Each day, thousands of parents present their children for vaccination at schools, clinics, and private physician’s offices. Most are good parents who want the best for their children. What parent doesn’t dream of having healthy children?

Most parents consider vaccination to be a necessary part of the child raising process. The medical paradigm is so deeply engraved into the consciousness of most Americans that few question the procedure.

The rare parent who questions the wisdom of administering vaccines to a child is quickly met with intense criticism. Such a parent will be badgered by relatives, pediatricians. and school nurses. If emotional manipulation fails, coercion will be employed.

The issue of vaccination is too complex to adequately address in a short column. However, it is possible to present one illustration of vaccine technology gone terribly wrong. That example is polio vaccine.

The polio vaccine is often cited as one of the greatest triumphs of modern medicine. Persons who lived through the polio epidemic of the 1950s remember the braces and iron lungs. They watched the disease seemingly vanish following the polio vaccination campaign, and credited the vaccine. Yet, there is much more to the story than meets the eye.

Let’s look at what really happened.

Infectious diseases often come and go in cycles. By 1942, the polio epidemic of the first half of the century was subsiding, and there were fewer than 5,000 cases reported in the United States. Around 1948, the number of polio cases increased dramatically. Polio reached a high in 1949 with nearly 43,000 cases. This was followed by a natural decline. By 1951, the number had dropped to 28,000 cases.

Following a government subsidized study of polio vaccine and its mass administration, the number of cases soared to an all-time high of 55,000 cases. The manufacturing process for the vaccine was altered, and the natural decline of the disease continued. The vaccine took the credit — a classic case of confusing correlation with cause and effect, and the “post hoc, ergo propter hoc” fallacy. (1)

Another abuse of statistics involved a change in the diagnostic criteria for polio. As noted in the Los Angeles County Health Index: Morbidity and Mortality, Reportable Diseases, “Most cases reported prior to July 1, 1958 as non-paralytic poliomyelitis are now reported as viral or aseptic meningitis.” Why? Since the vaccine allegedly “wiped out” polio, persons with polio symptoms must have had something else!

Today, it is readily acknowledged that the live virus vaccine will rarely cause polio in a vaccine recipient or the caretaker of a vaccine recipient who may handle an infected diaper. A report by the Institute of Medicine concluded that causality was established between oral polio vaccine, poliomyelitis, and death from polio-strain virus infection. (2)

Yet, this admittedly small risk is not nearly as worrisome as the long term consequences which may follow administration of the polio vaccine.

Polio vaccine was (and still is) produced using monkey kidney tissue. As a result, contamination of these vaccines with monkey viruses is a more insidious risk. The effects of such viral contamination may not appear until decades after the vaccine is administered. Harvard Medical School professor Ronald Desrosier referred to this polio vaccine risk as a “ticking time bomb.” (3)

Although only about two percent of monkey viruses are known, an important monkey virus, SV-40, has been found in polio vaccines. SV-40 is a carcinogen. Unusual forms of cancer bearing the distinctive DNA pattern of monkey virus have been found in persons who received the vaccine decades ago. (4,5)

Dr. Maurice Hillman of Merck described the virus in the 1950s. Vaccine batches as early as 1960 were found to be contaminated with the virus, but the public was never told. Hillman explained why: “It was important not to convey to the public (this) information, because you could start a panic. They already had production problems with people getting polio. If you added to that the fact that they found live (monkey) virus in the vaccine, there would have been hysteria.” (4)

Although it is claimed that current vaccines are free of SV-40, the virus has been detected in human semen. (6)

The virus, which originally was transmitted by the vaccine, may have integrated itself into the genomes of the vaccine recipients, causing it to be transmitted through sexual contact. Since it is possible to test only for the roughly two percent of known monkey viruses, testing for SV-40 offers little comfort.

Besides causing cancer, it has been suggested that polio vaccine may be responsible for the emergence of AIDS and other new diseases.

Biologist Richard de Long wrote: “During the last twenty years a number of new and very serious diseases has arisen. Some of these are Reye’s syndrome, Kawasaki disease, Lassa fever, Marburg disease, non-A non-B hepatitis, Ebola hemorrhagic fever, and acquired immune deficiency syndrome. …

“Since 1961 we have been immunizing the human population with attenuated viral vaccines en masse. Such unparalleled use of live viral vaccines may be the reason for the appearance of new diseases. …

“Since most humans in the world are now harboring live vaccine viruses of different kinds within their cells, the probability of genetic recombination between these viruses and other viruses as they infect cells becomes quite high. …

“All the new diseases listed above appeared after the mass administration of the live poliomyelitis vaccine and followed by mass immunization with other live viral vaccines.” (7)

More recently, the popular magazine Rolling Stone (8) reported concerns raised in an article published in The Lancet (9).

It was suggested that the origin of AIDS may have been oral polio vaccine contaminated with Simian (monkey) retroviruses. Other authors have hypothesized that the AIDS pandemic may have originated with a contaminated polio vaccine. (10)

The adverse effects of polio vaccine include the neurological disorder Guillain-Barre syndrome. (11,12)

Guillain-Barre syndrome has been found temporally related to the administration of oral polio vaccine. Ironically, the symptoms of Guillain-Barre syndrome are similar to those associated with poliomyelitis in the 1950s and 1960s.

It is reprehensible that parents, led by sincere but misguided physicians, subject their children to vaccination — a ritual of cultural child abuse.

References

1. Kent C, Gentempo P: “Immunizations: fact, myth and speculation.” International Review of Chiropractic Nov/Dec 1990;45(6):13.

2. Stratton KR, Howe CJ, Johnston RB Jr: “Adverse events associated with childhood diseases other than pertussis and rubella.” Summary of a report from the Institute of Medicine. JAMA 1994;271(20):1602.

3. Rock A: “The lethal dangers of the billion-dollar vaccine business.” Money Dec 1996:148.

4. Wechsler P: “A shot in the dark.” New York Nov 11, 1996:38.

5. Pennisi E: “Monkey virus DNA found in rare human cancers.” Science Feb 7 1997;275(5301):748.

6. Martini F, Iaccheri L, Lazzarin L, et al: “SV40 early antigen and large T antigen in human brain tumors, peripheral blood cells, and sperm fluids from healthy individuals.” Cancer Res 1996;56(20):4820.

7. de Long R: “A possible cause of acquired immune deficiency syndrome (AIDS) and other new diseases.” Med Hypotheses 1984;13(4):395.

8. Curtis T: “The origin of AIDS: a startling new theory attempts to answer the question ‘was it an act of God or an act of man?’” Rolling Stone Mar 19, 1992:54.

9. Kyle WS: “Simian retroviruses, polio vaccine, and origin of AIDS.” The Lancet 1992;339(8793):600.

10. Ellswood BF, Stricker RB: “Polio vaccines and the origin of AIDS.” Med Hypotheses 1994;42(6):347.

11. Kinnunen E, Farkkila M, Hovi T, et al: “Incidence of Guillain- Barre syndrome during a nationwide oral poliovirus vaccine campaign.” Neurology 1989;39(8):1034.

12. Friedrich F, Filippis AM, Schatzmayr HG: “Temporal association between the isolation of Sabin-related poliovirus vaccine strains and the Guillain-Barre syndrome.” Rev Inst Trop Sao Paulo 1996;38(1):55.

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Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Adaptation Guide

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One of the rites of passage every student of chiropractic must endure is learning a litany of eponymic orthopedic tests. Most of these tests are named for their developers. Therefore, instead of descriptive terms, students must memorize proper names which communicate nothing more than egomania. Proper names make great examination fodder. State boards love them. Until recently, few M.D.s or chiropractors questioned the validity of these procedures. Thankfully, this is changing.

A growing number of clinicians are beginning to question the appropriateness of orthopedic tests (1,2,3). Most of those which have been investigated have failed to demonstrate clinical utility. Walsh (4) recently wrote, “The use of orthopedic tests has been an integral part of the physical examination for a long time. They have remained a part of the examination more by virtue of common use than on the basis of any scientific demonstration of their validity and clinical significance. To make a judgement on the clinical worth of a test, its validity, reliability, sensitivity and specificity should ideally be known. Unfortunately, for most, if not all, orthopedic tests, these measures have not been determined.”

van den Hoogen et al (5) concluded, after a comprehensive literature review, that “Not one single test appeared to have high sensitivity and high specificity in radiculopathy.” For nonspecific low back pain, things are just as bad. Walsh (4) states, “The use of orthopedic tests in the valuation of non-specific LBP seems to be limited because of a generally low frequency of positive results and a lack of test validity.”

In sacroiliac joint dysfunction tests, Potter and Rothstein (6) found that “Reliability was poor.” Maigne et al (7) studied sacroiliac tests and concluded that “No pain provocation test reached statistical significance.”

What about stroke screening tests? After examining 12 patients with dizziness reproduced by extension-rotation and twenty healthy controls with Doppler ultrasound of the vertebral arteries, Cote et al (8) concluded, “We were unable to demonstrate that the extension-rotation test is a valid clinical screening procedure to detect decreased blood flow in the vertebral artery. The value of this test for screening patients at risk of stroke after cervical manipulation is questionable.” Terrett (9) noted, “There is also no evidence which suggests that positive tests have any correlation to future VBS (vertebrobasilar stroke) and SMT (spinal manipulative therapy).”

The lack of evidence for the stated purposes of these tests is bad enough. A more important question to ask is, “Do orthopedic tests reliably demonstrate the presence of vertebral subluxations?” I was unable to find any evidence to support the claim that they do.

One is compelled to ask, “If there is little to no evidence that these tests do what they were designed to do, and they do not provide useful information regarding vertebral subluxation, why do we embrace them?”

Colleges might reply, “Because they are asked on board exams.” Examiners might reply, “Because they are part of the core curriculum of all chiropractic colleges.”

With tongue firmly in cheek, an old psychology professor of mine wryly stated, “If you can’t measure something meaningful, measure something that’s easy to measure.” It is time to break this vicious cycle.

References

1. Souza T: “Which orthopedic tests are really necessary?” In: Lawrence DJ (ed): “Advances in Chiropractic. Volume 1.” Chicago. Mosby, 1994.

2. McCarthy KA: “Improving the clinician’s use of orthopedic testing: an application to low back pain.” Top Clin Chiropr 1994;1(1):42.

3. Deyo RA, Rainville J, Kent DL: “What can the history and physical examination tell us about low back pain? JAMA 1992;268(6):760.

4. Walsh MJ: “Evaluation of orthopedic testing of the low back for nonspecific lower back pain.” JMPT 1998;21(4):232.

5. van den Hoogen HM, Koes BW, van Eijk JT, Bouter LM: “On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice.” Spine 1995;20(3):318.

6. Potter NA, Rothstein JM: “Intertester reliability for selected clinical tests of the sacroiliac joint.” Phys Ther 1985;65(11):1671.

7. Maigne JY, Aivaliklis A, Pfefer F: “Results of sacroiliac pain provocation tests in 54 patients with low back pain.” Spine 1996;21(16):1889.

8. Cote P, Kreitz B, Cassidy J, Thiel H: “The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis.” JMPT 1996;19:159.

9. Terrett AGJ: “Vertebrobasilar stroke following manipulation.” NCMIC, Des Moines, 1996. Page 32.

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Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Seeing RED: A Guide to Scan Interpretation and Communication

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Demonstrating the health benefits of chiropractic care presents a challenge. Many chiropractic researchers have followed the path of allopathic medicine. These investigators have attempted to determine how chiropractic care affects the course of specific symptoms or disease entities.

Such designs potentially limit chiropractic to the “treatment” of disorders which pass muster. These designs fail to adequately evaluate the general health benefits of chiropractic care, and improvements in the quality of life of asymptomatic patients.

Fortunately, there are strategies which provide an appropriate framework for chiropractic research.

One example is “quality of life” research. These designs seek to determine how chiropractic care affects general well being.

Two recent studies have yielded exciting findings.

A detailed analysis of a database collected during a three-year randomized study of senior citizens over 75 years of age revealed that patients who received chiropractic care reported better overall health, used fewer prescription drugs, and spent fewer days in hospitals and nursing homes than elderly non-chiropractic patients. The chiropractic patients were also more likely to exercise vigorously and more likely to be mobile in the community. (1)

Eighty-seven percent of the chiropractic patients described their health status as good to excellent, compared to only 67% of the non-chiropractic patients. Furthermore, the chiropractic patients spent 15% less time in nursing homes and 21% less time in hospitals than the non-chiropractic patients.

A retrospective assessment of 2,818 respondents in 156 practices found a strong connection between persons receiving Network Care and self- reported improvement in health, wellness, and quality of life. (2)

Ninety-five percent of the respondents reported their expectations had been met, and 99% wished to continue care. Whether these results are comparable to those obtainable by other technics remains to be seen.

The challenges imposed by public demands for increased accountability in the health professions may be met, in part, by using quality of life assessment strategies borrowed from the social sciences. By focusing on how chiropractic care improves the quality of life, the potential benefits of our profession will be better realized.

References

1. Coulter ID, Hurwitz EL, Aronow HU, et al: “Chiropractic patients in a comprehensive home-based geriatric assessment, follow-up and health promotion program.” Topics in Clinical Chiropractic 1996;3(2):46.

2. Blanks RHI, Schuster TL, Dobson M: “A retrospective assessment of Network care using a survey of self-rated health, wellness and quality of life.” Journal of Vertebral Subluxation Research 1997;1(4).

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Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
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Seeing RED: A Guide to Scan Interpretation and Communication

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Many chiropractors have found the Mercy Guidelines to be inconsistent with the principles of chiropractic. A survey was conducted of members of the International Chiropractors Association, in which 454 responses were received. Seventy percent of the respondents stated that the Mercy Guidelines had an adverse effect on their practices, and 63% reported that they were used to cut insurance claims or otherwise deny reimbursement for chiropractic services. Ninety-eight percent supported the concept of “lifetime, subluxation-based family wellness care.” (1)

It is important to realize that the Mercy Guidelines were based upon consensus, not necessarily evidence. In this regard, Powers has stated, “As the strength of the evidence declines, the composition of the panel and the process it follows become increasingly important determinants of the recommendations.” (2)

Furthermore, Mercy has serious methodological flaws. (3) These include failure to hold an open forum, failure to conduct a peer review of the document, failure to follow their own criteria for rating procedures, and selective reviews of the literature.

It became apparent to many D.C.s that the chiropractic profession desperately needed practice guidelines based upon evidence, not caprice. Furthermore, the proposed guidelines needed to be methodologically sound. This meant field practitioner input at an open forum, international peer review by practicing chiropractors, a comprehensive, unbiased literature review, and consistent application of standards.

The CCP

In the summer of 1995, chiropractic history was made in Phoenix, Arizona with the formation of the Council on Chiropractic Practice (CCP). The meeting was attended by an interdisciplinary assembly of distinguished chiropractors, medical physicians, basic scientists, attorneys, and consumer representatives.

The Council on Chiropractic Practice (CCP) is an apolitical, non-profit organization. It is not affiliated with any other chiropractic association. The CCP represents a grass roots movement to produce practice guidelines which serve the needs of the consumer, and are consistent with “real world” chiropractic practice.

The mission of the CCP is “To develop evidence based guidelines, conduct research and perform other functions that will enhance the practice of chiropractic for the benefit of the consumer.”

Evidence-based practice

Evidence-based clinical practice is defined as “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients…(it) is not restricted to randomized trials and metaanalyses. It involves tracking down the best external evidence with which to answer our clinical questions.” (4)

This concept was embraced by the Association of Chiropractic Colleges in their first position paper. This paper stated:

“Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.

“A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.

“A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.” (5)

The CCP has developed practice guidelines for vertebral subluxation with the active participation of field doctors, consultants, seminar leaders, and technique experts. In addition, the Council has utilized the services of interdisciplinary experts in Agency for Health Care Policy and Research (AHCPR) guidelines development, research design, literature review, law, clinical assessment, and clinical chiropractic.

Guidelines development

In harmony with these general principles, the CCP has created a multidisciplinary panel, supported by staff, and led by a project director. The guidelines were produced with input from methodologists familiar with guidelines development.

The first endeavor of the panel was to analyze available scientific evidence revolving around a model which depicts the safest and most efficacious delivery of chiropractic care to the consumer. A contingent of panelists, chosen for their respective skills, directed the critical review of numerous studies and other evidence.

Since the guidelines process is one of continuing evolution, new evidence will be considered at periodic meetings to update the model of care defined by the guidelines.

During its initial meeting, the panel focused on defining the scope of the guidelines, establishing necessary committees to facilitate the process, and discussing the topics for literature review.

The panel gathered in a second meeting to interview technique developers to ascertain the degree to which their procedures can be expressed in an evidence-based format. Individuals representing more than 35 named techniques participated. Others made written submissions to the panel. The technique developers presented the best available evidence they had to substantiate their protocols and assessment methods.

A primary goal of the panel is to stimulate and encourage field practitioners to adapt their practices to improve patient outcomes. To achieve this objective, it was necessary to involve as many practitioners as possible in the development of workable guidelines.

Consistent with the recommendations of the AHCPR, an “open forum” was held where any interested individual could participate. Practitioners offered their opinions and insight in regard to the progress of the panel. Field practitioners who were unable to attend the “open forum” session were encouraged to make written submissions. Consumer and attorney participants offered their input. A meeting was held with chiropractic consultants to secure their participation.

After sorting and evaluating the evidence gathered in the literature review, technique forum, written comments, and open forum, the initial draft of the guidelines was prepared. It was distributed to the panel for review and criticism. A revised draft was prepared based upon this input.

International input from the field was obtained when the working draft guidelines document was submitted to 195 peer reviewers in 12 countries.

After incorporation of the suggestions of the reviewers, a final draft was presented to the panel for approval. This document was then submitted for proofreading and typesetting.

The purpose of these guidelines is to provide the doctor of chiropractic with a “user friendly” compendium of recommendations based upon the best available evidence. It is designed to facilitate, not replace, clinical judgement.

As Sackett wrote, “External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient’s clinical state, predicament, and preferences, and thereby whether it should be applied.” (4)

The most compelling reason for creating, disseminating, and utilizing clinical practice guidelines is to improve the quality of health care. The new “Clinical Practice Guideline for Vertebral Subluxation in Chiropractic Practice” is an embodiment of that vision.

References

1. Kent C, Rondberg T, Dobson M: “A survey response regarding the appropriateness of professional practice guidelines to subluxation-based chiropractic.” Journal of Vertebral Subluxation Research 1996;1(2):13.

2. Powers EJ: “From the Congressional Office of Technology Assessment.” JAMA 1995;274(3):205.

3. Kent C, Gentempo P: “The Mercy document: salvation or suicide?” American Journal of Clinical Chiropractic, October 1993 (Part 1) and January 1994 (Part 2).

4. Sackett DL: Editorial. “Evidence-based medicine.” Spine 1998;23(10):1085.

5. Position Paper #1. Association of Chiropractic Colleges. July, 1996.

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Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
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INSiGHT Communication Guide

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A perception that medicine is “scientific” and chiropractic is “unproven” seems to pervade a growing element of our profession. This perspective has resulted in a low perceived value of our unique principle and practice.

By Dr. Christopher Kent

Science provides investigators with a useful method of inquiry. Scientific methods have led the healing arts out of the world of anecdotal observation, myth, and superstition. However, doctors must not lose sight of the fact that science may not be the only valid method of inquiry.

Furthermore, it must be realized that while predictability may be considered in designing clinical strategies, all that ultimately matters is what is effective for a given patient in a specific circumstance. Educational institutions producing health care providers must guard against graduating practitioners who are automatons following flow charts rather than thinking, feeling, human beings.

Although science is not an enemy of chiropractic, scientism most certainly is. Scientism limits all fields of human inquiry to contemporary technology. Smith states that scientism “…refers to an uncritical idolization of science — the belief that only science can solve human problems, that only science has value.” Holton observed that “Scientism divides all thought into two categories: scientific thought and nonsense.” (1,2)

What’s wrong with that? A practitioner of science 100 years ago would be forced to declare cosmic waves, viruses, and DNA “unproven” concepts. Such a scientist, bound by the limitations of the technology of the times, would be unable to “prove” or “disprove” the existence of such things. Our hypothetical scientist might go one step further and deny the possibility of their existence, active as some of them may have been in the dynamics of health and disease! Scientism is a scourge which blinds the visionary and manacles the philosopher.

Aldous Huxley was acutely aware of the folly of limiting all human inquiry to the scientific method. He stated, “The real charm of the intellectual life — the life devoted to erudition, to scientific research, to philosophy, to aesthetics, to criticism — is its easiness. It’s the substitution of simple intellectual schemata for the complexities of reality; of still and formal death for the bewildering movements of life.” (3) Science has a place in chiropractic — scientism does not.

Just as scientism limits human inquiry to available technology, bad science, characterized by questionable research designs, leads to faulty conclusions. For example, some critics of chiropractic claimed that it was impossible for subtle disrelationships termed “subluxations” to produce enough pressure on neural structures to alter their function. Through a process of “rationalism” based on animal studies, and a poorly designed study using human cadavers, it was concluded that chiropractic theory was false. (4)

The point is simple. Bad science leads to faulty conclusions. And any scientific inquiry is limited by the technology available to the investigator, the design of the experiment, the analysis of the data, and the conclusions drawn from the data. In short, if you can’t reliably measure something, you can’t investigate it scientifically.

That’s fine, unless you are trying to investigate something for which reliable and valid measurements have not or cannot be devised. For instance, we cannot measure innate intelligence. Does this mean that it is not “real” and that we should abandon the concept merely because we have no technology to detect or quantitate it? I think not.

Baruss wrote, “If we are serious about coming to know something, then our research methods will have to be adapted to the nature of the phenomenon that we are trying to understand. The purpose of science should take precedence over established methodologies…Similarly, belief in a universal, inflexible scientific method that can guarantee truth belongs to scientism. If one is authentic, one’s effort to develop one’s understanding by changing opinions into questions may cut so deeply that traditional research methods themselves are called into question and are replaced by others that serve one’s purpose better. One may need to draw on the totality of one’s experience and not just on that subset that consists of observations made through the process of traditional scientific discovery.” (5)

Our profession has very limited research resources. To our credit, we have done a phenomenal job with what we have. Unfortunately, there is a growing trend in chiropractic to embrace allopathic research designs emphasizing symptomatic rather than physiologic change. A plethora of projects are attempting to determine if “manipulative therapy” is effective in ameliorating back pain and other symptoms.

Many of these designs are inherently flawed in that they fail to adequately define the nature of the intervention applied (a basic adjustment is quite different from an atlas toggle or a lumbar roll). Worse, from a philosophical standpoint, symptoms are used as outcome criteria rather than the correction of subluxations.

It is sometimes argued that in the absence of reliable and valid indicators of subluxation, subluxation-based outcome evaluation is impossible. Indeed, this is where our initial research efforts must be directed. Developing technologies to reliably assess the clinical manifestations of vertebral subluxation is a high priority item. It is not an excuse, however, for failing to use existing technologies which can reliably evaluate manifestations of the vertebral subluxation.

Fortunately, social scientists have developed “paper and pencil” instruments to assess patient-perceived wellness and quality-of-life issues regardless of whether specific diseases or identifiable symptoms exist. Such tools may not find favor with mechanists who idolize the randomized clinical trial.

Chiropractic research is in very real danger of succumbing to the scientism so pervasive in the allopathic community. And by copying the experimental designs of the symptom-oriented allopathic model, chiropractic’s unique non-therapeutic approach may be lost.

I have heard many chiropractors parroting the misconception that patients and insurance companies will only pay for care rendered to symptomatic patients.

Such utter nonsense has caused many to promote the notion that D.C.s should treat pain syndromes only. In fact, chiropractic may be the only health care discipline which sports a faction that does not consider early detection of an asymptomatic, progressive process a virtue, if not a necessity.

Abnormalities can exist in the absence of symptoms! Consider asymptomatic breast cancer, asymptomatic dental caries, or the “silent killer” hypertension. Basing outcome assessments for these conditions on patient symptomatology would have disastrous results.

I find it repugnant to force an asymptomatic patient to wait for pain to manifest before receiving an adjustment. Clinical strategies must be based upon subluxation-based outcome assessments which address aspects of health beyond the amelioration of symptoms.

References

1. Smith RF: “Prelude to Science.” Charles Scribner’s Sons. New York, NY, 1975. P. 12.

2. Holton G: “The false images of science.” In Young LB (ed): “The Mystery of Matter.” Oxford University Press. London, UK, 1965.

3. Huxley A: “Point Counter Point.” Quoted in Smith RF, op cit P. 8.

4. Crelin ES: “A scientific test of the chiropractic theory.” Am Sci 61(5):574, 1973.

5. Baruss I: “Authentic Knowing. The Convergence of Science and Spiritual Aspiration.” Purdue University Press. West Lafayette, IN. 1996, pp 40-41.

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Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
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A previous column (1) revealed the news that physical therapy is no more effective than a placebo for the relief of pain in musculoskeletal conditions, and may actually make things worse. The evidence in support of this claim is growing.

According to a recent study by Feine and Lund (2) of McGill University, there is little evidence that physical therapy and physical therapy modalities provide any long-term efficacy greater than placebo. The therapies which were examined included exercise, ultrasound, thermal agents, acupuncture, low-intensity laser therapy, electrical stimulation, and combination therapies for a variety of musculoskeletal pain conditions including chronic back pain. Patients receiving either therapy or placebo seemed to do better during either. It was concluded that giving a patient attention has a powerful effect, regardless of treatment.

The authors wrote, “We are not pleased to have to report that…our results suggest that none of the therapies under review cause improvements in symptoms of chronic musculoskeletal pain or in quality of life that outlast the therapy…including placebo.”

It doesn’t take a Nostradamus to realize that managed care groups and insurance companies aren’t going to continue to shell out easy money for treatments that don’t work. “Work” in this context means pain relief.

So what’s the musculoskeletal chiropractoid got left to keep the charges up? How about back school? More bad news. A randomized study of 4,000 persons in a back school educational program found that workers who attended the education group actually had a higher rate of back claims than the control group! According to a study by Daltroy et al (3) educating postal workers about back mechanics, posture, and “correct” ways of lifting proved to be “an expensive waste of time.” (4). The authors wrote, “The education program did not reduce the rate of low back injury, the time off work per injury, or the rate of repeated injury after return to work.”

Hmm. Let’s try industrial consulting. After all, ergonomics has been the dominant back pain prevention strategy of the last 50 years. And who is better suited to industrial consulting than the chiropractor? Well, before you sign the papers for that new boat, you might want to have a look at the editorial by Hadler (5) in the New England Journal of Medicine. According to Hadler, efforts to eliminate offending biomechanical stresses from the workplace have not had any positive effect on back pain or back pain claims in the workplace. The author wrote, “In fact, workers with back ‘injuries’ have increased in numbers and suffered more.” More discouraging news is available in a longer article in Spine (6).

“Ah,” you’re thinking, “he’s going to tell us about how we should stick to manipulation, since it is proven effective in treating back pain.” Sorry. Despite all the hoopla and hype surrounding the AHCPR Guidelines, things aren’t as rosy as some pied pipers might lead you to believe.

Skargren et al (7) reported the results of a study involving 323 patients who were assigned to care by a physiotherapist or a chiropractor. A visual analog scale and the Oswestry pain disability questionnaire were used to evaluate the results. Those receiving chiropractic “treatment” received primarily “manipulation.” Those in the physiotherapy group received a variety of treatment modalities. The mean number of chiropractic visits was 7. The mean number of PT visits was 7.9. The conclusion: “Both chiropractic and physiotherapy as primary treatment reduced the symptoms. No difference in outcome or direct or indirect costs between the two groups could be seen, nor in subgroups defined as duration, history, or severity.”

Skargren’s team found that chiropractic “manipulation” was as good as physiotherapy at symptom relief. And according to Feine and Lund, PT is as good as a placebo. Does this mean we should all call Sally Struthers and seek new careers? Certainly not! It means that we must differentiate manipulation for the treatment of musculoskeletal pain from adjustment for the correction of vertebral subluxation.

Those who have been reading this column for a while have seen reports of research demonstrating the whole body benefits of chiropractic care. Some of these benefits include less use of medical care, including hospitalization and prescription drugs, and a greater perception of wellness. (8,9) This is where we excel.

Trying to keep one step ahead of the third party pay game is a recipe for clinical and financial disaster. There is no need for a third rate, symptom chasing medic in today’s health care system. However, there is a desperate need for a profession which offers a new level of thinking concerning health. The future of chiropractic lies in lifetime, subluxation-based, family wellness care in the context of a non-third-party dependent practice. Only in such an environment will the vision of a subluxation free world flourish.

References

1. Kent C: “Shake and bake.” The Chiropractic Journal, October 1997.

2. Feine JS, Lund JP: “An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain.” Pain 1997;71:5.

3. Daltroy LH, Iversen MD, Larson MG, et al: “A controlled trial of an educational program to prevent low back injuries.” N Engl J Med 1997;337(5):322.

4. “Prevention program fails.” The Back Letter 1997;12(9):97.

5. Hadler NM: “Workers with disabling back pain.” New Engl J Med 1997;337(5):341.

6. Hadler NM: “Back pain in the workplace: What you lift or how you lift matters far less than whether you lift or when.” Spine 1997;22:935.

7. Skargren EI, Oberg BE, Carlsson PG, Gade M: “Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain.” Spine 1997;22:2167.

8. Coulter ID, Hurwitz EL, Aronow HU, et al: “Chiropractic patients in a comprehensive home-based geriatric assessment, follow-up and health promotion program.” Topics in Clinical Chiropractic 1996;3(2):46.

9. Blanks RHI, Schuster TL, Dobson M: “A retrospective assessment of Network care using a survey of self-rated health, wellness and quality of life.” Journal of Vertebral Subluxation Research 1997;1(4).

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ABOUT THE AUTHOR

Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
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Adaptation Guide

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Media reports of a recent article in the New England Journal of Medicine (1), that chiropractic care did not benefit asthma patients, is inconsistent with the larger body of other studies, case reports, and more than 100 years of clinical experience.

This study had many significant flaws. The most serious was the use of active chiropractic procedures in the “simulated treatment” procedure. In actuality, the only difference between the active and “simulated” groups was the presence of a “pop” sound. Since some adjusting procedures result in a “popping” sound and some do not, the distinction is artificial. However, it is impossible from this study to determine if a vertebral subluxation was present in the subjects, or whether any such subluxation was reduced. No objective measures of subluxation correction were employed by the authors of the study.

Finally, the media reports failed to report that both groups receiving “hands on” care by chiropractors had decreased symptoms, decreased medication use, and improved quality of life. What the study really demonstrated was that a variety of manual techniques may have a beneficial effect on asthma sufferers.

The most pathetic aspect of this so-called “study” is that it involved two chiropractic colleges, CMCC and LACC. Both, according to reports from students, are well known for faculty who disparage the fundamental tenets of chiropractic, particularly vertebral subluxation. This may be why no specific criteria for vertebral subluxation was considered. Apparently the liberation of decibels was equated with “adjustment.”

Although chiropractic is not the treatment of disease, medically defined disease processes frequently improve or resolve when vertebral subluxations are corrected.

Let’s look at the results of two studies where the presence and correction of vertebral subluxation were used as criteria. The media has been strangely silent about them.

A study of 81 asthmatic children reported an improvement in 90.1% after being under chiropractic care for 60 days. The children ranged from 1 to 17 years of age. The number of asthma “attacks” decreased by an average of 44.9%, and 30.9% decreased their use of medication. The authors concluded that “Chiropractic care, for correction of vertebral subluxation, is a safe, non-pharmaceutical health care approach which may also be associated with significant decreases in asthma related impairment as well as a decreased incidence of asthmatic `attacks.’” (2)

In another study involving 55 patients, improved pulmonary function was reported in patients receiving spinal adjustments. The study noted significant functional and clinical effects following chiropractic care for the correction of upper cervical vertebral subluxation. (3)

But no study can take into account the unique needs of an individual. Only a careful examination by a skilled doctor of chiropractic, using objective criteria, can determine if chiropractic care is appropriate.

References

1. Balon J, Aker PD, Crowther ER, et al: “A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma.” New England Journal of Medicine 1998;339(15):1013.

2. Graham RL, Pistolese RA: “An impairment rating analysis of asthmatic children under chiropractic care.” Journal of Vertebral Subluxation Research, 1997;1(4):41.

3. Kessinger R: “Changes in pulmonary function associated with upper cervical specific chiropractic care.” Journal of Vertebral Subluxation Research, 1997;1(3):43.

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ABOUT THE AUTHOR

Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
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Adaptation Guide

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The last two years have been marked by some very exciting research publications related to vertebral subluxation. In case you missed them, here are some highlights:

  • A comprehensive review of models of vertebral subluxation (1).
  • A proposed model of vertebral subluxation reflecting traditional concepts and recent advances in health and science (2).
  • Detailed description of chiropractic techniques, including Network Spinal Analysis (3), Kale Knee-Chest specific (4), and Bio-Energenic Synchronization (5).
  • Studies showing improved athletic performance (6), improved pulmonary function (7), improvement in asthmatic symptoms (8) and improvement in visual acuity (9) under chiropractic care.
  • The largest study ever undertaken in the chiropractic profession looking at patient satisfaction and quality of life. The study involved 2,818 subjects from 156 offices, and was conducted by medical school faculty. 95% of the patients stated their expectations were met, and 99% wished to continue care (10).
  • Reviews of literature (11) and normative data (12) concerning surface EMG in the assessment of vertebral subluxation.
  • Study examining the relationship between cervical spine curvature and spinal degeneration (13).
  • A survey concerning the appropriateness of professional practice guidelines (14).
  • Assessment of whiplash patients undergoing subluxation-based chiropractic care (15).
  • A pre- and post-adjustment functional MRI showing changes in brain function following chiropractic care (16).
  • Description of a new differential compliance instrument (17).
  • Risk assessment of neurological and/or vertebrobasilar complications in the pediatric patient (18).
  • A point system to assess progress under chiropractic care (19).

If you haven’t seen these papers, you probably haven’t been reading the Journal of Vertebral Subluxation Research, a peer-reviewed publication dedicated to subluxation-centered chiropractic research. In its two short years of existence, JVSR has achieved indexing in the MANTIS and CINAHL databases.

Your ability to practice subluxation-centered chiropractic is dependent, in part, on having a scholarly journal to disseminate research findings. This includes research on the global effects of chiropractic care beyond back pain, and research into improved strategies for the analysis and correction of vertebral subluxations.

If this sounds like a commercial for JVSR, it is. I’m passionate about JVSR because I realize its importance. If you only subscribe to one professional journal, I suggest that you choose JVSR. It needs and deserves the support of every subluxation-centered chiropractor. For subscription information, call 800-347-1011.

References

1. Kent C: “Models of vertebral subluxation: a review.” Journal of Vertebral Subluxation Research 1996;1(1):11.

2. Boone WR, Dobson GJ: “A proposed vertebral subluxation model reflecting traditional concepts and recent advances in health and science.” Journal of Vertebral Subluxation Research 1996;1(1):19.

3. Epstein D: “Network Spinal Analysis: a system of health care delivery within the subluxation-based chiropractic model.” Journal of Vertebral Subluxation Research 1996;1(1):51.

4. Kale MU, Keeter T: “A mechanical analysis of the side posture and knee-chest specific adjustment techniques.” Journal of Vertebral Subluxation Research 1996;1(3):35.

5. Morter Jr T: “The theoretical basis and rationale for the clinical application of bio-energetic synchronization.” Journal of Vertebral Subluxation Research 1996;2(1):23.

6. Schwartzbauer J, Kolber J, Swartzbauer M, et al: “Athletic performance and physiological measures in baseball players following upper cervical chiropractic care: a pilot study.” Journal of Vertebral Subluxation Research 1996;1(4):33.

7. Kessinger R: “Changes in pulmonary function associated with upper cervical specific chiropractic care.” Journal of Vertebral Subluxation Research 1996;1(3):43.

8. Graham RL, Pistolese RA: “An impairment rating analysis of asthmatic children under chiropractic care.” Journal of Vertebral Subluxation Research 1996;1(4):41.

9. Kessinger R, Boneva D: “Changes in visual acuity in patients receiving upper cervical specific chiropractic care.” Journal of Vertebral Subluxation Research 1996;2(1):43.

10. Blanks RH, Schuster TL, Dobson M: “A retrospective assessment of Network care using a survey of self-rated health, wellness, and quality of life.” Journal of Vertebral Subluxation Research 1996;1(4):15.

11. Kent C: “Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review.” Journal of Vertebral Subluxation Research 1996;1(3):97.

12. Gentempo P, Kent C, Hightower B, Minicozzi SJ: “Normative data for paraspinal surface electromyographic scanning using a 25-500 Hz bandpass.” Journal of Vertebral Subluxation Research 1996;1(1):43.

13. Shaikewitz M: “A demographic and physical characterization of cervical spine curvature and degeneration.” Journal of Vertebral Subluxation Research 1996;1(2):41.

14. Kent C, Rondberg T, Dobson M: “A survey response regarding the appropriateness of professional practice guidelines to subluxation- based chiropractic.” Journal of Vertebral Subluxation Research 1996;1(2):13.

15. McCoy HG, McCoy M: “A multiple parameter assessment of whiplash injury patients undergoing subluxation-based chiropractic care: a retrospective study.” Journal of Vertebral Subluxation Research 1996;1(3):51.

16. Cover and page 3. Journal of Vertebral Subluxation Research 1996;2(1).

17. Evans JM: “Differential compliance measured by the function recording and analysis system in the assessment of vertebral subluxation.” Journal of Vertebral Subluxation Research 1996;2(1):15.

18. Pistolese RA: “Risk assessment of neurological and/or vertebrobasilar complications in the pediatric chiropractic patient.” Journal of Vertebral Subluxation Research 1996;2(2):77.

19. Vanquaethem PL, Gould JL: “The use of a numerical point system in the assessment of clinical progress in patients under subluxation- based chiropractic care: a case study.” Journal of Vertebral Subluxation Research 1996;2(2):97.

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ABOUT THE AUTHOR

Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
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INSiGHT Communication Guide

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In both Canada and the United Stares, reports have appeared in the popular media suggesting that chiropractic “manipulation” of the cervical spine is associated with strokes. Some writers have suggested that such procedures be banned. These allegations require a swift and vigorous response.

In his book, “Galileo’s Revenge,” attorney Peter Huber describes “junk science” as “A hodgepodge of biased data, spurious inference, and logical legerdemain…It is a catalog of every conceivable kind of error: data dredging, wishful thinking, truculent dogmatism, and, now and again, outright fraud.” (1)

An excellent example of “junk science” is the popular notion that chiropractic adjustments cause strokes. Although individual case reports of adverse events following “manipulation” have been reported in the medical literature for decades, recent exposés in the popular media seem to have led some individuals to accept this premise at face value. Careful examination will reveal that these individuals have fallen prey to a classic case of “junk science.”

A common error in logic is equating correlation with cause and effect. The fact that a temporal relationship exists between two events does not mean that one caused the other. As Keating (2) explained, “To mistake temporal contiguity of two phenomena for causation is a classic fallacy of reasoning known as ‘post hoc, ergo propter hoc,’ from the Latin meaning ‘after this, therefore caused by this.’”

Consider the application of this fallacy in the case of chiropractic adjustments and strokes. Lee (3) attempted to obtain an estimate of how often practicing neurologists in California encountered unexpected strokes, myelopathies, or radiculopathies following “chiropractic manipulation.” Neurologists were asked the number of patients evaluated over the preceding two years who suffered a neurologic complication within 24 hours of receiving a “chiropractic manipulation.” Fifty-five strokes were reported. The author stated, “Patients, physicians, and chiropractors should be aware of the risk of neurologic complications associated with chiropractic manipulation.”

What’s wrong with this? Let’s change “neurologic complications” to “automobile accidents.” Would it be reasonable to suggest that if 55 patients over the last two years had car accidents within 24 hours of seeing a chiropractor that the D.C. caused the accidents? Want to see how absurd this can get? Change “neurologic complications” to ice cream consumption. Or sleep.

Some neurologists are suggesting that the history of stroke patients include a question concerning whether the patient had received chiropractic care. Others claim that a “manipulation” administered weeks prior to a stroke may have caused the event.

Is there anything that would either strengthen or weaken a case of alleged causality? Yes. If we have reliable reporting, we can compare the number of times the event in question (in this case, stroke) occurs as a random event to the number of times the event occurs following the putative causative event (in this case, a “chiropractic manipulation”). In a letter to the editor of JMPT, Myler (4) posed an interesting question: “I was curious how the risk of fatal stroke after cervical manipulation, placed at 0.00025% compared with the risk of (fatal) stroke in the general population of the United States.” According to data obtained from the National Center for Health Statistics, the mortality rate from stroke was calculated to be 0.00057% If Myler’s data is accurate, the risk of death from stroke after cervical manipulation is less than half the risk of fatal stroke in the general population!

But is Myler’s data accurate? His 0.00025% figure is from a paper by Dabbs and Lauretti (5). Their estimate is probably as good as any, since the basis for it was a reasonably comprehensive review of literature. Yet, there is potentially conflicting information which must be considered. Jaskoviak (6) reported that not a single case of vertebral artery stroke occurred in approximately five million cervical “manipulations” at The National College of Chiropractic Clinic from 1965 to 1980. Not one. Osteopathic authors Vick et al (7) reported that from 1923 to 1993, there were only 185 reports of injury out of “several hundred million treatments.”

All of the figures which I found concerning stroke following “manipulation” involve estimates, not hard data. In the “Back Letter,” (8) it was wisely observed that, “In scientific terms, all these figures are rough guesses at best…There is currently no accurate data on the total number of cervical manipulations performed every year or the total number of complications. Both figures would be necessary to arrive at an accurate estimate. In addition, none of the studies in the medical literature adequately control for other risk factors and co-morbidities.”

Furthermore, Leboeuf-Yde et al (9) suggested that there may be an over- reporting of “spinal manipulative therapy” related injuries. The authors reported cases involving two fatal strokes, a heart attack, a bleeding basilar aneurysm, paresis of an arm and a leg, and cauda equina syndrome which occurred in individuals who were considering chiropractic care, yet because of chance, did not receive it. Had these events been temporally related to a chiropractic office visit, it is likely that they would have been inappropriately attributed to the chiropractic care.

Another concern is the application of the term “chiropractor” or “chiropractic” to strokes which did not involve doctors of chiropractic. There are many cases of strokes attributed to chiropractic care where the “operator” was not a chiropractor at all. Terrett (10) observed that “manipulations” administered by a Kung Fu practitioner, GPs, osteopaths, physiotherapists, a wife, a blind masseur, and an Indian barber were incorrectly attributed to chiropractors. As Terrett wrote, “The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non-chiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader’s opinion of chiropractic and chiropractors.”

A common error made in these reports is failure to differentiate “cervical manipulation” from specific chiropractic adjustment. They’re simply not the same. Many chiropractic techniques (upper cervical toggle, Activator, Logan basic, Torque release, etc) do not involve taking a joint to tension, applying a thrust, and producing cavitation. Klougart et al (11) published risk estimates which reveal differences depending upon the type of technique used by the chiropractor.

After careful review of the available evidence, the Council on Chiropractic Practice concluded, “The panel found no competent evidence that specific chiropractic adjustments cause strokes.” (12)

This conclusion begs the question, “What about screening tests to identify patients at risk?” After examining 12 patients with dizziness reproduced by extension-rotation and 20 healthy controls with Doppler ultrasound of the vertebral arteries, Cote et al (13) concluded, “We were unable to demonstrate that the extension-rotation test is a valid clinical screening procedure to detect decreased blood flow in the vertebral artery. The value of this test for screening patients at risk of stroke after cervical manipulation is questionable.” Terrett (14) noted “There is also no evidence which suggests that positive tests have any correlation to future VBS (vertebrobasilar stroke) and SMT (spinal manipulative therapy)”.

The illusory concept of chiropractic “manipulation” and stroke should be considered in the context of the de facto standard for health care safety — allopathic medicine.

In a review of errors in medicine, Leape (15) reported that if the results of the papers reviewed were applied to the U.S. as a whole, “180,000 die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every 2 days.

It was reported that drug-related “problems” each year cost as much as $182 billion, kill as many as 198,815 people, put 8.8 million in hospitals, and account for up to 28% of all hospital admissions. (16) Adverse drug events in hospitalized patients nearly doubles the risk of death. (17) It is important to realize that these reports deal with iatrogenic events, which do not necessarily involve negligence on the part of the physician.

What about physician negligence? How widespread is the problem? Lesar et al (18) observed that adverse drug events occur in up to 6.5% of hospitalized patients. The causes? “A large number of errors appeared to result from a lack of knowledge…as well as apparent mental lapses and mental slips.” In another study, adverse drug events were found to add an average of 4.6 days to the length of stay in the hospital, at an average cost of $5,857. (19)

The consumer magazine Public Citizen reported on the results of a Harvard study. It was concluded that medical malpractice is the third leading cause of preventable death in the United States, ahead of traffic fatalities and firearms deaths. Only cigarette smoking and alcohol lead medical malpractice. The authors estimated that medical malpractice is responsible for 80,000 deaths per year, one every seven minutes. (20)

Even apparently innocuous diagnostic procedures can be lethal. Myocardial infarction occurs in 1 out of 2,800 persons undergoing treadmill exercise testing. One out of 20,000 individuals will die as a result of treadmill exercise testing. (21) Those with suspicious results may undergo cardiac angiography, a procedure with a mortality rate of 0.10% to 0.25%. This translates to 1 in 1,000 to 1 in 250. (22).

Despite this, attorneys continue to file stroke-related lawsuits against chiropractors, and muckrakers masquerading as journalists stir the emotions of the populace. It is time to replace yellow journalism with scientific investigation. Chiropractors should respond swiftly and vigorously to these allegations.

References

1. Huber PW: “Galileo’s Revenge. Junk Science in the Courtroom.” Basic Books. 1991. Page 3.

2. Keating JC Jr: “Toward a Philosophy of the Science of Chiropractic.” Stockton Foundation for Chiropractic Research, 1992. Page 189.

3. Lee K: “Neurologic complications following chiropractic manipulation: a survey of California neurologists.” Neurology 1995;45:1213.

4. Myler L: Letter to the editor. JMPT 1996;19:357.

5. Dabbs V, Lauretti WJ: “A risk assessment of cervical manipulation vs. NSAIDS for the treatment of neck pain.” JMPT 1995;18:530.

6. Jaskoviac P: “Complications arising from manipulation of the cervical spine.” JMPT 1980;3:213.

7. Vick D, McKay C, Zengerle C: “The safety of manipulative treatment: review of the literature from 1925 to 1993.” JAOA 1996;96:113.

8. “What about serious complications of cervical manipulation?” The Back Letter 1996;11:115.

9. Leboeuf-Yde C, Rasmussen LR, Klougart N: “The risk of over- reporting spinal manipulative therapy-induced injuries: a description of some cases that failed to burden the statistics.” JMPT 1996;19:536.

10. Terrett AGJ: “Misuse of the literature by medical authors in discussing spinal manipulative therapy injury.” JMPT 1995;18:203.

11. Klougart N, Leboeuf-Yde C, Rasmussen LR: “Safety in chiropractic practice, Part I; The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988.” JMPT 1996;19:371.

12. “Vertebral Subluxation in Chiropractic Practice.” Council on Chiropractic Practice Clinical Practice Guideline No. 1. Chandler, AZ. 1998.

13. Cote P, Kreitz B, Cassidy J, Thiel H: “The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis.” JMPT 1996;19:159.

14. Terrett AGJ: “Vertebrobasilar stroke following manipulation.” NCMIC, Des Moines, 1996. Page 32.

15. Leape L: “Error in medicine.” JAMA 1994;272(23):1851.

16. “Reaction.” American Medical News; January 15, 1996. Page 11.

17. Classen DC, Pestotnik SL, Evans S, et al: “Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality.” JAMA 1997;277(4):301.

18. Lesar TS, Briceland L, Stein DS: “Factors related to errors in medication prescribing.” JAMA 1997;277(4):312.

19. Bates DW, Spell N, Cullen DJ, et al: “The costs of adverse drug events in hospitalized patients.” JAMA 1997;277(4):307.

20. Dye M: “Silent danger of medical malpractice. Third leading cause of preventable deaths in the U.S.” Public Citizen. May/June 1994.

21. Mildenberger VD, Kaltenbach M: “Life-threatening complications of ergometry.” Fortschr Med 1989;107(27):569.

22. Jansson K, Fransson SG: “Mortality related to coronary angiography.” Clin Radiol 1996;51(12):85 8.

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Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

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Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
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Vertebral subluxation represents the heart and soul of chiropractic. It is our “raison d’etre” as a profession. Yet, to many chiropractors, it remains a clinical conundrum. I believe that the controversy and confusion surrounding the chiropractic concept of vertebral subluxation is due to the lack of an operational definition which is compatible with most techniques.

A review of models of vertebral subluxation has been published elsewhere (1). However, regardless of the elegance of a theoretical model, it must be capable of being operationalized if it is to be used to develop clinical strategies.

The three-dimensional model was developed as an initial step in the operational definition of vertebral subluxation. It incorporates traditional chiropractic constructs, and serves as a bridge to contemporary technology.

As Lantz noted, “Common to all concepts of subluxation are some form of kinesiologic dysfunction and some form of neurologic involvement.” (2)

The 3-D model of vertebral subluxation has three components. Each component may be reliably measured using appropriate instrumentation. These measurements provide objective evidence concerning manifestations of vertebral subluxation. The three components are:

1. DYSKINESIA. Dyskinesia refers to distortion or impairment of voluntary movement (3). Spinal motion may be reliably measured using inclinometry (4). Alterations in regional ranges of motion are associated with subluxation (5).

2. DYSPONESIS. Dysponesis is abnormal involuntary muscle activity. Dysponesis refers to a reversible physiopathologic state, consisting of errors in energy expenditure which are capable of producing functional disorders. Dysponesis consists mainly of covert errors in action potential output from the motor and premotor areas of the cortex and the consequences of that output. These neurophysiological reactions may result from responses to environmental events, bodily sensations, and emotions. The resulting aberrant muscle activity may be evaluated using surface electrode techniques (6). Typically, static SMEG with axial loading is used to evaluate innate responses to gravitational stress (7).

3. DYSAUTONOMIA. The autonomic nervous system regulates the actions of organs, glands, and blood vessels. Acquired dysautonomia may be associated with a broad array of functional abnormalities (8,9,10,11,12.13). Autonomic dystonia may be evaluated by measuring skin temperature differentials (14). Uematsu et al determined normative values for skin temperature differences based upon asymptomatic “normal” individuals. The authors stated, “These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction…Deviations from the normal values will allow suspicion of neurological pathology to be quantitated and therefore can improve assessment and lead to proper clinical management.” (15) Skin temperature differentials are associated with vertebral subluxation (16).

This three-dimensional model may be used with any technique which has, as its objective, the detection, management, or correction of vertebral subluxation. Correction of vertebral subluxation facilitates the restoration of proper tone throughout the nervous system.

Health is dependent upon maintaining appropriate tone in the nervous system. As D.D. Palmer explained, “Life is action governed by intelligence. Intelligent life, the soul, depends upon the execution of functions. Functions performed by normal energy is health. Disease is the result of the performance of functions above or below a normal degree of activity. Impulses properly transmitted through nerves, result in functions being normally performed, a condition which results in health.” (17)

The ability to maintain tone requires a nervous system free of interference. Restoration of tone is dependent upon correction of vertebral subluxations. Alterations in the tone of the somatic system may be objectively evaluated using surface EMG. Altered autonomic tone may be evaluated using skin temperature measurements. Changes in ranges of motion may be measured to assess dyskinesia. Such objective assessments have the potential to make chiropractic the dominant strategy of 21st century health care.

References

1. Kent C: “Models of vertebral subluxation: a review.” Journal of Vertebral Subluxation Research 1996;1(1):11.

2. Lantz CA: “The subluxation complex.” In: Gatterman MI (ed): “Foundations of Chiropractic Subluxation.” Mosby, St. Louis, MO, 1995.

3. “Dorland’s Pocket Medical Dictionary.” 25th edition. WB Saunders Company. 1995.

4. Saur PM, Ensink FB, Frese K, et al: “Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility.” Spine 1996;21(11):1332.

5. Blunt KL, Gatterman MI, Bereznick DE: “Kinesiology: an essential approach toward understanding the chiropractic subluxation.” Chapter 11. In: Gatterman MI (ed): “Foundations of Chiropractic Subluxation.” Mosby, St. Louis, MO. 1995.

6. Whatmore GB, Kohi DR: “Dysponesis: a neurophysiologic factor in functional disorders.” Behav Sci 1968;13(2):102.

7. Kent C: “Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review.” Journal of Vertebral Subluxation Research 1997;1(3):15.

8. Backonja M-M: “Reflex sympathetic dystrophy/sympathetically mediated pain/causalgia: the syndrome of neuropathic pain with dysautonomia.” Seminars in Neurology 1994;14(3):263.

9. Goldstein DS, Holmes C, Cannon III RO, et al: “Sympathetic cardioneuropathy in dysautonomias.” New Engl J Med 1997;336(10):696.

10. Vassallo M, Camilleri M, Caron BL, Low PA: “Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis.” Gastroenterology 1991;100(1):252.

11. Baron R, Engler F: “Postganglionic cholinergic dysautonomia with incomplete recovery: a clinical, neurophysiological and immunological case study.” J Neurol 1996;243:18.

12. Soares JLD: Disautonomias. “Acta Medica Portuguesa” 1995;8(7- 8):425. Written in Portuguese. English abstract.

13. Stryes KS: “The phenomenon of dysautonomia and mitral valve prolapse.” J Am Acad Nurse Practitioners 1994;6(1):11.

14. Korr IM. The Collected Papers of Irvin M. Korr. American Academy of Osteopathy. Indianapolis, IN. 1979.

15. Uematsu S, Edwin DH, Jankel ER, et al: “Quantification of thermal asymmetry.” J Neurosurg 1988;69:552.

16. Kent C, Gentempo P: “Instrumentation and imaging in chiropractic: a centennial retrospective.” Today’s Chiropractic 1995;24(1):32.

17. Palmer DD: “Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners.” Portland Printing House Company. Portland, OR. 1910. Page 661.

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Take our Free Practice Strategy Assessment. A Personalized Guide and Expert Strategy Call to Help Determine How Scanning will Help you Grow
ABOUT THE AUTHOR

Dr. David Fletcher is actively involved in all aspects of innovation teaching and research connected to the INSiGHT™ scanning technologies. He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.

Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto. He is a sought-after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be.

https://insightcla.com/wp-content/uploads/2022/07/david-1.png
Dr. David Fletcher
DC FRCCSS(C) – Founder & CEO CLA Inc.
LIKE THIS ARTICLE? HELP US SPREAD THE WORD

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