A few years ago, listening to the radio, I heard a report on some stats associated with drinking and driving. Of course, being an occasional consumer of the fermentation of wheat, I perked up. The announcer, speaking with indignant reproach and scathing/slashing tones, proceeded to describe the situation from 6:00pm Friday evening until 6:00 pm Sunday. Apparently, during that time 80% of the drivers on the road have been drinking. Concurrently, during the same time period, 60% of the wrecks that occurred involved at least one drinking driver. Horrendous was the word the announcer used to describe the situation.
Reaching for my glass and reflecting on the situation, it occurred to me that the 20% of the drivers who were not drinking, were causing 40% of the accidents. That's two for one where as the drinking drivers, 80% according to this report, were causing only 60% of the wrecks, less than one for one from what I could tell. Interestingly, the non-drinkers seemed to be causing more than their fair share of the wrecks from 6 o'clock Friday till 6 o'clock Sunday.
An interesting situation here. The stats being presented here were being interpreted to support the notion that people who have been drinking should not drive, but from a different perspective, it shows the non-drinker to be more dangerous on the road than the drinker, at least from a different perspective than the anti-drinker.
Not identically but in a similar fashion, studies showing the risk of stroke associated with chiropractic manipulation as opposed to visiting your PCP (MD) are also being interpreted based upon bias perspectives.
In a previous study:
Risk of Vertebrobasilar Stroke and Chiropractic Care, Results of a Population-Based Case-Control and Case-Crossover Study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.by Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.(5)
Dr Cassidy concluded that the risk of stroke after visiting a chiropractor was the same as the risk of stroke after seeing a PCP (MD), where of course, no manipulation would have been performed. It was suggested that the occurrence of the stroke might have already been in progress which might have prompted the visit to the DC or the PCP(MD) and that no matter the treatment which resulted from the visit, the stroke was on it's way to occurring anyway. Depending upon your perspective, this study reflects well or ill on your particular field, just as the stat's above reflect good or ill on your position as a drinker or not.
Now, once again the topic of strokes caused by chiropractic cervical manipulation has reared it's ugly head, specifically on the Science Based Medicine Blog of Dr Harriet Hall. More than once have they heaped criticism onto the chiropractic community regarding this rare event. Obviously it is an area which needs attention as would any risk to patients from any procedure. But it seems Dr Hall and her following want to lead the way to save an unsuspecting public from this ravage of society.
My point is this: given that medical mistakes (not difficult cases) cause 500 deaths a day in the US alone, who are these people to raise the indignant flag of reproach against chiropractors when they can't clean up their own house, even a little bit. With medical mistakes there really is no risk vs benefit consideration, unless you want to weigh the benefit of the procedure your doctor wants done in a hospital, for instance, versus the risk of actually being admitted, which is apparently high.
Sure, if your position is that cervical manipulation has no benefit, then why perform it ever. If your position is that there is benefit, then the risk is extremely small and the procedure is not necessarily to be avoided. Additionally, if the risk can be further reduced by altering how the manipulation is performed and avoided completely in high risk groups, then it becomes even safer and continues to be a viable option for the chiropractor treating patients.
But don't go crowing about the hazards of something as safe as manipulation in a back drop of 500 deaths per day due to medical errors, not to mention the risks and reactions of the pharmaceuticals and surgical procedures. Your concerns become a bit disingenuous.
Tuesday, February 10, 2009
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3 comments:
Well there is no method to determine risk groups. We just do not have one. And as far as teaching lower risk methods you have to first as a profession admit there is a substantial risk (and there is). There is because each year people are hurt terribly. Proportionately not many but quite a few independent of proportions.
So it has to start with the schools not teaching certain moves and we all know what moves they are. And virtually everyone takes the easy way out and does not learn to adjust Gonstead. They use the easy diversified which is much higher risk. Also toggle is very low risk and very few people use it.
I mean look. I was 30 years in practice and induced one major cervical neuro event. For a while I saw 500 per seek. But at this point in retrospect I would not adjust the way I did which was diversified. I would go Gonstead and toggle. And actually toggle does a heck of a great job and clearing out the c spine and increasing ROM.
You'll get no argument from me that it needs to be addressed further. But the point here is the anti-chiro sentiment behind the indignation of those who continue to rant on about it.
When the medical profession figures out how to stop actually killing 500 or so people every day of the year by mistake, then I think they can take the high road on this and make it more of an issue.
It's not a tu quoque argument, it is a point about their bias, hypocritical as it is, continuing to twist and turn this issue with what they say is a great deal of evidence, which, in fact, is very little.
The point was made on their blog, Science-Based Medicine, that their argument is so weak that if they were actually objective about it, they themselves would admit the same thing. Go on there and try to make some sort of argument about anything that they take issue with.
Tell them you are a chiropractor and you think antibiotics are good for the treatment of sinus infections. They will all but tell you that there is no true evidence to support the use of anti-biotics to treat sinus infections, all because you are a chiropractor. The objectivity is lost when the topic of chiropractic comes up because the anti-chiropractic bias is so strong.
Anonymous>
How do you come to the conclusion that there is a substantial risk? Yes, each year people do have VBA strokes, and yes, some of them had seen chiropractors prior to the culmination of the incident. BUT - as has been evidenced from the most recent study (put forward by a panel made up of DCs, MDs, and PhDs) shows it doesn't happen any more often than it does following a visit to your MD.
So true, proportionally the injuries following chiropractic are lower, but then you qualify by saying there are "quite a few" .... ? Again, do you have ANYTHING to back up such a claim? even the most rabid anti-chiropractic sites only list a total of ~300 cases of patients having poor reactions to chiropractic care - many of which are not VBA related, and 270 of which are wrapped up in 2 particular reviews which most likely overlapped information. So I guess "quite a few" for you works out to fewer than 3 per year that chiropractic has existed, and much more likely closer to less than 1 per year?
Don't get me wrong ... I am by no means a fan of supine diversified cervical adjusting, but it is tought (very explicitly) in the schools that any such adjusting is done without extension of the neck. Practitioners who become lazy and fail to maintain such a standard thus causing CVAs aren't the fault of the technique nor the education no more so than one would hold the medical profession or medical schools to task for a heart surgeon who consistently used dirty surgical tools.
Again, I'm not saying that diversified cervical adjusting is the best thing since sliced bread - far from it, as I see it having very little (if any) lasting structural or functional effect on the patient. But it also irks me to no end when these half-truths and partial-understandings are used as fodder against chiropractic in general. If someone wants to make an argument, I welcome and encourage them - that's what drives us as a race forwards in all areas, but put the time in to make an educated and accurate argument if you are going to do so. Otherwise we just get to re-hash the same old ground over and over again instead of moving forward.
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