Thursday, July 30, 2009

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

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.

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.

Wednesday, July 29, 2009

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.

Thursday, July 23, 2009

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.

Thursday, July 02, 2009

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?