Are We Dangerous?

A View From the Cold Cruel World of Insurers

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We have the choice to use the gift of our life to make the world a better place — or not to bother.

~ Jane Goodall                         

Wolves don’t mince words. Go ahead and cross the alpha male and see how long your pulse is palpable.

There are other animals in this world. One of the more dangerous species is the insurance company. The predator insurer studies and stalks its prey, assesses risk, and decides how to be certain that the bounty is worth the efforts.

We, as a profession, can be a bit more sophisticated than the alpha above, but let’s not confuse this with either shyness or timidity. Often what’s needed is temerity.

The recycling of the accusation of chiropractic and stroke (cerebrovascular accidents or cervical manipulation and cerebrobasilar dissection) rears its head. There are the dispassionate responses from the academic and research members of our profession. What’s said is correct, but the presentation rarely hits home. Or hits back.

The stated thesis is that the chiropractic profession is dangerous and great caution is needed or better yet, patients would be wise to go elsewhere. And we limply defend ourselves. We know, in general, that the indictment is false. Yes, there have been a few unfortunate cases but, given the numbers of chiropractors, the volume of adjustments and the minimal tragedies, our profession has some reason to gloat.

The scientific literature supports the last paragraph. (1-8) but, if we are to win in the public’s eye, research evidence can be boring and circuitous. I suggest another way. Or, at least, an additional way.

All doctors carry malpractice insurance. The rates of payment are tied to an individual’s claim record and the specialty in which they practice. The dollars related to risks, litigation, and costs of legal settlements/judgments are crunched and the safety or danger is expressed in the insurance premium. The results are telling.

The predator insurer goes to great lengths to assess the costs and risk of cost. The result of their study is called actuarial data. This data, and the interpretation of said data, is what allows an insurer to live and thrive or to die of financial hunger. They do not “wing it.” Instead, they are cold, calculating, and complete.

To be fair (aka with scientific rigor), we have to compare equivalent groups. If we look at the malpractice insurance premiums for several physician and non-physician specialties in full time practice in San Francisco carrying $1 million per event and $3 million in aggregate in 2020, we see the following:

Chart 1

The malpractice insurers are only interested in the relationship between risk and provider (or provider groups). They are uninvolved with the public relations of MDs vs. DCs and/or their political battles. Their actuarial data is the unemotional evidence. They have done the boring work and we should take their numbers, which are based in reality, and make them public.

The insurer’s real world evidence coupled with the scientific literature is a potent argument demonstrating the safety of the chiropractic profession. Any attempt at refutation of the actuarial and scientific data sets would have to be underpinned by bias, omissions of evidence, and obfuscation.

Our profession has both data sets. To date, we have focused on the science. To a marginally scientifically literate public, we haven’t been effective in stating our case. We take the defensive posture.

In my opinion, we can take the substantial weight of scientific evidence and the financial facts of the insurers and create a presentation that is both accurate and compelling to a public swimming in information and speak a language that can be easily understood.

The public knows that if you have a motor vehicle collision or moving violations or get caught driving under the influence, your auto insurer will see you as a high risk. The risk is quickly translated into a doubling or tripling of the premium. The relationship between risk and insurance costs have been and are comprehended.

Given good information about chiropractic science and the various professional malpractice insurance premiums, the public will be able to decide where the dangers really are and who would be wise to go elsewhere.

I contend that this is the way of the wolf. It is fair and direct. Bite a member of the pack at your own peril.

  1. Haldeman S, Chapman-Smith D, Peterson OM. Guidelines for Chiropractic Quality Assurance and Practice Parameters. Gaithersburg, MO: Aspen Publishers, 1993, 170-172
  2. Jaskoviak PA. Complications Arising from Manipulation of the Cervical Spine J Manipulative Physiol Ther 1980; 3: 213-219
  3. Henderson OJ, Cassidy JO. Vertebral artery syndrome: In: Vernon H, ed. Upper Cervical Syndrome: Chiropractic Diagnosis and Treatment. Baltimore: Williams & Wilkins, 1988. 195-222
  4. Eric L. Hurwitz, DC, PhD; Peter D. Aker, DC; Alan H. Adams, DC; William C. Meeker, DC, MPH; Paul G. Shekelle, MD, PhD Manipulation and Mobilization of the Cervical Spine. A Systematic Review of the Literature Spine 1996 (Aug 1);   21 (15):   1746–1760
  5. Carey PF. A Report on the Occurrence of Cerebral Vascular Accidents in Chiropractic Practice Journal of the Canadian Chiropractic Association 1993; 57 (2): 104-106
  6. National Chiropractic Mutual Insurance Company, unpublished case records 1991-1993
  7. Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial Dissections Following Cervical Manipulation: The Chiropractic Experience Canadian Medical Association Journal 2001 (Oct 2); 165 (7): 905-906
  8. Terrett AGJ. Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy J Manipulative Physiol Ther 1995; 18 (4): 203-210