Tuesday, February 09, 2010

Simon Singh at Sheffield Skeptics - mini review

The monthly Sheffield Skeptics in the Pub meeting is rapidly turning into one of the best attended events in Sheffield. The back room at the Lescar last night was full to capacity, and then some, and it was clear that the bar staff were a bit unprepared for the sudden demand for large quantities of beer on a cold Monday night.

The speaker this time was Simon Singh, a scientist with a background in particle physics and cosmology (who famously once pedantically rewrote a verse of a Katie Melua song to be more scientifically accurate). His interest in alternative medicine was sparked four years ago when he saw a documentary about acupuncture on BBC2 which opened with an amazing scene of a woman having open heart surgery whilst fully conscious, supposedly with only needles for pain relief. On further investigation it became clear that the woman had also had three very strong sedatives and a local anesthetic, and the effect of the acupuncture was merely cosmetic.

He began to look at the evidence for different fields of alternative medicine, comparing studies and meta-analyses to see if there was anything in it, and wrote a book in conjunction with Professor Edzard Ernst called Trick or Treatment. He made it clear that he was not dogmatically against any form of alternative medicine, and that there are some studies where things like St John's Wort have been shown to have a mild anti-depressant effect. He also urged caution because there are also possible side-effects and interactions with other medicines, with St John's Wort affecting liver functions. To quote Tim Minchin, alternative medicine that works is called medicine and should be used with the same caveats as any other medicine.

He then moved on to the subject of chiropractic, which landed him with a libel suit when he wrote an article about in the Guardian two years ago. Chiropractic is founded on the belief that all ailments are due to misalignments (called 'subluxations') of the spine that interrupt energy flows to different parts of the body, and can therefore be cured by manipulating the corresponding vertebrae. While there is some evidence that manipulations can help with lower back pain there is no evidence that it can treat any other illness, and manipulation of the upper spine can be potentially very dangerous leading to strokes in some cases. Some chiropractors have claimed that it can cure things like childhood asthma and colic in babies, and it was these claims that Singh called 'bogus' in his piece.

The British Chiropractic Association launched their libel case based on a narrow legal interpretation of the meaning of the word 'bogus' and promised to produce a 'plethora of evidence' in support of their claims. After a lengthy period of prevarication they produced just 18 studies, which were, in the words of the British Medical Journal, 'demolished' by Ernst's review of them. The legal case continues with a new ruling due shortly.

The problem with the libel laws as they stand is that it is prohibitively expensive to defend a case - apparently it costs between 70 and 140 times more than anywhere else in Europe. If you lose a case then you will almost certainly be bankrupted, and even if you win, you can still be out of pocket by tens of thousands of pounds. This means that only wealthy individuals and corporations can ever afford to use the libel laws, and the advice generally given to those accused is settle out of court as quickly as possible regardless of the rights and wrongs of the case. Perversely, the libel laws put the burden of proof on the defendant, and the accuser does not have to quantify the actual value of damages caused. This can lead to absurd cases where somebody can be award millions of pounds of damages for an injured reputation where the victim of a violent assault may only receive a few thousand in compensation. The net result is that London has become a centre for 'libel tourism' where global corporations and individuals will bring cases, and this has a 'chilling' effect on publishers and institutions that are deterred from publishing anything that may potentially be the subject of an action.

Simon Singh bravely chose to defend the case and believes that he has a good chance of winning. As a successful author he is lucky enough to have resources to fall back on, unlike other cases he mentioned where people are facing financial ruin. Hopefully this case will highlight the need for urgent reform and there are signs of this happening, although pressure needs to maintained on politicians, particularly with an election in the offing.

After the main talk, there was a brief interval and then a very lively question and answer session, including a discussion with a somewhat aggrieved chiropractor in the audience. Unfortunately he didn't say whether he had any evidence that chiropractic was effective, but he was upset about what he saw as an attack on his profession. Singh pointed out that the BCA have really brought this trouble on their own heads by pursuing the case when they had been offered a 'right of reply' in the Guardian newspaper where they could have presented their evidence and concluded the matter.

He was also asked about the cost of staging trials of alternative therapies and pointed out that there is a lot of money being spent on such things so the professional bodies should be able to afford it. It also seems that money has been spent on flawed studies that do not include proper controls and double blind randomised elements. He mentioned a case of a German company that has tested and produced an effective treatment for some heart problems based on hawthorn, and has been very successful doing so. Perhaps some therapists avoid trials because they fear their treatments will be shown to be ineffective?

The final question covered how Singh is coping personally with the stress of the libel case, and it seems he is holding up fine particularly when he gets so much positive support from public meetings and groups like Skeptics in the Pub.

Very heartening to hear.

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