Editor's note: Jane Brody, who writes the "Personal Health" column for the N.Y. Times, wrote the article "When Simple Actions Ravage Arteries" in the April 3, 2001 edition.
The article contained a particular "offending" sentence that caught the attention of DCs and chiropractic patients, not to mention millions of other readers. It read: "Chiropractic spinal manipulation, estimated to cause strokes in as many as one in 20,000 patients who undergo it, is but one possible cause." The "one possible cause" refers to "arterial dissections."
We received a number of concerned calls from DCs who wondered why Brody would print such erroneous information, and from where the information was derived. While estimates vary, the best research places the incidence of stroke from chiropractic cervical manipulation between one and three injuries per million adjustments.1 Another authoritative study, a 10-year survey of Danish chiropractors, estimated the risk of stroke resulting from cervical manipulation at one in 1,320,000, and one in 414,000 when rotation techniques were employed in the upper spine.2
Louis Sportelli, president of the NCMIC, immediately sent off a letter of protest to the editor of the N.Y. Times. He wrote:
To the Editor:
The recent article by Jane E. Brody, "When Simple Actions Ravage Arteries" was a disservice to your readers as well as to the entire profession of chiropractic. As president of the largest chiropractic malpractice insurance company in the world, we have the best data of any
source to estimate the numbers of incidents. Chiropractic adjustments (manipulations) are without question, the safest therapeutic procedure in the entire health care system. The actual estimates of stroke from a chiropractic manipulation is one in one million. By contrast, the most common serious adverse effects associated with commonly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) are gastrointestinal ulcers, which cause 76,000 hospitalizations and more than 7,600 deaths each year.
Ms. Brody seriously miscalculates the strokes alleged to be caused by chiropractic, either by gross negligence on her investigation or by design to malign the chiropractic profession.
Either way, the N.Y. Times owes its readers a clarification on the safety and efficacy of chiropractic care and a correction of the distorted representation in this article.
Louis Sportelli,DC
President
NCMIC Insurance Co.
Editor's note: To e-mail a letter to the N.Y Times editor, write to
. You may also send your letter to:
Letters to the Editor
The New York Times
229 West 43rd Street
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fax: (212) 556-3622
References
- Lauretti W. The comparative safety of chiropractic. In Daniel Redwood, ed., Contemporary Chiropractic. New York: Churchill Livingstone, 1997, p. 230-8.
- Klougart N, et al. Safety in chiropractic practice, Part I. The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988. Journal of Manipulative and Physiological Therapeutics, 19(6): 371-377(1996).
"Totally one-sided"
Dear Editor:
I am writing in response to the article "Mood Wellness Screening Questionnaire" written by John Maher, DC in your March 26th, 2001 issue. By way of background, I am a licensed clinical psychologist with 20 years of experience in health psychology. I have worked extensively with pain and disability, am published in both medical and psychology journals, and for the past 10 years have worked closely with chiropractors. Mine is a multidisciplinary private practice in which chiropractic, medicine, physical therapy, and psychology work together.
I have several issues with the article. The questionnaire (which is in fact the Beck Depression Inventory, not so credited) is an excellent tool to identify depression in primary care settings. My major concern is that Dr. Maher speaks only of supplementation and herbal therapies. This presentation is totally one-sided, and does not represent the current consensus on depression treatment. My points are as follows:
- Large-scale studies have clearly identified the necessity for counseling, primarily cognitive therapy, in all types of depression. When compared to antidepressant medications, counseling provided greater therapeutic effects and was more resistant to regression.
- Dr. Maher completely misses the crucial point of the necessity of patient education in depression treatment. To pass out supplements without proper assessment and education is to be the same as family practice physicians who pass out Prozac (with exceptionally poor results!).
- The supplements he suggests, with the exception of St. John's Wort, have no research support for their effectiveness in depression treatment. St. John's Wort has shown some benefit in mild depression and is certainly worthy of further study.
- Finally, to suggest that chiropractors begin diagnosing and treating depression, especially with methods that are not supported by current studies, is to lay oneself open to huge malpractice liability. Imagine trying to defend recommending an unproven supplement (or worse, selling it!) to a patient who is subsequently harmed.
I practice daily with chiropractors, and believe fully in their benefit. I would argue that current research supports chiropractic as the first line of treatment in acute back pain. In an active chiropractic practice, one will indeed encounter depression, both as a result of pain and disability as well as from multiple other sources. Recognition and appropriate referral for effective treatment is a crucial component of comprehensive care. It is incumbent upon the chiropractor to develop good working relationships with a trained mental health professional and refer when appropriate.
David P. Schwartz, Ph.D.
Clinical Psychology and
Behavioral Medicine
Hamilton Health Associates