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British Chiropractic Association produces its plethora of evidence

June 18th, 2009 · 44 Comments

On 17th June 2009, 15 months after Singh’s article was published, the British Chiropractic Association (BCA) has finally produced its evidence (though only after enormous pressure from bloggers [download as pdf]..

Jack of Kent has already made some comments from the legal point of view.

As expected, the list of references they give is truly pathetic, The list of 29 references has nine about infantile colic, four about asthma (two of which refer to osteopathy not chiropractic). three about the safety of chiropractic (a contentious matter but not the point here) amd three about the safety of non-steroidal anti-inflammatory drugs (an important matter but utterly irrelevant here).

Let’s look at the papers about colic. Most are in obscure alternative medicine journals, not easily available, but the BCA’s own synopsis is sufficient for now.

  • Klougart N, Nilsson N and Jacobsen J (1989) Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases, J Manip Physiol Ther,12:281-288. [ download thr reprint]. As evidence it is about as useless as the infamous Spence study so beloved of homeopaths. There was no control group at all. It simply follows 316 babies and found that most of them eventually got better. Well, they do, don’t they? It is a sign of the pathetic standard of research in chiropractic that anyone should think this paper worth mentioning at all.

  • Mercer, C. and Nook, B. in the Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic (1999) (so no peer review, for what that is worth). “Resolution of symptoms [of infantile colic] in 93% of infants treated with spinal manipulation”.. This sounds as useless as Klougart et al. Why only 93% one wonders? Every parent knows that 100 percent of babies stop crying eventually.

  • Wiberg et al. J Manip Physiol Ther, 1999, 242 517 – 522. This one was randomised (but not blind) and showed that spinal manipulation was as effective as dimethicone for colic. [Download pdf]
    I expect that all that means is that dimethicone doesn’t work either.

  • Hayden & Mullinger (2006) Complementary Ther. clin. Prac. “This preliminary study suggested that cranial osteopathic treatment can benefit infants with colic”. So. (a) preliminary and (b) not chiropractic.

  • Hipperson AJ (2004) Clinical Chiropractic 11, 122 – 129. A report of two case studies, so essentially worthless as evidence The journal isn’t even listed in Pubmed.

  • Browning M. Miller, J. Clinical Chiropractic (2008) 11, 122—129 [download pdf] Comparison of the short-term effects of chiropractic spinal manipulation and occipito-sacral decompression in the treatment of infant colic: A single-blinded, randomised, comparison trial. This paper just compared two different chiropractic methods. It shows that both are equally effective, or equally plausibly, both are equally ineffective.

  • Leach RA (2002) J Manip Physiol Ther, 25, 58 -62. Merely two case reports and they refer to usie of a mechanical device, not the usual chiropractic manipulation.
  • Miller J (2007) Clinical Chiropractic 10, 139—146 Cry babies: A framework for chiropractic care [download pdf]. No evidence at all here. It isn’t a research paper.

  • Nilsson N. 1985 Eur J Chiropr 33, 264 – 255 Infantile colic and chiropractic. “Respondents to a questionnaire revealed that 91% of of infants improved after 2 – 3 manipulations”. Again, no controls. So, babies stop crying, eventually.

That seems to be the best they can do. What they don’t do is mention any of the papers that contradict their claims. They cite Sackett et al. (1996) as their criterion for what constitutes evidence, That paper says “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence”. That means all the evidence. So why, for example, is there no mention of Olafsdottir et al. (2001), “Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation”. That is one of the few really good papers in the area. It compared chiropractic treatment of babies for colic with placebo treatment (the nurse just held the baby for 10 minutes (the time the chiropractor took). The conclusion was

Conclusion Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.

More on this dishonest selectivity can be found at Holfordwatch.

No doubt there will soon be more analyses of what passes, in the eyes of the BCA, for evidence, The nine papers they cite for colic are truly pathetic. Not a single one of them amounts to anything that would be recognised as evidence in the real world. And papers that do provide real evidence are not mentioned.

Follow-up

As always, the blogs provided a very fast response to a document that appeared only late last night.  And, as always, these unpaid people, working in their spare time, have done a far better job than the suits at the BCA (or NICE).

Here are some of them.

“A Review of The BCA’s Evidence for Chiropractic”.    Martin on The Lay Scientist.

“The BCA have no evidence that chiropractic can help with ear infections” on Gimpy’s blog

“Examining the BCA’S ‘Plethora’ of Evidence”.  Unity, at Ministry of Truth.

“British Chiropractic Association and The Plethora of Evidence for Paediatric Asthma”. On Evidence Matters

“BCA Statement Baffles Blogger”. James Cole on jdc325’s Weblog

“Careful, BCA, you might slip a disk. The British Chiropractic Association may need to hire a chiropractor to work on themselves: they’re shoveling so hard they’re likely to hurt their backs.” In the US magazine, Discover.

“British Chiropractic Association (BCA) demonstrate what evidence-based medicine isn’t” at Holfordwatch. This one shows nicely how the BCA fail to apply their own standard of evidence, based on Sackett et al. (1996).

“The BCA’s worst day”. “Today has not been a good day for the British Chiropractic Association”. Jack of Kent summarises the demolition, in 24 hours, of the BCA’s ‘evidence’

Laurie Taylor says it all.

Could this bit (dated 18 June) in Laurie Taylor’s saga of the University of Poppleton possibly have been inspired by the Singh affair?

Sweet smell of success

Our campus burst into colour last week as members of the Department of Aromatherapy, led by Professor Gwendolyn Frisson, paraded round the former administrative block happily waving bunches of wild carrot, devil’s claw, cinnamon leaf and lime blossom.

What sparked the herbal celebration was the news of a full retraction from the journalist on the Poppleton Evening News who had described the department in print as “a hotchpotch of untestable propositions and unproven medical interventions”.

The journalist in question, Simeon Rainbow, explained in his published retraction that he’d had time to reflect on the department’s reaction to his original article and now fully recognised that there was no better way of deciding upon the scientific validity of practices such as aromatherapy than by threatening anyone who denied such validity with an enormously costly libel action.

Professor Frisson said that she welcomed the retraction. She would now be able to return with renewed enthusiasm to her research on the beneficial effects of grated angelica root on patients with advanced encephalitis.

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Tags: British Chiropractic Association · chiropractic · chiropractor · defamation · evidence · Simon Singh

44 responses so far ↓

  • 1 Blue Bubble // Jun 18, 2009 at 10:04

    Wow, just wow … I am absolutely flabbergasted (though not in the slightest bit surprised).

  • 2 Jonathan Hearsey » ‘Plethora of Evidence’ // Jun 18, 2009 at 10:07

    […] DC […]

  • 3 Mike Eslea // Jun 18, 2009 at 12:04

    Nice one, DC. Clearly this sorry parade does not add up to “a jot of evidence”. Can you imagine the meeting where they compiled the list?

    “Christ, we can’t put that in, it’s totally irrelevant. And this one’s total bollocks!”

    “It doesn’t matter, we just need the list to be as long as possible. Most people won’t look at the actual papers: we just need a long list of sciencey-sounding titles.”

    “Oh, right. How about this one then, and this, and this….”

    “Hee hee, now you’re talking. This will keep the bloggers busy!”

  • 4 Blue Wode // Jun 18, 2009 at 12:17

    Thank you for the valuable insight into the appallingly shoddy quality of the BCA’s evidence.

    Just one small point, JJM at the JREF forum notes that “Reference #18 on the BCA list is incorrectly cited, it should be Clinical Chiropractic (2004) volume 7, 180—186.”

  • 5 jdc // Jun 18, 2009 at 12:46

    I was going to feign suprise at your statement that “the list of references they give is truly pathetic” but I doubt I could have done so convincingly. Some time ago, I emailed the BCA regarding the “Research supports chiropractic” page on their website and was extremely disappointed with their response. I went back to them with some further questions on 28th May and have received no response, despite emailing them to ask if they had any intention of answering my questions. I seem to be on their “ignore” list.

  • 6 Unity // Jun 18, 2009 at 14:08

    I’ve covered three of the early colic papers here –

    http://www.ministryoftruth.me.uk/2009/06/18/examining-the-bcas-plethora-of-evidence

    To add to the Prof’s comments…

    Mercer and Nook’s paper was published in abstract only, so no detailed methodology and no published results, therefore no value whatsoever.

    Bronford et al. appears to be similar to a paper by Wiberg et al that was published two years earlier and which claimed that chiropractic was slightly more effective than dimethicone. [DC it should have read Wiberg et al: my mistake, now corrected]

    Unfortunately, dimethicone has been shown to be no better than a placebo in treating colic and the single blind design of Wiberg et all means that, at best, one could only conclude from its results that chiropractic may be a slightly more effective placebo than dimethicone.

  • 7 Paula Thomas // Jun 18, 2009 at 14:48

    Great, so the new definition of ‘plethora’ is ‘little and tenuous’ – hmmm

  • 8 BCA Statement Baffles Blogger « jdc325's Weblog // Jun 18, 2009 at 16:21

    […] 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 […]

  • 9 ff5166 // Jun 18, 2009 at 16:23

    I think this “evidence” shows, even if we accept Justice Eady’s definition of the word bogus, Simon is not guilty of libel.

    And if any of you call my claim that I can levitate bogus, I’ll sue your shirt off.

  • 10 British Chiropractic Association and The Plethora of Evidence for Paediatric Asthma « Evidence Matters // Jun 18, 2009 at 18:42

    […] Professor David Colquhoun: British Chiropractic Association produces its plethora of evidence […]

  • 11 Jonathan Hearsey » ‘BCA have a Cillit Bang Day’ // Jun 18, 2009 at 21:21

    […] If this is true – and it needs to be corroborated – then today will go down as the BCA’s ‘Cillit Bang’ day… […]

  • 12 Simon Singh Case Response Roundup « God knows what… // Jun 18, 2009 at 22:43

    […] Colquhoun takes apart the studies dealing with colic on his Improbable Science […]

  • 13 British Chiropractic Association (BCA) demonstrate what evidence-based medicine isn’t « Holford Watch: Patrick Holford, nutritionism and bad science // Jun 18, 2009 at 23:24

    […] Professor David Colquhoun: British Chiropractic Association produces its plethora of evidence […]

  • 14 If the BCA ask to borrow your library card… « Cubik’s Rube // Jun 19, 2009 at 00:37

    […] David Colquhoun examines some of the 29 references given by the BCA in this paper, and explains why they thoroughly fail to constitute the “good evidence” they seem to think they’ve provided. Studies with no control groups, studies that weren’t blinded, papers that aren’t research papers, papers that don’t address chiropractic manipulation at all… it seems quite a sorry bunch. And he touches on the matter of other studies not mentioned here by the BCA, which were rather better performed, adhering better to good scientific practices, but show no effect more than placebo. […]

  • 15 ralaven // Jun 19, 2009 at 04:35

    Didn’t the BCA read the Klougart N et al. paper. Right at the end of their discussion they note that a proper double-blinded controlled study is needed to identify how much of their response is due to the placebo effect, and that they were setting just such a study up. Since that was 20 years ago, I think we can judge that either it didn’t work or we would have seen published by now!

  • 16 The BCA have no evidence that chiropractic can help with ear infections « gimpy’s blog // Jun 19, 2009 at 09:10

    […] of Kent – General commentary and legal background. Prof. Colquhuon – Detailed look at the nine colic papers. Ministry of Truth – General review focusing […]

  • 17 Revenge of the Singh « God knows what… // Jun 19, 2009 at 12:44

    […] trials listed in the plethora about colic. David Colquhoun and Ministry of Truth together provided a detailed analysis of the significant problems with each […]

  • 18 Dr Petra Boynton I Blog I British Chiropractic Association presents their evidence – do you think it supports their claim for chiropractic treatment of children? // Jun 19, 2009 at 20:40

    […] Colquhoun reviews the papers on colic presented by the […]

  • 19 BadlyShavedMonkey // Jun 19, 2009 at 22:47

    It is frankly scary that this bunch of duckspeakers, given over a year to produce their best shot, come up with this pile of shite. Do they think everyone else is stupid or are they so incredibly stupid that they think this vindicates them?

    I’d almost be happier if I could believe the average SCAMmer was an intelligent fraudster because they at least would know their limits and know when to stop. The alternative is that they are so utterly utterly dim that they think they are right, which means they are so deep in their delusion that there is no escape from their deep well of stupid. Truly “incompetent and unaware” as that insightful phrase has it.

  • 20 Lewith lashes out « A canna’ change the laws of physics // Jun 20, 2009 at 17:10

    […] chiropractors assert they have evidence centres on treating children by spinal manipulation for: colic, asthma, nocturnal enuresis, and otitis media.  There is no “only” about this: the […]

  • 21 The British Chiropractic Association is All About Free Speech—So They Filed a Libel Suit « Confutata // Jun 20, 2009 at 21:04

    […] such as colic and asthma. (For those interested, these have been dissected here, here, and here, among many other places.) Interestingly, it’s taken them 15 months to make their evidence […]

  • 22 Journey through a Burning Mind » A “plethora” of evidence for chiropractice // Jun 22, 2009 at 21:02

    […] code of practice! Not much to discuss here really. This is a truly pathetic evidence base, as Prof. Colquhoun notes, that if anything, totally proves Simon’s point: there is no solid evidence to back up a […]

  • 23 A “plethora” of evidence for chiropractice « Skepfeeds-The Best Skeptical blogs of the day // Jun 23, 2009 at 21:43

    […] much to discuss here really. This is a truly pathetic evidence base, as Prof. Colquhoun notes, that if anything, totally proves Simon’s point: there is no solid evidence to back up a practise […]

  • 24 More make-believe from the University of Westminster. This time it’s Naturopathy // Jun 25, 2009 at 10:09

    […] is a short break from the astonishing festival of chiropractic that has followed the British Chiropractic Association (BCA) v Simon Singh defamation case, and the […]

  • 25 whatgoesaround // Jun 30, 2009 at 08:29

    Quangoland somewhere near you, so zeno has received a plethora of evidence, mainly subscriptions to catalogues showing that his personal data was not safe with the gccquango, perhaps bloggers have had a private detective used, the gcc seems to be very fond of Philip Swift, a simple data protection request by you to the gccquango may help. I was unsurprised to read zenos blog, however rules are rules and in particular
    Obtaining of information concerning allegations
    4. – (1) Where an allegation to be investigated by the Committee is of a kind
    mentioned in section 20(1)(a) or (b) of the Act, the Committee shall, before the
    beginning of the period of three weeks ending with the day on which notice is served
    under Rule 3(1), invite the person making the allegation, and any other person
    appearing to it to have information relevant to the question whether there is a case to
    answer, to make a statement of evidence by statutory declaration or affidavit as to the
    matters giving rise to the allegation; and the Committee may invite such evidence in
    any other case.

    So you can be allowed to give evidence in support of zeno,
    http://www.gcc-uk.org/files/link_file/Legislation_IC_Rules.pdf I should point out that the investigating committee finds lots of statements very useful in deciding if there is a case to answer, and as recent cases such as cat hairs in the clinic show, they normally would put through these cases. Still Quangoland retrospectively may decide all sorts of things, having sacked the deputy registrar reported him to the police and then allegedly him getting a new job regulating psychotherapists, I would put nothing past them! Once I have learnt how to post attachments you may get the hilarious resignation letter from the registrars PA or the deputy registrar’s two resignation letters, why would anyone resign twice on the same day?

    As usual feel free to post acidic verbiage below

  • 26 GCC ‘What Can I Expect’ leaflet « Holford Watch: Patrick Holford, nutritionism and bad science // Jul 6, 2009 at 22:53

    […] these conditions, see for example Evidence Matters on asthma. Colic has been discussed by Unity and David Colquhoun, among others. We do hope that the GCC has rather more compelling evidence to present: after all, […]

  • 27 The Spinal Trap « Tycho's Elk // Jul 29, 2009 at 16:21

    […] Much has been written about this case around the internet, so for the full story, I would direct you here, here or here. […]

  • 28 The difficulties facing the chiropractic profession are not helped by the dope leading the British Chiropractic Association. : Chiropracticlive.com // Jul 29, 2009 at 23:47

    […] Professor David Colquhoun of UCL pointed out, on infant colic, that the BCA cited weak evidence in its favour, while ignoring strong evidence contradicting its claims. He posted the evidence and explained it. LayScience flagged up the BCA selectively quoting a Cochrane review. Every stone was turned by Quackometer, APGaylard, Gimpyblog, EvidenceMatters, Dr Petra Boynton, MinistryofTruth, Holfordwatch, legal blogger Jack of Kent, and many more. At every turn they have taken the opportunity to explain a different principle of evidence based medicine – the sin of cherry-picking results, the ways a clinical trial can be unfair by design – to an engaged lay audience, with clarity as well as swagger. […]

  • 29 Consultation opens on Pittilo report: help to stop Department of Health making fool of itself // Aug 4, 2009 at 20:02

    […] by the General Chiropractic Council, which was established by the Chiropractors Act of 1994. The British Chiropractic Association (BCA) recently decided to sue the science writer, Simon Singh, for defamation when he cast doubt on some […]

  • 30 Singh Along « In the Dark // Aug 4, 2009 at 22:49

    […] of dodginess and over the last few weeks it has been comprehensively dissected, discredited, debunked and demolished all over the blogosphere. A recent editorial in the British Medical Journal […]

  • 31 Chiropractic “For Sceptics Only” Pages « Stuff And Nonsense // Aug 31, 2009 at 20:54

    […] support chiropractic treatment of infantile colic. David Colquhoun has an overview of these studies here and he found that the studies referred to included trials that were unblinded or had no control […]

  • 32 Mea Culpa // Sep 13, 2009 at 17:02

    […] In a sense, it really doesn’t matter much anyway, because it is now apparent that chiropractic is pretty well discredited without having to resort to arguments about rare (though serious) effects. There is real doubt about whether it is even any good for back pain (see Cochrane review), and good reason to think that the very common claims of chiropractors to be able to cure infant colic, asthma and so on are entirely, ahem, bogus.  […]

  • 33 Chiropractors, advertisers, and liars… « Cubik’s Rube // Oct 8, 2009 at 22:30

    […] confident in the typical claims of their profession, and no evidence beyond the notorious “plethora” seems to have been presented to give them any reason to feel confident. Basically, […]

  • 34 when the laws aren’t there for your protection « weird things // Oct 19, 2009 at 06:17

    […] the BCA sued Singh for libel and has made pretty much every effort to cover their tracks, then justify their claims with cherry-picked data after a solid year of being shouted down by skeptical bloggers and groups […]

  • 35 How to Support English libel law reform « Computer Floss // Feb 12, 2010 at 13:25

    […] is far from sufficient to back up their claims that chiropractic can cure conditions such as infant colic or ear […]

  • 36 Up yours, BCA! « Skepfeeds-The Best Skeptical blogs of the day // Apr 1, 2010 at 18:47

    […] Simon Singh was not only right about the lack of evidence (the so-called ‘plethora’ was swiftly demolished outside the courtroom) but is also comparatively solvent, he wasn’t about to do what most people […]

  • 37 La BCA contra Simon Singh: ¿el final del caso? | :: SobreNatural.NET :: // Apr 14, 2010 at 03:58

    […] da por llorar y luego, hagas lo que hagas, dejan de hacerlo. Lo contaba en su día, por ejemplo, David Colquhoun. Evidentemente, si la BCA considera semejante cosa (y otras del mismo calibre) como […]

  • 38 Last summer BCA president Tony Metcalfe tried to calm members concerns about Simon Singh by telling them“How many of your patients are aware of what is going on” | Chiropractic Live // Apr 18, 2010 at 23:38

    […] Professor David Colquhoun of UCL pointed out, on infant colic, that the BCA cited weak evidence in its favour, while ignoring strong evidence contradicting its claims. He posted the evidence and explained it. LayScience flagged up the BCA selectively quoting a Cochrane review. Every stone was turned by Quackometer, APGaylard, Gimpyblog, EvidenceMatters, Dr Petra Boynton, MinistryofTruth, Holfordwatch, legal blogger Jack of Kent, and many more. At every turn they have taken the opportunity to explain a different principle of evidence based medicine – the sin of cherry-picking results, the ways a clinical trial can be unfair by design – to an engaged lay audience, with clarity as well as swagger. […]

  • 39 Apologists for Andrew Wakefield at Southampton University: a Russell group university teaching some dangerous nonsense // Jul 5, 2011 at 12:54

    […] case, because, in the wake of the Singh-BCA libel case, the claims of chiropractors have been scrutinised as never before and most of their claims have turned out to be bogus. There is a close relationship between […]

  • 40 Bilim Güncesi » Blog Arşivi » Atıflar sizi aldatabilir // Sep 18, 2011 at 02:58

    […] Konuyla ilgisiz onlarca kaynağın verildiği hallere ise daha bir şüpheyle yaklaşabiliriz. Meselâ İngiliz Kiropraktik Derneği, aslında hiçbir bilimsel dayanağı olmayan bir uygulamayı savunmak için 29 makaleye atıf yapan bir duyuru yayınlamış, ancak dikkatle incelendiğinde bunların çoğunun kiropraktikle uzaktan yakından ilgili olmadığı, gerisinin de düşük nitelikli çalışmaları tarif ettiği anlaşılmıştı. […]

  • 41 Why Write About Alternative Medicine? Part Three: Risks « Stuff And Nonsense // Feb 6, 2012 at 13:31

    […] often offer to treat conditions that there is no evidence they can successfully treat: colic, ear infections, or bedwetting to pick just three […]

  • 42 The 21st Floor » Blog Archive » Attempting to ‘manipulate’ the entire Scottish population? // Mar 14, 2012 at 03:35

    […] once again to the philosophical stance of the SCA, it’s worth mentioning that even the embattled BCA has made it clear that it takes exception to vitalistic practices. Along with the MCA and the […]

  • 43 London Chiropractor boasts of endorsement by UCL. Just make-believe again. // Apr 23, 2012 at 12:40

    […] inspection of evidence that followed the attempt by the British Chiropractic Association (BCA) to sue Simon Singh showed […]

  • 44 Atıflar sizi aldatabilir | Yalansavar // Jul 3, 2013 at 05:16

    […] Konuyla ilgisiz onlarca kaynağın verildiği hallere ise daha bir şüpheyle yaklaşabiliriz. Meselâ İngiliz Kiropraktik Derneği, aslında hiçbir bilimsel dayanağı olmayan bir uygulamayı savunmak için 29 makaleye atıf yapan bir duyuru yayınlamış, ancak dikkatle incelendiğinde bunların çoğunun kiropraktikle uzaktan yakından ilgili olmadığı, gerisinin de düşük nitelikli çalışmaları tarif ettiği anlaşılmıştı. […]

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