051- Researching Chiropractic Safety

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are going to have one of the most important episodes that we have ever recorded of the Evidence Based Chiropractor podcast. We are going to do a pretty deep dive on the safety of chiropractic care. So this has been a hot button media issue for the last few weeks. I initially kind of stayed out of the fray. There was a lot of experts coming forth with their opinions and with statements and policy statements, etc. But due to an over overwhelming amount of emails and Facebook messages and everything in between, I thought it would be a good opportunity to take today and release a podcast episode that dives into the research. Not myth, not conjecture, not theory, but the research showcasing the safety of chiropractic care. So before we do, I'll say a few words about Rock Tape as we do each and every week. Rock Tape is proud to be a sponsor of the evidence based chiropractor. Rocktape offers the world's best kinesiology tape, pain relief topicals, mobility tools and functional fitness accessories. New from Rock Tape is Roxas Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol. It's stronger than the freeze competition. They are more than a tame company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com so today we are going to touch on two studies showcasing highlighting however you want to describe it. Two studies that took a look at at the safety of chiropractic care and I think that they really tell the story and I'm going to let them do most of the talking throughout our podcast episode today. So if you are a member of the Evidence Based Chiropractor, I also want you to keep your eye out. Our November research brief which goes out November 25th will be focused, that's later this week will be focused upon safety of chiropractic care. Couple house cleaning notes before we dive into the research we reached over 50 episodes. I completely blanked on it. I think it was last episode we reached 50. If you've been listening, there's a few thousand chiropractors listening each and every week getting their research and the time it takes to get to your office. The best thing you can do if you've been enjoying this. If you want to take one moment of your time and help me, give me some feedback, a rating or a review on itunes or share the podcast, let a colleague know that we are giving you research on the time in the time it takes to get to your office office each and every Monday morning. I would greatly appreciate that we can help spread the word, especially with this week's episode being so important. So let's dive in. The first piece of research we are going to look at was a piece released From Spine Journal, Volume 32, Number 21 in 2007. Spine Journal we all know top tier research publication and they had an article titled Safety of Chiropractic Manipulation of the Cervical A Prospective National Survey. I'll say that one more time. Spine Journal 2007 Safety of chiropractic Manipulation of the Cervical A Prospective National Study There are really just three stats that I want to bring forth from this study that are going to tell the tale of what the researchers found. This study looked at over 19,700 patients over 19,700 patients receiving over 50,000 chiropractic adjustments or manipulations. Again, let me say that one more time. Nearly 20,000 patients looked at 19,722 patients looked at over 50,000 adjustments performed with zero serious adverse events. Zero serious adverse events. That is pretty powerful. And if we want to put that into context before we look at the second piece of research, I'll bring up a few items and we're going to go heavy and then we'll kind of pull back. So if you've been listening to Evans based chiropractor, if you see anything we put out, obviously opioids are unbelievably addicting, unbelievably dangerous medications that unfortunately are still somewhat commonly being prescribed for spine related complaints. So if we look at those medications, there's over 28,000 people that die due to an opioid overdose each and every year. 28,000. Now here's the real kicker on that at least half of those overdoses are from a prescription opioid, not from a street drug. So probably in excess of 14,000 people are dying per year based upon a prescription medication that perhaps should not be prescribed for many of those people in the first place. And to reference back to what we just talked about, 50,000 adjustments, 20,000 patients, zero serious adverse events. Secondly, we'll talk about, as I talked about pulling it back, we'll talk about NSAIDs, NSAIDs, we know unbelievably commonly prescribed. If we thought about it, we probably wouldn't like to think about it, but I would imagine if we were honest with ourselves and actually took a good gander at our patients, probably even the most wellness oriented practice in the world probably has 20% of their patients taking NSAIDs. That's a guess. I would say there's many of us that do. If it's more of an acute care practice, let's say, or a sports injury practice, you might get up to 50, 60 more percent of your patients actively taking an NSAID. And if you're ready to hear something startling, here it goes. For NSAIDs, there are over 16,500 deaths annually from GI bleeding as a direct result of NSAID use. I'll say that one more time. Nsaids, some of the most commonly prescribed medications thought of as completely benign. Most patients are absolutely not scared or apprehensive of taking them. Therefore they take them quite frequently and for quite a long duration. 16,000 deaths annually as a result of GI bleeding directly due to NSAIDs. And we just talked about a study with 17,000 patients, 50,000 adjustments and zero serious adverse events. Now that's not to put the blame on one practitioner type or anything of that nature, but I think it's very important. You have to know the context. The numbers tell the story, but you have to know the context relative to what else is going on in the world. And the second study we're going to talk about here really frames things, perhaps even in a more appropriate fashion. It was from the European Spine Journal in the year 2008. The risk of vertebrobasilar stroke and chiropractic care is the title. Results of a population based case control and case crossover study. Again, risk of vertebrobasilar stroke and chiropractic care. Results of a population based case control and case crossover study. I will also have in the show notes, I will have references for both of these with direct links@the evidencebasedchiropractor.com so if you want to check that out and get to these on PubMed, you are more than welcome to do so and I would encourage you to do so. So this study, I'm going to pull out one quote and that well let me tell you, it's a nine year study, so that's very infrequent. Do we see a study that's of nine years duration specifically when it has anything to do with chiropractic care? That's a very long study. Sometimes we're criticized because our studies, the follow up might just be weeks or a few months. This was a nine year study. The researchers ultimately found we found no evidence of excess risk of VBA stroke associated with chiropractic care to primary care. I'll say that one more time. The researchers found we found no evidence of excess risk of VBA stroke associated with chiropractic care to primary care. And I really want to just I'm going to pull a little bit from the abstract on this because as again I think the most important thing specifically in this podcast is truly the research. So let me say a few words. This is all quoted so you can it's cited and I more than welcome you to find this article on PubMed. The researchers found there were 818 VBA strokes hospitalized in a population of more than 100 million person years. So we just talked about 16,000 deaths. They've only found 800 VBA strokes in 1 million person years. So take that for what you want. They found in those aged less than 45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than the controls. Results were similar. In the case control and case crossover analyses. There were no increased association between chiropractic visits and VBA stroke in Those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. That's interesting. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke. The conclusion they found VBA stroke is a rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits are likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care to primary care. This was a nine year study that looked at hospital admitted VBA strokes for nine years and these researchers found absolutely no evidence of excess risk. And as a matter of fact they really found and said positive associations, if anything, were found between PCP visits and VBA stroke in all age groups. So again, I wanted to take a few moments today, touch on what the research said. Two seminal papers that we all should be familiar with as chiropractors. And if you'd like, go to the evidencebasedchiropractor.com find our show notes and you will be able to have a direct link to these articles on PubMed to download for yourself. So I hope this gives you a little more confidence in practice. I know we've been taking a beating, so to speak, in the press and in the media and there's been a lot of myth and conjecture and probably a lot of questions from your patients as time has gone on. But you can rest rest assured here at the Evidence Based Chiropractor, we're going to continue to put out the best research based content we can each and every Monday as we come into this New year. Have an absolutely great Thanksgiving if you are here in the States. Hope you enjoy it. I'm going to enjoy my time here in Tampa. We'll be back next Monday and certainly keep your eyes out the Evidence Based Chiropractor we are going to run a Cyber this might be timely for next week's episode. We are going to run a Cyber Monday Sale. If you're looking to get in, get set, get ready for 2017 marketing, research, the whole shebang. The Evidence Based Chiropractor is going to have a Cyber Monday sale that you will not want to miss. So I hope you have an awesome week in practice. Doc and I will talk to you soon.

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