Articles by JCS

The Power of Prejudice

The Power of Prejudice

By

JCS

Recently on November 1, The Daily Show with Jon Stewart had a parody with comedian, John Hodgman, who defended “moneyed Americans” against attacks by the poor. He admitted there are “acceptable prejudices,” which certainly registered on my radar as a chiropractor. (http://www.thedailyshow.com/watch/tue-november-1-2011/men-of-a-certain-wage---money-talks)

Coincidentally, just a few days later on November 7, Stephen Colbert of the Colbert Report noted with his Bigot-O-Tron 9000 the clearly anti-Semitic statements made by a Texan politician, Rep. Larry Taylor. (http://www.colbertnation.com/video/Bigot-O-Tron+9000+)  

Aside from these two comical commentaries, bigotry is no laughing matter nowadays. A case can certainly be made that medical prejudice against chiropractors rates at the top of that list of “acceptable prejudices” by “moneyed Americans” and, in terms of the Bigot-O-Tron 9000, medical bigotry would blow a fuse.

Just as The Help showed the harm bigotry did to black housekeepers in the Jim Crow South in the early 1960s, the medical assault on thousands of chiropractors whose reputations were unfairly stigmatized by medical bigotry was painfully similar.

Although it is politically incorrect nowadays to be racist, sexist, anti-Semitic or homophobic, I have never heard any news pundit speak out against chiropractors being called “quacks” by chauvinistic medical professionals. While you may not read it in articles once seen in the era of the Committee on Quackery, their “everybody knows chiropractic is an unscientific cult” belief remains a wink-wink attitude among medical bigots although, ironically, research shows that chiropractic care is superior to medical care for most spine-related disorders, a fact untold by the media and unknown by the public. [1]

            Nor do I hear anyone in the news media asking why most public hospitals exclude chiropractors despite the Wilk antitrust victory considering the fact that DCs are licensed by every state. The fact that public hospitals are controlled singularly by one trade association smacks of antitrust activity flies in the face of free enterprise. It also stands in defiance of the Wilk antitrust trial, denying the public a freedom of choice in healthcare.

Nor do I understand why Medicare and many HMOs limit DCs while PTs and MTs are allowed many more visits, or why the military health services and VA still greatly limit access to chiropractors despite laws signed by Presidents Clinton and Bush allowing our services to help the injured warriors.

Like racism, the discrimination against chiropractors is well woven in our society on many levels, yet we have no public champion fighting our cause for equality. We have no Fredrick Douglas, no Betty Freidan or Martin Luther King, Jr. And I certainly don’t think a retired football player is an equivalent spokesman.

In this era of so-called evidence-based healthcare where science is supposed to be the guiding light, we would think research would be on our side. Still, the medical powers to be ignore the positive public surveys in favor of chiropractors (Gallup[2], TRICARE[3], Consumer Report[4]). They ignore the comparative international studies recommending manipulation over drugs, shots, or surgery (AHCPR-US[5], Manga-Canada[6], NICE-UK[7]).

We are constantly reminded that the real power behind this oversight is not science or evidence as much as money and prejudice. As the Clinton and Obama healthcare reforms showed all, economic-based healthcare is the real power driving medical care, and behind that power is the medical prejudice that has been its mania for over a century.

The Origin of Medical Bigotry

Whereas sexism, racism, and anti-Semitism have diffuse origins, medical bigotry can be traced back to a few specific events and people in the annals of political medicine.

A seminal event occurred in 1910 when Abraham Flexner introduced “Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching.” He used the Johns Hopkins School of Medicine as the acceptable scientific model. With this medical paradigm as its guiding light, the AMA was empowered to eliminate homeopaths, naturopaths, among various eclectic professions, as well as attack true osteopaths and chiropractors who followed different models of care.

The Introduction to this report was written by Henry S. Pritchett, president of the Foundation who remarked on the institutional bias they encountered:

As a rule, the only knowledge which the public has concerning an institution of learning is derived from the statements given out by the institution itself, information which, even under the best circumstances is colored by local hopes, ambitions, and points of view.[8]

Pritchett believed in the power of public disclosure to enforce the Foundation’s model of education:

The attitude of the Foundation is that all colleges and universities, whether supported by taxation or by private endowment, are in truth public service corporations, and that the public is entitled to know the facts concerning their administration and development, whether those facts pertain to the financial or to the educational side. We believe, therefore, that in seeking to present an accurate and fair statement of the work and the facilities of the medical schools of this country, we are serving the best possible purpose which such an agency as the Foundation can serve; and, furthermore, that only by such publicity can the true interests of education and of the universities themselves be subserved. In such a reasonable publicity lies the hope for progress in medical education.[9]

Certainly the objective of the Flexner Report is admirable, but we quickly see Abraham Flexner’s own “medical dogma” about chiropractic education when he states his poor opinion of “sectarians” like “chiropractics” who are “unconscionable quacks”:

The logical position of medical sectarians today is self-contradictory. They have practically accepted the curriculum as it has been worked out on the scientific basis. They teach pathology, bacteriology, clinical microscopy. They are thereby committed to the scientific method; for they aim to train the student to ascertain and interpret facts in the accepted scientific manner. But scientific method cannot be limited to the first half of medical education. The same method, the same attitude of mind, must consistently permeate the entire process. The sectarian therefore in effect contradicts himself when, having pursued or having agreed to pursue the normal scientific curriculum with his student for two years, he at the beginning of the third year produces a novel principle and requires that thenceforth the student effect a compromise between science and revelation.

Once granted the possibility of medical dogma, there can be no limit to the number of dissenting sects. As a matter of fact, only three or four are entitled to serious notice in an educational discussion [homeopathistis, eclectics, physiomedicals, and osteopaths]. The chiropractics, the mechano-therapists, and several others are not medical sectarians, though exceedingly desirous of masquerading as such; they are unconscionable quacks, whose printed advertisements are tissues of exaggeration, pretense, and misrepresentations of the most unqualifiedly mercenary character. The public prosecutor and the grand jury are the proper agencies for dealing with them.[10]

Flexner admits to the possibility of “institutional bias” and “medical dogma” and yet he emphatically states chiropractic education has no place in his analysis and is best left to the “prosecutor and grand jury.”

Certainly his bias was the origin of the acceptable medical prejudice that the AMA has followed since 1910, headed feverishly by Morris Fishbein, MD, the executive director of the AMA from 1924 to 1949. Fishbein, also known by his contemporaries as the Medical Mussolini due to his tyrannical leadership, took Flexner’s bigotry to heart throughout his administration. For example, in 1925 Fishbein wrote: “Scientific medicine absorbs from them that which is good, if there is any good, and then they die.”[11]

The apparent objectivity of the Flexner Report is clouded by this inherent medical dogma. Grant Gillett writes that organized medicine is a partner in a “regime of truth that defines its own scientific standards, disciplines, rules, and methods of validation and can effectively exclude all apart from the orthodox and privileged.”[12]

Just like moneyed John Hodgman’s acceptable prejudice, the Flexner Report became the standard prejudice of acceptable healthcare despite its limited allopathic perspective.

The history of the AMA clearly shows the deeply rooted bigotry within political medicine. After Fishbein was removed from power in 1949, his policy continued into the 1960s with the AMA’s Committee on Quackery that announced its goal to “contain and eliminate the chiropractic profession,”[13] calling chiropractors “rabid dogs” and “killers.”[14]

The Committee on Quackery institutionalized its prejudice and rested its power on Principle 3 of “The Principles of Medical Ethics” that stated: “A physician should practice a method of healing founded on scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle.”[15]

Despite the trial evidence submitted by George McAndrews showing workers’ comp studies that chiropractic care had a 2:1 superiority rating than medical care for low back pain, the AMA executives turned a blind eye.

One of their own board members, Dr. Irwin Hendryson, admitted that chiropractic “has prospered through the years and it is a difficult thing to quarrel with success.”[16]

He submitted a lengthy report that was ignored for fear of being “misconstrued”.[17] Don’t confuse us with the facts is the AMA’s attitude.

This medical prejudice was embedded into the medical mindset in medical schools and certainly within the medical societies. Indeed, no MD will gain hospital privileges who espouses freedom of choice for patients to use chiropractic care. Touting the Fishbein fascist attitude is essential to the power of acceptable medical prejudice.

This tomfoolery eventually led to the AMA’s Watergate—a landmark antitrust case brought by four brave chiropractors against the AMA et al. in 1976.[18]

The federal judge in the Wilk trial, Susan Getzendanner, found in favor of the chiropractor-plaintiffs and stated in her Opinion that “The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations.”[19]

The damage was done and the AMA went on with business as usual despite this little legal bump in their road to power. The AMA’s goal was to character-assassinate chiropractors, not view them as equals or allow them to compete for patients on a level playing field or to work in public hospitals. As one AMA attorney admitted, “The ultimate objective of the AMA, theoretically, is the complete elimination of the chiropractic profession.”[20] 

Certainly at this point, evidence-based medicine was superseded by politically-based medicine. My book speaks of this dark chapter of American medicine that few people understand and a story the AMA would prefer left in the dark.[21]

For example, few people, including most DCs, know that 12,000 chiropractors were arrested in the first half of the 20th century allegedly for practicing medicine without a license. This was a ruse because chiropractors never use medicines or surgery. The AMA’s real goal was to eliminate all competitors by any means, including a massive media propaganda campaign that hired famed columnist Ann Landers to disseminate misinformation against chiropractors.

Surgical Scam

Aside from the genocidal nature of this medical bigotry, the power of prejudice has led to one of the biggest medical scams ever perpetrated on the American public—the thousands of unnecessary spine surgeries now deemed to be ineffective, costly, and disabling. Oddly, the chiropractic profession has been strangely silent on this scam.

This renaissance in spine diagnosis began in 1990 when research by Scott Boden et al. followed in 1994 by a supportive study by Maureen Jensen et al. found no clear correlation between disc abnormalities and back pain. [22],[23]

Other medical researchers have revealed the fallacy of abnormal discs—the basis of spine surgery—as “trivial, harmless, and irrelevant.”[24]  

Despite the new research, warnings, and recommendations for non-invasive methods, there are more spine surgeries done today than ever before. According to Richard Deyo, MD, MPH, “The most complex type of back surgery has increased dramatically between 2002 and 2007 with a 15-fold increase.”[25]

As to the reason for this increase, he concluded that “More people are interested in getting on the gravy train than on stopping the gravy train.”[26] Hopefully this gravy train will reach a dead-end soon.

The business of back pain remains huge—a $100+ billion industry, the leading work injury, and the largest disabling condition in the country. While back pain may not kill you like heart disease or cancer, the wrong treatment like spine surgery may leave you disabled, depressed, and bankrupt. The saddest part is research now suggests the majority of spine surgeries are risky, unnecessary and terribly expensive; opioid drugs are addictive and epidural steroid injections shots are no more effective than saline solution.[27] Indeed, this war has left many victims of collateral damage at a huge cost.

Medical voices now admit the damage spine fusions have done. According to Gordon Waddell, MD, orthopedic surgeon, “It [back surgery] has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”[28] Rather alarming confession from a renowned medical author, yet an admonition the public has never heard from their local MDs.

Unethical Journalism at CNN

Another example of the power of medical prejudice occurs daily at CNN. Other than one small segment with Robert Hayden, DC, of Griffin, GA, I have never seen any significant program on CNN concerning the benefits of chiropractic care, which happens to be the third-largest physician-level health profession in the country. 

I searched the CNN website for programs by Dr. Sanjay Gupta and found one video that shamelessly smeared our profession with an exaggerated allegation that chiropractic care has caused hundreds of strokes:

  • Stroke after chiropractic care updated Wed June 25, 2008
  • Hundreds of people have had strokes after having their necks manipulated. Dr. Sanjay Gupta reports.

http://www.cnn.com/video/#/video/health/2008/06/25/gupta.chiro.stroke.cnn

I might add this video was taken down after I filed a complaint with Richard Davis, EVP at CNN.

Certainly, the facts belie Dr. Gupta’s claim. According to research by Alan Terret et al., the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic is only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.[29]

Despite the overwhelming evidence of the comparative safety of chiropractic manipulation for neck problems, a dubious study from England with a sensational title, “Deaths After Chiropractic: A Review Of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter, once again raised the level of fear over chiropractic care when he noted that “Twenty-six fatalities were published since 1934 in 23 articles.”[30]

Considering this covers 26 fatalities over 77 years that equates to 0.34 deaths per year, instead of sounding an alarm, Ernst should have praised chiropractic care for its obvious safety since this is an extremely low rate in comparison with equivalent medical methods such as neck surgery that has shown a 3-4% rate of complications for cervical spine surgery. Estimates suggest this equates to 4,000-10,000 deaths per million neck surgeries.[31]

Obviously Dr. Gupta’s video about chiropractic care causing “hundreds of strokes” is odd considering it equates to one-third of a person annually, yet he has made no attempt to correct his misinformation nor did he inform his audience of the thousands who die from spine surgery annually.

This is clearly unethical journalism. Obviously distorting the facts does not inform today’s health care consumer of the safety or efficacy of chiropractic care, clearly indicating his lack of objective and fair journalism.

Call for Restraint on Back Surgeries

My second complaint was directed to another important issue—the rash of criticism about spine surgeries that Dr. Gupta has ignored. Considering he is a neurosurgeon, undoubtedly he is unwilling to incriminate his fellow spine surgeons about the rash of unnecessary spine surgeries or mention the dubious disc theory.

 In this era of evidence-based medicine, numerous MRI studies have shown the disc theory has been debunked, many medical critics have raised concern over these unnecessary surgeries kept alive by spine surgeons and, moreover, many news media now have investigated medical corruption by Medtronic.

Over the last few months, the mainstream media has jumped on the unnecessary, risky, expensive, and corrupt spine surgery scam. For example, here are a few recent media exposés on spine surgery:

  • “Surgery May Not Be the Answer to an Aching Back,” by Joanne Silberner, NPR, April 6, 2010.
  • “Back Surgery May Backfire on Patients in Pain,” by Linda Carroll, MSNBC, Nov. 14, 2010
  • “Top Spine Surgeons Reap Royalties, Medicare Bounty,” by John Carreyrou and Tom McGinty, Wall St. Journal, Dec. 20, 2010
  • “Highest-Paid U.S. Doctors Get Rich with Fusion Surgery Debunked by Studies” by Peter Waldman and David Armstrong, Bloomberg News, Dec. 30, 2010.
  • “Spinal Fusions May Cause More Harm Than Good,” by Terrance Pagel, Daily Health Report, Jan. 20, 2011
  • “Medicare Records Reveal Trail of Troubling Surgeries” by John Carreyrou and Tom McGinty, Wall St. Journal, March 29, 2011

I find it odd the CNN ignores this newsworthy medical controversy while other reputable news media have exposed the ineffectiveness, greed, and questionable disc theory behind spinal surgery. These articles also spoke of the untold cost in human suffering as well as wasted revenues of these unnecessary surgeries. 

The obvious question remains: why hasn’t Dr. Gupta or another CNN special documentary covered this huge spine controversy, the call for reform, the ruse of the disc theory, or the recommendations for spinal manipulation? I believe medical bias is the main reason. Just like racial prejudice, the medical bigotry toward chiropractors is deeply ingrained into most MDs, including Dr. Gupta.

Another paradigm shift away from spine surgery occurred when Blue Cross Blue Shield of North Carolina announced in January, 2011, that it would no longer pay for spinal fusion for back pain in the presence of only disc degeneration or disc herniation. This is a huge policy change that will hopefully have a ripple effect among all state BC/BS and other insurance companies to curtail payment for this epidemic of ineffective spine surgery. [32]

Yet, there has been no mention of this remarkable policy change by Dr. Gupta. Considering heart and back surgeries are the two largest revenue streams in hospitals, his omission continues to raise questions—why he refuses to report these landmark changes in spine care and insurance coverage that could greatly lower healthcare costs?

Dr. Gupta has ignored the monumental changes in treatment policy by national and international guidelines that recommend chiropractic care before surgery for non-specific low back pain. This began in 1994 with the US Public Health Service’s AHCPR guideline on acute low back pain[33], plus more recent guidelines including the North American Spine Society[34], the American Pain Society[35], and the Milliman Care Guidelines.[36]

All recommend spinal manipulative therapy as a first avenue for treatment and spine surgery as the last option, a point lost to most MDs who railroad patients into risky drugs, unnecessary shots, and expensive spine surgery.

As you can see, the spine surgery scandal is huge, and has led to thousands of unnecessary spine surgeries performed each year costing millions in lost work days, billions of dollars in medical expense, as well as the incalculable human toll in suffering and depression by patients who never needed a spinal fusion. This also contributes to the opioid drug addiction we now face in the so-called Hillbilly heroin epidemic of patients who often seek intervention from failed back surgeries. Yet the chiropractic leadership has been quiet on this exploding issue.

Considering the enormous scope of this spine scandal, Sanjay Gupta has completely ignored this troubling situation that affects hundreds of thousands of back pain patients annually and costs the healthcare system billions of dollars. While other national news organizations are criticizing this spine scandal, why hasn’t CNN’s leading medical reporter? Is he forgetful or prejudiced? Okay, stop laughing.

My contention is Dr. Gupta as a neurosurgeon obviously has a conflict of interest not to criticize the onslaught of spine surgeries since he and his colleagues greatly profit by this medical scam.

Let’s Make a Tipping Point

As long as this acceptable medical prejudice permeates the mainstream media—from conservative FOX News and liberal CNN alike—we will not get our message out. The facts are clear that we offer the majority of spine patients a better, cheaper, and safer service, but they are confused by medical bigotry that lingers on like racism and sexism.

The lack of attention in the mass media also poses a huge barrier to our hope to reposition the public to our brand of spinal care. In the world of evidence-based spine care, the tide has turned against the massive amounts of spine surgery, but the public remains in the dark tainted by the medical bigotry against chiropractors who should be the primary spine care providers in this epidemic.

Perhaps we need to take a lesson from the Occupy Wall Street movement. Imagine hundreds of chiropractors and college students on the Capitol Steps at next year’s NCLC with placards. Just like other rallies that have gotten national press attention, imagine us doing the same by stating our grievances in a peaceful manner. That would surly have more impact than any advertisement in The Wall Street Journal, and it would cost nothing but time, effort, and a lot of courage.

Indeed, if 12,000 chiropractors were willing to go to jail for our profession in the first half of the 20th century, would you be willing to participate in a peaceful demonstration to bring our situation to the nation’s media?

Our profession was built on the dedication of those great men and women who had the courage of their convictions.  From DD Palmer who was the first and spent 17 days in jail in 1906 to EJ Nosser, the last man to be jailed in Louisiana in 1975, I still believe that this dedication is present in most chiropractors today.

Think of yourself in the saga of two chiropractic “jailhouse martyrs” that occurred in New York in 1949. Katherine “Kitty” Scallon and her husband, Mack Scallon, also a chiropractor in Manhattan (their patients included Ambassador Joseph Kennedy), who were jailed simultaneously when they refused to desist in the practice of medicine without a license.

Kitty Scallon said from the Women’s House of Detention in 1949:

Being here [in jail] is sometimes like a bad dream…but I’d throw my shoulders back and be ready and willing to make any sacrifice to help free our beloved science.[37]

Aside from the freedom to practice our beloved chiropractic without harassment and inequality, perhaps we need to keep the bigger vision of our forefathers about freedom of choice for all Americans to seek the type of health care they prefer.

A Founding Father and Signer of the Declaration, Dr. Benjamin Rush, MD, foresaw what has happened today in American healthcare—the formation of a medical “undercover dictatorship” that aptly describes his own profession and AMA, Inc.:

 Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship.[38]

 

That time has certainly arrived. We are fighting the medical dictatorship that he foresaw, albeit not undercover anymore.

Are we willing to fight back in a new type of media battle that attracts attention to the lack of medical freedom that Dr. Rush mentioned? Just as the Constitution guarantees freedom of religion, conversely it guarantees freedom from religion. I daresay we need the same guarantee—medical freedom as well as freedom from political medicine.

The freedom I speak is not merely insurance equality. It is a freedom from prejudice—the freedom of philosophy, the freedom of science, and the freedom to practice without discrimination and pejoratives hanging over our image from medical propaganda.

The medical prejudice was proven wrong by McAndrews at the Wilk trial, the medical disc theory has been proven wrong by researchers, spine surgery has been deemed baseless by NC BC/BS, and the proof for our care has emerged in nearly every comparative study and public poll. Yet the medical prejudice stands in our way at every turn.

Perhaps what is missing is a peaceful movement to confront and eliminate medical “acceptable prejudice” in our society. Hopefully, like any other movement, the concept I have outlined will germinate and grow into a full-fledged movement to provide chiropractic with its rightful place in the delivery of health care and enabling those who seek care to have a CHOICE based on evidence and not prejudice.

While some now seem to believe in a “make love, not war” strategy with our medical rivals, this is not the time to declare peace because a cold war is very much alive. Until we have equality in all facets of American healthcare, a presence in all universities, equality in research funding, officials in government health bureaucracies, access and equal pay in private insurance coverage, and an equal presence in all health care news programming, there will be no peace.

Will you fight for our profession as Palmer, Nosser, Scallon and thousands of our forefathers have done? Do you have a strong backbone and the irrepressible pride in our profession as they had?



[1] W Trever, “in the Public Interest,” Scriptures Unlimited, Los Angeles, Calif., (1972):11

[2] The Gallup Organization, Democratic Characteristics of Users of Chiropractic Services (Princeton, NJ:  The Gallup Organization (1991)

[3] Chiropractic Care Study, Senate Report 110-335 accompanying the National Defense Authorization Act for FY 2009; letter sent to Congressmen by Ellen P. Embrey, Deputy Assistant Secretary of Defense (September 22, 2009):2.

[4] “Relief for Aching Backs:  Hands-on Therapies were Top Rated by 14,000 Consumers,” Consumer Report (May 2009)

[5] 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)

[6] P Manga, D Angus, C Papadopoulos, W Swan, “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain,” (funded by the Ontario Ministry of Health) (August, 1993):104

[7] The National Institute for Clinical Excellence (UK-NICE) 2009

[8] Abraham Flexner, “Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching,” Bulletin number Four (1910): p. ix

[9] Ibid.

[10] Ibid. p. 158.

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

[12] Gillett G. “Medical science, culture, and truth,” Philosophy, Ethics and Humanities in Medicine. 2006; 1:13.

[13] G McAndrews, “Plaintiffs’ Summary of Proofs as an Aid to the Court,” Civil Action No. 76 C 3777, Wilk, (June 25, 1987) Throckmorton, Howard, Taylor, and Monaghon Deps.

[14]  JA Sabatier, Minutes from the “Chiropractic Workshop,” Michigan State Medical Society, held in Lansing on 10 May 1973, exhibit 1283, Wilk.

[15] PX-56, 156A

[16] Ibid. Letter by Dr. Irwin Hendryson to RB Throckmorton, PX-241, May 13, 1966.

[17] PX-240, p. 2

[18] Chester A. Wilk, James W. Bryden, Patricia A. Arthur, Michael D. Pedigo v. American Medical Association, Joint Commission on Accreditation of Hospitals, American College of Physicians, American Academy of Orthopaedic Surgeons, United States District Court Northern District of Illinois, No. 76C3777, Susan Getzendanner, Judge, Judgment dated August 27, 1987.

[19] Wilk et al. v. AMA et al., Opinion pp. 10

[20] Memo from Robert Youngerman to Robert Throckmorton, 24 September 1963, PX 173, Wilk v. AMA.

[21] JC Smith, The Medical War Against Chiropractors, www.medicalwaragainstchiropractors.com

[22] 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.

[23] MC Jensen, MN Brant-Zawadzki, N Obuchowski, MT Modic, D Malkasian, JS Ross, “Magnetic Resonance Imaging Of The Lumbar Spine In People Without Back Pain,” N Engl J Med. 331 (1994):69–73.

[24]Richard Deyo, MD, MPH and Donald Patrick, PhD, MSPH, Hope or Hype, The obsession with medical advances and the high costs of false promises. 2005 AMACOM books.

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

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

[27] Ann Rheum Dis. 2003;62:639-643

[28] G Waddell and OB Allan, “A Historical Perspective On Low Back Pain And Disability, “Acta Orthop Scand 60 (suppl 234), (1989)

[29] AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, (2001)

[30] E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162–1165

[31] Gueret G, Bourgain JL, Luboinski B., “Sudden death after major head and neck surgery,’ Curr Opin Otolaryngol Head Neck Surg. 2006 Apr;14(2):89-94.

 

[32] http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/lumbar_spine_fusion_surgery.pdf

[33] 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)

[34] Freeman MD and Mayer JM, NASS Contemporary Concepts in Spine Care: Spinal Manipulation Therapy For Acute Low Back Pain, The Spine Journal  2010 October; 10 (10):918-940

[35] Chou R, et al., Diagnosis and Treatment of Low Back Pain:  A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society, Low Back Pain Guidelines Panel, Annals of Internal Medicine 2007 October 2; 147  (7):478-491

[36]Milliman Care Guidelines for Lumbar Fusions, Low Back Pain and Lumbar Spine Conditions—Referral Management, www.allmedmd.com

[37] Gibbons, ibid. p. 27.

[38] ER Booth, History of Osteopathy and Twentieth Century Medical Practice, Cincinnati: Caxton Press, 1905 (1924):312.

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