« June 2009 | Main | August 2009 »

Wednesday, July 29, 2009

Beware the Spinal Trap

Last year, Simon Singh wrote an article in the UK Guardian that was critical of chiropractics. In response, the British Chiropractic Association sued him for libel, and actually won the case. Singh is obviously appealing the judgment, but unfortunately, in the UK, the burden of proof in libel cases is on the accused, not the accusers.

Today, apparently, a bit of a grass roots movement has been started to re-post Singh's article on multiple websites and blogs. Since I agree with Singh's article, and since I think the UK libel laws are very bad for free speech, it seemed that joining in and re-posting the article on this site was the thing to do. So, below is the infamous article that got Singh in hot water. Following Orac's example, I'm posting the original article in full, with those statements that a few others have decided to edit out in bold (another re-post with more details of Singh's case is at the Science Based Medicine site.)

Beware the Spinal Trap

Some practitioners claim it is a cure-all but research suggests chiropractic therapy can be lethal

Simon Singh
The Guardian, Saturday April 19 2008

This is Chiropractic Awareness Week. So let's be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, 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 they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. 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.

I can confidently label these treatments as bogus [changed to "utter nonsense" in the scrubbed version] 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 Professor 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.

Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week - 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 the co-author of Trick or Treatment? Alternative Medicine on Trial


Keep Libel Laws Out of Science

Friday, July 24, 2009

Hard Working Conservatives vs. Bleeding Heart Liberals

I received another of those e-mail forwards that prompted me to write a response to the person who forwarded it to me. This was a long one, so I'm not going to include it here or my full response (after a little googling, here's the original blog entry the e-mail was copied from). It's pretty typical of what you hear coming from the right these days - a handful of things I agree with, a few things that are objectively wrong, a few things I subjectively disagree with, and a lot of complaining.

Anyway, one of the major themes of themes of the e-mail was something I hear a lot from my more conservative friends, about how they've worked hard, and don't want to have their tax dollars going to support lazy people who don't work as hard as them. To simplify their viewpoint just a bit, they see America as the land of opportunity, so the only reason most unsuccessful people are unsuccessful is because they don't work hard enough, and they consider those who want to help the unsuccessful to be bleeding heart liberals. So, I've adapted the portion of my response to the e-mail that addressed that sentiment and put it in this blog entry.

There's no doubt that many successful people have worked hard to get where they are, but I think a little perspective is needed.

I'll use myself as an example. I feel I've done pretty well so far. I studied hard in school, kept my act together, stayed out of trouble, and I feel I have a pretty good work ethic. But, I recognize how extremely fortunate I was to be born into the family I was. I had two parents in a stable relationship, who were both very supportive and who had/have an active interest in what I did, and who weren't so busy working multiple jobs that they were unable to be involved in my life. They made enough money to keep a stable lifestyle - never having to worry about where the next meal was coming from, or whether or not we'd get evicted because we couldn't make the rent. Even college was assumed - I knew my parents would pay for whatever I couldn't get covered by scholarships.

Now, compare that to someone I know (but who would rather I didn't use her name on this blog). Her dad died when she was 4. She left to a new country, and started elementary school without knowing a lick of English. Her mom did remarry, but the man was, to put it frankly, an asshole. But, because of her mom's religious convictions, she didn't divorce the man until much later than she should have. My acquaintance dropped out of school before starting high school so that she could work full time to help support her younger brothers and sisters, but she still managed to study on her own and get her GED the same year she would have graduated from high school. When the opportunity arose, she put herself through college and got her degree. But, being a bit naive because she didn't have any high school guidance counselors to give her advice, she didn't realize the opportunities she had for financial aid, and so ended up paying for a good portion of her education through credit cards and out of pocket.

So yes, I know I've worked to get where I am, but comparing it to someone like my acquaintance, it's obvious just how many more obstacles she had to overcome, and how much harder she had to work to get to where she is today. It's no surprise that all of my parents' children got college degrees, while my acquaintance was the only one in her family that managed to do it.

Now, whether or not you think kids that were born into less fortunate circumstances deserve a helping hand from the government and our tax dollars is still a subjective question, but I'm not going to be so smug as to say that if those kids just worked as hard as I did, that they'd end up as successful as I have.

On a related note, I wanted to discuss generally the concept of helping others in society. Even if you ignore compassion, there can be pragmatic reasons for doing so. For example, where the e-mail discussed drug addicts, look at it this way. Assume that there's a person addicted to a dangerous drug like heroin. You can ignore the problem, but because of his desparation to get money to support his addiction, he'll probably end up turning into a criminal, and may end up robbing your house or injuring you or your family. You could lock him up in prison, but then we're stuck supporting him with taxpayer money, and he's nothing more than a burden on society. And once he's back out, he's liable to go right back to his drug habit and criminal behavior. Or, you could get him treatment, after which he can go back to being a productive member of society. A little up front cost could end up being a better investment.

For a non-hypothetical case, consider homeless alcoholics. Seattle recently started a pilot program where 75 homeless alcoholics received free housing, no strings attached, not even requiring the residents to quit drinking. In the first year, Seattle saved over $2 million due to reduced jail/medical costs. So, even if someone doesn't think those people deserve help, or considers it a free ride, the end result is that it still helps save taxpayer money.

I'm not saying that there aren't problems in government programs that need to be fixed (I still like Eric Jones's idea of compulsory birth control drugs while on welfare - if you can't even support yourself, why create another life you can't support), but it doesn't do any good to pretend that we have complete control over our own destinies, and that people are in dire straits simply because they're lazier than us. As the old saying goes, don't judge a person till you've walked a mile in their shoes.

Back from Vacation

Sorry for no posts last week - I was on vacation (I didn't announce it beforehand because, well, even though this blog isn't very widely read, there's no sense in advertising that my house will be empty for a week). Anyway, we went to D.C. Yeah, I lived inside the beltway for a few years, so I've already seen most of the touristy stuff, but my wife had only ever been there once for an afternoon, and my daughter had never been there. So, we looked at all the monuments, went to the museums, and even got to see my family one day. I'll post photos when I get a chance to review them (my wife took over 1300 photos with her new digital camera). Anyway, back to regular posting.

« June 2009 | Main | August 2009 »