Simon Singh and Chiropractic

Right, haven’t posted since forever, have a huge backlog of books, realistically I’m never going to review them (although there is one that I’ve had a few derogatory thoughts about that I’d definitely like to mention), but this is a cause pretty close to my heart and they’re asking anyone with a blog to post on it.  I know no-one reads this, but the more the merrier.  Showing solidarity  counts.

Quick background (and a much more comprehensive, intelligent and funny summation of the situation than I could ever give can be found here).  A scientist and author called Simon Singh who rights excellent, easy-to-read books about hard-to-understand subjects such as cryptography, the big bang and Fermat’s Last Theorem, wrote an article on chiropractic in the Guardian newspaper.  The British Chiropractic Association took exception to some of the comment within this article, specifically the following two sentences:

“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.”

Bless their craven, supposedly free-speech supporting cold, black hearts, The Guardian promptly pulled the article in its entirety.  The BCA, sniffing victory, asserted that they had no beef with the newspaper and were instead suing Simon Singh independently.  We have some deeply insane libel laws in Britland, and a deeply peculiar judge called Mr Justice Eady who is well known for upholding very dodgy claims, such as this, and, particularly reprehensibly, this. When Singh called the BCA’s bluff and fought their action he unfortunately fell foul of these lawas and that judge and lost.  And so Singh launched an appeal, using his own money (well into six figures), and fought back.  He’s like Revenge of the Nerds in a single, interestingly coiffed package.

Whether Mr Justice Eady is wildly out of control in other rulings is a subject for another day but I, along with a huge proportion of the science community, are vehemently opposed to allowing libel laws to dictate what can and can’t be stated in a scientific context.  A campaign was set up to support Singh and hopefully bring about a change in libel laws such that actions like these can never be brought again.  Please take a look:

Sense About Science

Anyway, there’s been an awful lot of back and forth but now, in an effort to make it clear exactly what the wretched BCA are complaining about supporters of the campaign have been asked to reprint the entire article as originally published, minus the two sentences complained about, in order to demonstrate exactly what all the fuss was about.  So, for any three of you who do read this, please take a look at the article below, and try to find it in your heart to sign the petition.  It’s important stuff.  Why?  Because if this case is upheld, then anyone in the UK who has the temerity to question alternative medicine practices is now liable to be sued, due to the peculiar British convention of precedent to determine the validity of an action.  So, you know, important.

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.