The age of chiropractic miracles is not yet done

The age of chiropractic miracles is not yet done

One might be surprised to learn that chiropractic was once said to cure deafness. The creator of chiropractic, D.D. Palmer, claimed that by manipulation of the spine he restored hearing in a deaf man, Harvey Lillard. From that moment on Palmer decided, ipse dixit, that the spine was the key to all disease. Yet despite Palmer’s miraculous first manipulation, in the hundred or so years since, chiropractors the world over have failed utterly to recreate Palmer’s success with the deaf; a failure so stupendously comprehensive and absolute that  this treatment modality should have long ago fallen into ignominy and disuse.

So much for Palmer’s original chiropractic miracle. Most practitioners of chiropractic today tend to steer well clear of making such claims; surely nobody would believe them anymore, not in this enlightened age.

Chiropractic for the World Foundation is a registered Canadian charity “whose vision is pure and simple: to bring the gift of chiropractic to the world.” They have been working in Ghana and are delighted to report that the age of chiropractic miracles is not yet done:

Person regained eyesight. Several threw away their canes. Another canceled his appointment with his doctor. Talk about a good day at the office! 3 out of 3 of our helpers want to become chiropractors to take care of their own people here. We are spreading so much light I’m surprised the sun went down tonight!

I’ll admit that when I first read that I was taken aback. How could a Canadian-educated professional individual so sincerely believe that Palmer’s patented back rub for all ailments actually cured blindness? Even Palmer never tried to sell manure of that odour to the public, although his claiming to cure deafness was certainly a stretch. Yet giddy-in-Ghana reports that the blind can see and the lame can walk. I hope those souls didn’t throw their canes too far out of reach. Nonetheless, if a person really did have their sight restored after a chiropractic manipulation, I’d hope – as indeed would the chiropractic profession – that the clinician involved would at least exert themselves to writing it up as a case study. That would show us skeptics what for, what?

Maybe they mean well, and believe that their help wouldn’t go amiss. Ghana ranks 188th in the world for life expectancy at birth. It has an HIV rate of 1.9%. The risk of major infectious diseases is very high: watch out for diarrhea, hepatatis-A, typhoid, malaria, schistosomiasis, meningococcal meningitis and rabies. These disease risks are manageable with the use of vaccines, public health interventions, and good patient care, and Ghana could certainly benefit from better health resources. It is to that end, one supposes, that, the visiting chiropractors have been offering their help:

We were invited to meet several key government officials, including two medical doctors (Regional Health Directors), and the Minister of Accra, Ghana’s largest city and capital. During all of our communications, whether to patients or to government officials, one thing was consistent – we kept the message of chiropractic very pure and simple! Our message was very well received – people in Ghana are so ready for what we have to offer! They know innately that the body heals itself… that’s why chiropractic make so much sense to them.

It might be helpful to point out at this juncture that an evidence base for the chiropractic treatment of HIV, diarrhea, hepatatis A, typhoid, malaria, schistosomiasis, meningococcal meningitis and rabies does not exist. But this is not about evidence. This is about evangelising the original message of chiropractic, evidence be damned, a century of abject failure of the whole idea of chiropractic be damned. It’s about the idea of innate intelligence of the body that flows through the spine, that can be freed with chiropractic manipulation, that can make the deaf hear, the blind see and the lame walk. Chiropractic rejected the germ theory of medicine from the outset. Instead, the straight chiropractic paradigm allows only that diseases arise from subluxations in the spine, malaria parasite notwithstanding. For heaven’s sake, the existence of the malaria parasite itself should be  evidence enough to abandon chiropractic, and sufficient cause to turn back its adherents at the Ghanaian border.

Yet they say their message was very well received. I’d like to assume the Ghanaians were just being polite, but they really shouldn’t have to listen to this nonsense in the first place. They have enough to do with actually treating malaria without having alt-medicine peddlers try to persuade them how not to treat it. It isn’t the first time. We have seen variants on this story before: Matthias Rath took his vitamin pills to South Africa and convinced the government they had no need for expensive anti-retrovirals to treat HIV. As the head of Médecins Sans Frontières said, “This guy is killing people by luring them with unrecognised treatment without any scientific evidence.” Right now in Ghana, homeopaths have set up a malaria prophylaxis clinic “to help combat the effects of malaria through homeopathic care.” I have nothing but sympathy for their patients. There’s something malodorously colonial about these people, chiropractors, homeopaths and pill peddlers alike, their actions as superficially well-meaning yet utterly pointless as flying four thousand miles just to give a starving child a Bible.

Still, the miracles continue. The chiropractors report that they found evidence of “’the adjustment exchange rate’, that one adjustment in Ghana is worth approximately 10 in Canada or USA.” It’s because the Ghanaians live simpler lives, we are told; “ their bodies are not as polluted, mentally, physically and chemically. Their diets are more natural.” Yes, it’s amazing these people die of anything at all.

I can’t be entirely negative. The Foundation raised enough money from chiropractors and their patients in Canada to establish a children’s school in a village in Ghana, which is a worthy accomplishment. I can’t agree that the world needs more chiropractic, but more access to education is always welcome. I would also welcome it if the homeopaths, chiropractors, and alt-med peddlers would keep their useless nostrums at home where they belong, marginalised in modern medicine and as the placebo of choice for the wealthy worried well.

Chiropractors get Royal seal of approval

Chiropractors get Royal seal of approval

The College of Chiropractic Sports Sciences (Canada) is to be named the Royal College of Chiropractic Sports Sciences (Canada). Her Majesty has apparently only handed out 45 such Royal designations since 1952, so I have no idea why she would grant this one. Her usual powers of discrimination have surely failed her.

The CCSS work with athletes and are thoroughly intertwined with sports at the national level here in Canada, for example attending Olympics as part of the health care team. That’s nice for the chiropractors, but I wonder if it does any good at all for the athletes.

Let’s not forget what happened to one young Canadian. At the previous Olympics, Canadian hopeful Samantha Cools was knocked out of commission by her chiropractor after he “over-rotated her neck during a routine adjustment, tearing tendons and muscles”. Granted, he may not have been a member of the CCSS, but a chiropractic manipulation is just as pointless and potentially dangerous whoever is performing it. One wonders if the CCSS avoid the brutal, stroke inducing, headache causing types of manipulations, because they know that they are pointless and dangerous – despite such manipulations being an integral part of chiropractic.

Chiropractic has bugger all evidence to support its use beyond, perhaps, treating lower back pain, and that’s probably because it’s not much different to a good lower back massage, and equally as effective. There’s little reason to expect chiropractic to be effective in the first place: it was created out of whole cloth by a charlatan who imagined chiropractic could cure deafness, and just about everything else under the sun, through the correction of entirely imaginary ‘subluxations.’ The Queen has gone and given the Royal Seal to an organisation predicated on magical thinking.

“Chiropractic Sports Specialists keep active Canadians at their best by treating mechanical imbalances or dysfunctions”. Canadian chiropractors have also left people in comas, paralysed vocal chords, and induced strokes, resulting in death.

My advice? Canadian athletes can keep at their best by staying the hell away from chiropractors. Go see a sports physiotherapist instead.

Chiropractors still using bogus back device DRX-9000

Chiropractors still using bogus back device DRX-9000

Chiropractors, much more so than real medical health professionals, have to invest a lot of effort into practice promotion, and nothing helps promote a practice so much as having an edge. The DRX-9000 back compression machine, a high tech machine for treating back pain, fits the bill: with LED lights, monitors, and a claimed 86% success rate, this ersatz medical device looks like the real thing.

mp-drx-9000device306x172

Back pain can be debilitating enough to people that a $4,000 price tag for 20 treatments is not an obstacle, not with a success rate as high as 86%, as the manufacturers claim.

Only the claim isn’t true.

CBC marketplace investigated the devices in early 2010 and found no scientific basis for the claims of success, nor any support for the device being able to work as it should. Health Canada asked the manufacturer to provide evidence for its use. When none was forthcoming, the licence for the DRX-9000 was pulled.

Unfortunately, this doesn’t mean they are no longer in use. While the company can no longer sell the devices, and indeed has gone bust, operators – that is to say, chiropractors – have no obligation to stop using them. The manufacturer is obliged to tell people that they are no longer licensed, but that’s all. In the meantime, chiropractors still tout the benefits of the DRX-9000 and consumers are none the wiser. In fact a lot of consumers will continue to be scammed and end up thousands of dollars poorer, with nothing to show for their money.

This underlines a fundamental failing in the chiropractic industry. Chiropractors operate outside mainstream medicine, yet want to be taken as seriously as real medical health professionals. However, doctors are trained and held to a very high standard, and tightly regulated as to what treatment modalities they can use. Chiropractic simply does not hold itself to a similar standard and does not have the same tradition of respect for evidence based medicine; but then, how could it, when it has failed, over and over again, to provide scientific support for the claims it makes?

The DRX-9000 is another in a long line of chiropractic money making schemes. It’s gone, but you can bet there will be others. When your practice depends on drumming up business by any means, it’s only a matter of time before someone shows up with the next big thing.

BCA vs. Simon Singh: a letter to an MP, and the responses

BCA vs. Simon Singh: a letter to an MP, and the responses

Back in June, I wrote the following letter to my MP, and received a reply, also printed below.

I encourage anyone who is concerned about the chilling effect and consequences of the BCA’s libel case against Simon Singh to contact their Member of Parliament. MPs that are aware of this case, and are made aware that it is of concern to their constituents, will be much more likely to do something about it.

Representative democracy is responsive democracy, but MPs first need something to which they can respond. So, write!

Dear [M.P.],

I write to express my deep concern regarding the recent libel case brought by the British Chiropractic Association (BCA) against Simon Singh, and the implications for English libel law.

In 2008, Simon Singh wrote a comment piece in The Guardian newspaper on the evidence for and against chiropractic. The BCA took offense at one line in particular, on the lack of evidence for the use of chiropractic in treating babies. Simon Singh had recently written in depth about the evidence for chiropractic in his book ‘Trick or Treatment?’ and so knew well of which he spoke in the comment piece. He is, as am I, a scientist, and therefore is used to the scientific method: in the face of scrutiny or disbelief from our peers, we endeavour to defend our work on its merits and on the evidence. This is how science progresses, and it is how advances in medicine are made. It is how the public good is protected. Yet the BCA, rather than provide a robust defence of their practices and claims, chose instead to sue. What was an earnest comment, written in the public interest and for the public good, was pulled by The Guardian as soon as the writ was served.

The implications are profound. You are surely aware of the concerns that many have regarding English libel law, but with this case, English libel law has taken a turn down sinister new paths. For anyone considering writing about the evidence, or lack thereof, for a treatment, the threat of a libel action will have a chilling effect on that intention. The public good is poorly served when scientists or health professionals cannot write freely about evidence and fraud in medicine, for fear of damages and costs that can run into well over 100,000 pounds just for a preliminary hearing.

In the field of public health, it should not be open for any provider or promoter of treatment to sue for defamation in respect of their provision or promotion of those treatments*. There must be a balance between the rights of the individual to protection of reputation, and the rights of the public to hear discussion of the merits of treatments provided by said individual. Defendants should be protected by qualified privilege in such cases, as are journalists under the so-called “Reynolds Defence”, or we may see further erosion of the rights to free speech and comment in England.

I note that the Commons Select Committee on Culture, Media and Sport has been considering libel law. I hope that by bringing this particular case to your attention you will be more aware of the serious and chilling directions that libel law has been taking, and will be able to offer whatever appropriate support you can toward moderating these tendencies. Additionally, the charity Sense About Science has been campaigning for a change in the law, and your colleagues Dennis MacShane, Michael Gove and Dr Evan Harris have put their names to a statement of support that you will find attached to this letter**.

Yours, [name here]

*{h/t to JoK}

** see here and here.

A few weeks later, I received the following reply.

Dear [me],

Thank you for your letter regarding the recent libel case brought by the British Chiropractic Association (BCA) against the journalist Simon Singh, and the implications for English libel law. I apologise for the short delay in responding. Your concerns about journalistic freedom of speech and the UK’s current libel law are duly noted.

Freedom of speech is essential in a functioning democracy and indeed is recognised in international and human rights law. The right to freedom of speech is particularly important to the media, which plays a special role as the bearer of the general right to freedom of expression for all.

I have therefore written to the Rt. Hon. Ben Bradshaw, Secretary of State at the Department of Culture, Media & Sport about this issue and have asked him to comment. I will let you know as soon as I receive a response.

In order to get the reply to you as quickly as possible, I may forward it to you directly. However, if there are any issues arising from the response which you wish to pursue further, please do not hesitate to let me know.

Thank you again for bringing this issue to my attention.

Best wishes,

[M.P.]

In August 2009, I received the following letter from Bridget Prentice, the Parliamentary Under Secretary of State, to my Member of Parliament. He was good enough to forward it on.

From: Bridget Prentice MP. Parliamentary Under Secretary of State.

Thank you for your letter of 26 June to Ben Bradshaw at the Department for Culture, Media and Sport, about a recent libel case brought against Mr Simon Singh. Your letter has been passed to this department and I am responding as the Minister responsible for civil justice issues.

As a Government Minister I am unable to comment on individual cases which are or have been before the courts. In that context, I understand that this case may be subject to appeal. However, it may be helpful if I begin by explaining the law in this area in general terms.

It is important that people have an effective right to redress through the law of libel where their reputation as been damaged as the result of the publication of defamatory material. Whether material is defamatory is a matter for the courts to determine based on all the relevant circumstances. The main tests established by the courts in determining whether material is defamatory are whether the words used “tend to lower the plaintiff in the estimation of right-thinking members of society generally”, “without justification or lawful excuse [are] calculated to injure the reputation of another, by exposing him to hatred, contempt, or ridicule”, or tend to make the claimant “be shunned and avoided and that without any moral discredit on [the claimant’s] part.”

Your constituent is concerned about the effects of the libel laws on freedom of speech. The Government firmly supports the right to freedom of expression, which is protected by Article 10 of the European Convention on Human Rights (ECHR). In addition, section 12 of the Human Rights Act 1998 requires courts to have particular regard to the importance of the right to freedom of expression, particularly in relation to freedom of the press. Of course, the exercise of this right carries with it duties and responsibilities that are expressly recognised in the law. It is not an absolute right, and can be restricted for a number of reasons set down by law, such as public safety, the prevention of crime, or respect for the rights or reputations of others. Often, the right to freedom of expression may need to be balanced against other rights, like the right to respect for private and family life, home and correspondence, which is protected by Article 8 of the ECHR.

As you may be aware, the Department for Culture, Media and Sport Select Committee is currently conducting an inquiry into Press Standards, Privacy and Libel and is considering a wide range of issues in this area of law. The Justice Secretary gave evidence before the committee on 19 May and the Government will consider carefully any recommendations that the Committee may wish to make in its forthcoming report.

I hope you find this information helpful, and I enclose a copy of this letter for you to forward to your constituent, should you wish to do so.

Bridget Prentice.

Chiropractors at the Olympics

Chiropractors at the Olympics

The 2008 Olympics, Beijing. Behind the scenes, and sometimes right there with the athletes, were the chiropractors. Here are a few of their stories.

The BMX athlete and the neck adjustment

Samantha Cools was a Canadian medal hope in the debut of BMX on the Olympic stage. She was a five time world junior champion, and she was looking good. That is, until her chiropractor in Switzerland “over-rotated her neck during a routine adjustment, tearing tendons and muscles, which then pushed up against the main artery in her neck and also the nerves.”

Horrifying, potentially fatal and entirely unnecessary. The consequences of her chiropractic ‘care’ were being unable to train for five weeks before leaving for China, and being unable to chew food. And, once she got to Beijing and competed, a disappointing fifth place finish and a DNF.

One would hope that a lesson was learned, but it seems not. Cools credited her being able to compete at all with the care she was receiving from another chiropractor. He worked on her for 30 minutes before each race in Beijing to loosen her muscles. One presumes he was steering well away from the violent chiropractic neck adjustments that injured her in the first place, and just sticking to massage.

The mysterious magical black muscle tape

kerri-walsh

Did you spot the black tape that some athletes were wearing? Kerri Walsh, the US beach volleyballer, was never seen without it on a shoulder. It’s called Kinesio tape, and it was developed in the 1970s by a Japanese chiropractor. It does all sorts of magical things, like: “works to support the muscles, remove congestion, activate the endogenous system and correct joint problems”. Blimey,and its only a bit of tape. In fact, unlike rigid tapes, that can be used to, say, hold an ankle in position, Kinesio tape is super thin and flexible. I struggle to imagine how it can have any benefit at all, given that. One might as well take a black sharpie and draw black lines on the shoulder. It would cost less.

I am here to learn, though, and the manufacturers to educate.  Here’s what they say it can do.

• Re-educate the neuromuscular system
• Reduce pain
• Enhance performance
• Prevent injury
• Promote good circulation and healing

And how does it do all that? Well, it:

• Creates a lifting effect which improves circulation and relieves pain
• Tension on tape has the ability to relax or stimulate muscles

Got that? Nah, me neither. As explanations go, it’s a bit scant. Supposedly, the tape lifts the skin, and then all these wonderful benefits follow from said lifting action.

Actually, at this point, I’m even unclear as to how it can lift anything. It’s tape, it is stuck directly to the skin, and it just sits there. Is it an antigravity tape?  That would lift the skin. Maybe they mean that it lifts the skin when you have to take it off, but before that, one has to wear the tape for the suggested 3 to 4 days and look like a bit of a tit. What the tape does do, if it is stretched before applying to the skin, is provide “a constant pulling (shear) force to the skin over which it is applied.” Fine, but I’d want a wee bit more proof before believing it can therefore ‘re-educate the neuromuscular system’.

Kinesio tape doesn’t have any clinical study evidence for all these marvellous benefits, at least according to to one physical therapist who regularly uses it. He goes on to give this far from ringing endorsement: “I mean it works for some people and it doesn’t work for others. I’ve put it on patients and they’ve felt an immediate difference. I’ve put it on patients and they haven’t felt a single thing.” In other words, some people fall for it, and some people don’t.

But even if it doesn’t have good clinical evidence, it does have some sterling celebrity endorsements, including Lance Armstrong. Lets give him the last word. In his book ‘Every Second Counts’, he described Kinesio tape as “a special hot-pink athletic tape that came from Japan and seemed to have magical powers.”‘

There you go. Magical.

Summary

It isn’t a surprise that athletes turn to chiropractors. It’s probably fair to say that most people are unaware of the dangers of chiropractic, but athletes also have a particular vulnerability to chiropractors, and that is an all too common tendency for magical thinking and superstition. For all the athletes out there willing to try anything, no matter how silly, for an edge, there are plenty of charlatans willing to sell them something, be it a magical tape or the promise of unblocked nerves from a neck adjustment. Michael Shermer, founder of the Skeptics Society, had this to say.

“I began visiting a chiropractor not because I needed one but because I had read that energy flows through the spinal cord and can get blocked at various places. I discovered that the more I got adjusted, the more I needed to get adjusted because my neck and back kept going “out”. This went on for a couple of years until I finally quite going altogether, and I’ve never needed a chiropractor since.

All told, I raced as a professional ultra-marathon cyclist for ten years, all the while trying anything and everything (except drugs and steroids) that might improve my performance. As the Race Across America got bigger – it was featured for many years of ABC’s Wide World of Sports – I had many offers to try all sorts of things, which I usually did. From this ten-year experiment with a subject pool of one, I drew two conclusions: nothing increased performance, alleviated pain, or enhanced well-being other than long hours in the saddle, dedication to a consistent training schedule, and a balanced diet; and it pays to be skeptical.”

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.

A chiropractor struggles to defend chiropractic

A chiropractor struggles to defend chiropractic

Lawyered up

The British Chiropractic Association took Simon Singh to court for libel. In a stunning example of the Streisand Effect, the criticism that they were trying to suppress –  that their claims that “chiropractic can be used to children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying” were unsupportable – have come under new, unprecedented scrutiny.

Richard Brown, chiropractor and Vice President of the BCA, tried to defend chiropractic in the pages of New Scientist. Here is some analysis of his unconvincing defence.

Chiropractors are so misunderstood

Brown:  Many critics – including Edzard Ernst  – hark back to the origins of chiropractic. This has the clear intention of suggesting that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases. While a tiny minority retain this view, most are aware that such claims have long since been debunked.

Let’s take a look at his first testable claim: that a tiny majority of chiropractors retain the view that “spinal misalignments are responsible for the majority of diseases”. Palmer’s original belief was that subluxations of the spine cause disease, and that correcting subluxations, therefore, will correct the disease. What do UK chiropractors believe?

A  survey of chiropractors in the UK (from 2007) found that:

Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.

Far from just a tiny minority, we can see that clear majorities of chiropractors hold the belief that asthma, GI complaints and PMS can all be treated with chiropractic. Large minorities believe chiropractic can help with hypertension, infertility, osteoporosis and obesity. Infant colic, ear infections and childhood muscular problems were believed to be treatable by chiropractic by more than 50%. A fair reading of the survey will see that it shows a majority belief that spinal misalignments play a role in at least these aforementioned, non-spinal diseases.

Of course his actual statement,  “that modern chiropractors cling to the 19th century idea that spinal misalignments are responsible for the majority of diseases” is extreme and exclusionary, and deliberately so. A critic will find it hard to factually dispute, which succeeds in shifting the frame away from the areas of debate where chiropractic is weak, viz. the evidence and the philosophy. One must, on the evidence, accept that his statement is likely to be true, as there surely are but few chiropractors who firmly believe subluxations to be the cause of every disease. However, a majority of chiropractors do still cling to the ludicrous belief that subluxations are the cause of the aforementioned diseases, as the evidence clearly shows.

Brown also uses the rhetorical device of ‘conceding the point’. By admitting that the basic principle of chiropractic has “long since been debunked” – he even uses the language of the skeptic – he hopes to get the readership on his side. But in a scientific publication, defending chiropractic will take more than decorum. One also needs logos.

Cherry picked data

Brown: Claims that chiropractic is dangerous overlook two recent pieces of research. One found no causative association between chiropractic manipulation and stroke. The other concluded that the incidence of stroke after chiropractic was no greater than after a consultation with a general practitioner (Spine, vol 32, p 2375, and vol 33, p S176).

Here is the second testable claim: that there are two research papers that demonstrate the safety of chiropractic that the critics have overlooked. For a skeptical, scientific audience, that’s a sit up and listen moment, but as one is reading the claim and not being Gish-galloped with it in a live debate, the audience has the luxury of testing it out. There are two questions we can ask. First, what do the two papers say, and are they of good enough quality to support the idea that chiropractic does not cause stroke? Secondly, where do the papers fit into the larger body of research on the safety of chiropractic?

Spine, vol 32, p. 2375.  Safety of Chiropractic Manipulation of the Cervical Spine. A Prospective National Survey. (2007). This survey was the first national, large scale effort to poll chiropractors and estimate incidence of adverse events arising from cervical spine manipulation. The authors found that minor side effects of chiropractic manipulation were common, including neck pain, stiffness, soreness and headaches. However, no serious adverse events such as stroke or hemorrhage were reported by the chiropractors. So, no stroke, but the paper is far from a ringing endorsement for the safety of chiropractic. They report that manipulation of the neck commonly leads to headaches, a finding that is profoundly concerning. And there are other criticisms: patients were not followed up, it is not known if chiropractors under-reported adverse events, and people may not have told their chiropractor about a serious adverse event after chiropractic treatment. If they found themselves in hospital with a vertebral arterial dissection, they would have more important things on their minds. To keep things in context, a number of researchers have found that there is an association between chiropractic and stroke. A survey of chiropractors, like this one, does not invalidate all the research that preceded it.

Spine, vol 33, S176.  Risk of Vertebrobasilar Stroke and Chiropractic Care. Results of a Population-Based Case-Control and Case-Crossover Study. (2008). This paper is very popular among chiropractors, who see in it validation for their practice of manipulating the neck vertebrae. I’ll not recap it in depth, but will just say, again, that one paper does not supercede all that has preceded it, and wonder why it is that it takes a survey or an indirect population study, like this one, to identify the risks of chiropractic. It begets the question: does the profession not want to find out the risks for itself? Apparently not. For a more detailed look at what the researchers found, go here.

So, placed into context, Brown’s cherry picked citations rather reveal that there are risks associated with chiropractic, and chiropractors themselves have done little research, on their own initiative, to quantify these risks. Furthermore, there is a large body of research that shows an association between chiropractic and stroke, and Brown would do well to read up.

More to chiropractic than spine bending

Brown: Our critics also make the mistake of equating chiropractic with spinal manipulation, especially with regard to treating non-spinal conditions such as asthma. This demonstrates a lack of understanding of the fact that chiropractors utilise a range of treatments, including postural advice, reassurance and exercise.

I suppose that if one cannot defend the claim that subluxations cause asthma, one should retreat from the claim. Why argue for something that is factually indefensible? The problem with what Brown says here is that he seems to suggest that chiropractors can utilise postural advice, reassurance and exercise… to treat asthma.

It is no surprise to me that chiropractors do more than spine bending. Practice growth and financial success in the chiropractic business is not held back by the same barriers that real doctors face, like prescribing restrictions or evidence based medical practice. Take a look at a chiropractor’s office and see what they have to offer. In fact, Richard Brown, our valiant defender of chiropractic, offers all manner of wonderful woo at his clinic: aromotherapy, reflexology, ear candling and Indian Head Masssage.

So yes, there’s more to chiropractic, but not much more.

I know you are, but what am I?

Brown: Ernst and others claim that chiropractic lacks evidence, pointing to a paucity of randomised controlled trials. This overlooks the fact that many accepted medical interventions have little or no research evidence to support them.

No, it doesn’t overlook that fact, because that fact is not, in fact, relevant. What is relevant is the fact that chiropractors lack evidence in support of their claims, and ignore the evidence that disprove their claims.

Medical interventions, when found to be unsuccesful, will be discarded. Chiropractic, when found to be unsucessful, will just insist on being tested again and again until the researchers get their sums ‘right’.

Summary

The last thing the chiropractic profession wants is scrutiny, but by suing Simon Singh, that’s exactly what they got. This is a profession that chooses to sue a science writer for criticising their claims, rather than countering with the evidence. It is a profession that won’t look for evidence of harm from chiropractic unless first prodded to do so. It is a profession where the majority are adherents to a discredited, bogus 19th century pseudo-medical concept of disease. It is a profession so divorced from reality that the best they can muster in their defence is a grab bag of rhetorical tricks and diversions and the hammer of English libel law, because, as they well know, the evidence for chiropractic just isn’t there.

free debate

What to call chiropractic

What to call chiropractic

Chiropractic was invented in the 19th Century by Daniel David Palmer, a spiritual and magnetic healer. In 1895, he claimed to have cured a deaf janitor by  ‘racking’ the man’s back. Shortly thereafter, he cured ‘a case of heart trouble’ in similar manner. In a truly epic failure of logic and reason, Palmer decided that all human ailments could be treated by manipulating the spine, and thus was Chiropractic born.

This strange and bizarre fantasy got its name from a brief dalliance with the Greek language, as recorded in Palmer’s book, ‘The Chiropractor’s Adjustor’:

“Rev. Samuel H. Weed of Portland selected for me at my request two Greek words, cheir and praxis, meaning when combined ‘done by hand’, from which I coined the word ‘chiro-practic.'”

But ‘Chiropractic’ is such an unwieldy word. Even people that should know better, those guardians of the English language (okay, journalists) can’t quite believe it is correct. Hence The Independent calls it ‘Chiropractice‘. The Telegraph calls it ‘Chiropracty‘. Clearly there is a need for another word.

‘Chiromancy’ would fit nicely, being constructed from the two Greek words ‘cheir‘ and ‘mantea‘, meaning ‘hand’ and ‘divination’ respectively. It aptly captures the manual manipulation and magical thinking needed for chiropractic to work. Sadly, though, ‘Chiromancy‘ is already in use as an alternative word for palmistry, so that’s out of the question.

‘Chiropraxis’ has the virtue of sounding the way that people seem to expect the word to sound. But the potential for confusion only begins with this construction. In German, ‘chiropraxis’ is in fact osteopathy, a similar and equally as daft 19th Century system of medicine, one that believed the bone was the starting place for all human ailments. But the Germans only add confusion on top of this with alternate spellings. Their homophone to ‘Chiropraxis’, ‘Cheiropraxis’ does in fact mean ‘Chiropractic’, although, rather more helpfully, so does the word ‘Chiropraktik’. In the interest of international relations, perhaps ‘Chiropraxis’ should also be left off the table.

The elegant and derisive portmanteau derived from the words ‘chiropractic’ and ‘quack’, ‘chiroquacktic’, has acquired new popularity, driven especially by the media storm around the British Chiropractic Association’s decision to sue the writer Simon Singh for libel. ‘Chiroquacktic’ does have the quality of conveying the snake oil origins of the chiropractic art.  In fact, a very early usage can be found in the Journal of the American Medical Association from 1922:

“To the Editor:

—Noticing that THE JOURNAL, January 14, made reference to an article on chiropractic, which appeared in Leslie’s Weekly, I procured a copy of the magazine.

Might I say that this seems a step in the right direction— articles exposing such quackery as chiropractic. I wish that every Fellow of the American Medical Association would buy a copy of Leslie’s and read Severance Johnson’s article on “Chiro-quack-tic” and then leave it on his waiting-room table for his patients to read, or pass it on to some newspaper editor, in his town or city.”

In addition to the excellent and venerable ‘Chiroquacktic’, I would like to propose, and with apologies and gratitude to that master of manipulation, prestidigitation and magical thinking, Mr. Uri Geller,  that Chiropractic also be called ‘Spine Bending’. After all, bending spoons with the power of one’s mind is as plausible as curing deafness by bending the spine with one’s hands.

But whether they are to be called spine benders, chiropractors, chiromancers, chiroquacktors or just plain quacks, for the love of all that is good, let’s not call them Doctor.

Write your MP about the BCA libel chill

Write your MP about the BCA libel chill

Are you concerned about the recent libel case in Britain, brought by the British Chiropractic Association against the author Simon Singh?

If you want to do something about it, I strongly recommend writing to your MP.  This is why you should.

Letters (actual, snail mail letters) get noticed. They also get answered, or they should be. Whereas an email may be deleted or overlooked, a letter is not so easily ignored. It has a physical presence in the bureaucracy.

Politicians consider a single letter to be representative of a larger body of opinion. And they are right. When an issue becomes of such concern that it prompts an individual to put pen to paper, it is worth their while to pay attention to the subject.

Letters get noticed in the system. Sustained letter writing campaigns can have a definite impact, in that enough letters can choke the civil service that has to deal with them. But even a smaller number of letters on an issue can demonstrate to an MP or minister that there is a real base of concern.

Communications in order of effectiveness from least to most effective, and with thanks to Elizabeth May for the advice:

  • Form emails (least effective)
  • Individually written emails
  • Form snail mail letters
  • Individually written snail mail letters, typed
  • Individually written snail mail letters, written by hand (most effective)

The Commons Culture, Media and Sport Committee has been considering press standards, privacy and libel. A letter to your own MP and to the committee members would be a great idea. Let them know your concerns. It doesn’t take much to demonstrate that the citizens are growing restless. It just takes a letter or two.

You can find a list of the committe members here.