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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.