BCA Statement Baffles Blogger

June 18, 2009 at 3:21 pm (Alternative Medicine, Chiropractic, Legal Chill) (, , , , )

It’s true. I’m baffled by the statement that has been issued by the British Chiropractic Association. I suspect I am not the only one.

Apparently, “the BCA had no wish for its dispute with Simon Singh to end up in the courtroom”. I found this claim surprising, given that the BCA were offered right of reply by the Guardian at the time the original article was published. If they didn’t want to end up in the courtroom, then why didn’t they simply respond by to Singh’s article by making their case for chiropractic – perhaps by publishing the plethora of evidence that they claim backs up the use of chiropractic for colic, asthma etc?

The BCA also claim that “there is evidence for the BCA to have made claims that chiropractic can help various childhood conditions” and point out that they never claimed that chiropractic could cure these conditions. Regardless of the BCA’s distinction that chiropractic will “help” rather than “cure”, I’ve yet to see evidence that chiropractic will help these childhood conditions. The evidence that the BCA have listed below their statement appears to be deeply unimpressive, an impression confirmed by the Lay Science and Improbable Science blogs. (The Lay Science blog includes links to other bloggers covering this farcical statement.)

It “is the BCA’s case that there is good evidence” for chiropractic helping various childhood disorders. This is, unfortunately for the BCA, manifestly untrue. As shown by the Lay Science blog, the one paper that they list that looks at the efficacy of chiropractic as a treatment for asthma turns out to be a letter to the editor, which contains no actual evidence.*

Perhaps the most interesting element of the BCA’s latest statement is their remarkable claim that “the BCA welcomes full, frank and open scientific debate”. I think this is bullshit. If they welcomed full, frank and open scientific debate then they would at least respond to emails from members of the public who wanted to discuss the “research” page on their website. They would debate Singh – not sue him. Having written to the BCA and received a wholly inadequate response, I wrote again to the BCA on the 28th May (full text below). They have failed to respond, despite my contacting them on the 6th June to ask if they intended to answer my questions.

Email text:

Dear Ms Wakefield,

In response to your email of 27th May, I would like to ask some further questions of the BCA:

1. You state that: “While spinal manipulation is one of the widely used treatment techniques used by chiropractors it is by no means the only one.” What treatment techniques other than spinal manipulation are used by chiropractors?

2. Have these other techniques been tested? If so, what kind of tests have they been subjected to and what results have been found?

3. You state that: “it is not, and never has been our practice to comment on systematic reviews of chiropractic, particularly when many of these have been demonstrated to be flawed”. What flaws have been demonstrated in systematic reviews of chiropractic?

4. Why don’t the BCA comment on systematic reviews? Is this official policy? (Surely if there are flaws in systematic reviews it would be better to discuss these flaws and look at whether these flaws can be eliminated from future reviews?)

5. Why do you dismiss an important tool in evidence-based medicine, the systematic review, but at the same time assert that outdated guidelines, which have been withdrawn, are “an important publication”? Do you believe that guidelines are more reliable than systematic reviews?

Regards, James Cole.

Given that the BCA stated in an email to me that “it is not, and never has been our practice to comment on systematic reviews of chiropractic, particularly when many of these have been demonstrated to be flawed” and that they have subsequently refused to answer my requests for clarification of their stance (or any other element of my email of 28th May), how credible is the BCA claim in their latest statement that they “welcome full, frank and open scientific debate”? How credible is it in the light of their decision to sue Simon Singh rather than take up the Guardian’s offer of a right to reply? I find it incredible. I’m actually a little shocked that they expect anybody to believe their statement. I’m surprised that they had the brass neck to put something so inaccurate into the public domain. Frankly, I doubt that the BCA are capable of telling us the truth. I say this because I don’t think they are capable of judging what is true and what is not.

More

Jack of Kent on the BCA statement. Another general look at the BCA’s statement comes from the Thinking is Real blog. I have decided not to look at the BCA’s evidence myself but will leave it to those better qualified to do so. I think that Gimpy and Lay Science will be listing those bloggers that take a critical look at this “evidence”.

*The author of the Lay Science blog had already dealt with Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized clinical pilot study. The abstract is available here: http://www.ncbi.nlm.nih.gov/pubmed/11514813. The authors note that “There were no important changes in lung function or hyperresponsiveness at any time.” The only positive results appear to be the children’s own assessments of their asthma severity and quality of life and even then, the authors state that “The observed improvements are unlikely as a result of the specific effects of chiropractic SMT alone, but other aspects of the clinical encounter that should not be dismissed readily.”

EDIT: Relevant to my above comment about ‘deciding not to look at the BCA’s evidence myself but leaving it to those better qualified to do so’ and the reference to the BCA’s asthma evidence, here is Evidence Matters with their take on the British Chiropractic Association and the plethora of evidence for paediatric asthma.

17 Comments

  1. AndyD said,

    From the (locked!) statement…
    In the spirit of a wider scientific debate, and having taken appropriate professional advice, the BCA has decided that free speech would be best facilitated by releasing details of research that exists to support the claims…

    If there was ever a time to get shares in an irony meter business, it’s now. The skeptical blogosphere will be replacing them in droves by the end of this week.

  2. dvnutrix said,

    You are not the only baffled blogger. There must be a nostrum for that, surely?

    I am particularly puzzled by the inclusion of a paper that criticises the conduct of medical researchers. According to the BCA summary, it raises questions about “the integrity of the peer review process and the nature of academic mis-conduct”. All well and good, but that does not make the quality of the evidence that they offer look any better.

  3. British Chiropractic Association produces its plethora of evidence said,

    […] “BCA Statement Baffles Blogger”. Dave Walker on jdc325’s Weblog […]

  4. jdc325 said,

    “You are not the only baffled blogger. There must be a nostrum for that, surely?”
    I’m sure you will be relieved to learn that I have managed to find a homeopathic remedy for confusion – Silicea.

    Martin’s summary of the BCA’s evidence over at Lay Science was very revealing. Of particular interest to me were the number of papers referenced by the BCA that were irrelevant to the efficacy of chiropractic in childhood diseases: three on NSAIDs; a description of evidence-based medicine*; a paper about medical ethics; the GCC’s code of practice; another four papers on osteopathy. As a commenter on Lay Science noted, the BCA look to be either dishonest or inexcusably ignorant (or perhaps both). Either way, this ridiculous statement hardly enhances the BCA’s reputation. My recommended reading for chiropractors post suggested that the BMJ article Evidence-Based Medicine – what it is and what it isn’t might be useful for chiropractors. But for it to be useful would require them to understand it rather than mindlessly quote it…

    *Bearing in mind the GCC’s claim that “Adjustment of the atlas, craniosacral therapy and applied kinesiology all fall within the above definition of evidence-based care”, I’m not sure how valuable the BCA’s inclusion of a definition of EBM could be in any case. Neither the BCA nor the GCC seem to have any real understanding of what EBM is.

  5. jdc325 said,

    @AndyD: I can definitely hear a strange sound. I think it is a “spoing”.

  6. Dr*T said,

    Yep, it was a “spoing”. It’s just that about a squillion of them went off at the same time, so it ended up more of a “ssssspppppspppooooiiinnnngggggg”

  7. jdc325 said,

    Currently reading: HolfordWatch on BCA demonstration of “what evidence based medicine isn’t”. Excellent.

  8. Simon Singh Case Response Roundup « God knows what… said,

    […] jdc325 sums up the blogging world’s response to the BCA’s third statement nicely in his analysis of how their various bizarre arguments and claims (such as hoping that by bringing a court case they would not end up in court) are ‘baffling bloggers’. […]

  9. If the BCA ask to borrow your library card… « Cubik’s Rube said,

    […] since, as jdc325 reminds us, the Guardian offered the BCA a right of reply at the time, and they turned it down, deciding […]

  10. The BCA have no evidence that chiropractic can help with ear infections « gimpy’s blog said,

    […] would constitute good evidence? Apgaylard – A more detailed look at the bed-wetting papers. JDC – General comment on the BCA statement. Think Logic – General comment on the BCA […]

  11. jaycueaitch said,

    Definitely in the market for a new irony meter.

    Do you think the BCA expected Simon Singh to fold and not say “Let’s see your evidence, not your legal muscle”?

  12. jdc325 said,

    Yes, I think perhaps they understimated his desire to be able to tell it as he sees it.

  13. Pediatric Chiropractor said,

    Olafdottir’s study does bring into question the effectiveness of chiropractic intervention for colic, which prior studies such as Nillson’s had supported. It is, however, underpowered, as calculation of confidence intervals compared to the p values shows. The real solution would be for a study utilizing thousands of infants treated by dozens of pediatric-board-certified chiropractors at multiple centers to be designed, funded, and performed. This would cost about 1/10th of 1% of the funding allocated by the US government to conduct one typical series of trials on one drug.

    Lastly, if you had bothered to read Nilsson et. al., you would know that dimethicone drops are used precisely because they are no better than placebo, as a control group for the study, and that the study includes references to research on the natural history of colic which shows that both control and placebo groups did better than the normal progression of the untreated condition.

  14. Blue Wode said,

    @ Pediatric Chiropractor

    Isn’t it about time you called it a day with research into chiropractic as an intervention for infantile colic?

    Professor Jennifer Bolton, Director of Research at the Anglo Europrean College of Chiropractic, has more or less already admitted that chiropractic has no benefit over placebo:

    Is chiropractic an effective treatment in infantile colic?
    Hughes and Bolton Arch Dis Child.2002; 86: 382-384
    http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382

    [Subscription only]

  15. rhiniingetwer said,

    Outstanding Article , I thought it was tremendous

    I look ahead to more innovative postings like this one. Does This Site have a subscription I can subscribe to for new postings?

  16. jdc325 said,

    Thanks rhiniingetwer. If you would like to subscribe, there are links to RSS feeds for posts and comments in the top right-hand corner of each page of my blog.

  17. Simon Singh and the British Chiropractic Association « Stuff And Nonsense said,

    […] turned out that they were (but they were not alone in doing so). My most recent post on the BCA is this one, regarding a baffling statement they […]

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