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.

Simon Singh

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On 29th July a number of magazines and websites are going to be publishing Simon Singh’s Guardian article on chiropractic from April 2008, with the part the BCA sued him for removed.

They are reprinting it, following the lead of Wilson da Silva at COSMOS magazine, because they think the public should have access to the evidence and the arguments in it that were lost when the Guardian withdrew the article after the British Chiropractic Association sued for libel.

We want as many people as possible around the world to print it or put it live on the internet at the same time to make an interesting story and prove that threatening libel or bringing a libel case against a science writer won’t necessarily shut down the debate.

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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.

Northern exposure

I took this picture out of the upstairs window last night, using the windowsill as a tripod and a 60-second exposure. Despite not really being able to aim the camera where I wanted it, I managed to capture the constellation Ursa Minor with Polaris in its tail, thus proving that I am really in the northern hemisphere. In the lower right-hand corner, you can see the lights of Buffalo glowing behind the top of a spruce tree.

I'm no astrophotographer, but I'm quite proud of this effort considering the limitations of my equipment. And I'm pretty sure I've identified that little blob of pixels correctly: I checked it against the Your Sky map. Although I've been in the northern hemisphere several times, last night was the first time that I have had the opportunity, the weather and the reference material to go out and look for the north pole star. It's an unfamiliar sky, for me, but now I know where I am.

Fresh as a daisy

I am reading Michelle de Kretser's Booker-Prize-non-winning novel The Lost Dog. I hadn't really intended to read it, despite the fact that I was intrigued by the interview with Michelle on The Book Show, because I don't like dogs. However, when I saw it in the bookstore I picked it up because I liked the cover and, when I read the first page, I didn't want to put it down.

It's one of those books that has the remarkable ability to stir memories and illuminate coincidences and spark tangential trains of thought. It represents new ways of looking at the world that chime in with everyday events and put a new spin on ordinary things -- even changing my nephew's nappy (or diaper, as they must be called in the USA). Also, there's not too much dog lovin' in it.

So here's how I came across the inspiration for my next embroidery project:

Early one Sunday he went fossicking with Nelly at the flea market in Camberwell. There was a purposeful air to her, signalled by the black bag worked with yellow daisies carried over her arm. She avoided the professional dealers; lingered among the offerings of stallholders who had turned out their cupboards so they could go shopping again.

If you haven't read the book and don't already know Tom and Nelly, this might not seem a very inspiring image. But as soon as I read this paragraph I knew I had to have a bag like that. I could immediately see it in my mind's eye; now I need to convince my extremely pregnant sister that we simply must make a trip to Joanne's for some black fabric and yellow embroidery thread. I'll keep you posted as the project develops.

But is it art?

I went to an exhibition today, called Reality Cheque, which comprises artists' responses to the GFC. A friend of a friend has a work in the show, but I don't want to talk about his fluffy chickens here.

Many of the artworks were thought-provoking, some were funny, and some were simply weird. The one that stood out for me, however, was a photograph of a refrigerator with the door open. The photograph itself was not the artwork but was representative of the "art", which was that the artist, Mark Dahl, left his fridge door open for the duration of Earth Hour.

My first reaction was that such an act of social sabotage was not only pointless but disgustingly selfish. I was incensed. How dare he negate the environmental goodwill cerated by Earth Hour in this way? How can this be art?

But the more I thought about it, the more I realised that this moment of rebellion serves to draw attention to the hidden meaning of Earth Hour and of people's participation in it. It provokes thought and assessment in the viewer; it points out that Earth Hour is no more than a token gesture; that those who participate and feel they have fulfilled their debt to the future for the year are hypocrites; and that deliberately leaving a fridge door open for an hour is probably no greater crime than running an air-conditioner on a hot day.

So, despite my initial reaction to the work, I came to the realisation that this piece of art is actually my favourite of the whole exhibition: it best achieves the aim of all art, which is to reflect the world back to the viewer and change the way they think about reality.

What do you think?

Investing in gambling

Further to my recent rant about gambling, today's newspaper features the following letter (emphasis mine):

Share it around
Now that Oz Lotto has reached the absurd surplus of $90 million, isn't it about time it considered taking divisional prizes that have not been won and spreading them down through lower divisions in the same draw?
That way, those who have invested in a particular draw can enjoy a proper share of the prizemoney.
David Dolphin Summer Hill

Despite the fact that His Honour often refers to buying a lottery ticket as "Financial Plan B", it is not, in fact, an investment of any sort. It is, purely and simply, gambling. If David Dolphin doesn't like the odds, he should "invest" in something more likely to give him a return, such as hiding his money under his mattress.

Hyperbolic crochet

I've been busy crocheting hyperbolic coral for the exhibition at the Powerhouse Museum in August this year. Here are some of my contributions, just using up scraps of yarn that I had accumulated.
The hyperbolic crochet project was all started by a mathematics professor in 1997, who worked out that it was a simple way to demonstrate complex concepts. It was taken to new heights (or should that be depths) by Australian sisters Margaret and Christine Wertheim of the Institute for Figuring. There is a great tutorial on the IFF website about hyperbolic space if you want to know more.

Overheard on a bus

As I took my seat on the 310 to Circular Quay last week, I couldn't help but overhear one end of the mobile phone conversation of the woman who twisted and squirmed in the seat opposite. She was dressed in faded black jeans and a brown hoodie jacket, with a bubble-gum-pink knitted beanie pulled down over her lank, mouse-brown hair. I'd estimate her age at around 30, although her skin showed the sallow, wrinkling effects of a nicotine addiction.
Having described at some length the state of her pet cat's digestive problems and toilet habits, I heard her say to her interlocutor:
"Yes, you'll see me at the pokies tonight."
"Someone is going to sit with me and show me what to do..."
"...yeah, I really need it. I only had $10 to live on last week."
At this point, she leapt up and got off the bus, dashing across the road to catch the tail end of the traffic lights. All her movements were jittery and rapid, as though she were a bundle of nerves.
It made me really sad to think that the best financial advice her friends could give her for making $10 last a week was to feed it into a poker machine. I wonder how long it will take her to learn the hard way that she'd be better off using the money to line her cat's litter tray, because at least then she wouldn't have to buy the newspaper as well.
I know that there are lots of people who can afford to put $10 through the poker machines and walk away thinking, "you win some, you lose some". His Honour regularly splurges on Lotto or Powerball tickets, saying "it's a cheap way to buy a dream for a few days". But if your dream is just to have money for enough food, and the lights of the poker machines are winking at you and promising fun and riches, what happens when all you get is eyestrain and an empty belly?

Living for the moment

Like, I don't love Graham Rawle enough already.

Pet hates

Yesterday it was the Pet Shop Boys, today it's just the pet shop. Ms ND and the Dude came running this morning to see what had me groaning in frustration. How many times do I have to say it? Pets are not people.

If it is true the highest test of a civilisation is the way it cares for its most vulnerable, then Australia's animal welfare record has nothing to do with it. Australia's human welfare record does: we could do a lot better when it comes to the way we treat the disabled, the mentally ill, the elderly -- who ARE our civilisation's most vulnerable members. Pets are not members of civilisation, they are commodities and luxuries.

Don't get me wrong, I'm not saying it's okay to mistreat animals. And I'm not saying people shouldn't keep pets. In fact, I agree with the majority of the article: owning a pet is a choice and a responsibility, not a right, and people need to think carefully about doing so. However, humanely killing unwanted dogs and cats that are incapable of existing by themselves in an environmentally friendly way is not a violation of civilised standards. It's a shame, but it won't be the downfall of our society.

Argue with me if you like: I'm sure Dr Peter Singer would.

Drawing a long bow

This morning's newspaper included an article about the Pet Shop Boys, one of His Highness' favourite bands. I was astonished by a claim in the second paragraph that they were on a surge of "Obama-inspired positivity"; I mean, the boys are Londoners through and through, somewhere between indie and UK Pop -- so NOT the sort of thing you'd associate with hopping on a US bandwagon.

I had to read right through to the end of the article to find the throwaway line that led Bernadette McNulty to this extraordinary leap of logic:

"We did feel quite positive making this, because you could sense the times changing," Tennant says. "It was the same as at the end of '88 when we recorded our version of It's Alright. The Berlin Wall was coming down, Nelson Mandela was coming out of prison, acid house was starting. It was an astonishing period of change. And last year, it was the same. When Obama was fighting Hillary it was like the future versus the past, and George W. Bush was finally going."

And now I'm thinking the PSBs have lost the plot. Obama is not Nelson Mandela, by any stretch of the imagination. The Berlin Wall coming down was an iconic moment that is not in any way to be compared with George W Bush's retirement. And they're only 50! Gah! That means senility is just around the corner for me as well...

How to talk about books you haven't read

I found How to Talk About Books You Haven't Read (by Pierre Bayard, Granta, 2008) on the sale table at the bookstore on the weekend, and couldn't resist taking a peek inside. By the end of the first page, I was hooked. Written by a professor of literature, it begins with the premise that there are millions more books you have never read and will never read than you have actually read or will read in your lifetime. Of necessity, you will therefore spend the majority of your life talking about the plethora of books you have not read.
He further categorises books into four categories: books you have skimmed (encompassing most of the books you've read), books you have heard of, books you have read but entirely or partially forgotten, and unknown books. Bayard is French and unsurprisingly leans towards a Derridean theory of reading, espousing the postmodernist precept of multiple readings of any given text. That's a concept I particularly like, since it would be a boring world indeed if we all got exactly the same meaning out of every single shared book (although it would certainly save time in our household, in which one or the other of us is generally to be found loyally but disappointedly ploughing through books recommended by another member of the family -- the phrase "you MUST read this, you'll love it" is almost never, in our experience, true.)
Bayard says that you can say a lot about books you haven't read, just by being able to place them in your personal library. If you know what books they'd be filed next to on your mental shelving, for example, you can learn a lot without ever opening the cover. For instance, I just bought Ransom by David Malouf (which is presently a book I have heard of, but I hope to make it a book I have skimmed soon). I have read other David Malouf books (although it was some time ago), so I'll mentally shelve it with The Great World (a book I have mostly forgotten). I know it's a retelling of the Iliad, so on its other side I'll shelve the original Iliad (in translation, a skimmed and partially forgotten book), as well as other Greek literature, mythology and history (skimmed, heard of and wholly or partially forgotten). Thus, without having read past the cover blurb, I already know a great deal about what the book is like and can attend the Writers' Week seminar with impunity.
Isn't that fantastic! Think how much time and stress you'll save now that you know you don't have to read your next book-club book before you get to the meeting! I feel so free...

A thousand words

A tour of Chernobyl and its surrounds. 'Nuff said.

Philosophy of journalistic ethics

The Philosopher's Zone podcast this week featured an interview with David Neill from the University of Wollongong in which he said much the same thing as I said in my previous post, only better and more philosophically.

How advertising ruined my life

A couple of days ago I promised a rant about the insidious effects of advertorials on good journalism, so here it is.
There are really two forms of advertorial. In most cases, an "editorial" mention is promised to accompany an advertising booking. This can be done reasonably, if the journalist writing the article is free to include non-advertisers' products and services as well (although it is still not ideal). For example, I recently wrote an article recommending certain restaurants in Sydney, in which three of the four I was required to mention had full page ads in the same publication. This kind of advertorial is usually fairly obvious to the reader, who can easily see the ad near the editorial and infer a link between the two. I don't believe it is harmful, because it is simply a recommendation; I wasn't writing an exposé on health inspections, for example, or pretending that the list was comprehensive.
A more insidious form of "advertorial" is when journalists cannot write anything in editorial that may have a negative reflection on an advertiser. Here's an example: when I was employed on a parenting magazine, I wrote an article on the pros and cons of the use of disinfectants in the home. As part of this story, I related a true personal anecdote about a television advertisement for an unnamed cleaning product. When the camera "zoomed in" on scary-looking green germs on a pristine white surface, the friend with whom I was watching burst out laughing. She was a microbiologist, and immediately recognised that the supposedly scary "germs" were just yeast, a substance which we all have in our gut nearly all of the time.
When the article including this anecdote was printed, a major advertiser threatened to withdraw advertising from all of the company's publications. I was forced to apologise in person to the client, who claimed that, although I hadn't mentioned their product specifically, it was obvious that it was their ad to which I referred, since I had correctly identified that the "germs" were yeast! As well as grovelling to the advertiser, I was made to write a short news item in the next issue of the magazine specifically promoting their product. (As there was nothing inherently wrong with the product itself, but only the advertising for it, I felt able to do this without compromising my principles, thus keeping my job.)
Related to the use of advertorial pressure to compromise journalistic standards, as well as to compromise the finances and ethics of the publication in general, is the use of contra. For those not in the industry, "contra" is the name given to payment for advertising in kind, rather than in dollars. Used properly, contra can be great: for example, every time you get a free gift with your magazine you are probably getting contra -- free gifts boost copy sales, so a magazine will accept 100,000 tubes of lip gloss in exchange for a double-page spread of advertising. This works out well for publisher, advertiser and reader.
The problem I have with contra is when it doesn't feed back into the finances of the publication. At some publishing companies I have worked for, there were credible rumours among the staff that the CEO or senior executives were using contra ad bookings and editorial coverage to supplement their personal lifestyles -- for home renovations and holidays, for example. The problem with this is that there is no feedback into the economics of producing the magazine (I'd bet my bottom dollar that the execs didn't take a pay cut to make up for the freebies they were receiving). Less real advertising revenue means budget cuts for editorial expenses and no pay rises for journalists, while the execs and senior staff enjoy virtual, tax-free, pay rises. The reader receives no benefit at all.
As in my last post, having raised this issue I really have very few ideas about changing the industry practices. These days, as a freelance journalist, I can to some extent choose who I work for and what I write, but I actually have very little bargaining power if I want to continue to get regular work. (And that's another rant.) Enforcing ethics is hard, particularly in this economic climate.

Death of the journalist

Dr Steven Novella, at Skepticblog, asked the question: Is journalism dead? and naturally I can't help putting in my two cents' worth.
I agree with Dr Novella, that the internet is changing the way we learn about news, and the sources we choose to obtain it from. This is the future, and we need to strap in for the long haul and ride out the transition. However, I'm sure there were similar complaints when both radio news and television news first came on the scene, so reports of my death are exaggerated.
Publishers have a bottom-line-driven attitude to their output. Advertising has always been the main revenue source, and editorial is valued only as the stuff that fills the space between the ads. These days, it is often bastardised by tacit "advertorial" content (that's a whole different kettle of fish that I'll save for another rant), or produced on a shoestring by overworked journalists trying to find a balance between the good reporting that their personal standards demand, and the lack of time and resources to do it properly.
Nevertheless, publishers will all agree that good editorial draws in more readers, thereby attracting more advertising dollars. This is where I want to put the spotlight back on readers: do you really care about good journalism?
Let me ask the question this way: how much are you prepared to pay for a newspaper or even a website that delivers really good quality journalism? One hundred years ago, a newspaper cost between about threepence and sixpence. (For the sake of argument and decimal currency, we'll say five cents.) A quick conversion to today's relative value reveals that the modern equivalent, based on the average unskilled wage, would be more than $5.00. How much do you pay for your newspaper? My home-delivery subscription costs less than a dollar per day, and the internet edition is free.
The main effect of the cheapness (or free-ness) of news sources is insidious. It's a well-known marketing adage that you don't value something you can get for free (or cheaply). YOU don't expect your internet news source to be accurate, you just want it to be timely. YOU don't care if Pauline Hansen's racist policies have changed, as long as we find out if those nudie photos are really her (see the front page of today's Sydney Morning Herald). If you had to pay a fairer rate for it, would you be more picky about what you read?
Dr Novella asked the question, and so do I: what business model can we develop that will allow journalists to make a decent living out of doing a good job? I'm no economist, but I think that at least part of the answer is in the readers. If YOU demand the truth, and are prepared to pay for it, we'll all be able to eat tomorrow.

(Come back in a few days for my rant on advertorials: another economic rationalist reason why good journalism is in decline.)

Eureka!

Yesterday I returned to the old alma mater for a public lecture by Dr Karl in the Eastern Avenue Auditorium (formerly known as Carslaw, with new bits and a water feature). I've been to the uni regularly in recent days, mostly by car, but this was the first time I'd strolled down the pedestrian mall that now runs between Fisher Library and the Wentworth Building.
I was totally gobsmacked and impressed by the new law school building next to Fisher library. It's so sleek and, surrounded as it is by open space, I felt as though I had somehow slipped into a Brobdignagian architect's model. Who knew those old fogeys on the Sydney Uni Senate had it in them to approve such a breathtaking postmodern structure? It certainly makes Carslaw (what's left of it) look like the muddle of mid-century utilitarian garbage that it is. And the Chemistry building should hang its head in shame.

On a side note, it always amuses me that the Transient Building is still there, now more than 20 years after I graduated.

Postcard from home

Graham Rawle, author of one of the best books I read last year, is running a workshop at the V&A on Friday, and he posted the instructions on his blog so that those of us on the wrong side of the globe can participate. The idea is to make a collage from magazines to represent what "home" means to you. Here's my effort:

Something to read, something to look at, something to sew, a window on the world, a comfy chair and a cuppa -- bliss!

Fun with fungi

Not mushroom for art in your school curriculum? I love this project and am off to make my own brown-bag basidiocarps. [Pics to come.]

Australian of the Year

Congratulations, Mick Dodson. This appointment, following on the heels of Barack Obama's inauguration, ushers in the unofficial Year of the Black Leader.

Next on the agenda: restoring human rights in Aboriginal communities. Yes, we can!

Art or nature?

Yesterday a soccer player, whose name I have thankfully already forgotten, was interviewed for one of those 20 questions-style profiles in the Good Weekend magazine. I was impressed by many of his answers, thinking that he showed a surprising amount of intellect and originality for a footballer.

Unfortunately, he undid all his good work with his answer to the question: "What is your favourite work of art?" He replied, "a woman's body".

NO! Wrong answer! Do not objectify women! Admire all you like, but remember that a person's body is the result of genetic inheritance, not of anyone's creation.

Sigh. Football Australia, back to the drawing board.