Do you remember the case of Katie May who died “as the result of visiting a chiropractor for an adjustment, which ultimately left her with a fatal tear to an artery in her neck”?
Here is the abstract:
A 34-year-old female suffered a fatal stroke 7.5 h after cervical spine manipulation (CSM) performed by a chiropractic physician. Imaging noted vertebral artery dissection (VAD), basilar artery occlusion, and thromboembolic stroke. The medical examiner opined that CSM caused the VAD which embolized to cause the fatal stroke. However, causation of VAD by CSM is not supported by the research.
We utilized an intuitive approach to causation analysis to determine the cause of the VAD and the stroke. Causation of the VAD and the stroke by CSM could not be established as more likely than not. The malpractice case was settled by bringing allegations of misdiagnosis and failure to diagnose and refer the VAD to medical emergency.
We conclude that in the absence of convincing evidence that CSM could cause VAD, forensic professionals should consider VAD as a presenting symptom prior to CSM in such cases. Adherence to the standard of care for the chiropractic profession with attention to differential diagnosis could prevent such cases.
The author states that the objectives of this case report were to:
- Perform a forensic analysis to determine the most likely causal mechanism of the VAD.
- Perform a forensic analysis to determine the most likely causal mechanism of the stroke.
- Perform a medicolegal analysis of the standard of care with the aim of determining how this case could have been prevented, and how future such cases could be prevented.
There are, as far as I can see, at least three major problems with these objectives:
- The author is not qualified as a forensic analyst.
- He is merely a chiro (and acupuncturist) with a massive conflict of interest.
- Neither does he seem to be medically nor legally qualified for doing a medicolegal analysis (Dr. Brown received his undergraduate degree in Philosophy and History from Illinois State University in 1989. He went on to attend one semester of Law school at California Western School of Law in San Diego.)
The author even states that his information was taken from publicly available court documents. Background information was taken from publicly available investigative journalism and media coverage of this case. Any information that has not been made public is not reflected in this analysis. Images of the forensic microscopic review of the vertebral arteries were not available for review.
So, how valuable is chiro Brown’s medicolegal second opinion?
11 Responses to Katie May died after chiropractic manipulation – but that’s not the chiro’s fault, claims chiro Steven P. Brown
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We have three dogs and, daily, we have pick up duty. Methinks the completed bag is more credentialled than Brown.
Studies, though I can’t immediately cite, show intelligent people are far less likely to offer an opinion when they know they lack the necessary knowledge and background. Dunderheads, like Brown, have no such impediment simply because they aren’t intelligent. It is classic Dunning-Kruger effect.
Brown’s gibberish is a pathetic word salad, useful for nothing.
It is well established that symptoms of preexisting vertebral artery dissection are often non-specific pain, stiffness etc. in the head and neck area. Neurologic signs are seldom present if occlusion or embolism hasn’t happened (yet) and such signs are easily overlooked when subtle (e.g. Horner’s syndrome in carotid dissection). Therefore vertebral and also carotid artery disection can never be ruled out by clinical examination or any methods available outside a fully equipped ER or hospital.
This means that any patient with any pain and/or other non-specific symptoms from the head and neck area may potentially have a preexisting disection, which may easily be aggravated by the application of external force including any form of direct or indirect manipulation. The only way to rule out preexisting latent or manifest dissection is by specialised medical imaging.
Many practitioners of manipulative medicine claim they use examination and even X-ray to rule out so called “red flags” as indicating contraindications for manipulation. This is totally useless for exclusion of preexisting arterial injury.
It is my professional conclusion (surgeon with decades of experience including trauma &vascular surgery), based on extended studies of the literature and individual cases, that any form of cervical manipulation is to be considered severely hazardous, not the least in those presenting with non-specific symptoms from the head and neck area. Manipulation of the neck can has never been shown to be of use as a preventive measure in the symptom free and therefore not justifiable.
Furthermore, cervical manipulation has never been shown to be superior to non-manipulative treatments. Even if adverse events are relatively rare the outcome is potentially catastrophic. The risk-benefit ratio is therefore unacceptably high. My conclusion is therefore that neck manipulation (even including non-HVLA) can never be justified in any clinical situation.
I may add that even massage and deep palpation of the fronto-lateral aspect of the neck may potentially disrupt a latent/imminent dissection of the carotid artery so massage of this region should also be discouraged.
Björn Geir writes:
«It is well established that symptoms of preexisting vertebral artery dissection are often non-specific pain, stiffness etc. in the head and neck area.»
Perhaps I am misinformed, but this would seem like exactly the sort of symptoms for which chiropractors would consider that cervical manipulation is indicated? If so, this seems like a really bad thing: that is, even the chiropractor who might use this manipulation sparingly might be likely to select exactly the cases which are at higher risk of severe adverse events with this “treatment”.
You have a valid position however since even minor activities such as a rapid turn of the head while driving could dislodge a VA thrombus leading to a stroke, why don’t MDs rule out a dissection on everyone with neck pain?
perhaps because they don’t manipulate the neck of their patients?
Wrong. Try again.
Word list:
A “chiropractic physician” = an oxymoron and a moron.
An “intuitive approach” = a biased denial.
” how future such cases could be prevented” = avoid everything except neck manipulation …
Hm…
Massive conflict of interest? Interesting.
“On January 29, 2016 and February 1, 2016, a reasonable and prudent Doctor of Chiropractic would have suspected a cervical artery dissection, provided no treatment whatsoever, and referred Katie Beth May for CT angiogram and emergency medical care.”
SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF LOS ANGELES- WEST DISTRICT
DECLARATION OF DOCTOR STEVEN BROWN
Executed on this November 20, 2020 in Gilbert, Arizona.
“a reasonable and prudent Doctor of Chiropractic would have suspected a cervical artery dissection, provided no treatment whatsoever, and referred Katie Beth May for CT angiogram and emergency medical care.”
“Lying by omission, otherwise known as exclusionary detailing, is lying by either omitting certain facts or by failing to correct a misconception.”
https://rationalwiki.org/wiki/Lying_by_omission
Mr Brown deploys lying by omission each time he quotes Biller J et al.
Here’s one of his previous deployments:
https://edzardernst.com/2024/06/cervical-spine-manipulation-and-cervical-artery-dissection-an-embarrassingly-daft-attempt-of-a-white-wash/#comment-152187
Personal experiences:
A “doctor”of chiropractic once told me that there’s a greater chance of having a stroke in a hair salon while tilting the head back for a shampoo. My response: Even though it’s conceivable that this could happen, at least the shampoo has the beneficial outcome of making the hair clean.
Two separate healthcare professionals, a (real) physician & a nurse told me of identical cases of patients admitted to the emergency room suffering from strokes directly following a chiropractic neck manipulation.