Articles by JCS

Tainted Image

Tainted Image

The Mystery Science Profession

By

JCS

How can so many people be unaware of the chiropractic profession when it’s the third largest healthcare profession in the world, the largest of the alternative/complementary health professions in North America, and used by more than 50+ million Americans each year?[1]

To understand why you don’t know very much about my mystery science profession, one must understand the history of the medical vs. chiropractic warfare, an issue most people could care less about. But the impact upon Americans’ health is a direct function of this messy professional warfare; indeed, you may be a victim of it if you’ve had an ineffective back surgery that probably wasn’t necessary at all.

Considering up to 90% of all adults will suffer from an acute low back attack, and the average person will have 6 or 7 episodes in his lifetime, or that there are over 200 treatments for low back pain (most of which are unproven), and that back treatment costs are in the $90+ billion range, or that the direct costs are astronomical:

  • a lumbar fusion can cost as high as $169,000,
  • lumbar laminectomy: $82,614,
  • cervical laminectomy: $60,304, and
  • cervical fusion: $112,480. ([2])

Text Box: Richard Deyo, MD, MPH Not only are spine surgeries costly, they are also ineffective. Little are patients told beforehand that nearly 20% of back surgery patients will need re-operations and that 71% to 95% of lumbar fusion patients will never return to work.[3] The public and press remain ignorant of this situation or that up to 90% of these surgeries are now deemed unnecessary.[4] The medical profession doesn’t want this cat let out of the bag; it just makes too much money to be forthcoming.

Medical bias continues today that ignores the opinions of the back experts like Richard Deyo, MD, MPH, University of Washington Medical School. Deyo has written many articles dealing with the ineffectiveness of spinal surgeries, especially spinal fusions.

Dr. Deyo suggests spine fusions are based on “old concepts supported only by weak evidence” and the reliance on MRI exams to infer disc abnormalities as the universal cause of back pain. This is the medical scam that has forced many unsuspecting patients into unsuccessful spine surgery despite the fact that spine surgeons are well aware of this fallacy.

In The New England Journal of Medicine, he debunks the disc theory that often leads to a “false positive” misdiagnosis:

“Early or frequent use of these tests [CT and MRI] is discouraged, however, because disc and other abnormalities are common among asymptomatic adults. Degenerated, bulging, and herniated disks are frequently incidental findings, even among patients with low back pain, and may be misleading. Detecting a herniated disk on an imaging test therefore proves only one thing conclusively: the patient has a herniated disk.”[5]

Dr. Deyo mentions in the NEJM article that chiropractic is a popular solution, but seems hesitant to tell the popular press the same.

“Chiropractic is the most common choice, and evidence accumulates that spinal manipulation may indeed be an effective short-term pain remedy for patients with recent back problems.”[6]

In 1994, the US Public Health Service’s Clinical Practice Guideline on Acute Low Back Pain in Adults also was critical of spine fusions:

"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.”[7]

 Many medical researchers have noted this epidemic of failed back surgery with very poignant comments. Dr. Gordon Waddell mentions that the high disability rate is actually caused by medical methods and admits that chiropractic care is effective:

 “Sadly, we must conclude that much low back disability is iatrogenic [doctor-caused]…It [back surgery] has been accused of leaving more tragic human wreckage in its wake than any other operation in history…There is now considerable evidence that manipulation can be an effective method of providing symptomatic relief for some patients with acute LBP.”[8]

In a keynote address at the first meeting of the Primary Care Forum for Low Back Pain Research in Seattle, Washington, in 1995, Scottish researcher Gordon Waddell, MD, mentioned “Worse, patients with simple backache may receive inappropriate and even harmful investigations and treatment designed for different problems. The relative balance of these difficulties varies in each health care system.” [9]

This is a major problem in the United States, where individuals with back pain seek primary care from any number of professions: family medicine doctors and internists, chiropractors, osteopaths, orthopedists, neurologists, neurosurgeons, rheumatologists, physical therapists, occupational physicians, massage therapists, acupuncturists, and various combinations of these and other professions.

And by most accounts, members of these professions aren’t consistent in the way they evaluate and treat back pain, in the information they give to patients, or the expectations they encourage. According to the editors of The BACK Letter, “If a group of world-class experts were to sit down at a table and try to design an ideal health care system for low back pain in the United States, it would probably bear no resemblance to the current crazy quilt of institutions, services, and professions. And that is an unsettling thought.”[10]

This difficulty begins with the AMA that has not been honest about the ineffectiveness and high cost of back surgeries, nor has it been truthful about value of the chiropractic profession. Instead of admitting chiropractic treatment is effective which will be discussed at length later, the AMA has fought to discredit and deter better solutions even when its own researchers suggest a change is needed. This campaign to shame chiropractors and to deny patients CAM treatments that work better than medical care is unconscionable, but well documented. Indeed, sometimes it’s hard being green.

The Medical Boycott & the Forgotten Antitrust Trial

Undoubtedly the foremost reason why some Americans remain skeptical of chiropractors stems from a lengthy, systematic and illegal boycott by the AMA that began officially in 1963 and only ended after two antitrust lawsuits begun in 1976 found the AMA guilty in 1987. The AMA petitioned the U.S. Supreme Court three times, but was denied each time and finally ended in 1990.

The goal of the AMA was not only found illegal, it was reminiscent of German fascists in WWII. This case was not just an antitrust case where one competitor tried to eliminate another; it was a clash of cultural might by the AMA to destroy the image as well as the chiropractic profession itself. The similarity is frightening.

The AMA’s Committee on Quackery established by its Board of Trustees for the sole purpose "to study the chiropractic problem” and whose prime mission was “to be, first, the containment of Chiropractic and, ultimately, the elimination of Chiropractic.” The AMA referred to chiropractors as “killers and rabid dogs,” and conspired with the ARA, AHA, and other medical associations to eventually “see them wither on the vine.” Sounds eerily reminiscent of Nazi Germany in tone, doesn’t it?

Little does the public recall that ethical MDs who referred to DCs were threatened with the loss of licensure and ostracized by the medical fraternity for consulting with “cultists and quacks.” If chiropractors were asked to join the Rotary Club, for example, MDs were forced to quit for fear of associating with quacks; hence, chiropractors were rarely asked to join most civic clubs. To this day many ethical MDs still live in fear of retribution if they refer cases to chiropractors.

An example of the AMA's propaganda campaign against chiropractors included the clout of columnist Ann Landers, who ridicule the practice in exchange for favors from the AMA, including a paid vacation to China. In a court deposition, Landers acknowledged she had been a paid delegate to the AMA to write “goofus feather” articles where Landers referred to the profession as such, supporting the AMA's condemnation of chiropractic as an “unscientific cult.” When confronted by intelligent rebuttals to her columns, she often recruited the help of the AMA to write responses under her byline.

Also in the early 1970s, Consumer Reports 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. According to Dr. Richard H Tyler, associate editor of a leading chiropractic publication, “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, only the Neanderthal scribbling of some "old time" chiropractic cretins, which only further emphasized the propriety of their stand to the public. So much for unbiased reporting -- they had been bought.”[11]

The public’s skewed perception of the chiropractic profession included ugly tactics by the AMA to thwart chiropractic education by pressuring school counselors from recommending chiropractic as a career as well as threatening colleges that offered pre-chiropractic courses. No stone was left unturned by the AMA’s goon squad to hurt the chiropractic profession.

This discrimination was obvious and had to come to an end, so in October 1976, led by Chicago attorney George McAndrews, plaintiffs Chester A. Wilk, James W. Bryden, Patricia A. Arthur, and Michael D. Pedigo, all licensed chiropractors, filed an antitrust suit against the AMA in the Northern District Court of Illinois. Few today remember after 11 years of legal wrangling on September 25, 1987, Judge Getzendanner issued her opinion that the AMA had violated Section 1 of the Sherman Act.[12]

The Seventh Circuit Court upheld the ruling by U.S. District Court Judge Susan Getzendanner that the AMA had engaged in a "lengthy, systematic, successful and unlawful boycott" designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic as a competitor in the U.S. health care system.

Among the many witnesses, Dr. John C. Wilson, former Director of the American Academy of Orthopedic Surgery, demonstrated during his own testimony to the medical bias that lies at the center of this professional boycott. The crux of the chiropractic treatment that the medical profession decried is spinal manipulative therapy (SMT). Simply, there are 137 joints in the human spine and when these joints are twisted, wrenched, compressed or whiplashed, this joint dysfunction is the main source of pain and SMT is the best treatment to restore proper joint motion. In other words, you don’t slip discs as much as you slip joints.

Below is a sample of the medical bias from a deposition by the chiropractors-plaintiffs’ attorney George McAndrews of Dr. Wilson, who testified as follows:

 

Q:            Is it possible to manually move a spinal joint through a range of motion?

A:             I simply cannot answer your question in that context.

Q:            Can you answer the question in any context including your own?

A:        No, because this is not a frame of reference in which medical doctors think, and we don’t relate to turning spinal joints around through manipulation.  That is the chiropractic concept, and we don’t understand it.  We don’t relate to it.  We don’t know what you are talking about.

     Q:        Have you ever done any research into that?

A:        No.  And I don’t have any desire to do any research into that or any other cult.

Q:        I am not really talking about cults now.  I am talking about the manual manipulation of spinal joints.

A:        No.  I have no interest in or desire to pursue the manipulation of spinal joints as a theory.

     Q:        Why?

A:        Because I don’t believe in this kind of thing.  I don’t know of any scientific basis that would cause me to pursue this as a way to help people.

 

By his own admission, Dr. Wilson basically admits his ignorance of the concept of manual manipulation of the spine, yet he has the gall to condemn it as unworthy of his investigation. Sadly, this insular attitude remains evident today despite the increasing evidence that manipulative care for spinal problems is as effective if not more effective as anything the medical world has to offer.

In effect, Dr. Wilson is saying, “Don’t confuse me with the facts,” yet he considers himself to be scientific minded or, I should say, close-minded.

Ironically, further testimony by Dr. John McMillan Mennell, another orthopedist and professor, enlightened the court of the value of spinal manipulation in his testimony at the Wilk trial:

“Eight out of 10 patients that come out of any doctor’s office complain of a musculoskeletal system problem regardless of from what system the pain is coming…I will say 100% of those complaints, which are, in fact, due to joint dysfunction in the musculoskeletal.

“The science of mechanics demands that joint play movement is prerequisite to normal pain-free functioning of movement …in the spine there are about 137 synovial joints between the lamina facets, the occipital condyles, the bottom of the skull as it rests on the atlas, the sacroiliac joints, the sacrococcygeal joints, the z-joints, even the joints of the fundusca in the neck.

“When you are dealing with manipulative therapy in the spine…your objective is to try to restore the proper motion joint play, which is prerequisite to the normal function in the spine…If you don’t manipulate to relieve the symptoms from this condition of joint dysfunction, then you are depriving the patient of the one thing that is likely to relieve them of their suffering.”

In fact, when asked about the medical training for musculoskeletal disorders (MSDs), Dr.  Mennell swore under oath: “Zero to about four hours.”

The court also heard incriminating testimony that the AMA committee was aware that

  • some medical physicians believed chiropractic could be effective,
  • graduates from many medical schools failed to demonstrate basic competency on a validated examination of fundamental concepts of musculoskeletal care, and
  • the court found that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.

The judge commented that often it appeared the AMA’s own witnesses were testifying in behalf of the plaintiff-chiropractors.

The district court found the AMA’s purpose was to prevent medical physicians from referring patients to chiropractors and from accepting referrals of patients from chiropractors, so as to prevent chiropractors from obtaining access to hospital diagnostic services and membership on hospital medical staffs, to prevent medical physicians from teaching at chiropractic colleges or engaging in any joint research, and to prevent any cooperation between the two groups in the delivery of health care services.

The Court ordered a permanent injunction order against the AMA due to “lingering effects of the illegal boycott and conspiracy;” “injury to chiropractors’ reputations,” and “economic injury as a result of the boycott.”

Mr. McAndrews blamed the AMA for what he termed a “bastardization of ethics” in its historic attitude toward chiropractic and he said that some ethical problems in the chiropractic profession have been caused by the AMA driving chiropractic into a “ghetto,” isolated from the health care mainstream.

Despite this lengthy antitrust trial that exposed the greedy underbelly of political medicine—its vicious goon squad with fascist attitudes, the glaring lack of expertise of MDs for back problems, and the damage done to both chiropractors’ image and income as well as to the public’s health—very little was said afterwards in the media of this landmark legal ruling that would have explained why chiropractors were tortured by poor and lingering public image at the hands of medical propagandists.

Although the chiropractic profession believed the antitrust case would be a breakthrough moment for our professional image, repair the damage to medical-chiropractic relationships, and foster integration of DCs into the medical mainstream, the sad fact this landmark decision went without much fanfare and actually stiffen the medical opposition.

While the court gave the AMA a slap on the hand, no one went to jail, no public apology of size was told to the public. The AMA simply wrote a professional apology to its own members in its own publications to state it was now ethical to associate with DCs, but no real public apology ever occurred. Indeed, the AMA’s overt campaign against its leading competition simply went underground for the past 40 years.

Now the discrimination is seen in health care insurance programs and in research. Surprisingly, one would think the sanctuary of research would reveal the truth of the matter, but the medical demagogues still found a way to circumvent this as well.

 

 



[1] Horstman J. The Arthritis Foundation's Guide to Alternative Therapies. Atlanta (GA): Arthritis Foundation; 1999.

[2] Schlapia A, Eland J. Multiple back surgeries and people still hurt. Available at http://pedspain.nursing.uiowa.edu/CEU/Backpain.html Accessed April 22, 2003.

[3] Berger E. Later postoperative results in 1000 work related lumbar spine conditions. Surg. Neurol 2000 Aug:54 (2)101-6.

[4] Widen, M. “Back specialists are discouraging the use of surgery.” American Academy of Pain Medicine, 17th annual meeting, Miami Beach, Fl. Feb. 14-18, 2001.

[5] Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001 Feb 1;344(5):363-70.

[6] Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001 Feb 1;344(5):363-70.

[7] Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publ. 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. 90.

[8]Waddell G. and OB Allan, “A historical perspective on low back pain and disability, “Acta Orthop Scand 60 (suppl 234), 1989.

[9] Has There Been Progress in The Management of Ordinary Back Pain? The BackLetter®, Volume 24, Number 1, 2009

[10] Has There Been Progress in The Management of Ordinary Back Pain? The BackLetter®, Volume 24, Number 1, 2009

[11] Tyler, RH, Dynamic Chiropractic, April 25, 1990, Volume 08, Issue 09

[12] Wilk  v.  American Medical Assn, 671 F. Supp. 1465, N.D. Ill. 1987.

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