Debate is crucial for science to develop

10 April 2012

As I write this, the libel case between Simon Singh and the British Chiropractic Association is being heard in the Court of Appeal. A brilliant scientist, thinker and broadcaster, Singh wrote an article for The Guardian in 2008, discussing chiropractice. He outlined its founder's erroneous belief that disease was supposedly caused by blockages in the flow of innate energy along the spine and manipulating the spine could therefore treat 95 per cent of all diseases.

It doesn't. It's a theory we have known for a long time to be hokum, and it has even been joked that chiropractic therapy is equivalent to thumping the side of a faulty television to remedy a defective picture. Yet some chiropractors still believe spinal manipulation can treat problems not related to the back. In particular, Singh wrote about the likely risks of chiropractic treatment and whether there is any evidence that it is effective for various childhood conditions, including asthma. The British Chiropractic Association (BCA) claimed that he had defamed its reputation and is suing for libel.

While ludicrous in the extreme, the case has drawn much needed attention to the problems in the English libel system. The costs are so considerable that articles that should be defended are dropped, and articles that should be written are shelved before they are published out of fear of potential libel action. The current laws gag scientists and journalists who want to debate and express their opinions on matters of public health — even the UN Human Rights Committee has condemned them. More perversely, the burden of proof is reversed in libel cases; in Singh's case, he must prove the accuracy of his statements, as opposed to the BCA having to prove that he is wrong. In other words, he is guilty until proven innocent.

What so concerns me is that if reputable scientists and researchers are sued for raising concerns about medical treatments and lose considerable sums of money in the process, why would anyone else bother to raise similar concerns? If health matters are not reported, it is the public who is put at risk. We must be free to criticise and question.

This brings me to another viper's nest: homeopathy. A new Science and Technology committee report says the NHS should not pay for it, as there is no evidence that it works any better than placebo. I couldn't agree more. Making homeopathy available on the NHS legitimises it in the minds of the public, and leads them to choose homeopathic vaccines for their children, homeopathic anti-malaria pills and homeopathic cancer treatments.

What I object to is the way many of these treatments are being promoted by the NHS when more than a dozen systematic reviews have failed to produce any convincing evidence for their effectiveness above that of placebo. I also disapprove of the way the rules and regulations controlling the use of drugs and medical interventions don't seem to apply to most complementary therapies. This could of course be taken to mean that they are so utterly innocuous and ineffective that they need not be assessed in this way.

If alternative medicine is going to be promoted as a component of conventional healthcare, which means recommending treatments that are known to cause adverse effects, then they should be subject to the same stringent tests and rigorous trials that any pharmaceutical products must undergo.

If Singh can win his case maybe we will feel more comfortable questioning certain practices and products. If we start to do that then medicine and the health of the vulnerable public will benefit greatly.

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