Bending over backwards to mislead…..

Sadly I am a pretty sporadic blogger (classic car ownership is to blame), but again I am driven to add my feeble voice to the case brought by the British Chiropractic Association against Simon Singh. I have known Simon for a couple of years, and been impressed not just by his searing intellect, but by his rock solid integrity.  As half the world seems to know, the BCA is suing Simon for the following article which appeared in The Guardian newspaper last year.

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.

Now this version has been slightly sanitised, because a man sitting on a bench in 18th century costume decided on the meaning of certain words, in disregard for the actual meaning which Simon explained in the article. He then twisted the knife in the wound by refusing leave to appeal. Now Simon has had his request to overturn that refusal refused by another fancy dress artist, despite some 13,000 people signing up to a statement requesting reform of the English libel laws. One is driven to consider whether the courts are being vindictive.

Well there are far more eloquent advocates for Simon than I, so I will leave this piece with a challenge for the BCA. I charge its officers with selectively citing `evidence’ in support of spurious claims for the efficacy of chiropractic for colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying. There are no absolutes in science, and it’s very well established as to what is solid evidence in health care. The stuff that the BCA described as a `plethora’ is not, and they can sue me if they want. Me and the other 50-odd bloggers out there.

Simon has made it very clear as to what he meant by `a jot of evidence’, and I am going to do the same. A `jot’ is not a case report or even several case reports. Neither is it a poor quality trial. These are not `jots of evidence’ because they tell us nothing. In dramatic contrast, the best quality evidence about for example chiropractic in asthma tell us that……yes you guessed it, it does absolutely nothing at all. Yet these self same high quality trials were not included when the BCA published its `plethora of evidence‘ – which was comprehensively demolished in the BMJ.

I am not going to accuse the BCA of deliberately lying, because I don’t know what goes on in their fuzzy heads. I am saying that, as self-proclaimed health care professionals, they have a duty to know what evidence is, and to present it fairly. They are clearly not doing that, but whether they are misleading by accident or design I will leave you to decide.

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6 Responses

  1. “I am saying that, as self-proclaimed health care professionals, [the BCA] have a duty to know what evidence is, and to present it fairly.”

    Indeed, as many bloggers have pointed out, a duty or at least requirement to make practice evidence-based is in most of the statutory regulator’s codes of conducts for health care professions. So the BCA’s members, and the organisation itself, have arguably been breaking the General Chiropractic Council’s own rules – one of the reasons for the mass complaints.

    There defence, of course, is their own one-eyed view of “evidence”, a view that would not pass muster in any respectable medical journal.

    We are all waiting to see if this view, ever gets a proper test in the legal sphere, perhaps at the European Court of Human Rights.

  2. I’m sorry but 13,000 signatures from the international community (even I’m on there) is nothing. You could probably get more than that on a Saturday morning at the local shops – for a petition to ban tap water.

    But even if it were 130,000 signatures, do we really want judges swayed by it? An awful lot of people think chiropractic works and I’d think “we” might well be outnumbered.

    The petition is surely for the consideration of politicians, not the courts.

    And while it’s true that members of the judiciary are allegedly human, I also think claims of judicial vindictiveness are misplaced. I imagine few people were surprised that that permission to appeal was denied – supporting the original decision by Eady.

    The ECtHR looks like an interesting option and, after all this is over, I think we might need a new phrase in the sceptical community – “What would Simon do?”

  3. You are right AndyD, the petition is for the politicians. I suppose I would be surprised if the judges had even heard of it, or read any of the media coverage. I am really railing against the power that judges have as individuals to make unilateral decisions with obviously inadequate checks and balances.

  4. Can’t disagree there. It seems perverse that one person can not only decide what you meant when you wrote something – but also deny you the right to appeal their decision such that you then have to first battle to regain the right to challenge their definition before you can then go on an actually try to get the definition corrected.

    At this point I’ll don my own conspiracy hat and argue that it looks like a ploy to keep the legal fraternity employed.

    • Well yes, the primary purpose of the legal system is to ensure that the lawyers get paid. Ethics have nothing to do with it (a lawyer told me that).

  5. It is easy to feel that the only response to all the legal nonsense is hollow laughter.

    Of course, occasionally common sense does win out – see McLibel, or the recent Dutch case nicely described by the Quackometer.

    I keep hoping that eventually the fact of its making us a global laughing stock will wake the politicians up to the undesirability, if not the utter idiocy, of the English libel law.

    Of course, one might feel that the historical dominance of lawyers in the Houses of Parliament mitigates against this somewhat, see Majikthyse’s last comment.

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