Garret Graves, who served in the House of Representatives until last year, was quoted in the July 27 article by Jack Brook, “Louisiana cancels $3 billion coastal restoration project funded by oil” that was distributed worldwide by the Associated Press.  The article, regarding the potential loss of coastal restoration funds from the Deepwater Horizon Oil Spill Settlement Fund, is an important topic which warrants a serious discussion. 

Statements attributed to you in the article  include “I don’t know what chiropractor or palm reader they got advice from on this but – baffling that someone thought this was a good idea.” (The quote has been used again by former Rep. Graves on social media.

In the letter sent by ICA’s CEO, Dr. Edwin Cordero, the following comments were provided:

“This quote from you has no place in such a serious discussion and implies that chiropractors lack credibility.  Whether provided as a cheap shot at the profession or out of a lack of understanding of the strong evidence-base supporting the safety and benefit of regular chiropractic care, your quote undermines the valuable work of more than 100,000 Doctors of Chiropractic in the United States including the more than 700 in the state of Louisiana. 

Chiropractors (Doctors of Chiropractic):

• Recognized as Essential Health Care Providers by the US Government.
• Physician level providers in Medicare, Medicaid, DOD and VA.
• Licensed in Every US State.
• Chiropractic Care is a covered service in Medicare, Medicaid, US military and Veterans Administration health care. 
• Extensive licensing and educational requirements: 
  • 3-4 Year Graduate Degree requiring minimum of  7 years undergraduate with science pre-requisites.  All US Chiropractic Programs are Accredited by the CCE, which is US Department of Education approved.
  • Licensure requires passage of 4 Boad Exams provided by the National Board of Chiropractic Examiners (NBCE) exams and fulfilling any state-specific licensing requirements.
• Safety of chiropractic validated through medical malpractice rates that are among the lowest in health care.
• Research including studies conducted by the US Defense Department show benefits of chiropractic care for improved performance, strength, and recovery.
• Studies show that for patients in pain, chiropractic is first line of care, the rate of opioid prescriptions being filled is reduced by at least 50%.
• Workman’s Compensation Research Institute Study found chiropractic care was less expensive for on-the-job injuries, and that employees returned to work more quickly.”

Dr. Cordero concludes the letter with a request for corrective action be taken. The full letter is available below:

“This is a tragic situation, but it’s also a gross misrepresentation of the chiropractic profession,” said Dr. Edwin Cordero, CEO of the ICA. “It’s yet another example of sensational journalism that draws conclusions without evidence, science, or clinical context.”

A Pattern of Blame Without Clinical Facts

Every time a vascular event occurs, and a chiropractor is even remotely involved in the patient’s history, it becomes headline news regardless of timing, medical context, or alternative risk factors. In this case, the patient herself stated that her symptoms developed weeks after the adjustment.

“If a traumatic arterial dissection truly occurred at the moment of care, we’d expect immediate neurological symptoms like severe headache, nausea, or difficulty walking,” Dr. Cordero noted. “Delayed symptom onset matters. That’s clinical evidence being ignored.”

Research Clearly Refutes a Causal Link

The best available research supports what principled chiropractors have long known: there is no causal relationship between cervical chiropractic adjustments and vertebral artery dissection.

A major population-based study by Cassidy et al. (2008), published in Spine, examined all vertebrobasilar strokes in Ontario over nine years and found no increased risk of stroke associated with chiropractic care compared to medical care. Patients experiencing early dissection symptoms like neck pain or headache—were just as likely to see a chiropractor as a medical doctor, showing that the stroke process had likely begun before any visit occurred.

This conclusion is supported by the American Heart Association and multiple systematic reviews, including a 2016 meta-analysis published in Cureus and a 2021 study in Chiropractic & Manual Therapies. Together, these findings make it clear: correlation does not equal causation when it comes to chiropractic care and VAD.

References:

1. Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83. doi: 10.1097/BRS.0b013e3181644600. Erratum in: Spine (Phila Pa 1976). 2010 Mar 1;35(5):595. PMID: 18204390.
2. Biller J, Sacco RL, Albuquerque FC, et al. (2014). Cervical Arterial Dissections and Association with Cervical Manipulative Therapy: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 45(10):3155–3174. DOI: 10.1161/STR.0000000000000016
3. Church EW, Sieg EP, Zalatimo OA, et al. (2016). Systematic review and meta-analysis of chiropractic care and cervical artery dissection: no evidence for causation. Cureus, 8(2):e498. DOI: 10.7759/cureus.498
4. Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. (2021). Risk of cervical artery dissection after chiropractic spinal manipulation in Medicare B beneficiaries aged 65 to 99 years with neck pain. Chiropractic & Manual Therapies, 29:16. DOI: 10.1186/s12998-021-00367-5

Overlooked Clinical Red Flags

According to People Magazine, Klundt had previously undergone breast explant surgery and suffered from chronic muscular pain, key indicators that should have prompted a comprehensive clinical evaluation. Additionally, the provider performing the adjustment was a substitute chiropractor, not her usual doctor.

“Every chiropractor must take full responsibility for history-taking and red flag screening, regardless of whether the patient has been to the office before,” Dr. Cordero emphasized. “Shared offices don’t mean shared clinical insight.”

Post-COVID Vascular Risks Must Be Considered

While the article avoids broader physiological context, chiropractors must not. The literature now identifies a potential link between post-COVID exposure (including vaccination) and vascular inflammation, clotting disorders, and endothelial damage—all factors that complicate case presentations.

“We’re not saying COVID caused this injury,” Dr. Cordero stated. “We’re saying that failing to consider the full clinical picture including immune system history is negligent.”

Chiropractic Is Safe, Effective, and Trusted by Millions

Chiropractors deliver over 280 million patient visits annually in the U.S.—that’s more than 1 million visits per day with one of the lowest malpractice claim rates in healthcare. Serious adverse events remain exceedingly rare, with studies estimating a risk of 1–2 incidents per million cervical adjustments.

“Every day, chiropractors help millions live healthier lives without drugs or surgery,” said

Dr. Cordero. “And yet when something goes wrong even with multiple unknowns the media zeroes in on chiropractic. Meanwhile, the 250,000+ deaths from medical errors each year barely get a mention.”

What Chiropractors Must Do Now

To protect patients and themselves chiropractors must:

•      Treat every adjustment like it’s the first

•      Re-screen frequently for red flags and systemic symptoms

•      Ask about surgeries, medications, and immune status

•      Document thoroughly, including “normal” findings

•      Refer out when anything seems off

“If your notes don’t reflect your thinking,” said Dr. Cordero, “then legally, it’s as if you didn’t think at all.”

The ICA Will Keep Standing in the Gap

The ICA will continue to defend principled chiropractic care, push back on media misinformation, and ensure our drug-free identity is protected.  We also promote evidence-informed clinical decision making and best practices.

“This isn’t just about one article—it’s about the future of our profession,” said

Dr. Cordero. “And we’re not backing down.”

To learn more about ICA advocacy and how to get involved, visit www.chiropractic.org.

###

Fox News broadcast a story in which our own ICA Council on Pediatrics President, Dr. Lora Tanis was quoted regarding chiropractic care for babies. The story, “Ohio baby ‘smiling again’ after chiropractic adjustments, parents say — but is it safe?” shared the amazing but – as our Pediatrics Diplomate doctors know – all too common story of a child who benefited from chiropractic care. The second story “How a ‘chiropractic adjustment’ finally helped Max Muncy return to the Dodgers” shares the story the integral role of chiropractic in the combined health professions efforts to return a star professional athlete to the lineup.

Both stories detail how chiropractic was not the first line of care, but the care of last resort – and in the pediatrics story, as we always see, a medical doctor with no training in the science, art, or philosophy of chiropractic is quoted with an attempt to plant doubt in the public’s mindset about the safety and benefit of chiropractic care across the lifespan.

It is times like these that I am reminded that we – the ICA and the chiropractic profession – need to constantly be responsible for defining ourselves and not allow others to take that power and responsibility from us.

Don’t let others define you. Don’t let the past confine you. Take charge of your life with confidence and determination and there are no limits on what you can do or be.

Michael Josephson, Founder of Josephson Institute of Ethics

The International Chiropractors Association has been and remains the moderate voice in the chiropractic profession. We stand stalwart in our protection and promotion of the chiropractic profession as a separate and distinct profession with its own science, art, and philosophy. We unapologetically respect and protect this system of healing and the underlying premise that it is founded on – that identification and correction of the vertebral subluxation removes the barriers of communication from the brain to every cell in the body so that the body’s own innate is freed up to focus on recovery and optimal health and life expression.

You, as a doctor of chiropractic or chiropractor, hold within your hands the ability to facilitate health through the chiropractic adjustment. It is time to recognize and give voice to the fact that chiropractic care is both patient-centered and evidence-based.

History shows us that assumptions made about chiropractic care have been wrong. An example of that is the long-standing presumption within states that providing coverage of chiropractic care for lower back pain-related injuries in Worker’s Compensation Programs would increase costs. In the 1990s, many states, faced with dramatically increasing medicals costs in Workman’s Comp claims, restricted reimbursement of chiropractic care because they believed the assumption of increased costs without evidence. Fast forward a quarter century and the Workman’s Compensation Research Institute (WCRI) conducted a study to determine if this the assumption was true. The findings were published in 2022 and reported that the average medical cost-per-claim for injured workers with lower back pain who were treated exclusively by a chiropractor was 61% less than for those who received no chiropractic treatment. Another finding of this study was that the utilization of chiropractic – and the resulting cost savings – was higher in states where the individual was able to choose their course of care rather than the employer or the state.

Research is Something to Get Excited About: The growing research record on the clinical- and cost-effectiveness of chiropractic validates the call from the chiropractic community and the public to improve and increase access to chiropractic care more equitably in federally managed or funded health systems and programs, particularly Medicare. While regular chiropractic care has a whole person effect, it is most widely known as a first line of care for back and neck pain and that is where most of the research evidence exists so far. As you know, chiropractic care falls into the category of “conservative care” from chronic and acute pain issues and is considered preferable as a first line of care over pharmacological and more invasive medical interventions.

While chiropractors use the term “chiropractic adjustment,” many researchers use “spinal manipulation therapy” or SMT. Data show that those who seek chiropractic care first are more than 50% less likely to fill an opioid prescription. In 2004, back pain accounted for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations.[1] By 2014, the costs for back pain annual were in excess of $200 billion.[2] The costs continue to increase.

Below is a small snapshot of some of the important studies pointing to the value of chiropractic and its cost-savings.

Thirty years ago, research concluded that if chiropractic care were insured to the extent of other medical specialties, it would likely emerge as a first option for many patients with certain medical conditions. They also believed this could result in a decrease in the overall treatment costs for these conditions. The outcomes from economic assessment conducted at the College of William & Mary and the Medical College of Virginia of mandated health insurance coverage for chiropractic treatment within the Commonwealth of Virginia found chiropractic care to be a lower cost option for back-related ailments. The study reported that:

• The low cost of chiropractic is due not to its low rate of use, but to its apparently offsetting impacts on costs in the face of high rates of utilization.
• Formal studies of the cost, effectiveness, or both of chiropractic, usually measured against other forms of treatment, show it to compare favorably with them.
• By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs.
• Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.[3]

More recent studies conclude:

2022: Health care utilization and costs for low back pain:

• Total cost of care was lowest for individuals who first saw a chiropractor ($5093) compared to primary care physicians ($5660) and highest for individuals who saw Orthopedic specialist ($9434) first.
• Expensive MRIs have been shown to be used more by Orthopedic specialists (Ortho) and physical medicine and rehabilitation doctors (PM&R), with significantly less MRI for chiropractors (Chiro) over the 1-year follow-up.
• The variances seen in early- and long-term opioid prescriptions rates are concerning given the ongoing opioid crisis. The study demonstrated that patients first seeing Emergency Medicine physicians (EM), PM&R, and advanced practice registered nurse (APRN) initially had higher early and long-term opioids prescription rates than Chiros.[4]

2022: A first of its kind study in France of participants who presented with chronic musculoskeletal pain and depressive symptoms in a hospital setting. Most participants were satisfied with the chiropractic care they received at the hospital and would recommend it for varied reasons. One participant stated, “In terms of efficiency, for me it was quite spectacular, it did me a lot of good, so I highly recommend it.”[5]

2021: An analysis of Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT) (chiropractic). Adults aged 65 to 84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain but higher long-term total healthcare costs under Medicare compared with patients who initiated long-term treatment with SMT.[6]

2021: Chiropractic is a leading conservative management approach to chronic primary back and neck pain. This study notes that SMT as a preferred conservative management approach increasingly recommended by conventional medical organizations.[7-9]

2021: The Journal of the American Medical Association provides the following patient recommendation: “For patients with chronic low back pain, priority should be given to nondrug treatments combined with exercise. According to the ACP, therapies to combine with exercise include multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercises, progressive relaxation, electromyographic biofeedback, low-level laser therapy, cognitive behavior therapy, and spinal manipulation.”[10]

2020: A study analyzing chiropractic care versus physical therapy (PT), found:

• Higher satisfaction rates in patients visiting chiropractors.
• In the short term, chiropractic care is a more cost-effective alternative compared to PT for the treatment of acute low back pain. Chiropractic resulted in a lower cost ($48.56).
• Chiropractic had a higher daily adjusted life years (DALY) than the PT over a one-month treatment period and five months follow-up.[11]

Sources Cited:

1. Legorreta, A.P., et al., Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Arch Intern Med, 2004. 164(18): p. 1985-92.
2. Ma, V.Y., L. Chan, and K.J. Carruthers, Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil, 2014. 95(5): p. 986-995 e1.
3. Schifrin, L.G., Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, with Implications for the Commonwealth of Virginia. 1992, The College of William and Mary: Virginia.
4. Harwood, K.J., et al., Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res, 2022. 22(1): p. 694.
5. F, M., et al., Characteristics, expectations, experiences of care, and satisfaction of patients receiving chiropractic care in a French University Hospital in Toulouse (France) over one year: a case study. BMC Musculoskelet Disord, 2022. 23(1): p. 229.
6. Whedon, J.M., et al., Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults. J Manipulative Physiol Ther, 2021. 44(7): p. 519-526.
7. Gevers-Montoro, C., et al., Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Front Pain Res (Lausanne), 2021. 2: p. 765921.
8. Foster, N.E., et al., Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 2018. 391(10137): p. 2368-2383.
9. Corp, N., et al., Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain, 2021. 25(2): p. 275-295.
10. Traeger, A.C., A. Qaseem, and J.H. McAuley, Low Back Pain. JAMA, 2021. 326(3): p. 286.
11. Khodakarami, N., Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation. Healthcare (Basel), 2020. 8(1).

January 17, 2024 (Falls Church, VA) – ICA President Dr. Selina Sigafoose-Jackson responded to an article in Lancaster Online from a medical doctor who discussed referring her pediatric patients to a chiropractor. Given the article made negative and inaccurate information about the International Chiropractors Association (ICA), Dr. Selina submitted a full rebuttal (provided below and attached). The editors requested a truncated response limited to 250 words. Dr. Selina agreed with the stipulation that a link to the full original letter be provided in the article.

ICA Executive Director, Beth Clay, stated, “ICA has a duty to respond to misinformation in the media regarding chiropractic or the ICA. Anytime someone sees articles in the media that paint the profession or the ICA in a negative or invalid light, we ask that you notify us so that we may respond and correct the record.”

**********************************************************************************

January 9, 2023

Mr. Tom Murse
Executive Editor
LancasterOnline
PO Box 1328
Lancaster, PA 17608-1328

Re: Response to Dr. Pia Fenimore’s article “Refer children to chiropractor?”

Dear Editor Murse:

As a chiropractor in practice in the York/Lancaster area, and the current President of the International Chiropractors Association, I have reviewed with interest the above-mentioned article regarding a Medical Doctor’s referral of patients to Doctors of Chiropractic also referred to as Chiropractors. While it is laudable that Dr. Fenimore makes a public statement acknowledging she at times refers her patients to Chiropractors, her discriminatory statement against the International Chiropractors Association (ICA) requires correction, which is provided below.

History Confirms the Discrimination Against Chiropractors: Medical Doctors (MDs) have a long history of discriminating against Doctors of Chiropractic (DCs) that dates at least back to the mid-20th Century, when the American Medical Association (AMA) and other medical associations instituted policies actively discriminating; establishing policies that medical doctors were not to refer patients to or even socialize with Chiropractors. As a result, Dr. Chester Wilk with several other chiropractors filed a federal anti-trust lawsuit against the AMA and others in the medical profession alleging Sherman Act violations. The ICA played an integral in supporting Dr. Wilk’s case for the 20 years it took to resolve. In 1987, federal Judge Getzendanner concluded that the AMA “had engaged in an unlawful conspiracy in restraint of trade to contain and eliminate the chiropractic profession”…and the ”AMA had entered into a long history of illegal behavior.” (Wilk v. American Medical Ass’n, 671 F. Supp. 1465, N.D. Ill. 1987). The vestiges of these actions linger even today in antiquated health policies and quiet actions of discrimination by MDs who make statements limiting the scope of care to which they believe a doctor of chiropractic should be involved. Chiropractic is a whole person health care system, separate and distinct from allopathic medicine which is a drug centric system of care.

ICA is a Premier Provider of Advanced Post-Graduate Training in Pediatrics: The ICA was established in 1926 by Dr. B.J. Palmer to promote and protect chiropractic as a separate and distinct profession with its mission focused on chiropractic philosophy, art, and science. The ICA stays focused on helping doctors of chiropractic become the best chiropractors they can be and does so with high quality post graduate continuing education programs, including a diplomate program for chiropractors who focus on caring for women and children.

Our Diplomate in Clinical Chiropractic Pediatrics (DICCP) is an intense, 360+ hour program completed over three years after our doctors have obtained their Doctor of Chiropractic degree. These doctors, who complete the rigorous program and pass the final exam, provide chiropractic care for neuromuscular issues, as well as issues that mothers have found no resolution through other approaches including allopathic medicine. These issues include failure to thrive because of nursing challenges and colic. Chiropractors are also able provide non-surgical solutions to scoliosis. The ICA Council on Chiropractic Pediatrics publishes an open-source peer-reviewed journal available to everyone at https://jccponline.com/ .

Correcting the Record on Two Ill-informed Comments: Dr. Fenimore makes two comments that are ill-informed. First, her comment that she “does not want a lot of imaging (x-rays) done on my patients due to concerns for radiation” is not based in the latest scientific evidence validating the safety of x-ray imaging and its important role in chiropractic and other analysis of the spine. Chiropractors only x-ray when there is a need; and as Oakley, et al stated in their 2021 paper in Dose Response, “Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic…. low-dose radiation in the amounts given from X-rays (and CT scans) offers no threat to public health as they have never been shown to cause harm…” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375354/)_

Dr. Fenimore’s second comment that she does not refer to ICA doctors because the organization “does not support immunization of children” is blatantly false. The ICA takes no stance against immunizations, and in fact for 50 years has maintained a policy which we restated in 2021. The ICA position states, “The International Chiropractors Association recognizes that the use of vaccines is not without risk and questions the wisdom of mass vaccination programs. Chiropractic principles favor the enhancement of natural immunity over artificial immunization.

The ICA supports each individual’s right to select his or her own health care and to be made aware of the possible adverse effects of vaccines upon a human body. In accordance with such principles and based upon the individual’s right to freedom of choice, the ICA is opposed to compulsory programs which infringe upon such rights.” ( https://www.chiropractic.org/ica-affirms-policy-on-health-freedom/) ( https://www.chiropractic.org/wp-content/uploads/2021/08/ICA-Health-Policy-Statement-August-2021.pdf )

Our fact-based statement that every vaccine carries the risk of a possible adverse effect aligns with that of the U.S. Government. That information is provided at Appendix A (below).

As a second-generation chiropractor for more than 30 years, I have been honored to provide chiropractic care to patients of all ages in the York-Lancaster communities. I am honored to serve as President of the ICA, and in that role promote a factual representation of the chiropractic profession, which is that we are doctors of chiropractic who provide drug-free care focused on identifying subluxations of the spine (misalignments) and correcting them through the chiropractic adjustment.

ICA is pleased to have launched a public education campaign this year on public television. Our video message can be seen at: https://www.viewpointproject.com/features-international-chiropractors-association/.

I respectfully request that this message in its entirety be published in response to Dr. Feinmore’s article.

Sincerely,

Selina Sigafoose Jackson, DC, FICA
President
International Chiropractors Association

Dr. Sigafoose Jackson is co-owner/operator of
Sigafoose & Jackson Chiropractic
2816 E. Market Street York, PA 17402

Cc:
Ms. Stephanie Zeigler
Managing Editor of Content

Delivered Via Email to: tmurse@LNPnews.com and szeigler@LNPnews.com

Appendix A

Data from the U.S. National Vaccine Injury Compensation Program December 2023

The National Vaccine Injury Compensation Program (VICP) is a federal program to compensate individuals who experience a serious adverse reaction to a covered immunization (which includes the complete list from the Childrens Recommended Vaccine Schedule.) (https://www.hrsa.gov/vaccine-compensation ). This month the program reported that since 1988, over 10,371 individuals have been compensated for vaccine injuries for a total of over $5 billion. This equates to 38.6% of filed cases in the VICP. (https://www.hrsa.gov/sites/default/files/hrsa/vicp/vicp-stats-12-01-23.pdf).

The Department of Health and Human Services publishes a table of recognized vaccine injuries at https://www.hrsa.gov/sites/default/files/hrsa/vicp/pre-march-2017-vaccine-injury-table.pdf to streamline the compensation process.

The information for COVID-19 vaccine injuries, which go through the Countermeasures Injury Compensation Program at HRSA. HRSA reports, “Of the 12,700 COVID-19 countermeasure claims, 9,621 allege injuries/deaths from COVID-19 vaccines.” (https://www.hrsa.gov/cicp/cicp-data/table-1).

A reliable non-government resource on vaccine is the National Vaccine Information Center at https://www.nvic.org/