Sandra Nette is a prisoner, condemned to spend the rest of her life in the cruelest form of solitary confinement. Her intact mind is trapped in a paralyzed body and she is unable to speak. She can move one arm just enough to type on a special keyboard. She cannot swallow or breathe on her own, and must be frequently suctioned. She feels sensations and is in pain. Her condition is known as “locked-in syndrome” and has been described as “the closest thing to being buried alive.” She is suing those responsible for her cruel fate and I hope she wins.
She was a healthy 40 year old woman who wanted to stay healthy. She did all the right things like watching her weight, eating right, and not smoking. She followed the advice of a chiropractor to include regular maintenance chiropractic adjustments in her health regimen. On September 13, 2007 she had the last adjustment she would ever have.
There was nothing wrong with her. She didn’t see the chiropractor for headaches, neck pain, back pain or any other complaint. She went for a “tune-up” that she thought would help keep her healthy. The chiropractor did a rapid-thrust adjustment on her neck. Right afterwards, she complained of feeling “sore, dizzy and unwell.” She tried to leave but had to sit down. The chiropractor failed to recognize the medical emergency, and instead of calling an ambulance he recommended that she would benefit from purchasing massage therapy from his clinic. He let her leave the office and drive home alone. She only made it part way.
In the hospital, doctors determined that she had tears in BOTH vertebral arteries in her neck. One tear was 3 inches long.
Chiropractors would like us to believe that strokes after neck adjustments are mere coincidence, that patients like Sandra go to a chiropractor because they have neck pain from a stroke-in-progress and the manipulation is not the culprit. But cases like this are crystal-clear: she had no prior symptoms and there is no question that the neck maneuvers directly caused the tears in the arteries. One of the doctors in the ER took one look at her and asked her husband, “Chiropractor?” Neurologists, emergency physicians, and rational chiropractors all recognize that neck adjustments occasionally cause strokes, but the majority of chiropractors are still resisting reality.
Chiropractors tell us that strokes after neck adjustments are exceedingly rare, and that other forms of treatment, such as NSAIDs, are more dangerous. But in this case, it wasn’t a question of comparing treatment options, because nothing was being treated. There is no evidence to support the practice of maintenance adjustments. The absolute risk is small but the risk/benefit ratio is infinite because the benefit is zero. For a fuller discussion, see my previous blog article on Chiropractic and Stroke.
Sandra didn’t know that neck manipulation could cause a stroke. She didn’t know that maintenance adjustments only benefit the chiropractor’s bank balance. She wasn’t informed, so she couldn’t give informed consent.
Sandra isn’t just suing the chiropractor. She and her husband are suing:
• Gregory John Stiles,
• The Spa and Life Stiles,
• The Alberta College and Association of Chiropractors, and
• Her Majesty the Queen in Right of Alberta (Minister of Health and Wellness).
And they are seeking an order to make it a class action suit to cover every patient who received “an inappropriate and non-beneficial adjustment from any Alberta chiropractor since 1998.” Potential beneficiaries include those patients’ spouses and their estates if they are deceased.
Among other things, they contend that the defendants owed their patients a duty to not advise procedures that lacked scientific justification, to fairly disclose the benefits and risks of their interventions, and “not to charge them a fee for services that cannot restore, maintain or enhance human health.”
The Statement of Claim runs to 80 pages and describes the foundation of chiropractic, previous lawsuits, the published literature, and warning statements by groups like the 62 Canadian neurologists who spoke out in 2002. It provides extensive, detailed evidence to show that the College and the government were well aware of the risk of stroke and it argues that the College and the Minister of Health should have acted to regulate chiropractic to prevent disasters like Sandra’s.
They accuse the College of acting in bad faith, concocting evidence, sponsoring “methodologically inadequate research studies designed to validate rather than investigate the issue” and distorting scientific findings to support traditional chiropractic beliefs and economic interests. Strong words.
They are asking for $529 million dollars in damages.
Consumer advocates and victims of chiropractic have asked to meet with Canadian legislators and the Minister of Health to propose the following guidelines:
ONE: INFANTS AND CHILDREN: Highest neck manipulation should never be done in infants and children for claims to treat such conditions as ear infections, tonsillitis, infantile colic, asthma and gastro-intestinal disorders nor as an alternative to scientific immunization against diseases such as polio, tetanus, measles, mumps, German measles or chicken pox. The Chiefs of Paediatrics of our Canadian Hospitals have all condemned such claims by chiropractors.
TWO: PHILOSOPHICAL CLAIMS: Highest neck manipulation should never be done for the claim that it is effective to awaken the “innate intelligence of the spinal cord” and thereby provide “wellness or health” of the entire body. The idea that the spinal cord has some magical “innate intelligence” is a fundamental chiropractic belief. It is false.
THREE: REPETITIVE HIGHEST NECK MANIPULATIONS: Highest neck manipulation should not be done on a repetitive basis with claims that this will keep the neck vertebrae in proper alignment. It is false to claim that highest neck manipulation is necessary for the “maintenance” of the alignment of the highest neck vertebrae. The vertebrae are attached to each other by a complex structure of bone, ligaments and muscles. Manipulating the highest neck time and time again on people who have no complaints in that area should not be done.
FOUR: INFECTIONS: Highest neck manipulation should not be done for any claims that it alters in any manner, the immune system, to prevent or to treat infections such as Acquired Immune Deficiency Syndrome and other bacterial, viral or fungal infections.
FIVE: BODY ORGANS: Highest neck manipulation should not be done for claims that it can have a health benefit upon a body organ such as the heart, lungs, kidneys and liver or as a means of preventing the onset of genetic disorders or cancer.
SIX: VERTEBRAL SUBLUXATIONS: Highest neck manipulation should never be done for the claim that it can remove so called “vertebral subluxations” in the highest neck area. It is false to claim that these top vertebrae are out of alignment, even in new born babies, and that manipulating the highest neck area one can improve the function of the brain stem as well as treat conditions such as sinusitis and even multiple sclerosis. There is no neurological or scientific basis for such claims.
These guidelines make sense, and rational chiropractors should have no objections to them. They would not interfere with spinal manipulation therapy for musculoskeletal conditions, and they would eliminate much of the quackery in chiropractic.
The outcome of this lawsuit could have broad implications. If the judge finds that providers owe their patients a duty to not advise procedures that lack scientific justification, it will open the door to similar lawsuits involving other alternative medicine modalities. It might also open the door to lawsuits against scientific MDs who can’t convince the court that a treatment is adequately supported by scientific evidence. We want to eliminate quackery, but we don’t want to make the courts the arbiters of what constitutes sufficient scientific evidence.
Lawyers are smart and they will undoubtedly put up a good defense. If nothing else comes of this lawsuit, it should at least promote a useful discussion. There have been repeated recommendations to require chiropractors to at least disclose the risk of stroke to their patients, and no official body has yet acted on those recommendations. Maybe now they will. If not the official bodies, maybe the chiropractic malpractice insurance agencies, out of sheer financial self-interest, will start requiring their clients to get informed consent from their patients.
The transcript of the trial alone ought to furnish enough documentation for someone to write a book on the risks and benefits of chiropractic and the associated science or lack of science. This may do for chiropractic what Dover did for Intelligent Design. I will follow it with great interest.
This article was originally published in the Science-Based Medicine Blog.