The libellous Simon Singh article on chiropractors
Posted by gimpy on August 17, 2008
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Here is the full unedited version, as published by The Guardian, of Simon Singh’s article that was critical of chiropractors and is subject to legal threats by the British Chiropractic Association (BCA) as reported by Holfordwatch and the Quackometer. I have added the evidence to support Singh’s claims.
Beware the spinal trap
This is Chiropractic Awareness Week. So let’s be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, 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.
[This claim comes from D.D. Palmer The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.]
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.
[This claim comes from D.D. Palmer The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.]
You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.
[These claims are found in the following documents from the BCA website, Happy Families and A Real Pain in the Back.]
I can confidently label these treatments as bogus 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.
[All details on Ernst's research on chiropractic can be found on PubMed here. Simon Singh has indeed co-authored a book with Professor Ernst.
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.
[This appears to be personal opinion based on research conducted by Ernst & others and is not libellous.]
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.
[This paper can be found here]
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.
[This is a personal opinion based on evidence]
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.
[Some reports here.]
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.
[Details of this case and some conclusions here.]
This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Professor 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.
[Details in this paper.]
Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week – 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.
[Personal opinion based on evidence]
__________________________________________________________________________
I wonder what grounds the BCA have to sue? It seems that every one of Dr Singh’s claims is backed up by peer reviewed evidence. For the BCA to prove that his opinions are not justified it will have to show why the evidence is wrong. It seems strange to resort to the court of law to do this, most journals are more than happy to publish comment and corrections on published research. This is looking more and more like the BCA have failed to overturn to the evidence so have now resorted to bullying tactics to silence critics. Sadly for the BCA the fact that this article is likely to be reproduced across the web, far beyond the jurisdiction of British courts, renders pointless any attempt to censor by legal weight. The fact that they appear to have no argument of libel in the first place is doubly tragic for them. No matter what they do they will suffer a massive loss of reputation.
It seems the greatest danger for quacks is not that their critics will take their argument seriously and demolish them, it is that they take their own arguments seriously in the face of contradictory evidence and defend them.
Thanks to Svetlana for the article.
Dr* T said
It’s a pretty tame article – I’m willing to bet pennies to pounds that Simon Singh will not have to pay out.
What on earth are the back-cracking quacks doing? This is going to end pretty miserably for them, IMHO.
T
GrumpyBob said
Nice to see the interpolated links to the evidence. Hope the web page references have been copied and date-stamped in case they change between now and the court-case (if it ever happens, which I doubt). It does sound like a rather bizarre legal move on the part of the BCA.
What’s the status of a D.C. qualification? Does it entitle the holder to style themself “Doctor”? (See for example ‘Dr’ Antoni Jakubowski of the BCA quoted on Quackometer).
Robert
gimpy said
Thanks GrumpyBob, I have copies of the BCA pages and their PDFs. As for the status of D.C. qualifications, wikipedia hints (it is more overt in the discussion) that it is a matter of some controversy. Personally, I would favour a system in which only those with doctorates can style themselves Doctor while medical doctors would adopt a different prefix. This would prevent quacks with doctorates in irrelevant disciplines or graduates of quack medical schools abusing the term. MDs would probably disagree with me though.
British Chiropractors Join the Legal Intimidation Party « Holford Watch: Patrick Holford, nutritionism and bad science said
[...] At the time of writing the British Chiropractic Association’s website does not carry any stories about this legal action. However, this does answer the questions raised on UK Sceptics since July 3rd about where Simon Singh’s article had disappeared to from the Guardian. It seems that the Guardian piece about Singh And Professor Ernst’s book and written to mark National Chiropractic Week is the cause of contention between Singh and the British Chiropractic Association. Update: Gimpy has managed to track down a copy of the article and has posted it: The ‘libellous’ Simon Singh article on chiropractors. [...]
Svetlana said
Thank you, Gimpy.
I am glad to see that you have created such powerful post from the full text of the article.
dvnutrix said
My one reservation in this matter is that in Wilk v. American Medical Assocation, the AMA lost in some regards (relating to federal anti-trust laws). However, the upside is that the judge took a very robust attitude.
gimpy said
Thanks for that note of caution Dvnutrix. Regardless of the outcome of this situation it should be remembered that the validity of medical interventions is not established in courts of law, but rather the pages of journals.
dvnutrix said
Certainly should be but if, for whatever reason, the Autism Omnibus hearings hand down a judgment that favours the plaintiffs, it is hard to imagine that that would not be the most frequently-quoted assessment, irrespective of the 50% + scintilla balance for the scientific proof. After that, I would imagine that the anti-vaxers would try and use that to open up vaccine exemptions in more states in the US.
And, unfortunately, although the legal judgment should not trump reports from experts and the corpus of work that indicates that there is no known association between vaccination and autism, I would imagine that the court’s judgement would be taken a disproving scientific expertise on this matter.
As you say – adjudicating such issues is not a matter for law courts.
BillyJoe said
Gimpy:
“For the BCA to prove that his opinions are not justified it will have to show why the evidence is wrong”
Apparently, in libel law, the onus is on the defendant to prove himself innocent. It will be up to Simon Singh to prove that what he wrote is not libellous by proving that it is true.
Someone please correct me if I am wrong.
gimpy said
BillyJoe, I’m no lawyer but JackofKent is and covers this on his blog.
Jack of Kent said
I have now added a brief guide to English libel law on my site: http://jackofkent.blogspot.com/2008/08/on-english-libel-law-brief-guide-for.html
Skepti.net » Litigation instead of Evidence… said
[...] from the Guardian but is mirrored here. The article itself is pretty tame and, as detail here, the claims made are supported by peer-reviewed [...]
Chiropractors resort to legal intimidation said
[...] Shortly after this came the news that the British Chiropractic Association is to sue one of out best science communicators, Simon Singh, because he had the temerity to inspect the evidence and give his opinion about it in the Guardian. His original article has gone (for now) from the Guardian web site, but as always happens with attempts at bullying and intimidation, it is more easily available then ever, For example here, and here. [...]
starpath said
Clearly, evidence-based treatments are not highly important to the millions of patients attending the CAM practitioners. Other factors within the treatment process must override the science.
Colin Rossie said
Probably one major reason why so called CAM enjoys such popularity is because it fills a void created by modern medical practice. Medical doctors do not touch their patients anymore, both because of a lack of knowledge about musculo-skeletal pain and because of fear of being sued. Also, standards of medical training are in decline: many graduates have a decent understanding of systems anatomy but a poor grasp of nuero-musculo-skeletal anatomy. Their treatment regimes, from drug therapy to chemo & radio therapy, are not as efficacious as they would like us to believe. If someone has repetitive strain injury, analgesics will mask the pain symptoms but not treat the cause. Sure, they have a place in the immediate, short term management of pain, but not in any long term solution. What percentage of cancer patients die or have a poorer quality of life after chemo? How effective are SSRIs versus cognitive behavioural therapy for anxiety and depression?
PodBlack Cat | Bloggers Behind Simon Singh - Where The News Is At said
[...] Chiropractic Association after writing an article in the Guardian, which you can find in full here thanks to Gimpy’s Blog. As you can see, “The libellous Simon Singh article on chiropractors” includes evidence [...]
Looking Out To Sea » If you don’t have anything nice to say, say it on lawyer’s headed paper said
[...] best reposting is on Gimpy’s blog: the article comes with full references for every one of Simon Singh’s [...]
Main ethical issues in the Equine Industry - Page 2 - Stockyard Horse Discussion Forums said
[...] article in the Guardian (no longer on the Guardian website, but a kind soul has made it available here). __________________ I consider that the thorough-bred horse makes man perfect. ~ James [...]
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[...] comments, which can be read in Blogospace here and here, were clearly derived from Trick or treatment?, the book about Alternative Medicine he recently [...]
Back Pain said
Very nice blog! Keep up the good work.
Alethea said
My compliments – every bit as good as advertised (coming from the Quackometer). Your work is obvious and highly convincing. If only mainstream journalists could be convinced to back up their research so well.
gimpy said
Thank you Alethea for your kind words. However, I remain in awe of the prowess of the Quackometer.
Ben Goldacre and The Guardian triumph over murderous Matthias Rath « gimpy’s blog said
[...] The libellous Simon Singh article on chiropractors [...]
Tampa Chiropractor said
Pretty fair article.
Patent medicines in 1938 and now: A.J.Clark’s book. said
[...] Simon Singh, one of the best science communicators we have, has not been so lucky. he is going to have to defend in court an action brought by the British Chiropractic Association because of innocent opinions expressed in the Guardian. [...]
David Colquhoun Questions Part 2 - Trick or Treatment « Jon Wardle said
[...] un-regulated. One thing I actually have in common with Simon Singh is that I too have attracted litigious consequences due to my outspoken views on regulation. As it exists in Australia – as I am aware it also does [...]
Arjen de Landgraaf said
Having seen Simon couple of weeks ago at the SurfNet conference in Eindhoven, Netherlands, where I was also asked to speak, I can only say that I am asthonished by such a singular point of view Simon has ventilated here.
What a shame, after writing splendid books on cryptography, he now lowers himself to such a “Sun Level” of arrogance and ignorance. I am deeply dissappointed with such a narrow minded, sensation hungry attitude. No I am not a Chiropractor, but an IT Security professional.
In 1987 I fell on my neck when thrown of a horse (for my first and last jump…)while living in New Zealand. Established medical experts decided I needed surgery, and my spine fused. I refursed, and ended up with visiting a chiropractor (using what is called the ” American Method” the push and crunch method. He has been my saviour and lifesavor. I can lead a normal life, even do sports, and I know for sure without him this would have been impossible. I know of many people who have great relief and benefit from chiropractig treatment. Shame, Simon.
Arjen
The Netherlands
Rider Of Giraffes said
Arjen,
I appreciate that you personally have benefitted directly from the appropriate use of chiropracty. However, I urge you to look closely at the claims by Chiropractors that Simon is contesting, and his basis for doing so. If you do, you may be less inclined to condemn him.
Felix said
I would not be in the slightest inclined to condemn Simon Singh’s article and much of what he says may be true. I could write – from personal experience and observation – a similar article about regular medical practice, in particular with regard to treatment of slipped disks,with which qualified chirop’s are having greater success.
I could write about all the damage done to the spine by regular medics if requested to do so. I have googled about and found the impartial statement that subluxation can’t be scientifically proved, but that there is an increasing body of evidence that Chiros treat certain types of back problem with success. Mr. Singh might have conceded at least this.
I have effectively been cured – after going through medical tortures – by a chirpracter. All the others I know, who restricted themselves to regular medicine, surgical intervention and loony therapies that aggravate the pain, are as badly off or worse off than before.
I was suffering such atrocious pain that I could not walk except with the aid of powerful pain-killers – which are bad for your liver – until I met my chiro man. Within a few days the pain was going and now I can walk about like a normal human being, while others, under medical treatment, are suffering. There is no way smart-Alecs can tell me the pain would have gone anyway, as my slipped disk was at its very worst, due to medical tortures, and I improved after a few days of chiro treatment.
I told my chiro man that I had heard rumours that chiropractice could be damaging. He said, “Of course it can. There are many unqualified people setting themselves up in the profession.” I’d say, as many as the unqualified or dim-witted medics.
The chiros and Kinesiologists look at your posture and try to improve it; the medics I have encountered, don’t. Now, one doesn’t require scientific evidence to prove that a better posture and development of the right muscles to support your spine must be beneficial.
I have the impression that chiros, like all people who want to make money, are exaggerating the claims about everything they can do. My chiro man, so far as I can tell sticks essentially to back ailments. I haven’t seen pamphlets about pregnant women etc. I will certainly go back to him. It is people like him that should not suffer from a universal condemnation of the profession, but he won’t as he has too many patients who know what he has done for them. In any case, if I had noticed adverse side effects – I didn’t -I would have stopped!
The story about the waitress who died is tragic. But for every qualified or unqualified Chiro that gets something wrong, there are a hundred medics that do the same. My father was a doctor and told me it was almost impossible not to make a mistake sometime during your professional life.
Unfortunately I don’t yet know how to make links, but the is a site in which Alvan Calverd puts the arguments against Singh quite cogently. The Site:
The Science Forums – Chiropractors sue Simon Singh
Calverd considers Singh’s views point by point.
If the discussion is not open to all views,but is selective, Singh begins to look not so good.
I will continue to proffer my neck to the Chiro.
Nash said
Felix
Last year my manager pulled his back and went to a chiroprator 2 times a week to clear the pain. After each session his back felt numb and the pain returned the next day. One week he had important meetings and couldn’t make his chiro appointments. He had no back pain that week and ever since he has not been going to chiro and his back has been OK.
When I started bodybuilding I was given the following advice. If you get a pulled muscle see a physio or an osteopath, only use a chiropractor if you don’t to walk again.
Quick update on Simon Singh vs the back quacks « gimpy’s blog said
[...] 25, 2009 You may remember that the British Chiropractic Association (BCA) took legal offence to an article by Simon Singh that cast doubt on the efficacy of their therapies, well Jack of Kent has informed us that the [...]
Kenzie said
I do not think it is fair to lump all chiropractors together. There are chiropractors who practice very orthopaedically and biomechanically, much like a physiotherapist would except they have the tool of spinal manipulation. And there are chiros out to make money telling you that they can cure every disease under the sun. We just cannot condemn a whole profession and call all chiropractors quacks when some or most of them are really able to effectively help people with their pain and related dysfunction/s. Perhaps the author of this article should have made a distinction between the good chiropractors out there and then gone into more details about what bad chiros do.
gimpy said
Kenzie, all this may be true and I don’t think anyone reasonable would argue against a proper open debate, except the BCA aren’t reasonable and want to stifle debate by using the libel courts.
Sam said
Physiotherapists in the US are educated on spinal manipulation techniques but only use them when needed (ie, when there is hypomobilitity in the spine). There are very effective, gentle methods to reallign the spine without high velocity, low amplitude thrust techniques. I went to a seminar on chiropractic care regarding the possibility of co-treating with physiotherapists. This chiropractor pretty much stated that any chiropractor that suggests he can fix something other than spinal problems is a quack and physiotherapists should refer to a chiropractor if the therapist is not skilled in spinal manipulation.
Richard Lanigan said
As someone who trained as a chiropractor and resigned from the chiropractic register in January 2009, I would have to disagree disagree with what Simon Singh had to say in his article. However I think he and other sceptics have every right to hold these opinions and a court room is not the way to change your view of chiropractic treatment.
It is only because of the incompetence of the people promoting the profession in recent years that the chiropractic profession are now having to rely on barristers to defend the profession in the UK. I say this having been on the receiving end of many legal threats from the chiropractic establishment in my time, in fact a Freedom of Information request informs me that the GCC has hired private investigators to try and discredit me and have me arested for implying that I am a chiropractor by putting my qulaifications on the wall of my clinic.
Simon Singh would have been on stronger ground if he had focused his criticism on the General Chiropractic Council (GCC) and how they are dumbing down chiropractic education standards in the UK by not subscriping to European standards of chiropractic education. It is not a coincidence that promoting chiropractic has recently been removed from the statutory duty of the GCC, so it hardly a surprise that many view chiropractic as a “bogus treatment”.
Many senior people in the BCA would probably share Simons view on chiropractors treating children because they could not articulate how stimulating mechanoreceptors in the spinal joints could affect the function of the autonomic nervous system. The BCA leadership were probably unaware that the information in Simon Singhs article was not accurate to win this argument before instructing their legal teams.For example DD Palmer who discovered chiropractic in 1895, was 15 in 1860, and there is no evidence that he began “developing his theories” in the 1860s as stated in the article I suspect Simons article may have confused Palmer with Andrew Still who founded Osteopathy in 1874.
Palmer’s hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask.
Few chiropractors would claim that the scientific evidence to support the efficacy of chiropractic to help conditions like asthma, colic, ear ache was compelling. However, for Simon to say there was “not a jot of evidence” is simply untrue. Unfortunately much of the evidence for children is mostly a collections of case studies however by the same token to rely on case studies particularly the example of Laurie Mathiason (who suffered a stroke ten years ago after receiving chiropractic treatment and other things she may have done prior to the stroke) is hardly convincing “evidence” to make the case that chiropractic is not safe.
Every five minutes someone in England will have a stroke(National Audit Office 2006), there are no epidemiological studies that would even hint that this finding has anything to do with chiropractic treatment.
The chiropractic profession needs to do a much better job promoting itself and explaining how spinal adjustments affect nerve function, rather than using the legal profession and the old chiropractic suits they have used in recent years
the quackometer: Chiropractors Try to Silence Simon Singh « Propos et Commentaires du Climenole said
[...] leave a comment » via quackometer.net More details here: The libellous Simon Singh article on chiropractors [...]
Supporting science speech : Stochastic Scribbles said
[...] Simon was unjustified in calling some treatments promoted by the BCA as bogus treatments in an opinion piece for the Guardian, ostensibly because “bogus” implies the BCA was being intentionally deceptive. This [...]
Simon Singh to appeal libel decision « gimpy’s blog said
[...] Comments Supporting science s… on The libellous Simon Singh arti…MickVagg on Homeopaths organise mass lette…EP123 on Homeopaths organise mass [...]
Sam said
what a superb article, the BCA have resorted to the most primitive of tactics and to their fortune have landed (to the nations suprise…) a narrow minded judge who has somehow misread and misunderstood the original article paying no heed to its irrefutable evidence and back-up opinion. This judge is well known for his messing around with privacy laws. what a stroke of luck he presided over the BCA case ey…? Despite his preliminary ruling, Anoth £100,000 grand in legal cost’s on Singhs part will be well worth the turning over from a higher court.
see article from ‘The Times’
Article begins:
“April 21, 2008
Mr Justice Eady
High Court judgeHe may be just one of more than 100 High Court judges but Sir David Eady, 65, is nonetheless arguably more influential than any of his colleagues. Almost single-handedly he is creating new privacy law. A series of rulings have caused some disquiet within the press — although Sir David, a quietly spoken courteous man, is tapping into a public distaste for invasions of privacy. In 2006 he granted a gagging order to a celebrity who had an affair with a married woman to prevent the wronged husband from selling his story and unmasking the well-known “family man”. In 2005 he ruled that passages of a book by the author Niema Ash about her former friend, the Canadian singer Loreena McKennitt, be removed on the ground that Ash had violated a duty of confidence; and awarded damages to a Saudi Arabian billionaire against the Wall Street Journal Europe over allegations that Saudi authorities were monitoring the bank accounts of prominent Saudis for links with terrorism. Of course, he is subject to higher courts — and this last was overturned by the law lords. But his influence is certainly being felt.”
Simon Singh is charming! Er, appealing! « Cubik’s Rube said
[...] the time), and although I haven’t got to the chapter on chiropractic yet, I’ve read the article that sparked all this controversy, and I’m becoming fairly familiar with the nature of his approach and the rigorous care with [...]
ndt said
Obviously not libelous. Too bad the case got assgined to an incompetent and/or corrupt judge.
Simon Singh and the Case of the Chiropractors « The Bumper Fun Blog of Science said
[...] with particular reference to its use in the treatment of chronic conditions such as asthma. Gimpys blog has the full article for your viewing pleasure, and has done an expert job of annotating it for you [...]
popurls.com // popular today said
popurls.com // popular today…
story has entered the popular today section on popurls.com…
Ben said
Richard,
If you are talking about studies such as Zhang, Dean and Nosco, or Roy, Boucher and Comtoid on HRV then you are sorely mistaken. Not only is there still disagreement about what, if anything, HRV truly measures, but the statistics used in these studies were laughable. P values and mean’s aren’t enough in these types of studies. We don’t care whether the groups WERE different, but whether the difference was LARGE enough to be clinically meaninfgul. It’s called effect size, and if a study like this doesn’t mention it, it’s usually useless.
If you can, I’d love to see some clarifications on what excactly you mean by spinal manipulations influencing the autonomic nervous system, and how said changes are clinically relevant.
Ben.
Richard Lanigan said
A few years ago I spent a lot of time on a sceptic site, debating with many sceptics, Bluewode was one and in the end we had to agree to disagree. I would go anywhere and debate chiropractic, I have done a masters in Public Health and Health Promotion under Professor Theodore MacDonald one of the most brilliant minds in Health Promotion and author of many books. That was the point where I started to look at the people who represented the chiropractic profession in a very unflattering way (not the sharpest pencils in the box, but very good at schmoozing). I said it publicly as they would not debate with me either.
I was elected onto the GCC council as an independent in 2007, I was not a member of any of the chiropractic associations. I was thrown off the GCC for calling someone a liar, not realising in defamation law just because someone tells you something that is not true it does not necessarily make them a liar, 13 of the 20 council members voted me off the council in March 2008.
The main evidence against me was provided by the president of the BCA Tony Metcalfe, I had e-mailed him (Whistelblowing) that the GCC was covering up the activities of their executive officer Greg Price who had to resign for posting obscene messages about me and other chiropractors on the internet and had then showed up working at another regulatory body UKCP with a reference from the GCC (The GCC would not authorise an investigation so I went outside council and contacted Tony). Not wanting to rock the boat and score brownie points by outing me, Tony forwarded the e-mail to his mate the Chairman of the GCC Peter Dixon, a former BCA president and the rest as they say is history. I would have resigned from the register then, but I did not want the powers that be implying that I had been struck off so I waited until January 2009 to resign and began practising as a Health Promotion specialist who performs spinal manipulation.
The thing that annoys the GCC most is I have been practising in Kingston upon Thames for 15 years, I am good at what I do and the patients are not bothered whether I am registered or call myself a chiropractor or not. I am no longer allowed to use my x-ray equipment, but that is not a big loss as the more experienced I became the less I used it. Paying VAT is a pain but worth it, just to be able to give the finger to the chiropractic leadership without being hauled before a tribunal, this has happened about nine times. The first time was after I acted as an expert in the first case to come before the GCC. The GCC accused a Jesper Jensen of making Bogus claims about chiropractic and their expert was David Byfield head of the school in Glamorgan and a member of the GCC.
Rather than have an honest debate Byfield altered the evidence against Jensen 37 times to make his point, that what Jensen was claiming was bogus. However because of his “alterations” which Byfield claimed were mistakes under cross examination, it was no difficult for me to pull his evidence apart, for which the law firm paid me £27,000 for my work, thats where the money is not treating little old grannies, he complained to the BCA and the GCC because I had made his “mistakes” public.
After that the GCC decided to use the ASA and get their experts to advise behind the scenes to restrict scope of practise for the less competent in the profession. I don’t dispute chiropractors say stupid things in their advertising or others use fear to get people to sign up for a year of treatment (US sales technique) In fact in 2004 I complained about a chiropractor trying to extort £2000 from a patient for a years care. Because it was me making the complaint the GCC never investigated the allegation.
I don’t hide unethical practise on my blog, I was the only Council member who wanted to ban prepayment schemes because the chiropractic profession needs to clean up its act in this area. see http://78.129.175.29/unethical-practise/
So what do I tell people? You have 24 vertebra and 48 spinal joints which should move symmetrically. When they move they stimulate nerve receptors which send impulses into the CNS. When I find a joint that is not moving properly (subluxation) I adjust it (manipulate). Usually it helps back pain and neck pain, headaches, it also seems to help people with menstrual pain, asthma, colic and a few other things. If it is a placebo ( and I don’t believe it is) does it matter, the adjustment helps most people who need it. I worked in a hospital in CUBA one summer was adjusting 12 patiens an hour eight hours a day for four weeks (no chiropractors there because of the blocade)
According to the latest NICE guidelines for back pain, the NHS have been using Laser therapy, Interferential, Ultrasound, Tens, Lumbar supports, traction, and spinal injections for years and guess what they don’t work and their advice now is not to give them to patients. But they must have helped some people, I believe its having a competent practitioner is more important than the therapy that is chosen.
I would use Melzack and Walls Gate theory to explain the effect of the chiropractic/osteopathetic adjustment on the nervous system, which suggests that stimulating mechano receptors in the spinal joints would inhibit nociceptors which produce pain in the brain, which in turn activates sympathetic part of the autonomic nervous system and inhibiting parasympathetic activity. When you see someone nodding off on the train their head drops stimulates mechano receptors which fires into the CNS and wakes the person up. I would be more than happy to go anywhere to talk about what I do, The leaders of the chiropractic are not able to, that is the problem.
I know I do ramble on I apologise.
Ben said
According to the evidence, it is the more dangerous manipulations that cause largest spindle activation (Pickar, Ernste etc). The effect seems proportional to the instantaneous force.
Given how gate neurons work, I believe chiropractors are simply practicing a crude & risky form of anaesthesia. Why not fix the problem, rather than use a crude tool with inherent risks?
L.E.N.L. said
@Arjen @Felix: anecdotes do not constitute proof or, even, a rebuttal. As has been pointed out elsewhere, the refusal of the chiropractors to participate in well-formed, rigourous analysis of their reputed claims makes one thing quite clear: their accomplishments lie more in their marketing than in their medicine.
Notsobad said
I had some back problems after a car accident, and I found the chiropractor helped me a great deal. I don’t know about curing all ailments, but it did the trick for what ailed me. Yes, it has the potential of going horribly awry, but so can treatments in the medical world. A chiropractor is just as capable of malpractice as a medical doctor.
I don’t think anyone has the right to sue because of this article. plenty of articles have been published about smoking but people still do it because the benefits for them outweigh the risks.
What is wrong is trying to deny people access to information about the risks.
Simon Singh battles Britain’s amboguous libel laws « lightbucket said
[...] Guardian article by Simon Singh is reproduced with links to supporting evidence in the post “The libellous Simon Singh article on chiropractors” on Gimpy’s Blog, and the legal issues surrounding this case have been covered [...]
Las penas del Agente Smith » Esto no se arregla a martillazos en la columna said
[...] pues el Guardian lo eliminó de sus servidores, como explica Singh en su narración de los hechos – aquí hay, además, una versión anotada con referencias): […] la defensa de Singh exponía larga y claramente que, en efecto, la evidencia no existe [...]
BCA vs Singh « Pippard Vigander said
[...] Here’s the original, unedited Simon Singh article. Posted in news, science | 2 Comments [...]
kevin wilson said
hhhmmmm.transparent observation of medical professions noting and documenting results is a necessary requirement.Manipulation of the spine at the neck is a sensitive ad serious matter.A very controlled process step by step is required to initiate a curing effect;monitored frequently for certain evidence of result
Having studied and participated in research
regarding incurable disease;its essential to offer hope but to move past this through providing result.
There is in fact an esoteric side to healing that deals with energy.But it is up to clinicians to provide apparatus which clearly shows and demonstrates live footage and result of any cure.
To this I state we are behind the times in the alternative medicine field.
We need to advance to this step to be fair to the public and ourselves as clinicians.
Colin Rossie said
To state my bias up front: I am a manual therapist, specifically of the “structural integration” tradition (also known as Rolfing).
Though one could extrapolate all sorts of benefits and therapeutic inter-relationships based on wishful thinking (as indeed many C.A.M. disciplines often do), all the best manual therapy is always evidence based. Increasingly, this will be the way of the future. Therapeutic efficacy should be based on results, which in turn are either predicated upon or validated by research. Wishful thinking and ideology belong to the realm of sciosophy, not science, and bodies of work based on them don’t belong in the modern therapeutic paradigm. While the work of the pioneers of these sciosophies can be interesting to post modernists as cultural movements or expressions, their ideas should either stand up to to the rigour of modern scientific scrutiny or be relegated to the dust bin of history as cultural curios. I refer here specifically to people such as D.D. Palmer and even Dr I.P.Rolf.
The best practitioners think about what they do, research constantly and keep abreast of scientific developments. I question what I do and analyze the results of my work on a daily basis. One shouldn’t just blindly accept industry dogma, received notions or the ministrations of vested interests. Surely degree qualified, educated health professionals (which is what chiros are) would do the same? It seems the more academically inclined do, but that vast sections of the modern chiropractic industry still retain superstitious notions born of the nineteenth century.
One major point that disturbs me regarding the chiropractic industry is their laissez attitude to vertebral artery testing before performing HVLAs on the cervical spine. I have had seven chiropractors do neck work on me over a 35 year period and not one has done a Vertebral Artery Test (VAT) beforehand. I have asked all my clients that have previously received chiropractic if they have had the VAT done. Only once in hundreds of clients has the answer been yes. Some of these people have been seeing a chiro regularly for years. Yet this simple test for vertebral compromise could avoid the complications of stroke or vascular compromise of the brain if performed before a treatment.
Another aspect of chiropractic that disturbs me is manipulation of the cervical vertebrae in very young children. Given that the ossification pattern in the cervical vertebrae of neonates means that little more than the centrum of the vertebral body has ossified, what could justify the use of manipulation there when the bone is far from fully ossified?
Simon Singh on chiropractic: “Beware the spinal trap” said
[...] this bowdlerised version still presents the case very strongly (and the unedited version appears here and [...]
Michael Meadon said
I’m trying to organize a Google Bomb so that Singh’s article appears high in the search results for the terms “chiropractor” and “chiropractic”. The link we should all point to: http://svetlana14s.narod.ru/Simon_Singhs_silenced_paper.html
I have more details and a how-to on my blag: http://ionian-enchantment.blogspot.com/2009/07/google-bombing-for-singh.html
The article the British Chiropractic Association hopes you will not read « Millard Fillmore’s Bathtub said
[...] Gimpy Blog [...]
Hamish Allan said
While I agree that the libel laws of England and Wales seem to be in need of reform (just by looking at the costs involved), I would like to read the precise claims made by the BCA before forming an opinion on this case.
The campaign title “Keep libel laws out of science” does not make much sense to me. Libel is an action against (the author of) a particular piece of writing. If a particular piece of scientific writing is also defamatory, its genre should not give it automatic immunity against a libel action. While scientists generally agree that open debate is a much better route to truth than censorship, we live in a world in which some voices are louder than others, and genuine defamation should not be allowed to go unchecked. I’m not saying that this is the true of Simon’s case, but the campaign is supposed to be further-reaching than Simon’s case.
Science will presumably form part of the defence against this libel trial, which is as things should be. However, I did notice that the linkage to peer-reviewed evidence in the following annotations:
“[This appears to be personal opinion based on research conducted by Ernst & others and is not libellous.]”
“[This is a personal opinion based on evidence]”
“[Personal opinion based on evidence]”
is rather conspicuous in its absence. If such evidence turns out to be rather thin, and the “justification” defence is not possible, then the case may rest on whether or not those statements are presented as opinion. Perhaps the English legal system does not consider naming a section “comment” to be a clear enough indication that statements with the appearance of facts are actually opinion; and I must say, I have some sympathy with that position.
Cracking the Spine of Libel - Olivia Judson Blog - NYTimes.com said
[...] The original Singh article has been removed from The Guardian’s website. But it can be read here. [...]
Charles said
The case is a joke.
Singh’s claims are what are bogus.
Anyone who has studied the safety of chiropractic compared to even non-steroidal medication for the same condition will see that the risks of chiropractic are many many magnitudes less.
The problem for Singh and why he will lose the case miserablly is that he knows very well there is evidence for much of what he claims but has sought to pick and chose what he first considers evidence and then when there is evidence he attempts to discount it into something that isn’t evidence so he does not have to acknowledge it.
His thinking is not critical or attempting to find a truth but instead is completely biased.
There is virtually little relationship between “neck cracking” and stroke and Singh knows this research since it has been shown in a major study that there is no differnce in incident of stroke between a chiropractor and medical primaray physician. The reason appears from the study to be that people are seeing their health practitioners due to an ongoing stroke which involves neck and head pain. The relationship to chiropractic is therefore coincidental and not causal.
Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.
What of the evidence of chiropractic care for children? No evidence?
Well that isn’t the real story. There are studies that do show chiropractic care for the conditions referred to by Singh but they are in the preliminary stages. That means that there are no full scale studies yet while that may be the case, that does not equate to no evidence. Anyone in the scientific field knows this but if you have a strong bias you will make strong statements.
While there are quite a few studies relating to “colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying,” nmore research is clearly needed.
See: http://icpa4kids.com/research/
We all need to be critical and attempt to understand what may be wild conjecture but where there is evidence and the scientific community knows that evidence based healthcare does indeed involve a doctor’s clinical judgement, case reports, and biological plausibility.
Evidence based medicine: what it is and what it isn’t [http://www.bmj.com/cgi/content/extract/312/7023/71]
Chiropractors: clarifying the issues [http://www.bmj.com/cgi/content/extract/339/jul08_4/b2782]
zvi erez said
thanks for the splendid anointed article. it deserves to be distributed widely.
i’m ashamed to admit had seen and heard so many references to chiropractery in the press i thought that it was now accepted.
thanks for the education (and the reminder to be skeptic of the press, including the guardian).
Jim Conniff said
Britain and its “courts” of law has so much more to atone for across the centuries that it would be better employed doing penance in deep canisters of aged Indian and Irish and African pigshit,just for openers.