When the coroner's inquest into Lana Dale Lewis' 1996 death resumes today it will reignite the debate over the risks of chiropractic neck adjustments.The battle lines are clearly drawn.The family has its witnesses ready, and if it's shown that a neck manipulation was to blame for the 45-year-old woman's fatal stroke, it will be demanding public warnings about the practice. Chiropractors are also anxious to call their own experts to prove that adjustments are safe, and that any increased risk of stroke is minute. And for them, this battle is for their livelihood, plain and simple. While a coroner's jury cannot assess blame, it can make recommendations on how to prevent future deaths — if it determines chiropractic is to blame in this case.Already, anecdotal evidence indicates business has dropped since the coroner's jury first began hearing the case in April. In some cases, billings have declined by as much as 25 per cent, chiropractors say. For new graduates, their practices are not growing as rapidly as hoped.Although the provincial government only pays a small portion of chiropractic visits, billings from the first half of 2002 are down 3.5 per cent from the same period a year earlier, according to OHIP. Last year, the OHIP-covered portion — up to $150 a person — of chiropractic billings totalled $92 million.This long-delayed coroner's inquest — expected to last for many months, possibly even until Christmas — has brought a wave of negative publicity and put chiropractors in the spotlight. At the same time, a group of about 60 neurologists has spoken out, warning of the dangers of chiropractic neck manipulation.The five-member jury has the task of determining whether Lewis, a mother of three, died as a result of a neck manipulation. She regularly sought care from her chiropractor due to migraine headaches. Lawyers for the chiropractic community have insisted Lewis died of natural causes, citing her pre-existing health problems.The coroner's office is also investigating whether another death is linked to a chiropractic procedure: Dora Labonte, a 40-year-old Guelph woman, died in July after suffering a stroke.Chiropractic care brings out passionate views, sometimes even dividing families. Some patients swear by their chiropractor for curing all that ails them, while others vehemently question the value of such treatment.The chiropractic lobby is also powerful. Manitoba's provincial government quickly discovered this when it tried to reduce coverage for chiropractic care for adults and eliminate it for children.Last spring, Premier Gary Doer's government said it would be reducing coverage from $11.56 a visit to $8 a visit. Facing public protests and complaints from chiropractors and their patients, the Manitoba government retreated, saying it would increase coverage from $8 a visit to $9 by next year. And coverage for children would be reinstated.For Les Limage, there is no debate — he is suing his chiropractor.Limage, a once energetic used-car dealer in Waterloo, is now reduced to living in a wheelchair.According to Limage's statement of claim, while being treated by George Hickson last Nov. 30, the chiropractor reached up and cracked Limage's neck. A severe headache and tiredness followed. Limage visited Hickson again on Dec. 3, and two days later became nauseous, dizzy and lost his balance, his family says. His wife Flo rushed him to hospital, where he was diagnosed with a stroke and nearly died.Today, Limage suffers double vision, and the images before him vibrate. The proud 67-year-old is paralyzed on one side, and he can't walk. He's lost his swallow and gag reflex, so he can't eat or drink, and is fed through a stomach tube. Limage recently began breathing without a respirator, so he can talk again. But his voice is low and raspy and sometimes hard to follow. "I don't have a life," he says, sitting beside his wife in the sunny courtyard of the chronic care site of Grand River Hospital in Kitchener, where she spends almost every day.The couple ran Les Limage Motors in Waterloo, but they've had to let it go and they face financial hardship. "It's destroyed our life. It's destroyed our business," says Flo Limage, 58, her voice trembling. "I come home to an empty house all the time. Les has nothing to look forward to but hospital."Calls to the chiropractor who treated Limage were not returned. But in a court document responding to a $5.25 million lawsuit by the Limages, Hickson denied any responsibility for his health problems and stated that the chiropractor treated him "in a competent, diligent and professional manner."Chiropractic neck manipulations were the subject of a 1998 coroner's inquest into the death of 20-year-old Laurie Jean Mathiason. The Saskatoon woman died of a stroke brought on by a traumatic rupture of her left vertebral artery after having a neck manipulation.
`Let's stop and really take a look at the benefits, let's really look at the risks, and they'll see the ratio is quite favourable.'Chiropractor Joel Weisberg
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The jury, which is not mandated to find fault, made several recommendations to study the risks and benefits of neck manipulation and to ensure that literature indicating the risks associated with chiropractic treatment be visible in the reception area of every chiropractic office.Stan Gorchynski, chair of the Ontario Chiropractic Association, says as far as he knows information is available in every Canadian chiropractor's office outlining the risks of treatment. Informed consent is the law, he points out. The risks of stroke are very low, Gorchynski adds: one in 1 million to one in 5.85 million neck manipulations. By comparison, when it comes to prescribing a pharmaceutical drug, a risk of problems in one in 20,000 treatments would not be considered significant, says Gorchynski.Dr. John Norris, past chair of the Canadian Stroke Consortium — a group of neurologists and medical researchers studying strokes — says the incidence of stroke is at least one in 100,000 patients. Based on an assumption that a patient visits a chiropractor 10 times a year, this is essentially the same as the chiropractors' highest estimated risk of one in a million neck manipulations. And at the Lewis inquest, Norris testified that the risk may be as low as one in 2.2 million manipulations.But Norris insists in an interview that the incidence of stroke could actually be as high as one in 50,000 patients. "It's highly under-reported," he says. For patients who get relief from chiropractic treatments, which they couldn't find through traditional medicine, they become true believers and advocates.Sam Iwasiuk, a 27-year-old musician, says visits to his chiropractor Joel Weisberg managed to bring him the relief from his chronic neck and back pain. "Doctors could only give me anti-inflammatory (medications), and it didn't solve the problem," says Iwasiuk, who confesses he was initially a little concerned about visiting Weisberg, given all the media attention over adjustments. "I think the most important thing is to educate yourself," says Iwasiuk, who works part-time as an emergency ward clerk. "I overhear a lot of differing opinions. Some people get a chill up their spine when you say `chiropractic.'"But there are risks to just crossing the street," he adds. "It's important to know what the benefits could be ... I feel energetic. I can get a lot more achieved."Weisberg, 30, who is just starting a practice at Bathurst St. and Sheppard Ave., says his business has not been increasing quickly, which he attributes to the publicity surrounding the Lewis inquest."The growth I have experienced hasn't been as rapid as I experienced before," says Weisberg, who was trained in the United States. "But at the same time, the patients who are coming in are more committed than ever before."Weisberg believes any health intervention comes with risks, whether it's a chiropractic adjustment, taking a new prescription drug, or undergoing surgery."It's about looking at the risk," he says. "Let's stop and really take a look at the benefits, let's really look at the risks, and they'll see the ratio is quite favourable."Gorchynski says neck manipulations are part of almost every treatment he performs in his practice. Structural dysfunction of the spine can be transferred from one part to another, he explains.The benefits of chiropractic are well established, he says, citing research that shows it's the most effective health care for dealing with low back and neck pain, as well as headaches. But it has other wide-ranging benefits for the whole system, he says. He points to pictures of two children on his wall, one of whom he says was cured of ear infections and the other of behavioural problems.But Edmonton neurologist Dr. Brad Stewart contends the benefits of chiropractic are not established, although the risks are. "The reality is that there is not a lot of evidence for any kind of benefit from what they're doing, but we see the complications day after day," says Stewart, who organized a joint letter from about 60 neurologists last February warning about the dangers of neck manipulations."If you talk to any neurologist, he's seen multiple strokes, pinched nerves in the neck, compressed spinal cords, torn arteries in the neck, both front and back, and death," Stewart adds.Stewart suggests that chiropractic offices need warning notices that read: "This therapy has no proven clinical benefit. You are entering this at your own risk."But Gorchynski says "alarmist and incorrect information" is creating "a false impression in the public sphere."As a result, the chiropractors will do what they have to do to defend their profession."We do not shy away from the spotlight. It is a spotlight that we have not sought. ... We have to be defensive without being angry."
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