The BCA Writes

Thanks for your note. The BCA's Code of Conduct forms part of the BCA's Memorandum and Articles and is therefore only available for BCA members. What I can say, is that the Code relates specifically to members' responsibilities to the BCA - their requirements for professional conduct areset out in the GCC's Code of Practice and Standard of Proficiency. To my knowledge in the last five years, the BCA has not removed a member from the Association as a result of a breach of the Code of Conduct.

The Beacon Writes NICE

Dear sirs/mesdames,

Peter Littlejohns was recently paraphrased by the BBC in an article about the recent and controversial decision to support complementary and alternative medicines such as acupuncture and chiropractic, despite there being no evidence that they work better than treatments mentioned in previous advice. Littlejohns stated that:

the costs to the NHS would be minimal - in the order of £77,000 - because they are offset by the savings in terms of reducing future disability and healthcare needs and moving away from treatments with little supportive evidence.

This seems to suggest that these treatments have some kind of long-term benefit that rest, exercise and painkillers do not. I was wondering what supportive evidence NICE has that these expensive CAM measures are a long-term solution to back pain? Littlejohns quotes a specific figure, so I am assuming that the evidence exists and is robust; I'd be very keen to see it.

--
Kind regards,

Beacon Schuler.

Switzerland Embraces Pretend Medicine

There has been som quite jaw-dropping news from Switzerland where they have incorporated woo such as homeopathy (which doesn't work), acupuncture (which doesn't work), and herbalism (that mostly doesn't work) into their national health insurance scheme. Before, people's premiums were going towards funding evidence based medicine, but now rational human beings must stump up for a range of ineffective treatments. If someone ever says to you "alright, so these treatments are a load of hogwash, but what real harm are they doing?" you need only point to Switzerland to see the threat of real damage that these people pose. It's not even that the wrong pockets are being lined, but EBM is being massively undermined.

“It shows that we are beginning to come out of the two camps – one for orthodox medicine and the other for alternative medicine. In the future, hopefully, it will mean that medical students will study complementary therapies as part of their medical training and be able to integrate some of them into their practice,” says [Alexander] Harbaugh.

This is CAM fantasy, to force medical doctors to learn homeopathy, chiropractic and other nonsense despite it being at odds with our understanding of how our bodies work. David Colquhoun has attacked at length and with good cause at the fake respectability that CAM has been creating for itself, the creation of Bachelors of Science [sic] degrees in homeopathy, NICE's recent approval of chiropractic, Switzerland may prove to be a clear example of what may happen if such moves go unchecked.

The only fly in CAM's snake oil is hinted at in the following quote

The current criteria requires that the therapy benefits the patient, that it is cost-effective and appropriate for the patient’s condition.

This hopefully will mean that alternative medicine will have to prove that it is benefitial to the patient. I think most of us could live with evidence-based alternative medicine being included in state-run health schemes.

The General Chiropractic Council Writes

Dear Sir/Madam

The General Chiropractic Council investigates all the complaints its receives against its registrants, regardless of the source of the complaint.

The title 'doctor' is a courtesy title that chiropractors can choose to use. Our Code of Practice at C1.8 states that chiropractors

"must not use any title or qualification in such a way that the public may be misled as to its meaning or significance. In particular, chiropractors who use the title of ‘doctor’ and who are not registered medical practitioners must ensure that they make it clear that they are registered chiropractors and not registered medical practitioners."

The Code of Practice is binding and all registrants must comply with its provisions.

Please advise anyone who has a concern about a chiropractor to contact the GCC, the statutory regulatory body for chiropractors in the UK.

I hope this information assists you.

Yours sincerely

##################
Specialist Officer (Regulation)
General Chiropractic Council

Anyone operating as a Chiropractic in the UK must be registered with the GCC; they are the statutory regulatory body for the industry. If a Chiropractic isn't registered they are already breaking the law. You can search for them in the GCC registry here.

I'm not quite sure how much effort a complaint about inappropriate advertising to the GCC may be. Instructions can be found here, though, and it would be useful to complain to both the GCC and the ASA simultaneously as the appropriateness of use of the term "Doctor" is ultimately subjective.

It amuses me that part of the GCC code states "Chiropractors must make sure their own beliefs and values do not prejudice their patients’ care." The rule is designed to prevent chiropractors discriminating against homosexual patients, say, or ethnic minorities. It's a pity "beliefs" doesn't include belief in efficacy.

The GCC appear to take regulation seriously, though they do put out a patient information leaflet which features implicit claims that chiropractic can help with asthma and colic. As the ASA pointed out earlier this week, there is enough evidence to suggest further research is needed, but not enough evidence to comfortably make these claims.

How to Complain to the ASA

In forumland and the blogosphere I see a lot of people complaining about this or that advert for CAM, but suspect that these complaints don't get much further. Complaining to the ASA is quick, easy and worthwhile; they have the power to have ads removed and can insist on advertisers having to seek out approval from the Committee of Advertising Practices before placing further ads. Here's a quick guide on complaining where it counts.

1. Are the ASA the right people to complain to?

The ASA have a specific remit to handle complaints about the following media:

• Magazine and newspaper advertisements
• Radio and TV commercials (not programmes or programme sponsorship)
• Television Shopping Channels
• Posters on legitimate poster sites (not flyposters)
• Leaflets and brochures
• Cinema commercials
• Direct mail (advertising sent through the post and addressed to you personally)
• Door drops and circulars (advertising posted through the letter box without your name on)
• Advertisements on the Internet, include banner ads and pop-up ads (not claims on companies’ own websites)
• Commercial e-mail and SMS text message ads
• Ads on CD ROMs, DVD and video, and faxes

But they don't cover:

• Claims on websites (http://www.tradingstandards.gov.uk/)
• TV and radio programme sponsorship (http://www.ofcom.org.uk/)
• Shop window displays (http://www.tradingstandards.gov.uk/)
• In-store advertising (http://www.tradingstandards.gov.uk/)
  
• Political advertising (http://www.ofcom.org.uk/).
  

2. What are the grounds of the complaint

There are three main columns of advertising regulation: misleadingness, harm and offense. Is the ad likely to materially mislead consumers? Is it likely to cause harm to consumers? Is it likely to cause widespread offense? As far as complaining about CAM advertising goes, you will primarily find grounds to complain due to misleadingness, where ads make unproven medical claims for a particular product, or harm, where ads, in promoting unproven products for serious conditions serve to dissuade consumers from seeking proper medical attention.

3. What is the procedure?

It couldn't be easier. The ASA website has an online form where you will be asked for information regarding the ad you wish to complain about - where and when you saw it, on what medium, and the specifics of your complaint. You don't need to go into too much detail here; it is enough to say that an advertiser is claiming homeopathy can treat asthma and that there is no evidence without having to point the ASA to a Cochrane review. The ASA take an evidence-based view of the world anyway - factual claims must be proved by the advertiser.

You will also be asked to provide, where possible, a copy of the advert itself. This isn't so important for radio or television, but is pretty vital for billboards, press and pamphlets. I find it easiest to just take a decent quality photo of the errant ad, which you can then upload to the ASA via the form.

It's also important to point out that although you give personal data to the ASA, they cannot pass this data on to the person being complained about without your consent. It's usually irrelevant, and tends only to come up where someone has failed to get something that was offered in an advert, or have entered into an agreement with an advertiser that didn't match the claims in the ad.

4. What Happens Next?

The ASA do not investigate every complaint that comes in. For each complaint lodged, they will identify whether a breach of the advertising standards codes may have taken place, and investigate only where they feel it appropriate. What they also will do is highlight aspects of the ad that they feel are in breach, whether or not that breach was part of the initial complaint. It is not unheard of for the ASA to not uphold a complaint from a member of the public, but go on to uphold elements of a complaint they themselves have introduced.

The ASA will keep you informed of the progress of the complaint. There are, in essence, three outcomes. The complaint will be either upheld or not upheld. Either way, the details of the complaint, the advertiser's response, and the ASA Council's decision, will be published on the ASA website. If the complaint is upheld, then there will be instructions to the advertiser on what they must do; invariably to withdraw the ad. Multiple offenders and non-respondents (not uncommon for CAM) will find themselves with additional instructions and the ASA may notify trade bodies of the issue with them. The third possibility is that the advertiser admits up front that their ad is misleading, withdraws it, and agrees to abide by the code in future. On this occasion the details of the investigation are not published in full on the website. This is what happened with a complaint I made against the Church of Scientology Stress hand-outs, who agreed that their medical claims were unfounded and that Dianetics was more of a belief system than a science as stated. So I just posted the letter from the ASA.

5. Post Adjudication

Once an adjudication is online, make use of it. They occasionally get picked up by the mainstream press (though often in a churnalism style) but ought to be bandied about a bit online. Complaints tend to be upheld because it is down to the advertiser to prove the claims they make and can't. That's something skeptics ought to be shouting out about!

Simon Singh's Bogus Journey

I was lucky enough to get along to the Simon Singh love in at Penderel's Oak last night. Simon, for the uninitiated, is a science journalist and co-author of Trick or Treatment, an excellent look at the evidence, or lack there-of, behind the claims of alternative medicince. Around the time this book was published, he wrote an article addressing some worrying claims being made about chiropractic and its use in the treatment of colic, along with feeding and sleeping problems. In it he suggested that the British Chiropractic Association promotes these "bogus treatments". The BCA felt such claims were damaging, and so decided, rather than to rebutt Singh's claims in the press, to simply silence Singh and other critics by bringing a libel suit against him.

The court case seemed, until recently, simple enough. The BCA simply cannot provide robust evidence for the claims made of chiropractic, and the court should note that Singh's article was correct inasmuch as he lays out exactly that claim in print. However, things took a rather unexpected turn when the Judge in the case, Sir David Eady, decided that what Singh had meant by "bogus" was that the BCA was knowingly and dishonestly promoting treatments that do not work. This placed Singh in a difficult position - if he were to continue with the trial it would be by defending a meaning he had not intended, and was much harder to prove, because it may well be that only the high-ups at the BCA really know their own mind when it comes to whether or not they believe in the powers of subluxation.

What the skeptic movement want to see happen is for Singh to appeal against Eady's ruling, to have the meaning returned to Singh's original sentiment, but, and quite rightly, this will only happen if Singh and his advisors feel that particular game is worth the candle. Last night's gathering was an opportunity for Singh to keep us posted as much as he is legally able, and for people following the trial to show their support.

Dave Gorman, TV humourist and professional geek, was the first to speak and rasied an interesting point, that in the eyes of the public Chiropractic isn't considered alternative medicine at all. It has taken people like Singh to bring to a wider audience the fact that Chiropractic has very little going for it in terms of evidence - some weak evidence that it may help with back pain; something slightly more intuitive than claims that it can cure deafness or heart disease.

And parallel to this, thanks to David Cohen's speech, it is becoming very clear to a widening audience that there is something dreadfully wrong with the English Libel laws. England's laws favour the plaintiff so much that we have become a destination for Libel tourism - where someone from Iceland sues someone from the Ukraine in an English court for something that was never even published in the English language.

It was clear from the mood in the room that there is a growing need for action, both against the pseudo-respectable claims made about Chiropractic and that drastic reforms are required for libel law in this country. What seems immediately clear is that the skeptic blogosphere is going to be scrutinising Chiropractic and Chiropractics very closely for the foreseeable future. I for my part will be writing to the BCA to ask if they have disciplined any bad advertisers and to request what evidence they had for the withdrawn pamphlet that Singh's article originated from. All in the interests of open discourse, of course.

Probably the best place to follow the Singh trial is the excellent legal blog Jack of Kent. And below is a post that, it seems, never made it to the Beacon proper, covering the origins of Chiropractic and some unusual parallels with a certain well known cult. During the seventies Chiropractics were considered ideal targets for recruitment for the Church.

Chiropractic was invented by D D Palmer, who believed that manipulation of the spine could cure all manner of ills, such as measles and deafness. Palmer believed that "innate intelligence" channeled through the spine and became blocked by misaligned vertebrae, and that reseating these vertebrae would bring the innate intelligence back into balance. Typical of much complimentary and alternative medicine, having had early initial successes in curing deafness in one individual and heart problems in another, Palmer went on to claim that Chiropractic could cure pretty much anything, despite seemingly never doing any proper research on it.

His "science" was so groundbreaking to him that he considered his discovery religious, likening himself to "Christ, Mohamed, Jo. Smith, Mrs Eddy, Martin Luther and other[s] who have founded religions." Palmer was repeatedly arrested for practicing medicine without a license, but this martyrdom only led to a strengthening of the cause of Chiropractic.

D D Palmer was killed after being run over by his son, B J Palmer, also a Chiropractor, and it is claimed that this may have been deliberate, as the two did not see eye to eye on a lot of things.

BJ went on to "invent," in 1924, a device called a neurocalometer that was said to be able to detect the blocks or "subluxations" in the innate intelligence. These devices were just thermocouples, a standard piece of lab equipment designed to detect temperature. That didn't stop BJ selling the devices for the price of a house.

As time went on, and as many earnest chiropractors became disillusioned with Palmer's initial claims for his treatment, the world of chiropractic became divided into the "straights" who stuck to Palmer's guns, and the "mixers" who recognised that chiropractic treatment could work towards easing back pain, but very little else. The straights accuse the mixers of never having been chiropractics to begin with. The mixers accuse the straights of being self-delusional.

So, a pseudo-scientific treatment offering medical claims with quasi-religious aspirations, an expensive device that is really just a simple bit of kit heavily overpriced, intergenerational rivalry leading to automobile-related death and a following fragmented into a body of fundementalists and a defamed bunch of open-minded and relatively more skeptical practitioners.

This, as a member of the Co€ pointed out to me in recent conversation, is true of many such organisations. What makes it moderately tastier, though, is that the e-meter's inventor, Volney Mathison, was a practicing chiropractor, and many chiropractors used e-meters in their treatments. This is conjecture, of course, but I can't help wonder as to whether or not Hubbard was familiar with Palmer's story as he set about creating Dianetics and Scientology.

On Personal Integrity

I've been thinking more about Gary Mannion, and folk like him. A notion that is widepread in new age and magical thinking is that we are all following "paths"1; that we are given a set of experiences or a lesson to learn and sent on our way, and it is our duty to construct a worldview based on those experiences, to take onboard whatever purpose our three score and ten is supposed to teach us. This idea, in part, stems from certain notions - that reality is subjective, and that all viewpoints are equally valid. So lets deal with those two first.

Reality is not subjective. Our perception of reality, it could be argued, is subjective, but evidence abounds for reality's refusal to be bound by our perception - from the guy who walks into (and not through) a patio door he perceives to be open to clinical trials that overturn perceptions about blood-letting, or even our understanding of the way that diseases are carried. Perceptions of reality can indeed be subjective; I doubt there's a child alive who hasn't at some point toyed with the notion that what one person perceives as the color red is not the same thing that someone else perceives as red. But this is just a difference in perception; we have no innate control over the way we perceive the world. Many illusions still have the power to fool us even when we know we are being fooled, such as the so-called Thatcher Effect. When we perceive, we create in a fantastically sophisticated and complex way a mental model of the universe as we perceive it. But it's important to understand that this model is created by information flowing from the universe as it really exists, through our senses, before being thrown up in a necessarily corrupted and incomplete fashion in the theater of our mind. At no point does the information flow from the model to the universe. We cannot vividly imagine an apple, say, and have that apple genuinely appear before us. Even if we see that apple, we know it isn't there the moment we pick it up and offer it to somebody else.

New age readers at this stage may be reaching for their copies of The Secret. I refer you, also, to the previous Beacon post on cosmic ordering. Even if the universe did bend to our will in this way, it would take the form of external communication; the universe bends to our will to no greater extent that K-Mart bends to our shopping list.

If we take this on board, then it knocks a hole in the second idea; that all viewpoints are equally valid. Again, they are not. This might hold water in more illusory fields, such as English literature or art criticism, but only because we are faced with notions of constructing meaning from oblique sources, and variant readings of texts do not effect what was intended by the author. And even here, it is clear that some readings are more worthy than others.

To take something realworld, that is more on-topic, look at evolution vs. creationism2. Here we have a theory that is based on empirical evidence that presents a coherent picture of the origin of the species; it describes the world. It has found itself in conflict with creationism, which cannot even be described as a theory inasmuch as it is not based on evidence but on a kind of black hole of reasoning. It is difficult to explain the complexities of life on earth, therefore we kick the question to a place that we cannot go, handing creation to an entity that is all-powerful and sits outside of such logical constraints as those posed by the question "what created the creator". At best, these two ideas are poles apart; one is scientific, in that it is based on evidence and on a progression of ideas, the other is not scientific. Creationism comes nowhere near balancing the scales, and yet there are those who insist "in the interests of balance" that it be taught alongside evolution in the science classroom. That would be akin to teaching flat earth theory in geography, or holocaust denial in history. These ideas are lacking in validity.

So where does that leave us. It leaves us with the uncomfortable truth that whatever ideas we have in our head, some of them will have validity and some of them won't. The idea of personal integrity being about honouring the ideas we have seems to be flawed. It's not personal integrity but ideological integrity, which is a different kettle of fish. In essence, by blindly honouring our ideas in the face of contradictory evidence is the opposite of personal integrity; we dishonour ourselves by not testing our beliefs strongly enough.

But this is a normal human trait. That model of the universe we have is based to a fair degree on "heuristics", on logical shortcuts that aren't 100% accurate but make it possible for us to function more efficiently in the world. To cite an oft-used example, we do not feel the need to test the sidewalk before we walk on it each time. Heuristics tells us that the sidewalk is solid, and that it will take our weight. Heuristics tells us that its state has not changed since we last walked on it, and that it does not differ in any meaningful way from any other sidewalk we have encountered. So it's great for the sidewalk, but not so helpful when dealing with the ineffable. It's not even so great when dealing with medicine. I take such and such a pill; my headache clears. There's a corelation there that we are quick to interpret as cause, but it aint necessrily so, and is not something that can be determined by carrying on taking the pills; stopping taking the pills; or switching pills. The same goes for faith healing and lucky briefs.

I was fortunate enough to go along to a demonstration of mediumship recently. The medium did not fair very well, perhaps as a result of not being in front of an audience that was invested in receiving messages from beyond the grave. I suspect the majority of the people attending were there to see the medium rather than hear from Nanny Johnson. I've seen cold reading before, and felt that that was all that was taking place. I've posted before on my belief that it is perfectly possible for people to learn to cold read without knowing that that is the method they are using. When developing one's ability in this field, one is presented with hits and misses, but the process itself remains mysterious. We receive waves of information; images, words, voices, and over time develop the ability to discern in that noise the particular pieces of information that are more likely to hit home with someone in the audience.

Following the demonstration was a Q&A. Someone raised a question that wasn't really answered fully. How does the medium know when he is receiving information from the other side; how does he tell the difference between that and plain guesswork. I suspect that he can't, because he has shifted his perception of what guesswork is. He has defined it as spirit communication, presented it as such, and surrounded himself with people who are invested in that reality. Like Garry, it will become increasingly rare that he encounters data that challenges his view of what he does. Because of the environment that he has built around himself, he will become increasingly convinced that the patio door is open; will reach such a level of certainty that he never feels the need to prove this perception by attempting to step out into the garden.

There is a skeptic mantra which is "extraordinary claims require extraordinary proof". I feel the real definition of personal integrity is to realise that the claims you are making are extraordinary, and to go in search of extraordinary proof. Test your abilities, and test them properly. Test your tests. Not only do you owe it to the people you present your skills to, but you owe it to yourself.

1It's important to note, here, how passive the notion of "life paths" is in the first place. We do not blaze our own trail, we follow some predetermined route to which we are either oblivious or meekly a slave to. To think of our lives as paths we are forced to follow renounces a fair amount of personal responsibility.

2At the risk of boring people, creationism seeks to describe the origin of life, evolution seeks to explain biodiversity, so these ideas are not necessarily incompatible outside of Genesis.