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Editorials

Science in court

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2254 (Published 03 June 2009) Cite this as: BMJ 2009;338:b2254

Chiropractors: clarifying the issues

Chiropractor Richard Brown explains why he thinks that the critics have moved the goalposts.

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 Harris1, Simon Singh has redefined the battle as one of free speech and the stifling of scientific debate2. It is nothing of the sort.

The British Chiropractic Association 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 having 'not a jot' of evidence to support them3, it was entirely understandable that the BCA should seek to have what were untrue and defamatory comments withdrawn in order to protect its reputation.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 conditions4- 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 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 which exists to protect the public and uphold standards of care. They are also bound to practice evidence-based medicine which, like their medical colleagues, comprises best available evidence from research, the preferences of the patient and the expertise of practitioners (including the chiropractor him/herself)24-25. 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 health care 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 enquiry with the BCA prior to 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 recently published NICE guidelines26 on low back pain was founded on peer-reviewed published research evidence demonstrating its efficacy. The risks of spinal manipulation have been researched and, in two comprehensive studies in Spine 27-28, have demonstrated it to be far safer as an intervention than commonly-prescribed medical interventions used for similar ailments29-31.

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, 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 whether or not he read the evidence relied upon by the BCA prior to the publication of the article, arguing, bizarrely, that it was because the request was not relevant or necessary in order for the BCA to understand his case. This is bizarre because of Dr Singh’s new found voice that the BCA are 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 healthcare. It has enjoyed phenomenal popularity 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.

Richard Brown is a practising chiropractor and is the vice-president of the British Chiropractic Association.

References

1. Harris E. Science in court. BMJ 3 June 2009; 338: b2254 (http://www.bmj.com/cgi/content/full/338/jun03_1/b2254)

2. Singh S. BCA v Singh: The Story So Far 3 June 2009. http://www.senseaboutscience.org.uk/index.php/site/project/340

3. Singh S. Beware the Spinal Trap. The Guardian 19 April 2008.

4. Klougart N, Nilsson N, Jacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 1989 Aug; 12(4): 281-8

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13. Glazener CM, Evans JH, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005 Apr 23; 2: CD005230

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20. Reed WR, Beavers S, Reddy SK, Kern GJ. Chiropractic management of primary nocturnal enuresis J Manipulative Physiol Ther 1994 Nov; 17(9):

21. Blomerth PR. Functional nocturnal enuresis. J Manipulative Physiol Ther 1994; 17: 335-338.

22. Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J Clin Chiropract Paediatrics 1997 Oct; 2(2): 167-183

23. General Chiropractic Council. Code of Practice. 2005 http://www.gcc-uk.org/files/link_file/COPSOP_Dec05_WEB(with_glossary)07Jan09.pdf

24. General Chiropractic Council. Code of Practice and Standard of Proficiency. 2005. http://www.gcc-uk.org/files/link_file/COPSOP_Dec05_WEB(with_glossary)07Jan09.pdf

25. Sackett DL, Rosenberg WH, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-72.

26. National Institute for Health and Clinical Excellence. Low back pain: early management of persistent non-specific low back pain. 2009 May.

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28. Cassidy JD, Boyle B, Cote P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebro-basilar stroke and chiropractic care: results of a population based case control and case crossover study. Spine 2008 Feb 15; 33 (4 suppl): S176-83

29. Blower AL, Brooks A, Fenn CG, Hill A, Pearce MY, Morant S, Bardhan KD. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther 1997;11: 283-91.

30. Hawkey CJ, Cullen DJ, Greenwood DC , Wilson JV, Logan RF. Prescribing of nonsteroidal anti-inflammatory drugs in general practice: determinants and consequences. Aliment Pharmacol Ther 1997;11: 293-8.

31. MacDonald TM, Morant, Robinson GC, Shield MJ, McGilchrist MM, Murray FE, McDevitt DG. Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study. BMJ 1997 315: 1333-7.

Competing interests:
Richard Brown is Vice President of the BCA

Competing interests: No competing interests

17 June 2009
Richard Brown
Vice President - BCA
GL2 4RU