Putting The Stroke Issue to Bed

number, I also understood that number that appeared in the literature to have been an opinion piece. I contacted Vanderbilt and, sure enough, Vanderbilt said, "Yeah, we got that from this article in Baylor that you referenced at the start of the discussion today," Stu. I said thank you, went back to Baylor and asked them about it. First, reviewed the article carefully. The first step in the process was, in reviewing the article, if you understand the literature and so on and you see the references that they're making in the article, are the references being applied properly? In this case, they weren't, and the references in the article that they had tied to their assertion that an adjustment resulted in a dissection in 1 in 20,000 cases was completely inaccurate. At first step, I wrote them and pointed out the fact that the evidence they offered, i.e, the reference, didn't support the statement they were making. They wrote back, and they said, "Thank you. We appreciate you pointing out the error. We'll change the reference. We did, in fact, make a mistake on it, and this is what we based it on." They based it on a 1989 article from the British Medical Journal by an author by the name of Vickers. The unfortunate part of the Vickers article is that it's an entirely opinion-based statement. There's no data. There's no study. There's no control group. It's just an opinion. It's kind of like, Stu, how often do people move to Phoenix? A hundred a day. You don't know that, and you don't have any basis to say that. There are people that do know that and can tell you that number, probably down to the family, but you don't know when you say that. This number was tossed out, this 1 in 20,000, as an opinion piece. All of a sudden, it gained a life of its own. Baylor came back, and they said, "By the way, there's two other pieces of literature that we'd also like to add to this discussion," and they came out of Australia. One was by a fellow by the name of Dunn that was in 1990, and then there was another by a fellow by the name of Mann. When you looked at all three of them, you soon realized that they got into this circular argument where each used the other to reinforce its opinion. Mann relied on Vickers, and Dunn relied on Mann and Vickers, so this thing starts to have a life of its own where this number of 1 in 20,000 pops up, and then it gets reinforced by the next person using it and the next person using it, and nobody goes back and says, "Hey, wait a minute. That's just an opinion piece." In 1989, that may have been the best available at the moment, but the bottom line was that, certainly, in 2016 when this was written, let alone 2017, it's certainly not the best available today. The next level of the discussion with Baylor was to point out the literature that's evolved since then, going on and starting with Rothwell in 2001 in Stroke, moving on to Cassidy in 2007 in Spine, moving on to Kosloff in 2015, and then moving on to Church in 2016, and how absolutely inconsistent their data-driven

Made with FlippingBook HTML5