The random thoughts of a sceptical activist

Profit and loss

I blogged on What the BCA got up to in 2007 some months ago and examined their 2007 accounts, lodged with Companies House.

Their 2008 accounts have just been published. And they make interesting reading. They give details of the BCA’s financial position at 31 December 2008.

To recap, in 2007, the BCA made a profit of £109,531.

In 2008, they made a loss of £85,425 — a drop of nearly £200,000 from the previous year.

What’s been going on? Where did all this money go? Have they been somewhat profligate with their members’ money? Have they been making poor decisions — financial or otherwise?

Well, we know some of it. In 2008, they spent a total of £121,484 on ‘Legal and professional’, made up of £78,146 on Simon’s case, £8,951 on other items in this category and £34,389 on:

…pursuing a case on behalf of a member against the Advertising Standards Authority.

More on that shortly…

The odds are stacked…

In an astonishing statement in the BCA’s Council’s report, they say:

Events since the end of the Year

The action against Dr. Simon Singh has continued and a pre-trial hearing is scheduled for 7th May 2009. Counsel’s opinion is that there is a 75% chance of a successful outcome, which should mean the recovery of legal costs to 31st December 2008 of £78,146 plus the recovery of legal costs incurred subsequently.

It is not clear when that 75% estimate was made. Although the accounts were filed on 14 October 2009, the report of the BCA Council is dated 13 May 2009, just 6 days after Mr Justice Eady gave his ‘Astonishing Illiberal Ruling‘ as described by Jack of Kent. The full ruling can be found here.

I bet the BCA were full of themselves after that ruling and might have been confident that their damaged coffers reputation would quickly be restored. Perhaps 75% was a good estimate of the odds at that time.

Perhaps then. But it’s looking a tad bleaker for them now after Lord Justice Laws granted Simon leave to fully appeal Eady’s ruling on meaning. This means that everything goes back to the start and Simon has another chance to argue what the words meant, this time taking Laws’ very helpful comments about fair comment, the European Convention of Human Rights and public interest into account.

It’ll be some time yet before this is even heard, never mind the actual libel case itself finally settled.

I am not a lawyer, but I find it fairly easy to follow the legal flow of this case. The same cannot be said for a certain Dr Lionel Milgrom, who published that Simon had already lost the case and had to pay substantial damages to the BCA. I don’t know what universe he inhabits…Ah! He’s a homeopath.

Of course, the BCA have a Conditional Fee Agreement, commonly known as ‘no win, no fee’. Like all things legal (and medical and scientific), I think you’ll find it’s a bit more complicated than that, but the BCA are banking — possibly literally — that they win. If they lose, then who knows what state their finances will be in.

The farce that followed the Appeal ruling has been well documented (see BCA Now Alleging Malice By Simon Singh and BCA Defame Simon Singh) and this may have a bearing on what the BCA do next, but they have put themselves in an unenviable and precarious position as their accounts show. Their General fund stood at £753,075 at the start of this year, down over 10% on the previous year. Goodness knows what losing the case will do to those funds, particularly since 60% of that is tied up in the freehold property they own.

Talking of farces, I just have to point out Dr Alun Salt’s utterly brilliant and scathing demolition (The extraordinary research of the BCA) of the BCA’s bogus claims of the origins of chiropractic:

It would seem that the BCA have access to some previously unknown examples of Chinese writing

the BCA’s website is as amazing as discovering your neighbour has built a time machine in her garden shed

However, we’ll just need to wait and see what they do next in their libel case.

A plethora of figures

In many ways, apart from the legal costs, the BCA accounts aren’t that much different from the previous year.

I have previously mentioned that they spent a very round £50,000 on ‘Research’. Amazingly, they managed to spend exactly the same amount on ‘Research’ in 2008 as well, although they don’t say what research they actually did and whether it was any more than customer satisfaction surveys.

Although they had the same number of staff, their staff costs increased by over 9% to £194,000 and their honoraria payments were up 12% to £88,000.

Public relations costs were up 20% to nearly £125,000, but it’s not clear what this was spent on.

Taking on the ASA

Going back to that intriguing snippet about the £34,000 spent pursuing a case against the ASA on behalf of one of their member. They give no further information on the case, so a little digging is required.

I have to assume that this refers to an ASA complaint that was brought against a BCA member and that it resulted in an adjudication. I will also assume it was a case in 2008. Looking through the ASA’s adjudications for that bumper year for chiropractors losing ASA adjudications, I suspect the BCA are referring to the two BritChiro Clinics cases. Although I’ve mentioned this case before, it’s worth going into more detail.

The chiropractors at BritChiro Clinic are all BCA members and it looks like the kind of thing a trade body like the BCA would try to defend on behalf of some of its members. Indeed, these cases alone have serious implications for all chiropractors, given the nature of the complaints made against this clinic and the ASA adjudication against them. The second adjudication they lost was from a chiropractic competitor about their use of the title ‘Dr’, but was not upheld.

By far the more serious adjudication was the one published originally on 28 May 2008 and then revised on 17 September. The complaints were:

1. The Carlton Clinic challenged whether the ad misleadingly implied that the practitioners listed held general medical qualifications.

2. The ASA challenged whether the ad offered treatment for serious medical conditions without the supervision of a doctor or suitably qualified health professional, and

3. whether the treatment was proven to be effective for the serious medical conditions listed, as implied by the ad.

I originally assumed that the complainant, the Carlton Clinic, was a chiropractic clinic, but it may be that they are osteopaths. There is a Carlton Clinic just down the road from BritChiro, both near Gatwick Airport. However, who they are is irrelevant. What is important is the ASA adjudication.

The original adjudication against BritChiro was made in May 2008 and was on the first two of these complaints. The ASA ruled against both. However, I assume the clinic, possibly backed by the BCA, appealed the ASA adjudication. The ASA revised their decision and the second time around did not uphold the second complaint, saying:

2. Not upheld

We noted that all BritChiros practitioners were suitably qualified and subject to regulation by a statutory body, the General Chiropractic Council. We therefore concluded that the treatments on offer were conducted under the supervision of a suitably qualified health professional.

On this point, we investigated the ad under CAP Code clause 50.3 (Health and beauty products and therapies – general) but did not find it in breach.

A win for chiropractic — the ASA consider them to be ‘suitably qualified health professional’ because they are ‘suitably qualified and subject to regulation by a statutory body’. No comment was made on the standard of that regulation.

A win, except for the fact that the ASA added the third complaint this time, questioning whether there was proof that chiropractic was effective for the conditions listed. A pyrrhic victory for the BCA indeed.

The clinic supplied a load of documents in their defence:

They sent the ASA a large number of journals and studies that they believed showed the efficacy of chiropractic in treating the listed serious medical conditions: whiplash, arthritis, migraine and chronic pain. The evidence mainly consisted of articles published in journals such as the British Medical Journal (BMJ), the Journal of Manipulative and Physiological Therapeutics (JMPT) and the Journal of Chiropractic Medicine. Some studies took the form of randomised controlled trials consisting of a large number of subjects; others took the form of case studies that focused on the effects of treatment on one patient.

BritChiro nevertheless agreed to remove the reference to chronic pain from future ads.

…and that’s even before the ASA made their adjudication!

So did this plethora of articles, even some published in the prestigious British Medical Journal, convince the ASA that chiropractic was effective for the conditions the clinic was claiming?

We noted the ad made references to conditions that were considered serious by the CAP Help Note on Health, Beauty and Slimming Marketing that Refers to Ailments: whiplash, arthritis, migraine and chronic pain.

We considered that the evidence submitted about migraine supported the efficacy of chiropractic in treating that condition. We therefore considered that BritChiro could continue to refer to the treatment of ‘migraine’ in future ads.

As we already know, the ASA will accept claims for migraines (but not headaches).

The clinic wheeled in their expert (presumably from the BCA) and the ASA consulted theirs. The ASA asked their expert:

…to assess the evidence BritChiro submitted in support of the treatment of whiplash and arthritis. Our expert concluded however that the studies were not sufficient to support efficacy claims for either condition.

Responding to this:

BritChiro’s independent [sic] expert concluded that the evidence for whiplash showed that chiropractic was effective in treating that condition, but was not effective in the treatment of arthritis.

So, chiropractic is effective for whiplash? Unfortunately, he concluded:

…chiropractic is effective (as opposed to doing nothing) in the treatment of whiplash

The best evidence they could muster for whiplash is that it is only better than doing nothing. Hardly a resounding success — and the placebo effect might be the reason for that.

Well, maybe chiropractic fares better for osteoarthritis? The clinic’s expert said:

The evidence for the treatment of osteoarthritis is less good … Chiropractic could rationally be seen as an adjunctive and not primary treatment for osteoarthritis

Less good that that for whiplash? Oh dear.

Their expert tried to launch a pre-emptive attack on proper trials and placebos:

With regards to clinical trials he stated “Bearing in mind that it would probably not be possible to produce an ideal chiropractic placebo … it would be very difficult to assess the specific efficacy of chiropractic.” He also stated “While … there are some placebos which have been “suggested” for trials of chiropractic, they are not properly validated or convincing or currently completely methodologically sound.” and that it was “misleading to suggest that placebo controlled trials in this area are simple, possible or reasonable at the moment … There is so much debate about what constitutes a placebo in the context of a physical intervention … that it is almost impossible for us to define a placebo in this context.”

In the light of this, one has to wonder whether any of the BCA’s £50,000 was spent on trying to validate chiropractic placebos or researching decent trials?

BritChiro agreed to remove references to arthritis from their ad.

They protested about whiplash:

They nevertheless asserted that, because chiropractors who were registered with the GCC were suitably qualified health professionals for the purposes of CAP Code clause 50.3 and because the evidence supported the efficacy of chiropractic as a treatment for whiplash, they should be allowed to continue to refer to that serious condition.

However, there was a slight problem with the evidence for whiplash:

Our expert pointed out that BritChiro’s evidence for whiplash and arthritis failed to include controlled clinical trials and therefore had no control for a placebo effect.

“Collectively, this evidence fails to demonstrate the effectiveness of chiropractic for whiplash injuries.”

Dismissing the clinics protestations about placebo controls, the ASA’s expert said:

“The following forms of sham have been used in clinical trials of chiropractic manipulation: non-therapeutic manipulation at the site of subluxation, therapeutic manipulation at the site of no subluxation, non-therapeutic manipulation at the site of no subluxation. These sham interventions might not be ideal placebos in every respect but they do exist and have been employed in clinical trials to minimize bias.” He added that, “Even if we accept that [clinical studies] cannot be rigorously placebo-controlled, there is no reason whatsoever why a controlled trial of chiropractic versus either no treatment or a standard treatment would not be feasible.”

Presumably the clinic was unable to answer this, so the ASA concluded:

We therefore concluded that the evidence submitted by BritChiro fell short of the standard required by the CAP Code.

We welcomed BritChiro’s decision to remove the references to arthritis and chronic pain from their ads but concluded that the reference to whiplash should also be removed.

Was the BCA’s £34,000 well spent? They certainly won on one of the points, but we now have an ASA adjudication that they have not seen evidence for the efficacy of chiropractic for whiplash, arthritis, chronic pain.

In the light of this, why are so many BCA members still making such claims?

In 2008, they spent a total of £121,484 on ‘Legal and professional’, this £78,146 on Simon’s case, £8,951 on other items in this category and £34389 on:

…pursuing a case on behalf of a member against the Advertising Standards Authority.

More of that later…

6 Responses to Profit and loss

  • Those legal costs only go up to the end of December 08. I’d imagine their costs for the Singh case in 2009 are significantly higher.

  • “…why are so many BCA members still making such claims?”

    To pay for their BMWs.

  • I emailed a copy of the 2008 accounts and report to some one who pointed out you had already blogged about them.

    Given the recent victory by Simon Singh in his appeal the BCA’s chances of victory are now greatly reduced.

    According to regulations, I think they will now have to make some kind of provision in their accounts for the fact they may not recover the legal fees. Presumably they have taken professional advice from their auditors and accountants.

    Their income from membership fees was about £1.7 million so I can’t set how they can continue spending money on legal fees without upseting their members.

    Under the Insolvency Act 1986 directors have duties not to drive their organisations to economic ruin. It will be interesting how they resolve this. Possibly we will see some of the directors resigning over the next few months.

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