I and many others in the past few weeks have mourned the passing of Chuck Jones, a childhood hero who was the creator of the immortal Bugs Bunny, Daffy Duck, Porky Pig, Elmer Fudd, and the parade of the denizens and situations we all knew of collectively as Looney Tunes. However, the recent barrage of negative media events on chiropractic - all based apparently upon the highly opinionated beliefs of a group of crusading Canadian neurologists1 - tell us in no uncertain terms that Looney Tunes ain't dead yet - not by a long shot. In fact, if only a money trail (in Canadian "looney" dollars or whatever) could lead to all the media outlets that have issued what are either unsupported or abysmally documented allegations about the dangers of chiropractic adjustments, with far more exposure than ever deserved, you could argue that "Looney Tunes" would be the perfect way to describe who's been paid off.
Like so many malformed and demented images at a carnival side show, complete with barkers and calliope music, national media presentations in just the past month have attempted to generate public hysteria over what has been described as the "perils" of chiropractic. The venue that chose the term "perils" elected to do so by plastering headlines that were larger than those run by the New York Times last September to describe the terrorist attacks in New York and Washington.2 This was followed, in short order by [i] an alarmist broadcast on Joan Hamburg's "Medical Minute" on WOR radio in the New York metropolitan area that created the impression that a visit to a chiropractor could turn out to be a lethal experience;3 [ii] a posting on Time magazine's website by the senior editor that not only made a mockery of the author's scientific credentials (chief science writer for Time, managing editor of Discover, and recipient of the Richard Leaky award from the American Association for the Advancement of Science, top journalism awards from the AMA and the American College of Allergy and Immunology), but of anything remotely connected with systematic information retrieval. In terms of objective news reporting, Edward R. Murrow and Howard K. Smith would be spinning in their graves.
Following the screaming headlines, Brad Evenson's article in the National Post put forth the statement from "60 leading Canadian neurologists" that neck manipulations "cause strokes and crippling injury with alarming frequency." For openers, a major clue that this statement was politically motivated was that it almost triumphantly proclaimed that it was being dispatched on the fourth anniversary of a single chiropractic patient who died after a neck manipulation in Saskatoon. The article insisted that the prevailing estimation of frequency of stroke - one per million neck manipulations (actually, substantially less5,6) - produces 200 strokes per year, or as many as one in 5,000 manipulations. Much of this data is based upon a study by John Norris, one of the chief signatories of the aforementioned communiqué to the Canadian neurologists.
To its credit, the Norris study correctly suggested that a variety of neck movements could precipitate vertebrobasilar artery events,7 in keeping with a large and compelling body of literature. However, spinal manipulation can be shown to represent but a tiny fraction of these precipitating movements, and is almost impossible to identify with any regularity as the predominating cause of an arterial dissection. The author did give his prejudices away by stating, "There is no doubt that chiropractic neck manipulation can result in the dissection of the carotid or vertebral arteries leading to stroke," with no support from either the data in his paper or the literature cited.7 His letter of response to criticisms only appeared to make matters worse, for it refused to disclose any details supporting his contention that manipulation of the cervical spine was associated with 27 percent of the strokes observed in 50 cases per year. Worse, Norris flaunted his prejudice by stating, "The research question is not whether neck manipulation can result in dissection of a cervical artery, for it surely can..." (italics mine).8 So can stargazing; yoga; hair-washing; driving a vehicle; archery; wrestling; emergency resuscitation; rap dancing; sleeping; swimming; and tai chi - at frequencies at or above those that can be attributed to spinal manipulation.5,9,10
By far the most offensive and pathological article was Leon Jaroff's, which graced the Time website (www.time.com). From its leading sentence ("Chiropractors have been taking their lumps lately"), to its headline ("Back Off, Chiropractors!"), to its profusion of pejorative terminology used to describe chiropractic ("bewildering variety of weird practices ... sillier ... troublesome ... bizarre"), it is not too difficult to assume that the article would have as many good things to say about chiropractic as Amnesty International would have found words to support the Holocaust. It began by quoting the Canadian neurologists again - this time at a meeting of the American Stroke Association in Texas - stating that 156 cases of stroke were analyzed, and that "nearly 40 percent of them had apparently resulted from chiropractic neck manipulation."4 Again, the obvious questions are: What was the instrument used to capture the incidence of arterial dissections? Within what time period following the precipitating factor were vertebral artery dissections noted? How many of these were transient? What was the number of cervical manipulations performed? What was the technique employed? Given the fact that vertebral basilar artery accidents are often attributed to manipulators falsely represented as fully licensed and trained chiropractors,11 who were the individuals performing the manipulations?
But Jaroff doesn't stop there. Farther down in his column, he claims that "doctors find many of the other claims and practices of chiropractic questionable, if not downright objectionable."4 What doctors are we referring to here, anyway? Neurologists? Physical therapists? Physiatrists? He suggests that the problem lies within their vast differences in methods of treatments without a uniform criterion for identifying a subluxation. It seems to me that the man is unaware of a few disparities on the medical side, such as: [i] over a sevenfold difference in the rate of back surgeries performed, depending upon which part of the United States you are referring to;12 [ii] over 70 times the variation in the usage rates of medication for attention deficit disorder given to public school children in neighboring towns in Virginia;13 or [iii] opposing treatment recommendations for prostate cancer, depending upon whether the attending physician is a urologist or radiation oncologist.14
In my book, "bizarre" and "objectionable" would include the death rates due to medication side effects estimated by the Institute of Medicine to range from 230,000-280,000 per year,15 while those caused by NSAIDs (such as ibuprofen) are reported to approach an annual toll of 16,00016 - dwarfing any estimate of chiropractic facilities by several orders of magnitude that could ever be served up by crusading neurologists, the scientific literature, or whatever.
Continuing on his wrecking expedition, Jaroff opines: "Even more troublesome, all too many chiropractors urge their patients to eschew such widely-accepted health measures as immunization and fluoridation and to be suspicious of anything medical. Are these guys for real?" I will grant that the immunization question remains a topic of controversy, but I have seen precious little, if anything, on fluoridation. And where's the evidence that chiropractors are driving their patients to be "suspicious of anything medical?" If anything should cause one to be suspicious of anything medical, it would be Jaroff's commentary!
Finally, Jaroff jumped all over a recent JMPT article that found fault with patient brochures from practitioners and chiropractic national organizations, gleefully declaring that the conclusions published were "damning." Let's see. The actual conclusion, as I read it, states: "A sampling of patient literature...suggests that a significant segment of 'official chiropractic' in Canada and the United States publishes uncritical and scientifically unvalidated claims for the chiropractic healing art."17 Damning indeed. Have we forgotten the word "critical?" I recall that only 15 percent of medical procedures have been reported to be validated by any scientific data,18 and that only one percent has been considered to be worthwhile.19
What is truly amazing is how Jaroff delved into a journal almost never quoted in the national media to ferret out this single article (more a commentary than a traditional scientific study) to discredit chiropractic. He clearly walked right by the vast majority of other published studies in that same journal, which unfortunately have not received the media attention they should, yet for over a quarter of a century have indicated that chiropractic treatments not only match the medical alternatives for treating such diverse conditions as back pain;20 carpal tunnel syndrome;21 cervicogenic, migraine and tension-type headache;22-25 dysmenorrhea;26 premenstrual syndrome;27 infantile colic;28 enuresis;29 and even ear infections,30 but do so for longer durations after treatment and without the common, injurious or even fatal side of medications.
With this buckshot condemnation of everything chiropractic, Jaroff seems clearly driven to discredit it by any means possible. There is more tarring with the brush here than in anything I've seen since the Three Stooges last attempted to paint each other. Until these fearmongering agents of the media can appreciate the simple fact that randomized clinical trials offer support for the efficacy of chiropractic treatment, not only for managing back pain, but for headaches, carpal tunnel syndrome, infantile colic and bedwetting problems, and can share this information with their deserving audience, they are trashing their primary responsibility for giving the public truly meaningful medical advice on treatment options, the centerpiece of which should quite simply be the risk-to-benefit ratio.
Needless to say, I have spent much of the past month responding in detail to each of these charades in what we used to call "journalism." The public, which is entitled to the best health care information at hand, clearly is the loser here. On the other hand, they may take solace in that - contrary to popular opinion - vaudeville is not dead, and Mr. Jones' Looney Tunes live on in the pages and the broadcasts of our free press.
To quote one of Chuck Jones' favorite characters, "Th-th-th-that's all, folks!" Or, perhaps we should be taking the issue directly to our Canadian neurologists and asking each, point-blank: "What's up, doc?"
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
