MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The British press recently reported that a retired bank manager (John Lawler, aged 80) died after visiting a chiropractor in York. This tragic case was published in multiple articles, most recently in THE SUN. Personally, I find this regrettable – not the fact that the press warns consumers of chiropractic, but the tone and content of the articles.

Let me explain this by citing the one in THE SUN of today. Here is the critical bit that concerns me:

Ezvard Ernst, Emeritus Professor of Complementary Medicine at Exeter University, published a study showing at least 26 people had died as a result. He said: “The evidence is not in favour of chiropractic treatments. Nobody knows how many have suffered severe complications or died.” Edvard Ernst, Professor of Complementary Medicine, says many have suffered complications or died from chiropractors treatments… A study from Exeter University shows at least 26 people have died as a result of treatment.

And what is wrong with this?

The answer is lots:

  • My first name is consistently misspelled (a triviality, I agree).
  • I am once named as Emeritus Professor and once as Professor of Complementary Medicine. The latter is wrong (another triviality, perhaps, but some of my more demented critics have regularly accused me of carrying wrong titles)
  • The mention of 26 deaths after chiropractic treatments is problematic and arguably misleading (see below).
  • Our ‘study’ was not a study but a systematic review (another triviality?).

Now you probably think I am being pedantic, but I feel that the article is regrettable not so much by what it says but by what it fails to say. To understand this better, I will below copy my emails to the journalist who asked for help in researching this article.

  • My email of 17/10 answering all 7 of the journalist’s specific questions:
  • 1. Why are you sceptical of chiropractic?
  • I have researched the subject for more than 2 decades, and I know that the evidence is not in favour of chiropractic
  • 2. How many people do you believe have died in Britain as a result of being treated by a chiropractor? If it’s not possible to say, can you estimate?
  • nobody knows how many patients have suffered severe complications or deaths. there is no system to monitor such events that is comparable to the post-marketing surveillance of conventional medicine. we did some research and found that the under-reporting of cases of severe complications was close to 100% in the UK.
  • 3. What is so dangerous about chiropractic? Is there a particular physical treatment than endangers life?
  • manipulations that involve rotation and over-extension of the upper spine can lead to a vertebral artery breaking up. this causes a stroke which sometimes is fatal.
  • 4. Is the industry well regulated?
  • UK chiropractors are regulated by the General Chiropractic Council. it is debatable whether they are fit for purpose (see here:http://edzardernst.com/2015/02/the-uk-general-chiropractic-council-fit-for-purpose/)
  • 5. Should we be suspicious of claims that chiropractic can cure things like IBS and autism?
  • such claims are not based on good evidence and therefore misleading and unethical. sadly, however, they are prevalent.
  • 6. Who trains chiropractors?
  • there are numerous colleges that specialise in that activity.
  • 7. Is it true Prince Charles is to blame for the rise in popularity/prominence of chiropractic?
  • I am not sure. certainly he has been promoting all sorts of unproven treatments for decades.
  • My email of 18/10 answering 3 further specific questions
  • 1. Would you actively discourage anyone from being treated by a chiropractor?
    yes, anyone I feel responsible for
    2. Are older people particularly at risk or could one wrong move affect anyone?
    older people are at higher risk of bone fractures and might also have more brittle arteries prone to dissection
    3. If someone has, say, a bad back or stiff neck what treatment would you recommend instead of chiropractic?
    I realise every case is different, but you are sceptical of all complementary treatments (as I understand it) so what would you suggest instead?
    I would normally consider therapeutic exercises and recommend seeing a good physio.
  • 3. My email of 23/10 replying to his request for specific UK cases
  • the only thing I can offer is this 2001 paper
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297923/
  • where we discovered 35 cases seen by UK neurologists within the preceding year. the truly amazing finding here was that NONE of them had been reported anywhere before. this means under-reporting was exactly 100%.

END OF QUOTES
I think that makes it quite obvious that much relevant information never made it into the final article. I also know that several other experts provided even more information than I did which never appeared.

The most important issues, I think, are firstly the lack of a monitoring system for adverse events, secondly the level of under-reporting and thirdly the 50% rate of mild to moderate adverse-effects. Without making these issues amply clear, lay readers cannot possibly make any sense of the 26 deaths. More importantly, chiropractors will now be able to respond by claiming: 26 deaths compare very favourably with the millions of fatalities caused by conventional medicine. In the end, the message that will remain in the heads of many consumers is this: CONVENTIONAL MEDICINE IS MUCH MORE DANGEROUS THAN CHIROPRACTIC!!! (The 1st comment making this erroneous point has already been published: Don’t be stupid Andy. You wanna discuss how many deaths occur due to medication side effects and drug interactions? There is a reason chiros have the lowest malpractice rates.)

Don’t get me wrong, I am not accusing the author of the SUN-article. For all I know, he has filed a very thoughtful and complete piece. It might have been shortened by the editor who may also have been the one adding the picture of the US starlet with her silicone boobs. But I am accusing THE SUN of missing a chance to publish something that might have had the chance of being a meaningful contribution to public health.

Perhaps you still think this is all quite trivial. Yet, after having experienced this sort of thing dozens, if not hundreds of times, I disagree.

7 Responses to Regrettable journalism around the tragic death of a chiropractic patient

  • Re question 7 in the email of 17/10, apparently much of the early work on the statutory regulation of chiropractors was done at dinner parties attended by Prince Charles:
    http://www.ebm-first.com/a-close-look-at-alternative-medicine/prince-charles-cam-news-items/2194-the-pursuit-for-chiropractic-legislation.html

    Here’s what his meddling helped to produce:

    QUOTE
    “In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.”
    Michael C. Copland-Griffiths, former Chairman of the General Chiropractic Council (European Journal of Oriental Medicine, Vol.2 No.6, 2004)

    Ref: http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1437-statutory-regulation-the-chiropractic-experience.html

  • @ Edzard

    What are the qualities and skills that define a good physio?

  • Perhaps you still think this is all quite trivial.
    No, unfortunately it is not. I watch some of the climate-change deniers in action and they will seize on the slightest error or discrepancy to try to discredit any report or real expert.

    I exaggerate but I sometimes think that the typo in footnote 234 on page 300 of a 750 page report is enough to prove deliberate fraud among the researchers.

    That said, with time pressures on reporters and often the lack of a dedicated science reporting staff the errors in the general media are likely to remain at this level or increase. It may even be that the reporter and editor did not appreciate the distinction between Emeritus Professor and Professor.

  • Well they have clearly been listening to all the feed back on this. They have even corrected your name! Go check for yourself “Ezvard”!

  • I attended this same Chiropractor in 2012 and attended a block of treatments where she cracked my neck over and over again on every visit. And I eventually fell very very ill with my left side go back, pelvis neck and my cognitive balance all making me feel very sick and I went to my GP who thought I had mental issue. I thought at the time that she was just wanting money as she would just crack you and with in 10 min if that be out. I was off work for 3 month and some how I managed to get back to work and save my job. To this day I still do not feel 100% with headaches and still having back and hip issues. I did contact this chiropractor to tell her that cracking the neck is a very dangerous procedure. I saw that a young female gymnast had died after a chiropractor cracked her neck. I think this was an accident waiting to happen in this chiropractor watch. And I think I may have got away lucky but like I said I still feel I have repercussion to this day of having my neck cracked.

  • A regrettable feature of pseudoscience and quackery-charlatans is that they attract 2 types of callers:
    1. the “educated” upper crust worried-well with no discernible real illness, and
    2. the lower socioeconomic and poorer educated with potentially serious illness (or co-morbidities).
    Thus you find injurious over Treatment issues endemic in many patients (rhabdomyolysis, burns, unstable joints/motion segments and intestinal issues from offensive supplements) complicating their problems. The overtreating-charlatan has no incentive to reduce care (and often turns a blind eye, and thus keeps NO record of any injury their ‘treatments’ create….and all the while perpetuates the notion MDs and drugs are the enemy of real health and wellness).
    A great quote regarding joint ‘cracking’ from Robin McKenzie: “manipulation shouldn’t be dispensed to the entire population (as Chiropractors do) to find the VERY few who might actually need it”.
    Problem is there are some pretty good evidenced-based standards as to when to manipulate…Chiropractors however appeal to none of them.

Leave a Reply

Your email address will not be published. Required fields are marked *

Gravityscan Badge

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories