With apologies to the title of the somber film classic by Ingmar Bergmann, one has to question through what lens the chiropractic profession is being perceived by the media. The continuing cavalcade of medical journal articles attempting to link cervical manipulation to almost anything short of a nuclear arsenal is ludicrous, if not a frightening blow of dizzying proportions to the chiropractic profession. As much of the media would have it, cervical spinal manipulation has indeed been hinted to be a "weapon of mass destruction."1-6 It has been reported that the miasma surrounding the perpetual Lana Lewis inquest in Toronto has already cost the profession $100 million in lost visits,7 to say nothing of a wave of anxiety and inquiries as to whether cervical manipulation is actually as destructive as it is cracked up to be.
A grim example of this innuendo, and living proof that satire has not died, was plainly evident when I had the opportunity in June 2002 to witness firsthand a day of the Lana Lewis inquest in Toronto. Actually, it was more like the Marx Brothers classic, "A Day at the Races." Anyone present will tell you it was far from being one of the best days for Dr. John Norris, the primary witness for the prosecution. Without digressing, suffice it to say, Dr. Norris issued a bushel of unsubstantiated and contradictory statements, which he had to retract.
Instead of devoting even a microsecond to this major turn of events, however, many of the television newscasts that evening focused on the bereaved family of Lana Lewis. About half the airtime seemed to dwell on one particular member of the party who showed up in a wheelchair, which of course had nothing whatsoever to do with the manipulation or chiropractor called into question, but obviously provided good street theatre to the effect that chiropractic could be wiping out our population. This was not a news story about the "miracle of Lourdes," folks - it was supposed to have attempted to clarify what might have brought on Ms. Lewis' stroke. It comes down to some issues in human nature, and just who is reporting these issues of stroke. This story can be traced back at least a decade, when F.C. Powell published a report in Neurosurgery that suggested:
"The risk/benefit ratio for patients with midline neck pain is unacceptably high, and cervical SMT should be discouraged as treatment. Moreover, it is unlikely that a sufficiently high benefit for SMT in patients with benign disease processes will be achieved to justify the risk of severe complications, no matter how infrequent the occurrence." [emphasis mine]8
It does not take more than a few "milliwatts" of intelligence to perceive that this statement is dripping with bias and has no place in a scientific journal. Students of 9th-grade algebra will immediately take note that with the benefits of spinal manipulation not given any attention and set to zero, the risk/benefit ratio with even an infinitesimal numerator will skyrocket toward infinity.
Things did not get any better two years later with the infamous publication by Lee, Carlini and others in the journal Neurology. This was a survey of 486 patients, only 177 of whom even responded at all, yielding the underwhelming participation rate of 36 percent. With the questionnaire not even validated; failure to indicate that the vast majority of VBAs are spontaneous;9,10 failure to indicate that the respondents even documented their outcomes directly from their files; lack of a baseline (frequency of cervical manipulations); or even comparisons to other treatments for similar conditions, it was easy to conclude this was one sick paper.11 In fact, it led no less an authority than Scott Haldeman, DC, MD, PhD, to conclude:
"Unfortunately, this article tells us more about the biases of the surveyed neurologists, the authors, and the editorial board of Neurology than it does about the complications of manipulation. It should never have been published."12
What about the more recent case-control studies,13,14 intended to be more rigorous than these retrospective reviews? Hardly an improvement, if you consider the simple fact that in both papers, the most obvious control - visits of the patients with complaints of neck pain to a nonchiropractor - was never even considered.
In fact, it gets even more bizarre: In addition to continuing to ignore the benefits of cervical manipulation, and thus deriving the aforementioned mushrooming risk-benefit ratios, the Smith paper14 stretches the critical reader's imagination to the breaking (or at least dissecting) point by:
Basically, the recurrent problems with these foregoing stroke studies appear to fall into seven major categories:
References
Anthony Rosner, PhD
Brookline, Massachusetts
rosnerfcer@aol.com
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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?
