The following is a reprint of an article by Simon Singh, which first appeared in the Guardian last year, and has been the focus of all the legal fracas to have followed. Ben Goldacre summarises the circumstances for anyone who hasn’t been paying attention to any of this. Everyone in the skeptical blogosphere has been posting this today, so you’ve probably seen it before a few times by now, but I’m just doing my bit. The version below has been slightly modified from how it originally appeared, but Orac and others have reproduced the original intact. Follow the campaign supporting Simon Singh at Sense About Science.
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.
I’ve been going to a chiropractor for years and it’s really helped me. Neither am I dead or foaming at the mouth. It’s a tragedy that happened, but I’m wondering if her chiropractor wasn’t properly trained.
There’s a whole extended saga to this which it probably wouldn’t be interesting to try and recap here. A lot of chiropractors these days do tend to limit themselves to treating back pain, in ways that actually make sense and are based on good evidence and clinical research. But a lot of them still hold strictly to the original ideology behind chiropractic when it was first invented, and believe that about 95% of all illness can be cured completely by manipulating the spine to adjust the flow of natural energy throughout the body. Which is both meaningless and unproven.
You personally are a sample size of one, which isn’t enough to draw any interesting conclusions. And, to be fair, so is the Canadian woman mentioned in the article. The clinical studies and systematic reviews he mentions are much more relevant than anybody’s anecdotes, and a broader view does tend to show that chiropractic manipulations don’t appear to be effective for things other than back pain (like colic and asthma), and that some commonly performed spinal manipulations can be dangerous.
Whether or not the chiropractor in question was properly trained depends on what you’d expect them to be trained in. In the particular field in which he worked, he might have been entirely qualified and well practised. In conventional, proven, science-based medicine, maybe not so much.
My chiropractor recently switched to this little machine that precisely pushes the vertebrae back into place and stop when the vertebrae is moving the way it’s supposed to. I find it gives a better adjustment and is probably less dangerous than the manual manipulations I had for years before. I don’t know…in the US in particular there are a lot of different chiropractic techniques, most of which I haven’t ever been treated by. Were the studies you cite at the UK level or internationally sampled?