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Homeopathy 2010; 99(01): 83-84
DOI: 10.1016/j.homp.2009.09.004
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Copyright © The Faculty of Homeopathy 2009

When sorry seems to be the hardest word: CAM, free speech, and the British legal system

Lionel R. Milgrom
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Publication History

Received09 July 2009

accepted07 September 2009

Publication Date:
16 December 2017 (online)

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Like some dysfunctional couple, free speech and libel law in the UK have always made uneasy bed fellows. We become aware of their conflicts usually when a prurient press is sued by outraged individuals, for delving too deeply into their private lives. Meditating on the nature of that troublesome boundary between what constitutes the public interest and the right not to be abused in public, is a concern that most of us most of the time regard as the domain of the rich, famous or powerful…and their lawyers. Those working in complementary and alternative medicine (CAM) however, might lately well have had urgent cause to pay more attention as a result of the libel case brought by the British Chiropractic Association (BCA) against science writer Dr Simon Singh.

Last year in The Guardian, Dr Singh alleged that the BCA was promoting ‘bogus’ treatments.[ 1 ] Nothing to get too hot under the collar about here, one might think, as so-called sceptics have always excoriated CAM in the press as unscientific; unproven; even dangerous and deadly, and it usually ‘blows over’. This however was all about to change.

Exceptionally for a CAM organisation, the BCA rounded on its tormentor and asked Dr Singh to withdraw his ‘bogus’ comment: he refused. So the BCA took him to court. They argued that use of the term ‘bogus’, being “factually wrong, defamatory, and a damaging allegation that could be seen to adversely affect the professional reputations of individuals or organisations”,[ 2 ] constituted a slur on their character, by implying chiropractors are knowingly mendacious. The judge agreed, finding against Dr Singh, and The Guardian withdrew the offending article (subsequently, Dr Singh has been given leave to appeal against the judge’s decision, so the case continues). Those in UK CAM who for years have had to put up with largely unanswered media attacks, could afford a smile. But against the background of the financial crisis, it went relatively unnoticed by the media.

Soon however, voices were being raised in support of Dr Singh among some scientists, writers, politicians and even a few comedians acclaiming him a champion for free speech and that robust scientific discussion was under attack by the British judiciary.[ 3 ] This has now resulted in a campaign to “keep the libel laws out of science”, spearheaded by the charity Sense About Science (of which Dr Singh is a trustee, and whose backers include some pharmaceutical companies, The Lancet medical journal and The Guardian newspaper).[ 4 ] Meanwhile, UK chiropractors and one of their representative bodies are now being made to appear as accessories to attempted stifling of honest, open scientific scrutiny.[ 5 ]

What is interesting here is how skilfully the media which by and large is hostile to CAM, is trying to turn the tables of opinion against the BCA. For example, it was invited to lay out its evidence ‘stall’ for chiropractic.[ 4 ] which Prof Edzard Ernst then dutifully ‘demolished’. This was an on-going thread recently on the BMJ Rapid Responses web-site. With a few notable exceptions, this demonstrated that it was not about scientific debate, but more about political debunking by the anti-CAM ‘Usual Suspects’.[ 6 ]

What tends to be forgotten in this attempt to distract attention away from Dr Singh's contentious ‘bogus’ allegation (for which he could have so easily apologised, and no-one would have thought any the less of him: indeed at least one of the contributors on the British Medical Journal (BMJ) Rapid Response site thought it an ‘unscholarly’ choice of word), is that the BCA went to court because Dr Singh refused to retract it, not as a recent BMJ editorial suggested,[ 5 ] to wage war against freedom of expression or proper scientific debate. Indeed, perpetuating this myth demonstrates the difficulty of having any reasoned debate about CAM.

Real debate is a balance of opposing views, and in the media these are hardly allowed column inches or air-time. The evidence base for CAM, particularly as it exists in complex clinical settings is dismissed out of hand when it is thought to contradict one particular version of scientific thinking.

Dr Singh and Prof Ernst are well known for their views on CAM, most of which they excoriate as unscientific; unproven; even dangerous and downright deadly. These are demonstrably false claims that go relatively unchallenged, especially as they exist in a climate where conventional medical blunders are commonplace.[ 7 ] Such unrelenting bias against CAM does not lend itself to constructive debate or free speech.

Much of Dr Singh's and Prof Ernst's ire against CAM stems from a particular scientific mind set (logical positivism) which they appear to regard as incontrovertible truth.[ 8 ] For understanding the workings of washing machines, guns, and rockets, etc, it is perfectly adequate. When applied to medicine (as much an art as it is a science) however, it effectively downgrades or ignores other important less scientifically defined forms of evidence.

The result is that clinical decisions are now supposed to be based solely on the scientific evidence, which incidentally was never the intention of those who originally formulated the tenets of Evidence-Based Medicine (EBM).[ 9 ] The irony here is that if such a draconian approach was to be enforced throughout medicine, nearly half of all current procedures would have to be withheld until the expenditure of much time, money and effort had finally ‘proven’ their effectiveness.[ 10 ]

Such a procedure could turn out to be a double-edged sword. Trials of one of the biggest selling drugs Prozac for example, recently found it to be no better than placebo.[ 11 ] Interestingly one does not hear Dr Singh or Prof Ernst campaigning for the removal of Prozac, as they do so vociferously against CAM. Fortunately, their scientific ‘fundamentalism’ is not shared by all in medicine. Thus, cancer clinician Karol Sikora (around 60% of whose patients use some form of CAM as adjuvant therapies) has uncompromisingly castigated attempts to tell him how to do his job by what he calls ‘inexperienced’, ‘armchair physicians’, while berating their attempts to rid the National Health Service (NHS) of its CAM services as ‘Stalinist’.[ 12 ]

Even Sir Michael Rawlins (Chair of the National Institute for Health and Clinical Excellence [NICE] and no great friend of homeopathy) in his Harveian Oration last year,[ 13 ] warned: “RCTs, long regarded as the ‘gold standard’ of evidence, have been put on an undeserved pedestal. Their appearance at the top of hierarchies of evidence is inappropriate; and hierarchies are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence base.” Indeed, Sir Michael's Oration could be interpreted as simply echoing one of the founders of EBM David Sackett's much earlier concerns that it might be in danger of turning into an evidence ‘mono-culture’, where the primacy of an ‘ideal’ scientifically-determined efficacy would subsume other no less important forms of evidence, to the possible detriment of patient and clinician concerns.[ 9 ] That a decade later, voices in the nursing profession were being raised concerning EBM's intolerance of therapeutic pluralism in healthcare systems,[ 14 ] suggests Sackett's early warning went unheeded.

Unfortunately, we are already beginning to see the possible effects of a scientific ‘mono-culture’, perhaps wedded to financial interest. Thus, the magazine Prospect recently reported on the almost systemic abuse of science in medical and pharmacological research.[ 15,16 ] And in 2008, the journal Nature, stated that “in the US around 1000 incidents of suspected fabrication, falsification, and plagiarism go unreported every year”.[ 17 ] In the UK, the Committee on Publication Ethics estimates that there are about 50 cases per year of serious fraud in biomedical research, and that academia has been trying to cover up this abuse of science. The Prospect article concludes,[ 16 ] ‘We may have to wait for fresh scandals before anyone acts. Until then, patients will remain in real danger of taking expensive drugs whose risk of harm or inability to cure, have been fraudulently suppressed.’ Clearly, all is not hunky dory in the world of Evidence-Based Medicine.

Finally, returning to the particular instance of Dr Singh, calls for all and sundry to sign up to ‘organised scepticism’ by militating to ‘keep the libel laws out of science’[ 4 ] miss a rather important point. For, if successful, it would in effect result in a conflation of what is now being argued as libellous comment with serious scientific criticism. Such a campaign could backfire if it were to be interpreted as an attempt to place scientists and science writers above the law. As if science in the UK is presently not in enough difficulty that for the sake of one science writer who seems to have difficulty apologising, it seems hell-bent on adding hubris to its list of woes.