I am writing regarding the hearings in Hartford on the requirement for chiropractic physicians to disclose to patients the risk of harm from cervical manipulation.
I am troubled in two ways by the legislation. First, I am concerned that the legislation is based on unsubstantiated fear and rumor rather than established science. Second, I am troubled by the way in which it singles out one medical provider among all others for this invasion into the doctor-patient relationship.
Stroke due to cervical manipulation is an exceedingly rare event. In fact, the most in-depth examination of this topic, a study published in the journal Spine in 2008, concluded that stroke due to chiropractic manipulation may be a non-event. The authors of the study reviewed 10 years worth of hospital records, involving 100 million person-years. Those records revealed no increase in stroke risk with chiropractic.
Even if you argue that spinal manipulation can result in injury, it is exceedingly rare. Another study, reviewing 10 years' worth of malpractice claims in Canada, concluded that the risk of stroke following chiropractic treatment could be only 1 in 5.85 million cervical manipulations. Another way of looking at this number is that it would occur only once in a chiropractor's lifetime if he were in practice for 1,430 years. And even then, the study did not find that chiropractic manipulation caused stroke.
Thus, I must ask the question: Will the government require that chiropractic physicians lie to their patients about the risks of chiropractic-induced strokes, when, in fact, the best science available shows that none exists?
Any good doctor, whether chiropractic or medical, cares sufficiently for his patients to inform them of the significant risks and consequences of their chosen course of treatment. This is simply good patient care, respectful of the patient and his rights and the doctor and his responsibilities. And any therapeutic intervention carries with it some degree of risk, although, as in the case of cervical manipulation, it may be extremely small, and the injury typically limited to a pulled muscle.
There is no need whatsoever for the legislature to involve itself in this process and begin the micro-management of the doctor-patient relationship, nor should it single out one single provider for its intrusiveness. The legislature would never even consider mandating that every medical specialty disclose in writing specific but rarely occurring abreactions to their treatment. Why then would chiropractors be held to a different standard?
Or, if a 1in 5.85 million risk of injury is sufficient to require specific notification, will the legislators also require an MD to obtain specific written consent every time he tells a patient to take an anti-inflammatory? That is not a low-risk treatment. Anti-inflammatory medications are the 15th leading cause of death in the country today.
Will the thousands of other procedures conducted by medical doctors with much higher risk of serious injury or death also come under the scrutiny of the legislators?
After all, during the two days in which your hearings were held, 4,296 people died as a direct result of their medical care.
Who provided the informed consent for that?
Very Truly Yours,
Avery L. Jenkins, D.C.