MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Many reader of this blog will remember the libel case of the British Chiropractic Association (BCA) against Simon Singh. Simon had disclosed in a Guardian comment that the BCA was happily promoting bogus chiropractic treatments for 6 paediatric conditions, including infant colic. The BCA not only lost the case but the affair almost destroyed this strange organisation and resulted in an enormous reputational damage of chiropractors worldwide. In an article entitled AFTER THE STORM, the then-president of the BCA later described the defeat in his own words: “in 2009, events in the UK took a turn which was to consume the British Chiropractic Association (BCA) for two years and force the wider profession to confront key issues that for decades had kept it distanced from its medical counterparts and attracting ridicule from its critics…the BCA began one of the darkest periods in its history; one that was ultimately to cost it financially, reputationally and politically…The GCC itself was in an unprecedented situation. Faced with a 1500% rise in complaints, Investigating Committees were assembled to determine whether there was a case to answer…The events of the past two years have exposed a blind adherence to outdated principles amongst a small but significant minority of the profession. Mindful of the adage that it’s the squeaky wheel that gets the grease, the vocalism of this group has ensured that chiropractic is characterised by its critics as unscientific, unsafe and slightly wacky. Claims that the vertebral subluxation complex is the cause of illness and disease have persisted despite the three UK educational establishments advising the GCC that no evidence of acceptable quality exists to support such claims.”

Only a few years AFTER THE STORM, this story seems to have changed beyond recognition. Harald Walach, who is known to readers of this blog because I reported that he was elected ‘pseudo-scientist of the year’ in 2012, recently published a comment on the proceedings of the European Congress of Integrated Medicine where we find the following intriguing version of the libel case:

Mein Freund und Kollege George Lewith aus Southampton hatte einen Hauptvortrag über seine Überblicksarbeit über chiropraktische Interventionen für kleinkindliche Koliken vorgelegt. Sie ist ausgelöst worden durch die Behauptung, die Singh und Ernst vor einigen Jahren erhoben hatten, dass Chiropraktik gefährlich ist, dass es keine Daten dafür gäbe, dass sie wirksam sei und dass sie gefährliche Nebenwirkungen habe, speziell wenn sie bei Kindern angewendet würde. Die Chiropraktiker hatten den Wissenschaftsjournalisten Singh damals wegen Verleumdung verklagt und recht erhalten. George Lewith hatte dem Gericht die Expertise geliefert und nun seine Analyse auf Kinder ausgedehnt.

Kurz gefasst: Die Intervention wirkt sogar ziemlich stark, etwa eine Standardabweichung war der Effekt groß. Die Kinder schreien kürzer und weniger. Und die Durchforstung der Literatur nach gefährlichen Nebenwirkungen hatte keinen, wortwörtlich: nicht einen, Fall zu Tage gefördert, der von Nebenwirkungen, geschweige denn gefährlichen, berichtet hätte. Die Aufregung war seinerzeit dadurch entstanden, dass eine unqualifizierte Person einer zart gebauten Frau über den Rücken gelaufen ist und ihr dabei das Genick gebrochen hat. Die Presse hatte das ganze dann zu „tödlicher Nebenwirkung chiropraktischer Intervention“ aufgebauscht.

Oh, I almost forgot, you don’t read German? Here is my translation of this revealing text:

“My friend and colleague Geoorge Lewith from Southampton gave a keynote lecture on his review of chiropractic interventions for infant colic. This was prompted by the claim, made by Singh and Ernst a few years ago, that chiropractic was dangerous, that no data existed showing its effectiveness, and that it had dangerous side-effects, particularly for children. The chiropractors had sued the science journalist Singh for libel and won the case. George Lewith had provided the expert report for the court and has now extended his analysis on children.

To put it briefly: the intervention is even very effective; the effect-size is about one standard deviation. The children cry less long and more rarely. And the search of the literature for dangerous side-effects resulted in no – literally: not one – case of side-effects, not to mention dangerous ones. The fuzz had started back then because an unqualified person had walked over the back of a thin woman and had thus broken her neck. The press had subsequently hyped the whole thing to a “deadly side-effect of a chiropractic intervention”. (I am sorry for the clumsy language but the original is even worse.)

Now, isn’t that remarkable? Not only has the truth about the libel case been turned upside down, but also the evidence on chiropractic as a treatment for infant colic seems mysteriously improved; other reviews which might just be a bit more independent and objective come to the following conclusions:

The literature concerning this topic is surprisingly scarce, of poor quality and lack of convincing conclusions. With the present day data on this topic, it is impossible to say whether this kind of treatment has a significant effect.

The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

And what should we make of all this? I don’t know about you, but I conclude that, for some apologists of alternative medicine, the truth is a rather flexible commodity.

24 Responses to AFTER THE STORM… the lies? Or: Does alternative medicine have an alternative truth?

  • The chiropractors had sued the science journalist Singh for libel and won the case. George Lewith had provided the expert report for the court…

    How utterly bizarre! Perhaps there was a parallel case involving a different Singh and Ernst? Or in a parallel Universe?

    But did Lewith really provide an expert report? The court never got as far as considering the evidence for or against chiro for colic; the BCA dropped the action after the Appeal Court decided possible interpretations of the words and hadn’t even considered whether they might or might not have been true. But bearing in mind that the BCA’s plethora of evidence was demolished within 24 hours of being published, it would have been interesting to read Lewith’s take on it.

    • must be the parallel universe where wishful thinkers have their annual meeting in Berlin and call it the EUROPEAN CONGRESS OF INTEGRATED MEDICINE; and whatever they wish becomes true of a little while.
      magic!
      I hope to get invited next year.

    • This remarkable ‘flexible reality’ effect is something often commanded by practitioners of Alternative Reality, sorry, Medicine. Who can forget, for instance, how Herr Dr med Rath actually won his libel case against Ben Goldacre, when you all thought he had lost?

      I even coined a slogan for this, which the prof might appreciate:

      “Wirklichkeit? Nein Danke!

      (See this old post onKeeping it Unreal)

  • The BCA’s victory in the libel case, with the award of “substantial damages”, was reported back in 2009 in the Journal of Alternative and Complementary Medicine.

    • interesting
      this is probably where it comes from. in the parallel universe of alternative medicine, one only reads the dodgy news stories reported in dodgy journals by dodgy experts.

  • I am not terribly sure whether this is the same type of treatment, but the side effect was death:
    Death of an infant following ‘craniosacral’ manipulation of the neck and spine’

  • I don’t know if any of you have watched the history channels mysterious mysteries of history junk (I have, I love b movies and such). Anyway they built a mythos by using a system of self reference wherein every level of self reference was used as source material until the whole thing swirled around into a ouroboros style kettle of unreason. Not a big deal considering the source and its honestly REALLY funny. From what I can see the European Congress of Integrated Medicine has applied the history channels research method for detecting historical aliens to their own situation.

    • Interestingly, the act of mythos building through self – referencing into an ouroboros – style kettle of unreason (beautifully put G) is exactly what I have been accusing Ernst of for all these years (look at his references that should tell tell u enough). Sounds like one orobouros-style kettle of unreason calling the other one black…
      Stefaan

      • true, in some articles I do cite quite a lot of my own papers; this is mostly because they are in areas where not many other scientists have published [do you know of many others investigating the safety of alt med, for instance?]. to claim that I do this regularly would require some statistical evidence which I doubt exists or would prove your point. therefore your comment turns out to be another primitive as hominem attack.

        • For the umpteenth time: an ad homing attack is where one rejects an argument made by a person because of a trait of that person (squint eyes, dodgy breath, body odour) rather than because of a flaw within the argument itself. I do neither. You on the other hand, by virtue of making me out to be constructing an argumentum ad hominem (which is neither eloquent or well-mannered) are effectively saying that I am not eloquent or well – mannered. And whilst not substantiating your ad hominem to my address (as it is incorrect to say that I am writing an Ad Hominem attack) proceed by building a straw man containing an admission (yes you do self – reference. A lot.) but then rejecting the admission as vacatious because you doubt that your self serving self – referencing is not statistically significant!!! Come on Edzard

          • An ad hominem (Latin for “to the man” or “to the person”[1]), short for argumentum ad hominem, is a general category of fallacies in which a claim or argument is rejected on the basis of some irrelevant fact about the author of or the person presenting the claim or argument [http://en.wikipedia.org/wiki/Ad_hominem]. you ARE running ad hominem attacks; and they have nothing to do with the subject at hand; they merely serve the purpose to discredit me. and you have no evidence that I am regularly and needlessly quoting my own papers.
            COME ON STEFAAN!!!

          • Really?
            1. I thought the comment I made was in regards to the G’s comment of “mythos building through self – referencing into an ouroboros – style kettle of unreason”?
            2. I did not know I rejected your argument? Can you tell me where I reject what argument of yours? If I don’t, which I don’t think I do, there is no ad hominem.
            3. What is the irrelevant fact (about your person) you claim forms the basis of my making ad hominem attacks? I would say that this too is quite pivotal to substantiating your claim I “run ad hominem attacks”.
            4. There was quite an interesting study on your studies, I rejected the conclusions because of researcher bias but it was quite clear that both in your articles and research the self-referencing is really quite high. This in itself is no evidence of anything, neither on inaccuracy or bias, but it is scary. Something you would do well to bear in mind, I think.
            Stefaan

          • there are numerous comments on my published research. this one [http://www.ncbi.nlm.nih.gov/pubmed/12442823] for instance identified my unit as the leading alt med research group worldwide – but presumably you do not mean that one!?
            anyway, if you repeatedly make a claim about my nasty habit to quote my own papers, you should provide the evidence for it – if not, it’s just a primitive ad hominem attack in my book.
            alternatively, I could give our readers some evidence. here are all the 7 own 2013 publications which I have as pdf on my computer:
            British general practitioners’ attitudes towards and usage of
            homeopathy: a systematic review of surveys – 39 references, 1 of mine.
            2) Chromium supplementation in overweight and obesity: a systematic review and meta-analysis of randomized clinical trials – 69 references, 0 of mine.
            3) The Efficacy of Irvingia Gabonensis Supplementation in the Management of Overweight and Obesity: A Systematic Review of Randomized Controlled Trials- 24 references, 0 of mine.
            4) A systematic review of reviews of systematic reviews of acupuncture – 25 references, 10 of mine
            5) Prevalence of herbal medicine use by UK patients/consumers: a systematic review of surveys – 25 references, 7 of mine
            6) The safety of massage therapy: an update of a systematic review – 29 references, 4 of mine
            7) Why is CAM popular? 17 references, 4 of mine
            this is not very systematic, of course, but it is better than your empty allegations. it suggest that the % of own papers depends on the subject; just as I claimed in my previous reply. and the average % is by no means unusually high!!!
            TIME FOR AN APOLOGY PERHAPS FOR YOUR PERSISTENT AD HOMINEMS???

          • So the crux of your argument (that I am running ad hominem attacks) is that I “repeatedly make claim about your nasty habit of quoting” yourself?
            Can you please point out where I do that? Particularly in the face of my just saying that I dismissed unfavourable research about you…
            Stefaan

          • oh dear, oh dear!
            how about this from above: “self – referencing into an ouroboros – style kettle of unreason (beautifully put G) is exactly what I have been accusing Ernst of for all these years”
            or that:
            “in your articles and research the self-referencing is really quite high”

          • “Prof Ernst has a well-documented history of delivering his own brand of revisionist science which has led to both his discreditation and repeated apologies” [http://gormano.blogspot.fr/2009/05/two-things.html] …do you make a habit of claiming something that is unsubstantiated only to disown it later?

          • My, O my Edzard,
            You acknowledge that the self-referencing is quite high so the latter comment can be ignored as part of the “evidence” and any referce to my stating that you do is just a statement of fact, recently acknowledged by you.
            The former: Edzard, seriously, that is me referring to myself (the European Council of Integrated Medicine quack, the charlatan, the seller of snake oil with ouroboros logic which G refers to) and denouncing myself as having called your kettle black for all these years and looking at your self-referencing with humour.
            Self-referencing is NOT an argument towards making out your research (or its conclusions) is poor, but I do think it needs to call for caution and wariness of integrated bias (the one which G refers to so beautifully again), don’t you agree? The fact you interpret everything I write like that just comes to show how much of an anticipatory bias you may have.
            Either way; even if interpreted in the way you suggest: where is the “repeated”? It can’t be the one by my own admission surely? It would be obscene to say the least, and more saliently: what in your mind is that argument of yours I am supposedly trying to dismantle for this to be an ad hominem attack?

            Still no ad hominem, still no apology, and quite frankly unless you can start proving your ad hominem claim you ought to be the one apologising to me don’t you think?
            Stefaan

          • I am afraid that – now that you do not make any sense any longer at all – I will end this exchange. it seems that chiropractic brains follow a different logic than mine. cheers

  • an interesting comment on George Lewith’s attitude towards chiropractic and me is here http://apgaylard.wordpress.com/2009/06/20/lewith-lashes-out/

  • Well, I’m no expert in libel, but I’d have thought the version of events offered in Berlin should give Simon Singh a clear run at the maker of the statement and anyone supporting it.

  • is it true what Stefaan is saying that you’re not posting his responses and falsifying the sequence by posting later blogs earlier or leaving some out all together?

    I’m not sure if we are getting the whole picture here Prof. Ernst

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