I have received an interesting email from the British Chiropractic Association in response to my queries about the Happy Families leaflet and whether the BCA still endorse chiropractic for the treatment of colic.
I set out this email response below with the kind permission of the BCA.
I am flattered that they have chosen my Blog as the means to place these important clarifications into the public domain rather than their own website or through their Brand Alchemists (er, PR company) Publicasity.
To recap, my queries were:
1. Does the British Chiropractic Association still endorse the "Happy Families" leaflet? If not, when did this endorsement cease and why?
2. Does the British Chiropractic Association still support chiropractic as a treatment for colic? If not, when did this support cease and why?
The BCA's formal response is:
"1. The BCA has removed this leaflet from circulation as it is the subject of legal action.
"2. The BCA does support chiropractic management for the treatment of colic in babies and young children where it has been demonstrated that it can help with the management of these conditions. This is in common with the management of such conditions by physiotherapists and osteopaths and medical practitioners using similar techniques."
My initial reactions to these clarifications are as follows.
1. The BCA has confirmed that the leaflet is withdrawn.
However, I am not sure that the "Happy Families" leaflet is actually the subject of any legal action. The subject presumably is instead the original Guardian article and the alleged libel therein.
Unless there is something of which I am unaware, I cannot see any legal reason for withdrawing the leaflet during these libel proceedings.
On that note, and again subject to anything of which I am unaware, I also can see no legal reason not to release the "plethora" of supporting medical evidence into the public domain. For example, I do not think (though I could be wrong) that there are currently live proceedings for the purposes of the Contempt of Court Act.
2. This appears to me to be a concession.
What the BCA response here appears to be saying is that chiropractic can be promoted for colic (and presumably all other ailments) subject to (in effect) it meeting the standards similar to those required by the Advertising Standards Authority (ASA).
But, as we saw recently, the ASA has prohibited a chiropractor from promoting chiropractic for colic because of breaches of the advertising code provisions on Substantiation, Truthfulness, and in respect of Health and Beauty Products and Therapies.
Even if I am wrong here (which I may be, and I should be grateful for further BCA clarification), a perhaps significant point should now be made.
The "Happy Families" leaflet simply did not state that the promotion of chiropractic for colic (or any of the other named children's ailments) is or should be subject to it being demonstrated that the treatment can help with the management of such a condition.
The BCA has brought libel proceedings because Simon Singh's article was, in their view, defamatory.
However, it appears to me that it is their original leaflet which was incomplete.
Had the "Happy Families" contained the careful wording now supplied in the first place, it may well be that Simon Singh would not have needed to criticise the claims made in the leaflet.
So where does this leave the libel case?
The High Court has held that Simon Singh said something he did not mean, and which almost nobody can actually see in the original article; and now the BCA has provided a clarification which in turn was not in the original leaflet and (in my view) really should have been.
But still the libel case moves.
The BCA do, however, deserve credit for now clarifying their stance on the promotion of chiropractic for colic (and I suggest, by implication, other ailments), and I am grateful for their prompt response to my queries.
Thursday, 28 May 2009
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13 comments:
re legal action: They are obviously confusing "subject" and "object"
I support violence and torture as long as nobody gets hurt.
I also support the right of MPs to claim expenses for moat cleaning in cases where the public purse is not asked to pay.
It is nice of them to reply though I find their answers to be somewhat evasive in that they are quite straightforward but also provide very little useful information.
First, they didn't answer whether they endorse the leaflet.
Second, the comments on colic mention that the BCA does support the chiropractic treatments "where it has been demonstrated that it can help with the management of these conditions". However, it fails to provide any clarification as to where it believes this has been demonstrated.
Singh, by contrast, laid out in his defence case the sources he was working from i.e.
"1. Colic
Simon Singh lists a number of trials where Chiropractic has been shown to be ineffective: Olafsdottir (2001), Ernst (2003), Husereau (2003), Ernst/Canter (2006).
He then provides a detailed critique of the Wiberg (1999) trial cited by the BCA, and in particular where it did not meet most of the standards required and expected of a properly-done clinical trial."
Would it be so difficult for the BCA to provide something similar?
Anyway, it is nice to see a response not entirely filtered by 'the brand alchemists' just a pity it doesn't really include much information.
"2. The BCA does support chiropractic management for the treatment of colic in babies and young children where it has been demonstrated that it can help with the management of these conditions. This is in common with the management of such conditions by physiotherapists and osteopaths and medical practitioners using similar techniques."
Does the first sentence mean that the BCA is sitting on the fence and can't (doesn't) want to make its mind up? Or, does it mean that chiropractic manipulation for colic is supported sometimes and not supported other times?
Does the second sentence mean that the BCA supports physiotherapists, osteopaths, and medical practitioners who do chiropractic manipulations to treat colic? Or, does it mean that the BCA supports physiotherapists who do abdominal massage, osteopaths who do cranial osteopathic manipulation, and medical practitioners who acknowledge that there is no proven cure for colic, and try to support the parents through a difficult few weeks or months?
What I don't quite understand is why they aren't able to just give references to these publicly available studies...surely this is a health and safety matter as much as a legal one?
Kate
They may be concerned about scoring an own goal. And such a concern would be a perfectly reasonable health and safety risk assessment from their point of view.
First post here, so thanks so much Jack of Kent for all your wonderful, informative blogs lately on the Simon Singh case.
I'm a scientist, with no virtually legal knowledge, and so find this whole situation baffling, and wonder if someone can clarify the situation for me on two points.
1) In light of the preliminary hearings, if Simon never intended to say that the BCA intentionally deceived, why does he not just publicly apologise for this implication, and state that the BCA do believe that their methods work. Wouldn't that pacify the BCA and call a halt to the proceedings? Presumably he could still be free to say that the evidence is lacking for chiropractic treatment of colic and whatnot, as that doesn't seem to be really what the case is about anymore?
2) If Simon wants to continue, then you've said the issue rests on Simon proving that the BCA were "consciously dishonest in promoting chiropractic for those children's ailments". One doomed and wrong way of interpreting this is that the BCA are nasty people wanting to make a fast buck by giving people totally ineffective treatments. But isn't there another way? The BCA clearly wishes to be viewed in a scientific context, having in their own words submitted "a plethora of medical evidence showing that the treatments work." In which case, they must be conscious of the requirement to produce sets of carefully controlled, peer reviewed publications from independent labs, demonstrating the efficacy of the treatment, and have valid reasons (e.g. flawed designs) for the publications that disagree with their position. That's how scientific argument works. If the only evidence for chiropractic treatment of colic is a few uncontrolled studies, and there is ample evidence from other studies that it is no better than placebo, then to my mind - simply by not playing by science's rules when you claim that you do - the BCA would be consciously dishonest. Is this not an option? Their only escape from this in court would be to admit that they haven't the first clue about what constitutes good evidence or an objective assessment of the facts - which they presumably don't want to admit ever.
"The BCA does support chiropractic management for the treatment of colic in babies and young children where it has been demonstrated that it can help with the management of these conditions."
It's not at all clear to me that this statement actually contains any conditions. They would like us to interpret the word "where" to mean "as far as", but I suspect they actually mean "regarding which" - that is, an implied comma before the "where".
I think they've made it deliberately ambiguous.
Twaza - I appreciate that they might not be too keen to publish the studies from a self-serving point of view, but I'm just not sure where it lies in legal terms. There are still BCA-registered chiropractors who are claiming to be able to treat colic, so it seems a matter of genuine public interest to make the studies available. JoK has said he can see no reason why they shouldn't be published, and to my (uninformed) knowledge, it seems that if someone could track down these studies somehow it could be very embarrassing for them indeed. (If they do happen to be robust, then hooray, we have another treatment for infant colic.) If someone could show that there really is no legal reason for them to be withheld, that's not going to make them look too good either.
Paul Taylor - that's a good point. If the email was written by the same person I got an email from then it makes even more sense as her use of commas was a touch on the inventive side.
Hang on one cotton-pickin' moment.
What about all the other conditions;
"Asthma Colic
Prolonged crying Sleep and feeding problems
Breathing difficulties Hyperactivity
Bedwetting Frequent infections, especially in the ears"
Jack, you asked only about colic. They have answered only about colic. They could have chosen to expand their answer to cover the other conditions, but they did not.
Colic, or perhaps I should say "colic" seems to be as elusive as a chiropractic subluxation.
http://en.wikipedia.org/wiki/Baby_colic
Roughly speaking, a colicky baby looks like a colicky baby but no one really knows why they are doing what they are doing.
It would be a particularly easy matter to bat that one away if I was a chiropractor. Ill-defined disease goes away after ill-defined treatment, I might genuinely think it was me what done it and it's not an easy thing to run a good trial on.
But, has the BCA been asked about the more definitive conventional medical diagnoses on that list? Can I suggest that they be asked these specific questions?
Kate
I was trying to understand the BCA, not defend them.
What I don't understand is the law, or, rather the way the law works. If you are being sued for libel, surely you have a right to see the evidence given to court by the claimant to support their case? If defendants can't see the argument against them, how can they have a fair trial? I hope Jack will be able to tell us that Simon Singh's lawyers will be able to have the "plethora of evidence" made available to them.
A document on the website claims that "Research supports chiropractic. Numerous studies throughout the world have shown that chiropractic treatment, including manipulative therapy and spinal adjustment, is both safe and effective."
They do not explain what "effective" means, but a list of 12 references follows and includes only three controlled trials. The references are either about back pain or covert marketing (how a GP can refer patients to chiropractors).
The scope of chiropractic seems to be shrinking as a result of the BCA's libel action, well before there is a verdict.
I'm completely and utterly legally untrained so I could be wrong about this, but I'm fairly sure that the defence has a right to see the claimant's evidence and vice versa, so presumably Simon has seen the studies but has been unable to comment on them so far. As far as I know the BCA are just withholding their evidence from people not involved in the trial. Funny that they're complaining that Singh hasn't been addressing the evidence made available to the court, yet practically in the same breath have been saying that they can't talk about it themselves as the trial is still ongoing. As Mojo pointed out though, perhaps they wouldn't have a problem with producing this evidence when challenged by the ASA.
Would it be worth clarifying exactly what they meant by 'The BCA does support chiropractic management for the treatment of colic in babies and young children where it has been demonstrated that it can help with the management of these conditions' now that Paul Taylor has pointed out the ambiguity of that sentence?
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