Today
the Australian magazine Cosmos, along with a vast number of other blogs
and publications, reprinted an article by Simon Singh, in slightly
tweaked form, in an act of solidarity. The British Chiropractic
Association has been suing Singh personally for the past 15 months, over
a piece in the Guardian where he criticised the BCA for claiming that
its members could treat children for colic, ear infections, asthma,
prolonged crying, and sleeping and feeding conditions by manipulating
their spines.
The BCA maintains that the efficacy of these treatments is well
documented. Singh said that claims were made without sufficient
evidence, described the treatments as "bogus", and criticised the BCA
for "happily promoting" them. At a preliminary hearing in May, to decide
the meaning of this article, Mr Justice Eady ruled that Singh's wording
implied the BCA was being deliberately dishonest. Singh has repeatedly
been clear that he never intended this meaning, but has been forced to
defend this single utterance, out of his own pocket, at a cost that has
run to six figures.
...read full
article
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 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's libel case v the British Chiropractic Association (BCA) was heard at the
Court of Appeal in front of three of the most senior judges in England and
Wales: Lord Chief Justice Lord Judge, Master of the Rolls Lord Neuberger and
Lord Justice Sedley. 
The
science writer Simon Singh has won the right to use the defence of fair comment,
in a landmark ruling at the Court of Appeal.
The
BCA have served a Notice of Discontinuance bringing to an end its ill-fated
libel claim against Dr Simon Singh arising out of criticisms he made of its
promotion of treatments for childhood ailments.
