Ben Goldacre, The Guardian, Friday 15 April 2010
[Full text at guardian.co.uk, abbreviated in the paper]
After 2 years of pursuing one man through the courts, at a cost to him of £200,000 and 2 years work, the British Chiropractic Association yesterday dropped their libel case against science writer Simon Singh. The case was over a piece he wrote on this very page, criticising the BCA for claiming that its members could treat children for colic, ear infections, asthma, prolonged crying, and sleeping and feeding conditions by manipulating their spines.
This case has come to embody the need for libel reform, which all too often is used to stifle reasonable criticism. In a year that has seen Trafigura and numerous other cases hit the headlines, the libel reform campaign has gathered 50,000 signatures, 268 MPs have backed an Early Day Motion to reassess our libel laws, and all 3 parties have committed to looking at some form of libel reform.
What’s most strange is how it could all have been avoided. The Guardian offered the BCA a full right of reply, where they could put their case at length, and explain the evidence for all these medical claims. The BCA refused. They didn’t want that, they explained: they wanted a personal apology from Simon Singh. It’s impossible to see this as anything but childish, so you can allow yourself a few paragraphs of schadenfreude.
This has been a spectacular reputational car crash for the British Chiropractic Association, and for chiropractors as a whole. Until they sued, most people thought chiropractors just did backs. Now everybody has seen how wild their ideas have become, and the astonishingly thin evidence for their claims has been torn apart by everyone from academic bloggers to the British Medical Journal. The case – and the laughable lack of scientific evidence for their claims – has been covered by every newspaper in the country.
The scale of online activism was unprecedented. Bloggers like Simon Perry and Zeno took the BCA membership head on: they waded through every single members website, checked if they were claiming to treat infant colic, and if so, referred them to the the General Chiropractic Council, a statutory body who are obliged to investigate all complaints. One in four chiropractors in the UK are now being investigated by the GCC for making misleading claims, including officers of the BCA. The GCC has had to recruit six new members of staff to deal with all the complaints.
Chiropractors are now a profession under siege. The message is clear: if you are surviving quietly in the shadows between real clinical evidence and vague superficial plausibility, then drawing attention to yourself with a big fight over evidence and some fairly moderate criticisms cannot ever be a good idea.
But most damnable is that this case should have taken place in the arena of medicine, where reasonable criticism of each others practises should never be stifled, for one very simple reason: it’s possible, in medicine, to do enormous harm, even when you set out with the best of intentions.
Anti-arrhythmic drugs provide a chllling example. For a few years in the 1980s these were prescribed to everyone who had a heart attack. It made absolute sense in theory: people who’ve had heart attacks often get abnormal heart rhythms, these irregular rhythms can often finish you off, but anti-arrhythmic drugs prevent them. Why not just give these anti-arrhythmic drugs to everyone who has had a heart attack, on the off chance? They were safe and effective when given to people who had abnormal rhythms, after all. But when prescribed preventively, to everyone, after a heart attack, they turned out to increase your risk of dying, and because so many people had them – because so many people have heart attacks – the deaths were on a biblical scale, killing as many Americans as died in the whole of the Vietnam war, before anyone had a chance to notice that something was wrong.
This is not an isolated case: this is the bread and butter of medicine. People die, you try and stop it happening, sometimes you make a bad call, but you try and catch it as soon as possible, and that’s why critical self-appraisal is at the heart of everything that doctors and medical academics do.
The questions after a lecture at an academic conference can often be a bloodbath, but in the best of spirits, because – like the more sadomasochistic sects in the catholic church – we know that our punishment is good for us, a necessary corrective. Every week, in every hospital around the country, from the remotest district general to the most famous teaching hospital, you will find a lunchtime meeting called Grand Round, usually on a Friday. This is a major event, where the whole hospital comes together to watch one team of doctors present a difficult case, and very frequently, one they haven’t been able to treat, while their colleagues criticise their actions. “But obviously it’s squamous cell!” “Why didn’t you do an MRI?”
In the journals you will find the same thing. The British Medical Journal – probably the most important medical journal in the UK – announced the three most popular papers from its archive, according to an audit that assessed their use by readers, the number of times they were referenced by other academic papers, and so on. Each and every one of these papers had a criticism of either a drug, a drug company or a medical activity as its central theme: the risks of Vioxx; failures to properly report adverse events in clinical trials; and the dangers of SSRI antidepressant drugs.
This is the culture of medicine, and it is there for a reason: to catch when things go wrong, because you can’t rely on your own personal appraisal of whether you’re a really nice guy when lives are at stake. We criticise each others ideas and practises, we engage in debate, because that is good .
The Singh case is the most famous, but it is by no means the most sinister medical libel case at present. The examples are endless. Dr Peter Wilmshurt is an NHS cardiologist and academic who spoke out – very mildly – about concerns he had over a flawed clinical trial of a heart implant in which he was the lead investigator. Dr Wilmshurst has now been pursued through the libel courts by the US manufacturer. He has been forced to defend himself, paying his own legal bills into 6 figures, and spending every spare second on the case. He has lost every weekend and all his annual leave for 2 years (and so have his family), he may lose his house, all because he did the right thing.
You should be very careful. One day, writers – and more importantly doctors and academics – will stand up and say: okay. You want these laws. You won’t protect us. We won’t speak out. If we see flaws in a trial, we will keep quiet. If we see false claims, we will be silent. You will suffer. And people will die.
drunkenoaf said,
April 15, 2010 at 8:55 pm
Eloquent and powerful, Ben!
TylerDurden said,
April 15, 2010 at 9:04 pm
Fantastic and important – as ever.
One thing, it is still Thursday 15th, Ben…
stever said,
April 15, 2010 at 9:08 pm
Bravo ben. excellent stuff
gammidgy said,
April 15, 2010 at 11:05 pm
Besides lobbying for reform, how can we practically help Wilmshurst?
pauldwaite said,
April 15, 2010 at 11:44 pm
> The GCC has had to recruit six new members of staff to deal with all the complaints.
Fighting for higher standards of evidence *and* helping the economy.
thegasman said,
April 16, 2010 at 12:44 am
gammidgy:
www.healthwatch-uk.org/news.htm#wilmshurst
kpod said,
April 16, 2010 at 12:45 am
Nice article. I’m interested in the anti-arrhythmic drug example; what exactly was the drug and what were the mechanisms that caused a higher overall death risk?
MrNick said,
April 16, 2010 at 1:02 pm
Brilliant as ever.
Nick
MrNick said,
April 16, 2010 at 1:04 pm
When I submit a comment I get taken to an empty page.
This has happend several times.
Firefox 3.6.3
Nick
b33k34 said,
April 16, 2010 at 2:35 pm
www.healthwatch-uk.org/news.htm#wilmshurst
Does anyone have any contacts there? They could really do with some help – I’d have happily made a donation but it’s unlikely I’ll get round to finding a chequebook and addressing an envelope. Can someone tutor them in the ways of online fundraising?
walks with tench said,
April 16, 2010 at 10:24 pm
Wow! How’s this for serendipity?
Just reading Macaulay’s wonderful History of England; William of Orange has just saved the country from the iniquities of the House of Idiot and parliament are deciding under what limitations the crown should be offered.
Macaulay writes thus: “It is a most remarkable circumstance that, while the whole political, military, judicial and fiscal system of the kingdom was thus passed in review, not a single representative of the people proposed the repeal of the statute which subjected the press to a censorship”
And concludes: “It was not yet understood, even by the most enlightened men, that the liberty of discussion is the chief safeguard of all other liberties.”
Somewhat relevant huh?
Chem_boi said,
April 17, 2010 at 12:26 pm
What worries me is how this case seems to have been decided on some obscure point of law. We really need to sort out our justice system so that it can’t get involved in issues that centre around the veracity of factual information if that veracity cannot be used as a basis for defense or appeal. It is ludicrous that we have a system whereby the fact of whether someone is telling the truth or expressing an opinion is secondary to how and where and who they talk about.
Bishop Gillian Wakefield said,
April 17, 2010 at 2:09 pm
Excellent article, and good news for Simon Singh – although I understand it remains to be seen who foots the bill for all this.
@walks with tench
I’m reading a book that could in no conceivable way ever relate to any aspect of this affair. Is that serendipity too?
😉
lasker said,
April 17, 2010 at 3:55 pm
@ Bishop Gillian Wakefield – LOL
Re the article. Let me get this right are you saying that in the 1980s a homeopathic tablet would have been better than the standard medication for a heart attack?
jwm said,
April 17, 2010 at 10:48 pm
@Lasker
That statement would be correct only if the antiarrythmic drug was the only medication given to the patients post MI. However even in the 80s there were several medications that DO reduce the rates of further heart attacks and reduce mortality that patients would have been on (eg aspirin and beta-blockers). So no, a sugar pill would very likely still be worse than the standard medication. (Although I do not have the odds ratios of risks and harms to definitivey state that the harms of antiarrythmics are outweighed by the benefits of the other medications)
Robert Carnegie said,
April 18, 2010 at 4:57 pm
Wikipedia on anti-arrhythmmic agents en.wikipedia.org/wiki/Antiarrhythmic_agent refers to “large clinical trials” that said Don’t. However, the article seems to me to be questioning whether drugs such as these are any good at all, particularly for mortality.
But then, I’m taking quinine for cramps, and that stuff could kill me, too.
Robert Carnegie said,
April 18, 2010 at 4:59 pm
Btw I’m getting this when I post a comment with Opera 10.51, any idea why? The comment evidently still goes in.
“Connection closed by remote server. You tried to access the address www.badscience.net/wp-comments-post.php, which is currently unavailable. Please make sure that the Web address (URL) is correctly spelled and punctuated, then try reloading the page.”
walks with tench said,
April 18, 2010 at 7:16 pm
Hi Bishop Gill,
No; that would just be ‘reading’.
Sorry.
Happy days,
DWT
jdvincent said,
April 19, 2010 at 2:36 am
I am a public health professional and a first year law student in the U.S.
Ironically, we just finished defamation in my torts class, both the common law and our 1st Amendment defenses. So this is interesting for a variety of reasons to me.
But THEN, this was the headline story on 60 Minutes here tonight: www.cbsnews.com/stories/2010/04/16/60minutes/main6402854.shtml?tag=contentMain;cbsCarousel
They mention at the end a suit filed by the ‘doctors’ in the story in an attempt to prevent the story from being aired, which I imagine must include a libel claim.
This story prompted, finally, a much needed FDA investigation into at least these two doctors and hopefully the entire industry (although that’s setting the bar a little for the FDA).
It would be a shame if an exposure like this could not happen in Britain.
Thomas Greenan said,
April 22, 2010 at 11:40 pm
@5
I’m a long term Bad Science reader and I actually got a brief temp job at the GCC doing photocopying, as they have huge amounts of paperwork, so I was quite pleased with this. Apparently their workload has gone up 1,500%.
stuboy said,
April 28, 2010 at 4:22 am
There’s a typo in “Wilmshurt” at one point – it should be “Wilmshurst”.
timboson said,
May 4, 2010 at 11:24 am
A (minor) point on the following remark
“the deaths were on a biblical scale, killing as many Americans as died in the whole of the Vietnam war”
Just under 60,000 Americans died in the Vietnam war, with an average age of 22. I don’t know how many died in this anti-arrhythmic drug case. Although 60,000 people dying because of a mis-prescribed drug is atrocious, in my opinion, 60,000 isn’t “of biblical proportions”. Misleads the reader. I’d say the holocaust, 6 million deaths, was of biblical proportions.
Otherwise, excellent article.
joey89924 said,
November 21, 2012 at 10:37 am
Although I do not have the odds ratios of risks and harms to definitivey state that the harms of antiarrythmics are outweighed by the benefits of the other medications.
CP2102