Articles by JCS

Strokes & AHA

                                                                                                                                                         

Chicken Little Crows Again

Yellow Journalism from

the American Heart Association

Every few years, the AMA’s fear mongers attack chiropractors with spurious claims about the danger of cervical spinal manipulation causing strokes.  Certainly this makes headlines for a while to alarm the public but, in fact, it is simply another desperate crow by Chicken Little journalism.

Since the medical profession cannot face the truth about their ineffective, dangerous, disproven, and expensive spine treatments (narcotic painkillers, epidural steroid injections, and spine surgery based on the out-dated ‘bad disc’ diagnosis) compared to safe and effective chiropractic care, the medical trolls renew the stroke issue to frighten the public and influence the press even though this issue has been dispelled more than once by real scientists who don’t have an axe to grind.

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.”

And this is supposed to be a “new scientific statement”?  Okay, stop laughing! Obviously the AHA’s brand of scientific journalism has fallen to a new low of yellow journalism.

Instead of fear-mongering, perhaps we should look at the facts rather take than the skewed opinion of a yellow journalist. Instead of instilling fear in the public, the facts concerning the safety of chiropractic care will buoy public confidence in our effective brand of spine care.

According to research by Alan Terret et al., the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic is only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.[1]

“We didn’t see any increased association between chiropractic care and usual family physician care, and stroke,” said Frank Silver, one of the researchers and also a professor of medicine at the University of Toronto and director of the University Health Network stroke program. [2]

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

The findings, which were published in the journal Spine,[3] helped to shed light on earlier studies that had cast a cloud on the chiropractic profession and suggested that their actions resulted in some patients suffering a stroke after treatment. In fact, the findings support the chiropractic position of its extreme safety when compared with drugs and surgery.

If we were to take a look at the rates of iatrogenic deaths from medical care (an issue medical trolls never broach), the numbers are staggering. According to the Journal of Patient Safety, as many as 440,000 patients a year die from hospital errors.[4] In all, some claim this figure is now over 1.5 million deaths due to medical mistakes.[5]

Why no mention of this medical iatrogenesis by Dr. Biller? If he seriously wants to discuss safety in treatments, why did he ignore the most obvious cause of patient deaths by medical procedures?

The fact is malpractice insurance companies know which doctors are hurting patients, and the actuaries show that chiropractors have the lowest malpractice rates among all spine practitioners. Chiropractors pay approximately $1,600 annually[6] compared to spine surgeons, who typically derive as much as 62 percent of all of their professional income from performing surgical procedures on the lumbar spine, will pay approximately $71,000 to over $200,000,[7] which clearly suggests the safety of care provided by chiropractors.

In 2006, Jay Triano, DC, PhD, wrote about the stroke issue in his publication, Current Concepts in Spinal Manipulation and Cervical Arterial Incidents, that included 675 references and a comprehensive discussion of cervical artery injury and manipulation. He also came to the sobering conclusion that chiropractic is very safe:

  • The increased risk of death resulting from NSAID use is 1,500 times greater than the risk of tetraplegia following cervical SMT.
  • On analysis, SMT as delivered by chiropractors is one of the most conservative, least invasive and safest of procedures in the provision of health care services. 
  • The risks of SMT pale when compared to known medical risks.  Chiropractors, by their training and skill in SMT and special emphasis on the spine, are the best positioned to deliver this mode of health care to the public.
  • Conclusion: 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. [8]

A study by Anthony Rosner, PhD, comparing medical procedures to chiropractic care concerning strokes flipped this coin to mention patients need to be warned of the dangers of medical procedures rather than chiropractic care. As he suggests, “The statistics really begin to spin one's head.”[9] 

Using a baseline figure of one per one million as an estimate of stroke incidence attributed to cervical manipulations, one finds a:

  • two times greater risk of dying from transfusing one unit of blood;[10]
  • 100 times greater risk of dying from general anesthesia;[11]
  • 160-400 times greater risk of dying from use of NSAIDs;[12]
  • 700 times greater risk of dying from lumbar spinal surgery;[13]
  • 1000-10,000 times greater risk of dying from traditional gall bladder surgery;[14]
  • 10,000 times greater risk of serious harm from medical mistakes in hospitals.[15]

Obviously these medical risks are unknown by the public and untold by the medical propagandists to the media, yet the same MDs who criticized chiropractors forget to mention these facts (the “professional amnesia” Dr. Rosner suggests many medical writers are inflicted) of the remote danger of manipulation or the fact that patients who seek medical care are equally susceptible, if not more so, to medical mistakes and iatrogenic problems.

Despite the overwhelming support for chiropractic manipulation for neck problems, perhaps the most blatant yellow journalism occurred in the 2010 study 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 when he noted that “Twenty-six fatalities were published since 1934 in 23 articles.”[16]

Considering this covers 76 years and equates to 0.34 deaths per year, instead of sounding an alarm to scare people as Ernst attempted, he 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 leading medical and chiropractic scholars. According to SM Perle, S French, and M Haas:

“Ernst ignored the evidence against a causal relation between spinal manipulation and death. Instead, he went boldly along a path of fear mongering and propaganda that we expect was predetermined to establish the dangers of CSM (cervical spinal manipulation).”[17]

Another review from The Dartmouth Institute for Health Policy and Clinical Practice was equally critical:

“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?”[18]

If Dr. Biller and the AHA were truly concerned about disseminating the truth about strokes, the recent article would have concluded that chiropractic care is safer, cheaper, and more effective than anything the medical world offers. Indeed, both Dr. Biller and the AHA should be ashamed with this blatant yellow journalism devoid of the facts but filled with trash talk.

Instead of telling the scientific truth, Dr. Biller and the AHA decided to take a cheap shot of yellow journalism to defame chiropractors. How sad that the medical profession remains mired in bigotry toward chiropractic, aka, chirophobia, in this era of equality and fairness in the American society. Not only is their chirophobia a disservice to all chiropractors, it is a greater disservice to suffering patients who could be helped with our brand of effective spine care.

I suggest Dr. Biller and the AHA owe the chiropractic profession and the American public an apology for this offensive and inaccurate article that was solely aimed at fostering chirophobia instead of focusing on the truth.

 



[1] AGJ Terret, Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation, NCMIC Group Inc, West Des Moines, Iowa, (2001)

[2] 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.

[3] JD Cassidy, E Boyle,  P Cote, Y He, S Hogg-Johnson, FL Silver, and SJ Bondy, “Risk of Vertebrobasilar Stroke and Chiropractic Care Results of a Population-Based Case-Control and Case-Crossover Study,” Spine 33/4S, (Feb. 2009):S176–S183.

[4] James, John T. PhD, A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care, Journal of Patient Safety, September 2013 - Volume 9 - Issue 3 - p 122–128

[5] "Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually". The National Academy of Science. 2006. Retrieved 2006.

[6] National Chiropractic Mutual Insurance Company rate (2009)

[7] The Burton Report, “Why Spine Care is at High Risk for Medical-Legal Suits,” www.burtonreport.com/infforensic/MedMalSpCommonCause.htm

[8] Cassidy, ibid.

[9] A Rosner, “Evidence or Eminence-Based Medicine? Leveling the Playing Field Instead of the Patient,” Dynamic Chiropractic  20/25 (November 30, 2002) 

[10] J Paling www.healthcare speaker.com, 2000.

[11] Paling, ibid.

[12] V Dabbs, W Lauretti. “A Risk Assessment Of Cervical Manipulation Vs NSAIDs For The Treatment Of Neck Pain,” Journal of Manipulative and Physiological Therapeutics 18/8 (1995):530-536.

[13] RA Deyo, DC Cherkin, JD Loesser, SJ Bigos, MA Ciol, “Morbidity and Mortality In Association With Operations On The Lumbar Spine: The Influence Of Age, Diagnosis, And Procedure,” Journal of Bone and Joint Surgery Am 74/4 (1992):536-543.

[14] Paling, ibid.

[15] Paling, ibid.

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

[17] SM Perle, S French, and M Haas, “Critique of Review of  Deaths after Chiropractic, 4” Letters to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.

[18] 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.


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