Saturday, 13 June 2009

The Quacklash - Causes And Effects

The British chiropractic profession is now under intense regulatory scrutiny, and I think the strain is beginning to show.

This significant phenomenon really deserves its own name, and in view of its reactive origin, I will dub it the Quacklash.

This Blogpost is an exploration of the causes and effects of this Quacklash.

The Causes Of The Quacklash

The primary cause of this anxious scrutiny is clear.

It is a reaction of a number of activists and Bloggers (though not me) to the misconceived libel case brought by the British Chiropractic Association against Simon Singh.

Amongst the Bloggers involved in this frenzy of activity are Zeno and JDC325, though there are many others.

And earlier today the Blogger Adventures In Nonsense revealed how he went about reporting 500 chiropractors to Trading Standards and the General Chiropractic Council.

However, it really should not be a surprise to the chiropractic profession that they are under regulatory obligations.

In particular, they should be aware of three main sources of regulatory oversight:

1. chiropractors are a regulated profession, and so the prospect of complaints to the appropriate regulatory body are an necessary aspect of being in such a regulated profession;

2. chiropractors are also, in my view, traders under the Unfair Commercial Practices Regulations, and so they also face the prospect of interventions by Trading Standards; and

3. chiropractors advertise, and so - as is catalogued on the Lay Scientist site - they can be held to strict standards in their advertising.

Chiropractors surely should not be afraid of these regulatory regimes. No chiropractor wants to be in breach of their professional standards, to be adopting unfair commercial practices, and to be using misleading advertising.

However, many Bloggers and activists contend that chiropractors are indeed in breach of their regulatory duties and have made complaints to all the appropriate bodies.

Why this attention? Why is so much time and effort being devoted to the chiropractic profession rather than other complementary and alternative health practitioners?

Adventures In Nonsense eloquently provides his answer on his Blog:

"For some time, chiropractic has managed to get away with being the acceptable face of alternative medicine. With some evidence to show that it helps with lower back pain, and many chiropractors only using the therapy for this purpose, it was seen by many as a legitimate therapy and largely escaped criticism from sceptics.

"That all changed when the BCA decided to sue Simon Singh for libel. In a fine example of the Streisand effect, all the energy usually reserved for criticising homeopaths and reiki healers was redirected straight at those chiropractors making wild and outlandish claims to treat colic, asthma and a host of other problems unrelated to the spine.

"With the BCA attempting to stifle debate over the bogus* claims made by Simon Singh, I was determined to do something."

I suspect all those making the complaints and reports have similar views to those of Adventures In Nonsense .

The Short Term Effect Of The Quacklash

The immediate response by the chiropractic profession to this regulatory scrutiny seems to be panic: websites have been pulled; material have been withdrawn; and worried chiropractors have been contacting their regulator and professional bodies.

Amongst all this, there has of course been the McTimoney Letter.

I blogged quickly on this bizarre letter earlier this week. One or two followers of this Blog then suggested the letter perhaps had a wider impact for the Simon Singh case than I had set out.

I have thought about this, but I am afraid the McTimoney Letter really does not have a great deal of evidential value. It is actually a silly and badly-worded document, which misunderstands the applicable law, and is startlingly alarmist.

There is - sadly - no reason to believe that the McTimoney Chiropractic Association actually have the slightest clue what they are talking about when they mention "claims for treatment that cannot be substantiated with chiropractic research."

Unless they set out the evidential basis for this assertion, then their apparent implicit admission that the treatments cannot be substantiated is actually of no more probative or forensic value than the British Chiropractic Association's (so far) empty claim to the contrary.

All because the McTimoney Letter contains something convenient for the skeptic position, it does not somehow make the MCA gallant skeptics-in-exile.

For me, the main value of the McTimoney Letter is that it shows that there is no common position for the chiropractic profession in respect of promoting chiropractic for various children's ailments. This itself badly hinders the BCA case, as the opinions of other chiropractors cannot be as easily brushed off as those outside the profession.

So perhaps a more significant example of panic is the letter of the British Chiropractic Association itself revealed on Gimpy's Blog.

This important BCA letter undoubtedly would not exist but for the Quacklash.

And, in my view, the notorious Happy Families Leaflet fails completely to comply with the guidance in this letter.

The BCA letter is also interesting in what it omits. The recent adverse ASA ruling was not just that there had been a breach of the Health and Beauty Products and Therapies provision, but also of the requirements for Substantiation and Truthfulness.

However, the BCA letter makes no mention of these other ASA requirements and, unless there are separate letters in respect of Substantiation and Truthfulness, I wonder whether this is a telling omission.

Overall, it appears websites have been taken down and materials withdrawn by chiropractors across the country; Trading Standards and the ASA are already looking into complaints; the General Chiropractic Council is being prompted into action; and the MCA issues its own zany letter whilst the BCA finally reminds its members of their regulatory obligations (albeit seemingly incompletely).

This is the immediate effect of Quacklash.

The Long Term Effect Of The Quacklash?

But I think there may be a longer term effect of the Quacklash.

Here I am not sure that Adventures In Nonsense is totally correct that this invocation of regulation is a Streisand effect, which I take to mean widespread repeating of suppressed material; nor is it perhaps the Sparticus effect, where there is a collective assertion of solidarity.

As a Geek born and brought up in the 1970s, I prefer to call it the Obi-Wan effect:

"If you strike me down, I shall become more powerful than you could possibly imagine."

(Yep, I can even remember going to Star Wars on its original release.)

Whenever a CAM practitioner - or professional body or regulator or indeed entire profession - now resorts to using legal devices (especially libel) to seemingly suppress criticism or deter scrutiny, they can expect in turn to be subjected to the same intense Quacklash that is being endured by chiropractors.

Every effort will be made to hold the perceived culprits to full regulatory account and their claims will be scrutinised to a severe degree.

My personal view is that laws and regulations should not be used as light-sabres.

Both sides should instead join in a non-legalistic enterprise of providing and assessing the relevant evidence.

That is why I have not made a single complaint, and I do not intend to do so.

However, I suspect that any future sabre-rattling of a threatened libel writ in the context of CAM and public health will be answered by another Quacklash.

I would prefer neither a threat of libel nor a Quacklash to occur; but I do wonder if the real prospect of the latter will deter anyone again resorting to the former.

After all, libel really has no place in scientific disputes.

free debate


gimpyblog said...

My personal view is that laws and regulations should not be used as light-sabres.

Well I disagree on this, the whole point of having a statutorily regulated profession is to set in law minimum standards of behaviour and practice. Chiropractors are expected by the law to work within its framework, this, as is now abundantly clear, seems to be a difficult task.
This feeds into your other point:
Both sides should instead join in a non-legalistic enterprise of providing and assessing the relevant evidence.
Chiropractors have used the respect that comes with regulation by statute to avoid discussing the issue of evidence with sufficient self-reflection. This is now affecting them badly as the profession hasn't had enough internal debate to decide on a common line on evidence and the use of chiropractic. I suspect their drive for credibility in law will be seen as their worst mistake. They wanted to be taken seriously, now they are and are being called out on their claims.

Having said that I do have slight qualms about scaring people off libel actions because of fear of the consequences. Being afraid of the law, with the exception of criminal elements, is probably not a good thing for any society.

Jack of Kent said...

Dear Gimpy

On the first point, I am not sure we really do disagree.

I certainly agree with your statement that "the whole point of having a statutorily regulated profession is to set in law minimum standards of behaviour and practice. Chiropractors are expected by the law to work within its framework, this, as is now abundantly clear, seems to be a difficult task."

The key question for me in my Blogpost is what has prompted so many recent complaints about chiropractors invoking the regulatory framework.

It is clear that these complaints are prompted by the Singh case.

I do not think the complaints would have otherwise have happened.

By "used as light-sabres" I mean not that either libel or regulatory action is not available, but that the selection of such weapons should not be mutually dependent.

Chiropractors - like other professionals - should of course be abiding by the applicable regulations anyway!

I concur with your next point: chiropractors should be careful what they wish for. Statutory regulation is not a PR gimmick, a mere figleaf of legitimacy. It can and should have bite.

And - happily - I agree also with your last point. But for too long, those threatening libel have had no 'down-side'. Now, there is an opposite and possibly more-than-equal reaction.

A well-conceived libel case can still take place; I think it will just be the misconceived ones which may now be deterred.


Dr Aust said...

I like "Obi-Wan effect" too, Jack, see e.g. here (comment at 22.50 11th Oct07).

We tried out a few names back when Society of Homeopaths was attempting their legal chill on Le Canard Noir's post The Gentle Art of Homeopathic Killing. My personal favourite was always the "Spartacus Effect", but it is probably more specific to multiple re-postings of legally chilled (i.e. removed after legal threat) material.

Coincidentally, I've just been setting out some of my thoughts on this in a comment at the Science Punk blog.

Personally I take the view that if the chiropractors had been behaving as one would expect a "regulated healthcare profession" to behave - and I mean both in terms of their claims for their therapy, their advertising, and their recourse (or not) to law, none of this would have been needed. You don't see the doctors' professional associations like the BMA getting reported for misleading advertising that often, nor, as Evan Harris noted in the British Medical Journal last week, do you see them suing the Daily Fail at the drop of a hat (or medically inept and probably libellous article).

So the chiropractors brought the whole thing on themselves, and I do not feel the slightest bit sorry for them. If I may be permitted a Pulp Fiction type Biblical quote:

"For they have sown the wind, and they shall reap the whirlwind" - Hosea 8:7.

Tony Lloyd said...

The "Obi-Wan effect" is waaay too sad (I refuse to dignify Star Wars with the honourable epithet of "geeky").

You had it right first time: The Quacklash!

Now that should be the millionth word in English.

Andy said...

The lynchpin here was surely the ASA ruling against Carl Irwin. It is that ruling, as I see it, that has given the complaints campaign the, err, "authority" it needed to gain legs because the ASA statement was unequivocal.

I wonder if it would have gained the same impetus either without that ruling or without the ASA-compliance requirement in the GCC guidelines.

I'm not certain I'd compare a libel hearing - which involves substantial costs in determining what is often just a subjective legal opinion - with a complaint to a regulator which can be determined by simple assessment of a given claim against the written regulations.

Neuroskeptic said...

I agree that ideally we wouldn't be relying on authorities - legal or regulatory - to resolve this kind of thing.

The whole incident has a bit of a playground feel to it - "They started it!" "I'm telling on you!" "Well then I'll tell on YOU!"

But they did start this so I don't think they have a right to complain.

On the other hand if a given individual chiropracter were to come out in support of Singh, and were the subject of complaints regardless, I think they would have a right to feel a bit miffed at us. But I don't see any.

wertys said...

How about calling it the 'Brian' effect...I'm Brian and so is my wife !

mhw said...

Is spinal manipulation any more effective than placebo for treating quacklash? ;)

Chris C said...

I wonder whether the majority of the CAM profession would even bother to engage in a legitimate debate on what they do. The ideal thing it to just openly exchange published evidence and come to an objective conclusion, but I just don't see that happening.

We cannot get them to not believe what they believe, and so it seems the real impact can only come from the regulators. I think reporting them could therefore be the best approach and have the most impact. I certainly agree however that this would most definitely not have happened had it not been for the Singh lawsuit, although I don't think that matter much. A lot of action is essentially reaction; it takes the 'other side' to do something questionable in order to result in the response that we are currently seeing.

Having said that, we have to also keep in mind of how this could backfire on us, such as driving them underground, or having them resort to more deceptive ways to get past regulators.

As for what this effect is called... isn't it obvious: the Singh along. (I'll get my coat...)

Mark Gradwell said...

Or the McDonald's effect.

Their legal team had their fingers badly burnt in a famous, long lasting trial some years ago. The film of the stories of the defendants- "McLibel" is a fascinating watch.

I found the scene where they met with the top McDonald's execs. quite chilling but amusing at the same time.