MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

I came across an article that seems highly relevant to our recurring debates about the dangers of chiropractic. Since few of us might be readers of the Louisville Courier, I take the liberty of reproducing here a shortened version of it:

Amber Burgess, then 33, had never set foot in a chiropractor’s office when she went to Dr. Adam Fulkerson’s Heartland Family Chiropractic in Elizabethtown on May 18, 2020. In contrast, Becca Barlow, 31, had seen Dr. Leah Wright at Louisville Family Chiropractic 29 times for adjustments over three years when she went there on Jan. 7, 2019, seeking relief for “nursing mother’s neck.” Both say they will never see a chiropractor again. “That visit was my first – and last,” said Burgess, a former utility bucket-truck assembler.

In separate lawsuits, they claim they suffered strokes after chiropractic adjustments; Barlow, herself a nurse, said she realized she was having one before she even left the office and told Wright’s staff to call 911.

Citing studies on human cadavers and other research, chiropractors claim adjustments are physically incapable of causing tears to arteries that in turn cause strokes by blocking the flow of blood to the brain and other organs. In an opening statement in the trial of Barlow’s suit last March, attorney John Floyd Jr., counsel for Wright and the National Chiropractic Mutual Insurance Co., said no one has ever proved adjustments cause the tears – known as dissection – only that there is an “association” between them. “We associate the crowing of roosters with sunrise,” he told the jury. “But that doesn’t mean roosters cause the sun to come up.” Floyd also cited studies he said prove that when a patient strokes out immediately after adjustments, like Barlow, it is because they already were suffering from artery injuries when they sought treatment from their chiropractor.

Louisville attorney Brian Clare, who represents both Barlow and Burgess, previously settled two cases in Jefferson County, and has another suit pending in Warren Circuit Court. He said in an interview that “every time chiropractors perform adjustments on the neck they are playing with fire. They can go too far, too fast, turning the neck past therapeutic limits,” he said.

The jury in Barlow’s case emphatically rejected the chiropractic profession’s defenses. “We found those claims to be unbelievable,” said jury foreman Joseph Tucker, a lawyer, who noted Barlow had no symptoms before her adjustments. By a 9-3 vote, the jury awarded her $1,130,800, including $380,000 in medical expenses and $750,000 for pain and suffering.

Witnesses testified that Barlow fell off the table and vomited almost immediately after her adjustment, showing classic stroke symptoms, including vertigo, dizziness, numbness, and nausea. She lost consciousness, had to be intubated in an ambulance, then raced to Norton Brownsboro Hospital, where she underwent emergency surgery to restore the flow of blood to her arteries and save her life. Three of the four arteries in her neck had been dissected.

Burgess, in Elizabethtown, suffered a stroke in her spine that her expert, Dr. Louis Caplan, a neurology professor at Harvard University, said also was caused by her cervical manipulations. Caplan says he’s cared for more than 15,000 stroke patients over 45 years.

Fulkerson has denied liability; his lawyer, James Grohman, said he couldn’t comment because the case is pending; the trial is set for Aug. 28 in Hardin Circuit Court Caplan said in a report that Burgess’s stroke left her with partial but permanent paralysis in her arms and legs. She uses a wheelchair and walker with wheels to get around. She said she can’t work, can’t drive, and that while she can dress herself, it takes hours to get ready. She fears they will have to give up their plans to have a baby.

By any measure, strokes associated with adjustments are rare, although their incidence is disputed. The American Chiropractic Association says arteries are damaged in only one to three adjustments out of 100,000 But a 2001 report in the New England Journal of Medicine estimated dissections occur in 1 of 20,000 adjustments. And Dr. Alan Brafman, an Atlanta chiropractor, has said they occur more often than that. Brafman wrote that he’s consulted in 1,100 cases, including Barlow’s, and found in most of them, chiropractors were at fault, causing vascular damage that is “a tragic, life-altering situation for all parties involved.” Wright’s experts themselves divulged they had been retained in 200 cases, according to Clare, which he said suggests chiropractic-related strokes are more common than suspected. A survey at Stanford University in 2008 of 177 neurologists found 55 had patients who suffered strokes after seeing chiropractors, while a 2018 study in West Virginia found one in 48 chiropractors experienced such an event. Neurologists and other physicians point to a 2001 study in STROKE of 582 stroke patients that found they were five times more likely to have seen a chiropractor in the previous five days before their artery dissection than a control group without such injuries. The American Heart Association and other medical groups recommend that patients also be warned about the risks; Barlow said she never would have undergone her final manipulation if she had been informed.

__________________________

Yet again, I am impressed by the number of cases that go to court where a settlement of some sort is reached and further reporting of the incident is prevented. As a consequence, these cases are not published in the medical literature. In turn, this means that chiropractors can continue to claim that these complications do not exist or are exceedingly rare.

  • The truth, however, is that NOBODY can provide accurate incidence figures.
  • The truth is that, even if such complications were rare, they are devastating.
  • The truth is that neck manipulations do not generate any or very little benefit.
  • The truth is that their risk/benefit balance is not positive.
  • The truth is that we, therefore, have an ethical duty to tell potential patients about it.

I feel that I cannot repeat my warning often enough:

AVOID CHIROPRACTORS.

THEY CAUSE MORE HARM THAN GOOD!

5 Responses to More about the dangers of chiropractic

  • In the one case, “nursing mothers neck” it appears to be practitioner error, IMO.

    “The risk of stroke was highest during the third trimester and the first 12 weeks after giving birth. Those who had a stroke were more likely to have a history of preeclampsia, diabetes and a coagulation disorder.”

    https://www.heart.org/en/news/2019/02/08/pregnancy-may-increase-risk-of-deadliest-type-of-stroke

    Osteopath

    “Directed history revealed the patient frequented an osteopath where she had regular therapy for her chronic neck pain, which continued throughout her pregnancy and in particular postpartum including the day before presentation.

    Pregnant and puerperal women are physiologically more vulnerable to arterial dissection due to elevated levels of relaxin and progesterone and decreased collagen synthetic activity affective vessel wall properties combined with the hemodynamic changes of increased cardiac output and endothelial sheer stress”

    https://www.jcgo.org/index.php/jcgo/article/view/576/382

  • The chiropractors’ standard answer/excuse is “it is because they already were suffering from artery injuries when they sought treatment from their chiropractor.”
    That means that anybody visiting the chiropractor may be “already” suffering from artery injuries.
    And that, in its turn, must mean that neck manipulation is contraindicated in all cases where upcoming artery dissection is not a priori excluded.

    Why are these pseudo-doctors still legally allowed to “treat” people and even get paid for it?

  • The chiropractors’ standard answer/excuse is “it is because they already were suffering from artery injuries when they sought treatment from their chiropractor.”

    Yes, the VAD may have been pre-existing. It also may have occurred during that one second it takes to perform a HVLA. It may also have occurred after the HVLA which may or may not have contributed to the VAD.

    That means that anybody visiting the chiropractor may be “already” suffering from artery injuries.

    The probability that a person with a rare condition would seek chiropractic care which only sees around 10% of the population?

    And that, in its turn, must mean that neck manipulation is contraindicated in all cases where upcoming artery dissection is not a priori excluded.

    Apply to other activities which are associated with VAD and you have the whole population living in a bubble.

    Ask a MD…do they rule out every possible cause of neck pain or headache before applying a treatment? Even the rare causes?

    • Ask a MD…do they rule out every possible cause of neck pain or headache before applying a treatment? Even the rare causes?

      What on earth are you talking about? “Apply” what treatment? Doctors don’t “apply” treatments.
      We have been through this several times before but you do not seem tor grasp the very simplest of messages.
      A patient walks into your shop and complains of head and neck pain. What would do you do?
      The last idea in any real physicians head would be to “apply” a useless “treatment” that might dislodge a clot from a preexisting injury that it is impossible to rule out clinically.

      • apply: to provide as a remedy

        The American Heritage® Roget’s Thesaurus. Copyright © 2013, 2014 by Houghton Mifflin Harcourt Publishing Company. Published by Houghton Mifflin Harcourt Publishing Company. All rights reserved.

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