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Letters to the Editor
SELF Magazine
4 Times Square
New York, N.Y. 10036-6599
 
To the editor:

While the stories of Christa Heck and the other women featured in your article, “A Deadly Twist,” are exceptionally tragic, stroke following a chiropractic manipulation is an extremely rare occurrence. 

The American Chiropractic Association believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic; however, health care consumers should be aware that the risks associated with chiropractic treatment are infinitesimally small. In fact, research has shown negligible evidence to support a causal relationship between cervical spinal manipulation and vertebral artery dissection.

Medical standards dictate that a procedure with an adverse reaction less than 1 in 400,000 is considered “low risk.” According to scientific data, the odds of suffering a serious reaction from chiropractic cervical manipulation have been shown to be less than 1 in 3.8 million to 5.85 million manipulations. Studies have shown that the best estimates of the odds of suffering a serious complication from a chiropractic neck treatment are the same odds a person faces of dying in a commercial airline crash.

Even so, the chiropractic profession has taken an active role in educating doctors of chiropractic to recognize possible risk factors for stroke in patients and encourages all doctors of chiropractic to immediately refer any high-risk patients to other specialists for further evaluation.
 
To properly assess the risks of chiropractic treatment, it must be compared against the risks of other treatments for similar conditions. Some of the most common treatments for musculoskeletal pain – including prescription and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) – carry risks significantly greater than those of chiropractic manipulation. For instance, a study from the New England Journal of Medicine estimated that at least 16,500 NSAID-related deaths occur among patients each year. Furthermore, according to a study from the American Journal of Gastroenterology, approximately one-third of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the use of aspirin or NSAID painkillers like ibuprofen.

Contrary to what was reported in your story, the most common adverse reaction patients experience after spinal manipulation is minor discomfort, which – according to the scientific literature – usually fades within 24 hours.  Studies have also shown that the injuries mentioned in your article – joint dislocations and bone fractures – more frequently occur after visits to health care professionals who are inexperienced or inadequately trained in spinal manipulation, rather than to licensed doctors of chiropractic.

Moreover, it should be mentioned that the referenced study from Neurology is fraught with design flaws too numerous to detail here. But most surprising is the fact that the study excluded eight patients who had suffered “iatrogenic” vertebral artery dissection - or artery tears caused by medical doctors. Meanwhile, the study found only seven patients that supposedly suffered the same reaction after cervical spinal manipulation.

It is also unfortunate that you chose not to interview a patient who has benefited from chiropractic cervical manipulation. There are tens of thousands of success stories annually of patients whose lives were positively changed because of chiropractic care. Neither did you mention one of the many studies that points to chiropractic’s effectiveness for headaches and neck pain.

For any health care intervention, the issue should be appropriateness, which involves balancing effectiveness and safety. Focusing only on risk and not potential benefit demonstrates an editorial bias, a lack of understanding of the issue, or a complete disregard for the available research. Several extensive reviews of the scientific literature from leading authorities have agreed that neck manipulation is safe, effective, and appropriate for patients with a number of very common complaints like neck pain and headache.

For example, a recent study was published in 2001, when researchers at Duke University found cervical manipulation appropriate for both tension-type headache and cervicogenic headache and noted that “cervical spinal manipulation has a very low risk of serious complications,” which may be “one of its appeals over drug treatment.” For patients with many types of neck pain and headache, there is at least as much scientific evidence showing that chiropractic manipulation is an effective treatment as there is for any other medical or surgical treatment.

Although all available evidence demonstrates that there is an extremely small risk of major complications from chiropractic neck treatments, this remains an area of study for the chiropractic profession. The ACA and the chiropractic profession will continue to work closely with other medical professionals on this matter in the best interests of all our patients.
 
Sincerely,
 
Richard G. Brassard, DC
President, American Chiropractic Association