There has been much ado about Simon Singh and the libel lawsuit filed against him by the British Chiropractors Association in the last few months. If you look over to the right at the “Keep Libel Laws out of Science” link, it’s easy to tell what side I fall on. To briefly, briefly summarize the turn of events, Singh wrote an article for the Guardian in 2008 on chiropractic, criticising the BCA for claiming that chiropractic can treat ailments other then back pain. (Many bloggers reprinted part of the article in solidarity, such as Skepchick, and others included the disputed parts.) Instead of taking advantage of the Guardian’s offer to publish a response, the BCA sued Singh for libel. Unfortunately, in the UK, libel laws are different than they are here in the US. Singh is essentially guilty until proven innocent, and a judge ruled in May that Singh must prove that the BCA was being intentionally dishonest in promoting “bogus” treatments. Singh is appealed this ruling, and was turned down. You can read his most recent response, written August 11, to this here. He is essentially fighting for the rights of science writers and educators around the world to be critical of scientific claims without fear of lawsuit.
Before turning my attention to alternative medicine with a skeptical eye, all I knew of chiropractic was that it was something to help your back. I had no idea that a doctor of chiropractic, for one, has a different degree than a medical doctor. Also, there is much more to the story than just “cracking your back.” Today, chiropractic practices do focus mostly on musculoskeletal problems. However, its founders promoted it as a means to heal all kinds of disease at a time when there was very little science in medicine in general. Vertebral subluxation is the idea that all diseases can be traced to a misalignment of the spine which can be fixed by chiropractic. Although we know today that this is clearly false, as bacteria, viruses, cancers, and other causes have been discovered for most diseases, the idea still survives in chiropractic practices that claim to help with medical issues that are not directly related to the back or spine. Modern practices claim to be able to help with allergies, ADHD, colic, and other such problems for which science-based medicine does not yet have a simple, solid solution.
In June, the BCA urged all of its members to take down any medical claims from their websites and their offices, to avoid scrutiny by the legions of skeptics that were questioning dubious claims. More recently, the BCA recently produced a list of studies that claim that chiropractic is effective for treating certain childhood ailments, but Steve Novella points out that none of these are strong, double-blinded studies. The evidence presented is weak, and thorough studies show no positive effects from the treatment. So, is it so wrong to question the possibly harmful adjustment of the spine of developing babies and children for ailments such as colic or asthma when no evidence has been presented for efficacy?
I decided to poke around and see what local chiropractors had to say about such childhood ailments. Would they offer treatment? You bet they would. Maybe they should have gotten the BCA’s memo, too.
My favorite example, for no particular reason other than they came up first, is Balance Chiropractic. They have a very informative website with layers and layers of definitions for various medical ailments and suggestions that chiropractic care might be useful for people with these ailments. If you click the tab labeled “Conditions” you find descriptions of various back and neck problems. You need to dig a bit deeper, in the “Wellness Center” tab to find claims on various childhood ailments. I’m going to focus on infantile colic, partly because the recent statement by the BCA submitted 8 studies on colic, again, discussed by Steve Novella, and partly because I was a colic baby, as my mother ever so lovingly reminds me now and then. The website says:
Infantile colic is a common and frustrating condition affecting infants. It involves persistent and often violent crying for no obvious reason. There is also a considerable amount of flatulence present. Typically, it occurs within the 1st month postpartum and spontaneously self-resolves by the 3rd to 4th month. Results from a Danish study involving 316 infants indicate that chiropractic care was successful in treating infantile colic in 94% of the infants.
Klougart, Nilsson N, Jacobsen. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 1989;12:281-288.
I did some poking around and found that I could not access this study online, even with university resources. However, note that most parents won’t have access to a medical journal to check these claims. I did, however, find the abstract of the study which reads:
A prospective, uncontrolled study of 316 infants suffering from infantile colic and selected according to well-defined criteria shows a satisfactory result of spinal manipulative therapy in 94% of the cases. The median age of the infants was 5.7 wk at the beginning of the treatment. The results were evaluated by analysis of a diary continuously kept by the mother and an assessment file comprised by interview. The study was carried out as a multicenter study lasting 3 months and involving 73 chiropractors in 50 clinics. The results occurred within 2 wk and after an average of three treatments.
As Dr. Novella points out, this is an uncontrolled study, and results were charted by the diary kept by the mother. No controls, no check for a placebo effect on the mother. Just a prospective study. Hold this up against a randomised, blinded, and placebo controlled study of almost 100 infants by Olafsdottir et al. in 2001:
AIMS: To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic. METHODS: One hundred infants with typical colicky pain were recruited to a randomised, blinded, placebo controlled clinical trial. RESULTS: Nine infants were excluded because inclusion criteria were not met, and five dropped out, leaving 86 who completed the study. There was no significant effect of chiropractic spinal manipulation. Thirty two of 46 infants in the treatment group (69.9%), and 24 of 40 in the control group (60.0%), showed some degree of improvement. CONCLUSION: Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasizes the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.
As my mother reminds me time and time again, having a child with colic is rather difficult. The child cries constantly, is clearly in pain, and simply can’t communicate. It is no wonder that a desperate parent would “try anything” to help their child, but subjecting them to spinal manipulation appears not to be the answer.
Simon Singh’s legal battle has probably done more to raise awareness of the problems with chiropractic claims than his original article did. The BCA really shot themselves in the foot with this one. I would encourage parents to research a bit more carefully before taking their children (or anyone, before they take themselves) to a chiropractor for an ailment that isn’t specifically back or neck pain. Always follow the science.