Weekend Post - the problem with chiropractic

Most so-called “alternative” health treatments are fundamentally harmless. Reflexologists, acupuncturists and the purveyors of nonsense like Reiki, energy medicine and QXCI are highly unlikely to harm you, let alone kill you. That’s because none of these “therapies” actually DO anything. Of course there IS the risk that someone will use these fake treatments instead of real medicine and suffer as a result. A friend of mine is a doctor who I once saw deeply upset because a patient who’s life he had improved dramatically, whose life he’d probably saved, ended up dead because he’d dabbled with nonsensical “traditional” medicine.

There are, however, alternatives that CAN do harm, that CAN hurt you. Chiropractic is a good example of this.

Chiropractic is, like most “alternative” therapies, based on a ridiculously simplistic view of the human body. Energy medicine practitioners will tell you that it’s all about balancing energies, reflexologists invent pathways between the soles of your feet and the rest of your body and the QXCI “therapists” don’t have any idea what they’re doing. Chiropractors will tell you that many disorders are due to “misalignments” in your spine that are somehow interfering with nerve signals from your brain. They claim that manipulating the spine can free these nerve signals and improve the victim’s health.

Let’s start with the facts. This is all utter nonsense. Even chiropractors admit this. The UK General Chiropractic Council admits on its web site that the basic idea behind their profession:

“is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns”

If even the governing bodies admit that it’s nonsense, why do individual chiropractors think we should trust them?

Admittedly, a number of chiropractors have moved away from these ridiculous claims and now include more mainstream ideas in their thinking and treatments. However there is little evidence that anything the more modern ones do has any genuine effect either. The overwhelming body of evidence suggests that spinal manipulation for back and neck pain offers no greater benefits than massage or taking some painkillers.

Then there are the dangers. People have died as a result of chiropractic treatment. Just last week the BBC reported on a warning published in the British Medical Journal about the low-level risk posed by spinal manipulation. Describing the procedure as “unnecessary and inadvisable” they highlighted the risk of damage to the arteries in the neck that might result in a stroke. This risk isn’t just theoretical. There are many documented cases of people being permanently disabled and even being killed by their chiropractic treatment, by the chiropractors themselves.

Of course alternative therapists will say that this happens in conventional medicine as well and they have a point. People do sometimes suffer side effects of modern medicine but its very rarely the treatment itself that directly harms them. Having a chiropractor, who would be forced to admit that his therapy was not based on any science, fool around with your spinal cord is asking for trouble.

Some years ago the chiropractic industry in the UK suffered an enormous setback when the British Chiropractic Association tried to sue the science writer Simon Singh for defamation. He had criticized chiropractors’ claims that they could successfully treat children with asthma, ear infections, colic and sleeping problems. He said that the BCA “happily promotes bogus treatments” and they sued him.

The good news is after a lengthy court battle the BCA was forced to drop their case against him because they realized they were going to lose. What he’d said was true. Unfortunately, unlike here in Botswana, the British legal system has no “public interest defense” to allegations of defamation.

One effect of this case was a massive increase in the number of complaints against chiropractors for false advertising. One report suggested that 25% of all practitioners in the UK were under investigation for making false claims. The “profession” remains in crisis to this day, having brought public attention to itself by trying to bully a science writer for telling the truth about their treatments.

The irony is that it took a court case, not scientific evidence, to force chiropractors to face up to the truth about their bogus, pseudoscientific claims. Hopefully science can prevail in future without the support of the courts?

Simon Singh - Chiropractic

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.

You can see further discussion at Pharyngula, at Respectful Insolence or at Bad Science.

Beware the spinal trap

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

Simon Singh
The Guardian, Original version published Saturday April 19 2008
Edited version published July 29, 2009

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.

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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.