New book:
'Locked In - Chiropractic adjustment gone wrong'
https://scottslockedin.com/Home_Page.html
It was completely compiled by using a mouth/headstick to type.
Just days after Sandra and David Nette’s class action lawsuit was rejected by a judge in Alberta, Canada, comes the sad news from David Nette that quadriplegic chiropractic victim, Diane Rodrigue, has died. Diane Rodrigue featured in this 2005 Irish TV programme which looked at the dangers of alternative medicine:
http://www.rte.ie/news/2005/0505/primetime.html (from 25min 45sec in)
In view of the above, it is well worth reading Sandra and David Nette’s class action lawsuit Statement of Claim:
http://www.casewatch.org/mal/nette/claim.pdf
Originally Posted by Blue Wode
Interesting read, do you have access to the judgement? Would be interesting to read the reasoning of the Judge(s).
At a guess:
1. Absence of evidence for efficacy is not evidence for inefficacy - hence all charges of knowingly administering a useless therapy fall.
2. There is evidence of an association between manipulation and stroke not proof of causality
3. If such a relationship exists, the frequency of events (less than 1:20,000) is not sufficient to mandate specific mention of this risk.
Now were this a medical procedure, one is required to mention risks that lead to permenant disability - however, this has only been so in the UK for the last decade, so is not fully enforced. Hence by analogy with the medical position patients are given vaccination without generally requiring specific consent for the low risk of anaphylactic shock.
Arguments based on the risk benefit ratio definitely seem the way to go, but that requires much better evidence on the inefficacy front.
I don't think that tortured logic works. However, the finding against Nette was that she cannot file a "class action" suit; her personal suit is proceeding unimpeded.
I think that when the stroke occurs immediately when the chiro snaps the neck (and many have) that is pretty definitive. We also know the mechanism, artery dissection, that causes the stroke and the anatomy that permits it to happen. http://www.quackwatch.org/01Quackery...irostroke.html
When Nette arrived at the hospital, the neurologist noted the bilateral artery dissection that led to her stroke and he said to her husband "Chiropractor, right?" The bilateral artery dissection is chiro's only unique gift to humanity.
That may be true for effective procedures; but for procedures whose benefit is zero, it is misleading. Nette serves as a perfect example of this- she was generally healthy and was being given bogus, "maintenance" adjustments by the quack who snapped her neck. When the benefit is zero, risk/benefit involves division by zero (a very large number arguing against the "treatment"). Another woman, who died, was being "treated" for a bruised tailbone by a chiro who subscribes to NUCCA nuttiness- he believes that all problems stem from subluxations of the top two vertebrae.
"Maintenance" adjustments on healthy people and tailbone "treatments" involving the neck snap make a strong case for the inefficacy of such procedures. When a treatment is scientifically implausible, its routine use is unsupportable.
While it is easy to argue for an association being causative and the temporal association increases the liklihood of this being a correct deduction - it is not proof.
As for bilateral dissection being uniquely related ti Chiropracty - Nope:
1. Clin Neurol Neurosurg. 2007 Nov;109(9):816-20. Epub 2007 Aug 20.
Spontaneous bilateral carotid and vertebral artery dissections associated with
multiple disparate intracranial aneurysms, subarachnoid hemorrhage and
spontaneous resolution. Case report and literature review.
Marshman LA, Ball L, Jadun CK.
Department of Neurosurgery, North Staffordshire Royal Infirmary, Hartshill,
Stoke-on-Trent, Staffordshire ST4 7LN, United Kingdom.
l.a.g.marshman@btinternet.com
Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs)
are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden
onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid
hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and
VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels -
including the renal arteries - were normal, and no risk factors or underlying
vasculopathy were apparent. The presumed source of SAH (a posterior cerebral
artery aneurysm) was successfully clipped. Each dissection, by contrast, was
managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD
resolution occurred within 6 months. We present a unique case of four-vessel
dissection associated with multiple disparate saccular and fusiform aneurysms. We
suspect that underlying vasculopathy - perhaps novel - may become apparent with
time.
PMID: 17709178 [PubMed - indexed for MEDLINE]
2. Neuroradiology. 2003 May;45(5):311-4. Epub 2003 Apr 12.
Simultaneous bilateral internal carotid and vertebral artery dissection following
chiropractic manipulation: case report and review of the literature.
Nadgir RN, Loevner LA, Ahmed T, Moonis G, Chalela J, Slawek K, Imbesi S.
University of Pennsylvania School of Medicine, Hospital of the University of
Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Single-vessel cervical arterial dissections typically occur in young adults and
are a common cause of cerebral ischemia and stroke. Although the pathogenesis of
multivessel dissection is unclear, it is thought to be a consequence of
underlying collagen vascular disease. We present a 34-year-old previously healthy
man who developed bilateral internal carotid and vertebral artery dissection
following chiropractic manipulation.
PMID: 12692699 [PubMed - indexed for MEDLINE]
3. Ulus Travma Acil Cerrahi Derg. 2003 Jan;9(1):72-5.
[Traumatic dissection of bilateral vertebral arteries]
[Article in Turkish]
Akay KM, Izci Y, Uğurel S, Baysefer A, Timurkaynak E.
Gülhane Askeri Tip Akademisi, Nöroşirürji Anabilim Dali, Ankara, Turkey.
kmakay45@hotmail.com
58-year-old male comatose patient following a motor vehicle accident with a
history of coronary bypass surgery 5 years ago has been presented. The patient
was awake after the accident and he became comatose 30 minutes after the
accident. The early diagnostic investigations showed no responsible cranial or
spinal lesion. At the 2nd day of the accident, diffusion weighted magnetic
resonance scans, magnetic resonance arteriography and digital subtraction
arteriography revealed bilateral vertebral artery dissection at the second part
of the vertebral arteries. Clinical, radiological features and treatment options
of the vertebral artery dissection has been discussed with the ertinent
literature.
PMID: 12587060 [PubMed - indexed for MEDLINE]
4. J Trauma. 2002 Jun;52(6):1186-8.
Bilateral vertebral artery dissection after blunt cervical trauma: case report
and review of the literature.
Taylor MW, Senkowski CK.
Department of Surgical Education, Memorial Health University Medical Center,
Savannah, Georgia 31403-3089, USA.
PMID: 12045651 [PubMed - indexed for MEDLINE]
5. Cardiovasc Surg. 2000 Jan;8(1):72-4.
Complex traumatic dissection of right vertebral and bilateral carotid arteries: a
case report and literature review.
Busch T, Aleksic I, Sirbu H, Kersten J, Dalichau H.
Department of Thoracic Surgery, Georg-August-University, Göttingen, Germany.
A 27-year-old female motorcycle passenger was admitted with bruises and
concussion after a motor-vehicle accident. After a lucid interval of several
hours she became stuporous and progressed to an acute comatose state. Computed
tomography demonstrated extensive cerebral ischaemia in the territory of the
right middle cerebral artery. Angiography after transfer to the authors' hospital
revealed dissections of both carotid arteries and of the right vertebral artery.
The patient underwent surgical reconstruction of the left internal carotid artery
with saphenous vein. The management of this patient is discussed and the
literature reviewed.
PMID: 10661707 [PubMed - indexed for MEDLINE]
6. Mayo Clin Proc. 1999 Sep;74(9):893-6.
Spontaneous bilateral vertebral artery dissections: case report and literature
review.
Chang AJ, Mylonakis E, Karanasias P, De Orchis DF, Gold R.
Department of Medicine, Miriam Hospital, Brown University School of Medicine,
Providence, RI 02906, USA.
Vertebral artery dissection (VAD) has been increasingly identified as a cause of
ischemic stroke in young adults. We report the clinical and radiographic findings
in a case of spontaneous bilateral VADs and review the literature on the causes,
pathophysiology, diagnostic considerations, and treatment options for VAD. A
29-year-old man was admitted to our hospital after sudden onset of headache and
nuchal rigidity that progressed to a posterior lateral medullary syndrome in a
2-week period. The diagnosis of bilateral VADs was based on findings on cranial
magnetic resonance imaging and conventional angiography. The patient was given
anticoagulant therapy and had no further neurologic deterioration. The
differential diagnosis of craniocervical pain in young patients should include
arterial dissection of the neck because early diagnosis and treatment may reduce
the chances of long-term neurologic sequelae.
PMID: 10488791 [PubMed - indexed for MEDLINE]
Any info on why the class action failed? Agreed the personal suit has a greater chance of leading to damages, but even here I would be surprised.
The problem with the 'tortured logic' is that it represents the 'standard of care' argument. Medicine is littered with ineffective therapies that are hopefully being weeded out slowly. When sued, it is sufficient that a responsible body of opinion would support the approach taken. Where there is clear evidence that a therapy is ineffective and a consensus exists that it should no longer be used, then you are stuffed.
The problem is that the 'responsible body' in this case is comprised of other chiropracters.
So either one provides clear evidence of inefficacy that cannot be denied by the most battlehardened Chiro, or one campaigns to change the mind of the average chiro against such practices. Alternately one could change the law requring that all health interventions meet a prespecificed standard of evidence (many medical procedures would fall at this hurdle), or finally one could insist that independent committees review the guidelines issued by all 'responsible bodies'.
Just arguing that the benefit is zero, won't solve this problem.
Did your articles rule out chiro? As for trauma in (e.g.,) motor cycle accidents, who could be surprised. So, the fact remains that there may be other causes for bilateral artery dissection; but it is the chiro's unique contribution to health concerns.
The "standard of care" argument is the real problem, not the "lack of evidence against it" argument. The problem is not convincing the battlehardend chiro, the problem is convincing the judge/jury.
A puzzling argument. Either bilateral verterbral artery dissection is caused only by chiropractic manipulation, or it is the sole complication of chiropractic manipulation - if neither then how can it be unique?
Spine (Phila Pa 1976). 2009 May 15;34(11):E405-13.
Safety of chiropractic interventions: a systematic review.
Gouveia LO, Castanho P, Ferreira JJ.
Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal. lilianafog@gmail.com
Comment in: STUDY DESIGN: Systematic review of reported adverse events. OBJECTIVE: To evaluate the tolerability and safety of chiropractic procedures. SUMMARY OF BACKGROUND DATA: Despite the increasing popularity of chiropractic, there are few properly designed prospective controlled trials, and there is a disproportionate lack of evaluation of its safety profile. The literature reports multiple neurologic complications of spinal manipulation, some of which are clinically relevant and even life threatening. METHODS: We performed an electronic search in 2 databases: Pubmed and the Cochrane Library for the years 1966 to 2007. All articles that reported adverse reactions associated with chiropractic were included irrespective of type of design. The outcome measures were the type of adverse events associated or attributed to chiropractic interventions and their frequency. RESULTS: A total of 376 potential relevant articles were identified, 330 of which were discarded after abstract or complete article analysis. The search identified 46 articles that included data concerning adverse events: 1 randomized controlled trial, 2 case-control studies, 7 prospective studies, 12 surveys, 3 retrospective studies, and 115 case reports. Most of the adverse events reported were benign and transitory, however, there are reports of complications that were life threatening, such as arterial dissection, myelopathy, vertebral disc extrusion, and epidural hematoma. The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations. CONCLUSION: There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic. Further investigations are urgently needed to assess definite conclusions regarding this issue.
"Unique" the only other contribution from chiro is spinal manipulation as a possible benefit to low back pain; but others do the same thing.
We do not know the prevalence of harm due to chiros. "Spine" is a crappy (poorly refereed) "journal" that caters to chiropracty- here is a review in a better journal http://jrsm.rsmjournals.com/cgi/reprint/100/7/330 on adverse effects from chiro adjustment. Unfortunately, because "Spine" is not worth the paper it is printed on- I don't have ready access to the article you cite. I think they agree, there are adverse effects- we just don't know how common the serious ones are. Most particularly, we don't know how many people leave the chiro office and suffer a stroke and never return.
So now you are an authority on journal quality. What is the impact factor for spine versus JSRM? Hint the 'not worth the paper it is printed on' journal wins hands down.
Now I know that impact factors have their problems, but why should anyone take more notice of your opinion?
Actually, in the appropriate sciences I am. Aren't you?
Don't take my opinion, do your own research.
Irony, kind of passes you by then!
Maybe you don't have the gift of irony.
Enough of the tortured reparite, any info on the main question at hand?
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