Re: FW: CCWG Information Bulletin - December 2, 2002

December 10, 2002

After slogging through this record, I agree with Dr. Dallas. Keep this one

in your files to read before you testify.

--

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

601 First Street

Lake Oswego, OR 97034

503-635-6246

> From: " Dallas, H., Dr. " <whdallas@...>

> Date: Tue, 3 Dec 2002 15:34:18 -0800

> " ' ' " < >

> Subject: FW: CCWG Information Bulletin - December 2, 2002

>

> I strongly recommend that you read this bulletin. It contains an in-depth

> description of Herzog's work with the vertebral artery and establishes

> significant doubt in the arguments posited by some in medicine and law about

> the risks associated with cervical adjusting.

> This material is an excellent resource for DC's answering questions and

> accusations about CVA's and chiropractic.

>

> H. Dallas, D.C.

> President, Western States Chiropractic College

> Phone (503) 251-5712

> Fax (503) 251-5728

>

> CCWG Information Bulletin - December 2, 2002

>

> Information Bulletin

>

> From the Chiropractic Communications Working Group

>

> _____

>

> Tuesday, November 26, 2002

> Dr. Herzog Continues Testimony

> The day began with cross examination by Ms. Amani Oakley, counsel for the

> family, who asked Dr. Herzog about obtaining funding for his research

> projects. Dr. Herzog stated that if a particular project interested him, he

> would proceed regardless of the availability of funding, and acknowledged

> that funding agencies would generally not support a project unless it was of

> interest to them. Ms. Oakley suggested that researchers felt undue

> influence, stemming from the funds they received. To this Dr. Herzog

> disagreed, and further noted that he does not feel bias towards the

> chiropractic profession.

> Ms. Oakley turned her attention to the issue of presenting scientific

> results. Noting that Dr. Herzog has presented his research at countless

> national and international meetings, she asked him if it is appropriate to

> speak about research findings before they are published. Dr. Herzog

> testified that presentation depends on the context. He indicated that it

> generally takes up to two years for research to be published following its

> completion, therefore, by the time it gets into print it is considered old

> news within the research community. Dr. Herzog also pointed out that it is

> the norm for researchers to openly discuss their research at scientific

> meetings and forums, and to inform one another about work in progress. He

> further noted that some scientific conferences will not accept abstracts

> which have already been published. Dr. Herzog added, however, that it is

> considered inappropriate to speak on ones' results outside of the research

> circle before they are published.

> On the matter of disclosure of conflict of interest, Ms. Oakley asked Dr.

> Herzog if he declares a conflict when he produces papers related to

> chiropractic and spinal manipulative therapy. Dr. Herzog testified that he

> openly and truthfully answers all questions put forward by the journals.

> These questions may be related to employment, contracts, and funding, but he

> has never been asked about bias. He further noted that all journals are

> different in regards to their policy on disclosure and what they consider a

> conflict of interest. Dr. Herzog indicated the matter of researcher conflict

> of interest has only been a concern within the last two years.

> Ms. Oakley asked Dr. Herzog why he would state in the introduction of

> several of his published articles, without reference, that SMT is deemed to

> be effective in the treatment of back pain. He indicated that this was

> typical in an introduction and as part of a hypothesis. Dr. Herzog testified

> that one can logically come to this conclusion as the chiropractic

> profession has been around since roughly 1890, it is a successful

> enterprise, the profession is expanding, and patients continue to return for

> treatment. When pressed further by Ms. Oakley, Dr. Herzog clarified saying

> that in research you create a hypothesis, which may include unsupported

> statements, then observe reactions in a controlled environment. What

> determines if the statements hold true are the results. The conclusion

> supports or disproves the hypothesis.

> Ms. Oakley pointed to some of the case literature, and asked how one could

> not agree that there is a direct link between neck manipulation and stroke

> if a stroke happens right there on the adjusting table? Dr. Herzog stated

> that in a good research study, all variables are controlled as best as

> possible, you perform tests and make observations. The research does not

> connect manipulation to stroke. The case literature it is very different.

> These are situations unobserved by the researcher, and anything can happen

> within the space of time before and after the manipulation which may impact

> the outcome.

> Ms. Oakley reviewed with Dr. Herzog the details of his studies measuring the

> amount of force exerted during an adjustment. Dr. Herzog confirmed his

> findings, noting that the average force along the spine was 400 newtons, but

> along the neck was 100 newtons. In an attempt to point out the limitations

> of these studies, Ms. Oakley noted that one study included only 1 patient

> and 2 chiropractors. Dr. Herzog stated this was correct, however, in other

> studies more chiropractors and patients were studied. Ms. Oakley asked if he

> had studied rotational force. Dr. Herzog stated that he has measured several

> different kinds of treatments, and always ensures to re-orient the pressure

> map to attempt to get all measures. Ms. Oakley suggested that the treatments

> were selected based on what could be picked up by the mat. Dr. Herzog

> indicated in specific situations this was the case.

> Ms. Oakley then suggested that with the large variation in force from one

> chiropractor to the next, any conclusions were 'extraordinarily limited'.

> Dr. Herzog stated that he has tested dozens of chiropractors in the Calgary

> area, and while the force does vary from one to the next, overall the

> variation is not considered to be great. He added that even the same

> chiropractor will not do an adjustment the same way each time, although some

> are more consistent than others. Dr. Herzog testified that every adjustment

> would be slightly different, just as the situation is different each time a

> chiropractor sees a patient. He continued that each treatment will vary, but

> that there is consistency in the total range of force. He noted that the

> hand to body contact on the back distributes the force to a greater area. In

> a neck manipulation, Dr. Herzog noted, you do not have the same degree of

> contact, therefore, the force and distribution is reduced.

> Ms. Oakley asked about research with placebo manipulations. Dr. Herzog

> testified that if there is no manipulation there is no force. When asked why

> he did not consider studying the force associated with massage or

> physiotherapy, Dr. Herzog noted that there are other studies which have

> looked specifically at massage. He added that these found that force was

> present during massage treatment.

> Ms. Oakley asked what effect the speed of movement had on the tissues in the

> area of the adjustment? Dr. Herzog stated that speed does not matter as much

> as force. To Ms. Oakley's suggestion that the sudden movement could cause

> tearing, Dr. Herzog indicated that studies have found that the faster the

> speed, the higher the force required to produce a tear. On the matter of

> hyper extension of the joints, Dr. Herzog noted that the muscles have play

> and are not affected by the force. He added that when a chiropractor

> performs an adjustment, at peak force, there is a 3 to 5 centimeter give in

> the full spine, which is well within the normal range of motion. Dr. Herzog

> further noted that with an adjustment there is a quick thrust, release, and

> everything returns to position very quickly. He indicated that in his

> studies on cadavers they were careful not to measure one adjustment too

> close to the next, to ensure that the body had returned to its natural

> reference position. Dr. Herzog also indicated that he could not say for sure

> how long this process took, that they stopped measuring reaction 1 second

> after the adjustment was given. The next adjustment occurred within roughly

> 10 minutes thereafter, by which point the spine had returned to its natural

> reference position.

> Ms. Oakley pointed out that none of Dr. Herzog's studies to date have been

> very large, and yet he was satisfied enough to draw a conclusion that there

> was no link between SMT and arterial dissection. But, Ms. Oakley continued,

> you are not satisfied with case studies which link SMT with dissection and

> stroke. Dr. Herzog replied that, from his point of view, the two were

> different. On the one hand, you are attempting to measure something: you

> have a hypothesis and a question in mind; you give treatment; and see the

> results. Do the results agree with or reject your hypothesis? When you

> repeat this 4, 20, or 100 times with similar results, that is scientific

> evidence. While Dr. Herzog recognized that he was not an expert in the area

> of cause and effect, he indicated that he had given the " link " between

> dissection and SMT considerable thought. Dr. Herzog suggested that, in his

> opinion, if there was a direct cause and effect relationship one would

> expect to see 200 deaths in a 2 week period.

> Ms. Oakley asked how Dr. Herzog selected his cadaveric specimens. He

> indicated they were selected on the absence of injury or disease of the

> cardiovascular system. When asked about how the crystals, which detected

> force and movement, were inserted into the subjects, Dr. Herzog explained

> that a blunt cut was made at the base of the skull and, being careful not to

> cut through ligaments, approximately 1.5 grams of skin and connective tissue

> were removed. Following this the crystals were sewn into the head. He added

> that they measured C1 and C6, and that it was felt that these locations

> would give an accurate measurement of stress through the full length on the

> vertebral artery. Ms. Oakley suggested that the crystals would not be able

> to measure the tug at the most likely point of dissection. Dr. Herzog

> disagreed, noting that only once the artery is taut would a tug be measured,

> and that a SMT is well within this range, thereby a tug would not result.

> Ms. Oakley then suggested that if rotation had been applied creating a

> spiral affect, or a stretch and twist was applied that the crystal would not

> have picked it up. Dr. Herzog indicated that the crystals would have picked

> this up, however, that he could only scientifically substantiate that which

> was measured.

> Ms. Oakley suggested that given the results of some of his studies, it would

> not be possible for Dr. Herzog to conclude a tear could not occur. Dr.

> Herzog disagreed indicating that his studies show that even when the

> arteries are subjected to SMT there is still a lot of give before a

> dissection is likely. Then it was suggested by Ms. Oakley that he had now

> moved into projecting the results of his research beyond what was

> acceptable. Dr. Herzog indicated that the scientific evidence he has

> gathered allows him to make scientific statements as to what is possible.

> Dr. Herzog acknowledged, however, that more research is still required. Ms.

> Oakley offered that he simply could have said that the data provides for

> interesting observation but one could not yet draw conclusions. Dr. Herzog

> noted that could have been the case. He added, however, that he remains firm

> on his research, and that all of his work has been peer reviewed and found

> acceptable to the scientific community.

> Dr. Herzog concluded the day by reiterating that in every day of life, every

> time you move your head the vertebral artery is stretched more, often twice

> as much, as it is during a neck manipulation.

> Wednesday, November 27, 2002

> Dr. Walter Herzog's testimony is concluded

> Ms. Oakley continued her cross-examination by referring to an article by

> Thiel wherein it is suggested that the vertebral artery becomes more

> " accentuated with age. " She suggested that this could be important

> information informing his research. Dr. Herzog replied that it could be but

> that the assertion had no context and no reference. Since the statement was

> not supported it was scientifically irrelevant, moreover the elongation of a

> vertebral artery was only 50% the full range of motion regardless of

> anatomical differences. Dr. Herzog explained that while chiropractic

> adjustment might elongate the vertebral artery it does not stretch it.

> Ms. Oakley then referred to testimony from Drs. Deck and Norris which

> indicated that chiropractic cervical adjustment was unique, in that, it

> subjects the vertebral artery to unusual stretching which could lead to

> damage to the intima. Dr. Herzog testified that this is not the case since

> there is no stretching of the artery involved in a cervical adjustment.

> Following this there was just one question from the jury. Dr. Herzog was

> asked how many measurements were taken in the course of his most recent

> research. Dr. Herzog replied that there were 15 procedures repeated three

> times for a total of 60 measurements.

> Mr. Danson, counsel for the profession, then began redirect and Dr. Herzog

> about his role with CMCC. Dr. Herzog testified that he was an adjunct

> professor and that his contract with CMCC allowed graduate students to

> enhance their education at the human performance lab in Calgary with a

> six-month rotation.

> Concerning a scientist's reputation, Dr. Herzog testified that it was very

> important that a scientist safeguard his reputation by maintaining the

> highest standards of objectivity and quality; otherwise it would be very

> difficult to conduct research. He further testified that a scientist builds

> a reputation by quality research and hard work. He could never allow a

> granting agency to influence the outcomes of research, as this would

> compromise both reputation and the research itself.

> Concerning his relationship with the profession and its possible impact on

> outcomes, Dr. Herzog testified that when he began his research he did not

> know what the results would be. He further testified that the chiropractic

> profession was interested in his research and supported it, but did not

> attempt to influence the questions he explored nor the outcomes he found.

> Ms. , counsel for the Chiropractic College of Ontario, then proceeded

> with her redirect. She suggested that each research project was built upon

> previous projects. Dr. Herzog agreed and testified that his next project was

> to involve the service of a pathologist who would conduct microscopic

> examinations at the cellular level to determine what, if any, effect there

> was on vertebral artery tissue which had been systematically subjected to

> 10,000 elongations. He further testified that the study would be blinded in

> that the pathologist would be given tissue samples to examine without being

> told which had been subjected to elongation and which had not.

> Ms. then questioned Dr. Herzog on the concept of haemodynamic

> occlusion occurring during cervical adjustment that could potentially lead

> to an ischemic event. Dr. Herzog explained that the artery is a pressure

> vessel that is sealed at both ends. Using the example of a filled firehouse

> he testified that if there were stretching, the pressure caused by that

> stretching would be evenly distributed along the length of the vertebral

> artery. Thus it would be unlikely to fail -- less likely to fail, in fact,

> than an unfilled artery.

> Ms. Oakley then began her redirect focusing on Dr. Herzog's relationship

> with CMCC. She suggested that his research might have been skewed because he

> believed that chiropractic was beneficial. Dr. Herzog testified that this

> was not true because on a number of occasions his research showed that

> certain procedures were ineffective. His confidence in chiropractic was

> based solely on the findings of his scientific studies. Moreover, he has

> full confidence in his findings.

> Ms. Oakley then asked whether Dr. Herzog or the chiropractic community set

> his research agenda. Dr. Herzog testified that he has never in his life had

> his research initiated by a granting agency; he always initiated his own

> research.

> Ms.Oakley then returned to the Thiel article that described the vertebral

> artery becoming 'accentuated' with age suggested that there might have been

> 'micro damage at the molecular level' which led to thrombosis. Dr. Herzog

> testified that there was nothing to pursue since no support information had

> been given. She further referred to a study by Triano which used different

> protocols. Dr. Herzog testified that this study was very useful in that the

> different protocols supported his findings.

> Ms. Oakley again suggested that there could be a 'parting of cells at the

> molecular level which might lead to damage to the intima. Dr. Herzog replied

> that he would be very surprised if anyone could demonstrate this

> scientifically, but he did acknowledge that it is normal for scientists to

> disagree.

> Regarding the age of cadavers, Ms. Oakley asked Dr. Herzog if he had

> considered the point that the literature indicates that younger persons are

> involved in injury from cervical adjustment rather than older persons. Dr.

> Herzog testified that the tissue remains strong and is not subjected to

> stress.

> Ms. Oakley then questioned him about whether or not the cadaveric tissue

> would behave abnormally because in his experiment, connective tissue had

> been removed which would otherwise support the artery. Dr. Herzog testified

> that he had been very careful not to remove any material other than muscle

> tissue directly above the site.

> Mr. then conducted his redirect and with Dr. Herzog's testimony

> established that the chiropractic profession had been very interested in

> promoting research. Dr. Herzog testified that chiropractic was a very

> exciting research field because there were so many interesting questions to

> pursue. Dr. Herzog further testified that this research could best be done

> in a university environment, although the profession had done a great deal

> of research activity to the limit of its resources. He went on to affirm

> that there had been no interference from the chiropractic community, but

> that there had been active cooperation between the academic environments and

> the profession which clinical research requires.

> Dr. Herzog testified that he would like to see other universities involved

> in chiropractic research and he would also like to see more funds made

> available. Nevertheless, he stated, his work was partially funded by the

> Natural Sciences and Engineering Research Council of Canada, a group which

> was quite independent of the chiropractic community. He testified that he

> would still have enough work even if he were not involved in chiropractic

> research.

> Concerning his apparent disagreement with Dr. Deck, Dr. Herzog testified

> that he would accept evidence of pathology but only if it made scientific

> sense. He reiterated that if there was no force there could not be any

> stress and therefore, there could be no damage to the vertebral artery

> during cervical adjustment.

> Finally crown counsel Mr. Tom Schneider began his redirect challenging Dr.

> Herzog's use of the expression 'not possible', concerning the potential for

> damage to a vertebral artery during cervical adjustment. Mr. Schneider

> pointed to the fact that in his paper Dr. Herzog had used the expression

> 'highly unlikely'. Dr. Herzog testified that to be the language of

> scientific papers. Mr. Schneider, at length, pressed him to change his

> testimony in that regard. Finally Dr. Herzog relented and agreed that he

> would change not possible to, " very, very, very, very... to the 'nth' degree

> unlikely. "

> Next Mr. Schneider posited that chiropractic adjustment could be implicated

> in an embolism because even the normal range of motion involved in combing

> one's hair or turning to the rear to reverse an automobile could cause

> spontaneous dissection. Dr. Herzog testified that this was so, but that the

> normal range of motion exceeded the range of motion involved in a cervical

> adjustment.

> Mr. Schneider then suggested that the cadaveric studies could not inform us

> about the effect of a cervical adjustment on a living person. Dr. Herzog

> testified that there could not be damage because there was no force exerted

> on the artery.

> Mr. Schneider then suggested that Dr. Herzog's study did not rule out the

> possibility that there could be microscopic damage done to a vertebral

> artery which might cause a thrombus to be formed in 1/100 of a millisecond

> during a cervical manipulation which could cause an unfortunate chain of

> events which could lead to a stroke. Dr. Herzog again stated that there is

> no force and therefore, there can be no damage.

> Dr. Herzog then testified that he had supervised a chiropractic graduate

> student at the Human performance lab in Calgary for each of the last three

> years. Thus Dr. Herzog's testimony was concluded and he was excused.

> Keeping in Contact

> Please contact us if there has been any change in your contact information.

> Reach us by fax at (416) 482-3629; e-mail at infochange@...; or mail at

> Alumni Affairs, Canadian Memorial Chiropractic College, 1900 Bayview Avenue,

> Toronto, Ontario, M4G 3E6.

> In the meantime, if you have questions about this bulletin, please feel free

> to contact us by phone, fax or e-mail using the contact information listed

> in this bulletin.

> _____

>

> The Communications Working Group is comprised of the following

> organizations:

> Canadian Chiropractic Association:

> Phone (416) 781-5656; Toll-free 1-800-668-2076; website

> <http://www.ccachiro.org/> www.ccachiro.org; e-mail

> <mailto:ccachiro@...> ccachiro@...

> Ontario Chiropractic Association:

> Phone (905) 629-8211; Toll-free 1-877-327-2273; website

> <http://www.chiropractic.on.ca/> www.chiropractic.on.ca; e-mail

> <mailto:communications@...> communications@...

>

> Canadian Memorial Chiropractic College:

> Phone (416) 482-2340; Toll-free 1-800-669-2959; website

> <http://www.cmcc.ca/> www.cmcc.ca; e-mail <mailto:communications@...>

> communications@...

> Canadian Chiropractic Protective Association:

> Phone (416) 781-5656; Toll-free 1-800-668-2076; e-mail

> <mailto:CCPAcommunications@...> CCPAcommunications@...

>

December 10, 2002

With all due respect to Dr.s Abrahamson and Dallas I find the Herzog

data on healthy vertebral arteries to be completely useless in making

any determination as to the safety of a procedure that only causes

injury in, at most, 1 in a million manipulations. If the inherent

strength of a healthy vertebral artery could be compromised by a

manipulation the incidence of stroke would be more like 1 in 500 or

less. The clues to this problem lie in looking at the cases, not the

controls.

D Freeman PhD DC MPH

Forensic Trauma Epidemiologist

Department of Public Health and Preventive Medicine

Oregon Health Sciences University School of Medicine

Mailing address: 2480 Liberty Street NE, Suite 180

Salem, Oregon 97303

ph 503 763-3528

fax 503 763-3530

cell 503 871-0715

CCWG Information Bulletin - December 2, 2002

>

> Information Bulletin

>

> From the Chiropractic Communications Working Group

>

> _____

>

> Tuesday, November 26, 2002

> Dr. Herzog Continues Testimony

> The day began with cross examination by Ms. Amani Oakley, counsel for

> the family, who asked Dr. Herzog about obtaining funding for his

> research projects. Dr. Herzog stated that if a particular project

> interested him, he would proceed regardless of the availability of

> funding, and acknowledged that funding agencies would generally not

> support a project unless it was of interest to them. Ms. Oakley

> suggested that researchers felt undue influence, stemming from the

> funds they received. To this Dr. Herzog disagreed, and further noted

> that he does not feel bias towards the chiropractic profession. Ms.

> Oakley turned her attention to the issue of presenting scientific

> results. Noting that Dr. Herzog has presented his research at

> countless national and international meetings, she asked him if it is

> appropriate to speak about research findings before they are

> published. Dr. Herzog testified that presentation depends on the

> context. He indicated that it generally takes up to two years for

> research to be published following its completion, therefore, by the

> time it gets into print it is considered old news within the research

> community. Dr. Herzog also pointed out that it is the norm for

> researchers to openly discuss their research at scientific meetings

> and forums, and to inform one another about work in progress. He

> further noted that some scientific conferences will not accept

> abstracts which have already been published. Dr. Herzog added,

> however, that it is considered inappropriate to speak on ones' results

> outside of the research circle before they are published. On the

> matter of disclosure of conflict of interest, Ms. Oakley asked Dr.

> Herzog if he declares a conflict when he produces papers related to

> chiropractic and spinal manipulative therapy. Dr. Herzog testified

> that he openly and truthfully answers all questions put forward by the

> journals. These questions may be related to employment, contracts, and

> funding, but he has never been asked about bias. He further noted that

> all journals are different in regards to their policy on disclosure

> and what they consider a conflict of interest. Dr. Herzog indicated

> the matter of researcher conflict of interest has only been a concern

> within the last two years. Ms. Oakley asked Dr. Herzog why he would

> state in the introduction of several of his published articles,

> without reference, that SMT is deemed to be effective in the treatment

> of back pain. He indicated that this was typical in an introduction

> and as part of a hypothesis. Dr. Herzog testified that one can

> logically come to this conclusion as the chiropractic profession has

> been around since roughly 1890, it is a successful enterprise, the

> profession is expanding, and patients continue to return for

> treatment. When pressed further by Ms. Oakley, Dr. Herzog clarified

> saying that in research you create a hypothesis, which may include

> unsupported statements, then observe reactions in a controlled

> environment. What determines if the statements hold true are the

> results. The conclusion supports or disproves the hypothesis. Ms.

> Oakley pointed to some of the case literature, and asked how one could

> not agree that there is a direct link between neck manipulation and

> stroke if a stroke happens right there on the adjusting table? Dr.

> Herzog stated that in a good research study, all variables are

> controlled as best as possible, you perform tests and make

> observations. The research does not connect manipulation to stroke.

> The case literature it is very different. These are situations

> unobserved by the researcher, and anything can happen within the space

> of time before and after the manipulation which may impact the

> outcome. Ms. Oakley reviewed with Dr. Herzog the details of his

> studies measuring the amount of force exerted during an adjustment.

> Dr. Herzog confirmed his findings, noting that the average force along

> the spine was 400 newtons, but along the neck was 100 newtons. In an

> attempt to point out the limitations of these studies, Ms. Oakley

> noted that one study included only 1 patient and 2 chiropractors. Dr.

> Herzog stated this was correct, however, in other studies more

> chiropractors and patients were studied. Ms. Oakley asked if he had

> studied rotational force. Dr. Herzog stated that he has measured

> several different kinds of treatments, and always ensures to re-orient

> the pressure map to attempt to get all measures. Ms. Oakley suggested

> that the treatments were selected based on what could be picked up by

> the mat. Dr. Herzog indicated in specific situations this was the

> case. Ms. Oakley then suggested that with the large variation in force

> from one chiropractor to the next, any conclusions were

> 'extraordinarily limited'. Dr. Herzog stated that he has tested dozens

> of chiropractors in the Calgary area, and while the force does vary

> from one to the next, overall the variation is not considered to be

> great. He added that even the same chiropractor will not do an

> adjustment the same way each time, although some are more consistent

> than others. Dr. Herzog testified that every adjustment would be

> slightly different, just as the situation is different each time a

> chiropractor sees a patient. He continued that each treatment will

> vary, but that there is consistency in the total range of force. He

> noted that the hand to body contact on the back distributes the force

> to a greater area. In a neck manipulation, Dr. Herzog noted, you do

> not have the same degree of contact, therefore, the force and

> distribution is reduced. Ms. Oakley asked about research with placebo

> manipulations. Dr. Herzog testified that if there is no manipulation

> there is no force. When asked why he did not consider studying the

> force associated with massage or physiotherapy, Dr. Herzog noted that

> there are other studies which have looked specifically at massage. He

> added that these found that force was present during massage

> treatment. Ms. Oakley asked what effect the speed of movement had on

> the tissues in the area of the adjustment? Dr. Herzog stated that

> speed does not matter as much as force. To Ms. Oakley's suggestion

> that the sudden movement could cause tearing, Dr. Herzog indicated

> that studies have found that the faster the speed, the higher the

> force required to produce a tear. On the matter of hyper extension of

> the joints, Dr. Herzog noted that the muscles have play and are not

> affected by the force. He added that when a chiropractor performs an

> adjustment, at peak force, there is a 3 to 5 centimeter give in the

> full spine, which is well within the normal range of motion. Dr.

> Herzog further noted that with an adjustment there is a quick thrust,

> release, and everything returns to position very quickly. He indicated

> that in his studies on cadavers they were careful not to measure one

> adjustment too close to the next, to ensure that the body had returned

> to its natural reference position. Dr. Herzog also indicated that he

> could not say for sure how long this process took, that they stopped

> measuring reaction 1 second after the adjustment was given. The next

> adjustment occurred within roughly 10 minutes thereafter, by which

> point the spine had returned to its natural reference position. Ms.

> Oakley pointed out that none of Dr. Herzog's studies to date have been

> very large, and yet he was satisfied enough to draw a conclusion that

> there was no link between SMT and arterial dissection. But, Ms. Oakley

> continued, you are not satisfied with case studies which link SMT with

> dissection and stroke. Dr. Herzog replied that, from his point of

> view, the two were different. On the one hand, you are attempting to

> measure something: you have a hypothesis and a question in mind; you

> give treatment; and see the results. Do the results agree with or

> reject your hypothesis? When you repeat this 4, 20, or 100 times with

> similar results, that is scientific evidence. While Dr. Herzog

> recognized that he was not an expert in the area of cause and effect,

> he indicated that he had given the " link " between dissection and SMT

> considerable thought. Dr. Herzog suggested that, in his opinion, if

> there was a direct cause and effect relationship one would expect to

> see 200 deaths in a 2 week period. Ms. Oakley asked how Dr. Herzog

> selected his cadaveric specimens. He indicated they were selected on

> the absence of injury or disease of the cardiovascular system. When

> asked about how the crystals, which detected force and movement, were

> inserted into the subjects, Dr. Herzog explained that a blunt cut was

> made at the base of the skull and, being careful not to cut through

> ligaments, approximately 1.5 grams of skin and connective tissue were

> removed. Following this the crystals were sewn into the head. He added

> that they measured C1 and C6, and that it was felt that these

> locations would give an accurate measurement of stress through the

> full length on the vertebral artery. Ms. Oakley suggested that the

> crystals would not be able to measure the tug at the most likely point

> of dissection. Dr. Herzog disagreed, noting that only once the artery

> is taut would a tug be measured, and that a SMT is well within this

> range, thereby a tug would not result. Ms. Oakley then suggested that

> if rotation had been applied creating a spiral affect, or a stretch

> and twist was applied that the crystal would not have picked it up.

> Dr. Herzog indicated that the crystals would have picked this up,

> however, that he could only scientifically substantiate that which was

> measured. Ms. Oakley suggested that given the results of some of his

> studies, it would not be possible for Dr. Herzog to conclude a tear

> could not occur. Dr. Herzog disagreed indicating that his studies show

> that even when the arteries are subjected to SMT there is still a lot

> of give before a dissection is likely. Then it was suggested by Ms.

> Oakley that he had now moved into projecting the results of his

> research beyond what was acceptable. Dr. Herzog indicated that the

> scientific evidence he has gathered allows him to make scientific

> statements as to what is possible. Dr. Herzog acknowledged, however,

> that more research is still required. Ms. Oakley offered that he

> simply could have said that the data provides for interesting

> observation but one could not yet draw conclusions. Dr. Herzog noted

> that could have been the case. He added, however, that he remains firm

> on his research, and that all of his work has been peer reviewed and

> found acceptable to the scientific community. Dr. Herzog concluded the

> day by reiterating that in every day of life, every time you move your

> head the vertebral artery is stretched more, often twice as much, as

> it is during a neck manipulation. Wednesday, November 27, 2002 Dr.

> Walter Herzog's testimony is concluded Ms. Oakley continued her

> cross-examination by referring to an article by Thiel wherein it is

> suggested that the vertebral artery becomes more " accentuated with

> age. " She suggested that this could be important information informing

> his research. Dr. Herzog replied that it could be but that the

> assertion had no context and no reference. Since the statement was not

> supported it was scientifically irrelevant, moreover the elongation of

> a vertebral artery was only 50% the full range of motion regardless of

> anatomical differences. Dr. Herzog explained that while chiropractic

> adjustment might elongate the vertebral artery it does not stretch it.

> Ms. Oakley then referred to testimony from Drs. Deck and Norris which

> indicated that chiropractic cervical adjustment was unique, in that,

> it subjects the vertebral artery to unusual stretching which could

> lead to damage to the intima. Dr. Herzog testified that this is not

> the case since there is no stretching of the artery involved in a

> cervical adjustment. Following this there was just one question from

> the jury. Dr. Herzog was asked how many measurements were taken in the

> course of his most recent research. Dr. Herzog replied that there were

> 15 procedures repeated three times for a total of 60 measurements. Mr.

> Danson, counsel for the profession, then began redirect and Dr. Herzog

> about his role with CMCC. Dr. Herzog testified that he was an adjunct

> professor and that his contract with CMCC allowed graduate students to

> enhance their education at the human performance lab in Calgary with a

> six-month rotation. Concerning a scientist's reputation, Dr. Herzog

> testified that it was very important that a scientist safeguard his

> reputation by maintaining the highest standards of objectivity and

> quality; otherwise it would be very difficult to conduct research. He

> further testified that a scientist builds a reputation by quality

> research and hard work. He could never allow a granting agency to

> influence the outcomes of research, as this would compromise both

> reputation and the research itself. Concerning his relationship with

> the profession and its possible impact on outcomes, Dr. Herzog

> testified that when he began his research he did not know what the

> results would be. He further testified that the chiropractic

> profession was interested in his research and supported it, but did

> not attempt to influence the questions he explored nor the outcomes he

> found. Ms. , counsel for the Chiropractic College of Ontario,

> then proceeded with her redirect. She suggested that each research

> project was built upon previous projects. Dr. Herzog agreed and

> testified that his next project was to involve the service of a

> pathologist who would conduct microscopic examinations at the cellular

> level to determine what, if any, effect there was on vertebral artery

> tissue which had been systematically subjected to 10,000 elongations.

> He further testified that the study would be blinded in that the

> pathologist would be given tissue samples to examine without being

> told which had been subjected to elongation and which had not. Ms.

> then questioned Dr. Herzog on the concept of haemodynamic

> occlusion occurring during cervical adjustment that could potentially

> lead to an ischemic event. Dr. Herzog explained that the artery is a

> pressure vessel that is sealed at both ends. Using the example of a

> filled firehouse he testified that if there were stretching, the

> pressure caused by that stretching would be evenly distributed along

> the length of the vertebral artery. Thus it would be unlikely to fail

> -- less likely to fail, in fact, than an unfilled artery. Ms. Oakley

> then began her redirect focusing on Dr. Herzog's relationship with

> CMCC. She suggested that his research might have been skewed because

> he believed that chiropractic was beneficial. Dr. Herzog testified

> that this was not true because on a number of occasions his research

> showed that certain procedures were ineffective. His confidence in

> chiropractic was based solely on the findings of his scientific

> studies. Moreover, he has full confidence in his findings. Ms. Oakley

> then asked whether Dr. Herzog or the chiropractic community set his

> research agenda. Dr. Herzog testified that he has never in his life

> had his research initiated by a granting agency; he always initiated

> his own research. Ms.Oakley then returned to the Thiel article that

> described the vertebral artery becoming 'accentuated' with age

> suggested that there might have been 'micro damage at the molecular

> level' which led to thrombosis. Dr. Herzog testified that there was

> nothing to pursue since no support information had been given. She

> further referred to a study by Triano which used different protocols.

> Dr. Herzog testified that this study was very useful in that the

> different protocols supported his findings. Ms. Oakley again suggested

> that there could be a 'parting of cells at the molecular level which

> might lead to damage to the intima. Dr. Herzog replied that he would

> be very surprised if anyone could demonstrate this scientifically, but

> he did acknowledge that it is normal for scientists to disagree.

> Regarding the age of cadavers, Ms. Oakley asked Dr. Herzog if he had

> considered the point that the literature indicates that younger

> persons are involved in injury from cervical adjustment rather than

> older persons. Dr. Herzog testified that the tissue remains strong and

> is not subjected to stress. Ms. Oakley then questioned him about

> whether or not the cadaveric tissue would behave abnormally because in

> his experiment, connective tissue had been removed which would

> otherwise support the artery. Dr. Herzog testified that he had been

> very careful not to remove any material other than muscle tissue

> directly above the site. Mr. then conducted his redirect and

> with Dr. Herzog's testimony established that the chiropractic

> profession had been very interested in promoting research. Dr. Herzog

> testified that chiropractic was a very exciting research field because

> there were so many interesting questions to pursue. Dr. Herzog further

> testified that this research could best be done in a university

> environment, although the profession had done a great deal of research

> activity to the limit of its resources. He went on to affirm that

> there had been no interference from the chiropractic community, but

> that there had been active cooperation between the academic

> environments and the profession which clinical research requires. Dr.

> Herzog testified that he would like to see other universities involved

> in chiropractic research and he would also like to see more funds made

> available. Nevertheless, he stated, his work was partially funded by

> the Natural Sciences and Engineering Research Council of Canada, a

> group which was quite independent of the chiropractic community. He

> testified that he would still have enough work even if he were not

> involved in chiropractic research. Concerning his apparent

> disagreement with Dr. Deck, Dr. Herzog testified that he would accept

> evidence of pathology but only if it made scientific sense. He

> reiterated that if there was no force there could not be any stress

> and therefore, there could be no damage to the vertebral artery during

> cervical adjustment. Finally crown counsel Mr. Tom Schneider began his

> redirect challenging Dr. Herzog's use of the expression 'not

> possible', concerning the potential for damage to a vertebral artery

> during cervical adjustment. Mr. Schneider pointed to the fact that in

> his paper Dr. Herzog had used the expression 'highly unlikely'. Dr.

> Herzog testified that to be the language of scientific papers. Mr.

> Schneider, at length, pressed him to change his testimony in that

> regard. Finally Dr. Herzog relented and agreed that he would change

> not possible to, " very, very, very, very... to the 'nth' degree

> unlikely. " Next Mr. Schneider posited that chiropractic adjustment

> could be implicated in an embolism because even the normal range of

> motion involved in combing one's hair or turning to the rear to

> reverse an automobile could cause spontaneous dissection. Dr. Herzog

> testified that this was so, but that the normal range of motion

> exceeded the range of motion involved in a cervical adjustment. Mr.

> Schneider then suggested that the cadaveric studies could not inform

> us about the effect of a cervical adjustment on a living person. Dr.

> Herzog testified that there could not be damage because there was no

> force exerted on the artery. Mr. Schneider then suggested that Dr.

> Herzog's study did not rule out the possibility that there could be

> microscopic damage done to a vertebral artery which might cause a

> thrombus to be formed in 1/100 of a millisecond during a cervical

> manipulation which could cause an unfortunate chain of events which

> could lead to a stroke. Dr. Herzog again stated that there is no force

> and therefore, there can be no damage. Dr. Herzog then testified that

> he had supervised a chiropractic graduate student at the Human

> performance lab in Calgary for each of the last three years. Thus Dr.

> Herzog's testimony was concluded and he was excused. Keeping in

> Contact Please contact us if there has been any change in your contact

> information. Reach us by fax at (416) 482-3629; e-mail at

> infochange@...; or mail at Alumni Affairs, Canadian Memorial

> Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, M4G 3E6.

In the meantime, if you have questions about this bulletin, please feel

free to contact us by phone, fax or e-mail using the contact information

listed in this bulletin. _____

>

> The Communications Working Group is comprised of the following

> organizations:

> Canadian Chiropractic Association:

> Phone (416) 781-5656; Toll-free 1-800-668-2076; website

> <http://www.ccachiro.org/> www.ccachiro.org; e-mail

> <mailto:ccachiro@...> ccachiro@...

> Ontario Chiropractic Association:

> Phone (905) 629-8211; Toll-free 1-877-327-2273; website

> <http://www.chiropractic.on.ca/> www.chiropractic.on.ca; e-mail

> <mailto:communications@...>

communications@...

>

> Canadian Memorial Chiropractic College:

> Phone (416) 482-2340; Toll-free 1-800-669-2959; website

> <http://www.cmcc.ca/> www.cmcc.ca; e-mail

> <mailto:communications@...> communications@... Canadian

> Chiropractic Protective Association: Phone (416) 781-5656; Toll-free

> 1-800-668-2076; e-mail <mailto:CCPAcommunications@...>

> CCPAcommunications@...

>

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December 10, 2002

The study & testomony seems to suggest that normal neck motion and ROM testing are more stressful to the vertebral artery than the CMT (as performed by the chiropractors involved in the study). This supports the notion that individuals that suffer a stroke following manipulation were ticking bombs, likely to explode the next time they changed a lightbulb, had their hair cut or backed their car out of the driveway. The real challenge is to develop a test with a high degree of specifitiy without false positives to determine who these people are. Right now it seems only family and personal history are valid, as s test seems more risky than the manipulation itself. Anybody have any great ideas? Probably a lot of $$$ to be made in the invention of an "arterial risk assessment device".

Seitz, DC Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

(503)640-3724

>From: "Dr. Freeman"

>

>Subject: RE: FW: CCWG Information Bulletin - December 2, 2002 >Date: Tue, 10 Dec 2002 09:30:51 -0800 > > >With all due respect to Dr.s Abrahamson and Dallas I find the Herzog >data on healthy vertebral arteries to be completely useless in making >any determination as to the safety of a procedure that only causes >injury in, at most, 1 in a million manipulations. If the inherent >strength of a healthy vertebral artery could be compromised by a >manipulation the incidence of stroke would be more like 1 in 500 or >less. The clues to this problem lie in looking at the cases, not the >controls. > > D Freeman PhD DC MPH >Forensic Trauma Epidemiologist >Department of Public Health and Preventive Medicine >Oregon Health Sciences University School of Medicine >Mailing address: 2480 Liberty Street NE, Suite 180 >Salem, Oregon 97303 >ph 503 763-3528 >fax 503 763-3530 >cell 503 871-0715 > > > CCWG Information Bulletin - December 2, 2002 > > > > Information Bulletin > > > > From the Chiropractic Communications Working Group > > > > _____ > > > > > > Tuesday, November 26, 2002 > > Dr. Herzog Continues Testimony > > The day began with cross examination by Ms. Amani Oakley, counsel for > > the family, who asked Dr. Herzog about obtaining funding for his > > research projects. Dr. Herzog stated that if a particular project > > interested him, he would proceed regardless of the availability of > > funding, and acknowledged that funding agencies would generally not > > support a project unless it was of interest to them. Ms. Oakley > > suggested that researchers felt undue influence, stemming from the > > funds they received. To this Dr. Herzog disagreed, and further noted > > that he does not feel bias towards the chiropractic profession. Ms. > > Oakley turned her attention to the issue of presenting scientific > > results. Noting that Dr. Herzog has presented his research at > > countless national and international meetings, she asked him if it is > > appropriate to speak about research findings before they are > > published. Dr. Herzog testified that presentation depends on the > > context. He indicated that it generally takes up to two years for > > research to be published following its completion, therefore, by the > > time it gets into print it is considered old news within the research > > community. Dr. Herzog also pointed out that it is the norm for > > researchers to openly discuss their research at scientific meetings > > and forums, and to inform one another about work in progress. He > > further noted that some scientific conferences will not accept > > abstracts which have already been published. Dr. Herzog added, > > however, that it is considered inappropriate to speak on ones' results > > > outside of the research circle before they are published. On the > > matter of disclosure of conflict of interest, Ms. Oakley asked Dr. > > Herzog if he declares a conflict when he produces papers related to > > chiropractic and spinal manipulative therapy. Dr. Herzog testified > > that he openly and truthfully answers all questions put forward by the > > > journals. These questions may be related to employment, contracts, and > > > funding, but he has never been asked about bias. He further noted that > > > all journals are different in regards to their policy on disclosure > > and what they consider a conflict of interest. Dr. Herzog indicated > > the matter of researcher conflict of interest has only been a concern > > within the last two years. Ms. Oakley asked Dr. Herzog why he would > > state in the introduction of several of his published articles, > > without reference, that SMT is deemed to be effective in the treatment > > > of back pain. He indicated that this was typical in an introduction > > and as part of a hypothesis. Dr. Herzog testified that one can > > logically come to this conclusion as the chiropractic profession has > > been around since roughly 1890, it is a successful enterprise, the > > profession is expanding, and patients continue to return for > > treatment. When pressed further by Ms. Oakley, Dr. Herzog clarified > > saying that in research you create a hypothesis, which may include > > unsupported statements, then observe reactions in a controlled > > environment. What determines if the statements hold true are the > > results. The conclusion supports or disproves the hypothesis. Ms. > > Oakley pointed to some of the case literature, and asked how one could > > > not agree that there is a direct link between neck manipulation and > > stroke if a stroke happens right there on the adjusting table? Dr. > > Herzog stated that in a good research study, all variables are > > controlled as best as possible, you perform tests and make > > observations. The research does not connect manipulation to stroke. > > The case literature it is very different. These are situations > > unobserved by the researcher, and anything can happen within the space > > > of time before and after the manipulation which may impact the > > outcome. Ms. Oakley reviewed with Dr. Herzog the details of his > > studies measuring the amount of force exerted during an adjustment. > > Dr. Herzog confirmed his findings, noting that the average force along > > > the spine was 400 newtons, but along the neck was 100 newtons. In an > > attempt to point out the limitations of these studies, Ms. Oakley > > noted that one study included only 1 patient and 2 chiropractors. Dr. > > Herzog stated this was correct, however, in other studies more > > chiropractors and patients were studied. Ms. Oakley asked if he had > > studied rotational force. Dr. Herzog stated that he has measured > > several different kinds of treatments, and always ensures to re-orient > > > the pressure map to attempt to get all measures. Ms. Oakley suggested > > that the treatments were selected based on what could be picked up by > > the mat. Dr. Herzog indicated in specific situations this was the > > case. Ms. Oakley then suggested that with the large variation in force > > > from one chiropractor to the next, any conclusions were > > 'extraordinarily limited'. Dr. Herzog stated that he has tested dozens > > > of chiropractors in the Calgary area, and while the force does vary > > from one to the next, overall the variation is not considered to be > > great. He added that even the same chiropractor will not do an > > adjustment the same way each time, although some are more consistent > > than others. Dr. Herzog testified that every adjustment would be > > slightly different, just as the situation is different each time a > > chiropractor sees a patient. He continued that each treatment will > > vary, but that there is consistency in the total range of force. He > > noted that the hand to body contact on the back distributes the force > > to a greater area. In a neck manipulation, Dr. Herzog noted, you do > > not have the same degree of contact, therefore, the force and > > distribution is reduced. Ms. Oakley asked about research with placebo > > manipulations. Dr. Herzog testified that if there is no manipulation > > there is no force. When asked why he did not consider studying the > > force associated with massage or physiotherapy, Dr. Herzog noted that > > there are other studies which have looked specifically at massage. He > > added that these found that force was present during massage > > treatment. Ms. Oakley asked what effect the speed of movement had on > > the tissues in the area of the adjustment? Dr. Herzog stated that > > speed does not matter as much as force. To Ms. Oakley's suggestion > > that the sudden movement could cause tearing, Dr. Herzog indicated > > that studies have found that the faster the speed, the higher the > > force required to produce a tear. On the matter of hyper extension of > > the joints, Dr. Herzog noted that the muscles have play and are not > > affected by the force. He added that when a chiropractor performs an > > adjustment, at peak force, there is a 3 to 5 centimeter give in the > > full spine, which is well within the normal range of motion. Dr. > > Herzog further noted that with an adjustment there is a quick thrust, > > release, and everything returns to position very quickly. He indicated > > > that in his studies on cadavers they were careful not to measure one > > adjustment too close to the next, to ensure that the body had returned > > > to its natural reference position. Dr. Herzog also indicated that he > > could not say for sure how long this process took, that they stopped > > measuring reaction 1 second after the adjustment was given. The next > > adjustment occurred within roughly 10 minutes thereafter, by which > > point the spine had returned to its natural reference position. Ms. > > Oakley pointed out that none of Dr. Herzog's studies to date have been > > > very large, and yet he was satisfied enough to draw a conclusion that > > there was no link between SMT and arterial dissection. But, Ms. Oakley > > > continued, you are not satisfied with case studies which link SMT with > > > dissection and stroke. Dr. Herzog replied that, from his point of > > view, the two were different. On the one hand, you are attempting to > > measure something: you have a hypothesis and a question in mind; you > > give treatment; and see the results. Do the results agree with or > > reject your hypothesis? When you repeat this 4, 20, or 100 times with > > similar results, that is scientific evidence. While Dr. Herzog > > recognized that he was not an expert in the area of cause and effect, > > he indicated that he had given the "link" between dissection and SMT > > considerable thought. Dr. Herzog suggested that, in his opinion, if > > there was a direct cause and effect relationship one would expect to > > see 200 deaths in a 2 week period. Ms. Oakley asked how Dr. Herzog > > selected his cadaveric specimens. He indicated they were selected on > > the absence of injury or disease of the cardiovascular system. When > > asked about how the crystals, which detected force and movement, were > > inserted into the subjects, Dr. Herzog explained that a blunt cut was > > made at the base of the skull and, being careful not to cut through > > ligaments, approximately 1.5 grams of skin and connective tissue were > > removed. Following this the crystals were sewn into the head. He added > > > that they measured C1 and C6, and that it was felt that these > > locations would give an accurate measurement of stress through the > > full length on the vertebral artery. Ms. Oakley suggested that the > > crystals would not be able to measure the tug at the most likely point > > > of dissection. Dr. Herzog disagreed, noting that only once the artery > > is taut would a tug be measured, and that a SMT is well within this > > range, thereby a tug would not result. Ms. Oakley then suggested that > > if rotation had been applied creating a spiral affect, or a stretch > > and twist was applied that the crystal would not have picked it up. > > Dr. Herzog indicated that the crystals would have picked this up, > > however, that he could only scientifically substantiate that which was > > > measured. Ms. Oakley suggested that given the results of some of his > > studies, it would not be possible for Dr. Herzog to conclude a tear > > could not occur. Dr. Herzog disagreed indicating that his studies show > > > that even when the arteries are subjected to SMT there is still a lot > > of give before a dissection is likely. Then it was suggested by Ms. > > Oakley that he had now moved into projecting the results of his > > research beyond what was acceptable. Dr. Herzog indicated that the > > scientific evidence he has gathered allows him to make scientific > > statements as to what is possible. Dr. Herzog acknowledged, however, > > that more research is still required. Ms. Oakley offered that he > > simply could have said that the data provides for interesting > > observation but one could not yet draw conclusions. Dr. Herzog noted > > that could have been the case. He added, however, that he remains firm > > > on his research, and that all of his work has been peer reviewed and > > found acceptable to the scientific community. Dr. Herzog concluded the > > > day by reiterating that in every day of life, every time you move your > > > head the vertebral artery is stretched more, often twice as much, as > > it is during a neck manipulation. Wednesday, November 27, 2002 Dr. > > Walter Herzog's testimony is concluded Ms. Oakley continued her > > cross-examination by referring to an article by Thiel wherein it is > > suggested that the vertebral artery becomes more "accentuated with > > age." She suggested that this could be important information informing > > > his research. Dr. Herzog replied that it could be but that the > > assertion had no context and no reference. Since the statement was not > > > supported it was scientifically irrelevant, moreover the elongation of > > > a vertebral artery was only 50% the full range of motion regardless of > > > anatomical differences. Dr. Herzog explained that while chiropractic > > adjustment might elongate the vertebral artery it does not stretch it. > > > Ms. Oakley then referred to testimony from Drs. Deck and Norris which > > indicated that chiropractic cervical adjustment was unique, in that, > > it subjects the vertebral artery to unusual stretching which could > > lead to damage to the intima. Dr. Herzog testified that this is not > > the case since there is no stretching of the artery involved in a > > cervical adjustment. Following this there was just one question from > > the jury. Dr. Herzog was asked how many measurements were taken in the > > > course of his most recent research. Dr. Herzog replied that there were > > > 15 procedures repeated three times for a total of 60 measurements. Mr. > > > Danson, counsel for the profession, then began redirect and Dr. Herzog > > > about his role with CMCC. Dr. Herzog testified that he was an adjunct > > professor and that his contract with CMCC allowed graduate students to > > > enhance their education at the human performance lab in Calgary with a > > > six-month rotation. Concerning a scientist's reputation, Dr. Herzog > > testified that it was very important that a scientist safeguard his > > reputation by maintaining the highest standards of objectivity and > > quality; otherwise it would be very difficult to conduct research. He > > further testified that a scientist builds a reputation by quality > > research and hard work. He could never allow a granting agency to > > influence the outcomes of research, as this would compromise both > > reputation and the research itself. Concerning his relationship with > > the profession and its possible impact on outcomes, Dr. Herzog > > testified that when he began his research he did not know what the > > results would be. He further testified that the chiropractic > > profession was interested in his research and supported it, but did > > not attempt to influence the questions he explored nor the outcomes he > > > found. Ms. , counsel for the Chiropractic College of Ontario, > > then proceeded with her redirect. She suggested that each research > > project was built upon previous projects. Dr. Herzog agreed and > > testified that his next project was to involve the service of a > > pathologist who would conduct microscopic examinations at the cellular > > > level to determine what, if any, effect there was on vertebral artery > > tissue which had been systematically subjected to 10,000 elongations. > > He further testified that the study would be blinded in that the > > pathologist would be given tissue samples to examine without being > > told which had been subjected to elongation and which had not. Ms. > > then questioned Dr. Herzog on the concept of haemodynamic > > occlusion occurring during cervical adjustment that could potentially > > lead to an ischemic event. Dr. Herzog explained that the artery is a > > pressure vessel that is sealed at both ends. Using the example of a > > filled firehouse he testified that if there were stretching, the > > pressure caused by that stretching would be evenly distributed along > > the length of the vertebral artery. Thus it would be unlikely to fail > > -- less likely to fail, in fact, than an unfilled artery. Ms. Oakley > > then began her redirect focusing on Dr. Herzog's relationship with > > CMCC. She suggested that his research might have been skewed because > > he believed that chiropractic was beneficial. Dr. Herzog testified > > that this was not true because on a number of occasions his research > > showed that certain procedures were ineffective. His confidence in > > chiropractic was based solely on the findings of his scientific > > studies. Moreover, he has full confidence in his findings. Ms. Oakley > > then asked whether Dr. Herzog or the chiropractic community set his > > research agenda. Dr. Herzog testified that he has never in his life > > had his research initiated by a granting agency; he always initiated > > his own research. Ms.Oakley then returned to the Thiel article that > > described the vertebral artery becoming 'accentuated' with age > > suggested that there might have been 'micro damage at the molecular > > level' which led to thrombosis. Dr. Herzog testified that there was > > nothing to pursue since no support information had been given. She > > further referred to a study by Triano which used different protocols. > > Dr. Herzog testified that this study was very useful in that the > > different protocols supported his findings. Ms. Oakley again suggested > > > that there could be a 'parting of cells at the molecular level which > > might lead to damage to the intima. Dr. Herzog replied that he would > > be very surprised if anyone could demonstrate this scientifically, but > > > he did acknowledge that it is normal for scientists to disagree. > > Regarding the age of cadavers, Ms. Oakley asked Dr. Herzog if he had > > considered the point that the literature indicates that younger > > persons are involved in injury from cervical adjustment rather than > > older persons. Dr. Herzog testified that the tissue remains strong and > > > is not subjected to stress. Ms. Oakley then questioned him about > > whether or not the cadaveric tissue would behave abnormally because in > > > his experiment, connective tissue had been removed which would > > otherwise support the artery. Dr. Herzog testified that he had been > > very careful not to remove any material other than muscle tissue > > directly above the site. Mr. then conducted his redirect and > > with Dr. Herzog's testimony established that the chiropractic > > profession had been very interested in promoting research. Dr. Herzog > > testified that chiropractic was a very exciting research field because > > > there were so many interesting questions to pursue. Dr. Herzog further > > > testified that this research could best be done in a university > > environment, although the profession had done a great deal of research > > > activity to the limit of its resources. He went on to affirm that > > there had been no interference from the chiropractic community, but > > that there had been active cooperation between the academic > > environments and the profession which clinical research requires. Dr. > > Herzog testified that he would like to see other universities involved > > > in chiropractic research and he would also like to see more funds made > > > available. Nevertheless, he stated, his work was partially funded by > > the Natural Sciences and Engineering Research Council of Canada, a > > group which was quite independent of the chiropractic community. He > > testified that he would still have enough work even if he were not > > involved in chiropractic research. Concerning his apparent > > disagreement with Dr. Deck, Dr. Herzog testified that he would accept > > evidence of pathology but only if it made scientific sense. He > > reiterated that if there was no force there could not be any stress > > and therefore, there could be no damage to the vertebral artery during > > > cervical adjustment. Finally crown counsel Mr. Tom Schneider began his > > > redirect challenging Dr. Herzog's use of the expression 'not > > possible', concerning the potential for damage to a vertebral artery > > during cervical adjustment. Mr. Schneider pointed to the fact that in > > his paper Dr. Herzog had used the expression 'highly unlikely'. Dr. > > Herzog testified that to be the language of scientific papers. Mr. > > Schneider, at length, pressed him to change his testimony in that > > regard. Finally Dr. Herzog relented and agreed that he would change > > not possible to, "very, very, very, very... to the 'nth' degree > > unlikely." Next Mr. Schneider posited that chiropractic adjustment > > could be implicated in an embolism because even the normal range of > > motion involved in combing one's hair or turning to the rear to > > reverse an automobile could cause spontaneous dissection. Dr. Herzog > > testified that this was so, but that the normal range of motion > > exceeded the range of motion involved in a cervical adjustment. Mr. > > Schneider then suggested that the cadaveric studies could not inform > > us about the effect of a cervical adjustment on a living person. Dr. > > Herzog testified that there could not be damage because there was no > > force exerted on the artery. Mr. Schneider then suggested that Dr. > > Herzog's study did not rule out the possibility that there could be > > microscopic damage done to a vertebral artery which might cause a > > thrombus to be formed in 1/100 of a millisecond during a cervical > > manipulation which could cause an unfortunate chain of events which > > could lead to a stroke. Dr. Herzog again stated that there is no force > > > and therefore, there can be no damage. Dr. Herzog then testified that > > he had supervised a chiropractic graduate student at the Human > > performance lab in Calgary for each of the last three years. Thus Dr. > > Herzog's testimony was concluded and he was excused. Keeping in > > Contact Please contact us if there has been any change in your contact > > > information. Reach us by fax at (416) 482-3629; e-mail at > > infochange@...; or mail at Alumni Affairs, Canadian Memorial > > Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, M4G 3E6. >In the meantime, if you have questions about this bulletin, please feel >free to contact us by phone, fax or e-mail using the contact information >listed in this bulletin. _____ > > > > The Communications Working Group is comprised of the following > > organizations: > > Canadian Chiropractic Association: > > Phone (416) 781-5656; Toll-free 1-800-668-2076; website > > www.ccachiro.org; e-mail > > ccachiro@... > > Ontario Chiropractic Association: > > Phone (905) 629-8211; Toll-free 1-877-327-2273; website > > www.chiropractic.on.ca; e-mail > >

>communications@... > > > > Canadian Memorial Chiropractic College: > > Phone (416) 482-2340; Toll-free 1-800-669-2959; website > > www.cmcc.ca; e-mail > > communications@... Canadian > > Chiropractic Protective Association: Phone (416) 781-5656; Toll-free > > 1-800-668-2076; e-mail

> > CCPAcommunications@... > > > > > > >OregonDCs rules: >1. Keep correspondence professional; the purpose of the listserve is to >foster communication and collegiality. No personal attacks on listserve >members will be tolerated. 2. Always sign your e-mails with your first >and last name. 3. The listserve is not secure; your e-mail could end up >anywhere. However, it is against the rules of the listserve to copy, >print, forward, or otherwise distribute correspondence written by >another member without his or her consent, unless all personal >identifiers have been removed. > >

December 10, 2002

Good feedback, .

It would serve us all to take our ammo for testimony to Dr. Freeman for

vetting.

Abrahamson, D.C.

> From: " Dr. Freeman " <drmfreeman@...>

> Date: Tue, 10 Dec 2002 09:30:51 -0800

> < >

> Subject: RE: FW: CCWG Information Bulletin - December 2, 2002

>

> With all due respect to Dr.s Abrahamson and Dallas I find the Herzog

> data on healthy vertebral arteries to be completely useless in making

> any determination as to the safety of a procedure that only causes

> injury in, at most, 1 in a million manipulations. If the inherent

> strength of a healthy vertebral artery could be compromised by a

> manipulation the incidence of stroke would be more like 1 in 500 or

> less. The clues to this problem lie in looking at the cases, not the

> controls.

>

> D Freeman PhD DC MPH

> Forensic Trauma Epidemiologist

> Department of Public Health and Preventive Medicine

> Oregon Health Sciences University School of Medicine

> Mailing address: 2480 Liberty Street NE, Suite 180

> Salem, Oregon 97303

> ph 503 763-3528

> fax 503 763-3530

> cell 503 871-0715

>

> CCWG Information Bulletin - December 2, 2002

>>

>> Information Bulletin

>>

>> From the Chiropractic Communications Working Group

>>

>> _____

>>

>> Tuesday, November 26, 2002

>> Dr. Herzog Continues Testimony

>> The day began with cross examination by Ms. Amani Oakley, counsel for

>> the family, who asked Dr. Herzog about obtaining funding for his

>> research projects. Dr. Herzog stated that if a particular project

>> interested him, he would proceed regardless of the availability of

>> funding, and acknowledged that funding agencies would generally not

>> support a project unless it was of interest to them. Ms. Oakley

>> suggested that researchers felt undue influence, stemming from the

>> funds they received. To this Dr. Herzog disagreed, and further noted

>> that he does not feel bias towards the chiropractic profession. Ms.

>> Oakley turned her attention to the issue of presenting scientific

>> results. Noting that Dr. Herzog has presented his research at

>> countless national and international meetings, she asked him if it is

>> appropriate to speak about research findings before they are

>> published. Dr. Herzog testified that presentation depends on the

>> context. He indicated that it generally takes up to two years for

>> research to be published following its completion, therefore, by the

>> time it gets into print it is considered old news within the research

>> community. Dr. Herzog also pointed out that it is the norm for

>> researchers to openly discuss their research at scientific meetings

>> and forums, and to inform one another about work in progress. He

>> further noted that some scientific conferences will not accept

>> abstracts which have already been published. Dr. Herzog added,

>> however, that it is considered inappropriate to speak on ones' results

>

>> outside of the research circle before they are published. On the

>> matter of disclosure of conflict of interest, Ms. Oakley asked Dr.

>> Herzog if he declares a conflict when he produces papers related to

>> chiropractic and spinal manipulative therapy. Dr. Herzog testified

>> that he openly and truthfully answers all questions put forward by the

>

>> journals. These questions may be related to employment, contracts, and

>

>> funding, but he has never been asked about bias. He further noted that

>

>> all journals are different in regards to their policy on disclosure

>> and what they consider a conflict of interest. Dr. Herzog indicated

>> the matter of researcher conflict of interest has only been a concern

>> within the last two years. Ms. Oakley asked Dr. Herzog why he would

>> state in the introduction of several of his published articles,

>> without reference, that SMT is deemed to be effective in the treatment

>

>> of back pain. He indicated that this was typical in an introduction

>> and as part of a hypothesis. Dr. Herzog testified that one can

>> logically come to this conclusion as the chiropractic profession has

>> been around since roughly 1890, it is a successful enterprise, the

>> profession is expanding, and patients continue to return for

>> treatment. When pressed further by Ms. Oakley, Dr. Herzog clarified

>> saying that in research you create a hypothesis, which may include

>> unsupported statements, then observe reactions in a controlled

>> environment. What determines if the statements hold true are the

>> results. The conclusion supports or disproves the hypothesis. Ms.

>> Oakley pointed to some of the case literature, and asked how one could

>

>> not agree that there is a direct link between neck manipulation and

>> stroke if a stroke happens right there on the adjusting table? Dr.

>> Herzog stated that in a good research study, all variables are

>> controlled as best as possible, you perform tests and make

>> observations. The research does not connect manipulation to stroke.

>> The case literature it is very different. These are situations

>> unobserved by the researcher, and anything can happen within the space

>

>> of time before and after the manipulation which may impact the

>> outcome. Ms. Oakley reviewed with Dr. Herzog the details of his

>> studies measuring the amount of force exerted during an adjustment.

>> Dr. Herzog confirmed his findings, noting that the average force along

>

>> the spine was 400 newtons, but along the neck was 100 newtons. In an

>> attempt to point out the limitations of these studies, Ms. Oakley

>> noted that one study included only 1 patient and 2 chiropractors. Dr.

>> Herzog stated this was correct, however, in other studies more

>> chiropractors and patients were studied. Ms. Oakley asked if he had

>> studied rotational force. Dr. Herzog stated that he has measured

>> several different kinds of treatments, and always ensures to re-orient

>

>> the pressure map to attempt to get all measures. Ms. Oakley suggested

>> that the treatments were selected based on what could be picked up by

>> the mat. Dr. Herzog indicated in specific situations this was the

>> case. Ms. Oakley then suggested that with the large variation in force

>

>> from one chiropractor to the next, any conclusions were

>> 'extraordinarily limited'. Dr. Herzog stated that he has tested dozens

>

>> of chiropractors in the Calgary area, and while the force does vary

>> from one to the next, overall the variation is not considered to be

>> great. He added that even the same chiropractor will not do an

>> adjustment the same way each time, although some are more consistent

>> than others. Dr. Herzog testified that every adjustment would be

>> slightly different, just as the situation is different each time a

>> chiropractor sees a patient. He continued that each treatment will

>> vary, but that there is consistency in the total range of force. He

>> noted that the hand to body contact on the back distributes the force

>> to a greater area. In a neck manipulation, Dr. Herzog noted, you do

>> not have the same degree of contact, therefore, the force and

>> distribution is reduced. Ms. Oakley asked about research with placebo

>> manipulations. Dr. Herzog testified that if there is no manipulation

>> there is no force. When asked why he did not consider studying the

>> force associated with massage or physiotherapy, Dr. Herzog noted that

>> there are other studies which have looked specifically at massage. He

>> added that these found that force was present during massage

>> treatment. Ms. Oakley asked what effect the speed of movement had on

>> the tissues in the area of the adjustment? Dr. Herzog stated that

>> speed does not matter as much as force. To Ms. Oakley's suggestion

>> that the sudden movement could cause tearing, Dr. Herzog indicated

>> that studies have found that the faster the speed, the higher the

>> force required to produce a tear. On the matter of hyper extension of

>> the joints, Dr. Herzog noted that the muscles have play and are not

>> affected by the force. He added that when a chiropractor performs an

>> adjustment, at peak force, there is a 3 to 5 centimeter give in the

>> full spine, which is well within the normal range of motion. Dr.

>> Herzog further noted that with an adjustment there is a quick thrust,

>> release, and everything returns to position very quickly. He indicated

>

>> that in his studies on cadavers they were careful not to measure one

>> adjustment too close to the next, to ensure that the body had returned

>

>> to its natural reference position. Dr. Herzog also indicated that he

>> could not say for sure how long this process took, that they stopped

>> measuring reaction 1 second after the adjustment was given. The next

>> adjustment occurred within roughly 10 minutes thereafter, by which

>> point the spine had returned to its natural reference position. Ms.

>> Oakley pointed out that none of Dr. Herzog's studies to date have been

>

>> very large, and yet he was satisfied enough to draw a conclusion that

>> there was no link between SMT and arterial dissection. But, Ms. Oakley

>

>> continued, you are not satisfied with case studies which link SMT with

>

>> dissection and stroke. Dr. Herzog replied that, from his point of

>> view, the two were different. On the one hand, you are attempting to

>> measure something: you have a hypothesis and a question in mind; you

>> give treatment; and see the results. Do the results agree with or

>> reject your hypothesis? When you repeat this 4, 20, or 100 times with

>> similar results, that is scientific evidence. While Dr. Herzog

>> recognized that he was not an expert in the area of cause and effect,

>> he indicated that he had given the " link " between dissection and SMT

>> considerable thought. Dr. Herzog suggested that, in his opinion, if

>> there was a direct cause and effect relationship one would expect to

>> see 200 deaths in a 2 week period. Ms. Oakley asked how Dr. Herzog

>> selected his cadaveric specimens. He indicated they were selected on

>> the absence of injury or disease of the cardiovascular system. When

>> asked about how the crystals, which detected force and movement, were

>> inserted into the subjects, Dr. Herzog explained that a blunt cut was

>> made at the base of the skull and, being careful not to cut through

>> ligaments, approximately 1.5 grams of skin and connective tissue were

>> removed. Following this the crystals were sewn into the head. He added

>

>> that they measured C1 and C6, and that it was felt that these

>> locations would give an accurate measurement of stress through the

>> full length on the vertebral artery. Ms. Oakley suggested that the

>> crystals would not be able to measure the tug at the most likely point

>

>> of dissection. Dr. Herzog disagreed, noting that only once the artery

>> is taut would a tug be measured, and that a SMT is well within this

>> range, thereby a tug would not result. Ms. Oakley then suggested that

>> if rotation had been applied creating a spiral affect, or a stretch

>> and twist was applied that the crystal would not have picked it up.

>> Dr. Herzog indicated that the crystals would have picked this up,

>> however, that he could only scientifically substantiate that which was

>

>> measured. Ms. Oakley suggested that given the results of some of his

>> studies, it would not be possible for Dr. Herzog to conclude a tear

>> could not occur. Dr. Herzog disagreed indicating that his studies show

>

>> that even when the arteries are subjected to SMT there is still a lot

>> of give before a dissection is likely. Then it was suggested by Ms.

>> Oakley that he had now moved into projecting the results of his

>> research beyond what was acceptable. Dr. Herzog indicated that the

>> scientific evidence he has gathered allows him to make scientific

>> statements as to what is possible. Dr. Herzog acknowledged, however,

>> that more research is still required. Ms. Oakley offered that he

>> simply could have said that the data provides for interesting

>> observation but one could not yet draw conclusions. Dr. Herzog noted

>> that could have been the case. He added, however, that he remains firm

>

>> on his research, and that all of his work has been peer reviewed and

>> found acceptable to the scientific community. Dr. Herzog concluded the

>

>> day by reiterating that in every day of life, every time you move your

>

>> head the vertebral artery is stretched more, often twice as much, as

>> it is during a neck manipulation. Wednesday, November 27, 2002 Dr.

>> Walter Herzog's testimony is concluded Ms. Oakley continued her

>> cross-examination by referring to an article by Thiel wherein it is

>> suggested that the vertebral artery becomes more " accentuated with

>> age. " She suggested that this could be important information informing

>

>> his research. Dr. Herzog replied that it could be but that the

>> assertion had no context and no reference. Since the statement was not

>

>> supported it was scientifically irrelevant, moreover the elongation of

>

>> a vertebral artery was only 50% the full range of motion regardless of

>

>> anatomical differences. Dr. Herzog explained that while chiropractic

>> adjustment might elongate the vertebral artery it does not stretch it.

>

>> Ms. Oakley then referred to testimony from Drs. Deck and Norris which

>> indicated that chiropractic cervical adjustment was unique, in that,

>> it subjects the vertebral artery to unusual stretching which could

>> lead to damage to the intima. Dr. Herzog testified that this is not

>> the case since there is no stretching of the artery involved in a

>> cervical adjustment. Following this there was just one question from

>> the jury. Dr. Herzog was asked how many measurements were taken in the

>

>> course of his most recent research. Dr. Herzog replied that there were

>

>> 15 procedures repeated three times for a total of 60 measurements. Mr.

>

>> Danson, counsel for the profession, then began redirect and Dr. Herzog

>

>> about his role with CMCC. Dr. Herzog testified that he was an adjunct

>> professor and that his contract with CMCC allowed graduate students to

>

>> enhance their education at the human performance lab in Calgary with a

>

>> six-month rotation. Concerning a scientist's reputation, Dr. Herzog

>> testified that it was very important that a scientist safeguard his

>> reputation by maintaining the highest standards of objectivity and

>> quality; otherwise it would be very difficult to conduct research. He

>> further testified that a scientist builds a reputation by quality

>> research and hard work. He could never allow a granting agency to

>> influence the outcomes of research, as this would compromise both

>> reputation and the research itself. Concerning his relationship with

>> the profession and its possible impact on outcomes, Dr. Herzog

>> testified that when he began his research he did not know what the

>> results would be. He further testified that the chiropractic

>> profession was interested in his research and supported it, but did

>> not attempt to influence the questions he explored nor the outcomes he

>

>> found. Ms. , counsel for the Chiropractic College of Ontario,

>> then proceeded with her redirect. She suggested that each research

>> project was built upon previous projects. Dr. Herzog agreed and

>> testified that his next project was to involve the service of a

>> pathologist who would conduct microscopic examinations at the cellular

>

>> level to determine what, if any, effect there was on vertebral artery

>> tissue which had been systematically subjected to 10,000 elongations.

>> He further testified that the study would be blinded in that the

>> pathologist would be given tissue samples to examine without being

>> told which had been subjected to elongation and which had not. Ms.

>> then questioned Dr. Herzog on the concept of haemodynamic

>> occlusion occurring during cervical adjustment that could potentially

>> lead to an ischemic event. Dr. Herzog explained that the artery is a

>> pressure vessel that is sealed at both ends. Using the example of a

>> filled firehouse he testified that if there were stretching, the

>> pressure caused by that stretching would be evenly distributed along

>> the length of the vertebral artery. Thus it would be unlikely to fail

>> -- less likely to fail, in fact, than an unfilled artery. Ms. Oakley

>> then began her redirect focusing on Dr. Herzog's relationship with

>> CMCC. She suggested that his research might have been skewed because

>> he believed that chiropractic was beneficial. Dr. Herzog testified

>> that this was not true because on a number of occasions his research

>> showed that certain procedures were ineffective. His confidence in

>> chiropractic was based solely on the findings of his scientific

>> studies. Moreover, he has full confidence in his findings. Ms. Oakley

>> then asked whether Dr. Herzog or the chiropractic community set his

>> research agenda. Dr. Herzog testified that he has never in his life

>> had his research initiated by a granting agency; he always initiated

>> his own research. Ms.Oakley then returned to the Thiel article that

>> described the vertebral artery becoming 'accentuated' with age

>> suggested that there might have been 'micro damage at the molecular

>> level' which led to thrombosis. Dr. Herzog testified that there was

>> nothing to pursue since no support information had been given. She

>> further referred to a study by Triano which used different protocols.

>> Dr. Herzog testified that this study was very useful in that the

>> different protocols supported his findings. Ms. Oakley again suggested

>

>> that there could be a 'parting of cells at the molecular level which

>> might lead to damage to the intima. Dr. Herzog replied that he would

>> be very surprised if anyone could demonstrate this scientifically, but

>

>> he did acknowledge that it is normal for scientists to disagree.

>> Regarding the age of cadavers, Ms. Oakley asked Dr. Herzog if he had

>> considered the point that the literature indicates that younger

>> persons are involved in injury from cervical adjustment rather than

>> older persons. Dr. Herzog testified that the tissue remains strong and

>

>> is not subjected to stress. Ms. Oakley then questioned him about

>> whether or not the cadaveric tissue would behave abnormally because in

>

>> his experiment, connective tissue had been removed which would

>> otherwise support the artery. Dr. Herzog testified that he had been

>> very careful not to remove any material other than muscle tissue

>> directly above the site. Mr. then conducted his redirect and

>> with Dr. Herzog's testimony established that the chiropractic

>> profession had been very interested in promoting research. Dr. Herzog

>> testified that chiropractic was a very exciting research field because

>

>> there were so many interesting questions to pursue. Dr. Herzog further

>

>> testified that this research could best be done in a university

>> environment, although the profession had done a great deal of research

>

>> activity to the limit of its resources. He went on to affirm that

>> there had been no interference from the chiropractic community, but

>> that there had been active cooperation between the academic

>> environments and the profession which clinical research requires. Dr.

>> Herzog testified that he would like to see other universities involved

>

>> in chiropractic research and he would also like to see more funds made

>

>> available. Nevertheless, he stated, his work was partially funded by

>> the Natural Sciences and Engineering Research Council of Canada, a

>> group which was quite independent of the chiropractic community. He

>> testified that he would still have enough work even if he were not

>> involved in chiropractic research. Concerning his apparent

>> disagreement with Dr. Deck, Dr. Herzog testified that he would accept

>> evidence of pathology but only if it made scientific sense. He

>> reiterated that if there was no force there could not be any stress

>> and therefore, there could be no damage to the vertebral artery during

>

>> cervical adjustment. Finally crown counsel Mr. Tom Schneider began his

>

>> redirect challenging Dr. Herzog's use of the expression 'not

>> possible', concerning the potential for damage to a vertebral artery

>> during cervical adjustment. Mr. Schneider pointed to the fact that in

>> his paper Dr. Herzog had used the expression 'highly unlikely'. Dr.

>> Herzog testified that to be the language of scientific papers. Mr.

>> Schneider, at length, pressed him to change his testimony in that

>> regard. Finally Dr. Herzog relented and agreed that he would change

>> not possible to, " very, very, very, very... to the 'nth' degree

>> unlikely. " Next Mr. Schneider posited that chiropractic adjustment

>> could be implicated in an embolism because even the normal range of

>> motion involved in combing one's hair or turning to the rear to

>> reverse an automobile could cause spontaneous dissection. Dr. Herzog

>> testified that this was so, but that the normal range of motion

>> exceeded the range of motion involved in a cervical adjustment. Mr.

>> Schneider then suggested that the cadaveric studies could not inform

>> us about the effect of a cervical adjustment on a living person. Dr.

>> Herzog testified that there could not be damage because there was no

>> force exerted on the artery. Mr. Schneider then suggested that Dr.

>> Herzog's study did not rule out the possibility that there could be

>> microscopic damage done to a vertebral artery which might cause a

>> thrombus to be formed in 1/100 of a millisecond during a cervical

>> manipulation which could cause an unfortunate chain of events which

>> could lead to a stroke. Dr. Herzog again stated that there is no force

>

>> and therefore, there can be no damage. Dr. Herzog then testified that

>> he had supervised a chiropractic graduate student at the Human

>> performance lab in Calgary for each of the last three years. Thus Dr.

>> Herzog's testimony was concluded and he was excused. Keeping in

>> Contact Please contact us if there has been any change in your contact

>

>> information. Reach us by fax at (416) 482-3629; e-mail at

>> infochange@...; or mail at Alumni Affairs, Canadian Memorial

>> Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, M4G 3E6.

> In the meantime, if you have questions about this bulletin, please feel

> free to contact us by phone, fax or e-mail using the contact information

> listed in this bulletin. _____

>>

>> The Communications Working Group is comprised of the following

>> organizations:

>> Canadian Chiropractic Association:

>> Phone (416) 781-5656; Toll-free 1-800-668-2076; website

>> <http://www.ccachiro.org/> www.ccachiro.org; e-mail

>> <mailto:ccachiro@...> ccachiro@...

>> Ontario Chiropractic Association:

>> Phone (905) 629-8211; Toll-free 1-877-327-2273; website

>> <http://www.chiropractic.on.ca/> www.chiropractic.on.ca; e-mail

>> <mailto:communications@...>

> communications@...

>>

>> Canadian Memorial Chiropractic College:

>> Phone (416) 482-2340; Toll-free 1-800-669-2959; website

>> <http://www.cmcc.ca/> www.cmcc.ca; e-mail

>> <mailto:communications@...> communications@... Canadian

>> Chiropractic Protective Association: Phone (416) 781-5656; Toll-free

>> 1-800-668-2076; e-mail <mailto:CCPAcommunications@...>

>> CCPAcommunications@...

>>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

> foster communication and collegiality. No personal attacks on listserve

> members will be tolerated. 2. Always sign your e-mails with your first

> and last name. 3. The listserve is not secure; your e-mail could end up

> anywhere. However, it is against the rules of the listserve to copy,

> print, forward, or otherwise distribute correspondence written by

> another member without his or her consent, unless all personal

> identifiers have been removed.

>

December 11, 2002

I agree with 's statement to a point but a significant number of CVA

actions brought against DC's involve claimants who state that the sole

reason for the injury is the cervical adjustment of a patient with no

preexisting vascular disease or injury. This is the argument offered by

proponents of eliminating all cervical adjusting by chiropractors. Herzog's

work at least supports the adjustment as posing virtually no risk to a

normal artery. 's point of 1 in a million incidences is correct when

calculated objectively but denied by some of our detractors who aren't

objective. Now that the issue is so high-profiled, more research is the only

solution to doubts created in the public mind.

H. Dallas, D.C.

President, Western States Chiropractic College

Phone (503) 251-5712

Fax (503) 251-5728