American Heart Association Releases Stroke Paper

The American Heart Association and the American Stroke Association recently released a paper reviewing the issues related to stroke and dissection. Although the papers authors conclude that current biomechanical evidence is insufficient to establish the claim that manipulation causes dissection they recommend that patients should be informed of the statistical association between dissection and manipulation prior to undergoing manipulation of the cervical spine.

The paper is titled: Cervical Arterial Dissections and Association With Cervical Manipulative Therapy.

According to the ChiroFutures Malpractice Program's CEO and Co-Founder, Matthew McCoy DC, MPH: “There is nothing new in this paper from the American Heart Association and in many ways it perpetuates the same old myths and reveals a basic ignorance regarding epidemiology.”

According to McCoy, the issues of causation versus association are generally misunderstood by not only lay persons, but even those with training in health care. McCoy stated “The bottom line is that the research shows the same association between dissection and stroke whether you see a chiropractor or a medical physician.”

This is a timing issue and in epidemiology is known as temporality. This indicates that the providers are not causing the dissections but instead the patients are entering the doctors’ office with a dissection already in progress and it’s the signs and symptoms of neck pain and headache from the dissection that brought them there in the first place.

Given these facts, all health care providers should be cognizant of the risks related to stroke and dissection and if a patient presents with such symptoms an appropriate referral should be made.

Adding another layer of intrigue to the release of the AHA paper is the fact the American Chiropractic Association (ACA) had a representative appointed to the panel that produced the paper but they refuse to disclose who this individual is.

“The chiropractic profession should be outraged that the ACA had a representative on this panel and they refuse to reveal his identity” argued McCoy.

Further, one of the authors, Preston Long DC, Ph.D  is also a chiropractor and has written a couple of books disparaging his own profession.

In Long’s biography he brags about his work as an expert witness testifying against chiropractors.

Yet, in the AHA paper he claims he has no conflicts of interest.

“This fact, in and of itself, discredits the paper and Dr. Long” stated McCoy. "One would think that the American Heart Association and the American Stroke Association would know better than to use a self described plaintiff’s expert as an author and not check to see if his disclosures were accurate.”

Regarding the AHA recommendation that patients should be informed of the statistical association between dissection and manipulation prior to undergoing manipulation of the cervical spine, Anthony Carrino DC, FICPA, President and Co-Founder of ChiroFutures had this to say:

“We encourage and support a shared decision making process between doctors and patients regarding health needs. As a part of that process patients have a right to be informed about the state of their health as well as the risks, benefits and alternatives related to care. Chiropractors are thoroughly trained to recognize when a patient’s symptoms are from an ominous cause such as dissection and are well trained to make the appropriate referral to a medical specialist.”

According to a Press Release from ChiroFutures addressing the AHA paper and the issue of informed consent, the company explains that a risk should be disclosed if a reasonable patient in what the doctor knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether to forego the proposed therapy.

Patients and doctors must make this decision based upon appropriate information. Since there is no human experimental evidence that chiropractic adjustments or neck manipulations are causally related to strokes, suggesting that such a risk exists is poor public health practice.

American Heart Association Paper

ChiroFutures Press Release