Articles by JCS

SPINAL PLAGUE

Invisible Spinal Plague

We constantly hear and for good reason to “Wash your hands. Don’t touch your face. Don’t go to the bar. Don’t go anywhere at all. Wash your hands again.” I might add I’ve never used as much hand sanitizer since this viral outbreak started and my clinic smells like a Lysol bomb exploded.

President Trump called the coronavirus epidemic a ‘war’ with an ‘invisible enemy.’ He said, “One day we'll be standing up here and say, ‘Well, we won.’” Hopefully he’s not overly optimistic and the government will learn how to handle better the next viral pandemic because this COVID-19 has stumped them all, catching our state and federal governments flat-footed.

By now we’ve gotten the message loud and clear that COVID-19 is a serious threat to the world—a new Bubonic Plague or 1918 Spanish Flu, if you will. We’re currently participating in what’s been called “the world’s largest natural experiment in behavior change” that will forever change how nations react to pandemics and interact globally to solve it.

When Disney World closes amid talks to close the Tokyo Olympics, you know this is serious business that international medical systems still cannot control. Since there is no effective medicine or vaccine for this viral pandemic, the practice of “social distancing” seems to have “flatten” the rate of infection. People are working from homes and avoiding social gatherings such as schools, work, hotels, restaurants, and sporting events.

Ironically, an area not regulated by social distancing but perhaps the most contagious are local hospitals where sick people flock for help despite the close contact with infected patients and exposed medical staff. As well, the threat of “superbugs” such as MRSA bacteria may affect many patients in the not-so-safe haven of medical wards.

According to the Washington Post, Hospitals are germy, noisy places so some acutely ill patients are getting treated at home instead, which makes hospitalization a more perilous decision for COVID-19 patients seeking help.

Most people fail to realize hospitals are laden with superbugs:

·                  Methicillin-resistant Staphylococcus aureus (MRSA)

·                  Clostridium difficile (C.Diff)

·                  Vancomycin-resistant enterococci (VRE)

·                  Carbapenem-resistant Enterobacteriaceae (CRE) and Carbapenem-resistant    Klebsiella pneumoniae (CRKP)

·                  Necrotizing fasciitis, the flesh-eating bacterial disease.

 

Hospitals are also very dangerous from medical mistakes. A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors that now are the third-leading cause of death in America after heart disease and cancer.  What a dilemma for sick people—go to the  hospital to get well or to get sicker—it’s simply a toss of the coin!

The Spine Plague

Despite President Trump’s optimism in the face of this viral enemy, it made me think of another older plague the public has faced for decades and many more to come unless we have another “natural experiment in behavior change.”

Indeed, there is more than one “invisible enemy” and that includes culprits not viral but bio-mechanical in nature—the rampage of low back pain, the leading disabling condition in the world, workplace, and military, that continues to be mistreated by “usual medical spine care” consisting of narcotic painkillers, spinal injections, nerve ablations, spinal cord stimulators, and risky spine surgeries.

Perhaps we need to create a new public creed similar to the coronavirus to contain the Spinal Plague that is spreading since the medical-spine providers have no inclination to stop  their dangerous/expensive treatments or to follow guidelines. Here’s a public warning for patients suffering from acute or chronic LBP:

“If your pain hasn’t subsided with NSAIDs within a few days or if it’s recurring, go to the chiropractor. Don’t go to the primary care MD for advice. Don’t touch opioid painkillers. Don’t go to hospitals for MRIs or spinal injections or surgery before seeing a chiropractor. Follow the guidelines and see a chiropractor first.”

Of course, we know this medical mismanagement of gullible patients with back-pain speaks of the lack of cooperation by the medical community to follow the guidelines. Most MDs simply will not change their behavior and cease with their dangerous spine treatments that have led to a tsunami of unnecessary spine treatments that have left a “wake of disability behind.”

Just imagine what a huge impact it would be if we publicly demanded the medical profession stick to the evidence-based guidelines and demanded they follow the Doctrine of Informed Consent to give all patients all “practical alternatives.”

RESEARCH TO THE RESCUE

Controlling the spread of this spinal plague is not a new pandemic like COVID-19; in fact, it has been studied over the past few decades since 1994 with evidence-based guidelines such as the AHCPR guideline #14 on acute low back pain that stated spinal manipulation was a “proven treatment.” This guideline has been confirmed by many others such as:

·         2015: The Joint Commission  promoted chiropractors from the ranks of the medical zombies (note: the Joint was a co-conspirator in the boycott of DCs in the 1960s leading to the Wilk v. AMA antitrust trial) with its Revisions To Pain Management effective January 1, 2015:

Both pharmacologic and nonpharmacologic strategies have a role in the management of pain. The following examples are not exhaustive, but strategies may include the following:

Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy.

·         2016: The CDC released  CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016:

“Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including nonopioid pain medications and nonpharmacologic treatments).”

·         2017: The American College of Physicians updated its 2007 guidelines for treating nonradicular LBP with nondrug, nonsurgical conservative care that were released on Feb. 14, 2017, in the Annals of Internal Medicine, CLINICAL GUIDELINES:  Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians:

The American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline that physicians and patients should treat acute or subacute LBP with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation.

·         2017: A similar study by the Journal of the American Medical Association appeared on April 11, 2017: Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis, also recommending SMT before medical spine care.

Findings:  In this systematic review and meta-analysis of 26 randomized clinical trials, spinal manipulative therapy (SMT) was associated with statistically significant benefits in both pain and function, of on average modest magnitude, at up to 6 weeks.

·         2017: In its attempt to reign in the opioid crisis caused by primary care physicians, pain management clinics, and pharmacists, the Food and Drug Administration issued its FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain that included Complementary therapies – e.g., acupuncture, chiropractic”.

·         2018: The consensus of the British medical journal, The Lancet, completed a three-part analysis of the global burden of back pain. The following excerpt from Thousands of back pain sufferers given 'harmful' treatments[1] gives a good synopsis of The Lancet article:

 “Doctors regularly prescribe addictive opioids and potentially harmful treatments including spinal fusion surgery, despite there being little evidence these treatments work. Meanwhile, cheap treatments [chiropractic care] that do work are rarely prescribed.”[2]

 

PROFESSIONAL CRITICISM

Indeed, a case can be made the medical boycott of these guidelines and professional chirophobia bias has led to the spinal plague we now see worldwide. Instead of referring patients with nonspecific LBP to chiropractors as guidelines have recommended since the 1990s, the medical profession relied upon narcotic painkillers that led to the opioid crisis of abuse, addiction, and death.

Dr. Don Teater, Medical Advisor, National Safety Council, said it best, “Opioid painkillers don’t kill pain, they kill people.”

Mr. Mark Schoene, editor of The Back Letter, wrote in 2015 about the danger of PCP care:

“The most perilous setting for the treatment of low back pain in the United States is currently the offices of primary care medical practitioners. This is simply because of the high rates of opioid prescription in these settings.”[3]

Researcher Richard Deyo, MD, MPH, author of “Watch Your Back!”, also mentioned physician incompetence in diagnosis and treatment of low back pain:

"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, medicine's reliance on outdated ideas may have actually contributed to the problem."[4]

When the narcotic painkillers fail, gullible patients are then railroaded down the medical wild ride. First, they are sent to pain management clinics for spinal injections, then sent for MRIs looking for “incidentalomas” leading to inevitable spine surgeries based on the debunked “bad disk” theory with very high incidence of failure and, of course, at great expense.

Editor Schoene also coined the term “poster child of inefficient care” in his article, “U.S. Spine Care System in a State of Continuing Decline,” as a result of the inept training and dangerous treatments offered by primary care physicians, pain management clinic and surgeons:

Medical spine care is the poster child of inefficient care…such an important area of medicine has fallen to this level of dysfunction should be a national scandal. In fact, this situation is bringing the United States disrespect internationally."

Certainly, little in the medical spine arsenal is considered clinically effective or a good buy for the majority of these common LBP problems, yet this spine plague marches on undeterred by guidelines or ethics to “First, Do No Harm.” Primary care providers know they are poorly trained in musculoskeletal disorders, yet they keep this a secret to the patients despite the poor results.

As Mr. Schoene said, “The most perilous setting for the treatment of low back pain in the United States is currently the offices of primary care medical practitioners.” It’s past time we chiropractors told the public and press of this simply truth.

Scott Boden, MD, director of the Emory Orthopedics & Spine Center, also admitted to the incompetence of most MDs:

Many, if not most, primary medical care providers have little training in how to manage musculoskeletal disorders.”[5]

THE PLAGUE CONTINUES AD INFINITUM

Sadly, the tragedy of ineffective medical spine treatments doesn’t end there. Indeed, this trail of tears from opioid addiction and failed back surgery lasts a lifetime since patients never get over a failed back surgery, never. This futility then leads to more problems when people are still not referred to DCs but are prescribed narcotic painkillers for chronic pain. As we’ve seen with the opioid crisis, thousands of people then become addicted and die annually.

The same can be said of failed back surgery victims considering 50-90% fail leaving a wake of disability and despair that has reached into the millions of people since these profiteering surgeries began. The chart shows 2,500 per one million victims of medical spine care are seriously injured or die annually, but little is said in the media or by government officials.

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This scenario has been labeled the “Quiet Epidemic” since there is little fanfare about the failure of medical spine care. This Spinal Plague is worse than the viral pandemic. The USA (as of 3/20/2020) has a rate of 60 cases/1 million for this COVID-19 viral attack, which is small compared to the 2,507 cases/1 million of the Spinal Plague. In New York City, the epicenter in the USA, where there have been 13,119 cases in a population of 8.6 million, the attack rate works out to about 1 in 650. Although patients don’t die from back pain itself, millions have died from medical spine treatments, many of which were unnecessary.

There are no dramatic “town hall meetings” hosted by Anderson Cooper or Dr. Sanjay Gupta at CNN. There is no White House press meeting to announce a new initiative to reduce the Spine Plague by instituting conservative care as all the new guidelines recommend.

Instead of our hat in hand, it’s time we should carry a big stick to show Americans and the world we DCs were right. This point was well made at the Wilk v. AMA antitrust trial when the federal district court Judge Susan Getzendanner {Wilk v. American Medical Assn, 671 F. Supp. 1465, N.D. Ill.}[6]noted:

“…chiropractic was more effective than the medical profession in treating certain kinds of…back injuries” and “chiropractors were better trained to deal with musculoskeletal problems than most medical physicians.” 671 F. Supp. at 1481-83

Indeed, PCPS are inept, dangerous, and surgeons do not follow the guidelines, they follow the money that approaches $100 billion in medical spine services. Combine incompetence with greed and chirophobia makes for a dangerous brew that sickens millions of people daily.

If we are to “flatten the curve” in this spine plague it begins with “social distancing” to stay away from PCPs and spine surgeons. We must tell patients to wash their hands of medical spine care and to seek the advice of classic chiropractic care for the best, natural remedy to this worldwide pandemic of back pain.



[1] https://www.smh.com.au/national/thousands-of-back-pain-sufferers-given-harmful-treatments-20180321-p4z5h0.html

[2] Thousands of back pain sufferers given 'harmful' treatments by Liam Mannix, The Sydney Morning Herald, 21 March 2018

[3] The BackLetter, volume 30, number 10, 2015

[4] Deyo, RA. Low -back pain, Scientific American, pp. 49-53, August 1998.

[5] S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disk Disease,” Spine 28(2003):524-525.

[6] This trial is discussed at length in my book, The Medical War Against Chiropractors.

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