By all accounts, Connecticut has been at the center of the "stroke controversy" storm for the past five years. It all began in spring 2005 when a billboard warning that "Chiropractic Adjustments Can Kill or Permanently Disable You" appeared in the parking lot of an Italian restaurant in New Haven. The billboard referred passersby to the now-infamous Web site Neck911USA.com. Although unified chiropractic action led to the removal of the sign, an organization calling itself the Chiropractic Stroke Victims Awareness Group surfaced and took the anti-chiropractic campaign several steps further, not only posting a new billboard in downtown Hartford, but also placing an advertisement in the Hartford Courant calling chiropractic adjustments unsafe. The group also ran ads on public buses routed through 12 Connecticut cities - including, ironically, Bridgeport, home to the University of Bridgeport College of Chiropractic.
The Connecticut Chiropractic Association, assisted by the American Chiropractic Association, among other organizations, has spearheaded efforts to counter the negative campaign - including a CCA print ad in the Hartford Courant titled "Clarifying Chiropractic" (December 2005) and print, radio and TV ads launched in early 2007 - but the Chiropractic Stroke Victims Awareness Group's antic-chiropractic campaign has persisted. For example, in early 2008, we reported that the organization had developed a television commercial, aired on local networks, that asked viewers, "Have you been injured by a chiropractor?" and provided contact information for "victims" seeking information and support.
If all that weren't enough, along came the Victims of Chiropractic Abuse (VOCA), also based in Connecticut, whose stated mission is to "promote awareness of chiropractic risks through advocacy and legislation." The VOCA began its own negative PR campaign, with ads on buses, billboards and elsewhere spreading the "chiropractic is dangerous" message.
Both the Chiropractic Stroke Victims Awareness Group (now known as the Chiropractic Stroke Awareness Group) and the VOCA were founded by "victims" who say they suffered strokes as the result of a chiropractic adjustment, but the relationship, if any, between the organizations (and Neck911USA.com) remains unclear. However, a March 8, 2007 open letter to CCA members from then-association president Matt Pagano, DC, suggests a possible connection:
"Late in 2005, the billboards started. They were followed shortly thereafter with the newspaper ads, then it was the buses ... in various markets, followed by more newspaper ads and concurrently other smaller billboards in smaller markets. Each time, despite the [Neck911USA.com] reference on the ads there was always the reference to the 'Chiropractic Stroke Victim's Awareness Group.' Alternately, lately we have seen an appearance of the 'Victims of Chiropractic Abuse.' Most recently, we have seen a spate of unprecedented anti-chiropractic legislation."
Fast-forward to June 3, 2009, when the CCA and the VOCA entered into a legal agreement whereby the VOCA would end its anti-chiropractic ad campaign in exchange for a "declaratory ruling" by the Connecticut Board of Chiropractic Examiners. At issue: Whether Connecticut DCs must inform patients that they could experience a stroke following a chiropractic neck adjustment, and educate them on stroke symptoms. The VOCA has suspended its campaign pending the board's ruling.
On Jan. 19 and Jan. 22, 2010, in Hartford, the examining board heard testimony from members of the chiropractic profession and the Chiropractic Stroke Awareness Group / VOCA, among others. On the chiropractic side, the CCA and the Connecticut Chiropractic Council were represented, along with numerous other state and national chiropractic organizations who either sent representatives or were involved in the process leading to the hearings: the ACA, ICA, ACC, Foundation for Chiropractic Progress, Life Chiropractic College West, New York Chiropractic College, Parker College, Palmer College and the University of Bridgeport College of Chiropractic.
An impressive list of DCs spoke on the profession's behalf, including William J. Lauretti, DC; James J. Lehman, DC, MBA; J. Clay McDonald, DC, JD, MBA; Gerard W. Clum, DC; Stephen M. Perle, DC, MS; Gina Carucci, DC, MS, DICCP, and George Curry, DC, FICA. The most powerful testimony came from J. David Cassidy, DC, PhD, DrMedSc, professor of epidemiology, Department of Public Health Sciences, Faculty of Medicine, at the University of Toronto, and a member of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders. Speaking for the ICA, Dr. Cassidy addressed the research regarding chiropractic and stroke risk, attempting, as the ACA stated in a subsequent press release, "to bring the discussion from an emotional issue back to science and the objective research record."
The task force released comprehensive findings in 2007 suggesting that the risk of suffering a stroke following a cervical manipulation is attributable to a vertebrobasilar artery dissection (VAD) in progress prior to the adjustment. In fact, said the task force, the dissection likely results in neck pain that brings the patient to the DC's office seeking relief.
The task force also reported on a landmark study, co-authored by Dr. Cassidy, that documented only a handful of vertebrobasilar stroke cases (818) in a study population spanning more than 100 million person-years over a nine-year period (April 1993 through March 2002). The study data also suggest that although spinal manipulation could increase the risk of an embolism if a VAD is in progress, which can subsequently lead to a stroke, the association between the stroke and the office visit is no higher for patients seeking chiropractic care than for those visiting a general medical physician. Dr. Cassidy spent several hours explaining the study's design and methods to the examining board.
Speaking on behalf of the "victims" at the hearings were several patients who suffered strokes they attribute to chiropractic care (including VOCA founder Janet Levy), as well as a name all too familiar to longtime readers of this publication: Murray Katz, MD. The Canadian pediatrician has labeled chiropractic "quackery" for years (a term he repeated in prepared testimony) and has inserted himself in the stroke discussion before; in fact, he was disqualified twice from the highly publicized Lewis Inquest, which ultimately ruled the cause of death of a Canadian chiropractic patient who died from stroke complications six weeks after receiving a cervical adjustment "accidental."
As of press time, a third hearing is scheduled for Feb. 18, after which the board will consider the testimony in full and render a ruling. If the board rules that Connecticut chiropractors must specifically inform their patients about a possible relationship between neck adjustments and stroke, it could set a dangerous precedent. Look for news of the board's ruling in an upcoming issue.
Note: For related information, read "Canadian Stroke Suit Dismissed."