Simon Singh’s Bogus Journey

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  • Great summary of the issue & case to date.
    I particularly hope for, and look forward to, a coutroom examination of the BCA's "plethora" of supporting evidence for the treatment. As satisfying as it was reading the thorough destruction that followed in the blogosphere, it will be that much sweeter to be part of the official record.

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  • I'm having trouble now seeing the meaning of Simon Singh's words any other way than that the BCA was consciously dishonest. It's not so much his words that they promote bogus treatments but that they do so 'happily'. The pre-amble to his argument is that there is no evidence for some of the BCA's claims to treat particular ailments, and he wrote: 'This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.'
    I'm not sure how that could be interpreted other than meaning that the BCA is an organisation deliberately promoting treatments it knows are wrong.
    The presence of the word 'yet' implies that the words that follow it are in opposition to the 'respectability' of the organisation--that the fact that it promotes bogus treatments is something that contradicts its appearance to be a respectable organisation. The fact that it does this 'happily' implies conscious intent in my view.
    Much as I hate to agree with Mr Justice Eady, I can't see another way of reasonably interpreting those words. I'd be very pleased if someone could tell me, because I share your view of Simon Singh and his intentions and reputation, so please, could you add something to your blog explaining what Simon Singh actually meant?

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  • I find myself, like James C, having some difficulty in parsing the offending words in such a way that their primary meaning is not an attribution of dishonesty. Possibly Simon Singh subjectively knows what he intended to mean by them, and it is something other than what they actually mean. That said, he should have available to him a defence of justification, based on the evidently flaky-to-absent evidence base for chiropraxis (and especially its use to deal with juvenile ear infections). Mr Justic Eady has, of course, gone overboard in his analysis of the test that Singh would have to pass; mind reading is not required.

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  • I think the other way in which Simon Singh's words can be interpreted is quite simple: the BCA is deluded. For one reason or another, they believe in something for which there is no objective evidence. This happens quite a lot, even to scientists.

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  • Are the chiropractic claims bogus? According to Edzard Ernst they are (as stated in the article). Does the BCA happily promote these bogus practices? No doubt about that

    What I infer from the article is that the BCA is too lazy, ignorant, or biased to investigate and understand the evidence (or lack thereof). One possibility unstated reason why the BCA promotes bogus treatments is that they know the treatments are bogus, but Singh didn't say that.

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  • Have either of the previous posters read the full article? You can't just take a single line out of context and call it defamatory.

    Here's the whole thing (with some useful footnotes).

    http://gimpyblog.wordpress.com/2008/08/17/the-libellous-simon-singh-article-on-chiropractors/

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  • James,

    'This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.'

    You agree that there is no evidence that chiropractic is useful in the teatment of the childhood conditions that Simon mentioned in his article, right? Okay, so if the BCA is the "respectable face of the chiropractic profession" and do they not know what the evidence is and they do not know that there is no evidence to support the use of chiropractic for these conditions - which is what Simon believed at the time of his article, and which was probably true at the time he wrote his article - then how is he not justified in saying that they "happily promote bogus treatments"?

    Or have you not heard the phrase "happy in their ignorance"?

    It is trenchant criticism but it is not wrong.
    And it is justifiably trenchant criticism because the BCA are the "respectable face of the chiropractic profession" and yet they either have not bothered to examine the evidence or they do not know how to evaluate the evidence for the treatments that they promote. You agree that they should know this, right?

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  • @jamesc and anonymous.
    If there is no evidence for their claims then they are being intentionally dishonest.

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  • "This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments."

    I'm sure the lawyers chased this round in circles, but to my mind, it's obviously *not* an accusation of dishonesty. If I were to say, in an argumentative context -

    "You're an intelligent man, yet you go round promoting and encouraging the crock of nonsense that is Christianity."

    - it's clear I'm not accusing the person of not *believing* in his religion, yet there is nothing grammatically or logically unsound about the sentence (so long as you take it as my opinion).

    The accusation that rings out clearly from that short extract is one of failing to be sufficiently rigorous, to therefore behave responsibly and to deserve the 'respectable' reputation. It does not so far as dishonesty and Eady J has got it wrong.

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  • For Anonymous and James C above, perhaps it would help to see the words in context, where he clearly elaborates on his use of the word "bogus":

    "You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. 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.

    I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world's first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions."

    As they appeared in the original Guardian article.

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  • @JamesC and @Anonymous The adverb "happily" modifies the verb "promotes", not the noun phrase "bogus treatments". Singh knew the treatments were bogus, the BCA need not have done.

    If somebody reported that I had happily danced the tango with a terminally-ill Scientologist, it would not imply that I knew about their illness, or their faith, and it certainly wouldn't suggest that I was happy that they were terminally ill or happy about Scientology.

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  • James C, I might agree with you, if Simon Singh hadn't defined what he meant in the next paragraph of the article in question:
    "I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions."

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  • I understand that in the court today it was argued that "happily" in this context could be reasonably interpreted as "blithely" on the basis that Dr Singh explains that a helath care professional body (which is promoting treatments for sick children) ought to be aware (not "was aware") that a scientific analysis of claims of evidence of effectiveness did not stack up. Dr Singh also defined "bogus" in his article by relating it to the scientidfic findings of "no evidence".

    I am not a lawyer but (therefore?) the above seems to be at the very least arguable, and Counsel did that effecively. The defence case does not however rely on this alone. David Allen Green has a very readable account of the hearing at his Jack of Kent blog spot. http://jackofkent.blogspot.com/

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  • "happily" = "insouciantly"
    Problem solved?

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  • JamesC and Anonymous: Take an analogy. You pay for a newspaper with a pound coin. You pay the seller in good faith that the coin is legal tender - you promote the use of the coin. The seller accepts the coin as legal tender too. Turns out the coin is not legal tender, it's made of the wrong metal. As an observer, I could call the coin a bogus coin - or a fake coin, or a counterfeit coin - and yet this would not necessarily impute malice or deliberate deception on your behalf. The coin in my analogy is chiropractic treatments used for colic etc in Simon's article - promoted, happily promoted indeed, but at base bogus.

    My interpretation of the article, one that thousands share (but that Mr. Eady does not) is that although there is evidence that chiropractic does not work for the conditions indicated (not the same as lack of evidence...), the BCA continues to promote them - not maliciously, fraudulently, but rather in good faith that they work when they in fact don't.

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  • Surely the test as to meaning, as I understand it, is the meaning that would be reached by the 'ordinary reader on the Clapham omnibus'.
    If so the words would seem to suggest to me that Mr. Singh alleged that the BCA knew there was no evidence to support its claims yet continued to do so happily.
    Arguing about what Mr. Singh meant by 'happily' defeats the purpose of this test as he would not have been on the 'bus' so to speak to explain this to the reader.
    Also why did he not apologise when he had the chance and then publish the same article but with a slightly amended paragraph confirming what he actually meant.

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  • Although my sympathies on the issue are entirely with Simon Singh, I can't accept that any reasonable reader coming cold to the relevant words would conclude other than that the BCA promotes treatments knowing them to be ineffective or, in the context of the balance of the article, worse. Attempts at semantic analysis to demonstrate otherwise really only amount to wishful thinking.
    Eady's test, however is equally flawed in that it concludes that Singh has to prove the corporate mindset. On a proper interpretation of the justification defence, it is surely only necessary to demonstrate that the comment represented the only reasonable conclusion which one could come to on the basis of the known facts. Would the position have been different if Singh had commenced that part of his article "On the known facts, the only reasonable conclusion one could come to is that the BCA...etc"?
    That would leave the BCA to demonstrate that another conclusion could be reached on the same facts, but it would be dependant on them demonstrating that they were either naive, or gullible, or that they were unaware of the facts on which Singh based his statement.

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  • If I step back a second, this is a breath of fresh air. Articulate views, no swearing, no undue posturing, a degree of restraint even, and an understanding of the issues at stake... reading the comments on this article made me proud of lawyers. This is what all public debate should be like. Well done, all.

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  • I agree with a number of posters who see the word "happily" as key. It takes a lot of squirming around to get that adverb to mean anything else than "the BCA knows there's no proof, but it still promotes it."
    But here's where it gets really fun. Many schools of alternative/complementary medicine reject (or have to reject because they have no choice) the conventional scientific method of empirical testing and proof. They argue that the dominant paradigm of scientific proof cannot explain why certain medicines work or don't work, hence also the controversy about homeopathy. My GP - an Übersceptic - admitted as much in a conversation this week.
    All dominant scientific paradigms think they're the last word, until they're proven wrong. Alternative medicine practitioners (if indeed chiropractics belongs to this group) would say that Singh may be correct, but only according to his tried, tested and temporary paradigm of scientific proof. And certainly not the basis on which to go around accusing people of deliberately and consciously deceiving people. Whether that would carry any weight with Eady is another matter. Does law have to follow the scientific paradigm?

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  • How else would anyone expect the BCA to promote treatments - frumpily, grumpily, grudgingly? Of course it promotes them happily. If it isn't happy to promote them then it's in the wrong business. How does pointing that out become defamatory?

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  • Dare I suggest in a magazine read mostly by lawyers that the main point is not whether the article was defamatory but whether the BCA in bringing an action for defamation were being wise. If someone says I am a quack or incompetent or dishonest then the wise thing is refute his arguments by demonstration. Free speech can be used to disprove a false argument just as to make one.

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  • AndyD has dealt with Happily and Grumpily, but in this case he's missed the obvious dwarf - dopeyly

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  • @John Stobart
    "Dare I suggest in a magazine read mostly by lawyers that the main point is not whether the article was defamatory but whether the BCA in bringing an action for defamation were being wise. If someone says I am a quack or incompetent or dishonest then the wise thing is refute his arguments by demonstration. Free speech can be used to disprove a false argument just as to make one."

    I agree entirely.

    I have never said the BCA had a weak claim; I have always said it was misconceived.

    And the fault in the law is that such misconceived cases can be brought, without showing malice, in respect of matters of public health and public safety. Libel in these areas elevates a private right to reputation above the public interest in the free exchange of information.

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  • As one who has represented herself in a libel claim against The Daily Mail, Bruno Schroder of Schroders plc and others, and knows more than the layman about libel law, it's clear from the comments on this blog that the meaning of the defamatory words is not as straight forward as suggested.
    Although I have been on the wrong end of many of Mr. Justice Eady's judgments and orders that have caused me much pain and suffering, it is not clear to me that he is wrong in this case. As Mike above said, it is what the right-thinking members of society think generally that matters, not what Simon Singh intended. It seems the Court of Appeal has a difficult task in deciding this.
    And as a long term user of complementary medicine, it appears this case is being used to denounce it and I find that worryingly indeed. As someone else said above, proving the effectiveness of complementary medicine is not the same as conventional medicine.
    What is even more worryingly is that there appears to be a campaign across Europe to denounce complementary medicine at a time when America is finally willing to embrace it. There are very effective homeopathic medicines in Germany from the Heel company that are strangely being either discontinued or altered to decrease their effectiveness. Thousands of German doctors have used these medicines for many years to great effect and now they have fewer treatment options for their patients.
    Just because something cannot at the moment be proven to be 'scientifically beneficial', does not equate with it being useless or bogus. There is something to be said for anecdotal reports.
    Just what is actually going on with complementary medicine in the UK and EU? I certainly hope the pharmaceutical lobby has nothing to do with it.

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  • Elaine,
    The following sentences are all grammatically incorrect:
    "As one who has represented herself in a libel claim against The Daily Mail, Bruno Schroder ..."
    "Although I have been on the wrong end of many of Mr. Justice Eady's judgments and orders that have caused me much pain and suffering, it is not clear..."
    "And as a long term user of complementary medicine, it appears this case is..."
    So perhaps you are not the one to analyse what Simon Singh said
    "As Mike above said, it is what the right-thinking members of society think generally that matters, not what Simon Singh intended."
    If it was up to the "right thinking" members of society, what Simon said was spot on. However, it is how the average Guardian reader would interpret what he said.
    "there appears to be a campaign across Europe to denounce complementary medicine at a time when America is finally willing to embrace it"
    There is a campaign across the world to let the evidence speak for itself. This is especially urgent when treatments without any evidence base have become so commonplace in the population.
    "There are very effective homeopathic medicines in Germany"
    No, besides having no mechanism by which it could possibly work, there is also no evidence from properly conducted clinical trials that homoeopathy works and lots of evidence that it doesn't.
    "Just because something cannot at the moment be proven to be 'scientifically beneficial', does not equate with it being useless or bogus."
    No, it has been scientifically proven not to work. It is a completely useless treatment outside of its palcebo effect. And it does harm by being promoted as a substitute for treatment that does work (eg vaccinations, malaria prevention)
    "There is something to be said for anecdotal reports."
    No. Anecdotes are extremely unreliable. This is the reason for the development of the clinical trial. Anecdotal reports suggested that steroids were saving the vision of prem babies. Clinical trials showed that they were actually harmful.
    "I certainly hope the pharmaceutical lobby has nothing to do with it."
    They are, in fact, jumping on the bandwagon. They are buying up shares in the very lucrative CAM companies.

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  • BillyJoe,

    Firstly, with the username BillyJoe, it would be easy to assume you are an American. But if I apply a little mathematics (and dare I say, science) and consider the balance of probabilities, the method of proof for civil law claims, I would assume you are not. I make this assumption based on the evidence that this is a UK blog with mostly UK users, despite my being an American. So, am I right and have I been right to come to this conclusion based on the evidence available to me?

    I am trying to make the point that proving anything is often difficult. There is the difficulty of proving that something is dangerous. I happen to be of the view that mobile phone masts and wifi negatively affect people's health. The scientists say there is no proof that it does. Well, how are we going to prove or disprove it?

    It will start with anecdotal reports of illness before a study commences. Who would join such a study to provide the 'evidence' one way or the other?

    Back to BCA's claim against Simon Singh. I have been trying to finally read some background to this case and it appears Simon wants the world to take his view on alternative medicine and chiropractic in particular. I am puzzled as to why someone with a PhD in physics from Cambridge is even involved in this argument. It would be easy to assume this subject is not challenging enough for him.

    I regret to say that I have now read the article over several times and it appears so defamatory and libellous to me that I believe it would even violate most of the libel laws in the US. It does not appear to be an article about science and I think those trying to keep libel out of science may have chosen the wrong claim to support.

    The article is clearly a denouncement of all that chiropractic is about, including its well accepted treatment of back pain. It is also a character assassination of the BCA.

    I have not seen the Particulars of Claim in this case, nor Mr. Justice Eady's judgment (do you know where they can be found?), so I do not know what parts of the article are complained of besides the bogus claim. But in the mention of the tragic death of the Canadian woman in the article, there was no direct evidence that the chiropractic treatment she received was the cause of her death. And if it was, that is not a reason to claim the whole profession has no basis for being. What kind of scientific deduction is that? There are bad apples in every profession. There does indeed appear to be a campaign against alternative medicine as you confirmed to me:

    "There is a campaign across the world to let the evidence speak for itself. This is especially urgent when treatments without any evidence base have become so commonplace in the population."

    Why don't you tell us who is behind this campaign? There appears to be something very sinister going on trying to deny those of us who use alternative medicine with the option to continue.

    I can categorically say that complex homeopathy from Heel in Germany and ear acupuncture cured me of ME, along with an experienced doctor who knew how to use them. And I can categorically say that I got ME from a large dose of antibiotics given to me after my appendix ruptured. This was after being misdiagnosed twice by doctors in Massachusetts. So you can see I am a strong believer in homeopathy.

    Those campaigning for reform of the libel laws want more free speech. But, free speech does not mean saying whatever you want, even in America. I think one reason the BCA felt it needed to take action was because this article was published on the website (and possibly in the paper?) of one of Britain's broadsheet newspapers. That grated to be sure.

    I know what it is like to be libeled in British newspapers. It is an extremely unpleasant experience and I am using British understatement. I could write a book about my difficulty getting justice, so I am no fan of Britain's libel laws nor aspects of its legal system in general. My claim against The Daily Mail is currently stayed because of costs and I am the claimant. And no, I could not find a CFA.

    For the record, I do believe the Heel company has done homeopathic studies that have shown its effectiveness. However, few other companies have the resources to fund studies. They should not be criticised for that. Governments around the world are trying to cut healthcare costs and many believe alternative medicine can help. I am of that view and I know it works.

    As for how I turned to homeopathy after suffering a concussion because of my libel claim.....I'll leave that for another comment.

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  • the fact that the BCA website states that: 'The inception of modern chiropractic can be traced back to 1895 when Canadian Daniel David Palmer performed the first chiropractic adjustment...' shows that the BCA are willing to promote as truth a 'fact' which is highly open the interpretation and is in fact contested.' For example by the phrase - 'chiropractic adjustment' brings to my mind a well planned and researched experimental treatment with controls in place and observations systematically recorded.' According to some sources his 'chiropractic adjustment' was a slap on the back with a book. This shows that the BCA are happy to publish supposedly factual statements which in fact are not what they seem. Whether or not the statement is bogus is a question of objective fact and therefore the defence of fair comment must be accepted, as the 'truth' cannot at present be fully proven one way or the other. See for example the American case of Milkovich and Loraine

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  • I am not a lawyer - but I do consider myself the archetypal "reasonable man". I also think that the law is a servant of the "reasonable man". If the law fails to take account of the “reasonable man” then it fails in its’ fundamental duty.

    According to posts above the original quote is:

    "You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. 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 area of contention appears to be on the suggestion that the BCA “happily promotes bogus treatments”. There doesn’t appear to be any complaint about the comment that “fundamentalist” Chiropracters argue they can cure anything. There doesn’t appear to be any argument that modern chiropracters “possess some quite wacky ideas”. There doesn’t appear to be any suggestion that the BCA denies claiming that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying. There doesn’t appear to be any suggestion that there is not a jot of evidence to support those claims.

    The only area of contention appears to be whether the BCA is “happily promoting bogus treatments”.

    So the fundamental questions are:

    a) are the treatments bogus
    b) does the BCA know (or can it be reasonably expected to know) that the treatments are bogus
    c) does the BCA have any evidence to suggest that the treatments are not bogus
    d) would a reasonable man be expected to take an endorsement by the BCA of a treatment as an authoritative statement of efficaciousness of the treatment

    As Elaine Decoulos has adequately set out, I am not qualified to comment on the first of these questions. Indeed, I will happily rule out any “scientific” test as to the effectiveness of the treatments as “proving the effectiveness of complementary medicine is not the same as conventional medicine”

    This naturally rules out any defence for Mr Singh on the second question. It could well be (as implied by Ms Decoulos) that science is asking the wrong questions – and since the BCA is working within a paradigm that is removed from “conventional science” it would be ridiculous to ask them to answer such a question according to “conventional science”.

    The third question, however, is much simpler. The BCA could simply provide a list of treatments provided by it’s members where chiropractic cures had been followed by patients suffering from the listed ailments recovering to some extent. It would be churlish to require a validatable “scientific” causal link between cure and recovery as it is possible (as implied by Ms Decoulos) that the “scientific’ methodology is flawed. Just because we don’t understand why it has worked, or can’t provide a direct causal link, is no reason to discount the correlation between treatment and cure/alleviation of symptoms.

    As noted above – I will (and I’m sure Mr Singh will too) happily concede that the current scientific methodology could be fundamentally flawed and that the idea of (for instance) double blind trials of treatments may not be the best way to discover the effectiveness of treatments. I (although possibly not Mr Singh) will also be prepared to accept this challenge without an alternative suggestion being made as to an alternative methodology.

    I would, however, like to see some evidence of the effectiveness of any “alternative” treatments. I must emphasise that I don’t need to understand HOW or WHY it works – just some evidence that it does work, and that it is repeatable. If Ms Decoulos (or the BCA) is able to provide not only her own experience but a case that is in need of treatment that she is able to cure by use of whatever methods were used in her own case (or one advocated by the BCA), that would be sufficient.

    Which leads to my final point. The BCA or British Chiropractic Association. Without doubt I would accept (as a reasonable man) that a person operating under the banner of an organisation which encompasses a wide range of practioners would have a set of professional standards. It doesn’t matter what those professional standards are (they could, for instance, be a set of standards that dictated that members always painted their toenails pink). However, given the title I have a reasonable expectation that a) they are incorporated within the UK b) they have some knowledge of the manipulation of the musculoskeletor system in living people and c) that they have an ability to use this knowledge to my benefit.

    What this all boils down to is:

    1. Are the treatments bogus? If they are not bogus then Mr Singh will fall at the first hurdle. There is no doubt that the BCA promotes the treatments so all that is required is to show that the treatments are not bogus. The occasional anecdote is obviously not sufficient – but equally a fully validated “scientific” explanation would be an onerous burden. All that is really required is the production of a few individual studies in which a case of colic, asthma, or one of the other ailments listed by the BCA is diagnosed, then subjected to treatment by one of their members, and cured. It shouldn’t be difficult to agree a methodology between the BCA and their detractors for each case in advance
    2. Has the BCA undertaken any such case studies?
    3. Has the BCA undertaken any case studies (with or without the participation and critical oversight of others)?
    4. Would I (as a reasonable man) believe that the BCA is a professional body which has undertaken such studies?

    I can categorically state that I (as a reasonable man) believed that Chiropracters were exclusively involved in the manipulation of the musculo-skeletal systems. I had no idea that they claimed that they could cure asthma or that they were routinely treating infants. With hindsight I should have realised that the “massage” could aid insomnia – in much the same way that the services of a prostitute can have the same effect.

    If the BCA has any evidence that their members can cure asthma or prevent frequent ear infections then let them state what that evidence is. In the absence of any such evidence then it’s time to put the boot on the other foot.

    I, for one, will be standing outside my local BCA member’s “surgery” handing out leaflets to anyone attempting to enter the establishment that the practitioner is a member of a charlatan organisation and that any attempt to address issues due to professional incompetence is governed by a body that has no evidence that it’s practices work.

    Perhaps if we all do this then genuine chiropractitioners will abandon this body and set up a proper professional body that will govern their activities in a truly professional manner.

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