Articles by JCS

Response to Dr. Harvey

December 14, 2016

Response to Ken Harvey

Friends of Science in Medicine

Dear Dr. Harvey:

I was delighted to receive your response to my inquiry. I also enjoyed the links that you posted that I assume were to support your Skeptical position although, I must say, they actually suggested the fact that “modern medicine” is in worst shape than I imagined.

 As Ms. Sile Lane mentioned in the TED-x Talk video link you supplied, she revealed half of all medications are not tested as well as the culture of secrecy that keeps this information from the public.

Aside from her points, let me remark on your comments that I found without merit and offensive:

In short, I’m equally skeptical about aspects of mainstream medicine as I am about complementary and alternative medicine. However, mainstream medicine, despite its faults, has a track record of significant achievements in advancing health. The same cannot be said of complementary and alternative medicine (nor Chiropractic).”

What metrics have you used to come to your conclusion stating CAM providers have no “track record of significant achievements in advancing health”?

By advancing health do you mean helping patients get well or do you mean the commercial side of medicine with the production of more drugs, devices, and surgery?

I agree the medical profession has many accomplishments, it also has many follies. Most of all, political medicine is notorious as the bully in healthcare. Why does your profession feel compelled to deny freedom of expression to different schools of thought?

You must be aware that medicine is not an exact science; while it borrows scientific methods to research and practice, at best medicine is an applied science and not an exact science.

Certainly every profession has a different calculus to offer the public, but the Skeptics act as if they alone have the sole key to healthcare although they certainly own the bank. Your authoritarian policies have not advanced the pursuit of knowledge; instead it appears more like a Medical Inquisition.

Today the millions of patients who use chiropractic care would wholeheartedly disagree with your assessment. As Ms. Lane suggests, people realize taking medications is risky business as are many surgeries, so they turn to alternatives for care.

Indeed, the “pill for every ill” mindset has led to deplorable outcomes here in the U.S. that faces record mortality rates with over 47,055 overdose deaths reported by the CDC in 2014, which equates overall to 128 deaths each day of which 78 are attributed to opioid prescription painkillers and opiate street heroin.[1]

One obvious achievement of chiropractors that irks the medical industrial complex has been to reduce the need for opioid painkillers and surgery for the pandemic of back pain, the most lucrative market in medical care.

Growing CAM

The Skeptics also fail to realize Americans made more visits to CAM providers than to MDs according to Dr. David Eisenberg from Harvard’s Osher Institute who found in his study, “Trends in CAM and integrative therapies,” in 1990 Americans made more office visits to non-MDs than they did to their medical doctors. In fact, this trend to alternative health care had increased by more than 50% in a seven-year span to the astronomical number of 629 million visits compared to only 386 million to MDs. [2]

Upon seeing the huge number of Americans using CAM practitioners, Dr. Eisenberg concluded, “Maybe ‘alternative’ isn’t so alternative anymore.”[3]

The expanding role of CAM is also happening Down Under:

As you can see, Dr. Harvey, the widespread use of CAM Down Under and worldwide is quite an achievement despite your lack of acknowledgment and active role to stop this growth.

 Keep in mind the advancement of chiropractic care is similar to a guerilla effort with incremental gains in the medical war against chiropractors. The fact that chiropractors have risen to the third-largest physician-level profession in the world despite the medical war to “eliminate” it is tribute to the perseverance and effectiveness of this profession.

I daresay if my profession had the funding, facilities, and influence over the media as the medical profession, we would see greater strides in public utilization and understanding how chiropractors can help in the back pain epidemic as well as greater insight into the neurophysiology of health and disease, a concept well beyond the grasp of allopaths.

Fake News

Let me address the key to your Skeptical attack on Dr. Ian Rossborough. It’s one thing to be skeptical when you’re unaware of the research, but it’s another to be wrong and mean-spirited.

First of all, you have to admit this was a successful case without any harm to the child, a point lost in the media frenzy to assault this innocent chiropractor solely because the video of him adjusting a crying baby “looked bad.”

But tell me, Dr. Harvey, if a crying baby is enough to indict practitioners, I daresay many medical pediatricians and dentists would be in jail for the plethora of children crying in their offices.

If safety is the real issue of concern, the Skeptics and its news media partners should have turned their attention to the actual problems caused to infants born by forceps delivery, which is one reason why infants need chiropractic care to correct the spinal misalignments caused by these traumatic births.

If the truth be known, Dr. Harvey, your medical Skeptics have chosen the wrong witch to hunt. The inflammatory news articles about Dr. Rossborough repeatedly quoted 3 medical curmudgeons, Drs. Cunningham, Pappas and Jones, who scared the public about a supposed “cruel process” that brought “tears to his eyes,” illustrating yellow journalism that was long on emotions but short on facts.

Indeed, no where in the many news articles were the above-mentioned research studies mentioned nor were there fair and balanced quotes by anyone familiar with pediatric chiropractic care; instead the yellow journalists focused solely on the emotions stirred by  one crying baby who was helped by Dr. Rossborough and the rude comments of three medical curmudgeons.

The first clue of this witch hunt began in the introduction of an interview: Baby cracking chiropractor flounders, published on May 3, 2016, by Studio 10 hosted by Anne Blake:

“Interview with Melbourne chiropractor Ian Rossborough about the promotional video in which he claimed to treat a four day old baby for "colic" by administering a painful crack to the lower back. The loud crack and the baby's screams have caused widespread outrage and led to calls for the banning of chiropractic ‘therapy.’"

This misrepresentation of the nature of an adjustment—“a painful crack”—typified the rest of the articles that went viral. The media spin of “widespread outrage and led to calls for the banning of chiropractic ‘therapy’" came not from the public but from the journalist fanning the flames of yellow journalism.

Not only did she provoke an unwarranted stigma about the safety of chiropractic care, it was also an example of the lowest form of investigative journalism, what has now become known as “fake news” – a combination of real news mixed with lies and distortions – that often leads to the making of a smear campaign that goes viral.

The growing use of fake news is not only unethical, hurtful, and misleading, but also immoral according to a good authority, Pope Francis, who spoke of this issue on December 7, 2016. “Nobody has a right to do this. It is a sin and it is harmful.”[4]

The Pope criticized the media’s tendency to present only half a story while ignoring the rest, which he called “disinformation.” Considering the positive aspect of pediatric chiropractic care was never mentioned by Anne Blake or her colleagues, the disinformation quickly became an urban legend Down Under.

 “Disinformation is probably the greatest damage that the media can do" by creating scandal-mongering and smear campaigns just as we witnessed in the infantile colic reports. In her quest for ratings, Anne Blake was willing to ruin the reputation of Dr. Rossborough on baseless accusations.

“The communications media can be tempted to slander, and then use slander to smear people,” the Pope said, adding that this can turn into a form of “defamation.” This is exactly the modus operandi we witnessed Down Under. Indeed, is there no shame?

Scientific Quibbling

Dr. Harvey, you also dismissed the evidence I mentioned supporting chiropractic care for colic by stating “the results did not reach statistical significance.”

In your letter to me you quibbled over the research bias:

“…the 2012 paper by Miller was not a double-blind trial and the Cochrane review (which included Miller as a co-author) noted that most reviewed studies had a high risk of performance bias since the assessors (parents) were not blind to who had received the intervention.”

It’s alarming how quickly you dismissed these studies. In fact, the “high risk of performance bias” you suggest is not an accurate assessment as foreseen by the authors:

CONCLUSIONS:

In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.[5]

Despite your quibbling over these studies on infantile colic, the facts remain there is sufficient evidence to warrant chiropractic care for colicky babies and, furthermore, don’t forget Dr. Rossborough’s infant patient was helped, not hurt, a huge point omitted in the witch hunt against him.

 You also included a link to the Australian Chiropractic Board that posted:
          Advertising regulated health services

Inappropriate claims of benefit

Patients must be adequately informed when making health care choices. Advertisers must ensure that any statements and claims made in relation to chiropractic care are not false, misleading or deceptive or create an unreasonable expectation of beneficial treatment.

 “The statement is squarely directed at practitioners who are not toeing the line. Our position is unequivocal – false and misleading advertising is unacceptable,” said Dr Wayne Minter AM, Chair of the Chiropractic Board of Australia.

In fact, the supportive research I mentioned cannot be considered as “inappropriate claims of benefit” or “false, misleading or deceptive.” The fact remains pediatric chiropractic may very likely help many infants according to the research.

Secondly, the parents were adequately informed when they sought chiropractic care considering medical care offered no help or hope – “she’ll outgrow it” is the common medical advice to suffering and sleepless parents.

It appears the board simply does not want any type of care except for musculoskeletal disorders in adults despite the research showing some childhood conditions are helped. Indeed, throwing Dr. Rossborough under the bus was clearly a dereliction of duty by the board.

The board’s staunch position contradicts the position of the authors of “Best Practices for Chiropractic Care of Children: A Consensus Update,” by Cheryl Hawk, DC, PhD, Michael J. Schneider, DC, PhD, Sharon Vallone, DC, Elise G. Hewitt, DC:

Chiropractic Management of Pediatric Patients

Chiropractic management of the child should follow the 3 basic principles of evidence-based practice, which are to make clinical judgments based on the use of (1) the best available evidence combined with (2) the clinician’s experience and (3) the patient’s preferences. The research community has just begun to investigate the effectiveness of chiropractic care for many pediatric conditions; however, lack of research evidence does not imply ineffectiveness. Evidence-based practice is the integration of clinical expertise and patient values with the best available research evidence.[6]

Internationally, chiropractic is frequently used by children.5,6,7,8,9,10,11 Chiropractic care for children is most often sought for treatment of musculoskeletal conditions, except in the case of infants, where infantile colic is one of the more common presenting complaints.5,9 

In the United States, parents also frequently seek chiropractic care for their children for “wellness care”; and it has been found, that in general, children with a decreased health-related quality of life have a higher utilization of complementary and integrative medicine.8,12 However, the scientific evidence for the effectiveness and efficacy of chiropractic care and spinal manipulation for treatment of children is not plentiful or definitive.13,14,15

The principles developed by Dr. David Sacket, the father of evidence-based medicine, in his study, “Evidence based medicine: what it is and what it isn't,” was also mentioned in the Hawk, et al. study above.

The 3 criterions according to Dr. Sacket can easily be applied in this pediatric chiropractor’s case: (1) use the “best available evidence” from the supportive research studies on infantile colic combined with (2) the chiropractor’s vast experience in pediatrics, and (3) the parents’ informed choice.

Certainly this evidence meets the board’s demand not to “create an unreasonable expectation of beneficial treatment” for pediatric chiropractic care for colic.

If it does not meet the board’s standards, Dr. Harvey, then please tell me what more is required?

If it does meet them, then explain why he was crucified in the press and by the board’s sanctions against him for his victim-less non-crime?

Double Standard

If all medical practitioners are required to reach this high bar of evidence-based medicine before any health care is rendered, then please explain to me how the “off-label” use of medications can be deemed permissible?

Not only are half of meds unproven as Sile Lane mentioned, most drugs are also used “off-label” as discussed by Web MD[7]:

The next time your doctor writes you a prescription, consider this: The medication may not be approved for your specific condition or age group.

But you probably shouldn't call the medical board. The practice, called "off-label" prescribing, is entirely legal and very common. More than one in five outpatient prescriptions written in the U.S. are for off-label therapies.

G. Caleb Alexander, MD, MS, a medical ethics advocate and assistant professor of medicine at the University of Chicago Medical Center. "Off-label use is so common that virtually every drug is used off-lable in some circumstances."

In her TED-x Talk Ms. Sile Lane mentioned the “hidden side of clinical trials” and the secrecy surrounding these medications that are not tested. Yet I have not heard this issue of secrecy being criticized by the Skeptics who seem to turn a blind eye to their own unscientific practices.

If “public safety” is your Skeptical mantra, why the resistance to inform the public of this danger of “off label” meds? As the chiropractic board demands, aren’t these patients given “an unreasonable expectation of beneficial treatment”?

Please explain to me why this experimentation on patients with drugs never tested or approved is legal?

Nor did I hear you, the boards or the mainstream media sound an alarm about patient safety in 2013 when the BMJ published on its website, Clinical Evidence, another article suggesting 2,000 of 3,000 medical treatments were ineffective, unproven or too dangerous to use.[8]

Once again, your group of Skeptics seem blinded and become mute when their own methods are indicted by the prestigious British Medical Journal.

I also did not hear the board warned the public in 2016 when the BMJ revealed medical care is the third-leading cause of death in the United States (and undoubtedly in Australia to a lesser degree) in the range of 251,000 victims per year (that the authors admit is a conservative estimate), which equates to nearly 700 deaths per day due to medical mistakes by physicians or hospital staff members.[9]

Obviously there seems to be a double standard in your role as a medical sleuth, Dr. Harvey, considering we see many ineffective, dangerous, and unproven medical methods still in use, but not one MD has been character-assassinated in the media for using them or sanctioned by the medical board in its witch hunt to insure patient safety.

National Scandal

Nor have we heard the Skeptical guardians of the public health tout the rising chorus of criticism about medical spine care that grows louder, even in your own country.

You have ignored a related online article published by the MJA InSight newsletter on April 26, 2016, “Spinal Fusion Surgeries Questioned,” that was painfully clear the need to stop the tsunami of back surgeries is urgent:

“Spinal fusion surgeries for chronic low back pain are on the rise, despite the lack of research to back their efficacy, and experts are now calling for tighter guidelines, including a waiting period.”

Although you mentioned in your rebuttal to me that you recommend your students should read Dr. Ian Harris’s book, “Surgery, the Ultimate Placebo,” why didn’t the Skeptics jump on this issue to promote the year-long waiting period that was recommended before spine surgery?

Aside from the critical comments by Dr. Harris and this MJA exposé, there is a preponderance of evidence that many spine surgeries are unnecessary, disabling and often lead to opioid dependence, yet this huge issue did not go viral across your country as did the pediatric chiropractic incident because no one in the media or groups like your Skeptics were fanning the flames of mass hysteria with fake news about this massive spine surgery scam.

Undoubtedly there are many more victims of medical spine care, opioid abuse, and botched back surgeries than infants hurt by chiropractors, so why no outcry?

Apparently unknown to your Skeptical members and the media, a case has already been made that medical spine care consisting of opioid painkillers, epidural steroid injections, and disc fusion surgery is the “poster child” of inefficient spine care as noted by Mark Schoene, the editor of a prominent international spine research journal, The BackLetter.

He also warns that “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.”[10]

Apparently back surgeries are also the bane Down Under considering the MJA’s article calling for a year-long waiting period. Yet, why hasn’t the Skeptics echoed this national scandal in the media to expose these knife-happy spine surgeons profiteering off the backs of naïve patients?

Numerous researchers have been alarmed at many medical spine treatments ranging from “promiscuous prescribers” at pain management clinics dolling out opioids like Halloween candy, “needle jockeys”[11] rendering epidural steroid injections never approved by the FDA and, of course, “spine surgeons gone wild” that now constitute the leading expense with the poorest outcomes while chiropractic care is comparatively rated among the best in clinical and cost-effectiveness with higher levels of patient satisfaction.[12],[13],[14],[15]  

Why have your Skeptics avoided this issue since low back and neck pain top the list of disabling conditions worldwide[16] – outranking heart disease, cancer, diabetes and obesity in sheer numbers of patients?[17] However, people remain unaware of the enormity of this back pain problem distracted by fake news such as we’ve seen in the crying baby fiasco.

Instead, your Skeptics have ganged up on one hapless chiropractor who caused no harm to an infant while they ignore the largest segment of medical care that has created this “national scandal” of drug abuse and ineffective back surgeries “despite the lack of research to back their efficacy” according to the MJA itself.

Skeptics & Medical Chauvinism

Perhaps at the heart of this issue is not really a science-based debate as much as an eminence-based issue. Obviously many MDs share Dr. Harvey’s chauvinism because this medical supremacy attitude seems to be ingrained into many MDs.

Rarely have we seen a ‘fair and balanced’ approach toward chiropractic care as Dr. Richard Deyo attempted with his book, “WATCH YOUR BACK! How the Back Pain Industry is Costing Us More and Giving Us Less.” My kudos to one honest MD.

Instead of honesty, most often we see drivel such as “Stabbed in the Back” by Dr. NM Hadler that literally stabbed chiropractors in the back with a slew of snide remarks unsupported by facts. Similar to Dr. Harvey, Dr. Hadler offers just enough criticism of medical spine methods to appear objective, but many of Hadler’s comments are clearly biased as he confesses:

“I admit to chauvinism; I value my profession above all others to the extent that it tests the limits of certainly regarding the validity of its therapeutic offerings. I write extensively on how the institution of contemporary medicine has lost its way, but I also write extensively on how its practitioners hear a higher calling.” (p.64.)

        I daresay the same chauvinism has infected Dr. Harvey and his Skeptic colleagues who have convinced themselves of their own “higher calling” from their medical pedestal as self-appointed watchdogs of healthcare although they consistently overlook the failings of their own medical profession.

Although many MDs believe in their “higher calling,” the evidence shows they certainly have not taken the high road in their dirty tricks to sabotage their competition.

Here in the US, we’ve seen this before in the 1960s when the Committee on Quackery imposed its self-serving goal to prosecute anyone under the guise of “public safety” who practiced differently than allopaths when, indeed, it was actually their PR tactic of antitrust activity to defame and eliminate competition.

Judge Susan Getzendanner later admitted in a 1991 interview that the medical war was primarily a turf battle about money, not about safety. "Absolutely," she confessed. "Chiropractors compete with doctors. There's no question about it: it's basic competition."[18]

Mr. George McAndrews, lead attorney for the plaintiff-chiropractors in the Wilk v. AMA antitrust lawsuit, spoke of the medical conundrum in his article, “When the Texas Medical Association Looks for Quacks, It Should Search Its Own House”:[19]

The issue simply is that the AMA has in the past, and will in the future, continue to be one of the major causes of, not solutions for, the health care crisis in America. By its power and influence, the AMA has managed to "contain and eliminate" lower-cost and more effective health care providers from offering services that would impact the AMA directly as competition in health care delivery.

He likened the motive of the AMA was “no more interested in ‘patient safety’ by eliminating chiropractic than the tobacco companies were interested in people's health by selling cigarettes. The AMA, we now know, is interested in one thing: a monopoly over all health care delivery. I could list the many social programs the AMA has been opposed to, but suffice it to say, its goals are not lofty, its intent is not honorable and its methodology is not laudable.

“But most revolting and inexcusable, they are covering up the lack of training and skill of medical physicians in areas where their own studies show that chiropractic excels; and while doing so, contribute to the pain, suffering, unnecessary surgery and drug addiction/dependency of millions of patients.

“As you can undoubtedly see, I am extremely troubled at the AMA and its affiliates, who have for decades enjoyed a privileged class, akin to the fourth branch of government. What’s more, they have contributed to the escalating cost of health care delivery by their monopoly on the marketplace, and have subverted every attempt to reform the system.”

With the plethora of information published by the British Medical Journal, the Medical Journal of Australia, and The BackLetter, I agree with Mr. McAndrews these medical curmudgeons ought to clean up their own house before they throw stones at others, but no one expects these medical haters to play fair — it’s just not part of their “higher calling.”

It’s past time for the Skeptics Down Under to end their charade as caretakers of public safety, which is the role of state governments, and come clean to the public what they really are — members of a propaganda society whose “goals are not lofty, its intent is not honorable and its methodology is not laudable.”



[1] Drug overdose deaths hit record numbers in 2014, CDC Newsroom Releases,  December 18, 2015

[2] DM Eisenberg, RC Kessler, C Foster, FE Norlock, DR Calkins, TL Delbanco, “Unconventional  Medicine In The United States -- Prevalence, Costs, And Patterns Of Use,” N Engl J Med 328 (1993):246-252.

[3] DM Eisenberg, RC Kessler, C Foster, FE Norlock, DR Calkins, TL Delbanco, “Unconventional  Medicine In The United States--Prevalence, Costs, And Patterns Of Use,” N Engl J Med 328 (1993):246-252

[4] Mahita Gajanan, Pope Francis Warns Media Against Scandal-Mongering, time.com 12-8-2016

[5] J Manipulative Physiol Ther. 2012 Oct;35(8):600-7. doi: 10.1016/j.jmpt.2012.09.010.

Miller JE1, Newell DBolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. JMPT.

[6] Sackett, DL, Rosenberg, WM, Gray, JA, Haynes, RB, and Richardson, WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996; 312: 71–72

[8] http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

[10] U.S. Spine Care System in a State of Continuing Decline?, the BackLetter, vol. 28, No. 10, 2012, pp.1

[11] http://chiropractorsforfairjournalism.com/Needle_Jockeys.html

[12] Thomas M. Kosloff, DC, David Elton, DC, Stephanie A. Shulman, DVM, MPH, Janice L. Clarke, RN, Alexis Skoufalos, EdD, and Amanda Solis, MS, Conservative Spine Care: Opportunities to Improve the Quality and Value of Care, Popul Health Manag. Dec 1, 2013; 16(6): 390–396.

[13] Manga P, et al. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Ontario Ministry of Health, 1993.

[14] Richard L. Sarnat, MD, James Winterstein, DC, Jerrilyn A. Cambron, DC, PhD, Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update, JMPT, Volume 30, Issue 4, Pages 263-269 (May 2007)

[15] Davis MA, Yakusheva O, Gottlieb DJ, Bynum JP. Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain.”J Am Board Fam Med. 2015 Jul-Aug;28(4):481-90. doi: 10.3122/jabfm.2015.04.150005.

[16] Vox T et al, Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015, Lancet, 2016; 388:1545-602.

[17] Bigos et al. U.S. 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): p. 90.

[18] Bryan Miller, Chiropractors vs. AMA, Chicago Reader ,June 27, 1991

[19] George McAndrews, Esq, When the Texas Medical Association Looks for Quacks, It Should Search Its Own House, Dynamic Chiropractic – April 1, 2014, Vol. 32, Issue 07  

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