Beware the Spinal Trap

The article pasted below was written by Simon Singh and published in The Guardian on April 19, 2008. Singh was pointing out the fact that chiropractors promote treatments that have no basis in evidence. After this article was published, rather than presenting any evidence, the British Chiropractic Association sued him for libel.

British libel laws are such that the burden of proof is on the defendant (in other words they are presumed guilty and have to prove their innocence), and that the plaintiff carries almost no risk. These cases are usually settled out of court because of the tremendous expense imposed upon the defendant, but in this case Singh has decided to fight the suit in order to bring attention to the unjust libel laws.

By suing Singh for libel, the BCA was attempting to silence their critics. But this case is an example of the Streisand Effect, in which the attempt to hide information results in the information being reproduced and brought further into the light. In a show of solidarity with Singh’s mission of championing evidence-based medicine and bringing attention to the ridiculous British libel laws, bloggers everywhere are reproducing the infamous article. I’m posting the version of the article that has had the libelous sentences removed, but for the unedited version, see Orac‘s blog.

One more thing before I let you read the article…please click below to sign a petition (if you agree) to keep libel laws out of science.

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Beware the spinal trap

Simon Singh
The Guardian, Saturday April 19 2008

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.


3 Responses to “Beware the Spinal Trap”

  1. 1 Global Villager July 31, 2009 at 11:44 am

    What a joke! That being said, if people do not take the time to research things regarding their health they are as much at fault.

    I am sure Singh’s article is not the only material out there that debunks chiropractic thearpy.

    Does the average GP refer patients to Chiropractors? Is there not some sort of benefit? I do not know much about the subject.

  2. 2 linzeebinzee July 31, 2009 at 5:41 pm

    Like I said in my response to you in the post about homeopathy, I don’t think it’s right to blame the victim. Especially when it comes to something like Chiropractic, which I would say isn’t seen by people as being alternative medicine. I know I used to think that Chiropractic was as legitimate as Physiotherapy before I read Singh’s book (Trick or Treatment). I have back pain and have gone to a chiropractor a couple of times, and it all seemed very legit. The DC (doctor of chiropractic) was wearing a white coat and the room looked just like a doctor’s office, he had his certification up on the wall. I guess I should have been tipped off by the books on the table in the waiting room asserting that chiropractic works.

    Chiropractic has been shown to have possible benefits in alleviating back pain, but more research needs to be done. I don’t see GPs referring their patients to Chiropractors because it is not evidence-based medicine. If someone has a back injury, for example, the doctor would send them to a physiotherapist rather than a chiropractor, because physiotherapy is evidence-based and carries a much lower risk (or no risk at all).

  1. 1 Libel » The Daily Blague » Blog Archive » Daily Office: Thursday Trackback on July 30, 2009 at 10:02 am

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