29 Jul 2009

Simon Singh's chiropractic article: “Beware the spinal trap”

Many bloggers today are reprinting a slightly altered version of the article on chiropractic Simon Singh wrote for The Guardian. Unlike scientists who defend their claims by discussion in the scientific media, the British Chiropractic Association (BCA) used the method so beloved of practitioners of non evidence based medicine, and sued Simon Singh for libel. There's nothing the alties like so much as a spot of legal chill.

free debate

Like all forms of woo, chiropractic is said to cure/treat autism. Quentin Wilson says it cured his autistic son and he used to be on the telly talking about cars so he should know. His anecdote is used by this UK chiropractic clinic as some sort of evidence of effectiveness.

Chiropractic is one type of woo that has before now, seemed to avoid close inspection from the DCs of the world who excel in exposing pseudoscience, as it seemed more scientific, or at least, sciencey. But the decision of the BCA to apply legal muscle to silence reasonable critique has only drawn lots of people to focus attention on their practices and positions. They are not enjoying the scrutiny.

Simon Singh wrote a decent, informative article and it'd do no harm for more people to read it.
If you agree that the law has no place in scientific disputes, please add your name to the statement.


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.


Lisa said...

If Fox would just let me, I would send you the clip from The Simpsons where Homer uses a bent garbage can to treat people's back problems in his garage; until the Chiropractors come round and rough him and his garbage can up.

Why is it that the alt/health dudes feel so at ease with making the rash generalisations - And good sciencetists must stick to evidence based peer replicated statistics??


Lisa said...


lizw said...

Singh is either intellectually dishonest in this article, or else he has not properly researched his subject. The fatality rate from chiropractic is lower than from NSAIDs, which are the first line of attack that conventional practitioners use against back pain. Are we to take those off the market too - all of them?

Sharon McDaid said...

@Lisa, I've seen that episode. My lot are major Simpsons fans. It's amazing how often that show is spot on in its commentary.

Yep, the alties are always so fast to show up and deride real medicine, which keeps records on such things as side effects and efficacy, and which is discussed openly in journals.

@Lizw, I am not a doctor and know little about back pain and its treatment. I have followed some of the discussion recently about the use of chiropractic and acupuncture and how the benefits of these have been overestimated in the press. Wiser folk than I have given a good explanation of such things. Now if as you say a medical treatment for back pain is dangerous, the way to deal with that is via the scientific literature and health regulators. I don't think anyone should slap you with a libel suit for your claim. Free scientific discussion is to be encouraged.

It's obvious that Simon Singh did research his subject. He has collaborated with Prof Ernst who trained as a chiropractor is writing his book so I'd say he knows his stuff.

Chiropractic said...

Sadly, some new chiropractic patients are dipleased with their initial chiropractic experience because they chose a chiropractor whose approach was not consistent with the patient's wants and expectations.