Tag Archives: risk

Is Chiropractic Safe?

This is a controversial question, though I’m not sure why. The short answer is, yes, it is safe. The easiest way to tell is to look at malpractice insurance premiums. Insurance companies don’t mess with risk. They charge an arm and a leg if they think you are a risk. Can anyone say preexisting condition? The average premiums for different professions will tell you who has risk of problems, and does not. Here let me show you some numbers (source):

Approximate Malpractice Insurance Premiums

OB/Gyn
$120,000
General Surgeon
$75,000
Internal Medicine
$20,000
Family Practice
$15,000
Chiropractors
$2000-4000

In fact through out many studies proper chiropractic treatment has not been shown to cause anything more than short term soreness at the site of treatment.

Now here’s where it gets controversial. And people may say, wait a minute studies have shown more than that. It’s true there have been rare serious problems seen after chiropractic treatments. The problem is that they are so rare that research has not been able to prove a causal link to chiropractic, or to rule it out. In fact the most recent and complete study showed that the biggest risk is no greater visiting a chiropractor than visiting a medical doctor (second source). These problems are so rare that it is nearly impossible to prove one way or the other.The big one that you’ll hear about is stroke, and the risk is estimated (due to lack of concrete evidence) to be somewhere between 1 in a million to 1 in 5 million. You can see how difficult it would be to do a study with 1 million chiropractic neck pain patients, let alone 5 million. In contrast, the mechanism of treatment seems like it could cause stroke in a predisposed patient, because in those predisposed people, simply turning your head to look at something could cause a stroke. Unfortunately there are no known tests to determine if a patient is at risk.

OK, so let’s put them out there. The possible risks of chiropractic treatment include, bruising, muscle strain, undefined soreness, headache, bone fracture, stroke. Now let’s put them in perspective. You are at least 5 times more likely to be killed by a freak asteroid falling on you than you are to have a stroke after seeing a chiropractor. Now how many people do you know that have been hit by asteroids? Bone fracture is another one of those rare things, and again will probably only happen when someone is predisposed. A person with osteoporosis, or suspected to possibly have osteoporosis, should not be adjusted with a full force method. This is why I usually leave this side effect out of the list when talking about proper chiropractic treatment. As for the headaches, soreness, and bruising, this kind of stuff will usually occur when a patient is unable to relax and the doctor uses a lot of force to get by that problem. It can occur in probably 30% of patients, because sometimes it is necessary to get the joint moving even knowing that the patient is unable to relax. This is something that should be discussed with the patient, and normally the soreness is less than 24 hours.

The last thing that I will say is that you should always bring negative effects to the attention of your chiropractor. Even if they are not caused by the doctor himself he should be aware of them, so that if they are serious he can take care of them or get you to an ER if needed. Some of the serious things to report are; intense pain, dizziness, vertigo, slurring of speech, vision changes, weakness, tingling, or numbness. They may be nothing, but you should let your doctor determine that.

Informed Consent

In Connecticut there is a debate over chiropractic and the topic of informed consent.  (News Article) The debate is not over whether there should be informed consent.  In fact, in the United States, informed consent is already mandatory for all health care providers.  Informed consent is supported by chiropractors.  It is in the best interest of our patients .  No!  This debate is over whether chiropractors should be forced to inform every patient of a risk of stroke.

There are many problems with this.

CAUTION: there are risks to drinking water!

The most obvious is that chiropractic is not known to cause stroke.  The only evidence even remotely related does not show that it causes stroke, but that there is an association.  The same association that exists with medical doctors (oh, and hair dressers).  So if it’s not known to cause it why would you force chiropractors to inform people of the risk.  I think I know the reason.

If it is required for chiropractors then it should also be required of all health care practitioners that have equivalent risks. Can you imagine walking into every doctor’s office and having to sign a paper that says that if you came to that office to see them for neck, head or upper back pain there is a possibility you could have a stroke after seeing this doctor. Either no one would go to doctors for those conditions or it would become so prevalent that the warning would become like the boy who cried wolf, useless.

Another problem is the actual risk level that we are talking about. The risk of having a stroke after seeing a chiropractor is somewhere in the region of 30-300 times less likely than you dying in a lightning strike.  Should I have to also warn my patients that they may aspirate  and die from that water I recommended they drink.

Defining what must be included in informed consent adds loopholes for dishonest people and destroys the purpose of informed consent, that of an honest and open conversation between a doctor and a patient.  Please doctors share the likely and serious risks with your patients.  Inform them, by all means.  Don’t get ridiculous.

Your Choice for Pain Relief?

The FDA has fought any changes “because senior FDA managers saw them as too offensive to Johnson & Johnson.” However, last week the FDA changed the requirements for the number one pain medication in the United States, acetaminophen.  The new labels will be adding a warning for patients.  Unfortunately, to the general public, over the counter is interpreted as SAFE.  Any drug can hurt you.  You should always use medication as prescribed to reduce your risk.  Even when used as prescribed however drugs can be dangerous.  That is the reason for this new warning.

Acetaminophen is the number one cause of liver failure in the US and has been for some years. Even at recommended doses acetaminophen has been found to cause dangerous liver damage.

“Acetaminophen, sold under the brand name of Tylenol, is widely regarded as the safest pain reliever available, yet the drug accounts for 100,000 calls to poison control centers, 56,000 emergency room visits, 26,000 hospitalizations, and 450 deaths annually.”  -Healthfacts

Those numbers are relatively small risk. It is estimated that 100 million people in the US use acetaminophen so the risk of death statistically is about 1/250,000.  Statistics are always hard to grasp and are very misleading.  My numbers, for example, are taken from different articles and different years, so are only approximate.  The number of deaths also is more than just accidental overdoses, but it gives you an approximate idea of how dangerous even over the counter pain drugs can be.

The big concern is the accidental overdoses.  Because people don’t realize that they are overdosing when they take a NSAID for pain and something for their cold.  This is especially true when both medications are “safe.”  There are also increased dangers when people take these after drinking all night to reduce a hangover, or when they haven’t really eaten well in days.

The new labels are only required to list the danger of gastrointestinal bleeding and liver damage in bold.  They leave out the increased risks of high blood pressure and other controversial issues.

So the question is what should the millions of people with pain do? Many groups and websites discuss this question, and the risks and benefits.  The one thing that I haven’t seen them present is the option of chiropractic.  Even in the worst studies chiropractic has been found to be ONLY as good as these medications for everyday aches and pains.  The difference is that chiropractic doesn’t have the major side effects, addresses the underlying problem,  and the risks involved in chiropractic are much lower.