All spitzer bullets are inherantly "out of balance." As long as the pointy end is going forward, the bullet is travelling "backwards" as far as inertia is concerned - think about a shuttlecock, foster slug, or even a paper airplane. The heavy end always wants to go first... and the heavy end is at the BACK of a spitzer rifle bullet.
What keeps it pointy-end first is the rotation imparted by the rifling of the barrel. As long as that bullet is moving fast enough and - accordingly - spinning fast enough, it'll stay pointy end first. When that bullet enters a fluid (like the human body), it slows down dramatically and flips backwards, to continue its path in a stable, tail-first attitude...
Unless the stresses of that "flip" are too great for the jacket, at which point the round fragments and spalls violently, turning the temporary cavity into a large permanent one.