Terra Sigillata

My blog posts seem to run in themes – sort of like when after you buy a car, you see other people driving that model all over the place.

Yesterday we posted about homicide charges being leveled against an unlicensed California chiropractor operating a clinic out of his garage.

That post garnered a large number of hits from a related story in the Canadian National Post, where our blog was linked under “More from the Web.”

An Alberta woman has launched a $529-million class-action lawsuit against provincial chiropractors after a neck adjustment allegedly left her paralyzed. Sandra Gay Nette, of Edmonton, has been paralyzed since September, 2007. The lawsuit claims that a chiropractic session damaged both her vertebral arteries, which disrupted blood flow to her brain. On her way home from the chiropractor, Ms. Nette had to pull her car to the side of the road and call her husband for help, the statement of claim alleges. She suffered permanent neurological damage. Ms. Nette is mentally aware, but cannot swallow, speak or breathe on her own. She has limited movement in her right arm, but nowhere else in her body.

The more I learn about chiropractic, the more I am frightened.

Comments

#1 vic
June 16, 2008

In the past Chiropractic has been asked to measure itself with research in repued journas. The latest studies scientifically demonstrae that VBA ( stroke) is an extremely rare event associated with cevical manip. Further, it is less so then with other medcial interventions for similar conditions. Do a pub med serach and let the science talk.

Spine. 33(4S) Supplement:S176-S183, February 15, 2008.
Cassidy, J David DC, PhD, DrMedSc *+++; Boyle, Eleanor PhD *; Cote, Pierre DC, PhD *+++[S]; He, Yaohua MD, PhD *; Hogg-Johnson, Sheilah PhD +[S]; Silver, Frank L. MD, FRCPC [P][//]; Bondy, Susan J. PhD +
#2 PalMD
June 16, 2008

From the canadian data, vad is rare, but fairly strongly associated with chiro neck manip…that is, a plurality of VADs that have a known cause are caused by chiro manip, but it probably take hundred of thousands to millions of individual manipulations for each VAD.

Given that VAD is a somewhat rare but devastating complication of a pretty useless therapy (little proven benefit, great proven harm), neck manipulation is clearly not worth the risk.
#3 vic
June 16, 2008

The evidence for the benifit is just as high as it is for often perscribed medications. Furtermore, the research shows just as meuch benifit as other therapies that are used for neck pain.

Spine. 33(4S) Supplement:S184-S191, February 15, 2008.
van der Velde, Gabrielle DC *+++[S]; Hogg-Johnson, Sheilah PhD *[P]; Bayoumi, Ahmed M. MD, MSc +[//]**++; Cassidy, J David PhD, DrMedSc +++[S]; Cote, Pierre DC, PhD *+++[S]; Boyle, Eleanor PhD ++[S]; Llewellyn-Thomas, Hilary PhD ++++; Chan, Stella MSc *; Subrata, Peter MSc *; Hoving, Jan Lucas PhD [S][S]; Hurwitz, Eric DC, PhD [P][P]; Bombardier, Claire MD, MSc *+[//][//]; Krahn, Murray MD, MSc +[//][//]***

Other therapies such as electrical modalities have similar complication rates.
#4 PalMD
June 16, 2008

Please read more closely. The problem with neck manipulation isn’t the absence of great benefit, but the presence of rare but great harm.

If neck manipulation prevented heart attacks or cured lymphoma, the risk would clearly be worth it.
#5 DrMike
June 16, 2008

The benefits of manipulation outweigh the benefits of medications that are typically used instead of chiropractic care. The risks of those medication far outweigh the risks of manipulation. Also, recent study out of the University of Chicago school of medicine showed that upper cervical manipulation signifcantly reduced hypertension. If not chiropractic care, then what? Medications with higher risk? PT with lesser outcomes? Face it, we’re here to stay, which is why MD’s and PT’s are now trying to duplicate us.
#6 Joe
June 17, 2008

MrMike,

I don’t suppose you are going to provide citations to valid research showing the benefits of the neck-snap. The hypertension study is in an obscure magazine, and the lead author (Bakris?) has been playing it down.

On the other hand, some chiros are playing up their safety because they don’t snap necks. However, the chiro fan magazine Dynamic Chiropractic had a recent article titled “Chiropractors Eating Their Own.” http://www.chiroweb.com/archives/26/02/11.html The author bemoans the fact that some chiros are now advertising “Spinal correction without twisting or popping the neck.” He thinks this emphasis on safety makes their industry look bad!?

As for your assertion that MDs and PTs are trying to duplicate your results; no, they successfully avoid causing strokes. Here is a recent video (ca. 42 mins) explaining why chiro is a bad idea, and why health care professionals are not implicated in strokes. http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv
#7 Joe
June 17, 2008

This was the video (approx. 3 mins) in which Sandra Nette�s husband said that the first words out of the doctor�s mouth after viewing the MRI results were �Chiropractor�right?�
http://watch.ctv.ca/news/latest/class-action-lawsuit/#clip59878
#8 Paul
June 17, 2008

Hi Joe

?As for your assertion that MDs and PTs are trying to duplicate your results; no, they successfully avoid causing strokes.?

I am afraid they do. In a German study published in Neurology in 2006, an attempt was again made to link chiropractic and stroke when in fact none of those adjustments/ manipulations were carried out by chiropractors. 1 Half of the manipulations (not skilled chiropractic adjustments) that resulted in stroke were carried out by orthopaedic surgeons the other half by untrained unqualified heilopraktkers masquerading as ?chiro-practitioners.?

Your video ? it?s not from a pharmaceutical sponsored medical college is it? Do you know anything of the Wilks case?

I do wish Ms. Nette the very best whether or not the incident was as a result of her adjustment. It?s unfortunate she has become a pawn.

There is an element of risk with everything in our lives but it needs perspective.

From the citation of the first comment, the associated incidence of stroke post chiropractic visit is 1 in 5.85 million and is the same as the incidence of stroke post medical clinician visit.

Put into perspective, what are the risks for every day activities and medication promoted everyday? Reversing the car, jogging, taking HRT, blood pressure medication, cholesterol lowering medication, even taking a neurofen, a pain killer or an anti-inflammatory instead of being adjusted?

Even if we were to agree the association of one in 1 in 5.85 million, this is over 700 times lower than the established risk of death from taking anti-inflammatories such as aspirin and ibuprofen, yet these are prescribed everyday for head, neck and back pain. The figure of association is also much less than that associated with many everyday activities including reversing a car, jogging, tai chi, various sleeping positions, coughing, stooping to get a bucket and even yawning.2-4 Yes you are more likely to die from yawning than a chiropractic adjustment. Now do you see it?

In 2002, researchers announced they were calling a halt to a study after it had become clear that the risks of HRT, including stroke, outweighed its benefits. The study results, which appeared in the July 17, 2002 issue of the Journal of the American Medical Association, were released early because of the importance of the researchers’ findings. 5 HRT is still being prescribed, long term, despite this.

There is interestingly enough evidence to show those being adjusted are less likely to have a stroke. When you compare estimates of the risk of stroke following neck adjustment/ manipulation (using the higher estimate of 0.00025%) to the risk of fatal stroke occurring in the general U.S. population (0.00057%) it is less than half.6-10 There is also ample proof to show people adjusted regularly clearly benefit from regular chiropractic care and enjoy a higher level of health, mobility and an improved quality of life.

1.Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. Reuter U, Hamling M, Kavuk I, Einhaupl KM, Schielke E; J Neurol. 2006 Jun;253(6):724-730.

2. Dabbs V, Lauretti W. A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics 1995; 18(8): 530-536.

3. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. New England Journal of Medicine 1999; 340(24): 1888-99.

4. Graumlich JF. Preventing gastrointestinal complications of NSAIDs: Risk factors, recent advances, and latest strategies. Postgrad Med 2001; 109(5): 117-28.

5. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. Principal Results From the Women’s Health Initiative Randomized Controlled Trial. Journal of the American Medical Association. 2002;288:321-333.

6. Myler L: Letter to the editor. Journal of Manipulative and Physiological Therapeutics 1996;19: 357.

7. Cohn A. A review of the literature regarding stroke and chiropractic. Journal Of Vertebral Subluxation Research 2001;4(3):42-59.)

8. Shievink WT, Mokri, B, O’Fallon WM. Recurrent spontaneous cervical-artery dissection. New England Journal of Medicine 1994; 330: 393-397.

9. Shievink WT, Mokri B, Whisnant JP. Internal carotid artery dissection in a community: Rochester, Minnesota, 1987-1992. Stroke 1993; 24: 1678-1680.

10. Giroud M, Fayolle H, Andre N, Dumas R, Becker F, Martin D, Baudoin N, Krause D. Incidence of internal carotid artery dissection in the community of Dijon [Letter]. Journal of Neurology and Neurosurgical Psychiatry 1994; 57: 1443.
#9 DrMike
June 17, 2008

Joe- Why so antagonistsic and petty by calling me Mr? You know I am a Dr. You know that chiropractic education is very strong in differential diagnosis and by virtue of the US Dept of Education I have earned my doctorate. Actually, because of my ability to differentially diagnose organic pathologies from mechanical lesions the state where I practice has licensed me as a “chiropractic physician.” I do not need to list the evidence regarding PT and MD manipulation causing more harm at a rate of nearly 100:1 vs chiropractors because Paul so capably did such. PT’s and MD’s do less than 4% of the manipulation yet, cause nearly 80% of the injuries. Let’s be factual if we are going to stand up and be counted. we are not afraid of facts and do not rely on assumption. So, my unbalanced and uniformed friend, your assumptions are showing.
#10 StuV
June 17, 2008

my unbalanced and uniformed friend, your assumptions are showing

Thanks, I needed a laugh.
#11 Joe
June 17, 2008

Mike,

Yes, I know Wilk v AMA; do you? You cite it as if it validated chiropracty, it did not. The judge acknowledged that the AMA made a strong case that chiropracty is a sham; but she was deciding a business complaint. (Cue the chiro to say that judges cannot understand the technicalities of chiropracty.)

I know you are not a doctor, I never confuse a chiro with a medical professional; you are not even as well trained as a PT, let alone a doctor. I know that you can graduate and get a license without seeing anyone who is ill. Yes, by DoE standards you have a degree; as do some astrologers. That’s right, DoE recognition only assures that government sponsored student loans are secure. They care not one whit what the topic is. As for a law allowing you a title, everyone knows “the law is a ass- a idiot.”

How can anyone respect someone who believes in subluxations, Innate Intelligence, and that DD Palmer cured deafness by “adjusting” a man’s thorax?

Mike wrote “I do not need to list the evidence regarding PT and MD manipulation causing more harm at a rate of nearly 100:1 vs chiropractors because Paul so capably did such. PT’s and MD’s do less than 4% of the manipulation yet, cause nearly 80% of the injuries.”

Yes, you do need to list that evidence because it is contrary to most experience. Whoever Paul is, he did not cite any evidence. I assert that there is no benefit from your neck snap that cannot be achieved, more safely, otherwise. Your mission, if you decide to accept it, is to prove otherwise. Be warned: many chiros have accepted that challenge and were never heard from again. One rule is you must cite quality, medical literature; not the dreck published by, and for, quacks. I won’t waste my time looking at JMPT and JVSR since there peer reviewers have such low “standards.”
#12 DrMike
June 17, 2008

MeanJoe-

Yes, very familiar with Wik v AMA, although I did not cite it. I read your vitriolic biased diatribe and still am left wondering what the hell you are talking about? I practice a very clean, highly effective and safe form of physical medicine. In all my years in practice I have never once used the word “subluxation” although I now read it in some medical reports addressed to me. You’ve got to get out of 1895 if you are going to argue against chiropractic. I’m just trying to help you make some sense here. The overwhelming majority of the profession left that stuff behind many decades ago. Catch up with current times please if you want to debate with the big boys. Otherwise, who reads this thing? with this level of uninformed argument it hardly has credibility in itself. Scary huh? You so wlost on so many levels here and are much less credible than the chiropractors you have such deep hatred for, jealously toward, and fear of. Facee it we are here to stay and growing and excelling more and more each decade.
#13 StuV
June 17, 2008

Oh my, how precious.

MeanJoe

Are you joking? Anyone who calls your precious beliefs in question is “mean”? No wonder you don’t do well in the scientific community.

and still am left wondering what the hell you are talking about

That is becoming painfully obvious. No worries, you’re the only one though.

I practice a very clean,

I am thrilled that you wash your hands.

highly effective

Get some proof and come back.

and safe form of physical medicine.

Wait. Scroll up. Read the damned article. Go on, we’ll wait.

The overwhelming majority of the profession left that stuff behind many decades ago.

Wait, so now we have to distinguish between quack chiropractors and “real” chiropractors? Don’t the quacks possess the same quality education as you do? Use the same titles? Read from the same books?

Catch up with current times please if you want to debate with the big boys.

Delusions of grandeur do not make you right. Proof, please. Put up or shut up, big boy.

Scary huh? You so wlost on so many levels here

Yeah, meanies, no keepsies!

Tell me, honestly, you stomped your feet when you typed that, didn’t you?

the chiropractors you have such deep hatred for, jealously toward, and fear of.

Hatred? For the quack contingent, disgust. For the merely deluded, pity. And disgust. And yes, I am jealous of the ability to bilk people out of money for treatments that are only marginally helpful to some and downright dangerous at times. My conscience won’t let me do it.

And yes, I have a distinct fear of being paralyzed.

Facee it we are here to stay and growing and excelling more and more each decade.

Interesting. Any numbers to back that up?
#14 Joe
June 17, 2008

Mike, you did cite “Wilks” look at what you wrote.

Aside from that, Mike wrote “In all my years in practice I have never once used the word “subluxation” although I now read it in some medical reports addressed to me.” And “The overwhelming majority of the profession left that stuff behind many decades ago.”

Not according to the survey by and for chiros in 2003 �How chiropractors think and practice� William P. McDonald et al “Seminars in Integrative Medicine” 2004 V.2 #3 92-98 ISSN 1453-1150

Abstract http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75KC-4F1H9GS-5&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=754fe88415cd702aa52be6484f7005b8

Are you, also, ignorant of the recent (2006) chiro paradigm? http://www.chirocolleges.org/paradigm_scopet.html “Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.” And in the most recent issue of your news magazine “Is the Spinal Subluxation a Risk Factor?” http://www.chiroweb.com/columnist/gatterman/index.html You must be the most ignorant among the most ignorant.

“Catch up with current times please if you want to debate with the big boys.” Back at you! “Quackery 101″ is denial of claims; unfortunately, for you, chiroquackery is abundantly documented in your own literature.

Your own news magazine suggests your cult is not growing, read it. But don’t take the advice on what to do about it, it is as bogus as the subluxation.
#15 StuV
June 17, 2008

Some more nuggets from the paradigm:

The foundation of chiropractic includes philosophy, science, art, knowledge, and clinical experience.

I’m sorry… art?

A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.

Can you FEEL the science!
#16 Jane
June 17, 2008

Obviously this is a sensitive topic…and I can see why. It calls into question the chiropractic profession as a whole, but it doesn’t need to. There are both careful and careless people in every profession. I believe that respect for those who do a good job is just as important as calling on those who make mistakes to correct them.
#17 PalMD
June 17, 2008

Yes.

Of course, there are careful and careless shamans too…
#18 Paul
June 18, 2008

Joe, you stated: “I assert that there is no benefit from your neck snap that cannot be achieved, more safely, otherwise. Your mission, if you decide to accept it, is to prove otherwise. Be warned: many chiros have accepted that challenge and were never heard from again. One rule is you must cite quality, medical literature; not the dreck published by, and for, quacks.”

Here it is:

http://jmmtonline.com/documents/editorials/EditorialV14N1.pdf

http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS0161475405000552/fulltext

Whilst you state a preference for literature other than JMPT “since their peer reviewers have such low standards” it might be refreshing to hear that they are not drug company sponsored nor influenced and are widely accepted to be of equal standard of peer review to the BMJ and JAMA.

JVR whilst publishing mostly anecdotal evidence is not of the same level I agree but is of interest none the less.

And you review of the Wilks v AMA is disingenuous bordering on an untruth.

What the case Judge did state was “Trial evidence showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive misinformation campaign to discredit and de-stabilize the chiropractic profession, and engaged in numerous other activities to maintain a medical physician monopoly over health care in this country (US).”

Which is pretty much what you just did in your last few posts.

You’re not a medical practitioner by any chance are you?

.
#19 Blue Wode
June 18, 2008

@ vic
Is David Cassidy, the principal author of the Spine study which you cited, the same David Cassidy who was sued in Saskatchewan in 1999 by his research assistant for falsifying data, and 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”? Is he the same David Cassidy who, before he was dismissed from the University of Saskatchewan, was called as an “expert” witness by the Chiropractic Association of Saskatchewan (CAS) at Sharon Mathiason�s daughter�s inquest and who is in record as saying “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” – and who then went on to admit on the stand into the death of Sharon Mathiason�s daughter they he had manipulated the neck of a woman and caused a stroke (a very severe one called Wallenberg�s syndrome)? See here:
http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

@ Paul
Re your comparison of the risks of chiropractic neck manipulation with medications. It�s worth remembering that prior to taking OTC and/or prescription medications most patients have the chance to read the accompanying Patient Information Leaflets which invariably list the evidence based benefits and risks of each preparation. However, when carrying out their legal duty to obtain informed consent from their patients, it is evident that many chiropractors are failing to tell them not only of the lack of scientific evidence for ‘chiropractic’, but also of the risks involved with it:

Consent: its practices and implications in United Kingdom and United States chiropractic practice

CONCLUSION: Results from this survey suggest a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.

http://tinyurl.com/6ajn5d

Consent or submission? The practice of consent within UK chiropractic

CONCLUSION: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.

http://tinyurl.com/559ued

Indeed, if you watch this 3-min CTV clip which was posted by Joe, you�ll see Sandra Nette confirm that she wasn�t told about the potential risks involved with her chiropractic treatment:
http://watch.ctv.ca/news/latest/class-action-lawsuit/#clip59878

@ Dr Mike
You said �I do not need to list the evidence regarding PT and MD manipulation causing more harm at a rate of nearly 100:1 vs chiropractors because Paul so capably did such. PT�s and MD�s do less than 4% of the manipulation yet, cause nearly 80% of the injuries. Let�s be factual if we are going to stand up and be counted. We are not afraid of facts and do not rely on assumption.�

Well, according to this paper
http://www.ptjournal.org/cgi/content/full/79/1/50
you seem to have your facts the wrong way round. (See Fig.2)
#20 Blue Wode
June 18, 2008

@ Paul
Re the Wilks case:

�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
#21 Blue Wode
June 18, 2008

@ vic
Is David Cassidy, the principal author of the Spine study which you cited, the same David Cassidy who was sued in Saskatchewan in 1999 by his research assistant for falsifying data, and 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”? Is he the same David Cassidy who, before he was dismissed from the University of Saskatchewan, was called as an “expert” witness by the Chiropractic Association of Saskatchewan (CAS) at Sharon Mathiason�s daughter�s inquest and who is in record as saying “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” – and who then went on to admit on the stand into the death of Sharon Mathiason�s daughter they he had manipulated the neck of a woman and caused a stroke (a very severe one called Wallenberg�s syndrome)? See here:
http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

@ Paul
Re your comparison of the risks of chiropractic neck manipulation with medications. It�s worth remembering that prior to taking OTC and/or prescription medications most patients have the chance to read the accompanying Patient Information Leaflets which invariably list the evidence based benefits and risks associated with each preparation. However, when carrying out their legal duty to obtain informed consent from their patients, it is evident that many chiropractors are failing to tell them not only of the lack of scientific evidence for ‘chiropractic’, but also of the risks involved with it:
Consent: its practices and implications in United Kingdom and United States chiropractic practice
CONCLUSION: Results from this survey suggest a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.
http://tinyurl.com/6ajn5d

Consent or submission? The practice of consent within UK chiropractic
CONCLUSION: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.
http://tinyurl.com/559ued

Indeed, it you watch this CTV clip (3 mins) which was posted by Joe, you�ll see Sandra Nette confirm that she wasn�t told about the potential risks involved with her chiropractic treatment:
http://watch.ctv.ca/news/latest/class-action-lawsuit/#clip59878

@ Dr Mike
You said �I do not need to list the evidence regarding PT and MD manipulation causing more harm at a rate of nearly 100:1 vs chiropractors because Paul so capably did such. PT�s and MD�s do less than 4% of the manipulation yet, cause nearly 80% of the injuries. Let�s be factual if we ar going to stand up and be counted. We are not afraid of facts and do not rely on assumption.�

Well, according to this paper http://www.ptjournal.org/cgi/content/full/79/1/50 you have your facts the wrong way round. (See Fig.2)
#22 Joe
June 18, 2008

Paul wrote “Whilst you state a preference for literature other than JMPT … it might be refreshing to hear that they are not drug company sponsored nor influenced and are widely accepted to be of equal standard of peer review to the BMJ and JAMA.

It is not refreshing to note the reviewers are members of the cult of subluxation. JMPT is only on a par with medical journals in the fevered imaginations of those cult members.

AS for Wilk v AMA, Judge Getzendanner noted 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.” That situation continues, despite attempts to conceal it.

I note you did not support Mike’s attempt to dismiss the importance of the subluxation. This is the second time in recent memory that a chiro pretended that silly notion has been abandoned; I find it an interesting development.

The challenge to justify the neck-snap was issued to “no-subluxation-in-chiropracty” Mike, I doubt we will hear from him again. Paul, you have failed to provide reliable evidence that the neck-snap does anything that cannot be achieved, more safely, otherwise.
#23 Paul
June 18, 2008

Hi Blue Wode

“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.”

My post was not meant to infer the ruling endorsed effectiveness it was intended to drew attention to the AMA’s antichiropractic campaign and restraint of trade.

In regard to the ruling and evaluation of chiropractic methods. Either it is or it is not. In one post and now repeated by Joe MD I am told it was and that chiropractic was a quackery and in your post I am told it wasnt a ruling on its efficacy.

However what is no in question is that it did not make aa ruling on the efficacy of medicine but it is well reviewed here:

http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

By the way I love that chirobase site, you got to love a guy that provides expert testimony as a psychiatrist whilst not having a medical licence and who also states he is a legal expert even though he had no formal legal training. And lets not mention his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA), nor the source of his funding.

Joe in regard to not providing reliable evidence that upper cervical manipulation does something that cannot be achieved more safely perhaps you could provide evidence to disprove its validity? I doubt it.

Its an interesting point with sceptics. Scepticism used to be viewed as an intellectual virtue whose objective was the truth. But sceptics themselves generally have strong beliefs of their own; the more militant the sceptic, the stronger the belief.

Scepticism has become an important weapon to defend belief by attacking opponents and today has become an important weapon in the defence of commercial self interest, describing opposing views as junk science or not scientific at all.

I ll have to go now. I have a very busy chiropractic office and find this discussion has ground down to an issue of beliefs.

Best Wishes.

.
#24 Blue Wode
June 18, 2008

Hello Paul

Re: �Joe in regard to not providing reliable evidence that upper cervical manipulation does something that cannot be achieved more safely perhaps you could provide evidence to disprove its validity? I doubt it.�

Interestingly, this systematic review concluded that exercise was just as good as chiropractic spinal manipulation for neck pain:

�In conclusion, the notion that CSM (chiropractic spinal manipulation) is more effective than conventional exercise treatment in the treatment of neck pain was not supported by rigorous trial data.�

Ernst E. Chiropractic spinal manipulation for neck pain: a systematic review. J. Pain. 2003 Oct;4(8):417-21
http://tinyurl.com/64rlwz

And there�s this too:

�It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question�non-steroidal anti-inflammatory drugs (NSAIDs)�cause considerable problems, for example gastrointestinal and cardiovascular complications.72,73 Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.
-snip-
In conclusion, spinal manipulation, particularly when performed on the upper spine, has repeatedly been associated with serious adverse events. Currently the incidence of such events is unknown. Adherence to informed consent, which currently seems less than rigorous,75 should therefore be mandatory to all therapists using this treatment. Considering that spinal manipulation is used mostly for self-limiting conditions and that its effectiveness is not well established,5 we should adopt a cautious attitude towards using it in routine health care.�

Ernst E. Adverse effects of spinal manipulation: a systematic review, J R Soc Med 2007;100:330-338
http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

BTW, The reviewers of this study commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent:
http://pediatrics.aappublications.org/cgi/content/full/119/1/e275
Vohra S. Adverse events associated with pediatric spinal manipulation: A systematic review. Pediatrics 119(1) January 2007, pp. e275-e283

[It's also worth noting that the Vohra study didn�t consider harmful aspects of chiropractic care that are far more common than the reported events. They include (a) decreased use of immunization due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations," and (d) financial harm due to unnecessary treatment.
http://www.ncahf.org/digest07/07-14.html ]
#25 StuV
June 18, 2008

Scepticism used to be viewed as an intellectual virtue whose objective was the truth. But sceptics themselves generally have strong beliefs of their own; the more militant the sceptic, the stronger the belief.

Nice try. Just because people do not believe in your quackery without evidence means… THEY DO NOT BELIEVE IN YOUR QUACKERY.

Scepticism is the absence of belief.

Care to try again, or are you busy paralyzing people?
#26 Huh?
June 21, 2008

What a bunch of self relieving ego trippers. You ask for evidence. Its presented. Then you present your evidence and expect it accepted and begin a round of name calling. Here is is then you bunch of murdering medical believers read up your own evidence and see what you have done to the world’s health care systems.
#27 Ron Hylton
April 17, 2009

I am a 51 year old male that suffered a stoke after a neck adjustment on March 4 2009. I spent 10 days in hospital and 10 days in rehab. I am still recovering and very thankful that I lived.
#28 biologist25
January 12, 2010

Interestingly, today (Jan 12,2010) the supreme court denied the application for the class-action suit filed against Dr. Stiles, the alberta government and the chiropractic profession. It seems there is not enough evidence that cervical manipulation causes strokes in general, let alone enough evidence that Ms. Nettes stroke was caused by such a maneuver.

@ Ron Hylton: Evidence suggests your stroke was in progress or impending before your cervical manipulation.

It is quite interesting though how anecdotal evidence such as your experience is so often used against the chiropractic profession, but anecdotal evidence showing positive outcomes is never considered equally as worthy (eg: 100 years of happy and satidfied patients)