Why making large numbers of complaints about chiropractors was the right thing to do

I've been criticised recently for making large numbers of complaints against chiropractors for making unsubstantiated claims to treat colic. Criticism has come from comments on my blog, from posts and comments on Lanigan's blog, and from the Shadow Minister for Mumbo-Jumbo David Tredinnick MP.

The justification for my complaints is simply that there is no evidence that chiropractic is an effective treatment for infant colic. For the purpose of clarity, I'd like to add that there is also no evidence that chiropractic can help alleviate the symptoms of infant colic.

But some criticism has pointed out that I'm not suggesting an alternative treatment, and while no evidence-based treatment for infant colic exists, it makes sense to use a treatment with no evidence for its effectiveness.

I will now explain why this position is wrong.

What do we mean by "no evidence"? We mean, simply, that there is no sensible reason to believe that a given intervention is effective. There is no evidence that bathing your child in tomato juice is an effective treatment for infant colic. There is no evidence that hanging your child upside down for two hours a day is effective in alleviating the symptoms of infant colic. These might sound like strange things to suggest, but that's my point: there is no evidence base for these being effective. Chiropractic, as an intervention for treating colic, is no different in this respect.

I am aware that chiropractors do use chiropractic as a treatment for colic, but this isn't a reason to suspect it may work.

Some chiropractic colleges teach that chiropractic is effective in treating colic, but this isn't a reason to suspect it may work.

Some chiropractors notice that symptoms of colic appear to subside after chiropractic treatment. But this is equally consistent with the hypothesis that it is ineffective: we know that symptoms subside over time without treatment anyway.

Until there is a valid reason to suspect that chiropractic may be effective in treating colic, chiropractic as a treatment stands equal beside bathing your child in tomato juice and hanging your child upside down.

But chiropractic takes it one stage further. Because despite the fact that there is no evidence to suggest that bathing your child in tomato juice is effective, nobody has ever tried to look for the evidence. With chiropractic, the evidence has been searched for. Double blind trials have been performed. And they have failed to show it is effective.

If there are three hypotheses, all without evidence for them and one where evidence has been looked for but not found, then that one is clearly the least plausible hypothesis.

There are billions and billions of possible things you could do to a small child that might be effective in alleviating the symptoms of infant colic. Only a tiny fraction of them will work. It is completely unreasonable to suggest that any one of those billions of possible treatments may work without some sort of evidence. If you've looked for evidence that one of those billions of treatments works and failed to find it, then it is completely irresponsible to promote it as a treatment - especially, when like most interventions, it is not 100% safe.

With my complaints, I am not trying to deny patients the right to try whatever they want as a treatment. What I am trying to prevent is a group of people profiting by telling their patients that their treatment is effective when there is not only no evidence - but there is actually evidence to the contrary.