ACA Response to "Chiropractic Stroke in Canada"
By Dr.J W. Norris

The American Chiropractic Association (ACA) is denouncing as "junk science" a recent paper by Canadian neurologists1 regarding chiropractic and the risk of stroke. The study, which is extremely limited and seriously flawed, has needlessly alarmed patients about one of the most
safe and effective treatments in health care today, according to the American Chiropractic Association (ACA). 

The Canadian neurologists' study, presented by Dr. John W. Norris and colleagues at the American Stroke Association's 27th International Stroke Conference, contained no control group; it was essentially a random opinion survey based on the whims of doctors who themselves decided to participate. This outrageous paper, which is being falsely portrayed as legitimate science, leaves many basic questions unanswered, such as: Who, in fact, performed the manipulations?

Were they doctors of chiropractic, physical therapists, osteopaths? And what  specific technique was used? Given the fact that studies have shown that adverse reactions often do occur after visits to untrained health care providers, the answers to these questions are especially important.  What was the total number of manipulations performed? The answer to this question is critical to accurately determine the percentage of cases that resulted in arterial dissection. How long after spinal manipulation were the vertebral artery dissections noted?  Many
everyday activities such as hair washing in a beauty salon, turning the head while driving and dancing have been known to cause similar injuries - and could well have contributed to the injuries in these particular cases. These activities involve equal or higher rates of arterial dissection than ever seen by a doctor of chiropractic.

Without answers to these very important and elementary questions, this paper appears to be nothing more than junk science and a weak attempt by a group of politically-motivated medical doctors to steer patients away from chiropractic care. The ACA believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic. However, health care consumers should be aware that the risks associated with chiropractic treatment are infinitesimally low. The risks of chiropractic have been grossly
exaggerated, and health care consumers need to put these sensationalistic news reports into perspective. When compared to the number of illnesses and deaths that will occur this year  from the use of prescription and over-the-counter drugs, the number of serious complications from chiropractic treatment is extremely low. The use of oral contraceptives is considered to be safe by the medical profession,
but of every 100,000 healthy women under 40 who take birth control pills, 28 of them will suffer a stroke. Statistically, this translates into 1.4 in every 5,000 healthy women. A study published in the April 15, 1998 issue of the Journal of the American Medical Association found that more than 2 million Americans become seriously ill every year from reactions to drugs that were correctly prescribed and taken; 106,000 Americans die annually from those side effects.2

Complications from non-steroidal anti-inflammatory drugs (NSAIDs) -- a group that includes prescription and non-prescription pain medications such as aspirin and ibuprofen -- are responsible for 16,500 deaths each year, according to the New England Journal of Medicine.3 In comparison, a study by the Rand Corporation found that a serious adverse reaction from cervical manipulation occurs less than once in 1 million treatments.4  Studies have also shown that these rare adverse reactions often occur after visits to health care professionals who are inexperienced or inadequately trained in spinal manipulation, rather than licensed doctors of chiropractic.5

A more recent study published in the October 2, 2001 issue of the Canadian Medical Association Journal found only a 1-in-5.85-million risk that a chiropractic adjustment of the neck will result in vertebral artery dissection.6 Despite the sensational nature of this most recent Canadian report, the chiropractic profession does take the risk of vertebral artery dissection - no matter how minute - seriously. During their four-year post-graduate education, doctors of chiropractic are alerted to possible risk factors and taught when to modify their
technique or refer a patient for other specialty care. Risk management is also a frequent topic in the continuing education seminars that most states require practicing chiropractors to attend annually. Chiropractic researchers have spent a great deal of time investigating risk factors so that doctors of chiropractic can identify the rare patients who may be pre-disposed to injury. Other recently published and ongoing studies are testing the validity of pre-treatment screening
tests, and devising strategies for even further minimizing the risks of chiropractic neck treatments.

The time has come for the medical community and the media to focus their efforts on warning patients about common procedures with very real risks associated with them -- such as the inappropriate use of drugs and surgery. Chiropractic has been proven to be a safe and effective non-drug, non-surgical treatment, and tens of millions of satisfied chiropractic patients will attest to this fact.

References
1 Norris JW, Beletsky V, Nadareishvilli ZG, Canadian Stroke Consortium. Canadian Medical Association Journal 2000; 163(1): 38-40.

2 Lazarou JL, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. A meta-analysis of prospective studies. JAMA 1998; 279: 1200-5.

3 Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of non-steroidal
anti-inflammatory drugs. New England Journal of Medicine. 1999; 340(24); 1888-1899.

4 Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996; 21: 1746-59.

5 Terrett AGJ. Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. Journal of Manipulative and Physiological Therapeutics 1995; 18(4): 203-210.

6 Haldeman S, Carey P, Townsend M, Papadopoulous C. Arterial dissection following cervical manipulation: a chiropractic experience. Canadian Medical Association Journal 2001;165(7):905-06