I’d promised myself I wouldn’t go back to this whole “chiropractic neck manipulation” thing, but the letters keep coming in and each one is more amusing than the last. To review, I made a simple statement quoted in Reader’s Digest:
Over the years, a number of my patients have had strokes after chiropractic neck manipulation. It can cause something called vertebral artery dissection, where the main artery leading to the back of the brain actually splits. Now I tell patients, if you want to see a chiropractor, fine, but never let him touch your neck.
Based on the available evidence, I stand by that opinion, as do most of my well-informed colleagues. VAD is not a common outcome, but it is a known outcome and it is to be avoided.
Some chiropractors have come to the blog to debate the issue, which is always nice. I don’t particularly agree with their points as I think they’ve read the data wrong, but it’s been mostly polite. The hilariosity really comes through in the email and snail mail. I got a letter today (by certified mail no less) which I will offer to you in it’s entirety:
Dear Dr. Lipson,
In the October issue of Readers [sic] Digest, on page 153, you made a statement putting down the entire Chiropractic [sic] community. I would like for you to provide for me documented research to prove your statements. Three research articles and three case studies should suffice. All the research papers and case studies must have patients who are drug and medication free to eliminate the FACT that adverse reactions to medications often cause strokes, (this has been proven in several research projects) [sic]. Plus the “manipulations” must be done by a CHIROPRACTOR, not a physical therapist or osteopath or massage therapist or anyone else [sic].
If your team cannot provide this simple request, I would like an apology and a retract [sic] printed.
I normally never let rubbish such as this ruffle my feathers, however, I am tired of my patients bringing in articles such as this and questioning me when there is absolutely no proof behind it. All it does is discourage people from being healthier. I do not appreciate it.
A prompt response would be appreciated.
Dr. J.R. Crabtree [Arkansas Upper Cervical Center]
Mr. Crabtree, here’s your prompt response, which will be in the form of haiku:
senseless demands fly limply
like monkeys fling poo.
And now, iambic pentameter (English majors, go easy on me):
Demand a response? Who are you to demand?
Varlet of those who would spread deeds, and “facts”
most foul (some might allege). A pox!
And now in plain English.
First, if I had wanted to make a statement “putting down the entire Chiropractic [sic] community.” I would have said something like, “Chiropractic is a pre-scientific practice based on the mistaken idea that disorders of the spine are the cause of most medical problems, an idea as outmoded as phlogiston, and most practitioners must be either deceptive or delusional.” But I didn’t say that, and I don’t believe that. In fact I didn’t even say, “Stay away from chiropractors.”
As to the demands to provide research, it was provided in the previous posts, so I’ll direct my correspondent to those. (And, just a tip: sending me a photocopy of a bunch of crap written by Gary Null is not helping your case.)
As to the “FACT [sic] that adverse reactions to medications often cause strokes”, well, sure, I don’t doubt that this may be the case, however it is a non sequitur twice over. The connection between chiropractic neck manipulation and stroke is only relevant to a type of stroke known as “vertebral artery dissection”, and not to the much more common “embolic stroke”. Whether or not a patient who suffers VAD after chiropractic was also taking, say, amlodipine (rendering them “not drug free”) is irrelevant.
And I’m glad patients are making you look at critical articles. Welcome to the club. Patients bring real doctors literature every day, everything from newspaper articles to patent medicine ads to the latest medical journal studies. Patients are curious about what treatments we are offering them and want real answers based on our best knowledge. These encounters often lead me to read up on a topic, and sometimes change my mind. If someone’s practices cannot stand up to such simple scrutiny, they need to find a field where questions are discouraged and obedience demanded (although it seems to be a bad year for dictators).
As to an apology, um…no.