They want to look at what's the diagnosis of management [inaudible 00:05:59] and the state of the evidence and diagnosis in management of these dissections as they relate statistically to cervical adjusting. They go on to comment in some forms of cervical manipulative therapy a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. This is the first of the important acknowledgments. It doesn't say Chiropractor. The original or the first iteration of this article said Chiropractor all over the place. It was pointed out to them that there are people that provide manipulative care to the spine that aren't chiropractors and to suggest that this is a chiropractic-specific situation was inappropriate and they took that advice and counsel and made change from chiropractor to healthcare professional. Let's look at their statement and results. Case control and other articles have suggested an epidemiological association between cervical dissection, particularly vertebral artery dissection and chiropractic cervical manipulative therapy. It is unclear whether this is due to lack of recognition of preexisting cervical dissection in these patients or due to trauma caused by the cervical manipulative therapy. Let's go back and look at the first sentence. Case control and other articles suggest an epidemiological association between cervical dissection, particularly of the vertebral artery and CMT. That's what Cassidy said in 2008 in his publication in Spine, January 15, 2008, but he also said and the article doesn't say this, there was also the same statistical association ... Excuse me, a similar statistical association found between visits to the primary care medical doctor as was to the chiropractor. While this statement is correct, that the articles, case control and other articles have suggested an epidemiological association between cervical dissection and CMT, it's also true to say that case control and other articles have suggested an epidemiological association between primary care visits and vertebral artery dissection. We need to understand the broader context. This, we can be critical in this sense what it doesn't say, but what it does say is not incorrect, although it might be incomplete. We then look at the second sentence again. It's unclear, very important acknowledgment, very important on two levels. First it is unclear. Five years ago, ten years ago, this would have been a slam dunk of course it was the chiropractor, of course is the adjustment. Now the perspective is, it's unclear and that's the first acknowledgment. The second acknowledgment is that it's unclear and is not understood whether it's
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