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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.

In a statement, they said:

Having carefully considered its position in the light of the judgment of the Court of Appeal (1st
April 2010), the British Chiropractic Association (BCA) has decided to discontinue its libel
action against Simon Singh.

.

As previously made clear, the BCA brought the claim because it considered that Simon Singh
had made a serious allegation against its reputation, namely, that the BCA promoted treatments  that it knew to be “bogus”.

.

…the BCA now feels that the time is right for the matter to draw to a close.

Simon recently won the right to appeal the initial decision by Justice Lord over the meaning of the word “bogus” and had stated that he would continue to defend his position, even though he expected the case could cost him 1 million pounds. He has already spent 100, 000 pounds of his own money defending the case.

The action taken by the BCA resulted in significant scrutiny of chiropractic treatments and claims, and following complaints, one in four chiropractors in Britain are currently under investigation for allegedly making misleading claims in advertisements.

In another stunning move, the McTimoney Association of chiropractors (MCA) deleted their website, and advised its members to do the same. In a leaked email they told their members:

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.

In October 2009, Australian Skeptics had a complaint lodged with the Health Care Complaints Commission (HCCC) following the publication of Singh’s article on their website. Chiropractor Joseph Ierano wrote a letter to the organisation with a detailed but somewhat rambling rebuff of the article, and when he did not receive a response he liked, he went the the HCCC. The complaint was dismissed.

Simon Singh:“The case is not quite over, because we still have to argue over costs. Having backed down and dropped the case, I expect the British Chiropractic Association to pay my legal bill of 200,000 pounds. I fully expect the BCA to argue that they should not pay all my costs, but I think it is the very least that they should do because this entire legal battle has been instigated by the BCA.

The decision by the BCA to wthdraw the action despite being “…advised there are strong grounds for appeal against the Court of Appeal” is a victory for journalists and science writers. Singh said he was hugely relieved, but expressed his annoyance that libel actions continued to be used to block what he viewed as legitimate scientific inquiry and debate. See more on the BBC.

But libel reform is still desperately needed in the UK. Please sign the petition here – you do not have to be a UK resident to sign.

Happy Chiropractic Awareness Week!

More coverage at Sense About Science.

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.
—–

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.

——–

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.

From the Sydney Ideas website

Wednesday July 15th, 6:30 pm, Seymour Centre, York Theatre.

Tickets $20 full/$15 concession, special price for sceptics, $10 when you quote the promotional code “skeptics09″ when booking on the website.

For an interview with Simon about his upcoming Australian tour, listen to the Skeptic zone episode 37, available on the website.

Introduction by Professor David Day, Dean of the Faculty of Science

Prince Charles is a staunch defender and millions of people swear by it, but most doctors consider alternative medicine to be little more than superstition and a waste of money. And whilst much of this ‘medicine’ is sold on the High Street and on the internet, does it really work and is it safe? Indeed, does it even matter as long as patients are satisfied with the end results? Welcome to the world of alternative medicine.

Presenting the conclusions of his book Trick or Treatment?, co-authored with Professor Edzard Ernst, the world’s first professor of complementary medicine, Singh relies on the large amount of scientific evidence that has been accumulated to investigate which alternative therapies are safe and effective, and which are useless and even downright dangerous. From acupuncture to homeopathy, from herbal medicine to Hopi ear candling, Singh will also look at the origins of these therapies, their rapid growth in popularity and their supposed modes of action. Singh’s conclusions about effectiveness vary from good to bad (including downright dangerous), so he will discuss why so many ineffective alternative therapies have become so popular, and will consider how those that have been shown to be effective can be incorporated within conventional medicine.

Simon Singh received his PhD in particle physics from the University of Cambridge before embarking on a career as a science journalist. He joined the BBC in 1991 and worked as a director and producer on programmes such as Tomorrow’s world and Horizon. His documentary about Fermat’s last theorem won a BAFTA, and this also became the subject of his first book. He has also written The Code Book and Big Bang. He has presented The Science of Secrecy on Channel 4, Mind Games on BBC 4 and Five Numbers on Radio 4. His most recent book is Trick or Treatment? Alternative Medicine on Trial. Singh is currently being sued for libel by the British Chiropractic Association for an article published in the Guardian newspaper about the use of chiropractic to treat childhood conditions. (You can read the full article here).

Simon Singh is in Australia as a guest of the Adelaide Festival of Ideas and The Royal Institution of Australia, and his visit to Sydney is supported by the Skeptic Zone and Australian Skeptics.

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;

——

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;

——–

“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.”

—–

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.

—-

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.

—–

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

—–

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.

What exactly is detox?

Conventional detox has an established place in medicine, where it refers to weaning addicts off drugs or alcohol or eliminating poisons that have been ingested or injected (1). In alternative medicine the word detox has been hijacked to include a grab bag of pills, powders, supplements, kits, diets, magic water/drinks, colonic irrigation, chelation therapy and even shampoos and body brushes. Indicative of this, no two companies selling detox products use the same definition, as outlined by the Oxford English Dictionary as the removal of toxic substances or qualities. The word detox has simply been hijacked as a method for marketing expensive kits and supplements.

Taken from the Network of Young Scientists 'Debunking Detox" flyer

Why detox?

Many detox products refer to the large number of toxins – from cigarette smoke, exhaust fumes and pesticides to caffeine, alcohol and medicinal drugs – that our bodies are exposed to in today’s world. They talk of how toxins accumulate in the body, and of the extra burden this places on the body’s natural detoxification mechanisms. And they point the finger at this toxic overload as being behind a host of ills including constipation, bloating, flatulence, poor digestion, heartburn, diarrhoea, lack of energy and fatigue (2).

Claims on detox products include “stimulate your body’s natural detoxifying functions”, “improve the functioning of your digestive system”, “work like an intestinal broom”, “flush away potentially harmful toxins from your system” and generally give your body a “spring clean” and “improve your general health and wellbeing “and leave you feeling “revitalised” (2).

Does detox work?

Conventional detox can be life saving, however in alternative medicine, detox is a scam (1). In 2005, Choice (Australia’s consumer watch dog) conducted a study of 7 detox kits and concluded that, “Detox supplements provide little or no known benefit over a healthy diet. A week or two on a detox program won’t absolve you from a year of unhealthy eating, smoking or drinking too much alcohol. We suggest you save your money.” For full details see the report here.

Taken from the Network of Young Scientists 'Debunking Detox" flyer

Furthermore, a 2009 report from the Voice of Young Science Network (VoYS) and published by Sense about Science UK, reviewed 15 products from bottled detox-water to face scrub and concluded that “…at worst, some detox diets could have dangerous consequences and, at best, they were a waste of money”. You can read the full detox dossier here.

This report was the topic of a discussion between Dr Ben Goldacre (of the excellent BadScience column and website ) this week and the managing director of Detox-in-a-Box on the Today programme on Radio BBC 4. When asked if we ever need to detoxify, Dr Goldacre responded with an emphatic “No”. He went on to explain “..it is a purification ritual, it’s symbolic. The idea that you can fix things in just a month of healthy eating…is…dangerous because it means that people will imagine they are doing something quite useful for their lives when actually they’re not.” And in the words of Simon Singh and Edzard Ernst from their book Trick or Treatment; “the only substance that is being removed from a patient is usually money” (1).

Detox products that deserve ridicule

Detox foot pads

This gem is based on the concept that “toxins” can be removed through the soles of your feet. Now please. Just stop and think about this. The human body is well equipped with organs whose primary role is to get rid of waste products. You may have heard of them; the liver, the kidney and the skin, NOT THE FEET. Seriously, is science literacy so bad and are humans so gullible that we spend money on this stuff? My advice is, just don’t.

Here’s a brief overview of what how this thing “works”. Foot pads are like nappies or diapers for your feet. A pouch, reminiscent of a tea bag, containing a mixture of dried ingredients is secured to the soles of your feet usually overnight. When you wake up in the morning and peel of the pads, they will appear brown and sticky. Manufacturers will tell you the brown sticky stuff are the “toxins” which seeped out of your feet whilst you slept. If it sounds too good to be true that you can detox in your sleep, that’s because it is.

Foot pads contain various ingredients, including wood/sap or tree vinegar and hydrolysed carbohydrate or starch. Wood vinegar (or any other name) is a by-product of wood combustion and is highly hydroscopic, meaning it attracts and absorbs moisture readily (a little like silica beads which you find in foods to absorb moisture) upon which it turns brown. The sticky feeling described on the packaging is none other than the hydrolysed carbohydrate or sugar, which upon becoming wet feels sticky. As you can imagine, when these things are stuck to your feet overnight, you wil perspire. A recent investigation into foot pads by the NoYS reported this response from customer service upon enquiring about the reason for the foot pads turning brown and sticky; “Yes, the footpads turning brown is due to the ingredients getting wet...”(3).

Colonic irrigation

Enemas, colonic irrigation, colon hydrotherapy or colonics are marketed as a deep, whole-system cleansing method designed to remove toxins from intestine and “cleanse our body’s elimination system“. This treatment is sometimes administered with coffee (made popular by celebrities) or with various herbs. Based on the popular misconception that toxins build up over time in our bodies, this treatment is supposed to be effective against gastrointestinal disorders, migraine, obesity, allergies, bloating, cramping pains, acne and other skin complaints, arthritis and many other chronic conditions including chronic fatigue syndrome. Treatment involves insertion of a narrow tube via the rectum and flushing with considerable amounts of fluids. The fluid is flushed out through a viewing tube, so that what is eliminated may be monitored (nice!).

There is no scientific evidence that colonic irrigation has any benefit, as previously stated our bodies are perfectly equipped to eliminate toxins through various physiological processes. There have been reports of colonic irrigation causing harm by perforating the bowel or depleting the body of electrolytes. I can’t understand why anyone would voluntarily place a tube up their bottom and want to examine the resulting deposits; it’s a waste of money and a hazard to your health (1).

Is detox safe?

If these products do nothing then there’s no harm in detox right? Not necessarily. Many detox kits or detox diets involve several facets, such as pills, drinks, exfoliants and may even include a booklet advising about exercise and increasing fluid intake. Many of them recommend increasing the amount of water you consume, under the false pretence that this will assist your liver with detox and flush your system.

In July 2008, an English court awarded a woman 800,000 pounds after she suffered permanent brain damage whilst on a detox diet. Dawn Page began vomiting uncontrollably after commencing “The Amazing Hydration Diet” in 2001 and later suffered a seizure which damaged her memory, speech and concentration. She was diagnosed with hyponatraemia, a condition involving dangerously low salt concentrations induced by excessive water consumption.

Hyponatraemia or water intoxication occurs when a person drinks too much water, diluting salts and electrolytes in the blood which can then essentially “flood” cells and tissues. All cells in the body are bathed in a “salty” environment, but if the outside fluid becomes more dilute, it can rush inside the more salty cells, essentially flooding them and causing them to burst. In extreme cases, this causes organs such as the brain to swell up, and can stop it working properly, putting the drinker in serious danger.

In an article from the BBC entitled “The Dangers of too much detox Professor Graham McGregor of St George’s University of London “In normal circumstances, when people should drink when their body tells them to – when they get thirsty. Anything else is completely unnecessary, and will just leave you standing in the queue for the toilet. Detox diets are a complete con in that respect.”

Some people are a little slow to catch on it would seem. Here’s a quote from naturopath Spiro Sindos from the Naturopath Practitioners Association taken from an interview on the breakfast magazine-show Sunrise in Australia. Listen to his response about what detox is; “…what you’re trying to do is clean your body out I suppose, is the best way to put it, the best way to do that is to improve your diet, improve your lifestyle and drink copious amounts of water”. Ummm, Spiro, drinking copious amounts of water can kill you. I guess that sorts out your detox, when you’re dead you won’t need to bother.

Taken from the Network of Young Scientists "Debunking Detox" flyer

Should we detox?

The short answer is no. The bottom line is that no studies have shown that a detox regimen increases the elimination of toxins (4). As Trick or treatment reminds us; “Detox, as an alternative medicine is based on ill-conceived ideas about human physiology, metabolism and toxicology. There is no evidence that it does any good and some treatments such as colonic irrigation (enemas) and chelation therapy can be harmful”.

If you’ve overindulged this silly season, the best thing you can do is eat fresh fruit and vegetables, get some sleep, drink some water and stay off the booze and fags. Just like most things in life there is no quick fix for detox.

Further reading and references

(1) Trick or Treatment: alternative medicine on trial. Simon Singh and Edzard Ernst, 2008, Bantam Press, London, UK.

(2) choice.com.au

(3) Bad Science. Ben Godacre, 2008, Forth Estate, London, UK.

A recent article from Fairfax press about one person’s experience with a 10 day post-Christmas detox