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Pointing the bone at chiropractic quackery – lessons from the UK

Marcello Costa is a co-founder of “Friends of Science in Medicine”, an organisation established to campaign against university health-care courses that are not adequately supported by scientific evidence…

Science writer Simon Singh and Observer journalist Nick Cohen, at the Royal Courts of Justice, 23rd February 2010. Robert Sharp/English PEN

Marcello Costa is a co-founder of “Friends of Science in Medicine”, an organisation established to campaign against university health-care courses that are not adequately supported by scientific evidence. Here he talks to Dr Simon Singh, co-author with Ernst Edzard of “Trick or Treatment? Alternative Medicine on Trial" about complementary and alternative medicines in Australia and the United Kingdom.

Marcello Costa: You have been involved in the United Kingdom in the big debate on alternative medicine, including chiropractic. And you were sued for libel in 2008 by the British Chiropractic Association after criticizing some of their claims, and successfully defended your article in 2010. What lessons have you learned?

Simon Singh: During the 1980s and 1990s, doctors and researchers largely ignored alternative medicine, and the result was a major rise in its promotion and use. It would be wrong to say that all alternative therapies are ineffective or dangerous, but in general I think it is fair to say that the vast majority lack any decent supporting evidence and many carry direct or indirect risks.

The big shift in the last decade has been a willingness for doctors, researchers and concerned members of the public to make their voices heard, so that patients have the complete story. This has involved everything from blogs to books, from mass homeopathic overdose campaigns to letters from academics raising concerns, from the lobbying of members of parliament to use of the official complaints procedures.

It’s hard to measure, but my instinct is that this activism has shifted the public’s view of alternative medicine. So, to answer your question, the main lesson we have learned is that we must not sit back and do nothing. Moreover, if we do go on the offensive we can begin to make a difference.

Marcello Costa: In Australia, momentum has being gathering since early 2011 to openly criticize chiropractic and other “pseudo-sciences”. These efforts culminated in an article that reported on a campaign started by five concerned scientists, including myself, and backed by 29 other doctors, scientists and clinical academics with a letter to the science deans at a university asking them to reconsider their decision to offer a Bachelor of Science Degree (Chiropractic) from 2012.

The main reason for our campaign is concern for the increasing number of universities courses under the umbrella of health sciences that are not based on scientific principles or experimental evidence. The movement gathered momentum when we launched the group “Friends of Science in Medicine” in late December, which has now attracted more than 400 supporters. We recently sent a letter to all the vice-chancellors of Australian universities asking them to confirm their commitment to retain scientific principles in health-related courses or to review those based on pseudoscience.

What is the situation like in the United Kingdom?

Simon Singh: The last decade has seen a boom in pseudoscience degrees in the United Kingdom, but again there has been an effort to highlight the problem. Not only are universities undermining their own credibility, but they are fooling students into thinking they are learning something with a firm foundation, and (worse still) they are providing the academic emblems that ultimately will lull patients into a false sense of security.

Sometimes the backlash has come from within universities, and on other occasions, it’s outsiders who have tried to persuade universities that they should be upholding proper academic standards. Professor Edzard Ernst, Professor David Colquhoun and myself, for instance, have compiled league tables to show which universities offer the most dodgy alternative medicine degrees, in order to embarrass those at the top.

In 2008, the league was headed by the University of Westminster, which offered five Bachelor of Science (Honours) courses in complementary medicine and an Master of Science in Chinese herbal medicine.

Marcello Costa: The Chiropractors' Association of Australia’s (CAA) and many chiropractic websites express an aim “to achieve a fundamental paradigm shift in healthcare direction where chiropractic is recognised as the most effective and cost efficient health regime of first choice that is readily accessible to all people”. Is there a similar wedge approach by chiropractic in United Kingdom to replace general practitioners as primary sources of health care?

Simon Singh: I have spoken extensively about chiropractic and I have met many chiropractors. Some know their limits and seem like responsible practitioners. Others are completely bonkers. They offer treatments that lack evidence, they resent criticism from outsiders and they see conventional medicine as the enemy. There is a significant anti-vaccination constituency among chiropractors, who actively undermine public health messages.

Marcello Costa: One of the distinctive principles of chiropractic according to the Chiropractors Association of Australia’s (CAA) is the concept of subluxation, the alleged cause of most ailments.

The chiropractic course at one Australian university portrays “subluxation” as a fundamental principle that guides many chiropractic interventions. But a chiropractor involved in a course from another university has written that modern chiropractic is no longer based on the concept of “vertebral subluxation”, which should remains solely of historical interest.

Is there any similar contrast between competing brands of chiropractic in United Kingdom? And if chiropractic is not based on a unique principle, what distinguishes it from physiotherapy or other allied health disciplines?

Simon Singh: It is a very odd landscape. There are some chiropractors who treat animals and some who don’t, there are some who believe in subluxations and some who don’t, and there are some who use precision instruments and some who don’t, and so on. After the British Chiropractic Association lost its libel action against me, there seemed to be a genuine effort to create a coherent identity that was compatible with the best available evidence.

However, the more radical elements in the profession seemed to kick up a fuss, and I suspect that we are back to square one with chiropractors making all sorts of weird claims and a regulator that is unable or unwilling to take control.

Marcello Costa: The president of the Australian Medical Association (AMA) has joined our campaign by signing our letter to the university running a chiropractic course. What is the official position of the British Medical Association (BMA)?

Simon Singh: The British Medical Journal (BMJ) covered my libel case in detail and also ran articles analyzing the evidence for and against chiropractic, but in general I think the medical establishment has not played a very active role in highlighting the problems of chiropractic in the United Kingdom.

Instead, it’s been grassroots activists, members of the so-called skeptical community, who have tried to keep chiropractors in check by submitting formal complaints to the General Chiropractic Council.

Marcello Costa: In the existing courses of chiropractic offered at three Australian universities, several proper science disciplines are also taught in parallel to the “principles of chiropractic”. Is chiropractic increasing its credibility at the expense of the other sciences involved? And should science academics be involved in non-science based (pseudoscience) “alternative medicine” courses?

Simon Singh: I would like to see scientists in universities that teach chiropractic and other pseudoscientific courses standing up for science. It’s all too easy to focus on your research and your own teaching, and ignore what is going on in the building next door, but it is lazy and dangerous to allow such courses to go unchallenged.

Marcello Costa: We use the term “pseudosciences” to describe most alternative medicine practices. Would you suggest different choice of terminology?

Simon Singh: Pseudoscience, anti-science, dodgy science, bogus science, balderdash, claptrap… I am happy for people to use whichever word they prefer.

Professor David Colquhoun has been able to obtain some of the slides from these courses and there are lectures on vibrational medicine which tell students that “the human energy field or aura comprises numerous complex and interrelating layers of vibrational energy”. Students are also taught that amethysts “emit high yin energy”, enabling them to “clear and align energy disturbances at all levels of being”.

Marcello Costa: Often chiropractic portrays itself as being a form of complementary medicine. Do you think that would be more appropriate to regard chiropractic as a form of alternative medicine opposed to science-based medicine?

Simon Singh: The language is confusing – alternative, complementary, integrated? I tend to call therapies such as homeopathy “alternative”, not because it is always used as an alternative to conventional medicine, but because it is alternative at a fundamental level. It is biologically implausible, for instance, it defies the laws of physics and chemistry, it lacks any reasonable evidence base and it contradicts the pillars of conventional medicine.

Obviously homeopathy can be used in a complementary way or in an integrated way, but it is still alternative.

I should stress at this point, there are some co-called alternative therapies that do have some evidence to support them. These include some massage therapies, hypnotherapy and some herbal medicines. Are they alternative therapies? Or are they just therapies? I think probably the latter.

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18 Comments sorted by

  1. James Heathers

    PhD Candidate in Applied Physiology at University of Sydney

    The traditional problem with "alternative" was the implication that there was a cogent choice between two somewhat equal "alternatives"... but I do take Simon's point on that one.

    I've also seen Supplementary, Complementary and Alternative Medicine (i.e. SCAM)... but that might be a little mean.

  2. Tim Scanlon

    Author and Scientist

    Great article.

    I watched an interesting interview with Simon on Lateline (ABC TV) and this article takes his arguments and the campaign much further. I agree that quackery in all its forms is, at best, rubbish and, at worst, dangerous.

    What annoys me the most is the pseudo-science rubbish they use to justify their position. We only have to see some of the claims in the recent comments section of the "Alternative Medicine" article:
    There are all sorts of claims about supposed treatments made there, none of which are founded upon any valid scientific principles.

    1. Samuel McCracken

      logged in via Facebook

      In reply to Richard Dobson

      "plenty of valid science right here for you, Tim."

      this doesn't look like valid science to me

      "Although most of these studies were positive and demonstrated the effectiveness of acupuncture in cancer pain control, the findings have limited significance because of methodologic weaknesses such as small sample sizes, an absence of patient blinding to treatment in most cases, varying acupuncture treatment regimens, a lack of standard outcome measurements, and an absence of adequate randomization. Further investigations into the effects of acupuncture on cancer pain using rigorous scientific methodology are warranted."

      you might like to read this instead.

  3. jerry sprom

    logged in via email

    Professor Costa,
    As a co-founder of FSM, perhaps you outline how FSM defines 'evidence-based' practices and separates them from 'pseudo-science'? Is FSM using the definition of EBM as defined by Sackett, or is it redefining this term and developing its own a definition of EBM? What evidence will FSM accept as suitable to justify treatment? Does FSM hold the RCT as a prerequisite to treatment? How have you defined these terms to the supporters of FSM?

    As a co-founder of FSM and more specifically to this article, perhaps you could outline how each of the universities providing chiropractic degrees are teaching the subluxation complex. Perhaps you could also outline which universities in Australia are teaching students that subluxations are the cause of 'most ailments' or 95% of disease. And perhaps FSM could also details which parts of the subluxation complex being taught are 'pseudo-scientific'.

  4. Dr Laura Holland

    logged in via Twitter

    If universities allow courses such as homeopathy, kinesiology and other CAM courses to be included in a science degree, then the next thing will be allowing courses on faith healing. Both have as much scientific evidence of working.

    imagine going to a science class in highschool and having the teacher only teach their own theories as to why things happen, but nothing with any facts to back it up. They would be fired immediately. so why is it suddenly ok to teach this stuff at the university level? and then put it in a science degree? may as well stick arts courses in a science degree.

    if it isn't science it doesn't belong in a science degree full stop, regardless of whether or not you think it's an effective treatment for ailments.

  5. Shauna Murray

    Research Fellow at UNSW Australia

    Thanks I particularly like your final paragraph:
    "... there are some co-called alternative therapies that do have some evidence to support them. These include some massage therapies, hypnotherapy and some herbal medicines. Are they alternative therapies? Or are they just therapies? I think probably the latter."

    This is where I think we need a lot more data.
    What do we do about those therapies that have not yet been evaluated thoroughly? It is only in the last 10 or so years that we have begun to thoroughly study some 'alternative' therapies that have turned out to be effective.

    I think its very important to protect the public and at the same time to not dismiss, by inference, therapies that may yet prove to be effective .

    1. Jarrad Hall

      PhD candidate, Molecular Microbiology

      In reply to Shauna Murray

      One group is doing some work here with one form of herbal remedy. Tea tree oil is quite an effective anti-bacterial, due to turpene compounds. Artemether an anti-malarial is also derived from a Chinese herb, and the compound now part of evidence based medicine. Though a few herbs have clinically useful compounds, not all will. Even if a specific herbal extract can work in the clinical setting, doesn't mean it will always work in all settings.

      For a herbal derived remedy to work properly, they need to extract it correctly, formulate it so it remains in an active form (is it water or oil soluble?) dose it correctly (sometimes insufficient or variable in the plant itself). Absorption pathway and delivery, etc. So there are a lot of considerations which need to be tested and trilled before you have an effective product to begin with.

  6. Bayne A M Geikie

    water quality specialist

    'contradicts the pillars of conventional medicine.' This guy is a dyed-in-the-wool novice. He may even be in the pocket of the Big Pharma/biotech whom would dearly like to see all competition taken away...after all those same pillars of conventional wisdom fund research, uni positions & the like & wuld like to see a return on their dough. How better to do this than by employing 'tobacco science' tactics to scare away citizens fom exercising their own judgement. Don't let the petty issues of Big…

    Read more
    1. Sean Alexander

      Jack of all

      In reply to Bayne A M Geikie

      It's a conspiracy, for sure. As soon as we start adding homoeopathic quantities of bacon to our water, all will be solved.


    2. Richard Dobson

      logged in via Facebook

      In reply to Sean Alexander

      Mocking is not a luminous form of debate, Sean. Bayne makes a number of valid points:

      1) Pharmaceutical companies have been found guilty of demonstrable corruption.
      2) Conventional medicine kills (yes *kills*) an enormous magnitude of people each year.
      3) CAMs have less adverse side effects than many drugs, and are efficacious.
      4) The full extent of the true adverse side effects of many medications are obscured for commercial reasons.
      5) Some extremely mainstream medications are straight up completely ineffective, totally.
      6) There is still a lot to be learned and understood about medicine, and dogmatically sticking to just the one narrow paradigm is not the way to go about finding it.

    3. Sean Alexander

      Jack of all

      In reply to Richard Dobson

      I do agree that some or many alternative therapies "can" work; my mother and acupuncture is one example. But single examples are of course meaningless in the big picture. My understanding is that a therapy needs to be significantly effective for it to be considered to be recognised, obviously weighed up against the side effects. The word "significantly" is the big key here, and that's where alternative medicine gets its name- it doesn't "cure' enough people for it to be considered an alternative…

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    4. Citizen SG


      In reply to Sean Alexander

      Richard, I don't think it is a pertinent defence to redirect criticism. The mainstream health system is certainly flawed, hospitals are dangerous places and clinical incidents claim many lives every day. All this is in the public record and some of it is shameful, but all of it is admitted. Some (in fact many) health care practitioners are lazy, stupid and greedy. Some are unprincipled and some will bend the truth for a profit. Granted.
      Are you so sure that the CAM industry is not guilty of the same perfidy?
      I would like to see the same degree of self criticism and honest examination of efficacy in the CAM industry as in the mainstream industry.
      It is very easy to criticise a health industry that is so flawed but it is even easier to criticise athe CAM industry that won't even admit to its own flaws.

    5. Graeme Hanigan

      logged in via Facebook

      In reply to Bayne A M Geikie

      Bayne, you blithely overlook the fact that we spent more on quackery than we do on medicine, but does anybody criticise big quacka?

      Those that promote quackery just hate having their favourite fantasy scrutinised and yet this is what happens to medicine every day and yes mistakes are made and doctors get struck off and pharmaceutical companies sued.

      But what every happened to the quack that killed Penny Dingle with homeopathy, still flogging homeopathy and possibly still killing people. What about Fran Sheffield who the TGA requested remove her false advertising of a sham homeopathic alternative to vaccination. Fran just thumbs her nose at the TGA and keeps flogging her sham medicine because there are too many suckers out there with too much money and not enough sense.

      There are no ethics in CAM, in fact the entire Wellness industry is built on lies and deceit!

    6. Catherine Wilkinson

      Medical practitioner

      In reply to Bayne A M Geikie

      Your back pain relief (a paracetamol/codeine tablet); or a anti-inflammatory alternative sure rakes in big profits for Big Pharma. You can pick up a cheap supermarket brand of the tablet for a couple of dollars, a supply that should last you a week. That 5-10$ will have a small profit margin shared out to the supermarket, the manufacturer, the supplier. Nobody gets paid for 'ownership' of paracetamol (or codeine, or ibuprofen) anymore as these are old, well established drugs.
      The osteopath I'm…

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  7. Graeme Hanigan

    logged in via Facebook

    If the slack jawed academics, running some of our our University departments, cannot tell the difference between efficacy and the placebo effect then we are in real trouble as a civilisation!

    What's next a Masters Degree in Water Divining or Flat Earth Navigation?

    However I suspect that the true reason that Universities are offering courses in sham medicine is the same reason that pharmacies sell ear candles, for the easy money to be made from an ill informed populace.

  8. Leslie Nolen

    logged in via Twitter

    Part of the reason CAM practitioners feel such resentment over this issue is that we're applying a standard to CAM that isn't generally applied to conventional or allopathic medicine.

    Many of the "standard of care" treatments routinely used by conventional physicians aren't supported by anything other than "this is what we do, is what we've always done."

    For evidence, look no farther than the fairly routine overturning of accepted medical wisdom as we test "what we've always done" against actual evidence and data.

    Leslie Nolen
    The Radial Group
    The health and wellness business experts