Treating evidence with contempt

Sad commentary regarding the use of critical thinking by many complemenary and alternative proponents:

"For 15 years I have studied the effectiveness and safety of treatments such as acupuncture and homeopathy. Often, the results were not what the proponents ofthese treatments had hoped for. One would have thought that this might lead to debate, further research, or even health policy changes. Sometimes it has, but recently we have witnessed a new phenomenon.

People or organisations promoting highly questionable treatments are treating the evidence with contempt and flex their legal muscle to have it their way. The New Zealand Journal of Medicine recently published an article showing that most chiropractors use the title "doctor." The argument was that this might mislead patients and cause harm. As a consequence, the chiropractors sought to silence the journal by threatening legal action. (1) Fortunately the attempt failed.

The Guardian was sued for libel by Matthias Rath. The paper had exposed Rath’s strategyof convincing South Africa’s government that his vitamin pills were more effective than antiretroviral drugs for treating AIDS. The Guardian put up a fight, and eventually Rath dropped the libel action and was ordered to pay costs. (2) An editorial in the Guardian (http://www.guardian.co.uk/commentisfree/2008/sep/13/matthiasrath.aids noted that Rath’s activity in South Africa "provides a terrible illustration of thepotential consequences of treating the evidence with contempt."

Science journalist Simon Singh recently condemned the British Chiropractic Association for advocating chiropractic care as a treatment for childhood asthma and a rangeof other paediatric conditions. Instead of arguing their corner publicly, the association filed a libel action against Singh (www.telegraph.co.uk/news/newstopics/mandrake/2570744/Doctors-take-Simon-Singh-to-court.html). The case is likely to come before the courts soon.

When I critically commented on a report that Prince Charles had commissioned on the cost effectiveness of alternative medicine, (3) my university received a letter from the prince’s first private secretary, Sir Michael Peat, to "draw attention"to what he perceived as a "breach of confidence" on my behalf. It took a gruelling 13 months of an internal inquiry at Exeter University to clear my name.

Since I published a book with Simon Singh that evaluated the evidence for or against homoeopathy and other alternative treatments, (4) UK homoeopaths have been engaging in an elaborate campaign of multiple letter writing, repeatedly invoking the Freedom of Information Act to harass and silence me. This letter shows that they have failed. All of this "is not just unpleasant, it is also unhealthy," commented Ben Goldacre. (5)

I would add that the frequency of these events in recent months is downright scary. People who use legal muscle and power, rather than reason and debate, are a danger to reason and progress. What is at stake here is our right, I would argue our duty, to speak out against misleading claims and dangerous concepts. We should find ways of protecting ourselves against such enemies of reason. "

Cite this as: BMJ 2008;337:a2063 Edzard Ernst, Laing chair of complementary medicine"

Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture,chiropractic, and osteopathy.

N Z Med J 2008;121(1278):15-20Boseley S. Matthias Rath drops libel action against Guardian.

BMJ 2008;337:a1710(18 September.)Henderson M. Prince plots alternative treatments for the NHS.

Times 2005 Aug 24:1.Singh S, Ernst E. Trick or treatment? Alternative medicine on trial. London: BantamPress, 2008. Goldacre B. With their money, myopia and abuses, these pill makers match big pharma.Guardian 2008 Sep 13:34.