Stroke, Chiropractic and Subluxation: Sorting Fact From Fiction; JVSR Research Update

Of course I responded, along with many of you, by writing a letter to Time's Editor pointing out the absurdity of such a statement. And of course, Time did not print any of these letters to the Editor. Hmmmm. Now once again Leon Jaroff AKA "The Skeptical Eye" as he calls himself in his byline at Time, is at it again. This time he jumps on the Canadian Stroke bandwagon as an excuse to take shots at chiropractic and subluxation. How much you want to bet that Barrett fed him the info? In an article titled: "Back Off, Chiropractors!"

"Doctors find many of the other claims and practices of chiropractic questionable, if not downright objectionable." Most chiropractors for example, believe that "subluxations," or minor dislocations of the spine, put pressure on spinal nerves, resulting in a wide variety of disorders. All this despite the fact that no uniform criteria exist for even identifying a subluxation, let alone what it causes.

"Chiropractors also employ a bewildering variety of weird practices to diagnose their patients." Iris readings are commonplace in the profession " Even sillier are many of the treatments that chiropractors use and recommend " Chiropractors urge their patients to eschew such widely accepted health measures as immunization and fluoridation.

Jaroff makes it a point to state that not all of the criticism is coming from the medical profession and he refers to and quotes from a paper published in JMPT by Grod, Sikorski and Keating.

The "researchers" reviewed patient educational brochures from state, provincial and national chiropractic associations in the US and Canada. Their conclusion:

"The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of
scientific behavior."

"Within the chiropractic profession, there is debate as to the significance and existence of the vertebral subluxation. It is not within the intent or scope of the present article to address this controversial issue but the view that subluxation assessment is a valid diagnostic method is questioned in both the scientific literature and those chiropractic guidelines indexed in the National Guideline Clearinghouse that have evidence rating systems suited to scientific and technical areas of practice."

Want to know what really makes me mad as hell? We have probably less than 100 full time researchers in the chiropractic profession and we can't even afford to pay them a livable wage. The least we should be able to do is rely on our research journals, foundations and institutions to make sure idiots like this do not work in our profession. Their obvious skewing of data, mining of the literature and political agendas are obvious to anyone with a head just a tad
sharper than a bowling ball.

So, another negative article about our profession has been published. Once more it is our own members that hand them the gun, the ammunition and help them pull the trigger. The question remains: What will YOU do about it? Will YOU write a letter to Time? Will YOU join an association and get involved? Will YOU subscribe to JVSR?

Will YOU call your alma mater and ask why these people are still on the payroll? Will YOU write to the Editor of these journals and ask how these people get past peer review? Or will it be just like the last time we got attacked and YOU did nothing. It's up to YOU, right now. What will YOU do? My letter to Time follows.

If you write a letter, send a copy to me and I'll post it on JVSR. As always I look forward to your feedback comments and suggestions.

Time Columnist Ignores the Facts About Chiropractic

Dear Editor,

In his article: Back Off, Chiropractors! in the Wednesday February 27, 2002 issue of Time.com, columnist Leon Jaroff makes unsubstantiated statements regarding the chiropractic profession. First, he quotes an unpublished report from Canadian neurologists who contend that 40 percent of 156 stroke cases they analyzed were due to chiropractic neck manipulation. Besides it being unethical to report on supposed research that has not been published or subjected to peer review, Jaroff ignores the real research on the topic. A review of over half a dozen peer-reviewed published scientific papers places the risk of stroke associated with spinal manipulation at anywhere from 1 per 400,000 to 1 per 5.85M cervical manipulations. You stand a greater chance of getting struck by lightening than having a stroke from chiropractic treatment. I will refer you to the Journal of Vertebral Subluxation Research http://www.jvsr.com and its current issue, which is devoted to the topic of the stroke controversy for more factual information on this issue.

While it would seem logical that anyone concerned about errors in patient management might spend their time and effort on where the most damage is occurring, this is apparently not the case for Mr. Jaroff or Time. We have reports, such as the Institute of Medicine's, telling us that nearly 100,000 people die every year due to medical error and that these errors cost us $37.6 billion a year. Amazingly, based on that report organized medicine then says it needs billions of dollars from our government to try and find out why they are killing so many and to search for ways to stop it. They are literally asking the very people they are killing (American taxpayers) to pay to fix the problem they created. A problem that leaves the United Sates ranked 37th in overall health system performance by the WHO.

Lucian Leape, M.D. told us several years ago that the carnage of medical error is equal to three fully loaded jumbo jets crashing every other day. A recent report in the Journal of the American Medical Association stated that the numbers suggest that more Americans are killed in US hospitals every 6 months than died in the entire Vietnam War. The authors went on to state: "If these numbers are correct, the health care system is a public health menace of epidemic proportions."

The IOM report and others tell us that medical errors and malpractice rank anywhere from the 3rd to the 8th leading cause of death. More Americans are killed by medical error and malpractice every year than by car accidents, breast cancer, AIDS, cardiovascular disease and even handguns. According to Dr. John Eisenberg, Director of the Agency for Healthcare Research and Quality, "If the fifth leading cause of death was a disease, we'd invest hundreds of millions of dollars trying to understand its cause and research for new drugs. We've got to pay that kind of attention to this cause of death."

While I agree with Dr. Eisenberg that we have to pay attention to this cause of death, I prefer Dr. Leape's analogy. If fully loaded planes started falling out of the sky every other day, nobody would fly and the airline industry would be dragged into Congressional Hearings. It would be the airline industry's responsibility to find out and explain why it's happening.

Is there risk from undergoing chiropractic care? Of course, nothing in this world is without risk. However, we must look at the evidence and decide if it is politically and financially motivated or if it based on real science. Further, it is suggested that those studying risk in health care concentrate their resources where the greatest threat exists: the trillion dollar medical and pharmaceutical industrial complex that kills and cripples more Americans every year than our most feared scourges. Perhaps Jaroff's time is better spent casting his "Skeptical Eye" on another profession?

Secondly Jaroff takes another pot shot at the raison d' etre of chiropractic - the vertebral subluxation. His statements are akin to saying that dental caries do not exist and that dentists have no uniform criteria for identifying them. Left unanswered, Jaroff's allegations pose a threat to public health since a person with a subluxation may not get needed care. Readers of TIME should know that state laws, the United States Federal Government, The World Chiropractic Alliance, The Council on Chiropractic Practice, The International Chiropractor's Association, The American Chiropractor's Association, The Federation of Straight Chiropractic Organizations, and The Association of Chiropractic Colleges all define the responsibility of chiropractors as the detection and correction of vertebral subluxation and its resultant neurological interference.

The chiropractic guideline document: Vertebral Subluxation in Chiropractic Practice, produced by the Council on Chiropractic Practice was reviewed by an independent research agency (ECRI) which is a Collaborating Center of the World Health Organization. Based on this review it was accepted for inclusion in the National Guideline Clearinghouse of the Agency for Health Care Policy and Research of the United States Federal Government.

The existence of subluxation is in accordance with the published paradigm statement of The Association of Chiropractic Colleges, which was accepted and signed by every Chiropractic College President in North America. The ACC defines the purpose, principles and practice of chiropractic as the finding and reduction of vertebral subluxations, which will prevent and restore health by removing interference to the body's inherent recuperative powers. This document, among other things, states that chiropractic as a profession "focuses particular attention on the subluxation."

The assessment and management of vertebral subluxation is either taught as part of the regular curriculum of chiropractic colleges in North America or as part of their post graduate programs. All of these programs, including the general curriculum of the chiropractic colleges and the post graduate programs, are approved and Accredited by the Council on Chiropractic Education which is subject to the rules and authority of the United States Federal Government's Department of Education. These schools also hold accreditation through various local and regional accrediting bodies.

The American Medical Association, in its Guides to the Evaluation of Permanent Impairment, list the following as acceptable means to rate
impairment: Impairment due to loss of muscle power and motor function, impairment due to abnormal motion of the spine, impairment due to loss of motion segment integrity, impairment due to disc problems, impairment due to pain or sensory deficit, and segmental instability. These are, in fact, components of the Vertebral Subluxation Complex.

The Guidelines for Evaluation and Management Services published by the Health Care Financing Administration of the United States Federal Government and the American Medical Association (May 1997) outline what an objective examination should consist of and these include commonly used neuromusculoskeletal exam procedures within chiropractic such as: postural analysis, palpation, assessment for subluxation, range of motion and assessment of muscle tone. All of these are used to assess and manage subluxation.

The Federal Government of the United States specifically defines what chiropractors do as the detection and correction of subluxation under Medicare and Federal worker's compensation laws. Common to all state statutes is the adjustive process being utilized to reduce subluxations and the resultant interference to nerve transmission. No less than 38 states employ the term adjustment in licensing laws in reference to the procedures applied by chiropractors. 18 state statutes additionally include the concept of manipulation, 34 states contain specific references to responsibility for neurological complications of biomechanical origin (subluxation) and over half the chiropractic profession practice in these states. In addition, 11 states specifically discuss the concept of subluxation in their statutes by using the term and for those that do not specifically use the term there is an implied understanding of the concept in their statutes.

The existence of subluxation and its acceptance is spelled out in explicit detail by published policy statements of chiropractic organizations as well as federal and state laws regulating the practice of chiropractic. The epidemiology of subluxation has been researched since the inception of chiropractic over 100 years ago with basic science and clinical research to further elucidate the nature of it continuing to this day. Leon Jaroff's comments regarding subluxation are irresponsible and lack any scientific justification. I trust you will inform your readers of the facts regarding this matter.

Dr. Matthew McCoy editor@jvsr.com
Editor - Journal of Vertebral Subluxation Research http://www.jvsr.com

References

Journal of Vertebral Subluxation Research. Vol 4 # 3. http://www.jvsr.com

Foundation for Chiropractic Education and Research: The Week in Chiropractic.Vol. 8, No. 18

To err is human: Building a safer health system. The Institute of Medicine. November 1999.

Report to the President on Medical Errors.

Landers, S.: The world's health care: How do we rank? American Medical News. August 28, 2000.

Leape, L: Error in Medicine. JAMA 1994;272(23):1851

Hayward, RA, Hofer, TP.: Estimating hospital deaths due to medical errors. Preventability is in the eye of the reviewer. JAMA Vol. 286, No. 4 July 25, 2001

Causes of preventable death in the United States. Public Citizen. May/June 1994

Gregg, V.: Medical errors becoming major research focus. Reuters. March 6, 2000

Kent, C Models of Vertebral Subluxation. Journal of Vertebral Subluxation Research. Vol. 1 No. 1 August 1996. http://www.jvsr.com/abstracts/1197-0061_models.htm

Leach, R.A. The Chiropractic Theories. Principles and Clinical Applications. Williams and Wilkins. 1994.

Gatterman, M.I. Foundations of Chiropractic - Subluxation. Mosby. 1995.

Ruch, W.J. Atlas of Common Subluxations of the Human Spine and Pelvis. CRC Press. 1997.

Policy Statements of the International Chiropractors Association: 2000 ICA Membership Directory.

Medical Policy. Chiropractic Services. Medicare Operations Center, Fargo, North Dakota.

Vertebral Subluxation in Chiropractic Practice. Clinical Practice Guideline Number 1. Council on Chiropractic Practice. Chandler Arizona.

The Association of Chiropractic Colleges Position Paper # 1. July 1996. ICA Review November/December 1996.

What is Chiropractic? The World Chiropractic Alliance. 2950 N. Dobson Road #1. Chandler, AZ 85224

The Guidelines for Evaluation and Management Services. The Health Care Financing Administration of the United States Federal Government and the American Medical Association (May 1997)

The American Medical Association's Guides to the Evaluation of Permanent Impairment Fourth Edition.

Chiropractic Science and Practice in the United States. International Chiropractors Association Arlington VA. 1991.

Chiropractic: State of the Art 1991-1992. The American Chiropractic Association. Arlington, VA.

Recommended Clinical Protocols and Guidelines for the Practice of Chiropractic. International Chiropractor's Association. Virginia. 2000.

Dr. Matthew McCoy editor@jvsr.com
Editor - Journal of Vertebral Subluxation Research http://www.jvsr.com Subscribe and Support Chiropractic Research