Chiropractic Dangers

[Krankenstein]

Wrong, but a family member used to be a Chiro, so I know all about shamopractics. He was Smart and choose another profession long ago.

Probably because he suffered from the same delusional ideas that you do?  Did you wake up to your usual pearl necklace again 'elite_penispuffer'?

[elite_lifter]

Probably because he suffered from the same delusional ideas that you do?  Did you wake up to your usual pearl necklace again 'elite_penispuffer'?

[Krankenstein]

I figured thats all the response I would get out of you.  Is it hard to type and smoke pole at the same time?

[JohnnyVegas]

Wrong, but a family member used to be a Chiro, so I know all about shamopractics. He was Smart and choose another profession long ago.

So your "family member" is now working with you as an esteemed  garbage man 

[Krankenstein]

So your "family member" is now working with you as an esteemed  garbage man 

Naw....'elite_fudgepacker' encouraged his family member to go to med school and become a proctologist.  He  volunteered himself any time, day or night, as a test subject not just for his family member....but the whole class.  Mind you, he did this from the beginning of his pre-requisites all the way through graduation.  He did say that he was doing it 'merely for scientific purposes'.

[JohnnyVegas]

Naw....'elite_fudgepacker' encouraged his family member to go to med school and become a proctologist.  He  volunteered himself any time, day or night, as a test subject not just for his family member....but the whole class.  Mind you, he did this from the beginning of his pre-requisites all the way through graduation.  He did say that he was doing it 'merely for scientific purposes'.

LOL....Yes, Elite is quite the "asshole" 

[elite_lifter]

I figured thats all the response I would get out of you.  Is it hard to type and smoke pole at the same time?

What do you want a dissertation on Chiropractics, I wouldn't waste my time for internet assholes, Fuck off prick.

[Krankenstein]

What do you want a dissertation on Chiropractics, I wouldn't waste my time for internet assholes, Fuck off prick.

HA HA.....wouldnt waste your time....yet you keep posting on it.  How is it I have provided you with research and facts, and all you can pull out of that worn out, stretched beyond recognition, punished ass of yours is that drivel? 

Wow...elittle_penis_lift er is quite the failure.

[elite_lifter]

Just a very small part of why Chiropractics is a scam.


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Chiropractic's Dirty Secret:
Neck Manipulation and Strokes
Stephen Barrett, M.D.
Stroke from chiropractic neck manipulation occurs when an artery to the brain ruptures or becomes blocked as a result of being stretched. The injury often results from extreme rotation in which the practitioner's hands are placed on the patient's head in order to rotate the cervical spine by rotating the head [1]. The vertebral artery, which is shown in the picture to the right, is vulnerable because it winds around the topmost cervical vertebra (atlas) to enter the skull, so that any abrupt rotation may stretch the artery and tear its delicate lining. The anatomical problem is illustrated on page 7 of The Chiropractic Report, July 1999. A blood clot formed over the injured area may subsequently be dislodged and block a smaller artery that supplies the brain. Less frequently, the vessel may be blocked by blood that collects in the vessel wall at the site of the dissection [2].    

Chiropractors would like you to believe that the incidence of stroke following neck manipulation is extremely small. Speculations exist that the odds of a serious complication due to neck manipulation are somewhere between one in 40,000 and one in 10 million manipulations. No one really knows, however, because (a) there has been little systematic study of its frequency; (b) the largest malpractice insurers won't reveal how many cases they know about; and (c) a large majority of cases that medical doctors see are not reported in scientific journals.

Published Reports
In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo (dizziness). The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tears of the carotid arteries [3]. In 1991, according to circulation figures from Dynamic Chiropractic, California had about 19% of the chiropractors practicing in the United States, which suggests that about 147 cases of stroke each year were seen by neurologists nationwide. Of course, additional cases could have been seen by other doctors who did not respond to the survey.

A 1993 review concluded that potential complications and unknown benefits indicate that children should not undergo neck manipulation [4].

Louis Sportelli, DC, NCMIC president and a former ACA board chairman contends that chiropractic neck manipulation is quite safe. In an 1994 interview reported by the Associated Press, he reacted to the American Heart Association study by saying, "I yawned at it. It's old news." He also said that other studies suggest that chiropractic neck manipulation results in a stroke somewhere between one in a million and one in three million cases [5]. The one-in-a-million figure could be correct if California's chiropractors had been averaging about 60 neck manipulations per week. Later that year, during a televised interview with "Inside Edition," Sportelli said the "worst-case scenario" was one in 500,000 but added: "When you weigh the procedure against any other procedure in the health-care industry, it is probably the lowest risk factor of anything." According to the program's narrator, Sportelli said that 90% of his patients receive neck manipulation.

In 1996, RAND issued a booklet that tabulated more than 100 published case reports and estimated that the number of strokes, cord compressions, fractures, and large blood clots was 1.46 per million neck manipulations. Even though this number appears small, it is significant because many of the manipulations chiropractors do should not be done. In addition, as the report itself noted, neither the number of manipulations performed nor the number of complications has been systematically studied [6]. Since some people are more susceptible than others, it has also been argued that the incidence should be expressed as rate per patient rather than rate per adjustment.

In 1996, the National Chiropractic Mutual Insurance Company (NCMIC), which is the largest American chiropractic malpractice insurer, published a report called "Vertebrobasilar Stroke Following Manipulation," written by Allen G.J. Terrett, an Australian chiropractic educator/researcher. Terrett based his findings on 183 cases of vertebrobasilar strokes (VBS) reported between 1934 and 1994. He concluded that 105 of the manipulations had been administered by a chiropractor, 25 were done by a medical practitioner, 31 had been done by another type of practitioner, and that the practitioner type for the remaining 22 was not specified in the report. He concluded that VBS is "very rare," that current pretesting procedures are seldom able to predict susceptibility, and that in 25 cases serious injury might have been avoided if the practitioner had recognized that symptoms occurring after a manipulation indicated that further manipulations should not be done [7].

A 1999 review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors [8].

In 2001, NCMIC published a second edition of Terrett's book, titled, "Current Concepts: Vertebrobasilar Complications following Spinal Manipulation," which covered 255 cases published between 1934 and 1999 [9]. NCMIC's Web site claims that the book "includes an analysis of every known case related to this subject." That description is not true. It does not include many strokes that resulted in lawsuits against NCMIC policyholders but were not published in scientific journals. And it does not include the thoroughly documented case of Kristi Bedenbauer whose autopsy report I personally mailed to Terrett after speaking with him in 1995.

In 2001, Canadian researchers published a report about the relationships between chiropractic care and the incidence of vertebrovascular accidents (VBAs) due to vertebral artery dissection or blockage in Ontario, Canada, between 1993 and 1998. Using hospital records, each of 582 VBA cases was age- and sex-matched to four controls with no history of stroke. Health insurance billing records were used to document use of chiropractic services. The study found that VBA patients under age 45 were five times more likely than controls to (a) have visited a chiropractor within a week of the VBA and (b) to have had three or more visits with neck manipulations. No relationship was found after age 45. The authors discuss possible shortcomings of the study and urge that further research be done [10]. An accompanying editorial states that the data correspond to an incidence of 1.3 cases of vertebral artery dissection or blockage per 100,000 individuals receiving chiropractic neck manipulation, a number higher than most chiropractic estimates [11].

In 2001, British researchers reported on a survey in which all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of neck manipulation over a 12-month period. The 35 reported cases included 7 strokes involving the vertebrobasilar artery and 2 strokes involving a carotid artery. None of the 35 cases were reported to medical journals [12]. Edzard Ernst, professor of complementary medicine at the University of Exeter School of Sport and Health Sciences, believes that these results are very significant. In a recent commentary, he stated:

One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an underreporting rate of 100%. This extreme level of underreporting obviously renders estimates nonsensical [13].

In 2002, researchers representing the Canadian Stroke Consortium reported on 98 cases in which external trauma ranging from "trivial" to "severe" was identified as the trigger of strokes caused by blood clots formed in arteries supplying the brain. Chiropractic-style neck manipulation was the apparent cause of 38 of the cases, 30 involving vertebral artery dissection and 8 involving carotid artery dissection. Other Canadian statistics indicate the incidence of ischemic strokes in people under 45 is about 750 a year. The researchers believe that their data indicate that 20% are due to neck manipulation, so there may be "gross underreporting" of chiropractic manipulation as a cause of stroke [14].

In 2003, another research team reviewed the records of 151 patients under age 60 with cervical arterial dissection and ischemic stroke or transient ischemic attack (TIA) from between 1995 and 2000 at two academic stroke centers. After an interview and a blinded chart review, 51 patients with dissection and 100 control patients were studied. Patients with dissection were more likely to have undergone spinal manipulation within 30 days (14% vs 3%). The authors concluded that spinal manipulation is associated with vertebral arterial dissection and that a significant increase in neck pain following neck manipulation warrants immediate medical evaluation [15].

In 2006, the Journal of Neurology published a German Vertebral Artery Dissection Study Group report about 36 patients 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. In 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.

Two subsequent reports have added to this denial. In the first study, 377 members of the British and Scottish Chiropractic Associations and more than 19,000 of their patients were asked whether complications had occurred following neck manipulations. No strokes were reported, but symptoms that may have indicated neurologic involvement—headache (reported in 3.9% of cases), numbness/tingling of the arms (1.3% of cases), and fainting/dizziness/lightheadedness (1.1% of cases) were reported. About 400 patients who discontinued treatment could not be reached for follow-up, so what happened to them is unknown [17]. The second study compared insurance billing records and hospital discharge records and concluded that (a) the incidence of strokes was following primary-care (medical) visits was similar to the incidence of strokes following chiropractic visits, and (b) therefore the strokes that occurred in chiropractic offices were not caused by the treatment they received [18]. However, the study is meaningless because—unlike the German Vertebral Artery Dissection Study Group—the researchers did not examine clinical records and were not able to determine whether the diagnoses they tabulated were accurate or whether the strokes were related to the type of manipulation.

Are Complications Predictable?
Some chiropractors advocate "screening tests" with the hope of detecting individuals prone to stroke due to neck manipulation [19-21]. These tests, which include holding the head and neck in positions of rotation to see whether the patient gets dizzy, are not reliable, partly because manipulation can rotate the neck further than can be done with the tests. Listening over the neck arteries with a stethoscope to detect a murmur, for example, has not been proven reliable, though patients that have one should be referred to a physician. Vascular function tests in which the patient's head is briefly held in the positions used during cervical manipulation are also not reliable as a screen for high-risk patients because a thrust that further stretches the vertebral artery could still damage the vessel wall." In a chapter in the leading chiropractic textbook, Terrett and a conclude have stated:

Even after performing the relevant case history, physical examination, and vertebrobasilar function tests, accidents may still occur. There is no conclusive, foolproof screening procedure to eliminate patients at risk. Most victims are young, without [bony] or vascular pathology, and do not present with vertebrobasilar symptoms. The screening procedures described cannot detect those patients in whom [manipulation] may cause an injury. They give a false sense of security to the practitioner [22].

Several medical reports have described chiropractic patients who, after neck manipulation, complained of dizziness and other symptoms of transient loss of blood supply to the brain but were manipulated again and had a full-blown stroke. During a workshop I attended at the 1995 Chiropractic Centennial Celebration, Terrett said such symptoms are ominous and that chiropractors should abandon rotational manipulations that overstretch the vertebral arteries. But, as far as I know, his remarks have not been published and have had no impact on his professional colleagues.

The lack of predictability has been supported by data published by Scott Haldeman, DC, MD, PhD, a chiropractor who has served as an expert witness (usually for the defense) in many court cases involving chiropractic injury. In 1995, he published an abstract summarizing his review of 53 cases that had not been previously reported in medical or chiropractic journals. His report stated:

These cases represent approximately a 45% increase in the number of such cases reported in the English language literature over the past 100 years. . . . No clear cut risk factors can be elicited from the data. Previously proposed risk factors such as migraine headaches, hypertension, diabetes, history of cardiovascular disease, oral contraceptives, recent head or neck trauma, or abnormalities on x-rays do not appear to be significantly greater in patients who have cerebrovascular complications of manipulation than that noted in the general population [23].

Haldeman's main point was he could not identify any factor that could predict that a particular patient was prone to cerebrovascular injury from neck manipulation. This report was published in the proceedings of 1995 Chiropractic Centennial Celebration and was not cited in either the RAND or NCMIC reports.

In 2001, Haldeman and two colleagues published a more detailed analysis that covered 64 cases involving malpractice claims filed between 1978 and 1994 [24]. They reported that 59 (92%) came to treatment with a history of head or neck symptoms. However, the report provides insufficient information to judge whether manipulation could have been useful for treating their condition. Of course, malpractice claims don't present the full story, because most victims of professional negligence do not take legal action. Even when serious injury results, some are simply not inclined toward suing, some don't blame the practitioner, some have an aversion to lawyers, and some can't find an attorney willing to represent them.

What Should Be Done?
Chiropractors cannot agree among themselves whether the problem is significant enough to inform patients that vertebrobasilar stroke is a possible complication of manipulation [21,25]. In 1993, the Canadian Chiropractic Association published a consent form which stated, in part:

Doctors of chiropractic, medical doctors, and physical therapists using manual therapy treatments for patients with neck problems such as yours are required to explain that there have been rare cases of injury to a vertebral artery as a result of treatment. Such an injury has been known to cause stroke, sometimes with serious neurological injury. The chances of this happening are extremely remote, approximately 1 per 1 million treatments.

Appropriate tests will be performed on you to help identify if you may be susceptible to that kind of injury. . . . [26].

This notice is a step in the right direction but does not go far enough. A proper consent should disclose that (a) the risk is unknown; (b) alternative treatments may be available; (c) in many cases, neck symptoms will go away without treatment; (d) certain types of neck manipulation carry a higher risk than others; and (e) claims that spinal manipulation can remedy systemic diseases, boost immunity, improve general health, or prolong life have neither scientific justification nor a plausible rationale.

In 2003, a coroner's jury concluded that Lana Dale Lewis of Toronto, Canada, was killed in 1996 by a chiropractic neck manipulation. Among other things, the jury recommended that all patients for whom neck manipulation is recommended be informed that risk exists and that the Ontario Ministry of Health establish a database for chiropractors and other health professionals to report on neck adjustments [27].

In 2005, the Canadian Chiropractic Association published a comprehensive clinical guideline for treatment of adult neck pain not due to whiplash.. Among other things, the document noted that very few studies have compared chiropractic treatment to no treatment, which means that it is difficult to determine the likely benefit of neck manipulation. The guideline also discussed risk factors and recommended that minimal rotation should be used when upper-neck manipulation is done [28,29].

In 2007, following an unnecessary neck manipulation, Sandra Nette developed "locked-in syndrome," a condition that has been described as "the closest thing to being buried alive." She is fully aware of her surroundings and suffers at times from extreme pain. She cannot swallow, speak, or breathe without regular mechanical ventilation and suctioning of her secretions. She cannot move her legs or left arm. Slight use of her right arm enables her to use a computer keyboard to communicate through a voice synthesizer. Her plight is readily apparent in videos posted to YouTube [30]. In 2008, she and her husband filed a class-action lawsuit intended to stop inappropriate chiropractic manipulation and force Canadian regulators to deal with this problem [31].

The Bottom Line
As far as I know, most chiropractors do not warn their patients that neck manipulation entails risks. I believe they should and that the profession should implement a reporting system that would enable this matter to be appropriately studied. This might be achieved if (a) state licensing boards required that all such cases be reported, and (b) chiropractic malpractice insurance companies, which now keep their data secret, were required to disclose them to an independently operated database that has input from both medical doctors and chiropractors.

Meanwhile, since stroke is such a devastating event, every effort should be made to stop chiropractors from manipulating necks without adequate reason. Many believe that all types of headaches might be amenable to spinal manipulation even though no scientific evidence supports such a belief. Many include neck manipulation as part of "preventative maintenance" that involves unnecessarily treating people who have no symptoms. Even worse, some chiropractors—often referred to as "upper cervical specialists"—claim that most human ailments are the result of misalignment of the topmost vertebrae (atlas and axis) and that every patient they see needs neck manipulation. Neck manipulation of children under age 12 should be outlawed [32].

For Additional Information
Neck911USA.com: Dangers of neck manipulation.
Chiropractors Angry about bus ad
Reader Comment
From a former chiropractor:
I have been doing a vascular surgery rotation for the past month, which is part of my postgraduate medical education. During my chiropractic training, when the subject of manipulation-induced stroke was brought up, we were reassured that "millions of chiropractic adjustments are made each year and only a few incidents of stroke have been reported following neck manipulation." I recently found that two of the patients on my vascular service that suffered a cerebrovascular accident (stroke) had undergone neck manipulation by a chiropractor, one the day that symptoms had begun and the other four days afterward. If indeed the incidence of stroke is rare, one M.D. would see a case of manipulation-induced CVA about every 10 years. But I believe I have seen two in the past month! I therefore urge my medical colleagues to question their patients regarding recent visits to a chiropractor/neck manipulation when confronted with patients that present with the neurologic symptoms of stroke. I also urge potential chiropractic patients to not allow their necks to be manipulated in any way. The risk-to-benefit ratio is much too high to warrant such a procedure.


                                                            

[onlyme]

Just a very small part of why Chiropractics is a scam.


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Your Guide to Quackery, Health Fraud, and Intelligent Decisions Send This Page to a Friend       
 
 

Chiropractic's Dirty Secret:
Neck Manipulation and Strokes
Stephen Barrett, M.D.
Stroke from chiropractic neck manipulation occurs when an artery to the brain ruptures or becomes blocked as a result of being stretched. The injury often results from extreme rotation in which the practitioner's hands are placed on the patient's head in order to rotate the cervical spine by rotating the head [1]. The vertebral artery, which is shown in the picture to the right, is vulnerable because it winds around the topmost cervical vertebra (atlas) to enter the skull, so that any abrupt rotation may stretch the artery and tear its delicate lining. The anatomical problem is illustrated on page 7 of The Chiropractic Report, July 1999. A blood clot formed over the injured area may subsequently be dislodged and block a smaller artery that supplies the brain. Less frequently, the vessel may be blocked by blood that collects in the vessel wall at the site of the dissection [2].   

Chiropractors would like you to believe that the incidence of stroke following neck manipulation is extremely small. Speculations exist that the odds of a serious complication due to neck manipulation are somewhere between one in 40,000 and one in 10 million manipulations. No one really knows, however, because (a) there has been little systematic study of its frequency; (b) the largest malpractice insurers won't reveal how many cases they know about; and (c) a large majority of cases that medical doctors see are not reported in scientific journals.

Published Reports
In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo (dizziness). The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tears of the carotid arteries [3]. In 1991, according to circulation figures from Dynamic Chiropractic, California had about 19% of the chiropractors practicing in the United States, which suggests that about 147 cases of stroke each year were seen by neurologists nationwide. Of course, additional cases could have been seen by other doctors who did not respond to the survey.

A 1993 review concluded that potential complications and unknown benefits indicate that children should not undergo neck manipulation [4].

Louis Sportelli, DC, NCMIC president and a former ACA board chairman contends that chiropractic neck manipulation is quite safe. In an 1994 interview reported by the Associated Press, he reacted to the American Heart Association study by saying, "I yawned at it. It's old news." He also said that other studies suggest that chiropractic neck manipulation results in a stroke somewhere between one in a million and one in three million cases [5]. The one-in-a-million figure could be correct if California's chiropractors had been averaging about 60 neck manipulations per week. Later that year, during a televised interview with "Inside Edition," Sportelli said the "worst-case scenario" was one in 500,000 but added: "When you weigh the procedure against any other procedure in the health-care industry, it is probably the lowest risk factor of anything." According to the program's narrator, Sportelli said that 90% of his patients receive neck manipulation.

In 1996, RAND issued a booklet that tabulated more than 100 published case reports and estimated that the number of strokes, cord compressions, fractures, and large blood clots was 1.46 per million neck manipulations. Even though this number appears small, it is significant because many of the manipulations chiropractors do should not be done. In addition, as the report itself noted, neither the number of manipulations performed nor the number of complications has been systematically studied [6]. Since some people are more susceptible than others, it has also been argued that the incidence should be expressed as rate per patient rather than rate per adjustment.

In 1996, the National Chiropractic Mutual Insurance Company (NCMIC), which is the largest American chiropractic malpractice insurer, published a report called "Vertebrobasilar Stroke Following Manipulation," written by Allen G.J. Terrett, an Australian chiropractic educator/researcher. Terrett based his findings on 183 cases of vertebrobasilar strokes (VBS) reported between 1934 and 1994. He concluded that 105 of the manipulations had been administered by a chiropractor, 25 were done by a medical practitioner, 31 had been done by another type of practitioner, and that the practitioner type for the remaining 22 was not specified in the report. He concluded that VBS is "very rare," that current pretesting procedures are seldom able to predict susceptibility, and that in 25 cases serious injury might have been avoided if the practitioner had recognized that symptoms occurring after a manipulation indicated that further manipulations should not be done [7].

A 1999 review of 116 articles published between 1925 and 1997 found 177 cases of neck injury associated with neck manipulation, at least 60% of which was done by chiropractors [8].

In 2001, NCMIC published a second edition of Terrett's book, titled, "Current Concepts: Vertebrobasilar Complications following Spinal Manipulation," which covered 255 cases published between 1934 and 1999 [9]. NCMIC's Web site claims that the book "includes an analysis of every known case related to this subject." That description is not true. It does not include many strokes that resulted in lawsuits against NCMIC policyholders but were not published in scientific journals. And it does not include the thoroughly documented case of Kristi Bedenbauer whose autopsy report I personally mailed to Terrett after speaking with him in 1995.

In 2001, Canadian researchers published a report about the relationships between chiropractic care and the incidence of vertebrovascular accidents (VBAs) due to vertebral artery dissection or blockage in Ontario, Canada, between 1993 and 1998. Using hospital records, each of 582 VBA cases was age- and sex-matched to four controls with no history of stroke. Health insurance billing records were used to document use of chiropractic services. The study found that VBA patients under age 45 were five times more likely than controls to (a) have visited a chiropractor within a week of the VBA and (b) to have had three or more visits with neck manipulations. No relationship was found after age 45. The authors discuss possible shortcomings of the study and urge that further research be done [10]. An accompanying editorial states that the data correspond to an incidence of 1.3 cases of vertebral artery dissection or blockage per 100,000 individuals receiving chiropractic neck manipulation, a number higher than most chiropractic estimates [11].

In 2001, British researchers reported on a survey in which all members of the Association of British Neurologists were asked to report cases referred to them of neurological complications occurring within 24 hours of neck manipulation over a 12-month period. The 35 reported cases included 7 strokes involving the vertebrobasilar artery and 2 strokes involving a carotid artery. None of the 35 cases were reported to medical journals [12]. Edzard Ernst, professor of complementary medicine at the University of Exeter School of Sport and Health Sciences, believes that these results are very significant. In a recent commentary, he stated:

One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an underreporting rate of 100%. This extreme level of underreporting obviously renders estimates nonsensical [13].

In 2002, researchers representing the Canadian Stroke Consortium reported on 98 cases in which external trauma ranging from "trivial" to "severe" was identified as the trigger of strokes caused by blood clots formed in arteries supplying the brain. Chiropractic-style neck manipulation was the apparent cause of 38 of the cases, 30 involving vertebral artery dissection and 8 involving carotid artery dissection. Other Canadian statistics indicate the incidence of ischemic strokes in people under 45 is about 750 a year. The researchers believe that their data indicate that 20% are due to neck manipulation, so there may be "gross underreporting" of chiropractic manipulation as a cause of stroke [14].

In 2003, another research team reviewed the records of 151 patients under age 60 with cervical arterial dissection and ischemic stroke or transient ischemic attack (TIA) from between 1995 and 2000 at two academic stroke centers. After an interview and a blinded chart review, 51 patients with dissection and 100 control patients were studied. Patients with dissection were more likely to have undergone spinal manipulation within 30 days (14% vs 3%). The authors concluded that spinal manipulation is associated with vertebral arterial dissection and that a significant increase in neck pain following neck manipulation warrants immediate medical evaluation [15].

In 2006, the Journal of Neurology published a German Vertebral Artery Dissection Study Group report about 36 patients 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. In 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.

Two subsequent reports have added to this denial. In the first study, 377 members of the British and Scottish Chiropractic Associations and more than 19,000 of their patients were asked whether complications had occurred following neck manipulations. No strokes were reported, but symptoms that may have indicated neurologic involvement—headache (reported in 3.9% of cases), numbness/tingling of the arms (1.3% of cases), and fainting/dizziness/lightheadedness (1.1% of cases) were reported. About 400 patients who discontinued treatment could not be reached for follow-up, so what happened to them is unknown [17]. The second study compared insurance billing records and hospital discharge records and concluded that (a) the incidence of strokes was following primary-care (medical) visits was similar to the incidence of strokes following chiropractic visits, and (b) therefore the strokes that occurred in chiropractic offices were not caused by the treatment they received [18]. However, the study is meaningless because—unlike the German Vertebral Artery Dissection Study Group—the researchers did not examine clinical records and were not able to determine whether the diagnoses they tabulated were accurate or whether the strokes were related to the type of manipulation.

Are Complications Predictable?
Some chiropractors advocate "screening tests" with the hope of detecting individuals prone to stroke due to neck manipulation [19-21]. These tests, which include holding the head and neck in positions of rotation to see whether the patient gets dizzy, are not reliable, partly because manipulation can rotate the neck further than can be done with the tests. Listening over the neck arteries with a stethoscope to detect a murmur, for example, has not been proven reliable, though patients that have one should be referred to a physician. Vascular function tests in which the patient's head is briefly held in the positions used during cervical manipulation are also not reliable as a screen for high-risk patients because a thrust that further stretches the vertebral artery could still damage the vessel wall." In a chapter in the leading chiropractic textbook, Terrett and a conclude have stated:

Even after performing the relevant case history, physical examination, and vertebrobasilar function tests, accidents may still occur. There is no conclusive, foolproof screening procedure to eliminate patients at risk. Most victims are young, without [bony] or vascular pathology, and do not present with vertebrobasilar symptoms. The screening procedures described cannot detect those patients in whom [manipulation] may cause an injury. They give a false sense of security to the practitioner [22].

Several medical reports have described chiropractic patients who, after neck manipulation, complained of dizziness and other symptoms of transient loss of blood supply to the brain but were manipulated again and had a full-blown stroke. During a workshop I attended at the 1995 Chiropractic Centennial Celebration, Terrett said such symptoms are ominous and that chiropractors should abandon rotational manipulations that overstretch the vertebral arteries. But, as far as I know, his remarks have not been published and have had no impact on his professional colleagues.

The lack of predictability has been supported by data published by Scott Haldeman, DC, MD, PhD, a chiropractor who has served as an expert witness (usually for the defense) in many court cases involving chiropractic injury. In 1995, he published an abstract summarizing his review of 53 cases that had not been previously reported in medical or chiropractic journals. His report stated:

These cases represent approximately a 45% increase in the number of such cases reported in the English language literature over the past 100 years. . . . No clear cut risk factors can be elicited from the data. Previously proposed risk factors such as migraine headaches, hypertension, diabetes, history of cardiovascular disease, oral contraceptives, recent head or neck trauma, or abnormalities on x-rays do not appear to be significantly greater in patients who have cerebrovascular complications of manipulation than that noted in the general population [23].

Haldeman's main point was he could not identify any factor that could predict that a particular patient was prone to cerebrovascular injury from neck manipulation. This report was published in the proceedings of 1995 Chiropractic Centennial Celebration and was not cited in either the RAND or NCMIC reports.

In 2001, Haldeman and two colleagues published a more detailed analysis that covered 64 cases involving malpractice claims filed between 1978 and 1994 [24]. They reported that 59 (92%) came to treatment with a history of head or neck symptoms. However, the report provides insufficient information to judge whether manipulation could have been useful for treating their condition. Of course, malpractice claims don't present the full story, because most victims of professional negligence do not take legal action. Even when serious injury results, some are simply not inclined toward suing, some don't blame the practitioner, some have an aversion to lawyers, and some can't find an attorney willing to represent them.

What Should Be Done?
Chiropractors cannot agree among themselves whether the problem is significant enough to inform patients that vertebrobasilar stroke is a possible complication of manipulation [21,25]. In 1993, the Canadian Chiropractic Association published a consent form which stated, in part:

Doctors of chiropractic, medical doctors, and physical therapists using manual therapy treatments for patients with neck problems such as yours are required to explain that there have been rare cases of injury to a vertebral artery as a result of treatment. Such an injury has been known to cause stroke, sometimes with serious neurological injury. The chances of this happening are extremely remote, approximately 1 per 1 million treatments.

Appropriate tests will be performed on you to help identify if you may be susceptible to that kind of injury. . . . [26].

This notice is a step in the right direction but does not go far enough. A proper consent should disclose that (a) the risk is unknown; (b) alternative treatments may be available; (c) in many cases, neck symptoms will go away without treatment; (d) certain types of neck manipulation carry a higher risk than others; and (e) claims that spinal manipulation can remedy systemic diseases, boost immunity, improve general health, or prolong life have neither scientific justification nor a plausible rationale.

In 2003, a coroner's jury concluded that Lana Dale Lewis of Toronto, Canada, was killed in 1996 by a chiropractic neck manipulation. Among other things, the jury recommended that all patients for whom neck manipulation is recommended be informed that risk exists and that the Ontario Ministry of Health establish a database for chiropractors and other health professionals to report on neck adjustments [27].

In 2005, the Canadian Chiropractic Association published a comprehensive clinical guideline for treatment of adult neck pain not due to whiplash.. Among other things, the document noted that very few studies have compared chiropractic treatment to no treatment, which means that it is difficult to determine the likely benefit of neck manipulation. The guideline also discussed risk factors and recommended that minimal rotation should be used when upper-neck manipulation is done [28,29].

In 2007, following an unnecessary neck manipulation, Sandra Nette developed "locked-in syndrome," a condition that has been described as "the closest thing to being buried alive." She is fully aware of her surroundings and suffers at times from extreme pain. She cannot swallow, speak, or breathe without regular mechanical ventilation and suctioning of her secretions. She cannot move her legs or left arm. Slight use of her right arm enables her to use a computer keyboard to communicate through a voice synthesizer. Her plight is readily apparent in videos posted to YouTube [30]. In 2008, she and her husband filed a class-action lawsuit intended to stop inappropriate chiropractic manipulation and force Canadian regulators to deal with this problem [31].

The Bottom Line
As far as I know, most chiropractors do not warn their patients that neck manipulation entails risks. I believe they should and that the profession should implement a reporting system that would enable this matter to be appropriately studied. This might be achieved if (a) state licensing boards required that all such cases be reported, and (b) chiropractic malpractice insurance companies, which now keep their data secret, were required to disclose them to an independently operated database that has input from both medical doctors and chiropractors.

Meanwhile, since stroke is such a devastating event, every effort should be made to stop chiropractors from manipulating necks without adequate reason. Many believe that all types of headaches might be amenable to spinal manipulation even though no scientific evidence supports such a belief. Many include neck manipulation as part of "preventative maintenance" that involves unnecessarily treating people who have no symptoms. Even worse, some chiropractors—often referred to as "upper cervical specialists"—claim that most human ailments are the result of misalignment of the topmost vertebrae (atlas and axis) and that every patient they see needs neck manipulation. Neck manipulation of children under age 12 should be outlawed [32].

For Additional Information
Neck911USA.com: Dangers of neck manipulation.
Chiropractors Angry about bus ad
Reader Comment
From a former chiropractor:
I have been doing a vascular surgery rotation for the past month, which is part of my postgraduate medical education. During my chiropractic training, when the subject of manipulation-induced stroke was brought up, we were reassured that "millions of chiropractic adjustments are made each year and only a few incidents of stroke have been reported following neck manipulation." I recently found that two of the patients on my vascular service that suffered a cerebrovascular accident (stroke) had undergone neck manipulation by a chiropractor, one the day that symptoms had begun and the other four days afterward. If indeed the incidence of stroke is rare, one M.D. would see a case of manipulation-induced CVA about every 10 years. But I believe I have seen two in the past month! I therefore urge my medical colleagues to question their patients regarding recent visits to a chiropractor/neck manipulation when confronted with patients that present with the neurologic symptoms of stroke. I also urge potential chiropractic patients to not allow their necks to be manipulated in any way. The risk-to-benefit ratio is much too high to warrant such a procedure.


                                                             

More doctors misdiagnose patients than chiropractors everyday of the week. 

[exoslimjim]

where did u go to med school pitt?

[Krankenstein]

Dr. Stephen Barrett of Quackwatch Exposed In Court Cases
At trial, under a heated cross-examination by Negrete, Barrett conceded that he was not a Medical Board Certified psychiatrist because he had failed the certification exam.

This was a major revelation since Barrett had provided supposed expert testimony as a psychiatrist and had testified in numerous court cases. Barrett also had said that he was a legal expert even though he had no formal legal training.

The most damning testimony before the jury, under the intense cross-examination by Negrete, was that Barrett had filed similar defamation lawsuits against almost 40 people across the country within the past few years and had not won one single one at trial.

During the course of his examination, Barrett also had to concede his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA).

P R E S S R E L E A S E

FOR IMMEDIATE RELEASE

Date: October 13, 2005

Location: Allentown, Pennsylvania

Court Case: Stephen Barrett, M.D. vs. Tedd Koren, D.C. and Koren Publications, Inc.
Court of Common Pleas of Lehigh County for the State of Pennsylvania
Court Case No.: 2002-C-1837
Contact: Carlos F. Negrete
LAW OFFICES OF CARLOS F. NEGRETE
San Juan Capistrano, CA 92675
Phone: 949.493.8115
Fax: 949.493.8170
email: mediarelations@healthfreedomlaw.com
mediarelations@negretelaw.com
URL: www.healthfreedomlaw.com
www.negretelaw.com

Dr. Tedd Koren, DC.
Phone: 800.537.3001
267.498.0071 Fax: 267.498.0078
URL: www.korenpublications.co m

Subject: Quackwatch Founder Stephen Barrett loses Major Defamation trial in Hometown

In a stunning development, Lehigh Valley Pennsylvania Judge J. Brian Johnson on Thursday, October 13, 2005, tossed out nationally known self-proclaimed ‘consumer medical advocate’ Stephen Barrett’s defamation lawsuit just minutes before it was going to be considered by a local jury.

The lawsuit, filed in August 2002, against also nationally known Pennsylvania chiropractor, lecturer, researcher and publisher, Stephen Barrett sought unspecified damages against Koren and his company, Koren Publications, Inc. for statements that he wrote in his newsletter in 2001 about Barrett.

Barrett, a long-time nemesis of chiropractic, filed the lawsuit because of Koren’s publication that Barrett was ‘licensed’ and in trouble because of a $10 million lawsuit and because Barrett was called a ‘Quackpot’.

In his defense, Koren contended that the statements were true and not defamatory and that he had a First Amendment right to write them in his newsletter.

Thursday’s ruling by Judge Johnson represented a major reversal of the finding of an arbitration in August 2004 wherein a panel of three local private attorneys reviewing the case had found in favor of Barrett and awarded Barrett $16,500 in damages and that Koren should publish a retraction. That award was appealed by Koren.

Dr. Koren was represented by well-known health freedom San Juan Capistrano, California, attorney Carlos F. Negrete for trial and Washington, D.C. attorney James Turner of Swankin & Turner. Easton, Pennsylvania attorney Christopher Reid of Laub, Seidel, Cohen, Hof & Reid served as local counsel for the team and was co-counsel for the trial along with Negrete.

Turner and Negrete have been well known for their representation of clients in the health food, supplement and vitamin industries as well as representing naturopaths, nurses, dentists, physicians, chiropractors and complimentary therapists across the country.

Turner’s experience dates back the 1960s when he joined consumer advocate Ralph Nader and was one of the groundbreaking Nader’s Raiders that made consumer advocacy popular and brought about significant changes in manufacturing and consumer protection.

In making the ruling to throw out the case, Judge Johnson granted a rare directed verdict to the jury finding there was insufficient evidence to support Barrett’s claims. Judge Johnson indicated that this case was one of those rare times where such a motion was appropriate.

Barrett operates the web site www.quackwatch.org , www.chirobase.org and 20 other web sites and has been a long time critic of chiropractic calling much of it"quackery".

The victory to chiropractor Koren comes almost 18 years to the date that chiropractors received national attention with their victory against the American Medical Association (AMA) by obtaining an injunction against the AMA from an Illinois federal judge for engaging in illegal boycotting of doctors chiropractic in Wilk et al vs. AMA.

Barrett had been an outspoken supporter of the AMA at the same time that Koren had been a vocal advocate that the AMA has, in recent years, violated the spirit of the federal judge’s order.

After the ruling, Koren proclaimed that: I am overjoyed and enthusiastic that this nightmare is over and that the science, art and philosophy of chiropractic and the work of all of my colleagues have been vindicated.

“This case took a toll on my life and family, but I knew that I was right in publishing the truth.”

Dr. Barrett has no right to misinform the public about chiropractic and other natural healing arts or to try to silence anyone who criticizes him or tell consumers that he is not what he purports to be.

“I believe that it is not right to be silent when there is a duty to inform the public and let the truth be told.”

For years, Barrett has touted himself as a medical expert on ‘quackery’ in healthcare and has assisted in dozens of court cases as an expert. He also was called upon by the FDA, FTC and other governmental agencies for his purported expertise.

He was the subject of many magazine interviews, including Time Magazine and featured on television interviews on ABC’s 20/20, NBC’s Today Show and PBS.

He has gained media fame by his outspoken vocal disgust and impatience over natural or non-medical healthcare, including his criticisms of two time Nobel Prize winner Linus Pauling.

Dr. Tedd Koren is known for his writings and lectures on chiropractic science, research, philosophy, and chiropractic patient adjusting.

He is known for his Koren Publications chiropractic patient education brochures, posters, booklets, books and other products that are used in chiropractors’ offices throughout the United States and around the world.

Dr. Koren also co-founded a chiropractic college, is on the extension faculty of two chiropractic colleges, is published in chiropractic and bio-medical journals and has received numerous awards in his field. His web sites include www.korenpublications.co m and www.teddkorenseminars.co m

In his 2001 newsletter, Koren published articles that revealed that even though he touted himself as a medical expert, Barrett had not been a licensed physician since the early 1990s.

He also published that Barrett had been the subject of a $10 million racketeering lawsuit [that had been withdrawn] and called him a ‘quackpot’ for the contradiction of his website and lack of credentials.

Koren’s trial attorney, Carlos F. Negrete of San Juan Capistrano, California, is known for his defense of physicians, chiropractors, dentists, clinics and natural heath providers who practice what is known as complimentary & alternative medicine and holistic healthcare. Negrete has also handled groundbreaking cases against HMOs in California and has represented many celebrities and politicians.

At trial, under a heated cross-examination by Negrete, Barrett conceded that he was not a Medical Board Certified psychiatrist because he had failed the certification exam.

This was a major revelation since Barrett had provided supposed expert testimony as a psychiatrist and had testified in numerous court cases.

Barrett also had said that he was a legal expert even though he had no formal legal training.

The most damming testimony before the jury, under the intense cross-examination by Negrete, was that Barrett had filed similar defamation lawsuits against almost 40 people across the country within the past few years and had not won one single one at trial.

During the course of his examination, Barrett also had to concede his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA).

This was not the first time that Negrete was a trial attorney in a Barrett case. He also represented anti-fluoridation advocate Darlene Sherrell in a federal lawsuit filed in Eugene, Oregon by Barrett.

Barrett also lost in trial of that case. Negrete also represented Robert King of King Bio Natural Medicine of North Carolina and MediaPower (manufacturers of CalMax and Nu-Zymes) of Maine in cases filed by an organization led by Barrett, which were lost by Barrett's organization.

Barrett has also filed a lawsuit against Negrete and his client Dr. Hulda Clark (author of The Cure for All Diseases and The Cure for All Cancers) , which is now pending and awaiting trial in San Diego, California federal court.

After the Koren trial, Negrete stated: “The de-bunker has been de-bunked. I am pleased and satisfied with this outcome for Dr. Koren and am proud that Dr. Koren did not succumb to the pressures of the intimidation of Barrett’s legal wrangling. Not everyone can stand up to someone as well known as Barrett.”

Negrete continued, “It is another great day for health freedom and alternative healthcare around the world. I am especially pleased that this most important victory was in Barrett’s own hometown. It just goes to show you that there is justice anywhere, even when you are a visitor challenging the home team.

Barrett is a shill for the medical and pharmaceutical cartels and his bully tactics and unjustified discrediting of leading innovators, scientists and health practitioners should not be tolerated.”

Negrete said, “You can be assured that our legal team will be wherever health freedom advocates and practitioners are being persecuted. The tide is now turning and people are no long accepting that synthetic drugs are the only form of treatment are the only way to address health concerns.

"Every day, consumers are becoming more educated about the benefits of holistic and alternative methods. This is something that the medical establishment obviously fears and wants to crush with false propaganda.”

Koren said that he would now go back to his home in Pennsylvania to spend more time with his family and continue to write, research, and lecture on topics concerning chiropractic and healthcare and the experiences he has gained from this precedent setting legal battle.

He plans to give new lectures to chiropractors across the country who are under attack or have been subjected to governmental actions.

He also announced that he is forming a new organization aimed at informing and assisting chiropractors across the country.

The trial started on Monday, October 10, 2005 and ended on October 13, 2005 Barrett was represented by local Allentown attorney, Richard Orloski.


CHIROWNED!!!!

[Krankenstein]

http://www.quackpotwatch.org/quackpots/quackpots/barrett.htm

CHIROWNED AGAIN.....

PLEASE tell me you have more than just Quack-Barrett as your proof.....

Oh, by the way....the Mayo clinic actually contacted my office to be part of a study on possible help with chiropractic and MS.  Wow..we must REALLY be a scam. 

[elite_lifter]

The FACTS still stand regardless, he just repoted them. I never claimed he was an expert.

[Krankenstein]

Quackbuster Barrett Loses Appeal, Leaves Town

Self-proclaimed Quackbuster, Stephen Barrett, MD, who was recently handed
crushing defeats by chiropractor Tedd Koren and Ilena Rosenthal, has
announced he is leaving his home town and operating base in Allentown,
Pennsylvania.

On June 11th, 2007, the Superior Court of Pennsylvania affirmed a lower
court dismissal of Barrett's defamation suite against Dr. Koren. Barrett's
case was so lacking in merit the judge blocked it from going to the jury.
Barrett simply had no case against Dr. Koren.

This followed another stunning defeat last month in California. There an
appeals court ordered Barrett and crony Terry Polevoy, MD to post bonds of
more than $400,000.00 after they lost a defamation case against Illena
Rosenthal virtually identical to the Koren case.

Perhaps the fact that lawyers and judges in Allentown are catching on to his
intimidation schemes explains why Barrett is moving to Chapel Hill, North
Carolina. Barrett can run but he can't hide. Chapel Hill collection
attorneys are already being asked to locate his assets to pay his unmet
legal obligations. Assets of other Quackwatch, Inc., principals might also
be sought.


CHIROWNED yet AGAIN!!!!

By the way....his 'accomplice' Allan, Bostwick (will NOT refer to him as doctor as he is a scum bag) is in hiding so he cant be served with lawsuit papers.  Coincidentally MISTER Bostwick wrote an article for Barrett just before disappearing.  Perhaps he is actually dead from a upper cervical adjustment??  Wow...wouldnt that be ironic.

[Krankenstein]

The FACTS still stand regardless, he just repoted them. I never claimed he was an expert.

Dude..pull VALID research off of pubmed.....not some bullshit from a guy who is an OBVIOUS scam artist like you claim chiros to be.  I mean, come on...the guy claims NO INCOME from 1993 and forward..yet is brough on as an 'expert witness' when major medical companies go to trial.  When I have been called for depositions, I get $375/hr.  How much do you think he is getting??  Look at who you are aligning yourself with!!