doctors within a week of these events occurring?" In fact, Cassidy found in 2008 or published in 2008 that there was in virtually every parameter a greater incidence of dissection among patients who saw their primary care medical doctors within a week of the dissection rather than saying or … as compared to those who say a chiropractor. This means that in those cases it wasn't what was going on the chiropractor's office that was contributing to the problem, it's again is what walks through the door. Huge consideration we need to be aware of and we need to understand completely. Let's look at these things again and review. What do we take from this joint position statement, "Insufficient evidence to establish the claim that CMT causes CD," big statement. "It is unclear whether this, in epidemiological association is due to a lack of recognition of a preexisting dissection in these patients or due to trauma caused by CMT." Again, we talked about the idea that the association between primary medical care is there as well countering some of that claim that was in those first few slides. Based upon the American Heart Association and American Stroke Association statements and other literature, what can we say or what shouldn't we say? Let's talk about what we shouldn't say first. The literature has shown no association between chiropractor cervical adjustments and CD. We can't say that. The literature has shown a statistical association between cervical spine adjustments and cervical dissection, it's a fact. It's also that same statistical relationship or stronger, between in fact this phenomenon and primary care medical visits. The American Heart Association/American Stroke Association has said chiropractic adjustments don't cause cervical dissection or can't cause cervical dissection. They didn't say that at all. They simply said there is insufficient evidence to support a cause statement. The third thing we can't say is, "Chiropractic adjustments don't cause cervical dissection and/or stroke." They may well not, but based upon this literature and what we have to work with, we cannot definitively say that. We need to understand those and use those terms and use this information completely and make sure what we say about our interpretation is solid. Let's just leave the American Heart Association Stroke Association behind and let's look at an article from 2011 from Wouter Schievink, who is at Cedars Sinai hospital in Los Angeles. Schievink is probably one of the most prolific writers in medicine. He is a neurosurgeon, works predominantly in Cerebrospinal Fluid Leaks and things of that nature but
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