While the Battle of Antietam was fought on several fronts, General Burnside's unrelenting and painfully slow march across a bridge that could accommodate only a few columns of soldiers was disastrous. It allowed about 450 Georgia militiamen to pick off wave after wave of the exposed Union Army practically at will as it set foot upon this bottleneck.
Antietam was, and still is, the bloodiest single-day engagement in American history. Burnside's maneuver was largely responsible for denying what could have been a key Union victory and could have shortened the Civil War by as many as three years. The general's campaign (or folly) immortalized what widely became known as the Burnside Bridge.1
There is clearly a lesson here. The chiropractic profession has been drawn into a major conflict on the issue of cerebrovascular accidents linked to cervical manipulation, undoubtedly a health risk, but by no means as widespread as a number of external parties have implied. The flawed science behind many of these assertions2-6 and the failure of both the media and deliberate detractors to adequately disclose the benefits that constitute the risk-benefit ratio of any health care intervention7-12 create a grossly distorted picture, discussed at length in this space previously.13,14
While the defense of these safety issues is both necessary and commendable, marked by examples of research15,16 substantially more rigorous than those studies often cited as a means for attacking the practice of cervical manipulations,2-6 it is imperative for us to try to maintain a perspective on the big picture. The danger of becoming too preoccupied in the heat of battle, like General Burnside, is to lose the needed momentum in such other areas of needed research as:
- cost-effectiveness studies that examine in more detail the direct and iatrogenic costs encountered in both medical and manipulative procedures;
- outcome studies involving the extremities, ear infections, upper-respiratory infections and other plausible nonmusculoskeletal conditions;
- clinical manifestations of earmarks of what has become known as the subluxation;
- characteristics of the forces employed in adjustments;
- biochemical and neurological responses to manual procedures used in chiropractic therapy;
- the role of maintenance therapy in maintaining wellness;
- the role of nutrition in improving health and health care; and
- issues involving the effective training of chiropractic physicians.
There is a real danger in becoming too fixated upon CVAs at the expense of everything else, sapping those resources needed for accomplishing all these other objectives, which are so important for establishing the validity of chiropractic care within the health care marketplace. The paranoid among us might even suggest that this tactic is in some ways deliberate. There could be those who not only are attempting to limit the potential of the chiropractic scope of practice by directly seeking to block the chiropractic management of all conditions other than selected cases of low back pain, but also indirectly by confining our conscientious research effort on that one limited area that could terrify the general population if it is presented in the hysterical tones seen in the media as of late.7-12 In other words, chiropractic researchers cannot afford to be panicked into having their agenda written by interests that are ultimately hostile to both the profession and the conduct of responsible and needed research.
This is not to suggest that efforts to arrive at a definitive conclusion as to how and how often CVAs result from chiropractic intervention should be abandoned. And the questions of spontaneous CVAs or the risks of medical procedures that might be followed instead of those selected by the chiropractor should not be ignored. It is simply to realize that the safety issue constitutes only a fraction of the entire landscape that needs to be populated with definitive studies that inform the general and selected populations as to the advisability of seeking chiropractic care, and for which conditions chiropractic intervention offers an effective and economical alternative. The FCER remains the first and oldest resource within the profession for achieving this objective, for which your support is urgently needed.
The flurry of media events and the Canadian inquest of Lana Dale Lewis have focused our attention upon the safety aspects of chiropractic care, with promising research being offered and planned in response. My point is simply to avoid being confined to only a small niche in both the scope of practice and research efforts during a limited window of opportunity, in which the validity of chiropractic intervention needs to be more firmly and convincingly established across a broader number of conditions affecting the patient. In this manner, the lessons of history from the Burnside Bridge will have been effectively learned.
- Lehrer J. Musings: Hallowed ground. Hemispheres August 2002: 30-32, 60.
- Lee KP, Carlini WG, McCormick GF, Walters GW. Neurologic complications following chiropractic manipulation: A survey of California neurologists. Neurology 1995; 45(6):1213-1215.
- Bin Saeed A, Shuaib A, Al-Sulaiti G, Emery D. Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients. The Canadian Journal of Neurological Sciences 2000;27 (4):292-296.
- Hufnagel A, Hammers A, Schonle P-W, Bohm K-D, Leonhardt G. Stroke following chiropractic manipulation of the cervical spine. Journal of Neurology 1999;246(8): 683-688.
- Norris JW, Beletsky V, Nadareishvilli ZG, Canadian Stroke Consortium. Canadian Medical Association Journal 2000;163(1):38-40.
- Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: A population-based case-control study. Stroke 2001;32(5): 1054-1060.
- Brody J. When simple actions ravage arteries. New York Times, April 30, 2001.
- Bill Carroll Show, CFRB 1010 radio, February 6, 2002, posted on the internet.
- Evenson B. National Post, February 7, 2002.
- Hamburg J, Medical Minute, WOR-AM 710 radio, February 22, 2002.
- Jaroff L. Back off, chiropractors! www.time.com, February 27, 2002.
- A different way to heal. Episode of Scientific American Frontiers Public Broadcasting System telecast, June 4, 2002.
- Rosner A. Waiting for science: the VBA argument. Dynamic Chiropractic August 13, 2001;19 (17).
- Rosner A. Gone fishin' for whoppers. Dynamic Chiropractic October 8, 2001;19(21).
- Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine: A systematic review of the literature. Spine 21(15):1746-1760.
- Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: The chiropractic experience. Canadian Medical Association Journal 2001;165 (7):905-906.
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