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The Man Behind

An Interview With John W. Kinsinger, MD - July 7, 2005

Dynamic Chiropractic (DC): I wanted to try and get your views on chiropractic in general. What's your opinion of chiropractic?

Dr. John W. Kinsinger (JWK): That's a pretty open-ended question. I'll do my best to give you a relatively succinct answer. I think there is no question that there's a significant role for the use of manual and manipulative therapy in our society - predominantly for the treatment of musculoskeletal disorders like low back pain. Chiropractic certainly - chiropractors, rather -certainly have the ability and the training, etc., to play an integral part in that role, and that's a good thing. Unfortunately, though, it's my experience that a large number of chiropractors - a majority, and in fact, it's a strong majority - want to go beyond that, and want to fall back on these ideas from the Palmers that chiropractic does a lot more than provide manual therapy for the treatment of musculoskeletal disorders, and want to expand their practice to, and want to treat, nonmusculoskeletal disease. And they want to treat vertebral subluxations.

The theory is that by relieving the body of these vertebral subluxations, the body's innate intelligence can heal ailments that are nonmusculoskeletal in nature. Unfortunately, while that sounds real nice, there's just no evidence for that whatsoever. That's the real problem that I have with chiropractic in general.

DC: You were recently vocal about the establishment of a chiropractic college at Florida State University. Could you give us some reasons for your opposition?

JWK: We felt that because the chiropractic profession has not taken what we believe were the steps toward the reform that it needs to take to abandon these theories of vertebral subluxation and treating all manner of ailments, that it would be inappropriate. We believe that those views are not only unscientific, but antiscientific, and so we felt that without those steps being taken, that if a major research university like Florida State, or any other publicly funded major research university, were to embrace chiropractic, we truly felt that it would be harmful to the scientific academic reputation of such a university.

DC: How do you feel about neck manipulation? Is that an issue as well?

JWK: Absolutely. There is 60 years of evidence in the scientific literature that upper neck manipulation - occiput to C1, C1 to C2 - does on occasion result in tearing of the vertebral arteries, which does then lead to the formation of a thrombus, which then the thrombus breaks loose and dislodges and travels downstream to the brain, and results in stroke. And those strokes can result in severe, permanent neurological deficits like Wallenberg's syndrome, or locked-in syndrome, or quadriplegia, or even death. To make the tragedy even worse, the majority of the victims are young people, most of them in their 20s and 30s, most of them women. Piling on top of that, most of them, or many of them, at least, are being treated for things for which - and this kind of goes back to what I was saying earlier about treating those vertebral subluxations, and unlocking innate intelligence to treat all manner of ailments - many of these people were being treated for things for which there's no likelihood that they could have improved from upper neck manipulation. So yes, we - myself, and my like-minded colleagues, of which there is a large group of us - feel that upper neck manipulation is a procedure which is utilized way too often, and is - we feel that it's a dangerous procedure.

DC: Is that what encouraged you to launch

JWK: Yes. You could say that that's the whole purpose behind it.

DC: In looking at that site, it's pretty much geared toward the consumer, rather than the profession.

JWK: I think that's a fair assumption.

DC: How would you judge your Web site? Would you say that it's balanced?

JWK: If I were someone other than myself looking at it, clearly, it's not balanced. The point of the site is to bring attention to this issue. The site's not intended to give "equal time" to whatever limited benefits may be derived from neck manipulation, if that's what you're asking. The site is intended to point out the dangers which we are sincerely concerned about. I think it's fair. My opinion is that it's fair in pointing that out, because the information we're providing is accurate, but if you're going to ask, is it balanced? I guess one would say, not necessarily so. But I don't think it's fair to the site to equate lack of balance with being unfair, or certainly not erroneous.

Can I ask you a question? Are you aware - and this is not on my site yet, although I need to get it on there - are you aware that the current (August 2005) issue of Consumer Reports contains an article about alternative treatments, and they specifically point out that neck manipulation is a cause of these same types of strokes that I described? The particular area where they talk about the dangers of neck manipulation is on page 40.

DC: What do you see as the right path for chiropractic if it wants to legitimize itself?

JWK: That's a great question. I think we can make a comparison to the osteopathic profession. Decades ago, the osteopathic profession was in a similar situation to the chiropractic profession, in that they had some ties to history that [were] not consistent with science, but they also had reasonable educational programs set up, and they made a decision as a profession - they didn't have to have it forced down their throats - they made a decision as a profession to abandon their "quackery" of the past. They made their educational and training process more and more in line with that of allopathic medicine. And as you follow the last few decades, you'll find that osteopaths are considered for all practical purposes equivalent to MDs. I have many colleagues and friends that are osteopathic physicians that are every bit as good as, if not better than, some of my allopathic colleagues. But keep in mind what I said: They made that decision on their own, and they did it the right way. They reformed their profession from within, and then the recognition and legitimacy followed.

I think the chiropractic profession as a whole needs to [reform from within], and I'm well-aware that there are a number of chiropractors that are already doing this on their own. They're utilizing their training and skills to provide safe, scientifically based manual and manipulative therapy. But unfortunately, that remains a minority. The profession as a whole needs to embrace those types of practitioners, and of course, you're familiar with the NACM - National Association for Chiropractic Medicine. Ron Slaughter is the executive director of that organization. I would encourage you to go to their Web site and read their mission statement. You'd find that they echo the same things that I'm stating. They acknowledge that their role is to treat musculoskeletal disease in a safe and scientific manner, and they speak out against this nonsense of vertebral subluxation, and they call a spade a spade. They call it quackery. Well, unfortunately, that small group of chiropractors has been marginalized by the leadership of the profession, and it is my opinion that it needs to be the opposite. People like Dr. Slaughter and others in his small, fledgling organization need to be embraced. That's the path that needs to be followed. I think at that point, then we can say, OK, let's get university affiliation and make sure the training programs are up to speed. But you can't do it in reverse order. I think they have to reform themselves. They can't ask a university to reform the entire profession with one school, or even a couple of schools.

DC: You mentioned that upper neck manipulation had a limited benefit. What benefit do you see it as having?

JWK: I'm not prepared to say that it has any benefit. If you're familiar with the 2004 Cochrane Review that was published in Spine, you'll find that for treatment of mechanical neck disorders, mobilization is equal in benefit to manipulation. I guess that doesn't mean that there's no benefit to it, but the point I'm trying to make is that mobilization, which is a much safer technique and does not have a track record of causing strokes, provides equal benefit to manipulation, at least according to that review published only a year ago. That's for mechanical neck disorders. When you start talking about treating things like sinusitis or epilepsy or asthma or low back pain or anything, there's really no evidence of any benefit for those disorders.

DC: But there would be for neck disorders. It's as good as mobilization.

JWK: Well, once again, all I'm telling you is what this particular report said, that the benefits are no better than they are for mobilization.

DC: I haven't been on every page of your Web site; I've only taken a brief look at it. Is [manipulation for mechanical neck disorders] an alternative that the Web site talks about?

JWK: On the Web site, we talk about the orthopractic guidelines. I think there's an actual link to the orthopractic guidelines, and so, indirectly, yes. That's the point we're trying to make. Are you familiar with the orthopractic guidelines?

DC: No.

JWK: The orthopractic guidelines are from a group that originated in Canada. It's effectively a group of physical therapists, medical doctors, and even I believe some chiropractors, although I think there's been pretty limited participation. It's sort of like the NACM, but it's a Canadian organization. It's a group of individuals that are practitioners of manual therapy that want to make sure that it's all scientifically based and as safe as possible. In referencing that, that's what we're alluding to.

DC: In all fairness, do you think there's a possibility that a consumer who would benefit - and I'll even accept that there are very few - from upper neck manipulation would see the site and would not receive something they may need?

JWK: Do I think that's possible? Well, I believe it probably is possible. But I'm not let me rephrase my answer. I know you're recording all this, but I'll be very clear. I think it's possible that somebody might see the site and might not allow their neck to be manipulated. In part of your question, you said "receive the care that they need." Well, once again, I'm not comfortable stating that that's care that anybody needs. In other words, I think there are alternatives, including mobilization.

DC: Let's say care that they would benefit from. I worded my question wrong.

JWK: Well, once again, I'm just going to have to stick with the statement that I'm not comfortable saying that that's care they would benefit from, because there are other alternatives that are safer, particularly mobilization.

DC: What do you see for the future of chiropractic as it stands right now?

JWK: I don't know that that's for me to say, and I surely don't have a crystal ball. I think it depends. It's certainly not up to me. Anything I do is unlikely to have any great impact on what happens to the future of chiropractic. It's up to the chiropractors themselves, and their leadership. As I indicated, I will acknowledge that there's a role for them to play, but if they don't willingly leave behind their vitalistic roots and the nonsensical theories of Daniel David and B.J. Palmer, I think there's certainly a possibility that at some point, they're going to fade into obscurity.

There are 60,000 chiropractors, and there are 220,000 physical therapists, and physical therapists, despite what chiropractors would like the public to believe, can and do provide manipulative therapy in a safe and scientific manner. With the exception of three states - I believe it's West Virginia, Washington state and Arkansas - physical therapists have the ability to provide manipulative therapy to their patients, and they are expanding. Most of the physical therapy programs are now becoming doctorate-level program. They're already master's-level programs, and they're becoming doctorate-level programs, so I think it's conceivable that physical therapists will potentially fill in a lot of the gaps that have been there previously as alternatives to manual therapy that chiropractors have filled for the last hundred years or so.

Most medical doctors - although there are certainly some that are very comfortable with chiropractors - are not comfortable with referring to chiropractors, because of some of these beliefs and philosophies they're still clinging to. I think the future is up to them, but I think it would be beneficial for them as a group, as well as the public, if they take the steps to reform. Some have, but not the profession as a whole.

DC: Last question: What impact do you think your Web site is having?

JWK: Well, it sure is making a lot of chiropractors angry, judging by the hate mail that I get, threats, etc. Let me try and make a concise statement of the purpose of it, because I don't think you asked me what the purpose of it is. The purpose of the Web site, and anything that those of us associated with the Web site, which as I indicated, we're sort of an international group of physicians, attorneys, a few journalists, and mostly victims - the purpose of it is simply to raise awareness of this whole issue, and hopefully to prevent what we consider are senseless injuries and deaths.

Are we having any impact? Absolutely. In addition to the dozens of hate mails I receive every day from chiropractors on the Web site, we do get contacted on a regular basis by victims. Victims that didn't really know how many people were out there. In some cases, it's families of victims, because some of them are dead. They're motivated to try to shed some light on this subject. Once again, that's our purpose: to raise awareness and hopefully stop senseless injuries and deaths.

DC: Thank you.

JWK: Well, I just wanted to say, I told you I get a lot of hate mail, and I don't answer all of them, but we kind of share them around with different folks in our organization, and answer the ones that we feel justify an answer, but I would like to say, and you don't have to publish this, I know that, but we'd like the chiropractors to understand that this is not anything personal. We do this because we believe this is a legitimate issue, and we feel like we have a lot of evidence to back that up. Once again, if nothing else, you can look at the current Consumer Reports article. I don't think they're on a witch hunt, as a lot of people think that we are on. We are sincere in our effort to try to stop something that we think is a real tragedy. I've met many of these victims, and it's just very sad to talk to the mother of a 25-year-old, beautiful girl who was in perfect health and died for what we think is no reason. And so, once again, I'm just trying to say that it's not a personal issue. We're not on a witch hunt. We're doing something that we think is, that's sort of an unknown phenomenon, or not well-enough known, and that's what we're trying to do.

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