September 25, 2023 Puzzle Piece
Safety Comparison: Allopathic vs. Chiropractic Healthcare
All
healthcare disciplines are associated with risks of injury or death.
Rare but sensational occurrences are often exploited by the media,
leading the public to believe that rare events are commonplace. In
contrast, common occurrences are often under reported, leading the
public to have higher confidence in the safety of certain healthcare
disciplines and procedures.
How Safe Is Medical Care?
The risks of medical healthcare (allopathic healthcare) were shockingly
revealed in 1994 when Harvard’s Lucian Leape, MD, indicated that medical
error was responsible for 180,000 deaths per year. Dr. Leape’s analogy
was that this was “the equivalent of three jumbo-jet crashes every 2
days,” killing all on board. Dr. Leape’s revelation was published in the
prestigious Journal of the American Medical Association, and titled: Error in Medicine
Four years after Dr. Leape’s headlines pertaining to error in medicine,
Jason Lazarou, MD (neurologist) and colleagues from the University of
Toronto published a study in the Journal of the American Medical Association titled:
Incidence of Adverse Drug Reactions in Hospitalized Patients A Meta-analysis of Prospective Studies
The objective of this study was to estimate the incidence of serious and fatal adverse drug reactions (ADR) in hospital patients.
Serious ADRs were defined as those that required hospitalization, were
permanently disabling, or resulted in death. The authors performed a
meta-analysis of 39 prospective studies done in the United States over a
period of 32 years on the incidences of Adverse Drug Reactions (ADRs).
The goal of this study was to “estimate injuries incurred by drugs that
were properly prescribed and administered.” If the event was determined
to be a “Possible ADRs” it was excluded from this study. The authors
noted:
“We estimated that in 1994 overall 2,216,000
(1,721,000-2,711,000) hospitalized patients had serious ADRs and 106,000
(76,000-137,000) had fatal ADRs, making these reactions between the
fourth and sixth leading cause of death.”
“We have found that serious ADRs are frequent and more so than
generally recognized. Fatal ADRs appear to be between the fourth and
sixth leading cause of death. Their incidence has remained stable over
the last 30 years.”
“It is important to note that we have taken a conservative
approach, and this keeps the ADR estimates low by excluding errors in
administration, overdose, drug abuse, therapeutic failures, and possible
ADRs. Hence, we are probably not overestimating the incidence of ADRs.”
This study on ADRs excluded medication errors “to show that there are a large number of serious ADRs even when the drugs are properly prescribed and administered.”
“The incidence of serious and fatal ADRs in US hospitals was found to be extremely high.”
The incidence of hospital adverse drug reactions detailed in the Lazarou and colleague’s study is stunning:
- 106,000 yearly deaths; these deaths rank between the 4th and the 6th leading causes of death yearly.
- 2,216,000 yearly events that required hospitalization to recover or resulted in a lifelong disability.
Importantly, these numbers require additional discussion. These statistics pertain only to hospitalized patients;
they did not assess similar such events occurring outside of the
hospital setting, in locations such as nursing homes, extended care
facilities, at home, etc.
Additionally, and more startling, these deaths and serious adverse
events occurred as a consequence of taking the correct drug for the correct diagnosis in the correct dosage. As such, these deaths and serious adverse events are not considered to be as a consequence of error. Rather, they are considered to be “fallout” of a health care delivery discipline that is heavily dependent upon pharmacology.
Dr. Leape’s premise of “Error in Medicine” was updated in 2016, showing
that the problem has not improved in the past two decades. Published in
the British Medical Journal, Johns Hopkins University
School of Medicine professor Martin A. Makary (MD, MPH) and research
fellow Michael Daniel (medical student) produced an article titled: Medical Error The Third Leading Cause of Death in the United States
This title is misleading, and lay publications were misled into
believing that medical error was the 3rd leading cause of yearly death
in the United States. The article clearly notes that the 3rd leading
cause of death in the United States is error in hospitals.
Once again, the data did not assess medical error deaths occurring
outside of the hospital setting, in nursing homes, extended care
facilities, at home, etc. Nor did it assess “fallout” deaths either in
the hospital or outside the hospital setting.
In this study, Makary and Daniel analyzed the scientific literature on
hospital medical errors to identify its contribution to US deaths. In
their appraisal of the magnitude of the problem, they note:
“We calculated a mean rate of death from [hospital] medical error of 251,454 a year.”
“We believe this understates the true incidence of death due to
medical error because the studies cited rely on errors extractable in
documented health records and include only inpatient deaths.”
[Hospital] “medical error is the third biggest cause of death in the US and therefore requires greater attention.”
As noted, the 251,000 deaths from medical error underestimates the
actual number because it represents only medical error deaths that occur
in the hospital setting. Medical error deaths occurring in non-hospital
facilities or at home are not included in the estimated number.
How Safe Are Pain Medications?
The primary reason people seek chiropractic care is for pain.
Chiropractic is considered an alternative therapy for pain management,
and especially for spinal pain. An important study looking at some of
the risks associated with the chronic use of nonsteroidal
anti-inflammatory drugs (NSAIDs) for pain was published by M. Michael
Wolfe, MD, and colleagues, from Stanford’s Medical School and Boston
University School of Medicine and published in the New England Journal of Medicine in 1999. The article was titled:
Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
In this study, spinal manipulation was performed by licensed
chiropractors (two visits per week). The medications used were Celebrex
or Vioxx, both prescription NSAIDs. The acupuncture (also two visits per
week) was performed by an experienced acupuncturist. The study
evaluated 115 chronic neck and back pain patients. The treatment
interventions extended over a 9-week period. These authors made the
following observations and statements:
“Adverse reactions to nonsteroidal anti-inflammatory (NSAID) medication have been well documented.”
“Gastrointestinal toxicity induced by NSAIDs is one of the most common serious adverse drug events in the industrialized world.”
“The newer COX-2-selective NSAIDs are less than perfect, so it is imperative that contraindications be respected.”
There is “insufficient evidence for the use of NSAIDs to manage chronic low back pain.”
“The highest proportion of early (asymptomatic status) recovery
was found for manipulation (27.3%), followed by acupuncture (9.4%) and
medication (5%).”
“Manipulation yielded the best results over all the main outcome measures.”
“The consistency of the results provides evidence that in
patients with chronic spinal pain, manipulation, if not contraindicated,
results in greater short-term improvement than acupuncture or
medication.”
“The results of this efficacy study suggest that spinal
manipulation, if not contraindicated, may be superior to needle
acupuncture or medication for the successful treatment of patients with
chronic spinal pain syndrome.”
“Medication apparently did not achieve a marked improvement in
chronic spinal pain and caused adverse reactions in 6.1% of the
patients.”
“In summary, the significance of the study is that for chronic
spinal pain syndromes, it appears that spinal manipulation provided the
best overall short-term results, despite the fact that the spinal
manipulation group had experienced the longest pretreatment duration of
pain.”
Highlights of this study show that chiropractic spinal manipulation is
five times more effective than prescription NSAIDs in the treatment of
chronic low back and neck pain, and the results from spinal manipulation
were accomplished without any reported adverse events. In contrast, for
the patients taking the drugs, more experienced an adverse event (6.1%)
than those who became asymptotic (5%) over the nine-week clinical
trial.
Importantly, when this study was published in 2003, Vioxx had been on
the market since 1999, four years. The following year, 2004, Vioxx was
pulled off the market due to an unacceptable incidence of fatal heart
attacks and strokes. It has since been established that in the five
years that Vioxx was on the market it caused more US deaths (about
60,000) than the Viet Nam war did in 10 years (about 58,000).
This information was taken from the following source: FEBRUARY 10, 2017 BY CHIROTRUST
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