Beware the spinal trap

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

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.

See also “Paralyzed Alberta woman sues chiropractor.”

Hat tip to PZ Myers at Pharyngula


5 Responses to “Beware the spinal trap”

  1. CriticalOfModernMedicine Says:

    Did Singh’s original actually contain any actual sources? Or is it all sensationalistic news and personal bias?

  2. monado Says:

    Well, if you look at this article on Science-based Medicine, which discusses the libel case by which the British Chiropractors Association is trying to silence and punish Singh, some studies are cited:

    Also, the BCA left off the best designed study, which not surprisingly was negative. Olafsdottir et al (1) studied 86 infants with colic in a randomized controlled trial and found:

    “Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic.”

    How does the BCA justify omitting this study from their list? Do they think that an open scientific discussion of evidence means presenting only the evidence that seems to support their position? The BCA also neglected to reference a review of the evidence for chiropractic for colic by Hughes and Bolton (2) which concludes:

    “The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.”

    Their conclusion was curious – chiropractic treatment for colic does not work but parents report that it does. Ordinarily science-based practitioners would simply interpret such results as being consistent with a placebo effect alone.

    Any more questions?

    • CriticalOfModernMedicine Says:

      I understand that the article you’ve linked to at Science-Based Medicine sites sources (2 for colic) and defends Singh’s position, but I’m getting the impression that Singh only vaguely referred to studies he read/heard without sourcing them so people could know where this medical information actually came from so we (the public) could read them and decide for ourselves whether he’s right.

      Do I believe that the chiropractors should have omitted the study? No. Sadly though, it’s no different than drug companies selectively choosing their studies or rephrasing studies to hold their (new) drug in the best light. I’m not excusing the practice of doing it by saying this, just showing that if you are going to hold one group to account, all groups should be held to account for the same practice. But I see little in blogs or magazines demanding this, though it could simply be that I’m reading the wrong blogs or magazines for that.

      Also unless all the spinal manipulations done in the studies were done by a practicing chiropractor, and not some other type of doctor (osteopaths or massage therapists for example) I will continue to dismiss the results of these studies, for similar reasons that I wouldn’t take the negative results of a new surgical technique seriously if a GP performed the surgery for the study instead of a surgeon.

      Should science be silenced? No.
      But then from what I’ve seen, what Singh did/said wasn’t actually science-based in this case, it was an attempt to sell his book at the expense of Chiropractors.

  3. monado Says:

    The article that I referred to did link to the article. I don’t want to repeat everything they said. I’m sure that Simon Singh was quite aware of it.

  4. CriticalOfModernMedicine Says:

    I wasn’t actually asking you to, though it appears as though I’ve given the impression to the contrary.

    Singh found the negative studies and news stories he wanted to and made a book about it and wrote an article too.
    The chiropractors performed/found the studies they wanted to and have advertised based on them.

    The truth/efficacy of their treatments, for what Singh talked about, is somewhere in the middle (no, not the exact middle). It works for some of the people some of the time (dependent on the cause of the condition as to whether a chiropractor can help or not). But certainly all of their treatments are not a sham, even for the pediatric treatments, nor dangerous as was the impression given in the initial article in The Guardian.

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