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Science journalist sceptical of chiropractic -

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Science journalist sceptical of chiropractic therapy

Broadcast: 06/07/2009

Reporter: Tony Jones

Science journalist Simon Singh joins Lateline to discuss the defamation case brought against him.
Dr Singh is being sued by the British Chiropractors Association after he criticised some
chiropractors in the UK for claiming they could treat some childhood conditions like colic.

Transcript

TONY JONES, PRESENTER: The debate over chiropractic treatments in Australia largely mirrors that in
Britain, where the celebrated science writer Simon Singh is being sued for libel by the
practitioner's association there for comments he made in the Guardian newspaper in 2006 about the
way children are being treated with chiropractic therapy. Singh's latest book is called Trick or
Treatment: alternative medicine on trial. He joined us in our London studio just a short time ago.

Simon Singh, thanks for joining us.

SIMON SINGH, SCIENCE JOURNALIST: My pleasure.

TONY JONES: Now since the libel case against you by the British Chiropractic Society, you've become
something of a cause celebre for the right to free speech, particularly in science, obviously. So
let's start there: what are the implications of the case against you for those who are openly
sceptical of alternative therapies and particularly chiropractic?

SIMON SINGH: I think - and one thing to possibly point out is that I think these issues go beyond
me. In England there's been almost a fashion recently for suing scientists for libel. There's a
chap called Peter Wilmshurst, a very well-respected cardiologist who's currently being sued and
then last year there was a chap called Ben Goldacre, a very respected medical journalist, who was
also sued. And I think what all of us are doing in our journalism or in our interviews is to put
forward our view of the evidence. And it's a cornerstone of science - the only way that science and
medicine progress is by putting forward the evidence, debating the evidence, challenging it fairly,
but forthrightly. And the problem with English libel laws in particular - I'm afraid it's a very
English problem is that our libel laws make it very difficult sometimes to be a science journalist,
and perhaps a journalist of any kind, really. And what that means is that good articles are often
withdrawn, good articles are often gutted so that the meat of the content is removed before it's
published and sometimes articles that should be published aren't even published or written in the
first place because of the fear of libel laws in England.

TONY JONES: Does the case against you - does this particular case impede your ability to be openly
critical of therapies and particularly of chiropractic therapies?

SIMON SINGH: Gosh. I think it does to a very large extent because there are things - there's a
reverse burden of proof. So, a science writer such as myself is guilty until proven innocent. The
sheer costs involved. A libel case can cost 1 million pounds, and that might be over damages that
are just a few thousand pounds. And so it turns journalism into a sort of high stakes poker game.
Somebody threatens you with a libel suit, do you have the absolute confidence and financial
resources to see it through to the end. If you don't, then you'd probably be smarter backing off
immediately and apologising, even if you think you're right. So, it does have this intimidation
effect on journalism. And in my case, probably for the last year I've done virtually nothing else
except fight this legal case. It becomes - so that's the other problem, is that even if you end up
winning the case, you probably have lost a year of your life. So again, you have to question
whether or not it's worth fighting these legal battles in the first place, which implies that
there's something perhaps wrong with the libel system, that it consumes so much money and so much
time in order to get to the bottom of the issue.

TONY JONES: We can't repeat, for legal reasons, the exact words that you said in the article. The
judge, in a preliminary hearing, has effectively decided on the meaning of what you said, and he's
decided that you where essentially accusing the British Chiropractic Association of being
deliberately dishonest. Now you're appealing that. But what is the core of what you're trying to
say about the association and what it's actually been doing?

SIMON SINGH: I think it comes down to - well, I think first of all, in terms of treating back
problems, I think the evidence is mixed, back problems are notoriously difficult to treat. So if
somebody has a back problem, I would probably advise them to try other treatments first. But if
they really had a problem and they wanted to try chiropractic, that's not an unreasonable thing to
do. But the core of my article, and where my concerns are, is in relation to treatments that go
beyond the back or beyond the musculoskeletal system. So things like asthma and colic and ear
infections, particularly with children. So can a chiropractor, can spinal manipulation, treat these
conditions? Now, I question the evidence on this in my article. I used phrases like sometimes
chiropractors are fundamentalist, they have some whacky ideas. So, I think my view is that
chiropractors have some very odd views. I don't think they necessarily understand the evidence
fully or appreciate the evidence fully - or the lack of evidence perhaps - and, therefore they're
promoting treatments which I don't think necessarily should be promoted. That's the crux of what I
was writing. And I wrote that in a national newspaper because I think parents should be aware of
the lack of evidence in order that they can make the right decisions, and that perhaps some
societies ought to rethink what they promote in light of this lack of evidence. So that's the meat
of what I was saying. I think it's a matter of public interest, which again is why it's worrying
that the libel laws can perhaps infringe on some of these articles being written.

TONY JONES: Indeed. The core of it was about the treatment of children, obviously. Our viewers have
just seen footage of American chiropractors treating children and even babies, including the
classic neck manipulation. So, here's my question: do you believe, looking at the evidence that
you've seen, that chiropractors should even be allowed to treat children and babies?

SIMON SINGH: I think not for these - it's a balance. It's a balance of what are the benefits and
how likely are they to be real? What are the risks and how likely are those risks to be real? And
when we look at the evidence for benefits for, let's say, asthma, there have been actually some
good clinical trials on this and three in particular. One published in the 'New England Journal of
Medicine', a very respected journal. Those clinical trials do not suggest that chiropractic is
effective in the treatment of asthma, that spinal manipulation can help children with asthma.
There's no real biological reason why it should help, and the evidence, again, reinforces that
view, that it doesn't seem to be helpful.

Now what are the risks? The risks are hard to pin down because I don't think necessarily there's
been enough research down to show the risks. There's definitely evidence of some minor pain
associated with spinal manipulation, some minor bruising and so on. That's not particularly serious
or worrisome. There's also some evidence that suggests that manipulating the top of the spine, the
neck, can cause serious damage. Those effects would be very, very rare, but they're obviously very
serious - stroke, possibly even death - and we don't really know - we don't know how big that risk
is because it's been so poorly studied. So in light of the potential risks that we don't know much
about, and in light of the lack of evidence of benefit, I would say that chiropractors should not
be treating children for these sorts of conditions.

TONY JONES: In your book, you cite a 2001 study done by researchers in Britain showing - working
with the Association of British Neurologists. Now, what did that study show? Because it seems to
conflict with the general claim made by chiropractors that it's a one in a million chance of a
problem; or in the case of the Australian Chiropractic Association, they say it's a one in 5.85
million chance of a problem.

SIMON SINGH: I think what that particular study highlighted was - it looked into - it asks
specialists whether they'd come across cases of stroke or - following a visit to a chiropractor.
And I think perhaps 70 cases were then reported back to the researcher in question, a friend and
colleague of mine, Professor Edzard Ernst. Now, those cases had not been documented elsewhere. Now
what that implies is that there's a lot of risks associated with chiropractors that aren't being
documented and because they're not being documented and evaluated necessarily, then the estimates
of one in a million or one in five million are underestimates of the true risk. I think there needs
to be a lot more research done. If we look at many conventional drugs and conventional therapies,
there are obviously risks associated with many of those, but those risks have been really well
pinned down so that when a conventional doctor talks to a patient, there can be an informed
discussion of the risks and benefits. In chiropractic, as I say, the benefits seem to be very small
in many cases if non-existent and the risks are unknown. And that's the worrying thing.

TONY JONES: Going back to what chiropractic may be useful for. I mean, obviously there is some
benefit, it's claimed, for back problems. But there's a sort of split within the chiropractic
community over the level of benefits. I mean, we've seen in our background film, for example, that
one of our (inaudible), a very experienced chiropractor, says it's absolutely wrong for
chiropractors to suggest that they can actually use their therapies for helping a wide range of
children's ailments, yet it's fine to use it for back ailments. Now, that split has a very long
history, doesn't it, in chiropractic?

SIMON SINGH: Yes, it goes back to the inventor, the pioneer of chiropractic, a chap called Daniel
Palmer, around 100 or so years ago. And Palmer was something of a maverick, to say the least, a
sort of magnetic healer was one of his talents. He claimed that the first person he ever treated
with chiropractics - spinal manipulation - was a janitor who was profoundly deaf. The second person
he treated had heart problems. Now he believed that he could treat almost any condition because -
by spinal manipulation, because the spine carries the nervous system through to the rest of the
body. If you have a problem with your hearing, he believed that was due to a blockage in the
nervous system, probably in the spine. So if you manipulate the spine, you free up nervous system,
you allow the nervous energy - he called it the "innate energy" - to flow through the body and then
you recover more easily. And - because, as I say, because the nerves tap through to the rest of the
body, he thought he could treat the entire body for almost any condition.

Now, modern chiropractors have largely moved away from that and focused more on the back.
Manipulate the spine, treat the back, sounds fairly reasonable. But a minority - well, perhaps not
even a minority; maybe it's a split. There are chiropractors who will treat, as we've heard,
childhood conditions like colic and ear infections and so on. There are others - you know,
recently, you'll see claims about trying to help patients, help people ward off things like swine
flu. So you have extremely bizarre notions going on in some quarters. Some odd notions going on in
some quarters, and then what I would perhaps call more conventional chiropractors who realise that
what they're good at, if anything, and I think even this is somewhat debatable, is the back.

TONY JONES: Well, Simon Singh, the jury is out obviously, as they say, on how much benefit you can
get from chiropractic treatment, as it is on the libel case against you. Good luck with your
appeal, and we'll see you again next time. Thanks for joining us.

SIMON SINGH: My pleasure. Thanks a lot.