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Friday, 10 July 2009

BMJ: The "Plethora" Has Been Completely Demolished

In what seems a potentially devastating blow to the British Chiropractic Association, an editorial in the current British Medical Journal says the following of the review by Edzard Ernst of the BCA's 'plethora' of evidence:

"His demolition of the 18 references is, to my mind, complete."

Read this aloud, slowly; and then imagine this sentence being read out in court.

This is surely devastating.

Why?

For after a complete demolition, of course, there will not be a jot remaining.

Ernst also make very interesting points indeed as to the completeness of the references and whether the BCA did or should have known better. These points may well be relevant in the trial, regardless of how successful Simon Singh is with his appeal.

I understand this editorial, and Ernst's review, was repeatedly "lawyered" before publication: so I would like to say very well done to my learned friends for approving the text which appeared.

Le Canard Noir now has an outstanding post on all this here. I agree entirely with the wise duck.

In my view, it is now entirely appropriate that we routinely describe the culprits in all this as "the discredited BCA".

For it seems that even the BMJ now concurs that there is not a jot of evidence...

18 comments:

TK said...

Does that make it homeopathic evidence?

Chris (from Oz) said...

Well, there's technically still evidence.

Just like the eaten biscuits and beer is evidence that Santa has been there. It remains evidence, even when presented with the photos of your Dad eating the stuff.

It's just really bad evidence.
It's discredited evidence.

So, there is evidence. There's just not a jot of non-discredited evidence......

Think Logic said...

To my mind, the interesting question is surrounding the reports that the BCA knew of the other studies, but failed to mention them.

IANAL, of course, but to my mind this could be construed as deliberately concealing evidence. Or, in other words, deliberately misleading people.

I wonder: just how strong would Dr Singh's case be now, if the ruling of the judge is not overturned?

Is the case winnable as things stand now, and without appeal?

bender.oh said...

Whilst the BCA may now be "discredited", it is surely was (and still is) the "happily promotes bogus treatments" remark that will continue to cause Simon Singh problems for some time to come.

Anonymous said...

This case has been hi-jacked and manipulated by some very clever people. The libel case was never about freedom of speech or the existence of evidence.

You stated: "The rules of the game in science are that this ‘defamation’ takes place in the open – most often in journals and conferences and public debate – not in the courtroom"... why public debate? Why not get all the facts together before presenting them to the public? Why the national press where Simon has a distinct advantage as a scientific journalist? Why did he not initially reveal all this evidence and rip it apart at that stage? It has always been accessible.

Simon is clearly martyring himself, as you said: "Singh has since contended that what he meant was that the BCA were simply wrong in their assessment of evidence." ... if this is the case then why did he not just apologise or explain what he meant and move on. The real skeptic would suggest that he is using this for publicity. I wonder how his book sales are going?

Singh and Ernst keep quoting reviews and papers that use case studies and anecdotal evidence to highlight the danger of manipulation, yet as soon as a Chiropractor or CAM practitioners mention anecdotal evidence it is discredited and cast aside.

The skeptic "sheep" have launched their attacks and venom upon the Chiropractic profession about treating visceral complaints and yet no mention is made of the Osteopaths who treat far more of these complaints. No mention is made of the Physiotherapists that perform manipulation. No mention is made of the ASA comments that there is no evedince to support Physiotherapy treatment of neck pain (yet the patients are referred daily for treatment on the NHS and private practitioners run very successful clinics treating neck complaints).

Is this because they are much large professional bodies? This is looking more and more like a simple case of bullying.

Lots of why's

10 July, 2009 20:12

Anonymous said...

Jack, sorry for the "you stated" comment in the second paragraph. This was directed at the write up by Le Canard Noir.

Andy said...

Jack, does sincerity play any part in the ultimate trial?

If Singh loses the appeal and decides, therefore, to pursue the case according to Eady's ruling of deliberate dishonesty, can his recent "that's not what I meant or believe at all" work against him? After all, he would be going into court arguing that he does believe the BCA to be deliberately dishonest - regardless of what he's claimed in the past.

Is there any risk of perjury or would that be unprovable? Can he simply claim to have changed his mind and, if so, what bearing would that have on the implications of the original article?

If you know what I mean.

Michael Kingsford Gray said...

@Anonymous:

It is no wonder to any thinking person that you choose to remain Anonymous.

Neuroskeptic said...

anonymous: What are you saying? That Singh wanted to get sued? That skeptics shouldn't care about chiropractic because other CAM is worse? We rip apart other CAM on a regular basis.

Your only reasonable point is "Singh and Ernst keep quoting reviews and papers that use case studies and anecdotal evidence to highlight the danger of manipulation, yet as soon as a Chiropractor or CAM practitioners mention anecdotal evidence it is discredited and cast aside." but this is still not necessarily a good argument. By their nature, rare-but-serious adverse events are more likely to be reported in case reports than clinical trials.

Twaza said...

I wonder if the court, the BCA, and the BCA's supporters would agree with Abraham Lincoln:

"I believe it is an established maxim in morals that he who makes an assertion without knowing whether it is true or false is guilty of falsehood, and the accidental truth of the assertion does not justify or excuse him."

Mojo said...

"The skeptic "sheep" have launched their attacks and venom upon the Chiropractic profession about treating visceral complaints and yet no mention is made of the Osteopaths..."

Well spotted, "Anonymous":

http://www.skeptics.org.uk/forum/showthread.php?t=2452

The difference is, of course, that the osteopaths haven't sued anyone.

Mojo said...

@Andy: Singh wouldn't have to argue that he believes that the BCA were deliberately dishonest; under the current ruling he has to prove that they actually were. His beliefs aren't relevant.

Canucklehead said...

Nice review by lecanardnoir and follow up by Jack.
I wonder if we will see the B.C.A. actually start to encourage some good quality research into chiropractic? Perhaps somewhere, somehow the chiropractors really can make a difference in health care, but it's probably not what they think it is.
Interesting times.

Strawberry said...

What is your thought, Jack, on the fact that the ahem, plethora of evidence blatantly was an incomplete and skewed view of the studies out there, and that any semi-competent student could have created a more thorough list with a simple pub-med search? Does the have a bearing on the "happily promoting bogus treatments" angle with the new definition of bogus provided by Judge Eady as it now seems that the BCA may have been knowingly dishonest.

Mojo said...

"I wonder if we will see the B.C.A. actually start to encourage some good quality research into chiropractic?"

Like the research they omitted from their "plethora", perhaps?

Tony Lloyd said...

@Anonymous

There are a lot of "whys", but very little actual substance in your whine.

You imply that Osteopaths are worthy of criticism and note that we do not criticise Osteopaths. You have not shown why Chiropractors are not worthy of criticism. If Osteopaths and Chriropractors are worthy of criticism it follows that Chiropractors are worthy of criticism. Chiropractors are worthy of criticism.

But why do we concentrate our spleen on Chiropractors? Because they sued. Simple. I know that, you know that, to pretend otherwise is just dishonest.

"Why public debate"? Because it's public before the debate starts. The leaflet distributed by the discredited BCA was a public leaflet, not a submission to a journal. The discredited BCA attempted to market the treatments to the public, it's members interact with (and charge) the public. It begins in public and should be carried on in public.

As for "anecdotal evidence" being used in an attempted refutation of a treatment you ought to reflect on the asymmetric relation between evidence for and evidence against. The well-worn example is the question of whether all swans are white. We would require a damn good set of data before we concluded that all swans were white, just the one well attested sighting of a black swan should lead us to reject it. You also seem to be conflating the statement "there is no good evidence against" with "there is good evidence for". I do hope that this is either a misreading of mine or that they have a nice comfortable home for you and don't let you sharpen the crayons too much.

"Simon is clearly martyring himself". Not if he wins. Note that he is appealing against ruling that he meant what he claims he didn't mean.

"Why did he not initially reveal all this evidence and rip it apart at that stage?" Any number of reasons, prominent of which are:
1. There is a "plethora" of evidence: most of it deleterious. The BCA evidence is cherry picked and it would not be known in advance which evidence would be cherry picked. Simon Singh is under no obligation to build the best case for Chiropractic before criticising the BCA.
2. The article was in a newspaper and Simon Singh was given limited space. A thorough review was not possible, a fair summary was. As we now know it may be questioned whether "bogus" was a fair summary: a "total pile of shit" cannot be so questioned.

"The libel case was never about freedom of speech or the existence of evidence." What do you say to total bullshit? "That's total bullshit" maybe? Simon Singh says that the BCA have no evidence and are behaving badly. The BCA say "shut up". Speech, evidence; both central to the issue.

"(T)he national press where Simon has a distinct advantage as a scientific journalist?" With the offer of space for a reply? What "clear advantage" does Simon Singh then have: only knowledge and the ability to apply it.

Finally we appear to be both "very clever people" and "skeptic "sheep"". Actually, I'll accept both. I'm not a professional body, I don't have large amounts of funding, the ability to hire good lawyer and I can't fight this on my own. But I don't like what the BCA have done and, if the flock can do it, then I am happy to be part of that flock. Yes it's the "I'm Spartacus" solution, the time time when the little, feeble, but populous people turn round and deal with the school bully. You know what "anonymous"?:

I'm Spartacus

davidp said...

Another reason why Chiropractors are the target of so much criticism is that in the U.K. they have achieved professional statutory regulation as evidence based health professionals, eligible for NHS funding, but keep on promoting disproven 'treatments'.

They have also arrogated to themselves the title Doctor and pretend to be general health care practitioners.

BadlyShavedMonkey said...

Heads up, Jack.

http://www.bmj.com/cgi/eletters/339/jul08_4/b2766#217385

Let's see what Richard Brown can find to say in response.