Articles by JCS

CNN Suspends Gupta

                                                                                                         

 

Word count: 2630

CNN Should Suspend Dr. Sanjay Gupta

NBC has suspended Nightly News host Brian Williams for six months without pay for misleading the public about his experiences covering the Iraq War.[1] He now claims to have “misremembered” facts that he attributes to the “fog of war” when events become cloudy years later.

If misleading the public is cause for suspension, then CNN should do the same with its chief medical reporter, Dr. Sanjay Gupta, who has misled his viewers for years on many issues that are far more serious to the welfare of many more people.

Indeed, what’s good for NBC’s goose is also good for CNN’s Gupta.

Feet to the Fire

On previous occasions Dr. Gupta has been taken to task for his lack of truthfulness:

  • Dr. Gupta was called on the carpet for promoting two controversial drugs—Gardasil and Vioxx, both manufactured by Merck.
  • Dr. Gupta endorsed Merck’s controversial vaccine for girls and young women, Gardasil, even before the trials were complete.
  • He also minimized the dangers of Vioxx that had been linked to increased risk of heart attack, stroke, sudden cardiac death; it was later withdrawn from the market in 2004, resulting in a class action lawsuit.[2]
  • Gupta also withheld from viewers his payola relationships with Merck and Accent Health, clearly an unconscionable quid pro quo situation for any objective reporter.[3]
  • Dr. Gupta also misspoke and was forced to publicly apologize in 2007 about Michael Moore’s documentary, Sicko. Gupta claimed that Moore “fudged his facts” when “the truth was Moore was actually right and CNN was wrong,” according to New York Times columnist, Paul Krugman.[4]
  • He was among the first to attack chiropractic with his June 25, 2008 video, “Stroke After Chiropractic Care,” when he stated, “Hundreds of people have had strokes after having their necks manipulated.”[5] Although the AHA/ASA Scientific Statement recently admitted, “a direct cause-and-effect link has not been established between neck manipulation and the risk of stroke,” Gupta has never retracted his comment.[6]

Telling Tiger’s Woes

Without a doubt the largest lapse by Dr. Gupta has been ignoring transformational research in the back pain epidemic that has been right under his nose since 1990, but unreported due to his obvious conflict of interest as a neurosurgeon-turned-reporter.

His ‘misremembering’ was again evident when golfing great Tiger Woods withdrew from another tournament in January due to suffering with his bad back despite having supposedly a successful microdiscectomy surgery for a ‘pinched nerve’ last year.[7]

Hundreds of thousands of people have back surgery for ‘bad discs’ and, like Tiger, many are never the same, which poses the question: if ‘bad discs’ are the cause of pain, why do many still hurt after disc surgery?

In the unique position as a neurosurgeon/reporter, we should expect Dr. Gupta to be on top of Tiger’s situation. Yet, there has been no mention of Tiger’s current dilemma by Dr. Gupta to explain why this golfing great still suffers after surgery or, more so, Gupta has ignored the accumulating research that suggests why his surgery failed and he has not improved.

As well, Dr. Gupta has failed to report on the present back pain epidemic, a $100 billion annual expenditure that has now become the #1 disabling condition in the nation, military, and in the world.[8] This becomes even more important considering the Optum White Paper found treatment of musculoskeletal conditions is the top category of medical expense at 17.0%, followed by cardiology at 10.2%, oncology at 9.6%.[9]

Yet, Dr. Gupta has been strangely mute on this huge issue that should be close to his heart as a neurosurgeon. Perhaps his miscues may be blamed on the ‘fog of Vioxx’ along with his willful ignorance of this situation that casts his profession in a very bad light.

Bad Discs Dead, Again

Not only is the back pain epidemic widespread and costly, moreover there has been a huge newsworthy issue concerning the paradigm shift as to the cause of back pain that Gupta has ignored for nearly a quarter of a century.

Although the ‘bad disc’ concept still prevails in medical folklore, in 1990 this concept was undermined by Scott Boden, MD, Director of the Spine Center at Emory University, where Dr. Gupta also practices, so it is hard to imagine he is unaware of this game-changing research right under his nose.

Boden’s seminal MRI research and that of subsequent researchers found ‘bad discs’ in pain-free people confirming suspicions that herniated, bulging, or degenerated discs were “coincidental” and not the sole cause of back pain. [10],[11]

Despite the fact that Dr. Sanjay Gupta resides at Emory alongside Dr. Boden, inexplicably Gupta has never told his viewers of Boden’s game-changing 25-year old research that ‘bad discs’ were found in pain-free people. His error by omission speaks volumes about his truthfulness as a reporter on an issue close to his heart.

Red Herrings

Obviously debunking the ‘bad disc’ diagnosis is a huge news story since hundreds of thousands of spine fusions are based on this premise, but it has remained unknown to the viewing audience at CNN principally due to Dr. Gupta’s professional amnesia to ignore this disproven premise of disc surgery.

The ‘bad discs’ seen on imaging to convince patients of the need for spine fusion was adroitly described as “red herrings” by researcher Donald Murphy, DC, Clinical Director of the Rhode Island Spine Center who serves on the Clinical Faculty of Brown University School of Medicine.

He suggests that ‘bad discs’ are used to mislead unsuspecting patients because the evidence does not support a purely patho-anatomical model, i.e., ‘bad discs’, because it has been shown they also appear in pain-free people.[12],[13]

His sentiments echo the opinions of other spine researchers. Richard Deyo, MD, MPH, and co-author of Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises, also agrees that “many of these disc abnormalities are trivial, harmless, and irrelevant,” so they have been dubbed “incidentalomas,” equivalent to “finding gray hair” since, he contends, both are part of the normal aging process.[14]

Slipped Joints, Not Discs

According to another article, “Differential Diagnosis of Low Back Pain,” Dr. Deyo opined in 2001 that 97% of back pain is “mechanical” in nature [joints, muscles, kinetics] whereas “non-mechanical” spinal conditions [disc, fractures, infections] accounted for “about 1%”. [15]

More research ignored by Gupta confirms the role joints play in back pain and the value of spinal manipulation as done by chiropractors. Two studies led by Donald Murphy found joint dysfunction was the cause of neck pain in 69% of cases and the cause of low back pain (lumbar and sacroiliac) in 50% of patients.[16],[17]

In a 2006 study on lumbar spinal stenosis also led by Dr. Murphy and Eric L. Hurwitz, DC, found patients treated with manipulative therapy had an astounding self-rated improvement of 75% overall.[18] Yet these patients still had stenosis despite feeling better, illustrating that physiology trumps anatomy in such cases.

Still to this day, Dr. Gupta has made no comment on the 25-year old research on the benefits of spinal manipulation or the revolutionary research debunking the ‘bad disc’ diagnosis. Indeed, he may be purposely avoiding these issues that don’t cast his spine surgeon colleagues or their science in a favorable light.

National Scandal

 Dr. Gupta wants nothing to do with harming the income of his fellow neurosurgeons or to impugn their credibility. Fusion has helped spine surgeons become the best paid doctors in the U.S. with an average annual salary of $806,000, not counting kickbacks.[19]

Nor does he want to tell the truth about the outdated treatments—narcotic painkillers and epidural steroid injections—still used in “pain management” spine care despite the emerging science critical of these placebo treatments.

Mark Schoene, editor of THEBACKLETTER, a leading international spine research journal, also suggests, “Spinal medicine in the US is a poster child for inefficient spine care” and described this confusing situation as a “national scandal.”[20] Without a doubt, the blame for this pandemic of chronic back pain can be laid at the doorstep of the medical spine industry, a conclusion not shared by Gupta with his television viewers.

While this scandal in spine care remains prominent news in the scientific journals, the omission of these controversial issues at CNN illustrates Dr. Gupta’s conflict of interest as a reporter who will never blow the whistle on his fellow spine surgeons who continue to sell “red herrings” to unsuspecting patients despite the poor results as we’ve seen with Tiger Woods.

Is this not reason enough for CNN to question Dr. Gupta’s credibility as a journalist when he apparently has a greater allegiance to his surgeon-friends than to the public’s safety?

Deadly Omission

There are more examples of his lack of truthfulness about the back pain epidemic. On November 18, 2012, Dr. Gupta aired an exposé at CNN on the Hillbilly Heroin epidemic exposing the abuse of opioid painkillers. He found most of the victims were taking narcotic painkillers not to get high, but because they were suffering from back pain.

As Dr. Gupta explained the addictions and deaths from opioids, ostensibly CNN viewers like me thought Dr. Gupta was looking for a non-drug solution for back pain, but inexplicably he failed to mention the elephant in the room—chiropractic care, the most obvious non-drug treatment for back pain.

Is this not another reason for CNN to question Dr. Gupta’s journalistic ethics as an MD-turned-reporter?

As a neurosurgeon, he should know that chiropractic is the third-largest, physician-level profession that focuses exclusively on spine-related disorders, but his ‘chirophobia,’ the medical bias against all-things-chiropractic, prevents him from mentioning his rival profession. Indeed, to speak of back pain without mentioning chiropractic is equivalent to speaking of a toothache and not mentioning dentistry!

Yet another example of Dr. Gupta’s “fog” occurred recently when he had a recent opportunity to report on a review from the Mayo Clinic published on November 27, 2014 that also found ‘bad discs’ are ubiquitous in pain-free people, but once again he has remained mute on this important topic.

Waleed Brinjikji, MD, and his colleagues at the Mayo Clinic published a systematic review of all studies that reported on the prevalence of lumbar degenerative findings on MRI scans among individuals with no history of low back pain. The researchers found 33 studies of 3110 individuals published through April of 2014 and found the vast prevalence of ‘bad discs’ in pain-free people and considered them no more significant than “gray hair or crow's feet around their eyes.”[21]

The Mayo reviewers concluded:

“Our study suggests that imaging findings of degenerative changes such as disc degeneration, disc signal loss, disc height loss, disc protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention.”

Mark Schoene, editor of The BACKLetter, also commented on the Mayo study:

“The largest systematic review to date drives home the point that spinal degeneration visualized on imaging scans often has no relationship to low back pain—and should not be routinely viewed as evidence of the source of low back symptoms.”[22]

Here’s the Proof

Just as Dr. Gupta willfully ignores these studies that debunk the outdated ‘bad disc’ rationale for spine surgery, he can also be accused of ‘misremembering’ on the litany of studies supporting chiropractic care as a “proven treatment” for low back pain.[23] As the focus of more than 1000 random controlled trials over the last 25 years[24], today research clearly vindicates chiropractic care as the most clinical and cost-effective treatment for most cases of mechanical back pain.

The growing number of comparative research studies[25] cannot be clearer that chiropractic stands at the top of cost-effective spinal treatments as Anthony Rosner, PhD, testified in 2003 before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[26]

Yet, Dr. Gupta has never told his CNN audience that chiropractic care has vaulted to the top of back pain treatments. Neither will he tell his viewing audience that the ‘bad disc’ theory is dead, undermining the hundreds of thousands of disc fusions done annually by his spine surgeon colleagues.

Clearly a case can be made that Dr. Sanjay Gupta has made many serious breaches as a medical reporter. Considering his expertise as a neurosurgeon, his many lapses in the spine controversies and his omission of chiropractic care clearly illustrates his biased journalism.

CNN Cover-up

Obviously Dr. Gupta has been in a fog on many important issues in this field, but his misstatements and omissions have never been admitted by CNN, even when I pointed them out to the CNN executives who failed to respond.[27] Apparently Dr. Gupta remains untouchable aloft his pedestal at CNN despite the shaky ground.

In light of these many examples of shoddy journalism, it is easy to see the bias at CNN against chiropractors and Dr. Gupta’s cover-up of game-changing research that undermines the spine surgery industry. Indeed, if CNN proclaims to be the ‘most trusted name in news’, it’s time they restored credibility to their medical reports by holding Dr. Gupta’s feet to the fire just as we now see with Brian Williams at NBC.

A good tabula rasa would be an exposé on CNN about the chiropractic profession. For example, when have you seen on CNN an in-depth, ‘fair and balanced’ program hosted by Dr. Gupta about the benefits chiropractic care brings to society suffering from back pain, the #1 disabling and costliest condition in the nation, military, and in the world?

Of course you haven’t because chiropractic remains a taboo issue at CNN. However, it would be a fascinating human interest story from medical persecution to scientific vindication. Viewers would learn that over 12,000 chiropractors were arrested in the first half of the 20th century, equivalent in effect to the first freedom fighters in healthcare. Few people appreciate the price chiropractors have paid to bring this safe, effective, and affordable ‘hands-on’ treatment to a suffering world.

As well, it would enlighten millions of people suffering with back pain that there is a better treatment than narcotic painkillers, steroid injections, and spine surgery as virtually every guideline now recommends. When chiropractors are seen as America’s primary spine care providers as they should be, perhaps then we will see the reduction of back pain as the most disabling condition in the nation.

Another mea culpa gesture by CNN would be an apology by Dr. Gupta, just as he apologized to Michael Moore or when Gupta apologized about his condemnation of medical marijuana, Why I changed my mind on weed,” on August 8, 2013.

He should also apologize to every chiropractor by omitting the obvious fact that chiropractic care is a non-drug alternative to narcotic painkillers as he failed to mention on his program, Deadly Dose. He needs to also apologize to his viewers for misleading them about this national epidemic.

As well, Dr. Gupta needs to admit to his cover-up of the newsworthy paradigm shift in the outdated ‘bad disc’ concept that has been under this nose for years and was once again mentioned by the Mayo Clinic study that somehow he missed.

Of course, Dr. Gupta’s oversight is not by chance but on purpose not to bring any good attention to his rival profession. Considering Life University, the largest chiropractic college in the world, resides only ten miles from CNN Headquarters in Atlanta, his omission of this ‘elephant in the profession’ speaks volumes.

If NBC suspends Brian Williams for an insignificant comment, why hasn’t CNN suspended Sanjay Gupta over issues that have a far more serious impact on millions of people?

Again, what’s good for NBC’s goose is also good for CNN’s Gupta.

 

 

 



[1] David Bauder, NBC suspends Brian Williams for six months without pay, Associated Press, 2/11/2015.

[2] Rita Rubin, How did Vioxx debacle happen? USA TODAY, 10/12/2004

[3] Pam Martens, Doctoring the News, Weekend Edition, July 20-22, 2007 

[4] Paul Krugman, The Trouble with Sanjay Gupta, NY Times, January 6, 2009

[8] Peter W. Crownfield, Back Pain Is #1 Cause of Disability Worldwide, Global Burden of Disease 2010 highlights the pressing need to prevent, treat spinal and musculoskeletal disorders. Dynamic Chiropractic – February 15, 2013, Vol. 31, Issue 04

[9] Optum. Conservative Care: Ensuring the Right Provider for the Right Treatment, 2012.

[10] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

[11] MC Jensen, MN Brant-Zawadzki, N Obuchowski, MT Modic, D Malkasian, and JS Ross, “Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain,” NEJM, 331/2 (July 14, 1994):69-73

[12] DR Murphy, Clinical Reasoning in Spine Pain volume 1, Primary Management of Low Back Disorders Using the CRISP Protocols © Donald Murphy 2013, p. viii

[13] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

[14] RA Deyo and DL Patrick, Hope or Hype:  The Obsession with Medical Advances and the High Cost of False Promises (2002):191.

[15] Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001 Feb 1;344(5):363-70.

[16] Donald R Murphy and Eric L Hurwitz, Application of a diagnosis-based clinical decision guide in patients with neck pain, Chiropractic & Manual Therapies 2011, 19:19

[17] Donald R Murphy and Eric L Hurwitz, “Application of a diagnosis-based clinical decision guide in patients with low back pain,” Chiropractic & Manual Therapies 2011, 19:26

[18] Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar

spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord. 2006;7:16.

[19] Highest-Paid U.S. Doctors Get Rich with Fusion Surgery Debunked by Studies” by Peter Waldman and David Armstrong, Bloomberg News, Dec. 30, 2010

[20] The BACKPage editorial vol. 27, No. 11, November 2012.

[21] Brinjikji W, et al., Systematic literature review of imaging features of spinal degeneration in asymptomatic populations, American Journal of Neuroradiology, 2014, prepub ahead of print; www.ajnr.org/content/early/2014/11/27/ajnr.A4173.long.

[23] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)

[24] US Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2012, pp.1

[25] David Chapman-Smith, Cost-Effectiveness Revisited, The Chiropractic Report, November 2009 Vol. 23 No. 6

 1 Choudhry N, Milstein A (2009) Do Chiropractic Physician Services for Treatment of Low-Back and Neck Pain Improve the Value of Health Benefit Plans? An Evidence-Based Assessment of Incremental Impact on Population Health and Total Health Care Spending. Harvard Medical School, Boston, Mercer Health and Benefits, San Francisco.

3 (2004) United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial: Cost Effectiveness of Physical Treatments for Back Pain in Primary Care, BMJ;329:1381.

4 Manga P, Angus D (1998) Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Outcomes and Achieving Equitable Access to Select Health Services, Ontario Chiropractic Association, Toronto.

5 Stano M, Smith M (1996) Chiropractic and Medical Costs for Low-Back Care, Med Care 34:191-204.

6 Smith M, Stano M (1997) Cost and Recurrences of Chiropractic and Medical Episodes of Low-Back Care, J Manipulative Physiol Ther, 20:5-12.

7 Jarvis KB, Phillips RB et al. (1991) Cost per Case Comparison of Back Injury of Chiropractic versus Medical Management for Conditions with Identical Diagnosis Codes, J Occup Med, 33:847-52.

8 Ebrall PS (1992) Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management within the Victorian Workcare Scheme, Chiro J. Aust 22:47-53.

9 Johnson W, Baldwin M (1996) Why is the Treatment of Work-Related Injuries so Costly? New Evidence from California, Inquiry 33:56-65.

10 Jay TC , Jones SL et al. (1998) A Chiropractic Service Arrangement for Musculoskeletal Complaints in Industry: A Pilot Study, Occup Med 48:389-95.

11 Mosley CD, Cohen IG et al (1996) Cost-Effectiveness of Chiropractic Care in a Managed Care Setting, Am J Managed Care 11:280-2.

12 Legorreta AP, Metz RD, Nelson CF et al. (2004) Comparative Analysis of Individuals with and without Chiropractic Coverage, Patient Characteristics, Utilization and Costs, Arch Intern Med 164:1985-1992.

13 Meade TW, Dyer S et al. (1990) Low-Back Pain of Mechanical Origin: Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, Br Med J 300:1431-37.

14 Haldeman S, Carroll L et al. (2008) The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders; Executive Summary, Spine 33 (4S):S5-S7

15 Wolsko PM, Eisenberg DM et al. (2003) Patterns and Perceptions of Care for Treatment of Back and Neck Pain. Results of a National Survey, Spine 28(3):292-298.

16. Whedon JM, Song Y, Davis MA. Spine J., Trends in the use and cost of chiropractic spinal manipulation under Medicare Part B., 2013 Jun 14. pii: S1529-9430(13)00521-4. doi: 10.1016/j.spine.2013.05.012.

[26] Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.


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