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113 thoughts on “Chiropractic and Stroke: Evaluation of One Paper

  1. nwtk2007 says:

    What an utterly absurd (as you say) and hypocritical comment.

    The anti-chiro community demands absolute EBM standards of proof for all scientific issues in question so why should chiro’s demand it of you? This concept of EBM doesn’t apply to you? I figured.

    To say that chiropractic does not apply the EBM concept to itself is also absurd. Chiro’s do research and publish it but the EBM people here refuse to actually look at it, read it, critique it and explain why the research is not valid. They simply dismiss it as being in “substandard” journals which they refer to as “magazines”.

    Your comment about chiro’s exposing patients to risk is laughable at best and once again begs me to point out the dangers of medicine’s mistakes, bad reactions and side effects of drugs that KILL thousands every year, and without any true informed consent or acknowledgment on the bottle of these dangerous OTC drugs.

    At least I can say that some, if not most, chiro’s, including me, use informed consent and discuss this issue with patients. I don’t see anything on a bottle of ibuprofen that says that it causes 3000 deaths a year and is the recognized number two cause of peptic ulcer in the USA.

    Total, total hypocrisy.

    Sometimes the bloggers here stretch the imagination of anyone who might consider the existence of bias and religious dedication to a form of, in this case, health care, who refuse to, even a little, admit to the basic dangers of chemical substance abuse in the general population through overly available medications and an undereducated general public, with no effort what so ever to change it or improve it or decrease it’s risk to the public.

    All the while proclaiming the dangers of something which has dangers which are minuscule when compared to medicine and and the same time pronouncing it as pseudoscience, yet unwilling to really look at studies which might or might not support it or show it’s proposed benefit by chiropractors, just because they are chiropractors and for no other reason. (Yes I know this is not a complete sentence.)

    I would expect that from insurance executives who do not want to pay for chiropractic services, but not from “unbiased” EBM “believers”.

    Basically, I stand in Awe.

  2. pmoran says:

    The “it is OK to kill and maim people so long as everyone is does it” gambit truly reveal the utter irresponsibility of some chiropractors. This is not some schoolyard game. The standards we aspire to in medicine should never be set by the lowest common denominator.

    There is *nothing* comparable to this attitude within conventional medicine. I would be the last to claim that conventional medicine is reaching optimal standards of safety — it is certainly not, but it does its best to ensure that practitioners *and patients* are aware of all the anecdotal adverse reactions from drugs, and expects doctors to adjust their practices to accommodate known and potential risks. This is undeniable.

  3. nwtk2007 says:

    pmoran – “it is OK to kill and maim people so long as everyone is does it”

    There is nothing in what I have said that implies that “it is OK”.

    This is EBM’s defense of any counter argument that points to their elitist hypocrisy.

    The fact that you imply that chiropractic actually kills and maims is another point in that you have very little more than anecdotal stories which are un-explored (an don’t even amount to case histories) and virtually nothing in studies or research to support that belief other than the fact that you WANT to believe it in order to to placate your own conscious and guilt caused by what you obviously know is a travesty being done to an unsuspecting public.

    It sounds like your position is such that if it is EBM and science based then it is OK to maim and kill.

    Once again, I do not defend what may well be a small risk to patients who have cervical manipulation. I simple point out that medical science as it is today us not the one to point the finger at anyone. I point out that the medical house, as necessary as it is, is a dirty, slimy mess. Not to defend the use of cervical manipulation, but to open the eyes of the accuser to see his own part in his own crime against humanity.

    You even minimize the risks of medicine now by implying that it is “anecdotal” and I quote you, “it does its best to ensure that practitioners *and patients* are aware of all the anecdotal adverse reactions from drugs”.

    Are you actually hearing yourself?

  4. pmoran says:

    These are not “stories”, and they are not so rare as you claim. Reuter et al found 36 cases over a three year period in Germany of well-documented cases of vertebral artery dissection following chiropractic neck manipulation, diagnosed by digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or duplex sonography. (Journal of Neurology Volume 253, Number 6 June 2006 Pages: 724 – 730 )

    I was not minimising the risk of drugs by implying that the evidence is anecdotal, I was pointing out that all post-marketing surveillance of adverse drug reactions is anecdotal, yet the medical profession still propagates the information and acts upon it as indicating at least a potential risk. We do not and cannot wait for patient risk to be proved by RCTs, in contrast to the position you and some of your fellows are taking with neck manipulation (some chiropractors are more responsible).

    Remember that what we regard as EBM is mainly directed at determining whether certain outcomes occur with treatment. Here we have a very definite outcome and a very strong association. The only issue is causality and we must be more sensitive to patient risk than we are to the subjective patient patient benefits that strict EBM is mainly looking at.

    The problem is, of course, that chiropractic has too much invested in neck manipulation, and cannot easily substitute other methods, as can doctors or physiotherapists.

    My last words.

  5. nwtk2007 says:

    Maybe you could provide a link to that article because a search for it yields nothing.

    As to options for chiro’s, we have all the options that any physiotherapist has and many times we emply those instead of manipulation.

  6. nwtk2007 says:

    If this is the study I am familiar with, it was not just chiro’s, the manipulation involved rotation (now not done by most who do manipulation, hopefully PT’s as well) and the cause is “certain” in only a few of the cases.

    And it was 32 cases not 36.

    Again, not damning and not a smoking gun compared to other treatments for neck pain that’s for sure.

  7. Blue Wode says:

    Here’s the study cited by pmoran:
    http://www.chiro.org/Professional_Regulation/reuter_u06.pdf

    And here’s some interesting comment on it:

    Quote:
    “In 2006, the Journal of Neurology published a German Vertebral Artery Dissection Study Group report about 36 patients [24 F/12 M, mean age 40+11 years] who had experienced vertebral artery dissection associated with neck manipulation [16].

    Twenty-six patients developed their symptoms within 48 hours after a manipulation, including five patients who got symptoms at the time of manipulation and four who developed them within the next hour. I

    n 27 patients, special imaging procedures confirmed that blood supply had decreased in the areas supplied by the vertebral arteries as suggested by the neurological examinations.

    In all but one of the 36 patients, the symptoms had not previously occurred and were clearly distinguishable from the complaints that led them to seek manipulative care.

    This report is highly significant but needs careful interpretation. Although it is titled “Vertebral dissections after chiropractic neck manipulation . . . ” only four of the patients were actually manipulated by chiropractors. Half were treated by orthopedic surgeons, five by a physiotherapist, and the rest by a neurologist, general medical practitioner, or homeopath.

    It is possible—although unlikely—that the nonchiropractors used techniques that were more dangerous than chiropractors use in North America. The authors suggested that the orthopedists’ treatment was safer, but there is no way to determine this from their data. Regardless, the study supports the assertion that neck manipulation can cause strokes—which many chiropractors deny.”

    http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

    Perhaps not surprisingly, the latest news from stroke victim Sandra Nette’s lawyer is that *dozens* more Albertans are coming forward with similar health complaints after visiting various chiropractors:

    http://watch.ctv.ca/news/clip98302#clip98302 (2 mins 43 secs)

  8. nwtk2007 says:

    Thanks for posting this. I have been trying to get this one for a while.

    It is an interesting article in that the manipulations were, for the majority of cases, performed by orthopedic surgeons, but it is still referred to as chiropractic manipulation. Even the manipulation performed by the PT’s (physiotherapists) is called chiropractic manipulation.

    This is only semmantics, I know, but it interesting, the differing attitude in Europe vs the US.

    For example, the PT’s in the US would be adamant that the manipulation they do is different and quite superior to manipulation performed by both chiropractors and orthopedic surgeons.

    It would be interesting to see all cases of VAD in the facilities which contributed to the study for comparison purposes. They also mention that the design of the study precludes any new evidence of a cause-effect relationship, but I would say it is, at least, suggestive of one to a limited degree. It is that degree that needs to be further explored, as well as other causes.

    As to the dozens of others coming forward in the Nette case, that is probably true, but each case will have to be evaluated for more than just an “it also happened to me” quality. One example of a case such as that is a guy who posts here occasionally and claims chiro was the cause of his situation. In his case he even claims skull fracture and a cover up by all medical persons involved. I am sure some of the dozens coming forward will fall into that category.

    Do orthopedic surgeons also do manipulation in Canada and do they also call it chiropractic manipulation?

  9. Blue Wode says:

    On 04 Oct 2008 at 10:39 am nwtk2007 wrote: “It is an interesting article in that the manipulations were, for the majority of cases, performed by orthopedic surgeons, but it is still referred to as chiropractic manipulation. Even the manipulation performed by the PT’s (physiotherapists) is called chiropractic manipulation. This is only semmantics, I know, but it interesting, the differing attitude in Europe vs the US.”

    FYI, chiropractors in Germany are part of a group of unregulated lay complementary therapists known as “Heilpraktiker”. As for German medical doctors, they usually undertake around 4 weeks of training and study in manipulation as part of their CPD in order to practice what they term “chirotherapy”.

    On 04 Oct 2008 at 10:39 am nwtk2007 wrote: “As to the dozens of others coming forward in the Nette case, that is probably true, but each case will have to be evaluated for more than just an “it also happened to me” quality.”

    Yes, and that’s exactly what happened in the case of the young mother who recently suffered a stroke at the hands of a New Zealand chiropractor:
    http://www.hdc.org.nz/files/hdc/opinions/07hdc20616chiropractor.pdf

    From page 6 of the above link:

    Quote:

    “In this case, the artery that dissected was a vertebral artery, which is more likely to be prone to dissection because of anatomy and the action of the neck manipulation. The personal injury was present within 9 days of treatment. Other than tension headaches, there is no reliable evidence to identify any underlying disease that would be implicated in the dissection of the artery. On balance, the personal injury is determined to have been caused by the neck manipulation performed on 09/11/2007.”

    So it’s going to be interesting to see just how many more stroke victims are confirmed by the Nette lawsuit. For new readers, details of the suit can be found here:
    http://www.chirobase.org/08Legal/nette.html

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