Chiropractic case studies

Patrick, thanks for your very measured and reasonable response to my ‘moment of frustration’ posting, I thought I'd get the fundamentalists on my case.

However, I think these questions need to be answered:

1. From the petition can Singh or the public continue to:
“criticise assertions (made by chiropractic) robustly and the public should have access to these views”
The answer is unreservedly yes.

2. Again, from the petition, what has the BCA action done prevented
“The scientific community would have preferred that it had defended its position about chiropractic for various children's ailments through an open discussion of the peer reviewed medical literature or through debate in the mainstream media”
The answer must still be nothing – only a perceived prevention as a result of Singh’s spin.

And so, I would challenge you to find one bit of evidence that demonstrated that the BCA are doing anything that would, as an example, prevent Singh and Ernst from publishing another book tomorrow that examined the evidence for and against chiropractic. Yet, the spin is that this action is stopping this from happening. It is not, and anyone can challenge the profession of chiropractic in any medium, in any language, any time and they’ll be safe to do so. What they can’t do is say that personally I am bogus or that the BCA is lying without having to prove it.

Singh should have known better since he's a journo (and as an aside it is intersting to note that the BCA are not taking Ernst to court for his misrepresentations - he seems to be wiser than Singh). Singh made a mistake and he did it in the worst country in the world for libel. But, I also feel let down by him as I enjoyed his last few books and his TV work and by what seems a lack of judgement in using such poor science doloped out by Ernst. Here is the example from the Guardian article:

“In 2001, a systematic review of five studies [oh, yeah, done by Ernst on studies by Ernst] 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 [proven by what science – the say so of Ernst]. 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 [what! – where, when, who? ahhh – good science provided by Ernst and not cross checked by Singh].

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.” [Controversial stuff and the publishing life blood of Ernst for a decade and it is just poor science to suggest this is the case – and again unchecked by Singh for this ill-considered article]

Finally, the spun Sense in Science petition has the nerve to say:

“Singh's only (only! not what I saw) objection, if you read the article, is evidentially unsubstantiated claims on the BCA website about chiropractic spinal manipulation curing such childhood problems as bed-wetting, colic and asthma. In the end, we have to support his support as a whole whilst examining if he is right to look at unsubstantiated claims”

bloody misrepresentation in my and I hope anyone's book.

The Singh issue has its roots buried deep his financially motivated decision to co-author ‘Trick or Treatment? Alternative Medicine on Trial’ with the crypto-denialist Ernst. Ernst is a poor scientist; the references on his papers seem to refer to a lot of his own work or to other carefully selected cases and neatly ignore the substantial, and it is now, body of evidence which is robust enough to convince NICE that chiropractic is safe.

After leaving the BBC, Singh wrote a series of great bestselling popular science books ("Fermat's Last Theorem", "The Code Book" and "Big Bang") and, as he freely admits, made a fair bit of money out of these projects. And why would Ernst co-author with Singh? because, I suspect, Singh could provide the reputation to get Ernst’s unscientific book sold (Kerching” for Singh). This Singh does with his ill-considered article in the Guardian, which you will notice has as its last telling line:

”• Simon Singh is the co-author of Trick or Treatment? Alternative Medicine on Trial “

(more Kerching for Singh)

Now, he’s a journalist and should know that if in the article he libels a profession then he’s in the clear (i.e.: all doctors are in the thrall of the drug companies) but if he libels an individual or an organization he is not (i.e.: Dr Smith is in the thrall of the drug companies). He made a mistake and was supported by the Guardian – but only for a while. So now he’s scared as all the financial gain from the previous three books (triple Kerching for Singh) look like being sucked up by the law case.

But why the suit? As a summary in the Guardian article Singh says:

“ - 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.” (unlike paracetamol, celebrex and any one of the COX-2 inhibitors then)

which is entirely based on the utterly piss-poor ‘evidence’ delivered up by Ernst rather than the solid evidence produced such as the BEAM report which said:
“Conclusions: Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise. “
UK Back pain Exercise And Manipulation (UK BEAM) Trial
A randomised trial of physical treatments for back pain in primary care.

As well as the MEADE report and the all evidence that convinced NICE to issue its pro-manipulation clinical guidelines only in May this year.

So with this ill-informed, unscientific, drubbing ringing in the profession’s ears the BCA notice that they have been kicked in the book, kicked in the article and libelled in the article, and all for Singh’s financial gain based on discredited science. What would you do?

So, where does Singh go before he goes bankrupt? He creates a media storm, because that’s what he can do, and he repackages the issue (or spin it to repackage the term) to look like this taken from the online petition:

“The British Chiropractic Association has sued Simon Singh for libel. The scientific community would have preferred that it had defended its position about chiropractic for various children's ailments through an open discussion of the peer reviewed medical literature or through debate in the mainstream media.
Singh holds that chiropractic treatments for asthma, ear infections and other infant conditions are not evidence-based. Where medical claims to cure or treat do not appear to be supported by evidence, we should be able to criticise assertions robustly and the public should have access to these views.”

So Singh has managed to spin the issue away from the utter damnation of all chiropractic set out in his article, designed to sell his book (Kerching for Singh), to a freedom of speech issue based about chiropractic for various children's ailments claim by some chiropractors to treat colic and other fringe activity. Neatly done.

And then he got his media friends and science colleagues and you and me to see his side of the story and I think we may have been misled.

Perhaps.

If Singh had spent a bit of time reading round the subject and using his judgement rather than just seeing the £ and listening to Ernst than none of this would be happening.

Studies show that the number of Americans willing to try alternative treatments continues to increase. A 2007 survey by the federal government found that more than one-third of adults and nearly 12 percent of children in the United States used alternative therapies, including acupuncture and herbal supplements.

Many mainstream physicians continue to be skeptical of acupuncture, saying their efficacy has not been proven and their successes may be nothing more than variations of the placebo effect. But increasing numbers of institutions, including Johns Hopkins Hospital and the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center, have established integrative medicine units that bring together conventional and alternative approaches to care.

Health insurers are also beginning to recognize and pay for some alternative therapies, including acupuncture and herbal remedies, although Medicaid and Medicare do not cover them.

"It's not as evidence-based, which is why doctors are somewhat averse to the practice,'' said Shnider, who is affiliated with Cardiology Associates. "But if [they] didn't work, why would we still be doing them thousands of years later?"

Source: washingdonpost.com(By Lori Aratani Washington Post Staff Writer Tuesday, June 9,2009)