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Beware the spinal trap.

As part of the Keep Libel Laws Out of Science campaign here is the article at the centre of the BCA's libel case against Simon Singh. 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.

This is an edited version of Simon Singh's Guardian article from April 2008, for which he is currently being sued for libel by the British Chiropractic Association. We have published it as part of a coordinated campaign to demonstrate that bringing legal proceedings against a science writer will not close down free debate. You can learn more by visiting the Keep Libel Laws Out of Science campaign.

So much pandemonium caused by so small a thing.

How can something as minute as H1N1 influenza cause so many problems?

Ebay?

Is it time to put these chaps on Ebay?

Pandemic Flu?

Hat-tip New Humanist magazine

Good to see the homoeopaths helping with a cure for Pandemic flu.

"At present we do not have a nosode, i.e.a remedy made from the disease material. However, we do have existing remedies which have been used successfully over many years to treat all stages of flu. These are effective and safe for everyone from babies to the elderly.
Our advice regarding Swine flu is that your best protection against disease comes from looking after your health generally and taking simple common-sense preventative measures. There are a number of vitamin and mineral supplements and herbal remedies that will help to boost the immune system. These can be viewed on our website Home Page, select Newsletters, then WINTER ALERT for more information."

"At present" suggests that research is being carried out. How does that work? Do they need to find something that makes your nose run and eyes hurt? How about a ridiculously dilute onion tincture. Hey, right first time, I'm good at this.

Nice to see the old "boost the immune system" chestnut being promoted again too. I have a pile of Tamiflu, I think I wil stick with that.

Levonelle Advert

Quite an interesting advert for Levonelle which is shortly to be advertised on the television in the UK. The only problem is it does not mention the price (£26 in my pharmacy, about 38 USD)

Obviously, the patient can choose to get it from their doctor instead, at no cost to themselves. I suspect most people in the target age-range are going to be unable to pay, or not want to pay. It's a good tool to have in one's therapeutic armoury but I cannot see it flying off the shelves. (Unlike Alli which is flying off the shelves, and then down the toilet!)

131 Viagra

This is what 131 Viagra 100mg looked like shortly before I destroyed them. These were returned by one patient who did not want them. Even though he did not use them he still ordered them from his doctor every single month! Why did he do this? Well, in the United Kingdon people over the age of sixty, people on limited incomes and people with certain illnesses pay exactly zero towards their medications.

This results in horrendous wasteage. People do not, in general, value things that they get for free. Total cost to the NHS of this one episode? Approximately £800! ( 1122 USD)

I suppose I should be thankful that they were returned and not given way to friends, sold or kept in a cupboard. [and yes, I really did destroy them and did not take them home with me.]

Happy New Year

Happy New Year everybody.

Nine Lessons and Carols for Godless people

Robin Ince hosted the evening of science readings, comedians and music. The music wasn’t all to my taste but Jarvis Cocker went down very well with the crowd with “They said there’ll be snow at Christmas.” This he picked for its mean-spirited lyrics.

Simon Singh gave an interesting talk about his book on the Big Bang and also his argument with Katie Melua about the lyrics to her song “Nine million bicycles” . Obviously we aren’t 12 billion light years form the edge. Simon didn’t mention the trouble he was having with the British Chiropractic Association, presumably for legal reasons. Hopefully the case will be resolved very soon, it should be very interesting to follow.

The comedians were a mixed bunch. The event lasted for three hours with each act getting, I think, eight minutes. So, there were a lot of performer of variable quality. Some excellent, some okay and some not to my taste at all. I have seen Mark Thomas a fair few times and he did much of the same material that I had seen previously. Stewart Lee is always worth seeing live and did some very funny material asking whether the sale of Pope John Paul II lollipops increased or decreased after his death.. Ricky Gervais got a very good reception but seemed to offend people by making a joke about raping an old woman. Personally, I thought it was amusing and his logic was impeccable. But there was an audible sharp intake of breath.
Dara Ó Briain has a science degree and doesn’t have much time for alternative medicine. His proposal to put nutritionists, psychics and homeopaths in a burlap bag and then hit them with a stick caused great applause. He also pointed out that whilst dietician is a protected title (as is pharmacist in the UK) anybody can call himself or herself a nutritionist in the UK. (Hence, the pseudoscientific mumbo-jumbo written by nutritionists in every UK newspaper)

The highlight for me was Professor Richard Dawkins. Mr God Delusion himself. He read three extracts from his work including an interesting and humbling piece from “Unweaving the Rainbow” Dawkins has a voice that reminds me of Professor Yaffle from Bagpuss, but it is a very sonorous one and I could listen to him for hours.

Ben Goldacre gave an impassioned speech about his legal battle with Matthias Rath. Rath sued Goldacre and The Guardian over articles in which Goldacre criticised Rath’s peddling of vitamin pills for the treatment of HIV and AIDS. A chapter in Goldacre’s book “Bad Science” was cut due to ongoing litigation. This has since been dropped by Rath who now owes The Guardian about £500,000 in legal fees.

Tim Minchin was also amazing, ending the show with a nine minute beat poem, “Storm.” It sounds horrendous but it was actually incredibly moving and inspiring.

It was a very interesting evening and a rational celebration of Christmas. Considering the room was largely full of atheists, it was not particularly anti-religion. More anti-woo and pro- evidence-based medicine.

Never have I seen so many geeks and nerds in one room. As Robin Ince said “This is our time!”

Merry Christmas