issue related to chiropractic?
Wm. Esteb:
Stu, I rarely hear of patients talking about stroke. They talk about something else that's somewhat related, but rarely does the word stroke show up. I think the whole stroke argument is largely the fodder used by professional anti-chiropractic groups in an attempt to undermine the profession more than it is the concern of a typical patient. I think most patients feel incredibly vulnerable when they do have their neck adjusted. I think it's the vulnerability and the fear that is the real issue. I'm not so sure that they are showing up with some type of dissection issue in their mind. That's interesting. What a great way to start the conversation because I totally agree with you. My experience is that the public isn't as aware as we think that they are, but I'll tell where it does come into play. When I'm talking to doctors that have patient incidents in their office, it doesn't mean that someone went to the emergency room with symptoms of dissection or anything like that, but a patient may get upset with the doctor. The first thing that they do is they go on the Internet and start searching all of the bad things chiropractors do, and that's when they start asking for money back because you conned me into getting this care I don't need, and it's risky, dangerous, and all of that. It's also when there are press releases of sorts that come out that this becomes heightened. Dr. Clum, you've been part of that conversation with the American Heart Association article and numerous other pieces that have been out there. What do you see? Thanks, Stu. I appreciate the opportunity to participate with you and everyone today. It's a vantage point issue. For us as practitioners, we look at the epidemiological data that's out there, and we know that there have been three very, very large studies that have been completed over the past seven, eight years, two within the last year, that have looked at the incident of vertebral artery [inaudible 00:07:02]. The largest of these studies involved 5% of the population of the United States. That's a massive number of people to be involved in this study. Their conclusion was that there is no association between cervical spine adjusting and vertebral artery injury. That study was the second iteration of a study that was done in 2008 by Cassidy in Canada that was published in spine. The third iteration of this came out of University of Pennsylvania. It was completed by medical doctors as opposed to chiropractors and came to the same conclusion. You've got one data set that says we're not associated with it, and you've got this lore that exists on the Internet says we are. We all know that one of the serious questions in this whole thing is the idea of the dissection in progress when the patient presents for care. At that point, for most of these individuals, the dye has been cast, and they're going to end up where they're going to end up. Whether they go to the chiropractor, go to the medical doctor, or go to Starbucks, they're going to wind up where they wind up. Teasing out those people from this occurrence of this phenomenon is a critical element that's quite often lost on the public and quite often lost, frankly, on the neurology community that wants to make a quick conclusion about, of course, a cause and so forth. Get out of this thing. The reality is, as Bill pointed out, we look at it from one viewpoint that this is a very common routine thing we do that is cervical spine adjusting. We know the remarkable safety associated with it because we do it every single day, day in and day out, in comparison to the patient, who only has it done a few times in their lifetime or perhaps weekly or monthly or whatever the case. But let's assume somebody who's coming under
Dr. Hoffman:
Dr. Clum:
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