Jun 17 2008

Chiropractic Lawsuit

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Comments: 177

Sandra Nette suffered a stroke following a neck manipulation by an Edmonton chiropractor. She alleges that the manipulation caused the stroke and she is therefore suing the chiropractor and the provincial government that allowed him to practice for $500 million dollars. This is an interesting development and how this case plays out is likely to have a dramatic effect on not only chiropractic but the regulation of non-science-based medical practitioners.

Chiropractic Neck Manipulation and Stroke

At present there is no evidence-based indication for chiropractic neck manipulation. There are many claims made for this procedure, that it can cure migraine or other headaches being the most common, but the evidence does not support such claims. Straight chiropractors – those who believe in the ideology that a magical life energy they call “innate intelligence” is necessary for health, and that most or all disease is caused by the blockage of innate intelligence. They manipulate the spine, including the neck, in order to relieve imagined subluxations and free the flow in innate intelligence. This form of chiropractic is pure pseudoscience.

But even those who partly or completely reject this ideology may still not live up to the ideas of science-based medicine. Since there is no indication for which there is adequate evidence to conclude that neck manipulation is an effective treatment, any risk to the procedure will be risk without benefit. Assessing the risk/benefit ratio of every intervention is one of the cornerstones of scientific medicine. Zero benefit means no measurable risk is justified.


The risks of neck manipulation are not trivial. The primary risk is that aggressive neck manipulation may cause a tear (called a dissection) in one of the four arteries that feed the brain – two carotidsto the front of the brain and two vertebrals to the back. If a tear forms in one of these arteries then a clot (called a thrombus) can form around that tear, blocking off flow through the artery and causing a stroke. It is also possible that the thrombus may break lose and flow downstream and then lodge in and completely block off an artery – when a clot moves it is called an embolus.

This is apparently what happened to Sandra Nette. She had a dissection in one of her vertebral arteries causing a stroke in her brainstem. This resulted in what is called a “locked in” syndrome – probably the worst outcome possible of a stroke. People who are locked in can move their eyes but nothing more (depending upon how complete it is). They may or may not be able to breathe on their own, but they cannot speak or move any of their limbs. They are locked into a living death.

Malpractice Suits

Even though I am a practicing physician, I believe in the necessity of malpractice suits. I have even given expert testimony for both plaintiffs and defendants.  It is not a perfect system – but it is necessary that genuine malpractice can be redressed through the courts. It is a needed “back end” method of regulating quality control – if a practitioner falls too far below the standard of care of harms patients, they should have to give compensation and perhaps even have their ability to practice restricted. Without such a system in place quacks would flourish.

Of course the system can be abused as well, and in this country the system could benefit from some reforms – but that is a topic for another blog

It is interesting that so-called alternative practitioners seem to be much less liable for malpractice suits. There is far greater variability in practice, and far less logic and evidence behind the practices, and yet they do not get sued as often as physicians. Part of the problem is that malpractice is based upon the standard of care – if there is no standard of care, because the practices are not based upon evidence, then how can you prove that what someone did was substandard. In other words – if a “healing profession” is entirely based upon pseudoscience, then pretty much everything they do is magic and quackery  – so what is there to sue for?

As regulations are progressively eased on these practitioners the situation becomes worse. Increasingly practices that are not medicine are allowed to be labeled as medicine. For example, Minnesota just gave permission to naturopaths to call themselves “doctor.”  Invariably, when a profession like naturopathy or chiropractic is recognized by the government they are generally given the ability to regulate themselves. Therefore unscientific practitioners can decide what their standard of care is by any methods they choose. They can decide that utter quackery is accepted practice, and the government signs off on it.

Law suits generally only happen when direct harm is caused – as is alleged in this case. I think this lawsuit is a good thing, and I hope it is successful and spawns more. If an MD performed a procedure that was not supported by scientific evidence and it directly caused a young patient to have a horrible stroke – you better believe they would be sued blind. If chiropractors won’t regulate themselves and the various governments let them get away with it – the courts are the last line of defense for the public against this dangerous quackery.

The very interesting twist in this case is that Sandra Nette is also suing the government for allowing this practice to continue. Good for her. If insurance companies and governments are going to be involved in deciding what care can be delivered, they have to share the liability. I have no idea about the legality of this case, especially in Canada – I don’t know if it is even possible to sue a provincial government. I would not be surprised if that part of the case were thrown out for technical legal reasons.

But I think this case should be a wake up call. The government cannot continue to license nonsense and call it medicine.  The public deserves better. I also think that public awareness about the risks of neck manipulation needs to be raised, and more importantly this practice needs to simply stop.

Watch how the government and chiropractors respond to this law suit. It will be very telling.

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177 responses so far

177 Responses to “Chiropractic Lawsuit”

  1. krissncleoon 17 Jun 2008 at 9:44 am

    There was an article in either the SF Chronicle or the Sacramento Bee last week about a man that died of a neck manipulation from an unlicensed “practitioner” that operated out of his garage. The ‘garage practitioner’ had a following in his Hispanic neighborhood for many years with many return customers. His training was a massage class taken years ago (the forties I believe) and that seemed to be enuff to satisfy his flock.

    It is unfortunate that many people can not afford health insurance and have to go to such charlatans, or that they just don’t know any better. At least the person in your article did not die (this time), but it makes one wonder about how many have died or have been seriously injured throughout the years, but it just went unreported.

    Once again Doctor, excellent work. Quackwatch, Science Based Medicine, & You, just to name a few, are doing a great public service. Thank you so much. Out

    Kriss

  2. pecon 17 Jun 2008 at 11:17 am

    You are taking one example of an extremely rare occurrence and implying that it happens all the time. That is intentional deception.

    And how exactly do you know that neck manipulation has no benefits? You didn’t bother to cite any research showing it cannot be helpful. If there has not been enough research to decide either way, that is just another reason we need to increase CAM funding.

  3. jdayon 17 Jun 2008 at 12:05 pm

    pec, pec, pec…

    There is no implication in this blog that injury from neck manipulation happens all the time.

    It is known that neck manipulation has no benefits through numerous studies (e.g., check out the article “Chiropractic’s Dirty Secret: Neck Manipulation and Strokes” and the references therein, over at Quackwatch, for a good start).

    And, there *has* been enough research to decide one way or the other: CAM is garbage.

  4. The SkepDocon 17 Jun 2008 at 12:57 pm

    pec,

    I re-read the article and didn’t find anything that implied that stroke “happens all the time.” Dr. Novella is well aware that it is uncommon, but he is saying that even one stroke is too many if there is no benefit from manipulation.

    There is no evidence in the medical literature that the kind of manipulation this patient received is helpful for any indication, much less for “maintenance” of an asymptomatic patient which was the case here. You can’t expect Dr. Novella to cite research showing it CAN’T be helpful, because no research could possibly show that it “can’t.” It is up to the person making the claim to show evidence that it CAN.

    I don’t see any need to increase funding for studying chiropractic neck manipulation. They’ve had over a century to show benefits from it, and they haven’t been able to. Many chiropractors provide their services without seeing any need for the kind of manipulation that has been associated with (rare) strokes. For example, Sam Homola, the author of “Inside Chiropractic,” does only gentle mobilization through a limited range of motion. And he never did “maintenance” adjustments. The kind of manipulation that caused this patient’s stroke could easily be eliminated from the chiropractic repetoire and a self-policing action of that sort would only tend to increase their prestige.

  5. Coronachon 17 Jun 2008 at 1:15 pm

    References are in the links:

    http://www.sciencebasedmedicine.org/?p=94

    Lot’s of references here:

    http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

    Burdon is on the chiropractor to show that it’s helpful, not on us to show that it’s not. It’s been demonstrated again and again the basis of chiropractic is bunk. If the foundation is garbage, not much reason to take the rest too seriously, right?

    Hardly means more money needs to spent on it.

  6. DavidCTon 17 Jun 2008 at 1:56 pm

    It is more than a little difficult to always know what is and is not nonsense. How is someone serving in the state legislature to know for sure when medical schools are increasingly allowing “integrated medical” programs. To further add to the confusion, heads of these departments are saying that these treatments should be judged by separate standards.

    This blog and others like it are a great source of information, but it will take a lot to counter the acceptence of woo by respected institutions.

  7. Skeptical Caton 17 Jun 2008 at 2:50 pm

    [blockquote]It is up to the person making the claim to show evidence that it CAN.[/blockquote]

    Right. And pec, if you really don’t believe that the burden of evidence is on the person with the positive claim, then I will tell everyone about your collection of midget porn.

    Just try to prove that you don’t have a collection of midget porn, I dare you.

    [blockquote]If there has not been enough research to decide either way, that is just another reason we need to increase CAM funding.[/blockquote]

    If there is some reason to think that a medical intervention might work, why does it need a special funding source? Why shouldn’t it have compete with every other prospective treatment? If there is no good reason to think that a medical intervention might work, why should we fund it at all?

  8. Skeptical Caton 17 Jun 2008 at 2:51 pm

    Gah. Those should have been angle brackets…

  9. Abbson 17 Jun 2008 at 3:03 pm

    There’s absolutely no evidence to suggest that chiropractic manipulation causes stroke. Look at how often these strokes occur after a manipulation and compare that to how often they occur in the general population and you won’t see any difference in the rate of occurrence. Who’s to say that this lady wouldn’t have had an arterial dissection regardless of whether she received a chiropractic manipulation or not. What if she had the stroke while driving her car…would she be suing the auto manufacturer?

    Also, some person supposedly dying from a manipulation in some guy’s garage has nothing to do with chiropractic. The person wasn’t a chiropractor and obviously had no idea what he was doing. Chiropractors go through 4 years of intense graduate school training to learn these adjustments.

  10. Reasonableon 17 Jun 2008 at 3:34 pm

    My father suffered a BRAO about an hour after a neck manipulation.
    Because of this, my father had to have a complete cardiovascular workup which demonstrated diffuse plaque along the carotid arteries, the likely culprit of the BRAO. The cardiologist has thankfully put a stop to my father’s chiropractor visits.

    I had been poo-pooing my father seeing a quack for years thinking that it was probably harmless, but I had no idea that the chiropractor was performing aggressive massages of the neck. Unfortunately, I think many of us in academia see much of woo as ‘probably harmless’, but it is increasingly becoming so mainstream that I fear that we will be soon inundated with stories of its true harm.

  11. orDoveron 17 Jun 2008 at 4:00 pm

    Chiropractic really bothers me because it is much more normalized than other CAM shams, like acupuncture or even homeopathy. In my home town (Phoenix) you can find a Chiropractic office as easily as you can find a Blockbuster. They are in virtually every mini-mall. That kind of high visibility makes Chiropractic seem as uncontested as dentistry. Who would even think to question it? You never hear about these sorts of stories from mainstream news outlets, and without them there is no reason for your average person to doubt Chiropractic’s validity and efficacy. My family would never think of getting acupuncture, but they all visit the chiropractor regularly, and swear that it cures whatever ails them. Never mind the fact that they can’t explain to me why cracking your back would make a cold go away or reduce a fever.

    “I think the only people who should not be required to vaccinate their children are Chiropractors.” – My Mom

  12. pecon 17 Jun 2008 at 4:33 pm

    Ok, I took one of the links: http://www.ncbi.nlm.nih.gov/pubmed/15247576

    “There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for painreduction”

    So are you kidding or lying when you say there is absolutely no evidence in favor of chiropractic?

  13. DevilsAdvocateon 17 Jun 2008 at 4:40 pm

    One clue is found, locally to me anyway, in the way radio and TV ads promting local chiros mention miraculous cures ad nauseum but never, ever actually say the word ‘chiropractic’.

    This is interesting. In the Tag-a-log language “pec” means “straw man”.

  14. Coronachon 17 Jun 2008 at 6:43 pm

    Pec,

    That appears to be a meta-analysis. Not always particularly useful. I’m not expert, but it’s not clear they are talking about chiropractic.

    Reading beyond your quote:

  15. Coronachon 17 Jun 2008 at 6:44 pm

    Sorry for the double, post got trunc’d.

    Pec,

    That appears to be a meta-analysis. Not always particularly useful. I’m not expert, but it’s not clear they are talking about chiropractic.

    Reading beyond your quote:

    Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior.

  16. The SkepDocon 17 Jun 2008 at 6:52 pm

    pec said

    “So are you kidding or lying when you say there is absolutely no evidence in favor of chiropractic?”

    There is evidence that spinal manipulation is useful for low back pain. There is no evidence that maintenance adjustments or the kind of neck adjustments this patient received are useful for any condition.

  17. jdayon 17 Jun 2008 at 6:59 pm

    pec,

    You are cherry-picking from their abstract (which is not very intellectually honest of you, especially considering that you accused Steve of being intentionally deceptive). The same paper you reference clearly states:

    “Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache.”

    True, the authors conclude:

    “Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache.”

    But they also find that:

    “Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior.”

    Finally, they summarize by stating:

    “This systematic review of 33 trials did not favor mobilizations and/or manipulations done alone or combined with other treatments like heat for relieving acute or persistent pain and improving function when compared to no treatment.”

    So who’s kidding whom here?

  18. The SkepDocon 17 Jun 2008 at 6:59 pm

    Abbs said,

    “There’s absolutely no evidence to suggest that chiropractic manipulation causes stroke.”

    There most certainly is evidence. An overview of that evidence can be found at http://www.sciencebasedmedicine.org/?p=94. The fact that these manipulations can cause stroke is not in question; the only question is how frequently it occurs.

  19. The SkepDocon 17 Jun 2008 at 7:53 pm

    The story is even worse than Dr. Novella described. This woman was in good health. She had no complaints in her neck, back, head or anywhere else – she was seeing the chiropractor simply for “maintenance” adjustments which he had led her to believe would keep her in good health. She developed symptoms during the neck manipulation. She told the chiropractor she was feeling pain and dizziness. She had to sit down for a while before she could leave the office. He failed to recognize a medical emergency; he suggested massage might help; he let her leave the office alone. And she didn’t just have a damaged artery – she had tears in both vertebral arteries, and one tear was 3 inches long.

  20. vlewskion 18 Jun 2008 at 12:24 am

    Dr. Novella,

    Is it just as dangerous to “pop” or “crack” my own neck by simply twisting it until it does so? It seems that I have gotten in the habit of doing so but am unsure whether or not it is a safe or effective practice.

  21. Abbson 18 Jun 2008 at 1:21 am

    vlewski, the difference between cracking your own neck and a chiropractic adjustment is that the chiropractor palpates your neck statically to feel for malpositions and then motions individual spinal segments to feel for restrictions in movement. The chiropractor then delivers a high velocity, low amplitude thrust to the specific segment that they find restricted and/or in malposition. When you crack your own neck, you’re cavitating joints that aren’t necessarily restricted or in any malposition, while missing the ones that are. So, it basically puts your vertebral arteries in the same position as a chiropractic adjustment. So, if that scares you…stop doing it…but I assure you that there is no risk of stroke. If anything, you’re creating joint laxity by constantly stretching out your muscles, tendons, and ligaments.

    The reason that it feels so good when you crack your own neck is because your body releases hormones called enkephalins which are similar to endorphins in that they are opiates which are much stronger than morphine. They are your bodies natural pain killers.

  22. jjutkowitzon 18 Jun 2008 at 3:08 pm

    This is the usual flatus. The relationship between stroke and doctors visits for neck pain is the same for chiros as it is for MDs.

    Even the lawers now know it is the stroke causing the neck pain for which they seek treatment rather than the other way around.

    If it was not that, the stroke incidence would be higher post-chiro visits but it is not any higher than post MD visits:

    A recent research study published in Spine (2008)1 investigated the association between chiropractic visits and vertebrobasilar artery (VBA) stroke, then compared it to the association between family physician care and VBA stroke.

    Earlier published studies had cast a cloud on the chiropractic profession suggesting chiropractic adjustments resulted in some patients suffering from a stroke after treatment. One such study, published in 2000 in the Canadian Medical Association Journal, concluded there was a 1 in 5.85 million risk a chiropractic neck adjustment could cause a stroke.2 The current study first published in Spine (2008) is more instructive as it investigated not only the relationship between chiropractic visits and VBA stroke, but also between pre-stroke family doctor visits and VBA stroke.

    Reports on vertebrobasilar artery dissection following chiropractic care have attracted media attention and calls by some medical specialists to avoid neck manipulation for acute neck pain. The prevailing theory is that extension and/or rotation of the neck can damage the vertebrobasilar artery, particularly within the foramen transversarium at C1-C2 level. It has also been theorized that since patients with vertebrobasilar artery dissection commonly present with headaches and neck pain, before a chiropractic adjustment, it is possible that subsequent VBA stroke occurs spontaneously, implying that the association between chiropractic care and VBA stroke is not causal. Since patients also seek medical care with their family physician for headache and neck pain, the researchers looked at the association between VBA stroke following chiropractic and following primary care physician visits.

    The results of this 2008 study challenge previously held beliefs on the connection between chiropractic care and VBA. The authors concluded:
    There was no increased association between chiropractic visits and VBA stroke in those older then 45 years. Positive associations were found between PCP [primary care physician] visit and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA strokes.

    Conclusion. VBA stroke is a rare event in the population. The increased risks of VBA stroke associated with chiropractic care and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic compared to primary care.� (Emphasis Added)

    If you interest in a copy of this study, please email our office (kcruse@adlergiersch.com).

    1. Cassdy, DJ, et al., Risk of Vertebrobasilar Stroke and Chiropractic Care: Result of a Population-Based Case-Control and Case-Crossover Study. Spine. 33:45: S176-S183 (2008)

    2. Cassdy, DJ, et al., Risk of Vertebrobasilar Stroke and Chiropractic Care: Result of a Population-Based Case-Control and Case-Crossover Study. Spine. 33:45: S176-S183 (2008)

  23. mrmikeon 19 Jun 2008 at 1:50 am

    As someone concerned about the science of health care, you should know that taking an anecdote and making a generalization about is not very scientific.

    Spine recently published an important study on the correlation between vertebrobasilar stroke and chiropractic, and found:

    “VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”

    http://www.ncbi.nlm.nih.gov/pubmed/18204390?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    One could look at a number of medical treatments and question the validity of them, as well. For instance, chiropractic has been found to be more effective than muscle relaxants for back pain, but I don’t see the outrage about the use of muscle relaxants — even though they may have more adverse reactions than chiropractic.

  24. Steven Novellaon 19 Jun 2008 at 10:04 am

    I am not extrapolating from an anecdote. I linked to a longer discussion of strokes and chiropractic – because the focus of this blog entry was the lawsuit, not a review of chiropractic or the literature on stroke.

    For those cherry-pickers out there here is a recent systematic review of published literature on chiropractic manipulation and VBA dissection: http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

    Read it. It reviews multiple studies showing an association between cervical manipulation and VBA stroke – even when you control for neck pain. Also, in many reported cases the stroke occurs within 30 minutes of the manipulation.

    I acknowledge that overall VBA stroke is a rare occurrence. I also acknowledge that some people may go to a chiropractor for the neck pain they have from an existing VBA dissection. But this does not appear to be all cases, and also even in cases where this is true – the worst thing you can do to someone who has a VBA dissection is manipulate their neck. Further, a proper medical exam may reveal that the neck pain is due to VBA dissection and then proper treatment may prevent a stroke.

    The bottom line is this – without adequate evidence for the efficacy of neck manipulation the risk of rare severe outcomes (including stroke and death) is unacceptable.

  25. nwtk2007on 19 Jun 2008 at 11:31 am

    No matter what the evidence is for chiropractic manipulation, the anti-chiro group will always discount it and call it bogus or anecdotal at best.

    And rare is an understatement. Compared to harm from medical mistakes, this type of event is extremely fractional at best.

    But when anti-chiro’s look at this topic, they will site any one example and use that as argument that all of chiropractic should be shut down. Using the same degree of accusation, so to speak, then medical science should be shut down on a daily basis, at least based upon their own admission of harm done to the public everyday.

  26. nwtk2007on 19 Jun 2008 at 1:22 pm

    In terms of the type of manipulation given and the stroke risk, from what I have read, it is the manipulation which involves upper cervical segments combined with full rotation, I assume to 80 or 90 degrees.

    One commenter on another forum used the term “maximal extension” in his description of cervical manipulation. As a chiro, I would say that most chiro’s now avoid the manipulations which involve extreme rotation when combined with any extension in performance of cervical manipulation. In school, this was occasionally a topic of concern and it was recommended that we avoid such extremes in manipulation.

    Even so, the rarity of the event here in question remains even with some chiro’s apparently using the rotational techniques.

    As far as the studies show, it looks to me like they could go both ways in terms of stating risk or not. The Canadian study is the most recent, I believe, and seems to have been able to side step the bias issue that occurs when the medical profession views stroke and chiropractic treatment.

    For instance, in one of the studies sited by your post, it was pointed out that stroke sufferers had been more likely to have visited a chiro in the weeks and months prior to having the stroke. Now seen in conjunction with the Canadian study published in Spine, one could also conclude that they were having S/S associated with pre-emminent stroke and that is why they might have go to the chiro in the first place.

    I would point out also, that many anti-chiro groups, such as the one sited in a previous post here, claim that chiro has no effect what so ever. Based upon that reasoning, then chiropractic manipulation should not be able to harm as well. It is a contradiction of their position to say no effect and then to place blame for harm to a patient.

    I know there is more to that than I have articulated but that is one way of looking at it.

    In terms of this case, there needs to be a thorough investigation into what type of manipulation was being used, how often this patient was being seen and for what, etc. She had apparently been going for a great many years and it would be interesting to see how many manipulations and how frequent they have been administered as well as the techniques used.

  27. Karion 24 Jun 2008 at 11:51 pm

    1. Cassdy, DJ, et al., Risk of Vertebrobasilar Stroke and Chiropractic Care: Result of a Population-Based Case-Control and Case-Crossover Study. Spine. 33:45: S176-S183 (2008)

    2. Cassdy, DJ, et al., Risk of Vertebrobasilar Stroke and Chiropractic Care: Result of a Population-Based Case-Control and Case-Crossover Study. Spine. 33:45: S176-S183 (2008)

    These references should be to issue 33:4S. They are from a supplement. In most medical journals, the supplements are not peer reviewed. What about in this journal? Not likely.

    So to cite a non-peer reviewed article as any type of proof is a stretch.

  28. Blue Wodeon 25 Jun 2008 at 4:58 am

    It’s also interesting to read what Sharon Mathiason (a mother whose daughter died following chiropractic neck manipulation for a tailbone injury) has to say about David Cassidy DC, the lead author of the two studies in Spine cited above by Karion:

    Quote:
    “This new “study” itself is a review of billing records. No patient charts or tests were examined. There was no new scientific data. The authors took 819 strokes and then used billing records to see who had seen a doctor in the past year and who had seen a chiropractor.

    Considering that billing payments were very limited for chiropractors in Ontario and now thank God have been completely eliminated, this is a very poor record of the actual number of visits to a chiropractor. Did the scientists not realize this simple statistical fact?

    Of course, the strokes caused by the chiropractors happened in their offices while none happened in the office of the doctors. Where did they tell us that? According to the logic of this study, if my daughter Laurie or anyone else saw your medical doctor in January and then had a stroke in December after having a neck manipulation, it did not count against the chiropractor. Almost everyone has seen their doctor within a year. You would get the same result if she had stopped at McDonald’s to buy a hamburger and then went to the chiropractor.

    The Globe and Mail [the publication in which the study was recently featured] is also negligent in not identifying the principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as “all of the study’s authors conclusions are completely invalidated by their methods”.

    David Cassidy, before he was dismissed from the University of Saskatchewan,was called as an “expert” witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest.

    In the Globe and Mail article co-author David Cassidy is quoted “Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office”.

    Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome. Did he say it never happened because this poor woman also saw her doctor in the past year? I doubt if he has ever seen a patient coming out of a doctor’s office having a stroke after a neck manipulation.”

    More…
    http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

    (Scroll down the link a little to locate the letter)

  29. Joeon 25 Jun 2008 at 7:09 am

    Kari,

    I agree, however, even if the articles had some form of peer-review, one must bear in mind that the peers were undoubtedly quacks, too.

    In the body of the post, Steve referred to naturopathy and chiropractic as professions. They are not so, in the traditional sense- they are properly termed cults. I recognize that the modern meaning of “profession” means an identifiable group, and that chiros are unified by opposition to criticism.

  30. nwtk2007on 29 Jun 2008 at 9:59 pm

    Kari, you couldn’t be further from the truth. Chiropractic is no more a cult than the anti-chiro movement, in fact less so.

    Most of us treat regular musculoskeletal problems and injuries. The antichiro movement likes to single out the far out forms of chiropractic and broad brush us all as practicing that way but it is wrong.

    The people satisfied with their chiropractic treatment for what ever condition do not consider chiro’s quacks, they see us as relief where none was before.

    And chiropractic doesn’t kill 500 or so everyday by making mistakes. Look at what the Department of Health and Human Services says about risks associated with medical health care and then you will see why so many go to chiropractors.

    http://www.ahrq.gov/qual/errback.htm

  31. deciuson 30 Jun 2008 at 2:59 am

    “the anti-chiro movement”

    Fantastic

  32. Blue Wodeon 30 Jun 2008 at 5:51 am

    nwtk2007 said: “Most of us treat regular musculoskeletal problems and injuries. The antichiro movement likes to single out the far out forms of chiropractic and broad brush us all as practicing that way but it is wrong.”

    Are you sure about that? Research carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA feel that spinal manipulation should not be limited to musculoskeletal conditions – a figure which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon…
    http://www.chirobase.org/02Research/laidler.html
    …which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge.

    Now, bearing in mind that it is wholly evident that those beliefs and practices are rife on a global scale, it is very interesting to note the following section (146; p.55) of Sandra Nette’s Statement of Claim:

    Quote:

    “Incredibly, and, acting in bad faith, the College [Alberta College and Association of Chiropractors] attacked the new and surprisingly high number of vascular accidents associated with chiropractic services that were published medical literature and reported in the media by demanding a level of evidence it has never demanded of itself. It maintained that the causal link between strokes and chiropractic adjustment remained unproven.”

    http://www.casewatch.org/mal/nette/claim.pdf

    In other words, many chiropractors – and their regulators – seem to find it acceptable to rely on anecdotal or weak evidence where it supports chiropractic treatment, but where similar, or more robust evidence suggests that serious complications (e.g. stroke) can result from chiropractic treatment, they are quick to dismiss it.

    No prizes for guessing why.

  33. nwtk2007on 30 Jun 2008 at 2:55 pm

    Blue Wode – “Research carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA feel that spinal manipulation should not be limited to musculoskeletal conditions”

    I am not sure that I would believe so many chiropractors would apply the term “spinal” manipulation to extremities. If you refer to chiropractic manipulative treatment, then you are probably right, but it doesn’t translate into all chiropractors treating anything other than musculoskeletal conditons.

    As far as the study done by the high school students goes, although I would trust the high schoolers more so than any research group, it should be noted that the office staff took the calls and answered the questions. But I see your point.

    I don’t know what these studies have to do with chiropractic and stroke but I am listening.

    And as far as chirobase is concerned, I am inclined to apply the ad hominem to them and conclude that if it comes from there then it is not to be trusted or believed, but that is just my opinion.

    I am also not necessarily in agreement with the description of stroke research as being more robust. I doubt if chiropractic dismisses this research any faster than the medical community dismisses any research supporting chiropractic care simply because it is research done by chiro’s.

  34. Blue Wodeon 30 Jun 2008 at 6:49 pm

    nwtk2007 said: “I am not sure that I would believe so many chiropractors would apply the term “spinal” manipulation to extremities. If you refer to chiropractic manipulative treatment, then you are probably right, but it doesn’t translate into all chiropractors treating anything other than musculoskeletal conditons.”

    Hello nwtk2007

    You seem to have misunderstood the results of the 2003 study by McDonald et al. It indicates that many chiropractors are treating conditions other than musculoskeletal ones – in other words, they seem to be using spinal manipulation as a panacea.

    Perhaps it would be better for you to look at the research which the World Federation of Chiropractic (WFC) gathered during its 2004-2005 consultation on ‘The Identity of the Chiropractic Profession’. It gives valuable insight into the chiropractic profession’s perceptions of itself on an international scale. For example, not only did the consultation result in the participating chiropractors’ unanimous agreement that the most appropriate public identity for the profession within health care was “The spinal health care experts in the health care system” – a definition which clearly allows pseudoscientific chiropractic practices to continue to flourish – it also produced a document entitled “Abstracts of Previous Relevant Research” which cited the 2003 McDonald et al study, and specifically mentioned the following in section E, #6:

    Quote:
    “Approximately 9 in 10 [USA chiropractors] confirmed that the profession should retain the term “vertebral subluxation complex” (88.1%) and that the adjustment should not be limited to musculoskeletal conditions (89.8%). Subluxation is rated as a significant contributing factor in 62.1% of visceral ailments.”

    http://tinyurl.com/55kl36

    In addition to that, the results of the consultation produced a chart called “Perceptions of How the General Public Perceives the Chiropractic Profession”. It illustrates the percentage of chiropractors who said that the following phrases described the profession “perfectly” (7 on a scale of 1 to 7) or almost perfectly (6):

    Quote:
    “Management of vertebral subluxation an its impact on general health”
    - 65% of chiropractors said that the general public should perceive chiropractic that way

    “Management of vertebral subluxation”
    - 57% of chiropractors said that the public should perceive chiropractic that way

    http://tinyurl.com/sxzl2
    [Scroll down to "Survey Results - the survey report by the WFC's consultants, Manifest Communications Inc." Click on the link next to it, and then 29 clicks will take you to the chart.]

    In view of those quotes, perhaps you should review your claim that “The antichiro movement likes to single out the far out forms of chiropractic and broad brush us all as practicing that way but it is wrong”.

    nwtk2007 said: “I don’t know what these studies have to do with chiropractic and stroke but I am listening.”

    I cited the studies to counter your claim that the “antichiro movement likes to single out the far out forms of chiropractic”. However, it’s interesting to note that the studies also support the main claim made in Sandra Nette’s lawsuit, i.e. that many chiropractors are administering “inappropriate and non-beneficial chiropractic adjustments” – including neck manipulations which expose patients to life-threatening complications.

    As Dr Novella commented, it will, indeed, be very telling how the government and chiropractors respond to the lawsuit.

  35. nwtk2007on 01 Jul 2008 at 5:40 pm

    I don’t see how “wanting to be spinal experts” implies using spinal manipulation as a treatment panacea or that it “clearly allows pseudoscientific chiropractic practices to continue to flourish”.

    I will agree that many chiropractors relate perceived subluxations to certain medical conditions which you would not agree are related, but even those chiropractors do not “treat” those conditions specifically.

    But that is neither here nor there as it is unrelated to the question of whether spinal manipulation causes stroke or not, no matter why the manipulation is performed. Spinal manipulation is an effective treatment for spinal injuries to say the least and there is ample evidence to support it as being better than or equally as effective as many prescribed medicaltions and with fewer side effects. The research has been sited at times on these types of forums but is simply sneered at as being done by chiropractors and thus not as “robust” as you would say.

    I also see your point in siting these studies to single out the far out forms of chiropractic, but I really don’t see that they do.

    Now as I understand it, Ms Nette had been going to this chiropractor for many years and had apparently been satisfied with the results up until now. What was it that she specifically went to the DC for in this instance and had the DC “treated” the condition before with good results? Also, I was wondering if Ms Nette has had any previous bad experiences with the medical profession in the past that caused her to want to go to a DC for several years?

    Generally speaking, a person won’t return to a docor, any doctor, if no positive results are forth coming. I know I would not and have changed peditricians several times due to their inability to properly diagnose and treat consistently. They do little in the way of examination and have no rhyme nor reason as to when they prescribe certain drugs and when they don’t.

    Again, I see your point wiht the studies although I disagree with your conclusion. My concern is that the risk of stroke associated with manipulation is being blow out of proportion. I know some will see my position as being insensitive but to be perfectly honest, when I mention the fact that medical mistakes kill 500 or so everyday and it seems to go straight over the heads of those very same individuals, then who are they to say that I might be insensitive.

  36. nwtk2007on 01 Jul 2008 at 5:44 pm

    One additional note, most chiropractors who treat “subluxations” also treat with nutritional and herbal remedies as much or more as with manipulation. They focus on prevention and maintinance of health in a practical way, and not just through manipulation.

  37. Blue Wodeon 01 Jul 2008 at 8:53 pm

    nwtk2007 said: “I don’t see how “wanting to be spinal experts” implies using spinal manipulation as a treatment panacea or that it “clearly allows pseudoscientific chiropractic practices to continue to flourish”.”

    Then perhaps the following explanation given by the well-respected veteran chiropractor, Samuel Homola, will help to give you a better understanding:

    Quote:
    “On June 15, 2005, the World Federation of Chiropractic, at its 8th Biennial Congress, unanimously agreed that chiropractors should be identified as “…spinal health care experts in the health care system…with emphasis on the relationship between the spine and the nervous system…” This definition fails to place proper limitations on chiropractors who use spinal adjustments to treat general health problems, plunging the profession deeper into pseudo-science and away from establishing an identity for chiropractors as back-pain specialists.

    -snip-

    Definition by consensus, with such vague goals and catch phrases as “cultural authority,” may do little to define and limit chiropractic in a scientifically acceptable way. Failure of the chiropractic profession to conduct the research required to fill the societal need for a specialty treating mechanical-type neck and back pain and related problems may keep chiropractors on the fringes of health care without identity or a secure future.”

    http://jmmtonline.com/documents/HomolaV14N2E.pdf

    nwtk2007 said: “I will agree that many chiropractors relate perceived subluxations to certain medical conditions which you would not agree are related, but even those chiropractors do not “treat” those conditions specifically.”

    So what are their patients paying them to treat?

    nwtk2007 said: “But that is neither here nor there as it is unrelated to the question of whether spinal manipulation causes stroke or not, no matter why the manipulation is performed.”

    Why the manipulation is performed certainly does matter otherwise the risk/benefit ratio for the procedure cannot be assessed. And with regard to the question of “whether” spinal manipulation causes stroke or not, there does appear to be evidence of a causal relationship:

    Quote:
    “Brain stem infarction due to chiropractic manipulation of the cervical spine”

    http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=6359460

    Quote:
    “Cervical manipulation, specifically chiropractic manipulation, is an important cause of vertebrobasilar and occasionally carotid distribution strokes. Neuro-ophthalmologic findings are a common and at times relatively isolated feature of cervical manipulation-induced stroke.”

    http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=11130746

    Quote:
    “Wallenberg’s syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation”

    http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=14606051

    And in the Case Reports section (Table 1) of the study in the link below, 11 cases are listed where a chiropractor was the therapist involved in administering cervical spine manipulation in which the causality of the adverse event is listed as ‘certain’. In two of these cases (Corazzo 1998 and Siegel 2001), the adverse event was vertebral artery dissection and stroke:

    “Cerebrovascular Complications Associated with Spinal Manipulation”
    http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002
    [Full text is subscription only]

    nwtk2007 said: “Spinal manipulation is an effective treatment for spinal injuries to say the least and there is ample evidence to support it as being better than or equally as effective as many prescribed medicaltions and with fewer side effects.”

    Bearing in mind the fact that the frequency of adverse events caused by spinal manipulation is currently not known, would evidence-based chiropractic treatment really be the safest option? It’s interesting to note that in their 2008 book, ‘Trick or Treatment? Alternative Medicine on Trial’, British scientists Simon Singh and Professor Edzard Ernst reviewed all the scientific data on chiropractic and concluded that all chiropractors should be compelled by law to disclose the following to their patients prior to treatment:

    Quote:
    “WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”

    nwtk2007: “The research has been sited at times on these types of forums but is simply sneered at as being done by chiropractors and thus not as “robust” as you would say.”

    Then perhaps you might like to comment on some research conducted by a British chiropractic professor. She and her co-author advise using chiropractic as a placebo treatment for infantile colic (i.e. a self-limiting, non-life threatening condition) in the absence of chiropractic paediatric safety data. See here:
    http://www.skeptics.org.uk/forum/showpost.php?p=25936&postcount=189

    Indeed, you might like to comment on the integrity of the British chiropractic profession. It was recently questioned by Professor Edzard Ernst in the journal, Focus on Alternative and Complementary Therapies, in an article entitled ‘The safety of chiropractic cervical manipulation’. It looked at a British study which was recently published in Spine called ‘Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey’. See here for the criticism:
    http://www.skeptics.org.uk/forum/showpost.php?p=32759&postcount=204

    And you might also like to comment on the integrity of one particular US chiropractic researcher, David Cassidy, DC, the lead author of a recent study published in Spine entitled ‘Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study’. Criticism of both David Cassidy and the study can be found here:
    http://www.skeptics.org.uk/forum/showpost.php?p=33005&postcount=206

    nwtk2007 said: “as I understand it, Ms Nette had been going to this chiropractor for many years and had apparently been satisfied with the results up until now. What was it that she specifically went to the DC for in this instance and had the DC “treated” the condition before with good results? Also, I was wondering if Ms Nette has had any previous bad experiences with the medical profession in the past that caused her to want to go to a DC for several years?”

    Tragically, Ms Nette had simply trusted what her chiropractor had told her:

    Quote:
    “She was a healthy 40 year old woman who wanted to stay healthy. She did all the right things like watching her weight, eating right, and not smoking. She followed the advice of a chiropractor to include regular maintenance chiropractic adjustments in her health regimen. On September 13, 2007 she had the last adjustment she would ever have. There was nothing wrong with her. She didn’t see the chiropractor for headaches, neck pain, back pain or any other complaint. She went for a “tune-up” that she thought would help keep her healthy. The chiropractor did a rapid-thrust adjustment on her neck. Right afterwards, she complained of feeling “sore, dizzy and unwell.” She tried to leave but had to sit down. The chiropractor failed to recognize the medical emergency, and instead of calling an ambulance he recommended that she would benefit from purchasing massage therapy from his clinic. He let her leave the office and drive home alone. She only made it part way.”

    http://www.sciencebasedmedicine.org/?p=152

    nwtk2007 said: “Again, I see your point wiht the studies although I disagree with your conclusion. My concern is that the risk of stroke associated with manipulation is being blow out of proportion. I know some will see my position as being insensitive but to be perfectly honest, when I mention the fact that medical mistakes kill 500 or so everyday and it seems to go straight over the heads of those very same individuals, then who are they to say that I might be insensitive.”

    But aren’t most medical procedures – some of which can be very invasive – normally undertaken only when the benefits outweigh the potential risks? And don’t many of them help to save lives? (Likewise for prescription drugs such as antibiotics, insulin, etc.)

    nwtk2007 said: “One additional note, most chiropractors who treat “subluxations” also treat with nutritional and herbal remedies as much or more as with manipulation. They focus on prevention and maintinance of health in a practical way, and not just through manipulation.”

    But don’t the vast majority of medical doctors focus on prevention and maintenance of health as well?

  38. nwtk2007on 01 Jul 2008 at 11:10 pm

    This is really too much to respond to in any good fashion, however, just a few points.

    First, I can’t open most of the papers you sited but the first one I could open was the Cassidy study which sates that the risk of going to your chiro and your PCP is the same because you go for the S/S associated with the already ongoing stroke. Then you site an article critical of the author, Dr Cassidy. You use it if you need it but if it doesn’t help our case, you go after the author and don’t delete your reference. OK.

    You also say that medical procedures are invasive and only undertaken when the risk out weighs the benefits. This is true but the data I have sited is related to mistakes and NOT risk related to the procedure. Another article stated that more than 15,00 prescriptions are filled incorrectly everyday. You can add that to the number and cause of 500 deaths and injuries per DAY.

    See also, http://www.youtube.com/watch?v=bfhUN4FIa1U, Medical Errors part 1 and you will see that there is a difference.

    You also say that the vast majority of medical doctors focus on prevention and maintenance. Nothing could be further from the truth and thus the biggest reason people go to chiro’s for conditions not seemingly related to the spine. People are looking for answers and as once was said, if they can’t get a drink, they will eat the sand. They are not getting the help they need from medicine and are going to chiropractors and most are finding relief they never got with the medical profession. Yes they are anecdotal stories, but they are adding up.

    Medicine has saved a lot of lives, but they have also tried to monopolize health care and have forgotten the needs of their patients with their “God” complex. They have forgotten how much we don’t know and cannot figure out. And they have utterly failed to educate the public on every single aspect of health care. Ridding the world of chiropractic will only spawn a difference branch of alternative treatment because of their failure in this regard. (Yes, off topic but true and somewhat realated.)

  39. Blue Wodeon 02 Jul 2008 at 5:07 am

    Hello again nwtk2007, and thank you for your reply.

    You said: “First, I can’t open most of the papers you sited but the first one I could open was the Cassidy study which sates that the risk of going to your chiro and your PCP is the same because you go for the S/S associated with the already ongoing stroke.”

    In that case, surely the last thing a chiropractor should be doing is manipulating a patient’s neck?

    For the benefit of drive-by readers, here’s the relevant part of the criticism of the Cassidy et al study which was recently published in Spine:

    Quote:
    “This new ‘study’ itself is a review of billing records. No patient charts or tests were examined. There was no new scientific data. The authors took 819 strokes and then used billing records to see who had seen a doctor in the past year and who had seen a chiropractor. Considering that billing payments were very limited for chiropractors in Ontario and now thank God have been completely eliminated, this is a very poor record of the actual number of visits to a chiropractor.

    Did the scientists not realize this simple statistical fact?

    Of course, the strokes caused by the chiropractors happened in their offices while none happened in the office of the doctors.

    Where did they tell us that?

    According to the logic of this study, if my daughter Laurie or anyone else saw your medical doctor in January and then had a stroke in December after having a neck manipulation, it did not count against the chiropractor. Almost everyone has seen their doctor within a year. You would get the same result if she had stopped at McDonald’s to buy a hamburger and then went to the chiropractor.

    The Globe and Mail [a newspaper in which the study was recently featured] is also negligent in not identifying the principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as “all of the study’s authors conclusions are completely invalidated by their methods”.

    David Cassidy, before he was dismissed from the University of Saskatchewan, was called as an “expert” witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest.

    In the Globe and Mail article co-author David Cassidy is quoted “Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office”.

    Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome.

    Did he say it never happened because this poor woman also saw her doctor in the past year? I doubt if he has ever seen a patient coming out of a doctor’s office having a stroke after a neck manipulation.”

    More…
    http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

    nwtk2007 said: “You also say that medical procedures are invasive and only undertaken when the risk out weighs the benefits. This is true but the data I have sited is related to mistakes and NOT risk related to the procedure. Another article stated that more than 15,00 prescriptions are filled incorrectly everyday. You can add that to the number and cause of 500 deaths and injuries per DAY.”

    Yes, it’s true that the medical profession makes mistakes, but that doesn’t justify chiropractors not telling patients that they are being subjected to inappropriate and non-beneficial chiropractic adjustments which have the potential to cause devastating injuries.

    Why aren’t chiropractors adopting a more cautious attitude towards the use neck manipulation and dropping it from their routine until its safety profile is better understood? After all, it is perfectly obvious that, at present, the risks attached to the procedure overwhelmingly outweigh any benefits that might be derived from it.

    nwtk2007 said: “You also say that the vast majority of medical doctors focus on prevention and maintenance. Nothing could be further from the truth and thus the biggest reason people go to chiro’s for conditions not seemingly related to the spine. People are looking for answers and as once was said, if they can’t get a drink, they will eat the sand. They are not getting the help they need from medicine and are going to chiropractors and most are finding relief they never got with the medical profession. Yes they are anecdotal stories, but they are adding up.”

    Let’s not forget that the scientific evidence for chiropractic shows that it (spinal manipulation, actually) can only deliver short-lived relief in some cases of acute low back pain – and even then it is no better than conventional treatments, most of which are cheaper, more convenient, and safer. Therefore, doesn’t it follow that people who go to chiropractors “for conditions not seemingly related to the spine” will be subjected to (in many cases probably unwittingly) the potentially life-threatening risks associated with inappropriate and non-beneficial chiropractic adjustments?

    How can that be ethical?

    nwtk2007 said: “Medicine has saved a lot of lives, but they have also tried to monopolize health care and have forgotten the needs of their patients with their “God” complex. They have forgotten how much we don’t know and cannot figure out. And they have utterly failed to educate the public on every single aspect of health care.”

    Do you have any sound evidence to support that claim?

    nwtk2007 said: “Ridding the world of chiropractic will only spawn a difference branch of alternative treatment because of their failure in this regard. (Yes, off topic but true and somewhat realated.)”

    Well let’s hope that any new branch of alternative treatment won’t involve the inappropriate and non-beneficial manipulation of patients’ necks.

  40. nwtk2007on 02 Jul 2008 at 9:13 am

    Blue Wode, I am still pressed for time but while reviewing your post and it’s links, I came across this response to the article you sited:

    I am a chiropractor practicing in Canada. Dr. Cassidy, who holds both a PhD and a Dr of Medical Science degree and is an epidemiologist at the University of Toronto, was not the author of the official report of the Quebec Task Force on Whiplash Associated Disorders. He was the Editorial Coordinator of this very esteemed Task Force, which was chaired by Dr. Walter O. Spitzer, MD, FRCPC, Professor of Medicine, McGill University and included 3 Physiatrists (Medical Specialists), 3 Epidemiologists, a Neurologist, a Neurosurgeon, an Orthopaedic Surgeon. a Psychiatrist, a DrMedSciPhysiotherapist/Ergonomist, a PhD Physioptherapist/Epidemiologist, and Engineer and a Biostatistician. One of the members of the Task Force was Dr. Ake Nygren, MD, PhD, DDS, Professor and Director of the famed Karolinska Institute of Stockholm Sweden. The report to which this discussion is referring is the Bone & Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. This was a study sponsored in part by the World Health Organization. It consisted of a 13-person Scientific Secretariat. and a 17-member Advisory Committee. Included were 18 Research Associates and Graduate students. Committee members represented 19 clinical and scientific disciplines or specialties from 9 countries. There were 8 collaborating universities or research institutes from 4 countries. Dr. Cassidy was a member of the Scientific Secretariat and the Executive Committee. A review of the scientific literature indicates that Dr. Cassidy has authored more than 100 scientific papers and several chapters in textbooks. He is highly respected for his work in Saskatchewan and throughout the research community.

    Without out going into much detail, where did this information about Dr Cassidy and that study come from anyway? For instance, from your previous post,

    “Of course, the strokes caused by the chiropractors happened in their offices while none happened in the office of the doctors.”

    Where does this “information” come from?

    And once again, I am continually amazed at how anti-chiropractic people “gloss” over the risks of medical science. From your post above:

    “Yes, it’s true that the medical profession makes mistakes, but that doesn’t justify chiropractors not telling patients that they are being subjected to inappropriate and non-beneficial chiropractic adjustments which have the potential to cause devastating injuries.”

    Yes they make mistakes, to the tune of 500 or so injuries and deaths every DAY as opposed to what appears to be a very small, not necessarily insignificant, risk of one type of spinal manipulation, which is supported by research but research which is not considered valid by anti-chiro folk because it is chiropractic research.

    The lack of perspective here is astounding. If you want to get up on a soap box and save the world from something, why not try to eliminate medical mistakes. And again, not just related to invasive procedures or clinically difficult cases, but MISTAKES.

    And it is constantly stated by anti-chiro folk that there is no research when, on fact, there is a great deal. On another forum a Dr posted dozens of references to research supporting chiropractic manipulation for a wide range of conditions, but as was typical, it was ad homenimly dismissed as being chiropractic in nature and thus not even considered.

    You said it yourself,

    “doesn’t it follow that people who go to chiropractors “for conditions not seemingly related to the spine” will be subjected to (in many cases probably unwittingly) the potentially life-threatening risks associated with inappropriate and non-beneficial chiropractic adjustments?”

    How can you say non-beneficial? Chiropractic research supports a good deal of what chiropractors do, but siting the research for the anti-chiro public is a waste of time to say the least.

    Oh yes, you also said that medicine never tried to monopolize health care. Wasn’t there a law suit brought by the chiropractic associations against the AMA in the 70′s which showed otherwise? Wasn’t it won by the chiropractors because the court said that very thing, that medical doctors were trying to monopolize health care?

  41. Blue Wodeon 02 Jul 2008 at 2:31 pm

    nwtk2007 said: “Without out going into much detail, where did this information about Dr Cassidy and that study come from anyway?

    You can locate it by scrolling down this link:
    http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

    nwtk2007 said: “And once again, I am continually amazed at how anti-chiropractic people “gloss” over the risks of medical science…..Yes they make mistakes, to the tune of 500 or so injuries and deaths every DAY as opposed to what appears to be a very small, not necessarily insignificant, risk of one type of spinal manipulation, which is supported by research but research which is not considered valid by anti-chiro folk because it is chiropractic research.

    If you read through Sandra Nette’s Statement of Claim here
    http://www.casewatch.org/mal/nette/claim.pdf
    you’ll see that her legal team will be challenging the claims of the chiropractic community that the type of spinal manipulation to which you are referring is supported by good evidence.

    It’ll be very interesting to see what transpires. In the meantime, Dr Novella’s comments, lifted from further up this page, will have to suffice:

    Quote:
    “I am not extrapolating from an anecdote. I linked to a longer discussion of strokes and chiropractic – because the focus of this blog entry was the lawsuit, not a review of chiropractic or the literature on stroke.

    For those cherry-pickers out there here is a recent systematic review of published literature on chiropractic manipulation and VBA dissection: http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

    Read it. It reviews multiple studies showing an association between cervical manipulation and VBA stroke – even when you control for neck pain. Also, in many reported cases the stroke occurs within 30 minutes of the manipulation.

    I acknowledge that overall VBA stroke is a rare occurrence. I also acknowledge that some people may go to a chiropractor for the neck pain they have from an existing VBA dissection. But this does not appear to be all cases, and also even in cases where this is true – the worst thing you can do to someone who has a VBA dissection is manipulate their neck. Further, a proper medical exam may reveal that the neck pain is due to VBA dissection and then proper treatment may prevent a stroke.

    The bottom line is this – without adequate evidence for the efficacy of neck manipulation the risk of rare severe outcomes (including stroke and death) is unacceptable.”

    nwtk2007 said: “The lack of perspective here is astounding. If you want to get up on a soap box and save the world from something, why not try to eliminate medical mistakes. And again, not just related to invasive procedures or clinically difficult cases, but MISTAKES.”

    Are strokes caused by chiropractic treatment ‘mistakes’, or are they the result of the deliberate exploitation of patients through the administration of inappropriate and non-beneficial adjustments primarily for chiropractors’ economic gain? Because let’s not forget that current scientific research has shown that ‘chiropractic’ (or spinal manipulation to be more precise) can only provide short-lived pain relief in some instances of acute low back pain.

    nwtk2007 said: “And it is constantly stated by anti-chiro folk that there is no research when, on fact, there is a great deal. On another forum a Dr posted dozens of references to research supporting chiropractic manipulation for a wide range of conditions, but as was typical, it was ad homenimly dismissed as being chiropractic in nature and thus not even considered.”

    Can you provide a link to those studies? Do they include systematic reviews from non-trade (chiro) journals?

    nwtk2007 said: “Chiropractic research supports a good deal of what chiropractors do, but siting the research for the anti-chiro public is a waste of time to say the least.”

    It would seem that citing such research is only viewed as “a waste of time” if the “anti-chiro public” doesn’t agree with it. Don’t you ever objectively try to analyse why they don’t agree with it?

    nwtk2007 said: “Oh yes, you also said that medicine never tried to monopolize health care. Wasn’t there a law suit brought by the chiropractic associations against the AMA in the 70’s which showed otherwise? Wasn’t it won by the chiropractors because the court said that very thing, that medical doctors were trying to monopolize health care?”

    Yes, there was a lawsuit and this was its conclusion:

    Quote:
    “In 1987, federal court judge Susan Getzendanner concluded that during the 1960s “there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious.” The judge also noted that chiropractors still took too many x-rays. However, she ruled that the AMA had engaged in an illegal boycott. She concluded that the dominant reason for the AMA’s antichiropractic campaign was the belief that chiropractic was not in the best interest of patients. But she ruled that this did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public. Although chiropractors trumpet the antitrust ruling as an endorsement of their effectiveness, the case was decided on narrow legal grounds (restraint of trade) and was not an evaluation of chiropractic methods.”

    http://www.chirobase.org/08Legal/AT/at00.html

    Doesn’t that suggest that the AMA was trying to protect the public?

  42. nwtk2007on 02 Jul 2008 at 6:08 pm

    Blue Wode – “there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious”

    How do you get more deleterious than killing 500 or so each and every day of the year? No one has even attempted to answer this question nor even acknowledged the problem other than saying doctors make mistakes. You would think that some one trying to “protect the public?” as you quoted, would be a bit more concerned with this than chiropractic and it’s rare and questionable effect discussed here.

    On the question of where the information about Dr Cassidy and the Spine study came from, your link just takes me to what I have been referring to, statements by a Ms Mathiasan. For example, she states – “Of course, the strokes caused by the chiropractors happened in their offices
    while none happened in the office of the doctors.”

    Where does she get this information? Her information about Dr Cassidy is obviously not correct although she might have a biased view of him and his involvment.

    Did you see the information I posted above about him? There is much more to this study than the anti-chiro group is relating to anyone reading.

    You also keep referring to manipulation and chiropractic treatment as being un-beneficial. Go to Topix and look at the chiropractic related threads and look at the posts by DrE. He posted a great deal and really only scratched the surface. And to be honest, I have only reviewed a bit of chiropractic research, but I found it to be statistically sound, a bit simplistic, but relevant and results based in it’s conclusions. My question would be have you? Take some of this research and analyse it and let’s see if it is, indeed, any good. We invited all anti-chiro’s at that site to do just that and had no takers.

    In terms of stroke and it’s being directly caused by manipulation, I don’t think there is anyway to investigate this experimentally. Links are established statistically and strong links would be more than preesented thus far and would be in more agreement than 1 in some thousand to 1 in some millions to none at all.

    You also ask – “It would seem that citing such research (supporting chiropractic” is only viewed as “a waste of time” if the “anti-chiro public” doesn’t agree with it. Don’t you ever objectively try to analyse why they don’t agree with it?

    They never give any reason for disagreeing with it, they just say it is chiropractic and thus it is invalid. Like I said, we have invited anyone to review some of the research provided and explain why they think it is invalid but have had no takers.

    Getting interupted a lot so I am skipping around quite a bit.

    One final thing here, why did Ms Nette go to a chiropractor so often. A friend said he read where she went for conditions that she was getting chronically and were not being helped by he PCP. He said he read where in this case she specifically when on this occasion for an ear ache. How often had she gone to him for these types of conditions and if she had, was she helped previously? I had asked this earlier with no response. If she was receiving no benefit, why would she keep going and for such a long time?

  43. HHCon 04 Aug 2008 at 11:03 am

    The cerebral vascular accident occurred while the chiropractor’s client was driving on roads in Edmonton, Alberta, Canada. There is an extended time delay between the neck manipulation and the actual time of CVA. The act of driving a car should be reviewed for the stresses it places on the human body. The car and driver are subject to seasonal hazards as well as directional changes in velocity. For example, sudden directional changes can frequently result in concussions. We do not know the status of the physical health of the female client. Was she sufficently fit to be driving on Edmonton roads on the day in question? Driving well requires a fit person to engage in a minimum of aerobic exercise and weight training. Had she undertaken any fitness regimen other than chiropractic adjustments?

    The socialized medicine available in Canada makes the amount of damages that the chiropractic client is suing for seem exceedingly excessive. The chiropractor would have to be guilty of using extraordinary force for the female client to obtain such a large settlement. Logic would dictate that the client was subject to the standard application of force for neck manipulation by the chiropractor in question. Chiropractors are trained to deliver standard applications of force to the cervical spine but they are not trained to engage in an act of battery.

  44. [...] Professor David Coluqhoun: Doctor Who? Deception by Chiropractors Chiropractors Resort to Legal Intimidation. Samuel Homola, a retired chiropractor comments that the majority of chiropractors believe that “spinal adjustment should not be limited to treatment of musculoskeletal problems” although “there appears to be little evidence to support the value of spinal manipulation for nonmusculoskeletal conditions”: Chiropractic: A Profession Seeking Identity. Bruce Thyer and Gary Whittenberger investigated the willingness of chiropractors’ representatives to agree to consider treating hypertension and arthritis: A Skeptical Consumer’s Look at Chiropractic Claims: Flimflam in Florida? jdc offers A Beginner’s Guide to Chiropractic. We would also add Dr Mark Crislip’s analysis of a paper on chiropractic and stroke; Dr Harriet Hall on the sad case of Sandra Nette who is now living in locked-in syndrome following chiropractic treatment that went badly awry and Dr Steve Novella’s account of Sandra Nette and chiropractic. [...]

  45. HHCon 24 Aug 2008 at 3:58 pm

    Locked-in syndrome is also known as deefferentation. The reticular formation is not damaged in these patients. The patient can be alert and conscious. Neuropsycholgy patients have been able to use a Morse code with blinking and vertical eye movements.
    This syndrome according to Brazis, Masdeu & Biller (1985) could be due to any of the following: infarction, tumor, hemorrhage or trauma. The barristers representing Ms. Nette would have to attempt to produce documentation that no other medical factors
    or neck impact injuries during driving resulted in their client’s syndrome.

  46. HHCon 02 Sep 2008 at 8:31 pm

    Mrs. Nette is currently receiving rehabilitation at the Glenrose Rehabilitation Hospital. She is using a speech synthesizing touchpad to make her comments about chiropractors. The law firm of Fraser, Milner, Casgrain LLP (FMC) filed a class action lawsuit against Gregory Stiles and The Spa at Life Stiles, Alberta College and Association of Chiropractors, and the Alberta Ministry of Health on June 12, 2008. P.Daryl Wilson, lead barrister at the law firm intends to succeed at finding class action clients so his firm can be the first to prosecute chiropractors in Canada. In order to achieve this first in Canadian history , the firm posted an article entitled ” Don’t agree to neck manipulation” from the February 2004, University of California Newsletter. One should be duly impressed with the science in this article. In fact, the article states at the outset that an individual can create a stroke on his/her own at simply turning one’s head. The law firm is recruiting any person, or estate, if the person is deceased who paid for chiropractic adjustment in Alberta in the last decade or any person who suffered injury from an adjustment of the spine other than those diagnosed with acute or sub-acute uncomplicated low back pain. The firm wants more than $5 million for its clients. Perhaps, Shell Oil of Canada will
    find Alberta’s earth rich in oil by the time this lawsuit is settled,
    so Canadians can shoulder the burden claimed by the law firm
    against its defendants.

  47. HHCon 07 Sep 2008 at 4:43 pm

    Does the correlation of chiropractic services to stroke mean the causation of stroke by chiropractic practitioners? FMC’s lead lawyer would have the public believe that correlation is causation. FMC public statements are that all chiropractic services are fraudulent and valueless. This is contrary to the Health and Wellness Ministry’s expert panel report in 2002, which recommended Alberta continue to fund adult services for muscle and joint problems of the spine and pelvis. Alberta’s government minister rejected in 2003 recommendations limiting funding of chiropractic care to only adults with these existing problems. However, FMC intends to work the fears of the Canadian public about healthcare, not only in Alberta, but most likely in the provinces Saskatchewan and Ontario. These provinces had coroner inquests in 1998 and 2002 involving two female deaths. The cause of deaths appeared to be neck manipulation. The fact sheet on FMC’s class action lawsuit frankly blames chiropractors for not recognizing stroke and reporting it. Also, FMC states that the time delay between adjustment and onset of stroke makes for a tenuous connection. FMC’s fact sheet concludes that victims fail to associate minor to severe symptoms to chiropractic treatment.
    Apparently, FMC believes it can lead the witness to court with such statements. Ms. Nette will willingly be FMC’s representative plaintiff in the Alberta class action suit. Unfortunately, she has to recover from her stroke. She was employed as a land administrator in the oil and gas industry.

  48. Joeon 07 Sep 2008 at 5:38 pm

    HHC wrote “Chiropractors are trained to deliver standard applications of force to the cervical spine but they are not trained to engage in an act of battery.”

    Considering that there is no acceptable reason to deliver chiropractic force to the cervical spine, any such application can be construed as battery.

    If you dispute this, show us reliable evidence; not argument and sputtering.

  49. Joeon 07 Sep 2008 at 6:06 pm

    HHC asked “Does the correlation of chiropractic services to stroke mean the causation of stroke by chiropractic practitioners?”

    There is more than correlation. There is knowledge of anatomy that explains the relationship.

    Once again, if you dispute this, show us reliable evidence; not argument and sputtering.

  50. nwtk2007on 07 Sep 2008 at 8:41 pm

    Show us your evidence Joe. The “evidence” presented thus far on this and other forums doesn’t even begin to pass your own EBM analysis.

    The evidence thus far is next to nothing.

    Summarize it now for us Joe. Bring it all into one big post.

    Invite all from the EBM website to go over it all again.

    By their own standards it is not evidence at all.

    If I were the defense attorney in this case, I would call the EBM folk to testify about the “evidence”. If they were capable of not lying and able to ignore their own biases, they would admit that there is no true evidence at all.

  51. Cause and Effecton 30 Sep 2008 at 9:47 pm

    I find it amusing that the people speaking out against Chiropractic are the same people who are members of the #1 cause of DEATH in America, our medical profession.

    When all mistakes and errors are combined with the number of DEATHS caused by PROPER medical proceedures, our own health care system is the #1 cause of DEATH in our country.

    At some point the sheer volume of DEATHS must enter the conversation. There is much talk on this blog about risk/reward without any indications of overall numbers. People DIE due to over the counter medications as well as prescription medications and no one responds; there are no blogs; no media coverage, no doctors talking about it.

    When the science of medicine is funded by the same companies that that perform the research, it is only human nature to want to see that product succeed an make it to the market. One only needs to look at the number of deaths due to medications such as Gardisil or (insert latest drug withdrawn from the market here) or the number of oxycotin addicts there are to know that medication is not as scientific as the medical community would boast about. People DIE because our medical system does things. There is little to no long term research about medications on the market, yet they are there and people DIE from them.

    There is also much talk of pseudoscience and quakery on this site. May we remember that medicine is founded in folk potions and the great Mr. Rockefeller’s desire for the American dollar. That culture still persists today. I believe the quote is “A pill for every ill.” Don’t get me wrong, I am thankful for medicine and its science but it not for Chiropractic, my nephew would have died at the hands of the 0% chance of life given him by his MDs while he laid in a coma.

    Even if this lawsuit passes and even if others come forward, the number of people hurt by Chiropractors over the course of the past century will still not equal the the number of people who have DIED THIS YEAR due to medical interventions.

    As doctors we must remember that the title doctor does not give us any priveledge. It does not make us better than anyone else. In fact the title Doctor gives us the responsibility to educate, not mislead or rile up, but educate. The folks at Quackwatch have already lost a lawsuit to the Chiropractic profession because of Chiropractic’s SAFETY RECORD.

    What you say, may or may not be true, but the statistics still state that Chiropractic is safer than medicine. Insurance companies aren’t stupid…it is their business to asses risk/reward. Higher risk, higer premium, lower risk, lower premium. It’s really a simple system.

    Doctor is a title given to those who have completed a satisfactory course of education. It has nothing to do with medicine or healthcare. It is not a title distinct to the medical profession. PhD’s are doctors, dentists are doctors, soon PTs will be called doctor. Because of their course of study, not some elite club that one is admitted to. Personally teh Chiropractors I am aquainted with know that the DC at the end of their name means more than the Dr. before it.

    As for the belief of an Innate Intelligence that we Chirorpactors hold true(or Life Force as other natural healers would say); I have yet to see a single surgery or medication, or medical intervention that has changed a patient’s status of DEATH. Healing only occurs in the living. Just because one can not feel, does not make one healthy. The average cancer patient or diabetes patient lives an asymptomatic life for seven years or so before the symptoms or diagnosis. Are they healthy for it?

    Any woman who has had a “Maternal moment” or any man who has “trusted their instinct” knows well of the inner intelligence or innate that Chiropractors speak of. I have yet to find one person who has not “listened to or trusted their gut.” If we are going to base our evidence on math, percentages and statistics, then we as humans should not even exist, those numbers are staggering. Yet we do. And we recreate that life time and time again…in nine months no less. Astonishing that the math would say we shouldn’t be here, yet in nine months another one of us is brought forth from nothing. With all of the amazing advances in medicine and there have been many, the one thing that can not be done is create LIFE. There is something else….What would you prefer to call it?

    I have a patient whose family member went in for a check up because she didn’t “feel right.” All her tests came back “normal.” Her MD told her it was all in her head and that she was fit and healthy. She went to another doctor and the same results, another and the same. One day she tripped and fell and broke her hip. Her husband brought her into the ER and X-rays were taken, tests were done. Aside from the broken hip, she was healthy and eventually released from care. A week later she died. Upon autopsy, it was found she had a malignant cancer throughout her body. Even with all of the advances of medicine and tests available, it was not picked up and she DIED.

    How about you stop patting your medical egos on the back at this blog. There are too many benefits that have been witnessed by Chiropractor and patient alike. As a Chiropractor, I and my colleagues do not claim to treat any dieases. That is the field of medicine. We release the innate intelligence of the body so the body may HEAL ITSELF…they still teach that in medical school, yes? That the body heals itself. It is a law of the universe to do so. That is the realm of the Chiropractor.

    I’ll leave you with a question that a mentor of mine asked me once…
    How does the body seperate the power that heals a cut on the finger from the power that heals cancer?

  52. carpdcon 13 Oct 2008 at 5:36 pm

    I had a Yale neurologist spend and afternoon at my office in West Haven watching me do adjustments. He had a look of horror on his face, at first. He was quite surprised to hear the patients tell of their improvement afterwards. He then became a patient himself. I have had the privelage of treating many well known medical physicians affiliated with Yale over the course of my career. Most find your style of bias amusing, to say the least. Empirical, evidence-based science is the best we have now, however, it has many gaping holes. The good neurologists pontificating is one example of the deity complex that has gotten medicine to be so mistrusted by the average consumer today. We are continuing to fund good studies in chiroipractic and I would welcome you to my practice with open arms so that we can come together and do what serves patients best. Just this morning I had the privilege to see a gentleman with an acute herniated disc who came from 2 hospital emergency room visits where they told him he had a “pinched nerve” and gave him pain medicine. He came in at 9/10 on pain rating and left 1 hour later at a 4/10. There are competent chiropractors and incompetent chiropractors just as there are both in medicine. The stroke situation is a road to nowhere if you try to make a correlation. It simply does not exist. I had a neurologist in my office a few weeks ago who told me his clinician at Yale has seen many strokes at the hands of chiropractors but when I showed him the Spine article he agreed that the evidence was purely anecdotal. A good clinician evaluates the risk before he renders the adjustment and the proper technique does not rotate the neck as many of you imagine. The thrust is in the lateral line of drive. Patients get well without drugs and surgery all the time. Let’s leave medicine to what it can competently treat which is acute trauma and life threatening situations. Medicine must do better though. It is vastly inadequate in answering the rise of degenerative diseases and woefully inadequate in the maintenance of health. This is where chiropractic is FAR superior to allopathy. I challenge you to put your energy to where it can serve the greatest need. Put it towards improving the education of medical doctors and in the openness to learn from non-medical physicians so that all patients will benefit.

  53. Steven Novellaon 13 Oct 2008 at 5:51 pm

    carpdc – that is a classic jumble of chiropractic propaganda. Anecdoates and arguments from authority are of no use in scientific medicine.

    You accuse me of pontificating, when all I do is advocate for scientific standards – yet you claim boldly that scientific medicine is only useful for trauma and life-threatening situations. Utter nonsense- what is your evidence for this? What about diabetes, seizures, hypertension, asthma, neuropathy – or just about everything I treat as a neurologist. You are completely insincere when you offer to come together in one sentence, but then dismiss my entire field of specialty with another.

    You also boldly claim that chiropractic is superior to “allopathic” (a derogatory and completely inaccurate term betraying your bias) medicine – again based upon nothing.

    Show me the evidence that chiropractic is good for anything, other than acute uncomplicated lower back strain – let alone superior to mainstream medical methods. I can be convinced by good evidence – just show it to me.

    The link between chiropractic and stroke is legitimate, denying it is not good medicine in the interest of patients. And a good clinician evaluates risks AND benefits. There are no proven benefits to neck manipulation, so any risk is unacceptable.

  54. Cause and Effecton 14 Oct 2008 at 5:33 pm

    Advancing “Scientific medicine” has only succeeded in advancing health complications….

    SN Wrote: “What about diabetes, seizures, hypertension, asthma, neuropathy – or just about everything I treat as a neurologist.” And… “I can be convinced by good evidence – just show it to me.”

    Yet, many posts could be quoted to the “Anecdotal” nature of us Chiropractors. In MY OPINION, if you were a true scientist, you would commend these anecdotes and suggest further research, rather than write them off as here-say and folly. All good scientists produce their proof or lack-there-of from a single thought. Such was the case in the early 1900′s with the advent of medication to relieve ailments. It began as a thought, was promoted by those in business and has remained as such since.

    For example, If you were to witness for yourself a patient with any of these conditions change at the hands of a Chiropractor….For instance, let’s say a child who is instantly relieved of his or her seizure…A common anecdote of a Chiropractor…would you agree that research is warranted? Or would you write it off as coincidence? What if it happened time and time again as it does on a regular basis in Chiropractic offices? Would it be a series of co-incidences and anecdotes or would you then agree that research to the benefits of ADJUSTMENTS (not manipulations) are warranted?

    Secondly, it is the treatment that is of concern to the Chiropractor, as we do not “treat.” For example, Hypertension…a typical medical scientific approach is to administer a medication to lower blood pressure….at least that is what my patients and friendly MDs tell me…but why? To lower the “number?” Why not then lower the BP when a person is exercising? The body has driven it up to accommodate the need of increased blood flow (due to exercise); but it is now “not normal” according to medical standards; it is above “normal.” Hypertension is the same…the body reacting to an increase in “exercise;” a situation that requires increased blood flow.

    I myself was a medical “failure.” As a teen, I was diagnosed with “Asthma” and was told there is no cure, but it can be controlled and treated with medication. That was a risk/benefit decision that I choose to take, although against my judgment. After multiple years of medication, I found a Chiropractor who adjusted my neck subluxations and my asthma went away; I threw away my medications and haven’t looked back since. The only change I made was to be adjusted. Even today, in our Chiropractic office, people with “asthma” find they no longer need their medications, breathe easier and enjoy life to the fullest potential they dream of. Doesn’t that warrant further investigation? Not only investigation and research to the help provided the dis-ease, but as to what happened to the body due to the adjustment. That is investigative science.

    When people DIE due to medication, liver damage is due to medication, kidney failure is due to medication…When proper medical protocols are followed and people DIE…when the wrong organ is removed, or the wrong knee is operated on…when does the risk/benefit need to be re-evaluated? The ratios are minimal, yes, but so to are the ratios of Chiropractic and stroke.

    As the AMA regularly reports the causes of DEATH and recently reported in 2000 that medical mistakes were the number 4 cause of death in America, it wouldn’t be hard for a patient or other health profession to turn the same tables on medicine that medicine is attempting to place on Chiropractic. This is the evidence necessary to state that allopathy is best at trauma and life-threatening illness and Chiropractic at health.

    Why do you choose to scrutinize Chiropractic when there are far greater mistakes made by your co-professionals? Why has Chiropractic become your pet project? Do not medical procedures cause stroke? Why don’t we turn on hair dressers? Why don’t we turn on yoga instructors? Or taking a nightly walk in our neighborhood…all of which show the same occurrence of stroke as Chiropractic.

    Thinning the blood with aspirin can cause someone to “bleed out.” It also has the noted side effect of causing stomach ulcers…why don’t we attack Tylenol instead? Because it has the benefit of reducing pain? That’s a tough risk/benefit call. I’m sure the makers and shareholders of Tylenol would love to hear you “pontificate” about the side effects and listed deaths due to it. …Yet you accuse Chiropractors being at it for their own economic gain…is there anyone in America who is more “out for their own economic gain” than a publicly held company? That is in fact the rule in capitalism…for publicly held companies…make money.

    If it was your child or wife or mother and all medical interventions failed, would you let them die, or could you swallow your pride and see a Chiropractor? Would you allow yourself to see the miracle of LIFE occur before your eyes, or would you cling to your “medical science” and lose hope? I pray for you that never occurs, because it has in my family and thank GOD for Chiropractic. If you ever do, I hope you change your stance and that your heart is not so hardened because you have more faith in your pills and knife than you do in the power that made the body.

  55. nwtk2007on 15 Oct 2008 at 8:00 am

    Cause and effect – “when does the risk/benefit need to be re-evaluated? The ratios are minimal, yes, but so to are the ratios of Chiropractic and stroke.”

    The ratios in chiro are much, much better than in medicine when chiro is appropriate.

    The bloggers here only admit to benefit for uncomplicated low back pain but evidence has been posted supporting chiro for neck pain and HA, but they refuse to even read it or consider it, thus they feel there is never a good reason to do cervical manipulation based upon their assessment of the “risk to benefit” ratio.

    It appears that in many instances anecdotal stories are OK if in support of the anti-chiro position but not in support of chiro.

    You will be told that your success with chiro was placebo effect and that errors in medicine that kill, not to mention side effects of meds, are not relevant to chiropractic.

    They will say they really do try to stop medical errors and side effects but that they are saving lives and that makes it alright.

    As a practicing chiro, I can easily see how the errors happen when I have to try to deal with the lunacy of some of my patients PCP’s. I had a patient just yesterday tell me her PCP told her that the black spots she sees when she rises from bed or a chair are due to her high blood pressure, as well as her HA’s. She was given Bp meds and hydrocodone with tylenol. Her Bp the day before was 128/85 the first day I saw her and yesterday, with the meds, was 95/50. High Bp? Causing HA and black spots? All I could do was call her PCP and have them schedule her for a f/u.

    Another, a few days ago, came in injured and in her history she reported she was on disability for a “crooked” spine. Since she was injured I shot an X-ray which revealed one of the best looking skeletons, perfectly straight, I had ever seen. Great disc spaces, perfect alignment, the works. Off course, only an MD can provide clinical evidence to support disability.

    I could write a book on the lunacy I have seen in the medical profession just looking at patients history.

    But it’s all just anecdotal.

  56. Joeon 15 Oct 2008 at 10:01 am

    nwtk2007 on 15 Oct 2008 at 8:00 am “I could write a book on the lunacy I have seen in the medical profession just looking at patients history.”

    See: “How chiropractors think and practice” William P. McDonald et al “Seminars in Integrative Medicine” 2004 V.2 #3 92-98. This is a large survey of and by chiros. It shows that 9 in 10 believe in subluxations, 4 in 5 think they are involved in visceral illness, 2 in 10 think they explain all of illness (so-called straight chiros). My local paper carries an ad for a chiro offering a discounted exam for new customers, including an unnecessary x-ray, for new customers.

    Yet, on other blogs, you insist you cannot find any quacks in your trade?! I seriously doubt your ability to detect lunacy.

  57. nwtk2007on 15 Oct 2008 at 1:40 pm

    There you go twisting what I have said Joe. I never ever said I can’t find quacks in chiro. I said I don’t know any and don’t work with any.

    A bit defensive aren’t we?

    As to your surveys of chiro’s I really don’t care. I guess a survey of MD’s would show that they don’t worry about their own profession killing hundreds everyday because they “really, really, reeeeely are trying to stop the needless slaughter”.

    You can quote me BoZo but don’t mis-quote me.

    And why is it that so many anti-chiro’s employ that strategy of twisting what a chiro has said and mis-representing their statements?

  58. Joeon 15 Oct 2008 at 2:27 pm

    nwtk2007 on 15 Oct 2008 at 1:40 pm wrote “There you go twisting what I have said Joe. I never ever said I can’t find quacks in chiro. I said I don’t know any and don’t work with any.”

    You must not know many chiros, hard to believe. So, where can we find quacks in chiro? I hear crickets.

    nwtk2007 on 15 Oct 2008 at 1:40 pm wrote “As to your surveys of chiro’s I really don’t care.”

    No, it was your survey of chiros, I made that point. You can look it up, I gave a full citation.

    nwtk2007 on 15 Oct 2008 at 1:40 pm wrote “I guess a survey of MD’s would show that they don’t worry about their own profession killing …”

    The reason that you know about medical mistakes is because they study, and try to reduce, those mistakes. How thick are you? Where can I read chiros enumerating the errors in your business?

    nwtk2007 on 15 Oct 2008 at 1:40 pm wrote “{snip} And why is it that so many anti-chiro’s employ that strategy of twisting what a chiro has said and mis-representing their statements?”

    I don’t think I do, I mostly ask for your evidence that you do anything better than a masseur. So far, nobody has risen to that challenge. I also ask for someone in your business to show what is wrong with articles at http://www.chirobase.org and none of your ilk who have promised to do so has done so.

  59. nwtk2007on 15 Oct 2008 at 2:40 pm

    Same old anti-chiro rant.

    You said – “The reason that you know about medical mistakes is because they study, and try to reduce, those mistakes. ”

    Yes I am sure that is utterly true. Injured patients never complain about their injuiries from them and families who have lost loved ones never say anything. And if one dies in your hospital due to some error or mistake, it is a little bit hard to get rid of the body such that no-one ever knows.

    Who are you trying to fool?

  60. TheTruthon 15 Oct 2008 at 2:49 pm

    As we all know, CAM research is still in its infancy…..and unlike the medical profession, we do not receive millions and millions of dollars from the pharmaceutical industry to perform research.

    “Show me the evidence that chiropractic is good for anything, other than acute uncomplicated lower back strain – let alone superior to mainstream medical methods. I can be convinced by good evidence – just show it to me.” – Steven Novella

    Here’s some evidence to show the benefit of a cervical adjustment:

    http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure

  61. Joeon 15 Oct 2008 at 3:19 pm

    nwtk2007 on 15 Oct 2008 at 2:40 pm wrote ” “Huh?” ”

    Is there anyone here who can translate Nonsense into English?

    I still don’t see the evidence (in legit, medical journals) that chiros are more effective than masseuses. And I don’t see any refutations of articles at chirobase.

    nwtk2007 on 15 Oct 2008 at 2:40 pm wrote “Who are you trying to fool?”

    You are trying to fool unsuspecting customers.

    nwtk2007 on 15 Oct 2008 at 1:40 pm wrote “There you go twisting what I have said Joe. I never ever said I can’t find quacks in chiro. I said I don’t know any and don’t work with any.”

    So, reveal the quacks in your business. You don’t know any; but you know they exist? That is a revelation. I have cited the evidence that they abound. Do you have a special way of avoiding them? That would be useful to know.

  62. nwtk2007on 15 Oct 2008 at 4:28 pm

    As usual, more of the same.

    I’ve told you my policy on chiro evidence as relates to you Joe. You have proven you won’t read it so why site it, although I have and as I thought and predicted, you did not read it and would not read it, but were very able to comment on it. Typical.

    As relates to the “quacks” in my profession, you ask, “Do you have a special way of avoiding them?”

    Once again, for your misunderstanding, duh! I don’t refer to chiropractors unless a patient moves and needs continued care, and the ones I trust are not like the ones you call “Quacks”. However, I am in constant contact with a very large and ever growing number of MD’s as I have new patients everyday and many, not all, have PCP’s or family doctors or have seen a doctor at an emergency room and I request records.

    I not only get to hear what the patients say about them but I also get to see their records. Some are very good and others are way, way out there.

    Like I said, I can give example after example of incompetent MD’s and their “exploits” as well as many examples of very competent MD’s. I doubt very seriously that you could claim the same based upon experience.

    —nwtk2007 on 15 Oct 2008 at 2:40 pm wrote “Who are you trying to fool?”

    Joe – “You are trying to fool unsuspecting customers. “—-

    A totally out of context response which means absolutely nothing and is nothing more than an intended insult. Another typical strategy employed by the anti-chiro fanatics.

    As to your idiotic “masseuses” comment, I can’t, in all honesty, even begin to qualify it with a response.

    —Joe – “nwtk2007 on 15 Oct 2008 at 2:40 pm wrote ” “Huh?” ” —

    You continue to astound me with your genius and insite.

  63. [...] several chiropractors have been posting comments on this blog, under the blog entry about a law suit over a stroke allegedly due to a chiropractic neck manipulation. A detailed-enough [...]

  64. Joeon 16 Oct 2008 at 3:53 pm

    nwtk2007 on 15 Oct 2008 at 4:28 pm “…I’ve told you my policy … you won’t read it … ”

    You seem seriously aggrieved that I don’t read and comment on quack literature. I did not mean to hurt your feelings. Just cite some support in reliable, medical literature.

  65. howeon 16 Oct 2008 at 5:29 pm

    Cause and Effect, I have a great anecdote about asthma.

    When I was either three or four years old, I was diagnosed with severe asthma and told I was not likely to improve. After about 15 years of being on every treatment that the numerous specialist I had been to could come up with I still had asthma and it showed no signs of improving and was barely being “controlled” (as in I was having attacks multiple times a day but was only having to be hospitalized from them about three or four times a year). Around this same time I decided that If my lungs were going to crap out on me I would give them a some help and started smoking cigarettes heavily. Within about a month I was having almost no asthma attacks, and this was the only thing that changed in my life. To this day I almost never have an attack (a little over a year since my last one).

    Does this this mean that smoking would make a good treatment for asthma?? Of course not, but this is the danger of an anecdote, just because A occurs then B, does not mean that A caused B. As best anyone can tell “I just grew out of it” and I happened to start smoking around the same time, much to my later regret. This isn’t even a treatment that would be worth looking into, much less replicating.

    I’m not saying all anecdotes are bad or worthless, but by themselves do not constitute science.

    P.S. — No one should think smoking is in anyway a treatment for any disease or condition. It is bad for your health!! (I would feel bad if I inadvertently caused someone to so much as consider taking up smoking)

  66. nwtk2007on 16 Oct 2008 at 5:39 pm

    Upset? Hardly.

    I am amused by your typicality.

    Why should you read that which you can already comment on.

    EBM/SBM at it’s finest.

  67. mindmeon 17 Oct 2008 at 4:02 pm

    nwtk2007: I’ve told you my policy on chiro evidence as relates to you Joe. You have proven you won’t read it so why site it, although I have and as I thought and predicted, you did not read it and would not read it, but were very able to comment on it. Typical.

    I’d be happy to read what you *cite*. Sorry not to be a spelling nazi but I’d hope a man trained in science would know the difference between site and cite and not (repeatedly) make such a sophomoric error.

    Anyway, I’m curious what chiro can treat that sports massage (or medical doctors) can’t? And what is the peer reviewed scientific research for it? Like, what conditions should I go to your for and what double blind trials establish I’m making the right choice?

  68. nwtk2007on 17 Oct 2008 at 4:58 pm

    mindme, are you sure you have totally removed all spelling errors from your post?

    Didn’t you know there is an inverse relationship between spelling ability and intelligence?

    As to the “peer reviewed research” you asked for and the “double blind trials” that establish what I as a chiro treat, well you can go find it for your self. You might try the ODG used in Texas W/C system and then go to the “reputable” chiro journals of your choice which you can select from the past 50 years of chiropractic research. After that there are the Canadian studies, which again, I will not bother to dig up for you. As an added point, any evidence or studies which suffice as evidence for PT treatment will do since chiro’s essentially do the same things, we just provide more in terms of manipulation and mobilization. Or the same evidence that supports a DO’s use of manipulation, which as I am told, is the same thing as chiropractic manipulation in Europian arena’s.

    Been there and done that. Waste of time with the EBM crowd.

    And since you asked, when are you or anyone else here going to tally up all the “evidence” for manipulation and stroke, all in one place, for all to reference and all to examine and discuss? Let’s see if it passes the EBM/SBM standard for evidence.

    How about you show me your involvement in double blind experimentation.

    As to what I treat that sports massage cannot, try C,T L – spinal sprain/strain injuries, muscle spasms, segmental dysfunction, HNP, rotator cuff tears, shoulder sp/st, knee sp/st, meniscal tears of the knee, post operative rehab, etc, etc, etc. Of course an MD can also treat these conditions, but a “sports massage -whatever-” certainly cannot. If you can’t diagnose it, you can’t treat it. Maybe by referral, but only as a licensed provider.

    Massage can provide some paliative releif, but for the most part, has no therapeutic effect.

    And please don’t kid yourdelf into thinking you have managed to insult me with your, as you would say, “sophomoric” attempt to do so. I am very comfortable with who I am and spelling is definitely not my strong point. It could be my dyslexia, my eyes, my typing skills, my age, or what ever you could come up with. Either way, that kind of thing bores me.

  69. Joeon 17 Oct 2008 at 7:23 pm

    nwtk2007 on 17 Oct 2008 at 4:58 pm wrote “I have 100 years of science-fiction behind me; trust me.”

  70. mindmeon 17 Oct 2008 at 8:14 pm

    nwtk2007: mindme, are you sure you have totally removed all spelling errors from your post?

    It’s not spelling errors or typos. I’m talking about a “scientist” using basic science terminology incorrectly and repeatedly. That you can’t get a basic term in science and academics correct (a term any 2nd year university student should be familiar with) implies to me maybe you’re not overly familiar with basic science.

    nwtk2007: As to the “peer reviewed research” you asked for and the “double blind trials” that establish what I as a chiro treat, well you can go find it for your self.

    You begged off supplying it to Joe claiming he wouldn’t read it, I believe. I’m asking you honestly to supply the research so I might read it in good faith. It’s not my job to research your claims for you.

    Dr. N in this blog frequently *cites* the primary research and will, if asked, happily supply such if he missed it. He seems to assume a person who asks for the research is of the intelligence to read it.

  71. nwtk2007on 17 Oct 2008 at 9:02 pm

    mindme – “I’m talking about a “scientist” using basic science terminology incorrectly and repeatedly. That you can’t get a basic term in science and academics correct (a term any 2nd year university student should be familiar with) implies to me maybe you’re not overly familiar with basic science.”

    Please, try to make a point here. If you’re going to challenge me on my use of scientific terminology, saying I use it incorrectly and repeatedly, then I think we should bring out the resumes. I have enough science behind me to use the terminology as freely as I want and a mis-spelled word don’t cut it as evidence of that. I’m willing. Are you?

    mindme – “a term any 2nd year university student should be familiar with”

    Which, if any, university are you so familiar with that you can make that claim? Name it and we’ll talk to the profs and see just exactly the 2nd year science students know. You will be surprised.

    mindme – “It’s not my job to research your claims for you.”

    Go back and look at what has been posted. I am time constrained. I am not the only one who has posted something either. And there are plenty of sites and searches that can yield chiro research, both pro and con. No matter the now sincere sound of your “voice”, I have been that road and won’t go there again except to again document the refusal of anti-chiro’s to address the research.

    And keep in mind that the issue here is cervical manipulation. What chiro’s do these days, for the most part, at least those of us who treat injuries, is provide the same treatments and therapies provided by PT’s on a day to day basis. Thus, any research supporting their work with neck and back injuries as well as extremity injuries would also support what chiro’s do for the very same patients.

    Maybe I should also outline for you what PT’s do in CARF certified facilities on a day to day basis and that would educate you as to what is really going on in the PT world as opposed to the chiro world. You might get perspective.

    I mean really, the basic EBM/SBM flaw is perspective; along with a bit (a big bit) of bias.

  72. nwtk2007on 17 Oct 2008 at 9:04 pm

    Joe – “nwtk2007 on 17 Oct 2008 at 4:58 pm wrote “I have 100 years of science-fiction behind me; trust me.”

    Gosh Joe, you just don’t have a clue do you?

    Sorry.

  73. mindmeon 17 Oct 2008 at 11:59 pm

    nwtk2007: Please, try to make a point here. If you’re going to challenge me on my use of scientific terminology, saying I use it incorrectly and repeatedly, then I think we should bring out the resumes. I have enough science behind me to use the terminology as freely as I want and a mis-spelled word don’t cut it as evidence of that. I’m willing. Are you?

    Again, I’m not talking about misspelling a word. I’m talking about a very basic term you’ve misused time and time again. I’ll let that speak for itself. That you’re unfamiliar with “cite” leads me to believe you’re unfamiliar with the actual activity. It’s like a sports reporter using “bawl” instead of “ball”. One might question a sports reporter’s knowledge of the game if he keeps making a fundamental error in terminology.

    nwtk2007: Go back and look at what has been posted. I am time constrained. I am not the only one who has posted something either.

    Special pleading. I would think any good scientist in any field would have some cardinal lit references at his finger tips and could cite them by heart or with very very little effort. You can’t, despite all your years of practice? You came specifically to a blog about science based medicine to debate and yet you did not come armed with hard data? If I walked into a debate with creationists, I would surely come armed with several excellent peer reviewed scientific references that back my case. Weird you do not or cannot. Odder still, you won’t cite lit because Joe won’t read it. Now you won’t cite lit because you’re too busy. Geez.

    nwtk2007: And keep in mind that the issue here is cervical manipulation. What chiro’s do these days, for the most part, at least those of us who treat injuries, is provide the same treatments and therapies provided by PT’s on a day to day basis. Thus, any research supporting their work with neck and back injuries as well as extremity injuries would also support what chiro’s do for the very same patients.

    My question was what do chiros bring to the table that’s different and what is the peer reviewed evidence for it? I’m some what aware chiros have branched out into massage and nutrition, which probably says a lot about the unscientific foundations of your field in the first place (the whole innate energy stuff). If your services are no different than a Physical Therapist, why not simply call yourself that? Why should a health consumer go to you over a physical therapist or a massage therapist? Do you believe you can diagnose illnesses based on examining the spine? If you do, what is the scientific evidence for it? What is the inter–rater reliability of the diagnostic technique? It seems to me in medical science a diagnostic technique that gives a different and inconsistent diagnosis is viewed as wholly useless and soon discarded by medical science. Further, there is considerable and welcome research by doctors into the reliability of any diagnostic technique. What kind of research do chiro docs do in this regard? What are the published, peer reviewed findings?

    nwtk2007: Which, if any, university are you so familiar with that you can make that claim? Name it and we’ll talk to the profs and see just exactly the 2nd year science students know. You will be surprised.

    You’re going to need to read a bit closer. I said “should know” not “does know”. A good sophomore should know this. One should know this at the beginning of your university career, and not have to have it pointed out to you decades after your advanced education. No?

  74. nwtk2007on 18 Oct 2008 at 12:47 am

    You’re going to have to try harder.

    I get bored repeating myself.

    And tit for tat is a sleep inducement.

    And by the way, for you “knowledgeable” ones, a spinal exam is only a small part of the examination performed by doctors, including chiro’s.

    Spinal exam is NOT the basis of diagnosis.

    Please try to be aware of what chiro’s do.

    And a good “sophomore” where? Do know what the hey you are talking about?

    Oh I see, it is about insulting and not about discussing.

    Typical once again.

    And I have never heard a sports reporter “say” “bawl” or “ball”.

    AND, I don’t “cite” reference for common knowledge topics. Also, my “citations” are readily available for those who wish to review “all” of them as are the “citations” of others who have posted here.

    Too boring. Bye.

  75. mindmeon 18 Oct 2008 at 8:26 am

    Ah nwtk2007 your evasions are clear to all. If not you, then I fear the state of modern chiro. I’ve asked some very basic questions about your profession and you’ve come up 100% snake eyes on scientific data and merely spent considerable time waving your hand at what the data should support and then arguing why you won’t offer scientific data. That’s simply pathetic. What were you thinking when you came to a blog about science and medicine? A white coat and arrogance maybe takes you far with patients but it won’t take you very far here. Sorry. You appear to exhibit all the traits you think are wrong with the medical system.

    nwtk2007: And I have never heard a sports reporter “say” “bawl” or “ball”.

    Did the analogy escape you?

    At least I schooled you on cite vs site. Now you know, eh?

    nwtk2007: Spinal exam is NOT the basis of diagnosis.

    Chiros don’t examine the spin for structural derangement and then believe these derangements are a part of disease?

  76. nwtk2007on 18 Oct 2008 at 10:02 am

    Mindme, you didn’t school me on anything but pointing out a mispelled word. You now have commited the ultimate blunder of the self-righteous “you can’t spell so how could you know anything” crowd, by spelling spine “spin”. Can we get beyond the continued “sophomoric”, as you put it?

    There is also no evasion here either. I and others have presented evidence which was dismissed without a read or because it was in a chiropractic journal. Ad hominem at it’s finest. So I have pointed out to you that the evidence for PT’s doing cervical manipulation should suffice for now, because it is the same as is osteopathic manipulation.

    Also, chiro’s have a responsibility to perform examinations to the same degree as any other provider and bill for it accordingly using the very same CPT codes as all other providers. The examination must meet the criteria of that CPT code and must be documented. For example, an expanded problem focused exam must include three components: history, examination and medical decision making. In this particular example the history and examination must at least deal with the area of the complaint and the associated systems and the medical decision making must be at least straightforward. If these criteria are not met and documented and the chiro bills for it then he/she has commited a fraud.

    Your statement shows what you lack in knowledge of chiropractic responsibility in today’s health care system.

    I have no doubt that chiro’s in the past did something like you have described, but that is a thing of the past except for the old crones and loonies that you apparently think all chiro’s still are. You couldn’t be further from the truth. I would suggest that if insurance companies don’t want to pay for chiro services or any other medical services that they actually look to see if the proper service has actually been performed and documented, but that is another topic.

    In that light however, I would point out Mr Crislip’s description of codes from an article he wrote for the SBM blog (where he is a contributing editor) and submit to you for your take on it’s ethical sense –

    “And, at least in the US, coding is an art to maximize reimbursement, not a method of determining what the patient really had. ”

    Does this sound any worse than your description of a chirpractic examination? Does it sound the least bit fraudulent? I think it does. I know it is not related and you will no doubt point out the tu quoque quality of it, but as I have said before, it provides perspective.

  77. mindmeon 18 Oct 2008 at 10:49 am

    nwtk2007: Mindme, you didn’t school me on anything but pointing out a mispelled word. You now have commited the ultimate blunder of the self-righteous “you can’t spell so how could you know anything” crowd, by spelling spine “spin”. Can we get beyond the continued “sophomoric”, as you put it?

    As I’ve noted, I’m not talking about typos. For example, I have no issues with your spelling of chiropractic as “chirpractic “. It’s clearly a typo. If you kept spelling your own profession incorrectly, I’d question what your actual profession is. As I note, if a sports reporter kept writing “bawl” for “ball” I would question his expertise. If someone claiming to be a Rear Admiral spelled naval academy “navel academy” and kept spelling it that way, you might wonder if he was a navy man. If I kept using “spin” for “spine” (as you kept blindly using “site” for “cite”) then one might wonder about my education in basic human anatomy. How could I keep missing such an obvious typo? For example, spelling Ottawa as Ottowa is common among Americans but it’s not an error many Canadians would make. We’d catch that typo right away. However, I have to return to the point when a man educated in science seems really, really unfamiliar with a key term, well, that speaks for itself.

    nwtk2007: There is also no evasion here either. I and others have presented evidence which was dismissed without a read or because it was in a chiropractic journal. Ad hominem at it’s finest. So I have pointed out to you that the evidence for PT’s doing cervical manipulation should suffice for now, because it is the same as is osteopathic manipulation.

    Beyond claiming there is evidence, you’ve presented none. I’m not sure why you don’t grasp that basic point. Further, beyond techniques of physical therapists, does your science bring anything else to the table and if so what is the documented scientific evidence for it? Your excuse this time? Not enough time? You clearly have time to debate with me. Can’t run off and do a quick lit search on pubmed?

    If you represent the chiro journal article, I’d be happy to read it. That was my original request. It’s quite a long debate and if you could just copy and paste the link offered eariler, that would be great.

    nwtk2007: I would suggest that if insurance companies don’t want to pay for chiro services or any other medical services that they actually look to see if the proper service has actually been performed and documented, but that is another topic.

    Insurance companies look to reduce costs. People have chronic pain and seek treatment that will only ever bring temporary relief. It’s cheaper to send a person to you than a real medical doctor. No?

    nwtk2007: Does this sound any worse than your description of a chirpractic examination? Does it sound the least bit fraudulent? I think it does. I know it is not related and you will no doubt point out the tu quoque quality of it, but as I have said before, it provides perspective.

    It shows doctors are free to criticize their medical system. But your school, from appearances here, seems to circle the wagons and read the marketing blurbs in your brochures versus present the actual evidence.

  78. Fifion 18 Oct 2008 at 11:00 am

    mindme – nwtk has had his mistaken use of “sited” (which does reveal a very distinct lack of familiarity with science and research despite his many claims to authority since it’s a commonly used word and anyone who’s had an education in science – rather than an “education” in pseudoscience they cling to as being science – will be familiar with it). Of course, it’s easy to understand that someone would want to defend their livelihood and the investment of time and money it took to be “qualified”, not to mention the authority and resources they want to tap in to via claiming to be MDs and science-based. It’s the rage with all the religions – from Scientology (which apparently is a very attractive religion to chiros!!!) to Christianity with it’s whole ID faith thing pretending to be science. Daedalus’ identification of chiro as a cargo cult isn’t that far off! And the persistence and style of chiro trolls makes much more sense to me now that I’ve noticed the Scientology connection – wacky! Though it seems more are waiting for the return of Thetan spaceships than planes ;-)

  79. Fifion 18 Oct 2008 at 11:08 am

    That should read…

    nwtk has had his mistaken use of “sited” pointed out many times – apparently he’s even incapable of adjusting his language based on accurate information so it’s no surprise that evidence doesn’t sway his beliefs and he engages, like many people who base their beliefs on magical thinking, that if he just keeps repeating lies they’ll become the truth. Or maybe, like Bush wearing blue jeans, maybe he thinks it makes him appear more “down to earth” – it’s all part of the attempted con and it’s often used as a technique in political campaigning/propaganda and in indoctrination to cults.

  80. nwtk2007on 18 Oct 2008 at 11:12 am

    OK FiFi, you just keep on believing what ever it is you believe.

    No comment on Crislip’s take on coding?

  81. nwtk2007on 18 Oct 2008 at 12:06 pm

    Mindme, here are some of the more recent studies and articles that you could easily find if you were so inclined. The studies from the 70′s and 80′s are more interesting but are not readily available without a visit to the library. Some are studies, some are surveys and others are cost effectiveness studies.

    1. Chronic Mechanical Neck Pain In Adults
    Treated By Manual Therapy
    Vernon H, Humphreys K, Hagino C.
    J Manipulative Physiol Ther. 2007
    Mar-Apr;30(3):215-27.

    2. A Non-Surgical Approach To The Management
    Of Patients With Cervical Radiculopathy
    Murphy DR, Hurwitz EL, Gregory A, Clary R.
    J Manipulative Physiol Ther. 2006
    May;29(4):279-87

    3. Factors Associated With Patient
    Satisfaction With Chiropractic Care: Review
    Of The Literature.
    Gaumer G, PhD
    J Manipulative Physiol Ther. 2006
    Jul-Aug;29(6):455.

    4. Symptomatic Outcomes And Perceived
    Satisfaction Levels Of Chiropractic
    Patients With A Primary Diagnosis Involving
    Acute Neck Pain.
    Haneline MT.
    J Manipulative Physiol Ther. 2006
    May;29(4):288-96

    5. Effectiveness of Manual Physical Therapy to
    the Cervical Spine in the Management of
    Lateral Epicondylalgia: A Retrospective
    Analysis.
    Cleland JA, Whitman JM, Fritz JM.
    J Orthop Sports Phys Ther. 2004
    Nov;34(11):713-22

    6. Intermittent Cervical Traction and Thoracic
    Manipulation for Management of Mild
    Cervical Compressive Myelopathy Attributed
    to Cervical Herniated Disc.
    Browder DA, Erhard RE, Piva SR.
    J Orthop Sports Phys Ther. 2004
    Nov;34(11):701-12

    7. The Effect of Spinal Manipulation in the
    Treatment of Cervicogenic Headache.
    Nilsson N, Christensen HW, Harvigsen J.
    Journal of Manipulative and Physiological
    Therapeutics 1997; 20(5): 326-330.

    8. Spinal Manipulation vs. Amitriptyline for
    the Treatment of Chronic Tension-Type
    Headaches: A Randomized Clinical Trial.
    Boline PD, Kassem K, Bronfort G, Nelson C,
    Anderson A.
    Journal of Manipulative and Physiological
    Therapeutics 1995; 18(3): 148-154.

    9. Treatment of Workers’
    Compensation
    Claimants in the State of Texas.
    Executive Summary. MGT of America Feb 2003.
    This retrospective study of workers’
    compensation claims from 1996 to 2001 was
    conducted to determine the use and efficacy
    of chiropractic care in Texas. The
    researchers reviewed 900,000 claims during
    that time period to determine if
    chiropractic was cost-effective compared to
    medical treatment. They found that
    chiropractor treatment costs were the
    lowest of all providers. Their data
    clearly demonstrated that increased
    utilization of chiropractic care would lead
    to declining costs relative to lower back
    injuries.

    10. Chiropractic care of Florida workers’
    compensation claimants: Access, costs, and
    administrative outcome trends from 1994 to
    1999.
    Folsom BL, Holloway RW
    Topics in Clinical Chiropractic 2002; 9(4):
    33-53.

    I particularly like the cost effective study in Texas as that is where I practice. Our CARF certified rehab facilities have nearly 90% “RTW without restrictions” success rate. The patients receive chiropractic care and PT and under the supervision of chiropractors whoare their treating doctors.

    I know this represents variable “evidence’ and you will call for ‘double blinded” studies etc, but it is very difficult to do double blinded studies on physical medicine modalities as the PT’s will readily attest to. It is the same with surgeries and medical procedures.

    Also, I have posted many of these references before so don’t imply that I never have. Others have also.

  82. Fifion 18 Oct 2008 at 12:08 pm

    Heh, just pointing out your lack of ability to take in new information and attendant inability to adjust to and incorporate this new information. You cling to the use of “site” just as you cling to your beliefs about chiropractice that you continually promote here while asserting lies about the blog authors. (Clearly science is the biggest threat to pseudoscience, just as being rational is the biggest threat to religion – I can see why this site/blog would be so threatening to someone who makes their living selling people pseudoscience.) I’m not particularly surprised by the connection between chiro and Scientology – both are a bogus mix of religion and pseudoscience, both have a hate on for the medical profession and science for a couple of reasons, the most profound being that it gets in their way of fleecing people.

    I understand the blog authors’ stance on censorship and banning but you add little of interest and are clearly here merely to try to defend chiro by any means available (since, like Scientology, it’s a belief system that apparently is at war with science and medicine). You simply make a ritual show of presenting evidence (once again Daedalus’ cargo cult analogy holds true since this is like a magic ritual offering meant to impress the gods/customers/patients/marks rather than about weighing evidence) and then repeat lies in the hope that through this incantation you’ll make it true (magical thinking, though really more of an indoctrination technique when applied to others).

    Thanks for illustrating another of your general diversionary tactics with your rather lame attempt to change the subject to something that’s entirely unrelated.

  83. Fifion 18 Oct 2008 at 12:22 pm

    nwtk – For the record, I don’t think you’re here because of faith in a particular belief system or because you value science (clearly you don’t value science considering how you treat evidence and people who quite normally ask for it). I get the impression that your interest in promoting both chiro and supplements here is entirely mercenary. You’re no lost soul who believes in an “alternate” science for emotional reasons, you’re just here to try to massage your message using lies and diversionary tactics to try to influence people who may stumble across this blog while investigating chiro and to, no doubt, annoy the blog authors. Kinda Scientology lite really….sorta sad really considering that Scientology lifted some of their wacky beliefs and tools from chiro!

  84. Fifion 18 Oct 2008 at 12:32 pm

    Heh, now nwtk is whining about how hard it is to do clinical trials for chiro so chiro shouldn’t be held to the same standards of evidence! I’ve never seen a Physical Therapist make this complaint, or anyone in any of the other areas of medicine that are even harder to design clinical trials for, so don’t try to pretend that once again you’re just like a PT and it’s all so unfair! PTs DON’T do the kind of dangerous neck manipulations being written about in this blog post – there are a number of reasons but one would be that there’s no good evidence that there are any or sufficient benefits to outweigh the weight of the risk. (While strokes caused by chiropractic neck manipulations may or may not be common, it’s clear that the severity of the risk associated with this practice and the lack of evidence for benefit makes it ill advised.)

  85. Fifion 18 Oct 2008 at 1:21 pm

    And once again nwtk claims to have evidence but tells the person he’s making his claim to that they’ll have to uncover and find the evidence themselves. If this “evidence” presented did actually support nwtk’s claims – and he’s really repeatedly used the appearance of evidence not the content of studies as “evidence” – then clearly just keeping it on hand, citing the specifics of the study and posting links would be an easy way to support his claims. That he creates roadblocks to his claimed evidence over and over again, speaks to the actual contents (the evidence part) of his “evidence”. In many ways, just presenting the study titles is once again employing propaganda and magical thinking. The study titles operate as magical talismans – their mere presence is meant to be a substitute for actual evidence and present a facade of science (since clearly anyone visiting this site/blog would give science weight and is trying to uncover what the scientific evidence and consensus on a certain medical or scientific issue is, the appearance of science is a very important part of the con or propaganda). Pseudoscience is only an effective sales tool because people really do have quite a bit of respect for science, as is clear by nwtk’s ongoing work here trying to alternately discredit science and the blog authors and then doing an about face and trying to claim science supports chiro. Clearly most people who come here do have an interest in and respect for science as a discipline (and tool), that’s why nwtk tries to keep distancing himself and other chiros from what’s promoted and taught in chiro schools (even claiming that chiro schools don’t teach what they promote on their websites that they teach and believe!) Apparently he’s now (as is the chiro industry it seems) pushing the idea of chiros as GPs with PTs as underlings – though I know of no GP who works with a PT as an underling, that would just be weird and unnecessary (for obvious reasons, unless of course one believes that disease stems from spinal misalignment….).

  86. nwtk2007on 18 Oct 2008 at 1:27 pm

    FiFi, who are you talking to?

    Are you having conversations with someone in your mind and attributing them to me?

    Whoosh!

    I’ll tell you what. You show me one clinical trial done by PT’s insupport for manipulation or mobilization on the cervical spine.

    And enjoy reading the “sited” articles provided by one of my associate doctors. I look forward to your comments on their content.

  87. Fifion 18 Oct 2008 at 3:34 pm

    Well nwtk if you actually linked to the articles that you display as a talismanic substitute for “evidence”and they were posted on a site for people to read then I guess you could use “sited”. As it is, you’ve once again presented hollow titles and no actual evidence.

    You really are an interesting example of how certain kinds of propagandists work and how magical thinking and diversionary tactics are used by people promoting pseudoscience. Thanks for giving me the opportunity to observe, interact and dissect – it really is interesting how you apply magical thinking to science. I find people peddling pseudoscience and their tactics fascinating. While I doubt you’re actually very effective on this site/blog for a number of rather self evident reasons, I can certainly see why there’d be a vested in interest in trying to erode standards on your part and to protect your livelihood.

  88. mindmeon 18 Oct 2008 at 4:44 pm

    nwtk2007 thank you for finally giving me some papers to look at.

    Googling on one at random turns up this:

    http://www.chiro.org/LINKS/ABSTRACTS/Symptomatic_Outcomes_and_Perceived_Satisfaction.shtml

    Unfortunately, I did request blinded studies. Here let me quote myself:

    ||Like, what conditions should I go to your for and what double blind trials establish I’m making the right choice?||

    The paper above is not blinded in any way. You do understand placebo effect, right? Give someone a cheap wine and tell them it’s a $200 bottle and people oddly report how good it tastes.

    Looking at another one:

    http://www.chiro.org/LINKS/ABSTRACTS/Manipulation_Treatment_of_Cervicogenic.shtmλ

    This one appears a bit better in that the patient is getting some white lab coat manipulation, hence both should have an equal placebo effect. However, there’s still another side of the coin. How was the DC blinded? You’ll notice in medical drug trials neither the patient nor the person administering the variable know who is getting what. If a DC believes in the efficacy of spinal manipulation vs “deep friction massage”, his bedside manner may be superior to a DC who has been given the placebo group. Pain is subjective.

    Are the others you’ve cited as worthless (ie lacking blinding)? Please advise.

  89. Fifion 18 Oct 2008 at 5:26 pm

    Anyone interested in the link between Scientology and chiropractic business techniques should check out David Singer and WISE (who also target dentists).

    http://en.wikipedia.org/wiki/David_Singer

    “In 1976, Singer was recognized as the “Chiropractor of the Year” by the Parker Chiropractic Research Foundation, the youngest person to ever receive this award. In 1978, the Jaycees named him the “Outstanding Young Man of America”, and he also received the “Distinguished Service Award” from the New Jersey Chiropractic Society. In 1999, Chiropractics Economics magazine awarded him the “Chiropractor of the Year” award. In 2002, he received The Parker Centurion Award.”

    Interestingly, Parker is often held up as being THE most scientific and respected chiropractic college by nwtk and other chiros here – yet Parker’s “research” foundation is giving out awards to someone who is controversial even amongst chiros because WISE is a self-proclaimed Scientology recruiting organization.

    http://en.wikipedia.org/wiki/World_Institute_of_Scientology_Enterprises

  90. Fifion 18 Oct 2008 at 5:47 pm

    A concerned chiropractor writes a letter to the editor of Dynamic Chiropractic regarding the appropriateness of having Singer on the board of an ethics organization that supposedly formed to prevent just the kinds of things that Singer does and gets brushed off by the head of the supposed ethics org..hmmmm….sounds like once again the fox is being put in charge of the henhouse….

    http://www.chiroweb.com/mpacms/dc/article.php?id=44456

  91. nwtk2007on 18 Oct 2008 at 8:49 pm

    Mindme, your concern for “double blinded studies” demonstrates your lack of clinical experience.

    Try to get beyond that and comment on the findings. Try to get beyond your bias and be objective.

    Do you even know about “blinding” and why it is important in some cases and not in others? Do you think the authors did not know about “blinding” a variable in a study?

    Come on dude, you don’t do research and these studies are not the type you think they have to be, nor does evidence need to always be blinded and placebo is not always the alternate conclusion.

    This might be a hopeless try here. We’ll see.

    Go for it FiFi, I know you’ll get off on this one.

  92. mindmeon 19 Oct 2008 at 12:01 am

    nwtk2007: Do you even know about “blinding” and why it is important in some cases and not in others? Do you think the authors did not know about “blinding” a variable in a study?

    Double blinding is rather key to biomedical research. How do those studies control for the placebo effect? Are you aware of any drug trials that are not double blinded? Why should chiro be exempt? Special pleading won’t cut it, sorry.

  93. nwtk2007on 19 Oct 2008 at 1:08 am

    Mindme – “Are you aware of any drug trials that are not double blinded? Why should chiro be exempt?”

    Because it is not a drug. So not totally exempt but definitely not an absolute necessity. Physical medicine does not lend itself to blinded studies. Ask the PT’s. Or the surgeons.

  94. Joeon 19 Oct 2008 at 6:22 am

    Mindme,

    Am I exonerated for refusing to look at non-medical literature?

  95. mindmeon 19 Oct 2008 at 9:58 am

    nwtk2007: Because it is not a drug. So not totally exempt but definitely not an absolute necessity. Physical medicine does not lend itself to blinded studies. Ask the PT’s. Or the surgeons.

    Special pleading. Please even I could think of a double blind trial. Patients are randomly assigned. Chiros are not told of patient symptoms or complaints. No talking is allowed. Some chiros perform one form of manipulation. Some chiro perform the manipulation that supposedly has an effect on “cervicogenic headaches”.

    Then you have blinded observers interview the patients after the fact.

    A good, large trial blinded in this fashion with positive results would falsify my belief. Would it falsify yours? If not, what double blinded experiment would?

  96. daedalus2uon 19 Oct 2008 at 2:02 pm

    You would have to have the chiropractors do sham interventions; a laying on of hands that the chiropractor thinks will be ineffective. Otherwise the patient would know that he/she was receiving “real” vs “sham” chiropractic manipulations.

    Of course that might be easy to scam if the chiropractor hurt the patient during the sham procedure. If you compared the sham to no treatment, that should eliminate that possibility.

    The chiropractors will never agree to participate in such a study. If they do, they will complain that the results were “manipulated”, just like the homeopaths complain that when they do unblinded tests and achieve positive results there is no manipulation, but when skeptics do blinded tests and achieve negative results the skeptics are manipulating things (even though because of the blinding such manipulation is not possible).

  97. nwtk2007on 19 Oct 2008 at 3:20 pm

    I can appreciate your sarcasm boys, but it only proves my point about you.

    Deadulus, did you see the article in this months Scientific American supporting the programmed aging hypothesis?

  98. Fifion 19 Oct 2008 at 3:27 pm

    nwtk – You’ve already had the rubbish unblinded studies you’ve presented dissected here (and yet you keep ritualistically posting the titles to these same studies over and over again, as if this magic ritual will suddenly turn them into acceptable evidence…) It really is a very hollow ritual and simply believing really hard won’t make your weak studies into robust evidence.

    I can fill you in on what a double blind study is if you like so next time someone asks you to present a double blind study as evidence to support your claim, you’ll know what they’re asking for and not present unblinded and poorly designed studies that don’t serve as reliable evidence.

    That said, I’m much more interested in observing your tactics and their relationship to the methods that Scientology promotes to recruit and indoctrinate. Particularly since the school you constantly promote and praise for their education and scientific research, Parker College, is so keen on those methods. So much so that the “research” department named WISE’s main man out to induct chiropractors into Scientology their chiropractor of the year! Wacky how snuggly with Scientology and their “marketing techniques” Parker College seems to be!

  99. daedalus2uon 19 Oct 2008 at 5:01 pm

    I did not see the article and couldn’t find it online. If you post a link I will look at it. I am pretty up on the primary literature and don’t think there is any real support for such a hypothesis. It really doesn’t fit with evolution.

  100. mindmeon 19 Oct 2008 at 7:18 pm

    nwtk2007 no comments on my double blind trial? Why can’t this be done? Why hasn’t it been done?

  101. daedalus2uon 19 Oct 2008 at 7:23 pm

    mindme, it probably has been done many times, but it doesn’t show that chiropractic works, so no one who believes in chiropractic considers it reliable.

  102. nwtk2007on 19 Oct 2008 at 8:00 pm

    First you FiFi, you haven’t read the studies and it is a farse for you to pretend to have done so.

    “dissected”? Hardly.

    What is scientology anyway? I was raised in the Church of Christ, as I have told you, and got my BS at Abilene Christian University. Have not been in church sense 1992.

    Daedulus, it is in the magazine. I don’t think it is online. I have no link. I read the mag. I have since 1972. And you might be right about it’s validity. I just wanted to let you know it was there. No insult intended or “I told you so” meant.

    mindme – …..

    Daedulus says it might have been done many times, but it doesn’t show chiro works so no one who believes in chiro considers it reliable. Sarcasm? That is truly a strange statement.

    And FiFi, you say I have been “ritualistically” posting links to evidence. So why is it that I am accused of not providing any? I’m 52 and I thought “MY” memory was going. I guess it’s the other way around.

    And one final thing FiFi, can you give us a double blind study supporting bypass surgery, or one that supports, or doesn’t, cervical mobilization by PT’s?

    Nope.

  103. Fifion 20 Oct 2008 at 9:54 am

    nwtk – You have consistently promoted Parker College as the epitome of scientific chiropractic and as a chiro college that promotes science (and even though the college promotes “innate intelligence” and subluxation as the basis of illness on their site, you claim that’s not what they teach….either more false advertising from chiros or lies from you apparently!). Parker College holds up the very person who fronts a Scientology organization dedicated to training chiros in Scientology “business” methods as chiro of the year – and it’s their “research” arm that gave the award! Singer and his org serve as a front for recruiting chiros into Scientology (and in turn make some chiro clinics into fronts for recruiting people into Scientology since Singer advocates forcing employees to attend Scientology sessions or be fired). Now, there seem to be chiropractors who speak out against this, you’re obviously not one. Whether you personally are a Scientologist or not is irrelevant, you continually endorse and promote a chiro institution that elevates “business” techniques developed by Scientology and a front person for Scientology recruitment. That you can’t acknowledge this and continue to promote this melding of chiropractic and Scientology – and can’t seem to distinguish between chiropractic and Scientology (not surprising really since they both promote a mix of pseudoscience and religion, and are hostile to medicine while wanting to replace it).

    You haven’t actually been posting ritualistic links to evidence. What you have been doing is ritualistically posting article titles and then telling people to do their own research. These poorly conducted studies aren’t actually decent evidence (as I discovered when I first read them and you’ve been told why they’re not over and over again so there was no need for someone like me to do so again when he good doctors here have already explained to you why the studies aren’t adequate). What makes your actions ritualistic and an attempt at “magic” (or manipulation/illusion) is that you present not the study but the title as symbolic stand in for the study, and you keep representing poor evidence pretending it’s of double blind quality (and hiding this lack by not actually linking to the study).

    As for reading the studies you represent yet again, I did this when I first arrived here but it soon became evident it was a waste of time and that you ritualistically throw up weak studies, create strawmen and try to change the subject (as you did by bringing up something you know Daedalus was interested in and attempted to do with me earlier). Since