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Saturday, 1 August 2009

Simon's Choice

Even if Simon Singh proceeds to an oral hearing for permission to appeal (PTA), he is unlikely to succeed. PTA has already been turned down twice, by the High Court at the preliminary hearing, and by Court of Appeal this week.

There are a variety of ways forward if he is unsuccessful in PTA but, for me, they are two broad options.

The case can continue

The case can continue in a number of fashions.

There is actually still an issue outstanding from the preliminary hearing - whether the (now discredited) British Chiropractic Association can as a corporartion sue for libel: there is actually little legal authority, if any, for a company without shareholders to sue for defamation. So there still has to be a ruling on the "corporate" issue once the current "meaning" issue is finally dealt with.

And an adverse ruling on this corporate issue can also be appealed to the Court of Appeal (subject always to PTA, but refusal of PTA can of course also be appealed).

The case can continue to full trial. Here Simon Singh's defence is in a slightly stronger position than it was before the BCA's incredible plethora gaffe - for example, the selective quotation from the Cochrane review may come back to haunt them (a very great hat tip to the Lay Scientist for that).

However, the meaning selected by the High Court will always be difficult to establish. And, as it is not the meaning which Simon Singh actually meant, such a trial will perhaps be rather artificial.

The case can also go off to the European Court of Human Rights (ECtHR), and this can be either at this preliminary stage or after full trial and any appeal. This would probably be on Article 10 (free expression) grounds. The ECtHR is not a great supporter of English libel law (and was critical in the Tolstoy and McLibel cases). However, this would take years and may not ultimately succeed.

The case can come to an end

One senses the BCA no longer have much appetite for this fight. Their statement yesterday was conciliatory, in contrast
to the strident barminess of some of their other statements.

It cannot be nice for the BCA to survey the lasting and very serious damage to their profession caused by their misconceived libel action.

So it may be time for the case to settle. This may require Simon Singh to execute the "Heresiarch Manoeuvre" (named after the excellent blogger who described it) of apologising to the narrow meaning ascribed by the High Court.

One benefit of this for the skeptical movement generally would be to free the ongoing scrutiny of alternative and complementary health from being tied to the particular issue of chiropractic for various children's ailments.

(The other immense benefit will be to Simon Singh's resources; he really can only be expected to persist with his defence as long as it is reasonable to do so. His heroic status for all liberals, skeptics, and scientists is now assured.)


Going forward

I know Simon Singh values the views of the skeptic and blogging community. (Indeed, this community showed their appreciation in return in that one day demolition of the plethora.)

So please do set out your thoughts below.

(And, in doing so, please do tag your comment with some name, rather than just "anonymous" - it makes it so much easier for others to respond.)

Update

See the Open Letter to Simon Singh at the great blog of The Heresiarch - where I have also commented.

54 comments:

Chris K said...

After reading the legal options it's very hard to know what to recommend.

On the one hand I would like to see Simon have his day in court and have his position vindicated.

However, as the case has gone on I've also become increasingly aware of how badly suited the legal process is for addressing these kind of topics.

The scientific evidence seems to have had very little influence over any of the legal proceedings so far and that to me should have been what this case was really all about.

On top of this the thought of Simon having to devote years of his life and hundreds of thousands of pounds to continue with the case doesn't sit well with me.

A few months back settling seemed like a decision I would have fully understood but not fully agreed with but now I think settling may be the sensible option.

Simon has bravely fought for his article and I think that his disappointment in the court should be weighed against his clear victory in the public arena. Even if the BCA win their loss of reputation and the unwanted scrutiny that their actions have created for their entire profession should give pause to the next organisation who think a quick libel case will shut up their critics!

Ultimately it's for Simon to decide how he wants to proceed but as Jack says his heroic status is already firmly established and he should feel no shame in settling.

Chris Kavanagh

Dennis said...

Is there some way that we can make a donation to Simon's defence fund? He is doing us all a huge service.

Lothian said...

Without knowing the 'Conclusion' the BCA have in mind it is difficult to advise.

They rejected the chance to reply offered by the paper. Simon has already stated he does not believe that they deliberately scam people rather that the evidence is not there for chiropractic helping the named ailments. The plethora is unlikely to change his mind on that.

Financial compensation is not appropriate. The vice president of the BCA has said business has not been affected.

Other that credibility what does he have that they want?

The terms of any potential settlement will not be discussed in Public. In those discussions Simon only needs to think about himself. He owes the sceptic community nothing.

Jody said...

As an osteopath I have been keenly "watching this space" and have learned much about the British legal system thanks to Jack's excellent blogging.
I can't say I have taken sides though.....I think Simon's comments were unnecessarily provoacative especially as he presents himself as a serious science commentator (which is is....)
I also think that the concept of FREE SPEECH has been somewhat highJACKED (no pun intended)as it is not about free speech but rather a BOGUS reference....it's as simple as that!!
and...
The BCA were knee jerk reactive to sue. They should have simply presented the evidence...it was pretty dumb and I think everyone agrees that even though they won it was an "own goal" for them in the court of public opinion.
In the USA recently there was the case of a white policeman arresting a black Harvard professor for breaking into his own house.....even President Obama got into the fracus and in the end invited both the Harvard Professor and the Policeman to "have a beer" together with the President in the Rose Garden at the White House.
Perhaps its time for Simon, Jack, some chaps from the BCA and some impartial uncommitted observers to "have a beer" at a local pub or maybe we can even get ourselves invited to Number 10!!
Oh....one more thing. Even after having a beer neither the Professor or the policeman apologised...
Jody

Andy said...

I'll leave the advice to Singh's layers, family and friends, in whichever order he chooses.

But I wonder if the BCA would tolerate (or survive) another three years of scrutiny. It's become a question of who'll blink first.

If he has the time, money and patience to see this through, whatever the outcome, then at the very least he'll have something to write about when it's over.

How many people would have pursued it this far? Not many I'd dare say.

Steve Page said...

Jody, how were Simon's comments provocative? He pointed out that chiropractic is based upon magical thinking and that the supposedly respectable BCA promote chiropractic for some ailments although there is no credible evidence to support their use. All of this is true, so the only reason it could be seen as provocative is if you either don't believe it to be true, or don't want it to be true. Which is it?

Andy said...

"I'll leave the advice to Singh's layers,..."

Damn! That should, of course, be lawyers.

Ade said...

Going all the way is a risky business for both sides. But it is easy to get sucked into the idea that the claimant in a libel case always wins.

In practice, the jury often sides with the most famous, most sympathetic, most reasonable. Witness Tom Bower's recent win against Desmond. For Singh, there couldn't be a better time to remind BCA's lawyers that defendants sometimes win.

BadlyShavedMonkey said...

Jody

I'm afraid the 'beer in the pub' option is misconceived.

Chiropractic as it currently exists needs to be destroyed. It is founded on a fundamental error (subluxations). No compromise can be made with that lunatic idea.

Chiropractic without subluxations isn't chiropractic. I'm not sure what it would be.

I'm afraid David Colquhoun was right in reminding us that right cannot meaningfully compromise with wrong. There is no rational halfway position.

We must not confuse this with the political notion of reconciliation and mediation where one side never has a monopoly of moral right. The subject at hand is a matter of basic scientific fact, not morals and politics, and one side does have a monopoly on being right.

BadlyShavedMonkey said...

p.s. The above is why the alt.meddlers are so intolerant of sceptical examination. Their belief systems (and often their livelihood) are threatened with oblivion. Their world is not that of normal medicine where physicians can just drop a disproven mode of treatment and use something else from their repertoire.

A good physician is a generalist, or is part of a system that has a generalised competence. Of course, this is because normal medicine is well-grounded in basic scientific principles, the understanding and application of which confers this adaptability. In contrast, alt.meddlers are one-trick ponies. Or, more accurately, their repertoire consists of the same old tricks all of which have been busted.

BadlyShavedMonkey said...

p.p.s. Sorry doing this on a mobile phone and it makes organising a post rather fiddly...

Be that as it may, I vote strongly in favour of the "Heresiarch Manoeuvre". We need to move on from the BCA's misconceived libel case and Simon need not keep spending loads of his money.

I want to see a detailed public scrutiny of the curious voids in the BCA's "plethora". Those voids do make it seem possible for Simon to pursue the case even under Eady's definition of bogus, but Simon has stated publicly and adamantly that Eady's meaning is not his. To pursue the case on that basis would have a certain rottenness at its core. But, with the case settled on a sufficiently narrow basis we can then explore the discrepancy between the BCA's version of the evidence and the actual evidence.

It would also be good to get the focus wider than just one chiro organisation. An unwelcome effect of Simon's article is that we have had to focus on just the BCA and tread around the niceties of not defaming them. A broader focus will allow everyone to be rude about chiros in general without the inconvenience of having to keep an eye on England's awful libel laws. I don't want anyone to martyr themselves and I do want to see a great deal of hostile comment directed at chiros and their alt.meddling friends.

Les Rose said...

Maybe I'm a bit cynical, but it does look to me as if the judges are being just a tad vindictive. They appear to be doing their best to show that they are not going to be influenced by 13,000 people who consider the case unjust, but rather they are going to reject Simon's appeals at every turn. Have they looked at the initial tranche of signatories? Do they consider these people to be wrong? OK, I know the judiciary has to be independent, but I think they are being deliberately perverse, just to put us in our place.

BadlyShavedMonkey said...

Dennis

I think this has been covered before, possibly by Jack. If you financially support such a case you open yourself to unlimited personal liability alongside the defendant.

SVETLANA PERTSOVICH said...

What???!! To settle??! And be a hero after this??!!!

And why have you decided that Singh remain a hero if he settles?? To settle with charlatans and to remain a hero? What a nonsense.
Not at all. Rather he will become a coward and fool! Does he want it?
Moreover - he will lose his right to appeal to European Court. Indeed! What will he say to European Court? That he settled with quacks? And European Court will send him to devil's granny!
No. He must continue the case.

Certainly, there is almost zero chance to win, because the idiotic English libel law exist and statutory regulation of chiropractor's craft exists in your country too. And certainly, if he loses, he will be forced to pay to court and chiropractors. I fear he has not enough money. But if skeptics don't want to look like scoundrels, traitors and greedy pigs, they will help him to pay the expenditures!! Yes, yes, egoistic, selfish and greedy Britons! You will pay!!! And this action will make you real skeptics and real friends!
Nevertheless, Singh's loss will give him specific advantage. Yes! Because 1) he will be a real hero and victim of unjust law, so the question about libel law abolishment will be raised with a vengeance 2) he will get a right to appeal to European Court, 3) he will win in European Court.
And when Singh will win in European Court, the latter will require English court and BCA to recompense all Singh's expenditures and his money will return to him!
And it will be real and complete victory of Singh and all skeptics! Because after this the libel law will be abolished ... by English court itself! ;) Indeed! What the hell does this law exist, if English court must pay a fine for its existence? ;) And, of course, the statutory regulation of chiropractors will be impeached and, probably, will be abolished too.

So, it is best and the only way of victory - though very-very difficult.

Michael Kingsford Gray said...

They could have a homoepathic lager, as in the amusing Mitchell & Webb sketch!

Kallan.G said...

I'm going to go along with Jack and Chris here. Simon has quite simply done enough. The only point I can see in carrying on will be if we can use this case to force reform of libel law otherwise it's served it's purpose; the point has been made, the BCA have lost.

Having said that though I'm left with lingering doubts. Does anyone know the impact this is having outside of sceptical circles? Are we fooling ourselves into thinking it's a win because the case has been made to sceptics and scientists?

Alex said...

If Simon thinks he can fight on and do better than settling up now, then he should fight on.

Andy said...

@ Les Rose,

Jack made it clear a long time ago that this "permission to appeal" was unlikely to succeed as they almost never do.

You could argue that there's 13,000-15,000 behind Simon but the sad reality is, that's a pitiful number of people on an international scale. Sorry, but that's reality as I see it.

The silent majority probably support ("or don't care about) chiropractic. But agumentum ad populum is no way to win a debate - regardless of which side has the numbers.

Legal cases should not be popularity contests and if they were, I think Singh would lose.

I'm intrigued to know more about the validity of the claim since it seems rather pointless to continue with expensive and time-consuming appeals if the case should never have been allowed to be brought in the first place. It looks like cart before horse.

If it is deemed invalid, what would happen with regard to costs?

Steve Page said...

BadlyShavedMonkey said...
Dennis

I think this has been covered before, possibly by Jack. If you financially support such a case you open yourself to unlimited personal liability alongside the defendant.

Can't Simon set up a "Simon Singh's rainy day fund", which we can donate to and he can do whatever he wants with? I'll donate in the hope that Simon spends the money on household cleaning products and fuel bills; of course, that may free up some money for other endeavours... ;)

Suzanne said...

Oviously Simon must do as he sees fit but the "Heresiarch Manoeuvre" might serve him well. Because of the narrowness of his apology he will have secured a moral victory over the BCA; the reputation of Chiropractic will remain tarnished in the minds of anyone who knows about the case; and Simon will live to fight (and write) another day.

Tony Lloyd said...

The wider import of this case is the chilling effect on free-speech of libel actions. Even if we give Jody his distinction between free speech and “bogus” (please note I do not wish the use of the conditional to imply I think that this distinction is anything but ridiculous) this leaves writers with a real risk of libel action if they choose one word slightly incorrectly. There is no approved list of words, no clear guidelines as to what is “free-speech” and what isn’t. Sitting at a keyboard the writer may err on the side of caution, and to err on the side of caution is to err.

The best response to “libel-chill” would be either reform of the libel laws or by having a corresponding “libel-action-chill”. Reform of the libel laws is not an option Simon, or others, can just “chose” and so we are thrown onto “libel-action-chill”. By “libel-action-chill” I mean a state whereby persons would be terrified of launching libel actions for fear of the consequences. (Imagine the effect of a virtual BCA sitting in a cardboard box on the street with a sign saying “Tried to limit free-speech. Please help”). I see three ways of creating “libel-action-chill”:

1. Carry on the case and win. We have seen selective quotation and selective use of evidence. Simon’s legal team might also like to consider whether the use of the word “plethora” could be argued to be dishonest. There may be other correspondence, more to uncover and cross examination may prove effective.
2. “Heresiarch Plus”. By which I mean to agree a Heresiarch settlement, followed by a new article written to such exacting standards it is not actionable but which squeezes in the most damaging criticisms. Preface anything even slightly arguable with “in my opinion”. Use plain language, if necessary crude language. Simon’s problem was using the word “bogus”. Fine, use the word “shit”.
3. Quacklash. Already happening, and having an effect. More of a Quacklash could be forthcoming if universities and media companies became involved. I think they should be involved. The common good is best served by Simon fighting, but Simon’s good is best served by dropping everything as quietly as possible. Whilst individuals may not be able to contribute to a fighting fund research universities and media companies could. They should not only underwrite costs but also supply expertise, information and action. I’m sure that many research universities and media companies have contact with the BCA. Perhaps they have meetings arranged now, perhaps they are discussing joint projects. If so cancel them, pick up the ‘phone and say “we are not having anything to do with you until you drop this case, apologise to Simon Singh and mend your ways”.

Dr Aust said...

Re. Tony Lloyd's comment:

It is, sadly, highly unlikely (as in "not a chance") that Universities would contribute to a pro-Singh fund.

These days British Universities are so terrified of taking any position other than "we strive for excellence" that they are fanatically averse to anything with the slightest breath of contentiousness.

To give you an example, someone told me about one leading UK institution where a science faculty would not let an announcement that the "Keep Libel Out Of Science" campaign even existed go out on their internal email update - even though several senior figures at the University had signed the statement in a personal capacity. The line was

"It might be seem to potentially infringe academic freedom if we take a position on this, and even linking to it could be seen as implying endorsement."

SVETLANA PERTSOVICH said...

I have read Heresiarch's open letter to Simon Singh:

http://heresycorner.blogspot.com/2009/08/open-letter-to-simon-singh.html

It is low, sly and shifty attempt to persuade Simon Singh to bow to the quacks and to settle with them! :( It is dirty game! In fact if Simon Singh accept this proposal he will lose the case himself and sentence to a loss ALL next similar cases of his allies (and such cases will be inevitable after this "settlement"!).
Simon Singh have all chances TO WIN! I showed in my previous comment that even honest loss of Simon Singh (honest loss, but not "the settlement" in Heresiarch's style!) can give Simon Singh a victory in future!

NO SETTLEMENT WITH QUACKS!!! No belief to dirty compromisers!

Down with obsolete silly laws!!!

SVETLANA PERTSOVICH said...

These heart-rending cries "to settle! to settle!..." are sounding constantly from the first day of the case.
Hmmm.... you need not so roar. You could settle else year ago quietly and easily! Why did you need to waste a mountain of money and energies, to spend 1,5 years of time, to gather 15-thousands crowd of people, to bring into "heels_over_head"_position all mass media and scientific press , to scribble a lot of blogs, to boaster about your courage in the pubs, to blab in the forums, etc, etc, etc? WHY? WHAT FOR? You could settle with your quacks at once and haul into the nearest tavern to drink a couple of the beer with them :P
Why did you so fuss about?
Or maybe did Simon have spare cash and he decided that to waste them, having lost the case against quacks and then having made a peace(!) and drunk a beer with them is the best way of modern investment?

And maybe it was such new English game under name "Believe in quackery! or How to make the fools of 15000 people!"? And who does win? Who doesn't believe and who thinks that "to settle" is inadmissible way. Oh, indeed, it's nice game! I won already in the second times and outplayed 15000 idiots, that believed and tried to settle! I think we must continue... ;)

No. To settle with quacks (in any form!) is unacceptable decision. There is only two ways - either to lose or to win. I showed in my previous comment that even "to lose" isn't worst way. Even such way will lead to victory ultimately. But who did say that we can't win? Why must WE make the succumbings to quacks? It is necessary to MAKE THEM to yield! We must make them to withdraw their allegation, to make an apology to Simon Singh and to pay all legal expenditures to court and other bodies and persons.

And generally the behaviour of the court is strange! Why are they pressing Singh? Have they decided that he have a bottomless hogshead of money? And why have they decided that he will pay? And what if he refuse to pay? Will they compel him to pay, seize his bank accounts, break him and make him a beggar? Hmmm... And what if the skeptics in reply overthrow a crown and parliament, set up new republican government in the country and change all laws? ;) What? Too fantastical story, eh? :) Is it impossible? But why? It happened in many countries of the world! Great Britain can't be exclusion. The situation in Britain is very far from ideal. Ancient, obsolete form of government, mistakes of parliaments, a lot of stupid laws, financial crisis at last.... Thus a revolution is quite possible. And skeptics are very dangerous people in this sense... There are socialists, republicans, marxists, and other politically-oriented people among them...I would recommend the court to be more careful with sceptics.
As for BCA , it is absolutely toothless organization! :) If the court decides that they are lost and orders them to pay the expenditures, they will do it without any squeak! Or will they rush to complain to European court? ;) Not at all! Or will they make a revolution in the country? No, noways! Will they come to monarch to complain? And what next?... ;) Nothing.

So, I think that it will better if the court changes its decision and doesn't press skeptics any more.

rick said...

As an osteopath who takes an active interest in evidence based practice, having spent the best part of the last 3 years reviewing the evidence base for manual therapy im intrigued by this campaign. Many of you seem to be disturbed by the chiropractors use of spinal manipulation and/or their theory of subluxation. There's a fair bit of decent evidence supporting spinal manipulation for low back pain. Is it the more spurious claims regarding chiropractics treatment of non-musculoskeltal conditions which is upsetting you all, or is it their whole therapuetic approach, which would include manipulation for LBP? If its the former i sympathise, if its the later then do you also classify NHS physiotherapists using spinal manipulation to treat LBP as quacks too? Many physiotherapists do post-grad spinal manipultion courses and this is accepted by the profession as a legitimate treatment modality.Im sure there are many chiropractors who see themselves as purely musculoskeletal therapists and who work in not too disimilar way to physios and osteopaths. Theres a huge ammount of cross-over of techniques and treatment approaches between these three schools of physical therapy and its reductive in the extreme to suppose that all chiropractors treat in the same way.
So, im curious, if your gonna kill em all, its good to know what for. Is it for picking on Mr Singh? Is it for being crazy quacks who think they can heal systemic disease by clicking your back? or is it for just being a chiropractor even if you work in a way that can at times be fairly indistinguishable from physiotherapy and osteopathy?

Cheers

Rick

Les Rose said...

Andy - no I am not proposing argumentum ad populum. The point is not really the number of signatories, but their quality, eg the former govnt chief scientist. The fact is that virtually the entire scientific community disagrees with the judiciary on this matter. But the judges do not care about science or ethics and only about the letter of the law - as they choose to interpret it. Surely this is now broader than libel law per se? Is it not about the lack of checks and balances in the legal system?

Tony Lloyd said...

Hi Rick

"Working in a way that can at times be fairly indistinguishable from physiotherapy and osteopathy"

It is an utterly trivial matter to find something correct about anything. It is also utterly pointless. Quacks, real dangerous quacks, use buildings: just like real doctors. Quacks, real dangerous quacks, have heads: just like real doctors. Quacks, real dangerous quacks, wear white coats: just like real doctors!

To be perfectly honest I am beginning to worry about the medical profession as a whole. There is too much of this conflation of correspondence with evidence. Often it rivals the woo merchants in its "logic".

The only way to improve anything (theories, behaviour, treatments, whatever) is to change. This is also trivial: if you do not change something then it is the same and cannot be better. The only way to change is to find out what is wrong with something. Once again this is trivial: if you find out that something is right then you don't change it! The only way to find out what is wrong with something is to criticise it.

What the BCA have done wrong is to produce a leaflet which promotes Chiropractic for conditions it should not be promoted for and sought to silence criticism of that.

Anonymous said...

Ade said that the most famous and most appealing often win libel cases. Unfortunately I can find no other reason to ascribe to the result of the Branson-vs-Snowden libel case (details at the end for those unfamiliar). And likewise Jeffrey Archer won in front of the jury, when his star was still high, with the assistance of that misguided "is she not fragrant" summing-up by the judge. (Archer later served time for perjuring himself in that case.) And most recently Tommy Sheridan won in front of the jury, despite the damning evidence of about 20 independent witnesses, though he is now too the subject of a perjury trial, expected for next January.

But it is not always so. In Branson vs Bower, Bower won, even though it required a precedent-making liberal ruling from, yes, Eady to assist him. Private Eye lost to both Robert Maxwell and Monica Hindley, among others, even though it was telling the truth about these awful people. Oh, and Oscar Wilde lost his case too, at huge cost.

Branson v Snowden: Guy Snowden was the chief executive of GTech, the lottery equipment company. There had already been an enquiry commissioned by OfLot into the allegation that Branson made that Snowden had tried to bribe him, and the enquiry found there was no substance in the allegation. The enquiry concluded, sensibly, that Snowden's "everyone has a price" comment to Branson was much more likely a desire to do business with him, not an attempt to buy him off. Surely Snowden's libel case was a shoo-in. But a British jury took a different view - they voted for the nice man with the beard, not the fat American. The fall-out from the case was large. Snowden had to retire, GTech had to sell out its share in the Camelot lottery consortium, and it was the final nail in the coffin for the DG of OfLot. An interesting contrast with Hamilton-v-Fayed where Fayed, to win his case, had to demonstrate that he had given a bribe to Hamilton, in which he was successful.

Jack of Kent said...

Anonymous,

I have approved your comment only because you clearly spent time typing it. But please do use a name tag next time. I will then bother to correct your factual inaccuracies :-)

Jack.

rick said...

Tony,

Yes, but in responding to my post you managed not to address the questions i raised at all. Which was pretty pointless.

BadlyShavedMonkey said...

Rick;

"Is it the more spurious claims regarding chiropractics treatment of non-musculoskeltal conditions which is upsetting you all, or is it their whole therapuetic approach, which would include manipulation for LBP?"

To answer your point, it is the use of spinal manipulation, based on a bonkers theory of "subluxations", for non-spinal conditions that is the problem that sceptics insist must be dealt with, if I can presume to speak on behalf of such a disparate group.

However, chiros' therapy for back pain is similarly based on the fallacious theory of subluxations. If chiros' manipulations of backs are genuinely beneficial, given appropriate controls against which to compare them, then it would show that they have stumbled upon a technique for helping backs that is free of any anchor in a rational theory of its practice. It would probably suggest that the detail of the specific spinal manipulations matters rather little, but would not mean that, as a matter of principle, the manipulations don't work. Whereas for colic, asthma etc both experimental evidence and theory tell us chiro doesn't work.

But, this poses a problem for teaching them: their manipulations are supposedly based on correcting subluxations, but the latter don't exist. This would result in chiropractic being a list of variably successful recipes for physical manipulation for back pain, but a list that provides no internal basis for extending and refining its practice because it has no rational underlying theory. This does not strike me as a safe or reasonable way to practice medicine especially given its well-documented risks.

As I said above, without its "subluxations" what is chiropractic? I guess they are physiotherapists who have just failed to be given the theoretical part of a physiotherapist's training.

What should be the result of all this? The title chiropractor and its legal underpinnings should become dead letters: if no treatment can be based on the idea of subluxations there can be no chiropractors. Manipulative therapies would continue to be used and trialled but not by people called chiropractors.

How osteopaths fit into this picture I'm not sure. I've never clearly understood what makes them stand out from physiotherapists and what their underlying principles are. In other words, I'm not sure which camp I see you as being part of, but so far as I know you do not share with chiros this idea of "subluxations".

To turn this around, it is the theory of subluxations that led chiros to see their therapy as a panacea. Physiotherapists are not so tempted because their teaching does not tell them that infectious diseases or asthma or deafness or eczema result from a spinal problem. I don't think osteopathy pretends to have a theory to explain all of medicine and in this it is dissimilar from all the quack therapies.

Homeopathy, chiropractic, Reiki etc etc, each claims to explain all of medicine, but are mutually incompatible even though their practitioners often practise more than one of them.

Quacks love an all-encompassing theory even if it diverges from reality. Homeopathy has its "Like cures like". Chiropractic has its "subluxations". The theory comes first and once the theory has been dreamed up then practice gets invented ad hoc to fit into the theory.

Real medicine simply loves things that work and developments of theory and practice tend to go hand in hand.

Does that clarify things?

Allo V Psycho said...

For Simon to apologise will require that the wording of the apology is acceptable both to Simon and the BCA, and this cannot be taken for granted. For instance, an apology along the lines of "I didn't mean that chiropractic is fradulent, merely that it was useless" might not be acceptable to the BCA. And in any case, they will trumpet any apology as "Simon Singh said chiropractic was bogus and we made him apologise!!!!" Plus they will obtain the full legal chill effect on future commentators, for the whole of alt med. I would prefer the ECtHR appeal route. Does that bring about a halt in the UK proceedings while it is in progress? Would it be as expensive as a UK action? I feel bad about recommending anything that costs Simon huge(r) sums of money, though.

Ivan said...

Sorry that there were factual inaccuracies, Jack. Hope not too bad.

I now see that I can have a name without a URL! I'll post with a name in future.

Andy said...

a Les Rose: - so now it's an argument from authority? :)

Your point about judges only caring about the letter of the law is hopefully closer to the truth - as opposed to your earlier idea about them vindictively acting against Simon because some people support him.

On a separate note...

I find myself wondering what the BCA's advisers are making of this discussion - assuming they're looking in.

Are they bolstered, by talk of capitulation, and convinced to stare a little longer hoping for Simon to blink?

Are they annoyed by suggestions to stay and fight?

Do they give a damn what the rest of us thinks?

Tony Lloyd said...

Rick: but in responding to my post you managed not to address the questions i raised at all.

Question: So, im curious, if your gonna kill em all, its good to know what for.

Answer: What the BCA have done wrong is to produce a leaflet which promotes Chiropractic for conditions it should not be promoted for and sought to silence criticism of that.

Les Rose said...

Well Andy, we are on the same side so no need to fall out over words :). Are you saying that the great and the good standing up for science is of no consequence?

Regarding the judges, my point is not just that they follow the letter of the law, but that they actually create the law in a large part, by setting precedents. As we know some of these decisions have been incredibly perverse, and considered inequitable by the proverbial reasonable person. Yet once embedded in case law they seem very difficult to overturn.

Dr Aust said...

I agree with Les Rose's second paragraph.

Also, remember that even in cases where higher courts overturn the judgements, the laws that allowed the defamation suit remain on the statute book. Lawyers argue about the case law precedents, and the plaintiff's (expensive) lawyers can always argue "but this case is different". So I don't think changes to case law stop the "legal chill" - because the potentially ruinous financial costs of defending a libel action always remain, as long as one side can afford to burn £ 50 K but the other side can't.

Surely what is required is legislation to reverse the burden of proof in libel, or some kind of requirement for the plaintiff to demonstrate "malicious intent" by the defendant, or at least "utter recklessness with the truth". And certainly in the face of a sort of "default" public interest defence.

As long as the burden of proof remains with the defendant, the rich and poor will in practice remain utterly unequal before the libel law, especially when they are defending an action.

As I understand it, the defence of the current set-up one hears offered (usually by lawyers) is that it "allows the ordinary man to protect his reputation" (e.g. by getting a lawyer to take him on on conditional fee and then having the burden of proof on his side in a libel action). But.... how often do you actually see some quote, ordinary, unquote, person suing? The people suing for defamation are overwhelmingly celebrities, public figures and corporations or organisations. None of whom, it seems to me as a non-lawyer, would be suddenly catastrophically damaged by a reversal of the burden of proof. Are English celebrities and public figures really delicate flowers, in greater need of legal protection of their reputation than American ones? In any case, the privacy laws - shaped in practice by case law from Sir David E and friends - provide a lot of protection, as we have seen in recent years.

Getting back to Simon Singh's case, personally I would like to see the wider issues that are raised by the case, and arguable before the European Court of Human Rights, end up there. But in the end the choice is Singh's, not anyone else's.

Jody said...

I believe the Chiros are being attack because of their sense of hubris and excess.....one chiro was bragging on his site that he sees 150 patients BEFORE LUNCH and then has time for teaching in the afternoon.
Having said that their are chiros who have given up the idea of the subluxation...just like the medics have given up the idea of leeching, bloodletting and drilling holes in the head to release the bad ethers!
It is generally accepted by chiros that back pain is multi factorial and can arise from a multitude of aetiological factors just like the medics.
Some Chiros, perhaps most do do good work and relieve suffering.
As do medical people.
Let us not forget that medical intervention and bad reactions to drugs are a top cause of death in the western world.
Percetage wise the Chiros are safe compared with the medics......but I'm not suggesting that you stop seeing your medical doctor or stop taking drugs which mostly help....what I am saying to the skeptics is to look at the excesses and junk science in ALL the health care professions otherwise you the skeptic come across as some sort of doctranaire fundamentalist with bad manners....and do it in a scientific, non name calling way to be taken seriously by the scientific community.
Jack bogged that Simon values the views of skeptics and the blooging community...I would hope that as a serious scientific writer that Simon appreciates all evidenced based approaches and has an open mind to whatever community as long as they are decent, rational and science minded

Jeff Keogh said...

Jody,

You said, "Let us not forget that medical intervention and bad reactions to drugs are a top cause of death in the western world."

I keep seeing this claim made, but I've yet to see anyone provide the data that backs such a remarkable statement up.

I'm quite prepared to be shown my error, but I would suspect that there would be other causes of death which have a much higher impact in the West, such as poor lifestyle choices (poor diet, smoking, alcohol abuse etc).

So why do you make this claim?

SVETLANA PERTSOVICH said...

And maybe do you stop your wild guesses about mortality causes in the world and look at real statistics?

Here is the statistical data of World Health Organization about main causes of the death in the world:

http://www.who.int/mediacentre/factsheets/fs310/en/

Jody said...

Jeff, I am glad you asked that.
But I will point you in the direction of the website and article of medical Doctor Joseph Mercola to explain far better than I could in this forum.
Here is the link:
http://articles.mercola.com/sites/articles/archive/2004/07/07/healthcare-death-part-one.aspx

SVETLANA PERTSOVICH said...

Well. We admit this Mercola is right partly (though his opinion is tendentious).
But is it the reason to come to charlatans and to be being cured by them?
And it is excuse for their actions, when they sue all and everything?

Dr Aust said...

Joseph Mercola is hardly an authority on anything. American surgeon and noted antiquackery blogger Orac recently described Dr M in the following terms:

"Dr. Mercola, ├╝ber-quack, whose website is third (and not by much) only to John Scudamore's Whale.to and Mike Adams' NaturalNews.com for unabashed promotion of virtually every quackery under the sun."

Indeed, I suspect Mercola's name is another of those internet laws like "Scopie's Law", as in:

"In any discussion of the distinction between reality and unreality in medicine, anyone citing Dr Mercola as any kind of authoritative or reliable source of information immediately loses the argument and gets laughed out of the room."

...Any suggestions for a name for the law?

Jody has a point only in the limited sense that people should certainly be told honestly about the risk-benefit balance of ANY treatment. However, quacks repeatedly falsify this information by claiming their treatments have "proven benefits" (which they usually don't) and "little or no risk" (which is also often a lie).

Unlike real doctors, most quacks do not have to take an oath to be honest with their patients. Most of them simply opt for being "honest" within a limited frame of reference, as in:

"We tell you honestly what we believe to be true".

Of course, a lot of the time what they believe to be true is arrant nonsense.

Which, in the context of the Singh case, is where we came in.

Mike from Ottawa said...

There's a mechanism in Ontario courts that allows a party to make an offer to settle and if the offer is rejected and the rejector doesn't get a better result at trial than the offer, the rejector only gets their costs to the date of the offer and the offeror gets their costs (generally on the higher solicitor-client costs basis) for costs from that date on. Making a reasonable offer in that system puts the other party under serious pressure to accept a reasonable offer or at least to counter with a reasonable offer of their own. I suspect if such a system existed in Britain, it would have been mentioned. Are offers to settle are taken into account in awarding damages and costs, where the person who rejects the offer and does no better at trial gets punished for not having been reasonable?

Are any of the legal documents available anywhere on the web? Apologies if I've just been too dumb to find them in obvious places.

Excellent blog, BTW, Jack.

SVETLANA PERTSOVICH said...

Important news.
http://www.dcscience.net/?p=2007&cpage=1#comment-3592
David Colquhoun has written new post in his blog.
Consultation about Pittilo’s report is opened!!!

Will a statutory regulation of CAM be adopted in Britain?

If - yes, the lawsuits against skeptics, bloggers and honest scientists will flow as a huge stream and Singh's case will be recollected as a happy quiet times!

Our task is now – to express our protest against statutory regulation of CAM in Britain. Details – look at in David Colquhoun’s post.
Folks! Go ahead! Down with a statutory regulation of quackery!!!
Down with the degrees in quackery!!!

SVETLANA PERTSOVICH said...

Good and competent comment, Dr. Aust.

And your healthy reasonings show once again why any settlement with quacks is inadmissible.

;)

Mark Zwinderman said...

Simon should simply settle if he can find a way of doing so. Whatever the wording the BCA will simply portray it as a victory anyway.

A legal case such as this is not only costly in financial terms but in mental and emotional energy nvolved. Not to metion the time it takes.

Pursuing this case is going to be costly in all these respects. I think Simon (and the skeptical world) would be better served if he put his resources into less straining fields.

Yes he could win, but what other opportunities to communicate science and skepticism would he miss out on pursuing?

His committment is amazing and admirable. He can get on with his work with his head held high.

My two cents.

Jeff Keogh said...

Hi Jody,

Your claim was that "medical intervention and bad reactions to drugs" are a top cause of death in the western world.

I do not have the time to investigate Mercola's numbers, which may be true. However, I can make two points.

1. Mercola's figures were for the US only. Despite what a large percentage of its inhabitants believe, the United States is not the western world. Even so, among western nations the US is widely agreed to have one of the worst healthcare systems.

2. Mercola makes no reference the the underlying medical conditions leading to the medical treatment. These treatments are not given out of the blue, you know, to perfectly healthy people. Many of these treatments are being given to people whose health is already compromised.

Tony Lloyd said...

Jody, if “A and B” is true then “A” is true. If it is true that chiropractors do bad things and mainstream medics do bad things then it is true that chiropractors do bad things. If you do not say “mainstream medics do bad things” you are not saying “mainstream medics do not do bad things”. Neither does not saying “mainstream medics do bad things” render “chiropractors do bad things” false. Further saying “chiropractors do good things” in no way falsifies “chiropractors do bad things”.

If “chiropractors do bad things”, “they can stop doing bad things” and a few other rudimentary ethical propositions are true then the statement “chiropractors should stop doing those bad things” is true. The same locality in the logic applies: we need neither condemn others nor recognise good in chiropractic for that statement to be true.

“Woo” (the practice of medicine where there is insufficient evidence to establish the efficacy of the treatment) is a bad thing and those that practice it should stop. Applying woo to children is worse. It should stop. Taking legal action against someone who has objected to the application of woo to children is, even if the said person used two words incorrectly, nothing short of disgraceful. Chiropractors do bad things.

They may do good things (there is evidence to show that chiropractic can be effective in helping lower back pain). It doesn’t effect the fact that chiropractors do bad things.

The medical profession and, especially, “Big Pharma” does bad things (see Ben Goldacre’s blog for a medic criticising these things). It doesn’t effect the fact that chiropractors do bad things.

Some people concentrate on the bad things that chiropractors do, to the exclusion of other bad things other people do (often much worse things). It doesn’t effect the fact that chiropractors do bad things.

I had a pop at the medical profession’s grasp of logic above (see: I will attack medics) now I will confront a repeated theme coming from the BCA apologists. This is the “other side do x” or “you’re just picking on Y, X does just as much”. This is the standard of ethical argument that I might expect from a seven year old. It wouldn’t matter if mainstream medics were running though wards with scythes in an attempt to significantly reduce the worlds population: the BCA have behaved disgracefully.

(Jeff, can I add another couple of problems with Mercola’s thesis to your two?
1 - Using his methodology it is correct to say that the premiership teams that got relegated should have been crowned champions. Newcastle got 34 points, Middlesbrough 32 and West Brom 32. That’s 98, well in excess of the so-called champions 90 and clearky gives "the teams that got relegated" the number one rank.
2 – He includes deaths for “medical intervention and bad reactions” that are not clearlycaused by “medical intervention and bad reactions”. He quotes “bed sores” ffs! Bed sores are a result of being in bed. This is caused by illness, people can’t get out: strapping people to a bed is not a treatment. A moment’s reflection shows “bed sores” to an incorrect entry into his list: he either didn’t reflect for that moment, is intensely stupid or …)

Tony Lloyd said...

"not clearly" in my previous post should be "clearly not".

BadlyShavedMonkey said...

I said;

"How osteopaths fit into this picture I'm not sure."

Jody said;

"Let us not forget that medical intervention and bad reactions to drugs are a top cause of death in the western world.
Percetage wise the Chiros are safe compared with the medics.."

I think I now have a clearer picture of where at least some osteopaths fit into this.

And it does look like osteopaths have a 'theory';

http://en.wikipedia.org/wiki/Osteopathy#Osteopathic_principles

Ah, well. Add another to the list.

Corey said...

@ Jody,

Where were you trained? I worked for a time at the NBOME and some of your comments indicate you ignored the allopathic portion of your training as an osteopath, specifically the comment about bad pharmaceutical reactions being a top cause of death. The osteopaths I interacted with didn't hold such a position and in fact did their best to meld their osteopathic and allopathic training to create the best patient outcomes...and I will note using evidence-based approaches.

Singh's article specifically focuses on the lack of evidence to support their claims. As such, it's nowhere near provocative.

rick said...

Didnt Jody just supply you with some evidence to back up these claims?
He seems to me to be far more reflective and objective in his point of view than the majority of those on here.
You're right that most osteopaths respect and have a general working knowledge of evidence based medicine. However , having just completed an MSc in Pain Management at Cardiff Uni. alongside GPs, anaesthetists, neurosurgeons, nurses and physios, allopathic practitioners have as sparse and shakey knowledge of the latest evidence base as any osteopath ive met or worked with. Rare on these skeptic sites are people who have spent time researching evidence to any respectable level. If that were the case there would be less bombastic opinions and a little bit more humility. The NHS is awash with practice thats based on protocol and anecdotal evidence, and yes, i know this doesnt justify crazy chiro practice, but thats not the point.

Mike from Ottawa said...

"If you financially support such a case you open yourself to unlimited personal liability alongside the defendant."

One can, I'm sure, provide some small measure of finacial support to Simon Singh without that risk by buying a copy of his book to read. Now, if someone bought up a couple hundred thousand copies, it might raise some issues, but I'll just buy the one copy. From his Guardian article, it sounds like it will be an interesting, if at times infuriating read.

In Canada we have plenty of our own purveyors of non-evidence-based 'medicine' and our libel laws also need reform for that matter.