The Assault Against the Chiropractic Profession

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists

An Existential Threat

Harmful assault is currently being waged upon the Chiropractic profession. Such attacks appear to be conducted in a methodical and coordinated manner that poses an existential threat to the Chiropractic profession.

Highly biased case reports and articles are being published that inappropriately associate Chiropractic with adverse events. Substantial protopathic bias is being promulgated, despite highly powered research that refutes such causal relationships.

Poor research methodology and conclusions offered by medical sources are often unimpeachable in such forums. Direct responses to such biased reporting are often not published and do not receive the same viral readership.

How to Respond?

It seems to me that the best response to such attacks on the Chiropractic profession is advanced continuing education and research to improve and define patient safety.

In 2018, I published the novel hypothesis that fluoroquinolone (FQ) antibiotics are causally related to spontaneous cervical artery dissection (sCAD). [1] This causal relationship was never previously reported. Since my paper was published, three independent researchers have initially confirmed my hypothesis. [2, 3, 4]

My discovery was likened to, “The invisible elephant in the room.” FQs may represent a substantial medical iatrogenic cause of sCAD. Ironically, medical error may be the root cause of dissections and strokes occurring in the younger population.


Current highly powered research does not provide evidence of a causal relationship of Chiropractic and sCAD. It has been estimated that up to 9 of 100,000 person-years will be affected by sCAD. The spontaneous nature of these events are not predictable, and can be precipitated by normal and incidental activities of daily living. This risk should not be assigned through association and protopathic bias.

Means to Improve Patient Outcomes

Healthcare providers need to improve their ability to recognize an extraordinarily difficult developing sCAD. Deficits in the research and medical education need to be addressed that may include:

  • The role of FQs and the genesis of CAD;
  • Recognizing the prevalence of CAD that are undetected in the normal population;
  • The role, importance, recognition and reporting of pre-existing, predispositions to CAD;
  • Improving the CAD diagnosis that at times can be nearly impossible;
  • Improving communication between medical providers, patients and chiropractors;
  • Etc.

Our PostGradDC Response

This year, we launched the PostGradDC Cervical Artery Dissection Certification©. To our knowledge, our certification is the only of its kind in the world. Leaders in our profession, have indicated that every chiropractor and chiropractic student in the country should take this certification.

We have published many Clinical Pearl articles that address this complex problem.


  1. Demetrious, J. Spontaneous cervical artery dissection: a fluoroquinolone induced connective tissue disorder?. Chiropr Man Therap 26, 22 (2018).
  2. Del Zotto et al. Eur J Neurol. 2019 Jul;26(7):1028-1031. 
  3. Harada et al.Intern Med. 2021 Sep 1;60(17):2863-2865.
  4. Wang et al.Intern Med. 2021 Sep 1; 60(17): 2863–2865.

At PostGradDC, we offer advanced CAD Certification.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is an internationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. Register for coursework at


The information provided in this article and all PostGradDC coursework should not be considered standards of care. We offer this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding medical conditions or treatment.