Canadian inquest testimony refutes stroke claims

Much of the testimony presented by expert witnesses during the now-famous Canadian inquest into the death of Lana Dale Lewis clearly refutes neurologist accusations that chiropractic neck adjustments can cause stroke.

Lewis, 45, received upper vertebral manipulation from Toronto chiropractor, Philip Emanuele, on Aug, 2, 1996. Six days later, the woman suffered a stroke and, on Sept. 12, she died. Initially, the coroner's office did not feel that an inquest was warranted.

However, after a Saskatoon woman, Laurie Jean Mathiason, died following a neck manipulation in 1998, Canadian neurologists began issuing warnings that chiropractic treatments were linked to stroke. In January 2000, Lewis' family -- convinced by this publicity that the stroke was caused by the chiropractic treatment -- filed a $12 million civil lawsuit against the Dr. Emanuele and several chiropractic organizations for "ignoring their professional and civic responsibilities to widely disseminate the facts and findings surrounding the death." The family also asked the coroner's office to re-examine the case and call for an inquest.

Although two judges had already turned down requests for an inquest, the chief coroner relented after the media, spurred by medical interests, began focusing on the case. The inquest was to begin in April 2001 but was delayed after the family's legal agent, Montreal pediatrician Murray Katz, was removed from the case for sending a threatening letter to a coroner, since retired, in the case.

Dr. Katz is well-known for his vehement opposition to chiropractic. In 1998, speaking at the Hospital for Sick Children in Toronto, Katz scoffed at the concept of subluxations. "This is all a sham. There are no bones out of place. Readjustment is a treatment in search of a disease," he stated. Katz had also testified in the Mathiason case, stating that radiologists might be liable if they provide X-rays to a chiropractor.

About that same time, the coroner dismissed Dr. John Norris as a witness for the state. Norris, a Toronto neurologist, was head of the Canadian Stroke Consortium.

Although the Consortium describes itself as "an academic alliance committed to the pursuit of anti-stroke therapies by designing and/or conducting research projects and clinical trials," their client list reads like a directory of pharmaceutical companies, including: Astra Pharma, Bayer, Bristol-Myers Squibb, Dupont-Pharma, Eli Lilly & Co., Glaxo-Wellcome, Hoffman-La Roche, Novartis, Pharmaceutical Research Associates, Pharmacia Upjohn, Pfizer, SmithKline Beecham, Warner Lambert (Parke Davis Canada), and Wyeth-Ayerst Research.

It was also revealed that Norris had been in contact with Katz about the case. The coroner's office stated that it wanted the inquest to focus solely on Lewis' death, rather than become an indictment of chiropractic in general. New evidence further delayed the inquest.

Finally, in April 2002, the inquest began with the testimony of Dr. Al-Noor Dhanani, Lewis' treating neurologist.

Under intense interrogation by Tim Danson, counsel for the Canadian Chiropractic Association and Canadian Memorial Chiropractic College, and Brian Foster, counsel for Dr. Emanuele, Dr. Dhanani admitted that Lewis had numerous risk factors for stroke. She was overweight, had high blood pressure, smoked, used alcohol, had elevated cholesterol, and a family history of heart disease and hypertension.

The cross-examination of Dr. John Deck, one of the two neuropathologists who wrote the original neurological autopsy report, began on April 26.

Under Danson's questioning, Dr. Deck admitted that during his 31 years of experience and more than 10,000 autopsies, he had never seen an arterial dissection related to chiropractic manipulation. He said his knowledge of a relationship between cervical manipulations and dissection was based only on medical literature.

One of the most persuasive witnesses, however, was Dr. Michael Pollanen, who worked as a consultant with the coroner's office under Deck's supervision in 1996.

Although Dr. Pollanen had a doctorate in neuropathology, he had not yet received his medical degree at the time he and Deck concluded that Lewis' stroke was caused by the chiropractic treatment. In court, though, he recanted that statement, saying that after examining 507 specimen slides of tissue, bone and arteries he was convinced that the adjustment was not related to the women's stroke or subsequent death.

"We were wrong," Pollanen stated during the inquest on May 7. "In retrospect, our conclusions were erroneous." He told the jury that he now felt a "reasonable degree of medical certainty" that Ms. Lewis died of natural causes.

Also testifying during the inquest was Scott Haldeman, D.C., Ph.D., M.D., who serves on the faculty as clinical professor in the Department of Neurology at the University of California- Irvine, and as adjunct professor at Los Angeles Chiropractic College. He stated that Lewis' death was definitely not caused the by chiropractic neck manipulation but from a blockage in one of the arteries leading to her brain. He emphasized the many lifestyle factors which made Lewis a prime candidate for stroke.

At press time, the inquest was continuing as both sides called expert witnesses about the possible connection between chiropractic and stroke.