Articles by JCS

#Chiropractors Matter

#Chiropractors Matter, Too!

                                           "Opioids do not kill pain. They kill people."                                
Donald Teater, MD, National Safety Council[1]

#Black Lives Matter has become synonymous with the African-American activist movement that began after the brutality and deaths of black people by law enforcement officers as well as issues of racial profiling by police and racial inequality in the United States criminal justice system. Black Lives Matter used social media—including hashtag activism—to reach thousands of people rapidly--an idea we chiropractors need to do on a grand scale.

Just as this #Black Lives Matter movement demands civil rights for all black citizens, the same can be said about civil and professional rights for chiropractors in healthcare. Just as brutality against African-Americans was an acceptable part of Jim Crow’s America, so is the verbal abuse and segregation by Jim Crow, MD, in healthcare that created prejudice and discrimination against chiropractors we still experience today.

 Little do people realize during the first half of the 20th century, more than 12,000 American chiropractors were prosecuted over 15,000 times, and some 3,300 were sent to jail for practicing medicine without a license when, in reality, it was a bogus charge since they were practicing nondrug, nonsurgical chiropractic spinal care.[80]

While branding chiropractic as “quackery” and “dangerous,” today the shoe is on the other medical foot, but few in the public or media are aware of this disinformation as a tool of political medicine. Like racism, "chirophobia" continues with little push-back by our associations to inform the public of this disinformation campaign.

It's past time the chiropractic profession branded itself rather than being the scapegoat of the AMA's propaganda campaign and the best avenue to take is with the pandemic of pain, opioid abuse, and unnecessary spine surgery. It's past time we acted up just as the #MeToo and #Black Lives Matter campaigns. Long after the COVID-19 pandemic ends, the pandemic of back pain will continue, and chiropractic is now posed more than ever before to be the solution to this problem.

We are the vaccine for back pain, if you will, but few people understand why.

Not only has the recent research and clinical evidence shown medical spine care to be a “national scandal”, today we find Americans amidst an opioid painkiller pandemic tearing at the fabric of our society; we also see epidural steroid injections deemed "underwhelming", and the latest research now shows spinal fusions to be ubiquitous, ineffective, expensive, and dangerous. Yet this medical railroad continues to mislead thousands annually into the "quiet epidemic" of chronic pain and disability.

Indeed, the white coat of silence about spine care is driving patients into opioid addiction and failed back surgeries at a rate unlike any other country in the world. Today there is a huge need for the public to learn of the scam of medical spine care before they become victims of this medical brutality.

Just as #Black Lives Matter, so do #Chiropractors Matter.  Many patients come to chiropractors as the proverbial last resort when, in fact, it should have been their first resort. Not only are these patients victims of medical incompetence, there are disillusioned, living in chronic pain, taking dangerous opioid painkillers and have little hope of the futures — all the factors in the equation for suicide.

This is the kind of medical nonsense that happens to thousands of patients daily in this country. Yet this medical malpractice is not making the nightly news because the complicit medical reporters will never tell this truth, just as they won’t tell the truth about other medical illusions in spine care such as opioids, epidural shots, and spine fusions. Just as there is a blue code of silence within the police corps, there remains a white coat of silence among medical physicians and reporters.

PANDEMIC OF PAIN PILLS

The 2016 death of music icon Prince once again brought to public attention the epidemic of opioid painkillers that are ravaging our country. He joins other Hollywood celebrities such as Elvis Presley, Marilyn Monroe, Whitney Houston, Heath Ledger, John Belushi, Bruce Lee, Jimi Hendrix, Judy Garland, Joan Rivers and Michael Jackson who shared a problem with millions of other Americans — prescription drug abuse.

 These are medications prescribed every day by doctors, mostly for chronic pain, but now used recreationally since this is, in effect, heroin, a fact few people realize.[2] It should also shock people that 2,500 teenagers every day start using prescription painkillers, leading to a new wave of addicts. [3]

Due to the lack of media attention over the past 20 years on this issue until it came to a boil, the public was unaware of the enormity of the impact of this mind-boggling prescription painkiller pandemic upon peoples’ lives. Only when celebrities were involved did the mass media bother with this national issue.

Indeed, this sad situation represents the tip of the prescription drug iceberg in America. As CDC Director Tom Frieden mentioned, “The opioid epidemic is devastating American families and communities,”[4] not only in Hollywood. Undeniably Pharmageddon continues to ravage our country. Today there are 13 million users, 2 million abusers, and 165,000 have died since 1999 from opioid overdose.[5]

More shocking facts: every 19 minutes, someone in the United States dies from an unintentional prescription drug overdose.[6] Today one in 12 Americans can say they know someone who died from a prescription drug overdose. No other disease can make that claim.[7]

The figure of deaths is startling: there was a 96.6 percent increase in drug-related deaths in a five-year period. What’s most shocking is the drugs involved are not cocaine, heroin or methamphetamine. They are prescription drugs. Excluding alcohol, prescription drugs are the second most commonly abused substance — marijuana is the first.[8]

Overall, there were 47,055 overdose deaths reported in 2014, which equates to 128 deaths each day.[9] To put these deaths into perspective – this is equivalent to the 130 deaths when Islamic terrorists attacked Paris on the evening of November 13, 2015.

Without a doubt, if Islamic terrorists were killing 128 Americans daily in our country, there would be a huge public uproar, Congress would be up in arms rattling its sword calling for military action, and the media would be swarming for a scapegoat to blame.

However, when 128 people die from medication overdoses, there has been reluctance by medical reporters to accuse the medical profession for promiscuous prescribing or blame Big Pharma for its shady promotions of these dangerous drugs.

On April 15, 2016, the CDC released its “Guideline for Prescribing Opioids for Chronic Pain — United States, 2016,”[10] revealing many shocking statistics including that MDs prescribed 259 million prescriptions for opioids in 2014, equivalent to one for every American adult.[11]

Nor does the public realize Perdue Pharma, the maker of OxyContin, was convicted of misinforming the public about the safety of its opioid painkiller and the $634 million court fine was ‘pocket change’ to a company that since 1996 has earned more than $27 billion on sales of OxyContin alone.[12]

The responsibility for this Pharmageddon tragedy is clear to researchers if not to the public or media that have been strangely quiet placing blame where it is due. "The prescription overdose epidemic is doctor-driven,” said Dr. Frieden who suggests MDs have essentially replaced street corner drug pushers as the most important suppliers of narcotics.[13],[14] A Harvard poll also found 34 percent of the public also blame doctors for inappropriately prescribing the medications.[15]

This drug pandemic is growing faster than wildfire across our country and there is very little anyone can do to stop it since the arsonists are the local medical doctors and pharmacists. According to the National Institute on Drug Abuse, the United States consumes 80 percent of the world’s entire oxycodone supply and 99 percent of the world’s hydrocodone supply.[16],[17]

According to Dr. Len Paulozzi, a medical epidemiologist with the Centers for Disease Control and Prevention, “The prescription drug problem is a crisis that is steadily worsening. The vast majority of unintentional drug overdose deaths are not the result of toddlers getting into medicines or the elderly mixing up their pills. Our scientific evidence suggests that these deaths are related to the increasing use of prescription drugs, especially opioid painkillers, among people during the working years of life.”[18]

Now there is a new wave of addicts on the horizon. One in five high school students abuse painkillers with 2,500 teenagers starting every day. By survey, almost 50% of teens believe that prescription drugs are much safer than illegal street drugs — 60% to 70% say that home medicine chest are their source of drugs.[19]

Ironically, the bathroom medicine chest used to be referred to as the “bathroom cabinet” storing toothpaste, band aids, shaving cream, deodorant, and other toiletries. Today, however, with the onslaught of a “pill for every ill,” it’s been renamed the “medicine chest” and the easiest source of abused drugs among kids.

Dr. Robert Lynch of the Maine Board of Chiropractic Examiners put it bluntly about this opioid epidemic, “There is a smoking gun and it is the prescription pad. The training and the ammunition is provided by the pharmaceutical companies.”

Blaming the Victims

Too many medical journalists blame the victims for promiscuous consumption of opioid painkillers, which is the wrong end of this opioid equation; if the victims were never initially given these painkillers for the musculoskeletal pain, they might not have become addicted. Indeed, considering chronic low back pain is the leading diagnosis for opioid painkillers, the boycott of chiropractors by the medical establishment is a leading factor of these deaths, too.

Yet, very little about this pandemic of medications has been recounted in the public media despite the growing concern among the science journalists and government officials. This neglect is not due to ignorance, but avoidance is the result of the media’s conflict of interest not to bite the hand that feeds them – Big Pharma.

Although the media seems to have taken a blind eye to this medical negligence, a new poll of adults in the United States by STAT and Harvard T.H. Chan School of Public Health, Americans’ Attitudes About Prescription Painkiller Abuse,[20] shows more than one in three Americans believe that doctors who inappropriately prescribe painkillers bear primary responsibility for the growing problem of prescription painkiller abuse in the U.S. today.

 According to the STAT-Harvard poll, patients blame doctors for the nation’s epidemic of opioid addiction about as much as they hold individuals responsible for abusing the drugs.[21] Clearly the responsibility lies with the medical doctors who were giving out the drugs in the first place, not the victims who became addicted.

This pandemic of opioids is more pervasive than people realize when almost half – 41 percent – of American adults admit they knew someone who had abused prescription drugs in the last five years. Of those, 20 percent said the abuse had led to the person’s death and many people who abuse this illegal drug begin by using prescription painkillers.[22]

The poll found that the public was split about who is mainly responsible for the epidemic that is killing nearly 16,000 Americans a year: 37 percent blamed the users of strong pain pills, while 34 percent blamed doctors inappropriately prescribing the medications. Far fewer held pharmaceutical companies (10 percent) or the US Food and Drug Administration (7 percent) responsible.[23]

If the public actually understood the role Big Pharma has played in this opioid epidemic, the 10 percent would be much larger. Little does the public realize the amount of dishonest marketing undertaken by Big Pharma to bribe MDs into prescribing opioids, to bribe “thought leaders” with payola to promote these dangerous, addictive drugs, or the money made while Americans became more addicted.

The obvious question to ask is where were the nation’s investigative journalists as this national tragedy was developing during the last 20 years? This oversight by the media illustrates the bias, myopia and shoddy investigative journalism into this medical mess. 

Even today after the horses have left the barn, journalists are still missing key issues in this pandemic of opioids, including the most obvious piece of this puzzle that has gone unmentioned – the role chiropractors should be playing.

One would think among the thousands of investigative journalists in America that someone would put this attack of opioids into a broader perspective rather than accepting the medical status quo as the only solution to the chronic pain problem.

One big clue missed by newsmen in this epidemic of chronic pain is the fact low back pain is the leading reason for the use of prescription painkillers.[24]

I would have thought someone in the press would then have asked the obvious question: if back pain is the main cause for the use of opioid painkillers, why hasn’t the chiropractic profession been called upon to solve this problem considering they offer a nondrug solution that researchers now have shown to be more effective than drugs, shots or surgery?

If just one newsman had open up this can of worms, he or she would have noticed this opioid poisoning did not happen by chance but was the construction of a medical profession that had lied to the public for over a century about the benefits chiropractors as well as lied to patients about the failings of drugs, shots and spine surgery.

Indeed, if it weren’t for the work by thousands of practicing chiropractors, millions more in the public would be addicted and disabled.

It’s past time to admit the media and health licensing boards that took a blind eye to this 20-year development are just as culpable in this painkiller mess as the medical-pharmaceutical industry that profits so dearly.

Fortunately there are honest journalists in the scientific community. Mark Schoene, the 25-year associate editor of an international spine research journal, The BackLetter, wrote of this opioid mess:

“There is now an overwhelming body of evidence that excessive prescription of opioids has triggered a wave of addiction, injury, and death across American society—one that will likely batter U.S. communities for decades.

“There is an urgent need to restrain the routine prescription of opioids for common noncancer pain conditions—and especially chronic low back pain. There is no evidence that they are an effective long-term treatment. And their risks are obvious.”[25]

Aside from the 47,000+ deaths annually from prescription drugs, the misuse or abuse of narcotic pain relievers is flooding the emergency departments with over 420,000 visits in 2011 according to The Drug Abuse Warning Network,[26] which equates to 1,150 people daily in American hospitals who overdosed on drugs.

Again, if terrorists were flooding our hospitals with 1,150 victims from bombings, there would be a huge outcry, but when Big Pharma has as many victims, little is said by the media and even less is done to prevent this medical mess by MDs who continue to flood our society with opioids instead of referring chronic pain patients to chiropractors and other CAM providers.

Is Everyone Stoned?

Dr. Frieden spoke of the irony about the cure being worse than the problem with chronic pain. “Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem.”[27]

Nay, the treatment IS the problem considering several studies have shown the use of opioids may actually worsen pain and functioning as well as lead to addictions and deaths.[28]

Dr. Frieden also mentions the low value of opioids. “It’s become increasingly clear that opioids (such as OxyContin, Vicodin, Hydrocodone, Percocet) carry substantial risk but only uncertain benefits — especially compared with other treatments for chronic pain. We lose sight of the fact that the prescription opioids are just as addictive as heroin.”[29] 

The flood of drugs is not limited to opioids. This potpourri of medications includes many other types in the cocktails people abuse to control their pain or to just get high. Among patients using opioids on a long-term basis, 30 percent had also filled a prescription for tranquilizers (benzodiazepines), such as Valium, Librium, Xanax and Ativan. Nearly 30 percent of patients who took opioids also had a prescription for muscle relaxants such as Soma and Flexeril. Approximately 8 percent of patients were taking all three medications at the same time.[30]

According to the CDC, people in the United States consume opioid pain relievers at a greater rate than any other nation. Americans consume twice as much per capita as Canada, the second ranking nation. Prescriptions for the 8 most frequently prescribed forms of opioid analgesics include codeine, fentanyl, hydrocodone, methadone, oxycodone, oxymorphone, tramadol, and propoxyphene. The CDC indicates these opioids were associated with 75% of prescription drug overdoses in 2010.[31]

The irony of this deadly situation is the fact that opioid painkillers have not shown to have any long term effectiveness for chronic pain. Scientific consensus[32] confirms there is little, if any, evidence that opioids provide safe and effective treatment for chronic non-cancer pain, and include common side effects such as hyperalgesia and constipation, aka, narcotic bowel syndrome,[33] that can complicate long-term treatment.

Opioid-induced hyperalgesia refers to worsening pain despite increasing opioid doses and may create abnormal pain symptoms such as allodynia — experiencing pain from a non-painful stimulation of the skin, such as light touch. [34],[35]

Don’t think for a moment that opioid-induced constipation is a small issue. In fact, this condition went big time during Super Bowl 50 with a 30-second $5 million ad for AstraZeneca featuring a man looking for relief for opioid-induced constipation.

Todd C. Frankel of The Washington Post commented on this unusual Super Bowl ad:

“Today, health care providers write more than 250 million prescriptions for opioid painkillers each year, according to the U.S. Centers for Disease Control and Prevention.

“That’s a lot of pills. And the popularity of this prescription has opened the door to another – a pill to tackle opioid’s side effect: Constipation.

“Prescription drug advertising during football games is not new. Viagra and Cialis have been posting spots for years, splicing in mentions of what to do if your erection lasts more than four hours amid calls to buy a new truck or use a certain credit card.

“But an ad for opioid-induced constipation is different.

“It's a sure sign of just how pervasive painkillers have become.”[36]

Think of the irony of this situation in that Big Pharma profits from “both ends” of this opioid equation. Initially, patients take opioid painkillers for pain and then have to take another pill to help with constipation. Then if patients become addicted, they take more narcotic drugs such as Methadone or Bruprenorphene – opioid agonists aimed to reduce heroin dependency. If the patient does overdose, they are given Naloxone, a narcotic overdose-reversal drug.

At each step in this pain equation, Big Pharma profits as the patients slide down this slippery slope to addiction or death.  Indeed, Big Pharma has the patient hooked every step and profits at both ends.

Ironically, by using an MD instead of a street dealer, this drug deal is perfectly legal and paid by health insurance. Plus, as a cultural authority, an MD dispensing medicinal heroin takes the stigma out of narcotic consumption by mainstream Americans.

Research shows the use of opioid painkillers has also become a gateway to heroin when patients are denied additional prescription opioids and then turn to the street dealers for “smack.”[37] It is estimated that 4 out of 5 heroin users started out by abusing opioid pain relievers.[38] Consequently, the rate of deaths involving synthetic opioids nearly doubled between 2013 and 2014.[39]

It appears Big Pharma and its promiscuous medical prescribers are also grooming potential clients for “El Chapo” and his drug cartel. 94 per cent of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”[40]

As President Ronald Reagan might have said, “There you go again” with more drugs after more drugs. Sadly, people are filled to their gills looking for relief in the wrong places — their MD’s office and the drug store.

Indeed, no other health profession would be given such slack.  Considering the harm from millions of opioid addictions and tens of thousands of deaths from overdose, “Do No Harm” seems to have been replaced with “Don’t Confuse Us with the Facts” as the new Hippocratic Oath.

Is this the best modern medicine can do for chronic pain?

Medically-Made Epidemics

Although bigger than heart disease, cancer, diabetes, and stroke combined, what has been deemed the “quiet epidemic” of chronic pain in the U.S. rarely gets the headlines it deserves, apparently not deadly enough to warrant fund-raising campaigns or “awareness” ribbons.

After all, people through the ages have always had chronic pain, but it didn’t turn deadly enough until opioid pain relievers were introduced. In fact, this quiet epidemic of pain and opioid abuse is not by chance but brought to you by the American Medical Association (AMA) in cahoots with Big Pharma in conspiracy to mastermind one of the biggest cons ever perpetrated on the American public.

It is important to understand this is not the first time the AMA has been a co-conspirator in the history of medically-made epidemics. A recent example is the over-use of antibiotics, the original “wonder drug” that helped many infections but has now led to the current “super-bug” infections. The indiscriminate use of antibiotics in farm animals and over-prescribing among patients led to resistant bacteria such as the latest culprit called MRSA (methicillin-resistant staphylococcus aureus), a bacterium that triggers infections so virulent they turn deadly within days.

The CDC now admits more than two million people get antibiotic-resistant infections each year and at least 23,000 die because current drugs no longer stop their infections.[41] Stronger antibiotics have not stopped this resistance and may only cause stronger “super bugs” in the future brought by the AMA and Big Pharma. What was originally a true “wonder drug” has now become a lethal nightmare.

The most egregious but lesser known example of a medically- made epidemic occurred in 1930 when the AMA gave its stamp of approval to cigarettes in exchange for millions of advertising dollars from Big Tobacco, the AMA’s first sugar daddy.[42]

Some of you are old enough to remember the images of MDs in public ads touting cigarettes. In return for millions of dollars, the AMA allowed tobacco ads in its medical journals, tobacco vendors were allowed to host booths distributing free samples at medical conventions, and public media ads gave the AMA’s stamp of approval despite the emerging evidence in the 1950s of the dangers of tobacco products.[43],[44]

On a similar note, the commercial news media also ignored the dangers of tobacco in exchange for millions in advertising dollars. Who doesn’t remember the Marlboro Cowboy or Joe Camel, two iconic cigarette advertising figures? Both the AMA and the media were complicit bedfellows as they allowed Big Tobacco to wreak havoc without warning the public until decades later after the damage was done and tobacco became an ingrained bad habit in our society that still kills nearly a half million Americans annually. Every day, more than 1,200 people in this country die due to smoking.[45]

These two examples of medically-made epidemics clearly illustrate the sad fact the medical profession is not the exemplary “guardian of health” as it professes to be. When a lot of money is at stake to fund the AMA’s political agenda, the public also becomes collateral damage. Now we’re experiencing the same hidden conspiracy between the AMA and Big Pharma with the opioid painkiller epidemic.

The Price of Pain

Not only is there a huge social cost to society in terms of addiction, disability, and deaths, the annual national economic cost associated with chronic pain is estimated by the Institute of Medicine to be $560–635 billion (an amount equal to about $2,000 for everyone living in the United States). Acute and chronic pain affects large numbers of Americans, with at least 116 million U.S. adults burdened by chronic pain alone. [46]

This estimate combines the incremental cost of health care ($261–300 billion) and the cost of lost productivity ($297–336 billion) attributable to pain. The federal Medicare program bears fully one-fourth of U.S. medical expenditures for pain; in 2008, this amounted to at least $65.3 billion, or 14 percent of all Medicare costs.

In total, federal and state programs — including Medicare, Medicaid, the Department of Veterans Affairs, TRICARE, workers’ compensation, and others — paid out $99 billion in 2008 in medical expenditures attributable to pain. Lost tax revenues due to productivity losses compound that expense.

This “invisible addiction” of the non-medical use of opioid painkillers by those who have become addicted costs health insurers up to $72.5 billion annually in direct health care expenditures.[47] The broader prescribing of opioids has led to a significant increase in rising insurance expense, hospitalization, incarceration and rehabilitation.

The Profit of Pain

Despite the societal cost to Americans in this Pharmageddon, both the drug cartels and Big Pharma continue to profit despite the sword rattling on Capitol Hill.

Indeed, whether pushed or prescribed, the drug economy far exceeds the imagination of everyone as the monies involved in the illicit drug trafficking is one of the largest sectors of the modern global economy. The international business of illegal narcotics produces around $400 billion each year, which accounts for almost 10% of all worldwide trade.[48]

As well, Big Pharma is wealthy beyond the belief of most people and doles out plenty of money to increase its market revenues. Global pharmaceutical sales reached $1.1 trillion in 2014.[49] In 2001, worldwide revenue was around $390.2 billion. Ten years later, this figure stood at almost one trillion U.S. dollars. It is estimated by 2020 the pharmaceutical market will increase to around $1.4 trillion. [50]

The top ten Pharma companies in 2013 earned over $441 billion in sales.[51] Johnson & Johnson was ranked first with a net income of approximately $16.3 billion. Opioid painkillers for back pain brought in $17.8 billion, and OxyContin alone made $3 billion in 2010.[52]

In 2014, prescriptions for pain medication alone totaled 480 million in the United States and ranked third in total prescriptions. Antihypertensive medications ranked first at 705 million prescriptions. Mental health medications ranked second at 537 million. Antibacterials ranked fourth at 267.[53]

The pharmaceutical industry is pouring billions more into new TV and print campaigns that dominate the advertisements. Worldwide pharmaceutical industry spending was nearly $71 billion in 2014.[54]

In the U.S. alone, ad spending soared more than 60 percent in the last four years, hitting $5.2 billion last year.[55] In 2012, the pharmaceutical industry spent more than $27 billion on drug promotions— more than $24 billion on marketing to physicians and over $3 billion on advertising to consumers (mainly direct-to-consumer (DTC) television commercials).[56] By 2015, Big Pharma spent $3.7 billion on DTC television campaigns and $5.2 billion overall including magazine, newspaper, radio, outdoor and cinema ads.

And it’s not slowing down considering nine prescription drugs are on pace to break $100 million worth of TV ad time in 2016. The makers of the top 20 best-selling prescription drugs bought a collective $29 million worth of ads on the History Channel last year, $12 million on the Food Network and $8 million on Animal Planet.

 The advertisers of the top 20 best-selling drugs directed two-thirds of their TV ad spending last year on just four networks — broadcast titans CBS ($511m), ABC ($296m), NBC ($250m), FOX ($128m) and all other TV ($607m). [57]

Obviously the media networks have no interest to expose or criticize the amount of advertisement monies paid to them by Big Pharma despite the implications of

Seductive DTC Ads

As everyone can see on TV, other than trucks, beer, and chronic arthritis/joint/muscular pain ads, undoubtedly the most abundant direct-to-consumer ads are for sex-related issues, specifically, the very suggestive ads for erectile dysfunction ads such as Viagra, which in 2013 had revenues of $1.88 billion.[58]

We’ve all seen the TV and magazine ads with gorgeous female models wearing provocative lingerie speaking seductively about erectile dysfunction while the background announcer warns, “If you have an erection lasting more than 4 hours, call your doctor.”

As comedian Jeff Foxworthy once quipped, “If I had an erection for 4 hours, I’d call everyone I know!”[59]

Among the litany of “common, infrequent, and rare side-effects” from Viagra listed by WebMD.com[60], these advertisements purposely chose to cite the rare side-effect of priapism, or prolonged erection. Since sex sells, every warning after hearing “4 hour erection” falls on deaf ears!

What the Viagra ads don’t highlight are the serious side-effects:[61]

  • Cardiovascular side effects such as cardiovascular morbidity, myocardial infarction, sickle cell anemia with vaso-occlusive crisis
  • Ophthalmic side effects such as non-arteritic ischemic optic neuropathy, and retinal hemorrhage
  • Otic side effects such as decreased hearing, and sudden hearing loss
  • Reproductive side effects such as priapism, which is an undesirable prolonged erection
  • Dermatological side effects such as erythema, or flushing
  • Gastrointestinal side effects such as indigestion
  • Neurological side effects such as headache and insomnia
  • Ophthalmic side effects such as visual disturbance
  • Respiratory side effects such as epistaxis, nasal congestion, and rhinitis.

Although DTC ads have been profitable for Viagra, drug marketing has had a tremendously negative influence on back care across the United States according to editor Mark Schoene. “Aggressive drug marketing was, of course, a major driver of the opioid overtreatment, addiction, and mortality crisis. It has played a role in up to 500,000 deaths.”[62]

Instead of referring these non-specific mechanical back pain patients to chiropractors and other nondrug providers, people have grown to expect prescription painkillers as the standard of care, not realizing the long term damage, addiction and ineffectiveness of these drugs. There is simply too much power, pride and prejudice in the medical profession to admit its shortcomings in this pandemic of chronic pain.

“Dollars for Docs”

The price of pain has extended to most MDs who are bribed to push drugs with other inducements. Over 90% of physicians have some relationship with the pharmaceutical industry, from contacts with drug representatives to research collaborations.[63] Moreover, many doctors are rewarded with gifts, trips, speaking fees and other inducements to prescribe particular drugs or use medical implant devices.[64]

In an effort for transparency, the Affordable Care Act requires pharmaceutical and medical device companies to release details of their payments to a variety of doctors and U.S. teaching hospitals for promotional talks, research and consulting, among other categories. The results were shocking.

According to an article “Dollars for Docs” in ProPublica, $3.53 billion in disclosed payments was paid to 681,432 doctors by 1,630 pharmaceutical and medical device companies in just five months from August 2013 to December 2014.[65],[66] $3.53 billion extrapolated over the entire year equates to $8.4 billion of influence.

Not only are MDs bribed, the FDA also has its hands in the pockets of Big Pharma. The FDA increased its budget by $821 million, making its proposed 2014 budget a hefty $4.7 billion. Out of the extra $821 million, 94 percent or $770 million would come from user fees that are paid by the drug companies to hasten the review and approval of their products.[67]

Rubber stamping drugs on the fast track is the quid pro quo deal that may explain why the FDA without explanation approved OxyContin for kids.[68] To the astonishment of many addiction professionals, the FDA in 2014 also approved another new opioid product, Zohydro, in easily crushed capsules that contain up to 50 milligrams of pure hydrocodone; that’s 10 times more hydrocodone than a regular Vicodin. One capsule is enough hydrocodone to kill a child. An adult lacking a tolerance to opioids could overdose from taking just two capsules.[69]

The FDA approved Zohydro over the strong objection of an FDA advisory committee that voted 11-to-2 against it. More than 40 medical organizations signed a letter to then FDA Commissioner Margaret Hamburg urging her to keep Zohydro off the market to no avail. Apparently $770 million speaks louder than expert opinion.

Indeed, the drug cartel consisting of Big Pharma, MDs, pharmacists, researchers, the FDA and the medical reporters in the commercial media has no interest to see any restrictions imposed that may decrease this lucrative drug market despite the addiction, despair or deaths their products have caused.

Capitol Capital

The price of pain also extends to our legislators. NM Hadler, MD, in his book, “Stabbed in the Back”, wrote, “The pen may be mightier than the sword, but it is not mightier than the dollar,[70] and Big Pharma has plenty of dollars to wield its sword on Capitol Hill.

As we know in Washington, D.C., money equates to power.[71]

Little do people know the medical-industrial complex spends four times as much on lobbying as the No. 2 Beltway spender, the much-feared military-industrial complex, which explains one reason why Harper’s Magazine once called the AMA as “the most terrifying trade association on earth.”[72]

According to OpenSecrets.org, the annual lobbying on health legislative issues in 2015 was $381,223,403 ($712,567 per congressman) of which Big Pharma alone spent $178,863,490 ($334,324 per congressman).[73] The total spent in 2015 was down from $556,002,269 ($1,039,256 per congressman) at the height of the Obamacare debate.

The total contributions by health professionals to federal candidates and parties amounted to $70,377,772 ($131,547 per congressman) for the election cycle ending in 2014. The AMA alone contributed $19,650,000 in 2014 ($36,728 per congressman).

In comparison, all chiropractic contributions amounted to a paltry $527,832 ($986 per congressman).

Indeed, there is simply too much money for Congress to criticize either Big Pharma or the medical dealers who pad their pockets.

Medical White Collar Crime

Actually, this onslaught of prescription opioid painkillers should be viewed as another white collar crime, or should I say, a “white coat” crime that has affected millions of Americans with addiction and killing nearly 17,000 annually.

The blame of this opioid tragedy is quite clear according CDC Director Tom Frieden, MD, MPH, when he admitted, "The prescription overdose epidemic is doctor-driven."[74] It is also Big Pharma-driven with the help of complicit media.

Moreover, these medical perpetrators have gotten off Scot-free, reminiscent of the Wall Street bankers who caused the economic recession in 2008 were nonetheless rewarded with zero-interest bailouts and huge year-end bonuses. None of these white collar criminals went to jail while millions of blue collar Americans suffered lost jobs, lost savings and lost homes.

Now we witness a similar situation with the opioid scandal sweeping America that has also destroyed lives, families, and created the worse case of drug addiction ever seen. Yet we see the same lack of punishment of the white coated medical professionals and white collared Big Pharma executives making billions while orchestrating this “health recession.”

Just as it took a few years to understand how Wall Street bankers conspired to exploit the American public, we now see a similar unraveling of the events that have led to this silent epidemic of addiction and deaths from prescription painkillers.

Indeed, the development of this opioid epidemic is still not fully clear to the public or press that is slowing piecing this puzzle together with tidbits of information although a few of the biggest pieces of this puzzle remain hidden.

Greed is Good

This obscure puzzle reminds me of the two movies depicting the Wall Street fiasco and mindset of the brokers who created the collapse of our economy. The health recession stems from a similar attitude among executives in Big Pharma and the AMA who knew their campaign of painkillers had become an onslaught of addiction and deaths, but none of them have shown any remorse or mea culpa.

Most adults recall the 1987 American drama film Wall Street, directed and co-written by Oliver Stone, which stars Michael Douglas, Charlie Sheen, Daryl Hannah and Martin Sheen. The film was well received among major film critics and Douglas won the Academy Award for Best Actor. The film came to be seen as the archetypal portrayal of 1980s excess among stockbrokers, with Douglas' character unforgettably declaring that "greed is good."

Another famous movie nominated for Best Picture in 2015 was The Big Short that portrays several of the key players in the creation of the credit default swap market that ended up profiting from the financial crisis of 2007–08.[75]

Both of these movies would accurately depict the same mindset we now see with this opioid poisoning engineered by the AMA and Big Pharma.

This epidemic did not have a natural onset such as Ebola or the Swine Flu, but the opioid onslaught is totally man-made or more appropriate, medically-made. There are more pieces of this puzzle that need to be in the spotlight before any significant change will occur, if it’s not too late, which it very well may be. Indeed, how do you stop the addiction of 13 million American adults as 2,500 teenagers daily start on the same path to addiction?

A case can be made the most unlikely but important missing piece of this opioid puzzle is the chiropractic profession, the leading nondrug chronic pain treatment that has been purposely suppress by the medical-drug industry, yet as been vindicated by research and public opinion surveys for more than twenty years. Indeed, chiropractic care is the missing link in this pain puzzle.

Indeed, there is a little known history to this problem that has escaped the attention of the media and public, namely the twenty-year misinformation campaign by Big Pharma used to convince MDs to prescribe these addictive narcotic painkillers despite proof of ineffectiveness and the potential for great harm with addiction.

Nor do the public and press understand the depths of deception used to con MDs to prescribe these narcotic drugs. Little is known of the “though leaders” like Robert Portenoy who was paid to convince prudent MDs about the safety of medicinal heroin. Little does the public understand the under-the-table bribes used by Big Pharma to persuade MDs to prescribe these dangerous drugs.

Nor does the public and media realize MDs are deemed inept in their training and understanding of musculoskeletal disorders, such as low back and neck pain, which are the leading causes for opioid usage. Although the CDC found MDs wrote 259 million prescriptions for opioid painkillers in 2013, equivalent to one per every American adult, the ineffectiveness of opioids has been well proven, yet still dispensed routinely by MDs who refuse to refer to chiropractors and other nondrug alternative practitioners as the guidelines now suggest.

Indeed, there are many pieces of this puzzle that remain unseen by the public because the press has been complicit in this cover-up due to bias and ignorance. The historical medical prejudice toward chiropractors—“chirophobia”—is clearly detailed in history as the biggest antitrust and professional defamation campaign ever perpetrated by one profession upon another, but the lack of coverage in the media keeps the “urban legend” alive that chiropractors are dangerous quacks.

Consequently, without “fair and balanced” in-depth journalism about this opioid disaster and the lack of honesty about chiropractic care as the primary treatment to solve this opioid epidemic, it will continue as long as the arsonists are in charge of the fire station.

The medical community rarely mentions strong opioids are no more effective than acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with musculoskeletal disease and other forms of noncancer pain, according to a review published in Joint Bone Spine.[76]

And MDs certainly rarely mention to patients that nondrug chiropractic care is known to be more effective than any drug, prescription or not. This is the biggest piece of the puzzle that remains unseen and unspoken by the media.

Considering the majority of prescription painkillers are for low back pain[77] and chiropractors constitute the third-largest physician-level health profession in the world that utilizes nondrug treatments for this pandemic of chronic back pain, wouldn’t it be logical to use chiropractic care before resorting to drugs, shots, and surgery as recommended by the joint clinical practice guideline from the American College of Physicians and the American Pain Society?[78]

The fact that MDs also refuse to follow the Joint Commission[79] guideline and refer these pain patients to chiropractors, preferring to prescribe medicinal heroin instead, clearly illustrates the continuing malpractice that permeates the medical profession with the lack of informed consent when patients are legally required to be told the options and risks to care.

The NIH report asks, “The overriding question is: Are we, as a nation, approaching management of chronic pain in the best possible manner that maximizes effectiveness and minimizes harm?”

Obviously the answer is a resounding “No.”

Say Yes to Chiropractic

This chronic pain pandemic offers an excellent opportunity to showcase the chiropractic profession as the leading nondrug profession that deals specifically with spine-related and musculoskeletal disorders.

The National Pain Strategy study on opioid abuse along with the Joint Commission’s policy revision to include chiropractic care may be the chiropractic profession’s foot into the door opened by the same medical establishment that kept it closed for decades. This is where chiropractic enters this war on drugs to fight this attack of opioids; the research is clear and the need is paramount.

Now is the time for the chiropractic profession to be openly critical of opioid drugs – but not the “all drugs are bad” stance since some meds have helped many people.  We need to tell the public that they can live without opioid drugs, especially painkiller pills taken for low back pain. Whereas this would have been viewed as hyperbole in yesteryear before the research began in the early 1990s, today we are on safe ground; in fact, we are on high ground.

When former First Lady Nancy Reagan taught schoolchildren to “Just Say No” to drugs in 1982, little would she know the real danger in 2015 would not be street drugs, but pharmaceutical drugs. “Understanding what drugs can do to your children, understanding peer pressure, and understanding why they turn to drugs is...the first step in solving the problem. If you can save just one child, it's worth it."[81],[82]

It’s also worthwhile if you can save anyone addicted to prescription painkillers laced with medicinal heroin that have become the new scourge of Americans, effecting people of all ages and social strata.

The medical war against chiropractors has led to the worst epidemic of addiction and deaths among the public. In its crusade to persecute, marginalize and eliminate chiropractors, innocent bystanders have become collateral damage in this war, poisoned by unnecessary and ineffective opioid painkillers for back pain that could have been helped with nondrug chiropractic care.

Indeed, Mrs. Reagan’s saying “Just Say No” to drugs should be extended today to include, “Just Say No to Opioid Painkillers, Epidural Shots and Spine Surgery, But Say Yes to Chiropractic.”

 

 



[1] Da Hee Han, PharmD, “Survey Finds Most Doctors Prescribe Opioids for Longer Than CDC Advises,” MPR Daily Dose, March 28, 2016

[2] “Prescription drug abuse is the fastest growing form of substance abuse,” by Karmen Hanson, A Pill Problem: March 2010, National Conference of State Legislatures

[4] Centers for Disease Control and Prevention Press Release, CDC Vital Signs: Overdose of Prescription OPR—United States, 1999-2008; 2011: www.cdc.gov/media/releases/2011/t1101_presecription_pain_relievers.html.

[5] Assessing Benefits And Harms Of Opioid Therapy, CDC, 

http://www.cdc.gov/drugoverdose/pdf/assessing_benefits_harms_of_opioid_therapy-a.pdf

[7] Dylan Scott, “1 in 3 Americans blame doctors for national opioid epidemic, ATAT-Harvard poll finds.” Boston Globe, March 17, 2016

[8] Treatment Episode Data Set (TEDS) 1998–2008: National Admissions to Substance Abuse Treatment Services is published by the Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

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

[12] “Purdue Pharma has privately identified about 1,800 doctors who may have recklessly prescribed the painkiller to addicts and dealers, yet it has done little to alert authorities,” by Scott Glover and Lisa Girion, Los Angeles Times, August 11, 2013

[13] Robert Lowes, CDC Issues Opioid Guidelines for 'Doctor-Driven' Epidemic, www.medscape.com, March 15, 2016

[14] Centers for Disease Control and Prevention Press Release, CDC Vital Signs: Overdose of Prescription OPR—United States, 1999-2008; 2011: www.cdc.gov/media/releases/2011/t1101_prescription_pain_relievers.html.

[15] Dylan Scott, “1 in 3 Americans blame doctors for national opioid epidemic, ATAT-Harvard poll finds.” Boston Globe magazine, March 17, 2016

[16] Opioid painkillers used in dangerous combinations, CBS News, December 9, 2014,

[17] How should U.S. regulate powerful painkillers? PBS NEWSHOUR with Judy Woodruff, January 6, 2015

[18] “Prescription drug abuse is the fastest growing form of substance abuse,” by Karmen Hanson, A Pill Problem: March 2010, National Conference of State Legislatures

[21] Dylan Scott, “1 in 3 Americans blame doctors for national opioid epidemic, ATAT-Harvard poll finds.” Boston Globe, March 17, 2016

[22] Dylan Scott, “1 in 3 Americans blame doctors for national opioid epidemic, ATAT-Harvard poll finds.” Boston Globe, March 17, 2016

[23] Dylan Scott, “1 in 3 Americans blame doctors for national opioid epidemic, ATAT-Harvard poll finds.” Boston Globe magazine, March 17, 2016

[24] 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.

[25] Are U.S. Physicians Focusing on the Wrong Aspect of Chronic Low Back Pain? BackLetter: February 2016 - Volume 31 - Issue 2 - p 13–21

[26] Substance Abuse and Mental Health Services Administration. The DAWN report: highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2013.

[27] New CDC Vital Signs: Opioid Painkiller Prescribing, http://www.cdc.gov/media/DPK/2014/dpk-vs-opioid-prescribing.html

[29] CDC Releases Guideline for Prescribing Opioids for Chronic Pain, http://www.cdc.gov/media/releases/2016/p0315-prescribing-opioids-guidelines.html

[30] Opioid painkillers used in dangerous combinations, CBS News, December 9, 2014.

[31] Leonard J. Paulozzi, MD, Karin A. Mack, PhD, Jason M. Hockenberry, PhD, Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012, July 4, 2014 / 63(26);563-568

[32]YNGVILD OLSEN, MD and GAIL L DAUMIT, MD, MHS, “Chronic Pain and Narcotics: A Dilemma for Primary Care,” J Gen Intern Med. 2002 Mar; 17(3): 238–240.

[33] The Narcotic Bowel Syndrome: Clinical Features, Pathophysiology and Management. Grunkemeier DMS et al. Clin Gastrointerol Hepatol 2007 Oct;5:1126-1139.

[34] Complications of Long-Term Opioid Therapy for Management of Chronic Pain: the Paradox of Opioid-Induced Hyperalgesia. Brush DE. J Med Toxicol 2012;8:387-392.

[35] Mitra S, Opioid-induced hyperalgesia: pathophysiology and clinical implications, J Opioid Manag. 2008 May-Jun;4(3):123-30.

[36] “This Super Bowl ad proved just how much America loves its opioid painkillers,” by Todd C. Frankel, The Washington Post, February 8, 2016

The Price of Pain

[37] Benedict Carey, Prescription Painkillers Seen as a Gateway to Heroin

The New York Times, Feb. 10, 2014

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

[40] Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.

[41] CDC report Antibiotic Resistance Threats in the United States, 2013,

[42] JC Smith, Medical War Against Chiropractors, 2011, p. 48.

[43] D Ullman, How the American Medical Association Got Rich, Berkeley:  North Atlantic Books (2008) p.90

[44] NaturalNews.com: “American Medical Association Promoted Tobacco, Cigarettes in its Medical Journal,” http://www.facebook.com/note.php?note_id=44588419945

[45] Preventing Tobacco Use Among Youth and Young Adults, CDC Fact Sheet, http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/factsheet.html

 

[47] OxyContin: Purdue Pharma's Painful Medicine by Katherin Eban @FortuneMagazine, November 9, 2011

[48] Illicit Trade and Drug Trafficking Proving to be a Major Problem, http://www.123helpme.com/preview.asp?id=63042

[49] Global drug sales to top $1 trillion in 2014: IMS, Reuters, Apr 20, 2010

[50] Statistics and facts about the pharmaceutical industry worldwide, Statistica, http://www.statista.com/topics/1764/global-pharmaceutical-industry/

[51] Eric Palmer, The top 10 pharma companies by 2013 revenue, Fierce Pharma, March 4, 2014, http://www.fiercepharma.com/special-reports/top-10-pharma-companies-2013-revenue

[52] Rafia S. Rasu, BPharm, MPharm, MBA, PhD; Kiengkham Vouthy, PharmD; Ashley N. Crowl, PharmD; Anne E. Stegeman, PharmD; Bithia Fikru, PharmD, MPA; Walter Agbor Bawa, MS, PharmD; and Maureen E. Knell, PharmD, BCACP, “Cost of Pain Medication to Treat Adult Patients with Nonmalignant Chronic Pain in the United States,” Vol. 20, No. 9 September 2014 JMCP Journal of Managed Care & Specialty Pharmacy

[53] Statistics and facts about the pharmaceutical industry worldwide, Statistica, http://www.statista.com/topics/1764/global-pharmaceutical-industry/

[54]

Pharma Digital Investment is Increasing, But Still Only 3-6% of the Total Promotional Spend, Pharma Marketing Blog, November 13, 2015, http://pharmamkting.blogspot.com/2015/11/pharma-digital-investment-is-increasing.html

 

[55] Cegedim Strategic Data, 2012 U.S. Pharmaceutical Company Promotion Spending (2013), http://www.skainfo.com/health_care_market_reports/2012_promotional_spending.pdf.

[56] Ibid.

[57] Rebecca Robbins, Drug makers now spend $5 billion a year on advertising. Here’s what that buys, STAT, March 9, 2016, https://www.statnews.com/2016/03/09/drug-industry-advertising/

[58] http://www.pfizer.com/files/investors/presentations/FinancialReport2013.pdf

[59] https://video.search.yahoo.com/yhs/search;_ylt=A0LEV7pF9VlVMBkA.8InnIlQ;_ylu=X3oDMTByMjB0aG5zBGNvbG8DYmYxBHBvcwMxBHZ0aWQDBHNlYwNzYw--?p=Comedian+Jeff+Foxsworthy+Said%2C+%E2%80%9CIf+I+Had+An+Erection+For+4+Hours%2C+I%E2%80%99d+Call+Everyone+I+Know!%E2%80%9D&fr=yhs-mozilla-004&hspart=mozilla&hsimp=yhs-004

[60] http://www.webmd.com/drugs/2/drug-7417-297/viagra-oral/sildenafil-oral/details/list-sideeffects

[61] http://www.bad-drug.net/bad-drug/viagra

[62] Be Aware of Drug Advertising! BackLetter: May 2016 - Volume 31 - Issue 5 - p 60

 

 

[63] Campbell EG. Doctors and drug companies—scrutinizing influential relationships. N Engl J Med. 2007;357:1796–1797. [PubMed]

[64] Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA. 2003;290:252–255. [PubMed]

[65] Tim Lahey, The High Costs of “Free” Drug Samples Clin Transl Gastroenterol. 2014 Dec; 5(12): e67. Published online 2014 Dec 18. doi:  10.1038/ctg.2014.16

PMCID: PMC4274368

[68] C Waismann, FDA Approves OxyContin for Kids: Could Lifelong Addiction Follow?

August 19, 2015

[69] Andrew Kolodny, M.D., “Zohydro: The FDA-Approved Prescription for Addiction,” The Huffington Post, March 6th, 2014

[70] Hadler, NM, Stabbed in the Back; confronting back pain in an overtreated society, University of North Carolina Press, 2009, pp. 88

[71] Steven Brill, What I Learned From My $190,000 Surgery, TIME, Jan. 8, 2015

[72] M Mayer, ibid. p. 76.

[74] Robert Lowes, CDC Issues Opioid Guidelines for 'Doctor-Driven' Epidemic, www.medscape.com, March 15, 2016

 

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

[82]  "Mrs. Reagan's Crusade". Ronald Reagan Presidential Foundation.

Website Builder