Winnipeg Free Press - PRINT EDITION

Questions over chiropractic care

Some patients, neurologists say neck manipulations linked to strokes; chiropractic profession argues its procedures are safe

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Laura Brownson ran a successful dog grooming business on North Main Street for two decades. She would occasionally visit a chiropractor to deal with the aches and pains from handling the frisky canines, some weighing as much as 70 kilograms. She felt the visits helped her.

But that changed when the chiropractor -- whom she had seen off and on for 20 years -- manipulated her neck during an appointment in March 2010.

"I had an instant headache and I didn't feel right, but I didn't think a lot of it (at first)," Brownson recalled.

The pain refused to go away. She returned to the chiropractor, thinking he could fix it. He couldn't. She visited her doctor, telling him it felt as though a bone in her neck was broken. An X-ray revealed nothing. The pain in her neck was unbearable. "I was crying. I was hysterical. I was begging for my life," she said.

An ugly lump formed in the middle of her neck. Her ears blocked and she had vision problems. Her balance failed her and she had a nasty fall. Her speech was affected for months.

Brownson saw a series of doctors looking for answers. Finally, after eight months of searching, a St. Boniface Hospital neurologist told her she had suffered a stroke. More than one of her neck arteries had been dissected. "She (the neurologist) told me that I was lucky to be sitting in the chair across from her."

Brownson, now 44, has been unable to work for the past 21/2 years. "I went from being completely functional, running a business, having employees, taking care of two children... to doing absolutely nothing," she said.

She considered suing the chiropractor but a lawyer told her conflicting diagnoses from medical professionals would hurt her case. She filed a complaint with the Manitoba Chiropractors Association, but balked when she said the group demanded two years of medical records.

Brownson is part of a small group of former chiropractic patients and family members that is lobbying the Manitoba government to withdraw subsidies from chiropractic care. The group's members are demanding a review of the profession's practices and seeking a ban on what they term 'high neck' manipulations. The group met for more than an hour on Thursday with Health Minister Theresa Oswald. Oswald promised to look into its concerns.

Manitoba is the only province that subsidizes chiropractic care for all residents. Ontario delisted the service in 2004 and Alberta did so in 2009 -- for cost reasons. Saskatchewan and British Columbia limit chiropractic coverage to certain groups, while Alberta recently reintroduced coverage for seniors.

Canadian neurologists, meanwhile, have raised red flags about certain chiropractic procedures for years. A decade ago, more than 60 specialists issued a statement decrying the "debilitating and fatal damage manipulation of the neck may cause to the nervous system."

The specialists said physicians -- and the general public -- need to become more aware of the complications that can result from neck manipulations, most of which are performed by chiropractors. They also endorsed the major recommendations of a 1998 inquest into the death of Laurie Jean Mathiason of Saskatoon, a 20-year-old who died after having her neck manipulated by a chiropractor. The inquest recommended the risk of stroke associated with chiropractic treatment be visible in chiropractic reception rooms.

Chiropractors dispute any link between their practices and stroke. They say posted warnings would also be redundant since their patients already sign consent forms.

Dr. Brad Stewart, an Edmonton neurologist, said he has documented 10 deaths due to strokes in Canada over a 10-year period that were the result of chiropractic manipulations. In an interview, he said he treats five patients per year who have had strokes caused by chiropractic manipulation.

"The strokes -- it's not like it's an epidemic out there. But they're all unnecessary," he said. "We're seeing young, healthy people who are having their necks cracked for no good reason."

Stewart said if a procedure carries a small risk of harm, but there's a significant benefit, it is worthwhile. But if there is a small risk of harm and "no meaningful chance of benefit, then you don't go ahead with it." He said "it's not scientifically based" that the manipulations performed by chiropractors do any good.

A Winnipeg neurologist, Dr. Francis Dominique, is equally dismissive of the chiropractic profession. He said Manitoba Health shouldn't cover it. Right now, anyone with a Manitoba Health card qualifies for $11.20 in coverage per chiropractic session ($12.35 in the north) for up to 12 visits per year. The provincial support amounts to between one-quarter and one-third of the actual cost, depending on whether the patient is seeing the chiropractor for the first time or it's a subsequent visit. Chiropractic treatments cost Manitoba taxpayers $10.5 million last year.

"Doctors are being squeezed, because medicare cannot afford to pay this and can't afford to pay that," Dominique said. "And we're paying people for procedures, none of which has been proven by any good study to help anybody."

The College of Physicians and Surgeons of Manitoba has had a sometimes testy relationship with the chiropractic profession over the years.

In 1985, the college issued an alert to physicians warning about the dangers of neck manipulation. That and other statements prompted the Manitoba Chiropractors Association to threaten court action. But the two sides have since largely settled their differences.

"We've always said that for acute lower back pain, chiropractors can do a very good job," the college's registrar, Bill Pope, said recently.

But he said the college still strongly opposes chiropractors manipulating the necks of newborns, and it has also taken issue with chiropractors who question the value of vaccinations. Told of complaints the Free Press received from Manitobans who claimed to have been harmed by chiropractic neck manipulations, Pope said: "That's pretty frightening from our point of view."

-- -- --

Dr. Greg Stewart, a chiropractor in Winnipeg for 26 years, winces when confronted with charges by some neurologists the procedures he and his colleagues perform do not do patients any good.

"I can't refute stupidity or ignorance," he said over coffee recently at a Stafford Street restaurant. "If they don't want to do the research, if they don't want to review the current literature, I can't make them read. The research is sound and it's voluminous."

The Manitoba Chiropractic Association initially refused to be interviewed for this story. But eventually -- at the urging of the health minister's office -- it relented. The association asked Stewart, a former president of the Manitoba and Canadian chiropractic associations and the current first vice-president of the World Federation of Chiropractic, to defend the profession.

"We're dealing with this stuff (criticisms) internationally, not just locally," Stewart said.

Research shows a combination of chiropractic care and exercise is superior to medications -- with fewer adverse effects -- in dealing with neck pain, he said.

Stewart disputes there is cause and effect between neck manipulations and stroke. He said a study published in The Spine Journal -- a medical, not a chiropractic publication -- found while there was an association between a visit to a chiropractor and stroke, it was no greater, in fact even slightly less so, than following a visit to a family doctor.

Stewart said folks with head and neck pain -- a potential precursor to stroke -- will seek help from either practitioner. "These are called strokes in evolution. These people are going to have one; they're seeing someone for a symptom."

He said if chiropractors stopped doing neck manipulations, there would be no drop in the number of dissections of the vertebral or carotid arteries -- arteries that pump blood to the brain -- which can lead to stroke.

But if research ever showed this type of neck manipulation to be harmful, he said he wouldn't perform it. "There is no procedure in my office that is so sacred that I would not abandon if the patient was going to be placed at higher risk than another procedure."

Stewart said chiropractors are well trained to carry out the manipulations they perform. He obtained a degree in physical education from the University of Manitoba before his four years of training at the Canadian Memorial Chiropractic College in Toronto.

-- -- --

Health Minister Theresa Oswald says the government has no immediate plans to curtail its chiropractic coverage.

In a recent interview, she said she's not about to withdraw funding for certain manipulations without clear evidence they are harmful.

She said there are medical professionals who wouldn't agree with the claims made by some neurologists and anti-chiropractic activists about the harm done by neck manipulations.

"It's no great surprise to you that in my office I encounter one professional group being very skeptical about another professional group almost every day," Oswald said.

"I have to take a step back and let the evidence and the professional colleges make the determination about what's appropriate for patients in Manitoba."

Last year, the province inked a four-year contract with chiropractors that expires on March 15, 2015.

The Free Press has so far been unable to obtain a copy of that contract.

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition October 6, 2012 A6

History

Updated on Saturday, October 6, 2012 at 9:20 AM CDT: adds colour photo

9:32 AM: adds fact box

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