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.
Examining chiropractors’ claims: first blow to them
The kerfuffle surrounding the British Chiropractic Association’s libel action against science author Simon Singh has resulted in a group of bloggers closely examining the claims made by chiropractors in Britain. And they found them wanting. This has spooked at least one group of chiropractors and judging by the slew of correspondence between blogger Zeno and the General Chiropractic Council (GCC), the entire industry seems to be spooked. The GCC seems to be going as far as to attempt changing the rules of complaint.
Three weeks ago today I wrote the following letter to the BCA:
Dear SirThank you for drawing my attention to the defamatory nature of the word “bogus” through your action against Simon Singh. I had no idea the word meant anything other than “fake” – as in the opposite of genuine. On looking up the word in the dictionary I did indeed notice that there are many pejorative meanings attached to it, including “fraudulent” and “counterfeit”. I was surprised that using such a common word to criticise a set of scientific claims could land one in such trouble. I have always been careful of my facts but it appears it is much more important to be careful of one’s vocabulary.
The publicity around this case has piqued my interest in the claims made by chiropractors, a group of people I had always thought of as back manipulators. I notice that there have been a large number of complaints made against British chiropractors. This has spurred me into investigating if similar claims are made by chiropractors practising in South Africa. My preliminary investigation has shown that indeed the same claims – used as basis for the complaints in Britain – are being made here. I am now going through the various rules and regulations that would apply to South African chiropractors, including advertising standards and healthcare acts, to see if any are being breached.
Please advise me what word/s I could use to describe claims not backed by scientific evidence. Or claims for which scientific evidence is said to exist but not disclosed. Clearly, I will avoid using the word “bogus”.
My interest is not in impugning anyone’s dignity or reputation, nor to convey deliberate attempts to defraud. It is simply in examining if practitioners claims breach any standards or rules, and bringing such breaches to the attention of the authorities. I’m sure this approach would be enthusiastically endorsed by the BCA.
Once again, thank you for drawing my attention to this important matter.
Yours faithfully
Tim Beck.
Strangely, I have had no reply.
I have indeed been examining the claims made by chiropractors in South Africa. In broad summary, most of them make the same claims that are the subject of the complaints in Britain. I will follow up in a later post with more details of these claims.
However, all the chiropractors I investigated call themselves “doctor”. Now this is a “claim” that elicited complaints in Britain. I wanted to find out what the position in South Africa is so I trolled though Health Department sites, the Health Act (as amended, as amended…), various codes of conduct and anything else I could find. Oddly, in all of this I couldn’t find a single reference to who is and who isn’t entitled to call themselves “doctor”.
Chiropractors have to be registered by the Allied Health Professions Council of South Africa (who don’t have a functioning website) so I phoned them and was pleasantly surprised to get an informed answer. Which is this: Both registered chiropractors and homoeopaths are entitled to call themselves to call themselves “doctor”. To register they have to have completed a five or six year masters degree (available at Durban University of Technology and University of Johannesburg), followed by an “internship” year.
So that, at least, is above board. Their medical claims, however, surely can’t be legislated away. Or can they? Watch this space.
I did wonder, what could they possibly be studying for six years? Perhaps, for homoeopaths: 1001 Ways to Administer a Placebo. And for chiropractors: 600 Diseases You Have Never Heard Of Which Are Cured Through Clicking The Back.
Chiropractors running scared
Following the British Chiropractic Association suing Simon Singh for libel over the word “bogus” rather than present evidence for their claims, it appears there is a concerted campaign to unmask those making unverified claims. The BCA were looking for a fight and it seems they’ve got one.
According to a letter sent out to its associates, Britian’s McTimoney Association urges them to immediately take down their websites, remove pamphlets from their offices and make sure they are not passing themselves off as registered medical practitioners. They say this is in response to a “witch hunt” against chiropractors.
It looks like a stunning admission that they are making false claims, particularly the statement:
IF YOU DO NOT FOLLOW THIS ADVICE, YOU MAY BE AT RISK FROM PROSECUTION.
In a broadside against their chiropractic colleagues, the Park Clinic complains the McTimoney association are spineless.
The current leadership never had the courage of their apparent convictions and have little to offer chiropractic, they should bring back Tony Gilmore, Dana Greene et al. Christina Cunliffe flirtation with the biomedical model is going to end in tears. My clinic is www.parkclinic.info I will not be taking it down because I have not made any false claims.
Go to the Park Clinic website and look what you find:
Babies and children can benefit from chiropractic, osteopathy and spinal health care as conditions like colic, ear infection, asthma can be caused by spinal nerve irritation.
Well these are precisely the sort of claims Singh labelled as “bogus”, even though they are carefully worded. All anyone is asking is: “show us the evidence”.
Now is the time for watchdog groups and individuals all over the world to stop the quacks and purveyors of woo from making unsubstantiated claims for profit.
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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