Infomercial #2

Back Pain Treatments:

Buyer Beware

Hello again, I’m JC Smith and I’ve been a doctor of chiropractic for over 30 years, and in addition to practicing in Warner Robins, I’ve also authored 5 books, written over 200 articles and letters-to-the-editors that some of you might have read. As well, I’ve had the honor to lecture from Britain to Oregon to Jekyll Island when I spoke before former Governor Barnes’ Advisory Commission on Workers’ Comp about the new research trends in back treatments.

I’ve studied the evolving research and politics concerning spine treatments, so let me describe to you some of the underlying reasons for this 100 billion dollar epidemic of back pain we have in America. I realize I’m speaking to members of the medical profession as well as to the public, so I’ll choose my words carefully to be accurate.

Since 1990 when researchers began investigating the back pain epidemic, they’ve come to a few conclusions that I’d like to share with you today because all is not well in the back pain treatment business. Indeed, buyer beware is the title of this show and for good reasons.

President Obama has said he will make reforming the U.S. healthcare system his top fiscal priority this year contending that reining in skyrocketing medical costs is critical to saving the nation from bankruptcy. I daresay the high cost of treating back pain is one area to look at.

Actually, in February of this year, research from the University of North Carolina School of Medicine has shown the prevalence of chronic low back pain is getting worse—a triple increase from 1992 to 2006.[1]

Considering the back pain business is huge, this 3-fold increase is not only alarming, it’s an indictment of the medical methods that have proven so ineffective. The study’s principal investigator Tim Carey, MD, admitted,

“Since the costs of back pain are rising, along with the number of cases, current treatments overall do not seem to be very effective.”  

Another recent two-year study by Consumer's Medical Resource revealed Fortune 500 corporations spend over $500 million a year on avoidable back surgeries for their workers and lose as much as $1.5 billion in indirect costs associated with these procedures in the form of missed work and lost productivity.[2]

This study, "Back Surgery: A Costly Fortune 500 Burden," found one in three workers recommended for back surgery by their doctor said they avoided an unnecessary procedure after being given treatment options. Some studies comparing surgical and non-surgical treatment outcomes have shown little difference between the two approaches.

"Our research concludes Fortune 500 companies are wasting $500 million each year from more than 13,000 unnecessary back surgeries performed on their employees in the U.S. each year," said David Hines, president and founder of CMR.

According to the study, as many as 100 million working days are lost each year due to back pain. The average cost of back surgery in the U.S. is $36,000 to $38,200, and the reoperation rate is nearly 20%.

And don’t assume back surgeries are typically successful. According to a study done by Dr. E. Berger,[3] 1,000 workers’ compensation patients who had undergone lumbar spinal surgery were divided into two groups: one group consisted of 600 patients with single operations and the second group consisted of 400 with multiple operations. The results were stunning, to say the least.  71% of the single-operation group had not returned to work more than 4 years after the operation, and 95% of the multiple-operations had not returned to work. In none of these cases was there a neurological deficit that precluded gainful employment–the failure to return to work was blamed on chronic postoperative pain.

In addition, those patients who refused surgery and opted for alternative and less invasive procedures like chiropractic care to treat their back pain reported healthier and more personally satisfying outcomes.

This mirrors the Gallup poll in 1991 that showed chiropractic patients have always been satisfied with their local chiropractors. In fact, Gallup recognized that

• Chiropractic care is more patient-friendly than medical care with three times the patient satisfaction rates.
• 90% chiropractic patients felt that their treatment was effective and met or exceeded their expectations.[4]

While most people with back problems may think modern medical science is on the cutting edge of this problem, the facts contradict this belief. In fact, the back pain treatment business is riddled with outdated ideas by a biased medical profession, all leading to high costs and ineffective results.

Choosing treatment options for chronic or acute LBP can be a daunting task and “analogous to shopping in a foreign supermarket without understanding the product labels” according to Scott Haldeman, DC, MD, PhD, and treatment options include over 200 different medications, therapies, injections or surgical procedures. [5]

Indeed, buyer beware is fair warning to all in terms of treatments and in terms of qualified doctors.

The call for reform is growing louder and louder to expose the ineffectiveness in back pain management, but the medical establishment isn’t listening to its own experts.

For example, Dr. Gordon Waddell, orthopedist and author of the book, “The Back Pain Revolution,” confessed that

“Low back pain has been a 20th century health care disaster. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem.”

As a chiropractor in the back pain profession for nearly 30 years now, I agree that most treatments are not effective because most of them are the same old drugs, shots and surgery that repeatedly have been shown to be expensive, short-term at best, and unnecessary in most cases; this ineffective medical treatment has become a case of throwing good money in after bad. It’s time for a change in treatments, but this won’t happen until there’s a change in attitude.

However loud the call for reform, change comes slowly to the medical profession. As I tease my medical colleagues, if the electronics industry were as slow to change as medicine, we’d still be in the vacuum tube era.

According to the National Academy of Science,

“In the current health care system, scientific knowledge about best care is not applied systematically or expeditiously to clinical practice. An average of about 17 years is required for new knowledge…to be incorporated into practice, and even then application is highly uneven…”[6]

This is definitely a case of buyer beware: don’t think for one moment when you ask a medical doctor about your back problem that you are always getting the best advice based on recent research or scientific guidelines. For the most part, you will probably be hearing outdated advice from a primary care physician who during his or her medical career has had little actual training in this area of musculoskeletal disorders like back pain.

In fact, research published in The Physician and Sports Medicine journal described the musculoskeletal training of medical students as “woefully inadequate.”[7]

According to Dr. Scott Boden, Director of the Emory Spine Center,

“Many—if not most—primary care providers have little training in how to manage musculoskeletal disorders.” [8]

Dr. Richard Deyo also mentioned this problem of medical mistakes and incompetence by some physicians in diagnosis and treatment of low back treatments:

“Calling a [medical] physician a back-pain expert, therefore, is perhaps faint praise—medicine has at best a limited understanding of the condition. In fact, medicines’ reliance on outdated ideas may have actually contributed to the problem.”[9]

And you certainly won’t hear the advice of Anthony Rosner, PhD, who testified in 2003 before The Institute of Medicine:

“Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.” [10]

Why has it taken over 100 years for this advice to come forth? Except for chiropractic patients and spine researchers who understand the value of chiropractic care, many in the public haven’t learned this lesson due to a very extensive propaganda campaign conducted by the American Medical Association that was revealed in a federal antitrust court in Chicago that began in 1976.

This is a dark chapter in medical history that few people are aware of, but one that has shaped your attitude about my profession more than you can ever imagine. Sadly, not all but many MDs today still preach this bias to scare patients.

Unfortunately, talking about chiropractic to some folks is as controversial as talking about religion or politics—people have strong bias one way or the other. Sometimes when I mention that I’m a chiropractor, some folks simply say, “I don’t believe in chiropractic.” It’s a knee jerk reaction that they don’t understand why, they’ve just been taught that belief.

Some MDs ridicule patients who seek referral to chiropractors, scaring them with unsubstantiated fears and outright lies. You know this is true since you and I have heard it many times.

So where does this unwarranted skepticism come from? Not from our patients who have always given chiropractors high satisfaction rates, nor did it come from the US Public Health Service or Veteran’s Administration and the US Armed Forces that hire chiropractors.

Nor has it come from medical and chiropractic researchers who have stated that spinal manipulation is a “proven treatment” for back pain according to the US Public Health Service: “This treatment (using the hands to apply force to the back to ‘adjust’ the spine) can be helpful for some people in the first month of low back symptoms. It should only be done by a professional with experience in manipulation.”[11]

This skepticism is not by chance, but it is the result of a campaign going back to the 1960’s by the AMA to “contain and eliminate” chiropractic. It was an array of illegal dirty tricks that were never revealed to the public by the media since many were also co-conspirators in this criminal boycott.

My goal here is to discuss this antitrust trial and the impact it has had upon your health care and my profession, and it will explain why Americans face an epidemic of back pain today that has only gotten worse over the years as Dr. Carey admitted.

So let me give you a quick history lesson that may help provide some facts and perhaps change your mind about my profession and the best care for your back pain.

First of all, hands-on spinal care is not new: the history of spinal manipulation has its origins in antiquity. Egyptian documents written in the 17th century BC described spinal care. By the time of Hippocrates in the 4th century BC, physical means such as traction was being used to correct spinal deformities. The Renaissance produced Leonardo da Vinci who accurately described the anatomy of the spine. The first comprehensive treatise on biomechanics was published by Giovanni Borelli back in 1680, who is considered the “Father of Spinal Biomechanics.”

In many European countries “bonesetters” have treated strains and sprains of the spinal column since time immemorial as a trade passed down from father to son for many generations.[12] Even Queen Victoria who suffered with migraines allegedly was treated by a spinal manipulator.

The origin of chiropractic began in a similar fashion in America when DD Palmer re-discovered the art of spinal manipulation in 1895 and his teachings were popularized into the mid-20^th century by his son, BJ Palmer.

Today, there are over 80,000 chiropractors worldwide licensed in 88 countries around the world treating millions of people daily. In the US alone, there are 23 million chiropractic visits each year. This age-old art has finally come of age with 35 accredited colleges around the world teaching the science, art, history, and philosophy of this natural form of health care; right here in Georgia we have one of the largest chiropractic colleges in the world.

As you can see, the art of spinal manipulation has been around for a long, long time as a valued healing art. In fact, it’s older than most medical treatments, and modern chiropractic care is neither as dangerous nor as unscientific as the AMA portrayed it to be in the past. Despite the AMA’s opposition, spinal manipulation as performed by chiropractors has emerged as one of the safest and most effective treatment methods for back pain.

Nevertheless, the AMA turned its political and propaganda guns against this healing art and chiropractors for reasons that maintain the medical monopoly through illegal dirty tricks that made the Watergate burglars  look like a bunch of amateurs.

The history books will never mention that chiropractors were jailed over 15,000 times in the first half of the 20^th century for allegedly “practicing medicine without a license” although chiropractors never used drugs and surgery as everyone knows. Ironically, their real crime was getting people well without drugs or surgery.

Chiropractors were finally protected legally from vindictive medical societies after passage of state laws to create a separate scope of practice for chiropractic, which occurred here in Georgia in 1924 with the last state being Louisiana in 1974, but not before serious damage was done to the chiropractic profession.

The following chapter of medical history is a black eye that has never been adequately told to the public by the news media, and I doubt historians will teach this to medical students at Mercer Medical School. This case was not simply an antitrust case where one competitor tried to corner the market; it was a blitzkrieg of cultural, economic, and political might by the AMA to destroy the chiropractic profession completely.

This federal trial not only found the AMA guilty, but most shocking were the tactics, language, and attitude of the AMA as noted in the trial’s evidence, which appeared eerily reminiscent of German Nazis in World War II—in this case, the trial focused on the AMA’s Final Solution to “the chiropractic problem.”

For example, just listen to the very words of the AMA’s Committee established by its Board of Trustees for the sole purpose “to study the chiropractic problem” and whose prime mission was to

“first, the containment of Chiropractic and, ultimately, the elimination of Chiropractic.”

Simply substitute the word “Jewish” for “chiropractic” and you can understand the mindset of these medical men led by Morris Fishbein, MD, who was the executive secretary of the American Medical Association and editor of the Journal of the AMA for 25 years. He was also called the Medical Mussolini by many of his opponents.

Fishbein called chiropractors “rabid dogs” and “killers,” but gave no proof that chiropractors were dangerous. He portrayed chiropractors as members of an “unscientific cult, caring about nothing but taking their patients’ money,” when, in fact, emerging research of case studies proved that chiropractic care was effective, and chiropractors were certainly the cheapest of all spinal doctors. Nothing Fishbein said was true, but the media and public had no idea he was lying. After all, he was the voice of the AMA for 25 years.

Once state laws were passed to protect chiropractors from frivolous lawsuits, the court records revealed that the AMA broadened its war against chiropractic in other ways, such as:

• distributing propaganda to the nation’s teachers and guidance counselors to discourage students from seeking a career in chiropractic,
• punishing community colleges that offered pre-chiropractic programs,
• revoking the license of any MD who referred to or accepted referrals from chiropractors,
• encouraging hospital staffs to bar chiropractors, and
• discouraging radiologists from accepting requests from chiropractors to x-ray their patients.

Indeed, the AMA did everything it could to blackball chiropractors by throwing them in jail, destroying their public image with lies, boycotting their presence in hospitals, colleges, and in the mainstream healthcare delivery system, and using the media to disseminate its propaganda. It was the AMA’s Final Solution in the Chiropractic Holocaust.

An example of the AMA’s propaganda campaign against chiropractors included syndicated newspaper columnist Ann Landers, who ridiculed chiropractors in exchange for favors from the AMA, including a paid vacation to China.

In a court deposition, Landers admitted she had been paid by the AMA to write articles condemning chiropractic as an “unscientific cult.” When confronted by intelligent rebuttals to her columns from readers and chiropractors who refuted her misinformation, she recruited the help of the AMA to write responses under her byline.

This discrimination was obvious and had to come to an end, so in October 1976, 4 chiropractors led by Chicago attorney George McAndrews filed an antitrust suit against the AMA in the Northern District Court of Illinois, now known as the Wilk Trial. This was the showdown that beleaguered chiropractors had long awaited with the medical supremacists.

In order to defend its anti-competitive policy, the AMA’s defense focused on the issue of “patient safety,” to which Judge Susan Getzendanner later opined that many of the medical witnesses actually testified in behalf of the chiropractors-plaintiffs:

Dr. Per Freitag, a medical physician who associates with chiropractors, has observed that “patients in one hospital who receive chiropractic treatment are released sooner than patients in another hospital which does not allow chiropractors…

Dr. John Mennell, an orthopedist and medical professor, enlightened the court of the value of spinal manipulation in his testimony at the Wilk trial:

 “In the spine there are about 137 synovial joints…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.”

Since the spine has 137 joints, if these joints slip, twist, buckle or wrenched out of alignment, until proper joint alignment is restored, pain control is impossible as Dr. Mennell testified. This is the main reason why spinal manipulation has proven so effective for neck and back pain.

Dr. Mennell also testified that the average classroom hours spent on the musculoskeletal system by the average physician is “zero to 4 hours.”  In comparison, the average chiropractic education is over 2,000 hours in the study of the musculoskeletal system.

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.[13] Also convicted with the AMA were the American College of Surgeons and the American College of Radiologists.[14] 

(Wilk v. American Medical Ass’n, 671 F. Supp. 1465, N.D. Ill. 1987).

Judge Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession with a “lengthy, systematic, successful and unlawful boycott” designed to eliminate the profession of chiropractic as a competitor in the United States health care system.[15]

Judge Getzendanner also noted that:

“The activities of the AMA undoubtedly have injured the reputation of chiropractors generally…

In my judgment, this injury continues to the present time and likely continues to adversely affect the plaintiffs. The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations.”

So true: the AMA and its members never made any attempt to repair the damage to the reputations of chiropractors. This is the lingering bias from this illegal campaign by the AMA that has never been openly repudiated.

Although the court pronounced the AMA guilty, no one went to jail and no apology was made to the public. The AMA simply swept this under the rug and the AMA’s campaign went underground for the past 40 years to contain chiropractic via insurance limitations.

It’s as if the Civil War ended but the South continued with its slave society without any Reconstruction or World War II ended with the Nazis still in control.

The AMA obviously wasn’t sorry for being found guilty as charged since two objectives were accomplished—to ruin the reputations of chiropractors and to contain them to the margins of the healthcare system. The AMA didn’t eliminate chiropractors, but they certainly still work to limit patients’ access to chiropractors.

Back Pain Epidemic

Aside from the damage done to chiropractors’ reputations, what else can we attribute to the AMA’s campaign to eliminate chiropractors and their healing art? I believe a case can easily be made that the medical profession itself is responsible for this epidemic of back pain.

Gordon Waddell, orthopedist and author, confessed that

“Low back pain has been a 20th century health care disaster. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem.”

Without a doubt, this “lengthy, systematic, successful and unlawful boycott” as the judge proclaimed, has led to the present epidemic of low back pain in America.

It seems paradoxical that Americans are so prone to back problems, doesn’t it? Could this be due to genetically inferior spines? Or could it be patients are not being told the truth about their back problems and the best treatments available?

I think we all know the answer by now. By discouraging the use of chiropractic care, the AMA forced people to use less effective medical treatments. This epidemic is in part a result of the medical society’s attempt to corner the market of back pain, but in this case, their methods have proven to be less than effective for the vast majority of cases as the recent researchers have concluded.

Imagine the epidemic of tooth decay and gum disease we’d see today if the AMA had been successful in ruining the reputation and practices of dentists.

Well, this is exactly what’s happened as a result of the AMA’s boycott of chiropractic to corner the market and, according to attorney George McAndrews:

“When patients are forced to take their health problems from a chiropractor to a medical physician who isn’t skilled in that area…that is a funneling of business from the most-skilled to the least-skilled providers.”[16]

I firmly believe this suffering and huge expense can be blamed on the AMA’s propaganda campaign to deny Americans the best form of spinal care done by chiropractors, especially considering when Tim Carey, MD, admitted “… current treatments overall do not seem to be very effective.”

According to Dr. Scott Boden, Director of the Emory Spine Center,

“The best thing is to have an organized, integrated approach that uses state-of-the-art and cost-effective care.” [17]  

In my office, if patients do not respond well to spinal manipulation or spinal decompression on the DRX9000 table, I refer them to neurosurgeons in Macon or to Dr. Boden at the Emory Spine Center.

Most guidelines such as the US Public Health Service suggest this integrated approach begins with conservative non-invasive methods like spinal manipulation before drugs, shots and surgery.[18]

Instead, for the most part, patients are typically treated by their general practitioner with pain pills and muscle relaxants, then when that fails, patients are automatically referred to the surgeon’s office bypassing the chiropractor’s office, driving up the costs by ignoring the safer, cheaper, and more clinically-effective spinal care—spinal manipulative therapy.

Dr. Paul Goodley, MD, an orthopedist who popularized manipulative therapy in his book, Release from Pain, also found the medical bias to this healing art has led to this back pain epidemic.

Despite the history of spinal manipulation dating back to the ancient Egyptians and Greeks, the American Medical Association in its attempt to blackball chiropractors, inexplicably declared this art “unscientific” and threatened to punish MDs who referred to chiropractors, thereby effectively denied this healing art to millions of Americans suffering with neck and back pain.

Dr. Goodley mentioned:

“The conflict remains so near unimaginable that future historians may well describe the past century as a time of unnecessarily perpetuated pain.”

Just imagine the thousands if not millions of Americans who’ve been drugged with narcotics, injected with steroids, and had unnecessary spine surgery all due to this irrational bias toward chiropractors. This also explains why 80,000 cases of failed back surgery occur each year in our nation.[19] If every American had access to chiropractors, this pandemic of pain caused by this medical bias would be dramatically reduced.

Slowly the truth about the effectiveness of spinal manipulation is emerging. One study, Treating Back Pain Less Costly With Chiropractic Care, published in the October 2004 issue of Archives of Internal Medicine[20] compared four years of back pain claims from two groups: 700,000 health plan members with chiropractic care coverage were compared to 1 million members with doctor-only health plans without chiropractic care coverage, and they found that:

• Chiropractic care cut the cost of treating back pain by 28%.
• Chiropractic care reduced hospitalizations among back pain patients by 41%.
• Chiropractic care reduced back surgeries by 32%.
• Chiropractic care reduced the cost of medical imaging, such as X-rays or MRIs, by 37%.

This study shows when patients have direct and unencumbered access to chiropractors, the costs are dramatically lowered. While the AMA’s propagandists were trying to convince the public that chiropractors were ineffective, in reality as you can see, nothing could be further from the truth.

But the truth has never stopped the medical society before. For example, the issue of “patient safety” is still used by some local MDs to scare patients although I think it’s clearly a deliberate attempt to divert an argument from the dangers of drugs, shots and surgery. For years the medical propagandists have told the public that “chiropractors might break your neck or paralyze you,” which is simply untrue and certainly a case of the pot calling the kettle black.

I’ve never forgotten a conversation I had with a patient who was a nurse who assisted spine surgeons in the operating room in Macon. I thought it was interesting that she came to see me for her back pain, so I asked her why I kept hearing from some people that chiropractic care might paralyze them.

Her response stunned me when she said, “Oh, we’re taught to tell that to anyone who asks about going to a chiropractor.” She paused, and then added, “I don’t know why anyone believes me since I’ve never seen anyone hurt by a chiropractor, but I’ve seen lots of patients hurt by surgery.”

Obviously the malpractice insurance companies know who’s hurting who.

• A local neurosurgeon confessed to me his malpractice insurance costs $200,000 each year.
• A local OB-GYN admitted his insurance cost $60,000 annually.
• But my malpractice insurance costs only $1,600 a year.[21]

It’s quite obvious who’s hurting who, and it’s certainly not the chiropractors!

As you can see, spinal manipulation is extremely safe in skilled hands, but some local MDs would have you think half of our patients leave in ambulances!

Without a doubt, the chiropractic profession urges buyers to beware when it comes to drugs, shots or surgery for your back pain.

Once you learn the truth about the medical vs. chiropractic warfare, if you’re a fair-minded person like most Americans, you too should be mad to learn of the illegal dirty tricks used by the AMA to deny to you the best form of back pain treatment for political reasons. After all, it was you, the general public that the AMA has lied to over these many years about the best form of spinal care.

It’s time to appreciate the trials and tribulation of chiropractors who fought to save the great art of spinal manipulation. Instead of looking at chiropractors with jaundiced eyes as the AMA would prefer you do, you might give them a long-deserved pat on the back.

Chiropractors today should be heralded as the first healthcare reformists in America, long before it was politically correct. If it weren’t for the tenacity of the much maligned chiropractors, spinal manipulation would be a lost art today and people would have no freedom of choice other than drugs, shots, and surgery that their own experts like Drs. Carey and Waddell now tell us are ineffective treatments.

After all, it’s your body and it’s your suffering we’re talking about.

Our new president speaks of a new hope and change in America, and I say we need the same in healthcare.

Too many people have suffered too long and it’s time for a change, it’s time for new hope for the epidemic of back pain that the chiropractic profession can deliver best as the facts have shown.

By now you can see this degradation of chiropractors was not self-inflicted nor did it come from any public outrage. It is the total fabrication of the AMA to monopolize health care by demonizing their main rivals.

Unfortunately, the AMA isn’t interested in healthcare reform, reducing costs nor is it interested in transferring these cases to chiropractors. Everyone, including ardent fiscal conservatives, should be enraged over the billions of dollars lost and the pandemic of pain caused by outdated medical policies that discriminate against the best form of spinal care—spinal manipulation done by chiropractors.

Once more, please listen to Anthony Rosner, PhD, when he testified before The Institute of Medicine:

“Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.” [22]

Let me encourage you to take Dr. Rosner’s advice, reject the medical prejudice, understand the source of your skepticism, and discover for yourself the benefits of a healthy, well-adjusted spine. Indeed, you don’ t know how good you can feel until you’ve had your spine adjusted.

Once again, buyer beware: Don’t stay trapped in old attitudes, old ineffective concepts, and old medical treatments. It’s time to think out of the box of drugs, shots and surgery and discover the new science of chiropractic spinal care.

You do have a choice when it comes to your neck or back problems at Smith Spinal Care in Warner Robins. We’ll consult with you, do a thorough spinal exam, and then give you a report about your options to treatments.

Just bring your x-rays or MRI scans so we can discuss your case and so you can learn how our safe, effective and inexpensive chiropractic care can help you feel better, naturally without drugs, shots or surgery.

 Phone 478-922-4091 or Logon to www.smithspinalcare.com

[2] Fortune 500s Waste Over $500 Million a Year on Unnecessary Back Surgeries for Workers, Consumer's Medical Resource, July 21, 2008.