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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


Chiropractic therapy is a subject that leaves a bad taste in my mouth. I'm conflicted on the subject. I was in a pretty serious rollover in 2004 that my back and neck have just not recovered from. I almost always have an ache or a crick in my neck. The army providing the wonderful care that it does only proscribed pain medicine. I don't want to live my life all doped up, so I just accepted the fact that I would always have a little bit of pain.

Fast forward a few years to 2008, and the pain is just a normal part of my life. I don't even notice it really. I was wrestling with my daughter on the living room floor, and I picked her up from a weird angle. My back made a popping sound and an intense feeling of pain shot up my back and down my legs. I could barely move. I went to a doctor and they said pain medicine and rest. After a few more days with no real improvement, I called my health insurance and found out that I have full chiropractic coverage. I've heard all of the controversy, and lack of scientific proof, but my back hurt so bad. I waited another day, and then made an appointment.

I showed up to the appointment a little skeptical, but left a little more comfortable. They took x-rays and the doctor actually told me that I had had a traumatic injury a few years prior, probably a car accident. I had omitted those details as a sort of test. He aligned my back which was an uncomfortable experience, but which provided immediate relief from my pain. I was a little sore the next day, but no pain! They scheduled me for three visits a week. Good thing my insurance was paying for all of it. The idea was, that my back muscles were actually pulling my back out of alignment, and that by putting my back into it's correct position over and over again, that over time my muscles would get used to the back in the right spot. Then, they would actually hold it in the correct spot. Sounded plausible to me.

I did a months worth of two to three times a week. After a few times I didn't even get sore afterwards. All of my pain went away including the crick in my neck. The only problem was that if I missed a day, then after a few days, it would start to hurt again. I got activated to go to Afghanistan, and the military doesn't do chiropractic therapy (mostly) and I had to stop the treatments. Most of the pain is gone, but I still have mild pain most days and a crick in my neck rather often. I don't know if I didn't give it enough time, or if I would have had to keep going for the rest of my life.

I do know that the doctor made me lose confidence in him when he told me that he could cure allergies, colds and infections simply by popping someones back. I also didn't see any before and after x-rays that showed that someone could come to a chiropractor all jacked up, and then after x amount of treatments they could leave a fixed person. I wouldn't consider my car fixed if I had to stop by the mechanic three times a week for him to align it.

I would really like the quackery removed, and some in depth, truthful research conducted. I suppose that I need a sports therapist, but I don't know if that's even the right type of help I need. How are you supposed to know when even normal doctors either recommend basically doing nothing, or chiropracty?

Oh yeah, I almost forgot. On the real subject of your post, the libel verdict is bullshit. If they wanted to be taken seriously than they should seek out the controversy and fight it off with good science (if there is any). It really makes it seem doubtful that there is any real science behind it when all they can do is try to silence the opposition.

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