Trick or Treatment (27 page)

The chiropractors were told that Judy was generally in good health, but that she suffered from a few earaches, some mild headaches and allergies, and that there was concern about the possibility of asthma. One chiropractor examined Judy and agreed that she was fine and recommended no spinal manipulation, but the other four found a whole range of problems. Moreover, different chiropractors found different problems and gave conflicting diagnoses.

According to Benedetti and MacPhail: ‘The other four put her through a barrage of tests and found imbalances, partially locked vertebrae, asymmetry, uneven weight distribution, and a spinal column riddled from top to bottom with subluxations. They found subluxations in the upper, middle and lower spine, but not necessarily in the same vertebrae.’ The chiropractors claimed that the subluxations that they had identified could lead to learning problems, digestive ailments and reproductive difficulties, and one of them claimed to detect signs of early osteoarthritis. Not surprisingly, these chiropractors recommended spinal adjustment, with one of them proposing immediate care in the form of six visits a week for two weeks, then three times a week for six weeks, followed by twice weekly visits until the problems had improved.

The journalists transcribed the comments of the chiropractors. One suspected that Judy’s problems could be traced back to her birth: ‘The surgeon or somebody grabbing her head, twisting it one way or the other. A lot of stress was created. I would estimate probably 85 to 95 per cent of all the problems I see in adults start from the process of delivery if you can believe it.’

Another chiropractor took a thermal scan of Judy’s back and phoned her uncle later to explain the results: ‘Okay. I can tell you that her scan is horrible. Her thermography scan is terrible. From the top of her neck all the way down to the upper part of her low back is showing nerve interference. That’s a huge area in someone her age. Now, I haven’t seen her X-rays obviously because I don’t think you’ve had them done yet, is that correct?’ Although the uncle explained that Judy’s mother did not want her daughter to be X-rayed, the chiropractor tried to change her decision: ‘Okay, her mum would need to speak to me then. But I really think it’s necessary, especially seeing what I’m seeing on the scan and what I saw in the exam.’

Encouraging a child to have unnecessary X-rays, raising unjustified concerns about serious conditions and offering to manipulate immature bones all reflect badly on the chiropractic profession. Benedetti and MacPhail, however, uncovered an even more disturbing practice, namely the chiropractic manipulation of babies. One of their colleagues pretended to be the mother of a two-year-old baby prone to ear infections and called fifty chiropractors selected at random from the Toronto phone directory. Her survey revealed that 72 per cent offered to treat her fictional child, even though there is no evidence that chiropractors can help with ear infections.

The risks of alternative medicine

Most people view alternative medicine as a safe option. On the other hand, conventional medicine is often criticized because of the side-effects of pharmaceutical drugs or the risks associated with surgery. But is alternative medicine really safer than conventional medicine?

We have already seen that chiropractic therapy carries a range of risks, from the minor hazard associated with X-rays to the strokes that can be caused by manipulation of the upper spine. In short, chiropractic therapy is certainly more dangerous than conventional physiotherapeutic exercise. But, what about the other alternative therapies?

In the previous chapters we deliberately omitted the issue of safety in the context of acupuncture and homeopathy, as we wanted to focus initially on whether or not these therapies were effective. However, now that we have raised the issue of safety, we will discuss the risks associated with these treatments in the remainder of this chapter. For both these therapies, the primary issues are an assessment of the risk, determining whether or not the benefit outweighs the risk, and comparing the risk/benefit ratio with the risk/benefit associated with conventional medicine.

In the case of acupuncture, studies have shown that treatments can result in minor pain, bleeding or bruising, but these adverse reactions are only minor: they occur in roughly 10 per cent of patients and are transient. Slightly more serious side-effects include fainting, dizziness, nausea and vomiting, but again these events are rare and are usually associated with anxious patients who may have a fear of needles. Although most patients may accept such risks as an unsurprising consequence of being pierced with needles, there are two very serious adverse effects that patients should consider in advance of visiting an acupuncturist.

The first of these is infection. This is a concern because there have been several documented cases of patients contracting diseases such as hepatitis. For example, the journal
Hepatology
documented how 35 out of 366 patients contracted hepatitis B from an acupuncture clinic in Rhode Island. A detailed study of this outbreak showed that patients who received fewer than 150 needle insertions during the course of their treatment ran a 9 per cent risk of contracting the disease, whilst those who received more than 450 needles ran a 33 per cent risk. The infection is caused by re-using needles that have not been properly sterilized, and part of the problem may be due to the Chinese tradition of storing needles in alcohol solutions, which is not sufficient to protect against the hepatitis virus.

The other serious risk to patients is the danger that needles might puncture and damage a major nerve or organ. For example, needling at the base of the skull can lead to brain damage, deep needling in the lower back can damage a kidney, and there are over sixty reported cases of punctured lungs, known as
pneumothorax
. Most worrying of all, there is a report of an acupuncturist inserting a needle in the chest of an Austrian female patient and penetrating her heart. Normally needling at this point is entirely safe because the sternum protects the heart, but one in twenty people have a hole in that bone. This abnormality cannot be felt or seen because it is covered by very strong ligaments, but an acupuncture needle will go right through these structures. In the case of the Austrian patient, it pierced the heart and killed her.

Although acupuncture carries some common and serious risks, it is important to stress that the common risks are not at all serious and the serious risks are not at all common. The sixty cases of pneumothorax reported in recent decades have to be appreciated in the context of the millions of acupuncture treatments given each year. Moreover, the serious risks can be minimized by visiting a medically trained acupuncturist who uses disposable needles.

On the other hand, it should be remembered that the evidence for the efficacy of acupuncture ranges from zero for a whole range of conditions to borderline for some types of pain relief and nausea. Hence, it would only be worth considering acupuncture for treating pain relief and nausea, and only then if you feel on balance that the supposed benefits are large enough to outweigh the small risks.

In Chapter 3 we discussed the efficacy (or rather the lack of efficacy) of homeopathy. The conclusion was that the benefits of homeopathy were purely placebo, which is not surprising bearing in mind that the final medicine often contains no active ingredient because of the extreme levels of dilution. One might assume, therefore, that homeopathy would at least be safe. Surely, if homeopathic remedies are devoid of any active ingredient then they must be harmless?

Unfortunately, homeopathy can have surprising and dangerous side-effects. These have nothing to do directly with any particular homeopathic remedy, but rather they are an indirect result of what happens when homeopaths replace doctors as sources of medical advice.

For example, many homeopaths have a negative attitude towards immunization, so parents who are in regular contact with a homeopath may be less likely to immunize their child. To evaluate the extent of this problem, Edzard Ernst and Katja Schmidt at Exeter University conducted a revealing survey among UK homeopaths. Having obtained e-mail addresses from online directories, they sent an e-mail to 168 homeopaths in which they effectively pretended to be a mother asking for advice about whether or not to vaccinate her one-year-old child against measles, mumps and rubella (MMR). This was in 2002 when the controversy over MMR was subsiding and the scientific evidence was clearly in favour of vaccination. Although 104 homeopaths replied, the ethics committee overseeing the research survey required that these homeopaths be informed of the real purpose behind the e-mail and be given the opportunity to withdraw their replies if they were unwilling to be involved in the survey. Sure enough, twenty-seven homeopaths took advantage of this opportunity. Of the remaining seventy-seven respondents, only two (or 3 per cent) advised the mother to immunize. Of course, the responses of the twenty-seven homeopaths who withdrew from the survey have never been made public or evaluated, but it seems reasonable to assume that their general attitude on average would have been even more negative. It is clear that the overwhelming majority of homeopaths will discourage immunization.

This anti-immunization stance is not unique to homeopaths, but it is also common among other alternative therapists. At the same time as surveying homeopaths, Ernst and Schmidt also emailed chiropractors with the same request for immunization advice. There were twenty-two responses, but six chiropractors withdrew when they realized their replies were part of an academic survey. Out of the remaining sixteen responses, only four (25 per cent) chiropractors advised immunization. Again, we can assume that those who withdrew from the survey would have had an even more negative attitude. And, again, it is clear that the vast majority of chiropractors will discourage immunization.

This negative response from chiropractors was in keeping with the openly hostile attitude that is expressed in much of their literature. Senior chiropractors have written statements such as ‘smallpox vaccination was stopped in the US and UK because it was realized that the vaccinated suffered the worst effects of the disease’ and ‘the dangers of vaccination to the young child are profound…in some cases, the vaccine acts non-specifically to increase a child’s pre-existing chronic disease tendency’. Both these statements are misleading and damaging. The truth is that immunization is arguably the single most important discovery in the history of medicine. Indeed, there is probably a substantial proportion of readers, possibly including you, who would not be alive today if it were not for the immunizations that we all received when we were children.

Thankfully these diseases are now rare in the developed world, but this means that it is easy to forget their potentially devastating impact – we no longer appreciate why we used to fear them. If, however, we look beyond the developed world then we can be reminded of the dangers of childhood diseases and the value of vaccination. For example, the Measles Initiative was launched in 2001 to vaccinate children and reduce deaths from measles around the world. In its first five years the programme has already reduced the annual number of deaths from measles in Africa by 91 per cent, from over 400,000 to 36,000.

The widespread anti-immunization stance among alternative therapists is just one of the ways in which they offer harmful advice to patients. Another example is that alternative therapists sometimes meddle with a patient’s conventional drug-treatment programme, even though they are not qualified to advise about a patient’s prescription. A 2004 survey of UK-based acupuncturists showed that 3 per cent of patients received advice about their prescriptions, some of whom suffered adverse consequences.

Perhaps the greatest danger in the way that alternative therapists behave is simply the promotion of their own treatments when patients should be in the care of a conventional doctor. There are numerous reports of patients with serious conditions (e.g. diabetes, cancer, AIDS) suffering harm after following irresponsible advice from alternative practitioners instead of following the advice of a doctor.

This danger is amplified by a particularly strange facet of many alternative therapies, a phenomenon known as the
healing crisis
. This means that an expected part of the healing process is that the therapy might cause symptoms to deteriorate before they improve – this is supposedly due to the body fighting back or toxins being expelled. In one case, a patient being treated for pancreatitis (a life-threatening condition) was given a homeopathic remedy with a label advising that abdominal pain was part of the healing crisis, otherwise known as a
homeopathic aggravation
. So, just when the pancreatitis might be worsening and the patient ought to be seeking urgent medical attention, the homeopathic advice would be that the patient should relax because everything is progressing as expected.

In 2006, Simon Singh, one of the authors of this book, attempted to highlight the extent to which homeopaths give bad advice by finding out what they would offer to a young traveller seeking protection against malaria. Working with Alice Tuff and the charity Sense About Science, Singh developed a storyline in which Tuff would be making a ten-week overland trip through West Africa, where there is a high prevalence of the most dangerous strain of malaria, which can result in death within three days. The idea was that Tuff, a young graduate, would explain to homeopaths that she had previously suffered side-effects from conventional malaria tablets and wondered if there was a homeopathic alternative.

Before approaching homeopaths, however, Tuff visited a conventional travel clinic with exactly the same storyline, which resulted in a lengthy consultation. The health expert explained that side-effects were not unusual for malaria tablets, but that there was a range of options, so a different type of tablet might be advisable. These tablets could then be taken in the week prior to departure to check that they had no unpleasant side-effects. At the same time, the health expert asked detailed questions about Tuff’s medical history and offered extensive advice, such as how to prevent insect bites.