BCA plethora – the previously unavailable Fallon paper

When I had a look at the papers in the British Chiropractic Association’s (BCA) ‘plethora’ for ear infection I noted that I could not access the Fallon JM (1997) paper of which the BCA claim  ‘[t]he results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study.’, I did, however, criticise it based on the abstract, admittedly a slightly dangerous thing to do, given that abstracts do not always accurately reflect the content of the paper.

“Looking at it it seems not to involve a control group, thus cannot tell us anything about the efficacy of chiropractic vs other treatment or placebo, and is more of an argument for the use of a measuring technique in assessing the impact of chiropractic rather than the BCA’s stated claim.  In fact, the BCA’s (and the author’s) claim about a correlation is disingenuous given that in the absence of a placebo control it is impossible to say if the correlation is due to a placebo effect, the BCA (and the author) would do well to remember that correlation is not proof of causation.”

Now I have been sent a copy of the paper and coincidentally almost simultaneously found it online, here, so I can confidently reiterate my previous criticism after having read it.  However there are several discrepancies between the figures in the paper and those in the abstract which indicate a somewhat slipshod approach to detail.  The abstract states that:

The body text of the paper indicates that:

It is clear that the while the initial pool of participants was 332, only 315 of these took part in the study, despite the abstract appearing to claim otherwise.  Now it is perfectly normal for subjects to be excluded from any medical study for any number of reasons and the small number of participants lost will not affect the validity of the results, the lack of control see to that, but it is an unfortunate proofreading error.  Of course one should be willing to accept a small amount of human failing in data presentation and occasional lapses are forgivable.  However, there are several other such lapses in the abstract.

The data for the average number of adjustments in the body text is as follows:

You will of course notice that the data given in the abstract for Acute OM, 4.0±1.03 varies slightly from that given in Table 15, 4.09±1.03 – the 9 has been left off.  Rounding of the digits is not a plausible explanation as the error is given to two decimal points (and oddly some numbers are given to one decimal point while the error is given to two).  A lack of proofreading seems to be the case.  These errors continue with respect to the normalization data:

Again the careful reader will notice that the data given in the abstract for normalisation of otoscopic exam for Acute OM, 6.67±1.9, varies from that in Table 17, 6.67±1.99.  Again a digit has been lost from a decimal place, and once again the 9.

Now, these errors in the abstract do not appear to misrepresent the general thrust of the paper, the lack of control groups does that, but they do indicate that maybe the peer review wasn’t thorough enough in picking up such obvious mistakes, if it was peer reviewed at all.  It does make you wonder if such a slipshod attitude to review permeates the approach to references or experimental detail.  Perhaps an unfair criticism, and I don’t have the time to investigate the references and reanalyse the data (feel free in the comments), but I would not be having these thoughts if such obvious typographical errors had not been made.

Another strange detail in the paper, unrelated to its validity – the lack of control groups renders this suspect, is that it makes numerous references to ‘allopathy’.  Now allopathy was a term invented by the founder of Homeopathy, Samuel Hahnemann, to denigrate conventional medicine, as it was then – it implies that conventional medical practices cause unnecessary harm through their treatments.  Its continued modern usage is a shibboleth of alternative medical practitioners who maintain its deregotary usage, its use in this paper indicates that the author may thus have deregotary feelings about conventional medicine.  This is a minor detail unrelated directly to the BCA’s case but it does suggest that at least some chiropractors see themselves as a replacement rather than a adjunct to modern medical practice.

There is also some doubt as to whether or not the BCA even read this paper before adding it to their ‘plethora’.  A correspondent requested the paper from a representative of the BCA, who indicated they had only just received a copy from the AECC chiropractic college – the document does indeed bear an AECC library stamp.I hope the BCA did read this paper prior to issuing their plethora.  To claim that “there is actually a significant amount” of evidence supporting chiropractic without actually having read it would indicate that their position on the stupidity spectrum is perilously close to moving from visibly stupid to ultra stupid.

Thanks to John.

*update*

Colin in the comments points out that:

I poked around a little, and it turns out that Joan Fallen co-founded the organisation that publishes the journal JCCP and she’s been on the board (sometimes as chair) ever since. I’ve got more detail on my blog at http://www.blue-genes.net/2009/07/the-bca-plethora-of-evidence-the-fallon-paper/ . And yes, the stated aim of the ICACCP is to promote the use of chiropractic for children

This is all very incestuous and it does create the question, is this paper part of a lobbying effort to encourage the use of chiropractic for children rather than just research?