Chiropractors: Is this what you wanted?
Not wanting to be left out, here is the article that got Simon Singh into so much trouble with the British Chiropractic Association. By posting this, ReasonCheck joins the many blogs and online magazines worldwide who have reposted it over the last few days. As Ben Goldacre says, “We are more possible than you can powerfully imagine”.
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.
Beware English libel laws
Jack of Kent has been covering a story that has been generating a great deal of heat and fury amongst scientists, writers, academics, and virtually everyone who supports freedom of speech. It concerns the British Chiropractic Association suing the highly respected science write Simon Singh over an article he wrote in the comment section of the Guardian.
In his article he criticised the BCA for promoting treatments for potentially serious aliments affecting children without clinical evidence for them. The offending passage is:
“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.”
Astonishingly, the judge ruled that the word “bogus” meant deliberate and targeted dishonesty. Under English libel laws, Singh would have to prove that the BCA was being deliberately dishonest. An impossible task. It’s obviously not what Singh was saying; he was saying the BCA was promoting treatments for which there was no evidence of their effecacy (or safety, for that matter).
Singh certainly knows what he’s talking about. He’s co-author (with Edzard Ernst) of Trick or Treatment: The Undeniable Facts about Alternative Medicine, in which most alternative treatments – including chiropractic – are shown to be worthless.
Bravely, and at the urging of his many supporters, Singh is now appealing this ruling. It’s brave because defending a libel suite is a particularly expensive business in England. Having already coughed up £100,000 defending his right to speak freely, he could now face up to £3,250,000! Compared to other European countries, England is more than three times more expensive than the next most expensive country, Ireland. Ireland in turn is many times more expensive than any other European country.
But what does this mean to those who don’t live in England? A lot, if anything you write has even the vaguest possibility of being consumed in England. A new industry, libel tourism, has been spawned by Englands outlandish libel laws.
Seen one way, it is nothing short of a scandal. Small non-British news outlets and humble non-British authors (in many cases catering almost wholly to a non-British public) are being sued in English courts by rich, mighty foes. The cost of litigation is so high ($200,000 for starters, and $1m-plus once you get going) that they cannot afford to defend themselves. The plaintiffs often win by default, leaving their victims humiliated and massively in debt.
A Ukrainian publication was sued by a wealthy Ukrainian. At first there was a settlement (remember it’s prohibitively expensive to defend such an action), and later the wealthy Ukrainian won another, undefended judgement. The English system virtually guarantees that you can squeeze cash out of your victim just by accusing him of libel. And all it takes is some tenuous readership link to England. In this case, barely 100 subscribers were from England.
A small, totally Ukrainian website was successfully sued on the same grounds. Any alarm bells ringing yet? These publications are not even in English and couldn’t have been read or understood by more than a handful of English citizens. How much more at risk are English-speaking writers?
Well at least the US is getting serious about it. As described in the Wall Street Journal, a New York-based author, Rachel Ehrenfeld was sued in England by Saudi banker Khalid Bin Mahfouz. Her book, Funding Evil: How Terrorism is Financed and How to Stop It, named Bin Mahfouz as a possible funder of terrorism. The book was published in New York. But a few copies found their way to England, giving Bin Mahfouz the pretense to sue. On advice from her lawyer, Ehrenfeld didn’t contest the matter.
The English court found against her and entered a judgment of $225,000. She immediately sought protection from the order through a New York court, which ruled that it was a legislative matter. The New York legislature, to its credit, passed legislation to give Ehrenfeld and other New York citizens who are sued for libel abroad the right to obtain a declaration that their works are protected under American law.
A campaign for a similar law has been stuttering along. The latest version submitted to the Senate, the Free Speech Protection Act, also gives American-based litigants an additional right to countersue for harassment.
A campaign has been started by UK-based Sense About Science, The law has no place in scientific disputes. It has broad, high profile support. Signatories include Richard Dawkins, Derren Brown, Stephen Fry, Ricky Gervais – and thousands more, even a few lawyers.
You can sign the statement here.
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