Articles by JCS

Science Friday Response

TO:                  Ira Flatow

Christie Taylor

Science Friday

19 West 44th Street, Suite 412

New York, NY 10036

               

FROM:       JC Smith, MA, DC

RE:           Science in the Crosshairs

Dear Ira:

As a regular listener to your show, on October 14th I was stunned to learn how politicians once again have stymied science with a new “witch hunt” against fetal research, Science in the Crosshairs. Just as we’ve witnessed with global warming and climate change, some politicians appear to have an antipathy to scientific evidence if it conflicts with their political ideology or lobbying interests.

Your introduction to this segment rhetorically asked: “Have you ever been harassed or intimidated because of your line of research?”

Let me respond to your question with an emphatic Yes!

We chiropractors have endured a medical witch hunt for over 115 years although the latest research has vindicated our struggle that chiropractic care is a “proven treatment” for the pandemic of low back pain, the #1 cause of disability in the nation.

Instead of opposition from Congress, most journalists understand chiropractors have fought the unelected 4th branch of government, the American Medical Association  (once called the “most terrifying trade association on earth” by Harper’s magazine[1]) whose stated goal was to “contain and eliminate” the chiropractic profession. Although not completely eliminated, the AMA did achieve its goal of containment, especially in the media.

As example, when have you seen an in-depth, fair and balanced discussion on the benefits chiropractors bring to an ailing society suffering not only from back pain but now from opioid addiction and failed back surgery? Like most, you never have.

Although the AMA was convicted in federal antitrust court in 1987,[2] the medical media continues to defame chiropractors such as now claiming chiropractors cause strokes and abuse infants; both allegations were shown to be hyperbolic and unsupported by research. The same “patient defense” strategy didn’t persuade the federal judge, but this unproven tactic continues today in the court of public opinion.

Nor do medical reporters care to report the paradigm shift in spine care 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.”[3]

As you can see, chiropractors have long been victimized by biased medical reporters, consequently the public remains in the dark about the benefits we bring to an ailing nation addicted to pain pills.

Medical Witch Hunt

If there is a whistle-blower among your journalists at Science Friday, let me explain why the untold story about chiropractic is worthy of an in-depth segment on your program.

Just as the witch hunt against the fetal researchers is abhorrent to science as your guests suggested, a case can be made the medical witch hunt against chiropractors has led to the current opioid pandemic considering 30% of opioid use is for chronic low back pain.[4]

As well, chiropractic care is now regarded as a proven nondrug treatment. An editorial in the Annals of Internal Medicine published jointly by the American College of Physicians and the American Society of Internal Medicine (1998) noted that “spinal manipulation is the treatment of choice”:

Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice. [5]

Perhaps the most surprising endorsement of chiropractic care came from the North American Spine Society. This society of spine surgeons developed its Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy[6] that admits spinal manipulation was found to be comparable to successful surgery:

Of patients with lumbar radiculopathy due to lumbar disc herniation, 60%  who  failed  three  months  of  medical  management  obtained  comparable  relief  to  those  patients  that  underwent successful surgery.  The authors concluded that of patients with sciatica that fail three months of medical management, 60% will benefit  from  spinal  manipulation  to  the  same  degree  as  if  they  undergo surgical intervention. For the 40% that are unsatisfied, surgery provides  an  excellent  outcome.    Although  this  study  is  a randomized controlled trial, it provides case series (Level IV) therapeutic  evidence  that  spinal  manipulation  is  beneficial  in  treating patients with lumbar disc herniation with radiculopathy.

When the NASS guideline touts SMT as effective as surgery, obviously there is a new day in spine care, but these recommendations have not stopped the tsunami of expensive and ineffective spine surgeries because medical reporters have never told their audiences.

National Scandal

Not only has the latest research endorsed spinal manipulation for the pandemic of back pain, it also has revealed medical spine care (opioids, epidural steroid injections, and spine fusion) are mostly unnecessary, terribly expensive, clinically ineffective, and scientifically outdated based on a debunked “bad disk” theory. Again, this new information eludes reporters in the mainstream medical media.

However, science journalists are aware of this scam. Mr. Mark Schoene, an international spine journal editor, has dubbed medical spine care the “poster child of inefficient care.” 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.”[7]

Richard Deyo, MD, MPH, professor at Oregon Health and Science University, openly admits that too many people are still getting risky and expensive back surgery when more minimal approaches would work.[8] Overuse of spine surgery is a huge reason why the nation’s health bill was so high. He concluded “More people are interested in getting on the gravy train than on stopping the gravy train.”[9]

Another major omission in the mainstream media is the “bad disc” premise has been debunked as the main cause of low back pain and the justification for disc fusion.

Back in 1990, Dr. Scott Boden, presently director of the Emory Spine Center in Atlanta, discovered “bad discs” in pain-free people.[10] Despite this 26-year old research, medical reporter Dr. Sanjay Gupta at CNN has never mentioned this historic finding to this audience. As fate would have it, Dr. Gupta works in the same department with Dr. Boden at Emory, suggesting he is very aware of Dr. Boden’s study.

In 2014, the Mayo Clinic did a systematic review of 33 studies that confirmed Boden’s seminal research debunking “bad discs” as the causative factor for back pain, suggesting bad discs were as commonplace as grey hair in the aging process. The following chart from the Mayo Review illustrates the ubiquitous nature of “bad disks” among pain-free people.

According to the Mayo Clinic Review:

“Our study suggests that imaging findings of degenerative changes such as disk degeneration, disc signal loss, disk height loss, disk protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention.”

Unfortunately, the naïve public is unaware “bad disks” are part of the normal aging process like grey hair because unethical surgeons often use “bad disks” as red herrings to mislead them into disc fusions. Obviously, this Mayo Review undermines the high rate of disc fusions in America as well as explains the poor outcomes from back surgeries.

Too Many, Too Costly, Too Ineffective

Research suggests of the 500,000-plus disk surgeries performed annually (a significant increase of late), as many as 90 percent are unnecessary and ineffective. Richard Deyo notes, "It seems implausible that the number of patients with the most complex spinal pathology [has] increased 15-fold in just six years" and mentions one strong motivation includes "financial incentives involving both surgeons and hospitals." [11]

 This “bad disc” premise for disc fusion is the biggest scam in medicine today that could have been avoided if well known medical reporters had done their journalistic diligence to inform viewing audiences of Dr. Boden’s seminal study and the recent Mayo Review.

As example of another study kept from public view, researcher JT Anderson, et al.[12] in 2015 published in the journal Spine the poor outcomes of disc fusion in two groups—spondylolisthesis (slippage of one vertebrae upon another) and degenerative disc disease (DDD).  

This study revealed rather pitiful success rates – only 36 percent for spondylolisthesis and 24 percent for DDD cases were able to return to work after two years of recovery. Conversely, this means nearly 2/3rds of the spondylolisthesis and 3/4ths of the DDD patients did not return to work by two years and most were still taking opioid painkillers.

The Anderson study concluded:

“Our study is support of the conclusion that DDD is a questionable indication for spinal fusion. Given the generally poor outcomes of this study, future studies should determine if lumbar fusion surgery is an effective treatment modality in similar patients.”[13]

Despite the poor outcomes and research debunking the very basis of disc fusions, people continue to be railroaded to the surgeons’ offices on a disproven premise rather than referred to nondrug, nonsurgical chiropractic care beforehand as the guidelines now recommended.

NPR: All Things Not Considered       

Research also found that your program, Science Friday, which I listen to regularly, and other NPR programs have been negligent reporting on the benefits of chiropractic care.

According to research aggregated by HighBeam Research, the frequency of chiropractic as a topic on NPR programs is strikingly scarce as of December 1, 2014:

  • “All Things Considered”:            8 of 123,063      =      0.0069 percent
  • “Morning Edition”:                     7 of 120,408      =      0.005 percent
  • “Science Friday”:                       0 of 2,791          =      0.0 percent
  • “Weekend ATC”:              0 of 6,471          =      0.0 percent
  • “Fresh Air”:                      2 of 4,196          =      0.047 percent
  • “Talk of the Nation”:                 2 of 11,846        =      0.0169 percent
  • “NPR Special”:                  0 of 15,378        =      0.0 percent                   

This accounting shows chiropractic was mentioned only 19 times in a whopping 284,153 segments on these seven NPR programs, a frequency rate of only 0.0063 percent.

Considering the chiropractic profession is the third-largest physician-level profession in the nation that offers a nondrug, nonsurgical care for the #1 disabling condition in the nation, workplace, military, and VA, doesn’t it appear odd of the lack of coverage the value my profession brings to our ailing nation?

      My point is obvious—political harassment has been part of our landscape for a long time, and it doesn’t come only from political foes in Congress. Although the fetal issue may make headlines because of the emotional controversy, I daresay the chiropractic boycott in the media will affect many more millions of people as collateral damage.

Initially your program asked, “Have you ever been harassed or intimidated because of your line of research?”

As you now know, the chiropractic profession remains the untold story of the medical war—the proverbial “elephant in the news room”—despite the recent research supporting our treatments over medical spine care.

So, let me ask when will my profession get a break on your program?

      I hope to hear your answer.

Regards,

JCS



[1] M Mayer, “The Rise and Fall of Dr. Fishbein,” Harper’s Magazine, 199/1194 (Nov. 1949):p. 76.

[2] Wilk et al v AMA et al., US District Court Northern District of Illinois, No.  76C3777, Susan Getzendanner, presiding judge; Judgment dated August 27, 1987.

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

[4] Denise Boudreau, PhD, Michael Von Korff, ScD, Carolyn M. Rutter, PhD, Kathleen Saunders, G. Thomas Ray, Mark D. Sullivan, MD, PhD, Cynthia Campbell, PhD, Joseph O. Merrill, MD, MPH, Michael J. Silverberg, PhD, MPH, Caleb Banta-Green, and Constance Weisner, DrPH, MSW. “Trends in De-facto Long-term Opioid Therapy for Chronic Non-Cancer Pain,” Pharmacoepidemiol Drug Saf. 2009 December; 18(12): 1166–1175. doi:10.1002/pds.1833.

[5] MS Micozz,  “Complementary Care: When Is It Appropriate? Who Will Provide It?” Annals of Internal Medicine 129/1  ( July 1998):65-66

[6] https://www.spine.org/Documents/ResearchClinicalCare/Guidelines/LumbarDiscHerniation.pdf

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

[8] J Silberner, “Surgery May Not Be The Answer To An Aching Back,” All Things Considered, National Public Radio, Melissa Block, host. (April 6, 2010)

[9] R Abelson, Financial Ties Are Cited as Issue in Spine Study, NY Times (January 30, 2008)

[10] 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.

[11] J Silberner, “Surgery May Not Be The Answer To An Aching Back,”  All Things Considered, NPR (April 6, 2010)

[12] Anderson, Joshua T. BS; Haas, Arnold R. BS, BA; Percy, Rick PhD; Woods, Stephen T. MD; Ahn, Uri M. MD; Ahn, Nicholas U. MD, Single-Level Lumbar Fusion for Degenerative Disc Disease Is Associated With Worse Outcomes Compared With Fusion for Spondylolisthesis in a Workers' Compensation Setting, Spine: 01 March 2015 - Volume 40 - Issue 5 - p 323–331

[13] http://journals.lww.com/spinejournal/Abstract/2015/03010/SingleLevelLumbarFusionforDegenerativeDisc.15.aspx

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