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The other day I received a link from one of my Twitter colleagues about (to my understanding) informed consent becoming mandatory in Connecticut, specifically for the claim that chiropractic cervical (neck) adjustments cause strokes. Here’s the link to the article. It’s a pretty one-sided article, but in the video that’s there and in the text you start to see a bit of a glimmer of truth.

Before I continue, let me explain what informed consent is if you’re unfamiliar with the term. It’s essentially a written document and verbal conversation about the dangers and sometimes benefits and costs of treatment from a medical provider. It was my understanding through school that it was already a necessity for doctors due to the growing litigious stereotypes out there of patients. In my mind, informed consent has so much more to provide than just a safety net for doctors. It can help to empower patients to get involved with their treatment and make a decision on their healthcare.

Fantastic, I say. Why not have more, well-informed patients? Well, that’s where I think a lot of this debate is coming from. There’s actually a lot of research out there that states that there isn’t a causation effect between chiropractic cervical adjustments and the incidence of stroke (specifically, in this case, a vertebral artery dissection). Here’s a short list summary of the research that’s been done to support the lack of a relationship between the two. Look them up on PubMed for the whole articles, if you want.

It’s great news for chiropractors to have evidence that if there is a relationship between the two, it’s around 1 per 1 million (at worst).

Here’s where all the evidence in the world falls apart: there’s anecdotal “evidence”. All people know is that they went to a chiropractor and then shortly after (whether in the office or hours later, or even days later) they experience a stroke. So they want to have it be mandatory to include that cervical manipulation may lead to a stroke, even though research shows it’s such a remote chance. To put it into perspective, it’s almost the equivalent of being struck by lightning twice in your lifetime. Does it happen? With the millions of cervical adjustments going on in a day, those are actually really good numbers.

So here’s what I think we should do as chiropractors: hit it head on. We have the research to put it to rest. Why not compare our treatments with other alternatives?

Yes, Ms. Johnson. There is a lot of fear that this cervical adjustment can cause a vertebral artery dissection, commonly referred to as a stroke. However, if you’re concerned about it I can show you the research that’s been conducted over the past quarter century that concludes it’s so safe that it’s almost identical to no treatment. Now, surgery might be able to help you, but the costs of that can be much higher. Not only in price, but the physical dangers as well. Stroke, loss of function, even death are much more likely with that option. So I would like to start off with more conservative, more safe treatments before we send you to surgery. So how would you like to continue?

Something along those lines. It’s actually very true. If it’s still a concern for them, then assure them that you can perform various procedures to identify if they are at risk (again, there would be the warning that no test is 100% and the best course of action is the quick identification of any negative feelings, no matter how minor).

So coming back to that original article’s poll: should chiropractors be required to tell their patients about the remote risk of a stroke from cervical manipulation? I said “it depends.” If it’s a concern they have, be prepared to address it with the facts. If you’re so inclined, include it in the paperwork. There are a lot of misconceptions about chiropractic (which I hope to help to eliminate with this site) and it all starts with the doctor taking the initiative and informing the patient to help make them a little bit wiser and more in control of their health.

Here are some risks that you may not have thought of:

• Risk of stroke for those taking birth control pills: 8.5 per 100,000 (85 per 1,000,000, 850% increase)
• There is over a 3.5 times greater risk of gastrointestinal bleeding in patients on high dose ibuprofen than a placebo group. (I can’t find the original study for it currently, but I’ve read that minor GI bleeds occur in 1 per 70 uses and hospitalizations are needed in about 1 per 700-1000 uses. That’s a 1000% increase in side affects, to treat your neck pain.)
• This study was small, but it’s hard to ignore: 191 of the 312 patients for coronary artery bypass surgery had some neurological complication. One died and four had severe neurological disorders. It was determined that the neurological complications were not serious for 138 of those patients with complications.

Unlike the other two examples mentioned above, the last one does have the informed consent about the dangers. The patients knew what they were getting into.

Ladies, did your doctor tell you that stroke was a possibility with birth control? That it was more than doubled than if you weren’t taking birth control?

When was the last time the clerk at your local grocery store had you sign an informed consent to buy your generic pain reliever?

For those two medications, and for many more, the risks are much higher than chiropractic and other alternative/complementary medicine, yet we brush it off.

What this comes down to is that an informed patient is a healthy patient. So if I have a patient that is so apprehensive about my (at this time, future) treatment, I’d help them find something that they’re more willing to accept the risks on. Even if those risks are much higher, or the benefits much lower.

Image Credit: www.heartsandminds.org

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Tags: Adjustments, brain, healthcare reform, neck, patient