The article the British Chiropractic Association hopes you will not read

July 31, 2009

Science-based Medicine carried this article yesterday, and several other blogs have joined in.  Below is the article Simon Singh wrote for which he is being sued for libel by the professional association for British chiropractors.  It’s a good cause, so I’ll stretch it another little while.

Science-based Medicine introduced the article with this:

Last year Simon Singh wrote a piece for the Guardian that was critical of the modern practice of chiropractic. The core of his complaint was that chiropractors provide services and make claims that are not adequately backed by evidence – they are not evidence-based practitioners. In response to his criticism the British Chiropractic Association (BCA) sued Simon personally for libel. They refused offers to publish a rebuttal to his criticism, or to provide the evidence Simon said was lacking. After they were further criticized for this, the BCA eventually produced an anemic list of studies purported to support the questionable treatments, but really just demonstrating the truth of Simon’s criticism (as I discuss at length here).

In England suing for libel is an effective strategy for silencing critics. The burden of proof is on the one accused (guilty until proven innnocent) and the costs are ruinous. Simon has persisted, however, at great personal expense.

This is an issue of vital importance to science-based medicine. A very necessary feature of science is public debate and criticism – absolute transparency.This is also not an isolated incident. Some in the alternative medicine community are attempting to assert that criticism is unprofessional, and they have used accusations of both unprofessionalism and libel as a method of silencing criticism of their claims and practices. This has happened to David Colquhoun and Ben Goldacre, and others less prominent but who have communicated to me directly attempts at silencing their criticism.

This behavior is intolerable and is itself unprofessional, an assault on academic freedom and free speech, and anathema to science as science is dependent upon open and vigorous critical debate.

What those who will attempt to silence their critics through this type of bullying must understand is that such attempts will only result in the magnification of the criticism by several orders of magnitude. That is why we are reproducing Simon Singh’s original article (with a couple of minor alterations) on this site and many others. Enjoy.

Here it is:

Beware the spinal trap

Some practitioners claim it is a cure-all but research suggests chiropractic therapy can be lethal

Simon Singh
The Guardian, Original version published Saturday April 19 2008
Edited version published July 29, 2009

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.

Other venues:

Related material:


School district sues parent over blog posts

November 18, 2007

You know, the obnoxious parent who stands up at every school board meeting, making the same boring point week after week, month after month, finally slipping into accusations about the ethical behavior of the board members and administrators who do not jump to the parent’s wishes — yeah, that one.

She’s a thorn in the side of any district governing board, but often enough correct about new policies, and sometimes in exposing wrongdoing, that most boards tolerate the barbs and try to fix the problems legitimately pointed out.

But what if the parent “thorn” has a blog?

The drama unfolded in Galveston; as of right now, it looks as though the district will back down from its threat after the blogger held fast; surely this will not be the last of such stories we see.

The school district in Galveston, Texas, threatened to sue a parent for views expressed on her blog. It alleged libel. Slashdot had one of the earliest rundowns, including the fatal flaw in the district’s complaint and how it tried to deal with it:

“A Texas School District is threatening to sue a parent over what it terms ‘libelous material’ or other ‘legally offensive’ postings on her web site and are demanding their removal. Web site owner Sandra Tetley says they’re just opinions. The legal firm sending the demand cited 16 items, half posted by Tetley, the rest by anonymous commentators to her blog. The alleged libelous postings ‘accuse Superintendent Lynne Cleveland, trustees and administrators of lying, manipulation, falsifying budget numbers, using their positions for “personal gain,” violating the Open Meetings Act and spying on employees, among other things.’ The problem for the district is that previous courts have ruled that governments can’t sue for libel. So now, in a follow-up story, the lawyers say the firm ‘would file a suit on behalf of administrators in their official capacities and individual board members. The suit, however, would be funded from the district’s budget.’ So far, Tetley hasn’t backed down, although she said she’ll ‘consult with her attorneys before deciding what, if anything, to delete.'”

The site is dedicated to watching the Galveston Independent School District, GISD Watch, by concerned parent Sandra Tetley.

According to the Galveston Daily News:

[David]Feldman [of the district’s law firm, Feldman and Rogers,] said Tetley’s Web site — www.gisdwatch.com — contained the most “personal, libelous invective directed toward a school administrator” he’s seen in his 31-year career.

“It is not the desire of the School District, the Board, or this Firm to stifle free expression or inhibit robust debate regarding matters pertaining to the operation of the public schools,” Feldman wrote in the demand letter. “This is solely about the publication of materials that clearly go beyond that which is legally and constitutionally encouraged and permitted, and into the realm of what is legally offensive and actionable.”

Feldman cited 16 examples of what he says are libelous postings. Half were posted by Tetley; the other half were posted by anonymous users.

The postings accuse Superintendent Lynne Cleveland, trustees and administrators of lying, manipulation, falsifying budget numbers, using their positions for “personal gain,” violating the Open Meetings Act and spying on employees, among other things.

Tetley said the postings were opinions only.

“Everyone deserves to have their opinion,” she said. “I don’t think they have a right to make me, or anyone else, take down criticisms of them off the Web site. They’re not going to force us to take off our opinions because we have no other place to go.”

The Drudge Report posted a story about the case, attracting 64,000 viewers. Tetley hired Galveston attorney Tony Buzbee, who has had great success suing institutions in Galveseton. Buzzee warned the district that his client would strongly fight against any suit filed against her.

As of November 10, district Superintendent Lynn Cleveland said the district would probably drop legal action, to focus on delivering education to students.

Quite a drama in two or three weeks. Press freedom won out.

On the one hand, no one likes to be sued for libel. On the other hand, Ms. Tetley knows the school district’s leaders are paying attention to what she says.

What’s the moral of this story?

Tip of the old scrub brush to Pamela Bumsted, who alerted me to this by e-mail.


%d bloggers like this: