel is any way to proceed if you are serious about science. Why, you have to ask yourself, is the BCA leaning on libel laws that place an undue burden of proof on the defendant?

This cannot stand. If science means anything, it must be strong enough to call into question any and all claims. If what the BCA says is within the power of chiropractic is backed by scientific evidence (I admit I haven’t looked hard enough), then hurrah — it will be a victory for patients and scientists alike. If not, let them withdraw and fall silent on the matter.

If you have a care about science, I would urge you to take an interest in this case. Let us all take a closer look. But let us do so carefully, rationally, rigorously, openly. Let us take a measured approach.

If you want to offer support, start here.

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46 Responses to In my opinion the British Chiropractic Association is being unscientific

  1. Eric Michael Johnson says:

    This seems more like the tactics used by Intelligent Design creationists than a quasi-scientific outfit. I guess BCA is showing their true colors. Just out of curiosity, what sort of legal standing would they have if a blog commenter were to call them glorified massage therapists engaging in scientific quackery? Not that I’m actually referring to them that way, of course. Just curious. Can the UK libel laws reach the cloudy shores of the Pacific Northwest?

  2. Stephen Curry says:

    According to Nick Cohen last night, the UK libel law has a rather surprising reach, but apparently no purchase in the US.
    But the point I was trying to make is that any criticism should be science-based – and that the BCA should be applying scientific standards in engaging with Singh, not simply throwing their legal weight around. Equally, if there are grounds for taking them to task about the claims they have made for chiropractic, these should be laid out carefully and rigorously.

  3. Brian Derby says:

    This is a very complex legal issue that highlights the details (os shortcomings) of British libel law rather than the merits or not of Singh’s claims. The [Singh] article is a reasonable read from the point of view of a reader who understands the scientific method and the logic of hypothesis based trials. However, as Ben Goldacre points out in the comments linked in Stephen’s original post above, Simon may have gone a little too far in the criticism (these points are also covered in some of the comments in Jack of Kent’s blog on the case.
    Unfortunately, I don’t think Simon Singh will get a lot of public support. The BCA does not have a demonic image outside sceptical circles and thus Simon will be unlikely generate the popular support that other higher profile libel cases have achieved, e.g. Mclibel, which in any case took 10 years to resolve. Indeed, I expect that a large fraction of those who believe large corporations are by default in the wrong, are generally those who believe CAM (complementary and alternative medicine) is always a good thing. Remember Andrew Wakefield and MMR.
    Nonetheless I believe the BCA have overstepped the mark in raising the stakes by taking out a legal action and may lose out in the popularity war if the financially better resourced Guardian helps Simon in any pursuit of expensive defenses of libel.

  4. Matt Brown says:

    I was also there last night. It was heartening to see so many people turn up at short notice. I suspect the pub broke its health and safety regulations to let over 200 people down into the basement.
    I got the impression that even Singh himself sees this as one battle in a much larger fight to change British libel laws and improve freedom of speech. Each speaker in turn highlighted the parlous state of a system that allows people living in other countries, and mostly publishing in countries other than the UK, to sue in our courts.
    Dave Gorman made an interesting point. Until a few weeks ago, he had no idea what chiropractic was, assuming it to be a perfectly non-controversial and effective form of back therapy. This case made him (and presumably many others) more aware of its less-than-rigorous groundings in science, which can only be a good thing.
    Singh is not yet able to say whether he will take the potentially costly step of appealing the court decision that ruled in BCA’s favour.

  5. Jennifer Rohn says:

    I would be shocked if Simon Singh does not have libel insurance – most professional writers do. Let us hope he is up to date on his policy payments.
    I am not too surprised that the BCA sued, to be honest. If they feel (rightly or wrongly) that they are being attacked with falsehoods, such publicity could affect their livelihood, if it drives patients away. I would have been surprised if they had not defended themselves. Since it is the general public they don’t want scared away from their services, they are taking a defensive approach that the general public will understand: a lawsuit. Had they merely replied in the lofty court of scientific discourse, would anyone have noticed besides scientists? I don’t mean to be cynical, but their approach makes sense, even if they are completely wrong-footed about the grievance. This does not mean I am not fervently hoping that this can be settled without any damage to Singh – the arguments about free press are compelling. I think his statements about ‘bogus’ claims were qualified and explained adequately, but it’s a pity the court didn’t agree in the initial assessment.

  6. Brian Derby says:

    Litigation insurance is one of the reasons why actions are taken out. Most insurances are finite in their extent and if you lose you (in English law) are liable to the expenses of the other party. So continuing litigation may be too much of a risk. This is presumably why the BCA took the unusual practice of only pursuing Singh rather than also litigating against the (wealthier) Guardian Media Group.

  7. Stephen Curry says:

    Thanks to all above for your lucid and savvy comments. As Brian points out (and it was certainly the mood of the evening last night) the important issue here is that of freedom of scientific discourse. Singh can be criticised for a certain lack of care but the BCA response is potentially very damaging.
    Matt – I had forgotten about Gorman’s point about his own consciousness on this issue being raised. Let’s hope that the publicity surrounding the case will cause others similarly to question the claims of the BCA. Jenny and Brian are probably right to be pessimistic that this issue may not get much of an airing outside the circles of the cognoscenti. But Jenny, in the same way that you once mused on the possibility of science receiving the same prominence as “sports reporting”:–-hypothetically-speaking, do you think there are avenues that science bloggers might pursue to get the issue more profile?
    Trouble is, with litigious organisations prowling out there, people may be inhibited from speaking up. I hope I chose my words carefully in writing the post…!

  8. Jennifer Rohn says:

    Yes, Stephen – I was actually a bit worried about your title, to be honest. Bloggers are not traditional targets of libel suits, but I can see it happening – does anyone know of any actions that have been brought against bloggers in the past? I guess one just needs to qualify one’s statements more carefully than SS did. (For what it’s worth, saying something is “your opinion”, to use your title as an example, is probably not the sort of qualifier that could get you out of a scrape. It’s like saying “in my opinion, such-and-such is a fraud” – it’s still defamation, if I grasp everything correctly.)

  9. Stephen Curry says:

    Thanks for the intel. Should I be worried? I trust my piece makes clear that it is the BCA’s decision to use the courts rather than to engage in an open discussion of the evidence that I find unscientific. I’m happy to leave their claims for treatment efficacy to the charge of rigorous peer-reviewed experimental testing and would use such sources to form an opinion.

  10. Jennifer Rohn says:

    I wouldn’t worry – there are probably hundreds of bloggers talking about this now, many much more critical of the BCA than you! But it is an issue we bloggers should probably educate ourselves about. It’s not something I’ve had to worry about in my professional freelance writing because most of this was ‘news’ – very factual stuff, nothing too contentious.

  11. Matt Brown says:

    Here’s a (pretty lame) video of Singh last night. To right of shot, you can gain the occasional glimpse of the back of Stephen’s head.

  12. Stephen Curry says:

    Great – my best side! 😉

  13. Clare Dudman says:

    Excellent post, Stephen.
    A New Scientist article written by someone who was there said that it felt like it was the start of something important. I hope it is. I wish I could have gone – I don’t think I have ever wished I lived in London so much!
    I had no idea that professional writers were supposed to be insured, Jenny! That worries me a little – but I suppose novelists aren’t often sued and with a blog I suppose you could just delete. I know it would always be there in some great monstrous cache in the web, but most people wouldn’t then see it, would they?

  14. Mike Fowler says:

    Fiction writers have to watch their backs too – Harry Potter’s mum, J K Rowling was involved in court proceedings to protect her copyright. Not libel, strictly speaking, but still an expensive business!
    Much of the discussion on the web in support of chiropractic (and they do get very hung up about that term1), errs more on the side of cultish than scientific. Anyone got links to peer-reviewed articles about this technique?
    1 Which probably just goes to show they’re more worried about style than substance.

  15. Stephen Curry says:

    Thanks for pointing out that New Scientist piece Clare – they were quick off the mark. They also published a piece yesterday by Jack of Kent, whose blog remains the best source of information for those wanting to get the background (and is now also reporting on the meeting).
    I see that Dave Gorman has also blogged about the meeting – his post is very good
    It also has a good discussion – with some comments by people who have experience of chiropractic (but I’m afraid you won’t find any refences cited, Mike). What’s a bit striking is the care that Gorman has taken not to attract the legal ire of the BCA. This libel business is clearly having an impact. With luck, the Singh case will provide some added impetus for a change in the law.

  16. Maxine Clarke says:

    Hello Stephen – I hope you won’t mind me adding this comment.
    To all commenters in this thread, and other visitors to Stephen’s blog:
    I am only just catching up after a few days’ away last week. I’ve set up a Nature Network Opinion forum entry about one aspect of this story – that of how well scientists do understand the legal implications of what they write. The Internet makes this of pressing concern, given that an article can in principle be considered as “published” in any country where it can be downloaded, therefore subject to that country’s laws. I hope that some Nature Network users will contribute to the forum.

  17. Maxine Clarke says:

    Incidentally, part of the above discussion is about legal insurance. Yes, publishing firms have this, but like any other form of insurance, the insurer will not pay out if it does not have to.
    Another point is that the great majority of defamation suits are settled before they get to court (contrary to popular belief), often at great expense and effort to the publisher and/or writer.

  18. Stephen Curry says:

    Not at all Maxine – the more the merrier.
    I think the forum to discuss that very issue will be useful. I did think carefully (I hope) when writing the post but I would certainly count myself among those who are only now waking up to the seriousness of this issue and the need for care even when voicing opinions (as Jenny has pointed out).

  19. Clare Dudman says:

    You have to be careful on twitter too, apparently. I think it is quite easy to get sucked into that, and perhaps say something on the spur of the moment that you regret because it does seem like a cosy chatroom – much more so than a blog post. But Jonathan Ross has learnt that tweets are not deleted – even though they appear to be…!
    And yes, Mike, I heard about that J K Rowling case – but quite a different thing, really isn’t it? The one doing the suing, I believe, rather than the one being sued.
    The only insurance I’ve ever been advised (by the Society of Authors) to take out is insurance for giving talks. I couldn’t believe it when I told that but apparently one writer was sued for helping to move a chair at the beginning of a talk – which someone then tripped over, broke their leg, and sued for the injury!
    But back to Simon – lots more on the Jack of kent facebook site now….they keep coming in.

  20. Stephen Curry says:

    Maxine’s forum has belatedly reminded me that I should have pointed out Brian Clegg’s Stick up for Simon Singh post last weekend. Apologies Brian!
    @Clare – I first thought to remarks that authors should stick to pens, rather than shifting furniture. But I guess the pen can be even riskier than the sword in these benighted times…

  21. Stephen Curry says:

    Clare – since this issue is fairly ‘live’ on the internet, I had thought of finally signing up for Twitter to help keep track of it. Would you recommend it? I think I can probably manage not to mistakenly give out my email address to the quarter of a million followers who will inevitably ensue…

  22. Clare Dudman says:

    I do think twitter is excellent, Stephen. I treat it much like an alert system- I keep getting little snippets from Nature News, SciAm, and quite a few other interesting sites – and since they provide links I can look quite quickly. I think it’s great…maybe too great. As with most of these things it is somewhat addictive and eats up time!

  23. Stephen Curry says:

    @Mike – lots of references to be found on The Lay Scientist’s blog.
    Things seem to be warming up. This could be a instance of one of the remarks made by Ben Goldacre at last year’s SciBlogs conference in London – that bloggers are good for digging out the detail.
    And Nick Cohen, who spoke at the meeting, has also posted his impressions.
    For better or worse, I am now a twitterer…

  24. Stephen Curry says:

    For those who weren’t there but would like a flavour of the event, here’s another video (filmed a bit closer to the action) from the New Humanist blog:

  25. Clare Dudman says:

    Thanks Stephen – almost like being there.

  26. Stephen Curry says:

    Cheers Clare.
    This story is certainly expanding my blog horizons. Here’s an excellent account of the meeting from Skepticat, who also attended court on the day the initial interpretation of ‘bogus’ was handed down.
    And from a commenter on Dave Gorman’s blog, a link to a recent judgement by the Advertising Standards Authority on the claims made by one practitioner. Hint: it did not go the chiropracter’s way.

  27. Stephen Curry says:

    The ASA ruling that a UK practitioner had insufficient grounds to claim that chiropractic was effective against colic has been carefully discussed by Dave Gorman and Jack of Kent. Both well worth reading.
    As Dave and Jack have pointed out, the claim that chiropractic could treat colic also appeared in the Happy Families leaflet that stimulated Simon Singh’s article. Though the BCA are suing Singh, they appear to have withdrawn the leaflet. It’s not clear yet what impact the ASA ruling may have on the Singh case, but it should certainly out the BCA under yet more pressure. As Jack of Kent has pointed out, the General Council of Chiropractors requires their members to abide by ASA standards.

  28. Lee Turnpenny says:

    Thanks for your coverage of this issue, and of the meeting, which I was unable to get to. And you’ve driven me to do something I was always determined not to – sign up to Facebook, solely in order to join the support group. And I think we should try and encourage other Facebook-ers in our localities to do likewise.

  29. Stephen Curry says:

    Cheers Lee. Let me now encourage others to go and read your contribution to the very interesting discussion that is developing on the forum.
    And yes people – don’t be afraid of facebook: sign up and offer Simon Singh your support.
    I would even go so far as to say that twitter is a great way to keep up to date with fast-developing issues like these. People are using the #singhbca tag to flag tweets about this issue. (God – ‘tweets’ – part of me can’t believe I just wrote that). And, in a wonderfully subversive touch, many are now also adding #chiropractic to their tweets so that all lovers of the profession who search on that tag will get wind of the discussion of the BCA lawsuit. Do you just love Web2.0?

  30. Stephen Curry says:

    One more before bed – The Lay Scientist blog has a very nice post summarising previous rulings by the ASA against chiropractors who have over-claimed the efficacy of their treatment against disorders such as “colic, IBS, learning difficulties, whiplash, arthritis”.
    And, according to this this post, the General Chiropractic Council code of practice states that chiropractors:

    must not use any title or qualification in such a way that the public may be misled as to its meaning or significance. In particular, chiropractors who use the title of ‘doctor’ and who are not registered medical practitioners must ensure that they make it clear that they are registered chiropractors and not registered medical practitioners.

    But here’s my question: is is not intrinsically misleading for anyone without a PhD or accredited medical training (or a timelord passport) to confer on themselves the title ‘doctor’?

  31. Darren Saunders says:

    There are at least two universities in Canada offering a DC (Doctor of Chiropractic) degree.
    As far as I know in Australia (at least in NSW) it is actually against the law for chiropractors to use the term doctor.

  32. Stephen Curry says:

    Sensible no-nonsense bunch, the Australians.

  33. Darren Saunders says:

    We like to think so 😉
    There is actually an entire act of Parliament in NSW (The Chiropractors Act 2001) covering their activities.
    Interestingly, I found this statement in a Wikipedia entry regarding the situation in Canada. the Canadian chiropractic schools teach an evidence-based medicine paradigm as opposed to the traditional vertebral subluxation model. The chiropractic schools state that the role of the doctor of chiropractic is primary care for neuromusculoskeletal conditions. Although the accreditation of these course is performed by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards, which seems a little circular.

  34. Austin Elliott says:

    Re. the BCA’s disputed Happy Families leaflet, they may have taken it down off their own site, but you can still find it on the websites of some chiropractors who are BCA members. And many of same simply cut ‘n’ pasted the disputed wording onto their websites – so that too is still widespread in chiropractors’ advertising materials. Links here.
    Re. chiropractors calling themselves “Doctors”, some actually do have a conferred degree of “DC” for “Doctor of Chiropractic”. However, it is usually against the chiros’ own code of practice, at least in non-US English-speaking jurisdictions, for them to call themselves “Dr”, even if they are a DC, unless they say specifically “Doctor of Chiropractic”. It is often against the law, too, though many chiropractors seem not to know this (for an extended argument exemplifying this, anyone with too much time on their hands can start here and read on down the thread.) The point is that it is misleading (and arguably false advertising), and counter to good practice, for them to do it under any circumstances where the reader/ prospective customer would be likely to infer that “Dr” meant “conventional medical doctor”.

  35. Stephen Curry says:

    @Austin – wow. I had some time on my hands and I see what you mean. They do crave the mantle of authority, don’t they…?
    On a side-note (you’ll have to follow Austin’s link), though only a PhD myself, I have delivered a baby. Does that make me a real doctor?

  36. Austin Elliott says:

    Delivering a baby certainly makes you a man with strong nerves, Stephen.
    Re. the chiropractors, it is the incredible lack of any self-insight that gets me. “Guru-like” is a phrase that springs to mind. Or possibly “Bullet-proof Messianic self-delusion”.
    This is actually a characteristic of many alternative therapists, most emblematically the homeopaths. But it is telling, I think, that you also see this with the CAM people who have been most dramatically successful at convincing people they are “serious professionals who practice an evidence-based therapy”, like the chiropractors.
    As I and many other people keep saying, it is the total lack of awareness of their and their therapy’s limitations – and indeed the near-refusal to admit that such limitations exist – that stands out as a key difference between things ultimately based in science and things based in belief.
    As well as the thin-skinned recourse to libel lawyers when somebody points out the holes in what they are saying, of course.

  37. Stephen Curry says:

    It is perhaps a forlorn hope but perhaps some of the interaction between the CAM community and evidence-based medics/scientists will allow a something of our skeptical, knockabout culture to infiltrate theirs.
    As you suggest, their outlook seems to be more akin to religious zeal. But if the challenges to chiropractic that seem to be emanating from the Singh case (and the recent ASA adjudication) gain further momentum, there may be more exposure of the flaws of their approaches in the public mind. Needs to break out of the blogosphere though…

  38. Stephen Curry says:

    JackofKent has written an interesting post on the latest press release from the BCA.
    Notably, the press release mentions “27 different publicly-available research papers” that they presented to the court in support of their claim. But not one of them is cited in the press release. Their legalising still trumps any scientific instincts they may have.
    Elsewhere David Colquhoun laments the bizarre decision by NICE (UK authority that licenses medical treatments provided by the National Health Service) to recommend “manual therapy” (chiropractic) and acupuncture for for treatment of lower back pain.

  39. Richard P. Grant says:

    “the issue goes to the very heart of our freedom to discuss science.”
    How prescient.

  40. Heather Etchevers says:

    I’m a little confused (but pleased, because c’mon, let’s be rational here of all places!) to still see this thread. Richard or Stephen, care to fill me in on what’s missing, elsewhere perhaps?

  41. Austin Elliott says:

    Thought you were one of the commenters on the “removed “Respect My Authority?” post”:, Heather?
    If you’re surprised to still see this one here, one interesting wrinkle might be that individuals can sue for libel, as can professional associations made up of individuals (like the British Chiropractic Association that is suing Simon Singh)… but “chiropractic” in general can’t – it is not a legal entity.
    As an anonymous libel lawyer commenting over at Jack of Kent’s excellent legal blog put it:
    “…it is perfectly possible to use the word “bogus” to describe chiropractic. Just be careful of mentioning an entity which is able to sue.”

  42. Stephen Curry says:

    @Heather – I hope Austin’s comment has cleared up any confusion. Oddly I thought this post to be the potentially more contentious of the two. Shows how much I know.

  43. Austin Elliott says:

    Must-read article by Nick Cohen in the Observer dealing with BCA vs. Singh and the wider implications for free speech. Cohen describes the English Law of Defamation as “a public menace”, with which I suspect few of those following the Singh case would disagree.

  44. Heather Etchevers says:

    Yes, sorry, what I meant is that I, too, thought this post was more contentious than the other. (But I did get confused for while there). After all, you mentioned a litiginous organisation by name. So I am very much looking forward to some guidance as to what is acceptable or not at the borderline – complete with examples, for bloggers on a lawsuit-shy platform.

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