Simon Singhs the Blues

May 9, 2009 6:01 PM

Simon Singh, author of Fermat's Last Theorem and The Code Book, was sued for libel by The British Chiropractic Association for comments he wrote in a column in The Guardian:

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.

As part of libel litigation, the court does have to rule as to the meaning of the relevant passages.

"The ruling was by Sir David Eady, the presiding judge. He has decided the "meaning" which should be given to the passage complained of in Simon Singh's original article.

So what should he do now?

posted by Dumsnill (62 comments total)

Steal a pig.
posted by Artw at 6:02 PM on May 9, 2009 [1 favorite]

There's that.
posted by Dumsnill at 6:04 PM on May 9, 2009

Those are both great books, and chiropractors are indeed quacks.

Shall I buy more copies to support Mr. Singh (sic), or just line up to be sued along with him?
posted by rokusan at 6:08 PM on May 9, 2009

Yeah, I corrected it twice to include the "h", but still it disappeared! Dammit! Cortex? Jessamyn?
posted by Dumsnill at 6:09 PM on May 9, 2009

I rather enjoyed "The Code Book," so naturally I think these chiropractors are assholes and the ruling can only be described as "bogus."
posted by grobstein at 6:41 PM on May 9, 2009

What should happen is to give this as much publicity as possible.

These law suits are counter-productive in the long run. They are giving free press to solid treatments of why most alternative medicine is nonsense ( read Singh's book to find out the few treatments that do pass the evidence based test if you want to find out more! ). Psuedo science gets in when it is out of the spotlight, when it's able to sneak in under people's radar by appearing like the real thing.

This is what really burns these associations for those pressing them. Most people don't pay much attention to chiropractors or accupuncturists or any of the non-evidence based medical treatments most of the time. Part of the reason they survive is that most people don't have easily available evidence that they are nonsense. Now when someone suggests a chiropractor someone else might suggest that they read Goldacre or Singh's book for an alternative opinion. This is because they have heard about Bad Science and Trick or Treatment because of these cases.

Previous related links on Mefi about Ben Goldacre
posted by sien at 6:42 PM on May 9, 2009 [1 favorite]

I would be curious to know whether English libel law has changed shape at all in the years since the integration of European human rights law.
posted by grobstein at 6:42 PM on May 9, 2009

Why, exactly, is it that I can't get my back adjusted without flirting with and supporting such quackery?

My last chiropractor was wonderful for me and did absolute undeniable good for my ability to straighten up and sit and stand like a healthy person without trying to pressure me into any treatments that I would have to laugh openly at, but I worry about trying to find a new one under my new insurance. As a person with naturally poor posture who carries all of her stress right in between her shoulder blades, what did I ever do to deserve this? Who cares for the spines of skeptics?
posted by mayhap at 6:43 PM on May 9, 2009 [5 favorites]

Wait British libel law is shit? Who knew?
posted by Sova at 6:44 PM on May 9, 2009 [1 favorite]

Why, exactly, is it that I can't get my back adjusted without flirting with and supporting such quackery?

A good masseuse or physiotherapist can probably help without the high-gibberish factor.
posted by rokusan at 6:45 PM on May 9, 2009 [2 favorites]

There are unfortunately a lot of quacks involved in Chiropractic care, but at the same time to claim that they don't do anything is absurd, and just as delusional as claiming they can cure ear infections or whatever.

If you have back pain, chiropractic care can certainly help, depending on what exactly is wrong with you.
posted by delmoi at 6:47 PM on May 9, 2009

Whenever I read about British libel law, I understand how British mefites must feel about the American electoral system. The idea of putting the burden of proof on the defendant just seems so counterintuitive, and no matter how often someone explains to me why it works that way, the information never seems to stick.
posted by nebulawindphone at 6:49 PM on May 9, 2009 [3 favorites]

...there is not a jot of evidence.

So the UK doesn't have an FDA?
posted by DU at 6:50 PM on May 9, 2009

That judge made a bogus ruling.

It is extremely disappointing that this legal decision was not made based on fact, but on the basis of the judge's poorly-informed opinion.

I think it is criminal that alternative medicine practicioners are allowed to make claims that are not proven to be true.
posted by five fresh fish at 6:52 PM on May 9, 2009

Oh No! It’s Mr Justice Eady! and from Bad Science
posted by Blacksun at 6:52 PM on May 9, 2009 [1 favorite]

I actually hope he drags this out as long as possible, and gets the lying exploitative bogus-science peddling bastards at the British Chiropractic Association all the publicity they deserve. I would gladly give a tenner to his defence fund.
posted by Sova at 6:52 PM on May 9, 2009 [1 favorite]

Who cares for the spines of skeptics?

Physical therapists and massage therapists. And chiropractors who understand that they are basically physical therapists; you can find such people by asking them whether they believe in subluxations or not.
posted by Sidhedevil at 6:54 PM on May 9, 2009 [10 favorites]

Chiropractic care for back pain absolutely can work. I had a very severe back problem as a young man, to the point of being completely disabling. It was like being stabbed randomly with a knife in the lower back every few minutes with no warning. I could barely function at anything, much less real activity. And it was a chiropractor that put me back together and gave me my life back.

There are at least two schools of thought in chiropractic practice, one of which is apparently defunct. One involves taking your joints past their normal range of motion and using them to tweak the back somehow. This is the bad kind. The practitioner I went to had studied what he called "the Palmer method", which works very simply. Fundamentally, they inspect your spine, and then use the heel of the hand to knock your vertebrae closer to true alignment with small percussive taps. There are other additional treatments (back compression, tables with rollers), but most fundamentally, they just rotate the bones in your spine back to where they're supposed to be. That's all there is to it. And it works very well indeed. My mother had a slipped disk, and the same chiro also put her back together and got her operational again -- she was at least out of bed within a few weeks of starting treatment and fairly normal within a year or so.

Even now, all these years later, when I start to get a sore back, I manually rotate the upper vetebra in my neck, which gets out of alignment, and reflects twice down the spine in the other direction. The first vertebra I can reach rotates to the right, so the midback rotates to the left to compensate, and the low back rotates back right again in another compensation, and that's what hurts. If I tweak that upper bone back (I have a vague memory it's called the mastoid), the rest of the back relaxes, and I'm fine again. Has been working for two decades now.

Now, this guy WAS prone to magical thinking in other areas -- I remember him reading the "Sharks Don't Get Cancer" book and thinking that shark cartilage would have an effect on real cancer sufferers, which is obviously foolish. (and that's why that idea has died out -- because those who tried it are dead now. :( ) And he seemed to think that chiropractic practice was good for more than just the back. I can't speak to those things, and I very strongly suspect they're bunk. But the core of the Palmer discipline is very, very gently putting the bones back where they're supposed to be, along with the observation that the mid-back reflects the neck in reverse, and the low back reflects the mid-back, reversed again.

That treatment works.
posted by Malor at 7:02 PM on May 9, 2009 [1 favorite]

That treatment works.

And the plural of anecdote is...?
posted by Sova at 7:14 PM on May 9, 2009 [12 favorites]

I wish Mr. Singh luck, but I fear he won't have any. In the UK you can speak the truth and still be found to have libeled someone. (Or so I understand it.)
posted by Chocolate Pickle at 7:16 PM on May 9, 2009

And the plural of anecdote is...?

Why don't you look up the studies yourself.
posted by delmoi at 7:22 PM on May 9, 2009

Malor, while I don't doubt for a second that your life was changed by chiropractic, I maintain that the mechanism by which it helps people is still unknown. If you ever actually handle a cadaverous spine - vertebrae, ligamentous support, muscle and synovial junctions - the notion of realigning vertabrae as you described would be akin to pushing on the origin end of a suspension bridge and expecting it to relocate it's connection on the other side. Not to mention that there isn't any real tolerance for movement in the spine as far as neural elements go. If it were indeed the case that you could "move" the spine with some perfectly calibrated touch, you would inevitably hear of hundreds of cases where too much force was applied and the patient crippled.

At a Mayo Clinic seminar a few years back devoted to back pain there was a really great point where they assembled a forum of about a dozen practitioners of all stripes who were highly regarded in their respective fields- internists, chiropracters, neurosurgeons, physiatrists - and to a person every one agreed that the current understanding of back pain and why certain things worked and didn't was still in the dark ages.

If people in my profession were hawking patent medicines out of their offices I'd do everyting possible to see that our Board took away their license. Why these assclowns don't do the same says a lot about what a mess their profession is when it comes to regulation. Or else they're all drinking from the same vat of KoolAid and some just choose not to espouse some of these things.
posted by docpops at 7:26 PM on May 9, 2009 [22 favorites]

Mostly offtopic, but from what I hear, chiros like to take before and after x-rays to show how they've "adjusted" the spine. I think a nice experiment would be to see if they could pick out the before and after images if they weren't labeled.
posted by 445supermag at 7:34 PM on May 9, 2009 [1 favorite]

Malor, while I don't doubt for a second that your life was changed by chiropractic, I maintain that the mechanism by which it helps people is still unknown..... the current understanding of back pain and why certain things worked and didn't was still in the dark ages.

So, devil's advocate here: if we really don't understand what we're doing anyway, shouldn't that make chiropractic care for back pain excusable?

Look: we don't understand why antidepressants work either, and they don't even always beat the placebo when we test them, but they seem mostly harmless and we don't have a better idea, so we let doctors go on prescribing those (and go on spouting all kinds of authoritative-sounding bullshit about their mechanism of action). I'm not suggesting we take away antidepressants. Hell, they changed my life. I'm just saying, we all seem to accept that doctors can prescribe those based on some vague unproven set of working assumptions, so why not chiropractic adjustments too?
posted by nebulawindphone at 7:40 PM on May 9, 2009 [1 favorite]

So, devil's advocate here: if we really don't understand what we're doing anyway, shouldn't that make chiropractic care for back pain excusable?

Yes, absolutely, and I think most reasonable doctors that manage back pain have a similar view - there is no treatment for back pain that is unreasonable. But you have to recognize that whatever path you choose - chiro, accupuncture, meds, massage, etc. - it is all, for the most part, palliative short-term management and relief. The only fundamental action that alters the long-term behavior of back pain is exercise, stretching, and physical conditioning. So whatever a person does is up to them, really, and their own personal philosophy.

But here's the thing - I don't know any chiros that would tell a patient they don't know why their treatment works, but I tell people every day just that. My antipathy toward chiro - and this applies more to them than any other realm - is that they fill people's heads with utter bullshit as to why they hurt - this part of the spine is misaligned, your C3 is subluxed on C4, you have a facet joint that needs hand-release. It never ends. By the time they get to me it's almost hopeless to get them to understand that years of passively having themselves kneaded like so much pizza dough has just wasted time they could have put to use getting fit and not living in their own heads imagining how broken they are because of what their chiropracter showed them on xrays.

And by the way, the films I see from the chiropracters office look they were taken with a pinhole camera on Neptune. You could convince someone Jesus himself was staring benignly from their lumbar vertebrae for all the clarity in those fucking things.
posted by docpops at 7:52 PM on May 9, 2009 [12 favorites]

Obviously, when it comes to back-pains, chiropracy can work. Manipulate the back, it might get better. But that's not the problem here. Singh himself admits that chiropracty can help bad backs. The problem is that chiropractors claim that they can cure all sorts of pains and diseases, when there is no evidence to support it.
posted by Dumsnill at 7:52 PM on May 9, 2009 [1 favorite]

The practitioner I went to had studied what he called "the Palmer method", which works very simply.

He pointed to his expertise in the Palmer Method as a qualification for working on your spine? Oh, yes, definitely not a quack.

(Yes, yes, apparently there is some chiropractic method with the same name. It's a joke, son!)
posted by The Tensor at 7:53 PM on May 9, 2009

So, devil's advocate here: if we really don't understand what we're doing anyway, shouldn't that make chiropractic care for back pain excusable?

Look: we don't understand why antidepressants work either, and they don't even always beat the placebo when we test them, but they seem mostly harmless and we don't have a better idea, so we let doctors go on prescribing those (and go on spouting all kinds of authoritative-sounding bullshit about their mechanism of action). I'm not suggesting we take away antidepressants. Hell, they changed my life. I'm just saying, we all seem to accept that doctors can prescribe those based on some vague unproven set of working assumptions, so why not chiropractic adjustments too?

I'm not sure where to begin.. You may not know much about aerodynamics, but you don't suppose that it's the angels that carry airplanes aloft. Right?
posted by c13 at 7:58 PM on May 9, 2009 [3 favorites]

I'm not sure where to begin.. You may not know much about aerodynamics, but you don't suppose that it's the angels that carry airplanes aloft. Right?

I sure don't. But you're going to have to spell out the next step in the analogy here, because I don't see it.
posted by nebulawindphone at 8:16 PM on May 9, 2009

Well.. In general, just because we don't know exactly why something happens, does not mean that we are unable to examine a set of possible explanations and separate more likely ones from bullshit. In particular, our understanding of back pain might be inadequate, but our understanding of things like anatomy and physiology is sufficient to dismiss the notion that realigning vertebrae in a certain way can affect immuno-mediated bronchoconstirction (asthma) is nonsense.
posted by c13 at 8:34 PM on May 9, 2009

AS nonsense...
posted by c13 at 8:35 PM on May 9, 2009

Actually, he attempted to write a cogent defense in his book Fermat's Last Theorem but the margins were too small to contain it.
posted by twoleftfeet at 8:43 PM on May 9, 2009 [11 favorites]

My favorite is the part where if your arm resists more to their push when you are holding bottle of supplement A than it does bottle of supplement B then clearly you needed A more.

Or is it B?
posted by Kid Charlemagne at 9:30 PM on May 9, 2009

I would make a modest financial contribution towards a Singh appeal.
posted by sindark at 9:40 PM on May 9, 2009

c13, I'm confused. docpops was specifically saying that most chiropracty is bullshit, but that it does work for a specific domain even if we don't know how. Your analogy involves something which we do have an explanation for, and you seem to interpret docpops's comment as endorsing chiropracty as a whole, which he certainly wasn't doing. What bone are you picking, or did you just misread docpops's comment?
posted by Picklegnome at 9:44 PM on May 9, 2009

I got a 'free' Chiro consult with a gym membership once. I knew nothing about it and assumed it was a valid branch of medicine. I knew it was baloney when the guy tried to get me to sign a waiver before he did anything. I mean, REALLY? Does your doctor get you to sign a waiver before he treats you? Then he told me that my 'general health' was affected by spinal subluxations. I asked him what he meant by 'general health' and he just started bullshitting. Then I asked him if he was a medical doctor. That was pretty funny. I asked him what other disciplines the college he studied at taught. That was even funnier. By then I had him on the run. I left his office about an hour later and I don't think he had ever been so glad to see someone leave.

I knew nothing about it before I went in, but it was TRANSPARENTLY snake oil to me.

I herniated a disc a couple of years ago, which was unbelievable painful. I can understand clutching at straws when you are so disabled, as I was. But Chiros are not the answer.
posted by unSane at 9:58 PM on May 9, 2009 [2 favorites]

Oh yeah, and ask for some peer-reviewed journal articles about subluxations. That's also pretty funny.
posted by unSane at 9:58 PM on May 9, 2009 [1 favorite]

sidhedevil:you can find such people by asking them whether they believe in subluxations or not.

As with most snake oil salesmen, a perfectly legit term is co-opted to add an air of legitimacy to what they're selling. An orthopedist will toss around the term subluxation all day long to describe a dislocated joint. Subluxation in the chiropractic sense is the notion that whatever ails you is traced back to a misaligned vertebra(e) that an adjustment will relieve the pressure and restore what balance was lost.

Trick or Treatment was mentioned up thread, but you gotta link the book. This is a great read on the topic overall and also delves into homeopathy, supplements, and the like.
posted by dr_dank at 10:00 PM on May 9, 2009

One involves taking your joints past their normal range of motion and using them to tweak the back somehow. This is the bad kind.

Hah. The one chiropractor I ever went to was recommended to me as someone who was "gentle". I went in with shoulder pain, and at the very first appointment he started working on me, primarily by turning my head farther than it really wanted to go. At the end of the appointment, he said that he'd take some X-rays the next time I came in. (I'd already decided there wouldn't be a next time; I'd promised myself I wasn't going to let him do any cervical manipulations, and I was pissed at myself for not having jumped off the table when he started.)

I went to an orthopedist some time later. Turns out the reason my shoulder hurt was that I have arthritis in my neck and C2 and C3 have autofused.

I'm not going to generalize to chiropractors in general. The one I saw, though, was a jackass.
posted by asterix at 10:08 PM on May 9, 2009

c13, I'm confused. docpops was specifically saying that most chiropracty is bullshit, but that it does work for a specific domain even if we don't know how. Your analogy involves something which we do have an explanation for, and you seem to interpret docpops's comment as endorsing chiropracty as a whole, which he certainly wasn't doing. What bone are you picking, or did you just misread docpops's comment?

You are confused. I haven't said anything about docpops' comment. I was commenting on what nebulawindphone said. That's why I quoted him in my 10:28 comment.


"..What bone are you picking.." That's funny.
posted by c13 at 10:11 PM on May 9, 2009

Well.. In general, just because we don't know exactly why something happens, does not mean that we are unable to examine a set of possible explanations and separate more likely ones from bullshit. In particular, our understanding of back pain might be inadequate, but our understanding of things like anatomy and physiology is sufficient to dismiss the notion that realigning vertebrae in a certain way can affect immuno-mediated bronchoconstirction (asthma) is nonsense.

Oh, sure, yes. And I do think it's bullshit when people claim their chiropractor can cure asthma or whatever, which is why I specified I was talking about chiropractic for back pain. My understanding there is that it's unproven but plausible. (Monkeying with your back makes your back feel better? Well, who knows, but it's not totally ridiculous a priori.)

And, I mean, I have no dog in this fight one way or another. I'm not pro- or anti-chiropractic. But I do think there's a genuine ethical issue here — what do you do with unproven-but-plausible treatments when you don't have a better option?
posted by nebulawindphone at 10:32 PM on May 9, 2009

Previously.

Personally, I'm prepared to believe that there might be something in what certain practitioners do to treat back pain. But until those treatments are validated by the kind of research and inquiry that we demand of mainstream medicine, I'm steering well clear.
posted by i_am_joe's_spleen at 10:41 PM on May 9, 2009

Ugh!

The problem is that there are too many different definitions for chiropractry and no standarization or generally accepted certification.

When I was a kid, chiropractry was about putting your bones/joints back into their proper places. Maybe some excercises to reinforce muscles that keep those bones/joints in place. It was all good and scientific (as in; we tried this for x number of people with q problem and for a significant number of them that problem was less bad).

I have no problem with that, kinesiobioligically. Hell, that's a pretty fucking good idea.

It's when chiropractors - or charlatans pretending to be chiropractors, for whatever reasons (many of which don't stretch the imagination) starting doing the hocus pocus bullshit and gleaning from the legitimacy of the oldschool chiropractory technique.

My mom seems to exclusively see quacks rather than the earnest practitioners of alternative medicine and it. makes. me. mad.

That I have to go beyond the reasonable and de-brainwash her, and start the education from scratch. Again. Because of the fucking brainwashing.
posted by porpoise at 10:58 PM on May 9, 2009

But I do think there's a genuine ethical issue here — what do you do with unproven-but-plausible treatments when you don't have a better option?

If they just stuck to back massage, I don't think anyone would have a problem with it.
Does massaging your back when it hurts helps? Sure it does. Provided it's not broken and your nerve roots aren't pinched too much. Oh, and they don't try to force the joints further than they are meant to go. (Seriously, WTF? --"Your vertebra are subluxated. Let me partially dislocate them in a different way, it'll make it all better"..) But that's just it -- a massage. Sounds a hell of a lot less glamorous than "releasing subluxation", doesn't it?
My problem with it is the same as docpops'. They do a certain deal of real good in certain cases, but they dress it up in so much pseudo-scientific bullshit that they confuse the patients. They (the patients) think they're actually doing something definitive to alleviate their condition, while in reality all they get (sometimes) is just a temporary symptom relief.
posted by c13 at 11:03 PM on May 9, 2009

I am extremely skeptical about chiropractic. What puzzles me is, (a) how it is the government certifies or licences them for practicing something that is so amorphous and (b) how it is that insurance plans agree to cover their treatments since there is so little objective basis for the practice.
posted by Rumple at 11:20 PM on May 9, 2009 [2 favorites]

It's when chiropractors - or charlatans pretending to be chiropractors, for whatever reasons (many of which don't stretch the imagination) starting doing the hocus pocus bullshit and gleaning from the legitimacy of the oldschool chiropractory technique.

The founder of chiropractic was the one who came up with all the hocus pocus like subluxation in the late 1800s. So it's always been there, though I agree there was a period where it was deemphasized.
posted by Lentrohamsanin at 12:19 AM on May 10, 2009

how it is that insurance plans agree to cover their treatments since there is so little objective basis for the practice.

Because on average, it saves the insurance plan money over the patient potentially visiting a medical doctor instead.

If people in my profession were hawking patent medicines out of their offices I'd do everyting possible to see that our Board took away their license. Why these assclowns don't do the same says a lot about what a mess their profession is when it comes to regulation.

This is a very good point. It says much about the discipline that those chiropractors who say they are not snake oil salesmen like those other chiropractors seem to have little influence on reducing the snake oil.
posted by grouse at 1:09 AM on May 10, 2009

...there is not a jot of evidence.

So the UK doesn't have an FDA?

The US has an FDA, but we still have chiropractors running around. I'm really not sure how they get away with it.
posted by spaceman_spiff at 1:21 AM on May 10, 2009

docpops: Malor, while I don't doubt for a second that your life was changed by chiropractic, I maintain that the mechanism by which it helps people is still unknown. If you ever actually handle a cadaverous spine - vertebrae, ligamentous support, muscle and synovial junctions - the notion of realigning vertabrae as you described would be akin to pushing on the origin end of a suspension bridge and expecting it to relocate it's connection on the other side. Not to mention that there isn't any real tolerance for movement in the spine as far as neural elements go. If it were indeed the case that you could "move" the spine with some perfectly calibrated touch, you would inevitably hear of hundreds of cases where too much force was applied and the patient crippled.

Well, first realize that I was about fifteen, so these are old memories and I may explain them wrong. But the way it was explained to me is that, for some people, under the typical pressure of standing and twisting, the disks between the vertebrae can be compressed just enough to stick them to the bone somewhat, like a drop of water between two mirrors. That part I remember clearly. The remainder is supposition on my part: I believe that the theory is that the sticking prevents the bones in the back from properly twisting and taking loads correctly. Past a certain point, the back can go into spasm as it tries to prevent injury to itself, which can be incredibly painful. The Palmer adjustments basically were a sharp tap to break the adhesion and then to guide the vertebrae back into something approaching normal alignment. I have NO idea whether or not this is actually true. All I know is that this is what I was told, and that it appeared to work.

I had had a very bad accident at about thirteen, and messed up my neck pretty bad; according to the chiro I was going to, the bones were profoundly rotated, particularly the "mastoid process", if I remember the name right. He predicted, and was borne out by symptoms, that I would have mid-back pain on the opposite side from the neck pain, and then low back pain on the SAME side as the neck injury. And, basically, that straightening out the upper bones in the neck would cause the rest of the back to resume a more normal alignment.

I should add, at this point, that I also have mild lordosis (a front-back curvature of the spine, something like scoliosis), which has never caused symptoms that I know of itself, but probably made the whole problem somewhat more complex. I don't remember whether we talked about the lordosis or not. It's just been too many years.

His treatment was basically putting me on a table, pushing straight down on my back until it popped, moving gradually down from the top. (He didn't do that at first, when I was hurting the most -- he didn't start the compressions until I was feeling better.) Next step was laying me on my side and whacking the bones in my neck with a gentle but very fast series of, um... not quite taps, more like high-speed drags. I just couldn't see it, so I'm not entirely sure exactly what he was doing. He attacked front to back on the neck, and then proceeded into the midback, and finally to the low. He didn't do any joint extension at all, which I gather is a point of contention between schools of thought in that field. All he did was direct manipulation of the back itself, as much as possible through skin. :)

At first, this didn't do much -- I was very tense, not knowing what to expect. After a couple of weeks I started relaxing, and when he was done I would feel amazingly better. At first, the relaxed and feeling-good state would last only for a few minutes at a time, but each day he did it, it would last longer, and before long I could do two days at a time, and then three, and so on. The difference between 'adjusted' and 'non-adjusted' was amazing -- the difference between my back feeling loose and normal, versus tight and painful. Gradually, the relaxed state became normal and the tight state became less and less frequent, and eventually, I didn't need to go at all anymore.

At this point, all these years later, when I'm out of whack, all I usually have to do is a manual adjustment on that upper bone, which I've called the mastoid process, whether or not that's right. I can feel it now; it's rotated to the right, always has been. At least, I assume it's a vertebra, I'm not sure I ever asked if what I was feeling was a bone. All I do is edge it back with a knuckle partway, let it sit for a bit, and then redo it a couple more times, and my back will loosen up, usually within a couple of hours. It's not foolproof, but as long as my pain is the usual kind, instead of from overstrain, it almost always works. And I've stayed out of other care and avoided all surgery for a problem that was almost disabling at one time.

Again, I REALLY think most of the chiropractic claims are hooey -- but this one thing, that directly adjusting your back can greatly reduce or eliminate back pain, depending on what's causing it -- this one thing appears to be quite effective, at least some of the time. There is some "there" there.

It would be interesting to take X-rays to find out if what I'm adjusting actually is a bone in my spine, or if I'm just placebo-ing myself. I don't think I am, but placebo patients never do. :)
posted by Malor at 1:32 AM on May 10, 2009

Sien,
Yeah there's no evidence basis for acupuncture. The NIH certainly thinks there is something worth investigating, but I guess they are nobody in your book.
posted by wuwei at 1:36 AM on May 10, 2009

I had an interesting discussion with a senior FDA employee about alternative medicine. He felt that they were in a real quandary, because the placebo effect is quite significant -- it has better proven results than many "real" treatments, and that's even before you factor in the zero fatalities. He said that if all the various placebo effects could be attributed to a single pill, that pill might well be considered the single most effective medicine ever devised. He said they struggled with the dilemma of taking actions that would lessen the very real benefits of placebos.
posted by StickyCarpet at 3:52 AM on May 10, 2009

Anecdotal Data
So, why would anyone thing that chiropracty can fix various things apparently unrelated to the spine? Try this: I have pains in various places. Many of them resolve to be somehow related to my neck or thoracic vertebrae. I say "related" because attention paid to my spine relieves the pain in these other places.

That being said, understand, this has nothing to do with my experience with chiropractors, whom I vehemently distrust! They've manipulated me right into more pain than when I arrived. I was medically diagnosed with a swollen disc in my neck. This came with all kinds of pains, due to a pinched nerve (according to my doctor).

As for the thoracic vertebrae: all too often I get chest pains, only to discover that a bit of attention to the middle of my spine (simple massage, done by a rank amateur to whom I am married) brings relief. So these pains certainly can relate to the spine, and playing with the spine can bring relief (and vice versa, some times!).

And I'm not saying any of this to support the baloney. Just saying, spine problems can manifest themselves away from the spine itself, with logical, scientific/medical explanation.
posted by Goofyy at 7:13 AM on May 10, 2009

Malor, thanks for the clarification. You have a hell of a memory and sincerely, if you were that miserable as a youngster I don't need to tell you what good fortune you incurred correcting your issues when you did. For some people it's a lifetime failed pursuit. You may be referring to the odontoid - the mastoid is the bony prominence behind the ear, fwiw.

Howard Stern credits Dr. Sarno for fixing his pain, which I think in his case is completely reasonable. Some of my most crippling episodes of lumbar strain occur(ed) within days of seeing family.

If back pain didn't seem so prosaic and instead had some sort of perceived mystery about it like psychiatry or slow-virus brain disease we would probably do a lot better by our patients and researching it in general.
posted by docpops at 7:18 AM on May 10, 2009

Hi Malor,

Speaking as a massage therapist/acupressurist:

One bit of anatomical science worth considering- our body naturally tries to protect joints more than muscles (muscles heal much better than joints) - our tendons and joints have natural nerve sensors that detect when a joint is being moved "too fast"* and sends a signal to the muscles on the other side (the antagonist muscle, for eccentric action) to act as a brake. This is where muscles will tear. If there's problems in the joint capsule, sometimes it will cause ALL of the muscles to lock up to serve as a natural splint and prevent movement in the joint.

When we talk about any joint being misaligned due to causes that aren't trauma/injury, it's usually a combination of poor ergonomics and one muscle getting tight vs. another getting weak. The way to resolve it is to a) relax the tightened muscle, b) mobilize the joint and restore it to a neutral position, and c) give folks exercises to strengthen the weakened muscle and/or change their ergonmics/behavior that's setting them up for that problem.

In your case, a one-time injury, it sounds like your chiropractor was definitely getting some muscle work in there, and the repeated sessions and gaining your own body awareness allowed your body to let go of the injured compensation position and for the adjustments to stay over time. So far, in my experience, most back pain is muscular, either from activity/inactivity, or the muscles locking into place from an injury (even long have the healing is done).

The big problem with our current studies of understanding back pain is that there's almost an infinite variety of things that can cause it, and any given cure is a combination of the practicioner correctly identifying the cause, recommending lifestyle changes which will prevent the problem from kicking back in, and most importantly whether the person in pain will actually attend to those recommendations. I'd like to see studies that would look at all of that, to really consider efficiency in treatment.

(* "Too fast" depends on the state of your muscle spindles and golgi tendon organs. The neurological reasoning behind a warm up is to reset your muscle spindles so your body doesn't freak out that you're moving it fast in the activity your doing and give you muscle tears. This includes the range of motion exercises as well- so "stretching" can be either beneficial if it helps your body get comfy with where it needs to be going, or it can be useless if you're stretching stuff that isn't going to be used, or it can be detrimental if you're resetting your spindles to expect greater ROM in a place where you need stabilization, because then the braking action will be turned off.)
posted by yeloson at 8:00 AM on May 10, 2009 [1 favorite]

yeloson, that explanation mirrors somewhat what the chiropractor was telling me, all those years ago -- that the back muscles get tight to protect the spine, and they have to sort of be tricked into releasing again. He said very clearly that the reason I was in such pain was a reaction to avoid truly serious damage -- and that as agonizing as it was, it was a lot better than not having it, since the consequences could potentially be so dire.

Maybe his adjustments didn't do what he said, but my sensation of them at the time matched what he was telling me -- pushing the bones in my neck left, the bones in my mid-back to the right, and the lower-back vertebra left again. And once I learned to relax and let him actually do his thing -- which really wasn't difficult -- it worked very well. In a way, I guess you could say it taught my back how to be straight again. And I gradually stopped needing to go, so if was placebo, it did leave a permanent effect behind.

gaining your own body awareness allowed your body to let go of the injured compensation position

That could also be a perfectly valid explanation. He might not ACTUALLY have been doing anything -- it might have been me fixing myself through better awareness of my injury. I tend to suspect that the adjustments were closely related though, for the simple reason that I just felt so damn good, after the first month or so, when I left the table each time. Just the massage? Maybe, but he didn't really do massage -- it was just compression and then using the heel of his hand somehow. He didn't really do much with muscles that I recall. But it was a LONG time ago.

recommending lifestyle changes which will prevent the problem from kicking back in, and most importantly whether the person in pain will actually attend to those recommendations

He did talk to me at length about how to sit and stretching exercises to do, and I did them religiously, as I was in too much pain not to. I don't think I've ever paid so much attention to anything in my life. :-)

I DO understand that the plural of anecdote isn't data, and I DO understand the placebo effect. I could very well be wrong here. But I think the idea that direct manipulation of the spine can alleviate back pain is perfectly sensible. I think that part of it might potentially become a real part of medical science, the evidence-based community.

The rest of that supernaturalist nonsense? Chuck it. But the central idea, that manipulating the spine can fix problems with the spine, seems like pretty much a no-brainer to me. It's just figuring out how.

docpops: I'm an idiot about the mastoid, I KNEW that was related to the ear, and just screwed it up. It's been two decades. Maybe he called it the atlas? IIRC (and obviously my memory isn't what it was :) ), it was the either the very top or the next highest vertebra in the spine.
posted by Malor at 9:47 AM on May 10, 2009

I had an interesting discussion with a senior FDA employee about alternative medicine. He felt that they were in a real quandary, because the placebo effect is quite significant -- it has better proven results than many "real" treatments, and that's even before you factor in the zero fatalities. He said that if all the various placebo effects could be attributed to a single pill, that pill might well be considered the single most effective medicine ever devised. He said they struggled with the dilemma of taking actions that would lessen the very real benefits of placebos.

Actually, the best evidence now suggests that the placebo effect is mostly mean reversion -- i.e., there's no causal connection between the administration of the placebo and the improvement of the condition. The studies which were thought to demonstrate the placebo effect failed to compare placebo treatment to no treatment at all; when you do that, the effect disappears.* In other words, the people who seemed to be cured by placebos were actually going to get better anyway.

It's a tremendous scandal that the medical profession and the public were so ready to believe the woo woo mind-healing explanation that they relied on studies that didn't compare placebos to no treatment. It's another scandal that the debunking work has been out for 8 years and the placebo effect still lives on in the conventional wisdom.

-----
*Except possibly in some special cases. For example, placebo treatments seem to treat pain better than no treatment. What this means is open to interpretation. However, for most physical conditions, they do nothing.
posted by grobstein at 1:14 PM on May 10, 2009 [2 favorites]

Actually, the best evidence now suggests that the placebo effect is mostly mean reversion -- i.e., there's no causal connection between the administration of the placebo and the improvement of the condition.

How are two meta studies of clinical trials "the best evidence"?

Hróbjartsson and Gøtzsche's conclusion has been criticised on several grounds. Their meta-analysis covered studies into a highly mixed group of conditions : the placebo effect does occur with peripheral disease processes (such as Hypertension, asthma, prostatic hyperplasia, anal fissure, bronchitis) though not for processes reflecting physical disease (such as venous leg ulcers, Crohn’s disease, urinary tract infection chronic heart failure.[95] Placebos also do not work as strongly in clinical trials because the subjects do not know whether they might be getting a real treatment or a sham one. Where studies are made of placebos in which people think they are receiving actual treatment (rather than merely its possibility) the placebo effect has been observed.[96] Other writers have argued that the placebo effect can be reliably demonstrated under appropriate conditions.

Obviously, there are going to be some conditions where the placebo effect isn't going to have an effect, and others where it's going to have a strong effect. It's not going to have much of an effect on heart disease, for example, but the effect for depression is very well established. The placebo effect over all clinical trials might not be very strong (for one thing, comparing against a real drug it might be obvious to the patients which one they're getting), but it's certainly a well documented and observed phenomenon when it's tested for directly.

For some reason, people love taking the results of one or two studies (in this case, two whole studies) and saying the overturn decades of established research. It's absurd. Your statement goes way beyond what the papers even said.
posted by delmoi at 1:42 PM on May 10, 2009

So they are just two meta-studies, but they are two meta-studies that cover

all published 156 clinical trials in which an experimental drug or treatment protocol was compared to a placebo group and an untreated group, and specifically asked whether the placebo group improved compared to the untreated group. [from the Wiki link above]

I've emphasized the word "all" up there. You see? We're not talking about some wildcat trials here. To establish that there's a placebo effect, you have to compare it to no treatment, and it turns out that when you do that it doesn't outperform no treatment.

I pointed out in my comment that there appear to be some conditions that respond to placebos, and in that I acquiesce to the conventional wisdom. But the rule is the opposite of what is generally observed.
posted by grobstein at 2:54 PM on May 10, 2009 [1 favorite]

(The comment I was responding to attributed to an FDA official -- a high level science bureaucrat -- the view that the placebo "has better proven results than many 'real' treatments," which I think reflects a view of the placebo effect that's out of line with reality. Doing nothing has better results than many treatments in many contexts, but this should not be attributed to a magical "doing nothing effect.")
posted by grobstein at 3:51 PM on May 10, 2009

An orthopedist will toss around the term subluxation all day long to describe a dislocated joint. Subluxation in the chiropractic sense is the notion that whatever ails you is traced back to a misaligned vertebra(e) that an adjustment will relieve the pressure and restore what balance was lost.

This is true, dr_dank, and I was being overly terse. A chiropractor who will be able to help you will say "I believe in subluxations in the orthopedic sense of dislocated joints; I don't believe that subluxations in the vertebrae are responsible for all illnesses. What I do in my practice is manipulate your joints and muscles in an attempt to relieve pain."

Physical therapists also do this, of course, without any mumbo-jumbo. Sadly, some insurance providers in the US make it harder to see qualified physical therapists than to see chiropractors, and so it's possible after an injury that your fastest or cheapest bet is to find a chiropractor whose approach is similar to a physical therapist's. Which is kind of ridiculous; such chiropractors do exist, though, and I have been helped by one in pretty much the exact ways I have been helped by physical therapists.
posted by Sidhedevil at 8:07 PM on May 10, 2009

Mark Liberman at Language Log on "bogus."
posted by Dumsnill at 1:36 AM on May 12, 2009

Also: Here's Singh's Guardian piece in full.
posted by Dumsnill at 1:45 AM on May 12, 2009