July 29, 2009

Beware the spinal trap

I'm joining a large group of skeptical activist bloggers around the world today in reposting an article written by Simon Singh in the UK about Chiropractic "medicine." Simon wrote a fully factual article about the complete lack of evidence supporting the efficacy of chiropractic in treating non-spine related conditions, like colic. (No, I'm not joking. Some chiropractors actually claim to be able to treat colic via chiropractic spinal adjustment. Frightening, isn't it?)

Mr. Singh, for his efforts, prompted the British Chiropractic Association to provide evidence for their claims-

-no, wait, that's not what they did-

-oh, yes, they sued him for libel. Once again, I am not joking.

British libel laws being what they are (guilty until proven innocent - I swear this is not a comedy piece, the burden lies upon Mr. Singh to prove his case, even though he is the defendant), no one would have blamed Mr. Singh for retreating in the face of a large group with deep pockets able to fund hot-shot lawyers. That is not what happened. Mr. Singh has appealed the initial judgement against him, and is taking his fight - at great personal cost and risk - to a higher court. In support, I, and hundreds of other bloggers have agreed to repost the article that started the entire kerfuffle. Note that minor changes have been made to the article on the advice of legal counsel in order to prevent the BCA from adding more defendants to their suit. Should you wish to read the unedited version of the article, you can do so, I am told, at Respectful Insolence.

(via Skepchick)

(10:02PM - edited to add: Go here to read an excellent article on this situation by Ben Goldacre, science writer for UK newspaper The Guardian.)

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.


Simon said...

In my early twenties my mother convinced me to go to her chiropractor for assistance with then-chronic sinus problems. I was all, like, a crack-o-practor for my sinuses? What the hell; give it a try.

He pushed on my back, twisted my neck, rubbed my forehead. I experienced no noticeable relief.

Then I moved out of home part way through university and realized I had been allergic to the cats all along.

(I am not denying the efficacy of chiropractic for back-specific problems, but common sense, people!)

Call me Paul said...

Although this post, and Simon Singh's initial article were specifically criticising the use of chiropractic for non-spine related conditions, even for back issues chiropractic sits on questionable footing. Its basic premise cannot be supported based upon current medical and physiological knowledge. No chiropractor (or anyone else for that matter) has ever demonstrated that something called a "subluxation" actually exists.

Simon said...

Well, at least you made me look up "vertebral subluxation".


Charley said...

Ugh. Stick to back adjustments and leave the other bits to the people that know what they're doing! Friggin quacks!

émilie b said...

Frank's back "cracks" sometimes when he stretches, and it makes me feel sick just hearing it. I don't think I would get on board with chiropracy (chiropractice? chiropiracy?...). Just reading that article is giving me a phantom backache...

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Beth said...

I have a cousin by marriage who is a chiro. He used to always claim that even the common cold could be cured with an adjustment. [rolling eyes] I guess he never learned about viruses in school. It used to drive my Dad crazy to hear such claims.

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