Trick or treatment?

(Note: this is the infamous article on chiropractic that got Simon Singh sued. It is being reposted all over the web today by multiple blogs and online magazines. Via Björn.)

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.

One thought on “Trick or treatment?

  1. I will first start by saying everyone is entitled to their opinion, that is what America was founded on. That being said, have you ever been to a chiropractor? I have many times. I have also been to a physical therapist, as well as a medical doctor and a surgeon. All of the practitioners have things they do well. The chiropractors I have gone to, have done things that the other have not been able to accomplish. Sometimes the physical therapist have done things the chiropractor could not accomplish. Lastly, I think we should do things to take care of our bodies that prevent future damage such as the chronic nature of disk degeneration that can sometimes be the result of abnormal motor control over a certain number of years or decades. Unfortunately in America we like to take care of things after they have happened rather than preventing them. In dentistry we use preventative care, so why not chiropractic and physical therapy? Unless you are quoting long term studies, your data is skewed. The information you are referring to about vertebral artery disection is not accurate. Please tell your viewers/readers what the rate of vertebral disection is, because I believe that rate of vertebral disection is less than one per one million adjustments. In fact I believe the Eisenberg Study shows this data. Have you ever looked at the curriculum for chiropractic school. The first two years are almost identical to M.D. School and the boards are also designed that way, so that chiropractors can be competent in diagnosis, Pathology, Histology, Biochemistry, Anatomy, Radiology, Microbiology,Renal Physiology, Cellular Physiology, Cardiophysiology, Neurology, ….. Were you aware of this, and what is your background? If aspirin were to come onto the market today, it would probably not get approved by the FDA. For the most part, Chiropractic treatment provides a wealth of benefits without many side effects, but can pharmaceuticals or medicine say the same? Chiropractic is not a cure all, neither is traditional medicine, but both provide some benefit that the other does not, and while I am only a sample of one, I have experienced the many benefits of chiropractic. I am sorry your opinion is such that you have not experienced that, and like any industry out there, there are always bad eggs somewhere. I hope you will do some research on the subject, longterm studies, and report some of the good data, not just the bad. Please feel free to respond if you would like and I can get some of that data for you, like the Eisenberg study.
    John Palthen

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