​In May of 2016 the esteemed British Medical Journal published the results of a study titled, “Medical Error – The Third Leading Cause of Death in the U.S.”  The doctor who wrote the study is a professor and research fellow at Johns Hopkins University School of Medicine.  He points out that the most commonly cited estimate of deaths from medical error is from a 1999 report, 98,000.  I have been using this very same number for nearly 20 years.  It’s grossly outdated and underestimates the larger problem.  Analysis of four studies has since set the rate estimate at 251,454 dead Americans each and every year due to the mistakes made by medical doctors or the medical system in general.  That’s a bunch of people and their families!!
The study goes on to point out how difficult it really is to collect this data and that it probably represents an underestimate of the real problem.  It even offers a relevant case study; “A young woman recovered well after a successful transplant operation.  However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis.  She was discharged but came back to the hospital days later with intra-abdominal hemorrhage and cardiopulmonary arrest.  An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death.  The death certificate listed the cause of death as cardiovascular.”  There is no box on the death certificate for medical error, hence the underreporting.  So where do we go from here?
The study talks about transparency, better statistics, independent investigations, and the like.  But from where I sit the problem is the medical ego, or what Dr. Robert Mendelsohn, M.D. called in his book “Confessions of a Medical Heretic”, the modern religion of medicine.  This religion believes that drugs and surgery is the only way, and that if it can’t be cured that way, then there is no way.  How many times in your life has your medical doctor suggested to you that you consult a chiropractor, an acupuncturist, a naturopath, or some other form of “alternative” health care, or what I prefer to call “natural” health care?  It’s rare.  I contend medicine would be a lot safer if medical doctors used it less.  Profound. 
            Since gate-keeper physicians rarely refer to natural practitioners, perhaps a natural practitioner should be gate-keepers.  Hmm.  Is there a natural practitioner that is trained and licensed to do that, to be a portal of entry physician, a gate-keeper to the larger health care system, someone who can know better when a natural approach can be taken, when to abandon that natural approach, and when to refer for drugs and surgery?  Let’s take a look at that question.  There are only three licensed doctors who are “whole body” health care providers, who are qualified and licensed to be portal of entry physicians; Doctors of Medicine, Doctors of Osteopathy, and Doctors of Chiropractic (M.D., D.O., and D.C.). 
Personally, I’m forced by my insurance to use a M.D. as my primary care provider, but my portal of entry or gate-keeper is always my chiropractor.    
            Regardless of who you use as your gate-keeper, to limit your future need of the dangerous world of medicine you must live your life in a manner to minimize your exposure.  That means regular adjustments, regular exercise, a regulated diet, regulated weight, regular supplementation, regular sleep, etc.     

For some, perhaps you, the first experience of chiropractic is unique, stressful, perhaps frightening.  This is one of the reasons why I spend so much of my time teaching and explaining, to remove the mystery, to attempt to remove the fear, and of course to educate you about your body.  And so you are sitting there, being told what is wrong, how it got that way, what we can do about it, and how what we do is safe.  But perhaps all you can hear is the swish of your pulse in your ears and all you can feel is the thumping of your heart in your chest and perhaps that trickle of sweat down your forehead, because you are about to have something done that seems wrong.  You are about to get your spine “cracked.”  Yeah, the chiropractor uses the word “adjustment of subluxation”, clearly propaganda to try to legitimize some sort of modern era barbarism, but it sure seems like a crack to you, right? 
By the time you get your first adjustment I’ve done a bunch of examination, I’ve said a lot of words, some of which you got and some of which you forgot.  Yet the question gets asked over and over, “What is happening when this “crack” thingy, this adjustment happens to my spine?  How is this really helping me?”  As simple as chiropractic really is, the adjustment is incredibly complex, powerful, and unique.  Nothing else in health care compares.  Read below and you will see what I mean:    
1)Scar tissue – The adjustment is breaking down old scar tissue in the joint structures.  This scar tissue has built up over a lifetime of TLG: Time, Life, and Gravity.
2)Movement – The adjustment is restoring motion and mobility to these same joints, a little bit at a time.

1. Pressure – The adjustment is instantly reducing pressure within the joint.  If we could put a pressure gauge on the joint (like a tire gauge) the pressure would instantly go down.
2. Inflammation – The adjustment is reducing the degree of inflammation in and around the spine at a fairly rapid rate.  50% of the inflammation can be reduced in one or two dozen treatments after decades and decades of build-up.  Way more effective than any drug. 
3. Muscle Reset – The adjustment is resetting mechano-receptors.  There are sensors in the joints that keep the local muscles tight or in spasm, and those sensors are reset after each adjustment, leading to immediate muscle relaxation.
4. Habit Pattern Retrain – The adjustment is retraining Negative Neurological Habit Patterns, bad motion patterns that are memorized in your brain.  In other words, decades of bad movement of the spine has become the new normal, even though it is grossly abnormal.  Repeated adjustments help to retrain the brain to know real normal again.
5. Cartilage Hydration – The adjustment is helping to rehydrate the intervertebral discs by activating the disc-pump, which is essential to slow or stop disc degeneration.
6. Nerve Stress – The adjustment is reducing stress to the nerve system, helping every cell, tissue, and organ in the body that those nerves travel to and control.
7. Anti-oxidation – The adjustment has been shown to increase blood levels of thiole, one of our primary anti-oxidant chemicals, essential to prevent and repair genetic mutation.   
8. Alignment – Sometimes, the adjustment is restoring better alignment in some rare cases.  Most spinal subluxation is more about how things are working, and less than how they line up.  But in rare cases restoring alignment is a main goal.

And The Time Factor – Like any retraining process, it requires time and repetition.  You can’t learn to throw a curve ball well by going on the mound every couple of weeks.  Your subluxated spine cannot be retrained by random or too infrequent visits.  Each adjustment has a lasting time-period.  If you are not adjusted within that time-period you will be starting over each time.  And if you quit early you will never achieve maximum correction. 
So “crack” might be the sound you hear, and it might be what you tell your friends that I do, but using that word may be the very thing that scares them from seeking out the very treatment that may change their life.     

              In the Southern California news is the sad story of Katie May, a model and internet celebrity, who died in February of a vertebral artery dissection, a rare type of stroke, also called a cervical artery dissection (CAD) and vertebra-basilar artery dissection(VBA).  Most strokes are due to a blood clot that breaks loose and travels to a smaller vessel and gets stuck, or a blood vessel in the brain that breaks open and bleeds.  A dissection-type stroke is one in which there is a tear in the wall of the artery, either the carotid or vertebral, and the blood begins to travel within the wall of the artery.  The body responds by trying to clot the damaged area eventually leading to brain infarction and possibly death.  This latter type of stroke typically takes time to develop when compared to the relative quickness of the clotting/bleeding types of strokes, and therefore, may take hours or days to run its course.  The tearing of the arterial walls can happen from violent abrupt movements all the way down to seemingly minor neck movements, the literature suggests.  You are at a higher risk of dissection if you have high blood pressure, arteriosclerosis, if you smoke, and if you have a variety of genetic predispositions including collagen disorder diseases.   
              As I understand the story, Ms. May felt she had a pinched nerve in her neck after a photo shoot and sought the help of her chiropractor.  It is my understanding that she saw him 3 times and the reports are that he adjusted her and provided mechanical traction.  We don’t know what kind of adjustment technique he used or which of the cervical vertebrae he adjusted.  We don’t know what mechanical traction means.  We don’t know what else he may have done during those visits.  We also don’t know if Ms. May had any predispositions to dissection.  We don’t know about her other activities prior to the dissection.  There are rumors of her taking a fall during the photo shoot but that has since been discredited.  And we don’t know exactly when the dissection time-line began.  There is much we just don’t know.  We do know that her symptoms worsened over days eventually effecting cognition, speech, and balance, and that she was taken to the E.R. where treatment failed to prevent her death.  What we have here is a tragedy on multiple fronts.  A beautiful life has been lost, a family has been left mourning and wanting answers, a doctor’s career and reputation is on the line, and the safety of an entire profession, or at least a procedure within that profession, has been called into question.   
              Again, that was February.  In October the coroner released his report which states that the cause of death was brain infarction due to cervical artery dissection (CAD) caused by chiropractic manipulation of the cervical spine.  With ironic timing, the same month that Ms. May died, a report was published by six neurosurgeons representing three University medical centers.  You can find the entire publication at http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation.  They conclude, “There is no convincing evidence to support a causal link between chiropractic manipulation and CAD.”  They go on, “Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.”  Kosloff published results of an American study in 2015 and Cassidy a Canadian study in 2008, neither of which found a causal relationship between CAD and chiropractic.  Kosloff concluded, “We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.”  
              What Kosloff and all the other studies on this subject are saying is that although there is a “temporal association” between CAD and chiropractic there is no “causal association.”  This makes perfect sense.  The primary symptoms of CAD are headache and neck pain, symptoms I see every hour in my practice.  If you are a chiropractic patient and you develop a dissection causing neck pain, you will probably seek the help of your chiropractor.  Sadly, there are no reliable screening procedures to rule out dissection as opposed to mechanical neck pain (what chiropractors call vertebral subluxation complex).  There might be subtle clues from the patient’s report of the character of their pain that might trigger a red flag for the clinician, initiating referral to the E.R., but since CAD is so rare and neck pain and headache are so common, the clinician is likely going to treat the patient just as he always has, with an adjustment.  If the condition is a dissection, it will progress in spite of the adjustment, not because of the adjustment, and the patient will end up in the E.R. once cognitive symptoms begin.  And had the patient gone to his/her medical doctor and been prescribed Ibuprofen, the patient would be in the same position later, again, in spite of, not because of the Ibuprofen. 
              So what are the real risks?  A study by Croft, et.al. published in 2002 found a mere 117 cases of post-manipulation ischemia(loss of blood flow) in all of the English-language scientific literature in the past 150 years.  It is extremely rare.  A RAND Corp. study put the risk of CAD associated with chiropractic manipulation at 1 in every 1.46 million patient visits.  A Danish study similarly put the risk at 1 in every 1.3 million patient visits.  This puts the risk of you having a cervical artery dissection associated with a chiropractic visit at less than 0.0001%, which is the exact same rate of cervical artery dissection in the general population.  In other words, you are at the same statistical risk of CAD if you seek chiropractic care, medical care, or do nothing.
              So where do we go from here?  There is no evidence that chiropractic manipulation causes CAD.  The risk of CAD following manipulation is the same as the risk of CAD anywhere else.  The fact is that the story of Katie May is news worthy because it is so rare, and helps to feed an anti-chiropractic agenda.  I’m not implying the coroner is anti-chiropractic.  I’m sure he is just doing his job, but perhaps ignoring science.  Regardless, there is a long history of bias against my profession by some in the medical profession.  As proof, on September 25, 1987, Judge Getzendanner (7th circuit court of appeals) issued her opinion that the AMA had violated Section 1 of the Sherman Anti-trust Act, and that it had engaged in an unlawful conspiracy in restraint of trade  "to contain and eliminate the chiropractic profession." (Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987).  She further stated that the "AMA had entered into a long history of illegal behavior".  I contrast this to the fact that mortality rate from the combination of medical mistakes, drug interactions, opioid addiction, and hospital-born infections makes the practice of medicine the 3rd leading cause of death in the U.S.  This is well established but ignored in the news cycle.  It’s just another statistic, and not headline grabbing. 
              I have never had a case of CAD in my practice, but I still pay attention to the character of my patients’ complaints to look for the rare red flag.  I pray I will be wise enough to see it if it ever crosses my threshold.  In the meantime I will continue to teach my patients about the wonderful benefits of chiropractic care.  I will continue to inform them of the real risks of chiropractic, which are blessedly few.  I will continue to provide quality chiropractic adjustments to my hundreds of patients.  I will go to my chiropractor for treatment of my neck.  When my wife, children and grandchildren complain of neck pain and headache, I will adjust them.  Lastly, I will hope that science will trump headlines and the truth of this most recent incident will come to light.  If this chiropractor did something to his patient that no other chiropractor in the history of my profession has done, and caused a CAD, then let the chips fall where they may.  If he ignored blatant and obvious signs of a dissection in progress and chose to not refer to the E.R. then he deserves punishment.  But if he is just the unlucky clinician who was simply the last doctor to see a poor girl who was moving irrevocably toward death, then his name needs to be cleared.  Regardless, chiropractic as a profession can hold its head high and know that what we do is extremely safe, and far far safer than any medical alternative. 

​Several of my patients have asked about the stroke suffered by Katie May, a model and internet celebrity.  In late January, she visited a chiropractor for treatment of neck pain that she perceived to be caused by a “pinched nerve.”  Sadly, in early February, she suffered a kind of stroke called a cervical or vertebral artery dissection (CAD), and died.  If you think of an artery as a hose, a dissection is when the blood goes between the layers of the outer wall.  For this to happen, the inner lining of the artery has to be damaged by something for the blood to get through it.  There are many things that can cause this damage ranging from high blood pressure, hardening of the arteries, drugs, congenital malformations, and trauma.  Last week the coroner released his conclusion that the cause of the dissection was trauma from the chiropractic adjustment she had received at that time.  While I cannot say the coroner is wrong, the fact is that science does not support his conclusion.  So let me unpackage this thing.
 
            It has long been asserted that cervical manipulation of the spine, in particular rotational manipulation, can cause torsion to the vertebral artery, and very rarely a dissection-type stroke.  However, the supposed risk of this happen has varied widely depending upon the source, ranging from 1:1,000,000 to 1:10,000,000 manipulations.  And I’ve seen numbers as low as 1:200,000.  On a personal note I’ve performed well over 600,000 cervical adjustments in my career and no stroke yet.  But there are two reasons for that.  The first reason is that the most recent science says there is no causal relationship between chiropractic manipulation and artery dissection.  The second is my chosen technique. 
 
            Six neurosurgeons from Penn State Hershey Medical Center, Loma Linda Medical Center, and Pennsylvania State University published their conclusions on 2/16/16 of an in depth “meta-analysis” of 253 published studies.  In their conclusions they state, “There is no convincing evidence to support a causal link between chiropractic manipulation and CAD (cervical artery dissection).”  The go on, “Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.”  The important words here are causal and belief.
 
            The chiropractor who is accused of causing the death of Katie May is most likely a victim of bad timing.  The scenario that best fits the evidence is that Ms. May’s neck pain was due to a dissection already in process, which is impossible to diagnose without ultrasound or CT imaging, and would appear the same as any typical mechanical neck pain.  The chiropractor did his thing and the dissection continued and she died.  There most definitely is a “temporal” relationship between his manipulation and the stroke, but a “causal” one, in all probability not.  I suspect the coroner has not read the latest study on the issue and is going by old science and outdated beliefs.
 
            I said there are two reasons for my spotless record.  The first is science, and the second is that the adjustment technique I use utilizes almost no rotation.  So even if there were to be found a scientific connection between chiropractic manipulation and CAD, by eliminating rotation from the adjustment process, there is no torsioning of the vertebral artery in the first place, making me safer than safe.