First things first, here are the sources for my statistics. I would not put out such inflammatory information if I didn’t have sources behind it.
Risk of death in fatal air crash, flying three
hours on a U.S. commercial airline: 1 in 2,000,000
Source: Based on 1997-2000 Transportation Statistics showing an average of 1.57 deaths per
1,000,000 flight hours
http://www.bts.gov/publications/nts/ Risk of death in motor vehicle accident, driving
35 miles: 1 in 2,000,000
Source: Based on 1.5 deaths per 100 million vehicle miles and 116 injuries per 100 million miles
traveled in 2000: Traffic Safety Facts 2000. National Highway Traffic Safety Administration
http://www.nhtsa.dot.gov/ .
Risk of being injured in motor vehicle accident,
driving ½ mile: 1 in 2,000,000
Source: same as above
Risk of serious stroke or neurological
complication resulting from a chiropractic neck
adjustment: 1 in 2,000,000 treatments
Sources: Terrett AGJ: Current Concepts in Vertebrobasilar Complications following Spinal
Manipulation. West Des Moines, IA: NCMIC Group, Inc., 2001
Klougart N, Leboeuf-Yde C, Rasmussen LR: Safety in chiropractic practice part I: The
occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from
1978-1988. J Manipulative Physiol Ther 1996; 19;371.
Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165:905.
Risk of death, per year, from GI bleeding due
to NSAID use for osteoarthritis and related
conditions: 800 in 2,000,000
Source: Fries JF: Assessing and understanding patient risk. Scan J Rheumatol 1992; suppl. 92:21.
Overall Mortality rate for spinal surgery: 7 in 10,000
Source: Bigos S, Bowyer O, Braen G, et al: Acute Low Back Problems in Adults. Clinical Practice
Guideline No. 14. Rockville, Maryland, 1994, U.S. Department of Health and Human
Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub.
Nos. 95-0642-3.
Death rate from cervical spine surgery: 4-10 in 10,000
Source: The cervical spine research society editorial committee: The cervical spine (2nd edition).
New York: J.B. Lippincott Company, 1989.
Rate of serious or life-threatening
complications from spinal stenosis surgery: 5 in 100
Source: Bigos S, Bowyer O, Braen G, et al: Acute Low Back Problems in Adults. Clinical Practice
Guideline No. 14. Rockville, Maryland, 1994, U.S. Department of Health and Human
Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub.
Nos. 95-0642-3.
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)
Source: Armstrong CP, Blower AL: Nonsteroidal anti-inflammatory drugs and life threatening
complications of peptic ulceration. Gut 1987; 28:527.
I apologize for the errors about the Denver anesthesiologist, apparently the LA Times article had its facts wrong. Thank God he’s gone, as no doubt many of my own colleagues should be.
Regarding the recent increase in Vertebral Artery Dissection (VAD), there are a variety of other possible causes which deserve further investigation. The first possibility is of increased detection and subsequent diagnosis of VAD due to the increased availability of MRI, rather than an actual increase in the number of cases. Increased risk of VAD has also been linked to conditions such as Marfan’s Syndrome, Osteogenesis Imperfecta and Ehler-Danlos Type IV. A 1999 study linked spontaneous vertebral and carotid artery dissections with recent respiratory infection, with an accompanying seasonal increase in VAD in the Fall. (Grau AJ, Brandt T, Buggle F, et al: Association of cervical artery dissection with recent infection. Arch Neurol 1999; 56:851.). Another recent study, published in Stroke, found a connection between mildly increased homocysteine levels and arterial dissection (Mild hyperhomocyst(e)inemia: A possible risk factor for cervical artery dissection. Gallai V, Caso V, et al. Stroke 2002; 32:714.). Again, I apologize for failing to address this earlier.
I would like to draw your attention to a study released in 2002 about the stresses placed on the vertebral artery during “vigorous” chiropractic treatment of the neck. This study found that the forces transmitted to the artery are less than 1/9th the force necessary to stretch or damage a normal vertebral artery. The forces measured during a neck manipulation were actually less than the forces measured during normal range-of-motion movements of the neck. Based upon recent evidence, many experts now believe that it is physically impossible for a competently performed neck adjustment to cause a vertebral artery dissection unless the artery already has a significant pre-existing weakness, such as from the congenital conditions mentioned above. (“competently performed” may be our operative words here…) (Symons BP, Leonard T, Herzog W. Internal Forces Sustained by the Vertebral Artery During Spinal Manipulative Therapy. J Manipulative Physiol Ther 2002; 25:504-10.)
With regard to the Rocky Mountain West, I cannot speak to their situation, as I am unfamiliar with their efforts. I will say, however, that I agree with the premise of “practicing independently” as the vast majority of MDs do not understand what we do and are therefore unwilling to refer patients to chiropractors. I believe to many, referral to an “alternative” practitioner would somehow be admitting defeat. The choice should be up to the patient: many third-party payers agree, and no longer require referrals for chiropractic care. The official stance of the chiropractic organizations with which I am familiar is strict opposition to prescription rights – I agree completely that chiropractors have no business prescribing drugs. We receive one course in pharmacology/toxicology, hardly enough to fully grasp the complexities of prescribing medication. But why would we want to? Drugs are part of the health care model for which we provide an alternative. I only care to know about them to better understand the state of health of my patients.
About x-ray, I clearly stated in my previous post that determining misalignments is only a small part of the reason we take films. There is a laundry list of conditions and congenital malformations to be ruled out on x-ray before a chiropractor should ever adjust! If you take opposing views (ie AP and Lateral Thoracic) and carefully measure on a vertebra-by-vertebra basis, misalignments in any or all of the three planes of vertebral motion can most certainly be found. Measurements in these spaces are not affected by minor variations in patient positioning. We determine if a vertebral level is in need of correction by careful correlation with our other exam findings, including electromyography and the same orthopedic and neurological test used by MDs. Incidentally, chiropractors are beginning to use more MRI – Parker College in Dallas is currently installing an MRI unit. CT is far too ionizing to use in routine settings such ours, great imaging and great for a lot of medical applications, but too much radiation to justify for our purposes.
I was not trying to assert that any system of the body can live without the others in my statement “the nervous system is the master system”. I fully understand that the body works as a whole. My point was that the nervous system controls all of the other systems. Where are the chronotropic and ionotropic centers for the heart? Respiratory centers? Cranial nerves? Endocrine control? The function of every cell of the body is dependent on the nervous system, either through direct innervation or chemical signals from the neuroendocrine system. Blood loss aside, cut off the head, and how long does a person live??? That’s my paradigm, yours may be different. (If the brain can’t get O2 from the heart, or if the blood is full of toxins because of kidney failure, or if the lungs can’t exchange gases…….the brain can’t function properly…..they all need each other, I know…) By the way, what if the origin of the “gastropathy or vasculopathy” was increased sympathetic input to those organs, caused by increased firing of the Intermediolateral Tract, secondary to decreased firing of muscle spindles and Golgi tendon organs to the spinal cord??? And doesn’t all disease begin as just an alteration of normal physiology? I could go into the neurology of what we do and why, but that would be getting into the whole visceral discussion, and we don’t want to go there…
I will grant you that modern allopathic medicine has far more research behind it than chiropractic. That is a situation we are trying hard to amend, but pharmaceutical companies are not exactly lining up to fund studies on drugless therapies for headaches, back pain, etc. Money is one of the major reasons we are at least fifty years behind in our research. Also, since we don’t treat conditions, we don’t have organizations like the American Heart Association or American Cancer Society helping to raise money for research. The situation is improving, with our chiropractic colleges creating research departments and our journals becoming peer-reviewed and indexed. It’s a start, but I agree we need more research!! I would respectfully request, however, that MDs do a better job of listening to their own research. Studies have shown the ineffectiveness of various procedures, such as the use of tympanostomy tubes and arthroscopic knee surgery, yet they remain two of the most common surgical procedures performed in the US today. All of the research on adverse drug reactions hasn’t slowed the rate of writing prescriptions, either.
My point about malpractice wasn’t meant as a cheap shot, just as an illustration that if chiropractic was so dangerous, shouldn’t our premiums be sky high???
Let me close by saying that I am not one of those chiropractors who hate all medical doctors and tell their patients to stay away from them. I am well aware that allopathic medicine is the standard of care in the US today. I wholeheartedly support many of the functions of allopathic medicine. If I am run over by a car, have a heart attack, have cancer, etc., by all means, take me to a medical doctor!! I view chiropractic care as a very conservative way to approach healthcare in non-emergency situations. Chiropractic care can be a great first step, and if it fails, and it sometimes does, then move on to more aggressive options. In the reverse, if everything else has failed, chiropractic should be an option to try to help the patient. Scaring patients with the kind of articles this whole thing started with keeps patients from exploring their options and forming their own opinions.
That’s why we each went into health care, isn’t it? To help patients???
P.S. Thank you for the compliment on my “very well-reasoned post.” I confess I am rather enjoying this discussion and sincerely hope that my efforts will at least convince you that we’re not ALL dummies and that I didn’t send in cereal boxtops for my Doctorate of Chiropractic degree!!!