Simon Singh is a good friend of mine.  As some of you may have heard, for the past few months he has been having a bit of an argument with the British Chiropractic Association.  The debate revolves around an article that he published in the Guardian about the lack of convincing scientific evidence to support the chiropractic treatment of various infant conditions.  You can find out more about the issue here.

To help support his case, various blogs are today reproducing a version of his article.  This is one of them – enjoy (article after the break).

Beware the spinal trap

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.

24 comments

  1. Already signed his petition. If you censor science papers to keep others happy, scientific discussion and therefore potential progress is stifled. Not a good idea!

  2. I’m intrigued and a bit concerned about the words ‘a version of’ in the introduction, “To help support his case, various blogs are today reproducing a version of his article.”

    I find myself wondering…
    Are there different versions of the article?
    Were different versions published by The Guardian?
    Is the version being published in the blogs the same as the one at the root of the legal challenge? If not … what are the differences?

    Why not publish a copy of the one that is at the root of the debate?

    Some new to the topic might wonder why you don’t simply link to the original article on The Guardian’s website. I guess the simple reason is … it’s not there. Why? Because The Guardian has taken its own legal advice and judged that that was the best course of action.

    http://www.guardian.co.uk/science/2009/jun/04/simon-singh-libel-british-chiropractic-association-bca

    My understanding is that the legal challenge is about words such as ‘bogus’ (and whether that word embraces notions of fraudulent, rather than simply mistaken, behaviour) as much as the scientific validity or otherwise of chiropratic. I think there’s also the question about whether the piece was presented as comment or fact. This is about journalism and language as much as science. This column invites us to think scientifically and critically; thoughts can be sharp things and so can words. Words are possibly the main medium for journalism, Simon’s profession. What concerns me is that the legal argument about words in a piece of journalism, not in the mainstream scientific press, is being conflated by the skeptical science community with an attack on science.

    The version published here doesn’t use the ‘Bogus’ word at all and that, as far as I can see, is at the root of the controversy. It seems the only way to get to the original article is to go and read a copy of the original paper version of The Guardian; each new publication of ‘a version’ can tend to simply add to the ‘fog of war’. I suspect that peer reviewed scientific journals would shy away from the use of phrases such as ‘bogus’, but Simon chose to proceed with an article that he says “is to some extent open to interpretation.” ( http://www.senseaboutscience.org.uk/index.php/site/project/340 29-Jul-09 10:30).

    I’m not sure whether (if there have been changes made in the published version) it’s to protect people who publish the ‘new version’ from possible litigation. If so, though, it would seem a little like saying ‘This is what Simon meant to write” or “This is what Simon wishes he had written”. But the legal challenge is about what actually was written and published originally by The Guardian. Today’s blog ends up, in my opinion, missing the heart of the issue; less “I am Spartacus”, more “I am Spoticus”.

    This column, like other ‘skeptical’ columns asks us to look at the evidence behind knowledge claims. I don’t really see that the process of uncovering the truth is helped very much by this publication of ‘a version’. I understand and admire scientists and those who have carried out direct research highlighting that research, or the research of others. I also admire loyalty. But they are not the same thing.

    I’m not sure that the partial publication, without explanation of the changes made from the original article really gets us closer to the truth. It may rally support for Simon, which may be a good thing, but let’s recognise the price that we are paying in terms of clarity for the prize of gaining the populist mindshare. Of course, with the Internet being the medium, of choice for many, a new flurry of versions of the article will tend to cloud searches for the original material too.

    I feel that the ‘skeptical science community’ plays an important part in popular debate of important issues but that the comunity, itself, sometimes drifts into the ‘popular’ and away from the ‘science’ through careless use of language or by concentrating on personalities rather than facts and knowledge claims. Even the ‘free speech king’ should expect to be scrutinized, without appealing to personal loyalty, to check whether he is really wearing clothes.

    1. Ooops – I didn’t mean to post this anonymously. Sorry. Signed copy follows. Maybe this was me subconsciously showing how much time can be spent checking for nuanced differences between two versions of a publication! 😉

  3. I’m intrigued and a bit concerned about the words ‘a version of’ in the introduction, “To help support his case, various blogs are today reproducing a version of his article.”

    I find myself wondering, “Is the version being published in the blogs the same as the one at the root of the legal challenge? If not … what are the differences?”

    Why not publish a copy of the one that is at the root of the debate?

    Some new to the topic might wonder why you don’t simply link to the original article on The Guardian’s website. I guess the simple reason is … it’s not there. Why? Because The Guardian has taken its own legal advice and judged that that was the best course of action.

    http://www.guardian.co.uk/science/2009/jun/04/simon-singh-libel-british-chiropractic-association-bca

    My understanding is that at least part of the legal challenge is about words such as ‘bogus’ (and whether that embraces notions of fraudulent, rather than simply mistaken, behaviour) as much as the scientific validity or otherwise of chiropratic. I think there’s also the question about whether the piece was presented as comment or fact.

    This is about journalism and language as much as science. This column invites us to think scientifically and critically, thoughts can be sharp things and so can words. Words are possibly the main medium for journalism, Simon’s profession. What concerns me is that the legal argument about words in a piece of journalism, not in the mainstream scienific press, is being conflated by the sceptical science community with an attack on science.

    The version published here doesn’t use the ‘Bogus’ word at all. It seems the only way to get to the original article is to go and read a copy of the original paper version of The Guardian, each new publication of ‘a version’ can tend to simply add to the ‘fog of war’. I suspect that peer reviewed scientific journals would shy away from the use of phrases such as ‘bogus’, but Simon chose to proceed with an article that he says “is to some extent open to interpretation.” ( http://www.senseaboutscience.org.uk/index.php/site/project/340 ).

    I’m not sure whether (if there have been changes made) it’s to protect people who publish the ‘new version’ from possible litigation. If so, though, it would seem a little like saying ‘This is what Simon meant to write” or “This is what Simon wishes he had written”. But the legal challenge is about what actually was written and published originally by The Guardian. It ends up, in my opinion, missing the heart of the issue; less “I am Spartacus”, more “I’d like to be who Spartacus wished he was.”.

    This column, like other ‘skeptical’ columns asks us to look at the evidence behind knowledge claims. I don’t really see that the process of uncovering the truth is helped very much by this publication of ‘a version’. I understand and admire scientists, those who have carried out direct research, highlighting/communicate that research, or the research of others. I’m not sure that the partial publication, without explanation of the changes made from the original article really us closer to the truth. It may rally support for Simon, which may be a good thing, but let’s recognise the price that we are paying in terms of clarity for the prize of gaining the populist mindshare.

    With the Internet being the medium, of choice for many, a new flurry of versions of the article will tend to cloud searches for the original material too.

    I feel that the ‘skeptical science community’ clearly has a role in popular debate of important issues but that the community, itself, sometimes drifts into the ‘popular’ and away from the ‘science’ through careless use of language or by concentrating on personalities rather than facts, evidence and knowledge claims. Even the ‘free speech king’ should expect to be scrutinized, without appealing to personal loyalty, to check whether he is really wearing clothes.

  4. I must agree with the anonymous DrBob 😉 We deserve to know exactly what is meant by “a version of” and we really can’t make any judgments without reading the full original text. Giving us an edited version does a disservice to analysis of the actual case, even if it is a good article. The word bogus is certainly loaded and would be unlikely in an academic article. Whether it is acceptable in a general publication when applied to a medical treatment that is unproven, is questionable at best. On the other hand, this is really nitpicking. The thrust of the article appears to be factual and the truth of those statements can be shown in court. One poorly chosen word that has little impact on a generally strong argument should not be grounds for a libel judgment. I certainly have concerns about this case given the overly generous British libel laws in which the burden of proof is on the accused.

    What really bugs me is that twenty years ago it seemed that chiropracters were generally considered quacks, but now they are viewed as legitimate medical practitioners when there appears to be no evidence to support that change of view.

  5. I think the point of hosting the edited version (which is the exact same as the original minus two lines) is simply to make more people aware of Simon’s ongoing legal battle AND to make his article’s message available to a wider audience. Finding the original article is not difficult nor is it difficult to find out about the ongoing legal battle for anyone with google.

    This is not meant to be an ‘I am Spartacus’ move it is meant to highlight how suing someone for libel doesn’t mean that the criticisms they made are going to disappear.

    Simon’s original article only contained 2 lines that referred to the BCA. The message of the article is not lost by the removal of those lines. Plus you can see them on practically every website discussing the court case!

  6. change radius so that it is slightly bigger than
    your earth. Rights managed images can be either exclusive
    to one buyer or sold to multiple buyers. Along with the
    usual performance and management questions, there was a series of lengthy questions on our opinions about
    subscription based models for future products.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: