Study

Chiropractic organizations and researchers heavily criticized a study in the May 2003 issue of Neurology that reported a significantly greater risk of stroke arising from spinal manipulation than previously suggested. A press release from the American Chiropractic Association (ACA) characterized the study as "fraught with design flaws."

Seven months later, WNBC, a New York television station, inexplicably felt it necessary to revisit the study and its erroneous implications. On Nov. 6, 2003, WNBC ran a segment on chiropractic adjustments and the risk of stroke. In the segment, Dr. David Marks, a medical correspondent, interviewed Susan Russell, who suffered from headaches, sore muscles and fatigue before seeing a chiropractor. According to Dr. Marks, the chiropractor didn't perform an adjustment, but rather "neck manipulation" that tore an artery in Ms. Russell's neck and caused a stroke.

"Many who seek relief will have their necks manipulated and feel better, but some could end up like Susan Russell," Dr. Marks warned. He then referenced the Neurology study, which examined the incidence of strokes in people under the age of 60 and found that a "relatively high percentage" of those diagnosed with torn neck arteries had visited a chiropractor in the previous month. While Dr. Marks conceded that the ACA had denounced the study as heavily flawed, he failed to mention any of the flaws specifically.

Following Dr. Marks' comments, neurologist Mitchell Fink, MD appeared on the program with a model of the spine, complete with neck arteries. "If I force this to an extreme degree," he said while manipulating the spine, "these bony structures will compress the arteries so that the blood supply stops completely."

Dr. Marks then interviewed Jeanette Anderson, DC, who admitted that while she didn't explain the risk of stroke to every patient, she doesn't manipulate anyone who is at an increased risk of stroke, either.

"We [doctors of chiropractic] know the clinical history of the patient as they present, Dr. Anderson stated. "Due to a full chiropractic orthopedic neurological and physical examination and X-rays, I know a lot about a patient before I even put my hands on them."

The segment concluded with Dr. Marks referring to the Neurology study before warning that patients should see a medical doctor immediately if they suffer increased neck pain or any neurological symptoms following manipulation.

The Neurology study alluded to by Dr. Marks has been the subject of constant derision by the chiropractic profession since it was published. The aforementioned ACA press release stated, among other things, that "Although the study found cases where vertebral artery stroke appeared to be correlated with a chiropractic visit, the stroke may not have been caused by the actual treatment. Scientific evidence implicating a neck treatment as a true cause of this type of stroke is still preliminary and controversial."

FCER Director of Research Anthony Rosner, PhD, in a review of the Neurology article published in the June 30 issue of Dynamic Chiropractic, noted that the study "fails to identify the actual numbers and locations of manipulations administered; fails to identify the qualifications and backgrounds of the individuals providing manipulations; and actually excludes more patients due to iatrogenic causes (8) than are actually presumed to bear a relationship to manipulation (7) because their events occurred within 30 days of treatment." In the same issue, Michael Haneline, DC, dissected the study point by point, concluding that "such studies unduly frighten patients who may be in need of cervical spinal manipulative therapy, and prevent certain members of the medical profession from referring patients who may benefit from chiropractic care."

As the old saying goes, there are two sides to every story. According to ACA President Don Krippendorf, DC, not only did Dr. Marks refer to a seriously flawed study repeatedly, he failed to give the chiropractic profession a fair chance to present its side of the adjustment-stroke debate. In a Nov. 7 phone conversation with Dynamic Chiropractic, Dr. Krippendorf related that the ACA presented Dr. Marks with several options for delivering a chiropractic perspective, but was rebuffed each time:

"I gave him contact information and asked him to use me as his chiropractic source of information, and Dr. Marks said his program would be broadcasting a program dealing with chiropractic and stroke. I immediately thought of [renowned chiropractor and neurologist] Dr. Scott Haldeman, and sent Dr. Marks another letter offering Dr. Haldeman's services. He declined the offer, saying that the distance between NBC in New York and the doctor in California would create a logistic inconvenience. At that, I said we would pay to fly Dr. Haldeman to New York for the express purpose of speaking with the media. I was still met with opposition.

"This is why I question the motivation and intentions of some - though not all - media sources when dealing with our profession. We are doing everything we can to accommodate those who disseminate the information, but the media - which should have the conscience to help protect the public - is ignoring it."

This is not the first time Dr. Marks appears to have slighted the chiropractic profession. In September 2003, Marks ran a story on manipulation and otitis media that stated osteopathic manipulation was "gentler" than chiropractic manipulation. He also suggested that children with repeated ear infections visit ah osteopath for treatment, ignoring several studies that demonstrate the efficacy of chiropractic adjustments for otitis media.

The International Chiropractors Association (ICA) also responded to the airing of the stroke story. Dynamic Chiropractic received a copy of a letter sent to WNBC President and General Manager Frank Comerford, in which the ICA expressed its concerns about the depiction of chiropractic adjustments as dangerous, and questioned Dr. Marks' journalistic integrity:

"The issue that concerns ICA the most is that of journalistic responsibility. The research record has shown that chiropractic is, by far, the safest of all health care interventions, and the inherently flawed study cited by the WNBC reporter is demonstrably lacking in scientific credibility. The question is, 'Why do the story at all?' The use of the media for what can only be characterized as the needless raising of public alarm about a health profession, the safety of which is so clearly established, raises serious ethical questions and issues of journalistic responsibility."

Concerned doctors of chiropractic, chiropractic organizations and patients should write to WNBC to express their feelings on the segment.