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Significant issues and developments related to chiropractic.
A link to the full unedited version, as published by The Guardian, of Simon Singh's article 'Beware The Spinal Trap' that was critical of chiropractors and is subject to legal threats by the British Chiropractic Association (BCA). Gimpy's Blog (17th August 2008)
A lawyer for the New Zealand Chiropractors' Association has sent a threatening letter to the New Zealand Medical Journal alleging libel in two articles. In response, the Journal's editor, Professor Frank A. Frizelle, said "The Journal has a responsibility to deal with all issues and not to steer clear of those issues that are difficult or contentious or carry legal threats….. I encourage, as we have done previously, the chiropractors and others to join in [the debate], let's hear your evidence not your legal muscle". DC Science (8th August 2008)
Consumer advocates and victims of chiropractic have asked to meet with Canadian legislators and the Minister of Health to propose the following guidelines:
1. INFANTS AND CHILDREN: Highest neck manipulation should never be done in infants and children for claims to treat such conditions as ear infections, tonsillitis, infantile colic, asthma and gastro-intestinal disorders nor as an alternative to scientific immunization against diseases such as polio, tetanus, measles, mumps, German measles or chicken pox. The Chiefs of Paediatrics of our Canadian Hospitals have all condemned such claims by chiropractors.
2. PHILOSOPHICAL CLAIMS: Highest neck manipulation should never be done for the claim that it is effective to awaken the "innate intelligence of the spinal cord" and thereby provide "wellness or health" of the entire body. The idea that the spinal cord has some magical "innate intelligence" is a fundamental chiropractic belief. It is false.
3. REPETITIVE HIGHEST NECK MANIPULATIONS: Highest neck manipulation should not be done on a repetitive basis with claims that this will keep the neck vertebrae in proper alignment. It is false to claim that highest neck manipulation is necessary for the "maintenance" of the alignment of the highest neck vertebrae. The vertebrae are attached to each other by a complex structure of bone, ligaments and muscles. Manipulating the highest neck time and time again on people who have no complaints in that area should not be done.
4. INFECTIONS: Highest neck manipulation should not be done for any claims that it alters in any manner, the immune system, to prevent or to treat infections such as Acquired Immune Deficiency Syndrome and other bacterial, viral or fungal infections.
5. BODY ORGANS: Highest neck manipulation should not be done for claims that it can have a health benefit upon a body organ such as the heart, lungs, kidneys and liver or as a means of preventing the onset of genetic disorders or cancer.
6. VERTEBRAL SUBLUXATIONS: Highest neck manipulation should never be done for the claim that it can remove so called "vertebral subluxations" in the highest neck area. It is false to claim that these top vertebrae are out of alignment, even in new born babies, and that manipulating the highest neck area one can improve the function of the brain stem as well as treat conditions such as sinusitis and even multiple sclerosis. There is no neurological or scientific basis for such claims'. [Ends] These guidelines make sense, and rational chiropractors should have no objections to them. They would not interfere with spinal manipulation therapy for musculoskeletal conditions, and they would eliminate much of the quackery in chiropractic.
Harriet Hall, MD, Science Based Medicine (1st July 2008)
Sharon Mathiason, mother of Laurie Jean Mathiason who died in 1998 a few days after having her neck adjusted by a Saskatoon chiropractor, has decided to resume her battle to have neck manipulation banned. "We don't want to see any more deaths. This is just a belief system. There is no science to it," Sharon Mathiason said as she compiled packages of information in her living room to be sent to various politicians this week. Saskatoon Star Phoenix news report (18th June 2008)
An Alberta woman, paralyzed after her neck was manipulated by a chiropractor, has launched the biggest-ever class action suit against chiropractic in Canada. The suit, filed yesterday in Edmonton, is asking for more than a half billion dollars in damages not only for the victim, Sandy Nette and her husband, David, but for an entire class — anyone in Alberta treated or harmed by chiropractors who deliver "inappropriate and non-beneficial adjustments." News report by Paul Benedetti and Wayne MacPhail (13th June 2008)
The Chiropractic Stroke Awareness Group (CSAG) is continuing the expansion of its chiropractic-stroke awareness campaign to western states of the USA, including Colorado, Arizona and California. This is the latest phase of a coast-to-coast public relations offensive intended to make the public aware there are possible severe risks to chiropractic treatment. Leaders in the chiropractic industry have publicly expressed concerns that warning the public about risks of certain chiropractic manipulations may scare away potential patients. Press Release from The Chiropractic Stroke Awareness Group (27th April 2008)
"Does it work? There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper…Neck manipulation has been linked to neurological complications such as strokes — in 1998, a 20-year-old Canadian woman died after neck manipulation caused a blood clot which led to stroke. We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer…If you do decide to visit a chiropractor despite our concerns and warnings, we very strongly recommend you confirm your chiropractor won't manipulate your neck. The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine." Article by Simon Singh and Professor Edzard Ernst, Daily Mail (8th April 2008)
Increased membership of the Chiropractic Stroke Awareness Group (CSAG) has delivered increased resources. "Our members worldwide are determined to share with the public an accurate, ethical and responsible message about the health risks of chiropractic," said Britt Harwe, Founder of CSAG. "Our informational message stands in sharp contrast to the deliberate deception fuelled by a chiropractic industry more interested in profits than patients." Wethersfield, CT — PRWEB (12th December 2007)
"Spinal manipulation (and/or use of diclofenac) does not speed up recovery from back pain reported five newspapers (9 November 2007). The newspaper reports of a well-conducted trial of people with acute back pain were generally accurate. The study's results appear reliable, and are applicable to people with acute lower back pain." NHS National Library for Health (12th November 2007) Links to newspaper reports included.
"The Chiropractic Stroke Awareness Group (CSAG) is expanding its television awareness campaign, this time asking the question, "Have you been injured by a chiropractor?" on the ABC affiliate in Connecticut. The commercial then provides contact information for victims to seek information and support. The ad is part of an ongoing public awareness effort (including print and outdoor advertising) designed to raise the public consciousness about the risks of chiropractic treatment. Last month CSAG launched the television component on WTIC-TV the Fox affiliate in Connecticut. "The response has been overwhelming," said Amanda Thompson of CSAG. "Many people are coming forward to share their horror stories and to seek help." The organization represents hundreds of people across the country who have been injured by chiropractic treatment. Potential risks can include stroke, permanent disability and even death. CSAG is dismayed at the chiropractic community's response of preferring not to inform patients apparently out of fear some people might decide against chiropractic treatment if they were informed. "Sadly, the chiropractic industry remains more concerned about protecting profits than protecting their patients," Ms. Thompson said." Wethersfield, CT — PRWEB (4th November 2007)
Victims of Chiropractic Abuse (VOCA) has released a stamp honouring the life and legacy of Linda Solsbury, the courageous activist who started the push for chiropractic reform by working diligently to warn the public that chiropractic is not without risks. In 1985 Ms Solsbury became mute and paralysed as the result of chiropractic manipulation. She died in 2006 during an operation to relieve some of the effects of her injuries. PRWeb Press Release (29th August 2007)
"Manipulating the upper spine during back treatments could result in serious injury, experts have warned. A review of studies published in the Journal of the Royal Society of Medicine (JRSM) concluded that spinal manipulation should not routinely be done on patients. When performed on the upper spine, it may result in serious and possibly fatal complications, such as stroke, the experts said." The Scotsman (1st July 2007)
Four-page article revealing how chiropractors' moves can trigger strokes in healthy patients. MSNBC News (17th June 2007)
"The scientific standard developed by families and by medical specialists, and by chiropractors who have given up highest neck manipulation, is very simple. In essence it states that highest neck manipulation should not be performed on infants and children or on people who have no neck pain, or as part of a philosophy that falsely believes it can be used to prevent or treat organic illness. This standard cannot be argued against rationally and scientifically." Article in the National Post (18th May 2007) [pdf]
Professor Edzard Ernst is reportedly against regulation of alternative medicine until there is evidence. In an article in the British Medical Journal on 5th May 2007 he argued that regulation would be interpreted by the public as having sufficient evidence to recommend it. He said: "The evidence for the efficacy of chiropractic, for example, is very slim indeed. And since it has been regulated, research for establishing that it works has diminished. People are saying: 'We are fully regulated so don't ask us questions about whether this works or not.'" Science and Progress (7th May 2007)
"A Quebec coroner has recommended a full review of chiropractic neck treatments, saying a cervical adjustment contributed to the death of a woman in 2006. Coroner Paul G. Dionne released his recommendations Thursday, more than a year after Pierrette Parisien died following chiropractic care for severe neck pain." CBC News (12th April 2007)
The story of a UK chiropractic patient who, in 2003, suffered an arterial dissection which caused a brain stem stroke. Her chiropractor admitted liability for her injuries. NOTE: The UK General Chiropractic Council claims that there is no evidence that neck manipulation causes stroke. Currently there appears to be no official system in place in the UK to monitor adverse reactions/injuries caused by chiropractic treatment. Action for Victims of Chiropractic (May 2006)
BBC News report on a new study published by the Journal of the Royal Society of Medicine. (22nd March 2006) [Click on the link below to read the paper]
This news update contains three films worth seeing, chiropractic references and articles, the Florida State Univesrity School of Pseudoscience Scandal and, with regard to manipulation of the cervical spine, the following suggested PRECAUTIONARY GUIDELINES:
[1.] Manipulation, especially with rotation (the most commonly used method by chiropractors), should be considered a contraindicated technique.
[2.] Manipulation of C1-C2 should be considered absolutely contraindicated. (This is also the area of the neck most commonly manipulated by many chiropractors.)
[3.] In principle these guidelines and cautions apply to all involved professions, since it is primarily the technique that is the problem, even though chiropractors are by far responsible for the greatest number of injuries, strokes, and deaths. This is a logical consequence of their exaggerated and unwarranted self-confidence and erroneous education, combined with their historically and educationally conditioned overrating of the value of spinal manipulation as a whole.
[4.] All healthcare professions, including Emergency Room staff, must be alert to the possibility of injuries caused by spinal manipulative therapy (SMT). The patient's medical history should include questions about possible spinal manipulation within the last 30 days, at the very least. Symptoms and injuries can include: headache, dizziness, vertigo, nausea, pain, strains, sprains, whiplash type injuries, Horner's syndrome, Wallenberg's syndrome, permanent or transient paralysis, blackouts, fainting, blood clots to the brain, and death. Few of these consequences, especially deaths, are ever identified as results of previous SMT, since autopsies are rarely performed in these cases. Since strokes can occur up to a month — and even later — after manipulation of the cervical spine, a suspicion of any connection is rarely awakened.
[5.] When dealing with stroke cases, all MDs — be they general practitioners, specialists, pathologists, or coroners — should routinely examine the patient's (or deceased's) medical history (including interviews with relatives) for any cases of SMT within the previous 2-3 months, including number of times, since each repetition increases the risk. If this isn't done, the real extent of SMT induced strokes and deaths will not be exposed, and it will be impossible to institute preventive measures in harmony with quality control principles.
[6.] Physical Therapists should encourage patients with such injuries to report them to their own doctors. (I can't be the only PT who has encountered patients with fractured spines, spinal stenosis, herniated discs, paralysis, stable fractures made unstable, severe sprains and strains, torn muscles, and unremitting headaches for years, all as a direct result of a specific chiropractic "adjustment". I have seen all of these injuries, but those who have died haven't come to me or their chiro, for obvious reasons.)
[7.] Whiplash patients should never receive cervical manipulation, especially in the acute phase. Hairline fractures are easily overseen on x-rays at this point in time. This may create a false sense of security, resulting in treatment which can destabilize otherwise stable fractures. Such fractures become visible after a short time, often within a few weeks *if* the x-ray is taken from precisely the right angle, which isn't necessarily one of the standard angles.
NO MORE UNDERREPORTING: The massive underreporting (nearly 100%) that is currently occurring must stop. Neurologists and Physical Therapists encounter these cases regularly, but may not be recognizing them. Awareness of the problem will help to bring far more cases to light. They should then be reported to centrally established centers in all lands. In Canada the Canadian Stroke Consortium is attempting to uncover the real frequency of these injuries and deaths, since they are much more common than are indicated by chiropractic sources, where there is a vested interest to deny, ignore, and even cover-up, the problem.
NO EXCUSE FOR MANIPULATION OF THE CERVICAL SPINE (MCS): There is no excuse (with rare exception) for the manipulation of the cervical spine (MCS), especially in light of several facts:
[1.] The majority of such manipulations are not indicated, especially when the problem is located elsewhere in the body. MCS in such cases constitutes gross malpractice and reckless endangerment.
[2.] The real problems in the neck, head, and upper extremities, for which treatment of the neck is properly indicated, can be treated (a) without the use of MCS, (b) using other methods, (c) with longer lasting results, and (d) with much less risk than is involved with MCS.
I hope that these precautionary guidelines will become widely disseminated and formally adopted (and adapted) by all medical professions which deal with the locomotor system."
Guidelines compiled by Paul Lee, PT, quackfiles.blogspot.com (2005)