Chiropractors and Consent – Quacks and Risk

I’ve had friends who complained of various ailments and bothers, some of whom swear that after visiting a chiropractor they felt 100% better…for awhile at least. I’ve always been of the opinion that everyone feels 100% better after a massage, a stretch and what passes for professional attention. The thing about chiropracty is that, when you look at the evidence, it’s really no better than sugar pills and rest…and in some ways it’s very much worse.

Chiropractors are dangerous, make outrageous and unsubstantiated claims about the effectiveness of their “treatment”, and now one group of these charlatans wants permission to NOT advise their patients that cervical manipulation might cause a stroke.

When Simon Singh wrote a scholarly article about the risks (many) and proven benefits (almost none) of chiropractic treatment in England, the organization of practitioners there sued for defamation in an effort to silence Singh and chill any future critical analysis of their methods and results. That a professional body of “health care providers” would want to prevent any sort of analysis of the effectiveness and quality of their treatment speaks volumes about whether or not they are concerned with helping patients or maintaining their income stream and avoiding anyone peeking behind the curtain.
Not only are they using England’s draconian libel laws in an attempt to silence critics, at the same time the governing body of chiropracty advised their members to strip their ads, websites and promotional material of all the many claims commonly made on behalf of their services for which there was, to be polite, absolutely not one shred of evidence. According to those previously commonly disseminated assertions, chiropractic treatment can help cure cancer, assist you in stopping smoking, repair nerve damage, lower cholesterol and cure arthritis. To listen to these con artists tell it, a couple of yanks on your neck, your ex-wife will come back and your lawn will come in lush and green.

Now, the chiropractors in Connecticut want to avoid having to inform their patients that treatment might just paralyze them.

Pagano, a Winsted chiropractor talking on behalf of the Connecticut Chiropractic Association, spoke out against a proposal that would require chiropractors to tell their patients about the remote risk of a stroke from cervical manipulation.

The State Board of Chiropractic Examiners will open hearings on the proposal this morning at the Capitol. Pagano showed up after a Capitol news conference organized by chiropractic stroke victims who want Connecticut to become the first state to require specific “informed consent.”

“What we do is substantiated by years of research,” Pagano said, repeating his “cause and effect” argument.

David MacDonald sat watching from his wheelchair. A neck adjustment led to a stroke nine years ago for MacDonald, a former package store manager who lives in Windsor Locks. Now 62, he remains partially paralyzed.

Pagano’s opposition didn’t sit well with Christa Heck, who also looked on in amazement. Six years ago, the New York woman had a stroke after a neck manipulation at age 39. She thought she had an inner ear infection and waited too long to go to the hospital. No one told her about the risk of a stroke.

Then there was Britt Harwe, a Wethersfield woman who also stood listening to Pagano’s embarrassing defense. If medical doctors had known Harwe had been to a chiropractor, it might not have taken them days to figure out what was wrong with her. It’s taken her 16 years just to resume the ability to eat solid food.

Every single thing these phony snake-oil pushers do only further and more clearly demonstrates that they are not in the business of providing health care to patients, but rather a pack of grifters out to scam the gullible while exposing them to potentially serious risks.

The Idea of “Informed Consent”

When you seek ANY medical treatment (or, for that matter, any service whatsoever), there must be a meeting of the minds before any agreement to proceed can be said to exist. The doctor must advise the patient of the expected benefit and the potential risks. The patient must understand these, and consent to the procedure.

In simplest terms, there are two elements to this process: Risks and Benefits. This applies to every element of the process – means, methods, expected outcome, potential consequences, likelihood of success, cost of the service, duration of treatment…everything.
In the practice of medicine, patients must sign a very complicated work order stating that not only are they requesting the work, but that they have received competent medical advice; were advised to seek alternative opinions; are aware that the work may not be effective; understand that any such work carries the risk of side effects; that they will hold the provider harmless – not liable – if things don’t work out.
When you sign, you agree that you have been informed, and that you consent.

Now, let’s take a closer look at the idea of risk. As the weaselly quacks want to argue, the risk of stroke is very small so they ought not be obligated to warn people about it. They think it unnecessarily frightens people – like telling every person who steps outside they might be struck by lightning.
The flip side of the risk coin, an argument they are not quite dumb enough to make, would be that the harm is minor. If having a stroke were like a mosquito bite, one wouldn’t bother to mention it. There’s an infinite list of possible side effects that MIGHT ensue, and it’s impossible to list them all. We don’t waste time with the trivial.

So, you can imagine a 2×2 matrix: The x-axis is “Likelihood of Harm” – High vs. Low, and the y-axis is “Severity of Harm” – High vs. Low.
This yields four possible outcomes:

LOW RISK – SMALL HARM: Where a possible negative outcome is both unlikely AND trivial, there’s no need to mention it. It would not likely affect anyone’s consideration of whether or not to undertake treatment.

HIGH RISK – SMALL HARM: Where a possible negative outcome is LIKELY and trivial, it ought to be mentioned. All likely outcomes form part of any fair definition of the concept of being informed. Nevertheless, if it were not mentioned and did occur, there would little likelihood of resulting litigation as the harm is, by definition, small. While these risks are certainly relevant to the notion of informed consent, they are not as significant as the next category for that reason.

LOW RISK – SEVERE HARM: Where a negative outcome is unlikely BUT SEVERE, it MUST be mentioned. Severe consequences, even if statistically unlikely, cannot be argued to be insignificant to the notion of informed consent. This is why there are signs in Yosemite warning about bears and cougars but none about the infinite number of sharp, pointy things (brush, branches, thorns, prickly weeds, splinters).
Severe harm – no matter how unlikely – is a factor that must weigh in any patient’s determination to consent to treatment.
The provider, for his or her part, is far more likely to face litigation in such circumstances. Patients who suffer severe consequences about which they were not advised DO sue.

HIGH RISK – SEVERE HARM: I need not canvass the fourth box. “It’s likely you will die,” is only something the doomed consider a reasonable option. Any provider who fails to inform patients of such likely outcomes is likely to face criminal charges before being sued.

The argument being made by these chiropractors in Connecticut is disgusting. It’s a bullshit argument that ignores the severity of the harm which may result from the application of their “treatment.”
In order to demonstrate what a crap argument it is, let’s return to the “struck by lightning” analogy. It’s true…the number of people struck by lightning every year is very small. But so is the number of people who present for chiropractic treatment.
Looking at the folks who WERE struck by lightning, we notice some things. The vast majority of them were outside. The weather was lousy, there were storm clouds around. They were on high ground…or standing in a field. Some of them were near a conductor, like a tree or a 7-iron. It would seem reasonable then, if someone were planning on playing a round of golf on top of a hill under storm clouds, to INFORM THEM that EVEN THOUGH it’s very rare, one might be struck by lightning.
Come to think of it, I’m pretty sure they blow a horn and clear the golf course when thunder clouds roll in.
All of these victims, and it is not an insignificant number by any means, who complain of stroke related to cervical manipulation were seeing chiropractors – the medical equivalent of waving your putter over your head while standing in a puddle.

The providers cannot argue that the severity is trivial, but they are willing say that very few people actually get struck by lightning, so they need not mention it when renting you the clubs under gray skies.

What ought to be done is this: After presenting a list of all likely AND/OR severe possible consequences, an additional requirement should be imposed upon these fakes IN ORDER to meet the demands of informed consent.
Before any patient of a chiropractor can be said to have consented to treatment, the practitioner must provide evidence in the form of data gathered from proper scientific studies, published in peer reviewed MEDICAL journals (not, for example, The Journal of Chiropractic Medicine), that chiropractic treatment is an appropriate course in each specific case and has been demonstrated to be effective. Absent that, we should permit these glorified massage therapists to treat nothing more serious than a pulled muscle and watch as hot water bottles put them out of business.

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One Response

  1. Also to note is that Chiropractors call themselves radiologists with a couple hundred hours training?

    While a MD has to do 5-7 residency and well over 30 thousand hours to be called a radiologist

    INFORM YOUR PATIENTS of the RISK OF STROKE

    DO THE RIGHT THING

    DO IT NOW

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