In the company of woo

I find myself in the company of woo, and as a skeptic it is bringing me some grief.

It's all about homebirth - planning to deliver a baby at home, attended by a midwife, rather than in a hospital.

Deena and I came to homebirth through an examination of the evidence. (Here's a discussion I participated in on the Bad Science forums before Kaia's birth.) We were convinced, by scientific studies and analyses, that planning a home birth here in the UK was at least as safe as planning a hospital birth, given a competent attendant and a handy hospital in the event of complications. So we went for it.

However, many people choose homebirth for less evidence-based reasons. They cite personal intuition, or the "naturalness" of it. Not just as reasons to prefer homebirth, but as evidence of its safety.

At Edinburgh's Pregnancy and Parents Centre (a haven for various types of woo, as well as useful support groups and great toddler activities), when we went to the "home birth support group" to relate our experiences and our evidence-based approach, it was alongside others promoting woo of various flavours as part of their support of homebirth.

A recent post on homebirth at Science-Based Medicine has stirred up an epic-length discussion, with passionate defenders on both sides. I've participated, but fear that just being on the homebirth side has made me, in some people's eyes, an advocate of woo.

This is the problem: I agree with the woo-birthers that homebirth can be safe, but I disagree (passionately, vigorously) about why this is a legitimate position. And the disagreement isn't immaterial. At the homebirth meeting, someone recommended homeopathy to treat post-partem haemorrhage. One of the most serious and potentially life-threatening complications of pregnancy, and she advised drinking high-priced water. That is dangerous advice, and I wish I'd been quick-thinking enough to respond persuasively (rather than sitting like a lump and grinding my teeth).

What is a skeptic to do? On the one hand, having someone agree with me in one breath, and back me up with an appeal to intuition in the next, makes me want to revisit and question my beliefs that much more carefully. (That's something a skeptic should be doing anyway, for all their beliefs, but who has the time?) On the other hand, to adapt Niven's 16th law, "There is no belief so true that one cannot find a fool believing it." Just because someone agrees with you for bad reasons doesn't mean you're wrong. I came to my belief about homebirth on the basis of the science, and I'm determined that only science will dissuade me.

But there's also the whole social side. Just as many of my fellow atheists wrinkle their brows at me when I say I go to church, many skeptics seem to do the same when I talk about homebirth. Atheists often assume that the word "church" is synonymous with supernatural beliefs and submission to a holy text, things that would feel alien in our Unitarian church. Similarly, many skeptics assume that, because it's associated with modern medicine, hospital-based birth is inherently safer.

I'm tempted to close by declaring, evangelist-style, that skeptics must beware of this tendency to take association as evidence. Its association with woo-birthers says nothing about the safety of homebirth; nor does its association with high-tech hospitals demonstrate the superiority of hospital birth.

But perhaps a more humble conclusion is in order. Here goes:

I promise to keep vigilant for evidence that might contradict my current beliefs.
I promise to honestly communicate any changes of position that such evidence might lead me to.
I promise to avoid being swayed by other people's assumptions (whether or not they are skeptics).
I promise to make every effort to pin my beliefs to the evidence, and nothing else.

Homeopathy at Boots: an open letter

In a move reminiscent of the very successful Australian Skeptics open letter to pharmacists, the Merseyside Skeptics Society has issued an open letter to Boots pharmacies.

This is in the wake of a parliamentary subcommittee meeting on the status and labelling of homeopathic remedies sold in pharmacies ("chemists" in this country). If you have time, check out the transcript here - a long but interesting read. (Thanks to Mike for the heads-up.) Here's Ben Goldacre's summary, as one of the people who gave evidence at the meeting.
Boots sells homeopathic products. By association, it lends medical authority to these products - which have been demonstrated, so far as good research is able to demonstrate, to be medically indistinguishable from placebos. That is, they are not real medicine, and do not replace real medicine. The will not protect you from malaria; they will not protect you from H1N1. They won't even cure your headache. If your headache does get better after homeopathy, there are three much more likely explanations: (1) it was a random coincidence (unsatisfying, but sometimes the world works that way), (2) it was going to get better anyway (you can't tell this from a single case, but a large study of many people could), or (3) your belief in the treatment had a real effect on your malady (a very cool possibility - see Ben Goldacre's book Bad Science for more, or go read his blog).

Though they sell them, the Boots representative who spoke to the committee admitted that homeopathic treatments have no good evidence supporting their effectiveness in dealing with any health complaint. His best argument for selling homeopathy comes out in this excerpt from the start of the transcript:

Mr Bennett: We do indeed sell them and there is certainly a consumer demand for those products.

Q4 Chairman: I did not ask you that question. I said do they work beyond the placebo effect?

Mr Bennett: I have no evidence before me to suggest that they are efficacious, and we look very much for the evidence to support that, and so I am unable to give you a yes or no answer to that question.

Q5 Chairman: You sell them but you do not believe they are efficacious?

Mr Bennett: It is about consumer choice for us. A large number of our consumers actually do believe they are efficacious, but they are licensed medicinal products and, therefore, we believe it is right to make them available.

Q6 Chairman: But as a company you do not believe that they necessarily are?

Mr Bennett: We do not disbelieve either. It is an evidence issue.

They don't have good evidence that they work, but people want to spend money on them. This is a disgustingly cynical attitude toward the public, and toward Boots pharmacists' own responsibility as front-line dispensers of medicine.

I include the open letter below. I will also be contacting Boots. If you are interested in this issue, I encourage you to do the same.

An Open Letter to Alliance Boots

The Boots brand is synonymous with health care in the United Kingdom. Your website speaks proudly about your role as a health care provider and your commitment to deliver exceptional patient care. For many people, you are their first resource for medical advice; and their chosen dispensary for prescription and non-prescription medicines. The British public trusts Boots.

However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies – many of them bearing the trusted Boots brand.

Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?

The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.

We don’t expect to find products on the shelf at our local pharmacy which do not work.

Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.

We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?

The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.

Yours sincerely,
Merseyside Skeptics Society

-----

Other blogs and websites have noted this, including Skepchick, The Not Quite So Friendly Humanist, Bruce Hood, Bad Science, A Glasgow Skeptic, RichardDawkins.net, Bad Homeopathy, and New Humanist.

Also, various newspapers have picked up on Boots' strange position: The Telegraph, Daily Express, Daily Mail, Guardian (and Ben Goldacre again, and their liveblog of the meeting), Times, and Mirror.

Feel free to comment and link to any I've missed.

Healthy newsreading

Very closely connected with humanism is scientific skepticism. I doubt there are many (secular) humanists who wouldn't also identify with the skeptical movement, exemplified in popular science blogs like Bad Science, podcasts like the Skeptics Guide to the Universe, and books by folks like Simon Singh.

Keep in mind, I'm not talking skepticism as in "kneejerk doubt". I'm talking skepticism as in "I'll believe it if you show me good evidence" - the definition most self-described skeptics would give. Much of skepticism involves learning how to tell good evidence from bad evidence.

One of the greatest day-to-day benefits of being a skeptic is having the skills to filter the claims we're exposed to. Particularly those that get uncritically spread by journalists (and by friends and family). To that end, in addition to recommending the above sources, I'd like to pass on an article that was passed on by Ben Goldacre at Bad Science:

How to read articles about health, by Dr Alicia White

The most important rule to remember: “Don’t automatically believe the headline”.

Of course, there's much more - read the full article to see what else she has to say. Skeptics will already be familiar with her points, but other people may find them useful. Pass on the link, or download and print off the PDF and pass that out.

I'll take this opportunity to point out that it is simple little strategies like the ones Dr White outlines that make up most of scientific literacy. People often tell me that they would never be able to understand things like quantum physics, evolution, or acoustics, because they're not scientifically trained.

Rubbish. The only barrier to most people understanding the key points of any science is lack of interest.*

And, when it comes to health, that's a rather strange barrier to erect around yourself. What possible excuse could anyone have for cultivating disinterest in their own well-being? (I know, I know - whole psychological schools of thought are devoted to answering this question.)

Anyway, enjoy the article.

Footnote:

* Okay, that was a very strong claim. But I stand by it, with one caveat: one must have a teacher (or book) with some competence to communicate the science.

I have an idea ...

At work, I recently came across an amazing resource: CiteULike. It's a free website where you can build up a list of citations. I use it to manage the long list of papers and books I read and cite as a researcher. I can label citations, like I label blog entries on this site, according to common themes.

It also has social features: sharing citations between users, getting automated recommendations based on common research interests. And there are Groups.

Which gives me an idea.

There are loads of skeptical blogs out there. There are the science-based parenting folks (such as SBP themselves, Rational Moms), the science-based medicine gang (SBM, Ben Goldacre, etc), and of course the general skeptics (Bruce Hood, Massimo Pigliucci, Richard Wiseman, and loads more).

These blogs often bring up new or interesting research that bears on our lives - as parents, as users (and taxpaying supporters) of health care, and just as people trying to navigate the modern world. But finding a particular study that I remember reading about on some skeptical blog can be a real pain.

So it occurs to me - why not set up a group, or a set of groups, on CiteULike, where skeptics could post scientific articles of interest to the community? You can put notes on each article - for example, pointing to reviews on skeptical blogs. You can talk about the articles (and the body of evidence around given topics, like acupuncture or spanking) in forums. You can associate informative tags with articles. Or you can simply hang out and see what other people have dug up. The resource could be used by bloggers who like to check original research, and also by skeptical consumers of new and traditional media claims.

It's not something I can do on my own. I don't have the time or the expertise to dig up all the relevant papers.

So this is a call to all you skeptics out there who have a little bit of time or expertise. Are you willing to help get things started?

I've taken the first step: I've created a CiteULike group, Skeptical Parenting, to pilot this idea. I chose parenting partly because that's where I am closest to having some substantive expertise, and partly because my second child is due to arrive any day now.

The next step is up to you. Here is what I ask of anyone who is interested:

• Join me as a member of the group, or start another group. "Paranormal Research", "Science-Based Medicine Users" - whatever you're most into as a skeptic. If you start another group, let us know in the comments here. (Do a search on CiteULike before starting the group to make sure someone hasn't already started one.)
  
• Blog about this yourself - not many people read my blog, but some of you have very widely-read blogs. The more people read about this idea, the sooner we'll reach a sustainable number of participants.
• Tell your friends. We don't all have blogs, but we all have skeptical acquaintances on- and off-line that we can share cool new ideas with.
  
• Comment here, so I know that I'm not just talking to myself.

I think we could build this into a really valuable resource. What do you think?

WHO rejects homeopathy

The WHO has publicly stated that homeopathy is not a good way to treat serious diseases such as tuberculosis, malaria, and HIV. This is excellent. Placebo and hydration are the only medically-measurable effects that homeopathic "remedies" exhibit, and these are not effective in combating serious diseases. It is encouraging that an international health body like WHO is willing to publicly side with the evidence on this.

Thanks to Steve Novella at Neurologica for this bit of news.

Spinal Trap rebroadcast

On Wednesday, a large number of online and print sources showed solidarity with Simon Singh by reprinting his critique of the British Chiropractic Association. They have removed the allegedly libellous portions - I invite you to read them, then the original, and decide whether the substance is different.

Here is a list of blogs that have reproduced the article, as compiled at Sense About Science.

Although I'm late joining in, I hereby offer the same service: a reproduction of the original article. Like most others, I'm omitting the allegedly libellous lines.

Let me be clear: I do not think they are libellous. I think the BCA's case is a cowardly attack meant to silence a critic, not a legitimate attempt to protect itself from malicious falsehoods. But I do not have the means to mount a defense should the BCA come after me. In my case, their cowardly tactics work. (That is one reason why the law must change.)

But, as I said, I think the substance of the article is unchanged by the omission (further evidence of the ridiculousness of their accusation). So here it is, as presented on the Sense About Science site:

Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results - and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that '99% of all diseases are caused by displaced vertebrae'. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer's first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying - even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense 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.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: 'Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.'

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher. If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

When ridicule is all an idea deserves

Check out this awesome video of an Irish comedian, on alternative medicine and affiliated topics (thanks to Mike, The Not Quite So Friendly Humanist, for pointing it out):

Science, skepticism, and chiropractors

In an apparent response to the great indignation stirred up by their libel suit against Simon Singh (which I have blogged about already, here and here), the British Chiropractic Association has put forth another defense of their actions (and their profession). This time, it takes the form of a letter to the British Medical Journal written by BCA vice-president Richard Brown. It is freely available on the BMJ's website, alongside a thorough critique by Edzard Ernst (professor of complementary medicine in Exeter) and an editorial by Fiona Godlee of the BMJ.

Brown claims that the BCA didn't want to sue Singh, but he left them no choice when he refused to retract his original article. That's the one that claimed the BCA promoted chiropractic as a treatment for childhood conditions when there is no good evidence that it is effective. He lists several studies, claiming that they demonstrate the effectiveness of chiropractic for "various childhood conditions." In effect, his letter suggests that they have evidence to support their medical claims, but that it is appropriate to sue someone who criticizes those claims (rather than simply presenting the evidence, as they were invited to back when Singh's article first came out).

Ernst doesn't address the legal or political issues at all, instead producing a thorough and easy-to-follow demolition of the studies that Brown puts forth - each of which is either irrelevant to the claims being debated or is of insufficient quality to count as substantial evidence. He also points out that "At least three relevant randomised controlled trials and two systematic reviews are missing from [Brown's list]." That is, not only is the BCA's evidence base of poor quality - they rely on it while ignoring good evidence that the interventions don't work.

Godlee's editorial provides a good summary. Remember that this is comment from an editor of one of the most prestigious medical journals around. It's titled "Keep libel laws out of science." (Sound familiar?) It is a masterful piece of writing, so you ought to read the whole thing. But here are some of the more delightful bits:

I hope all readers of the BMJ are signed up to organised scepticism. It’s not a blog, but it could be. It’s one of the four principles of good science as articulated by Robert Merton nearly 70 years ago.

The Guardian offered the BCA an opportunity to lay out their evidence rather than to sue him for libel. The BCA opted to sue.

Readers can decide for themselves whether or not they are convinced [by the evidence presented by Brown]. Edzard Ernst is not. His demolition of the 18 references is, to my mind, complete.

Weak science sheltered from criticism by officious laws means bad medicine.

And naturally, she echoes another medical journal editor who was faced with similar bullying recently:

And last year when chiropractors threatened to sue over an article in the New Zealand Medical Journal, its editor Frank Frizelle spoke for all of us when he asked them to provide "your evidence not your legal muscle."

As Chris Kavanagh points out in his post on this (where I learned about this latest development), the BCA has yet again failed to vindicate themselves in any way. They have at last presented their evidence in a forum where its actual quality matters, rather than its superficial plausibility. Which is good - they should have done this in the first place, rather than stooping to the level of legal bullying. But the fact is that their evidence is poor. Very poor. The fact is that Simon Singh was right in his original article. This was bound to come out when the issue made it to a scientific journal.

I don't know if this will have any effect on Simon's case - after all, that is based on a fundamentally bad law, and does not (as far as I know) depend on the quality of the scientific evidence. But perhaps it will help people see through the veneer of medical respectability that chiropractors try to project.

Homeopathy awareness

Steve Novella at the Neurologica blog just pointed out that this is the British Homeopathic Association's "Homeopathy Awareness Week".

He is right - I think we all need to be more aware of just how homeopathy can affect our lives. I encourage you to read Steve's post, which gives a quick history and an overview of what homeopathy entails. (See also the Science-Based Medicine blog.)

I also encourage you to look at what the carefully-assembled evidence from multiple scientific studies has to say about homeopathy. I recommend Ben Goldacre at Bad Science for this - here's a list of his Bad Science blog posts about homeopathy, and here's a particularly good overview. Also, anyone who can't imagine that their experiences with homeopathy could be "just placebo effects" should really listen to his two-part programme on the BBC about the placebo effect. You don't need to look to homeopathy for some mind-blowing, magical-seeming effects. There's plenty in the real world of scientific medical research. And read his book, Bad Science.

Bottom line: Real medicine is about proving something is safe and effective, and abandoning it as soon as it is shown to be either unsafe or ineffective.

Alternative medicine is about believing something is safe and effective, and rejecting, ignoring, or suppressing any evidence to the contrary.

It hurts people. It hurts people because alternative practitioners encourage distrust of real medicine in general. It hurts people because they take homeopathic treatments instead of real medicine. See for example this tragic story about Gloria Thomas Sam, a nine-month-old girl who died horribly because she was given homeopathic treatment rather than real medicine for eczema. Eczema!

Real medicine isn't infallible. But its researchers abide by strict rules of evidence: something must be proven both safe and effective before it is used in medical practice. Real medicine is self-correcting.

Homeopathy, and most alternative "medicine" modalities, are not self-correcting.

I encourage everyone - adherent, opponent, and uninterested layperson - to become a little more aware of homeopathy this week.

Photo credits:

Bad Science cover art from Bad Science blog (assumed fair use).

Water memory poster from Hell's News Stand (adapted from a less politely-worded version; also available with a G rating). Published with invitation to redistribute.

Singh fights on

The sceptical blogosphere is abuzz with delight at the news that Simon Singh, respected science writer, will be going forward with his legal defense against the British Chiropractic Association's accusation of libel.

For the basic story, see my earlier post or just do a web search for Simon Singh and BCA. Jack of Kent is keeping pretty detailed track of things from the legal perspective.

Also, check out the Sense About Science website. In support of Simon and to help prevent similar travesties in the future, they have begun a campaign to keep libel laws out of science.

They're calling it "Keep Libel Laws Out of Science". Nice title - it's quirky, but catchy. Here's a graphic that they're encouraging others on the web to put up:


If you have a website or blog, please help promote this appeal. Also, don't forget to sign the statement. (This is separate from the petition I linked to in my previous post.)

Photo credit:

Portrait of Simon Singh from the British Science Association website.

Science, Chiropractic, and libel laws

Scientist and author Simon Singh is in a spot of trouble. His crime is writing a strongly-worded article on the lack of evidence for several claims made by the chiropractic profession. In it, he criticizes the British Chiropractic Association's (BCA) promotion of chiropractic treatments for certain conditions:

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.

Note that he's not name-calling here. He's making a claim - that certain treatments promoted by the BCA have no good evidence behind them - and backing it up with data. (Here's an Amazon link for the book he mentions.)

So why is he in trouble then? Surely stronger (and less well-evidenced) claims are made in the media all the time.

Rather than try to refute his claims on scientific grounds - perhaps by submitting a counter-article - the BCA responded by crying libel. They have taken advantage of the ill-designed and internationally condemned libel laws in the UK, tying Singh up in expensive proceedings which are already going against him.

Specifically, the BCA is complaining about the word "bogus". The judge at the preliminary hearing agreed with the BCA that the word implied that the BCA knowingly promoted unproven treatments. I'll leave it to more savvy linguists to address the dramatic ridiculousness of this interpretation - or read Singh's article (linked and excerpted above) to see for yourself.

Basically, the BCA's original claims are factually wrong;, and Singh's critique was proportionate to the evidence, with no evident desire to exaggerate the facts in order to damage the BCA's reputation. Is he being sued only because the BCA doesn't like to be criticized? It looks like it. As a British taxpayer, I do not think that deserves my tax dollars. The case should be thrown out, and the BCA should pay expenses to Singh, plus a penalty for wasting the court's time.

But I'm not the judge. And even if I were, British law is skewed massively in favour of the accuser in libel cases - particularly if the accuser is rich.

Which is very worrying. Does British law value the tender feelings of professionals over free speech? Do we want honest, evidence-based criticism to be trampled on in favour of wealthy interest groups?

The judgement in the preliminary hearing feels like a blow against free speech, science-based journalism, and common sense, there is cause for hope. Check out these links for extensive roundups of the case and the coverage it has gained in the mainstream media and the blogosphere. Between the BCA's bullying behaviour, the bad law, and the ridiculous linguistic inclinations of the judge, they are likely to end up looking even worse (and Singh even more noble and valiant) than if they'd just let the article sink into yesterday's news.

If you live in the UK and are as disturbed as I am about how Britain's unjust libel laws can be and are used to silence important exercises of free speech, then sign this online petition. It will be seen by MPs. In conjunction with the increasing media coverage, a petition like this might actually motivate them to reform the libel law in this country.

And, since that won't change things in the short term, let's make some noise in support of Simon Singh. Here are some other bloggers that are keeping an eye on the situation:

• Mike, the Not-Quite-So-Friendly Humanist
• Ben Goldacre, the Bad Science dude (who recently had his own run-in with spurious libel accusations)
• Hemant, the Friendly Atheist
• P.Z. Myers, of Pharyngula
• And again, check out the roundups at God Knows What [+ update] and Holford Watch for comments and links to dozens of other articles and discussions of this situation.
  

Here is a Facebook group for supporters of Simon.

I would also like to extend kudos to the Guardian newspaper, for supporting Singh in this fight (and Ben Goldacre before him). The little-guy-against-the-giant image may be inspiring, but in real life it's good to have slightly more even odds. Good for them.

Sacked for being Christian?

Nurse Caroline Petrie has been suspended from her job as a part-time community nurse in a primary care trust in Somerset for offering to pray for an elderly patient, according to the Telegraph. This has been picked up by religious commenters, including Cath (whose blog first alerted me to the news item) and Cranmer.

Naturally, they (and many of their commenters) are appalled at this apparent overreaction by the trust. They are inclined to blame anti-Christian sentiment, or excessive political-correctness.

But they should be careful not to overstate the oppression that the actual incident implies. We are all prone to falling into a persecution mentality. For some further, highly relevant context, consider the following details. (I'm getting these from the Telegraph article, with corroboration from the Daily Mail.)

This was not an isolated incident. Mrs. Petrie regularly offers unsolicited prayers (formerly including handing out prayer cards). She has been reprimanded for this before, and has been told "you must not use your professional status to promote causes that are not related to health." That is a fair and relevant guideline. (It seems she stopped handing out the cards after that.)

She remembers, "I was told not to force my faith on anyone but I could respond if patients themselves brought up the subject [of religion]." So she is not to proactively offer prayer, but may offer prayer if asked by the patient. Again, a fair guideline that balances her professional responsibilities with her religious freedom.

Mrs. Petrie says "I only offered to pray for her because I was concerned about her welfare and wanted her to get better."

Well, prayer has been tested and has failed the scientific tests that we require of all medical interventions. She has every right to her religious beliefs, but she has an obligation to respect the boundary between the standard of evidence required by her profession and that she needs for her faith. If I were her patient, I'd be nettled at an offer of prayer for this reason. I want my health care professionals to be focusing on proven and effective techniques, not disproven supernatural techniques.

(Deena points out to me that Mrs. Petrie could easily just pray for patients anyway, and not mention it to them. Surely that satisfies both her beliefs and her professional guidelines.)

She says "[husband] Stuart and I have decided to put God first in our lives." That's their choice. But extends it into a choice to disregard reasonable guidelines of professional conduct. It is hardly persecution to be suspended for failing to follow those guidelines, after fair warning.

So she was given reasonable guidelines about the appropriate way to include her personal, non-medical beliefs in her professional, medical life. She was warned by her employer. And she decided to disregard the guidelines and the warnings. The trust's reaction is appropriate; Mrs. Petrie is not being discriminated against.

It looks like the Christians in this case are upset, not because their beliefs are being marginalized, but because they are not being given preferential treatment. (This is particularly apparent in some of Cranmer's statements.)

I have to remind them that this country still has an established church that holds seats in parliament (among other appalling privileges). How would you feel to live in a country where, say, Hindus had such a legislative advantage, if they began complaining because they were not being given special dispensation to promote their religion as they went about their publicly-funded roles?