With banner headlines larger than those used by the New York Times to describe the catastrophic terrorist attacks in New York and Washington on September 11 of last year, the National Post has accepted at face value what appear to be the blatantly political opinions of 60 neurologists to warn of "chiropractic peril." The hysteria engendered by both your February 7 headline and Brad Evenson's article ("MDs Warn of Chiropractic Peril" - at www.nationalpost.com) needs to be answered by the following established facts:
- A review of over half a dozen peer-reviewed published scientific papers puts the risk of cerebrovascular accidents (including stroke) associated with spinal manipulation at anywhere from one per 400,000 to one per 5.85 million cervical manipulations, the latter figure representing the most rigorously derived frequency.
On the other hand, the risk of deaths from the use of such medicines as nonsteroidal anti-inflammatory agents (NSAIDs), or from surgery to treat many of the same conditions as those managed by chiropractors, is 400 to 700 times greater; yet warnings pertaining to the use of these particular options do not seem to have been mentioned by the neurologists.
- The statement that "most studies, including one published in the New England Journal of Medicine (NEJM) in 1998, say it (neck manipulation) offers little or no medical benefit," shows blatant disregard of a series of studies published in the peer-reviewed and indexed scientific journals, which indicate that these very same manipulations not only match the medical alternatives for treating cervicogenic and tension-type headache, but do so for longer durations after treatment and without the common, injurious and even fatal side-effects of medications. A recently published study by Duke University confirms these same conclusions. Furthermore, the NEJM study cited by Evenson has been found to contain significant flaws in its design and has been discredited by many sources.
- As many as 68 everyday activities have been shown to disrupt cerebral circulation, 18 of which have actually been associated with vascular accidents but are decidedly nonmanipulative. Such activities would include childbirth; interventions by surgeons or anesthetists during surgery; calisthenics; yoga; turning the head while driving a vehicle; undergoing x-rays; treating a bleeding nose; stargazing; swimming; dancing; and beauty parlor events.
- Experiments with arterial models at the University of Calgary have shown that peak elongations of the vertebral artery during neck manipulations are, at most, 11 percent of the elongations that would be seen at the arterial failure limits; in fact, these elongations are consistently lower than those seen during routine diagnostic tests.
- Your statement that "chiropractors... extend the neck and rotate it sharply" is as fearmongering as it is inaccurate. These are the very maneuvers that recent research and directives seem to be discouraging, rather than endorsing for routine practice, as indicated in your text. Lateral flexion rather than rotation remains a treatment alternative; rotations themselves are described in chiropractic instruction as employing a short impulse without extension, rather than the distracting corkscrew maneuver implied in your text.
- The neurologists' deploring that "chiropractic is marketed as a treatment for childhood colic, inner ear infections, bedwetting and other malaises of children" is presented in such a manner as to discredit the choice of chiropractic treatment. For one thing, it so happens that the chiropractic management of two of the three conditions mentioned (colic, bedwetting) is supported by rigorous, randomized clinical trials already published in the indexed peer-reviewed scientific literature. Chiropractic treatment of inner ear infections, meanwhile, is documented in two published, large case series, and is currently under investigation in randomized clinical trials in a Boston teaching hospital. Secondly, there seems to be no relevance of any of these conditions to the primary subject at hand in your article (chiropractic perils), unless the goal here is to frighten away prospective chiropractic patients.
The chiropractic profession remains deeply concerned about and is actively researching the occurrences of any cerebrovascular accidents ever to occur with manipulations, which remains an event rarer than most activities in daily life. What is already becoming more and more apparent is that vertebral artery failures need to be regarded as the result of cumulative events such as those I have mentioned above, rather than simply the recent visits to the chiropractor, as maintained by the neurologists in your article. The only constructive alternative would be to continue to pursue productive research, hopefully with cooperation between the chiropractic and medical professions.
That goal is obviously discouraged by the type of article you have presented in the Post, having been generated by opinion only and orchestrated to coincide with the anniversary of the death of a chiropractic patient. I am certain that far more significant and praiseworthy contributions from the medical profession, as the discovery of penicillin or the development of the smallpox or polio vaccines, did not produce headlines nearly as large as your warning of the alleged "chiropractic perils!"
As the director of a national foundation that has supported research and postgraduate support in areas pertaining to chiropractic healthcare, I am horrified by the grossly misleading impression this type of journalism creates! Your readership deserves better.
Anthony Rosner,PhD
Director of Research and Education
Foundation for Chiropractic Education and Research
Brookline, Massachusetts
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