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.

Unfortunately there are serious problems with relying on Herd Immunity to protect someone from disease.

Herd Immunity Protects the Herd, Not Individuals

The biggest problem with Herd Immunity is that it protects the Herd, not individuals. Herd immunity stops a disease from spreading and becoming endemic. A disease is endemic in a population when it is able to exists within a population by spreading from vulnerable individual to vulnerable individual. Once immunity is high enough, the disease cannot continue to spread within the population and it eventually disappears.

However Herd Immunity does nothing to stop the spread from an infected individual to a vulnerable individual. The question is really this, what are the odds of a vulnerable person being exposed to an infected person? Herd Immunity reduces the likelihood of a member of your “herd” from being infected. However people from outside are another question entirely. We live a in global community, and diseases that are rare in developed nations (because of vaccinations) still kill millions of people worldwide. Places like Africa and India are just a flight away. Sick people enter our populations all the time (google can find many news reports). As long as our immunity rates are high, the damage is minimized. Of course, those planes fly both directions, and many of the most beautiful and exciting destinations are also places where infectious diseases are still a problem. Herd Immunity will do nothing to help someone who leaves the herd.

Herd Immunity Requires Very High Immunity Rates

It is estimated that for Herd Immunity to be effective 90 to 95% of the population must be immune. Vaccinations, like all medical procedures, are not 100% effective, so there are a number of individuals who received the vaccinations, but lack immunity. As well, there are some people who cannot be vaccinated, the very young, the immune compromised, etc. Anyone who chooses to not give vaccinations increases the risk that Herd Immunity will fail.

To see how quickly this can happen, consider the false MMR – Autism scare caused by Andrew Wakefield (at best an incompetent and at worse a fraudulent doctor). He produced a study saying that the standard MMR (measles, mumps, and rubella) vaccine was linked to increased rates of Autism. Conveniently he had his own patented MMR vaccine ready to go as a replacement. Instead of causing a switch in the vaccines used, parents stopped having their children vaccinated. Vaccination rates fell from 92% to 80%. In 1998, the year Wakefield’s paper was published, there were 56 cases of measles. In 2006, there were 1348, including 2 deaths. Measles is now considered endemic in Britain.

Summary

Herd Immunity allows diseases to be eradicated from a population without requiring 100% immunisations. This is very useful for public health because 100% immunization is impossible. However it will not protect vulnerable individuals from catching a disease if exposed.

The CanCon rules for broadcasters are designed to help promote CanCon within Canada. Without these rules, lesser known Canadian content may not be available. In the past content creators needed a third party to distribute their works so that they would be exposed to a large enough audience to become successful. However, with the Internet this is no longer true. On the Internet anyone can become a distributor for a very low cost. Sites like myspace and facebook allow creators to connect with fans more directly. Future sites will undoubtably make such connections easier to make. Thus the Internet enables the content creators to connect directly with the content consumers without needing the intermediate step of a distributor. Further, the global reach of the Internet means that Canadian content can be distributed anywhere in the world, using the same website. As the content creators no longer need third parties to connect them with consumers, there is no reason to require CanCon rules for sites that are in the business of distributing media. If CanCon rules were applied to such sites, they would only serve to reduce their competitiveness in the world market. Competitor sites in other countries without such restrictions can provide a better service to their worldwide customers.

Looking into the Future

If we look further into the future, I think that the content distribution sites (like ctv.ca) is going to very different than they are today. Currently these site have a lot of U.S. content because companies like CTV has distribution agreements with the U.S. producers. These agreements give them the right to broadcast that content in Canada (and only in Canada). Similarly there are sites in the U.S. that distribute content only within the U.S. Currently those creating the content make most of their money licencing their content to a distributor, however in the not to distance future this may change. I predict that content creators will start distributing their content worldwide via the Internet, with no country specific licensing. By doing so they can directly profit from their content without needing to enter licensing agreements within each country. This means that Canadian companies, like CTV, will no longer have these shows to distribute within Canada. If foreign content is no longer available to Canadian distributors, all they will have left is Canadian content, probably content that they have created themselves. This may sound grim, however the data flows both ways, and the Canadian creators will have equal access to the world market.

The anti-vaccinationists arguments are quite weak. One argument that Ms McCarthy put forward was the increasing number of children with Autism, however this statement is incorrect. There is an increase in the number of reported cases Autism Spectrum Disorder. The reason for this increase has an explanation. First the definition of Autism was widened to Autism Spectrum disorder, which inherently increased the number of individuals that are covered by the new definition. Second, as the awareness of Autism Spectrum Disorder increases (especially among those who work with children) the number of individuals diagnosed with A.S.D has increased, but that does not mean there is an change in the total number of individuals with A.S.D. Many cases would have gone undiagnosed in the past, especially given the widened definition of A.S.D. which includes individuals with less severe symptoms.

For more information please see these articles:

http://www.sciencebasedmedicine.org/?p=95
http://www.sciencebasedmedicine.org/?p=194
http://www.sciencebasedmedicine.org/?p=9

These are taken from a blog site run by scientists and medical doctors. The articles generally include references to scientific literature to back up their statements.

I hope you take the time to read these links and consider the harm that CTV and Canada AM could be responsible for if you do not allow the scientific consensus to be presented.

Thanks for your time

Darin Ohashi

For those unfamiliar with the DMCA, it makes breaking copy protection a crime. The problem with this is that it allows copyright holders to control how you can use the media you have legally purchased. This allows them to trump fair dealing (what we Canadians call fair use) by slapping any pathetic excuse for copy protection on the media you buy.

In today’s world, this makes copying a DVD to your hard drive (so you could watch it on a plane or an iPod) a crime. It would also be illegal to rip copy protected cds to mp3. In the end, this allows copyright holders to force you to buy their products multiple times, once for each device you want to use it on.

The DMCA has been a disaster in the USA. The music industry has realized that copy protection is a dead end. For both of these reasons it is very surprising that the government has decided to introduce this kind of legislation.

This is a fight over your rights in the digital age.

Just say no to C-61

There are a few interesting tidbits. Most interestingly, are the rules which allow weasel words when making statements that sound like efficacy claims.

For example:

“traditional use”: All this means is the there have been 50 or more years of the product being used for the claimed reason. Such a claim falls squarely under the Argument from Antiquity fallacy. Bloodlettings were traditionally used for thousands of years. However this does not mean that those who received the treatments were helped by them.

Homeopathic: Although homeopathic is one of the least sensible types of SCAM, Health Canada provides a way for homeopaths to make claims about their products. The claims must describe what they are “intended to address” not that they “can do”. Keeps them honest, but wording is very misleading.

To me, the interesting thing about these two claims is that instead of saying “these therapies work”, they say “other people think these therapies work”.

There are a few others, but hopefully you are already aware of these; “reduces risk”, “maintains”, “supports”, “promotes”, etc. Although it is not obvious what evidence, if any, is necessary to make such a claim.

In the end, our comprehension skills must be used when evaluating these claims. Do they actually say the therapy works, or do they claim something that sounds similar, but in the end is very different?