Thomas Wakley: relevant to today's society
Authors: Michael Baum
Journal: Journal of the Royal Society of Medicine (2009)

Roger Jones' essay on the turbulent life and the turbulent times of Thomas Wakley, the founding editor of The Lancet, is a racy story and a very entertaining read.1 However as far as I'm concerned there is still a lot to learn from the life and times of Wakley that is relevant to today's society, both lay and scientific.

Of course much has improved since the early 19th century for which we must be truly grateful. The profession is governed, regulated and disciplined by a GMC that is increasingly pro-active. Evidence-based medicine (EBM) is the rule rather than the exception, and in the last 50 years we have witnessed real advances related to both clinical practice and public health interventions, that are reflected in reductions in infant mortality and increases in expectation of life.

In 1950, the UK experienced 26,000 infant deaths; that has fallen by 80% at the time of writing.2 Today an average woman can expect to live to 79 years, which is twice the life expectation at the time Queen Victoria came to the throne in 1837.2 Worse still, in Wakley's day the expectation of life among the working class was often under 20 years.2 Life was short and brutal, and little that medicine had to offer could improve on these cruel facts. I would even go further and suggest that medicine in those days added to the cruelty rather than offering palliation or cure. Purgation, bleeding, poisonous potions and crude surgery without anaesthesia or antisepsis, only added to the sum of human suffering.

It is no wonder therefore that many of the alternatives to conventional practice, such as homeopathy, founded by Samuel Hahnemann (1755–1833) or chiropractic invented by Daniel David Palmer in 1895, that had little to offer in efficacy but were at the least mostly free of toxic side-effects, flourished at the outset. Yet the lay public is fickle and has a short memory. There are many today, aided and abetted by the celebrity culture, who deny progress, invoke a golden age that never was and contribute to a momentum that heralds the dawning of the age of ‘endarkenment’. Homeopathy whose success at birth was a result of the principle, not that like cures like, but rather that nothing was better than something, is enjoying a renaissance in spite of existing in an evidence free zone,3 yet in the modern era, for most maladies, something is most certainly better than nothing. As far as chiropractic is concerned, we are witnessing a return to the bad old days described in Jones' essay, where battles are played out through the courts rather than through the scientific journals.

You may be familiar with the case of Simon Singh versus the British Chiropractic Association (BCA). Simon Singh has a PhD in particle physics at Cambridge University and was a director and producer in the BBC science department. After leaving the BBC, he wrote a series of bestselling popular science books, such as Fermat's Last Theorem, The Code Book and Big Bang. In 2003 he received an MBE for services to science education and communication.

In April 2008, he wrote an article for The Guardian that focused on chiropractic. The article also coincided with Chiropractic Awareness Week, which was organized by the BCA. The article discussed the history of chiropractic and the founder's belief that manipulating the spine could treat 95% of all diseases, because disease was supposedly caused by blockages in the flow of innate energy along the spine and through the nervous system.

In particular, he wrote about the likely risks of chiropractic treatment and whether or not there is any evidence that it is effective for various childhood conditions, including asthma. The BCA claimed that he had defamed their reputation and sued for libel.

On 7 May 2009, there was a preliminary hearing at the Royal Courts of Justice. Sir David Eady, the presiding judge, decided that the article contained ‘the plainest allegation of dishonesty and indeed it accuses them (the BCA) of thoroughly disreputable conduct’. Singh is now considering taking the case to appeal at the personal risk of financial ruin. For a full description of the case and an opportunity to join the campaign ‘Keep the libel law out of science’, log in to the web page http://www.senseaboutscience.org.uk/index.php/site/project/333/.

The BMJ has taken up the case and issued a challenge to the BCA to produce their evidence that chiropractic might, among other systemic disorders, cure childhood asthma.4 Richard Brown, on behalf of the BCA, rose to the challenge, claiming that their was substantial evidence for efficacy.5

A Thomas Wakley is needed today to stand up for reason and prepared to thicken his skin against the slings and arrows of outrageous fortune. Perhaps Simon Singh is that man.