Weekend Reading

Heroin and Cocaine lozenges will make anyone’s throat feel better.

It’s hard to believe that summer is actually winding down here in North America. Summer vacations are wrapping up and school is starting soon. The header image from today’s post is from i09, Gorgeous Vintage Advertisements for Heroin, Cannabis and Cocaine. Here’s some additional posts worthy of your attention:

Not effective. Not cost-effective.

Health and insurance plans usually cover the cost of anti-inflammatory drugs. But what about acupuncture? Should it be an insured benefit? How about chiropractic?  Health insurance providers and medicare programs worldwide are scrutinizing health spending. Devoting dollars to one area (say, hospitals) is effectively a decision not to spend on something else, (perhaps public health programs). All systems, be they public or private, allocate funds in ways to spend money in the most efficient way possible. Thoughtful decisions require a consideration of both benefits and costs. So where does that place complementary and alternative medicine (CAM)?

One of the central tenets of a science-based approach to healthcare is that all health interventions should be evaluated based on a consistent scientific standard. From this perspective, there is no distinct or separate practice of medical care deemed “alternative”, “complementary” or more recently “integrative”. There are only treatments and interventions which have been evaluated and found to be effective, and those that have not. So why concern ourselves with unproven and disproven products and treatments? That these treatments persist is a testament to promoters of CAM who, unable to meet the scientific standard with their products and services, have argued (largely successfully) for different (i.e., lower) standards and special consideration — be it product regulation, like the Natural Health Products Directorate in Canada, or practitioner regulation. But this doesn’t mean that their services will be paid for by health insurace.  In an environment of economic restraint in health spending, promoters recognize that showing economic value of CAM is important. Consequently they use the tools of economics like they use scientific methods and research: to argue a belief, rather than answering a question. That seems to be the case with a recent paper that’s being celebrated by alternative medicine practitioners. Entitled, Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations, it attempts to summarize economic evaluations conducted on CAM treatments. The results of the paper are enlightening – but not in a way the authors intended.

Singh vs. the BCA: A Libel Reform Update

I’ve blogged in the past about the case of Simon Singh who has been sued by the British Chiropractic Association (BCA) for making the following statement:

The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

Rather than refute Simon’s comments with evidence to substantiate their claims, the BCA decided to sue. When organizations seek to supress debate and discussion about science by using legal means, it causes “libel chill”, where speech is suppressed by fear of legal action. Singh’s case is the impetus to a campaign for libel reform in the United Kingdom, where libel laws are horrendous, putting the onus and the costs solely on the defendant. An initial ruling went against Singh, and he appealed. Yesterday’s ruling was in his favour, and will allow Singh to use a “fair comment” defence in his arguments.

What was very encouraging for Singh, and for all who comment on the legitimacy and credibility of scientific matters, was the following comment from the Court:

’34. We would respectfully adopt what Judge Easterbrook, now Chief Judge of the US Seventh Circuit Court of Appeals, said in a libel action over a scientific controversy, Underwager v Salter 22 Fed. 3d 730 (1994):

“[Plaintiffs] cannot, by simply filing suit and crying ‘character assassination!’, silence those who hold divergent views, no matter how adverse those views may be to plaintiffs’ interests. Scientific controversies must be settled by the methods of science rather than by the methods of litigation. … More papers, more discussion, better data, and more satisfactory models – not larger awards of damages – mark the path towards superior understanding of the world around us.”‘

You might be asking – What does this case have to do with Science-Based Pharmacy? Quite a bit. It’s essential for health professionals to have the freedom to comment openly about the scientific evidence supporting any drug, treatment or health intervention. Criticizing data (or the lack of data) is fair comment.  Data and evidence should determine which treatments are deemed credible – not legal threats to silence critics.

It’s too early to declare victory, as Singh points out himself  in today’s Guardian column. The BCA could still appeal. But this entire saga has been such a public relations disaster for chiropractors worldwide. As press coverage has grown, so has the scientific and mainstream scrutiny of chiropractic. And it hasn’t been positive.

The battle for free speech and fair comment continues. Sign the petition at www.libelreform.org.

For more comment and discussion on yesterday’s ruling: Kim at Skeptic North; Orac at Respectful Insolence; Jack of Kent.

Keep Libel Laws Out of Science: The Simon Singh Affair

What’s the icon above about? You may have noticed it on the Science-Based Pharmacy website for the past several weeks. Simon Singh is a science writer who wrote about the British Chiropractic Association, and their stated claim that chiropractors can treat childhood conditions, like colic.  His comment, published in the British newspaper The Guardian, was as follows:

The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

The BCA was offered the opportunity to respond in writing in the Guardian. Instead of providing evidence to support their claim, the British Chiropractic Association decided to sue Simon Singh for libel. English libel laws are probably the most difficult for bloggers, authors, skeptics or anyone that critically appraises evidence, as the burden of proof lies on the defendant, not the group alleging libel.