Intended for healthcare professionals

Observations

Chiropractors: clarifying the issues

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2782 (Published 09 July 2009) Cite this as: BMJ 2009;339:b2782
  1. Richard Brown, practising chiropractor and vice president of the British Chiropractic Association
  1. brown.richard{at}dsl.pipex.com

    It is quite remarkable that scientists should expect themselves to become exempted from the laws of the land for publishing defamatory comments, be they about an individual or an organisation. Having mustered an army of supporters, including Evan Harris,1 Simon Singh has redefined the battle as one of free speech and the stifling of scientific debate.2 It is nothing of the sort.

    The British Chiropractic Association (BCA) neither wished nor intended this matter to end up in the courtroom. When Dr Singh went on the offensive against the BCA and spoke of it promoting bogus treatments that had “not a jot” of evidence to support them,3 it was entirely understandable that the BCA should seek to have what were untrue and defamatory comments withdrawn in order to protect its reputation. It sought from Dr Singh a retraction of the allegations along with a public apology. Scientific debate could then have continued away from the law courts. However, despite receiving invitations to retract and apologise, Dr Singh refused to do either.

    This case was never about enrichment; it was about fairly correcting libellous statements made about a respected national association representing more than half of the nation’s chiropractors.

    There is in fact substantial evidence for the BCA to have made claims that chiropractic can help various childhood conditions.4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Contrary to how this case has been reported, it never claimed to cure these conditions, nor did it seek to dissuade parents from continuing with regular medical management.

    Sadly, Dr Singh now argues for what he wished he had said, rather than what he did say. As a diversion from his defamatory comments, he has mounted a case for free speech and reform of the libel laws. The BCA fully supports free speech. However, with this fundamental right comes responsibility, and as a science journalist Dr Singh should not have published materials which he was fully aware would damage the BCA’s reputation.

    Reform of libel laws will not take away the rights of a named individual or an organisation to protect their reputation when they are the victim of defamatory falsehoods. It is right that the law exists to protect them from the publication of untrue and unjust statements, and it is understandable that the government has hesitated in putting forward proposals for reform. Agreed, the costs of defending such actions may be prohibitive, but so are the costs of bringing an action. With awards for damages rarely exceeding the figure for costs, often neither party stands to gain financially, and reward is hardly ever the motive for resorting to the courts.

    Chiropractors, as regulated healthcare professionals, should be accountable for their actions. They are subject to a code of practice23 that exists to protect the public and uphold standards of care. They are also bound to practise evidence based medicine, which, like that of their medical colleagues, comprises the best available evidence from research, the preferences of the patient, and the expertise of practitioners (including the chiropractor him or herself).24 To reduce the definition of evidence to only randomised controlled trials not only is impossible but would exclude many medical interventions performed in general practice each day.

    Contrary to the suggestion that chiropractic is purely synonymous with spinal manipulation, it is a primary healthcare profession that employs a range of interventions that benefit tens of thousands of patients each day. Had Dr Singh been serious about reasonable scientific debate he might have made due inquiry with the BCA before publishing his defamatory allegations.

    The BCA is fully supportive of chiropractic research and indeed gives tens of thousands of pounds every year to support research initiatives throughout the UK. It is preposterous to suggest that the BCA seeks to either “stifle scientific debate” or engage in “chilling” science writers from expressing their views. The inclusion of spinal manipulation in the guidelines on low back pain recently published by the National Institute for Health and Clinical Excellence25 was founded on peer reviewed, published research evidence demonstrating its efficacy. The risks of spinal manipulation have been researched, and two comprehensive studies in Spine26 27 demonstrated it to be far safer as an intervention than commonly prescribed medical interventions used for similar ailments.28 29 30

    That esteemed figures within the scientific and medical communities have been mobilised to speak on this issue is a reflection of the feelings that this case has engendered. The indignance is palpable that a group of complementary health practitioners should dare to challenge the scientific establishment. Yet this case is not about challenging science or freedom of speech; it is about wrongly publishing damaging allegations.

    Contrary to Dr Harris’s mistaken assertions,1 the BCA never promoted or implied chiropractic as a cure, and peer reviewed papers that demonstrate symptomatic relief for childhood conditions were readily available. Dr Singh declined to answer the BCA’s request as to whether or not he had read, before the publication of his article, the evidence relied on by the BCA, arguing, bizarrely, that it was because the request was not relevant or necessary in order for the BCA to understand his case. This is odd because of Dr Singh’s new found opinion that the BCA is trying to stifle “scientific debate.”

    In conclusion, before the BCA is further dragged through the mud by a concerted smear campaign, consider this: chiropractic has made huge strides to integrate itself into mainstream UK health care. It has enjoyed phenomenal popularity that is based on consistently delivering high quality care. As a modern healthcare profession it welcomes examination of its methods, yet libellous statements are not the modus operandi that critics should employ.

    Notes

    Cite this as: BMJ 2009;339:b2782

    Footnotes

    References