Beware the Spinal Trap

We’ve talked about our friend Simon Singh often here on Skepchick. Today, we join blogs around the Interwebbery in reposting his now-infamous article criticizing the British Chiropractic Association, who are now suing him for libel, despite the fact that everything he said was true. The article below has been cleaned up by lawyers to prevent the BCA from suing a shitload of other bloggers (unlikely, but it’s still an understandable precaution, especially cuz I’m a bit short on cash lately). However, Orac has helpfully posted the entire article and bolded the sentences that were removed by the lawyers.

Also, you may want to read Ben Goldacre’s stirring article in the Guardian today, discussing the case and highlighting the fact that a bunch of bloggers are doing a pretty great job of informing the public and protecting free speech. Reading Ben’s words, I’m trying and failing to suppress a surge of pride for Simon and his compatriots and optimism that against all odds, they will fucking bury the BCA.


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.

Rebecca Watson

Rebecca is a writer, speaker, YouTube personality, and unrepentant science nerd. In addition to founding and continuing to run Skepchick, she hosts Quiz-o-Tron, a monthly science-themed quiz show and podcast that pits comedians against nerds. There is an asteroid named in her honor.

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  1. I just finished reading Trick or Treatment over the weekend and it really is a fantastic book that takes a good truly skeptical look at alternative medicine. If you haven’t read it, I highly recommend you do.

    The libel laws in this country really suck – one essentially is assumed guilty and has to prove yourself innocent – and I hope Simon wins his case and it sees an end to the libel laws as they stand now.

  2. If this were the late 1800’s, the paper would have run this article accompanied by a beautifully drawn cartoon that showed Simon Singh riding a white horse named science towards a dragon who was twisting the body of a screaming victim. The dragon would have the word Chiropractor along it’s side.

    Or perhaps he would be clad in a frock coat, looking every bit the gentleman and holding a laboratory vial (the ever present symbol of science) out to a witch doctor who danced on the back of a twisted human.

    In any case, it would sum up my feelings for this determined rationalist and his fight. Go Simon!

  3. @Bookitty: “a beautifully drawn cartoon that showed Simon Singh riding a white horse named science towards a dragon who was twisting the body of a screaming victim. The dragon would have the word Chiropractor along it’s side.”

    I love it! Surely someone can do this?

    Oh, and if I may give my first nomination – COTW!

  4. @Bookitty:
    You have inspired me yet again! I so want to paint that. Simon Singh would be quite handsome immortalized in colorful acrylic!

    @Andrew Nixon:
    I agree, if you haven’t yet read “Trick or Treatment” grab yourself copy. It is very easy to read and extremely informative. Loved it.

  5. While I fully support Simon in his pursuit, and understand the case, I just find it really difficult to comprehend how he feasably win, the way things are now.

    Judging by the way intercessory prayer has been proved in scientific studies, I will be praying for a ruling in the BCA’s favor!

    Let’s start a prayer group!

  6. @Amy: For fun, go look up the political cartoons of that era. Thomas Nash is one of the most famous artists but his work, while quite stunning, doesn’t have the same impact as the more pointed pieces from magazines like ‘Puck’ and the UK magazine ‘Punch’

    This website is a bit of a mess but you could dig through it for days.

  7. One of the problems with the English justice is that “Truth is No Defense”, so Simon Singh will have a difficult time if no enough pressure is put on British judicial system.

  8. I’m a bit disappointed… If every blogger had left the sentences in, there’s no way the Bogus Chiropractic Association could sue every web user in every country in the world.

    Doesn’t anyone remember 09 F9 11 02 9D 74 E3 5B D8 41 56 C5 63 56 88 C0? Streisand effect? Anyone?

    The offending sentences shouldn’t be hidden, they should be posted on every blog, and in every comment on every other blog.

  9. @Funkopolis: I think that’s a very good point and I do agree. To be honest, I haven’t had a chance to talk to Simon about it, and felt that I had better stick to the rules lest risk making his life more difficult somehow.

  10. @Rebecca – fair enough, I appreciate the waltz along a knife edge that is the law.

    Just sayin’ though…. Bit of google bombing and “Bogus” goes from libel to common knowledge…

    BTW – Congrats to you and Sid!

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