First of all, let me state that I am a strong believe in the philosophy of the chiropractic model of health. I have many good friends who are chiropractors and I envision working with many to help transform the medical model that is seriously broken.

There are strong chiropractic arguments to counter this study, which I have posted below.

This study is not yet published so it is difficult to assess. However, it is always wise to be aware of both the potential risk and rewards of the high velocity neck or cervical manipulations or adjustments.

It would seem reasonable to be cautious about high velocity neck adjustments/manipulations. There are other techniques that work quite effectively for neck pain, like NST.

American Chiropractic Association Response to "Chiropractic Stroke in Canada

By Dr. John W. Norris

The American Chiropractic Association (ACA) is denouncing as "junk science" a recent paper by Canadian neurologists1 regarding chiropractic and the risk of stroke. The study, which is extremely limited and seriously flawed, has needlessly alarmed patients about one of the most safe and effective treatments in health care today, according to the American Chiropractic Association (ACA).

The Canadian neurologists' study, presented by Dr. John W. Norris and colleagues at the American Stroke Association's 27th International Stroke Conference, contained no control group; it was essentially a random opinion survey based on the whims of doctors who themselves decided to participate. This outrageous paper, which is being falsely portrayed as legitimate science, leaves many basic questions unanswered, such as: Who, in fact, performed the manipulations?

Were they doctors of chiropractic, physical therapists, osteopaths? And what specific technique was used? Given the fact that studies have shown that adverse reactions often do occur after visits to untrained health care providers, the answers to these questions are especially important.

What was the total number of manipulations performed? The answer to this question is critical to accurately determine the percentage of cases that resulted in arterial dissection. How long after spinal manipulation were the vertebral artery dissections noted?

Many everyday activities such as hairwashing in a beauty salon, turning the head while driving and dancing have been known to cause similar injuries - and could well have contributed to the injuries in these particular cases. These activities involve equal or higher rates of arterial dissection than ever seen by a doctor of chiropractic.

Without answers to these very important and elementary questions, this paper appears to be nothing more than junk science and a weak attempt by a group of politically-motivated medical doctors to steer patients away from chiropractic care. The ACA believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic. However, health care consumers should be aware that the risks associated with chiropractic treatment are infinitesimally low. The risks of chiropractic have been grossly exaggerated, and health care consumers need to put these sensationalistic news reports into perspective. W

hen compared to the number of illnesses and deaths that will occur this year from the use of prescription and over-the-counter drugs, the number of serious complications from chiropractic treatment is extremely low. The use of oral contraceptives is considered to be safe by the medical profession, but of every 100,000 healthy women under 40 who take birth control pills, 28 of them will suffer a stroke. Statistically, this translates into 1.4 in every 5,000 healthy women.

A study published in the April 15, 1998 issue of the Journal of the American Medical Association found that more than 2 million Americans become seriously ill every year from reactions to drugs that were correctly prescribed and taken; 106,000 Americans die annually from those side effects.2

Complications from non-steroidal anti-inflammatory drugs (NSAIDs) -- a group that includes prescription and non-prescription pain medications such as aspirin and ibuprofen -- are responsible for 16,500 deaths each year, according to the New England Journal of Medicine.3 In comparison, a study by the Rand Corporation found that a serious adverse reaction from cervical manipulation occurs less than once in 1 million treatments.4 Studies have also shown that these rare adverse reactions often occur after visits to health care professionals who are inexperienced or inadequately trained in spinal manipulation, rather than licensed doctors of chiropractic.5

A more recent study published in the October 2, 2001 issue of the Canadian Medical Association Journal found only a 1-in-5.85-million risk that a chiropractic adjustment of the neck will result in vertebral artery dissection.6 Despite the sensational nature of this most recent Canadian report, the chiropractic profession does take the risk of vertebral artery dissection - no matter how minute - seriously. During their four-year post-graduate education, doctors of chiropractic are alerted to possible risk factors and taught when to modify their technique or refer a patient for other specialty care.

Risk management is also a frequent topic in the continuing education seminars that most states require practicing chiropractors to attend annually. Chiropractic researchers have spent a great deal of time investigating risk factors so that doctors of chiropractic can identify the rare patients who may be pre-disposed to injury. Other recently published and ongoing studies are testing the validity of pre-treatment screening tests, and devising strategies for even further minimizing the risks of chiropractic neck treatments.

The time has come for the medical community and the media to focus their efforts on warning patients about common procedures with very real risks associated with them -- such as the inappropriate use of drugs and surgery. Chiropractic has been proven to be a safe and effective non-drug, non-surgical treatment, and tens of millions of satisfied chiropractic patients will attest to this fact.

ACA Today

References

1 Norris JW, Beletsky V, Nadareishvilli ZG, Canadian Stroke Consortium. Canadian Medical Association Journal 2000; 163(1): 38-40.

2 Lazarou JL, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. A meta-analysis of prospective studies. JAMA 1998; 279: 1200-5.

3 Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. New England Journal of Medicine. 1999; 340(24); 1888-1899.

4 Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996; 21: 1746-59.

5 Terrett AGJ. Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. Journal of Manipulative and Physiological Therapeutics 1995; 18(4): 203-210.

6 Haldeman S, Carey P, Townsend M, Papadopoulous C. Arterial dissection following cervical manipulation: a chiropractic experience. Canadian Medical Association Journal 2001;165(7):905-06

The National Post
Letter to the Editor

Dear Editor,

The alarmist views expressed by Calgary neurologist Dr. Brad Stewart, regarding the safety of neck manipulation simply have no basis in fact. Dr. Stewart should be challenged to produce the evidence for his claims in a manner that can be evaluated and verified. This is the standard practice in the research community.

The published, peer-reviewed studies agree that the incidence of stroke or stroke-like symptoms associated with neck manipulation is rare - in the range of 1 to 2 per million treatments. There is also a wealth of published research, as well as independent government-sponsored studies, that speak to the safety and effectiveness of chiropractic treatment particularly for neck and back pain.

Patient safety is the chiropractic profession’s number one priority and the profession is a leader in obtaining informed consent to treatment from patients.

This means explaining the risks and benefits of treatment options in direct communication with a patient. Informed consent is required by law of all regulated health professions and we take that responsibility very seriously.

Collaboration, not confrontation, is in the best interests of the public and we welcome all soundly designed research studies that are published and peerreviewed so that the credibility of their methodology and design can be evaluated. Dr. Stewart has no such foundation for his claims.

Dr. Mireille Duranleau
President
The Canadian Chiropractic Association

We note that several major media outlets such as the Globe & Mail and The Toronto Star (the largest circulation paper in Canada), and Sun Media chose not to run this story reflecting, we believe, their knowledge about lobbyist groups who try to manipulate them to gain attention.

WHAT ABOUT THE NUMBERS? WHAT DOES RESEARCH SHOW?

Reputable, peer reviewed research continues to show an incidence of stroke associated with manipulation in the range of one incident from a high of 1 million adjustments to a low of 5.85 million adjustments. By comparison with any other health care intervention, this is an extremely low level of risk.

WHERE IS THE STROKE CONSORTIUM GETTING ITS NUMBERS FROM?

There are a number of inconsistencies and distortions between the data provided on the consortium’s website http://www.strokeconsortium.ca/PG08i.spontads.html and as reported in the neurologists’ press release.

Manipulation as a major cause of stroke in the under 45 age group
The Consortium reports that there are 3,500 dissection strokes in this age group annually. They further claim that there have been, over the past three years, 40 such cases associated with chiropractic. This means there have been 13 strokes per year caused by dissections. One can scarcely argue that 13/3,500 = 0.4% constitutes a major cause of stroke.

More than "100 cases per year"
This number is speculative. The data actually presented shows 40 cases over three years. Another jump of logic is that the Stroke Consortium is assuming that those who died and who had adjustments up to three months previously should be examined for dissection.

The obvious implication is that a chiropractic adjustment will be cited when the cause could be quite different. In the February 10th issue of the Jerusalem Post there is an important article entitled HighRisk Victims may be startled into a Stroke. Researchers at Tel Aviv University Sackler Medical School and the Israel Center for disease Control report that:

Ischemic stroke may be triggered by people with cardiovascular disease by abrupt movements as simple as jumping when the doorbell rings, by sudden loud noises, or when something else startles them, according to a preliminary study presented Friday by Israeli researchers at the American Stroke Association’s 27th International Stroke Conference in Texas.

Dr. John Norris of the Consortium was a guest on Toronto radio station AM 680 Feb 20th at 7:30 am. At that time he suggested that the risk was 1:100,000. This is nothing like the number of ‘one in 5,000’ attributed to Dr. Stewart in the National Post article.

Clearly, proposing that dissection should automatically be ascribed to an adjustment, or that post mortem procedures should attempt to connect these two events makes no scientific sense, especially when one considers that the adjustment could have taken place months before and any number of subsequent health or lifestyle interventions could have occurred.

"Little or no medical benefit"
The implication in this claim has no merit. Please simply glance at the Sampling of Research References: Safety and Effectiveness of Chiropractic Adjustment attached to the second press release to confirm a wealth of evidence which is available to any who sincerely wishes to check. In our experience these kinds of brash statements are made by those whose opinions are hardened.

WHY DOES THE MEDIA ATTACK THE PROFESSION?

The media does not attack the profession, it reports stories and the more sensational the better. Sensational stories increase circulation, and increased circulation is tied to advertising rates, profitability, stock prices, and shareholder value. The media no more takes issue with chiropractic than the chiropractic profession takes issue with engineers.

The CCA tracks chiropractic media reports. Between March 2001 and February 2002, there have been 1,842 print and broadcast references to chiropractic. Of these, 60% are positive, 23% neutral, and 17% negative. This means that 83% of references to the profession are either positive or benign. Reviewing these figures objectively, one would have to conclude that chiropractic fares well in the media on an overall basis.

The same reporter who wrote the chiropractic article in the National Post also authored a negative story about the medical profession several months earlier. Again, the issue was controversy and on this occasion the topic related to the alleged abuses of power by medical regulatory colleges. There are daily media reports citing problems related to pharmaceuticals, hospitals, physicians under investigation, botched operations, and so on. These things are reported because they are sensational.

Mireille Duranleau, D.C.
President
The Canadian Chiropractic Association

Dennis Mizel D.C.
President
The Ontario Chiropractic Association

Ron Brady, D.C.
Chair, Board of Governors
Canadian Memorial Chiropractic College

Paul Carey, D. C.
President
The Canadian Chiropractic Protective Association