Beware the spinal trap

Beware the spinal trap

What follows is a reproduction, with a slight modification, of an article published in The Guardian in 2008. Written by Simon Singh, that article prompted a libel action from the British Chiropractic Association. The ensuing court case has resulted in much focused critical attention on chiropractic in the UK and around the world, and a campaign to change the libel laws in England. This article has had the ‘libellous’ sentence removed.

Read more about Simon Singh’s court case and the Sense about Science campaign here.

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.

Giving politicians political cover

Giving politicians political cover

It’s easier to complain about politicians being bought off by lobbyists and campaign donors than it is to do anything about it. In fact, doing something about the pernicious influences in politics comes down to just a few cost-free actions.

In representative government, politicians represent the people that contact them with their views. If only lobbyists and campaign donors contact them, don’t be surprised if that is who will be represented. However, politicians do have dedicated resources in place to help them represent their voters.

Take the House of Representatives in the U.S. These people represent very large numbers of voters. They have large numbers of staff, in local offices and in the capitol, and they will take steps to ensure that every time a constituent contacts them, the representative knows about it. Constituent management software (e.g.) is used to track and categorise the contacts that are made with the office. At the end of each day, the representative can get a breakdown of phone calls and emails urging a yes vote on a bill or a no vote on a bill, and whether the calls are from their own constituents or out of state. It isn’t quite direct democracy, but the idea that representative democracy is not responsive democracy is just obviously wrong.

So what sort of numbers are we talking about? Apparently the climate bill, now moving through the U.S. Senate, is generating a lot of constituent contact. Joe Romm at ClimateProgress has heard that call loads of 100-200 a day are coming in that oppose a climate and clean energy bill.  Opponents to the bill in Congress matched the number of calls from supporters of the bill, although most of the opponent’s calls came from out of state.

Phone calls, emails, and letters help politicians gauge public support and provide political cover. Senator Cardin’s chief energy policy advisor had this to say:

“If you want a stronger climate bill, we need to hear from you. Send us your input.”

There’s no shortage of lobbyists waiting to speak to politicians. But politicians also want to hear from their constituents, and they will give a high priority to what their constituents have to say.

Does money get votes? The cash for climate story

Does money get votes? The cash for climate story

As mentioned previously on this site, Ottawa city councillors get a fair whack of money from developers for their campaigns.

Here is yet more evidence that donations do affect voting intentions. This comes from the US, where both houses are wrangling with climate change legislation.

On June 26, the House narrowly passed the American Clean Energy and Security Act of 2009 (HR 2454) by a vote of 219 to 212. The final version of the bill that passed the House Floor differed substantially from the version that was originally introduced by Reps. Waxman and Markey.

As the bill heads to the Senate for further markups and compromises, MAPLight.org examined some of the House actions that illustrate the influence of special interests on the legislative process.

House members’ positions on changes to the bill tended to correlate with financial support from the interest groups that would benefit from these changes.

Money matters. Legislators respond to campaign contributions, and if their voters do not approve, yet say nothing, it’s the money that will talk.

I’ve heard from lobbyists that they only wish they had the influence over a legislator that constituents had. I only wish constituents knew it as well, and would take the time to contact their representatives. Even a phone call can make a difference.