Katz and dogma

I was talking to a friend today and she brought to mind an exchange between Murray Katz, MD and me from the McGill University, Faculty of Medicine, Continuing Medical Education discussion board. I thought that I would post some of it here.

Dr. Katz had presented an anti-chiropractic diatribe at McGill which is "so full of fabrications, extrapolation and cherry-picked use of the literature that his presentation really should be prefaced with a warning that this is fiction."

I was asked a question on the discussion board after posting the comment above (and more) about "high neck manipulation." I cited the recent literature on the topic:

Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, et al . Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008;33(4 Suppl):S176-83.

This is rather compelling evidence that the association seen in previous studies between cervical manipulation and vertebrobasilar stroke was actually an association between vertebrobasilar stroke and seeking the care of a health care professional. We know this from Cassidy et al because the association between stroke and seeing a chiropractor was identical to the association between stroke and seeing a primary care physician (PCP) AKA a medical doctor. Thus manipulation was not associated with stroke just seeking care was.

Then Katz joined in the discussion:

Re: High Neck manipulation Posted by Murray on Jul 23, 2008 9:38
The comment on various studies by Mr. Perle (with all due respect none of his many degree were obtained under the direction of a Faculty of Medicine) are typical of the chiropractic “spin”. There are endless studies on homeopathy but there is more urine from a shark swimming on Mars than the ingredients on the bottle. Likewise, this is no such thing as chiropractic vertebral subluxations. The study he quotes using billing numbers is typical of chiropractic studies which Wallace Sampson and J. William Kinsinger wrote about in their paper “Producing Quack Studies for Quackery”. To show the extent of this quackery, a German study using actual hospital records and also going backwards found 36 cases of chiropractic stroke. Chiropractors want us to waste our time discussing their studies. There are a few chiropractors who have crossed over to science. These admit freely there is no such thing as subluxations. They no longer claim to have meaningless degrees. They start with the basic question, why are 200 million high neck manipulations a year being done on everyone from newborn babies to senior citizens. What is the diagnosis? The following commentary was published last week in the Calgary Herald in Alberta. It deals directly with the issues. Re: "Anecdotes are not enough to condemn chiropractors," Susan Martinuk, Opinion, July 18. Susan Martinuk's column is typical of chiropractic spin. Seventy years of scientific literature from all over the world, the warnings of neurologists all across Canada, three coroners' reports involving the deaths of three young women in Canada as well as an endless number of life-devastating strokes are not anecdotes! Almost without exception, all of these victims of chiropractic neck manipulation stroke and death have a number of things in common. They did not have pain in the highest neck area. They had their highest neck manipulated with the diagnosis of vertebral subluxations, something which does not exist. No one should die or live a disabled life for a condition that does not exist. Highest neck manipulation was done on them at almost every visit no matter what the complaint, sometimes 50 or 100 times, or more. Does it ever work? From newborn babies to senior citizens, Albertans are being told they have vertebral subluxations and need to have the highest neck manipulated. This is a scam and a fraud paid for out of the public purse and your own pockets. Victims and physicians are asking for six reasonable and scientific restrictions to be placed on all chiropractic highest neck manipulation. None of these will prevent the use of scientific manual therapy for neck pain, most of which is done responsibly by physical therapists. These restrictions are that highest neck manipulation should not be done on babies and children, not for claims that this can provide "wellness" to the body, not 50 times on the same person, not to claim to treat liver, heart or other organ diseases and most important, not for the claim that there are vertebral subluxations in the highest neck area. Physical therapists abide by these restrictions and hence have no strokes or death due to neck manipulation. The Minister of Health of Alberta has already been warned to enforce these restrictions and since Sandra Nette's stroke, we now have another case in Alberta of a young man who suffered a locked-in stroke and has come partly out of it. There are others. The reason the College of Chiropractors of Alberta, there to supposedly protect the public, will object to these sensible restrictions is that their officials all believe in this quackery. In my own experience, I was placed on a table from which a part suddenly dropped away and as a result, I had a stroke. The College of Chiropractors fully supports such quack machines claiming they can treat neck pain? Never allow a chiropractor to place you on a drop table machine. In the words of the Wellness Center in California, never agree to neck manipulation. Diana Dingley, Chestermere, (a stroke victim), and J. William Kinsinger, MD, Edmond, Okla. © The Calgary Herald 2008

Here is my reply:

Re: Re: High Neck manipulation Posted by Stephen on Aug 02, 2008
7:08

Dear Dr. Katz,

It appears to me that somehow having a medical degree has conferred upon you a level of arrogance that most other professionals do not possess. Who gave you the right to determine who has or does not have a valid doctorate? I think that government has that prerogative and it has spoken in Canada, despite your views. By your thinking, I ought refer to you as Mr. Katz because, with all due respect, none of your degrees were obtained under the direction of a Faculty of Chiropractic. This rather juvenile of you don’t you think?

You write that “few chiropractors who have crossed over to science”. I searched pubmed and cannot find a single paper in the peer reviewed literature that you have authored only one letter to the editor. This sounds as if the pot is calling the kettle black. Your degree and likewise your comments do not provide me with evidence that you have “crossed over to science”. Coming from a scientific profession does not mean one is scientific. One actions and words speak louder than ones degree.

On the other hand my publishing record in the peer reviewed and pubmed indexed literature is available.

http://tinyurl.com/6y34tf

Likewise one can find my writings on ethics within chiropractic.

http://www1bpt.bridgeport.edu/~perle/ethics.htm

http://www.acatoday.org/level2_css.cfm?T1ID=15&T2ID=160

And finally I am quite clear when it comes to subluxations.

http://www.chiroandosteo.com/content/13/1/17

I suggest you read what I have published and stop assuming I defend bad chiropractic practice, any more than I should accuse you of defending bad medical practice.

Of interest is the fact that the Cassidy (1) study I cited is published in the preeminent orthopedic journal. I can’t find Sampson and Kinsinger’s paper in pubmed. I guess it wasn’t published in quite as prestigious journal. One wonders what the scientific world has come to when such an important work is relegated to the scientific backwater and the quack studies of quackery that use billing records written by people with meaningless degrees is published in such a prestigious journal. Or maybe Dr. Katz’s view of the world is a bit askew.

Cassidy’s (1) study is a population based study rather than a retrospective review of hospital records of some hospitals, which the German study (which Dr. Katz alludes to but does not cite (2) is). It turns out that in the German study 50% of the so-called “chirotherapy” was provided by orthopedic surgeons and only 11% was provided by chiropractors. (2-3) I would suggest Dr. Katz, when using a study to cite the hazards of chiropractic care one should carefully read the study to ensure that the so-called chiropractic treatment was actually provided by chiropractors and not medical doctors.

One could debate the merits of each study but that does not appear to be what Dr. Katz would like to do. His modus operandi appears to be ad hominem attacks, the use of spurious literature, misquoting his own sources and “scientific” debate via newspaper. This is not an exercise I choose to engage in any longer. If the level of debate rises to a professional level, I shall respond appropriately.

Stephen M. Perle, D.C., M.S.

[1] Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver FL, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.

[2] Reuter U, Hamling M, Kavuk I, Einhaupl KM, Schielke E. Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. J Neurol. 2006 Jun;253(6):724-30.

[3] Wenban AB. Inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' in the peer-reviewed biomedical literature. Chiropr Osteopat. 2006;14:16.

If anyone is interested in the whole exchange please go to McGill's web site

Again if anyone is interested in the best evidence on chiropractic stroke read the study by Cassidy et al

SMP

An inauspicious beginning

As they say a journey of a million miles begins with one step.

However, what motivates me to start writing results in an inauspicious beginning for my blog. I found out that one of my former students just pled guilty on Jan 22, 09 to insurance fraud

This makes me ponder what makes someone steal, what fundamentally is so little money (think Madoff ponzi scheme). I know that some will read this and say half a million dollars is a lot. But think about this. Since that money was stolen by committing insurance fraud, the money was reported to the IRS by the insurance company. Thus, after all the taxes this might have resulted in a net of $300K. It appears that the fraud was committed from 2005 - 2008. Thus, $100K/year.

I know that this is a little more money than the median family income in Simsbury, CT where the fraud took place. I say it is not that much money because of how great the downside risk was. In this case, the doctor not only has to repay the money but could end up going to jail for 10 years and could pay up to a quarter of a million dollars in fines. As a gamble the downside risk was way too high given the pay-off ($300,00).

Not that any amount of money would motivate me to steal but at least if he'd stolen many millions or billions he could have squirled away enough money in an off-shore account that when he got out of jail he'd be able to live well in a third-world country. In this case, I suspect when he gets out of jail he will have no money and no real prospects to earn money. If he has a family I suspect they are financially ruined. They might loose their home (as many honest people are right now) but at minimum they will loose, what no doubt, was a comfortable lifestyle.

This is a sad outcome for the doctor's family (who I am sure were innocent) and all who knew him. If I could have prevented the fraud, I would. However, given that the fraud actually occurred, I am actually glad that it was discovered and justice prevails.

For the chiropractic profession, fraud like this only serves to erode the profession's social and cultural authority. Thus as a chiropractor I condemn this fraud and applaud the FBI and the US Attorney's office for this successful investigation and prosecution.

SMP