Chiropractic libel suit snagged by its own ruling body?

By Grant Jacobs 06/03/2010 7

The UK’s ruling body for chiropractors, the General Chiropractic Council (GCC), has declared the same claims that the British Chiropractic Association (BCA) have charged science writer Simon Singh as falsely claiming as ’bogus’ are contrary to evidence. Or, some would say, actually bogus.

u-johannesburg-spineAccording to the GCC’s ’What is the GCC’ page, ’it is a criminal offence for anyone to describe themselves as any sort of chiropractor [in the UK] without being registered with the GCC’ and that one of their aims is to ’set the standards of chiropractic education, conduct and practice’ (my emphasis).

I’m no lawyer, but on the face of it the BCA have two obvious choices: pull out of the libel case against Simon Singh as a consequence of the GCC’s findings, or part ranks with the GCC and sue their own ruling body in order to be consistent with continuing with their suit against Simon Singh.

Although (highly) unlikely, particularly as they are almost certainly legally obligated to work within the constraints of the GCC, the latter option would be an entertaining dog fight.

The news of the GCC’s findings originate from an article from the Guardian by Martin Robbins that scibling Alison Campbell emailed me and earlier reported earlier tonight. In his article, Robbins claims that an up-shot of the law suit against Simon Singh is that:

A staggering one in four chiropractors in Britain are now under investigation for allegedly making misleading claims in advertisements, according to figures from the General Chiropractic Council.

The details for the interested are in Robbins’ article, but the essence is that the BCA is swamped with claims and it’s costing them.

I’d like to draw readers attention to these two paragraphs near the end of Robbins’ article:

Now even the General Chiropractic Council has disowned the claims of the BCA — the same claims that lie at the centre of its libel action against Simon Singh.

In a new report, it has attempted to clarify the assertions that chiropractors can and cannot make, backed up by a systematic review of the evidence. Notably, the report concludes that the evidence does not support claims that chiropractic treatment is effective for childhood colic, bed-wetting, ear infections or asthma, the very claims that Singh was sued for describing as “bogus”.

At most readers would realise, the ruling body has undermined the British association’s case. As far as I can see, they’ve obliterated it.

The article referred to, by Bronfort and colleagues, is available on-line (PDF file) for those who wish to draw their own conclusions. I would suggest, though, that you first read the original evidence which examines these claims that Alison Campbell has listed in her blog article. (The short article by Ernst is particularly worth reading and, I feel, may be easier for many to follow.)

Bronfort and colleagues summarise their findings in several tables, by region of body or symptom: spinal, extremity, headache or ’other’, non-musculoskeletal, noting the kind of intervention tested. Claims tested are listed by level of evidence–high, moderate, or inconclusive–and the outcome the nature of the evidence: positive, favourable, inconclusive or negative.

Evidence that is inconclusive or negative cannot be used to support a claim.

From their tables, symptoms that they list as having inconclusive or negative evidence for treatment by any of the treatments examined are:

Asthma, Colic, Otitis media, Nocturnal Enuresis, Premenstrual syndrome, Hypertension, Pneumonia in Older Adults, Fibromyalgia, Myofascial Pain Syndrome, Miscellaneous Headache, Morton’s Neuroma, Hallux Limitus, Hallux Abducto Valgus, Ankle Sprains or fractures, Knee Arthroplasty Rehabilitation, Hip Arthroplasty Rehabilitation, Carpal Tunnel Syndrome, Rotator Cuff Pain, Shoulder Pain, Sciatica / Radiating Leg Pain, Coccydynia, Mid Back Pain

The GCC rejects many of the claims many of it’s practitioners make, including the very claims that the BCA have objected to Simon Singh objecting to.

The only treatment they report as showing positive support at a high level of evidence was treatment for chronic low back pain using spinal manipulation /mobilization.

They offer mixed ‘moderate’ support for other spinal conditions: some have ‘moderate’ support under some treatment regimes, but are inconclusive under other treatment regimes.

Other, non-spinal, symptoms are listed as having ‘moderate’ support under particular treatment regimes. (The full list is too long to re-iterate here: interested readers can read them in the PDF copy of the article linked earlier.)

The authors point out that the ‘moderate’ standard of evidence is limited by:

  • The number, size, or quality of individual studies.
  • Inconsistency of findings across individual studies.
  • Limited generalizability of findings to routine practice.
  • Lack of coherence in the chain of evidence.

They conclude their description of the ‘moderate’ standard of evidence, stating:

As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.

As such, ‘moderate’ support should be taken as tentative. With this in mind, the only tested treatment by chiropractic with full evidential support according to their study is treatment of chronic low back pain.

A key concept here is that treatments offered should be based on claims that can be substantiated, as also lies at the heart of the issue with other remedies such as homoeopathy and ’treatments’ for autism based on unsound ideas.

It will be interesting to watch the impact has on the BCA’s libel case against Simon Singh and if the public exposure of these unsupported remedies encourages people to move on to sounder practice. Let’s hope so.

Other health/medicine-related article in Code for Life:

The inheritance of face recognition (should you blame your parents if you can’t recognise faces?)

Enabling deaf people to text emergency calls to 111

Homeopathy check-up: Not in the health system, disclaimers on labels

Rubella, not a benign disease if experienced during early pregnancy

Lancet formally retracts Wakesfield paper

Bill & Melinda Gates Foundation: $10B towards vaccines

Homeopathic remedies in NZ pharmacies

Deleting a gene can turn an ovary into a testis in adult mammals

7 Responses to “Chiropractic libel suit snagged by its own ruling body?”

  • Very nice article.

    There follows my inexpert interpretation and summary of material published mostly on JackofKent’s legal blog. It is probably wrong.

    Just one point. As things stand at the moment (an appeal judgement is pending) with the BCA v Simon Singh suit it seems that whether Simon’s statements regarding the efficacy of chiropractrickery are true or not is irrelevant. At an earlier ruling (Justice Eady) it was judged that the words (including bogus) meant that the BCA were knowingly and dishonestly promoting treatments that they knew to be ineffective. For reasons that I do not understand this meant that it did not matter if the treatments worked or not. No one will care. It will not be raised in court. All the BCA have to do is sit back and relax as Mr Singh tries to prove that the BCA was knowingly dishonest in the matter concerned. This is apparently regarded as more or less impossible, particularly since the BCA is a corporation and no one seems to know if a corporation can even know anything at all. Ever.

    It seems to me that if it turns out that a corporation can’t “know” anything (where is its mind?) then Mr Singh may have no defence at all – by definition.

    By the way, costs so far are estimated to be £100,000 each side and we have not even really started yet.
    transcript of the Court of Appeal hearing.
    General comments of English Libel
    Report on the appeal hearing
    Has many links to important comments on the case by other writers.
    BMJ article, BCA response (and further responses and editorial) linked to is especially entertaining.
    English libel proceedings, the “reverse burden of proof”

    And many more….

  • James,

    Thanks for the comment and links. I’m sure those trying to follow the courtroom drama will want to look into the links.

    I decided not to go into the legal side myself as aside from British libel law not being “my thing”, my own interests are mainly with the conflicting position of the GCC and the BCA, and that evidence should be the basis of treatment/remedy claims (a point I’ve brought up elsewhere about other remedies).

    That said—from someone who knows very little about the system and who can only take it second-hand at face value—it does seem as if the current libel system in the UK allows (encourages?!) defence to claims by bullying rather than presentation of evidence.

    Stephen Curry has also written an account of the opening session of the court case (with photos), in his article Science at Court over at Nature Network:

  • […] It became clear almost immediately that the BCA had overplayed its hand. Eady’s ruling rightly raised a worldwide clamour against the depraved state of the law and the health of free inquiry in the land of Newton and Darwin. (This has helped put libel reform on the agendas of all major parties in the current UK election.) It is, after all, almost not enough to say that science “depends” on the freedom to make tough evidentiary criticisms; considered socially, science is practically equivalent to the possibility of making them. Meanwhile, the beam of a million-watt searchlight had been attracted to the claims and conduct of the British chiropractic business. In a canonical demonstration of the Streisand Effect, the country’s statutory regulator of chiropractic, which holds the activity and advertising of practitioners to an explicitly scientific standard, was obliged to launch literally hundreds of investigations into strip-mall spine-crackers. […]

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