Articles by JCS

Affirmative Action

Academic Demagoguery
FSU Fiasco

by

JCS

 Two of the stated goals of the AMA Committee on Quackery’s goon squad were 1) the distribution of propaganda to the nation’s teachers and guidance counselors to discourage students from seeking a career in chiropractic, and 2) punishing community colleges that offered pre-chiropractic programs.

Of course, this extended to the established universities to resist the implementation of any chiropractic academic programs. In 1971, a “Dr. Nole reported the C.W. Post College on Long Island is willing to set up a Chair of Chiropractic, to teach the basic sciences only, and they desire to have a chiropractic college work with them.  No action taken.”[1] Undoubtedly this college capitulated to the threat of the AMA to cut funds.

Despite the medical critics call to upgrade chiropractic education, when the federal government began the process to establish a federal accrediting agency for chiropractic, the Council on Chiropractic Education (CCE), the AMA still complained.

According to historian Joe Keating:

“On March 1, 1974, Dr. Ernest B. Howard, Executive Vice-President of the American Medical Association, made a second attempt, following a similar attempt in 1972, to get the U.S. Commissioner of Education to discontinue its consideration of recognition of an accrediting agency for chiropractic education.  The thrust of his argument was that chiropractic had no scientific validity or social usefulness.”

            “In his response to Dr. Howard, U.S. Commissioner of Education, John Ottina, cited a July 19, 1972 memorandum from the Office of General Counsel to HEW on Dr. Howard’s 1972 request in which he stated:

“Under the relevant legislation requiring him to list nationally recognized accrediting agencies and associations, it is our view that the Commissioner is not called upon to express his opinion as to the legitimacy or social usefulness of the field of training of the agency seeking listing.  That is not to say that where training in the field under question or the practice of such training is patently illegal, or an apparent hoax or fraud, that the Commissioner must recognize and list an accrediting agency for that Subject.”

 

The American Medical Association, however, did not stop its relentless pursuit to destroy the chiropractic profession.  At the May 23-24, 1974 hearing of the USOE Advisory Committee on the CCE Application for Recognition in Washington, D.C., the AMA sent its chairman of the AMA Committee on Quackery, Boston neurosurgeon, Dr. H. Thomas Ballantine. 

He made a vicious attack on the chiropractic profession, the CCE and its Commission on Accreditation.  He characterized the chiropractic profession as a cult and stated that “medical authorities agree that chiropractic has no validity… and represents a significant hazard to the public.”

The thrust to improve chiropractic education from only private colleges operating on a shoe-string budget to a major university level became the goal of the Florida Chiropractic Association that convinced the state legislature and Governor Jeb Bush to implement a chiropractic program at Florida State University to access its research capabilities.

The legislature, led by Senate President and FSU alum Jim King, gave FSU the authority to offer a chiropractic degree earlier and provided the university $9 million a year for its non-existent School of Chiropractic Medicine.

The goal of the evidence-based chiropractic program was to do research at a major university that had the facilities, faculty and funding to determine the scope of care of chiropractic care, but this noble cause was killed before it saw the light of day when the medical plutocracy crushed the proposed chiropractic program there. Apparently the medical supremacists fear what truth might have been found that chiropractic care was more effective than they wanted to know.

Raymond Bellamy, MD, orthopedist and adjunct professor, led an academic revolt against this proposed chiropractic college that would have highlighted the profession's struggle to move from broad unscientific claims to evidence-based treatment, but Bellamy made it into a religious war instead, using classical methods of demagoguery to misrepresent chiropractic as “pseudoscience,” not allowing any chiropractor to rebut these allegations, suggesting a doomsday outcome for the university, then stirring actions among his frightened supporters, mainly other medical professors.

Certainly, it was a kangaroo court that fought to eliminate a rival.

The following excerpt from a newspaper article, “Question Of Science” by Melanie Yeager clearly illustrates this demagoguery.[2]

     “A frenzy of e-mail exchanges. Conference calls and closed-door meetings. Petitions circulating through the Internet.

     “Criticism against Florida State University's planned chiropractic program has gained momentum in the last few weeks as Dr. Ray Bellamy, a longtime Tallahassee orthopedic surgeon, has quickly become the loudest naysayer in town.

     “Calling chiropractic medicine "pseudoscience," Bellamy is telling all who will listen - FSU administrators, trustees, state officials - that the program needs to be stopped.

     “’There are quacks. There is no question,’ Abele said of the chiropractic profession. ‘But it's incorrect to say all chiropractic is non-science and non-evidence based.’ And he said FSU wants to bring better scientific practices to a health service used annually by 15 million Americans.

     “But Bellamy still thinks most chiropractic care is based on ‘gobbledygook ... not one shred of science.’ He said it degrades FSU's entire scientific effort.

     “‘It looks to me like the university's for sale here,’ Bellamy said.     “Bellamy's primary beef is academic and personal, not financial. He's fearful that establishing a chiropractic school would devalue his FSU degree, the university's reputation and its medical school, where he teaches as an adjunct faculty member.

     “‘I’m trying to avoid embarrassing FSU or threatening their funding, but it may not be possible,’ Bellamy said. ‘My sense is the only way we have of stopping this chiropractic school is getting the public educated.’

     “‘Not one single major scientific contribution has been made by chiropractic in 100 years, about the dangers of high neck manipulation and so on, but all I ask is that the facts be given a chance,’ Bellamy said.”

Bellamy’s blatant demagoguery mocked the proposal by circulating a map of the campus, placing a “Bigfoot Institute” and a “Crop Circle Simulation Laboratory” next to the proposed school. “I've got hundreds of petitions saying that this school is not wanted. It's a stupid idea.”[3] It appears that political medicine forgot about academic freedom at FSU where mob rule superseded academic research.

Apparently medical supremacists like Bellamy have as much tolerance for different ideologies that Bellamy led what can only be seen now as a mockery against academic freedom in higher education. Bellamy omits the fact that much of medicine evolved from unproven and folk lore remedies, as well as the field of psychology and psychiatry which remain unscientific. He also refuses to admit much of his own orthopedic treatments for spine problems are questionable, if not zombie science.

Obviously Bellamy and his medical mobsters missed the point of the FSU chiropractic program as espoused by John Triano, DC, PhD, a chiropractor who served on the advisory committee for the FSU school. “The chiropractic profession as a whole . . . is ready to step up to the plate and to let its belief systems be tested scientifically,'' said Dr. Triano. “Let the chips fall where they may.'' [4]

The FSU school could have been a force in chiropractic's transition from fringe to mainstream, according to Triano. “The transition is from the stereotypical impression of chiropractic as a bunch of people running around claiming they can treat everything, to a very evidence-based but open-minded practice approach.”

The argument against chiropractic is confusing since the clinical results of manual manipulation for musculoskeletal disorders is clouded by the vitalism espoused by the founders, DD and BJ Palmer, nearly 100 years ago. Today, medical critics still hark on the old image of “chirovangelism” to criticize the entire profession although the majority of DCs today are oblivious to vitalism and practice conservative spinal care with good results.

Despite the RCTs concerning SMT and the chiropractic brand of spinal care, MDs suffering from the medical bias use the chiropractic gaffes from yesteryear as a Straw Man argument to dismiss chiropractic’s effectiveness with MSDs. (A straw man argument is an informal fallacy based on misrepresentation of an opponent's position—an element of demagoguery.)

In fact, many chiropractors today are employed as primary care physicians, nutritionists, pediatricians, public health officials, some work alongside MDs in the VA and military health services, and many in the growing field of sports medicine. Indeed, this isn’t your grandfather’s chiropractic any more.

This image paradox hasn’t escaped the chiropractic leadership, as Dr. Triano points out: “It’s not what we do, but what we say about what we do that matters most.”[5]

Triano admits his angst toward the faith-based fundamentalists within the chiropractic profession. “How long will we let these radical DCs drive the agenda of this profession? Who’s in charge of chiropractic’s destiny?” [6] Apparently the medical mob is in control at FSU.

Obviously the failure by FSU to implement the hopeful chiropractic program was a huge disappointment to members of my profession who wanted to see an evidence-based research program that was well-funded. In my effort to understand the mindset of Dr. Raymond Bellamy, the adjunct professor who led the revolt against the proposed chiropractic program at FSU, I wrote to him in an attempt to understand his mindset.

The following email is a response by Dr. Bellamy. Once you’ve read his letter, please continue to read my response to his many comments.

Let me preface his comments by explaining the Deyo comment he refers to is one that I included in my original letter to him suggesting there is a need for reform in the back pain business. As you will read in Bellamy’s response, apparently he’s for change, just not chiropractic change:

“Back pain is one of the most common and expensive causes of disability in the U.S.,” according to Richard Deyo, MD. “Yet millions of Americans get substandard care for back pain; there's tremendous potential for improving outcomes and controlling costs by helping doctors and patients make more informed choices in this area.[7]

The rest of my inquiry is obvious in his response.

From: Bellamy, Raymond
Sent: Sat 6/20/2009 12:10 PM
To: Dr J C Smith
Subject: RE: response to FSU chiropractic school commentary

Several comments. First, please refresh my memory on what ACHPR is about?

Second, I am proud of my efforts regarding the FSU events and I will attempt to explain in good faith:

1. No argument with Deyo's statement. Repeatedly during the 2004-2005 FSU chiropractic battle I referred to the fact there are many surgical procedures which may eventually turn out to be no better than, or not as good as, placebo treatment, and fortunately, that there are many researchers endeavoring to determine which should be rejected and which retained.

 Unfortunately, in my opinion, there is abundant evidence that virtually all of chiropractic treatment is placebo, and there are strong forces within chiropractic through the last 110 years preventing the acknowledgement of that fact, and thus we have patients delaying appropriate treatment of a medical nature for their conditions, enuresis, otitis media, scoliosis, headaches, dizziness, etc. because they are diverted into placebo treatment by chiropractors. That results in an outcome worse than placebo, because of wasted expense and delay of appropriate medical care. There are the occasional, fortunately uncommon, strokes and death from vertebral artery dissection and carotid artery dissection caused by chiropractic neck manipulation, a procedure of no known value beyond placebo.

Face it, chiropractic has had over 110 years to come up with a major discovery or scientific advance and has nothing to show for it. To have a "research presence" for chiropractic on the FSU campus would be a major advance in prestige for chiropractic but would amount to chiropractic forcing themselves on the campus by political means when all other scientific disciplines represented on campus were invited and embraced by the scientific community. The other sciences have earned their place on campus by proving their place in the science community by hard research and advances, none of which chiropractic has accomplished in over 100 years. Not opposing chiropractic presence at FSU would have been an egregious lack of academic freedom.

2. As for fear of truth: let chiropractors design true double blind studies to compare their treatments with placebo (admittedly difficult to accomplish) and admit there is no such thing as a "subluxation" as used by every chiropractic licensing authority in every state in the U.S. The same patient cannot be examined by 2 different chiropractors with the result that the same subluxations are diagnosed. A blinded chiropractor examining a patient cannot tell if that patient has already been "adjusted" for their subluxation or has yet to be treated. A chiropractor cannot read a spinal x-ray and tell if there is a subluxation pre- or post- reduction and 2 chiropractors would not be able to agree from the x-ray which spinal segments were subluxed.

This is not science, it is pseudoscience, plus marketing and the clever use of the placebo effect. Again, not to deny the fact that much of mainstream medicine utilizes the placebo effect, but fortunately, major efforts are constantly underway to identify which treatments are only placebo or worse, and after identifying them, to eliminate them. My impression is that chiropractic is almost all placebo and tries to hide that fact.

3. I did not design the "FSU Science Map", but did forward it to others, including the press. It was sent to me by a biochemistry professor. There were nearly 500 email responses from the FSU science faculty opposing the chiropractic school. About 93 from the FSU College of Medicine, with about 12 clinical faculty declaring their intent to quit the teaching faculty if the chiropractic school came to FSU. I did forward to the press some of these emails opposing the chiropractic school if given permission by the sender.

4. You allude to some of the divisions within chiropractic regarding philosophy and core thought. The "straights" and the "mixed" etc. After 110 plus years there seems to be no clear agreement on what a subluxation is or how to define it, yet it is the unifying principle of all chiropractic. There are some "hole-in-one" chiropractors who do risky neck manipulation for every complaint, regardless of origin (even for low back pain) for instance.

There remains a strong bias within chiropractic against immunizations, which is a socially harmful position for chiropractic to take. As of a few years ago, and probably still, there was a sign over a doorway to one of the Palmer Chiropractic College buildings in Iowa declaring opposition to immunization, which has saved millions of lives the world over.

 Misguided marketing approaches by chiropractors such as recommending "adjustments" on a regular basis for asymptomatic individuals and for children "because obviously they have suffered spinal harm during passage through the birth canal..."  If chiropractic wishes to be taken seriously within the scientific community they have a lot of work to do. You refer to terms such as vitalism, etc. which the scientific community agrees is nonsense.

 My response:

First let me thank Dr. Bellamy for his frank answer, which was stunning to say the least, and left me trembling with disbelief and anger, to be honest.

I think his letter illustrates the Morris Fishbein supremacist attitude that permeates many in the medical profession. Indeed, Jim Crow, MD, is still very much alive.

Although there were many issues mentioned, let me address the most shocking comments.

“First, please refresh my memory on what ACHPR is about?”

I’m surprised that he is unfamiliar with one of the most significant studies in the history of low back pain, especially considering the backlash from the North American Spine Society that he is a member.

“No argument with Deyo's statement. Repeatedly during the 2004-2005 FSU chiropractic battle I referred to the fact there are many surgical procedures which may eventually turn out to be no better than, or not as good as, placebo treatment, and fortunately, that there are many researchers endeavoring to determine which should be rejected and which retained.”

 

 I believe that endeavor has been completed, yet Dr. Bellamy acts as if it’s still on-going. Perhaps what he admits is the researchers have shown spine surgery is out of control in the US, much of it is ineffective compared in the long term compared to conservative care, there’s too much variation from region to region, surgery should be a last resort after conservative care, but none of these findings has slowed down the gravy train as Dr. Deyo suggests.

The editors of The BACKLetter were adamant that spine surgeries are generally ineffective:

“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate…Despite a steady stream of technological innovations over the past 15 years—from pedical screws to fusion cages to artificial discs—there is little evidence that patient outcomes have improved.”[8]

“Unfortunately, in my opinion, there is abundant evidence that virtually all of chiropractic treatment is placebo, and there are strong forces within chiropractic through the last 110 years preventing the acknowledgement of that fact, and thus we have patients delaying appropriate treatment of a medical nature for their conditions, enuresis, otitis media, scoliosis, headaches, dizziness, etc. because they are diverted into placebo treatment by chiropractors. That results in an outcome worse than placebo, because of wasted expense and delay of appropriate medical care. There are the occasional, fortunately uncommon, strokes and death from vertebral artery dissection and carotid artery dissection caused by chiropractic neck manipulation, a procedure of no known value beyond placebo.”

Now that’s a mouthful. In one paragraph he condemns chiropractic as entirely placebo and dangerous because of delay of proper medical care.

“Unfortunately, in my opinion, there is abundant evidence that virtually all of chiropractic treatment is placebo…”

If that is true, just where are his references to support this allegation? His attitude reflects the talking points of the AMA and Morris Fishbein than reality since every major study on back pain contradicts his belief that chiropractic care is placebo.

He admits to be unaware of the AHCPR finding that said spinal manipulation is a “proven treatment,” he is also totally unaware of the recommendations of the many guidelines that endorsed manipulation.

Here’s a list of notable international studies on low back pain:

  • 1978: New Zealand Royal Commission on Chiropractic
  • 1990: RAND study on appropriateness of spinal manipulation
  • 1993: Manga Report Ontario (Canada) Ministry of Health
  • 1994: AHCPR Acute Low Back Pain Guideline
  • 1994: Clinical Standards Advisory Group (UK)
  • 1995: Council on Chiropractic Guidelines and Practice Parameters
  • 2003: Ontario Workers’ Safety and Insurance Board
  • 2003: Norway Spine Study
  • 2004: European Back Pain Guidelines.
  • 2004: The UK Back Pain Exercise And Manipulation (UK BEAM) Trial
  • 2004: Swedish Lumbar Spine Study
  • 2007: Guideline on Back Pain: American College of Physicians
  • 2008: Decade of Bone & Joint Disorders: CLBP
  • 2008: The Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders
  • 2009: The National Institute for Clinical Excellence (UK-NICE)

Dr. Bellamy also impugns spinal manipulation as dangerous, causing “strokes and death from vertebral artery dissection and carotid artery dissection caused by chiropractic neck manipulation, a procedure of no known value beyond placebo.”

Once again, Dr. Bellamy is ignorant of the research and simply parrots old talking points from the AMA. However, recent investigation of this issue reveals just the opposite.  

Current Concepts in Spinal Manipulation and Cervical Arterial Incidents includes 675 references and a comprehensive discussion of varied topics relevant to cervical artery injury and manipulation and came to much different conclusions, such as:

  • “The increased risk of death resulting from NSAID use is 1,500 times greater than the risk of tetraplegia following cervical SMT.” [9]
  • “On analysis, SMT as delivered by chiropractors is one of the most conservative, least invasive and safest of procedures in the provision of health care services.” 
  • “The risks of SMT pale when compared to known medical risks.  Chiropractors, by their training and skill in SMT and special emphasis on the spine, are the best positioned to deliver this mode of health care to the public.”
  • Conclusion. “VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”

According to Terret et al., the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic is only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.[10]

In comparison, the rate of iatrogenic problems associated with back surgeries is 15,600 per one million cases.[11] For Bellamy to suggest spinal manipulation is dangerous flies in the face of the facts, but that’s typical of demagogues to misrepresent their rivals.

Undoubtedly the safety of chiropractic manipulation is the reason why chiropractors pay only about $150/month in malpractice insurance compared to spine surgeons who pay nearly $200,000 per year.

Dr. Bellamy also thinks neck manipulation is placebo, but researchers again disagree in a huge study,  “Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.”[12]

This panel concluded: “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.” [13]

However, no form of cervical surgery has been proven to be superior to nonsurgical care—or waiting out the symptoms.

 Dr. Scott Haldeman, DC, MD, PhD, also noted:

“The deliberations of the Neck Pain Task Force suggest that there is currently no justification for surgery in patients with axial neck pain without radiculopathy, myelopathy, or serious pathology.”[14]

I.P. Fouyas, MD, in an article in Spine, mentioned that neck surgery is not effective for common problems:
            “There was no significant difference in results between people who received surgery compared with those who had non-surgical treatments. It is not clear whether the short-term risks of surgery are offset by any long-term benefits.” [15]                                

As Dr. Deyo opined, “People say, ‘I’m not going to put up with it,’ and we in the medical profession have turned to ever more aggressive narcotic medication and more invasive surgery.'” [16] It appears that many spine surgeons have the attitude of “don’t confuse me with the facts.”

Dr. Bellamy then criticizes chiropractors for not producing research, which again illustrates his complete lack of awareness of the plethora of research done by the chiropractic profession and chiropractors who have contributed to every major spine-related journal. It’s actually bewildering his lack of intellectual honesty.

 

“Face it, chiropractic has had over 110 years to come up with a major discovery or scientific advance and has nothing to show for it. To have a "research presence" for chiropractic on the FSU campus would be a major advance in prestige for chiropractic but would amount to chiropractic forcing themselves on the campus by political means when all other scientific disciplines represented on campus were invited and embraced by the scientific community. The other sciences have earned their place on campus by proving their place in the science community by hard research and advances, none of which chiropractic has accomplished in over 100 years. Not opposing chiropractic presence at FSU would have been an egregious lack of academic freedom.”

I am confused how he thinks opposing the study of an academic discipline would have been “an egregious lack of academic freedom”? I find it just the opposite—to reject a rival academic discipline outright due to preconceived beliefs and prejudices exemplifies the complete lack of academic freedom.

As a graduate of the University of California at Berkeley who attended there during the aftermath of the Free Speech Movement, I find his version of academic freedom to be the antithesis of what I experienced at Cal—censorship is not academic freedom by any sense.

Apparently he missed the point of the FSU chiropractic program as espoused by John Triano, DC, PhD, a chiropractor who served on the advisory committee for the FSU school. “The chiropractic profession as a whole . . . is ready to step up to the plate and to let its belief systems be tested scientifically,'' said Dr. Triano. “Let the chips fall where they may.'' [17]

Bellamy mentions “chiropractic has had over 110 years to come up with a major discovery or scientific advance and has nothing to show for it.”

The fact that chiropractic colleges have not produced more research projects as more to do with the lack of funding than interest. Compared to the millions medical schools receive, chiropractic research more closely resembles Oliver Twist asking for more gruel.

In his testimony before the National Institute of Medicine, Tony Rosner, PhD, mentioned the scant amount of federal monies awarded to chiropractic research:

“Even more remarkable is the efficiency of chiropractic research. When compared to the NIH budget of nearly $20 billion, the $10 million investment in federal funds is substantially less than a tenth of 1 percent, which makes it less than a rounding error. Put another way, as a couple of wags have offered in the past, the federal government must believe in alternative medicine, because it has given chiropractic researchers homeopathic doses of money with which to work.”[18]

Recall, due to the chiropractic witch hunt begun by Morris Fishbein and continued until 1976 when the Wilk et al. v. the AMA et al. antitrust lawsuit began, the chiropractic profession was fighting for its survival. During the first half of the 20th century during which chiropractors were jailed over 15,000 times, it’s hard to imagine they found the time to do research while dodging the bullets of the AMA.

This subjugation reminds me of the Warsaw ghetto Jews fighting to survive the Nazis, and then asking why none of them produced “a major discovery or scientific advance[ment],” as Bellamy questions.

He also wrote: “To have a "research presence" for chiropractic on the FSU campus would be a major advance in prestige for chiropractic but would amount to chiropractic forcing themselves on the campus by political means when all other scientific disciplines represented on campus were invited and embraced by the scientific community.”

Let’s be real: Bellamy makes FSU sound like a white country club only inviting other white people rather than a club based on members with skill or meritocracy. Obviously he’s more concerned about image than advancing science.

The fact is, Dr. Bellamy knows that healthcare has always been political; even today during this healthcare reform the AMA is fighting the same two things Fishbein fought—socialized medicine and competition.

The AMA’s fear of comparative effectiveness studies illustrates its own political interference to resist comparing its own methods against competitors. Is this not political or “zombie science,” according to Bruce Charlton, MD, who defines it as “a sinister consequence of evaluating scientific theories purely on the basis of enlightened self interest.” [19]

Undoubtedly, zombie science as evident by ineffective treatments prevails in the back pain business, reminiscent of the once routine but now considered unnecessary ritual of tonsillectomies, appendectomies, and hysterectomies. Indeed, spinal fusions and microdiscectomy ought to be considered the “sinister consequence of …enlightened self-interest.”

Indeed, in this era of evidence-based healthcare, why would the AMA oppose comparing its methods against all others? Because the comparison might show the medical methods are not clinically or cost-effective.

Recent medical research trials tell us that most back surgeries[20], heart procedures[21], and knee surgeries[22] are no better in the long run than non-invasive conservative care, but the AMA and its cohorts in the media have been slow to inform patients of these revelations that could drive down costs and improve outcomes.

Another good example of the medical cartel sabotaging emerging alternative healthcare was evident from the huge, $100 million federally-funded study known as ALLHAT that showed simple diuretics, aka, “water pills,” were the best blood pressure medicine to start with.[23] Unfortunately, the drug companies “ganged up and attacked, discredited the findings,” according to Curt Furberg, the early leader of the trial.[24]

Again, lest I repeat myself, to be “invited and embraced by the scientific community” is nonsense considering the political nature of medicine and academia. Undoubtedly, just as the medical and drug cartel didn’t like the results of the AHCPR, or the three surgical comparisons with conservative care or the ALLHAT findings, in reality the AMA fears comparative effectiveness studies on any of its methods that might be shown clinically inferior—the true nature of the medical monopoly.

Indeed, if Dr. Bellamy and the FSU faculty were so self-assured that chiropractic is placebo, why then would they not want to prove them wrong as Dr. Triano suggested to “let the chips fall where they may”?

“As for fear of truth: let chiropractors design true double blind studies to compare their treatments with placebo (admittedly difficult to accomplish) and admit there is no such thing as a "subluxation" as used by every chiropractic licensing authority in every state in the U.S. The same patient cannot be examined by 2 different chiropractors with the result that the same subluxations are diagnosed. A blinded chiropractor examining a patient cannot tell if that patient has already been "adjusted" for their subluxation or has yet to be treated. A chiropractor cannot read a spinal x-ray and tell if there is a subluxation pre- or post- reduction and 2 chiropractors would not be able to agree from the x-ray which spinal segments were subluxed.”

Although the early days of chiropractic science were as simplistic as were the early days of medicine, today’s research into the effects of “manual therapy” upon anatomical spinal “lesions” or “joint dysfunction” is well documented, which is why AHCPR, Manga, NICE, etc have all endorsed SMT for LBP.

An article published in 2002 by Drs. Meeker and Haldeman in the February issue of the Annals of Internal Medicine[25] noted that at least 73 randomized clinical trials assessing manipulation had been published in English-language, peer-reviewed, scientific journals. Of those, 43 addressed the treatment of low back pain, 30 of which favored manipulation over the comparison interventions, and 13 were equivocal. This is an even greater data base than the 13 RCTs assessed by the interdisciplinary panel that supported the use of manipulation in the 1994 AHCPR Guideline #14 on acute low back pain.[26]

In the 2002 Annals article on the UCLA Neck Pain Study, another 20 RCTs evaluated manipulation in the treatment of neck pain and headache. Again the majority of these favored manipulation over the comparative interventions with the remainder showing the outcomes to be equivocal at worst.[27]

Only a diehard medical chauvinist would still argue that chiropractic care doesn’t work for many of mechanical back and neck pain problems.

 “I did not design the "FSU Science Map", but did forward it to others, including the press. It was sent to me by a biochemistry professor. There were nearly 500 email responses from the FSU science faculty opposing the chiropractic school. About 93 from the FSU College of Medicine, with about 12 clinical faculty declaring their intent to quit the teaching faculty if the chiropractic school came to FSU. I did forward to the press some of these emails opposing the chiropractic school if given permission by the sender.”

This medical backlash demonstrates the mob mentality more than it does a rational decision by academicians. This reminds me of Liberty University that decided not to let students who were Democrats to speak on campus or Jim Jones University who won’t allow non-Christians on its campus. This is not higher education but pure academic demagoguery.

And for Bellamy to forward the ridiculous and insulting Science Map illustrates the demeaning and chauvinistic attitude of this medical mobster. Indeed, would Notre Dame ridicule other religions with the same degrading labels? It appears FSU medical school actually is afraid of the thought of a chiropractic department with its peculiar stance; indeed, what does it really fear? Perhaps the truth that there’s merit to chiropractic care that they don’t want to admit?

“You allude to some of the divisions within chiropractic regarding philosophy and core thought. The ‘straights’ and the ‘mixers’ etc. After 110 plus years there seems to be no clear agreement on what a subluxation is or how to define it, yet it is the unifying principle of all chiropractic. There are some "hole-in-one" chiropractors who do risky neck manipulation for every complaint, regardless of origin (even for low back pain) for instance.”

I don’t understand why Dr. Bellamy believes all chiropractors must think alike or subscribe to the outdated concepts from yesteryear. In fact, there are drastically different schools of thought, and the ol’ time chirovangelism he refers to is on the wane today. Typically, the medical critics will embellish the problems of the past as if the present majority of chiropractor still act in the same fashion. The fact is there is a strong reform movement within chiropractic that seeks progress; John Triano, DC, PhD, is at the head of this list and would have been an excellent chiropractic academician to work beside the medical faculty of FSU to “let the chips fall where they may.”

“There remains a strong bias within chiropractic against immunizations, which is a socially harmful position for chiropractic to take. As of a few years ago, and probably still, there was a sign over a doorway to one of the Palmer Chiropractic College buildings in Iowa declaring opposition to immunization, which has saved millions of lives the world over.”

I agree that the ol’ time chiropractic stance on immunizations were not well received, and there still exists dangers such as the fact that 1 in 150 children will develop autism from vaccines, but most chiropractors today agree that they’ve been very effective.  But to cast this aspersion over the entire profession makes as much sense as accusing Bellamy and every MD of the AMA’s past policy of endorsing tobacco, which only ended in 1988. I daresay policy mistakes on both sides have been made; foremost, the AMA’s genocide program against chiropractors.

Misguided marketing approaches by chiropractors such as recommending "adjustments" on a regular basis for asymptomatic individuals and for children "because obviously they have suffered spinal harm during passage through the birth canal..."  If chiropractic wishes to be taken seriously within the scientific community they have a lot of work to do. You refer to terms such as vitalism, etc. which the scientific community agrees is nonsense.”

 I understand the some chiropractors may use rather tacky advertisements to lure the public, but how is that different than the many drug ads on television that often mistakenly tout their benefits? It’s sad that chiropractors need to advertise at all since back pain is an epidemic. If the medical boycott didn’t exist and MDs referred these patients as they ethically should to chiropractors, this wouldn’t be a problem.

In regards to treating asymptomatic patients, I seriously doubt anyone has a perfect spine that doesn’t need to be checked or occasionally adjusted, just as people see dentists to do the same. In fact, research has now shown that regular chiropractic care is helpful:

“It also shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment.”[28] 

 “If chiropractic wishes to be taken seriously within the scientific community they have a lot of work to do.”

This is perhaps the most ironic of Bellamy’s statements. He challenges the chiropractic profession to prove itself to the scientific community, but he leads the academic mob against the opportunity to do just that at FSU. This reminds me of a racist who denies he’s prejudice, but he just doesn’t want any blacks living in his neighborhood.

The whole idea of the FSU chiropractic program was to gain access to the research departments to discover the pros and cons of chiropractic care in an objective, scientific manner. The state had already allocated the money for this project with the governor’s approval, but the academic demagoguery led by Dr. Bellamy killed this golden opportunity to do exactly what Bellamy now suggests.

Although I’m just a chiropractor from middle Georgia and not a researcher or academician, the research I’ve gleaned off the Internet shows that there’s more to the art and science than he obviously is willing to admit.

The FSU project would have cleared the air on this subject matter and either proved chiropractic to be placebo as he contends or else it would have brought an ageless healing art (SMT) to the forefront to help millions of people who suffer from both musculoskeletal disorders and those who suffer from spinovisceral reflex disorders that mimic serious visceral disorders.

Either way, the truth would have been found in the freedom of academia rather than killed by the hands of political medicine and academic demagoguery.

Perhaps it’s time for the AMA to admit its cure-all mindset of drugs, shots and surgery for any and all diseases makes as little sense as the early chiropractors making the same claim.

Regrettably, the medical world won’t admit this and certainly not encourage patients to seek those who do work in the field of “alternative” care.

It is time to move beyond the debate of alternative medicine versus traditional medicine. It is time to listen to consumers who want the best of care; it is time to protect the right of the practitioner to practice without discrimination, and it’s time for the right of the consumer to choose.

Dr. Andrew Weil, founder of the University of Arizona’s School of Integrative Medicine, commented on this trend to complementary and alternative healthcare, “The public has been on board for some time. The professionals are harder to win over.”[29]

Lastly, I do appreciate his feedback and I do hope this debate continues, in the name of academic freedom, of course.



[1] 1971 (June 17): minutes of “Meeting of the Logan College Board of Trustees” in St. Louis (Logan Archives)

[2] Yeager, Melanie “Question Of Science,” Critics of FSU's chiropractic school, Democrat Staff Writer, 12/12/2004

 

[3] Matus, Ron, Chiropractic school angers FSU professors, St. Petersburg Times, December 29, 2004.

[4] Palm Beach Post – January 15, 2005 .

[5] ACC-RAC Plenary Session, Las Vegas 2005.

[6] ACC-RAC Plenary Session, Las Vegas 2005.

[7]“National Spine Care Advisory Committee Formed,” Dynamic  Chiropractic September 14, 2005, Volume 23, Issue 19.

[8] The BackLetter, vol.12, no. 7, pp.79 July, 2004. The BackPage editorial, The BackLetter, pp. 84, vol. 20, No. 7, 2005

[9] JJ Triano and G Kawchuk. Current Concepts in Spinal Manipulation and Cervical Arterial Incidents. 2006. NCMIC: Clive, IA. 118. ISBN: 1-892734-14-1. page 75

[10] Terret AGJ Current Concepts in Vertebrobasilar Complications following spinal manipulation, NCMIC Group Inc, West Des Moines, Iowa, 2001.

[11] Shekelle, Paul G., et al,  RAND Corporation Report, The Appropriateness of Spinal Manipulation for Low-Back Pain, 1992

[12] Hurwitz, Haldeman et al. Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008 Feb 15;33(4 Suppl):S123-52

[13] The BackLetter® 46 Volume 23, Number 4, 2008

[14] The BackLetter® 46 Volume 23, Number 4, 2008

[15] Spine, 2002;27(7):736-747, April

[16] Kolata, Gina, “With Costs Rising, Treating Back Pain Often Seems Futile” NY Times, February 9, 2004

[17] Palm Beach Post – January 15, 2005 .

[18] Rosner, Anthony L. PhD, National Institute of Medicine Hearings, Foundation for Chiropractic Education and Research, February 27, 2003.

[19] Medical Hypotheses, 2008; 71:327–9.

[20] Weinstein JN et al., Surgical vs. non-operative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT) observational cohort, JAMA, 2006; 296:2451–9.

[21] William E. Boden, M.D., et al., Optimal Medical Therapy with or without PCI for Stable Coronary Disease, NEJM, No. 15, vol. 356:1503-1516, April 12, 2007.

[22] Alexandra Kirkley, MD, et al.,  A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee, NEJM, Volume 359:1097-1107, Number 11, Sept. 11, 2008.

[23] The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) December 18, 2002, JAMA.

[24] Goldestein, J. “Study found cheap blood pressure meds are best. No one cared.” Nov. 28, 2008, New York Times.

[25] Meeker WC, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine 2002; 136: 216-227.

[26] S. Bigos, et al., Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14, U.S. Public Health Service, U.S. Dept. of Health and Human Services, AHCPR Pub. No. 95-0642, Rockville, MD: Dec. 1994.

[27] E.L. Hurwitz, DC, PhD, H. Morgenstern, PhD, P. Harber, MD, MPH, G. F. Kominski, PhD, F. Yu, PhD and A. H. Adams, DC, MS, A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study, October 2002, vol. 92, No. 10, American Journal of Public Health 1634-1641.

[28] Martin Descarreaux,a Jean-Se´bastien Blouin, Marc Drolet, Stanislas Papadimitriou and Normand Teasdalea, Efficacy Of Preventive Spinal Manipulation For Chronic Low-Back Pain And Related Disabilities: A Preliminary Study, Journal of Manipulative and Physiological Therapeutics, October 2004

 

[29] Julie Deardorff, “More maintstream physicians turning to alternative treatments,” Chicago Tribune, Jan. 26, 2009.


Website Builder