I’m sure y’all have heard about the association of stroke and chiropractic manipulation of the neck. Chances are, it’s written in the informed consent that you sign before receiving treatment from a chiropractor. It was in the informed consent form that I had at my private practice, and it’s a discussion that I have with my patients in my current position.
The NIH states that “incidence of [vertebrobasilar stroke] was too small to report.” For those who like numbers, however, “1 per 5.85 million cervical manipulations” has been calculated by Haldeman et al. I also have notes from my alma mater that state that the risk is about 1 in every 3 million cervical manipulations, though I can’t seem to find this number cited elsewhere. (Can you? Let me know in the comments below.) The risk of stroke from chiropractic manipulation, however, is hotly disputed, with giants like Forbes slinging mud at the NIH, and the NIH striking back. These days, I put things into perspective for my patients by providing another number.
You guys, 1 in 1 million is significantly more risk than “too small to report,” 1 per 5.85 million, or 1 in 3 million. Do understand, and every patient of mine has understood after I’ve explained it in this way, that treatments and prophylactics can return to the marketplace despite risk. That was true of the Johnson and Johnson COVID-19 vaccine, and chiropractic has continued though there have been adverse events. Ultimately, it is not about risk, but rather the risk to benefit ratio that matters. Health care professionals have an obligation to inform you of the risks so that you can make a decision on whether you wish to undergo a procedure. I have had patients refuse treatment because they think that 1 in 3 million is too much risk to bear. I respect that fully. On the flip side, I have had to explain to other patients that chiropractic manipulation is highly inadvisable for them, because the risk to them, based on their health profile, is simply not worth the potential benefit. As sentient beings, we have choice.
I will conclude with a question I frequently ask to my patients. What are your questions?