Sense About Science

Simon Singh and the Appeal Decision

My Oxford studies might still be kicking my ass and making me break all my blogging promises but I simply cannot let last weeks development in the Simon Singh case past without comment.

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Simon Singh finally won his appeal!

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Detailed analysis of the victory and what it means, as always, is available from Jack-of-Kent who has provided four excellent articles on the decision (one, two, three and four). Jack’s dependable analysis has also been joined on this occasion by a raft of coverage in the mainstream media, with articles and news segments appearing on practically every notable UK news source (a partial roundup is available here).

The impact of the coverage has particularly struck me, in that I have had friends and family who previously knew nothing about the case (and thus suffered at the hands of my diatribes), contacting me to ask if I saw the decision on the news.  The coverage has also typically included discussion of the wider campaign for reform of the libel laws and has therefore increased the publicity for this excellent cause too!

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Libelous Article or Honest Assesment?

Simon Singh’s battle with the British Chiropractic Association all started over an article written for the Guardian over a year ago on 18th April 2008. Today, the article was republished on the Sense About Science website and across a whole host of magazines and blogs with the two alleged libellous sentences removed.

So I thought I’d contribute my own little bit of help by hosting it up here as well. So below is the original article that caused the whole fracas sans two sentences and if you just cannot live without seeing those immortal ‘allegedly libellous’ statements one more time then good old Jack-of-Kent has posted them up on his site. Enjoy…

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.

Simon says… Appeal!

Keep Libel Laws out of Science

A good idea...

I’m definitely flogging a dead horse at this stage but I’d be remiss if I didn’t at least mention that Simon Singh has announced that he will be appealing the horrendous decision from the preliminary hearing of his court case against the British Chiropractic Association.

This great news in itself but that’s not all… 

Yesterday, also saw the launching of an extensive and deeply impressive support campaign lead by the UK charity Sense About Science. The campaign is going under the straightforward title of ‘Keep Libel Laws out of Science’ and included the unveiling of a petition asking for exactly what the title suggests. The petition when unveiled already included an incredible list of signatories including university professors, renowned journalists, world famous comedians and yes even skeptical bloggers.

To drop a few names for anyone who hasn’t had a look: Richard Dawkins, Alan Sokal, David King, Stephen Fry, Dara O Brian, Derren Brown, Ben Goldacre, Alok Jha, Michael Shermer, Steven Novella, James Randi, Phil Plait, Nick Cohen, Ricky Gervais, Tim Minchin, David Starkey, Jonathan Ross and David Allen Green have all signed their support (and also all happen to be folks whose work I admire!). There are also many more impressive signatories and I encourage everyone to have a look and then provide their own signature which can all be done from here.

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