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Beware The Spinal Tap

EDITOR’S NOTE: This article originally appeared in the Guardian UK. Its Author, Simon Singh, was sued by the British Chiropractic Association and ruled against due to the UK’s stunningly illiberal libel laws. This has been making the rounds today, it’s presented here so that you might read and enjoy. Also, the BCA is kindly invited to fuck right off.

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.

  1. Miles Rost says:

    Shiny Happy People: Precisely. Though I would put out there that it’s not the chiropractors fault that people are complete and utter dumbfucks.

  2. Shiny Happy People says:

    One of the biggest problems I have with chiropractors is that people treat them as though a are a medical doctor, when in (obviously) they are not.

    A good example of this happened where I work.
    A fellow employee almost died from internal bleeding due to a ruptured spleen despite the fact that he had visited a chiropractor 3 times in the two weeks between when he ruptured his spleen and his wife called 911.

    The chiropractor failed to realize that the reason my coworker was turning grey was due to blood loss and not due to his spine being out of alignment.

  3. Gsim says:

    I hate to agree with Miles on anything and I certainly do not buy into subluxations, auras or body lay lines, but a few anecdotal examples of some quacks killing their patients is not what I would call convincing evidence. Neither is Dr. Ernsts findings of 700 “serious complications among the medical literature.”

    Similar things could be easily written about traditional medical doctors. If chiropractic care is so dangerous and harmful to the public it shouldn’t be terribly hard to produce some statistics regarding how many patients are mangled by adjustments?

    The article reads like a hit piece, it is noticeably lacking a statistical comparison to the success/failure of traditional medicine and it does a poor job convincing me.

    There are far better arguments against chiropractic health care than provided.

  4. Vincent says:

    It is a fact that in every form of medicine, just like every form of banking in Texas, has it

  5. Miles Rost says:

    I don’t see anything in my statement which would be considered “chump-worthy’. It’s a true statement, in all forms of medicine you have idiots. It’s a fact of life.

    Take for example the strange case of St. Cloud Hospital, in St. Cloud, Minnesota, and the doctor whose chicken-scratch caused my aunt to get too much of one medication, which then caused her to have a heart attack and ultimately die 5 months down the road. He would be considered one of the idiots in the general practice field of medicine, and therefore be evidence of my statement above. Had he had better penmanship, he would have avoided this issue entirely.

    As I stated before, there is nothing chump-worthy in my statement. It is a fact that in every form of medicine, just like every form of banking in Texas, has it’s idiots.

  6. Timothy says:

    Oh Miles, it’s nice to know you’re still a chump.

  7. Miles Rost says:

    Every form of medicine has it’s idiots. This article has done nothing to dissuade the said opinion.

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