Connecticut to Mandate Chiropractic Stroke Risk Warnings?Published: 2010-07-21 17:25:50Author: CHARLES ROCK | 27-7 Press Release | April 23, 2010This past January, the Connecticut State Board of Health and Board of
Chiropractic Examiners held a series of public hearings on whether there
is a need to mandate that chiropractors warn their patients of the risk
of stroke prior to performing certain spinal manipulations.
Chiropractors have been adamant that they should not be required to
provide patients with information on the risks of stroke prior to
performing cervical spine adjustments. During the hearings,
chiropractors from many states were brought in to argue that the Board
should not mandate
informed consent because it unfairly singles out
chiropractors. They also argued that they should not be required to warn
patients of the risk because there is no credible scientific proof that
such a risk is real.
There is, however, a substantial body of scientific literature developed
in over sixty years of case studies, and through other medical evidence
including autopsy and radiology, confirming the cause and effect
relationship between
neck adjustments and stroke.
Medical doctors are required to inform their patients of the risks of
undergoing their proposed treatment, the risk of foregoing treatment
altogether, the benefits and alternatives to their treatment, so that
when their patient gives permission for the treatment, their consent is
truly informed. So it is unclear how chiropractors can argue in good
conscience that they are being singled out.
Last year, Connecticut state lawmakers attempted to pass a bill that
would have required chiropractors receive written informed consent from
their patients prior to performing cervical spine adjustments. The
consent included a warning of the
risk of chiropractic stroke. The bill, however,
received strong opposition from state chiropractic groups and never
passed.
Should the Connecticut State Board of Chiropractic Examiners vote in
favor of informed consent, it will be the first state in the country to
have such a requirement and may pave the way for other state boards to
follow suit.
Risk of Chiropractic Stroke Real
Chiropractic cervical manipulations cause stroke in a certain number of
patients by tearing the lining of either the vertebral or carotid
arteries. These blood vessels travel up the neck and supply blood to the
brain. When these arteries are torn, blood clots may develop which can
break off and flow up into the brain until they lodge into a smaller
artery, causing a cessation of fresh blood to that portion of the brain.
This tissue dies quickly and can never be replaced. This is called a
stroke.
One way the arterial lining can be torn is by rapid rotation motion of
the neck, which can occur when a chiropractor improperly performs a neck
manipulation. In some cases, chiropractic patients actually have seized
and died on the table after receiving one of these neck adjustments in a
chiropractor's office. In other cases, patients may not suffer a stroke
until hours, days or even weeks after their chiropractic visit.
The true incidence of chiropractic stroke is not known. Estimates range
anywhere from one out of every 4.5 million manipulations to one out of
every 40,000 manipulations. Several factors make it difficult to
determine a more accurate risk level. For example, because chiropractors
do not follow-up with their patients progress the way that medical
doctors do, they may never know when a stroke occurs. Also, depending on
the length of time between the chiropractic visit and the stroke, the
patient may not make the connection between the neck manipulation and
the stroke. This is in part why advising the chiropractic patient about
the risk would enhance patient safety. The patient would be able to
advise the physician about the cervical manipulation when they have
stroke-like symptoms, then the physician could evaluate the arteries and
if there is a tear, preventive measures could be undertaken in time to
prevent a full-blown stroke.
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