Articles by JCS

Cognitive Dissonance

Creating Cognitive Dissonance

Harper’s Magazine in 1948 dubbed the AMA the “most terrifying trade association on earth” after 25 years under the autocratic leadership of Morris Fishbein, MD, the AMA’s executive director. Like the present NRA leadership, Fishbein fomented discord in healthcare by vilifying anyone who stood in his way of medical domination. Due to his reign of terror, he was dubbed the Medical Mussolini by his peers.[1]

Fishbein’s tyrannical attitude lingers in the medical profession and explains why members of the AMA’s House of Delegates at its annual meeting had no ethical problem passing Resolution 241 intended to repeal Section 2706 in Obamacare, the non-discrimination clause in Obamacare that Sen. Tom Harkin had the foresight to include allowing coverage for all CAM providers.

Section 2706 is equivalent to former insurance equality laws that allowed payment for all licensed providers and to allow patients a freedom of choice. By doing so, this will level the playing field to increase practitioner competition to improve outcomes and lower costs—the essence of the American free enterprise system.

However, the AMA wants nothing to do with equality or freedom of choice, hence it passed Resolution 241. If this isn’t a snub at free enterprise and evidence-based best-practices, what is?

Imagine the absurdity of a learned profession in this era of fairness that voted to pass a resolution to end equality and stymie evidence-based care in a broken healthcare system that needs all the help it can find.

Sadly, this nonsense doesn’t end with Resolution 241. Organized medicine has again proposed legislation to curtail fair trade in healthcare under the guise of the perversely named Truth in Healthcare Marketing Act of 2013 (HR 1427).

This confusing bill is simply another attempt by the AMA to copyright the term “doctor” exclusively for themselves. I wonder if they will also lay claim to the imagery of the white-coated doctor draping a symbolic stethoscope around his or her neck?

In a press release announcing the legislation, Rep. Larry Bucshon, MD, (R-In.) said:

"It is imperative that healthcare consumers have adequate information, including the education and training level of the healthcare professionals treating them, so that they are able to make wise healthcare choices. Ultimately, this bill will protect patient autonomy and decision-making and improve our healthcare system." [2]

I agree with Rep. Bucshon that “It is imperative that healthcare consumers have adequate information, including the education and training level of the healthcare professionals treating them.”

Of course, Rep. Bucshon, an MD himself, is implying that only MDs meet this criterion, which is questionable considering the well-known failing of medical spine care consisting of addictive narcotic painkillers, ineffective epidural steroid injections, and disabling spine fusion based on a debunked disc theory.

Not only are medical treatments dangerous and expensive, new studies also confirm that most primary care physicians are inept in their training on musculoskeletal disorders,[3] more likely to ignore recent guidelines[4], and more likely to suggest spine surgery than surgeons themselves.[5]

We DCs should jump all over this suggestion by Rep. Bucshon since MDs are considered incompetent in musculoskeletal disorders (MSDs). Let’s hold him to his own imperative that “healthcare consumers have adequate information, including the education and training level of the healthcare professionals treating them.”

Despite the lack of expertise by MDs in spine care, the average PCP still poses as an expert to patients, a concept chided by Scott Boden, MD, currently director of the Emory Orthopaedic and Spine Center in Atlanta, who admits that  “Many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”[6]

Nonetheless, the medical profession ignores the research and plows ahead with its attitude, “Don’t confuse us with the facts” with inept medical primary care providers funneling back pain patients onto the medical railroad with the usual destinations of narcotics, epidural shots, MRIs, and eventually leading to spine fusion.

However, this medical railroad rarely detours to any treatment other than surgery for most patients. A recent Washington State workers comp comparative study found patients who took the medical route for low back pain ended up having surgery 42.7% of the time compared to chiropractic patients who had surgery only 1.5%.[7]

After nearly a century of medical defamation, researchers now admit chiropractors are among the best trained in musculoskeletal disorders and use the best time-proven manipulative methods that treat the primordial problem of back pain—joint dysfunction.

John McMillan Mennell, MD, renowned spine lecturer who taught at numerous medical schools, testified at the Wilk antitrust trial to the importance of manipulative therapy for the epidemic of back pain. “If you don’t manipulate to relieve the symptoms from this condition of joint dysfunction, then you are depriving the patient of the one thing that is likely to relieve them of their suffering.”[8]   

This brings up an important point about spine anatomy that is virtually unknown by most people—the fact there are over 300 joints in the spine. Consequently, joint dysfunction is highly problematic from any stress from sports injuries, childhood falls, prolong sitting, or the activities of daily livings such as faulty lifting, bending, or sleeping posture.

Indeed, you don’t slip discs as much as you do slip joints out of alignment in the spine, which explains why any treatment that restores joint motion is effective, such as manipulation, traction, therapeutic massage, yoga, popular exercise tables that stretch and decompress, or any treatment that restores proper joint alignment, strength, and flexibility.

Rx: Cognitive Dissonance

With the growing supportive arsenal of evidence-based guidelines in mind, the chiropractic profession and media need to create a cognitive dissonance in the public’s mind to make them uncomfortable about medical spine care instead of the old medical stigma that makes patients uncomfortable about chiropractic care.

People will feel uncomfortable about medical spine care if they had heard the shocking comment by Mark Schoene, perhaps the most astute spine journalist in the world as editor of THE BACKLetter, who recently concurred that “Spinal medicine in the US is a poster child for inefficient spine care.”[9] 

Indeed, the fact that back pain is the #1 disabling condition worldwide and America spends nearly $300 billion annually on back pain care is testament to the ineffectiveness of medical care and the prolong boycott of chiropractic care that has led to this epidemic.

Imagine if the AMA had defamed and boycotted dentists how badly Americans’ teeth would look today because that is equivalent to the spines we chiropractors see daily. If you or your children have never visited a chiropractor, there is no telling how bad your spine may look from the accumulation of childhood accidents and other traumas. I advise you and your family to get checked immediately to prevent the inevitable back attack that affects millions of Americans annually.

Despite the past struggles fighting in the medical war against chiropractors, today chiropractors have a bright future with Obamacare, especially with Section 2706. Our goal now is to brand chiropractors in the minds of Americans as America’s primary spine care providers since we are better trained and our non-drug, non-surgical treatments are preferable for the majority (85%) of mechanical back pain cases.

JC Smith, MA, DC, is a 33-year practicing chiropractor, author of The Medical War Against Chiropractors, and he maintains a website, Chiropractors for Fair Journalism.



[1] M Mayer, “The Rise and Fall of Dr. Fishbein,” Harper’s Magazine, 199/1194 (Nov. 1949): p. 76.

[2] Marcia Frellick, New Bill Would Clarify Who Is a Medical Doctor and Who Isn't, Medscape Medical News, Apr 24, 2013

[3] EA Joy, S Van Hala, “Musculoskeletal Curricula in Medical Education-- Filling In the Missing Pieces, The Physician And Sports Medicine,” 32/11 (November 2004).

[4] PB Bishop et al., “The C.H.I.R.O. (Chiropractic Hospital-Based Interventions Research Outcomes) part I: A Randomized Controlled Trial On The Effectiveness Of Clinical Practice Guidelines In The Medical And Chiropractic Management Of Patients With Acute Mechanical Low Back Pain,” presented at the annual meeting of the International Society for the Study of the Lumbar Spine Hong Kong, 2007; presented at the annual meeting of the North American Spine Society, Austin, Texas, 2007; Spine, in press.

[5] SS Bederman, NN Mahomed, HJ Kreder, et al. In the Eye of the Beholder: Preferences Of Patients, Family Physicians, And Surgeons For Lumbar Spinal Surgery,” Spine 135/1 (2010):108-115.

[6] S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disc Disease,” Spine 28 (2003):524-525.

[7] Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM.,

Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State.,Spine (Phila Pa 1976). 2012 Dec 12.

[8] Transcript of testimony of John McMillan Mennell, M.D., Wilk v AMA transcript pp. 2090-2093.

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

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