Articles by JCS

Consumer Beware

 

Consumer Beware

By

JCS

As a patient and practitioner alike, I weep knowing that millions of patients are wasted on drugs, shots, and surgery by MDs using ineffective treatments who by now should know chiropractic spinal care ranks amongst the best treatment for most neck/back pain cases, but they’re willing to sacrifice their patients’ health in order to appease their gods of power and money.  I cringed at the realization of the millions of unnecessary back surgeries, addictive pain medications, expensive epidural shots, and worthless muscle relaxers that mostly impair rather than help as the latest research now reveals.

Sadly, the only time the public is informed about the chiropractic profession seems to be when something terrible occurs. A few years ago allegations that manipulative therapy caused strokes surfaced in the press when a lawsuit in Canada was filed. Although researchers proved it was virtually impossible for this to happen, and the chiropractor was found innocent at trial, in the court of public opinion, the medically-biased press had all but convicted chiropractors of murder.[1]

To this day, I still have the occasional patient who is scared to death of being manipulated after getting what I call the voodoo diagnosis from their MD: “If you’re stupid enough to go to a chiropractor, don’t come crawling back to me when you’re paralyzed.” If I had a nickel for every time I’ve heard this, I’d be rich.

Fortunately, the facts belie this falsehood. As I tell these frightened souls, the malpractice insurance companies know who’s hurting who. While rates vary by location, brain surgeons in Brooklyn currently pay $267,000 annually for malpractice insurance, while general surgeons in Manhattan pay $123,120 and obstetricians in Queens pay $180,490.

Last year I paid only $1,600 for malpractice insurance. In 30 years I’ve never been sued because spinal manipulation is incredibly safe in skilled hands. While adverse effects like soreness might occur, in general manipulation is safe and effective. Obviously the malpractice insurance companies know who’s hurting who, and we chiropractors are remarkably safe. Plus, a good spinal adjustment is the second-best feeling there is!

Not only did the U.S. Public Health Service recommend SMT, its guideline also warns that “It should only be done by a professional with experience in manipulation.”[2] Since chiropractors do 94% of all SMT in this country according to the RAND Corporation study on acute low back pain, one must acknowledge that DCs are the leaders in this form of treatment.[3]

Clinical iatrogenesis for chiropractors usually consists of broken ribs, occasional strokes or supposed disc aggravation, to name but a few. Of course, the rate of accidents is 1-2 per million for all SMT and, excluding the 40% of problems caused by the 6% of non-DCs who do manipulation, this rate actually drops to 1 in 3 million for neck manipulation. Considering the rate for cervical surgery is 15,600 accidents per million, I can live with our very low rates.

Despite the evidence of the efficacy of conservative, chiropractic treatment of disc herniation, many MDs still do not generally include referral to DCs for manipulation. One reason may be the presumed lack of safety and fear that joint manipulation may cause further injury to an already weakened disc. Yet published medical experts in manipulation such as Bourdillon and Day in Canada,[4] Lewit in the Czech Republic,[5] and Maigne in France,[6] agree with the chiropractic and osteopathic professions that skilled manipulation is safe and appropriate for the great majority of patients with disc herniation and should be considered a first option for conservative care.

In a comprehensive literature review in 1992, assessing all the studies internationally in English, French and German that reported adverse effects of lumbar spinal manipulation, Terrett and Kleynhans found a total of 65 cases in which disc-related complications were alleged.[7] Nearly half (44%) were medical manipulation under anesthesia. Oliphant provides a best estimate of the risk of spinal manipulation causing a clinically worsened disc herniation of “less than one in 3.7 million treatments.”[8]

A generation ago some researchers, such as Farfan, suggested that rotational stress (torsion) for manipulation might cause disc failure.24 However, Cassidy et al. conclude that in general “it is hard to comprehend how the small amount of rotation introduced during side-posture manipulation could damage or irritate a healthy or herniated disc.”[9]

More recently other extensive studies have concluded that spinal manipulation is as effective if not more so than anything the medical world has to offer. The Decade of Bone and Joint Disorders studied chronic low back pain treatments consisting over 200+ different types and also suggested SMT is as effective as anything in the medical arsenal. It also suggested there were too many drugs, shots and surgery, just like the AHCPR study concluded in 1994.

Indeed, the public wants improvement in the American healthcare delivery system. People understand by now that no one health care profession holds the key to every aspect of health care in this epidemic of back pain with escalating surgical costs and disability, and with the emerging evidence-based research and international guidelines now showing the efficacy of manual manipulation for both acute and chronic low back pain, people are clamoring for options to medical care.

As Tony Rosner, PhD, said in 2003, “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.”[10] It’s time the public learned this too.

Imagine the validity chiropractors could gain if the press and public knew  multidisciplinary groups of MDs now work alongside DCs, such as the Texas Back Institute, the Rehab Institute of Chicago, the Rhode Island Spine Center at Brown University, to name but a few in the private sector and, in the military health services, the Department of Veterans Affairs Medical Centers now has 30 clinics with MDs and DCs working cooperatively, as well as the  DoD that has multidisciplinary services in more than 50 clinics throughout the US including the Bethesda Naval Hospital.

Rather than outcasts as chiropractors are now perceived by many, instead DCs should be seen as overlooked heroes who brought a new non-drug, non-surgical vision of health along with effective tools to help this epidemic of neck/back pain.

I often liken chiropractors to the black aviator heroes of the . Fifty years after the war ended and racism abated in the military, these unsung heroes finally were honored for their bravery.

More recently, the AMA passed a resolution that announced a formal apology for its historical racism toward African American medical doctors. [11] While black MDs were forced to sit in the back of the medical bus for too long, chiropractors were thrown under the same bus. Few people realize that chiropractors were jailed over 15,000 times in the first half of the last century for allegedly practicing medicine without a license when, in fact, the real crime was practicing health care without drugs and surgery.

While this may be well known by most DCs, it is not common knowledge among the press or public. To this day, while many realize the medical profession has a bad attitude about chiropractic, they have no idea of its origins or its ugliness. As far as public perception goes, the Wilk antitrust trial never existed and the damage done to the chiropractic profession was never explained.

In one sense, it’s as if the chiropractic holocaust never existed and continues unabated despite the legal victory.  That’s why I thought when the AMA issued a public apology to its black members for years of discrimination, it would be an excellent time also to seek an apology to the chiropractic profession for its persecution.  Alas, no such contrition is forthcoming from the medical profession.

Apparently the AMA is willing to apologize to its own black members who suffered from prejudice within its own ranks, but to apologize for its documented genocidal program against chiropractors is asking too much, illustrating the demagoguery, bias, and prejudice that still exist within the medical profession.

I can only  imagine the public’s reaction if it were aware of the AMA’s Committee on Quackery established by its Board of Trustees for the sole purpose "to study the chiropractic problem and whose prime mission was to be, first, the containment of Chiropractic and, ultimately, the elimination of Chiropractic.

In this day of public condemnation of all things sexist or racist, imagine the public’s anger when told the AMA referred to chiropractors as “killers and rabid dogs,” and conspired with the ARA, AHA, and other medical groups to eventually “see them wither on the vine.” If this wouldn’t spark reactions among the public, what would?

Little does the public remember that even ethical MDs who referred to DCs were threatened with the loss of licensure and ostracized from the medical fraternity for consulting with “cultists and quacks.” MDs couldn’t even join the same social club for fear of being branded as unethical by their own medical society.

Nor does the public realize the many medical researchers who now admit that the medical management of this epidemic has added to the problem with unnecessary drugs and ineffective back surgery, and admit that chiropractic spinal manipulation may be the best solution for the majority of these LBP problems. This guideline states: “This treatment (using the hands to apply force to the back to ‘adjust’ the spine) can be helpful for some people in the first month of low back symptoms. It should only be done by a professional with experience in manipulation [chiropractors].”[12]

Gordon Waddell, M.D., renowned orthopedist and spine researcher, states,

“Low back pain has been a 20th century health care disaster …Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem… Medical care for low back pain in the United States is specialist-oriented, of high technology, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead.” [13]

 

Sadly, this honesty is not well known by most people and what most people know about chiropractic care is just foolishness learned from medical bigots. I’m not suggesting that every MD is prejudiced against chiropractors, but most are adamantly biased, not unlike a white person growing up in the Old South. The history of this sordid situation is well documented but remains unknown by nearly everyone.

As any type of prejudice slowly erodes as the light of truth shines upon it, many Americans today now realize they have been the victims of this medical racism, if you will, from ineffective and unnecessary drugs, shots, and surgery. Back treatments like pain pills, muscle relaxers, epidural steroid injections and spine surgeries are now considered by worldwide research as mostly unnecessary, ineffective, costly, and based on a failed disc theory.  This message has not reached the public although chiropractors have been the torchbearers of this caution for over 110 years now but, for the most part, getting short shrift by the media that is strongly influenced by the medical profession.

Hopefully soon public opinion of back surgeries will join the ranks of once considered routine but now regarded as unnecessary surgeries like appendectomies, tonsillectomies, pacemaker implants, coronary bypass surgery, hysterectomies, Caesarean section, prostate surgery, radical mastectomy, laparoscopy, or surgery for sleep apnea and jaw pain.[14]

Many experts believe up to 60% of all surgeries are unnecessary, and some suggest 50% to 90% of back surgeries are deemed the same. Most Americans don’t know that the rate of back surgery in the United States is at least 40% higher than any other country and was more than 5 times those in England and Scotland. [15]

This epidemic of back injuries is fueled in part by unnecessary, ineffective, and expensive back surgeries that could have been avoided by the use of chiropractic care and active rehab measures. Dr. Hubert L. Rosomoff, MD, from the University of Miami, called a moratorium on back surgeries when he realized, after two weeks of rehabilitation, his back patients no longer required surgery. “Following this kind of concept, you can eliminate 99% of the surgical cases. In fact, the incidence of surgery if one really looks at this appropriately is one in 500.”[16]

 

 



[1]Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver FL, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.

[2] S. Bigos, ibid.

[3] P. Shekelle, et al, “The Appropriateness of Spinal Manipulation for Low Back Pain.” RAND Corporation Report, Santa Monica, Calif., 1992.

[4] Bourdillon JF, Day EA (1987) Spinal manipulation, 4th edition, William Heineman medical books, London, 216-217.

[5] Lewit K (1985) Manipulative therapy and rehabilitation of the locomotor system; Butterworths, London and Boston, 178.

[6] Maigne R (1972) Orthopedic medicine: A new approach to vertebral manipulations trans and ed by Liberson WT, 300.

[7]Terrett AJ, Kleynhans AM (1992) Complications from manipulation of the low back, Chiropr J Aust 27:129-140

[8] Oliphant D (2004) Safety of spinal manipulation in the treatment of lumbar disk herniations: A systematic review and risk assessment, J Manipulative Physiol Ther 27:197-210

24 Farfan HF, Cossette JW et al. (1970) The effects of torsion on the lumbar intervertebral joints: The role of torsion in the production of disc degeneration, J Bone Joint Surg, 52A:468-497.

[9] Cassidy JC, Thiel HW, Kirkaldy-Willis KW (1993) Side posture manipulation for lumbar intervertebral disk herniation, J Manipulative Physiol Ther 16(2):96-103.

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

[11] AMA apologizes to black doctors for past racism, by Lindsey Tanner, AP Medical Writer Thu July 10.

 

[13]Waddell G. Low back pain: a twentieth century health care enigma. Spine 1996 Dec 15; 21 (24):2820-5

[14]Unnecessary Surgery by James Barron; Published: April 16, 1989, NY Times.

[15] Cherkin DC, Deyo RA, An international comparison of back surgery rates et al. Spine. 1994 Jun 1;19(11):1201-6.

[16] Widen, M. “Back specialists are discouraging the use of surgery.” American Academy of Pain Medicine, 17th annual meeting, Miami Beach, Fl. Feb. 14-18, 2001.

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