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    Inside Chiropractic

    Sam Homola, D.C.
    Stephen Barrett, M.D.

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    Stan Gorchynski under the gun

    CBC Radio-One - Metro Morning - April 23, 2002

    The interview with Gorchynski started with a defense of subluxation theory, and then went directly on a tirade against the 60 neurologists who published a letter aimed at stopping chiros from doing cervical neck manipulation. Pay attention to Gorchynski's attempt to step around the issues of the Laurie Jean Mathiason inquest back in 1998. Andy didn't have time to ask him who peer-reviewed the chiropractic world.

    AB: Andy Barrie, CBC Toronto's Metro Morning Host
    SG: Stan Gorchynski, DC, Former president of the Ontario Chiropractic Association

    AB: Chiropractic practices are getting reviewed by an inquest, as you know, this is stemming from the death of 45 year old Lana Lewis. This was in 1996. At issue is a particular neck manipulation used to treat Lewis, which may have contributed to the stroke that killed her two weeks after receiving it. Joining us now in the studio is Dr. Stan Gorchynski. He's a Toronto chiropractor and governor of the Canadian Chiropractic Association. Dr. Gorchynski, good morning.

    SG: Good morning Andy.

    AB: Let's speak specifically about upper neck adjustment, the procedure now being investigated. What is it, what is it for?

    SG: The adjustment itself is restoration of segments of the spine that don't work quite as well as they should. Either they're "too fixed", or they are moving in a way which is "not quite normal". And the adjustment itself is a process that is delivered within an individual's range of motion. There's nothing that's taken beyond a person's ability to turn their head. In fact it's done within the range. So, it's a very comfortable procedure, it's skillfully delivered, and a very mild force is used to help the segments restore proper function.

    AB: And let's talk anatomy for a moment. Through this area, some serious blood supply is going to the brain.

    SG: Yes... there is.

    AB: In terms of this adjustment, however severe or "un-severe" it is, what sort of pressure can be placed on these blood vessels? Because that's what we're talking about.

    SG: Yes, the artery itself that is under question is the vertebral artery, and it wends it's way through, and near the proximal spine, which then enters the base of the spine. Current research up at the University of Calgary indicates that the spinal manipulative therapy delivers a maximum of 8% of the force necessary to produce any type of trauma, any type of irritation to the artery. And in fact the dissection may begin at the 92nd percentile.

    AB: Dissection meaning slicing?

    SG: Slicing or a tear. Again at 8% chiropractors are well within a minimal range.

    AB: In February, as I am sure you know, 60 Canadian neurologists put together a statement warning that strokes and crippling injury caused by neck manipulations are not uncommon. What's your response to that?

    SG: First of all, the position that they took, and when I say "they" I will clarify that in a minute. But, the work that they based their position on was done by another group, called the Canadian Stroke Consortium, which we have great issue with because the work itself is not peer-reviewed, it is not a study that has been subjected for international peer study. And, some of the conclusions are based on some "mathematical jumps" that really do not bare any facts within consideration of what they've done. So, the group of neurologists, again that's a questionable statement, because even though there have been reports of 60 in the media, it turns out that a great many knew nothing about involvement in this particular approach. And it comes down to very small handful of individuals who have put out information that is alarmist, and unprofessional. It bears no relationship to the current literature, and the work that's being done in the last 40 years with regard to this whole risk area.

    AB: The inquest that's taking place in Toronto, is not the first of its kind. There was a similar inquest into the death of Laurie Jean Mathiason. It took place in Saskatoon in 1998. I'm looking at the recommendations made by that inquest jury to the Ministries of Health in Canada.

    "In collaboration with chiropractic associations, we must insure that literature indicating the risks of stroke and other inherent risks associated with chiropractic treatment be visible and available to the people in the reception area at every chiropractic facility." Now, they heard the same kinds of expert witnesses that no doubt will be heard from in this inquest, and came up with the conclusion that there are sufficient risks of strokes and other inherent risks, that literature should be available to people about to receive this.

    SG: That's right. The profession itself has had information and literature in this direction since the mid to late 80s. So, the actual statement by the Saskatchewan was in fact ratifying....(interrupted by Andy).

    AB: I'm looking at something that chiropractors give out, "Common Questions About Neck Adjustment". In this, I can't find any warning about stroke, at all....PERIOD!! This is February 2002

    SG: What document are you referring to?

    AB: This is the "Common Questions About Neck Adjustment".

    SG: The general information already presupposing that chiropractors are handing out information to their patients. This is an informational sheet.

    AB:This was an informational sheet from FEBRUARY 2002. So, in the seven-points that were made, if in fact, and of course you are nationally involved in chiropractic. If in fact the recommendations of that jury were accepted, I would think that since this was given to us, the media, to answer questions about neck adjustments, why wouldn't there be a mention of the risk of stroke?

    SG: Because it is handled in another area called "safety and effectiveness" of chiropractic care, which is not part of that document. There is information that relates to it, and it is the "law" in Canada that "every" health care provider obtain informed consent from the patient.

    AB: So, if that risk is sufficiently great to place a card in a chiropractor's office for the patient to see, why are you so certain that in this case that risk was accepted, and it could have turned into an injury?

    SG: Uh......

    AB: If there's a risk of injury, if there's a risk of stroke....

    SG: Certainly...

    AB: Isn't it at least possible that this women's stroke was caused by this manipulation?

    SG: Any health care intervention Andy, is, has a potential for doing harm. Anyone. It so turns out that the research surrounding vertebral artery difficulties has found that the risk of stroke or stroke-like effects within the profession, within chiropractic care is so low, it's almost impossible to measure. The rate, I hear what you're saying.

    AB: But, you have to warn them of.....

    SG: Of course, of course and it is being done. And I am trying to assure you of that.

    AB: Thank you very much. Dr. Stan Gorchynski is a Toronto chiropractor and a governor of the Canadian Chiropractic Association. Our VoxBox number is 416-205-5807.