Consumer Health Digest #02-07

Your Weekly Update of News and Reviews
February 12, 2002

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., and cosponsored by NCAHF and Quackwatch. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making.

New data on chiropractic-induced strokes. Researchers representing the Canadian Stroke Consortium have reported on 98 cases in which external trauma ranging from "trivial" to "severe" was identified as the trigger of strokes caused by blood clots formed in arteries supplying the brain. Chiropractic-style neck manipulation was the apparent cause of 38 of the cases, 30 involving vertebral artery dissection and 8 involving carotid artery dissection. Other Canadian statistics indicate the incidence of ischemic strokes in people under 45 is about 750 a year. The researchers believe that their data indicate that 20% are due to neck manipulation, so there may be "gross underreporting" of chiropractic manipulation as a cause of stroke. [Beletsky V. Chiropractic manipulation may be underestimated as cause of stroke. Presented at the American Stroke Association's 27th International Stroke Conference, San Antonio, TX Feb 7-8, 2002] Dr. Stephen Barrett believes that the chiropractic profession should implement a reporting system that would enable this matter to be studied more readily.

Naturopathic accrediting agency loses approval. The Council on Naturopathic Medical Education (CNME) is no longer recognized as the accrediting agency for naturopathic schools. CNME was recognized in 1987 and accredited three of the four full-time naturopathic colleges. But in 1998, the National Advisory Committee on Institutional Quality and Integrity recommended denial of that CNME's petition for continued recognition, and on January 16, 2001, U.S. Secretary of Education Richard W. Riley concurred. The committee's recommendation was based on evidence that CNME had not responded appropriately to violations of its standards at Southwest College of Naturopathic Medicine and Health Sciences. None of the naturopathic college Web sites mentions that CNME lost its recognition. Three of the schools remain accredited and the fourth is a candidate for accreditation by recognized regional accrediting agencies that are not health-related. Naturopaths are licensed in eleven states and are pressing for licensure in several others. Although Riley's decision may make it more difficult to promote licensing, it has received almost no publicity. Riley's decision cannot be appealed, but CNME is likely to reapply for accreditation in the future.

Florida doctors offered insurance against frivolous malpractice suits. Jeffrey Segal, M.D., a nonpracticing neurosurgeon concerned about the skyrocketing cost of malpractice insurance, has launched a company intended to deter frivolous suits. The insurance—called Medical Justice—will cover the cost of a countersuit if the plan's legal evaluation panel determines that the malpractice suit should not have been filed. As part of the policy—which will be administered by U.S. Legal Services -- the names of policyholders will be posted to the Internet with the hope that attorneys who were thinking of filing a frivolous suit would be deterred. The policy will be offered in Florida but may spread to other states if it proves marketable. [Albert T. Frivolous suits feel wrath of Medical Justice. American Medical News 45(6):1,4, 2002]

PC SPES and SPES recalled. Laboratory analysis by the California Department of Health Services has found PC SPES and SPES contain undeclared prescription drug ingredients that could cause serious health effects if not taken under medical supervision. Laboratory analysis of the products by the California Department of Health Services found PC SPES contains warfarin (an anticoagulant sold generically or as as Coumadin) and SPES contains alprazolam (an antianxiety drug sold generically or as Xanax). BotanicLab, which manufactures both products, has voluntarily recalled them. [State health director warns consumers about prescription drugs in herbal products. News release, Feb 7, 2002] PC SPES is openly marketed "for prostate health" but is also promoted as a cancer treatment. (The "PC" in the product's name stands for prostate cancer, and "SPES is the Latin word for hope.) The American Cancer Society has concluded that PC SPES "shows promise" but more research is needed to determine whether it is safe and effective for that purpose.

"Alphabiotics" practitioner loses chiropractic license. The Washington State Court of Appeals has upheld an administrative decision to discipline former chiropractor John D. Brown for unprofessional conduct for practicing with an expired license. In 2000, the Commission of Chiropractic Quality Assurance charged that Brown had performed chiropractic manipulations but called his practice "alphabiotics." which he claimed is a sacrament of the Alphabiotic Church, of which he said he is a priest. He testified that he was performing alphabiotic "alignment" and not a chiropractic adjustment. However, the Commission concluded that "alphabiotics" treatments are indistinguishable from chiropractic and that certain techniques he used are associated with risk of stroke. It also concluded that his failure to warn of the risk of stroke—and an inadequate response when one of his patients suffered a stroke during an adjustment—were below the state standard of care required for chiropractors. The Commission levied a $30,000 fine and revoked Brown's license for ten years. The Alphabiotics International Web site, which lacks a clear description of what its practitioners do, states that alphabiotics "can't be fully explained" but "must be experienced to be fully understood." However, the Commission concluded that Alphabiotics is a chiropractic variant in which treatment is limited to neck adjustment. The full text of the court decision is available on Chirobase.

Physical therapists may be barred from treating "subluxations." On January 15, 2001, the Centers for Medicare & Medicaid Services (CMS) declared that Medicare+Choice organizations "may not use non-physician physical therapists for manual manipulation of the spine to correct a subluxation." [CMS operations policy letter #OPL2002.023, Jan 15, 2002] The American Physical Therapy Association has responded with a letter seeking clarification. The problem has arisen because in the early 1970s, Congress amended the Medicare law to include coverage for "manual manipulation of the spine to correct a subluxation of the spine . . . which has resulted in a neuromuscular condition for which such manipulation is appropriate." To enable payment, chiropractors held a consensus conference that produced a 7-page document defining 18 types of "subluxations," many of which are fancy terms for the minor degenerative changes that occur as people age and are not changed by chiropractic treatment.

The significance of the CMS letter is unclear. Scientific practitioners (medical doctors and physical therapists) define "subluxation" as incomplete or partial dislocation—a condition in which the bony surfaces of a joint no longer face each other exactly but remain partially aligned. No such condition can be corrected by chiropractic treatment. The vast majority of chiropractors use the term to mean other things. Some describe subluxations as "bones out of place" and/or "pinched nerves"; some think in terms of "fixations" or loss of joint mobility; and some occupy a middle ground that includes any or all of these concepts. Physical therapists are justified in seeking to preserve their right to perform manual manipulation to relieve back and neck discomfort. They do not actually treat any type of subluxation. However, it remains to be seen whether the semantic tangle created by the Medicare law will be used to restrict them.

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This page was revised on February 14, 2002.