bilateral. Both sides were involved which is highly unusual, and I don't know if everyone has that information and can appreciate that. That's why the article that you are now talking about from Sanchez is so relevant to what we need to discuss. That's right, because the Sanchez article ... Excuse me, the coroner has cited an incidence of bilateral vertebral artery dissection based upon a report by Sanchez that cites incidence data based on a 2003 opinion piece, editorial from Williams that was published in the Journal in Neurology. If you go back and you start to trace the chain of literature that's involved, number 1, the coroner discusses incidence for bilateral vertebral artery dissection that is simply wrong, period. The data is wrong. The facts were wrong. The citation is wrong. Sanchez uses literature from an opinion piece in 2003 to support his assertions in the paper that the coroner referenced. All of this precedes the 2008 study by Cassidy. There's this whole line of reasoning associated with the incidence and so on that caused the coroner to come to the conclusion so abruptly that this was the cervical spine adjustment. There was no consideration in the coroner's report in any shape, form or fashion that there could even be the possibility of a dissection in progress when the patient to the chiropractor and the possibility that the chiropractic care may have worsen the dissection in progress, but there is no acknowledgement that it could have very well happened or occurred before the woman ever got to the chiropractor. That perspective of it occurring before she got to the chiropractor was reflected in the comments that were related by Harbaugh from Pennsylvania, that were related by Albuquerque, Dr. Albuquerque from Phoenix, and were consistent with the concepts and the language that Jeff Wang from UC ... Excuse me, from the USC Spine Center making reference to this as a freak accident. There's no question the woman died of an infarct. The infarct was a result of dissection in the vertebral artery. The question is the coroner's conclusion that this was straightforward no questions asked the result of neck manipulation? The more we look at the coroner's report in the autopsy report, the less likely that seems probably. Now, when we go back and look at the question of bilateral arterial dissections, particularly vertebral artery dissections, more often than not, far more often than not, these are associated with arteriopathy than they're associated with mechanical forces. If we go back to the work of Hertzog that was done at the University of Alberta, we understand that the forces involved with the cervical spine adjustment in the fashion described by Hertzog in that article are inconsistent with the development of bilateral vertebral artery dissection. There's lots that has come up as a result of this process of the autopsy report and our digging through it. Rather than clearing things up, if anything, it's muddied the waters a little bit more. Okay, and it leads me to believe that the coroner's statement about the cause of death which he did indicate as you said started with the blunt force injury to the neck, but his statement seems to be based on the history that he or she may have been presented with from the doctors that made statements at the hospital that Katie May died at. Is that your opinion too? How do you think he arrived? It took
Dr. Clum:
Dr. Hoffman:
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