Articles by JCS
December 14, 2012
TO: President ClintonClinton Global Initiative
RE: Deadly Dose Suggestion
FROM: JC Smith, MA, DC
Dear President Clinton:
I watched your heartfelt plea on Dr. Sanjay Gupta’s exposé, Deadly Dose, concerning the death of your friend’s son due to painkillers.
Your comments were palpable when you called for “a national conversation” to solve this problem. I would like to help. As an author on many articles concerning the epidemic of back pain, I am eager to contribute to this national conversation by commenting about the most notable solution omitted in Deadly Dose.
Dr. Gupta admitted this drug addiction “usually began with a back sprain.” His admission piqued my interest as a chiropractor, but Dr. Gupta never took the next logical step to solve this problem.
Indeed, how can anyone have a discussion on drug abuse caused by back pain and fail to mention as a reliable non-drug solution the main health profession most closely affiliated with drugless and effective back pain treatment—chiropractic care?
As I watched this 60-minute exposé, I waited with bated breath for Dr. Gupta to mention chiropractic care, the 3rd largest physician-level health profession in the nation and the one most associated with a non-drug treatment for back pain.
I was dumbfounded when he didn’t, which to me is equivalent to someone discussing a tooth ache and not mentioning dentistry.
My astonishment should not come as a surprise to anyone familiar with the new guidelines on back pain as Dr. Gupta surely must be or to the 20 million Americans who already use chiropractic care annually.
For your information, Mr. President, the paradigm shift in spine care began over 20 years ago when you were still in office, and compelling research evidence for chiropractic care has been building ever since. This new era of evidence-based practice has been a blessing to the chiropractic profession.
Unfortunately, many medical professionals and newsmen have ignored this new research and some have actively opposed or ignored the new guidelines due to their vested interests. “Don’t confuse us with the facts” seemed to be their attitude on this paradigm shift in spine care.
You may recall during your administration in 1994 when the AMA, led by the spine surgeons, attacked the Agency for Health Care Policy & Research after its guideline #14 for acute low back pain in adults recommended spinal manipulation over painkiller drugs, epidural shots, and disc fusion surgery.
Richard Deyo, MD, MPH, a renowned spine researcher, also warned of the failings of medical care for back pain: “Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels.”
Of course, we chiropractors are confident our brand of spine care is the “rethinking” America needs to solve this epidemic of back pain to avoid more drug abuse.
These glaring issues in medical spine care led Mark Schoene, editor of an international spine research newsletter from Georgetown University, to state “Spinal medicine in the US is a poster child for inefficient spine care.”
Unfortunately, this compelling research has not reached the public because many medical reporters have been silent on this matter. It did seem strange that Dr. Gupta spoke about drug abuse for chronic back pain, but failed to mention this paradigm shift or chiropractic care as a non-drug solution to this problem.
Indeed, if the AHCPR guideline had been fully implemented in our nation’s healthcare, we would not have the huge epidemic of back pain and drug abuse today.
I remember that you were supportive of chiropractic during your terms as Governor and then as President. Your friend, Dr. Stanley Heard, a chiropractor, unfortunately met with a sudden tragic death and somehow the chiropractic issue during the healthcare debate was never fully explored.
I recall that you also helped my profession during your administration when you signed legislation to make chiropractic care available in the military health services and the DVA. Although you signed into law the Veterans' Millennium Health Care Act and the Permanent Chiropractic Benefit for Military Act, both have been slow to implement its full inclusion according to a 2005 GAO report.
Instead of referring patients with back pain to chiropractors as the law allows, the medical personnel within the DOD and DVA still often deny patients our care by making them jump through hoops while hobbling chiropractors with severely restricted treatment plans.
I mention these problems because the medical profession is obviously still fighting the full implementation of chiropractic, hence the drug abuse problem and the many unnecessary steroid injections and disc fusions.
Since you were the driving force behind Dr. Gupta’s program, may I suggest that you carry the importance of chiropractic care to Dr. Gupta and the public by mentioning this well-established alternative to drugs?
The benefits to millions of Americans would be enormous and the cost savings in the billions, not to mention the help to thousands of individuals saved from a life of addiction through no fault of their own.
While your plea to Dr. Gupta opened the door to this discussion, this has become Pandora’s Box with bigger issues inside. If the objective was to inform the American public about the dangers of painkillers for chronic pain, another exposé should offer solutions like chiropractic care that were ignored.
Perhaps with your influence you can convince Dr. Gupta and CNN to take a fresh look at this issue.
Indeed, I would recommend that the benefits of America’s primary non-drug spine care providers, chiropractors, should be a major featured story as a follow-up to Deadly Dose.
 CNN Presents: Deadly Dose, aired November 18, 2012
 SJ Bigos, O Bowyer, G Braea, K Brown, R Deyo, S Haldeman, et al. “Acute Low Back Pain Problems in Adults: Clinical Practice Guideline no. 14.” Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; (1992) AHCPR publication no. 95-0642.
 The BACKPage editorial vol. 27, No. 11, November 2012.
 Donald R Murphy et al., “The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States,” Chiropractic & Manual Therapies 2011, 19:17 doi:10.1186/2045-709X-19-17