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The backlash from the BCA decision to sue Simon Singh back in 2009 resulted in a huge Streisand Effect for the profession. Attempting to silence Singh with legal chill had many knock-on effects including one in every four chiropractors in the UK being investigated for making false claims in their advertising. To avoid prosecution, the McTimoney chiropractors emailed all their members and instructed them to take down their websites and “remove information leaflets that state you treat whiplash, colic or other childhood problems in your clinic..”.

Here in Australia we haven’t seen anything as hysterical as this, but our paranoid friends over at the AVN were clearly worried, issuing a warning in their Nov 2010 newsletter that sceptics were posing as clients and reporting chiros to the authorities.

To me, this seems like a silly way to go about reporting chiros – paying them. It’s much simpler to just take a look at their websites or promotional material. Just like the anti-vax handouts I was given by Nimrod “I’m not anti-vaccine, i just don’t recommend it” Weiner, whom I’ve blogged about previously.

Of course, none of this would be a problem if they simply operated within their code of conduct and stuck to cracking backs.

So I suppose I shouldn’t have been surprised to see this claim in a leaflet sent to me by a friend earlier today:

The text says; IQ – A study demonstrated an increase in visual perception, motivation, performance and 100% of the sample group showed an increase in IQ.

One hundred percent of the sample group showed an increase in IQ? Wow, what an extraordinary claim! You’ll note there is no reference provide for this “study”, but if you want one, why not contact them through their website. (The page above is taken from a newsletter from October 2007).

As @cactopos suggested on Twitter; “I guess you could argue that alternative medicine increases everyone else’s IQ thru a process of natural selection?”. Touche Cactopos.

Things did not go well for Singh initially, when in the preliminary hearing, the Judge determined Singh’s use of the word bogus to mean the BCA were knowingly deceiving the public by using certain techniques. So in effect, Simon would have to prove that the BCA were being knowingly deceitful and not just niaively. This seemed like an impossible task.

But Simon took the risky step of appealing this decision and today he was granted the right to a full appeal to argue his right to publish the article as fair comment. In a hearing that took place in the London Royal Courts of Justice, the judge referred to the intitial judgement as “disproportionate” and erroneous. He then wasted no time in ruling a full appeal to Singh.

This is bloody good news for Simon but also for journalists and other commentators (like myself) who feared their right to critical comment was to be removed. Those of you who have been following this story would know that some chiropractors have not behaved in a particularly upstanding manner.  The MCA instructed their members to remove any reference to treating colic from all their material including websites. Australian Skeptics also received a complaint about republishing Simon’s article on their website from a chiropractor.

You can read more about this story here.

The edited version has the libelous sentence removed, but is reproduced to allow the public at large to understand the intentions of Simon’s original post. Given the current legal action currently in progress by the British Chiropractic Association against Simon, this provides insight into the claims for all to see.

Spearheaded by Sense about Science, the intention of campaign is to alert the public to the potential implications  of libel or defamation as it pertains to free speech and journalism, not only in the UK but also across the globe.

Below is the article produced in full, as approved by Simon and Sense about Science.
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Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

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Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

The story was broken by Andy Lewis from Quackometer, who published the letter in full on his website. An article, written by Chris French, detailing the events, was published today in the Guardian. You can read the full article here, but, briefly it says;

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On May 20, 2009, the Advertising Standards Authority (ASA) published its adjudication on whether chiropractors Dr Carl Irwin and Associates “could substantiate the implied claim that their therapies could successfully treat some of the conditions mentioned, in particular IBS, colic and learning difficulties”. The relevant part of the adjudication reads as follows:

We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).

Simon Perry, the founder of Skeptics in the Pub, Leicester, was so incensed by the British Chiropractic Association’s libel case against Simon Singh, he decided to do something about making sure this legislation was enforced. He searched chiropractic websites, collating those that claimed to treat colic or else implied that chiropractic was an effective treatment for this condition and reported 174 for breaching the advertising standards code. In response, the MCA sent a letter to their members advising them to do the following;

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“If you have a website, take it down NOW. 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”

“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.

“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 practices.

“Finally, we strongly suggest you do NOT discuss this with others, especially patients, Firstly it would not be ethical to burden patients with this, though if they ask we hope you now have information with which you can respond.

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.”

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One would have thought it would be more responsible to advise members to simply not use therapies for which there is no evidence, particularly when it comes to treating children. But then quacks will be quacks…

And now it appears we have the same problem in Australia. The article below appeared in a regional newspaper this week and was sent to me by a reader;

(emphasis is from reader).

The text says;
“Chiropractic treatment has also been shown to provide significant benefits for the treatment of colic. Research from the University of Southern Denmark found that spinal manipulation is effective in relieving infantile colic. Chiropractors use safe and gentle procedures to correct spinal misalignments affecting the nervous system. Chiropractors believe that trauma during the birth process can be a factor in the development of colic”.

I don’t know the laws in Australia regarding this, but given the smackdown the Arnica Montana website received this week from the Complaints Resolution Panel, this looks like a potential breach of the code.

In any case I plan to write a letter to the editior about this, citing the fact that there is no evidence for chiropractic being beneficial in colic. You should too; letters should be less than 250 words. Name, address, and phone number is required (can be withheld on request). Email editor@surfcoasttimes.com.au, snail mail, PO Box 714 Torquay VIC 3228, fax 5264 8413.

Thanks @eemyoo for the tip-off.

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UPDATE: Thanks to eemyoo for sourcing the CHIROPRACTORS REGISTRATION BOARD OF VICTORIA             STANDARDS OF PRACTICE GUIDELINES for ADVERTISING.

The sections this advertorial appear to breach appear below;

For the purpose of these Guidelines, advertising…..includes situations where practitioners make themselves available for, or provide information to, media reports, magazine articles or advertorials.

Advertising general guidelines; Chiropractors must be certain that they can substantiate any claims made in advertising material, particularly in relation to outcomes of treatment, whether implied or explicitly stated.

5.2 What is unacceptable advertising? a) create or be likely to create unwarranted and unrealistic expectations about the effectiveness of the chiropractic services to be provided

News of the launch of a campaign in support of free speech appears below in an extract from an email sent from Simon.

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1. Court of Appeal and Campaign Launch

I am glad to say that on Monday I will apply to the Court of Appeal in an attempt to overturn the recent negative ruling on meaning in my libel case with the British Chiropractic Association.

Also, Sense About Science have launched a campaign linked to my libel case and focussing on the need to overhaul the English libel system, which is deeply flawed and which therefore has a chilling effect on journalism.

The campaign has issued a statement of support, which has already been signed by an incredible list of people, including James Randi, Richard Dawkins, Ricky Gervais, Sir Martin Rees, Penn & Teller, Stephen Fry, Martin Amis and Steve Jones. It would be terrific if you would also sign up to the statement and (better still) encourage others to sign up. It is conceivable that this campaign could help reform the English libel laws (which unfortunately affect overseas journalists too). Please help us move closer to having a free press.

You can find the statement and sign up at: http://www.senseaboutscience.org.uk/libelcampaign

2. Fighting Fund

I have had many kind and generous offers of financial help, but at the moment I am able to fund my own legal costs. However, if you would like to help, then please make a donation to Sense About Science, who will need funding to maintain what could be a long battle to reform the libel laws. You can find out how to donate at: http://www.senseaboutscience.org.uk/index.php/site/project/336

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The statement now has over 4000 signatories and is gathering speed. Please spread the word about this, blog it, Facebook it, Tweet it. Simon needs our support. You can get the “Keep Libel Laws out of Science” button on your blog from Sense About Science.