How Katie May’s unfortunate death impacts the chiropractic community

In mid-November 2016, the chiropractic profession received significant exposure on nationally syndicated television, with a feature on The Dr. Oz Show.

Two segments of the show addressed the circumstances of model and social media personality Ms. Katie May, who succumbed to a brain infarction secondary to a vertebral artery dissection on February 4, 2016.

The show was presented during “Sweeps Week”—a designated time when ratings are assessed across the country—and was hyped with the ominous teaser: “Breaking news: Can your chiropractor kill you?”

As the show approached there was considerable apprehension about its impact on the profession and those who could be well-served by chiropractic care.

What was covered on the show?

The first of the two segments involved a discussion between members of Katie May’s family and Dr. Oz.

Much to the surprise of many, the family was not anti-chiropractic and did not blame the chiropractor from whom Ms. May had sought care. Their interest was in bringing attention to the possible risks of cervical spine adjusting, from their perspective, as a family that believes they were greatly impacted by such a risk. The family was dignified, tempered, and concerned as they shared their questions and opinions with Dr. Oz and his audience.

The second segment involved two repeat guests on the Dr. Oz Show, persons who were familiar with the show setting, as well as with the subject matter of the day. Among Dr. Oz’s content experts were Steven Shoshany, DC, a practicing chiropractor for more than 20 years from New York City, and Carolyn Brockington, MD, a neurologist at Mt. Sinai Hospital also in New York City.

Dr. Oz posed three questions to Shoshany:

1. Could chiropractic manipulation have played a role in the circumstances of Ms. May?
2. How important is an adequate patient history for the chiropractor in dealing with a patient with neck pain?
3. How is the chiropractic profession addressing concerns in this area?

What did the experts say?

Shoshany handled the opportunity with considerable professionalism and efficiency. Not only did he answer the questions using the science of the day referring to the articles of Cassidy, Kosloff, and Church, but he also provided an explanation of the origin of dissection based on the facts of a photo-shoot in which Ms. May was involved preceding her neck pain.

Shoshany did an excellent job contextualizing the discussion.

Brockington was equally adept in her presentation as she called on her experience as a neurologist at a major stroke center. She detailed how dissections occur in seemingly healthy and vibrant people for no apparent reason and that most dissections don’t yield a stroke, let alone a fatality.

She drew upon her recent experience with a patient who presented to Mt. Sinai experiencing stroke symptoms following painting a ceiling—a classic illustration of this problem referred to by chiropractors for decades.

The closing comments of Dr. Oz were extremely important, as after all, this was his show and his platform. He reminded the audience that dissections occur; they are a fact of life. He added there is no reason to avoid seeing a chiropractor with neck pain for fear of a dissection, but there is a need to be open and share any and all symptoms experienced with neck pain whether the patient thinks they are related or not.

What does this mean for chiropractic?

It is safe to say we likely have not heard the last of discussion related to Katie May and chiropractic care. It is also probable that this discussion in 2016 is emerging in a radically different manner than it would have in 1996 or 1976.

We all need to do everything we can to help make our care safer today than it was yesterday.

The transition from concern being placed on what is happening in the chiropractor’s office, to what the patients walks through the door of the chiropractor’s office with, is important and profound.

If the issue were something that the chiropractor did, then we need to explore changing our procedures. But if the issue is what the patient brings through the door of the office, e.g., a dissection in progress, then a different response needs to be enacted.

The demand on DCs is to not accept neck pain and headache as routine, typical, and common. Rather the profession should bear in mind the possibility that this may be something far more consequential and react accordingly.

There are many resources to help chiropractors get up-to-date on the scientific literature and its application.

Even if you think you are on the cutting edge of this information, take an hour or two and review what is available, then modify your history-taking procedures, examination procedures, patient dialogue, and informed consent procedures as required.

Appreciate what has wrought the difference between 1996 and 2016: Shoshany was able to represent the profession, as he did on The Dr. Oz Show, thanks to the efforts of a relatively small cadre of researchers, funders, and agencies who gave him the evidence to make our case.

Over the last half-century we have witnessed growth in the research structure of the profession from a handful of individuals to an impressive and broad-based community of basic science researchers and clinician-scientists.

People such as Scott Haldemann, DC, PhD, MD; John “Jay” Triano, DC, PhD; Walter Herzog, PhD; Pierre Cote, DC, PhD; and David Cassidy, DC, PhD, have changed our landscape, particularly as it relates to the area of vertebral artery dissection and a relationship, if any, with the care we provide.

The long road to here

In addition, there have been important landmark events in the continuum of this evolution. This includes the Lana Day Lewis Inquest in Ontario, Canada, and the Neck Pain Task Force report published in 2008.

The Lewis Inquest, one of the longest, most extensive, and most expensive inquests in the history of Canada, created a venue for the world’s authorities on the many aspects of the cervical spine adjusting and arterial dissection conversation to be presented and cross-examined under oath with respect to their expertise related to these questions.

This process, as painful and protracted as it was for our Canadian colleagues, amassed a treasure trove of information and opportunities that continue to be explored to this day.

Similarly, the Neck Pain Task Force, chaired by Scott Haldemann, DC, PhD, MD, presented a forum for the collection, refinement, and publication of literature and global expertise related to these questions. For it was out of this activity that the seminal paper on the question of a relationship between cervical spine manipulation and the occurrence of vertebral artery dissection by David Cassidy, DC, PhD, emerged in 2008.

The strategic brilliance of the profession in Canada to pursue the development of researchers at major universities across Canada cannot be overstated. This relentless pursuit by the chiropractic community in Canada led to several chiropractors being named to prestigious Canadian research chair positions.

Finally, the question of funding needs to be discussed. It was left to us to make our case in this area of cervical spine manipulation and vertebral artery issues. Making the case required funding in the millions of dollars. Many individuals, educational institutions, and technique communities answered this call. But no one responded as did the professional liability insurance community in chiropractic.

The National Chiropractic Mutual Insurance Company (NCMIC) and the Canadian Chiropractic Protective Association (CCPA) stepped up as no one else in and around the profession has ever done. You might argue that they had a vested interest in the research and its findings, and that would be a fair assessment.

At the same time, it would be important to acknowledge that they were putting millions of dollars on the next roll of the dice. As they funded the studies they had hopes for the outcomes no doubt, but they had no guarantees, either. Their courage and commitment was a part of the successful outcome of the profession’s 2016 exposure on The Dr. Oz Show as none other.

The Dr. Oz Show segment, as it discussed cervical spine manipulation and vertebral artery dissection, was in the final analysis a positive outcome for the profession.

It is important to remember how we got there and know that the contributions to that six minutes and 30 seconds were drawn from decades of hard work and dedication.

As a Chinese proverb goes, “When drinking water, one should never forget those who dug the well.”

 

Gerard Clum, DC, is a spokesperson for Foundation for Chiropractic Progress. He is a founding faculty member at Life Chiropractic College (now Life University) and first president of Life Chiropractic College West. Over the past four decades, Clum has been involved in the academic, accreditation, and organizational efforts of the educational community of the chiropractic profession. He has also been active in the broader infrastructure of the chiropractic world through the International Chiropractors Association (ICA), the World Federation of Chiropractic (WFC), and the Foundation for Chiropractic Progress (F4CP).