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chiropractic lawsuit
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RE: chiropractic lawsuit - June 15, 2008 8:38:42 AM
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proud
Posts: 941
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Folks, we have had this foolish debate on here before. The risks outweight the benefits. Mobilization has been shown to be as effective as manipulation without the risk.
When will governments step up to the plate and consider discontinuing reimbursment for this form of treatment?
The end is near for chiropractic I have to think.
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RE: chiropractic lawsuit - June 15, 2008 9:18:33 AM
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ginger
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From: Melbourne Victoria
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I'd go further Proud and claim that CM ( mobilisation ) done with skill, has benefits that far exceed that for manipulation, has longer lasting effect, is more likely to eliminate referred events associated with joint hypomobility and can be used over a wider spectrum of presentations, age and conditions than is the case for manipulation. Cm is safe, even in circumstances where manipulations are contraindicated. Why would anyone choose manips over CM? or any other style of mobilisation?, simple, $$$, time is money. The main cash cow of chiro is hardly likely to die out in favour of methods that seek redundancy in the provider, if the choice is left up to chiros. It will ultimately be by education and awareness within the general public that this method will die its late but certain death.
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RE: chiropractic lawsuit - June 15, 2008 9:26:34 AM
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proud
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Well I agree Ginger. I am certain we will see Chiropractic stream towards PT's mode of treatment. But it's a watered down version, without adequate research done by themselves...and too little too late.
That's even if the CCA choses to admit the obvious. I am sure we will see the "safety" debate rage on, but the fact remains....it is a debate..... and when patient safety is involved....with equally effective treatments available.....the choice should be patently obvious to any educated individual.
You are right though. The more the public becomes educated about the dangers of chiropractic manipulation thanks to easy access to media these days....the faster the demise will occur. Strange though that governments get involved with mandating the use of safety belts in cars....yet they ignore this one. Hello.....
< Message edited by proud -- June 15, 2008 9:33:56 AM >
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RE: chiropractic lawsuit - June 15, 2008 11:21:08 AM
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rwillcott
Posts: 427
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From: Canada
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I would like to see more public awareness campaigns to educate the public about manipulation. I would like to see PT's step up to the plate and discuss the benefits of mobilizations and exercise for neck pain.
Patients that I see have such a skewed idea of what chiropractic is. They seem to think they will become 'realigned' by the chiropractor. I wish there were some way to make people more informed. This lady is an unfortunate case of what can go wrong. It's too bad that it's too late for her.
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RE: chiropractic lawsuit - June 15, 2008 5:00:00 PM
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TexasOrtho
Posts: 541
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I recently had an entry on my blog about adverse events associated with chiropractic manipulation. It was based on an article published in spine. A pretty nice chiropractic student posted a few comments, and he and Jason had a good back and forth.
Here's the link: Adverse events of chiropractic care: Transparency Now!
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: chiropractic lawsuit - June 15, 2008 7:17:14 PM
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allenbr4
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Was interested to see how well-known this recent study (link) is in the PT community. Obviously, it was a big deal amongst chiropractors.
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RE: chiropractic lawsuit - June 15, 2008 7:43:39 PM
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proud
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quote:
ORIGINAL: allenbr4
Was interested to see how well-known this recent study (link) is in the PT community. Obviously, it was a big deal amongst chiropractors.
Read it. It's one of many all with different data and outcomes.
The points are these:
1. It's a debate...ongoing and therefore needs investigation with a conclusion. For Governments to continue to allow it's use opens them up to lawsuits( rightfully so).
2. Mobilization has been shown to be as effective as manipulation.
3. The argument that medicine kills more then manipulation is not grounded in any logic. You cannot compare a healthy population to an ill population. And people who walk into a chiropractors office are healthy by hospital standards.
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RE: chiropractic lawsuit - June 16, 2008 1:19:48 AM
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Kaden
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Proud,
What studies are you referencing when say that mobilization has been shown to be as effective as manip. I do not disagree with any of the above post, just curious of what articles you have in mind when you make that statement.
I would like to show these to some PT's I know that I think are to quick to manipulate the C-spine.
I have on the other hand heard some decent arguments as to why manipulation may be superior to mobs especially aggressive grade IV end range, sustained mobs.
The thought is, if done correct, with manip you are at end range with the chance to stress the artery for a much shorter period of time as opposed to hanging out at end range for a significant amount of time with graded mobs.
Just some food for thought.
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RE: chiropractic lawsuit - June 16, 2008 2:34:34 PM
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bonez
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Did anyone attend or follow up the bone and joint task force work on neck pain and these issues? The presentation was made in grand rounds format live but the studies were published in spine.
Several of these here issues were dealt with by a multidisiplanary panel and a worldwide comprehensive lit review. There is very objective information reported on all of these issues and it would do all well to review their findings.
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RE: chiropractic lawsuit - June 16, 2008 7:20:14 PM
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proud
Posts: 941
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Yes....I am aware. two words: Scott Haldeman.....DC. He lead the task force yes?
One of my collegues stated something quite funny. Having a Chiropractor lead a research project that in part looked into the risk of VBI's with cervical manipulation would be akin to a tiger gathering a bunch of other carnivorous animals and suggesting they produce a report that shows they rarely attack sheep, birds etc( because humans were planning to discard of all predatory animals): I bet the outcome would show....they rarely attack.....
Something like that....you get the point.
Other similar task forces have produced polar opposite results. I could care less really. I can manipulate the C-spine( don't). But I am clever enough to know one thing. Where there is smoke there is usually fire....and when it comes to patient care, it's unethical, unprofessional and downright foolish to play with fire.
So simple.
The debate brings to mind a great quote from Upton Sinclair:
"It is difficult to get a man to understand something when his salary depends on his not understanding it."
-Upton Sinclair
< Message edited by proud -- June 16, 2008 7:26:39 PM >
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RE: chiropractic lawsuit - June 16, 2008 7:43:31 PM
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rwillcott
Posts: 427
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From: Canada
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Great quote. Here's another along the same lines:
"Few men have the virtue to withstand the highest bidder." - George Washington
It's clear that this is a difficult mess that I don't see going away for Chiropractors. This lady is a tetrapalegic! Not para, not quad, tetra! She has suffered bilateral vertebral artery tears as a result of upper cervical manipulations. Bilateral!
What more evidence is required?
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RE: chiropractic lawsuit - June 16, 2008 10:08:03 PM
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proud
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On the Chiropractor's webpage( gregory Stiles?)....here would be a quote from that page:
quote:
...chiropractic could help in these ways:
• if your pain involves a subluxations, chiropractic adjustment may give immediate relief as your joint is restored to alignment and mobility
Ahhh....there is that "subluxation" word. It would be astounding to see how CCA wiggles out of this one. Also hard to imagine that the government of Alberta provides funds for:
1) A non existant diagnosis, and;
2) Treatment with questionable efficacy and safety for said non-existant diagnosis.
Meanwhile various other legitimate diagnoses suffer from a lack of funding( gotta cut somewhere right?). It's bizzaro world at it's finest.
.....that would make the Alberta government culpable would it not?
< Message edited by proud -- June 16, 2008 10:23:04 PM >
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RE: chiropractic lawsuit - June 17, 2008 12:44:48 AM
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bonez
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I understand that this situation has/will create a field day and I am in no means validating the practise of the individual in question but I also find it difficult to swallow the lack of factual belief that has been demonstrated here.
While you are right Dr Halderman started out as a Chiropractor he did then attend medical school and went on to get his speciality in neurology. He has not practised as a Chiropractor in decades. To further imply that the multinational multidisiplanry panel of specialists would categorically support chiropractors by playing a blind eye to the facts discovered really stretches it over the top. Taking that to the next level your comments essentially imply that the editorial board of the journal Spine would also let substandard material be published and this starts to sound like a white wash campaign.
There is no guidelines that support "maintenance care". The research that you criticize are infact guidelines that represent care for actual neck pain with a start point and an end point that, manipulative care was not found to be superior but on par with other manual care and is part of a program to include exercise etc. The same panel did not find that conventional PT care was any better either.The panel did not suggest that the published findings would be a fixed end point but in fact a beginning for further research.
I personally attended the presentation along with many of my Physio friends and GPs from my area. The list of speakers included mds from central america the USA and Europe. All were present and presented their findings in their respective areas.
There is no doubt that bilateral vertebral artery tears here represent a profound breakdown and abuse of the treatment, manipulation. There is no defending this approach but you (Proud) slide down a slippery slope when your generalizations challenge other learned professionals who are not Chiro's nor individuals who selectively do research to support Chiropractors. While I understand you will have an automatic and tongue and cheek response to this post I wouls suggest that you consider the material presented.
< Message edited by bonez -- June 17, 2008 12:51:16 AM >
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RE: chiropractic lawsuit - June 17, 2008 11:29:07 AM
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proud
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I will start by saying that was a well thought out post Bonez. I agree with many points however disagree with your insinuation that I fail to see the value in mult-national, multi-disciplanry panels. To insinuate otherwise in not in the spirit of my post. My post pointed out very well known facts:
1. When a researcher or leader of a study has a background in the subject being investigated....there are natural biasis that occur. That is one of the problems with much PT research as well. If the researcher is a PT...he/she is going to have a few natural biasis. And in this case, the "weight" placed upon certain studies really hinges on the leader of the reviews. When systematic reviews occur, they have to look at the strength of the research articles presented. There could be 1000 articles and only one with sigificant power....the rest stink. And most "research" into various modes of tx for neck pain are not exactly flawless in design. Funny thing about Literature reviews....bundling up RCT's in a systematic review has a few problems: Performing a quick search on Medline and other search engines, a number of systemmatic reviews will appear, with the same purpose and almost the same resources, yet.... with different conclusions!
Dr. Haldeman was the lead researcher here. His primary diploma was as a chiropractor. That in of itself should raise some eyebrows because I'm willing to bet he has some internal bias about the VBI link to cervical manipulation.
2. Also...to your comment about the editorial board on Spine journal. Come on now....do you think only greatly designed articles get published in reputable journals? How about the one that compared chiropractic care to PT care to a booklet in the Tx of LBP?( cherkin et al NEJM). look at the serious flaws in that study....IN THE NEJM!!! So no....I do not expect just because it got published in Spine that is therefore perfect...
Example 2: Spine published an article by Mauritis et all 2000( asystematic review of 39 RCT's) which stated : "Specific back exercises are not recommended for patients with acute and chronic LBP". The problem: All but one of the studies included in the review had higher than level 3 evidence. Yet latter indicated that there was strong evidence to support exercise for LBP based on the work of Richardson, Jull, Hides etc). Contradictory and bizzare....Yet there it was....published in spine.
3. And thirdly, I did not "challange" other learned professionals. I stated that other panels have uncoverd polar opposite results....THAT is the challange for all the learned professionals. Right?...right...
And since a variety of learned professionals tend to disagree with one another.....then the ethical thing to do is cease the Tx until an answer is made perfectly clear. It's one thing for a variety of learned individuals to disagree about what shoulder mobilization works best for impingement syndrome...no one get's killed if one of them is wrong....
Really Bonez...the Upton Sinclair quote applies. Are you suggesting that this panel that YOU choose to value is the end all? Why not have a look at other learned experts opposite opinion? Could it be because THAT is the panel that supports YOUR view of the safety issue?
Again...I do not care. I can manipulate the C-spine. But for me, my outcomes have been equally effective with my cervical spine patients since I disgarded the C-spine manipulation. So my salary simply does not depend upon it.
< Message edited by proud -- June 17, 2008 2:43:14 PM >
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RE: chiropractic lawsuit - June 17, 2008 4:16:36 PM
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Jon Newman
Posts: 1706
Joined: April 24, 2004
From: Amherst, WI
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The task force included a report, to their credit, that addresses potential conflict of interest issues. It seems they made a concerted effort to be transparent.
quote:
Author Reardon, Rhoda; Haldeman, Scott DC
Institution From the *College of Physicians and Surgeons of Ontario, Ontario, Canada; +Department of Neurology, University of California, Irvine, CA; and Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA.
Title Self-Study of Values, Beliefs, and Conflict of Interest: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
Source Spine. 33(4S) (Supplement):S24-S32, February 15, 2008.
Abstract
Study Design. Observation and survey of values, beliefs, and conflicts of interest.
Objective. To study the values, beliefs, and potential conflicts of interest that the Neck Pain Task Force brought to their deliberations.
Summary of Background Data. Researchers' values and beliefs were studied to uncover areas of divergence and to develop guiding principles to assist decision making.
Methods. An observer used direct observation and survey of the Neck Pain Task Force, facilitated discussion, and developed a "disclosure tool" to collect information about relationships between researchers, funders, and others with a vested interest in the outcome.
Results. Clinicians and research methodologists brought different imperatives to the research process. Clinicians focused on offering useful advice, whereas methodologists guarded investigative rigor to ensure that evidence actually supported advice. Group conflict did not polarize along "clinical discipline lines." The Advisory Committee had greater impact when given a clear task and time to work as a group. The Neck Pain Task Force agreed on a set of "guiding principles," which became an overarching doctrine to guide their work. The disclosure questionnaires described relationships between Neck Pain Task Force members and other entities that might have had a financial interest in the topic.
Conclusion. This study describes a process used to assess values, beliefs, and conflicts of interest among members of a scientific task force, and how this was used to create "guiding principles" to assist the research team in deliberations, particularly when conflict arose. Most members of the Neck Pain Task Force had potential conflicts of interest with various stakeholders, but there was marked diffusion of these potential conflicts and no evidence that any funder or other vested interest stakeholder was likely to have a significant impact on the deliberations or conclusions of the Neck Pain Task Force.
< Message edited by Jon Newman -- June 17, 2008 4:22:43 PM >
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RE: chiropractic lawsuit - June 17, 2008 4:42:22 PM
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Hpsg
Posts: 32
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For Rob -
quote:
This lady is a tetrapalegic! Not para, not quad, tetra!
Just a point of clarification: I couldn't find anything about any difference between quadriplegia and tetraplegia. Near as I could ascertain, the two terms are synonymous but for one being a purely Greek term and the other being a combination of Latin and Greek, which bothers some... also the term tetraplegia is used in Europe whereas the term quadriplegia is used mostly in N. America.
Links:
1. "People with this type of paralysis are referred to as Quadriplegic or Tetraplegic."
2. quote:
I am afraid that I was part of the group that suggested the use of the word tetraplegia. Tetraplegia has long been used in England and Europe where they are much more knowledgeable and sensitive to Greek and Latin roots of words than Americans. The words tetra and quadri come from the Greek and Latin words meaning "four". The word plegia come from the Greek word meaning a "blow". Thus, when you use the word quadriplegia, you are mixing Greek and Latin words.
3. Quadriplegia, also known as tetraplegia, ...
quote:
The condition is also termed tetraplegia. Both terms mean "paralysis of four limbs"; tetraplegia is more commonly used in Europe than in the US. In 1991, when the American Spinal Cord Injury Classification system was being revised, it was recommended that the term tetraplegia be used to improve consistency ("tetra", like "plegia", has a Greek root, whereas "quadra" has a Latin root).[3]
However, quadriplegia is still the term more commonly used by the general public in the US.
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RE: chiropractic lawsuit - June 17, 2008 8:36:34 PM
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bonez
Posts: 230
Joined: August 29, 2007
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quote:
ORIGINAL: proud
I will start by saying that was a well thought out post Bonez. I agree with many points however disagree with your insinuation that I fail to see the value in mult-national, multi-disciplanry panels. To insinuate otherwise in not in the spirit of my post. My post pointed out very well known facts:
1. When a researcher or leader of a study has a background in the subject being investigated....there are natural biasis that occur. That is one of the problems with much PT research as well. If the researcher is a PT...he/she is going to have a few natural biasis. And in this case, the "weight" placed upon certain studies really hinges on the leader of the reviews. When systematic reviews occur, they have to look at the strength of the research articles presented. There could be 1000 articles and only one with sigificant power....the rest stink. And most "research" into various modes of tx for neck pain are not exactly flawless in design. Funny thing about Literature reviews....bundling up RCT's in a systematic review has a few problems: Performing a quick search on Medline and other search engines, a number of systemmatic reviews will appear, with the same purpose and almost the same resources, yet.... with different conclusions!
Dr. Haldeman was the lead researcher here. His primary diploma was as a chiropractor. That in of itself should raise some eyebrows because I'm willing to bet he has some internal bias about the VBI link to cervical manipulation.
2. Also...to your comment about the editorial board on Spine journal. Come on now....do you think only greatly designed articles get published in reputable journals? How about the one that compared chiropractic care to PT care to a booklet in the Tx of LBP?( cherkin et al NEJM). look at the serious flaws in that study....IN THE NEJM!!! So no....I do not expect just because it got published in Spine that is therefore perfect...
Example 2: Spine published an article by Mauritis et all 2000( asystematic review of 39 RCT's) which stated : "Specific back exercises are not recommended for patients with acute and chronic LBP". The problem: All but one of the studies included in the review had higher than level 3 evidence. Yet latter indicated that there was strong evidence to support exercise for LBP based on the work of Richardson, Jull, Hides etc). Contradictory and bizzare....Yet there it was....published in spine.
3. And thirdly, I did not "challange" other learned professionals. I stated that other panels have uncoverd polar opposite results....THAT is the challange for all the learned professionals. Right?...right...
And since a variety of learned professionals tend to disagree with one another.....then the ethical thing to do is cease the Tx until an answer is made perfectly clear. It's one thing for a variety of learned individuals to disagree about what shoulder mobilization works best for impingement syndrome...no one get's killed if one of them is wrong....
Really Bonez...the Upton Sinclair quote applies. Are you suggesting that this panel that YOU choose to value is the end all? Why not have a look at other learned experts opposite opinion? Could it be because THAT is the panel that supports YOUR view of the safety issue?
Again...I do not care. I can manipulate the C-spine. But for me, my outcomes have been equally effective with my cervical spine patients since I disgarded the C-spine manipulation. So my salary simply does not depend upon it.
Well as I indicated there will be quite a bit of histronics over the collected posts on this topic.
I must say that the lion's share of the Bone and Joint decade did not deal with VBI. The thrust (haha)was in fact directed toward the affect neck pain has on society and what the true information says about it's treatment. I can only assume that you did not attend one of the the actual live presentations that were done around the world because if you did then you could have raised these concerns of yours toward the task force it's self. They should have the oppurtunity to defend themselves and not rely on me for that.
Your version of the apparent reasoning for these individuals choices as what to include is based on your bias and perception of what you assume was said.
As the "abnormal" chiro on this board I guess my attending the presentation was a waste of time because it was all about the association with VBI and not the current state of literature on the topic.
I would also suppose that when Dr Sackett testified at a hearing on VBI and it's research in Ontario where he indicated that the sample size necessary to do the research correctly was in the order of millions because of the raritiy of the event. He was also cowing to the Chiro monoply to make his statements fit our bias too?
At the end of the day your negative feelings toward this profession will always make it difficult if not impossible to produce anything supportive of my profession through any research direction and as such I expect more of your same posts which offer lots critical but quikly defensive if the position is challenged.
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RE: chiropractic lawsuit - June 18, 2008 6:20:54 AM
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Sebastian Asselbergs
Posts: 1191
Joined: September 29, 1999
From: Barrie, Canada
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Bonez, I happen to agree with Sacket. To prove a direct relationship between upper cervical thrust and VBI is FAR from easy - and has NOT been done. Causal relationships need a very strong level of evidence, and that is simply NOT available at this time - and may never be available.
What it ends up boiling down to, is potential risk versus possible benefit; is upper cervical thrust the ONLY tool for certain diagnoses? Or are there alternatives with less risk of potential injury? (hint: I think there are)
I personally think that at this time, a horrible personal tragedy tends to make lawsuits an emotional issue. Is the woman's care justifiably under scrutiny? Hell, yes.
Will there be enough strong evidence linking the "adjustment" with the incident? Darn unlikely. At this time, there only seems to be a time-line correlation; same as in the other reported cases of such nature. And thus far, the incidence of such events appears to be rare.
Having said that, it looks like it is time for chiropractors to drop the upper cervical thrust from their practice: first, because minimizing risk to patients - wherever possible - is always GOOD. Second, this technique is now under such scrutiny, they would be plain dumb to continue its use and open themselves up to more challenges....
I cringe when I think about the times I performed 2-person Cyriax manipulations - the forces were quite huge (check Cyriax's books for pictures - scary). Glad I was scared enough instinctively to drop those in the 80's.
_____________________________
Mundi vult decipi
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RE: chiropractic lawsuit - June 18, 2008 7:01:53 AM
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rwillcott
Posts: 427
Joined: March 20, 2006
From: Canada
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I agree with Sebastian in that it can be difficult to link an upper cervical manipulation with stroke in some cases. However, I think there is more than timeline as evidence in this particular case. This lady has suffered bilateral tears of here vertebral arteries. One was said to be 3 inches in length. What else could have caused this besides a manipulation? I think it's an easy case. She does not report falling down the stairs, an MVA or any other mechanism of injury. Seems like an open and shut case to me.
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