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.

According to The Record a woman in Waterloo was diagnosed with the first case of measles in the region since 1996. It is believed that the woman contracted the disease while in Florida, where she was in proximity to another infected individual from England (where vaccination rates are low enough that measles is endemic in the population). Neither individuals had been vaccinated against measles. If that was not bad enough, it appears she spent about three and half hours in Conestoga Mall (a local shopping mall) while infectious. It is expected that this will lead to more cases.

As I stated in my posting about Herd Immunity, highly infections diseases can travel the world pretty quickly. As long as the disease exists somewhere, you are just a few flights away from an infected individual.

• Mayapple
• Bloodroot
• Red and White Baneberry
• Canada Anenome
• Wild Ginger
• Wild Geranium
• Early Meadow Rue
• Heart Leafed Aster
• Woodland Strawberry
• Smooth Solomon’s Seal
• False Solomon’s Seal
• Starry False Solomon’s Seal
• Yellow Violet

We also supplemented these with purple violets and ostrich ferns from our backyard.

Natural Isn’t Safe

When used to describe food, medicine or other products, natural is often used to imply safety. However this association is demonstrably false. There are a huge number of natural things that are extremely dangerous. There are the obvious, venoms (snakes, spiders, jellyfish, etc), toxins found in mushrooms and poisonous plants and heavy metals (mercury, lead, etc, all of which occur naturally in the environment). Some things that are safe for some people, like peanuts, can be deadly to others. Further many substances are safe in some (or most) conditions, but become dangerous in others. For example ever water can be toxic if one drinks too much too quickly, (see Water Intoxication). Thus the claim that a substance is safe simply because it is natural is clearly false.

The only reliable way to tell if substance is safe, be it natural or not, is to test it. However even substances that are found to be safe via testing, should only be assumed to be safe within the limitations of the tests. There are few substances that people assume to be as safe as pure water. However every few years someone gets sick or dies after purposefully drinking too much water. Simply because normal amounts of water is safe does not mean that large amounts is also safe.

Natural Isn’t Healthy

The other major false association that is that natural is healthy. Most of health problems, world wide, are the result of perfectly natural causes. Disease is probably the biggest health issue and most diseases are caused by bacteria, viruses and other pathogens which are perfectly natural. In the developed world, where better sanitation and access to modern medicine makes these diseases rare, we are faced with issues of excess. Fat, sugar and carbohydrates are all natural ingredients in the food we, and our ancestors, eat. However today the ease of access to food has lead to a different set of diseases, caused by the excessive consumption of these natural ingredients. Thus simply because something is natural does not mean it is healthy.

Corollary: What Unnatural Isn’t

An equally important point, is that unnatural is no more unsafe or unhealthy than natural, which means, the only way to determine if something is safe, natural or otherwise, is through testing.

So what’s the point?

Every so often we discover something new, either natural or not. Instead of blindly accepting something because it is natural or dismissing it because it is not, we need to test it. Only through testing can something be determined to be safe and the limitations of its safe usage.

Hopefully the next time you see an ad for a food, supplement, face cream, drug, etc that says “all natural ingredients” you won’t be fooled into thinking that means much more that if it said “now comes in blue”.

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.

Immunization: The most successful public health measure

In the last century, vaccines have saved more lives than any other health
intervention. The World Health Organization estimates that every year, more
than two million deaths are prevented worldwide due to immunization.

Immunization is an important, cost-effective and successful public health
intervention. It effectively prevents disease, improves the health of
Canadians, and reduces pressures on our health care system.

Diving deeper into these pages we find:

Canadian Immunization Guide Seventh Edition – 2006

Which is a very in depth review of the current immunization recommendations.
There is lots of information here, but for me, the most interesting page is
this:

Comparison of Effects of Diseases and Vaccines

Which directly compares the risk of a disease with the risk of the associated
vaccine. This page provides a really nice summary of the risk verses reward
for the various vaccinations. I won’t get too in depth, this page is pretty
easy reading. However I think it is useful to crunch the numbers for an
example. Lets look at Measles. From the article:

Measles

Disease Description and Risks

Complications such as bronchopneumonia and otitis media occur in about 10%.
Encephalitis occurs in 1/1,000 cases (fatal in 15% and neurologic sequelae in
25%). Subacute sclerosing panencephalitis is a rare but fatal complication.
Case fatality < 0.05%. With 2-dose schedule, indigenous measles has been
eliminated in Canada.

Disease Rates, Pre-vaccination

5-year period: 1950-1954
Avg. annual rate: 369.1/100000
Peak annual no: 61,370 cases

Vaccine Description and Risk

Measles vaccine is given in combination with mumps and rubella (MMR). MMR
vaccine: Malaise and fever, with or without a non-infectious rash in about 5%;
up to 1% of recipients may develop parotitis, about 5% have swollen glands,
stiff neck or joint pains. Transient arthralgias or arthritis may occur and
are more common in postpubertal females.

About 1/30,000 develop transient thrombocytopenia, 1/1 million develop
encephalitis.

Disease Rates, Post-vaccination

5-year period: 2000-2004
Avg. annual rate: 0.2/100000
Peak annual no: 199 cases

Analysis

Risk from Measles

Lets look at the rates of serious complication for measles. Encephalitis in
1/1000, with 15% of those leading to death and another 25% leading to
neurologic sequelae (neurological damage). 15% of 1/1000 is
approximately 1/7000, i.e. measles is fatal in about 1/7000 cases.
Neurological damage occurs for about 1/4000. The average number of cases for the
pre-vaccination years was 369.1 cases per 100000 Canadians. If we estimate
today’s population at 33 million, there would be about 121000 cases this year,
leading to 17 deaths and 30 cases of neurological damage from encephalitis. Of
course, because of vaccination this is not happening. However those numbers
1/4000 and 1/7000 still apply to anyone unlucky enough to catch measles.

Note these risks are for healthy individuals in wealthy countries, the
risks in developing nations with poor nutrition and health care are
significantly higher, with death rates as high as 28%

Risk from Vaccines

The common side effects are mild and temporary, so they are not of significant
concern. Lets focus on the serious risks.

Transient thrombocytopenia (a lack of platelets in the blood): 1/30000
Thrombocytopenia can lead to bleeding and bruising issues. Unfortunately I am
not qualified to make any real statement about the severity of
thrombocytopenia, so I suggest you read the article I linked to. However I can say
that 1/30000 is significantly lower risk that 1/7000, the risk of death from
measles, which is the most unlikely result. To put 1/30000 in context, your
risk of dying in a car accident is about 1/10000, so the
risk of this side effect is 3 times lower than the risk of dying in a car
accident.

Encephalitis:

1/1000000 (1 in a million)

The risk of encephalitis from the vaccine is about 1000 times less likely than
encephalitis from measles. As a comparison, the risk of being murdered in
Canada (in 2006) is about 1.8/100000 , or 18 in
a million, so the risk of being murdered is 18 times higher than the risk of
encephalitis caused by the MMR vaccine.

No one gets measles any more

It is important to note that measles is still endemic in various locations around
the world, meaning that every year cases are imported into Canada by travellers.

http://www.insidetoronto.ca/News/NorthYork/article/48756

Measles is an airborne pathogen, thus it is very contagious, simply being in
the same room (or on the same plane) as sick individual is close enough
contact to become infected:

http://www2.canada.com/calgaryherald/news/story.html?id=80df07ef-3abf-477c-a371-ba6d13370b99&k=80923

Further, travelling to a location (India, Africa) where measles is still
endemic would be very risky.