Chiropractic and chiropractic revisited
by Dr. Joe Schwarcz

Note from Dr. Polevoy - ChiroWatch manager:

On February 1, 2001 I received a fax from Lynn Perry, the Manager of Licensing for Southam Publications/National Post who own the copyrights to this series of articles. They wanted me to stop posting these and other articles, to deliver all copies of these articles, and to guarantee that I will be a good boy and never never never do this again.

My suspicions are, and they are just that, suspicions, that Southam has been pressured to have my site targetted because of the upcoming inquest into the tragic death of Lana Dale Lewis. You remember she was the mother of 12 who died after she went to a chiropractor. I wonder how many other newspaper conglomerates will be sending me similar letters. Something is rotten here, and it really smells of coercive tactics from chiropractic interests. I'm sure that I probably can't prove it, but it makes sense, not only to me, but to others as well. What the chiropractic community wants to see in the newspapers are pictures of their minions going into Grade 5 classes to read stories about Little Johnnie or Joannie Spine to the kids to indoctrinate them to their aburd theories and pseudoscience.

Perhaps Southam's Ottawa Citizen wouldn't mind taking down all their own articles that boost quackery, i.e. CCRG and Bill O'Neill in return.

It really don't think it's copyright issue folks. Joe Schwarcz, the scientist who wrote the columns, wanted me to have his articles posted because they were not available on the Montreal Gazette web page. He wanted the world to read them because they were well written, and the public had a right to know about the harmful effects of medical misinformation that chiropractor's have a tendency to give out to families.

If Southam really wants to make sure that the public is well-served they should really be careful when they allow ridiculous stories to remain on their own web sites about people who promote cancer quackery, naturopathy, iridology, or any other quack-filled pseudoscience? The Ottawa Citizen probably has had more quack supporting articles over the years than the Weekly World News. And, they don't care to take them down.

The chiropractic associations are very sharp at doing the right thing at the right time. There were three major events that ocurred about a year or so ago. The first was a lawsuit against chiropractic leaders, associations, a protective association, and the CMCC by the family of Lana Dale Lewis. Then there was the on-again, off-again inquest about her death. Finally there was the sturggle by CMCC to buy its way in to York University.

What disappeared from all offical association sites across the country were all references to the treatment of infants and children by chiropractors. Some remnants of those sites remained on vehement anti-vaccine members such as the CAC, but organized chiropractic web sites purged their sites entirely.

Did this mean that all of a sudden CMCC, the OCA, CCA, changed their support of infant and pediatric treatments for bed wetting, colic, asthma, and other such nonsense? Where did this anti-medical energy go to? In December, 2000, Edward Barisa left his job as the executive director of the CCA. He was then free to advise a group known as Chiroclinix.com.

David Chapman-Smith, a prominent lawyer for Canadian chiropractic organizations, is also on that advisory board. What this site did was to take much of the type of material that was removed from the CCA and Ontario Chiropractic Association - OCA sites about pediatric chiropractic, and made it available to the public on Chiroclinix.com.

Also on the advisory board of that organization is Pran Manga, the economist from Ottawa who put together the "famous" Manga report that so many chiropractors around the world rely on to convince the public that chiropractic treatment is right for them.

Incidently, the logo of the Canadian Chiropractic Association is clearly displayed on their front page for all to see. It clearly says that this site is endorsed by the CCA. The Chiroclinix.com banner is on the CCA web site.

What does that really mean? If the CCA took all references to pediatrics off their site in November 1999, have they changed their mind? Do they now condone it, do they encourage their members to use homeopathy, naturopathy, therapeutic touch, and all the rest of this stuff?

CHIROPRACTIC

I was flipping through some magazines hoping to find a picture of a child with an earache. That may sound strange but I was actually looking for a photo to use in a lecture on antibiotics. And did I ever find the perfect one! A youngster holding both ears in apparent pain! But what really caught my attention was the caption under the picture.

Did you know that untreated ear infection can cause permanent hearing loss? Gentle chiropractic adjustments can restore normal function to the nervous system and allow fluid to drain. Mention this ad and the "doctors" will check your child at no charge to see if they can be helped by chiropractic." Quite a claim in view of the fact that there is no scientific evidence that chiropractic can help ear infections.

Most honest chiropractors would agree that advertising manipulations for the treatment of ear infections is not appropriate. But B.J. Palmer would have loved the sales pitch. B.J., the son of D.D. Palmer, the inventor of chiropractic, introduced his famous slogan in the 1920s: "early to bed, early to rise, work like hell and advertise."

Many chiropractors still abide by the advertising philosophy. These days the ads range from promoting reasonable treatments for back problems to ludicrous claims about items like the Q-LINK Pendant worn for protection from "toxic forms of energy, stress and jet lag."

Let's for a moment go back to the late 1800s and examine how the fascinating practice of chiropractic evolved. Daniel David Palmer was born in Port Perry, Ontario in 1845 but soon sought the greener pastures of the United States. He settled in New Boston, Illinois and opened a fish market. But soon he was casting for bigger fish. D.D. had developed an interest in what at the time was called magnetic healing which involved the laying-on of hands to painful areas of the body, followed by a vigorous shaking of the fingers to draw out the disease. Then in 1895 came the pivotal moment in D.D. Palmer's life; a moment that would have profound historical significance.

The healer had convinced Harvey Lillard, a janitor who had apparently become suddenly deaf after bending over, to undergo the Palmer treatment. While he was running his hands along Lillard's spine, Palmer noticed that one of his vertebrae was protruding. Unscientifically, he decided that the vertebra must have come out of alignment when the patient had bent over and that this somehow resulted in his loss of hearing.

Palmer immediately pressed the vertebra back into place and was gratified to discover that he had restored Lillard's hearing. At that instant the concept of chiropractic was born. The word itself was derived from a Greek expression "to work by hand" and the practice was built on a basic philosophy that health depended on the condition of the nervous system.

Disease ensued when a misaligned spine put pressure on the nerves and lowered the body's resistance to disease. Correcting the abnormal vertebral protrusions, known as subluxations, restored health. The idea of spinal manipulation was actually not new.

Hippocrates had long before suggested that spinal problems could cause disease. But it was certainly Palmer who fabricated the theory that underpins chiropractic.

So did Palmer really cure his patient of deafness by spinal manipulation? We only have his and Lillard's word for it. The reported success seems rather suspect because no one else that we know of has since been cured of deafness through chiropractic.

But apparently Palmer was convinced because within a year he had established "Palmer's School of Magnetic Cure." The medical establishment of the day did not look favorably on this intrusion and in 1906 Palmer was jailed for practicing medicine without a license.

His son B.J. was not deterred by his father's fate and saw in chiropractic a wonderful business opportunity. While the elder Palmer, it seems, believed in his treatments, B.J. believed in promoting chiropractic as a lucrative profession. In 1926 he wrote a book called Selling Yourself in which he laid out his ideas about the importance of advertising.

His advice in Selling Yourself has survived to the present day. There are chiropractors who specialize in "practice building." One such opportunist offers very specific recommendations to his colleagues on how to increase their profits.

Tell patients, he says, that medicine is very effective in its place, however, it is a simple fact that it is becoming obsolete because its theory is false. He suggests that patients never be told that they are well, only that they are getting better. If a patient asks if chiropractic treatments are to be continued for life, the pat answer should be: "No, only as long as you want to stay healthy."

Chiropractors are also advised to wear pagers so that they can be paged by their secretaries making them look more important. On a more disturbing note, the "business builder" urges chiropractors to tell parents that their children probably have subluxations that will manifest themselves as colon cancer if they are not corrected.

Most chiropractors today, as they were in B.J.'s time, are repulsed by such unethical approaches. Indeed, internal opposition to B.J. Palmer's ideas quickly developed in the 1920s when he came up with the Neurocalometer, a nonsensical device which supposedly located subluxations whether the patient had symptoms or not. This alienated chiropractors who already had misgivings about the subluxation theory and caused a split in the ranks.

B.J.'s opponents became known as "mixers" as opposed to his "straight" followers who believed in the use of spinal adjustments exclusively. The mixers began to use massage, herbal therapies, food supplements and physical therapy in addition to spinal manipulation. Today, there are very few chiropractors who are "straight," most offer various alternative therapies.

Unfortunately, some of these therapies are very questionnable. An investigative reporter recounts how one chiropractor placed a potato and an egg on his chest before testing his arm strength, how he held a magnet over his thymus gland and concluded that he had nutrient deficiencies which could be corrected with "glandulars" costing fifty dollars. Another one used something called a "biomagnetic scanner" to detect underactive glands. Fortunately these scams are the exception, not the rule. Every profession, including mainline medicine, has its rotten apples.

On the other hand many patients are obviously happy with their chiropractors because they visit them as often as their physicians. (And I'm sure I'll be hearing from many of them.) This is pretty interesting because studies have shown that chiropractic manipulation is no better than physiotherapy for low back pain. But patients are more satisfied. Why? Because chiropractors provide touching, a component often absent in modern medicine. They also provide hope, because it seems there is virtually no problem that they are unwilling to try and help. Chiropractors themselves, however, do not offer a very good testimonial for their powers. A statistical analysis of obituaries published in chiropractic journals shows an average life expectancy of only sixty six years.

Is there any danger in chiropractic? There are isolated reports of torn blood vessels in the neck after manipulation as well as strokes but in comparison to the number of patients treated, these are insignificant. The greatest risk is missing a diagnosis.

When in an investigative study children were taken to different chiropractors there was no agreement on diagnosis but all the practitioners said they could help. Then there is a report of a man who consulted a chiropractor for leg pain and had a treatment without his trousers even being removed. Three days later doctors discovered a blocked artery necessitating amputation. But again, this is a rare case.

By and large, while the effectiveness of chiropractic can be questioned, the practice is safe enough. I've even thought about suggesting chiropractic to my daughter who has tried almost everything else for her low back pain. At least she won't have to worry about the calamity that befell a man in Detroit who got his private parts caught in a folding chiropractic table and is suing for pain, suffering and disfigurement.

CHIROPRACTIC REVISITED - MARCH 26, 2000

The risks of cervical manipulation are definitely not insignificant

As I had expected, the column triggered strong reaction from the chiropractic community. There were a few well-composed comments from chiropractors describing their procedures and offering to back up their claims of success with testimonials from satisfied clients. There were also a couple of belligerent letters accusing me of being unscientific and intellectually dishonest. Being familiar with the history of chiropractic and the battles that have raged between chiropractors and their critics, I was not surprised by the strong attacks. But I was shocked by the extent of criticism from physicians and former chiropractic patients who thought that I had been "too soft on chiropractic."

I was severely taken to task by a group of neurologists over my comment that while the benefits of chiropractic may be questionable, "its risks are insignificant." Both chiropractors and their opponents flooded me with videotapes, books, newsletters and literature references to buttress their arguments. Most of this I had seen before, including some reports of strokes allegedly caused by chiropractic manipulation. But to me these had been just statistics. As described in the chiropractic (and as they always point out, "science-based") literature, a stroke caused by manipulation was about as likely as being struck by lightning. Now, however, doctors had provided me not with just numbers, but with some real names. I decided this needed a little further exploration. So I called Diane Rodrigue.

I heard how she had visited a chiropractor in 1994 for headaches, on the advice of colleagues who had raved about their own experiences. Diane's treatment, however, was a painful one. When a neck manipulation was performed, the headache got worse. Accordingly, a note was placed in her chart about "no neck manipulation for this patient." Diane kept going for more gentle treatments, paid for by Ontario Health Insurance, in spite of the fact that there was no improvement. When the insurance coverage ran out, she was quite happy to discontinue treatment and went to see the therapist to finalize some paper work. Unfortunately, a replacement chiropractor was on duty and suggested a manipulation. He had not read the chart and cracked Diane's neck. Within minutes she could not speak or move. A stroke! A large payment from the chiropractor's insurance was hardly a comfort to someone destined to spend her life a prisoner in her own body.

I then called Kim Barton, a young mother of two, who was more fortunate. In 1996 she too went to a chiropractor for headaches. After a few treatments Kim began to experience vertigo and was told by the chiropractor that this was fine, it was just a sign that blood vessels feeding the brain were opening up. She then switched to another chiropractor because of geographic proximity to whom she described her symptoms, including the dizziness and ringing in the ears. In spite of these warning signs, she was manipulated. Kim had a brain stem stroke on the table. She recalls that the chiropractor's reaction was to try and sit her up and place an ice pack on her neck. Finally an associate called an ambulance. When Kim woke up in hospital, she could not see or speak and could hardly move. Over a long period of rehabilitation she regained most of her faculties, although this highly educated lady now says that "her brain which used to run like a Cadillac now purrs along like a Honda Civic." Luckily, the Civic is still a good car. A lawsuit was understandably launched and spurred an attempt at mediation. As Kim describes this, it was an emotionally wrenching event with the chiropractor's lawyer essentially accusing her of responsibility. As an educated woman she should have known better, she should have known the risks involved! Unwilling to put up with the potential stress of a trial and the likelihood that she would feel as if she were being tried, Kim decided to accept the terms of the mediation as presented by the chiropractors's lawyers.

Kim and Diane were around to talk to me. Laurie Jean Mathiason and Lana Dale Lewis were not. Laurie had been seeing a chiropractor in Saskatoon in 1998 for back pain over several months. Then she developed a sore neck and had a cervical adjustment for it. Not only did the pain not resolve, it got worse and was accompanied by dizziness. Still, the next day the chiropractor thought she needed another adjustment. Laurie lost consciousness on the table, went into convulsions and tragically died days later from a ruptured vertebral artery. Her boyfriend, who was present during the treatment, recalls the chiropractor slapping Laurie's face in an attempt to rouse her and saying that everything would be all right. A coroner's hearing into the case ended with a six-member jury suggesting immediate research into the risks of cervical manipulation and recommending that literature about the risk of stroke be made available in chiropractors' offices. Laurie's parents are suing the chiropractor involved.

This case generated a fair amount of publicity with chiropractic representatives being interviewed on a variety of radio and TV programs. Spokespeople repeatedly stated that this was a tragic, but rare occurrence, in fact, so rare that it was the first such case in Canada. It seems that wasn't exactly correct. In 1996, Lana Dale Lewis suffered a stroke soon after chiropractic treatment for migraine. The Toronto Coroner's Office investigated the case and interviewed senior officials of the chiropractic community who, after some discussion, accepted the pathologist's report of death due to vertebral artery injury caused by cervical adjustment. An inquest was avoided because the chiropractors agreed to officially remind their colleagues of the risks involved in cervical manipulation. Yet, during the aftermath of the Mathiason investigation, the same chiropractic representatives were denying any knowledge of previous fatalities. Lana's son Adam has now filed a twelve million-dollar lawsuit for wrongful death.

In response to these allegedly rare cases, the Canadian Stroke Consortium, a network of stroke centers around the country, has begun to compile data on strokes in young people as a result of cervical adjustments. In less than a year the neurologists involved claim to have identified about 30 patients with strokes that were likely caused by such procedures. It is hard to get a feel for the extent of the risk because patients presenting with strokes in emergency rooms are not always asked about cervical manipulation. Is the risk one in several million as chiropractors suggest, or one in a few thousand as some neurologists imply? Even if it is like the risk of getting struck by lightning, shouldn't the public be informed? If you are a golfer, you may not want to give up golfing because of the risk of being struck by lightning, but you certainly would want to know how to avoid the risk in a thunderstorm!

I'm not sure how extensive this problem is. But I am now sure that it is not "insignificant", as I had stated in my previous column. No human life is insignificant. For that grossly insensitive comment I apologize to Diane, Kim and the families of Laurie and Lana as well as unnamed others. And there surely are others; a Medline search quickly revealed over two dozen similar reports. The Canadian Stroke Consortium is now actively trying to quantify the risk. Anyone with a relevant experience can send a message to mailto:neck911@sprint.ca

This discussion is not meant as a condemnation of all chiropractic treatments. As I stated before there are many happy patients and freedom of choice in health care is an important right. But the manipulation of the cervical one and cervical two joints can be a risky procedure, a risk of which chiropractors are aware and a procedure never performed by physiotherapists, physicians or those chiropractors who have dedicated themselves to the practice of safe manipulations.

As a result of my last column, I had a meeting with three Montreal chiropractors, pleasant gentlemen all, honestly trying to help people through what they said was scientific chiropractic.

The Stroke Consortium is now providing the science, so I hope these three will join other chiropractors who have recognized the risk of C1-C2 manipulation and will help spearhead a drive to reduce the risks. One of them has already indicated his committment to the cause and his total compliance with the Canadian Chiropractic Association's recent requirement that all patients sign an informed consent form. A great start.

The time has now come to put turf wars and legal posturings aside and prevent further tragedies, no matter how rare these may be. If this discussion leads to the prevention of just one stroke, it will have been worth it. Because that "one stroke" is not just a statistic, it is a person with family, friends, hopes and aspirations, like you or I.

Dr. Joe Schwarcz
Director
McGill Office for Chemistry and Society
514-398-6238
E-mail: schwarcz@chemistry.McGill.ca