Last summer Sense about Science asked bloggers around the world to reproduce the article Simon Singh wrote in the Guardian in April 2008 as a show of solidarity with the campaign to keep Libel out of Science. In asking bloggers to publish Simons article minus the “Bogus” comment “Sense about Science” seem to be forgetting their core value. The article was crap and no serious scientist would consider tabloid tennis an appropriate method to conduct scientific debate.
The Guardian pulled Simon’s article from its website, either because they were afraid of the BCA or because the Guardian saw the piece for what it is a bit of sensationalism to promote a book.
Perhaps Sense about Science should start a campaign to keep sensationalism and tabloid style journalism out of science. I support the campaign to keep libel out of science and in solidarity with the campaign I have reproduced the article and provided some commentary in red where the facts do not stack up.
Beware the spinal trap
by Simon Singh
This is Chiropractic Awareness Week. So let’s be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, 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.
If I was going to criticise a health care profession, I would say it was important to have all my facts and provide accurate information. DD Palmer was 15 in 1860, worked as a teacher in the mid 1860s, worked as a bee keeper and small famer in the early 70s. The first mention of DD Palmers involvement in “healing” was in 1885 when he became a magnetic healer. It would seem he was in fact developing “developing his theories” in the 1880s rather 1860s, I suspect Simon Singh has confused DD with Andrew Still who founded Osteopathy and was developing his theories about manipulation in the 1860s.
DD Palmer’s hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask. To define chiropractic along these lines is like defining medicine the way Harold Shipman practised.
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.
Stranger things have happened. Here we have a news report in 2008 stating a chiropractor restored a mans sight. I think its fair to say if Palmer had observed Harvey Lillard getting his hearing back he may have thought that he had discover the holy grail of healing. Look at the competition at the time 1895??
You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. 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.
Whether sceptics want to believe it or not, I have helped children with all these problems. Lets look at “Ear infections” and I will try not to let my “ideas rise above my station”. For many years ear problems have been misdiagnosed by medics and treated ineffectively with grommets and antibiotics.
So what is a clinician to do. Angela Peel White my anatomy tutor at The Anglo European College of Chiropractic was a qualified GP. I never held it against her because she was a brilliant tutor. She told us know the anatomy of the region you are examining. If you look at the inner ear it has “drain” called the eustachian tube. Its narrower at the top, children with small little necks have only a small gradient and the tube does not drain very well. The blockage causes pain due to the discrepancy of the air pressure outside the ear drum and inside. This can also be a problem for inexperienced divers. Who are not able to “equalise” ear pressure as they decent in water.
The biological explanation as to why “manipulation” could help a child with otis media is very similar to how experienced divers equalise when the eustachian tubes are blocked and unable to relieve the pressure on the inner ear as they descend in the water. They crack their TMJ as if blowing rings smoking dope (I am a child of the 60s), this helps open the eustachian tube and equalise the pressure on the ear drum.
There is also a neurological explanation, I will spare the details suffice to say when Professor Ernst or chiropractic sceptics say there is “no biological reason why spinal manipulation should with help ear Infections” the anatomy shows clearly they are talking through their collective arses.
I have four children, young children cannot crack their jaw themselves, the adjustment requires skill and practise, not all chiropractors can do it and that’s a problem when chiropractors enter these clinical trials. I am not an academic, I am just a clinician.
Then Simon continues to the bit that upset the BCA
……..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.
First I would question whether the BCA leadership is the respectable face of chiropractic. No One would dispute that the “scientific evidence” is weak for these conditions, which account for a very small part of my practice 5% and I probably see more children than most chiropractors. However if we look at Professor Ernsts own “Hierarchy of Evidence” at the bottom there are “case reports” and “observational studies”. Yes much of the chiropractic evidence is at the bottom of Ernsts pyramid however “not a jot of evidence” would only be accurate statement if Professor Ernst were to remove the bottom of his pyramid. David Sackett coined the term “Evidence Based Medicine” he based it on 4 pillars the “best available” published peer reviewed research, the ability of an experience practitioner to apply the “best available evidence” to the patient standing in front of them. And the patients own beliefs. Thats what distinguishes clinical science from physical science and perhaps someone should explain the difference to Simon Singh
In addition anyone with a limited knowledge of the politics of the chiropractic profession would know that the BCA leadership with rather stick to musculoskeletal pain syndromes and probably puts childhood disorders on their website to prevent more members from leaving the association. If Simon had directed those comments at the UCA or the McTimoney association the BCA leadership would have been leading the applause.
I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst.
What does that prove? Margaret Thatcher was the first women prime minister we can only pray the second one is better. The chapter on chiropractic in “Trick or Treatment” has only three chiropractic references all by the co-author Professor Ernst which should have set alarm bells ringing in a science journalist with a PhD. To pad out the chiropractic chapter they finish it talking about homeopaths and vaccines. I told Simon I did not believe he had written that chapter and it was all Ernsts work but he says he did write it.
Ernst learned chiropractic techniques himself and used them as a doctor.
I can carve a joint, this does that make me a surgeon? Chiropractors spend five years learning to adjust spinal joints. Simon has not visited the Anglo European College of Chiropractic to see how chiropractors develop their skills and Guardian readers are expected to believe professor Ernst thought himself these “chiropractic techniques” over a few weekends and it would appear he was not very good at it, many failed practitioners end up in academia.
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.
Arthritis is a chronic condition suffered by millions of British people often it has developed because it was not managed properly when it was just a small ache ( Pain killers and anti inflammatory medication to mask a mechanical problem). In May, the National Institute for Clinical Excellence in the UK published its guidelines for the management of Low back pain http://guidance.nice.org.uk/CG88 . What was extraordinary about these guidelines is that they were stating that doctors should no longer offer; Spinal injections, Traction, Lumbar Supports, Ultrasound, Interferential, Laser and should consider a course of spinal manipulation by a chiropractor or an osteopath or acupuncture instead.
In effect NICE is stating that the orthodox methods for treating back pain has not worked and the evidence is suggesting that it would be cost effective for the NHS to pay for complementary treatments like chiropractic and acupuncture in the future.
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 Professor 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.
Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week – 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.
Which drugs, Viox, Celebrex, statins etc,etc. In 1998 Lazarou et al estimated that 106,000 people die each year from adverse reactions to prescribed medications. Thats the equivalent of a jumbo jet crash every 2 days and no public enquiry? Professor Ernst has spent the last ten years trying to convince the British and Irish public that chiropractic is more dangerous than medicine.
The tragic story of Laurie Mathiason who suffered a stroke ten years ago while receiving chiropractic treatment in Canada is not convincing “evidence” that chiropractic is dangerous. Every five minutes someone in England will have a stroke(National Audit Office), there are no epidemiological studies that would even hint that this finding has anything to do with chiropractic, yet Professor Ernst goes on repeating his opinion.
I have practised in the same area for almost fifteen years, I adjust the cervical spine of the vast majority of my patients and I don not recognise the “dangerous” practise Simon describes. I have never had a complaint or hurt anyone, occasionally a patient feels worse after the first visit, but thats about it. If patients were having strokes surely I would have heard something and the fact Ernst wont let poor Laurie Mathiason rest in peace because he needs this anecdote to bases the theory on which has created his media profile, dont kid youselfs Professor Ernst is not well known for his research he has become the Jordan of the EBM community, I wonder what David Sackett makes of Ernsts evidence base? The inconsistencies in these arguments by the sceptics are staggering, something happens after a vaccine and its coincidence, anything happens after a chiropractic adjustment and its the chiropractors fault. For a small profession we must be good at hiding our bodies, perhaps thats where Harold Shipman learned how to kill his patients without anyone noticing.
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