Articles by JCS

Media Meddling

Hired Hands

Media Meddling

By

JCS

 

 

The impact of Morris Fishbein’s blatant yellow journalism attacking chiropractic set the seed for others to follow in his footsteps to misrepresent the value of manipulative therapy as well as mischaracterize chiropractors. Fishbein and the AMA recognized the power of the press to dissuade the use of alternative healthcare providers, and to this day this yellow journalism about chiropractic continues in the popular media.

The depths of political medicine’s control over the media is now better understood after the Wilk trial revealed such instances with the Committee on Quackery that disseminate misinformation through the press via such notables as columnist Ann Landers and hired freelance writers like Ralph Lee Smith, author of the infamous expose, At Your Own Risk: the Case Against Chiropractic (Pocket Books, 1969), to demonize chiropractors. The public in the time frame before the Wilk verdict had little understanding of the true magnitude of this yellow journalism ploy to influence the public’s opinion about chiropractic.

Despite the victory in the legal courtroom, in the court of public opinion the case against chiropractic is still out, if you will, due to the media’s own bias, financial benefits, and misinformation proffered by the AMA. To think the public has ever been given a fair and balanced opinion about chiropractic by the mainstream media is laughable. Indeed, when was the last time you saw a chiropractor on national TV as a spokesman on national issues like Dr. Sanjay Gupta on CNN; have you even see a chiropractor questioned on healthcare reform or as an expert speaking on spinal health care or a TV character hero like the original medical sitcom, Marcus Welby, MD, played by Robert Young? Obviously there still exists a virtual blackout on chiropractic care in the media.

Morris Fishbein, aka, the Medical Mussolini, and H. Doyl Taylor, aka, Adolf Eichmann, fully understood the power of the press and used it to spread misinformation about their chiropractic rivals. However, as attorney George McAndrews pointed out clearly at the Wilk trial, in the name of public safety and patient care, the AMA totally ignored the evidence that showed chiropractic care had a 2:1 effectiveness rate over traditional medical methods of drugs, shots, and surgery. Nor did the AMA defense produce anyone who had been hurt by chiropractors despite its claim that chiropractors were dangerous and posed a threat to “public safety.” Allthewhile, the media that had been duped by the medical misinformers never admitted it too had been deceived by the AMA and has virtually continued in its role as PR men for the medical profession.

Although the court decided the AMA’s “patient safety” defense was unsupported by evidence or testimony, the media failed to recognize the same lies and false accusations as unsubstantiated and has continued to write anti-chiropractic articles despite the Fairness Doctrine that was implemented in 1949 by the United States Federal Communications Commission (FCC), introduced in 1949, that required the holders of broadcast licenses both to present controversial issues of public importance and to do so in a manner that was honest, equitable and balanced.

The AMA, in its role as the self-appointed guardian of American health, used “public safety” as its reason for the attack on complementary and alternative healthcare competitors, thereby allowing the media to forego its “equal response” doctrine to allow chiropractors equal space to respond to medical criticism.

Text Box: R. Levin, “America’s Biggest Lobby, the A.M.A.,” Journal of the National Chiropractic Association 19/12 (Dec 1949): 27-28, 64, 66. After the trial judge was dissuaded by the patient safety argument, the media failed to admit it had been hoodwinked and were co-conspirators in the humiliation of chiropractors in the court of public opinion. In fact, the media’s attitude appears to be one of staying “politically-correct” to bash chiropractors despite the facts showing the superiority of manipulative therapy over medical methods for the epidemic of musculoskeletal problems.

Not only did the media ignore the Fairness Doctrine, it also ignored the equal-time rule that specifies that the media must provide an equivalent opportunity to any opposing political candidates who request it. This means, for example, if a news organization gives one free minute to a candidate, it must do the same for other candidates. Clearly the AMA’s campaign to eliminate chiropractors was politically motivated, but under the “patient safety” guise, the media took a blind eye to both the Fair Doctrine and equal-time rules.

Arm-in-arm the mass media led by the AMA would disseminate thousands of anti-chiropractic material, including up to 300,000 copies of At Your Own Risk, ignored the research presented at the Wilk trial showing the superiority of manipulative therapy for the epidemic of back pain just as the AMA wanted, and continue in its unholy alliance to stamp out chiropractors with degrading articles or misrepresentation of the guidelines that were to follow. In reality, the media was also a victim of Fishbein’s and Taylor’s ploy to lie to anyone about the truth, but they appeared happy to be in bed with these medical criminals.

Medical Misinformation

Aside from the 700 newspapers that carried Fishbein’s syndicated column for years, the most notable newspaper columnist was Ann Landers, (whose real name is Esther Pauline Friedman) who the AMA used to ridicule chiropractors in her “Dear Ann” columns in exchange for compensation from the AMA, including a paid vacation to China. The AMA used her to show that “third parties” were attacking chiropractors, not just the AMA goons.

In a court deposition, Landers admitted she had been paid by the AMA to write articles condemning chiropractic as an “unscientific cult.”  When confronted by intelligent rebuttals to her columns from readers and chiropractors who refuted her misinformation, she turned to the AMA for help in writing her responses. In a court deposition, Landers acknowledged she had also been a paid delegate to the AMA.

One would expect a nationally-known newspaper columnist would get her facts straight, but not in the case of Ann Landers. Not only were her columns without scientific merit, she resorted to ridicule to press her point.

“A person who has been massaged by a chiropractor and gets well often credits the chiropractor with having cured him. The truth is, he’d probably have been cured if he had fanned himself with goofus feathers.” – January 28, 1971

“This theory [of chiropractic] has been greatly discredited, yet millions of people continue to believe in it and they shell out a great deal of money on this poppycock.”- August 5, 1974

She admitted needing help from the AMA to answer her malicious remarks about chiropractic after receiving thousands of angry letters to her snide remarks:

“I know I’ll be inundated after my column of August 5th [1974, regarding chiropractic]. Can you supply me with a good response, which I will, of course, re-write?”[1]

Ann Landers’ relationship with the AMA was clandestine and clearly misleading considering she supposedly represented only her own views rather than those of a paid sponsor. During deposition, it was revealed that Ann Landers used an AMA consultant regarding her columns whenever health was discussed. She traveled to China with an AMA delegation as “volunteer advisor” although the AMA paid for the trip, but when questioned by attorney McAndrews, she responded sarcastically, “I need a free trip like a giraffe needs a sore throat.” Apparently her sarcastic remarks extended into the courtroom.

Dr. Chester Wilk noted in a 1991 newspaper interview that one example of the AMA's propaganda campaign against chiropractors involved Ann Landers, who wrote columns ridiculing the practice. “That's just one example—the AMA getting Ann Landers to write a `goofus feather' article,” he said.  “The AMA put in writing that it was their intent to contain and eliminate the chiropractic profession,” Wilk said. “They were either arrogant or stupid enough to even put in writing how they were going to do it.” [2]

The Committee on Quackery even lied to Landers about their misinformation when Doyl Taylor wrote a letter to her citing their own lies that were exposed during trial when they ignored the studies showing the 2:1 effectiveness rate of manipulation versus medical care; as well, the AMA’s tampering with the original Medicare study also was used as proof by a alleged third-party to show that chiropractic was condemned by a federal panel.

            Taylor wrote to Landers:

 

If I’m wrong in my opinions about chiropractic – opinions that are expressed uniformly in the scientific literature and in governmental studies at both the national and state levels – I’ll be the first to admit it.[3]

Recall that Doyl Taylor fled Chicago the day before the Wilk trial began to Arizona to avoid testifying in this case; apparently he lied again to Landers when he said “I’ll be the first to admit it,” and when the time was at hand to put up or shut up, he ran away.

Considering the decades of misinformation disseminated by the AMA’s two leading misinformers, Fishbein and Taylor, obviously its own arrogance led to their downfall perhaps believing they were immune to legal retaliation for their malicious slander against chiropractors.

Despite the AMA’s solid hold of the media during its chiropractic witch hunt, a few brave journalists spoke out against this unfair persecution.  An editorial from the Valley Morning Star from Harlingen, Texas, in 1966 wrote a reasonable and insightful response to the AMA’s accusation of quackery thrown at chiropractors. “As long as there are human beings there will be ‘quacks,’ persons who make false claims,” wrote the editor who recognized, “And some of them may even belong to that sacrosanct American Medical Association.”

 

AMA Tries To Discredit Nation’s Chiropractors

         The American Medical Association, one of the strongest unions of ’em all, has made another attempt to discredit chiropractors, a rival group engaged in the healing arts.

         It’s too bad the practitioners of medicine and chiropractic can’t get along and may be they could if the AMA would tend to its business and let the chiropractors alone.  It looks like there should be room for both groups.

         The AMA recently staged its third “Congress on Medical Quackery,” in which an effort was made to show that chiropractors are making false claims about their ability to help the sick, the generally accepted meaning of quackery.

         We also know that medical doctors have been known to seek help from chiropractors, on occasions.  However, they probably enter the chiropractor’s office through the back door.  But no matter.

         On the other hand there is a definition of the verb “quack” which is “to talk pretentiously without sound knowledge of the subject discussed.”  In that case, one might say that a spokesman for the AMA was doing a bit of quacking.

         “The confrontation between medicine and chiropractic is not a struggle between two professions,” said the spokesman, Dr.  Thomas M.  Ballantine, Jr.  of the Harvard Medical School.  “Rather it is more in the nature of an effort by an informed group of individuals to protect the public from fraudulent health claims and practices.”  Among other things, Ballantine accused chiropractors of treating cancer patients, and he said patients suffering from serious illness risk death when treated by a chiropractor.

         We suppose there are chiropractors who do claim to be able to help patients suffering from cancer.  But we have been told of medical doctors who are treating cancer patients without benefit.

         We do not know whether chiropractic is of aid to cancer patients, just as we do not know whether there are benefits to some other products the AMA and American Cancer Society and their partners in the state and federal health bureaucracy claim are quackery.  We do know there are people who claim to have been helped by unorthodox methods of treatment.  And we contend the AMA has no right to deny those persons their right to choose a method of treatment.

         As long as there are human beings there will be “quacks,” persons who make false claims.  And some of them may even belong to that sacrosanct American Medical Association.

         The AMA is doing no service to humanity to use every trick to attempt to show that its members have the only answer to healing the sick.  Some people still want to choose their own means of treatment, regardless of what the medical men say.  To devote a public forum to attacking others the AMA members disapprove, smacks something of quackery itself. [4]

It was refreshing to see one journalist during this medical boycott could see through the AMA’s smokescreen, although he undoubtedly drew the ire of the local medical society. Since there never was a public outcry against alternative methods of treatment, the state governments, licensing boards, and district attorneys had no cause to act against chiropractors without provocation from the medical societies, so  the AMA continued to use its people in the media to twist and distort the truth in the court of public opinion.

One would think Ann Landers had learned her lesson about being a paid mouthpiece for the AMA propagandists, but apparently not since she continued her campaign to misinform the public. In 1993, she wrote a Foreword for the book, The Health Robbers: A Close Look at Quackery in America, a similar anti-chiropractic book written by two known medical misinformers, Stephen Barratt and William Jarvis.[5] In her Foreword, Ms. Landers wrote:

PT Barnum was right. There’s a sucker born every minute…

The saddest letters of all come from the relatives of the desperately ill, those who are dying of cancer or kidney disease. “Our family doctor said there was nothing more he could do, so we took mom to this wonderful chiropractor. She seems a little stronger today. Do you think, Ann that we should have brought her to the chiropractor from the beginning and not wasted all that time and money on a specialist with a fancy diploma from Harvard hanging on his office wall?”

Every letter gets a personal reply in the mail if there’s a name and address. I urge my readers to beware of quacks and phonies. I warn them against the charlatans and fakers. More often than I care to admit, I have received in return a seething reply: “How dare you take away our hope! I’ll bet you are on the payroll of the American Medical Association. The medical doctor didn’t do anything but send us big bills…”

How can the public be protected against phonies, quacks, and unscrupulous money-grubbers who prey on the insecure, the frightened, and the sick? The answer is education. And that is what this book is all about.

Of course, Landers was aware of the Wilk trial and didn’t directly condemn chiropractors as quacks in her Foreword as she might have beforehand, but she did insinuate as much when she failed to answer the question asked if the writer was correct in taking her mother to the “wonderful chiropractor.” Instead, she continues with her inference by attacking “against phonies, quacks, and unscrupulous money-grubbers,” clearing suggesting chiropractors fall into that category and alluding to the fact that these satisfied chiropractic patients were “suckers.” This type of patient ridicule continues to this day when patients ask their MDs if they should see a chiropractor. Typically the response is along this line: “If you’re stupid enough to go to a chiropractor, don’t come crawling back to me when you’re paralyzed.”

Although Landers promoted this book, it is imperative to add that the authors of The Health Robbers have been denounced by authorities as self-appointed, so-called experts of quackery. Indeed, Barrett and Jarvis were disciples of Fishbein and Taylor. The chapter on chiropractic in The Health Robbers (entitled “The Spine Salesmen”) was written by Stephen Barrett, MD, of the Lehigh Valley Committee Against Health Fraud, who is a renowned medical opponent of chiropractic who periodically raises his voice to bash the profession, and his association with the AMA goon squad is well known now. 

In 1975, the Committee on Quackery was disbanded after the Wilk trial began, but the goal to disseminate misinformation about chiropractic and all alternative healing arts was kept alive by Barrett who had started the Lehigh Valley Council Against Health Fraud. Barrett was, allegedly, given access to all of the AMA's anti-quackery and anti-chiropractic files, quite likely part of the 44 file cabinets Barrett kept privately. The AMA now had an external group to carry its campaign against chiropractic and other natural health care providers.[6]

Barrett later became a founding board member of the National Council Against Health Fraud, started by William Jarvis, PhD. From 1970 until the present, Barrett has continued to attack virtually everything non-allopathic regardless of the scientific proof as we saw when the Committee on Quackery kept hush on the superiority of chiropractic care.

According to TIME magazine in 2001, Barrett retired from his psychiatric practice in 1993 to devote himself full time to “quack busting.” Touting his new fame, Barrett said, “Twenty years ago, I had trouble getting my ideas through to the media. Today I am the media."[7] Sounds eerily reminiscent of Morris Fishbein, doesn’t it?

Dr. Barrett’s propaganda war against chiropractic has been a battle which has been discredited by many respected authorities.  Unfortunately, his misinformation to the public about alternative medicine has been printed in numerous consumer magazines, including Redbook, American Health and Self, and he has been the health editor of Nautilus magazine and a consultant for Shape and Prevention magazines.

Rather than a medical man of enlightenment, he represents the same old myopic, monopolistic mindset of the AMA to denigrate all alternatives, including nutrition. Inexplicably in this day and age of the damage caused by junk food, Dr. Barrett wrote that readers should “ignore any practitioner who says that most diseases are caused by faulty nutrition,” and he stated that “there’s no reason to believe organic foods are safer or any more nutritious than ordinary fare.” Obviously, his expertise about nutrition is just as questionable as his view about chiropractic care. [8]  

Dr. Barrett, a practicing psychiatrist (perhaps the least scientific segment of medicine), demonstrated his lack of objectivity about chiropractic in 1978 when he testified against the profession before the New Zealand Commission on Chiropractic, which endorsed chiropractic in that country’s national health-care system.  After the hearing, the commission concluded:[9]

We have considered material published in Barrett's name. It is plainly propaganda. What we have seen of the rest of his writings on chiropractic has the same tone. Nothing he has written on chiropractic that we have considered can be relied on as balanced.

It is clear that the enthusiasm of the Lehigh Valley Committee Against Health Fraud is greater than its respect for accuracy, at least in regards to facts concerning chiropractic. We are not prepared to place any reliance on material emanating from the Lehigh Valley Committee.

Not only did the New Zealand Commission ignore Barrett’s remarks as biased, American attorneys representing the victims of Barrett’s wrath also came forth in legal action against this “quackpot.”

On October 13, 2005, Judge J. Brian Johnson, of the Lehigh County Court of Common Pleas, handed self-proclaimed "consumer medical advocate" Stephen Barrett another loss in court. Barrett had filed a defamation lawsuit against Tedd Koren, DC, and his company, Koren Publications, Inc. [10] The lawsuit, filed in August 2002, sought unspecified damages against Koren and his company for statements he wrote in his newsletter in 2001 about Barrett that he was "de-licensed," "in trouble because of a $10 million lawsuit" and a "quackpot." In his defense, Koren contended that the statements were true and not defamatory, and that he had a First Amendment right to print them in his newsletter.

In making the ruling to throw out the case, Judge Johnson found there was insufficient evidence to support Barrett's claims. Attorneys James Turner and Carlos F. Negrete represented Dr. Koren in the action against Barrett.

Mr. Turner remarked that “Barrett has been a gadfly, a thorn in the side of new ideas in health for over 30 years.” [11]

It is very important that a very responsible judge in Barrett's hometown recognized that he was making false allegations and dismissed the case. Our interviews with jurors also revealed that they too saw through Barrett and felt that he was a litigious, ungrounded and biased denier of the truth. Barrett has been a gadfly, a thorn in the side of new ideas in health for over 30 years. He has cost untoward numbers of consumers pain, anguish and probably serious harm by his misrepresentation of the facts about subjects as diverse as acupuncture and zinc. It is time that his activities see the light of day under objective scrutiny. Because once they're seen for what they are, they will have no more impact.

Attorney Carlos Negrete characterized Barrett and his allies as “skinheads with stethoscopes around their necks”:

Frankly, I am not certain who the supporters of the so-called Quackbusters are comprised of, but they seem to me to be just skinheads with stethoscopes around their necks. They are distinguished by the narrow and simple-minded intolerance of chiropractic. Chiropractors have brought no harm to them, why then do they feel it is so important to minimize the benefits of an entire, well-established healing art? These people have, for years, threatened, intimidated and harassed anyone that is not obedient and accepting of their banter. Finally, there has been a loud voice to silence their bullying tactics. All chiropractors can take in a breath of fresh air.[12]

 

The New Zealand Commission also investigated another example of yellow journalism that occurred in 1975, a year before the Wilk trial began; a two-part article published in September and October 1975 for Consumer Reports, "Chiropractors: Healers or Quacks?"[13] The report was based on a 6-month investigation by Mr. Joseph R. Botta, senior editor of Consumer Reports who specialized in medical reporting. His flip-flop on chiropractic typified the influence of these medical misinformers to thwart the truth about chiropractic.

This report was brought to the attention of the New Zealand Commission in 1979, but the Commission rejected its reliability after it was found Mr. Botta changed his opinion after speaking with Dr. Murray Katz, another member of the Lehigh Valley Committee Against Health Fraud: [14]

The Commission has another reason for its reservation on the weight to be placed on the Consumers Union report. That is because of evidence which was given before us by Dr. Murray S. Katz, a Canadian medical practitioner and colleague of Stephen Barrett of the Lehigh Valley Committee Against Health Fraud, Inc,  told the Commissioners that he had played some part in influencing the emphasis of the CU report. In the course of orally presenting his submissions he volunteered this comment:

The Consumers Union started off very much in favor of chiropractic. After hearing what the AMA had to say about chiropractic, they were even more in favor of chiropractic, considering they had a vested interest, but it was only after Joe Botta came to Montreal and discussed this issue over many hours and many telephone calls [with me] that the Consumers Union in the United States completely reversed their stand on the chiropractic issue and went exactly the other way.”

Next, Dr. Katz was very frank about how he came by certain material and information regarding chiropractic. It appears that he so strongly felt the need to investigate chiropractic from the inside that he adapted a series of dishonest stratagems to enable himself to do so.

The New Zealand Commission determined:

He said he was independent. He may well have believed he was when he gave evidence before the Commission. But in fact he was in no position to be independent…If it is true that Dr Katz was instrumental in convincing the author of the Consumers Union report to "completely reverse his position on chiropractic", then we must record that we are provided with further ground for placing little reliance on the report.

The New Zealand Commission also investigated another misrepresentation of chiropractic that began in 1969 with Ralph Lee Smith's book, At Your Own Risk:  A Case Against Chiropractic,[15] which was the AMA’s effort to condemn chiropractors with nothing more than anecdotal scare tactics.  Conversely, if one were to write a book on medical mistakes, it would need a multi-volume work to contain the entries of millions of people hurt or killed by bad drug reactions, botched surgeries, or super-germ infections contracted in hospitals.

After its investigation, once again the New Zealand Commission condemned Smith’s book: [16]

 We mention this book to show that we have not overlooked it. Some reliance was placed on it, and extracts from it, in the course of our inquiry. It comes down heavily against chiropractic.

It cannot in the Commission's opinion be regarded as a text on which any reliance can be placed. It was published in the United States and Canada in 1969. It is a piece of special pleading. There is no true attempt of objective appraisal of chiropractic. It emphasizes the sensational.

The author does not appear to have any particular qualifications except a desire to present chiropractic in the worst possible light. The Department of Investigation of the American Medical Association seems to have had something to do with encouraging Smith's investigations; certainly the American Medical Association took a considerable hand in disseminating the book once it was published. It appears to have been published shortly before the United States Senate's Finance Committee's investigation into whether chiropractic treatment should be included in social welfare aid programs. The Senate Finance Committee disregarded it and so do we.

As discovered during the Wilk trial, the AMA and its allies like Barrett and Katz were professional liars when it came to their attack on chiropractic. They so often repeated their lies that they actually began to believe them.

Actually, the Sore Throat character who revealed the AMA’s files in the book, In the Public Interest, wrote in his letter to chiropractic leaders, Drs. Jerry McAndrews and Louis Sportelli, as well as nationally syndicated newspaper columnist Jack Anderson, in which he characterized the AMA as a “self-perpetuating propaganda factory”:

…the biggest tool the AMA has against chiropractic is the sheer volume of discrediting material written about chiropractic that is quoted and requited even though it has no basis in fact. This self-perpetuating propaganda factory will never disappear until the source of the propaganda is brought to task.

Another question I am often asked, and perhaps the most significant question is, “Won’t the AMA attempt to smear chiropractic as a justification for the restraint of trade activities they have been involved in?” in other words, what about those chiropractic skeletons in the closet—whether real or the figment of some AMA executive’s imagination?

Realistically, chiropractic has been smeared for decades by the AMA. Do you really feel that the AMA can present much more evidence against chiropractic? From what I have seen they have used up any ammunition they may have had, and manufactured a good deal of ammunition in the bargain. [17]

            Unquestionably, it has been unethical medical zealots like Barrett and Katz who have kept the volley of misinformation in the news as unofficial spokesmen for the AMA hiding behind phony “public awareness” groups. This task became more difficult in the 1990’s once researchers found that chiropractic was not only effective, but superior to many medical methods. But that hasn’t stopped the medical misinformers from creating new problems about chiropractic care as you will learn in the following section.

 

Unethical Journalism: Two Cases

During the 1990s, the AMA greased the palms of its many friends in the media and once again we saw an upsurge of anti-chiropractic articles.  Most interesting is that these articles completely ignored the Wilk trial verdict and the cascading research showing chiropractic’s effectiveness. They also ignored the mounting evidence against the use of drugs, shots, MRIs, and back surgery.

After the Wilk antitrust trial, the AMA’s smear campaign against chiropractors never stopped; it began using covert tactics after the court issued a permanent injunction against the AMA.  By simply turning over its propaganda to their colleagues at the Lehigh Valley group, and its friends in the media, including notables such as Consumer Reports, ABC News, NBC News, and The Wall Street Journal, to name just a few, the AMA defamation campaign continues to this day via a biased media that refuses to speak objectively about chiropractors. Just as racism bias in the media took decades to change, so has the antipathy toward chiropractors.

A review of yellow journalism would be too voluminous to show the many instances where chiropractors were cast by the media as the black sheep.  Most interesting is that these articles completely ignore the Wilk trial verdict and the cascading research showing chiropractic’s effectiveness. They also ignored the mounting evidence against the use of drugs, shots, MRIs, and back surgery. Indeed, the intransigence of the medical profession and its media allies have made for a media mess.

During the 1990s, we saw an upsurge of anti-chiropractic articles despite the revelations by two prestigious scientific groups that investigated the epidemic of low back pain and chiropractic.  Not only were these two studies monumental, they also caused a furor among medical detractors in the media who couldn’t accept these accolades to chiropractors.

In 1992, RAND Corporation did a study on the appropriateness of spinal manipulation.[18]  In 1994, the U.S. Public Health Service’s Agency on Health Care Policy and Reform (AHCPR) recommended spinal manipulation as a “proven treatment.”[19]  Unlike the Medicare study that was “fixed,” the AMA couldn’t sway the researchers to do the same in these two studies because of the interdisciplinary makeup of the investigators. The AMA then realized it had to do something to squelch this positive evidence in spine care from medical care to “hands-on” conservative methods of treatment such as chiropractic.

Since the AMA could not publicly attack the chiropractic profession as it had done before the Wilk antitrust trial, nor could it pre-determine the outcomes with unethical members on the panels like the HEW panel on Medicare legislation, the AMA turned to its friends in the media who gladly toed the line, publishing misinformation to the public.  Columnists in magazines and newspapers, and certain television medical experts were hired hands for the AMA, and all gave a collective “thumbs down” to chiropractors despite the emerging evidence to the contrary.  Once again, political ideology trumped over science.

The first scientific review that endorsed spinal manipulation for low back pain was done in Santa Monica, California by RAND Corporation, one of America's most prestigious centers for research.[20] Despite this acknowledgement, as you will see, the yellow journalists in the mainstream media twisted its results.

The research panel included medical, chiropractic, and osteopathic doctors who are recognized experts in low back pain.  Results from a two-year multi-disciplinary study validated the assertion that spinal manipulation is an appropriate option for low back pain.

Significant conclusions reached in the first two reports issued in August of 1991 are:

  • Twenty-one controlled research trials on low back pain have been identified in the medical literature that has found varying degrees of benefits from spinal manipulation.
  • An expert panel of medical, chiropractic, and osteopathic experts agree that spinal manipulation is appropriate treatment for acute, uncomplicated low back pain and for acute low back pain with minor neurological findings.  (A great majority of low back conditions fall into the above categories.)
  • The expert panel also concluded that in clinical practice, four weeks is a reasonable trial period for spinal manipulation.  (The common prior medical position was that manipulation should be given only one to three times.)

Paul Shekelle, MD, PhD, MPH, primary investigator of the RAND study, assessed the results of part three:  “Both panels agree that spinal manipulation is appropriate for low-back pain without the indication of sciatica.  They differ with regard to sciatica and chronic pain.  It will remain to future studies to determine if these are appropriate to spinal manipulation or not.”

ABC Evening News

Rather than finally giving credit to the much-maligned chiropractors, the media misrepresented and distorted the RAND study.  Shortly after the RAND announcement, ABC Evening News reported on the results of the RAND Corporation study on spinal manipulation for low back pain.  After minimizing the significance of the RAND study, Timothy Johnson, MD, ABC Evening News medical expert, reported that some medical doctors, osteopaths, and physical therapists also do spinal manipulation, neglecting to add that 94 percent is done by chiropractors.  In light of the historical condemnation of spinal manipulation by medical doctors, it was totally surprising when Johnson suggested to viewers that medical doctors and physical therapists were just as competent as chiropractors to adjust the spine when, in fact, they are ill-trained in this area, many are afraid to venture into manipulative therapy for fear of reprisal, and most still hold it in contempt to this day. Indeed, after decades of berating manipulative therapy, why would any medical practitioner now claim to appreciate it?

He continued his report on the RAND study by saying that chiropractors were doing manipulation under anesthesia, and that it could lead to strokes, which was not an issue the RAND study dealt with at all.  Aside from his misrepresentation of this study, Johnson’s real ploy was to take the luster off chiropractic's obvious victory by once again scaring the public that manipulation is dangerous.  After a century of bashing chiropractic spinal manipulation, research has proved its effectiveness and safety for low back pain.  Not only did the medical hypocrites want to jump on the spinal manipulation bandwagon, they wanted to be in the driver's seat and throw chiropractors under the wagon. Obviously Dr. Johnson cannot give credit where credit is due.

AHCPR: The Shot Heard Around the Medical Profession

 

The second study that endorsed spinal manipulation and stunned the medical world was issued by the federal government in the winter of 1994, after a federal appeals court ended an injunction sought by the North American Spine Society (NASS) that was issued in the summer of 1994 to prevent its release.  This medical society simply did not want this information given to the public. Ironically, after decades of calling for chiropractic research, when it was done, the medical society used the courts to suppress it because this study condemned spinal surgery as well as recommending spinal manipulation for acute low back pain in adults. The cat was finally out of the bag, but the medical society stuffed it back in for six months until an appeals court finally interceded.

The Public Health Service was to be an ongoing partner with the health professions in an effort to improve medicine in America.  They were charged by Congress with being a federal arbiter of evidence and a setter of guidelines for treatment; thus the birth of the Agency for Health Care Policy and Research (AHCPR).  The study on acute low back pain was the fourteenth study. This Congressional empowerment of the AHCPR was part of the growing national movement to begin evidence-based care through linking practitioner choices to scientific evidence. 

The AHCPR’s responsibility was to choose conditions, focusing on high-cost, high-use conditions like back surgery for low back pain.  The AHCPR convened multi-disciplinary panels consisting of 18-25 highly-regarded researchers to create guidelines that were to be updated as new evidence was discovered.  The goal was to improve ineffective treatments, but the power of the medical profession would thwart this goal.

The most shocking recommendation focused on back surgery.  The panel of experts found back surgeries were costly, were sometimes based on misleading tests such as MRIs, and were generally ineffective.  In fact, the agency said only one in 100 cases of acute low back pain required surgery, which was a dagger in the pocketbooks of many spine surgeons.

Basically, the underlying disc abnormality theory as the primary cause of back pain was deemed inaccurate since many people with abnormal discs had no pain while many patients with healthy discs were in pain.  Thousands of MRI scans were deemed unnecessary and most spinal fusions were deemed ineffective—both of which are big moneymakers in the back pain business world.

The initial MRI study by Scott Boden, MD, [21] at Emory University in 1990 showed that disc abnormalities were incidental and part of the natural aging process, should be considered “false positives” in the diagnosis of back pain, likening them to finding grey hair, and leading to many unnecessary spine surgeries.  This was the first shot across the bow for spine surgeons.

The back surgeons in the NASS just could not stomach the thought that their spine surgeries were touted as ineffective, and the recommendation for spinal manipulation over traditional medical treatments by a federal agency was too much to bear.  To rub salt in this NASS wound, this panel was headed by an orthopedic surgeon, Stanley Bigos, MD.

            This study also showed the enormity of the back pain epidemic in America. [22]

  • 80-90% of all adults will suffer with acute low back pain sometime in their life;
  • LBP is the leading workers’ compensation injury;
  • LBP is the leading cause of disability for people under the age of 45;
  • LBP is the second-leading cause of visits to doctors’ offices;
  • LBP is the third-leading cause for hospital admissions;
  • LBP the second-leading cause of surgery other than heart surgeries.

This multidisciplinary study by experts from every profession that treated back pain was the most comprehensive analysis of acute low back pain in adults ever compiled by any governmental body.  The chiropractic and medical professions waited with bated breath for the results, and when the results were announced on December 8, 1994, the medical profession was livid. After this two-year investigation of over 10,000 published articles, the AHCPR concluded that spinal manipulation was listed as a “proven treatment” for acute low back pain in adults and was the preferred initial professional treatment for acute low back pain. 

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.[23]

            This federal agency made history when it recommended spinal manipulative therapy as an effective treatment for low back pain, concluding that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with, or as an alternative to, non-steroidal anti-inflammatory drugs, as well as heat or cold packs for temporary relief. 

At the same time, AHCPR concluded that various traditional methods, such as bed rest, traction, and other physical and pharmaceutical therapies like pain pills and muscle relaxers, were less effective than spinal manipulation and cautioned against lumbar surgery except in the most severe cases.  Perhaps most significantly, the guidelines state that unlike non-surgical interventions, spinal manipulation offers both pain relief and functional improvement.  But for acute low back pain not caused by fracture, tumor, infection, or cauda equina syndrome, spinal manipulation is the treatment of choice.

AHCPR entered this fray when its reviewed the research on low back pain and concluded that there was no evidence to support spinal fusion surgery and that such surgery commonly had complications.[24] What angered traditional medicine the most about the AHCPR study was its finding:

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.[25]

Because acute low back pain is the most prevalent ailment and most frequent cause of disability for persons younger than 45 years of age in the United States, adherence to these practice guidelines would have substantially increased the numbers of patients referred for spinal manipulation. 

While the chiropractic profession took this as a federal endorsement, the medical profession was not about to take it so lightly.  While it appears the most knowledgeable medical researchers ever convened were convinced of chiropractic's effectiveness, much of the media and many medical practitioners chose to ignore the new research guideline and attack back. 

AHCPR Backlash on Capitol Hill

 

While some politicians allege there is a vast right wing conspiracy about political events in this country, it is a proven fact that there has been a vast medical conspiracy that has kept the public misinformed about the benefits of chiropractic spinal care as well as suppressing guidelines that endorse chiropractic spinal care.

A good example of traditional medicine’s meddling occurred with an organized attack on the AHCPR. Despite the permanent injunction order from the Wilk trial judge to stop interfering with chiropractors, the medical demagogues launched another scheme to destroy the AHCPR.  When the AHCPR study on low back pain was concluded, the North American Spine Society filed an injunction to stop the release of its findings to the public.  It took over six months before another federal court allowed dissemination of these findings on December 8, 1994.

Unable to accept the experts’ criticisms of spinal surgery, NASS took their attack to Capitol Hill and protested the findings of this study, citing the research team was biased and inept, despite the fact that the team was headed by Stanley Bigos, M.D., an orthopedic surgeon along with 22 other spine experts.  It was interesting to note that the NASS criticized only one of the preferred forms of therapy:  spinal manipulation.

An historical review of the battle between AHCPR and NASS, Health Affairs: The Policy Journal of the Health Sphere, summarized how and why AHCPR was attacked and almost lost its budget after this firestorm over low back treatments.[26]

Unlike the first thirteen guidelines produced by AHCPR that received little condemnation, the fourteenth on acute low back pain in adults and its criticism of back surgery posed a much more serious threat to the AHCPR because it focused on the agency’s funding.  The surgeons found sympathetic ears among House Republicans who were prepared to believe the worst about the agency after the failed Clinton Health Care Reform Act in 1993-1994.

NASS argued that AHCPR was redundant, inefficient, and wasteful.  They noted that medical societies and HMOs had already turned out 1,500 guidelines.  They told the Republican Congress that came into power in 1995, which AHCPR was inappropriately meddling in what doctors should do and was inefficiently turning out guidelines, only fifteen in five years.[27]

AHCPR was also confronted in 1995 with an advocacy group, the Center for Patient Advocacy, whose goal was to get it de-funded.  In reality, this was not a “patient” group but were members of NASS formed by Neil Kahanovitz, MD, a back surgeon from Arlington, Virginia.  They organized a letter-writing campaign to gain congressional support for its attack on AHCPR. 

NASS created an ad hoc committee which attacked the literature review and the subsequent AHCPR practice guideline on acute care of low back pain.  In a letter published in 1994 in their journal Spine, the committee not only criticized the methods used in the literature review and expressed concern that the conclusions might be used by payers or regulators to limit the number and types of spinal fusion procedures, but it also charged that AHCPR had wasted taxpayer dollars on the study.[28]  Republican Congressman Sam Johnson (R-TX) proposed elimination of the agency and mocking referred to it as the “Agency for High Cost Publications and Research.”[29]

The AHCPR found more supporters in the Senate than in the House.  A letter by Edward Kennedy (D-MA), Jay Rockefeller (D-WV), James Jeffords (R-VT) and Orrin Hatch (R-UT) called for the maintenance of FY 1995 funding for the agency.  It observed that “there has been some misunderstanding about the role, purpose, and mission of AHCPR,” and argued that “it is essential to have a federal agency that works with the private sector to provide consumers with information to make informed choices, measure, and improve the quality of care, and improve the cost and effectiveness of our health care system.”

The Senate Appropriations Committee and the Senate itself approved a reduced budget figure for the agency ($127,310,000) that was similar to the amount that had been approved by the House Appropriations Committee.  In the conference committee, the House leadership, as promised during the floor battle months before, supported the Senate’s figure.  On April 26, 1996, almost seven months into the fiscal year, President Clinton signed the appropriations bill that, after a final small across-the-board reduction, was only slightly less than the amount approved by the Senate.  The agency had survived, but with a 21 percent budget cut, and it had been gutted of making treatment recommendations.[30]

Flip-Flopping on AHCPR Low Back Guidelines

The reaction of American spine surgeons was heated and mixed.  On one hand, they were incensed that their biggest money-maker, spine fusion, was criticized, afraid insurance might stop paying for them, and the endorsement of spinal manipulation infuriated many surgeons.  On the other hand, after their anger subsided, their own reviewers admitted a strong agreement with the AHCPR guideline.

NASS waged a political battle never seen before to cut the funding of AHCPR, illustrating once again that “the AMA is the most terrifying trade association on earth.”  We are now seeing the same meddling by the AMA over Obama’s healthcare reform plan, just as it opposed Clinton’s plan, Truman’s plan, JFK’s plan on Medicare, and every other plan proposed that might limit their profits.  The AMA has a long history of pushing around legislators with fear-mongering and money.

On January 9, 1995, Eric J.  Muehlbauer, executive director for NASS, sent out a memorandum to NASS members regarding the release of the clinical practice guideline from AHCPR on acute low back problems in adults.  The front page of the 1995 summer edition of NASS News proclaimed, “AHCPR Guidelines Disputed,” suggesting that “this has become a political, and not a scientific document.”[31] Ironically, the NASS made it a political issue since the panelists were diverse and scientific in their approach.

The article made many statements to rationalize its objection to the guideline, such as:

  • patients should not have treatment selected or denied based on the guidelines (the point of the guideline was to determine evidenced-based treatments rather than the whimsy of individual practitioners);
  • that the guidelines relied upon limited scientific information (how can 10,000 published articles be considered “limited”?);
  • that the consensus method does not necessarily identify the best forms of treatment or diagnosis (if not, then what does?); and,
  • that clinical judgments made by the AHCPR panel should be balanced with those of relevant medical societies (in other words, the panel should consider the vested interests of NASS before making recommendations). [32]

Obviously the NASS criticism was simply a smokescreen of misinformation considering the reason Congress created AHCPR was to establish goals to help improve healthcare outcomes and reduce costs in America.  The multidisciplinary panel accomplished all four goals stated by NASS although their methods were criticized by their own researchers on the best available research.

Most inconsistent was the NASS response letter that criticized reliance on randomized control trials (RCTs), the gold standard for research.  It seems odd for NASS to protest the strict reliance on RCTs, given its history of demanding hard science as evidence, a demand put upon chiropractic for decades.  Now that the shoe is on the other foot, the NASS bitterly complained.

We, the North American Spine Society, feel that this document should not be published in its present form.  Instead, a new consensus should be sought, with appointed input from all relevant medical specialties dealing with low back pain issues, and with AHCPR staff that is responsive to the criticisms of the methodology raised in this letter. [33]

Inexplicably, the consensus the NASS sought is exactly what AHCPR did.  The panel members were selected from nominees of all medical, osteopathic, physical therapy, and chiropractic societies.  Instead of these phony excuses, the only real objection by NASS was the panel’s conclusion.

 “Perhaps the NASS experience typifies the evolution most groups undergo as they wrestle with practice guidelines,” the editorial staff of Dynamic Chiropractic journal opined.  “Could it be that rage, denial, review, and grudging acceptance are all part of the guidelines experience for most health care providers?”[34] 

The AMA also feared the next AHCPR publication (#15) on cervicogenic and tension headaches that was reportedly prepared to endorse spinal manipulation.  This headache study was killed by political medicine after thwarting the implementation of guideline #14 on acute low back pain.

The Headache Report study was later continued by Duke University in 2001 with the sponsorship of the Foundation for Chiropractic Education and Research (FCER), a chiropractic research and education foundation, and became perhaps the most notable publication that endorsed manipulative therapy for headaches.[35]

Imagine if the public were told by the federal government and the media that according to the AHCPR experts, if you have low back pain or headaches, go see your chiropractor first.  It is doubtful the AMA would allow this to happen without a fight.  The AMA used its political acumen to gut the AHCPR, which today is out of the guideline business.  After hearing the NASS excuses, knowing full well the AHCPR report represented the current scientific studies, the bottom line resistance from the medical society seemed to be,  “Don’t confuse us with the facts because we ain’t gonna have the federal government telling us how to practice medicine.”

As a result, AHCPR had its guideline development work curtailed, even though it was originally ordered to develop guidelines by a 1989 Congressional mandate.  It would seem the wishes of special interest groups like AMA’s political action committee supersede Congress’ wish to determine the best treatments for common ailments.

The new name for this castrated body is the Agency for Healthcare Research and Quality (AHRQ) charged with “improving the quality, safety, efficiency, and effectiveness of healthcare,” but it can no longer make recommendations for treatment.

Research Meddling

The lawsuit to stop the release of the AHCPR guideline on acute low back pain by the  Center for Patient Advocacy, the NASS bogus advocacy group, also had the effect to intimidate present and future critics by eliminating the messengers who may report the many ineffective and costly medical procedures that have driven up health care costs to the $2,000,000,000 (that is two trillion dollars) range annually.

A member of the AHCPR panel, Richard Deyo, MD, MPH, co-authored an article in The New England Journal of Medicine, “The Messenger Under Attack:  Intimidation of Researchers by Special Interest Groups.” [36]  In it, he commented of this heavy-handiness to thwart progressive researchers:

“The huge financial implications of many research studies invite vigorous attack . . . Intimidation of investigators and funding agencies by powerful constituencies may inhibit important research on health risks and rational approaches to cost-effective health care.”

Deyo has written many articles dealing with the ineffectiveness of spinal surgeries, especially spinal fusions.  His opinion is based on fact, not just his personal feeling, which is confirmed by the Public Health Service’s own study. In AHCPR’s Clinical Practice Guideline, the section on Spinal Fusion clearly summarizes the research.

There appears to be no good evidence from controlled trials that spinal fusion alone is effective for treatment of any type of acute low back problems in the absence of spinal fractures or dislocation. . . . Moreover, there is no good evidence that patients who undergo fusion will return to their prior functional level.[37]

For decades medicine and its political machine have called chiropractic unscientific and demanded research from the chiropractic profession to prove itself.  Yet when it is finally done by the most universally accepted and acclaimed expert group of researchers ever assembled (AHCPR), the standard medical methods fell short of the same proof demanded by the AMA.

Once again the political machinery of the AMA fought any reform effort to improve healthcare in America. Just as the potential loss of authority and income moved the NASS to action, the economic opportunity was not lost on the chiropractors.  As Louis Sportelli, DC, noted: “If the doctors of chiropractic only cornered the market on one condition, i.e., back pain, there would not be enough [chiropractors] now to handle the volume.”[38]

Media Backlash

AHCPR’s endorsement has been the most significant recognition to date of manipulative therapy for the epidemic of low back pain.  Instead of being heralded as champions of this treatment, chiropractors got short shrift by the medical experts in the media who virtually ignored this landmark study or distorted its findings.

Examples of media misinformation occurred on several occasions after the AHCPR report was released in December of 1994.  Many elite media reporters twisted the conclusions of this thorough study to misrepresent the findings about chiropractic care.  Consumer Reports, Parade magazine, NBC's Today Show, to name but a few of the more prominent sources, all belied the actual thrust of the AHCPR report which endorsed spinal manipulation as the initial professional treatment for acute low back pain in adults.

NBC’s Today Show

Undoubtedly the most glaring example of media misrepresentation of the AHCPR’s findings occurred on NBC’s Today Show.  After the AHCPR guideline on low back pain was released in 1994, the Today Show’s in-house medical expert, Art Ulene, MD, presented the results of this impressive two-year study on back pain.

In a week-long series on back pain, Ulene mentioned the startling results of this study:  Only one in 100 back surgeries is helpful; physio-therapeutics like ultrasound, TENS, hot packs, and other standard treatments by physical therapists were also ineffective; and spinal manipulation was the preferred initial professional treatment.

To his credit, Dr. Ulene detailed the findings accurately, but his medical bias became evident when show host Matt Lauer concluded, “So, if you have a back problem, then you should see a chiropractor first.”

“Oh, no,” said Ulene, “I would never recommend a chiropractor.  Go see an osteopath instead.”

In one fell swoop, Ulene invalidated the healing art of chiropractic in the minds of millions of viewers, which was his goal. He knew full well that most osteopaths today do not do spinal manipulation.

Not only did the Public Health Service recommend spinal manipulation, its guideline also warns, “It should only be done by a professional with experience in manipulation.”[39] The facts also showed that chiropractors do 94 percent of all spinal manipulation therapy in this country (according to the RAND study on acute low back pain), so one must acknowledge that chiropractors are the leaders in this form of treatment.[40]

But not Ulene, who suggested osteopaths were preferable although he failed to mention that most osteopaths do not do manipulative therapy; it is now only an elective course in osteopathic schools. Indeed, if not for the courage of the chiropractic profession for over 100 years, the healing art of spinal manipulation therapy would have been lost.

AMA Handbook on Back Pain

Text Box: After the AHCPR guidebook on acute low back pain was released in December of 1994, the AMA published its own version in 1995, entitled Pocket Guide to Back Pain:  The Latest Information On All Treatment Options, Including Medications, Physical Therapy, and Surgery.[41]  It came as no surprise that this pocket guide excluded any mention of chiropractic or spinal manipulation that the AHCPR guideline recommended as a “proven method” of treatment.

This pocket guide was a pitiful effort by the AMA to circumvent the AHCPR guideline; it basically made a mockery of the research by endorsing the same medical methods that were strongly criticized by the AHCPR research staff.

Despite the fact that spinal manipulation therapy had already been recommended in the United States, United Kingdom, and Canadian studies (AHCPR[42], Meade[43], Manga[44]), neither chiropractic care nor spinal manipulation therapy are even mentioned by the AMA.  In addition, their pocket guide included recommendations that contradict the findings of the AHCPR guidelines.

Although it does state that there are “more than 100 separate joints connecting the bones of the spine to each other and to other bones,” no mention is made of spinal manipulative therapy.  It seems the AMA is willing to misrepresent the scientific research and governmental endorsements that conflict with its own vested interests, despite the harm it may cause patients who naïvely follow its ineffective, outdated advice.

Consumer Reports

In a September 1995 article on the AHCPR study entitled, “Back Pain:  The Best Treatment is Surprisingly Simple,” Consumer Reports confirmed that most back pain is not caused by the disc, but they failed to acknowledge that most back pain is due to joint dysfunction or that spinal manipulation was considered a “proven treatment” by the AHCPR panel of experts. 

But what, precisely, causes people’s lower backs to seize up in pain remains a mystery to this day.  Since the 1950s, blame has tended to fall on the discs, the spongy gel-filled cushions between some of the backbones, which can bulge, i.e., the familiar herniated or 'slipped' disc.  The assumption was that when the bulge pressed on a spinal nerve, it caused back pain.

Now the assumption is crumbling in the face of new studies showing that when people with no back pain whatever are examined with magnetic resonance imaging scans, about a third of younger adults and virtually all older ones have some bulging discs.  In fact, a back full of completely 'normal' discs is the exception, not the rule, even among healthy people.  'Given the high prevalence of these findings and of back pain, the discovery of bulges or protrusions in people with back pain may frequently be coincidental,' conclude the authors of one such study.

Other possible explanations, also still speculative, are that the lower back muscles somehow go into spasm or that the spinal nerve roots are being compressed by arthritic spurs or bony overgrowth.[45]

Although the cause of back pain remains a mystery to the Consumer Reports writer (who did note the erroneous disc assumption was dispelled by the new research), back pain is not a mystery to the thousands of chiropractors who have been treating millions of patients for a century with spinal adjustments.  It should no longer be a mystery that spinal joint dysfunction is the major cause of back pain, yet Consumer Reports could not bring itself to this conclusion despite the overwhelming research, ignoring instead the fact that the only doctor-treatment recommended in the AHCPR new guidelines was spinal manipulation. 

In the early 1970s, Consumer Reports also printed a study on chiropractic conducted for the Consumer's Union.  Many people felt that the last word in unbiased consumerism was espoused by that fortress of integrity, the Consumer's Union, and their distinguished publication, but its article on chiropractic proved that assumption wrong. 

Richard H. Tyler, DC, then-associate editor of Dynamic Chiropractic, a leading chiropractic publication, admitted this duplicity:

How wrong I was.  The report they came up with was dictated by the AMA, complete with all their stock phrases.  It was filled with half truths and outright lies.  They were, of course, flooded with letters, not the least of which was quite a lengthy and detailed answer by the ACA.  Since they had already decided on their official policy, they printed no constructive replies … So much for unbiased reporting—they had been bought.[46]

Ignoring the truth about chiropractic is not new for Consumer Reports, which had never given a positive review of chiropractic.  Shockingly, it took fourteen years for Consumer Reports to finally tell the truth, but it took a polling of 14,000 subscribers to overcome the bias of the editorial staff.  In May of 2009, Consumer Reports published a favorable article about chiropractic care.

About 80 percent of U.S.  adults have at some point been bothered by back pain.  The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery.  More than half said pain severely limited their daily routine for a week or longer, and 88 percent said it recurred through the year.  Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weight. 

Back pain can be tough to treat.  Most of our respondents tried five or six different treatments.  They rated the helpfulness of the treatments tried and their satisfaction with the health-care professionals visited. 

Hands-on therapies were among the top-rated.  Fifty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were "completely" or "very" satisfied with their chiropractor.  Massage and physical therapy were close runners-up. [47]

Parade magazine

Although not the pinnacle of journalism, Parade magazine is certainly a popular Sunday morning news magazine read by millions of Americans. In the January 14, 1996 edition of Parade magazine, writer Earl Ubell distorted the findings of the AHCPR report in his article, “What Works Best For Back Pain.”[48]  His article discounted chiropractic care as “controversial treatment . . . still under debate.”  One would think after the AHCPR, Meade, and Manga reports that few informed journalists would still consider chiropractic care as controversial; obviously Mr. Ubell’s personal bias from decades of medical propaganda weighed more than the research guidelines.

At best, he could only give chiropractic spinal manipulation a left-handed endorsement:  “[T]he health-care study reported that it can work well in certain situations.”  Ubell then focused the remainder of his article on the surgical solution to sciatica (which he also admits occurs in only two percent of back pain cases), while completely ignoring chiropractic’s success in similar cases.

Ubell neglected to mention AHCPR’s recommendation that spinal manipulation was the preferred initial form of professional care; AHCPR’s conclusion that only one in 100 back surgeries is helpful; and, two MRI studies by orthopedic surgeons (Scott Boden[49] and Maureen Jensen[50]) which undermined the basic premise of disc abnormalities as the cause of back pain in the majority of cases. 

Ubell’s article simply sang the same old medical song of back surgery as the best solution, despite the findings of numerous studies to the contrary.  When a panel of twenty-two experts in their field researched over 10,000 articles on back pain, then recommended spinal manipulation as the preferred initial form of care and further concluded that only one percent of back cases needed surgery, it is unclear how anyone could still endorse spinal surgery to the extent Ubell did. Indeed, if any treatment should be considered “controversial,” it is spine surgery.

It is time for the media to stop the lying; it is time to tell the truth.



[1] Letter to Ernest Howard, MD (Executive Vice President of the AMA), August 12, 1974. Wilk v AMA Trial Exhibit 1407

[2] Paulson, Tom,  Seattle Post-Intelligencer Reporter, Chiropractor Describes Fight For Respect With The AMA, Friday, March 1, 1991.

[3] Letter from Doyl Taylor, Secretary of the Committee on Quackery, to Ann Landers (Wilk v AMA Trial Exhibit 1408)

[4] Editorial, “AMA Tries to Discredit Nation’s Chiropractors,” Valley Morning Star (Harlingen, TX), November 1966.

[5] Barrett, Stephen M.D., and Jarvis, William T. Ph.D. The Health Robbers: A Close Look at Quackery in America, Foreword by Ann Landers, Amherst, N.Y.: Prometheus Books, 1993:321-335, p. vii.

[6] Sportelli, Louis, Bye Bye Barrett, Dynamic Chiropractic – August 27, 2007, Vol. 25, Issue 18

[7]Jaroff, L, The Man Who Loves To Bust Quacks, TIME magazine, Apr. 30, 2001

[8]Ibid.

[9] Inglis, BD.  Chiropractic in New Zealand:  Report of the Commission of Inquiry into Chiropractic.  Government Printer, Wellington, New Zealand, 1979.

[10] Editorial staff, Stephen Barrett Loses Major Defamation Trial in Hometown, Dynamic Chiropractic – December 2, 2005, Vol. 23, Issue 25

[11] Editorial staff, Stephen Barrett Loses Major Defamation Trial in Hometown, Dynamic Chiropractic – December 2, 2005, Vol. 23, Issue 25

[12] Ibid.

[13] Botta, JR, "Chiropractors: Healers or Quacks?" Consumer Reports XX September and October (1975), 542-47; 606-610.

[14] Inglis, BD.  Chiropractic in New Zealand:  Report of the Commission of Inquiry into Chiropractic.  Government Printer, Wellington, New Zealand, 1979.

[15]Ralph Lee Smith,  At Your Own Risk:  The Case Against Chiropractic (Simon & Schuster, 1969).

[16] Inglis, BD.  Chiropractic in New Zealand:  Report of the Commission of Inquiry into Chiropractic.  Government Printer, Wellington, New Zealand, 1979.

[17] Letter to chiropractic leaders from Sore Throat, postmarked 12-16-76, p. 21-22.

[18]Paul G. Shekelle, et al., The Appropriateness of Spinal Manipulation for Low-Back Pain (Santa Monica, CA:  Rand Corporation Report, 1992).

[19]S. Bigos, O. Bowyer, G. Braen,et al., Acute Low Back Problems in Adults, Clinical Practice Guideline No.  14.  AHCPR Publication No.  95-0642.  (Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994):  pp.7.

[20]Paul G. Shekelle, et al., The Appropriateness of Spinal Manipulation for Low-Back Pain (Santa Monica, CA:  Rand Corporation Report, 1992).

 

[21] S.D.  Boden, et al., “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects,” Journal of  Boneand Joint  Surgery (American edition) 72/3 (1990):  403-408.

[22] S. Bigos, et al., Acute Low Back Problems in Adults, Clinical Practice Guideline No.  14.  AHCPR Publication No.  95-0642.  (Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994):  90.

[23] Bigos, ibid, Patient Guide, p. 7.

[24] J.  Turner, et al., “Patient Outcomes after Lumbar Spinal Fusions,” Journal of the American Medical Association (August 19, 1992):  907–11.

[25] Ibid. p. 12.

[26] Bradford H. Gray, Michael K. Gusmano, and Sara R. Collins, AHCPR and the Changing Politics of Health Services Research:  Lessons From the Falling and Rising Political Fortunes of the Nation’s Leading Health Services Research Agency,” Health Affairs:  The Policy Journal of the Health Sphere (June 25, 2003); http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.283v1/DC1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=bradford+gray&fulltext=politics&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

[27] Weeks, John, “Back Surgeons, Chiropractic, and the Murder of a Federal Agency on Evidence-Based Medicine, theintegratorblog.com (June 11, 2006).

[28] A. White, et al., Letter to the Editor, Spine 19/1 (1994): 109–10.

[29] Congressional Record, 3 August 1995.

[30] Bradford H. Gray, et al., AHCPR and the Changing Politics of Health Services Research:  Lessons From the Falling and Rising Political Fortunes of the Nation’s Leading Health Services Research Agency,” Health Affairs:  The Policy Journal of the Health Sphere (June 25, 2003); http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.283v1/DC1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=bradford+gray&fulltext=politics&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT 

[31] Editorial Staff, North American Spine Society:  Flip-Flopping on AHCPR Low Back Guidelines? Dynamic Chiropractic 13/23 (November 6, 1995).

[32] Ibid.

[33] Ibid.

[34] Editorial Staff , “North American Spine Society:  Flip-Flopping on AHCPR Low Back Guidelines? Dynamic Chiropractic 13/23 (November 6, 1995).

[35] D.  McCrory, et al., Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache (Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research; Durham, NC:  2001).

[36] Richard A. Deyo, B.M. Psaty, et al., The Messenger Under Attack:  Intimidation of Researchers by Special Interest Groups, NEJM 336/16 (April 17,1997):  1176-79.

[37]S. Bigos, et al., Acute Low Back Problems in Adults, Clinical Practice Guideline No.  14.  AHCPR Publication No.  95-0642.  (Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994):  90.

[38] Louis Sportelli, DC, “AHCPR:  It Did Not Happen By Accident,” Dynamic Chiropractic 13/2 (January 16, 1995).

[39] Ibid. P. 7.

[40] Paul G. Shekelle, et al., The Appropriateness of Spinal Manipulation for Low-Back Pain (Santa Monica, CA:  Rand Corporation Report, 1992).

[41] American Medical Association pocket guide to back pain. Random House, copyright 1995 by AMA.

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