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’.
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.