Back in April 2008, Simon wrote a piece for the Guardian’s ‘Comment is Free’ colunmn entitled Beware the Spinal Tap. It appeared during the BCA’s ‘Chiropractic Awareness Week’. Here’s the relevant extract:

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.

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.

The BCA objected to the first paragraph above, which they interpreted as an accusation of deliberate dishonesty on their part. They (still) describe it as “a serious attack on the reputation on the BCA”. Despite claiming to have a “plethora of evidence” for the claims made, they turned down the Guardian’s very reasonable offer of a right of reply and decided to sue Simon instead — a decision that the Lord Chief Justice himself said he was “baffled” by. Responding today, the BCA said they turned down the Guardian’s offer because it fell short of their expectations, “not least because the original libel would have remained uncorrected”.

But…but…surely if they had a plethora of evidence, all they needed to do was write a nice little piece pointing to it and that would have given the lie to Simon’s allegation and the BCA’s reputation would remain intact? Mais non! Apparently Simon Singh is so revered and the effect of anything he writes is so powerful that he just had to withdraw his comments and apologise — nothing less would satisfy the fragile egos in charge of the BCA. And as Simon Singh was not only right about the lack of evidence (the so-called ‘plethora’ was swiftly demolished outside the courtroom) but is also comparatively solvent, he wasn’t about to do what most people would be forced to do in such circumstances and bend right over for the BCA.

Last May, I attended the preliminary hearing of the BCA v Dr Simon Singh, held to determine the meaning of the words used in Simon’s article. There I heard Simon’s lawyers argue that the paragraph the BCA didn’t like was an opinion — a comment — rather than a statement of fact and that this was clear from the context. Mr Justice Eady dismissed this argument out of hand. He’d apparently already made up his mind and prepared his judgement before even entering the courtroom and his judgment was that the passage was a statement of fact and that the words Simon used imply a deliberate intention to deceive. Eady placed the onus on Simon to prove that the BCA were being deliberately dishonest, should the case go to full trial. In other words, the burden of proof for something he didn’t claim or intend to imply in the first place was placed on the defendant.

This was, as Jack of Kent put it, an astonishingly illiberal ruling that seemed to designed to intimidate anybody from standing up to the threat of libel even when they know they are in the right, as Simon did. The BCA said in their statement today,

It never was, and it is still not our intention, to curb freedom of speech, whether in the field of scientific research or elsewhere, although sadly we recognise that this is how it has been portrayed by Dr. Singh and his supporters.

…which is probably one of the most transparently dishonest statements they have made during the course of this whole debacle. That’s my opinion — not a statement of fact — and, unfortunately for the BCA, it’s an opinion that their Lordships would seem to share. In their judgment today, they say,

It seems unlikely that anyone would dare repeat the opinions expressed by Dr Singh for fear of a writ….By proceeding against Dr Singh, and not the Guardian, and by rejecting the offer made by the Guardian to publish an appropriate article refuting Dr Singh’s contentions, or putting them in a proper prospective, the unhappy impression has been created that this is an endeavour by the BCA to silence one of its critics. (paras 11 & 12)

The judges ruled that the passage was not, after all, a statement of fact but an opinion.

The opinion may be mistaken, but to allow the party which has been denounced on the basis of it to compel its author to prove in court what he has asserted by way of argument is to invite the court to become an Orwellian ministry of truth. (para 23)

Love it!

On the issue of the meaning of the offending words, they ruled that the use of the word ‘bogus’ is “explicitly supported by the next paragraph of the article”. In other words, it is clear from the context what Simon meant by it, which is what Simon’s lawyers argued in the first place. And the judges reject the suggestion that ‘happily’ means ‘knowingly’:

…we respectfully doubt whether the judge was justified in any event in attributing to the word any significance beyond, say, “blithely”. The natural meaning of the passage, in other words, was not that the BCA was promoting what it knew to be bogus treatments but that it was promoting what Dr Singh contended were bogus treatments without regard to the want of reliable evidence of their efficacy…(para 30)

The full judgment can be read here and, if you can understand it all, you’re either a lawyer or just a lot cleverer than I am but here’s my favourite bit:

We would respectfully adopt what Judge Easterbrook, now Chief Judge of the US Seventh Circuit Court of Appeals, said in a libel action over a scientific controversy, Underwager v Salter 22 Fed. 3d 730 (1994):

“[Plaintiffs] cannot, by simply filing suit and crying ‘character assassination!’, silence those who hold divergent views, no matter how adverse those views may be to plaintiffs’ interests. Scientific controversies must be settled by the methods of science rather than by the methods of litigation. … More papers, more discussion, better data, and more satisfactory models – not larger awards of damages – mark the path towards superior understanding of the world around us.” (para 34)

Amen.

It’s a chilling thought that if almost anyone else had written that article, they would have had no option but to give in to the intimidation and withdraw it. How many of us can afford to take the financial risk of defending a libel action under England’s draconian libel laws? (Cue to rush off and sign the petition for libel reform if you haven’t already.)

Simon could’ve given up after Eady’s ruling but didn’t. Further opportunities to give up were afforded when two of his three applications to appeal against Eady’s decision were refused. Having followed the case closely, I can’t help but notice just how easy our ‘justice system’ — for want of a better term — makes it for people to give up fighting for justice and how difficult it is to continue. Having taken two years out of the defendant’s life and with some £200,000 in costs run up since the launch of the litigation, this case is far from over but, as Simon said at the press conference after the hearing, he now “relishes” the prospect of seeing the BCA in court to defend what he actually wrote rather than what they wrongly inferred from it.

And where are the BCA at now? If you can’t be bothered to read their weaselly statement, I’ll sum it up for you in three words:

Their lawyers suck.

(I should stress that’s the BCA’s opinion. Personally, I wouldn’t dream of publicly criticising libel lawyers.) Will they risk more of their members’ money by continuing this debacle, which — irony of ironies — has served only to damage their reputation while enhancing that of Simon Singh, or will they throw in the towel?

I don’t care. Whatever happens now, the moral victory is Simon’s and quite right too.

Jack of Kent’s blog about today’s ruling is here.

2/2/10 Simon writes in the Guardian about it here.

4/4/10 Jack of Kent’s detailed explanation of the judgment and its implications is here.

I’ll call the chiropractor I was booked to see ‘Jim’. He called himself ‘Dr Jim’ and that’s also how he was referred to by surgery staff.

That some chiros should misrepresent themselves as doctors is altogether in keeping with the clumsy word that is ‘chiropractic’. In Classical Greek cheiro means ‘hand’ and praktic means ‘action’. Ignoring the rules of declension of Greek nouns, D.D. Palmer slammed these two words together to forge a name he felt accurately represented his therapy and, as a bonus, gave it an aura of ancient wisdom and culture. Nice idea, D.D., but as a name it sucks. ‘Hand action’ could just as easily apply to reiki, reflexology or any other um…manual activity.

Until a few years ago I assumed, when I heard the words ‘Dr X, a chiropractor’, that they referred to a doctor of medicine who specialised in a fully recognised branch of medicine. The closest I had ever got to a chiropractor was when a friend was referred to one by her GP, to treat her sciatica. The treatment she received didn’t help at all and she was peeved but I didn’t think anything of it. No therapy has a 100% success rate and there was no reason to think she hadn’t seen a medical specialist. If I’d thought about it at all, the GP referral would have reassured me that chiropractic is a fully established medical specialty like dermatology or rheumatology.

The alarm bells only rang when I saw one of their stalls in a shopping centre one day, complete with chiros touting for business. I surely can’t be the only person who finds it utterly weird that people claiming to represent a serious health discipline behave so evangelically and hang around public places hustling, (though, come to think of it, D.D. Palmer did say something about possibly making chiropractic  a religion). What I didn’t know until recently was how chiropractics use ‘bait and switch’ to gain respectability. At these public promotional events, they focus plausibly on muscular-skeletal conditions and give the impression they are something to do with physiotherapy. Given their low cost introductory offers, why wouldn’t anyone with a chronic ache or pain give them a go? Once they’ve lured people into the surgery they start talking nonsense about subluxations and how these cause all manner of conditions that have nothing to do with the spine.

I didn’t give chiropractic another thought until the BCA took the momentously stupid decision to sue Simon Singh, thereby exposing the dearth of scientific evidence for claims blithely made by its members and inspiring thousands of open-minded and concerned people like myself to do some serious research.

It was in that spirit that I submitted to a free spinal check by a chiro outside Sainsburys a few months ago and was told that treating the ache in my shoulder (which I knew was caused by my poor posture while using my laptop) would probably need a series of expensive appointments. I turned down the special offer of a £30 introductory appointment and bought a £15 lap top table instead. The ache soon went away but I kind of regretted not taking advantage of the offer just to see what they did. So, when I saw a different bunch of chiropractors offering an even cheaper deal in another shopping centre recently, I jumped at the chance to broaden my understanding of chiropractic.

‘Dr Jim’ is handsome and charismatic, if somewhat inarticulate when answering unsolicited questions about chiropractic. Nevertheless, he delivered his well-rehearsed spiel with charm and confidence and I’m sure that, if I hadn’t known he was talking crap, I would have believed every word of it. I tried to be as convincing in my own role as a potential customer but it wasn’t easy, given that there was nothing whatever wrong with me. Overall, I was impressed at the thoroughness of Jim’s questioning and the checks he did on my flexibility which, as he acknowledged, is extremely good. I am in my fifties with an athletic build and a healthy weight. I can effortlessly place my hands flat on the floor without bending my knees while standing, for example. He was similarly impressed by my blood pressure reading and with my reflexes. (Edit: I have since been examined by a neurologist and now realise Jim’s testing of my reflexes were very limited in comparison to the real doctor’s).

I asked him about the “lump” in my neck his colleague had found at the initial check in the shopping mall. He said my neck felt good but there was some tension in my occiput. He guessed that I spent long hours in front of the computer and said something about the dangers of degenerative disease if problems are left untreated. However, he was less concerned about my neck than about the “occasional lower backache when standing for a long time,” which I’d invented as a cover story just to see what he’d say about it. It was easy to describe because I used to get it fairly regularly until I was liberated by the menopause.

Jim wanted me to have two x-rays­­ – one from the front and one from the side – so he could “see what’s going on”. I asked him what he’d be looking for and he replied with a clumsy explanation of how stiff joints in the lower back resulted in nutrient loss to the invertebral discs and this could lead to osteoarthritis.

Jim conceded he couldn’t actually feel anything that alarmed him but he wanted x-rays to check the state of the discs for signs of injury or wear. “If we can catch it at an early stage we can slow down or halt the degeneration”. He’d also be looking for any “misalignments”.  He would see if there were “any curves or twists or rotations” because he could “make corrections” to those.

On the wall of his large surgery was a poster featuring a picture of a spine with a ‘subluxation’ circled in red. The text read,

A subluxation. The silent killer. Chiropractors correct subluxations.

Dr Jim – bless him – earnestly explained how the nerves in the spinal column control everything and send messages to other parts of the body. A subluxation, he said, is a misaligned joint or area of inflammation around the joint that stop the nerves doing their job properly. Thus, “any irritation or damage to the middle part of the spine can send a message to the digestive system to not work so well.”

I imagine any chiros reading this will be nodding sagely in agreement with Dr Jim, while any skeptics will be snorting at the preposterous notion that adjusting the spine will cure a digestive problem. So it seems a good place to post a link to a recently-published epidemiological study on the chiropractic subluxation. Three of the four-strong team of researchers are chiropractors, the fourth is an associate professor of physical education.

From the conclusion:

No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. The lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.

I guess Dr Jim hasn’t seen that one yet.

I refused the x-rays. Jim made reassuring noises about both the cost – I was entitled to one free one as part of the special offer – and the low dosage of radiation. He suggested I talk it through with my husband (who was in the waiting room inspecting leaflets) and do some internet research on radiation. He very kindly said that he would keep the special offer open for a while in case I changed my mind. “Just call the surgery and ask to speak to Dr Jim,” he said, soothingly.

Trying to keep intact my cover as a naïve but curious shopper who’d been lured by the special price introductory appointment meant I had to be careful about what I said and one thing I had to bite my tongue over was his repeated use of the ‘Dr’ title. I believe chiros use this ‘courtesy title’ duplicitously to give the impression that chiropractic is an established branch of medicine but I wasn’t about to destroy our comfortable rapport by telling him that.

Nor did I question the ethics of his trying to persuade me to have x-rays simply on a report of an occasional lower back pain that I’d said was causing low-level nuisance – especially when he said he’d felt nothing untoward and I was obviously in good condition overall. I don’t know how relevant any family history of osteoarthritis would be but I’d already told him there’d been nothing like that in my extended family.

And I decided not to mention the report of the RCT by Hancock et al on lower back pain,  which concluded:

Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery.

This study was cited by the GCC Review but I don’t suppose Jim was familiar with it.

Instead, I inquired amiably about one of the posters on the wall, which indicated that chiropractic was suitable for babies.

It was the claims that chiropractic can treat various childhood ailments – including colic and ear infections ­– that were challenged by Simon Singh in the Guardian back in April 2008, resulting in a libel action by the British Chiropractic Association. The BCA claimed there was a “plethora of evidence” for the claims but they turned down the Guardian‘s offer of a 500-word reply, preferring instead to resort to the law to try to shut Simon up. To their dismay, Simon is defending the action. At an Appeal Court hearing last week, I sat behind Richard Brown of the BCA and observed the tension build up in his occiput as he helplessly watched his counsel take a battering from the Lord Chief Justice himself. His Lordship proclaimed he was “baffled” that, since the BCA were so concerned about the effect Simon’s article had on their reputation, they hadn’t taken up the offer of a reply at the time. His Lordship was ostensibly unaware that the supposed “plethora of evidence” has already been comprehensively demolished outside the courtroom.

Nevertheless, a poster on the wall of Jim’s room quoted extensively from two studies to the effect that chiropractic cured a range of conditions in babies. Here’s a sample:

Subluxations were found to be the cause of several health problems, including tonsillitis,  vomiting, hyperactivity, sleepiness, lower resistance to infections especially ear, nose and throat infections.

Subluxations: a serious interference with normal communication from the brain to the body. This interference may cause sickness and disease. No-one, especially a child, should have to live with subluxations. Have your family checked for subluxations frequently.

Refs: Hendricks, C.; Larkin-Thier, S Otitis Media in Young Children Chiro: The J of Chiro Res & Clin Invest 1989; 2 (1): 9–13 J Am Osteopath Assoc. 1966 May;65(9):964-72.  Manipulative therapy of upper respiratory infections in children.

Anyway, at the mention of babies, Jim began animatedly telling me that he’d been “adjusting” his baby daughter since the second day of her life to keep her spinal function and nervous system working properly. He said chiropractors saw many colicky babies and this was often related to stomach problems and was the consequence of subluxations caused through prolonged labour or the birth process. He also saw many kids with ear infections and chest infections.

“Can you actually treat ear infections? I asked.

He replied that it depended on the cause and whether there is pressure on the nervous system because there are “other things in the body that can create those symptoms” and that’s why a detailed examination is necessary. “Children are resiliant,” he added, “They bounce back really quickly and we tend to see changes in kids very fast.”

I asked him how he knew the chiropractic was benefitting them and they weren’t just getting better anyway,

“…or is that a silly question?” I added, sheepishly, for effect.

“No, it’s a good question,” he reassured me.

He didn’t answer it, though. Instead, he launched into some irrelevant anecdote about a kid he’d treated who’d got better, which proved nothing either way. In full kamikaze mode, he went on to say how problems in older people that have been there a while are harder to shift. In other words, he can successfully treat healthily growing children who’d probably get better anyway but frail, ageing people who probably won’t get better anyway are more difficult. Sounds about right.

Yet another poster on the wall of Jim’s room had a picture of two x-rayed spines. One was a 49-year-old spine and the other was 75 (allegedly). I couldn’t see a difference between them but the text helpfully explained that the younger one was suffering “loss of curve and spinal decay” while the 75 year-old had benefitted from years of maintenance care. “Preventive chiropractic care can help with many types of health problem,” read the text.

Sure enough, the appointment ended with Jim giving me the hard sell about the usefulness of regular chiropractic and emphasising that they didn’t just want people to come in when they were in pain but also when they didn’t so he could teach them how to take care of themselves.

In conclusion, chiropractors are fake doctors practising a questionable therapy with a pretentious name that was chosen to enhance its brand appeal while proselytising to the hapless public. In common with other alternative therapists, chiropractors encourage people who are perfectly well to part with cash for unnecessary treatment in order to keep perfectly well. Oh…and they may be successful in treating self-limiting conditions.

I’m not saying that everything every chiropractic does to anyone is worthless, I’m saying that the theory of chiropractic, which seems to have evolved only slightly from D.D. Palmer’s time, is nonsense and the fact that chiropractics may have picked up some useful techniques in treating muscular-skeletal problems along the way, doesn’t make the ‘subluxations cause ear infections/digestive problems/whatever and these can be cured by adjustments’ hypothesis any less unhinged nor those who promote it as if it were a scientific truth, any less irresponsible.

Finally, I recommend as a more reliable source of information than any chiropractor’s website I’ve seen, the newly set-up Discover Chiropractic website.

• Updated 4.3.10: I recommend this fascinating article by a retired chiropractor. I wish I’d seen it before I wrote the above. Science based chiropractic: an oxymoron?

What I like to do is live a life of health and vitality by eating well, exercising every day, making sure I receive Chiropractic every week, take no medications, not getting vaccinated, drinking pure water, taking wholefood supplements/fish oil/probiotics, no smoking or alcohol and making sure I treat my body with respect.

When a chronically ill skeptic tells me that my lifestyle is quackery, I only feel sorry for them being trapped in a belief system that suppresses their quality of life. It’s not my job to change that belief system.

I like the fact that it is a free world and I get to choose what I do with my body.

This very sad comment, by someone called Jeremy, appeared on my blog months ago but I ignored it and forgot about it. I was reminded of it only after seeing the same kind of nonsense posted on different websites recently. It’s not all nonsense, of course. Eating “well” (we assume he means a balanced, nutritious diet) and taking regular exercise together with not smoking or drinking heavily are indeed a good idea for anyone who wants to stay as well as possible and the NHS has a huge website which includes a wealth of information about healthy eating and exercise and much else besides.

The nonsense part is in the middle and starts with weekly chiropractic sessions and ends with probiotics. I can’t be bothered to deal with most of it at the moment. Obviously the guy’s living a great lifestyle and, as long as he manages to keep out of the way of any serious infectious diseases and any organic banana skins when he’s out exercising with his blinkers on, I’m sure he’ll be fine. In any event, the people who are most likely to die in epidemics are not healthy adults like him and if he wants to reject evidence-based medicine and spend his own money on unnecessary food supplements and probiotic yogurts or whatever, I’m sure nobody cares enough to try to stop him.

No, what I’d like to challenge here is the weekly chiropractic he “makes sure” he gets. Why, for fuck’s sake?  Time and time again I see this notion that we have to do something more than just eat, exercise and not smoke. To keep really, really well, it seems we have to regularly fork out extra money for some quack therapy or wonder foodstuff. Too often, the normal ups and downs of everyday life: tiredness, aches and pains, the odd tension headache, occasional insomnia or bowel problems, etc, are viewed as problems we need to not only treat as if they were potentially life-threatening medical conditions but that we should spend money on trying to prevent them happening at all.

Hmm…that maybe wouldn’t be such a bad thing if these therapies were effective but here’s the thing about chiropractic: having it regularly doesn’t make an iota of difference to your physical health and you may as well spend the money on talking about yourself to a counsellor or just having a nice evening out. Decide which leisure activity you can afford that is most likely to lift your spirits and go for it — but preferably choose one that doesn’t carry a risk of a vertebrobasilar artillery stroke.

Thanks to the British Chiropractic Association’s unutterably stupid decision to sue Simon Singh, which has forced the spine wizards into the spotlight, many of us know a lot more about chiropractic now than we did before. Indeed, there are many who didn’t realise that chiropractic isn’t part of mainstream medicine. But they realise it now, in spite of the best efforts of some quacks to continue to misrepresent the BCA v Singh case. (If you missed the storm kicked up by an idiotic homeopath called Lionel Milgrom wrongly stating that the BCA had won the libel case and been awarded substantial damages when it hasn’t even gone to trial yet, read about it here, here and here.)

And for those that have been on another planet for the last few months, the backlash against Mr Justice Eady’s decision at the preliminary hearing took the form of hundreds of complaints being made to the GCC and Trading Standards about the implausible claims made by hundreds of UK chiropractors. The message is clear: if there is a jot of scientific evidence for these claims, bring it forth or withdraw the claims. Don’t resort to legal muscle to shut us up.

Inevitably, a few pissed-off spine wizards dipped their toes into the shark-infested waters of internet forums where skeptics gather or left their droppings beneath the blog posts of the complainants. It was a “witch-hunt” said one. The complaints are “vexatious”, said another, who goes by the name of David and more of him in a moment .

I’ve always thought the term ‘witch-hunt’ quite an appropriate one to use about people who promote and practise pre-science therapies. As for ‘vexatious’, isn’t this adjective usually reserved for complaints that are intended to cause inconvenience but have no real grounds? The complaints against chiros do have good grounds: there are chiros making unsupported claims that they can treat things like asthma, which have nothing to do with the spine, chiros misrepresenting themselves as doctors and chiros claiming that having regular sessions will help maintain good health. That the complaints should cause inconvenience or annoyance is just an added bonus. Yes, it may be annoying and inconvenient for them to have to change their websites and leaflets but they shouldn’t have been making those claims in the first place. Those who call these complaints ‘vexatious’ presumably believe that chiropractic really can treat everything from asthma to bedwetting to sports injuries to colic. I wonder if they also believe it can cure deafness?

Because that’s how it all started that day in September 1895 when, so the story goes, a grocer called D.D. Palmer prodded and poked at a deaf man’s spine after which the man said he could hear again. There’s an excellent article by the SkepDoc, Harriet Hall, in the current issue of Skeptic magazine, which reminds us that a science develops over many decades but a pseudoscience can pretty much be thought up over breakfast. A pseudoscience like chiropractic is, in my opinion, more like a New Religion — otherwise known as a cult — than like science. D.D.Palmer and L.Ron Hubbard, founder of Scientology, seem to have a have been cut from the same cloth. Indeed, Harriet Hall tells us that Palmer “spoke of a God-given calling and seriously considered making chiropractic a religion”.

It’s reasonable to describe what Palmer invented as a pre-science therapy because he based it on an idea that we know now to be wrong: that all bodily functions are controlled by the nerves. He thought he could feel bones out of place in the spine and decided for no good reason that these “subluxations”, as he called them, were the cause of most cases of disease. Funnily enough, these chiropractic subluxations, didn’t show up in x-rays, an inconvenience chiropractors addressed by changing the definition of subluxation from the partial dislocation that Palmer imagined to

A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.

The World Health Organisation quoted by Wiki.

It may seem hard to believe that anyone still subscribes to the idea that disease prevention depends on keeping one’s spine ‘aligned’ but evidently many people do. Harriet Hall’s article includes a list of chiropractic insanity in her local community (somewhere in the US, I presume) and it includes this:

A chiropractor informed me that if germs caused disease we’d all be dead and insisted that you can’t become ill if your spine is properly aligned.

Presumably my commenter, Jeremy, who makes sure he gets his weekly preventative dose of chiroquackery believes the same thing, as does the chiro who helpfully commented beneath another of my previous posts thus:

Do you get regular check ups at the dentist to avoid tooth decay? Do you get your car serviced regularly to prevent major engine problems? Our bodies are constantly put under stresses of everyday living, therefore, some patients like to have problem areas worked on at regular intervals (every one-six months perhaps) to help prevent their problem returning…I do this by using spinal manipulation, massage, postural advice, exercises programs, dry needling (like accupuncture) etc.

I’m sure he gives a great massage and gives very good advice on how to sit up straight and what exercise to take. These, however, are not chiropractic. You can get equally good advice from a physio and you can get a massage in, um, other places.

It’s disagreement over what chiropractic actually is that seems to be vexing David  over on Zeno’s blog. He is one of those chiropractors who eschews the use of the term “subluxation” and argues that the practice of most British chiropractors is properly described by the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic i.e. they focus on what the latter calls the “diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the functions of the nervous system and general health”.

Well, it’s true that description doesn’t use the word ‘subluxation’. It does, however, allude to the effects of “mechanical disorders” of the musculoskeletal system on the nervous system and general health. It stops short of giving examples of these effects but it sound suspiciously like the idea that a back problem can be connected in some way to ailments that having nothing to do with the back, which is at the heart of why chiropractic is dismissed as quackery by so many. It’s also the reason why there are currently hundreds of complaints being investigated about chiros claiming on their websites that they can treat a variety of different complaints that have absolutely nothing to do with the back.

David asserts that “spinal manipulation does not equal chiropractic”, which we all knew anyway. “It’s the complete package that counts,” he tells us. “We have the whole range of techniques available to us”. What he does not tell us is this: If chiropractic is no longer the theory that mythical subluxations of the spine are the cause of most ailments, then what is it? I mean what is the theory behind chiropractic nowadays? What distinguishes these modern chiropractors who are focussing on “mechanical disorders” from other practitioners who use manual therapies?  David does not tell us and neither does the Anglo-European College or the Welsh Institute. Nor, in spite of David insisting that chiropractic treatment is scientifically supported, do any of these sources tell us where to find the scientific evidence that supports it.

Another claim he makes is that,

Interestingly, physiotherapists only really took to manipulation when they realised that chiropractors were getting so much better results in the treatment of back pain.

Actually, that’s not very interesting. At least, not as interesting as this systematic review, which reveals that spinal manipulation is no better than other therapies for treating lower back pain. And there is no evidence that it is effective in treating — or preventing — anything else. What’s more there is a “very small but very real risk”, as Hall puts it, of stroke with neck manipulation. In a previous post I gave the example of a young woman called Kristi Bedenbaugh who saw her chiropractor for sinus headaches. During a neck manipulation she suffered a brain stem stroke and she died three days later. Harriet Hall mentions 20-year-old Laurie Jean Matthiason,  who saw her chiropractor for lower back pain and had 186 neck manipulations over a six month period. The last one killed her.

The gullible fool who goes for a weekly chiro session in the belief that it maintains his good health, might be interested in the case of Sandy Nette, who used to believe the same thing until she suffered a severe stroke. Click on her name to see her website if you dare. It’s mostly still under construction but here’s a taster:

Due to Chiropractic Highest Neck Manipulation
I Am Now Trapped Inside An Immobile Body

I don’t mean to scaremonger…well, not very much anyway. I will happily concede that vertebrobasilar artillery stroke resulting from chiropractors performing their manipulations is extremely rare. In a nine year population-based study [Cassidy et al] conducted in Ontario, “only” 818 patients were hospitalised for VBA strokes after chiropractic manipulation. The best article I’m aware of on the dangers of chiropractic manipulation and which refers to the Ontario study is right here.

As the man, Jeremy, says, it’s a free world and we can choose what to do with our bodies, including subjecting them to costly, needless and potentially dangerous physical therapies. Just don’t make claims for those therapies unless you can point to evidence that your claims are true. That’s all.