Articles by JCS

Rigged Media

Rigged Media

I agree with Donald Trump on just one topic—the media is rigged. No where has this been more evident than the media war against chiropractors. Case in point:

When was the last time you’ve seen an in-depth, fair and balanced report about the benefits chiropractors bring to an ailing society where back pain is the leading cause of disability in the workplace, military, VA and in the entire nation?

Of course, you never have despite the fact that the chiropractic profession brings the best nondrug solution to this pandemic of pain that is crippling patients with opioid painkillers, epidural steroid injections, and the debunked disc fusions based on an out-dated “bad disc” premise that the Mayo Clinic suggested was simply a natural aging process in its study, “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.”[1]

Instead of touting our benefits in this crisis, we see the media continue its character assassination with hyperbolic reports based on rare accidents such as the recent death of Playboy pin-up that went viral last week after the coroner ruled a chiropractic adjustment caused her death.

The recent flap about the death of model, Katie May, a 34-year-old Playboy model dubbed “The Queen of Snapchat,” illustrates the blind-sided journalism about her unfortunate and accidental death that went viral to impugn the reputation of our entire profession in one fell swoop.

She reportedly suffered a “nasty fall” at a photo shoot inflicting trauma to her neck to which she sought care first at a hospital, but when her pain persisted, she sought help from a chiropractor. Sadly, her life ended a few days later.

Los Angeles Assistant Chief Coroner Ed Winter tells PEOPLE that a chiropractor shifted May’s neck, tearing her left vertebral artery. The tear blocked blood flow to May’s brain and caused the stroke.

Her cause of death is listed as “infarction of brain” and has been ruled an accident, Winter says.

“She had some clotting and went to the hospital where they tried to do some procedures but she passed away,” he tells PEOPLE. “I personally have not seen this before.”

Rather than a logical detail of the mechanism of her demise, as a scapegoat explanation the Los Angeles County coroner attributed her death to the actions of the chiropractor; obviously he was ignorant of the plethora of evidence accumulated since the precedent  Lana Lewis case in 1996, twenty years ago.

Compounding his admitted ignorance, ABC’s Action News added more insult to her injury by making an unsupported link between her death and manipulative therapy, “The coroner's office said the official cause of death was vertebral artery dissection, which is essentially the manipulation of the neck.” No mention of her “nasty fall” that precipitated her neck injury and death.

This is a complete disregard for the actual mechanism of her accidental death and certainly is a gross misstatement to equate VAD to SMT that smacks of medicine’s attempt to impugn our profession that has the safest iatrogenic rates in the healthcare professions.

As you will learn and as the public needs to hear is this collective condemnation of chiropractic care is not merely a case of the pot calling the kettle black, this is ironically a case of making a mountain out of a molehill. Regardless, when the mainstream media takes this issue viral, we have a huge PR problem that will require more than a few infomercials in response.

People magazine also wrote a short article, “Are Chiropractors Safe? Experts Weigh in on Playboy Model Death After Chiropractic Adjustment,” that obviously convicted chiropractic in its headline.

Whether on purpose or not, this allegation is a huge stain on our public image that needs to be address, if we can find a receptive newscaster not biased from chirophobia. Merely sending out three paragraph press releases will not suffice. Again we cannot take a spoon to a knife fight.

Lost in this emotional event was the real cause of her neck problem rarely mentioned in the string of articles although TMZ initially did report the fact: Katie May Stroke Triggered By Brutal Photo Shoot Fall, a fact shortly omitted in subsequent articles:

Playboy and Instagram sensation Katie May took a nasty fall during a photo shoot last week, injuring her neck, and that is the leading candidate for what caused her fatal stroke ... TMZ has learned.

Sources with direct knowledge of Katie's situation tell us the accident happened late last week when she was shooting in Los Angeles. We're told Katie's neck pain after the fall was so bad, she went to a hospital to get checked out, and was released later that day.

But on Friday the pain remained -- she tweeted, "Pinched a nerve in my neck on a photo shoot and got adjusted this morning. It really hurts!" 

Our sources say the operating theory is the 34-year-old model did not pinch a nerve, but instead tore the carotid artery in her neck. As we first reported, doctors told Katie's family the tear caused a blood clot which broke off and caused her stroke on Monday. It's called a carotid artery dissection.

As TMZ first reported, Katie was taken off life support Thursday evening and died surrounded by family and friends.

 

Rather than acknowledging her “nasty fall,” nearly all the media reports attributed the cause of her death to the chiropractor’s adjustment—such as seen on Today.com:

October 21, 2016

Playboy model Katie May died from ‘neck manipulation by chiropractor’

Katie May, a 34-year-old Playboy model known as “The Queen of Snapchat,” died earlier this year after “neck manipulation” by a chiropractor triggered a deadly stroke, officials say. The death is listed as an accident and no charges have been filed against the chiropractor. NBC’s Gadi Schwartz reports for TODAY from Los Angeles

TMZ also convicted the hapless chiropractor its headline on October 19, 2016: MODEL KATIE MAY'S DEATH: Coroner Finds ...CHIROPRACTOR DID IT

Playboy model Katie May died from a simple visit to a chiropractor for an adjustment, which ultimately left her with a fatal tear to an artery in her neck ... according to the L.A. County Coroner.

TMZ obtained a copy of Katie's death certificate, and it clears up a huge mystery surrounding her sudden death in February. The document says she died when a blunt force injury tore her left vertebral artery, and cut off blood flow to her brain

It also says the injury was sustained during a "neck manipulation by chiropractor." Her death is listed as accidental.

As TMZ first reported, Katie -- known as the "Queen of Snapchat" -- had taken a nasty fall during a photo shoot. She thought she had a pinched nerve and went to an L.A. chiropractor on Friday. She suffered a stroke on Monday, and remained on life support until Thursday.

Katie's family is aware of the coroner's findings. They would not comment on whether they or her estate would pursue legal action.

Apparently her initial visit to a hospital after her fall misdiagnosed her injury: “she went to a hospital to get checked out, and was released later that day.” This oversight was mentioned but later ignored in the numerous media articles. Obviously she had a cervical arterial dissection before seeing the chiropractor.

Why was there no mention by TMZ that the “blunt force injury” was the “nasty fall,” not the chiropractor’s adjustment?  Indeed, facts were omitted and some facts were changed during this news accounting of her death to support the media’s claim that the chiropractor was to blame, not the nasty fall or Emergency Room’s misdiagnosis.

Until a thorough investigation is complete, we will not know the string of events that led to her unfortunate death, but if this case follows similar cases, the path will show the chiropractor was blameless.

The Ruse of Patient Safety

During the height of the medical war against chiropractors in the 1960-70s, the Committee on Quackery used the patient safety issue as justification for the AMA’s boycott and defamation of chiropractors, all done allegedly in the name of public safety.

However, at the Wilk v. AMA antitrust trial, the medical attorneys offered no proof, no witnesses, and no lower court precedents of chiropractors injuring patients. In fact, the sole accusations of this patient safety ruse came from the AMA’s officials who admittedly had never been treated by a chiropractor, never studied chiropractic, nor had any proof other than their own misinformed opinions. Obviously, if you tell a lie often enough, you will believe it.

Fortunately, Judge Susan Getzendanner didn’t believe their lies and concluded:

“Taking into account all of the evidence, I conclude only that the AMA has failed to meet its burden on the issue of whether its concern for the scientific method in support of the boycott of the entire chiropractic profession was objectively reasonable throughout the entire period of the boycott.”[2]

She also was aware of this PR damage to the chiropractic profession:

“The activities of the AMA undoubtedly have injured the reputation of chiropractors generally…In my judgment, this injury continues to the present time and likely continues to adversely affect the plaintiffs.  The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations.”[3]

In his closing arguments, plaintiff’s attorney George McAndrews noted the AMA’s legal team was unable to find one injured patient to testify against chiropractors:

“And they haven’t brought in a patient. You’d think if all of these patients have been injured, some would come in here and say they were taken by a chiropractor. Not one walked through the door.”[4]

This is not to say a few patients weren’t injured in the 80 years preceding the trial, but certainly not at the rate the AMA wants the public to believe.

Katie May Goes Viral

Nonetheless, Katie May’s accidental death went viral like wildfire with sensational headlines and misleading stories convicting chiropractic care in the court of public opinion. Doyl Taylor and the Medical Mussolini must be smiling from their graves.

Doesn’t this also sound similar to the recent witch hunt Down Under when an innocent pediatric chiropractor was tarred and feathered in the press despite his victim-less non-crime? Nonetheless, the medical media had a field day misleading the public with unsubstantiated comments from medical trolls in the media.

A recent scan on Google found a tsunami of misleading articles:

Katie May Death News

  1. Playboy Model Katie May's Death Caused By Chiropractor, Autopsy Finds
  2. Katie May: How A Visit To The Chiropractor Triggered Snapchat Queen’s Tragic Death
  3. Family Speaks Out About Playboy Model Who Died After Visit to Chiropractor
  4. ·  Coroner's report suggests model Katie May's death...
  5. ·  Katie May Died After Chiropractor Injured Her Neck...
  6. ·  Family of Katie May, Playboy model who died after...
  7. ·  Model Katie May died after chiropractic visit,...
  8. ·  Playboy Model Katie May's Death Caused By...
  9. ·  34-Year-Old Model Katie May Died From A...
  10. ·  Playboy model Katie May's mystery death solved |...
  11. ·  How a Chiropractic Adjustment Led to Model Katie...
  12. ·  Dlisted | Playboy Model Katie May's Death Was...
  13. ·  Coroner Finds Chiropractor Involved In Model Katie...
  14. ·  'Playboy' Model Katie May's Death Caused By...
  15. ·  Model Katie May's death followed fall in photo...
  16. ·  Model Katie May Died After Chiropractor Injury:...
  17. ·  Playboy model Katie May's death linked to...
  18. ·  Coroner Reports Playboy Model Katie May Died After...
  19. ·  Katie May's Death: Stroke Caused By Nasty Fall At...
  20. ·  Playboy model Katie May's death ruled accidental |...
  21. ·  Katie May, Playboy model, died due to injury from...
  22. ·  Mystery solved: Chiropractic manipulation of the...
  23. ·  "Queen of Snapchat" Katie May Died After...
  24. ·  Playboy Model Katie May's Reason Of Death Revealed...
  25. ·  Katie May Death By Stroke, Chiropractic Neck...
  26. ·  Katie May Cause of Death: Revealed, Tragic - The...
  27. ·  Playboy model Katie May's sudden death was the...
  28. ·  Playboy Model Katie May's Death Caused By...
  29. ·  Katie May, Playboy Model and Snapchat Queen, Dies...
  30. ·  Katie May Instagram & Pics: 5 Facts About How She ...
  31. ·  'Playboy' Model Katie May's Death Caused By...
  32. ·  Playboy babe Katie May died after chiropractor...
  33. ·  Chiropractic adjustment gone wrong: Model Katie...
  34. ·  Coroner on Katie May's death: 'neck manipulation...
  35. ·  R.I.P Katie May | Facebook
  36. ·  Coroner Reports Playboy Model Katie May Died After...
  37. ·  Playboy model and social media star Katie May died...
  38. ·  New Details Revealed About 'Snapchat Queen' Katie...
  39. ·  Playboy Model Katie May's Cause of Death Revealed...
  40. ·  Chiropractor Visit Doomed Model Who Died at 34 -...
  41. ·  Playboy Model Katie May Died From a Stroke After...
  42. ·  Katie May: 5 Fast Facts You Need to Know |...
  43. ·  Watch XFINITY Videos Online | Music | News |...
  44. ·  Playboy Model Katie May Dead at 34 After Suffering...
  45. ·  Playboy model Katie May died from "neck...
  46. ·  Playboy Model Katie May's death due to...
  47. ·  Obituary: Katie May / 'The Queen of Snapchat' was...
  48. ·  Playboy Model Katie May Reportedly Died From a...
  49. ·  Katie May (Former 'Queen Of Snapchat') Supposedly ...
  50. ·  Katie May dead: Playboy model's mystery death...
  51. ·  Playboy model Katie May died from blunt force...
  52. ·  Playboy Model Katie May Died After Going to the...
  53. Katie May death: Playboy model tore artery in her...
  54. #mskatiemay hashtag on Twitter
  55. Doctor finds Playboy model Katie May died due to...
  56. Could Chiropractor Visit Have Caused Playboy Model...
  57. Playboy Model Katie May Died Due to Fatal Injury...
  58. Playboy model Katie May 'died after chiropractor...
  59. Playboy model Katie May died after chiropractor...
  60. Katie May Wiki: Modeling, Snapchat, Stroke and 5...
  61. Playboy Model Katie May Dies After Chiropractor...
  62. LA Coroner Blames Death of Playboy Model Katie May...
  63. Coroner: Playboy Model Katie May dies after...
  64. Katie May Died After Chiropractor Injured Her Neck...
  65. Chiropractic adjustment gone wrong: Model Katie...
  66. Coroner Says Chiropractic Manipulation Led To...
  67. 'Queen of Snapchat's' death caused by 'neck...
  68. 'Queen Of Snapchat' Katie May Died Of A Stroke At...
  69. Playboy Model Katie May's Death May Make You...
  70. US News: Playboy Model Katie May's Death Caused By...
  71. 'Queen of Snapchat' Katie May Died Because a...
  72. Model Katie May's death caused by her chiropractor...
  73. ·  Model Katie May, the 'Queen of Snapchat,' Died...
  74. ·  Katie May Hospitalized After 'Catastrophic'...
  75. ·  Katie May dead: Playboy model and 'Queen of...
  76. ·  Did chiropractic neck manipulation kill Katie May?...
  77. ·  Snapchat Queen Katie May Dies From 'Catastrophic'...
  78. ·  Snapchat Model Katie May Has Died After Having a...
  79. ·  Katie May: 'Queen Of Snapchat' Dead Because Of...
  80. ·  Katie May Dead: Did Stroke Really Kill 34-Year-Old...
  81. ·  Katie May, 'Queen of Snapchat' and Playboy Model,...

And the list goes on without one article giving our side of this story.

Obviously this volume of bad news is a huge PR problem that will remain imprinted in the minds of millions for years with untruths about the safety of chiropractic care and manipulative therapy. Can we ever hope to dig out from this tidal wave of bad press with only a short press release from the F4CP or ACA?

Plus, none of these inflammatory articles even attempt to do a “fair and balanced” article explaining the actual mechanism of her accidental death. Nor did any medical reporter compare the iatrogenic rates of SMT to medical care, obviously giving a one-sided view of the safety of chiropractic care.

Not only did the Katie May stroke issue inflame emotions, it also shows the double standard in the media in regards to reporting clinical iatrogenic problems. When a chiropractor is involved in an occasional accident, this issue goes viral (sometimes there is not even a victim as we’ve witnessed in the UK and Down Under), but how often have we seen the same over-reaction to medical iatrogenesis?

Indeed, if Katie May had died from unsuccessful spine surgery, aspirin or opioids, little would have been said since it happens so often, and certainly the entire medical profession would not have been collectively dragged through the media muck.

Now you can understand why the media war against chiropractors is rigged!

“Medical Care Gone Wrong”

For a moment, let’s do what the media constantly ignores and examine the relative amount of medical clinical iatrogenesis. The following chart from the Gallup-Palmer survey indicates the comparison of adverse events among providers and medical treatments for neck pain that was never published in the mainstream media during this Katie May incident.

Neck Pain Treatments - Be aware of the risks

  • Risk of death from spine surgery: 1,800 per 1 million[5]
  • Risk of serious side effects/death from cervical spine (neck) surgery: 500 in 1 million[6]
  • Risk of death from combined use of NSAIDS/aspirin: 153 per 1 million[7]
  • Risk of death from prescription opioid pain medications: 53.6 per 1 million[8]
  • Association between neck manipulation and stroke: about 1 in 5.85 million adjustments5 (or <1 in 1 million)[9]
  • More than 33 million U.S. adults saw a chiropractor last year[10]

Simple arithmetic of this chart will show for spine surgery for neck and back pain, medical care accounted for 2,300 serious side-effects or death per 1 million encounters. Aspirin and opioid medications accounted for 207 serious accidents per million per. Combining these stats of medical care, over 2,507 people per million are seriously injured or die. Yet where is the media outcry about these deaths from medical iatrogenesis?

Meanwhile, the rate of chiropractic care is less than 1 in one million. Considering American chiropractors treated 33 million patients in 2014, this equates to less than 5 or 6 serious adverse events or deaths annually. For example, if medical spine care also sees an equivalent 33 million patients, this equates to 82,731 serious events or deaths annually. So, who’s hurting who?

Not only was this comparison ignored as to the relative safety, nor did the same medical reporters embarrass their own colleagues when the British Medical Journal revealed in 2016 medical care is the third-leading cause of death in the United States in the range of 251,000 per year (an admittedly conservative estimate) that still equates to 700 deaths per day due to medical mistakes.[11]

You can listen to the author of this shocking article on Sound Cloud that, again, got no traction in the mainstream media (this a compelling audio interview you must hear).

Nor did the media in 2013 expound when the BMJ published Clinical Evidence, an article suggesting over half of medical care is ineffective, unproven or too dangerous to use. Here is a brief summary of their findings:

“The British Medical Journal posted on their website, Clinical Evidence, the results of an analysis of randomized controlled trials focusing on harms and benefits of 3,000 medical treatments. The effectiveness of each treatment was rated based on six criteria: (a) beneficial, (b) likely to be beneficial, (c) trade-off between benefits and harms, (d) unlikely to be beneficial, (e) likely to be ineffective or harmful, and (f) unknown effectiveness.

The results were striking. Only about a third of the treatments were shown to be beneficial (11%) or likely to be beneficial (23%). Another 7% were rated as trade-offs between benefits and harms, with 6% rated unlikely to be beneficial and another 3% rated likely to be ineffective or harmful. The authors at Clinical Evidence rated the remaining 50% of medical treatments as being of unknown effectiveness. The challenge that evidence ratings like these pose for clinicians is not new.”

The Washington Post was one of few that reported on this BMJ research, Surprise! We Don’t Know If Half Our Medical Treatments Work.”[12] Although this information is shocking, the BMJ article never went viral in the American media. Despite these alarming articles by the BMJ, perhaps the most prestigious medical journal in the world, neither article got any traction in the American media by medical reporters like Sanjay Gupta, MD, at CNN. Certainly no medical reporter wants to let these cats out of the medical bag of dirty linen.

Chicken Little Journalism

The one-sided media handling of this tragedy with Katie May is not a new issue. Every few years, the AMA’s fear mongers attack chiropractors with spurious claims about the danger of cervical spinal manipulation causing strokes or recently the alleged abuse of infants.  Certainly this makes headlines for a while to alarm the public but, in fact, it is simply another mistaken cry by Chicken Little journalists to scare the public about an issue that is as unlikely as being hit on the head by an acorn.

American Chicken Little

On August 7, 2014, the American Heart Association/American Stroke Association Scientific Statement issued another piece of yellow journalism, Neck Manipulation May Be Associated With Stroke,” by José Biller, MD, lead author and professor and chair of neurology at the Loyola University Chicago Stritch School of Medicine.

Even his introductory paragraph winced at the lack of credibility:

“Treatments involving neck manipulation may be associated with stroke, though it cannot be said with certainty that neck manipulation causes strokes, according to a new scientific statement published in the American Heart Association’s journal Stroke.”

The AHA and ASA statement also mentioned there may be a preexisting problem: “It is unclear whether this epidemiological association is due to a lack of recognition of a preexisting dissection in these patients or due to trauma caused by CMT."

The statement goes on to say, "Clinical reports suggest that mechanical forces play a role in a considerable number of dissections," such as automobile accidents or athletic injuries, but these factors generally were ignored as we’ve witness in Katie May’s “nasty fall.”

Needless to say, the Biller article drew a critical response from chiropractic researchers, Christine Goertz, DC, PhD, and Dana Lawrence, DC, MMedEd, MA, both senior faculty and research fellows at Palmer College of Chiropractic in their article, “CMT & Stroke Risk: Myth vs. Fact.”

They responded to the “half-truths and misleading statements” of this medical yellow journalism:

Currently, the best basic science evidence available indicates that the strains placed on the vertebral artery during CMT (chiropractic manipulative therapy) are unlikely to cause a stroke, and the best clinical evidence available shows that a person is as likely to have seen a primary care medical physician as a doctor of chiropractic in the seven days prior to experiencing a CD (cervical dissection).

As we critically assess our response, it is our opinion that the AHA statement mixes scientific facts with half-truths and misleading statements, leading people to ultimately arrive at the erroneous conclusion that it has been established CMT causes CD. If you look at the newspaper and blog headlines generated by this statement (e.g., "How Safe Are the Vigorous Neck Manipulations Done by Chiropractors?"[13] and "Chiropractic Manipulation of Neck: Stroke Risk?"[14]), you realize this is precisely what happened when the statement was released.

The AHA white paper lists several events that are associated with CD. These include major and minor cervical trauma, use of oral contraceptives, sporting activities, stretching the neck, some neck movements, violent coughing or vomiting, and visiting a health care provider who administers spinal manipulation. Yet for some reason, the AHA chose to focus its statement on the single association within that list for which there is the strongest evidence against a causal relationship.[15]

The AHA statement did make a huge admission stating “…current biomechanical evidence is insufficient to establish the claim that CMT causes dissection…" but this was ignored by the medical trolls in the media.

“That is a remarkable acknowledgment,” according to Dr. Gerry Clum in his presentation, Insight into the Stroke Issue.[16] “This means that in those cases it wasn't what was going on the chiropractor's office [CMT] that contributed to the problem, it is what walks through the door,” said Dr. Clum, past president of Life Chiropractic College-West.

 “No longer do we have to worry about some bozo coming into court and saying that cervical spine adjustments caused this problem, period.” Unfortunately when an uninformed media sensationalizes this issue with the blessings of biased medical reporters, it does remain a problem despite the facts.

Again, this is a huge admission that in most cases the CMT may not have been the instigating factor in the CD issue as much as prior trauma. This also explains why CD occurs in hair salons and dentist offices where merely neck extension may trigger a CD.

For example, an article in 2003, “Motor Vehicle Accidents: The Most Common Cause of Traumatic Vertebrobasilar Ischemia,” examined 80 cases of dissection over a 20-year period and found 75 of those cases were from automobile accidents or industrial accidents that were equivalent to automobile accidents in terms of the amount of mechanical injury to the neck.[17]

The authors noted the media exposure of strokes allegedly from chiropractic manipulation was mostly misplaced blame: “However, chiropractic manipulation, while the easiest cause to recognize, is probably not the most common cause of this condition.”

In some cases neck pain from an MVA led patients to seek chiropractic care, so the cause may have been compounded. The authors found in most vehicular cases the diagnosis had been missed (or even denied) by the neurologists and neurosurgeons initially involved. The longest delay between the injury and onset of delayed symptoms was five years.

The authors concluded:

Traumatic vertebrobasilar ischemia is most often due to MVAs; the diagnosis is often missed, in part because of the delay between injury and onset of symptoms and, in part, we hypothesize, because of reluctance of doctors to be involved in medico-legal cases.”

Isn’t this exactly what happened in Katie May’s situation when she went to the hospital that missed on her diagnosis? If the Chicken Little journalists had done their homework they might have discovered how a nasty fall causes a stroke.

According to Walter Herzog from the University of Alberta at Calgary in his study, “Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation,”[18] a chiropractic adjustment causes less strain on the neck arteries than a simple diagnostic range-of-motion exam.

"In the process of giving an adjustment, we induce less force on that artery than is induced during a normal cervical range of motion study, and the strains are much smaller than the failure strains that are involved, which cause the artery to fail mechanically."

Herzog and colleagues concluded the following from these findings:

"Cervical spinal manipulative therapy performed by trained clinicians does not appear to place undue strain on the vertebral artery and thus does not seem to be a factor in vertebral base or artery injuries."

According to two studies by Scott Haldeman, et al.[19],[20] concerning stroke, cerebral artery dissection and cervical spine manipulation therapy, the most commonly reported neck traumas include motor vehicle accidents, chiropractic maneuvers, sports, yoga, coughing, falls and even painting a ceiling.

They concluded:

  • Presently, no screening modality is available for the identification of patients at risk for cerebrovascular events following spinal manipulation.
  • Patients with increased risk of stroke due to atherosclerotic vascular disease, such as those with hypertension or diabetes mellitus, do not appear to have an increased risk for stroke after spinal manipulation.
  • Also, attempts to assess vertebral artery patency prior to manipulation have not been successful in identifying patients at increased risk.
  • The risk for stroke following neck trauma/manipulation appears to be inherently dependent on the manipulation technique and the rotational forces applied to the neck.

 “The stroke question is basically resolved,” said Dr. Haldeman in a 2016 TIME article.[21] Citing research[22] that shows the risk of suffering a stroke following a chiropractic visit is extremely low, Haldeman’s own research turned up only 23 such cases among more than 134 million chiropractic manipulations. This is equivalent to one in 5.85 million office visits.[23]

Research into the stroke issue by Allan G.J. Terrett, Associate Professor at the School of Health Sciences, RMIT University, Bundoora, Australia, found the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic is also quite remote—more rare than having a stroke while in a hair salon or a dentist’s chair,[24] or being hit by lightning (one in 600,000).[25]  It equates to one occurrence in 48 chiropractic careers.[26]

Most recently in 2016, researchers at the University of Pennsylvania Hershey Medical Center published a “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation” and concluded:

The quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection. This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.[27]

Not only will such media bias create “significant negative consequences such as numerous episodes of litigation,” it has created a scary image among millions of naïve readers who don’t understand the distortion within these articles, which is exactly the goal of the medical media to disparage the chiropractic profession as a whole.

Despite this research showing the relative safety of chiropractic, the recent public media flap failed to mention any of these facts. Also buried in the text or omitted altogether was the “nasty fall” initially attributed as the actual cause of her stroke, not the triggering by the adjustment. Although this tragic event is sad for her entire family, there is a long history to this media hysteria as just one of many unsubstantiated claims to impugn the chiropractic profession.

Canadian Chicken Little

This is not the first time chiropractic care has been attacked in the media concerning the stroke issue. Perhaps the most  notorious incident occurred in Canada when the alleged danger of spinal manipulation became a major issue during and after a coroner's inquest into the death of Lana Dale Lewis, who suffered a fatal stroke in Toronto, Ontario, on September 12, 1996, two weeks after receiving a cervical adjustment from her chiropractor, Dr. Philip Emanuele.

The Canadian media, with encouragement from the medical society, jumped on this case with headlines demanding that chiropractors no longer be allowed to perform cervical adjustments. An investigation later exonerated the chiropractor; nonetheless, he was convicted in the court of public opinion by the chirophobic press.

For 20 months, the longest inquest in Ontario's history, the jury considered more than 240 pieces of evidence and testimony from 20 international expert witnesses.[28] The evidence and testimonials centered on the association of chiropractic manipulations of the cervical spine with the risk of vertebral artery dissection. Many of the expert witnesses presented conflicting opinions regarding the scientific issues concerning cervical manipulations.

Rigged Headline News

From its inception, the Lewis inquest was entrenched in media speculation and political warfare. One article noted, “The Lewis inquest quickly became a forum for the chiropractic profession to gain (or lose) legitimacy in the eyes of the public.”[29]

Newspaper coverage of this inquest became the subject of a fascinating study in Health Law Review, “Print Media Coverage on the Lana Dale Lewis Inquest Verdict: Exaggerated Claims or Accurate Reporting?[30] This study was designed to focus on how the verdict of the coroner's jury—death by means of an “accident”—was reported in print media.[31]

According to the legal standards of an inquest, a causal statement associating the death from a stroke and the chiropractic adjustment characterizes inaccurate articles. Twenty-eight percent of the reviewed articles met the criteria of “inaccurate and incomplete” articles. For example, journalists for The Hamilton Spectator wrote, "A coroner's jury ruled that a 45-year old woman named Lana Dale Lewis died in 1996 as a result of a chiropractic upper-neck manipulation."[32]

Doesn’t this sound identical to the headlines in the Katie May articles?

According to the study, this was not the jury's conclusion nor was it empowered to make such a finding. Similar statements of causation were written in three other national publications: The Globe and Mail[33], National Post[34] and Canwest Global.[35] Causal statements by these news providers were particularly disconcerting due to their vast readership across Canada, the researchers emphasized.

In addition to the inaccurate statements in newspaper articles, 27 percent of the reviewed articles contained inaccurate headlines. The percentage of inaccurate headlines increased to 44 percent when the Canadian Press articles were removed from the calculations. These titles made dramatic claims, such as "Chiropractic Procedure Killed Woman, Inquest Finds"[36] or "Chiropractic Death Ruled Accidental."[37]

The Hamilton Spectator’s headline was most sensational: "Getting Back to the Truth; Once Again, The Chiropractic Community Simply Won’t Come Clean about Neck Manipulation." The headlines of other articles were completely false and exaggerated, the researchers wrote, yet this particular headline clearly suggested the chiropractic profession was covering up the truth.

Inaccurate headlines may be more troublesome than inaccurate articles because “sensationalized headlines may have a framing effect when readers who may be persuaded to interpret an article based on inaccurate headlines, regardless of the content of the article." [38]

Don’t Confuse Us with the Facts

At the Lewis inquest, researchers brought to light many interesting facts about spinal manipulative therapy and stroke that the medical chirophobes weren’t expecting nor did the media report this information afterwards.

 Adrian Upton, MD, head of the Department of Neurology at McMaster Health Sciences Centre, testified at the Lewis inquest that, based on all of the evidence he had reviewed, Ms. Lewis died of a stroke caused by advanced atherosclerosis. During examination, he stated the chiropractic neck adjustment she received not long before her stroke was, at best, “a remote possibility at the bottom of the list of probabilities” for causation.  Ms. Lewis was extremely hypertensive and had discontinued medication for its treatment, obese and was a heavy tobacco user. As Upton put it, “she was a time bomb ready to explode.”[39]

A Canadian study by The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders addressed the debate whether neck adjustments can trigger a rare type of stroke, concluding there is no increased risk related to chiropractic.

Researchers found patients are no more likely to suffer a stroke following a visit to a chiropractor than they would after stepping into their family doctor's office.[40] The most definitive study to date, published in Spine by Cassidy, et al.,[41] found that while there is an association between cervical manipulative therapy (CMT) and cervical dissection (CD), a similar association exists between a visit to a family-practice medical physician and CD. These findings support the chiropractic position of its extreme safety when compared with drugs and surgery.

Despite the supportive testimony, research and final verdict absolving Lana Lewis’ chiropractor, the outcome failed to gain the same amount of headlines as did the initial “bleeding” when the story first broke.

Indeed, where does the chiropractic profession turn to redeem its reputation after besmirched in the same media? Indeed, a case can easily be made the medical media is rigged against chiropractors.

Certainly this sensationalism rekindles the fire of chirophobia to frighten the public and to influence others in the press, even though this issue of stroke has been dispelled more than once by objective scientists who don’t have an axe to grind.

The British Chickens

This stroke issue is not exclusively a North American issue. In 2010 this issue resurfaced with an incendiary report from England, “Deaths after Chiropractic: A Review of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter. He raised the level of fear over chiropractic care anew when he noted, “Twenty-six fatalities were published since 1934 in 23 articles.”[42]

Considering 26 deaths over 76 years equates to 0.34 deaths per year (one-third of a person!), instead of sounding an alarm to scare people, Ernst should have praised chiropractic care for its obvious safety since this is an extremely low rate in comparison with equivalent medical methods for the same diagnostic condition.

Ernst’s paper drew quick criticism from The Dartmouth Institute for Health Policy and Clinical Practice:

“Three deaths were reported during the last 10 years of the study, so for that most recent time period, the absolute risk could be estimated to be 3/10 per 100 million, or three deaths for every billion chiropractic encounters…This rate is so low that it cannot possibly be considered significant…An interesting flip side to the research question might be: by undergoing a course of chiropractic spinal manipulation, how many patients were able to avoid death by avoiding complications of surgical intervention?”[43]

On June 8, 2012, a London newspaper published another article that came unexpectedly and immediately went viral: Letting Chiropractor 'Crack' Your Neck to Relieve Pain Could Trigger Stroke with the teaser, “Neck 'cracking' could trigger 'catastrophic' health problems such as strokes, experts have warned.”[44]

Once again, this was a victim-less non-crime and a good example of the classic “If it bleeds, it leads” yellow journalism:

“The common therapy to ease pain is ‘clinically unnecessary’ and should be abandoned for an affliction that affects two in three people at some point in their lives.

Its effectiveness divides medical opinion with some doctors even believing it helps lower blood pressure.

Known scientifically as spinal manipulation, the technique involves the application of various types of thrusts to the lumbar spine for the lower back or cervical spine for the neck to reduce back, neck and other musculoskeletal pain.

However, physiotherapy lecturer Neil O'Connell, of Brunel University, Uxbridge, and colleagues have warned that cervical spine manipulation ‘may carry the potential for serious neurovascular complications.’

Writing online in the British Medical Journal, they added that the technique is ‘unnecessary and inadvisable.’”

The outlandish statements in the original report attributed to physiotherapy lecturer Neil O'Connell, of Brunel University, Uxbridge, were extrapolated into subsequent articles as “expert opinion” and “scientists” rather than what it was — unsubstantiated speculation by a single physiotherapist.

Let’s be clear: We are not talking about an NIH expert, nor are we listening to the U.S. Public Health Services, WHO or the British NHS. We are witnessing one physiotherapist from an unknown university in a village in England who took a swipe at chiropractors that went viral worldwide. This is clearly Chicken Little journalism, not peer-reviewed literature.

Nonetheless, this publication went viral with numerous articles appearing within days across the pond. This unfounded attack was not spurred by any event — no one had died or been injured—so this attack virtually came out of nowhere.

  1. “Letting chiropractor 'crack' your neck to relieve pain could trigger stroke.” London, Fri, 08 Jun 2012, ANI, quoting Physiotherapy lecturer Neil O'Connell, of Brunel University, Uxbridge,
  2. Why does the government subsidize chiropractic colleges? by  Steven Salzberg, Forbes, Jun. 10, 2012
  3. Is Spinal Manipulation for Neck Pain Safe? By LARA SALAHI,  ABC World News with Diane Sawyer
  4. Is spinal manipulation for neck pain safe? Experts disagree, by Kim Painter, USA TODAY
  5. Should Spinal Manipulation for Neck Pain Be Abandoned?, Science Daily (June 7, 2012)
  6. Spine manipulation for neck pain 'inadvisable, ' BBC News, 7 June 2012 
  7. "Debate over risk from spinal manipulation," NHS Choices, 7 June 2012
  8. Scientists debate safety and value of spinal manipulation for neck pain, Arthritis Research UK, Published on 08 June 2012
  9. Is Spine Manipulation for Neck Pain Safe? A common chiropractic treatment for neck pain is “inadvisable” due to a risk of stroke, and should be avoided, say experts." by Shawn Radcliffe, Men's Fitness, 
  10. Stroke risk from neck pain treatment, Spinal manipulation used by chiropractors as a treatment for neck pain should be abandoned because of the risk of causing strokes, say experts." by Peter Russell, Web MD
  11. Spinal manipulation for neck pain should be abandoned," by Ingrid Torjesen, OnMedica News, Friday, 8 June 2012

This outcry is another paranoid Chicken Little delusion aimed to cause public hysteria about chiropractic care; it’s also an example of “citation laundering”[45] whereby writers misquote the facts, embellish each other’s stories, and pass them on as “perceived wisdom” by supposed experts who quote each other or parrot incendiary comments from other non-experts because they are controversial sound bytes that “bleed.”

Fair and Balanced?

Despite the plethora of evidence about the dangers of medical care, how often have we seen comparable media articles attacking the medical profession after iatrogenic deaths?

The flap over the CDC’s attempt to reign in opioid painkillers created a short-lived look by the media into opioid addiction and deaths, but none of the articles impugned the medical profession or Big Pharma as co-conspirators to drug Americans. Indeed, who needs “El Chapo” pushing narcotics when we have “Dr. Chapo” and his drugs are perfectly legal?

These “promiscuous prescribers” were not dragged through the media although they contributed to record mortality rates with over 47,055 overdose deaths reported by the CDC in 2014, which equates overall to 128 deaths each day of which 78 are attributed to opioid prescription painkillers and opiate street heroin.[46]

To put these 128 overdose deaths into perspective – this number is equivalent to the 130 deaths when Islamic terrorists attacked Paris on the evening of November 13, 2015.

Indeed, if Islamic terrorists were killing 128 Americans daily in our country, there would be a huge public uproar, Congress would be up in arms calling for military action, and the media would be swarming for a scapegoat to blame.

But when 128 people die from medication overdoses, there has been reluctance by the media to accuse the medical profession for promiscuous prescribing or blame Big Pharma for its shady promotions of these dangerous drugs. In fact, only a handful of news programs have investigated this prescription opioid pandemic mainly due to a conflict of interest to indict their biggest sponsor, Big Pharma.

After the BMJ found there were 251,000 deaths annually in the US due to medical mistakes, certainly one would think the medical reporters would finally admit the dangers of medical practice, but only one article appeared in The Washington Post, “Researchers: Medical errors now third leading cause of death in United States.”

Although this BMJ article is ignored by the rigged media, when a beautiful Playboy pin-up has an adverse reaction to an adjustment after a “nasty fall” and an unproductive visit to a hospital, all hell breaks loose in the mainstream media to condemn chiropractic after an ill-fated adjustment.

Past president of the ACA, Keith Overland, recounted his experience in this matter:

“I have given 6 or 7 interviews on this.  Most have edited out any comments on evidence and science; instead focused on the pure emotion. At least on the Today Show we got the Haldeman article in and Cassidy was on another, but they often edited out the message that consumers needed to hear about our comparative safety.  I had all the documents and stats, and presented them simply, but those don't sell, especially when the tear was originated by a fall prior to any visits to the DC.”[47]

Obviously the mainstream media is not interested in the facts of this issue, just exploiting the death of a Playgirl with two million followers. Without a doubt, sex sells the news, especially if it bleeds with a sexy lady.

Herculean Task

Unfortunately, critics often appear in the most unlikely places. We can expect the medical trolls at ISM and at CNN to make haste whenever any patient of a chiropractor has an accident, but even unsuspecting reports emerge to smear the chiropractic profession.

For example, on September 2, 2014, the television broadcast of The Hour of Power hosted by Rev. Bobby Schuller aired a program featuring an interview with actor Kevin Sorbo who portrays Hercules in a television series, “Hercules: The Legendary Journeys”.[48]

Once again, chiropractic care was embarrassed when Sorbo told his story of suffering a stroke after a chiropractic adjustment.

 While Kevin’s comeback story and his role in Christian films such as "God's Not Dead," are noteworthy, his chiropractic accident may be used inadvertently as another blanket condemnation of chiropractic care. It was pleasing to see that Kevin turned his tragedy into triumph with his book, True Strength: My Journey from Hercules to Mere Mortal--and How Nearly Dying Saved My Life.

Sadly, I doubt anyone in the TV audience would seek chiropractic care if Hercules himself was hurt by a chiropractor. And the fact that Kevin also told his story at a convention of 1,600 neurologists will only inflame the antipathy toward chiropractors despite the rare chance of stroke or death caused by spinal manipulation and the statistics in our favor compared to medical care.

While Kevin's story represents one individual case, this interview failed to put into perspective that every procedure is fraught with some risk, but to make the “exception” in this case appear to be the “rule” does not serve to clarify the enormous value the chiropractic brings to alleviate pain and suffering.

Of course, neither Sorbo or Rev. Schuller were aware of the recent studies by M. Beaudry and JD Spence, Adrian Upton, Allan G.J. Terrett, Walter Herzog, Christine Goertz and Dana Lawrence, Jay Triano, Scott Haldeman, FJ Kohlbeck, and M. McGregor that all suggest there had to be a pre-existing condition such as a motor vehicle accident, sports injury, or perhaps in Sorbo’s case, neck trauma from his own athletic career and his many staged fights as Hercules.

The data is clear that a CMT alone cannot cause a CD or stroke that may be precipitated by a pre-existing problem as perhaps occurred in Sorbo’s case. Since he also mentioned in this interview that he was beforehand an 8-year long chiropractic patient, undoubtedly he was well-served until his accident.

In a past program, Dr. Schuller had also mentioned that he uses a chiropractor, too, so this issue was most likely unintentional if not ‘fair and balanced’ with the latest research that explains this mishap. I wrote a letter to Rev. Schuller suggesting he allow a response to this incident, but once again, it fell on deaf ears.[49]

 While Kevin’s story is unfortunately true and heart-wrenching about overcoming adversity in life, I fear his testimony will scare people from seeking chiropractic care in a time when back pain is the #1 disabling condition in the world and as researchers now suggest the medical methods of NSAIDs/aspirin, narcotic painkillers, epidural shots, and spine fusions are also fraught with serious adverse events.

Nonetheless, chirophobia and the prolong media war against chiropractors continues in the most unlikely places, including inside the church.

PR Workshop

So, how do we chiropractors in the US and around the world confront the damage done by this new attack on our profession? Certainly this Katie May tragedy will not be the last time we see this media attack.

If you recall, I recently sent a letter urging our leadership to start a PR Workshop at the upcoming ACC-ACC-WFC combined conference in Washington, DC, that seems to have fallen on deaf ears.

If this string of bad PR isn’t a wake-up call to our leadership and to the entire profession, what will it take?

Perhaps this recent embarrassment will convince them that we must organize a counter-attack by assembling our international forces of speakers, writers, and students to get them up the learning curve on these issues, the history of the media war against chiropractors and then to go on the offensive.

 I suggest every country, every state, every chiropractic college and anyone interested in becoming a spokesperson for our profession attend this workshop to learn the history of the medical war against our profession, to learn what has been done in the past as I recounted in my 2002 ACA PR Report, to learn what proactive DCs around the world are now doing, and to prepare the next generation of leaders to carry the torch.

Indeed, we can no longer wait for the next attack nor can we continue to take a spoon to a knife fight as we’ve done for years. It’s time to organize our best and brightest to go on the offensive and the best place to start is with the bad disk” scam, perhaps the biggest scam in the history of medicine.

Nonetheless, let’s assemble at the Washington conference to develop a plan to defend ourselves as well as to take our message to the public in the earned media.





[1] Brinjikji W, et al., Systematic literature review of imaging features of spinal degeneration in asymptomatic populations, American Journal of Neuroradiology, 2014, prepub ahead of print; www.ajnr.org/content/early/2014/11/27/ajnr.A4173.long.

[2] Getzendanner, Memorandum Opinion and Order p. 7.

[3] Getzendanner, Memorandum Opinion and Order,  p. 10

[4] G McAndrews closing argument, ibid. p 7076-88.

[5] Smith, JS et al. Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the Scoliosis Research Society Morbidity and Mortality Database. Spine 2012, Nov 1;37(23):1975-82

[6] Marquez-Lara A, Nandyala SV, Hassanzadeh H, Noureldin M, Sankaranarayanan S, Singh K: Sentinel Events in Cervical Spine Surgery. Spine 2014 Jan 29 [Epub ahead of print],   http://www.ncbi.nlm.nih.gov/pubmed/24480955

[7] Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.

[8] Email to American Chiropractic Association from Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, April 29, 2014.

[9] Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165:905.

[10] Cynthia English and Elizabeth Keating, Gallup, Majority in U.S. Say Chiropractic Works for Neck, Back Pain, September 8, 2015, http://www.gallup.com/poll/184910/majority-say-chiropractic-works-neck-back-pain.aspx

[13] Berger S. "How Safe Are the Vigorous Neck Manipulations Done by Chiropractors?" The Washington Post, Jan. 6, 2014.

[14] Thompson D. "Chiropractic Manipulation of Neck: Stroke Risk?" WebMD, Aug. 7, 2014.

[15] “CMT & Stroke Risk: Myth vs. Fact” by Christine Goertz, DC, PhD and Dana Lawrence, DC, M. Med. Ed., MA, Dynamic Chiropractic – November 1, 2014, Vol. 32, Issue 21

[16] http://www.chirosecure.com/clum/

[17] Beaudry M, Spence JD., Motor vehicle accidents: the most common cause of traumatic vertebrobasilar ischemia. Can J Neurol Sci. 2003 Nov;30 (4):320-5.

[18] Herzog, W. et al, Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.

Journal of Electromyography and Kinesiology;22:12, (2012), 740-746

[19] Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine (Phila Pa 1976) 2002;27(1):49–55.

[20] Haldeman S, Kohlbeck FJ, McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J Neurol. 2002;249(8):1098–1104.

[21] You Asked: Are Chiropractors Legitimate? Markham Heid @markhamh, TIME, April 6, 2016

[24] Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist, Anesth Prog. 2006 Spring; 53(1): 20–24.

doi:  10.2344/0003-3006(2006)53[20:MOMEIT]2.0.CO;2

[25] Allan G.J. Terrett, Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation (West Des Moines, IA:  NCMIC Group Inc., 2001).

[26] G Bronfort, M Haas, R Evans, G Kawchuk, and S Dagenais, “Evidence-informed Management of Chronic Low Back Pain with Spinal Manipulation and Mobilization,” Spine 8/1 (January-February 2008):213-25.

[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794386/

[28] Paul Benedetti & Wayne MacPhail, "Chiropractic twist on truth may have sparked inquest" Canoe.ca (26 June 2000), online: Canoe.ca <http://www.canoe.ca/Health0006/26_chiro.html>; Paul Benedetti & Wayne MacPhail, "Getting back to the truth; once again, the chiropractic community simply won't come clean about neck manipulation" The Hamilton Spectator (16 Feb 2004) F09.

[29] Laeeque, Hinna; Boon Heather, Health Law Review, Dec. 22, 2004, Print media coverage on the Lana Dale Lewis inquest verdict: exaggerated claims or accurate reporting?

http://www.thefreelibrary.com/Print+media+coverage+on+the+Lana+Dale+Lewis+inquest+verdict%3a...-a0128245743

[30] Ibid.

[31] Office of the Chief Coroner of Ontario, Province of Ontario, "Inquest Touching the Death of Lana Dale Lewis: Jury Verdict and Recommendations" (16 January 2004).

[32] Benedetti & MacPhail (Spectator), supra note 21 at F09.

[33] Gay Abbate, "Chiropractic neck manipulation linked to woman's death" The Globe and Mail (17 January 2004), online: The Globe and Mail <http://www.globeandmail.com/servlet/ArticleNews?TPPrint/LAC/2004117/TCHIRO17/National>.

[34] Elaine Marshall & Dawn Cuthbertson, "Chiropractic accident caused death: jury" National Post 2004 (17 January 2004) A20.

[35] Canwest Global, "Findings by coroner's jury rocking the chiropractic industry" Canwest Global (16 January 2004), online: Factiva <http://global.factiva.com> (date accessed: 23 March 2004) [on file with the author] ["Findings by coroner's jury"].

[36] Elaine Marshall, "Chiropractic procedure killed woman, inquest finds" The Gazette Montreal (17 January 2004), online: Factiva <http://global.factiva.com> (data accessed: 23 March 2004) [on file with the author].

[37] Canadian Press "Chiropractic death ruled accidental" Daily Miner & News (19 January 2004), online: Factiva <http://global.factiva.com> (date accessed: 23 March 2004) [on file with the author].

[38] Celeste M. Condit et al., "An Exploratory Study of the Impact of News Headlines on Genetic Determinism" (2001) 22:4 Science Communication 379.

[39]  Canadian News Wire, TORONTO, 03 November 2008

[40] J.  David Cassidy, DC, PhD, Eleanor Boyle, PhD, Pierre Coté, DC, PhD, Yaohua He, MD, PhD, Sheilah Hogg-Johnson, PhD, Frank L.  Silver, MD, FRCPC, and Susan J.  Bondy, PhD, Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study,” Spine 33/4, Feb. 2008:  176–83.

[41] Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine, 2009 Feb;32(2 Suppl):S201-8.

[42] E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162–1165

[43] JM Whedon, GM Bove, MA Davis, “Critique of review of deaths after chiropractic, 5” Letter to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.

[44] ANI, London, 08 Jun 2012

[45]On the Media”, NPR, March 18, 2012, http://www.onthemedia.org/2012/mar/16/calculating-body-counts

[46] Drug overdose deaths hit record numbers in 2014, CDC Newsroom Releases,  December 18, 2015

[47] Private communication with JC Smith, October 21, 2016.

[48] http://www.hourofpower.org/interviews/detail.php?contentid=8634

[49] http://chiropractorsforfairjournalism.com/Response_Hour_of_Power.html

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