Wednesday, 29 July 2009

“Spinal Trap”, Simon Singh

The UK's laws on libel are widely regarded as some of the most restrictive in the world, and one of the few instances where the burden of proof is placed on the defendent - in short, you are guilty until proven innocent.

While the guiding principle of this legislation, i.e. to prevent publication of material that damages the reputation of a person or organisation, is laudable and should encourage good journalistic practice, there is a worrying trend seeing libel laws being used to stifle open debate, most significantly well known author and broadcaster Simon Singh being sued for an article he published in the UK newspaper, The Guardian. This has resulted in the original article being removed from the Guardian's website, and represents a challenge to the ability of people to question what may appear to be spurious claims made, in particular, by alternative therapy practitioners.

In protest at this, many websites and blogs are reprinting Simon Singh's article, drawn from David Colquhoun's DC's Improbable Science blog. I am very proud to join this movement by providing an outlet for Simon Singh, whose superb article fully deserves to be read.

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.


  1. If someone threatens to sue you, it is quite often because they have run out of rational arguments! At least that is my opinion.

  2. Thanks for the comment Dorte - matches a lot of my thoughts too. I appreciate the need for laws on this sort of thing, because freedom of speech probably should have some limits when it's a one way conversation, but I feel the vast majority of libel suits are brought for the wrong reason, especially given the peculiarities of UK law and the rise of no-win no-fee lawyers.

    It's noteworthy too that the US is taking steps to protect US citizens from the rulings of foreign libel courts. Apologies for the unwieldy link, but the Press Gazette article below makes for interesting reading.

  3. So perhaps there are advantages to the Danish system which cannot really be called claimant-friendly.

    An Italian reader of my blog taught me how to do hyperlinks in comments some time ago so if you should need to another time it can be done in the following way:

    (a href="the web address")a description of the link(/a)

    and change all four parentheses to <>

  4. Clearly there is so much more to Denmark than Carlsberg, Maersk, and the Little Mermaid!

    Thanks too for the hyperlink pointer - it makes perfect sense that HTML will work in here - should have thought to try it really.