September 17, 2013
TO: Jeffrey Zucker, president of CNN Worldwide
Dr. Sanjay Gupta, CNN Chief Medical Reporter
Richard Davis, CNN EVP of News Standards and Practices
Val Willingham, CNN Medical Producer
One CNN Center
Atlanta, GA 30303
RE: Op-Ed: Dr. Gupta’s Weed & Other Controversies
(word count: 1541)
Let me applaud CNN’s chief medical reporter, Sanjay Gupta, MD, for changing his mind about medical marijuana:
“Recently, I have apologized for some of the earlier reporting because I think we’ve been terribly and systematically misled in this country for some time.
And I did part of that misleading.”
Upon hearing his mea culpa, I thought if Dr. Gupta can apologize for misleading viewers about the health benefits of weed, maybe he can do the same about misleading his viewers about the health benefits of chiropractic care.
Such a fair reassessment is not unprecedented considering two organizations of prominence—the AMA and Emory University—have apologized to their past victims of discrimination:
- in 2008, the “AMA Apologizes For Past Inequality Against Black Doctors” 
- in 2012, “Emory Apologizes For History Of Anti-Semitism At Dental School.”
Nor is another apology uncalled for in regards to chiropractic care. On June 25, 2008, Dr. Gupta reported @ CNN.com, Stroke After Chiropractic Care: “Hundreds of people have had strokes after having their necks manipulated” despite research to the contrary showing this remote likelihood as well as the overall safety of spinal manipulation.
On Nov. 18, 2012, Dr. Gupta did an exposé entitled, Deadly Dose, requested by former President Clinton, about deaths from opioid painkillers taken primarily for chronic back pain. Unfortunately, Dr. Gupta overlooked the most obvious non-drug solution to back pain, chiropractic care, as “a way to prevent people from taking a deadly dose” for millions of CNN viewers who would have been helped immeasurably by this mention.
Poster Child for Inefficient Spine Care
Larger newsworthy issues also have been virtually ignored @ CNN.com about the worldwide pandemic of back pain and the growing clamor in the news about controversial medical spine treatments. Articles in The New York Times, USA Today, and The Wall St. Journal over the last few years continue to reveal the dangers, expense, and abuse of spine surgery, opioid painkillers, and epidural steroid injections:
- “Back Pain Eludes Perfect Solutions” by Leslie Berger, The New York Times, May 13, 2008
- “Epidural steroid shots debated amid meningitis scare,” USA Today, Oct 6, 2012
- “Opioid Painkiller Prescriptions Pose Danger Without Oversight,” Barry Meier, The New York Times, April 8, 2012
- “Back Surgery May Backfire on Patients in Pain,” by Linda Carroll, MSNBC.COM, Oct. 14, 2010
- “Top Spine Surgeons Reap Royalties, Medicare Bounty,” by John Carreyrou And Tom McGinty, Wall St. Journal, Dec. 20, 2010
- “Medicare Records Reveal Trail of Troubling Surgeries” by John Carreyrou and Tom McGinty, Wall St. Journal, March 29, 2011
- “How Back Pain Turned Deadly” by Elisabeth Rosenthal, The New York Times, November 17, 2012
Mark Schoene, editor of The BACKLetter, an international spine research journal, summarized the research consensus best when he simply stated: “Spinal medicine in the US is a poster child for inefficient spine care.”
Even the North American Spine Society admits spine surgery is “a last resort and should be considered only after other conservative (nonsurgical) measures have failed.” The Spine Journal stressed that spinal manipulation in particular should be considered before surgery because research found it to “achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions.”
Anthony Rosner, PhD, echoed this call for chiropractic care 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.”
Surveys have shown that chiropractors also have vaulted to the front in polls done by Consumer Reports, Gallup, TRICARE, and Medicare of patients who were “very satisfied” with their chiropractic treatments.
Due to the dearth of news coverage, however, few people realize chiropractors are now the third-largest physician-level providers practicing in 90 countries around the world as the portal-of-entry (POE) for musculoskeletal disorders.
Paradigm Shift in Spine Care
Neurologist Scott Haldeman, MD, DC, PhD, a world-renown multi-disciplinary researcher from UCLA, confirms that “virtually all guidelines” on spine care now advocate conservative care first:
“The paradigm shift has already taken place. Non-surgical, non-invasive care is already the first choice for treatment for spinal disorders in the absence of red flags for serious pathology in virtually all guidelines.”
This paradigm shift essentially began over twenty years ago with game-changing research undermining the customary abnormal disc diagnosis. Dr. Gupta is uniquely aware of this issue both as a neurosurgeon and as an Emory University colleague of Scott Boden, MD, director of the Spine Center at Emory, whose seminal MRI research in 1990 debunked the underlying “bad disc” premise upon finding many pain-free people in his study had herniated or degenerated discs.
This issue recently became a topic in the news except @ CNN:
- “Highest-Paid U.S. Doctors Get Rich with Fusion Surgery Debunked by Studies” by Peter Waldman and David Armstrong, Bloomberg News, Dec. 30, 2010
- “Surgery May Not Be the Answer to an Aching Back,” by Joanne Silberner, NPR, April 6, 2010
- “Why You Should Never Get Fusion Surgery For Plain Back Pain” by Robert Langreth, Forbes, Jan. 10, 2011
- “600,000 Americans have back surgery each year,” TODAY, September 11, 2012
- Study Says Back Surgery Often Makes Things Worse, The Daily Hit, Oct 14, 2010
- New Study Reveals That Back Surgery Fails 74% of the Time, SPINE 2011 (Feb 15);36 (4):320–331
Research has also revealed other problems in spine care. Scott Boden, MD, confessed that “many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”
Moreover, patients do not realize that half of all medical schools do not even teach one class in musculoskeletal disorders. Consequently, most medical primary care physicians (PCPs) are deemed “inept” in their academic training on musculoskeletal disorders, more prone to be “naïve prescribers” as Dr. Gupta mentioned, and most PCPs were found to be more likely to suggest spine surgery than even surgeons themselves.
The ineffectiveness of medical spine care diagnosis and treatments has now burst onto the national scene with a flurry of yet more articles after a recent July 29, 2013, investigation in the JAMA Internal Medicine highlighted the Worsening Trends in the Management and Treatment of Back Pain. The authors of this study admit, “Back pain treatment is costly and frequently includes overuse of treatments that are unsupported by clinical guidelines.”
This article went viral overnight in the mainstream media except @ CNN.com:
- The LA Times (Back pain: Doctors increasingly ignore clinical guidelines)
- USA Today (Patients with back pain often get the wrong treatment)
- Medscape Medical News featured, Worrisome Trends in Back Pain Management
- CBS This Morning also carried a televised segment, New solutions for long-lingering back pain – CBS News that reported “many treatments are actually inconsistent with clinical guidelines.”
- Most recently on August 20, 2013, The New England Journal of Medicine published an editorial, Outpatient Back Pain Treatments: Not What the Doctor Should Order, by Jaime Toro, MD, stating, “Treatment of back and neck pain increasingly relies on strategies that run counter to published guidelines.”
Helping Millions, Saving Billions
Spine surgeons worry as insurance payers become more wary because stunning new research continues to show that fusion surgery has no advantage over non-surgical care for patients with chronic back pain and disc degeneration over the long-term (11 year) follow-up, according to Anne Mannion, PhD, et al.
As a result, some payers such as North Carolina Blue Cross/Blue Shield have announced they will no longer pay for spine fusion if the sole criterion is an abnormal disc that is now considered to be solely a clinical finding, but not a diagnosis.
The new guidelines will help patients avoid surgery as well as lower medical costs. For example, a recent workers comp study from Washington State compared patients with low back pain whose first provider was either a chiropractor or a surgeon. This produced drastically different rates for surgery: 42.7% of workers who first saw a surgeon had surgery in contrast to only 1.5% of those who first saw a chiropractor.
This study illustrates when modern, well-educated chiropractors assume their rightful POE role as America’s primary spine care providers (PSP) and patients are allowed the choice to a “proven treatment” for this pervasive pandemic of back pain, the potential benefits for the payers will be enormous saving billions of dollars in total costs from “inefficient” medical spine care, lost wages, and disability.
Call to Action
As “the most trusted name in news,” I urge Dr. Gupta and medical producer Val Willingham to embrace CNN’s motto by producing an objective exposé similar to Deadly Dose, perhaps titled Helpful Hands, about the paradigm shift in spine care citing the new evidence-based guidelines, the controversies surrounding inefficient medical spine care, and the emerging support for chiropractic care.
If Dr. Gupta is willing to come out of the closet about weed, then it’s time for CNN to come clean about other skeletons in the medical closet. Similar to the emergence of gays, lesbians, blacks, and women, this is another fascinating human interest story about a healthcare minority just waiting to be told. Indeed, it’s past time for chiropractors to come out of the medical closet, too.
cc: Georgia Chiropractic Association
American Chiropractic Association
Life University President Guy Riekeman
Foundation for Chiropractic Progress
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 Karen Fox, Emory apologizes for history of anti-Semitism at dental school, ADA News Staff, November 19, 2012
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