New study pits Neurologists vs. Chiropractors

BostonGlobe ^ | 5/27/2003 | Stephen Smith

[Jimmyclyde]

It is the medical world's equivalent of the Hatfields and McCoys: Neurologists vs. chiropractors, conventional vs. alternative medicine.

And the feud just got a little nastier this month, with the brain specialists using a freshly minted study by university researchers to load their slingshots with new ammunition aimed at chiropractors. That research links strokes in younger patients to chiropractic neck manipulations.

[Woahhs]

Your observations seem pretty much on the mark. The dirty little secret of healthcare is western medicine is abysmal at treating soft tissue complaints and eastern medicine sucks for things that are actually broken or damaged.

It really doesn't take much success on either side to make the other guy look inept.

[Woahhs]

I got news for you...Chiropractors aren't the only ones practicing silence. The only one you can trust your healthcare to is yourself.

[gas_dr]

You know, I noticed that but I thought I would take the high road :)

[chiromommy]

A few statistics to add a little perspective to the discussion:

Risk of death in fatal air crash, flying three
hours on a U.S. commercial airline: 1 in 2,000,000

Risk of death in motor vehicle accident, driving
35 miles: 1 in 2,000,000

Risk of being injured in motor vehicle accident,
driving ½ mile: 1 in 2,000,000

Risk of serious stroke or neurological
complication resulting from a chiropractic neck
adjustment: 1 in 2,000,000 treatments

Risk of death, per year, from GI bleeding due
to NSAID use for osteoarthritis and related
conditions: 800 in 2,000,000

Overall Mortality rate for spinal surgery: 7 in 10,000

Death rate from cervical spine surgery: 4-10 in 10,000

Rate of serious or life-threatening
complications from spinal stenosis surgery: 5 in 100

Risk of a developing a gastric ulcer visible on
endoscopic examination after 1 week’s
treatment with naproxen (at 500mg twice daily): 19 in 100
(380,000 in 2,000,000)


When placed in the context of other "risks," chiropractic care is actually much safer than a lot of commonly accepted procedures. The medical literature contains numerous reports of similar arterial dissections resulting from common medical procedures such as administering anesthesia during surgery, extending the neck during dental procedures or taking X-rays, or from normal activities such as talking on the telephone, swimming, yoga, stargazing, overhead work, or during sleep. “Beauty Parlor Stroke,” caused by extending the neck over a sink while washing the hair, is well-documented, but nobody is calling for an end to the hairdressers' right to wash hair. People fear what they don't understand and those who stand to gain from this fearmongering continue to do a great job of misinforming the public with half-truths and flawed research.

When considering the "safety" of modern medicine versus chiropractic, take a look at malpractice insurance rates. Chiropractic malpractice insurance is a fraction of that of medical doctors, and we all know that insurance companies are all about risk management. If we are the stroke-causing quacks you would have the public believe, why are researchers from Duke University and other reputable healthcare institutions supporting the safety and efficacy of chiropractic care to treat a variety of conditions?

Yes, we are different, and happily so. We do not want to be part of medicine, so there's no need for chiropractors "to be taken out of medicine". Our paradigm is different, part of wellness and prevention, not sickness and disease. We believe that healing comes from Above, Down (from our Creator, not a crystal or dreamcatcher!) and from within the patient (the body knows how to heal itself), not from the outside (through drugs and surgery). Chiropractors seek to correct minor misalignments of the bony skeleton to allow optimum function of the nervous system. What is the primary purpose of the skull and vertebral column? To protect the brain and spinal cord, the core of the master system, the nervous system. Chiropractic is about increased function and empowering the patient to take charge of their own health, not about taking money away from the orthopedic surgeons!

You specifically mentioned x-ray, so I'd like to clarify a couple of things. In the practice of chiropractic, x-ray is used with various protocols of marking and measuring the films to locate very small misalignments, in order to correlate the findings of the physical examination (posture, palpation, electromyography, orthopedic and neurological testing, etc.) The millimeters of misalignment we locate are not the gross misalignments which your eyes were trained to see. No reputable chiropractor looks at a radiograph to determine his or her adjustments each visit -- the primary reasons we take films are; to rule out pathology and malformation, to determine the degree of degeneration, if any, present in the spine and to assess postural alterations. You'd criticize us as irresponsible and reckless if we didn't take x-rays!

From reading the other posts out there, I can tell that a lot of chiropractors have done their own profession a disservice by their unprofessional antics (ie ambulance chasing and daytime TV commercials) and lack of explanation of what we do. There are good and bad practitioners of every profession. The modern chiropractors coming out of school now actually receive a very sound medical education: our basics are the same (taught by MD's at my school), but in the later years of study, where MD's learn advanced pharmacology, emergency medicine, surgery, etc., we learn various techniques of adjusting, most of which don't include the stereotypical neck-twisting type of adjustments. Unfortunately, as a "new breed" of chiropractors, we have the task ahead of us of informing the public of what we do, repairing the damage done by the bad apples, and fighting sensationalist attacks such as this one, based on faulty research and spread around the world by people who are either misinformed, threatened, or just plain hateful.

While I doubt I will change your mind about chiropractors, I hope this post will help someone else out there gain some perspective and perhaps see the other side of the story.

By the way, did you hear the one about the Denver anesthesiologist who fell asleep while monitoring an eight-year-old boy getting tubes in his ears? The child died, so do anesthesiologists "need to be taken out of medicine", too????

[Woahhs]

Very good post Doc.

Personally, I think there's a place for just about every modality in healthcare. Unfortunately, many of them can not be supported by the business model that has become the inflexible dictator of American medicine.

The "go to the doctor" regimen has been imposed, and become so ingrained, serious consideration of alternatives by the average American is all but impossible.

In my estimation, the big fear from Chiropractic in the medical establishment is that it DOES work fairly well with the aforementioned business model, and that means competition.

If aliopaths (sp?) had all the answers, you wouldn't have any business. I've personally observed enough of their failures, without hearing any admission of ignorance, to know the last thing they want is empirical evidence from a thriving industry that knows something they don't.

If for nothing else, Chiropractic is owed a debt of gratitude for introducing the homeostatic concept to Joe Six-pack. "Kill or be killed" is not the only approach to medicine, but you'd never know it from talking to your local M.D.

[Old Professer]

I am proud to be a physician (anesthesiologist) with a stron[sic] background in internal medicine. One day at the Minnesota State Fair last September, I went to the exhibition hall where there was a chiropractor booth. The propaganda said free chiropractic evaluation, will help cure disease.

Here is the scary part -- remember that I CAN READ XRay[sic] (although I did not tell him that). He shot a back film, told me that my back was entirely out of alignment and that I would need extensive chiropractic manipulation. He also said that I am on a lot of medications that should be stopped for vitamins. I am on NO medicines, and I looked at the xray -- and there was[sic] NO misalignments...[sic]

Remember -- these are the people that stop perscriptions[sic], which IMHO probably kills many more people than vertebral artery disruption.

Finally, the vertebral artery supplies the lower brain, stroke of this artery can produce lock in[sic] syndrome where the upper brain is fine (Thought, emotion) but motor movements, including speaking, is[sic] gone...[sic]

Chriporactors[sic] need to be taken out of medicine.

[gas_dr]

OK, fair enough...we will start at the end of your very well reasoned post

I am aware of the anesthesiologist that fell asleep and the child under his care died. Are you also aware that he was the subject of a criminal investigation, and to the best of my knowledge, also lost his license? Furthermore, you are incorrect that it was an ear tube...ear tubes take about 5 minutes to put in and are usually done my mask anesthesia. As the anesthesiologist has to physically hold the mask on the patient's face and ventilate the patient manually, it is impossible for him to have fallen asleep in this case. I am intensely familiar with the case, and you have your facts about half right and half wrong. Nonetheless, I thoroughly agree -- he had to go, and go he did.

Onto your statiscs about standard allopathic care. What are your sources? If you are seriously going to quote such controversial stats (ie 1/20 risk of serious or life threatening complications from spinal stenosis surgery), you should site a source as well as what the complications are. I do not accept these statistics as if there were a 5% chance of major morbidity and mortality, these surgeries would not be routinely performed.

Next question: are you denying the validity of the statement that vertebral artery injury has risen substantially and in a statistically significant way since the common practice of chiropracty? If not, what is the epidemiological cause for these catastrophic increases in otherwise young people? Vertebral artery tear or thrombosis is incredibly rare, even in the most advanced of vasculopatic conditions. I notice you did not respond to this?

Finally, onto the contention that chiropractors do not want to be part of medicine. Then why is there a drive in the ROcky Mountain West for chiropractors to attempt independent practice with Rx abilities? Why do you require X-ray for your work? I reject the premise that an X-ray is able to resolve millimeters of misalignment when this degree of measurement is well within the standard error of positioning and technique. That kind of resolution at minimum requires CT Scan or MRI. Yet I see very few chiropractors utilizing these standard allopathic technologies.

I disagree with your view that the central nervous system is the master system. It is vital, but the nervous system is not capable of reversing vasculopathy, gastropathy etc. etc. etc. The human body is an amazing organism (well created!) that is in integration of multiple vital systems. How can the central nervous system exist without the support of the cardia system, pulmonary system, or any of the others? Allopathic medicine has the history of scientific method fully behind it. We have well designed prospective, randomized trials that allow us reasonable therapeutics. This is not the case in alternative medicines.

Finally, your quip about malpractice is a flat out cheap shot. From your perspectivce -- malpractice is about risk management, and the fact is that chiropractic malpractice is infinitely less because the STANDARD of CARE in AMERICA IS ALLOPATHIC MEDICINE. We do many more procedures, and many more risky procedures. But those procedures are based on centuries of scientific progress and refinement via accepted methodology.

I agree that there are physicians who have got to go, but our profession has proof of virually everything that we do. I will happily discuss any point of the rational therapeutics of medicine based on the pathological state of disease whenever you want.

Until then, I await your sources and citations for your so called statistics...

[marajade]

You want a DC to do an xray... Adjusting someone without an xray can be very dangerous...

[wardaddy]

I know that...and I think they can probably help with minor pulled muscles and stuff in the lower back but many claim to go way beyond that...which I don't buy.

[marajade]

I used to work for a state regulatory board that oversaw DC licensees...

After having worked there... I'd never see a DC... ever...

[najida]

When RD's where lobbying for state licensing,
DCs were amoungst our biggest opponents..
From what I remember, there were literal fights on the courthouse steps..

Don't get me started....:-{

[Mamzelle]

Perhaps there needs to be extensive studies on relief of pain--have heard so many anecdotal claims for pain relief that one would have to credit that at least some of these manipulations function as effective physical therapy. Physical therapy has some risks involved, too. But, gee, when these guys start fooling around with herbal "cures", they are scary...

[Petronski]

Why does the mere mention of chiropractic make me want to laugh out loud? Is it their pretense to call themselves 'doctor?' Is it jealousy over the sweet scam they have going? Maybe it's the idea of getting neurologic help from a dude in sneakers next to the Chick-Fil-A down at the mall. I don't know, but in my mind they're just Scientologists with a really powerful political lobby.

[putupon]

There are DO's who are Neurologists and can also do manipulations.

[wideminded]

A woman I knew had been in a bad car accident. Her major injuries including a broken pelvis had been healed long before but she suffered from severe intermittent chronic pain and problems with her vision. MD's (including neurologists) had followed their usual shtick of saying it was all in her mind. But she had found a chiropractor in a distant part of the state who seemed to be able to offer her great relief usuing neck manipulation. To me this sounded very dangerous although it seemed like the guy was more careful than reckless amd I was very impressed with the results. The relief would last for a few months until some additional physical strain or injury aggravated the problem. To this woman it was worth a drive of hundreds of miles while experiencing severe pain because there was one person who could solve the problem.

I have always tended to look down on chiropractors, but they will never go away as long as they are able to offer people great subjective relief from conditions that MD's refuse to treat.

When a person is experiencing chronic pain it is very easy for an MD to "solve" the problem by saying that it is psychosomatic. There often is no test that can prove the pain is real or where in the nervous system it originates. The patient doesn't return to the same doctor, so the doctor sees the problem as solved and this encourages the doctor's feeling of self-righteous justification. There is also a "party-line" in medicine which doctors must follow to be a member of the club: 1. People with chronic pain are all just malingerers 2. Chiropractors are all complete charlatans; any perceived benefit from them is entirely psychosomatic.

If we had better technologies for locating and visualizing the sources of chronic pain, MD's might be able to actually help people more and thereby get some business back from chiropractors.

[Paul C. Jesup]

(sarscam) And I am sure you would suggest just taking two aspirin for a pitched nerve, causing extreme pain, caused by a popped out vertebrae along the spine.(sarscam ended)

Chiropractors are needed sometimes, NOT everything requires surgery.

[Paul C. Jesup]

That is a VERY good point.

[friendly]

No need to fret...if your chiropractor damages your vertebral artery just dangle a quartz crystal over your neck and all will be well.

LOL very funny.

I once toured a chiropractic college and was appalled there was no library. There were however marketing classes and business orientation seminars.

Here in New York the sleazy chiropractors hook up with the most crooked lawyers and bilk the no fault, workers' comp, medical insurance and phony accident case civil litigation with endless mega-billion dollar complete fraud.

Chiropractic not a profession, it is a well connected criminal enterprise.

[friendly]

The cause of tort reform would be greatly assisted by the elimination of chiropractors. With rare exception, all chiros that I have deposed are quacks who would treat a corpse four times a week for three months. Most chiro offices are nothing more than personal injury mills which are designed for billing, not truly rendering helpful treatment.

My observations exactly. Most of their billing for no fault is completely fraudulant. There role in phony litigation is equally bogus.

[aruanan]

It is the medical world's equivalent of the Hatfields and McCoys: Neurologists vs. chiropractors....

No, the Hatfields and McCoys were both hillbillies. Hmm, Dr. Oliver Sacks versus krodriguesdc.