July 2010 Newsletter

Expert Confirms Chiropractic Safety and Standard of Care in Testimony Before Connecticut State Board

Hartford, Connecticut – In late January, respected researcher and epidemiologist J. David Cassidy, DC, PhD, testified as a key witness in hearings before the Connecticut Chiropractic Board. The Board is considering a proposed rule that would require specific written warnings by doctors of chiropractic of the possible risk of stroke following a chiropractic adjustment, to be acknowledged by the patient’s signature.

Speaking as an expert witness and consultant to the International Chiropractors Association (ICA), with the support of chiropractic organizations such as the American Chiropractic Association (ACA), Association of Chiropractic Colleges (ACC), Foundation for Chiropractic Progress (F4CP), Life West, Palmer College of Chiropractic, Parker College of Chiropractic, New York College of Chiropractic, and the University of Bridgeport College of Chiropractic, Dr. Cassidy addressed key facts and issues, bringing the objective research record on the subject before the Board.

Dr. Cassidy was an investigator with The Bone and Joint Decade 2000-2010 Task Force on Neck Pain & Its Associated Disorders for the World Health Organization (WHO). The work of this international task force affirms the safety and benefits of chiropractic care for people with neck pain – a condition frequently treated by doctors of chiropractic.

Their study, which analyzed nine years’ worth of data from a population of 110 million person-years, demonstrated that patients suffering from headache and neck pain are no more likely to suffer from a stroke following a visit to a chiropractor than they are after a visit to a family medical physician, implying that there are more factors involved than just the type of care provided by doctors of chiropractic.

The study concluded that vertebrobasilar artery (VBA) stroke is a very rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different than the risk of VBA stroke following a visit to the office of a primary care medical physician. The study goes on to say that any observed association between a VBA stroke and chiropractic manipulation, as well as its apparent association with PCP visits, is likely due to patients with an undiagnosed vertebral artery dissection seeking care for neck pain and headache prior to their stroke.

Dr. Cassidy joined an extensive list of witnesses representing the chiropractic profession, including William J. Lauretti, DC, James J. Lehman, DC, MBA, J. Clay McDonald, DC, JD, MBA, Life West President Gerard W. Clum, DC, and Stephen M. Perle, DC, MS.

“The chiropractic profession unequivocally supports a patient’s right to be informed of the material benefits and risks of any type of healthcare treatment – not just chiropractic,” said Connecticut Chiropractic Association President Matt Pagano, DC. “Legislation or regulatory mandates governing informed consent should apply to all healthcare providers and all treatments in equal measure. A new law, regulation or mandate, however, highlighting one specific treatment by a specific health care profession that carries with it an extremely rare association, with no causal link identified in the research, is simply not good public health policy. It would set an unnecessary precedent for all health care providers, procedures, and products that would be virtually impossible to implement.”

The ACA, ICA, and other chiropractic organizations have policies that support informed consent for chiropractic treatments, chiropractic colleges teach informed consent to their students, and doctors of chiropractic are expected to inform patients of the material benefits, risks and options for contemplated treatment and document this in writing.

For many years the chiropractic community in Connecticut has battled a well-organized, heavily funded media campaign aimed at frightening the public away from seeking chiropractic care with stark warnings on billboards and in paid advertisements in newspapers that “Chiropractic Adjustments Can Kill or Permanently Disable You!” The same organizations promoting the anti-chiropractic campaign in the media have in recent months driven the issue of informed consent warnings by chiropractors that cervical adjustments “may cause” stroke to the Connecticut State Board of Chiropractic Examiners, having repeatedly failed in their attempts to get the state legislature to add such a mandated warning to the state’s chiropractic practice code.

Chiropractic Researcher and New York College of Chiropractic faculty member Dr. William J. Lauretti conducted and exploration of all scientific literature regarding the safety of cervical manipulation. The resulting article is one of the most comprehensive analyses available. He estimated the risks of stroke or other serious neurological complication resulting from a chiropractic neck adjustment, and compared it to risks associated with other medical treatments and accidents. He found the following:

Estimated Risk of Common Treatments, Common Medical Treatments, and Accidents

Beware of Acetaminophen Risks
by American Chiropractic Association
Acetaminophen — the main ingredient in medications such as Tylenol®—is the most widely used pain reliever. While generally considered safe when taken occasionally and in small doses, acute overdoses and chronic consumption of acetaminophen can cause liver toxicity.

According to research, 50 percent of all acute liver failure in the United States is attributed to acetaminophen consumption.(1) While many of these cases result from an overdose, even “correct dosage” may cause liver damage, liver failure and death.(1) In the United States alone, approximately 56,000 liver injuries requiring emergency treatment, 26,000 hospitalizations and 458 deaths per year are attributed to acetaminophen consumption.(2) The Food and Drug Administration (FDA) is currently considering measures to decrease the number of cases of unintentional and intentional overdose leading to liver injury, including limiting the maximum adult daily dose in both prescription and over-the-counter medications and improving labeling.(3)

Initial signs and symptoms of acetaminophen toxicity are nausea and vomiting, so it’s hard to identify it immediately. In some cases, liver toxicity may develop without symptoms.(4)

Risks of Accidental Overdosing

One of the main problems with this popular medication is how easy it is to overdose unintentionally. In addition to being the primary ingredient in Tylenol, acetaminophen is also contained in almost 200 brandname and generic products—from headache and backache pills to cold and flu remedies and sore throat medications—most of which are available over the counter.

It’s not uncommon for a patient to take several over-the-counter medications—for pain and fever and then for a sore throat, cough and cold, multiplying the risk of overdosing. Combining prescription medications and over-the-counter medications containing acetaminophen also increases the risk. Inadvertent overdosing can also happen from Children’s Tylenol being given to children to relieve a fever over a period of several days.(4)

Fasting (such as not eating because of illness), alcohol consumption or genetic predisposition to liver problems also increases the risk of liver toxicity, although the patient may be taking the prescribed dose of the medication.

Avoiding Damage

To avoid liver damage from acetaminophen:

•Do not take more than 1 gram (1,000 mg) of acetaminophen at once.

•Do not exceed 4,000 mg of acetaminophen in 24 hours. (The FDA is considering reducing the adult maximum daily dose to 3,250 mg, and even further reducing the amount for chronic alcohol users.)3

•Always check to see if over-the-counter or prescription medications contain acetaminophen.

•For children, do not exceed 10-15 mg/kg/dose of acetaminophen, and do not exceed five doses or 2.6 grams in 24 hours.(4)

Drug-Free Pain Relief

Patients often rely on medications to treat acute and chronic pain, but they should always check with a health care provider first to see if safer options are available. Talk to your doctor of chiropractic about conservative, medication-free pain relief. Depending on your individual needs, your doctor of chiropractic will develop a program of care that may combine more than one type of treatment instead of using drugs and surgery. The treatment plan may include spinal manipulation, mobilization, or massage, as well as procedures such as electric stimulation, rehabilitative exercises, advice on nutrition, and suggestions for posture modification. Doctors of chiropractic are committed to wellness and avoiding the unnecessary use of medications.

Common Medications Containing Acetaminophen (4)

Prescription medications
•Vicodin
•Darvocet
•Percocet
•Endocet
•Roxicet
•Ultracet
•Midrin
Common over-the-counter medications
•Tylenol
•Children’s Tylenol
•Tylenol PM
•Excedrin
•Excedrin PM
•Alka Seltzer Plus Cold and Flu
•Sudafed Cold and Sinus

These are just some of the many preparations containing acetaminophen on the market.

Exceptional Risk Factors of Acetaminophen Poisoning (5)

•Fasting (which frequently occurs when patients are ill or in extreme pain)
•Dieting
•Alcohol consumption
•Mixing medications (Acetaminophen is an ingredient in many cold and flu remedies and pain medications.)
• AIDS
• Liver disease
• Malnutrition
• Anorexia
• Kidney disease

For more information on prevention and wellness, go to the Patient Information section on ACA’s Web site at www.acatoday.org or call 800-986-4636.

Nataliya Schetchikova, PhD, Writer

(1) Larson AM, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005;42:1364-1372.
(2) Nourjah P, Ahmad SR, Karwoski C, Willy M.
Estimates of acetaminophen (Paracetamol)-associated overdoses in the United States.
Pharmacoepidemiol Drug Saf 2006 Jun;15(6):398-405.
(3) Recommendations for FDA Interventions to Decrease the Occurrence of Acetaminophen Hepatotoxicity Prepared for Janet Woodcock, M.D. Acting Director, Center for Drug Evaluation and Research by The Acetaminophen Hepatotoxicity
Working Group. Center for Drug Evaluation and Research Food and Drug Administration.
Department of Health and Human Services. February 26, 2008. www.fda.gov.
(4) Dangers of Too Much Acetaminophen! Minnesota
Poison Control System. www.mnpoison.org.
(5) Morgan B. Poison in the Medicine Cabinet. ACA
News 2009 Sept;5(9):18.