Articles by JCS
Iconoclastic or Progressive?
Germ Theory or Disk Theory?
JC Smith, MA, DC
We chiropractors are an unusual bunch of health professionals. Actually, “unusual” may be too vague since it fails to describe the lengths some DCs have gone to refute, deny, or discredit all other health methods. Perhaps “iconoclastic” is a better description since ol’ time chiropractors have attacked all that’s cherished by the medical establishment.
Indeed, it now appears to be a “principled” DC one must be against all medications, surgeries, vaccines, eating meat, wearing leather, tap water, food preservatives, plastic grocery store bags, logging forests, internal combustion engines, oil refineries, the new world order, and Harry Potter.
But the most adamant objection of our far-right colleagues is the dreaded germ theory. As Big $id once said, “If you’ve got an improved homeostasis, what damn difference does it make what diseases you gonna be encountering. The whole germ theory comes crashing down from its tower.” (Atlanta magazine, July 1993). Indeed, this inarticulate man has a way with words, doesn’t he?
It’s obvious that he’s taken a hint of the truth and embellished it into a ridiculous statement. I wonder if victims of Anthrax feel the same as Big $id? For anyone to ignore the role of germs in our environment is just nonsense. When hospitals are now running rampant with Hepatitis B and staph infections, to suggest that germs aren’t real or important smacks of sheer ignorance.
And then we wonder why the public, press and medical professions can’t take us seriously? The same can be said about the anti-vaccine stance that straight DCs have always taken. Don’t get me wrong: vaccines are dangerous for some people, homeopathic alternates should be available, and I think they ought to be voluntary nowadays. But to deny their effectiveness is to ignore their results.
Regrettably, I fell for this anti-medical establishment attitude while a student at Sherman and Life diploma mills. Being a grad of Berzerkly, it was easy for me to fall into the anti-establishment mindset with their rallying point to vilify the dreaded MDs and their drugs by believing Americans were being duped by the germ theorists and over-medicated by the drug companies. Evidence abounds that super germs have resulted from their over-use of antibiotics and that Americans are the most over-medicated society in the history of the world. It’s an easy trap to fall into, especially when Gelardi and Big $id were ranting about it incessantly.
But to suggest avoiding all drugs, vaccines and surgeries is ludicrous in light of the many benefits they’ve also created. Yes, many are unnecessary, many are dangerous, and many have failed, but many have also helped millions of folks. And to deny their benefits is myopic to say the least, and comes across as inane by most folks in our society. I doubt we’ll ever convince many in the public that the germ theory is invalid and, at the most, it makes us look dumb.
Instead of pinpointing the germ theory to debate, I suggest we take aim at the Slipped Disc Theory. The plethora of MRI research and statements by credible medical spine experts agree that disc abnormalities are the cause of back pain in only 1% of the cases.
Dr. Richard Deyo recently re-affirmed this point in his NEJM article. Dr. Deyo acknowledged that most back pain is “mechanical” in nature, meaning muscle, ligament, and joint dysfunction. According to this leading spine researcher, in his article, “Differential Diagnosis of Low Back Pain,” he showed that “Mechanical Low Back or Leg Pain” constitutes 97% of these cases, of which “lumbar strain, sprain” accounts for 70% of these cases; “Nonmechanical Spinal Conditions [disc problems] accounts for “about 1%”; “Visceral Disease” [referred pain from a diseased organ] accounts for 2%.”
Dr. Deyo also criticizes the over-reliance on imaging for low back problems.
“Early or frequent use of these tests [Computed tomography (CT) and MRI] is discouraged, however, because disk and other abnormalities are common among asymptomatic adults. Degenerated, bulging, and herniated disks are frequently incidental findings, even among patients with low back pain, and may be misleading. Detecting a herniated disk on an imaging test therefore proves only one thing conclusively: the patient has a herniated disk.”
The AHCPR federal guideline also concurred on the misleading interpretation of MRI exams to convey the notion of disk problems as the cause of back pain:
“Degenerative discs, bulging disc and even herniated discs are part of the aging process for the spine and may be irrelevant findings: they are seen on imaging tests of the lumbar spine in a significant percentage of subjects with no history of low back problems. Therefore, abnormal imaging findings seen in a patient with acute low back problems may or may not be related to that individual’s symptoms.
This points out the single-most prevalent cause of misdiagnosis in low back pain problems—that is, the use of MRI, CT or x-ray images to show disc abnormalities in order to convince patients that some sort of disc problem is the cause of their pain. In fact, as Dr. Deyo and other researchers have repeatedly shown, disc abnormalities are not the cause of back pain; in fact, they are part of the normal aging process. Patients without any back pain often have degenerated or herniated discs, while many patients with back pain have perfectly healthy spines.
This outdated concept is the major pitfall in this medical scam, and one the public is largely unaware of. Richard Deyo mentions this problem of medical mis-conceptions in low back treatments as part of this problem of back pain: “Calling a [medical] physician a back-pain expert, therefore, is perhaps faint praise--medicine has at best a limited understanding of the condition. In fact, medicines’ reliance on outdated ideas may have actually contributed to the problem.” 
The most shocking recommendation in the federal guideline by the AHCPR expert panel focused on back surgery. This expert panel found back surgeries to be costly, based on misleading tests, and were generally ineffective.
“Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”
Despite this expert evidence, more back surgeries are being done today than ever before. I hear patients tell me of friends who have already had 3 or 4 fusions, but are in line for a couple more because their surgeon has them convinced that their back pain is a degenerated disc. And they actually point them out on the x-rays saying, “See right here, this disc is degenerated and the cause of your back pain.”
We DCs know this is a huge medical scam, the researchers know it’s a scam, the government guideline knows it’s a scam, but the public doesn’t know it’s a scam since no one is telling them. Indeed, when was the last time you’ve seen an article in magazines, on TV or in the news about this scam?
Imagine the horror by MDs and hospital administrators if the disc theory was exposed as a fraud? Since spinal surgeries are second only to heart surgeries, most hospital would go broke if they didn’t keep beds filled with spinal fusion patients. In fact, over ten years ago when the leading back surgeon in Macon died of AIDS, the person crying the loudest at his funeral was not his boyfriend, Bruce, but the hospital administrator. Allegedly, this unscrupulous surgeon kept an entire wing of the hospital filled with fusion victims.
Before 1990 only DCs knew disc surgeries were a bust, but after the initial MRI studies by Dr. Scott Boden at Emory University revealed the fallacy of the disc theory, knowledgeable folks today know back pain has little to do with disc abnormalities. Between the researchers and the public, however, stands a middleman called the AMA which isn’t telling the public the truth. And as long as the chiropractic association remains quiet about this issue, the public may never know the fallacy of the disc theory.
Now here’s an argument we can win without alienating much of the public and press. Instead of trying to convince them that the germ theory is dead or that vaccines are inappropriate, why don’t we begin a PR campaign aimed at this bogus disc theory and the avalanche of unnecessary and ineffective back surgeries? We now have something we can hang our hats on—the proof is there, the medical experts agree, the public would understand, and the trend to alternative healthcare is growing by leaps and bounds.
Now all we have to do is tell them. Forget about the old anti-anything-medical arguments like drugs and vaccines. Let’s focus on an issue that directly affects our profession and incomes. Just imagine if the public did use us as their first-line of caregivers for the epidemic of back problems? We would be swamped with patients; we would save millions, if not billions, of dollars; and we would be within our area of expertise and not appear so iconoclastic.
The proof is here, the need is paramount, and the public is waiting for this good news, now all we must do is created a PR campaign for the press and public alike to disseminate this new paradigm in the care of back pain.
Or will we sit on our hands instead, focused on irrelevant issues that will never lead to an increase in our market share?
Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001 Feb 1;344(5):363-70
 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.
 Deyo, RA. Low -back pain., Scientific American, pp. 49-53, August 1998.
 Bigos S. idid.