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Monday, 9 March 2009

BCA v Singh: The First Court Hearing Is Ordered

The English High Court has ordered that a "preliminary hearing" take place between the British Chiropractic Association and Simon Singh.

This preliminary hearing will probably take place in the next two to three months, and it will determine exactly how this case will be heard at full trial.

The High Court's rulings at this preliminary hearing will have an important impact on the nature and scope of the defence - or defences - which Simon Singh will have to mount.

The High Court's Order states:

"It is Ordered...That a preliminary hearing be listed before a Judge with a time estimate of 1 day...

"(1) to determine what defamatory meaning(s) the words complained of bear;

"(2) to determine, in the light of the ruling at (1) above, whether the words complained of made and/or contained allegations of fact or whether they constitute comment;

"(3) to decide any other issue suitable for preliminary determination by the Judge at the same hearing, as agreed by the parties."


(The High Court has also ordered that the full trial will be heard by a judge witout a jury.)

The "words complained of" in the original Guardian article were:

"The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments."

When the BCA launched their Claim, they stated that the "words complained of" had the following defamatory meaning:

"In their natural and ordinary meaning, the defamatory words...meant and were understood to mean that the [BCA]:

"(a) claims that chiropractic is effective in helping to treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is absolutely no evidence to support its claims; and

"(b) by making these claims, knowingly promotes bogus treatments.
"

Please note, however, it is for the High Court to determine the defamatory meaning(s) - if any - of any "words complained of": the Claimant's contention is just a starting point. (Generally, see my discussion of the BCA Claim here.)

Please also note that the BCA may have subsequently revised or reformulated their Claim in any "Reply", but as yet no Reply has been filed at Court.

Simon Singh in his extensive and (in my view) powerful Defence denies that the "words complained of" carry such a defamatory meaning, and even if they did (and/or if they carry any other defamatory meanings), he would rely on the defences of both fair comment and justification.

The effect of the preliminary hearing will be to determine whether Simon Singh will have to mount at the full trial the defences of both fair comment and justification, each of which will involve costly extensive preparation and expert evidence.

And remember that Simon Singh seems to be funding his own defence and, as is the rule in English civil litigation, taking the terrifying risk of having to pay the BCA's costs as well if he loses.

I suspect that the BCA is hoping either to force Simon Singh to have to run both defences, or to run the defence of justification alone. Notoriously, it is in the general nature of English libel law that any defence of factual justification is always harder (and more costly) for the defendant to prove.

I also suspect that the preferred outcome for Simon Singh will be that the "words complained of" are held to have no defamatory meaning at all or that they are held to be comment alone, meaning that he only has to prove that it was a "fair comment" in respect of the material before him.

However, even if the BCA prevails at this preliminary hearing, and so forces Simon Singh to run with both defences, his Defence demonstrates that he is actually well placed to meet such a challenge; it will just be a lot more work and more expensive.

7 comments:

HolfordWatch said...

As ever, thank you for keeping us up to date on this.

The words "involve costly extensive preparation and expert evidence" must concern anyone who is engaged in what they consider to be fair comment about various dubious practices where those practices are supported by access to people with more substantial funds.

Milan said...

It seems to me that this might backfire enormously on the BCA.

In an ideal world, the court will agree that the criticism of chiropractic in Trick or Treatment is accurate.

Twaza said...

Hi

I have read your summary of Simon Singh's defence, and I think it has a weakness that needs plugging.

He needs to show what "reliable" means in "reliable evidence". The CONSORT statement and Jadad quality score are not enough. The CONSORT statement is essentially a checklist for authors to use to ensure that they have made a "full" and accurate report. When I last looked the CONSORT statement did not require the source of funding to be stated. I am told that this will be remedied this year. It is necessary because the pharamceutical industry has taught us how important a source bias the funder can be.

The Jadad score picks out 3 common sources of bias (failure to randomise, failure to blind, dropouts and withdrawals), but there are many other sources of bias, and even Jadad would not say that it is safe to use on its own.

Singh needs to quote some of the standard texts and authors on how evidence from clinical trials should be critically appraised to detect error and assess the risk of bias. There is quite a long list of EBM experts he can choose from, including Sharon Straus, Paul Glasziou, R. Brian Haynes, and Andy Oxman. Other resources are the manuals for the authors of Cochrane systematic reviews and NICE guidelines, and organisations such as CASP International.

I really hope that Simon Singh can take his defence as far as it is needed. Science is threatened from all quarters by legal intimidation: see this article published in the BMJ yesterday www.bmj.com/cgi/content/extract/338/mar09_1/b736?papetoc

PC Witch said...

Thanks for making the legalese clearer for us non-specialists, we really appreciate it.

Can I just point out what I think must be a typo (or else I understand less than I thought!),

"(2) to determine, in the light of the ruling at (1) above, whether the words complained of made and/or contained allegations of fact or whether the constitute comment;"

Shouldn't it be ..."whether theY consititute comment;"

Keep up the good work.

tom p said...

Very interseting article Jack.

It seems to this lay person that he's making both factual claims and comment in the words complained of:

"The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying"
Is a clear factual statement and can be easily verified by the leaflets and screenshots and the like that Singh no doubt has copies of. Surely this part should be quite simple to defend.


"even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments"
This part seems to be comment "not a jot of evidence", "respectable face", "happily promotes bogus treatments" and given that he's telling the truth, hopefully a fair comment defence would win hands down.

By the way, is there a defence fund or somethig to which we can contribute?

Blue Wode said...

Very interesting post, Jack. Thanks.

What I’d like to know is, how can it be anything other than unethical for the BCA to promote scientifically unproven treatment for children in the full knowledge that paediatric safety data on chiropractic spinal manipulation are virtually non-existent. See the comments in this systematic review from 2007:
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2006-1392v1

BTW, it’s interesting to note that in response to a news story in Nature entitled “Survey questions safety of alternative medicine” (Nature 436, 898; 200510.1038/436898b) which quoted Edzard Ernst as saying that complementary and alternative medicine (CAM) organisations were not doing enough to monitor adverse reactions, a representative of the BCA, Barry Lewis, responded by saying that, in conjunction with the Anglo European Chiropractic College (AECC), the BCA had set up a “chiropractic reporting and learning system” and went on to say the following:

Quote:
“More than 1,200 practitioners who are members of the BCA have recently received an information pack to enable them to participate in the scheme. Resulting data will be analysed at the Anglo-European Chiropractic College and outcomes will be relayed to the profession, through our newsletter, journal and website, so practitioners may learn from the experience of others. The intention is that the scheme will, if successful, be offered to other chiropractic associations within Europe in 2006.”

http://www.nature.com/nature/journal/v437/n7058/full/437476d.html

It’s also interesting to note that a few months later, in Item 7 of the Minutes of its 2nd March 2006 meeting, the UK regulatory body, the General Chiropractic Council (GCC), declared the following…

Quote:
“ *If* [my emphasis] chiropractors are to provide a safe clinical experience for patients then a reporting procedure needs to be put in place, within the clinics and within the profession as a whole, which allows for adverse events and near misses to be shared on an anonymised basis so that we can all learn from them.”

http://www.gcc-uk.org/files/link_file/C-020306-Open1.pdf

…because, three years on, there appears to be no sign of such a reporting procedure despite one of the GCC’s primary duties being that of *protecting patients*.

It all begs the question, how is it possible for chiropractors to perform any *valid* risk/benefit analysis?

Anonymous said...

I have read Trick or Treatment, and found it fair and factual. It is a pity that UK libel laws lean so favorably toward the plaintiff.

It saddens me that reasonable parents can abandon good sense and entrust the medical care of their children to quacks, who can do nothing at best and injure or kill at worst. Why would anyone seek asthma treatment from woo merchants like chiropractors, homeopaths, and naturopaths?.