Ah yes. The British Chiropractic Association has finally released the “plethora” of evidence that support their non-bogus treatments, and that put Simon Singh in his place. Indeed, BCA has produced an immense list of… 29 references^*.

This vast amount of conclusive trials prove the efficacy of chiropractice for the conditions mentioned in Simon’s article beyond any doubt. One can understand why it took the BCA more than a year (after they chose to file a lawsuit instead of resolving a scientific and public health debate using -gasp!- science) to present their evidence: it was purely a matter of logistics! Someone (oh the hero) had to dig out and collect this abysmal number of references. I can imagine the endless hours spent in trying to order and arrange the list -presumably in order of importance (?)

Which makes the very first reference the most important piece of evidence that chiropractice is effective and safe. The Ace of Spades for the BCA; the mother of all evidences; the Optimus Prime of research pieces that completely thrashes Simon Singh’s unfounded claim. This masterpiece is none other than the General Chiropractic Council’s… code of practice!

[/sarcasm]

Not much to discuss here really. This is a truly pathetic evidence base, as Prof. Colquhoun notes, that if anything, totally proves Simon’s point: there is no solid evidence to back up a practise that claims to treat potentially serious conditions… in babies! If you cannot realize the seriousness of this issues I suggest you have your head checked by a homeopath and your spine manipulated by a chiropractor…

The Lay Scientist has a great post up, destroying the BCA’s “plethora” of evidence and providing a plethora of references to other bloggers that were quick to dissect BCA’s document. It’s funny though to go through BCA’s list through the eyes of the Lay Scientist, to try and understand what they think constitutes good evidence in the arena of public health. So let’s do that, shall we?

We start with 29 references:

Of the 29 references, 1 is just the GCC’s code of practice; 6 is an irrelevent paper about medical ethics; 8, 9, 10 and 17 are about osteopathy; 26 is a description of evidence-based medicine; 27, 28 and 29 are about NSAIDs. That’s 10 down straight away, but what’s interesting about these is that 6 of them are just attacks on conventional medicine. In other words, this is not a particularly comprehensive or focused review of the literature.

We are down to 19 already.

A further three papers, (12, 13 and 14) cover the safety of chiropractic, which has come under considerable criticism. Curiously, this brief selection ignores the numerous studies showing an increased risk from chiropractic. 14 isn’t a study at all, 12 is considerably less bullish than the BCA suggest it is pointing to a significant number of side-effects “with a possible neurologic involvement”, and 13 provided stronger support (”We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”), but should be taken in the context of the wider range of studies finding the opposite.

Down to 16 possibly relevant.

Of those 16 papers, 9 cover infantile colic, 1 looks at asthma, 2 study ear infections, 3 look at bed-wetting and 1 at a variety of conditions.
[...]
Professor David Colquhoun has reviewed the 9 infantile colic papers on his own blog, and the results are, well, poor. 2 had no control group, [...] Ditto 3 and 25. 4 compares chiropractic with the use of dimethicone. Apparently, this is an ingredient in some over-the-counter remedies for colic, which are themselves unproven, so hardly the greatest thing to compare your treatment with - the results simply show that chiropractic is as good as another unproven remedy. Meanwhile, 5 [suggests] that the effect obseved [sic] is largely placebo.18 and 20 are both reports on a couple of individual case studies, and therefore simply anecdote rather than the sort of evidence you’d get from a trial involving hundreds of patients. 19 simply compares one chiropractic treatment against another [and] 24 isn’t actually a study at all.

We are talking serious research; conclusive trials; proven safety and efficacy. Oh poor Simon, the BCA has nailed you… Anyway, down to 7 possibly supportive references…

1 on asthma, 2 on ear infections, 3 on bed-wetting and 1 on ‘various’. 7, the asthma paper, is simply a letter to the editor and contains no actual evidence, so we’re down to six.

Of the ear infection papers, 15 is an uncontrolled study that simply shows that children with ear infections tend to eventually get better but can’t say if that’s down to chiropractic. [...] 23 [...] looks rather like the same sort of thing again.

So on to bed-wetting then [...] 22 is a study of one person (an anecdote), and 21 is another uncontrolled “they eventually got better” study

Good. We are down to… ONE paper that might possibly show some real supportive evidence. And guess what? The very last paper is actually a good one! It’s a Cochrane Collaboration meta-analysis! In their press release, the BCA states that “There was weak evidence to support the use of [chiropractic].”

Good, finally. We cannot really call this conclusive; strong; plethora; powerful; whatever; evidence. And it’s hardly what we were promised, or what we would expect when discussing public health issues. But at least, of the 29 references, there was ONE good piece of research that suggest chiropractice might be effective… Oh no, wait a minute. Something’s wrong here. The actual conclusion of the meta-analysis reads:

There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture and chiropractic but it was provided in each case by single small trials, some of dubious methodological rigour.

F***! Are they completely useless, completely disillusioned, or completely dishonest? Their “plethora” of evidence consists of 10 completely irrelevant papers; a large number of uncontrolled trials; some case studies (!); a lot of inconclusive trials; a lot of cherry picking and “accidental” exclusions of unfavourable trials; and a misquotation from a Cochrane Collaboration review! And these people claim they can treat babies with their (non) bogus treatments!

When is someone going to take them to the court?

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Footnotes:

1. * You can find the document in BCA’s press release section here. A very interesting sidenote: the BCA, contrary to their previous habits, has locked this particular document and disabled copying! My naughty mind thinks this is probably to make life for their critics difficult. They were expecting a huge response -ridicule to be more precise, and for some reason decided to make themselves look even more foolish… [↩]