Articles by JCS

Medical Bully


Word count: 1775

 

Confronting the Medical Bully

 

 

Bullying has been a hot topic in the news lately whether the victims are shy teenagers and gay students who committed suicide after being relentlessly bullied or now as we see with a behemoth NFL player bullied as a right of passage into pro football.

 Chiropractors know this harassment only too well after a century of bullying by political medicine. This is not a new revelation since everyone has heard the unkind words most MDs have said about chiropractors; indeed, it’s not even a veiled bias but one spoken openly with pride among chauvinistic MDs.

While it is now taboo for people to refer to African-Americans with the n–word, yet many MDs have no qualms about using the q-word (quack) in reference to chiropractors. As a chiropractor myself, I’ve heard it hundreds of times, yet there has never been any media outrage at this degrading and unjustified epithet.

Like racism in the South, medical bullying remains the last bastion of acceptable bigotry evident by  segregating chiropractors from hospitals, the mainstream medical referral system, and the ubiquitous medical “hate speech” that go unchallenged and ignored in today’s media as well as among people who fancy themselves as social progressives.

For example, when was the last time you’ve read an in-depth article about the epidemic of back pain and the benefits of chiropractic care, now the third-largest physician-level profession in the nation? If you’re like most people, probably never, and for reasons that few people understand.

We also know of MDs’ intimidation of their patients who ask about seeing a chiropractor. Unless the MD is the rare “flower in the desert” as Wilk trial attorney George McAndrews called those few ethical MDs who refer to DCs, most often the response goes like, “Don’t come crawling back to me after the quack paralyzes you.”

Sadly, such bullying happens daily to unsuspecting patients, many of whom believe these medical bullies, consequently many avoid our brand of effective care and capitulate to opioid drugs, ESIs, and spine surgery based on the debunked disc theory, research be damn.

Medical Chauvinism

In fact, many medical chauvinists openly take pride in their discriminatory attitudes such as NM Hadler, MD, who wrote in his appropriately named book, Stabbed in the Back: “I admit to chauvinism; I value my profession above all others,” and he brags “how its practitioners hear a higher calling.”[1]

His admission to “chauvinism” and a “higher calling” is evidence that Hadler makes no bones about his elitist attitude:

“Medicine has achieved so much in the past fifty years that it merits and commands a perch atop the contemporary pecking order of healers.”[2]

I suggest this “pecking order” has more to do with political skullduggery than healthcare efficiency considering America is currently in the throes of a healthcare crisis never before seen in the recorded history of the modern world. Obviously myopia is a side-effect of medical chauvinism.

Despite the important subject of his book, “confronting back pain in an overtreated society,” Hadler even admits being clueless about the cause of back pain: “…we still have no earthly idea what causes regional low back pain…” and suggests “…biomechanics has little if anything to do with the persistent neck pain...”[3]

Not only is he wrong on both counts, inexplicably, Hadler’s  comments in 2009 conflict with a 1987 study published in Spine, “A Benefit of Spinal Manipulation as Adjunctive Therapy for Acute Low-Back Pain: A Stratified Controlled Trial,” that he did with Peter Curtis, MB (Bachelor of Medicine), who performed osteopathic manipulation on half the study participants and mobilization on the other half.

Hadler admits in his original study those who were hurting for two to four weeks experienced a 50 percent reduction in score more rapidly with spinal manipulation. In the 1987 study, his conclusion praised the “major ramifications” of this improvement from manipulation:

“In view of the extraordinary prevalence of low-back pain and its pervasive impact in so many social spheres, the ability to abrogate an episode of backache, even by a few days, has major ramifications.”[4]

Despite the initial accolades in his summary statement for manipulation, twenty-two years later in his 2009 book Hadler mentions the same study, but now trivializes the same findings, “However, at best this is much ado about very little. Certainly, it is little reason to advocate a form of sectarian medicine.”[5]

Isn’t it odd to have two different conclusions drawn by the same man about the same study? Obviously medical politics supersedes scientific objectivity when he cannot give credit to those who do SMT such as chiropractors and true osteopaths.

While Dr. Hadler swells with medical pride, he fails to admit medical spine care today is a travesty. Even spine journal editor Mark Schoene admits “Spinal medicine in the US is a poster child for inefficient spine care” [6] and opines “such an important area of medicine has fallen to this level of dysfunction should be a national scandal. In fact, this situation is bringing the United States disrespect internationally.”[7]

The Origin of Medical Bigotry

Unlike the diffused origins of racism, sexism, or anti-Semitism, medical bigotry can be traced principally to one man, Morris Fishbein, MD, the executive director of the AMA from 1924 to 1949, aka the Medical Mussolini. He made no bones about his bullying when he wrote in 1925, “Scientific medicine absorbs from them that which is good, if there is any good, and then they die.”[8]

Sounds like the schoolyard bully who stole your lunch money and then beat you up, doesn’t it?

According to Harper’s Magazine, Fishbein set the autocratic tone when he transformed the AMA from a “panty waist” organization that promoted education and research into “the most terrifying trade association on earth.[9]

Chiropractic historian, Russell Gibbons, recognized the singular impact of Fishbein and concluded he was “the most important non-chiropractor to influence the chiropractic profession.”[10]

Due to Fishbein’s policy, during the first half of the 20th century, over 12,000 American chiropractors were prosecuted over 15,000 times, and some 3,300 were sent to jail for practicing medicine without a license.[11] Their real crime was, in fact, competing for patients.

After Fishbein’s departure, his genocide campaign against chiropractors continued with the AMA’s illegal Committee on Quackery that formally announced in 1962 its goal to “contain and eliminate chiropractic.”[12]

Instead of inter-professional cooperation to benefit patient care, the early medical bullies used the courts to prosecute chiropractors, lobbied the state legislatures to resist licensing of chiropractors, fought against chiropractic educational improvements, and paid members of the media such as nationally-syndicated columnist Ann Landers to disparage the reputations of chiropractors.

Such bullying continues today, consciously or not, in the board rooms of insurance companies, media organizations, NGO health foundations, and government health agencies that ignore chiropractic care in the national healthcare discussion to lower costs and improve outcomes.

What is the net result of this medical bullying today in America? Certainly the low-usage of chiropractic care is clearly an issue for chiropractors and it almost eliminated the most effective treatment for the majority of back problems.

As to the impact of this boycott on the economy, back pain has become the #1 disabling condition in the nation with total costs approaching $300 billion. And for patients, research estimates 90% of Americans will suffer from an acute back attack in their lifetime; 20% consider their back pain to be serious, crippling, or disabling.[13]

Medical National Scandal

Ironically, many experts now agree that this epidemic of back pain is a direct result of medical mismanagement of spine problems—misdiagnosis, mistreatment, and misinformation.

Ironically, while medical bullies defame chiropractors, medical spine care has now become a “national scandal” with the growing evidence in the media of opioid drug addiction, ineffective and dangerous epidural steroid injections, and spine surgeons “gone wild” doing hundreds of thousands of unnecessary fusions based on the debunked disc concept.[14]

Nor is this a new revelation. Since 1990 MRI research began to show that “bad discs” were found in pain-free people to the point researchers now chide disc abnormalities as “incidentalomas.”[15],[16] Researchers at Dartmouth in 2006 suggested nearly 40% of back surgeries were unnecessary, which explains the high rate of failed back surgeries.[17]

The official paradigm shift in spine care toward chiropractic care began in 1994 after an agency of the US Public Health Service deemed spinal manipulation a “proven treatment” for acute low back pain in adults.[18] This finding has been duplicated in many countries around the world also plagued by the crippling costs of back pain.

Pran Manga , PhD, health economist from Ontario, Canada, conducted two studies in the 1990s and noted, “There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.”[19] There is now broad agreement internationally that surgery should not generally be considered until there has been a trial of conservative non-surgical care.[20],[21],[22]

Rather than “bad discs”, today spine experts agree most back pain is “mechanical” in nature due to joint dysfunction and, considering the spine has over 300 joints, this explains why manipulation works well by restoring proper joint play.

The proof is positive and research studies cannot be clearer that chiropractic stands at the top of spinal treatments as Anthony Rosner, PhD, testified before The Institute of Medicine: “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.”[23]

After nearly a century of calling chiropractic an “unscientific cult,” now it appears the shoe is on the other foot of the medical bully. “Buyer Beware” of medical spine care should now be the warning to patients.

Time to Bow Our Backs

With the new wave of spine research falling in favor of chiropractic care considering virtually every guideline now recommends conservative care before medical spine care (excluding red flags of fractures, cancers, infections, or the one-in-100 disc cases as the AHCPR study found), it is past time for the chiropractic profession to throw its weight around in the school yard of evidence-based healthcare.

 Rather than being afraid of the medical bully in the playground, now is the time for DCs to stand up and defend our profession with the bully issue now so inflamed in the public’s consciousness. It’s past time to put this medical bully in his place and for chiropractors to lay claim as the primary spine care providers in the media.

Indeed, the medical bullies owe both the public and chiropractors a public apology. Freedom of choice for patients, the right to informed consent, and professional cooperation in the era of “best practices” should be the hallmarks of health care instead of medical bullying and segregation.

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

 



[1] Hadler, NM, Stabbed in the Back; confronting back pain in an overtreated society, University of North Carolina Press, 2009, pp. 64

[2] Ibid, pp. 56

[3] Ibid, pp. 58.

[4] NM Hadler, P Curtis, DB Gillings, S Stinnet, “A Benefit of Spinal Manipulation as Adjunctive Therapy for Acute Low-Back Pain: A Stratified Controlled Trial,” Spine  12/ 7 (1987): 705.

[5] Hadler, ibid, p. 70.

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

[7] US Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2012, pp.1

[8] M Fishbein,  Medical Follies, New York, Boni & Liveright, (1925): 43.

[9] MS Mayer, “The Rise and Fall of  Dr. Fishbein,” Harper’s Magazine, (Nov. 1949): p. 78.

[10] RW Gibbons, From Quacks To Colleagues?” Viewing the evolution of orthodox tolerance of deviant medical practice, Journal of Chiropractic Humanities 4/1 (1994):61-71.  

[11] RW Gibbons, “Go to Jail for Chiro,” Journal of Chiropractic Humanities 4 (1994): 61–71.

[12] G McAndrews, “Plaintiffs’ Summary of Proofs as an Aid to the Court,” Civil Action No. 76 C 3777, Wilk, (June 25, 1987):126. PX-188.

[13] The Burden of Musculoskeletal Diseases in the United States Bone and Joint Decade, Copyright © 2008 by the American Academy of Orthopaedic Surgeons. ISBN 978-0-89203-533-5, pp. 21.

[14] US Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2013, pp.1

[15] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans Of The Lumbar Spine In Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

[16] RA Deyo and DL Patrick, Hope or Hype:  The Obsession with Medical Advances and the High Cost of False Promises (2002):191.

[17] Elliott Fisher, MD, on the CBS Evening News, “Attacking Rising Health Costs,” June 9, 2006.

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

[19] P Manga and D Angus, “Enhanced Chiropractic Coverage Under OHIP As A Means Of Reducing Health Care Costs, Attaining Better Health Outcomes And Achieving Equitable Access To Select Health Services.” Working paper, University of Ottawa, 98-02.

[20] H Weber, “The Natural History Of Disc Herniation And The Influence Of Intervention, Spine 19 (1994):2234-2238.

[21] J Saal, “Natural History And Nonoperative Treatment Of Lumbar Disc Herniation, Spine 21(1996):2S-9S.

[22] F Postacchini, “Results of Surgery Compared With Conservative Management For Lumbar Disc Herniations, Spine 21(1996):1383-1387.

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


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