Our book is a good source in print, online check out [url=http://sandynette.com/htm/links.htm]http://sandynette.com/htm/links.htm[...
Paralyzed woman sues chiropractic for half billion II
Sun, 2008-06-15 09:57
#52
Sun, 2008-06-15 10:22
#53
ElizaQ
Jas,
I found this article in that link. It's got stats in it. It also doesn't condemn chiropractic outright or say it's all bunk. It seems to lay out the concerns that wayne is talking about in reference to the specifics are neck manipulation.
It also appears to be written by someone who actually practiced for over 40 years if that means anything.
[url=http://www.quackwatch.com/01QuackeryRelatedTopics/chiroeval.html]Does the bad outweigh the good? [/url]
-------------------------
On another note what I find interesting in relation to this article is that many if not all of the positive anecdotes (including mine) that people have commented on these seem to fall in the realm of specific musculo-skeletal problems which this gut at least talks about the merit of.
Sun, 2008-06-15 11:23
#54
quote:
Originally posted by jas:
[b]I understand the point you're making about subluxation. I am trusting that you agree with me that vertebral misalignment does exist....
what I'm asking is, where, when, who? How often? I would think you would have this right at your fingertips. Is there no online source you can quickly refer me to?[/b]
There are many posts to which I could reply, but this is as good as any. To be upfront, I am a physical therapist who in the past worked in orthopedic practice alongside a chiropractor with a similar perspective on the body as I have. We have had many chats on this topic over the years, and I respect her because she will tell patients she cannot provide the type of treatment they would benefit most from, instead referring them to exercise therapists/kinesiologists, physical therapists, etc. To me, this is a critical element of a responsible practitioner - to know your limits and your strengths. And I do know that chiropractors exist who do recognize them, but others are selling a philosophy that is simply not backed by scientific inquiries on the topic. I do not think we need to know why or how something works, but knowing that it works is enough (e.g. studies on acupuncture effectiveness).
I have not worked at a clinical PT for almost six years, so do not pretend to comment on behalf of my colleagues. I am now a social scientist who studies Canadian health care from a variety of angles, so I speak from an unusual insider/outsider position.
To get to jas' point, I do believe that joints can be malaligned. If they are fully out of alignment, that is a dislocation, something so acute and painful that you will usually be unable to move it and a trip to the emergency room is in order. And yes, things like scoliosis exist, for a range of reasons. However, I am of the opinion that any orthopedically inclined clinician must assess the causes of things like scoliosis or refer to someone who can, and recommend treatment based on addressing the root causes when at all possible. Manipulating a joint out of a scoliosis, for example, might provide some form of pain relief, but will do little to alleviate the root cause of the painful curvature. For those with joints that repeatedly dislocate, no amount of joint manipulation will prevent that from happening.
And herein lies another aspect of my discomfort: former patients often described chiropractic manipulation as putting a joint back in place. Where did this story come from? If a joint repeatedly dislocates, then either a rigorous muscular stabilization training method is indicated (such as with shoulders or kneecaps), or surgical fixation (as would be the case in the spine).
In my humble opinion, much of what chiropractors 'adjust' are stiff joints, and sometimes painful ones. I would argue that there are other methods to manage these, but know that some find joint manipulation their treatment of choice. I've often wondered if this is because as another poster alluded to, the quick fix, as well as an expectation that our bodies should be able to do anything we want. But I digress.
I agree with Wayne MacPhail that the issues here are ones of informed consent and risk/benefit ratios. I know in the case of Laurie Mathiason, I was outraged by the results of the inquiry into her death. In particular, I was very upset that she presented with neurological symptoms that were, to my understanding, not explored by the chriopractor before she performed the manipulation. There are screening tests for vertebral artery compromise. While imperfect, they tend to create more false positives, which is better than the reverse because it means that practitioners proceed with caution in more cases than they need to. As well, there are a series of questions that should be asked to check for neurological compromise before one does anything that has even a remote chance of causing a stroke. To my recollection, this is not standard practice across chiropractic, and while I am uncomfortable with the class action suit for a range of reasons, I do think that the failure to screen patients properly amounts to negligence and a failure to fulfill the terms of informed consent. If the professional licensure bodies are doing nothing to ameloriate the situation, then they too are liable.
As the inquiry into Ms. Mathiason's death also demonstrated, there is little ability to clearly define a stroke after a manipulation as caused by the high velocity thrust. This is because in most cases, the effects are delayed by hours or even a day or two. I am unsure if anyone is keeping statistics on the association of strokes or other neurological injury in relation to recent exposure to chiropractic manipulation - perhaps Mr. Macphail can help us out in that regard. I know in the past, there was little tracking in place to report adverse outcomes of cosmetic surgeries, and this might be the same situation. Without tracking, informed consent is much tougher. But just a word of caution that 'cause' will always be difficult to prove.
Finally, there has been lots of tangential conversation on this thread: e.g. vaccinations. To me, this all comes down to risk, and perceived acceptability of risk when it is something for which we have control versus those times when we do not. I do think there are patients who have been informed there is a risk of stroke from chiropractic treatment, but who occupy the same space as most of us do, which is the "it won't happen to me" mentality. With chiropractic, we choose it freely and in an informed manner for ourselves, or at least, that is the theoretical idea. If this does not hold true in practice and the professional licensure bodies are doing little to enforce expected standards of practice, there is perhaps a basis for a class action suit. In comparison, with things like vaccination, or food/chemical regulations, etc., risk management is happening at a higher level, so I do not think that all the examples provided are analogous.
Sun, 2008-06-15 11:38
#55
"If this does not hold true in practice and the professional licensure bodies are doing little to enforce expected standards of practice, there is perhaps a basis for a class action suit."
This is precisely the case here.
Sun, 2008-06-15 17:01
#56
Just because chiropractors operate outside the public health care system, that doesn't mean they're selling snake oil. And the corollary is that even within a single-payer system, medical practice is hugely influenced by the profit motive.
For example, there are vastly fewer back surgeries carried out today than fifteen or twenty years ago for the simple reason that there are not enough orthopaedic surgeons -- talk to the CMA about that -- and the ones there are are now making money hand over fist on knees and hips. So what happens to all those back patients, now that no one is willing to operate on them?
It's wrong to try to impede access to the one form of treatment that many injured people find truly helpful, particularly when the system doesn't have any other effective form of relief to offer. Even physiotheraphy isn't covered by medicare anymore.
We are often talking here about the difference between someone who is withdrawn from the world, in excruciating pain and doped up on opiates 24 hours a day, versus the same person having enough control over their symptoms most of the time to be able to work and have a life.
It's not for us to try to take that person's options away.
Sun, 2008-06-15 17:19
#57
Thanks, Wayne. I'll take a look at some of those links. I notice though, that many of them, including the one Eliza cites, seem to be from Quackwatch, a site that I can't take seriously.
However, I will look at the other ones.
And thank you, PattyT, for your obviously informed input. I think I can agree with much of what you say.
Sun, 2008-06-15 17:23
#58
In the meantime, here's some info from The Canadian Chiropractic Association:
quote:
An extensive commentary on chiropractic care, published in the February 2002 issue of the Annals of Internal Medicine, which is the journal of the American College of Physicians, reviewed more than 160 reports and studies on chiropractic. It states the following with regard to the safety of neck adjustment: "The apparent rarity of these accidental events has made it difficult to assess the magnitude of the complication risk. No serious complication has been noted in more than 73 controlled clinical trials or in any prospectively evaluated case series to date."1A Canadian study, published in 2001 in the medical journal Stroke, also concluded that stroke associated with neck adjustment is so rare that it is difficult to calculate an accurate risk ratio.2 The study was conducted by the Institute for Clinical Evaluative Sciences (ICES) and the authors have stated: "The evidence to date indicates that the risk associated with chiropractic manipulation of the neck is both small and inaccurately estimated. The estimated level of risk is smaller than that associated with many commonly used diagnostic tests or prescription drugs."
The most recent research into the association between neck adjustment and stroke is biomechanical studies to assess what strain, if any, neck adjustment may place on the vertebral arteries. The preliminary findings of this ongoing work indicate that neck adjustment is done well within the normal range of motion and that neck adjustment is "very unlikely to mechanically disrupt the VA [vertebral artery]."3
[url=http://www.ccachiro.org/Client/cca/cca.nsf/web/Chiropractic%20Treatment%... - CCA[/url]
Sun, 2008-06-15 23:31
#59
Jas, there are lots of studies that come to different conclusions about the frequency of stroke following neck manipulation. I've read most of them. The bottom line is this, in my opinion.
There is no vertebral subluxation.
Adjusting something that doesn't exist is useless. And, that is exactly why many chiropractors adjust the upper neck.
All the studies indicate there is some level of risk of stroke and sometimes, like for Sandy Nette, that stroke's results are catastrophic.
Many chiropractors believe upper neck manipulation can cure all manner of ill and/or maintain health. This is false.
Many chiropractors believe there is no risk to the procedure.
Those too things combined mean that informed consent cannot be given since the risk/benefit analysis offered is based on nonsense.
Since there is no benefit and some risk, and informed consent is challenging, the procedure should be stopped.
We can argue studies all day, and the chiropractors love to do it. In the end, the bottom line for Sandy Nette was she got her neck manipulated over and over for no good reason. Now she is locked in her own body.
If you'd like to do further reading, go nuts:
1 Coroner’s Inquest into the Death of Laurie Jean Mathiason: Transcript of Inquest. Saskatoon, Saskatchewan: Meyer Compu Court Reporting; (1998).
2 Dan Zabreski, “Probe link between chiropractic therapy, stroke, jury urges,” The Star Phoenix [Saskatoon], September 12,1998.
10 H.R. Pratt-Thomas and K.E. Berger, “Cerebellar and spinal injuries after chiropractic manipulation,” Journal of the American Medical Association, 133 (1947), p. 600-603.
11A.G.J Terrett, Current Concepts in Vertebrobasilar Complications following Spinal Manipulation,” (Des Moines, Iowa: NCMIC Group Inc., (2001) p. 9.
14 V. Dabbs and W. J. Lauretti, “A Risk Assessment of Cervical Manipulation vs.NSAIDs for the Treatment of Neck Pain,” Journal of Manipulative and Physiological Therapeutics 18, 8 (1995) p. 530-536.
15 P.F. Carey, “A report on the occurrence of cerebral vascular accidents in chiropractic practice,” The Journal of the Canadian Chiropractic Association, 37, 2, (1993), p.104-106.
16 S. Haldeman and P. Carey, M. Townsend, and C. Papadopoulas, “Arterial Dissections following cervical manipulation: the chiropractic experience,” Canadian Medical Association Journal, 165, 7 (2001), p.905-6.
17 N. Klougart, C. Leboeuf-Yde and L.R. Rasmussen, “Safety in chiropractic practice. Part 2: Treatment of the upper neck and the rate of cerebrovascular incidents,” Journal of Manipulative and Physiological Therapeutics, 19 ,9 (1996), p. 563-9.
18 J. Dvorak and E. Orelli, “How dangerous is manipulation of the cervical spine?” Manual Medicine, 2 (1985), p.1-4.
19 A. Vickers and C. Zollman, “The manipulative therapies: osteopathy and chiropractic,” British Medical Journal, 319 (1999) p. 1176-9.
20 I. Coulter, “Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest?” Integrative Medicine, 1, 2, (1998), p. 61-66.
21 V. Dabbs and W. J. Lauretti, “A Risk Assessment of Cervical Manipulation vs. NSAIDs for the Treatment of Neck Pain,” Journal of Manipulative and Physiological Therapeutics 18, 8 (1995) p. 530-536.
23 M.T.Y Chan, N.G. Zurab, and J.W Norris, “Diagnostic Strategies in Young Patients with Ischemic Stroke,” The Canadian Stroke Consortium, 1999.
24 J.W.Norris, V. Beletsky and N.G. Zurab, “Sudden neck movement and cervical artery dissection,”Canadian Medical Association Journal, 63, 1, (2000), p 38-40.
26 E. Ernst, “Manipulation of the cervical spine: a systematic review of case reports of serious adverse events,” Medical Journal of Australia, 176, 8 (2002), p. 376-380.
27 E. Ernst, “Spinal manipulation: its safety is uncertain,” Canadian Medical Association Journal, 166, 1, (2002), p. 40-41.
29 D.M. Rothwell, S.J. Bondy and I. Williams, “Chiropractic Manipulation and Stroke, A Population-Based Case-Control Study,” Stroke, 32 (2001), p.1054-1060.
31N. Klougart, C. Leboeuf-Yde and L.R. Rasmussen, “Safety in chiropractic practice: Part 2:Treatment of the upper neck and the rate of cerebrovascular incidents,” Journal of Manipulative and Physiological Therapeutics, 19, 9 (1996) p. 563-9.
32 S. Haldeman, P. Carey, M. Townsend and C. Papadopoulas, “Arterial Dissections following cervical manipulation: the chiropractic experience,” . Canadian Medical Association Journal, 165, 7 (2001), p.905-6.
33P.F. Carey, “A report on the occurrence of cerebral vascular accidents in chiropractic practice,” The Journal of the Canadian Chiropractic Association, 37, 2, (1993), p.104-106.
35 N. Klougart, C. Leboeuf-Yde and L.R. Rasmussen, “Safety in chiropractic practice: Part 2: Treatment of the upper neck and the rate of cerebrovascular incidents,” Journal of Manipulative and Physiological Therapeutics, 19, 9, (1996) p. 563-9.
36 E.L. Hurwitz, I.E Coulter, A.H. Adams, B.J Genovese and P.G. Shekelle, “Use of Chiropractic Services from 1985 Through 1991 in the United States and Canada,” American Journal of Public Health, 88, 5, (1998).
37 J. Keating Jr., “Shhh! … Radiophone station WOC is on the air: chiropractic broadcasting 1922-1935,” European Journal of Chiropractic , 43, 29, 1995, p. 21- 37.
38 J. Keating, “Introducing the Neurocalometer: a view from the Fountain Head,” 35, 3 (1991) p.165.
39 J. Nash, C. Johnson and B. Green, “Hole In One: A History of Its Founding,” Chiropractic History, 16, 2 (1996), p.77.
40 J. Moore, “The Neurocalometer: Watershed in the Evolution of a New Profession,” Chiropractic History, 15, 2 (1995), p. 51.
41 B.J. Palmer, “Hole-in-One Theory Absolutely Right,” Fountain Head News. 18, 3 (1933).
42 S. Bolton, “The ‘Wet Specimen,’” Chiropractic Journal of Australia, 24, 4, (1994), p.147.
43 I. Coulter, E. Hurwitz, A. Adams, W. Meeker, D. Hansen, R. Mootz, P. Aker, B. Genovese and P. Shekelle, “The appropriateness of manipulation and mobilization of the cervical spine,” RAND, 1996.
46 G. Bove, N. Nilsson, “Spinal Manipulation in the Treatment of Episodic Tension-Type Headache,” Journal of the American Medical Association, 280,18, (1998), p.1576.
48 I. Coulter, “Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest?” Integrative Medicine, 1,2 (1998), p. 61-66.
50 A.G.J Terrett, “Misuse of the Literature by Medical Authors in Discussing Spinal Injury,” Journal of Manipulative Therapy, 18, 4 (1995).
51 World Chiropractic Alliance, “Chiropractic and Risk of Stroke,” [url=http://www.worldchiropracticalliance.org/positions/stroke.htm]www.worldc...
52 I. Coulter, “Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest?” Integrative Medicine, 1, 2, (1998), p. 61-66.
53 Chiropractic Canada, “Why Chiropractic is a Safe and Healthy Choice,” pamphlet, 1999.
55 B.J. Gleberzon, “Chiropractic Care of the Geriatric Patient: Clinical Diagnosis: Treatment, Management and How to Err on the Side of Caution: A Primer/ Workbook for the CD 410 courses at the CMCC,” 1998.
57 Coroner’s Inquest into the Death of Laurie Jean Mathiason: Transcript of Inquest, Saskatoon, Saskatchewan: Meyer Compu Court Reporting, (1998).
59 Paul Carey, “Letters to the Editor,” Journal of the Canadian Chiropractic Association, 39, 3 (1995), p. 188.
60 Igor Steiman, “Letters to the Editor,” Journal of the Canadian Chiropractic Association, 39, 3 (1995), p. 188.
61 David Chapman-Smith, “Cervical Adjustment: Rotation is Fine, Pre-testing is Out, but Get Consent,” The Chiropractic Report. 13, 4 (July 1999).
62 G.N. Dunn, “Managing Risk in Your Chiropractic Practice 2001,” Journal of the Canadian Chiropractic Association, 45,4 (2001), p . 248-255.
Sun, 2008-06-15 23:46
#60
M. Spector
Careful, Wayne. Apparently [url=http://www.rabble.ca/babble/ultimatebb.php?ubb=get_topic&f=31&t=000702#0...'s considered rude[/url] to suggest to another babbler that they do some reading to inform themselves on the topic at hand.
Mon, 2008-06-16 07:06
#61
This story derives from a particular personal injury lawsuit.
Any competent lawyer, unopposed, can almost always sell their own side of a story -- even when the people judging the case are neutral and expert and have access to all the information (which we don't, despite a long list of arcane references) and even when they have the experience of lawyers pulling wool over their eyes every day of the week. A big part of the technique is in framing the debate, and that's exactly what comes to mind for me when I hear this mantra about "unnecessary treatment causing harm". That just sounds to me like some lawyer's schtick, their theory of their case.
What would the other side say? How would they characterize the issues?
Just from our own discussion above, it looks like the defence could include factors such as (1) this plaintiff clearly did assess that she was benefitting from the ongoing treatment, just as a huge number of other chiropractic patients have experienced such benefits; (2) even she concedes transitory benefits; (3) she cannot discharge her onus of proof that the stroke resulted from the treatment, just as previous litigants were unable to establish legal causation; (4) it is her basic human right to choose to be treated; and (5) the whole larger argument against chiropractors is a politically motivated witch hunt.
A competent defence lawyer will weave those or other factors into a comprehensive theory of this particular case -- and it is listening those two stories in opposition, with access to the actual documentation in this particular file, that will enable a judge to make an informed decision, based on the legal test and jurisprudence, whatever that is.
As non-litigants we're certainly obviously free to have opinions about chiropractors for ourselves, but when it comes to making those decisions for others, I really think it's important to situate that debate in context of an understanding that our public health care system really fails to meet the basic needs of many patients with chronic musculoskeletal conditions.
Again -- I work with often severely injured people and I can attest to the scarcity of treatment options, with profound and far-reaching consequences on their whole quality of life.
Mon, 2008-06-16 07:12
#62
quote:
Originally posted by Wayne MacPhail:
jas, there are lots of studies that come to different conclusions about the frequency of stroke following neck manipulation. I've read most of them. The bottom line is this, [b]in my opinion[/b].There is no vertebral subluxation...
what is considered rude/bad form here on babble is continually citing your [i]own opinion[/i] as definitive fact, and to not cite sources for such an opinion.
being a journalist who specialises in technical reportage does not make one a medical expert that can pronounce verdicts on the legitimacy of anything.
being a journalist who is trying to sell a book, and then uses that book as the sole source of reference for thier arguments doesn't stand up to the burden of proof required in virtually every other thread on babble.
though that is one excellent example of capitalism and the free market.
two threads and over 150 posts, and repeated requests to do so have finally borne some fruit.
that list of references are not linked (something babblers generally insist on) and when a poster tells other posters to go look something up themselves, they are justifiably criticised.
the main subject of those references are to the Mathiason inquiriy in Saskatchewan that, yes, concluded that she did not die from the neck manipulation, nor was the chiropractor at fault.
the references posted just prior by jas quoted from the CCA, which any critically thinking person would suspect of bias, but funny how the studies past and ongoing cited are in [i]medical journals[/i], not quacky chiropractic organs.
Mon, 2008-06-16 08:49
#63
Farnival, you are quite wrong about the outcome of the Mathiason inquest. All the recommendations out of the inquest are about chiropractic and the evidence is quite clear. Inquest juries cannot find fault, they point to recommendations. I have spoken to Laurie Jean's mother about the inquest and have read transcripts of the case. Laurie Jean had a stroke right on the chiropractor's table and there were no other risk aspects to the case.
I provided citations from our book at Jas's request they are not linked 1) because many of the studies would be in fee-based journals 2) because they come from a book citation list.
I fail to see your point out medical journal citations, and, in fact, many of the citations are from chiropractic journals or chiropractors.
Finally, you are wrong about wanting to sell my book. If I did (and we've made thousands of cents on it so far) I would not be providing a full citation list to Jas here. I'd just say go read it.
My comments are, of course, my opinion based on years of research. You are welcome to extract whatever value you find in them.
Mon, 2008-06-16 10:02
#64
quote:
Originally posted by Wayne MacPhail:
[b]Farnival, you are quite wrong about the outcome of the Mathiason inquest. All the recommendations out of the inquest are about chiropractic and the evidence is quite clear. ...-snip-
... medical journal citations, and, in fact, many of the citations are from chiropractic journals or chiropractors.
-snip--
My comments are, of course, my opinion based on years of research. You are welcome to extract whatever value you find in them.[/b]
well, i guess we'll just leave it at that then. your [i]opinion[/i] is legit, as a published author and researcher, and quite clearly partisanly supported by both moderators [i]opinions[/i] and those of us that think this lawsuit is a witchhunt's are not.
my point about the citations was that after over 150 posts, two threads, and many requests, you provided none but your own book. the citations you did provide, excepting one, are not linked, which does go against typical babble etiquette. i should have said [i]published, peer reviewed, medical journals[/i] which jas cited, but you didn't until after.
as for the Mathiason inquest in Saskatchewan, i am not wrong, and followed it pretty closely, as did my chiropractor. the conclusions were that the woman in question had a litany of health problems and was not able to determine conclusively that the neck manipulation caused the stroke, and [i]said more research was necessary.[/i], same for the Ontario case, which was ruled an "accident" also because they were unable to prove conclusively it was related.
with all your research, you know this is one of the outcomes, but was not appreciated in the slightest by the families and lawyers of the patients that died, who all called it spin by the chiros.
Have any of the chiropractors in question, as a result of these inquiries or court cases ever been subsequently charged with wrongful death, manslaughter, or if your assertion that they know neck manipulation is unsafe can result in death, been charged with murder, [i]and been convicted and sentenced?[/i]. As a result of these inquiries, was the Chiropractic profession and chiropractors prohibited by law, either provincially or federally from continuing neck manipulations, and threatened with penalties for doing so?
no, they haven't. and neither will anyone in the alberta case.
Mon, 2008-06-16 10:23
#65
Farnival wrote: "same for the Ontario case, which was ruled an "accident" also because they were unable to prove conclusively it was related."
Farnival, you don't understand what "accident" means in the case of an inquest. There are only five possible causes of death an inquest jury can select from: - homicide, accident, natural causes, undetermined and suicide.
In the case of Lana Dale Lewis the only options were natural causes and accident. They would have picked natural causes had any lifestyle choices or prior medical issues (smoking, overweight etc.) been at play. The finding of accident doesn't mean the death was accidental, it means it was not natural causes.
I know that's a tricky thing, but that is the way inquests work. An accidental finding meant that chiropratic neck manipulation was responsible.
Trust me, I was in the room when the verdict came down, the chiropractors and their lawyer understood that loud and clear. Go back and read any of the news stories.
[url=http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1074263691771_5/?hub...
for example
quote:
The Canadian Chiropractic Association and the Canadian Memorial Chiropractic College expressed disappointment with the jury's verdict, saying "it represents a massive miscarriage of justice."
So, yes, very much so, the jury found that chiropractic was responsible for the death of Lana Dale Lewis. You have been misinformed.
Mon, 2008-06-16 10:34
#66
and furthermore...
quote:
your opinion is legit, as a published author and researcher, and quite clearly partisanly supported by both moderators opinions and those of us that think this lawsuit is a witchhunt's are not.
...
The moderators around here are as much entitled to their opinions, and to join into the fray and express them as anyone. There is nothing partisan about it. No one is inhibiting you or anyone else from expressing their point of view.
My own feelings about chiropractic formed before I was a moderator, and before I'd ever met Wayne. Nor are Michelle and I in complete agreement. I have a problem with adjustments to the upper cervical vertibrea, while if I understand correctly, Michelle has a certain skepticism about a broader range of "alternate" medicine. I also don't think chiropractic is all that "alternate" any more.
Mon, 2008-06-16 10:40
#67
so, was the chiropractor in question then subsequently charged with the death of the patient?
no, they weren't.
i'm not [i]misinformed [/i]wayne, i interpreted the reportage and verdict differently than you, which i'm free to do.
you have your [i]opinion[/i], that you've put forward in your book, based on your research, and good for you, you are free to do that.
i have my [i]opinion[/i], based on my direct personal experience, and personal research that is just as valid as yours, since neither of us have any medical qualifications, (unless you do, which i haven't found listed anywhere).
i believe the phrase "agree to disagree" is applicable here. the alberta trial will show whose opinion is the correct one, and i don't think it will be yours, but once again, that is my [i]opinion[/i].
meet you back here when it's done.
Mon, 2008-06-16 10:40
#68
Farnival wrote: "and was not able to determine conclusively that the neck manipulation caused the stroke"
Farnival, again, you misunderstand the inquest process. It is not an inquest jury's responsibility to find specific fault, but to determine what caused a death and what can be done to prevent future deaths.
In the case of Laurie Jean Mathiason
they recommended that the Ministries of Health in Canada provide funding immediately to implement studies to:
determine the incidence of strokes associated with cervical spine manipulations.
determine the benefits and harmful effects that are associated with single and multiple cervical manipulations.
pursue the development of effective screening tests that will identify patients who are at high risk of complications when receiving cervical spinal manipulations.
They also called on the government to “develop a prototype patient and family medical history form which elicits pertinent health data prior to Chiropractic treatment,” to work with “Chiropractic Associations to ensure that the contents of the consent for treatment form be discussed by the Chiropractor and the patient at the initial visit.”
They called for screening tests to be made mandatory before chiropractors performed neck manipulation and they asked that all health care experts work together to “maximize benefits and minimize risks inherent in cervical spinal manipulation treatments.”
Finally, and perhaps most importantly, they called for full disclosure to ensure the safety of the public. The jury recommended that the government collaborate with chiropractic associations to “ensure that literature indicating the risk of strokes and other inherent risks associated with Chiropractic treatment, be visible and available in the reception area of every Chiropractic clinic.”
Despite those recommendations, chiropractic associations started a spin program to suggest that Ms Mathiason did not die as a result of the neck manipulation. I'm afraid you are the victim of that campaign.
Mon, 2008-06-16 10:43
#69
Farnival, the outcome of an inquest is not a matter of opinion. It is a matter of fact. What you said about the Lana Dale Lewis inquest was based on an misunderstanding of inquest terminology. It is nonetheless, in error. Inquests are not criminal trials. And, in this case, the inquest found that chiropractic neck manipulation was responsible for the death of Lana Dale Lewis. The only opinion about that that matters is the opinion of the jury.
[ 16 June 2008: Message edited by: Wayne MacPhail ]
[ 16 June 2008: Message edited by: Wayne MacPhail ]
Mon, 2008-06-16 10:51
#70
quote:
Originally posted by oldgoat:
[b]and furthermore......
The moderators around here are as much entitled to their opinions, and to join into the fray and express them as anyone. There is nothing partisan about it. No one is inhibiting you or anyone else from expressing their point of view.
My own feelings about chiropractic formed before I was a moderator, and before I'd ever met Wayne. Nor are Michelle and I in complete agreement. I have a problem with adjustments to the upper cervical vertibrea, while if I understand correctly, Michelle has a certain skepticism about a broader range of "alternate" medicine. I also don't think chiropractic is all that "alternate" any more.[/b]
yes, you are absolutely right oldgoat, that moderators are free to have thier own [i]opinions[/i].
but [i]opinions[/i] are not fact, and many posters were definitively agreeing with wayne's [i]opinion[/i] as if it was fact, which it is not proven to be.
i used the word "partisan" in reference to the moderators, you being one of them, as wayne is a rabble columnist, and you are a babble moderator.
if this were an NDP thread, and i made comments supporting something an NDP pundit in the employ of the party said, i would be called "partisan". a simple comparison that you apparently don't like, but i still think is apropos, as did another poster in the first thread, and felt attacked, and felt unsupported by the mods due to your obvious support for wayne, eliminating any neutrality you may have had to moderate the situation. but that is my [i]opinion[/i] and yes, you are right, no one has prevented me from expressing it.
those of us posting here in support of chiropractic were effectively called wrong and misguided and our personal experiences dismissed by what appeared to be a cheerleading squad for wayne and his [i]opinion[/i], supported by two posters who are also mods. i would call that partisan.
that's all i meant by "partisan"
Mon, 2008-06-16 10:58
#71
quote:
Originally posted by Wayne MacPhail:
[b]Farnival wrote: "and was not able to determine conclusively that the neck manipulation caused the stroke"Farnival, again, you misunderstand the inquest process. It is not an inquest jury's responsibility to find specific fault, but to determine what caused a death and what can be done to prevent future deaths.
In the case of Laurie Jean Mathiason
they recommended that the Ministries of Health in Canada provide funding immediately to implement studies to:determine the incidence of strokes associated with cervical spine manipulations.
determine the benefits and harmful effects that are associated with single and multiple cervical manipulations.
pursue the development of effective screening tests that will identify patients who are at high risk of complications when receiving cervical spinal manipulations.
They also called on the government to “develop a prototype patient and family medical history form which elicits pertinent health data prior to Chiropractic treatment,” to work with “Chiropractic Associations to ensure that the contents of the consent for treatment form be discussed by the Chiropractor and the patient at the initial visit.”
They called for screening tests to be made mandatory before chiropractors performed neck manipulation and they asked that all health care experts work together to “maximize benefits and minimize risks inherent in cervical spinal manipulation treatments.”
Finally, and perhaps most importantly, they called for full disclosure to ensure the safety of the public. The jury recommended that the government collaborate with chiropractic associations to “ensure that literature indicating the risk of strokes and other inherent risks associated with Chiropractic treatment, be visible and available in the reception area of every Chiropractic clinic.”
Despite those recommendations, chiropractic associations started a spin program to suggest that Ms Mathiason did not die as a result of the neck manipulation. I'm afraid you are the victim of that campaign.[/b]
hmmm...i said the conclusion was more research and study was needed. and you have provided some excellent examples of such recomendations.
since you did all that research for your book, i'm assuming you've followed the inquiries recommendations and implementation? how is that work going? were the studies done? what are the results? i've google it and can't find any links to any follow up. funny that.
has neck manipulation been banned as a result? no.
have any chiropractors been charged with manslaughter or murder as a result of a stroke allegedly caused by neck manipulation? not that i can find.
so it appears we might have common ground here. no jury has found a chiropractor criminally responsible for the death of a patient as a result of chiropractic neck manipulation.
the rest is spin.
on that i can agree with you.
Mon, 2008-06-16 11:13
#72
These are inquests, not criminal trials. The lack of criminal trials is, frankly, beside the point.
I presented you with evidence that the Mathiason inquest held chiropractic neck manipulation to blame. You appear blind to that. I can't help you any further I'm afraid.
[ 16 June 2008: Message edited by: Wayne MacPhail ]
Mon, 2008-06-16 11:16
#73
quote:
Originally posted by Wayne MacPhail:
[b]sdfsd[ 16 June 2008: Message edited by: Wayne MacPhail ][/b]
what i am missing is your answers to the questions i asked about banning of neck manipulations or convictions of chiropractors and the results of the recommendations of the inquiry, which i've been unable to find. i would like to be enlightened.
you said what the jury said is the only answer that matters. has any jury answered my questions either?
not yet.
that is why criminal trials/convictions are relevant. it's entirely relevant that there aren't any.
you take different conclusions than i do from the inquiry results i've found and you've posted. that's ok to do. you've said inquiries don't reach criminal verdicts. that's fine.
but how many chiropractors have been charged/jailed/fined/lost a licence based on patients allegedly strokes from neck manipulation? any?
it is very relevant. the rest is spin, spin, spin.
as an aside, how many people die from going under general anasthetic each year?
according to the[url=http://en.wikipedia.org/wiki/General_anesthesia]General anathesia wiki[/url]
quote:
Mortality ratesOverall, the [b]mortality rate for general anaesthesia is about five deaths per million anaesthetic administrations[/b].[1] Death during anaesthesia is most commonly related to surgical factors or pre-existing medical conditions. These include major haemorrhage, sepsis, and organ failure (eg. heart, lungs, kidneys, liver). Common causes of death directly related to anaesthesia include:
aspiration of stomach contents
suffocation (due to inadequate airway management)
allergic reactions to anaesthesia (specifically and not limited to anti-nausea agents) and other deadly genetic predispositions
human error
equipment failure
[b]In the US, up until about 1980 anesthesia was a significant risk, with at least one death per 10,000 times administered[/b].[1] After becoming something of a public scandal, a careful effort was made to understand the causes and improve the results.[2] It is generally believed that anesthesia is now at least ten times safer than it was then.[3] However, there is some controversy about this.[4] In the US, the data is not made public (in fact, the data is not even collected), so the truth is uncertain.[5] The rate for [b]dental anesthesia is reported to be one out of 350,000[/b].[6]
obviously US information, but sounds higher than for chiropractic doesn't it?
written a book yet on the horrific practice of general anasthetic?
want to have the whole profession banned?
[ 16 June 2008: Message edited by: farnival ]
Mon, 2008-06-16 11:20
#74
I can't believe Mr. McPhale is still on here spreading this vitriol. Now here is the problem, Mr. McPhale says chiropractors cause strokes, but he can't define the rate. This is where if you are a conscientious person, your first red flag would go up. Why doesn't he define a rate? Because he'd be sued. That would be putting a number on something there is no number for.
If there is a a relationship between people attending chiropractors and strokes, the number would be easily definable, wuld be obvious from general statistics easily obtainable from Ohip or other organizations. The reason Mr. McPhale can't define a relationship is because there is none. Mr. McPhale's case is anecdotal. Mr. McPhale has taken anecdotal case, with no proven causal effect and is now trying to assume cause based on the opinion of a neurologist's anecdotal diagnosis. There is in fact no scientific basis to Mr. McPhale's criticism. The fact is that people go to see doctors and chiropractors in many cases because they have headaches and sore necks. The rate of strokes after seeing medical doctor and chiropractors for similar symptoms is exactly the same. WHat the evidence suggests is that if you are headed for a stroke, it is quite possible that neither a chiropractor or a doctor is going to be able to prevent that. Or in any case, they both have a similar stroke or prevention rate, if there is a prevention rate. It is quite possible that neither of them prevent this type of stroke and that both medical and chiropractic treatment are irrelevant. That is what the studies show. That's why you won't get an award against a chiropractor for a suit like this. What you see here is Mr. McPhale pleading a case before the public, he can't win before the courts. And why? Who knows. Is he hoping to be called as an expert witness, so that he can tell the courts he hasn't been able to put a number on chiropractic related strokes. That all that his research has done is confirm that he has a deep seated and irrational dislike of chiropractors so deep that he has managed to get a book published in which he no doubt wrote numerous pages explaining how he can't scientifically find any statistical relationship between chiropractors and strokes, but in which he assures you there is one.
As for his attack on chiropractors based on the concept of subexation no one cares. Let me give you and example.
SO I'm a cabinet maker and you like my work. But I believe wood comes from fairies and that it's the fairies that work in my shop while I'm sleeping. I fail to see how my theory of how my cabinets get made has anything to do with either the quality, the strength or anything else related to my cabinets. It's a fairy tale literally. But my cabinets may still be of better quality, because I use better glues , work with more care trying to please the fairies and may just for reasons unrelated to the whole fairy story just be a better craftsman than my competition in the furniture industry. IN fact my belief in fairies may make me work to higher standards because I believe the fairies will only favour my work if it is of the highest quality. My furniture may in fact be better than my competitions not despite my fairy tale but because of it.
Now lets discuss Mr. McPhale's claim that chiropractors do nothing. It used to be easy for [Libel removed by moderator] to claim that pain did not exist. It was very difficult at trial for someone to prove they were in pain. Over the last 20 years or so there has come into use a form of thermography, that takes advantage of the use of skin temperature to determine where pains is and provide a thermal picture of the pain. When my wife went through her settlement after a recent auto accident, it was actually the thermographs that convinced our insurance company, who were claiming my wife was fit to go back to work, to settle out of court. So thermographs are accepted by both the legal and scientific community as diagnostic tools. My chiropractor uses thermographic analysis to determine areas he thinks he can help, the same basic machinery the MD who diagnosed my wife's chronic pain used.
I can show you the differences after 3 months treatment. This has nothing to do with the kind of quackery Mr. McPhale discusses. He can talk to me about energies etc. till he's blue in the face. And I yawn and tune out. I could care less it the guy believes in sublexations and fairies and the boogy man. If his treatment continues to reduce the amount of pain my wife is in, and her thermography continues to improve, I'll continue to drive her there 3 times a week. Let me make it clear. I'm paying for this out of my own pocket. No insurance involved. I'm doing it because my wife says it's making a difference, and the same thermography that proved she was suffering from chronic pain in the first place backs up her feelings.
What Mr. McPhale is doing hear is attacking a proven method of treatment on spurious grounds [Libel removed by moderator]. So my advice for chiropractors as well as for any other medical practioner is give them a try, see if they help. If they do stay with them. A guy who charges you for triggering a placebo reaction in your system is just and uses techniques that have no scientifically proved benefit, that somehow makes you feel better, stick with the guy. Maybe it means you're one of a small fraction of the population that can be helped by such a guy and who won't respond to "scientifcally" supported treatments. It's better to be cured than to keep the scientific / medical community happy.
As for Mr. McPhail. He can't prove a link between chiropractic treatments and stroke and he admits it. The rest of what he says is irrelevant. Ignore him.
If Mr. McPhale wants to make a statement that there is a proven link between chiropractic adjustments and stroke fine. I'll be happy to pass the info on to the Chiropractic Association so they can sue him. He'll lose, and he knows it.
[ 17 June 2008: Message edited by: Michelle ]
Mon, 2008-06-16 11:31
#75
I suspect the last place chiropractors would like to see the discussion of neck manipulation and stroke played out is in a court of law, which is why the Nette case is so fascinating and important.
Mon, 2008-06-16 11:39
#76
quote:
Originally posted by Wayne MacPhail:
[b]I suspect the last place chiropractors would like to see the discussion of neck manipulation and stroke played out is in a court of law, which is why the Nette case is so fascinating and important.[/b]
i suspect it will turn out to be farcenating and impotent.
still haven't answered the questions wayne.
what is the rate of stroke and death of patients as a result of chiropractic neck manipulations? i've found the rates for anasthetic. can't find them for the former.
if it is so high that there is a scandal, why has it not been banned even after two inquiries in canada?
have any chiropractors been convicted criminally of causing a stroke or the death of a patient?
simple questions. waiting for answers and citations.
Mon, 2008-06-16 13:37
#77
speaking of statistics, in the [url=http://www.cbc.ca/canada/edmonton/story/2008/06/13/chiro-lawsuit.html]CBC story friday[/url], it says:
quote:
...Nette and her husband, David, said if the lawsuit is successful, other Albertans who suffered injuries after undergoing manipulation of the upper cervical spine since June 12, 1998, would share in any financial settlement...
so, are there published and verifiable statistics for this claim? who are they and why didn't they file a lawsuit, or join the class action? why have they not been reported on in the press? there must be something if they are basing a lawsuit on it. i can't seem to find anything though. wayne? how about your extensive research?
why since june 12, 1998? her injury happened sept. 17, 2007. what is significant about the earlier date?
answers seem to be hard to come by these days. [img]rolleyes.gif" border="0[/img]
[ 16 June 2008: Message edited by: farnival ]
Mon, 2008-06-16 13:41
#78
Farnival, I can be of no further assistance to you.
[ 16 June 2008: Message edited by: Wayne MacPhail ]
Mon, 2008-06-16 13:45
#79
didn't think so.
Mon, 2008-06-16 14:00
#80
Mr. McPhail, once again, the Chiropractic Association will go after anyone who makes the kinds of statements you are making here, as they have clear statistical data indicating you are wrong taken from the Ohip records. Instead of speculating on what the Chiropractic Association might or might not do. Why not just state out front what you have spent all this time implying.
Make a statement like "there is clear and indisputable evidence that Chiropractic neck adjustments cause strokes". I'll take it from there. You could also make a statement like "There is no evidence that any good comes from Chiropractic adjustments." Once again, a statement you're unlikely to make, because it's not true and could constitute slander.
What is truly amazing to me is that your best response to my last post, which covered a number of issues critical to this discussion was to say
"I suspect the last place chiropractors would like to see the discussion of neck manipulation and stroke played out is in a court of law, which is why the Nette case is so fascinating and important."
No response to the issues raised. Just another hollow defense with a meaningless assertion. The Nette case is fascinating to me in the same way the woman who sued MacDonalds for serving coffee that was "too hot" is. Every now and then the courts are offered the opportunity to do something totally off the wall. And sometimes they do. If the court awards the chiropractor in this case legal fees after finding the case a frivolous waste of their time, a very lilely conclusion with the legal precedents that have been established, are you going to come on here and apologize to all the chiroprators you've demeaned, by your own admission, without any evidence.
Just to clarify things, if a man has a stroke while driving his car, that doesn't prove driving a car causes a stroke. If a man has a heart attack climbing the stairs in his house, that doesn't mean climbing the stairs in your house will causes heart attacks. You need to clean up your thinking, and stick to the science. You seem to be incapable of understanding this distinction.
In response to the quote above, I'd have to so, no it's way more likely that the last place you'd like to be is in court against the Chiropractic Association defending your campaign of innuendo, guilt through coincidence and your lack of any conclusive evidence to back up your claims. This is a novelty case, and it hasn't been decided yet. Since it is almost certain that if the woman tries to prove that the chiropractic adjustment caused her stroke she will fail, I'm guessing this is your big chance, to get out and get your opinion out there before the judgement, which based on past judgements is likely to go against this woman. It's a legal gamble. She could win big, she could lose big. The only ones sure to make any money in this case are the lawyers involved.
Mon, 2008-06-16 16:13
#81
quote:
Originally posted by retiredguy:
I can't believe Mr. McPhale is still on here spreading this vitriol.
In fact, Wayne has been quite measured and restrained while presenting, in good faith, the arguments he believes to be true. You, on the other hand, are the one spewing vitriol, and you should know that libelous personal attacks like the ones you posted about Wayne, which I have now removed, are against babble policy. This is a warning. If you keep up this level of hostility, you will be taking a time out.
[ 17 June 2008: Message edited by: Michelle ]
Mon, 2008-06-16 16:59
#82
Over the years I have been bemused by the hostility of some (not all) babblers who advocate for alternative health practices. For the most part I no longer take part in these sorts of thread except in the most marginal way.
That said, I would like to contribute another timorous clarification: the reason Wayne can't produce "OHIP records" of people harmed by chiropractic neck manipulations is because such records don't exist in a retrievable form.
When you go for medical care, there isn't some central database that gets uploaded with all the details of your treatment, that can later be accessed by journalists. We know the incidence of strokes based on what's billed, but all the possible causes of the stroke aren't entered on some enormous all-encompassing database containing all information on whatever happened to the person in their entire life.
So if Wayne isn't able to provide all the statistics that would bolster his case, it doesn't mean he doesn't have a case.
Wayne makes a couple of points that stood out for me:
1) Neck manipulations attempting to address "subluxations" don't do anything for you because these "subluxations" don't exist.
2) These neck manipulations can kill or maim you.
As somebody (I think) mentioned in this or the previous thread somewhere, in health care there's the balance of risk versus benefit.
So....you've got these dubious neck manipulations balanced against the possibility that they can kill you. The risk here is maxed out.
Mon, 2008-06-16 18:52
#83
quote:
Originally posted by farnival:the main subject of those references are to the Mathiason inquiriy in Saskatchewan that, yes, concluded that she did not die from the neck manipulation, nor was the chiropractor at fault.[/QB]
Actually, that's not quite accurate. I followed that case closely; I was a physical therapy student in Saskatoon when it happened. There was little doubt that she died as a result of the procedure, but the inquest concluded that there was no way of determining in advance that this would happen. Which is why I, like many other physical therapists, was upset with the inquest verdict. We perform vertebral artery tests as part of routine screening, as well as ask questions for cardinal signs - signs of neurological or vascular problems. In Laurie Mathiason's case, she had been treated the day before her death for a headache. Her symptoms had worsened, and she went back. The chiropractor manipulated her neck again, though the symptoms she was reporting were those that would have been caught with cardinal screening. The coroners report was as conclusive as one can be in such a case - that the first manipulation had damaged the artery, that the second one that caused her to have a stroke on the table likely dislodged a clot from the day earlier. But because the inquest believed it could not have been detected, the chiropractor was not charged. She did die from the manipulation, but the chiropractor was not charged for reasons that baffled me and my colleagues.
Mon, 2008-06-16 19:15
#84
quote:
Originally posted by Sineed:
[b]That said, I would like to contribute another timorous clarification: the reason Wayne can't produce "OHIP records" of people harmed by chiropractic neck manipulations is because such records don't exist in a retrievable form.When you go for medical care, there isn't some central database that gets uploaded with all the details of your treatment, that can later be accessed by journalists. We know the incidence of strokes based on what's billed, but all the possible causes of the stroke aren't entered on some enormous all-encompassing database containing all information on whatever happened to the person in their entire life.
So if Wayne isn't able to provide all the statistics that would bolster his case, it doesn't mean he doesn't have a case.
[/b]
Thank you Sineed for this clarification, and as a health care researcher now based in Ontario, I can back that up. Billing data is very limited in what it tells us, and is not publicly accessible.
Okay, herein lies the problem with the demands for proof. The only way you can prove, beyond any doubt, that upper cervical spine chiropractic manipulation causes trauma of catastrophic proportions to the vertebral artery of the rare patient, you would have to do a study where you would do ultrasound scanning of the artery pre-manipulation, perform the manipulation, and scan again immediately after, to show that the cause of the injury was the manipulation. For obvious ethical reasons, this study will never happen. The best we can do is to have a tracking
system with mandatory reporting for all stroke patients that records the vessel compromised and many potential contributing factors, including recent exposure to upper cervical spine manipulation. This was one of the recommendations of the Mathiason inquest (perhaps not in this exact detail, but you get the idea), and if the chiropractic profession has not done this, something recommended 10 years ago, then they are negligent.
I appreciate that there are negative outcomes in relation to other types of medical treatment. But medical practitioners are required to obtain inform consent for procedures, and in my experience, are very diligent in doing so when the risk of harm is great. The issue here is informed consent, and a profession that might not be doing what was recommended by at least one government inquest. Self-regulating professions have a responsibility to protect the public, and I know my college of physical therapists takes that responsibility very seriously. From what I'm gathering about the current situation, the chiropractic licensure bodies have not been diligent enough.
Mon, 2008-06-16 20:16
#85
I guess the one point I'll concede is that any stroke potentially occurring as a cause of chiropractic manipulations is one too many, and if Wayne is hoping to put many chiropractors out of business by freaking out their potential customers, he may well succeed at that.
What the posters here are objecting to is
1)Wayne's assertions that these are a frequent occurence, without any official numbers suggesting this is true.
2)His focussing on the weirder aspects of chiropractic history in which the concept of "subluxation" was apparently engendered in some pretty confusing esoteric concepts, or at the very least not adequately explained at the time, BUT which has for the most part been subordinated to other physical therapy concepts by modern chiropractors. However, Wayne's insistence on the non-existence of the original kooky concept, and his seeming reluctance to nevertheless concede that vertebral misalignment does exist, kind of pins his argument to a trivial foundation, imo.
It may be valid to say that subluxation doesn't exist, and that the term is misleading and should no longer be used, but the solution is not to sue chiropractic as a profession, but rather to lobby for a more stringent definition. Neck manipulations would still be part of the practice whether the term "subluxation" is in use or not. So his point on this matter is moot in any case.
3) his insistence that others' experiences must all be a product of their minds, and his inability to see how insulting (not to mention incorrect) such an attitude is.
quote:
So if Wayne isn't able to provide all the statistics that would bolster his case, it doesn't mean he doesn't have a case.
No, but it certainly doesn't mean, according to scholarly tradition, that he's in any way right, either. The burden of proof falls to him. He claims he has proven this in his book, but none of that information has come through at all clearly in either of these threads. Instead we have him merely insisting that he knows he's right, and that we're all misinformed. It's just not a good basis for dialogue. Moreover, the original thread got off to a very provocative, reactionary start. Naturally that sends some flags up for some people as to the objectivity of this research. (Kind of like how the 9/11 threads go)
Tue, 2008-06-17 04:03
#86
Surely the burden of proof should be on chiropractors to show that a medically dubious procedure is worth the potential for a rare but devastating complication.
Tue, 2008-06-17 04:20
#87
Especially when they recommend that it be performed on perfectly healthy people with no problems.
Tue, 2008-06-17 04:45
#88
quote:
Originally posted by jas:
[b] His focussing on the weirder aspects of chiropractic history in which the concept of "subluxation" was apparently engendered in some pretty confusing esoteric concepts, or at the very least not adequately explained at the time, BUT which has for the most part been subordinated to other physical therapy concepts by modern chiropractors. However, Wayne's insistence on the non-existence of the original kooky concept, and his seeming reluctance to nevertheless concede that vertebral misalignment does exist, kind of pins his argument to a trivial foundation, imo.It may be valid to say that subluxation doesn't exist, and that the term is misleading and should no longer be used, but the solution is not to sue chiropractic as a profession, but rather to lobby for a more stringent definition.
[[snip]]
No, but it certainly doesn't mean, according to scholarly tradition, that he's in any way right, either. The burden of proof falls to him. He claims he has proven this in his book, but none of that information has come through at all clearly in either of these threads. Instead we have him merely insisting that he knows he's right, and that we're all misinformed. It's just not a good basis for dialogue. [/b]
First I would say that as a profession, chiropractic has not homogeneously adopted the same way of thinking that has become central to orthopedic physical therapy. There are some that have, and from what I am told by my chiropractor friend who used to investigate complaints against her colleagues, many who still hold to the 'original kooky' subluxation theory, purporting that manipulations can treat diabetes and asthma and such, that recommend that adult patients bring their children, their babies in for a check-up and will adjust their spines for preventative care. I'm not kidding, this stuff happens. I almost lost a friendship over a girlfriend bringing her three month old to the same chiro whose manipulation triggered the stroke that killed Laurie Mathiason. If the profession had moved to a place where they had assumed an orientation to the musculoskeletal system similar to that of physical therapy, this simply would not happen.
When it comes to the class action suit, the burden of proof will up to the prosecution. They will be able to rely upon inquests that made clear recommendations which were able to be implemented to judge against whether the profession has lived up to its responsibility. If, since the time of the inquest they have not implemented such tracking systems, vertebral artery and cardinal sign screening, then the profession will be negligent. True that such systems that depend on individual practitioners are difficult to implement, but my professional college does many quality assurance tests, including one physical therapist visiting another to complete an evaluation of their practice (using a standard methodology), which includes a review of their charting and observing treatment being offered. This is what I mean by licensure colleges for self-regulating professions taking their responsibility to ensure the public is offered safe treatment seriously. And if the chiropractic profession has not done the same, they will be negligent.
As for Mr. MacPhail's comments, I have found his clarification of inquest terminology helpful - it's good to learn something new. I came to this discussion board quite uncomfortable with the idea of a class action suit against chiropractic, but I now leave this discussion more confident that such an action might have grounds.
Tue, 2008-06-17 05:24
#89
Having been personally libelled on this discussion, I will no longer be participating. My best wishes for a fruitful discourse.
[ 17 June 2008: Message edited by: Wayne MacPhail ]
Tue, 2008-06-17 07:21
#90
Having re-read the passages, I think it's true that those two comments crossed the line from personal attack into libel. I'll just remove the libelous part of those sentences from the post and from my warning post.
[ 17 June 2008: Message edited by: Michelle ]
Tue, 2008-06-17 07:32
#91
Thank you Michelle. I am happy to engage in the discussion about chiropractic given those changes.
There has been discussion of proof. It is a generally held tenet of critical thinking that extraordinary claims require extraordinary proof. Certainly the chiropractic notion that manipulating an unproven entity, the vertebral subluxation, can effect health is an extraordinary claim. So is the notion that the vertebral subluxation exists. And, so far, in its 130-odd-year history, chiropractic has not been able to supply proof, extraordinary or otherwise.
In court, this will not go well for them. Court cases are determined on a body of evidence. There is no evidence of vertebral subluxations but there is much evidence that chiropractic administrators were aware or should have been aware of problems caused by subluxation-based treatments and did nothing.
This is why the court case is so important. It strikes at the heart of chiropractic. It's as if neurology was on trial with the charge being, there is no neuron. However, the difference is, there is a neuron, its provable, viewable and all neurologists agree on its nature.
Tue, 2008-06-17 09:35
#92
Sven
quote:
Originally posted by Wayne MacPhail:
[b]In court, this will not go well for them. Court cases are determined on a body of evidence. There is no evidence of vertebral subluxations but there is much evidence that chiropractic administrators were aware or should have been aware of problems caused by subluxation-based treatments and did nothing.This is why the court case is so important.[/b]
Unfortunately, as I noted in a post in the prior thread on this subject, courts are ill-equipped to address scientific issues.
99 out of a hundred scientists may believe X = Y. But, if a lay jury in a particular case, for whatever reason, is convinced that X ≠ Y, then legally, X ≠ Y, at least in so far as that case is concerned.
[ 17 June 2008: Message edited by: Sven ]
Tue, 2008-06-17 09:38
#93
Sven, I agree. In Alberta it is likely the trail, if it is certified and proceeds, will be tried by a judge, not a jury. Much depends on the scientific background of the judge. It's not a perfect system, but it's the best we have.
Tue, 2008-06-17 09:45
#94
quote:
Originally posted by Wayne MacPhail:
Sven, I agree. In Alberta it is likely the trail, if it is certified and proceeds, will be tried by a judge, not a jury. Much depends on the scientific background of the judge. It's not a perfect system, but it's the best we have.
It should be mentioned that in the "Kitzmiller v. Dover Area School District" one of the issues that both sides asked the judge to rule on was whether or not intelligent design was a scientific theory and his ruling on the matter was excellent showing a great understanding of what science is.
[ 17 June 2008: Message edited by: Trevormkidd ]
Tue, 2008-06-17 10:02
#95
Only scientists can judge scientists???
So should a Judge have to be a murderer to judge murderers? A drug user to sentence drug users? A war criminal to...
Scientists are subject to the same laws as everyone else and its not that hard to understand.
Tue, 2008-06-17 10:55
#96
It's Me D., Scientists will not be on trial, chiropractors will. Science will not be on trial, subluxations will. The challenge for chiropractors will be to provide evidence that the subluxation exists. The point about the judge is that it is important that he or she be clear about what studies show and have not shown around the nature of subluxation. There is less to be concerned about surrounding the non-science more marketing and regulatory aspects of the trial, should it occur.
Tue, 2008-06-17 10:57
#97
quote:
Originally posted by Wayne MacPhail:
[b]This is why the court case is so important. It strikes at the heart of chiropractic. It's as if neurology was on trial with the charge being, there is no neuron. However, the difference is, there is a neuron, its provable, viewable and all neurologists agree on its nature.[/b]
So then, it is your view that this case puts the whole practice of chiropractic on trial.
Your analogy is interesting because in my experience, neurology is a rapidly evolving area of medical knowledge and there is in practice no consensus regarding neuropathic effects. A typical neurological examination is arguably insensitive to certain very common manifestations of nerve damage; the usual tests -- reflex, pin prick, two-point discrimination, EMG -- were developed many years ago, are usually inappropriately administered and interpreted, and do not properly take into account the different kinds of nerve cells or the actions of for example, injured peripheral nerves on the central nervous system. Much of this information has only being published over the past couple of years.
To prove neuropathy in a particular case depends on the specific medical and other evidence, the rating schedule, legal test, jurisprudence and to whatever degree, the personal inclinations of whoever is making the decision.
You see, it is not possible to put neurology on trial.
Tue, 2008-06-17 11:16
#98
Yes, triciamarie, the trial would put chiropractic on trial as it argues that the subluxation does not exist and so any procedure flowing from its adjustment is legally fraudulent.
To your neuron example. My metaphor was meant to be simple. I was not talking neuropathology, just neuron existence.
There is no question a neuron exists. It can be viewed, acted upon and its outputs measured.
Question: Does the neuron exist? Yes. Can you prove it? Yes.
Question: Does the subluxation exist? No. Can you prove it? No.
There are lots of other things the trial will have to deal with, but chiropractors will have to prove what they have been unable to for 130 years.
[ 17 June 2008: Message edited by: Wayne MacPhail ]
Tue, 2008-06-17 13:29
#99
quote:
Yes, triciamarie, the trial would put chiropractic on trial as it argues that the subluxation does not exist and so any procedure flowing from its adjustment is legally fraudulent.
You have yet to acknowledge that not all chiropractors accept the theory of subluxation.
and as far as medicine and non-existent entities.
quote:
“"In medicine, strict criteria exist for calling a condition a disease. In addition to a predictable cluster of symptoms, the cause of the symptoms or some understanding of their physiology must be established. ... Psychiatry is unique among medical specialties in that... We do not yet have proof either of the cause or the physiology for any psychiatric diagnosis. ... In recent decades, we have had no shortage of alleged biochemical imbalances for psychiatric conditions. Diligent though these attempts have been, not one has been proven. Quite the contrary. In every instance where such an imbalance was thought to have been found, it was later proven false. ... No claim of a gene for a psychiatric condition has stood the test of time, in spite of popular misinformation." - Joseph Glenmullen, M.D., clinical instructor in psychiatry at Harvard Medical School, in his book Prozac Backlash (Simon & Schuster, New York, 2000), pages 192-193, page 196, and page 198
Tue, 2008-06-17 14:03
#100
N.R.Kissed
Yes, there are some chiropractors who do not agree with subluxation-based treatments.
To many other chiropractors, however, they are seen to have lost their way and strayed from the true chiropractic.
And the chiropractor who adjusted Sandy Nette's neck supports subluxations.
When chiropractic historians and academics denounce the subluxation in chiropractic journals they are pounced on in the next month's Letters to the Editors as though they were Godless heretics.
More importantly, in Alberta the College and Association of Chiropractors does endorse it. A statement on their website reads. "The chiropractic adjustment is thought to restore the body's powerful ability to heal itself ..." This idea finds its roots in belief in the subluxation.
As well a survey of Canadian Memorial Chiropractic College (CMCC) staff found that 79 per cent felt that chiropractic philosophy should play a part in the school clinic's patient management program. Again, this means treating subluxations.
And in 1997 the CMCC, along with other members of the Association of Chiropractic Colleges signed a postion paper that reads, in part:
quote:
Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation ...
So, while not all chiropractors support the subluxations, many do and leading colleges, associations and chiropractic colleges do. Hence the problem. Many chiropractors adjust patients' necks to remove non-existent subluxations and their colleges, schools and associations let them do it because they support the idea despite a complete lack of evidence.
[ 17 June 2008: Message edited by: Wayne MacPhail ]
Tue, 2008-06-17 14:22
#101
The neurology analogy was meant to be simple, and it's not.
If neurons in living, breathing bodies are as observable and measurable and predictable as suggested, medical practitioners would agree on their characteristics. But they don't -- either in the theoretical abstract, or not infrequently, with regard to any one person's neurological condition or lack thereof.
If there can be so much disagreement between doctors, some of them must be very wrong. What kind of terrible nonsense is underlying those determinations?
Does this call the whole practice of neurology, or conventional medicine for that matter, into question?
No, it does not.