UK Attack on Chiro


The following article in News Track India indicates the war on chiropractic in the media continues. It’s shocking that this one-sided article did not allow a chiropractic response, illustrating again the media bias. Imagine if the Republicans attack the Democrats w/o any response what the uproar would be. Apparently “fair and balanced” does not apply to medical journalists, so I contributed my own response.

June 11, 2012

To: Editor, NEWS TRACK India

RE: Response to “Letting chiropractor ‘crack’ your neck to relieve pain could trigger stroke.” London, Fri, 08 Jun 2012 ANI

Dear Editor:

According to your report, “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 above attack on spinal manipulation (SMT) is nothing less than another spurious attempt by medical Nazis to frighten the public from one of the safest methods to alleviate neck pain. Numerous studies affirm the value of cervical manipulation, but apparently Mr. O’Connell is less aware of these studies than his goal to scare the public with unwarranted statements.

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 the 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]

If we were to take a look at the rates of iatrogenic deaths from medical care, the numbers are staggering. Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, reported that medical care is now the third-leading cause of death in the U.S., causing 225,000 preventable deaths every year. [3]

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. [4]

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 [5] 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,[6] which clearly suggests the safety of care provided by chiropractors.

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.”[7] 

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;[8]
  • 100 times greater risk of dying from general anesthesia;[9]
  • 160-400 times greater risk of dying from use of NSAIDs;[10]
  • 700 times greater risk of dying from lumbar spinal surgery;[11]
  • 1000-10,000 times greater risk of dying from traditional gall bladder surgery;[12]
  • 10,000 times greater risk of serious harm from medical mistakes in hospitals.[13]

Obviously these medical risks are unknown by the public and untold by the medical propagandists to the media, yet the same medical professionals who criticized chiropractors forget to mention these facts (a case of “professional amnesia” as Dr. Rosner suggests) 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, the medical misinformers have again raised unwarranted concern for strokes caused by manipulation. A 2010 study from England, “Deaths After Chiropractic: A Review Of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter, once again raised the level of fear over chiropractic care when he noted that “Twenty-six fatalities were published since 1934 in 23 articles.”[14]

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).[15]

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?[16] (emphasis added)

If your news organization subscribes to “fair and balanced” reporting, I suggest you inform your readers that Neil O’Connell is painfully incorrect in his assessment of the value of SMT. Apparently his motivation as a physiotherapist is truly one of professional jealousy; at worst certainly he is a medical misinformer along the lines of Edzard Ernst. Whichever, he has done a great disservice to the public by suggesting they avoid chiropractic care considering the poor outcomes and risks of medical care for these conditions.


JC Smith, MA, DC

Warner Robins, GA, USA

[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] B Starfield, “Is US Health Really the Best in the World?” JAMA 284/4 (July 26, 2000):483-485.

[4] John J. Triano, Current Concepts in Spinal Manipulation and Cervical Arterial Incidents by (Jan 1, 2006)

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

[6] The Burton Report, “Why Spine Care is at High Risk for Medical-Legal Suits,”

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

[8] J Paling, 2000.

[9] Paling, ibid.

[10] 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.

[11] 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.

[12] Paling, ibid.

[13] Paling, ibid.

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

[15] 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.

[16] 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.