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324 thoughts on “Chiropractic and Stroke

  1. nwtk2007 says:

    You know Mr Maynard, your quest for scientific knowledge is commendable, but this thread has always been about chiropractic causing stroke, or not.

    Let’s look at your evidence.

    For one, there are a lot of folks who “say” the chiropractor did “it” to them. First hand info, I guess, but purely anecdotal to say the least, including your own tale.

    Second, you have reports and case studies by doctors who report that their patients had “it” done to them by a chiropractor. Based upon second hand info, patient history, and nothing more. They might have had a stroke, but the cause is totally speculation by a group who is openly hostile towards chiropractic. Again, nothing more than “he says she said”.

    Then there are the “studies”, incredibly weak to say the least. One saying that people who had strokes were 5 times as likely to have gone to a chiro recently when compaired to those who had not had a stroke. Yes, that one is a doosy to say the least. I would imagine that people who have headaches and neck pain, even dizziness or other S/S would also be more likely to visit a chiropractor. Another study suggests pretty much THAT and shows no difference in risk of stroke whether going to the chiro or the PCP/MD.

    Now if you want to bring forth any more “evidence”, none of which could constitute “evidence” thus far, then feel free.

    Chiro’s understand that because of the physiology and associated anatomy of the cervical spine and vertebral arteries, there might be a risk, but EBM doesn’t accept that “hypothesis” as evidence now do they?

    A jury might decide that a chiro caused a stroke, but they won’t do it based upon “evidence” or “science”. It will be emotion and drama that sways the jury.

  2. Harriet Hall says:

    See above. I have stopped responding to nwtk2007 and quackdoctor for obvious reasons and I hope others will follow suit.

  3. nwtk2007 says:

    Hey,

    You want to hide from the truth Harriett go ahead. Sucks for you.

    But the truth ain’t so yippy skippy as to agree with what you perceive as science and evidence all of the time.

    I find that you violate your own evidence “equation” as it suits you as do some of your “followers”.

    No matter.

  4. Graham Maynard says:

    Hi Harriet,

    There really is not anything worth responding to.

    Hi Blue Wode,

    Was your injury stroke, or other ?

    Cheers ……. Graham.
    http://www.gmweb1.net/

  5. darwinfan says:

    Just a thought, but I think the author may have misunderstood what she called the “tu quoque” argument of comparing the relative risks of chiropractic adjustments to NSAIDS. I’m not defending chiropractic or anything here, but I do think that the only reason this comparison is made is to give some perspective; to parallel the relative risks of a chiropractic adjustment to something better understood and well used by the general public. I see that occurring in other fields of medicine too, just to help patients understand what relative risk is. I don’t believe chiropractors use that as an argument to make the risk of stroke more acceptable.
    Just my thought though.

  6. Harriet Hall says:

    Darwinfan,

    if you think “the only reason this comparison is made is to give some perspective” I can only suspect that you don’t have much experience with chiropractors and their arguments.

    I’ve heard many, many chiropractors talk about the dangers of NSAIDS. Not once did I ever hear it in the context of a rational discussion comparing all the risks and benefits of all the different options for treating back pain. It is usually presented as if there were no other options besides NSAIDS and chiropractic adjustment, which is another logical fallacy, a false dichotomy.

    I see it all the time in newspaper ads that are trying to scare patients away from conventional medicine, ads that make extravagant claims for chiropractic adjustments and present them as risk-free. And I hear it every time anyone mentions the possibility of stroke or of any other harm from chiropractic, where it seems to me the message is clearly “Don’t you dare criticize us, because you hurt more people with your pills.”

  7. nwtk2007 says:

    I have said many times that the only reason I ever brought up the dangers of medicine, mainly medical errors, was to provide perspective to the raging anti-chiro front who encompass all chiro’s into their idea of what chiropractic is.

    And the message you should be hearing clearly is, “Don’t criticize us so self-righteously with such extreme venom, because medicine “kills” more people with it’s mistakes, not to mention the side effects of many medicines, NSAIDS just being one example, at a few thousand deaths per year.”

    Harriett – “I’ve heard many, many chiropractors talk about the dangers of NSAIDS.”

    True, so why don’t we hear the anti-chiro’s talk about the dangers of NSAIDS and medical errors? Given the risks of both chiro and NSAIDS, and given the sheer number of people who are openly willing to talk about the benefits they have gotten from their chiropractic treatment, even if not EBM as you claim, why wouldn’t you recommend it to a patient who is having back pain which has not been helped with or through other means?

    And as far as low back treatment is concerned, there is virtually no risk what so ever.

    Manipulation coupled with therapeutic exercise is very beneficial and far, far less dangerous.

  8. Harriet Hall says:

    nwtk2007 has just provided a perfect example of what I mean. He “says” he is putting things in perspective, but then he says

    “Don’t criticize us so self-righteously with such extreme venom, because medicine “kills” more people with it’s mistakes, not to mention the side effects of many medicines, NSAIDS just being one example, at a few thousand deaths per year.”

    That’s a tu quoque if I ever heard one.
    I answered the “death by medicine” accusation already at http://www.sciencebasedmedicine.org/?p=136

    I have said many times that spinal manipulation therapy is an acceptable choice for short-term treatment of garden variety musculoskeletal low back pain for patients who prefer it. I would prefer that a science-based practitioner provide that treatment, for obvious reasons.

    Medical doctors do talk about the dangers of NSAIDs and medical errors all the time: medical journals are full of articles criticizing current practices and suggesting improvements.

    And I object to being called an “anti-chiro” – I’m not on any kind of vendetta, and I support chiropractors who limit their practice to short-term evidence-based treatments of musculoskeletal conditions and reject the woo. I try not to be “anti” but to be “pro” science and critical thinking.

  9. nwtk2007 says:

    My statement is tu quoque only if it is offered as an argument for chiropractic. This is the point many just can’t grasp.

    It is only offered for perspective. Saying it is not a valid argument does not change the perspective.

    You say “Medical doctors do talk about the dangers of NSAIDs and medical errors all the time:”

    Well talk is cheap and the problem persists.

    It’s a universal concept really. Don’t bitch about my almost spotless house when yours is a pig barn.

    No tu quoque there. Just simple perspective.

  10. darwinfan says:

    I appreciate your objective point of view on this topic. You are correct in suspecting I do not have a lot of experience with chiropractors; I have never actually even been to one. I am curious about this practice though, and I’ve been trying to come to some conclusion about it, as I have a friend in medical school who has been telling me that he believes it is a valid medical field, the “woo” parts excluded however.
    At any rate, once again, I appreciate your honest evaluation of chiropractic, since there seem to be a lot of skeptical sites out there that seem very biased against it, and I was not certain I was getting a fair evaluation. There are obviously quacks in this field, but I failed to see why the rest of the field should be deemed useless because of these quacks, and wanted to find out if there was more to the story. Your article is very informative.
    I certainly am curious as to why there is not more research out there on the long-term benefits of chiropractic, as well as why chiropractic is utilized instead of the other treatments you say are available (and are safer).

  11. Harriet Hall says:

    darwinfan,

    If you want to learn more, the hands-down best book to read is Inside Chiropractic by Samuel Homola, a chiropractor who is also a critical thinker. He practiced evidence-based chiropractic throughout a long career (he’s retired now), so he can’t be accused of being anti-chiropractic, but he has shared his inside knowledge of what some of his colleagues are up to and what prospective patients should watch out for.

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  13. ten2fore says:

    I know strokes can happen after/during a chiropractic manipulation. I suffered a stroke during my only visit to a chiropractor in October of 1968. Would I have had the stroke later anyway ? I don’t know, but I have lived over forty years without going to another chiropractor, and without having another stroke.

  14. Mariners5144 says:

    I am a chiropractic student attending New York Chiropractic College. I am aware of your concerns about how a patient coming into a chiropractic office and getting manipulative therapy and getting a stroke after the adjustments. You don’t seem to have evidence based literature claims. It is very possible that the patients were already at the likelihood of suffering a stroke regardless what the patient experiences in their daily living. We don’t know about the patient’s history and what conditions they might have been coming into the office for. We don’t know if the patient had a stroke before. According to Scott Haldeman’s article about chiropractic and stroke, patients who have a vertebral artery dissection following a cervical manipulation is 1 in 8.06 million office visits, 1 in 5.85 million cervical manipulations. Scott Haldeman is a credible researcher who is both chiropractor and a medical doctor leading chiropractic research. Vertebral Artery Dissections will happen with or without the manipulations. If the chiropractor had taken a good case history on the patient, then a stroke will most likely not occur. Chiropractic students are taught to take a thorough history of the patient before treatment. Chiropractic care has been proven to help patients who have serious injuries. For you to say “Don’t ever let a chiropractor touch your neck is the safest advice”, is not accurate. There are a lot of benefits from chiropractic care. We do more than just manipulating the spine. We treat muscles, address nutrition concerns, and guide them through exercises for faster recovery. As a medical doctor, you should be aware of what other health care professions do instead of claiming that chiropractors cause stroke. Have you seen what a chiropractor actually does? Have you been adjusted by a chiropractor? It has been proven that there is a low incidence of chiropractic manipulation causing stroke. Chiropractic malpractice insurance is the lowest of all in the health care profession because chiropractic doesn’t hurt people. We are at a critical time in addressing our health care system in our country. We are living at the age where integrative health care is emphasized for everyone. Patients can benefit from all different types of health care and we should all work together to improve the patients’ condition rather than judge other health care professions.

  15. Harriet Hall says:

    Mariners5144,

    Even the chiropractic insurance companies recognize the risk of stroke and they pay claims for it. Your own professional journals recognize the risk and have tried to come up with screening tests to reduce the risk – without success. Yes, strokes can happen “anyway” but what about those smoking gun cases where an asymptomatic patient collapses on the table? We all agree that the risk of stroke is small, but what is the risk/benefit ratio? If you want to defend your chosen profession, you will need to provide hard evidence that chiropractic offers clinical results superior to other treatments.

    We shouldn’t judge other health care professions? Do you think homeopathy works? What about witch doctors? We have not only the right but the duty to judge treatments that don’t help and might harm.

  16. Fred Dagg says:

    Harriet

    The Bone and Joint Decade summary has addressed all the issues you raise in regard to strokes. So get over it.

    The Bone and Joint Decade Task Force on Neck Pain Report – January 2008
    The latest release (Jan 2008) has been the report by the Task Force on Neck Pain. … the Neck Pain Task Force considered almost 32,000 research citations and …www.fcer.org/html/News/bonejointdecade.htm

    We have discussed it ad nauseum and you trot out the same stuff about “smoking guns” and patients that have unfortunate events on the chiropractors table.
    Tell me it never happens to medical practitioners?

    We have also discussed to risk/benefit ratio of care. You seem to excuse the Vioxx debacle as a slight aberration, however I am sure the relatives of the 30,000 people that died as a direct result of taking it do not feel that way. Nor would relatives of the 120,000 people in the U.S. that die each year from “medical accidents”. I do include Chiropractors, physical therapists and osteopaths in those figures as no one profession can claim to be immune.

    Your attitude of strong paternalism (Doctor knows best) is severly outdated. It is no longer relevant in todays culture.

    It has been replaced by a bioethical model based around,
    1) Benefance..What is done by the healthcare provider must do some good. So judge everybody from the same level playing field.
    2)Nonmalfeasance… Do no harm.
    3) Patient Advocacy. What does the patient want to do, and respect the patients rights to their choice of care. (Something you seem to have great problems with).
    4) Social Justice, what is good for the community as a whole.

    If you look at what you are claiming from a bioethical model, rather than one of strong paternalistic “Doctor knows best”. Then you will realise how much of an injustice you do to the people of the U.S. and even more so your colleagues as you do not judge everybody or profession from the same level.

  17. Fred Dagg says:

    Harriet

    while we are on this topic, did you know that…

    The US spends about 16 per cent of GNP on healthcare, far more than France and Germany, which spend 11 to 12 per cent. Yet those countries provide universal care.

    Critics say the biggest issue is the profit motive that drives US healthcare.

    From a purely bioethical standpoint, you should be standing on your soapbox trying to help the President obtain a better system for the 47 plus million Americans who do not have good access to care, rather than writing poorly researched and emotive articles that do not fulfill the bioethical guidelines of Benefance, Nonmalfaefence, patient advocacy and Social justice.

  18. pmoran says:

    Fred, that is nonsense. Never have the chiropractic contributors to this discussion entered into serious consideration of cost/risk/benefit in relation to any of the conditions that chiropractors treat with neck manipulation.

    You and the others have done everything to avoid such discussion, sheltering, as you do yet again here, behind the “but doctors kill people too” ploy, and the Neck Pain Task Force’s pretence that pre-existing stroke can explain all the cases. That is clearly not true, and I don’t know how you personally can ignore the many individual cases and case series that demonstarte that.

    And Mariners5144, you will find that chiropractors bear far less responsibility than medicos for the diagnosis and management of serious and disabling illnesses. You would be paying almost no malpractice insurance if it were not for the strokes caused by neck manipulation.

  19. Joe says:

    @Mariners5144 on 25 Jul 2009 at 9:27 pm

    Chiros do cause strokes in otherwise-healthy people http://www.ptjournal.org/cgi/content/full/79/1/50

    http://stroke.ahajournals.org/cgi/content/full/32/5/1054

    We just don’t know how many. Due to the anatomy/physiology of the artery dissection, victims may succumb after leaving the chiro office and the connection could go unrecorded unless the neurologists has the opportunity to ask the question. In the unfortunate case of Sandra Nette, when her husband arrived at the emergency room the doctor saw him and said “Chiropractor, right?”

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