The Canadian Stroke Case
Radio, TV and the press in Canada recently carried some major national publicity on how a patient in Saskatchewan had a stroke and died following a chiropractic adjustment.
Society has been programmed for decades that people can get a stroke from neck manipulations, and so the public and media reaction was predictable. The media mercilessly attacked chiropractic. One of the newspapers referred to chiropractors as "killers."
The Canadian inquest determined that the patient died of a torn vertebral artery, but the inquest did not determine whether or not the chiropractor caused the death.
There wasn't any hue and cry about the ubiquitous over-the-counter nonsteroid anti-inflammatory drugs that any drug store clerk can sell you that have a death rate/complication ratio 400 times greater than a cervical adjustment.1
And forget the fact that a review of five million chiropractic adjustments in a chiropractic college clinic found no instance of stroke or death.2
And let's disregard the credible government studies from the United States, Canada and Great Britain3,4,5 which found that chiropractic is an exceptionally safe and therapeutically preferable treatment to medical care for low back pain as well as being more cost-effective.
And we'll ignore the fact that in 31 years involving billions of chiropractic adjustments, there were only ten cases of death following neck manipulations. Nine of these deaths were caused by MDs6, even though chiropractors perform 94% of the cervical manipulations/adjustments in America.7 In other words, six percent of the medical manipulators caused 90% of the lethal complications, which sends us a strong message for quality care.
This information did not get the same national exposure, and so misinformation, ignorance and prejudice prevailed.
Strokes will occur again as surely as the sun rises in the morning, and so a total understanding of the probabilities of them occurring compared to medical reactions must be put into proper perspective. The public must understand the entire picture.
The responsibility of educating the public lies with chiropractors. It's never been more vital for their growth and survival. We can't expect the medical profession or drug houses to provide a balanced picture of chiropractic; they never have and never will.
Being Squeezed out of Chiropractic
Our current health care direction will see highly skilled chiropractic spinal adjustors gradually being replaced with inferiorly trained medical manipulators or therapists. Chiropractors will gradually be so financially starved that they will be forced out of chiropractic, left to drive cabs, sell insurance, work for UPS, and engage in other non-related jobs. These are not the words of a prophet of doom and gloom, but of a deeply involved chiropractor candidly expressing some simple logic and common sense. You don't have to be a rocket scientist to see it. You just have to open your eyes to the obvious reality.
Scare Talk -- or Is It Real?
If any chiropractor insists that all of this is negative and ridiculous scare talk, I suggest that he or she may be compared to a victim of Auschwitz taking off their clothes and whistling on the way to the showers. Our national chiropractic leadership is acutely attuned to this crisis, acknowledges the danger, and needs the support of every chiropractor in the profession. But now that I may have candidly and hopefully caught your attention, please read on.
I have more than 40 years in practice, and the above scenario won't affect me personally. It's not about me, but what about the young practitioner looking forward to 40 or 50 years of practice? And what about the students in our colleges today, and what future will be awaiting them in the years to come? Our rank and file chiropractors had better wake up to the reality of what's happening before it's too late.
Chiropractic on the Medicare Chopping Block
The November 2nd issue of Dynamic Chiropractic carried a front-page article entitled "Chiropractic on the Medicare Chopping Block?" It revealed another example of the neverending assault on chiropractic. In 1990, Congress ordered the secretary of HHS to submit a report on the utilization of chiropractic in HMOs. HCFA ignored the Congressional mandate (So what else is new? Remember the HEW report?)8 HCFA created regulations which permit non chiropractors to provide spinal manipulation correct spinal subluxations. If HCFA can circumvent chiropractic's role and create its own regulations in which MDs or physical therapists manipulate the spine under the prescription of MDs and osteopaths, it will put physical therapists at the forefront of spinal manipulation, while chiropractors will be treated like substandard outsiders within the field they originated. Government guidelines generally become a blueprint for private managed care plans to follow, which will exclude chiropractic care.
Chiropractic's Main Weapon Is Truth!
Unless you think I am a purveyor of negativism, let me make myself clear. No one in chiropractic is more bullish on chiropractic than I. The reason is because we have a highly impressive story to tell which should rock the entire foundation of the health care system. On one side I see incredible hypocrisy, dishonesty and fraud which have been the hallmarks of organized medicine. On the other side, I see a magnificent profession which can make a major contribution to health care as only chiropractic can. Our profession suffers the pain of incredible misinformation, public ignorance, indifference and apathy. If chiropractors can act appropriately to change the course of health care history, we can literally go into orbit. We need major candid and properly communicated media exposure on appropriate health care coming simultaneously from many different sources to awaken our society to the importance of chiropractic's role. This will likely bring objections from medical politicians seeking to retain their monopoly by resisting any change, but nothing is stronger than the truth when it is appropriately delivered from many different sources.
Medical Schools Incorporating Spinal Manipulation
Spinal manipulation is being incorporated into medical school curricula, while physical therapists are lobbying in the various states to get in through the back door politically rather than academically to be able to do what we have been ridiculed and condemned for doing for decades. The medical propaganda line will soon be that patients should go to "qualified spinal manipulators affiliated with hospitals" rather than chiropractors.
I have no problem with other professionals learning how to adjust the spine. Imitation is a genuine compliment and endorses the fact that we've been right all along. However, they should go back to school and get the same superior training as a chiropractor before bastardizing the manipulative art into the gutter.
Hospital Chiropractic
We need chiropractors in hospitals to create a more balanced health care system and redirect some of those 80,000 unnecessary disc surgeries being done every year toward chiropractic adjustments. That's more than 1,500 unnecessary disc surgeries every week according to CBS News. This is truly a medical atrocity, yet we see no public outrage. The American people may be ignorant or disbelieving of this amazing statistic, but they can't be that stupid. They simply need to hear it over and over again from multiple sources until the truth ultimately sinks in. We are dealing with a deeply programmed society with a mindset that cannot see the obvious truth even though it literally hits them over the head. Chiropractors should not only be in hospitals but be gatekeepers directing the health care traffic. Until this happens, we cannot have the best possible balanced health care system.
The Solution -- A Five-Prong Proactive Program
Chiropractors have frequently been passive and tolerant toward their detractors. Criticisms of medical wrongdoings have often been viewed by chiropractors as "bashing" or being divisive or uncooperative. However, if we see inappropriate or dishonest health care practices, regardless of who it may be, we must stand up for the truth. This includes being equally critical and demanding of ourselves. While it makes good sense to encourage friendly cooperation with medical physicians as long as their professional conduct is fair and honest and in the best interest of patients, can we remain silent and look the other way and ignore inappropriate medical conduct which hurts patients? Of course not. This brings up the issues of supporting legal actions in court when indicated, becoming more proactive and not reactive, and using the powerful facts that we have at our disposal with the media, press and legislators to redirect public thinking and the course of health care. Let's discuss the five prong approach.
#1: Legal Action
Never in the history of chiropractic has it been more vital to have a strong national leadership than now. Whenever I realize that our combined national leadership represents less than 25% of our profession, I wonder how this profession could have survived this long. They must be doing something right. I'm convinced that chiropractic would not exist today if it wasn't for our chiropractic leaders in Washington. Our ACA leaders realize that what HCFA is doing now can become the death knell for chiropractic and has responded by filing a suit in court against HCFA to force it to deliver a report demanded by Congress on the extent to which chiropractic services are available through Medicare HMOs, and also to block the new HCFA Medicare regulations affecting chiropractic.
I applaud the ACA for the wisdom, courage and commitment to take a strong stand in the courts on this vital issue. If this action proves to be successful this alone will be worth your dues for the next 20 years and more. Even if it is unsuccessful, Congress will then be informed of the misinterpretations placed on its laws by hostile federal agencies working with medically controlled HMOs and insurance companies. New legislation will be sought.
Litigation is very expensive and beyond the regular budget of any organization, as we all know. Hence, chiropractors must support this litigation by sending contributions to the Legal Action Fund/HCFA Lawsuit, P.O. Box 75359, Baltimore, MD.
#2: State Speaker Bureaus -- A Top Priority
We need to initiate speaker bureau programs in every state and train chiropractors on how to approach the media and motivate the radio, TV and press to want to interview us. Modern technology allows most interviews to be done by telephone; there is no need to go to radio stations.
Sadly, chiropractic speaker bureaus do not exist in most states, and where they do, they are not given the top priority they deserve. This must change if we want to redirect the current direction of public awareness that threatens the existence of chiropractic as we know it. I'd be happy to go to any state to help you organize a speaker bureau program. There isn't enough money in chiropractic to be able to purchase the kind of massive media exposure we need. The good news is that we can get it free if we initiate a speaker bureau program in every state, learn how to get on the talk shows, educate the public and appropriately respond to any and all questions.
By the way, people love to patronize doctors who are spokespersons since the public views them as being a few notches above the rank and file. It's smart business for chiropractors to become good public speakers; they win and the profession wins in the process.
#3: Involve Our Colleges and Students
Chiropractic colleges need to alert their students of the crisis and get them involved in writing letters, contacting radio, TV and the press, and legislators. I will be happy to go to any college to speak to their assembly and spread the word. There is no honorarium, only travel expenses. The colleges are morally obligated to tell their students what they face in the future. The thousands of students we currently have in our colleges provide a formidable force to create this multiple exposure that we need to influence public opinion.
#4: Medicine, Monopolies and Malice -- A Weapon of Truth
The most powerful weapon that chiropractic has going for it today is the entire chiropractic story. (Editor's Note: Dr. Wilk is the author of just such a book: Medicine, Monopolies and Malice, published by Avery Publishing Group, New York.)
Avery has shown enough confidence in Medicine, Monopolies and Malice to put it on the cover of its catalog alongside these bestsellers. Avery has the capability to do the right kind of job in distribution, but it needs the support of the chiropractic profession.
Rudy Shur, the editor at Avery, directed me to write the book in a biographical format to be commercially acceptable. He insisted that it would make a great motion picture and compared it to the movie "Rudy" of a person aspiring to play football for Notre Dame. The editor proved that he was right, because the typical reader response I get is that they cannot lay the book down once they start reading it. Meanwhile, the book strongly educates the reader on chiropractic by providing insets as well as a special appendix at the back of the book containing the various government, HMO and workers' compensation studies supporting chiropractic's therapeutic superiority and safety.
We are very fortunate to have a publisher of the caliber of the Avery Group enthusiastically supporting us. They deserve our support as well.
#5: Send the "Fax-Facts" Program
When we have such powerful and overwhelming information going for chiropractic, we want to summarize it on two pages and send it to the media and legislators. You can obtain these two pages from me, then call your local radio stations and newspapers and offer to mail or fax them copies. They provide some major studies giving the outstanding results of chiropractic and how intellectually dishonest, if not outright fraudulent, it is to isolate chiropractic from more than 99% of the hospitals in the country. If the media wants further documentation of these pages, the publisher will send them a complimentary copy of Medicine, Monopolies and Malice. We may be able to obtain some great talk show interviews and newspaper articles from these contacts and get and get them at no cost.
Advise the stations and newspapers that the author is available to do interviews by telephone. I can also appear on television in your area if the local chiropractors sponsor the trip. I do not charge an honorarium to appear on talk show interviews.
Can we make a difference? You bet we can! It's our choice to make, and I don't like chiropractic's other option for the future if we don't act now. We can use the five-prong proactive approach and not only take control of our future but preserve it for future generations of chiropractors and patients.
References
- Dabbs V, Lauretti W. A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics Oct. 1995; vol. 18, no. 8, p. 530-536.
- Jaskoviak P. Complications arising from manipulation of the cervical spine. Journal of Manipulative and Physiological Therapeutics 1980, p. 213-219.
- Understanding Acute Low Back Problems in Adults, consumer version. Clinical Practice Guideline Number 14, AHCPR Publication No. 95-0644, Rockville, MD, Public Health Service, U.S. Dept. Of Health and Human services, Dec. 1994.
- Manga P, Angus D, Papadopoulos C, Swan W. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. University of Ottawa, 1993, p. 13.
- Meade TW, Dyer S. Randomized comparison of chiropractic and hospital outpatient management for low back pain from extended follow up. British Medical Journal 1995;311:p. 349-351.
- Kleynhans A. An exhaustive study of medical literature between 1947-1978 dealing with billions of chiropractic adjustments found ten cases of death, nine following medical and only one following chiropractic adjustments.
- Shekelle PG, Adams AH, et al. The Appropriateness of Spinal Manipulation for Low Back Pain. Santa Monica, CA, 1992.
- Independent practitioners under Medicare. HEW secretary report to Congress, December 28, 1968. See pages 35-36, 38, 88-89, 90, Medicine, Monopolies and Malice.
Click here for previous articles by Chester Wilk, DC.