Wednesday, 29 July 2009

Beware the spinal trap

Along with half the blogsphere today, I join in reposting Simon Singh's article from The Guardian which got him sued by the British Chiropractic Association. For the lowdown read Orac.

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.


yorksnbeans said...

I think I commented about chiropractic in another one of your posts. I feel I have been very lucky with the chiropractor I have gone to when needed. Without him, my only choice would have been an orthopedist who would probably have just given me injections to reduce swelling and pain. Both times I had to go to him, I couldn't walk. It was awful. I thought, my days were over as a normal human being. But, after his treatments I was (both times) back to normal and happy as a lark. Mr. YnB also has had good experiences. Especially with a heel spur (I think that's what it was called) He had originally gone to a foot doctor and spent alot of money to get no results. Then he went to my chiropractor and had "cold laser" treatments which totally healed it! A year later and both of us are still good.

Andy Holroyd said...

YnB I am pleased that your experience of chiropractic has worked for you and Mr YnB. Please do not misunderstand my opposition. Back and joint problems, (and often muscular/tendon problems) are very difficult to treat by any medical means and anything which can add to add to effective treatments is welcome. Cold laser therapy is separate to general chiropractic spinal manipulation. It is being studied and shows promising results especially with regard to wound healing.

The trouble with chiropractic is the unsubstantiated claim of effectiveness in cases far removed from skeletal or muscular problems. Claims which have no demonstrated medical benefit and which have not been properly investigated. Basing medical treatments on anecdotes and unproven theories is not the way forward for science or medicine. Taking people to court for criticising or questioning such treatments is a death knell for rational scientific study. This is why I object.

The BCA should be producing evidence for their claims, or running proper scientific trials, not hiring lawyers.