Guest post by Catherine de Jong
On the 22nd of February 2022, a criminal court in the Netherlands ruled in a case brought by a 33-year-old man who suffered a double-sided vascular dissection of his vertebral arteries during a chiropractic neck manipulation.
What happened?
On the 26th of January 2016, the man visited a chiropractor because he wanted treatment for his headache. The chiropractor treated him with manipulations of his neck. The first treatment was uneventful but apparently not effective. The man went back for a second time. Immediately after the second treatment, the patient felt a tingling sensation that started in his toes and spread all over his body. Then he lost consciousness. He was resuscitated by the chiropractor and transported to a hospital. Several days later he woke up in the ICU of the university hospital (Free University, now Amsterdam UMC). He was paralyzed and unable to speak. He stayed in the ICU for 5 weeks. After a long stay in a rehabilitation center, he is now at home. He is disabled and incapacitated for life.
Court battles
The professional liability insurance of the chiropractor recognized that the treatment of the chiropractor had caused the disability and paid for damages. The patient was thus able to buy a new wheelchair-adapted house.
Health Inspection investigated the case. They noticed that the chiropractor could not show that there was informed consent for the neck manipulation treatment, but otherwise saw no need for action.
Six days after the accident the man applied to the criminal court. The case was dropped because, according to the judge, proof of guilt beyond reasonable doubt was impossible.
In rare occasions, vertebral artery dissection (VAD) does occur spontaneously in people without trauma or a chiropractor manipulating their neck. The list of causes for VAD show, besides severe trauma to the head and neck (traffic accidents) also chiropractic treatment, and rare connective tissue diseases like Marfan syndrome. A spontaneous dissection is very rare.
It took several attempts to persuade the criminal court to start the case and the investigation into what had happened in the chiropractor’s office. Now the verdict has been given, and it was a disappointing one.
The chiropractor was acquitted. The defense of the chiropractor argued, as expected, that two pre-existent spontaneous dissections might have caused the headache and that, therefore, the manipulation of the neck would have played at most a secondary role.
It is this defense strategy, which is invariably followed in the numerous court cases in the US. Chiropractors in particular give credence to this argumentation.
The defense of the patient was a professor of neurology. He considered a causal link between manipulation to the neck and the double-sided VAD to be proven.
In the judgment, the judge refers 14 times to the ‘professional standard’ of the Dutch Chiropractors Association, apparently without realizing that this professional standard was devised by the chiropractors themselves and that it differs considerably from the guidelines of neurologists or orthopedics. In 2016, the Dutch Health Inspection disallowed neck manipulation, but chiropractors do not care.
The verdict of the judge can be found here: ECLI:EN:RBNHO:2022:1401
Chiropractic is a profession that is not recognized in the Netherlands. Enough has been written (also on this website) about the strange belief of chiropractors that a wrong position of the vertebrae (“subluxations”) is responsible for 95% of all health problems and that detecting and correcting them can relieve symptoms and improve overall health. There is no scientific evidence that chiropractic subluxations exist or that their alleged “detection” or “correction” provides any health benefit. In the Netherlands, there are about 300 practicing chiropractors. Most are educated in the UK or the USA. The training that those chiropractors receive is not recognized in the Netherlands.
Most chiropractic treatments do little harm, but that does not apply to neck manipulation. When manipulating the neck, the outstretched head is subjected to powerful stretches and rotations. This treatment can in rare cases cause damage to the arteries, which carry blood to the brain. In this case, a double-sided cervical arterial dissection can lead to strokes and cerebral infarctions. How often this occurs (where is the central complication registration of chiropractors?) is unknown, but given that the effectiveness of this treatment has never been demonstrated and that therefore its risk/benefit ratio is negative, any complication is unacceptable.
How big is the chance that a 33-year-old man walks into a chiropractor’s office with a headache and comes out with a SPONTANEOUS double-sided vertebral artery dissection that leaves him wheelchair-bound and invalid for the rest of his life? I hope some clever statisticians will tell me.
PS
Most newspaper reports of this case are in Dutch, but here is one in English
58 Responses to Double-sided vertebral artery dissection in a 33-year-old man. The chiropractor is not guilty?
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Back to my old question:
If they wanted to care for patients with headaches or pains in the neck/neurology, why did these folks become chiropractors and not doctors?
Any informed consent form must state clearly that chiropractic is founded on an unevidenced belief and that orthodox medical and scientific opinion has not identified any benefit from ‘adjustment’, nor any structure that needs ‘adjustment.’
Patients are being taken advantage of otherwise.
“ orthodox medical and scientific opinion ”
Opinion?
“ SMT alone or in combination with other modalities was effective for patients with acute neck pain. ” J Clin Med. 2021 Oct 28;10(21):5011.
doi: 10.3390/jcm10215011.
“ The combination of SMT and exercise may provide one of the best approaches for the management of NP.” Front. Pain Res., 25 October 2021 | https://doi.org/10.3389/fpain.2021.765921
“ Studies published since January 2000 provide low-moderate quality evidence that various types of manipulation and/or mobilization will reduce pain and improve function for chronic nonspecific neck pain compared to other interventions.” Pain Physician 2019; 22:E55-E70 • ISSN 2150-1149
“ There was moderate level evidence to support the immediate effectiveness of cervical spine manipulation in treating people with cervical radiculopathy.” Clin Rehabil. 2016 Feb.
A heavy deployment of fishing and quote mining.
Following the above quote from Ref 1 is:
“However, due to the large heterogeneity of the included RCTs, small sample sizes, lack of blinding, and unanswered placebo effects, future more robust RCTs are required for firm conclusions.”
Ref 2 [https://doi.org/10.3389/fpain.2021.765921] also states:
“Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain.”
“Overall, the current body of literature provides stronger support for thoracic rather than cervical SMT for the treatment of NP”
Ref 4:
Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta‑analysis
Liguo Zhu ¹, Xu Wei ², Shangquan Wang ³
Affiliations
1. Department of Spine, Wangjing Hospital, Beijing, People’s Republic of China.
2. Department of Scientific Research, Wangjing Hospital, Beijing, People’s Republic of China.
3. Department of General Orthopedics, Wangjing Hospital, Beijing, People’s Republic of China.
Data sources:
PubMed, the Cochrane Central Registry of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang data, the website of Chinese clinical trial registry and international clinical trial registry by US National Institutes of Health.
DOI: 10.1177/0269215515570382
They are higher levels of evidence than opinion.
In your opinion.
It’s called the hierarchy of evidence. Google it.
The cherry-picked quotes you provided were the opposite of evidence: lower rank even than opinion. No need to “Google it”.
Actually, you do need to Google it. Here, let me help.
https://openmd.com/guide/levels-of-evidence
… and then your brains fell out!
ad hom
Chiropractic is effective for headache, according to studies carried out by chiropractors who declare no conflict of interest. Ask yourself: if this is so compelling, why do reality-based doctors not do this? The answer is simple: it’s batshit insane.
Meanwhile, back in the real world, there is no plausible mechanism by which the chiropractic hangman’s twist manoeuvre could plausibly deliver any of the benefits claimed, no credible evidence that it does so, and the main reason that we don’t have absolute proof of whether it causes VAD or not is that chiropractors refuse to have any mandatory adverse event reporting.
Until you can show me one example of a chiropractic treatment that has been discarded because objective tests showed it to be ineffective or dangerous, I will continue to lump you in with all the other pseudoscientific quacks.
Guy, your other responses today were little more than gish galloping, but I’ll briefly answer this one: “Until you can show me one example of a chiropractic treatment that has been discarded because objective tests showed it to be ineffective or dangerous, I will continue to lump you in with all the other pseudoscientific quacks.”
Toftness is one example of an ineffective assessment/treatment technique that has not only been abandoned but also banned by the chiropractic board, at least in states that I’m familiar with.
There are others – including spinal manipulation in some cases – though it depends on the individual practitioner.
“Toftness is one example of an ineffective assessment/treatment technique that has not only been abandoned but also banned by the chiropractic board, at least in states that I’m familiar with.”
LOL!
See also The Toftness Radiation Detector Is a Bogus Device
https://quackwatch.org/chiropractic/dd/toftness/
Guy: and the main reason that we don’t have absolute proof of whether it causes VAD or not is that chiropractors refuse to have any mandatory adverse event reporting.
A mandatory AE reporting system won’t provide absolute proof that cSMT does or does not cause VAD.
what a daft argument!
you are surpassing yourself
“ Yes, FAERS data does have limitations. First, there is no certainty that the reported event (adverse event or medication error) was due to the product. FDA does not require that a causal relationship between a product and event be proven, and reports do not always contain enough detail to properly evaluate an event.”
https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers
“ VAERS reports alone generally cannot be used to determine if a vaccine caused or contributed to an adverse event or illness. Some reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable. VAERS reports often lack contextual information, such as total vaccinations given or information on unvaccinated groups for comparison. Most reports to VAERS are voluntary, which means they may be subject to biases. Data from VAERS reports should always be interpreted with these limitations in mind.”
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vaers.html
“ In conclusion, surveillance systems that uncover and document adverse events can collect valuable data, but they are not sufficient, by themselves, to improve medical care. The data need to be analyzed and interpreted to create a better understanding of the reasons for adverse events.”
https://www.gao.gov/assets/t-hehs-00-61.pdf
“ It is often not possible to tell from an individual ADE report if there is a causal relationship between the drug and the medical event…”
https://www.uspharmacist.com/article/reporting-adverse-drug-events
Etc.
Cannot agree more with you, DC.
Chrios are waiting for a perfect system to be implemented: https://en.wikipedia.org/wiki/Nirvana_fallacy
https://www.fda.gov/drugs/surveillance/questions-and-answers-fdas-adverse-event-reporting-system-faers
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vaers.html
Bolding mine
“…the main reason that we don’t have absolute proof of whether it causes VAD or not is that chiropractors refuse to have any mandatory adverse event reporting.
“VAERS…that might indicate…”
I stand by my comment. A mandatory AE reporting system will not provide absolute proof.
Guy: Ask yourself: if this is so compelling, why do reality-based doctors not do this? The answer is simple: it’s batshit insane.
Why don’t all MDs fill a dental cavity?
Why don’t all MDs rehab an amputee?
Why don’t all MDs do an optometry exam for an eyeglass prescription?
Because they use allied professions that are specifically trained for those activities.
Now do try and put forth a sensible argument.
DC,
If you are so inclined to answer Guy’s question, maybe you should cut thru your usual whataboutery BS.
I did. MDs refer to allied professions for stuff the don’t want to do or think others can do better.
Admission to Medical School is highly competitive and not everyone who wants to help patients can attend. I doubt that all such candidates understand the vast difference between alternatives such as dentists, podiatrists and opticians versus Chiropractors and naturopaths.
“Highly competitive…” for a good reason.
It’s called “setting standards”.
But why do folks who cannot (for whatever reason) train to be doctors, not take up nursing or physiotherapy?
Surely ‘Chiropractic’ does not advertise its colleges as “For those who are not up to doing medicine”?
On the contrary, they claim to be offering training in a field that is more beneficial to patients than ‘orthodox medicine’.
But where does that idea come from, and, in the 21st centuary, remain?
Has their disclipine not moved on from Palmer’s concepts -based on A.T. Still’s, and Paul Caster’s bone setting before then?
‘Medicine’ is constantly ‘moving on’.
Are chiropractors reverting to faith healing?
Sigh.
But we should not make ‘chiropractic’ illegal any more than any other faith.
We should identify it for what it is.
Thank you Professr Ernst for helping here.
To be honest chiropractic has just basically admitted that its colleges are for those who can’t get into med school.
To find out about their motivations, you can look to people who once were alt practitioners, like Britt Hermes. The book The Adventures of Holistic Harry is a novelized version of the experiences of an MD, formerly of an alternative flavor. He describes well the disillusion from being a true believer, and the temptations of continuing as a conscious quack bc it’s easier to make money that way. Also, it’s a good description of other alt-med practitioners: a spectrum of believers and conscious quacks.
What a terrible thing to happen.
The only way to stop this happening is to make chiropractic illegal.
“ He considered a causal link between manipulation to the neck and the double-sided VAD to be proven.”
Apparently he was wrong.
Wrong in the same sense that OJ was innocent. Exactly that kind of wrong.
Is the defence regarding the “dissection already taking place” non justifiable? Was it likely not the cause of the persisting head/neck pain?
The temporal association is hard to ignore but is not enough to infer causality.
The author seems to dismiss it as merely an argument of the chiropractor’s defense. Apparently, she isn’t aware of numerous papers by medical neurologists who agree with you.
“There is an association between manual adjustment and VAD but no causative relationship has been established. It is more likely that pain from VAD leads to neck manipulation than that neck manipulation leads to VAD.” Harold, P., & Robert, H. (2020). Commentary on: A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual therapy: a comprehensive review. Annals of Medicine, 0(0), 1–2. http://doi.org/10.1080/07853890.2019.1639807
case reports are never enough!
the best approach is to consider the totality of the available evidence. By doing this, one cannot exclude the possibility that spinal manipulations cause serious adverse effects. If that is so, we must abide by the precautionary principle which tells us to use other treatments that seem safer and at least as effective.
Hmmm, let’s change that a bit…
The best approach is to consider the totality of the available evidence. By doing this, one cannot exclude the possibility that NSAIDs and opioids cause serious adverse effects. If that is so, we must abide by the precautionary principle which tells us to use other treatments that seem safer and at least as effective.
So based upon the totality of the available evidence, which is safer and at least as effective: cervical spinal manipulation vs NSAIDs/opioids?
almost correct!
but very daft because there are less risky treatments than either opioids or SMT (and the addition of NSAIDs here is based on very poor data: https://edzardernst.com/2019/01/are-cervical-manipulations-for-neck-pain-truly-much-safer-than-the-use-of-nsaids/)
so for people a bit slow on the uptake, let me put it this way:
the best approach is to consider the totality of the available evidence. By doing this, one cannot exclude the possibility that spinal manipulations cause serious adverse effects. If that is so, we must abide by the precautionary principle which tells us to use other treatments that seem safer and at least as effective such as physiotherapeutic exercise therapy.
“the best approach is to consider the totality of the available evidence.”
so when choosing between NSAIDs and spinal manipulation, which is safer based upon the totality of the available evidence?
“The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease.
There is an increased risk of heart failure with NSAID use.”
https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory
I am not discussing here the choice between NSAIDs and spinal manipulation
you are just distracting from:
the best approach is to consider the totality of the available evidence. By doing this, one cannot exclude the possibility that spinal manipulations cause serious adverse effects. If that is so, we must abide by the precautionary principle which tells us to use other treatments that seem safer and at least as effective such as physiotherapeutic exercise therapy.
I am thinking like a someone who cares for patients. But I can understand why you don’t want to answer the question.
you can’t understand a lot, it seems to me.
True. I don’t understand
How MDs can claim cSMT causes a VAD when they don’t know if the VAD was pre-existing or not.
Why MDs claim this happens a lot and they “see it all the time” but prospective studies can’t even find enough cases to run a proper analysis.
Why, when MDs claim we are harming so many people, that when we attempt to do research on it, many MDs won’t even agree to participate.
Why, if we are ruining so many lives, that my malpractice premiums are less than my utility bill.
How MDs can claim cSMT causes a VAD when they don’t know if the VAD was pre-existing or not.
Why MDs claim this happens a lot and they “see it all the time” but prospective studies can’t even find enough cases to run a proper analysis.
NOT TRUE
Why, when MDs claim we are harming so many people, that when we attempt to do research on it, many MDs won’t even agree to participate.
UNWARRANTED GENERALISATION
Why, if we are ruining so many lives, that my malpractice premiums are less than my utility bill.
NOT TRUE
How MDs can claim cSMT causes a VAD when they don’t know if the VAD was pre-existing or not.
No response
Why MDs claim this happens a lot and they “see it all the time” but prospective studies can’t even find enough cases to run a proper analysis.
NOT TRUE
“Recruitment took 3 years, due to the relative low occurrence of CAD cases, at which point the study was halted….the desired sample size was not met.”
JOSPT 2015 45:7 503
Why, when MDs claim we are harming so many people, that when we attempt to do research on it, many MDs won’t even agree to participate.
UNWARRANTED GENERALISATION
I hope so but not according to the researchers I have talked to.
Why, if we are ruining so many lives, that my malpractice premiums are less than my utility bill.
NOT TRUE
Oh, you know my premiums and utility bill?
It’s your choice, ‘DC’, to be anonymous on this website and to use various pseudonyms, but doing so renders unverifiable all unevidenced statements that you make. Your personal statements have the same level of authority and credibility as a that of a nymshifting Internet troll: none; zero: nada.
With everything that you have written, it is prudent for the readers to apply Hitchens’s epistemological razor:
“That which can be asserted without evidence can also be dismissed without evidence.”
— Christopher Hitchens.
DC you comment that MDs will not participate into research into spinal manipulation.
Usually when people will not participate in research it is because the research or the thing being researched is so dangerous that it shouldn’t be researched at all
John. It depends on the design of the study. Looking at cases that come thru a trauma center is a worthy and an acceptable study.
Why wouldn’t a MD want to participate in such a study if the general thought is that cSMT is causing many of these VADs?
Perhaps a ER doctor or two who follow this blog and can give some insight?
“case reports are never enough!”
I’m not sure who brought up case reports, but since I agree, should we dismiss the one presented in this post?
“the best approach is to consider the totality of the available evidence.”
Agreed. Although, from what I can tell, the totality of available evidence on VAD risk that you present here consists almost exclusively of case reports. Have you discussed the research looking at biomechanical plausibility? Have you commented on the systematic reviews beyond than dismissing them out of hand? Do you acknowledge the neurosurgeons whose conclusion from the evidence differ from yours?
“By doing this, one cannot exclude the possibility that spinal manipulations cause serious adverse effects.”
Agreed. There is a possibility.
“If that is so, we must abide by the precautionary principle which tells us to use other treatments that seem safer and at least as effective.”
Ddisagree. This statement strikes me as an opinion based on absolutism rather than a rational conclusion. Where else in medicine does the mere presence of a possible serious adverse effect immediately lead to avoiding a treatment? Are there no safer alternatives to NSAIDs? (http://doi.org/10.1016/j.amjmed.2017.06.028) Are there no safer alternatives to spinal cord stimulators? (http://doi.org/10.1097/PTS.0000000000000971) How about the common orthopedic procedures with little evidence of effectiveness but a non-zero risk of serious harm? (http://doi.org/10.1136/bmj.n1511) I applaud the intent behind the precautionary principle and think it is an ideal to aspire to. While it “does play a role in health care, […] it should never rule medical decision making as an absolute principle.” (http://doi.org/10.1016/j.taap.2004.11.032)
Once again, you are using the absence of robust adverse event reporting as an excuse to arm-wave away a case series that points to – and I cannot stress this enough – an entirely plausible and serious outcome from a treatment that has no individualised evidence of benefit.
Chiropractors have assembled a body of sciencey-looking studies to show that manipulation can temporarily help with headaches, but none of this appears to be specific to the chiropractic hangman’s twist. It’s a bait-and-switch (so very common in SCAM).
If chiropractors were remotely serious about patient safety, there would be systematic, auditable adverse event reporting. None exists. Instead, chiropractors are routinely found making claims which the GCC says should not be made. This appears to be a profession completely out of control.
Consider the following:
Chiropractic was invented from whole cloth by a “magnetic healer” and known charlatan. His theory of disease has never been validated by anyone other than his own adherents, and is inconsistent with all relevant knowledge in the fields of medicine and human biology.
A treatment is routinely conducted which was introduced at some point based on no documented rationale, and which is a self-evidently plausible cause of potentially fatal injury. When that injury happens, rarely but often enough that people notice, shortly after the treatment is used by patients, and when the group conducting the treatment do not include any mention of the possible outcome in their informed consent, and when their immediate response s always denial, and when they refuse to institute systematic and auditable adverse event reporting, and when their schools are still teaching the discredited subluxation theory, then we are entitled to draw certain inferences, the first of which is that they are not acting in good faith.
In short, you are demanding that we prove that your treatment is dangerous, whereas it should be *you* who proves it safe. Appeal to tradition is not compelling when the tradition is widely documented, openly admitted, and based on nonsense. You need to distinguish yourselves from homeopaths.
If you were sincere in this argument you pose here, the very next link would be to the agreed methods chiropractors have adopted to check for incipient VAD so that their treatment does not trigger it. And possibly to disciplinary cases where chiropractors have not conducted suitable screening, failed to obtain informed consent, and a patient has been harmed.
I’d also point out that, certainly in English law, a patient having a weak artery wall, is not a defence. We have a thing called the “eggshell skull” doctrine: in a tort case, the unexpected frailty of the injured person is not a valid defence to the seriousness of any injury caused to them.
One of my standard challenges to alternative practitioners is: give an example where practitioners have found that a specific treatment is ineffective or dangerous, and modified practice accordingly. We can answer this with chiropractic: in the US, osteopaths separated from chiropractic, adopted reality-based standards, and now don’t teach most of the nonsense that chiropractic students are fed. They have parity with doctors of medicine, within their field. So, in effect, a chiropractor who follows the evidence is… no longer a chiropractor.
Another standard challenge is: what do you recognise as the limits of your valid scope of practice? People with chronic migraines and tinnitus may be a fertile market, but there is no evidence of any sustained effect on either from chiropractic (indeed, the best evidence for chiropractic generally shows only a short-term effect, which may be equal to analgesia, for musculoskeletal pain). A profession that is sincere about patient protection, has robust mechanisms to ensure that people do not stray outside their scope of practice. A GP cannot walk into theatre and conduct surgery, unless they first get the necessary training, but a heart surgeon *also can’t act as a GP*. Yet chiropractors seek to present themselves both as back specialists and as primary-care providers. Even without the strong subcurrent of anti-vaccinationism and dogmatic nonsense, especially from “straights”, this would be a worry.
Post-hoc studies relying on data collected *by practitioners* are not going to be compelling here. We have seen thousands of papers authored by homeopaths, acupuncturists and other quacks that – amazingly! – find that their main source of income is of immense medical value, despite there being no reason to think it should work, no way it can work, and no evidence it does work that convincingly refutes the null hypothesis.
You need to show (a) robust, comprehensive and transparent adverse-event reporting and (b) evidence that, if falsified, the treatment will be withdrawn by *all* practitioners, not just those who seek sufficient legitimacy to obtain public funding. Be like the surgeons who stopped performing knee washout surgery when it was shown to be useless.
Intriguing and unnerving how many cases I have seen and examined that describe the symptoms appearing immediately after or shortly following a repeat cervical manipulation. The obvious inference from this would be that intimal injury takes place and coagulation happens, which is then dislodged on the second manipulation to cause stroke.
The fact that the symptoms of a preexisting cervical artery lesion are quite unspecific and they cannot be ruled out, should lead to the conclusion that cervical manipulation is contraindicated in the presence of symptoms from the head and neck areas.
Also. How many cases are never discovered because the delayed stroke event happened while driving home after manipulation?
If cervical manipulation was a drug, would it not be under serious surveillance or even already taken off the market because of an alarming accumulation of extremely serious albeit rare adverse events discovered by ongoing post-marketing surveillance?
in our survey, the non-reporting rate was exactly 100%
https://pubmed.ncbi.nlm.nih.gov/11285788/
“Intriguing and unnerving how many cases I have seen and examined that describe the symptoms appearing immediately after or shortly following a repeat cervical manipulation.”
What is “repeat cervical manipulation”? Same visit? Same day? Within a week?
“Intriguing and unnerving how many cases I have seen and examined that describe the symptoms appearing immediately after or shortly following a repeat cervical manipulation.”
Timing of symptoms is an important aspect to try and determine causality but not the only factor.
“Timing of symptoms is an important aspect to try and determine causality but not the only factor.”
So you agree that anything other than a robust and auditable adverse event reporting system would be severely negligent here, then. It’s clearly biologically plausible (unlike “subluxations” or “innate”), there is a gun, it appears to be smoking, so anything other than diligent investigation, preferably by people with no conflict of interest, would be criminal, right?
Bjorn
“Also. How many cases are never discovered because the delayed stroke event happened while driving home after manipulation? If cervical manipulation was a drug, would it not be under serious surveillance or even already taken off the market because of an alarming accumulation of extremely serious albeit rare adverse events discovered by ongoing post-marketing surveillance?”
ERr… ummm
Would this example be similar to the phenomenon that patients experience after taking a vaccine jab, but later are told that the reaction is not due to the jab because correlation is not causation ?
I think so
Nothin to see here, move along.
NO WAIT ! IT’S a DOUBLE STANDARD !
First, the assumption that what they experience is due to the vaccine is an example of the post hoc ergo propter hoc fallacy, not because “correlation is not causation”.
But also, more work has to be done in order to establish causation than simply noticing that there have been many people who’ve had a stroke shortly after a chiropractor manipulates their neck.
This does give rise to a *suspicion* of causation, which has to be investigated.
In the case of vaccines, many suspicions of causation have been intensively investigated and found to be false – i.e. the vaccine wasn’t causing the harm.
The Johnson & Johnson Covid vaccine *was* temporarily halted because there was a suspicion, but no proof, that it might, very rarely, cause blood clots.
So no, it doesn’t look like a double standard. Regulators are very cautious about the safety of vaccines that are given to billions of people.
@Laura
lol….
You folks remind me too much of the hypocrisy of the political tyrants… “rules for thee, but not for me”
That has no logical content, just an insult. I explained to you the problems with your reasoning.
And why post comments like this? There are a lot of such comments on this site, from the skeptics as well as the true believers in something or other. They detract from the discussion, and don’t add anything useful.
@ concerned patient
After taking the jab and walking out of the doctor’s office, I hit my head on the door and that caused bad bruising. At first, I thought the vaccine caused me to bump my head on the door with one potential explanation being that I was being briefly controlled by someone via the 5G chip in the vaccine jab I just took, I did some brief internet searches and confirmed that to be the case. I immediately talked to the doctor and was told that “correlation is not causation” and that there are no 5G chips in the vaccine and that I was just a clumsy idiot. I was told to go home and ice my head and forget about it. I did ice my head but did not forget about it. I did more research on the topic and found several people online that had similar experiences where they got clumsy and fell or hit something after taking the jab. We shared our experience via a FB group, and we all decided that the jab is to be blamed for our troubles. Now that I have the 5G chip in my body I had no way of removing it. I designed a special tinfoil hat that blocks the 5G signal and started wearing it. As soon as I put my tinfoil hat on, I started feeling better and regained complete control of myself. My story is proof that vaccines contain 5G chips and that we are being controlled remotely like cattle under the guise of pandemic. Why am I telling you this? Because I want you to know what is happening to people after getting the jab and that you should be concerned about the shenanigans of big pharma. We need more people like you questioning the motivations behind vaccines and other life saving drugs that big pharma produces. Finally, if you think hard enough and do your “research”, most often than not “correlation leads to causation”.
Would this example be similar to the phenomenon that patients experience after taking a vaccine jab, but later are told that the reaction is not due to the jab because correlation is not causation ?
I don’t know what planet you live on, but here on earth, there is full informed consent for vaccines, with the side effects monitored and measured and acknowledged.
This is true of *every* medicine, of course, and vaccines are probably the most heavily scrutinised, because they are given to people who may be especially vulnerable due to other conditions.
Read the insert on any medicine and you’ll get a litany of things that were reported during the trials, many of which are very unlikely to be caused by the medicine. You’ll also see side effects that are documented through post-marketing surveillance.
People blame vaccines for SIDS because their children tragically die, and this might happen in the days or weeks after an injection. But the figures show, unequivocally, that vaccinated children are *less* likely to die of SIDS. And that’s SIDS, which has a single definitive event. Think how long it took to invent the vaccine-autism bogeyman (essentially one fraudulent paper and a press release) – decades later this zombie still lives, despite the evidence of thousands of studies on tens of millions of children across hundreds of countries that shows no association, temporal or otherwise, between vaccines and autism. In as much as science can prove a negative, it has done so with the vaccine-autism link.