You Can't Read This Book: Censorship in an Age of Freedom (27 page)

‘I am the originator, the Fountain Head,’ he bragged. ‘It was I who combined the science and art and developed the principles thereof. I have answered the time-worn question – what is life?’ He compared himself to Muhammad, Jesus and Martin Luther, and built the Palmer School of Chiropractic in Davenport, Iowa, in 1897 to spread his new religion.

Midwestern doctors were outraged, and had the courts send him to jail for failing to pay a fine for practising medicine without a licence. Far from convincing his followers that he was a fraud, the sentence persuaded them that he was a martyr persecuted by the bullies of conventional medicine. His son Bartlett moved into the family business, and made so much money from trusting patients that he was able to buy the first car Davenport, Iowa, had seen. Alas, in 1913 he used it to run down his father on the day of the Palmer School of Chiropractic’s homecoming parade. Daniel died in hospital a few weeks later.

His death may not have been an accident. Father and son had fought for control of the movement, and Bartlett had many reasons to loathe Daniel. His father’s violent therapy had its antecedents in the violent treatment of his children. He had pummelled them when they were young, and thrown them onto the street when they were eighteen, telling them to make their own way in the world. ‘All three of us got beatings with straps, for which father was often arrested and spent nights in jail,’ recalled Bartlett.

Once he was filling his father’s shoes, Bartlett Palmer proved himself an astute huckster. He sold expensive, if medically worthless, equipment to muscular initiates to the back-racking trade, established his own radio station to promote it, and pushed the chiropractic empire into Europe.

Doctors scoffed at the chiropractors’ belief that they could channel the mysterious force of innate intelligence. Along with satirists and journalists, they laid into the therapy without restraint. The alternative practitioners joined the argument by fighting among themselves. All mystical movements are prone to schism, and believers in the chiropractic gospel were no exception. Therapists who made a fleeting contact with reality began to doubt the movement’s claims to provide a cure for all sicknesses. They still believed that chiropractic therapy could treat musculoskeletal problems, but they doubted it was a panacea, and rejected the concept of innate intelligence. They called themselves ‘mixers’, because they accepted elements of conventional medicine. The ‘straights’, on the other hand, remained committed to the belief that chiropractic therapy could treat almost any condition. The arguments between the two sects added to the commotion. At no point did a court feel that it was its business to silence anyone taking part in the debate.

Scientists examining the therapy faced a special difficulty, which those who laughed at Palmer did not readily appreciate. Just because he was a violent mystic, with a mind clouded by ignorant mumbo-jumbo and egotistical self-delusion, that did not mean his treatments were necessarily worthless. His therapy could provide the right results for the wrong reasons; be effective in practice although ludicrous in theory. The scientific method insisted that it was not sufficient to say that an alternative therapist walked like a quack and talked like a quack – critics had to demonstrate that his treatments were quackery.

The task of doing so fell to a free-ranging researcher called Edzard Ernst. He was a professor at Vienna University’s medical school, whose prolific research record might have allowed him to take a job in the grandest of universities anywhere in the world. Instead, he decided in 1993 to become the world’s first professor of complementary medicine, at Exeter University, a fine institution, but something of a backwater in the opinion of his fellow academics.

Ernst’s decision was not so eccentric. Although alternative or complementary medicine was a neglected scientific subject, establishing what merit, if any, it possessed was of pressing public importance. Ernst estimated that the global spend on alternative health care stood at £40 billion in 2008. The pseudo-science of homeopathy generates the largest profits, because the cost of the raw material for homeopathic ‘remedies’ is so low. Homeopaths believe, on the basis of no evidence at all, that the smaller the proportion of an allegedly beneficial substance in a ‘remedy’, the more effective that remedy becomes. Their theory ensures that the most valuable animal on the planet is not a rare Chinese panda or endangered Siberian tiger, but a common French duck. Every year, functionaries working for a French homeopathic firm kill one. They extract its heart and liver, then dilute them with water to a ratio of 1:100
²⁰⁰
– that is, 1 part duck to 1 plus two thousand zeroes of water. Not a molecule of the offal survives the drenching; water is all that remains. The company drips it into sugar pills, and in keeping with homeopathic orthodoxy, claims that a ‘memory’ of the dead duck lingers in the medicine. Its remembrance of the unfortunate
canard
gives the sugar pills curative powers. From one bird, they produce warehouses-full of ‘medicines’ that they sell for millions of dollars.

Ernst resisted the temptation to dismiss the popularity of alternative medicine as the product of the silly obsessions of the rich world’s ‘worried well’. There are thousands of homeopaths in Britain, but hundreds of thousands in India, he noted. In the poor world as well as the rich, not just homeopaths and chiropractic therapists but the sellers of aromatherapy, hypnotherapy, magnet therapy, massage therapy, flower and crystal remedies, acupuncture, feng shui and colonic irrigation claim that there is no need for modern drugs. They offer ‘natural’, ‘herbal’, ‘holistic’ and ‘traditional’ remedies to desperate people with little money to waste on useless treatments as well as to the wealthy.

Ernst understood that practitioners of alternative medicine pose two dangers to rich and poor alike. First, their treatments may not cause actual harm, but because patients believe in the remedy and trust the therapist, they fail to visit clinicians who might actually help them. Second, the treatments may cause actual harm, while still deterring patients from visiting competent clinicians.

In the case of chiropractic therapy, Ernst and his colleagues conducted systematic reviews and meta-analyses of the available clinical trials. They showed that spinal manipulation could do nothing to relieve headaches, period pains, colic, asthma, allergies and all the other conditions therapists claimed to be able to treat. This was not a startling finding. If there were anything in the ‘straight’ version of chiropractic claims, trouble with the back would bring on a host of apparently unrelated medical problems. No one has been able to show that it has. For neck pain, the evidence was more mixed. Two reviews concluded that spinal manipulation was futile. A third found its effects were more beneficial, although Ernst pointed out that the lead reviewer in this case was a chiropractic therapist. There was more of a scientific consensus that spinal manipulation was as effective in treating back pain as conventional physiotherapy and anti-inflammatory drugs. But there’s the rub – no variety of back rubbing, conventional or alternative, does much to relieve back pain: they are all equally ineffective.

A credulous patient who believes that chiropractic treatment can cure or alleviate illnesses that have nothing to do with musculoskeletal conditions may well avoid seeking trustworthy advice, and suffer the consequences. Believers in the efficacy of nearly all other alternative treatments run the same risk – a traveller who believes that homeopathic treatments can protect her from malaria, for example, risks her life if she refuses to take conventional medicines as well. As for the further risk that the patient could suffer positive harm at the hands of the alternative therapists, chiropractic therapy stands out as one of the few alternative treatments that are dangerous in themselves. In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experienced temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. Patients put themselves in jeopardy when they allowed therapists to execute high-velocity, low-amplitude thrust on their necks – one of the most vulnerable parts of the body, as hangmen know.

Manipulating the neck risks attacking the arteries that carry the blood to the brain. Because there is usually a delay between damage to the arteries and the blockage of blood to the brain, the link between chiropractic treatment and strokes went unnoticed for many years. Typical of the suffering Ernst revealed was the case of a twenty-year-old Canadian waitress who visited a chiropractor twenty-one times between 1997 and 1998 to relieve pain in her lower back. 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, she began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She slipped into a coma and died three days later. At the inquest, the coroner declared that she died of a ‘ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck’. Hers was not an isolated case. A 2001 study by the Association of British Neurologists found thirty-five cases of neurological complications, including nine strokes, occurring within twenty-four hours of neck manipulation.

Conventional medicine can have fatal consequences. But medical regulators assess drugs before allowing them on the market, and doctors monitor their effects and seek the informed consent of patients. Neither of the first two checks exists in chiropractic treatment, and a 2005 study of British chiropractors found that 77 per cent did not seek informed consent.

Ernst did not start with a prejudice against alternative medicine – he had trained in herbalism, homoeopathy, massage therapy and spinal manipulation – but the good scientific principle of basing beliefs on evidence shook him out of his complacency. The Exeter University researchers found that 95 per cent of alternative medical treatments had no reliable evidence to support claims for their effectiveness, and suggested that we dropped terms like ‘alternative’, ‘complementary’ and ‘conventional’ medicine, and instead tried ‘medicines that work’ and ‘medicines that do not work’.

Leaving all medical questions to one side, Ernst’s research was a great story. The British alone spend £1.6 billion a year on alternative treatments that do not work except as placebos, and there was a pool of potential readers who wanted to know why. Ernst teamed up with Simon Singh, one of the best modern science writers, to bring his work to a wider audience. Singh trained as a scientist at Cambridge University. He completed his PhD at the CERN laboratory, where he learned about the demands of the scientific method. Before his colleagues would allow him to put a scientific paper into the public domain, they tore into his ideas, challenging his premises, doubting his methods and questioning his ability. It never occurred to Singh that he could sue a critic of his work, even if the criticism was damaging to his reputation or wholly misguided. If the criticisms were wrong, he could expose their falsity. If they were right, they would stop him making a mistake. It tells us something about our times that I need to labour this point, but freedom to speak includes the freedom to be wrong. In science, as in any other intellectual pursuit, free debate without fear of the consequences is the only way of allowing facts to be established and arguments to be tested. As Carl Sagan beautifully explained, ‘At the heart of science is an essential balance between two seemingly contradictory attitudes – an openness to new ideas, no matter how bizarre or counterintuitive, and the most ruthlessly sceptical scrutiny of all ideas, old and new. This is how deep truths are winnowed from deep nonsense.’

Singh had written acclaimed books on the history of code-breaking and the efforts of generations of mathematicians to find a proof for Fermat’s last theorem. He explained scientific ideas to a lay audience without glossing over difficulties the reader needed to understand – one of the hardest forms of prose writing there is, in my opinion.

In 2008, Singh and Ernst released
Trick or Treatment
, a history of how the various alternative therapies came about, why they once seemed plausible, and why patients and governments should now reject most of them. A few months after the book was published, the British Chiropractic Association held National Chiropractic Awareness Week. Singh noted that it offered its members’ services to the anxious parents of sick children, and wrote an article for the
Guardian
, ‘Beware the Spinal Trap’. He began by saying that readers would be surprised to learn that the therapy was the creation of a man who thought that displaced vertebrae caused virtually all diseases. A proportion of modern chiropractors still believed in Palmer’s ‘quite wacky’ ideas, as the British Chiropractic Association was proving by claiming that its members could treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying. There was ‘not a jot of evidence’ that these treatments worked, said Singh. ‘This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.’ He went on to explain that he could label the treatment as ‘bogus’ because Ernst had examined seventy trials exploring the benefits of chiropractic therapy in conditions unrelated to the back, and found no evidence to suggest that chiropractors could treat them.

By the standards of polemic, it was an even-tempered piece; far angrier articles have been written with less cause. Singh was warning that parents would be wasting their money if they took children to chiropractors, and could risk harming them too. He backed up his comments with reliable evidence, and concluded that ‘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.’ This unexceptionable thought was no more than a statement of the obvious.

On the offence principle, one could see why chiropractors would find Singh’s argument extremely offensive, even if it were true or mainly true. According to the harm principle, there was no reason to punish him even if his argument was not supported by strong evidence but was false. On the contrary, John Stuart Mill believed that if all reasonable people thought an opinion was false, they still had no right to suppress it. They must allow the debate to run its course. The courts of his native country turned Mill’s idea on its head. Instead of praising Singh for contributing to a debate on children’s health that all reasonable people should welcome, the judges allowed the British Chiropractic Association to sue him for libel.