After two years of pursuing one man through the courts, at a cost to him of £200,000 and two years' work, the British Chiropractic Association yesterday dropped their libel case against science writer Simon Singh. The case was over a piece he wrote for the Guardian in these very pages (now republished at Comment is free), 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 epitomise the need for reform of libel law, 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 50,000 signatures, 268 MPs have backed an Early Day Motion to reassess our libel laws,and all three 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, to explain the evidence for all these medical claims. The BCA refused. They didn't want that, they explained: they wanted a personal apology from Singh. It's hard 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 allegedly 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 has taken place in the arena of medicine, where reasonable criticism of each others' practises should never be stifled, for one 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 chilling 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 catch it as soon as possible – that's why 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 – recently 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 other's ideas and practices, 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 Wilmshurst is an NHS cardiologist and academic who spoke out – very mildly – about concerns he had over a clinical trial of a heart implant in which he was the lead investigator. 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 six figures, and spending every spare second on the case. He has lost every weekend and all his annual leave for two 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: OK. 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.
Ben Goldacre is a medical doctor and writes the Guardian's Bad Science column. Read Singh's original article at theguardian.com/commentisfree
