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28 comments from readers

Ralph Green
14 October 2009 at 19:58

During a sabbatical spent in Oxford this past summer, I was astonished to learn of the attempt at medieval silencing of Dr Singh's forthright criticism of charlatanry - by a British court in the 21st century!

The latest ruling restores my damaged faith in the UK legal system.

Leonard Waks
14 October 2009 at 20:25

It is one thing to think that beliefs out of the mainstream are wrong. It is entirely another thing to think they are damned! It is very easy to become complacent about today's certainties. It is very difficult to consider that other people of good faith may think differently and have their own reasons for their beliefs.

Thus, I am pleased that Singh reports on scientific evidence against chiropractic (or any other treatment modality). But I am not at all pleased that he labels it "bogus". However one wants to logic chop the definition, calling a belief "bogus" or "charlantry" (see Ralph Green above) is an attack on its holder.

My comment is not about the legal issue; I am in general not a huge fan of libel suits as they can chill free expression.

My gripe is with those possessing a scientific education (usually very shallow) who confuse science with religion. The Spanish Inquisition specialized in detecting error. People with an open mind look for the truth and report what they find, and don't conflate mistaken belief and evil.

George Greenwood
14 October 2009 at 20:48

I am not sure of the difference between seeking error and looking for truth. Scientific method is all about submitting your findings to your peers enabling them to look for errors and furthering the truth. Clearly the Inquisition did not do that and nor is the chiropractic allowing scientific critique.

Anon
14 October 2009 at 20:53

Mr. Waks -- the following may prove useful:

char⋅la⋅tan  [shahr-luh-tn]

–noun

a person who pretends to more knowledge or skill than he or she possesses; quack.

False claims to be able to treat a disease that one is not able to treat would therefore qualify as charlatanry. (please note the spelling)

David Wilson
14 October 2009 at 21:19

Surely, the 'reasons for belief' in the efficacy of a particular medical treatment should lie in the demonstrable fact that it actually works, and not lie in an arbitrary faith that someone has chosen to follow.

If someone is selling a medical treatment, and for a particular condition for which they promote it, it either doesn't work, or they haven't bothered to show that it does work the simple pointing out of that should be considered as a far more serious attack on the seller than whether someone chooses to use the word 'bogus'.

Whining about the precise words someone chose to use while pointing out an unacceptable state of affairs seems to be nothing more than an attempt at a distraction from the fundamental point.

Joke of Kant
14 October 2009 at 22:54

I remain confused why Mr Singh doesn't simply admit that 'bogus' was a poor choice of word, retract it, clarify it, apologise for it even, but leave the scientific critique of the particular chiropractic claims in place. I don't think I've ever heard a clear statement from Mr Singh that he regrets the use of the word.

I'm unimpressed at the use of emotive language such as 'bogus' as part of a serious piece of criticism. If Mr Singh did not realise that the word may be interpreted in the way that it has been in court. he is a less able communicator than I (and, I suspect, others) gave him credit for following 'Fermat's Last Theorem'. If he DID know that it was open to multiple interpretations, he shouldn't be surprised at the pushback from the BCA.

His friends/supporters appear to have tried to finesse a 'virtual retraction' of the offending word by publishing his article 'sans bogus'.

The confusion between an intended and received meaning of words is understood by many. Mr Singh has been elevated at least as much for his skill in communication as he has for his science. The point about the 'bogus' word being a distraction may be fair, but it's been easily within Mr Singh's power to simply retract the offending word, and hence the distraction, at a stroke.

I think I'm with Mr Waks. While the BCA's actions in the past were, like everything else, a reasonable target for scientific investigation, there is, it seems to me, an unpleasant trend towards personalising attacks rather than criticising the arguments and positions held by others amongst the skeptocracy.

David Colquhoun
15 October 2009 at 07:28

@Joke of Kant

Appeasement doesn't work, The evidence (or rather lack of it) has been repeatedly analysed, not least in Singh & Ernst's own book. When the BCA eventually produced its "plethora of evidence" it was demolished in 24 hours by bloggers who know what they are talking about,

This scientific analysis was ignored by the humanities graduates who run the media (and, it seems, the Department of Health), It took a bit of blunt language to bring the matter to their attention.

Singh is a hero to scientists and he should be a hero to journalists too. It is no wonder that the print media are dying. They just don't get the point until it has all been analysed for them by bloggers who, by and large, are quicker, and better at critical thinking.

Joke of Kant
15 October 2009 at 08:03

@David Colquhoun

I think you make my case for me.

I think there is a risk that the skeptocracy throws the baby out with the bathwater.

"Blunt language" If this simply meant 'simple language to help non specialists access an argument/investigation, I'd have no concern with it. In 'Fermat's Last Theorem' Simon did a fantastic job at giving many non-mathematicians a real sense of the excitement of that work.

If "Blunt Language" means engaging with tabloid shock tactics simply to gain column inches, I think it turns away from the very objectivity that scientists claim as a potent facet of their ways of knowing the world.

I'm concerned that some folk on the skeptic side of these arguments pick up the ball set down on the edge of acceptability (and, arguably, legality) by the heroes of the moment and think that the argument is even more powerful if they grab the ball and run into more extreme, personalised attacks on individuals. The risk is that we end up with another self opinionated 'mob' picking up on the sound bites and thinking they are experts. Don't get me wrong, I'd certainly class Simon an expert in this field, but I'm concerned that less able scientists will see the 'blunt language', think that that is a mark of good science and model it. If those cases are given some kind of 'get out of jail free' card of saying 'I'm a scientist, I have a right to call this other person a [fool, crook, joke] with impunity' the world will no richer for it.

If the 'bogus' word was there to catch the eye, well, it did it's job. No reason not to clearly withdraw it as an error and regard it as a catalyst to start the discussion. Continuing to let it stand at this point means that the 'bogus' word continues to be a distraction.

Words are powerful, and carry sharp edges. The professional communicators who deal them should, I believe handle them with care. They should accept responsibility if they find that their word are reasonably read with a different meaning than the one intended if a word has several meanings.

And no, I don't think that the subsequent paragraph adequately clarifies Simon's intent. His position and expertise give his voice and writing weight and authority, sharpening the edges of his words further, if you like.

A call to the 'heroic' nature of a person, even Simon, has little place in critical or scientific thinking, I'd suggest. It's exactly such calls to the emotions and loyalty that in these arguments that give me pause for thought about what is happening in science and science journalism.

CynoSure
15 October 2009 at 08:19

That BCA sued instead of providing their evidence is in and of itself proof that the term "bogus" was correctly used.

David Colquhoun
15 October 2009 at 08:40

@Joke of Kant

I do wonder if you have actually read the assessments of the science yourself. They are written in the normal sober language of science, and little notice was taken of them.

It is also relevant that when dealing with alternative medicine we are talking to people who are often actively antiscience, They don't accept the normal ground rules for rational discussion. It isn't easy to have a sensiible debate when yourr oppoent feels free to make things up.

Jack of Kent
15 October 2009 at 08:58

Joke of Kant - you seem somehow strangely familiar...

Thank you for your sincerest flattery :-)

Jerk of Kent
15 October 2009 at 09:11

The joker's comments are unarguable, in my view. After yesterday's decision, there is no better time to settle with the BCA on favourable terms. Simon has succeeded beyond all expectation in bringing the dubious nature of the claims to public attention. A simple clarification of the intended meaning of "bogus" - withdrawal if necessary - should satisfy the BCA who are now desperate for this to be brought to an end. Quit while you're ahead.

Adrian Bailey
15 October 2009 at 09:13

"All things must be examined, debated, investigated without exception and without regard for anyone's feelings." Diderot

Adam Sargant
15 October 2009 at 09:16

Mr Waks

This isn't an issue of personal beliefs... this is an issue of peer reviewable scientific evidence. When claims for a treatment (that an individual makes a living from and in some cases can harm the recipient of that treatment) relies on weak or no evidence at all, I think that charlatanry is a very moderate word indeed, while bogus allows for the benefit of the doubt that the individuals concerned are actually well meaning. I would choose to be less diplomatic, myself.

MarkEMarkEMark
15 October 2009 at 09:16

JokeOfKant - your arguments are well thought out. But, I'd like ot know why you can't call a spade "a spade". If he believes it fraudilent, why can't he say so without being sued?

Jaffa The Cake
15 October 2009 at 09:36

Simon doesn't have to apologise, he just needs to state his intention of the word (which is also how I read it) and let the courts decide.

The BCA are free to realise their case is petty and bringing more attention to the dubious nature of some of their practices than they intended, and withdraw. Or, continue making their case.

This should have been settled in a right-to-reply piece, by coming forward with proof and argument. The path the BCA took suggests they don't have either. I'm not saying they don't have proof, but that's how it looks on the outside.

@Joke of Kant "there is, it seems to me, an unpleasant trend towards personalising attacks rather than criticising the arguments..."

Are you simply following this trend by calling yourself "Joke of Kant"?

MarkEMarkEMark
15 October 2009 at 10:45

I've come up with a great new treatment for any condition called "Wonk Theropy". It can cure any ailment through self gratification. I can't provide any scientific evidence that it works, but I've plenty of anecdotal evidence that people feel better after it. I'll sue anyone who says it's bogus (or, indeed who calls me a "Wonker")

Tony Lloyd
15 October 2009 at 11:58

@Jerk of Kent

The BCA have already been offered free space in the Grauniad to publish a rebuttal.

Simon Singh has already clarified the use of the term "bogus". The use was clarified in the original article.

That's ample settlement. Indeed it's more than enough.

@Waks, Jerk and Joke

"Bogus" is hardly strident language neither is it tabloid gutterism. "Why do supporters of chiroquactic insist on being logic-crippled dickwads?" is strident language. (It comes from a comment on Crispian Jago's blog). To my mind its entirely justifed, but I will accept that it is both strident and insulting.

"Bogus" pales next to this.

I think your problem with "bogus" (especially Waks problem with it) is that it clearly said that the BCA are wrong. This is not (just) an issue on the public discussion of science but a general trend in discourse: the idea that we should say nice enabling things and definitely not upset anyone. We're to "take on board" what others say and then "share" our own ideas. ("Thanks for that Nick. I'm sure there's a lot to be said for the BNP's policies. Maybe others might contribute some ideas around not being thinly disguised racist morons.")

Unfortunately if someone is wrong then they need telling and there is no-one who can choose that precise form of words that will sugar coat the message "you are wrong" in all circumstances.

The BCA should grow up and not whine to teacher that Simon is "being mean".

robink
16 October 2009 at 04:45

Guess what? Chiropractic isn't going away. But Singh

just might be. He picked a fight. I've read the chapter on

Chiropractic in his Trick or Treatment book on Amazon.com ( for free, ha!) and found it laden with errors and bias.

He, Herr Ernst and most of you have it out for anything

or anyone not in your club. The BCA could never come up with evidence the Jack of Kent's,Goldacre and the badscience bunch would be satisfied with.

Why doesn't the medical profession get equal treatment ? Because as it

stands, very little therapuetic intervention has Goldacre/Ernst/Singh/JOK approved science behind it.

From the bmj:

http://jme.bmj.com/cgi/reprint/18/3/117.pdf

The quality of medical 'knowledge' has been

examined in detail by Professor Eddy, an American

cardiothoracic surgeon with a PhD in mathematics

(8). He - and others, such as Sir Douglas Black, a

former president of the Royal College of Physicians of

London - argue that only about 15 per cent of medical

interventions are supported by solid scientific

evidence; in other words, 85 per cent are not

http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

Of around 2500 treatments covered 13% are rated as beneficial, 23% likely to be beneficial, 8% as trade off between benefits and harms, 6% unlikely to be beneficial, 4% likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness.

Chris Lawson
16 October 2009 at 08:54

robink, did you actually read that Clinical Evidence link? Let's see what they say.

"For clinicians and patients we wish to highlight treatments that work and for which the benefits outweigh the harms, especially those treatments that may currently be underused. We also wish to highlight treatments that do not work or for which the harms outweigh the benefits. For the research community our intention is to highlight gaps in the evidence, where there are currently no good RCTs or no RCTs that look at groups of people or at important patient outcomes."

And, "We are continuing to make use of what is ‘unknown’...with a view to help inform the commissioning of primary research."

Clinical Evidence aims to find gaps in our clinical knowledge in order to help clinicians know what treatments are known to work and to direct research so as to improve the situation. In comparison, the BCA runs no such self-appraisal program, and when someone points out the deficiencies in their research base, sues him.

Tony Lloyd
16 October 2009 at 10:07

@ robink

I'm going to have to "call you" on your review of "Trick or Treatment"'s chapter on Chiropractic.

Amazon.com, where they have previews, tend to show the front and back covers, index, table of contents and the first few pages of the body of the work.

This is what Amazon.com have for "Trick or Treatment" at the time of writing. From this one can see that the chapter on chiropractic begins on page 145, well after the "first few pages". The "first few pages" visible are of the chapter "How Do You Deternine Truth?".

I thus very much doubt that you have read the chapter on chiropractic and surmise that your comments on this (and, by extension the rest of your post) is dealt with in the second book that appears if you search "Harry Frankfurt" on Amazon.com

robink
16 October 2009 at 12:15

Tony,

I was initially able to preview pages 157-174. That's

enough. I made a few notes of errors at that time. I just checked and now I cannot access . I hope

I don't have to buy that book, but go ahead if you want to,

you'll be helping your friend Singh. I'll be happy to elaborate but I do have to

go to work, unlike those that can sit and blog all day long.

To Chris,

The BCA knows it will never be done dodging critical bullets. My point is that

no one in these anti-chiropractic groups mentions medical treatments with no

"approved" backing. There is plenty of chiropractic research continually being done. It just isn't good enough for the anti-CAM bunch.

Seriously, when Singh or Ernst completely slashes a profession without constructive critism or acknowledgement of any good besides being a last

choice for low back pain and then makes any errors at all in their manifesto

on alternative medicine there's something seriously wrong.

I'll continue later if you wish to.

Chris Lawson
16 October 2009 at 21:49

robink,

The BCA shouldn't ever be done dodging critical bullets. Research needs to be ongoing and needs to be continuously critical. If the attitude in medicine was that we could stop dodging critical bullets, nobody would have found that HRT can cause breast cancer or that Vioxx can cause heart disease and we'd still be using these uncritically.

Secondly, Singh and Ernst *did* give constructive criticism: do good research before claiming efficacy. And I don't understand why they are any obligation to "acknowledge" the goodness of chiropractic for anything other than things they found benefit for, to wit low back pain. The only thing that is seriously wrong is that when confronted with a claim of lack of evidence, the BCA decided to sue Singh rather than present evidence (and I understand that at no time in their libel suit did the BCA actually present the evidence that would have shown Singh's criticism was unwarranted; I would welcome any correction and a pointer to the evidence that shows Singh was wrong).

Thirdly, your argument goes: because many things in medicine are unproven, therefore it is libellous for Singh to say many things in chiropractic are unproven. I hope I don't need to point out the flaws there.

robink
17 October 2009 at 03:42

Chris,

I accept your comments above. Too bad you

hadn't written the initial criticism, it would've went down easier all around. Hopefully some good will come from all of this.

Cheers

pv
18 October 2009 at 22:45

I'm interested in how the BCA and all those silly chiroquacks couldn't have known of the paucity (read "lack") of evidence for their claims.

The "plethora" they have come up with subsequently, supposedly in support of the justification to sue Simon Singh, has been so comprehensively demolished that one wonders, if they are not dishonest (according to Judge Eady's interpretation), then how can these people be considered fit and competent even to issue an aspirin.

Judge Eady might have been wrong with regard to Simon Singh's meaning, but he might very well be right with regard to the BCA and chiroquacks in general.

robink
19 October 2009 at 07:10

pv what planet are you from? Chiropractors don't issue

aspirin. You've read all the evidence then? Even if it's

weak evidence ( for now), that doesn't mean there won't

be more research. EBM is being embraced by many in

the profession and it will continue to grow by necessity.

Chiropractors aren't going away but I hear they're coming to look for you for calling them quacks.

Joke of Kant
19 October 2009 at 11:37

@CynoSure As I understand it the issue around the use of the word 'bogus' as to do with whether BCA/chiropractors intentionally misled [potential] patients/customers. I think (but I don't know for sure) that this is element in the meaning f the word that Simon wishes to clarify that he did NOT intend. I think this facet of the meaning is close to the difference between saying that someone is 'mistaken' and that they are a 'liar'. There is a world of difference between the two (I guess that 'professionally negligent' lies somewhere between the two). For BCA to accept some of those terms would probably lay them and their members open to litigation from thier clients, so it's not surprising that they have pushed back hard against this. I simply don't buy this as a 'smokescreen' tactic which some othere have mentioned here.

@David Colquhoun The fact that the sober science assessments (and yes I have read some of them) were not read much does not, in my opinion, give anyone carte blanche to do whatever they like to raise the profile. I don't see that claiming (or implying) that people knew they were giving false information without strong evidence of what they knew is warranted at all. If that evidence (of knowingly misleading their clients) is around then there is no problem about the use of the word 'bogus' I think. I don't think that is what Simon is trying to say in the revised version published by his friends.

With regard to 'dealing with alternative medicine' I accept that it can be hard to have a debate on the terms that either side is wholly comfortable with. Reason is not the only way we know things though, and some things that we feel that we know we can never justify (like what I dreamt last night). I'd prefer to see more ambassadors from both sides trying to truly engage and understand the 'other side'. I think your comment could equally be made about some of the skeptic crowd who appear (to me) to be "actively anti-'alternative medicine''. Personally I don't doubt that there are very probably errors in the alternative medicine current world view{s}. Equally I know that the scientific method allows for the possibility of theories to be overturned by experiment. What concerns me is when people are castigated for speculating. In know that elements of the alternative medicine community can be infuriating and poor communicators, but the same is surely true of some scientists.

@Jack Of Kent

The flattery is, indeed, sincere and well meant. It's meant to be mildly self deprecating and a nod to yourself and the helpful insights you've given so many of us into the legal 'niceties' of this case. Thank you.

@Jerk of Kent

Wonderfully succinct.

@Adam Sargant

I do think that the 'bogus' word is not simply about stacking up the scientific evidence against the chiropractors' evidence. The 'bogus' word introduces the element of what the chiropractors knew. I have spoken to people in the field of alternative medicine and I'm pretty sure that not all of them are aware of scientific evidence pertaining to their field. (indeed I believe GPs find it hard to keep up with trends in medicine at times). If a practitioner is not aware of, or sincerely discounts the scientific evidence, then I feel the use of the word 'bogus' with its connotation of willful misleading is not appropriate. Of course this raises questions of whether alternative medicine practitioners should, perhaps, be licensed with a condition that they do keep up with relevant science and develop their practice accordingly.

@MarkEMarkEMark

If he believes and can justify fraud then he's at liberty to say so and to rightly expect that the law will support him. If he believes that there is fraud but does not have the evidence of fraud then he's still at liberty to call it, but should expect that his call may be challenged legally. Again, here, I believe is not [only] about the question of the scientific validity of the procedures but [also] about what the practitioners knew at the time of making any claim.

On 'Calling a spade a spade' as a point of interest, I was told by an American back around 1980 that in the USA many regard that as a racially loaded and unacceptable phrase. I am not for a moment suggesting that you intended it that way, but it does demonstrate how meaning is refracted through various lenses when we attempt to communicate.

With regard to your 'Wonk Therapy'. If you make a claim that is false then it's open to be challenged. If you make a claim that it knowingly false then I'd hope that you are open to the the charge of making 'bogus' claims. You're free to counterclaim in either case. The most direct, objective engagement with a spurious claim is to go for the evidence, not go for the person.

@Jaffa The Cake

It's true, he doesn't have to apologise. I just like politeness and find it facilitates civilised discussion. I can understand why BCA regard the word 'bogus' as being so damaging (see my @CynoSure above)

To be clear (see my @Jack of Kent above) my choice of moniker was a choice to name myself and if anyone is the target of being called a 'joke' by it's use it is me. I genuinely value the legal insights that Jack of Kent has shared with the whole debate.

@Tony Lloyd

Clearly at least one legal judgement felt that it was not enough.

My issue with the word 'bogus' is not that it said that BCA were wrong, it was that it implied that they knew that they were wrong and made unsupported claims nonetheless.The first case is a mistake, the second seems to me - (and I'm not a legal expert) to look like fraud.

The aim of scientific discourse should be nothing to do with upsetting or avoiding upsetting. If I lose a scientific argument I may be upset but a scientific argument, once one, should only be refutable by experiment/evidence. Two risks accrue with 'strident' (I think I'd call it 'abusive') language. One is that it simply polarises the camps further, clouding the very scientific evidence you presumably want to put forward. Another is that people on the fringes of the argument will think that abusive language is the mark of good scientific discussion and spend their time thinking of pithy rejoinders rather than looking at the evidence. While the discipline of science is at its heart objective, we scientists are human too, we can help each other get closer to the truth by not cluttering the language we use.

I'd agree that you can't always sugar coat the pill, but you can keep the arguments evidence-focused. The use of the word 'bogus' drifts away from this (if you accept the implication of deliberate, knowing misleading). When we drift away from clear (and I'd also add 'respectful') language we open the gate to ever more intemperate words, like Crispian's where I hear echoes of a mob, rather than of the enlightenment. If we simply rely on who shouts loudest or gives the most colourful insults I doubt that the scientific community will be heard above the nonscientific majority.

@robink

I've heard that the claims for the benefits of chiropractic have been reduced on the BCA website since Simon's publication. I don't see any room for complacency if that is the case; it sounds like 'when they had no choice but to acknowledge some of the evidence they reduced their claims'. If this is the case then I think BCA, chiropractors and Alternative Medicine practitioners in general should take very seriously the question of how they stay up to date with information relevant to their field, not just from within their own community.

@pv

I absolutely agree that professional chiropractic practitioners should be expected to know if evidence emerges which indicates that their treatments may not be as effective as claimed, or contain previously unrecognised side-effects/risks. Where there are reports of risks, I'd hope that as a client/patient I would be told about them (as I am if I go for surgery or pick up a prescription) so that I can effectively make an informed choice.

robink
19 October 2009 at 18:45

@Joke of Kant

Thanks for your civil tone. You don't need to be to

PC with the Spade bit in the UK though.

http://www.phrases.org.uk/meanings/call-a-spade-a-spade.html

Calling someone or a whole profession "Quacks" and

"Charlatans" is offensive as it gets,any where.

Would you mind pointing that out to the Jack of Kents out there?