The famed children’s story Chicken Little made fun of a ridiculous notion by a nervous chicken that ran hysterically around the barnyard screaming “the sky is falling, the sky is falling” after an acorn fell on its head. Of course, everyone knew the sky wasn’t falling, and the point of this story was to make light of a paranoid idea that may lead to mass hysteria.
Apparently it’s time to play Bash the Chiropractors once again as some members in the health care media have now resorted to the same Chicken Little approach to attack chiropractic when several recent concurrent articles cried out, “Chiropractic causes strokes, chiropractic causes strokes.”
In the span of a few days from June 8 to 10, 2012, this outcry went viral on both sides of the pond where it originated in Great Britain. Eleven articles appeared within days of each other on the same issue—the safety of chiropractic.
- “Letting chiropractor ‘crack’ your neck to relieve pain could trigger stroke.” London, Fri, 08 Jun 2012, ANI, quoting Physiotherapy lecturer Neil O’Connell, of Brunel University, Uxbridge,
- Why does the government subsidize chiropractic colleges? By Steven Salzberg, Forbes, Jun. 10 2012
- Is Spinal Manipulation for Neck Pain Safe? By LARA SALAHI @BostonLara), ABC World News with Diane Sawyer
- Is spinal manipulation for neck pain safe? Experts disagree, By Kim Painter, USA TODAY
- Should Spinal Manipulation for Neck Pain Be Abandoned?, ScienceDaily (June 7, 2012)
- Spine manipulation for neck pain ‘inadvisable, ‘ BBC News, 7 June 2012
- “Debate over risk from spinal manipulation,” NHS Choices, 7 June 2012
- Scientists debate safety and value of spinal manipulation for neck pain, Arthritis Research UK, Published on 08 June 2012
- Is Spine Manipulation for Neck Pain Safe? A common chiropractic treatment for neck pain is “inadvisable” due to a risk of stroke, and should be avoided, say experts.” by Shawn Radcliffe, Men’s Fitness,
- Stroke risk from neck pain treatment, Spinal manipulation used by chiropractors as a treatment for neck pain should be abandoned because of the risk of causing strokes, say experts.” By Peter Russell, Web MD
- Spinal manipulation for neck pain should be abandoned,” by Ingrid Torjesen, OnMedica News, Friday, 8 June 2012
This outcry is not only another Chicken Little paranoid idea aimed to cause public hysteria about chiropractic care, it is best described as chicken shit journalism.
This sudden attack journalism is just too unlikely to pass off as coincidental on such an obscure topic. Indeed, considering the gigantic issues facing healthcare in America, such as the huge costs, unnecessary surgeries, medical mistakes, opioid addiction, and the battle over Obamacare, comparatively speaking, the issue of strokes after manipulation is a small one, which makes me wonder why they bothered to revive an issue that has already been resolved and affects so few?
The research is clear that this allegation of chiropractic causing strokes is extremely farfetched since the likelihood of a chiropractic adjustment is only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.[i]
It’s also an example of citation laundering where writers vaguely misquote and embellish each other’s story. For example, one outlandish and unproven statement in the original report, Letting chiropractor ‘crack’ your neck to relieve pain could trigger stroke, attributed to physiotherapy lecturer Neil O’Connell, of Brunel University, Uxbridge, was extrapolated into subsequent articles as “expert opinion” rather than what it is—unsubstantiated speculation by one physiotherapist in England.
Let’s be clear: we are not talking about NIH experts, nor are we listening to the US Public Health Services, WHO, or the British NHS. We are witnessing one physiotherapist from an unknown university in a similar unknown village, Uxbridge, in England who took a swipe at chiropractors worldwide. This is Chicken Little journalism, not peer-reviewed literature.
This is hit-and-run journalism so typical of the medical profession. O’Connell and colleagues also suffer from professional amnesia or worse, willful ignorance of the facts. Mr. O’Connell warned that “cervical spine manipulation ‘may carry the potential for serious neurovascular complications.’ Writing online in the British Medical Journal, he added that the technique is ‘unnecessary and inadvisable.’”
Most interesting again is his lack of evidence:
- Where are the injured patients with strokes caused by cervical manipulation?
- Where is the scientific proof, not merely conjecture by biased medical personnel, that manipulation “may carry the potential for serious neurovascular complications”?
- Where are the counterpoints made by the chiropractic researchers and educators?
- Indeed, where is the “fair and balanced” reporting on this issue?
Numerous studies affirm the value of cervical manipulation, but apparently Mr. O’Connell is less aware of these studies than his goal to scare the public with unwarranted allegations. This Red Herring attack on spinal manipulation (SMT) is nothing less than another spurious attempt by medical misinformers to frighten the public from one of the safest methods to alleviate neck pain.
For example, researchers led by Dr. Jan Lucas Hoving of Monash University in Victoria, Australia, reported the findings in the Annals of Internal Medicine that “hands-on” techniques like manipulation was more effective than exercise, pain-killers, and other standard physiotherapeutic treatments that Mr. O’Connell prefers. “Manual therapy seems to be a favourable treatment option for patients with neck pain,” Hoving’s team concluded.[ii]
A recent seven-year, international study, The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders, found that some alternative therapies such as acupuncture, neck manipulation, and massage are better choices for managing most common neck pain than many current practices.[iii] Numerous articles now support the value of SMT for neck and low back pain. To ignore these positive studies and miniscule adverse effects is evidence of O’Connell’s willful ignorance of the subject matter.
If Mr. O’Connell were truly interested in writing an objective report on the treatment of cervical problems, why the omission of these benefits of alternative treatments like chiropractic? Certainly the risks and benefits of all common treatments are fair game, but if they are fair game, there should be similar approaches to all common treatments. I don’t remember seeing any similar “debates” over stopping the use of NSAIDs, opioids, injections, or surgery for neck pain.
I am not suggesting spinal manipulation does not have adverse effects for some patients, but these are minimal in nature according to a 2008 study, “Adverse events following chiropractic care for subjects with neck pain,” by Sidney Rubinstein who concluded that “No serious adverse events were recorded during the study period.”
Conclusion. Despite the fact that adverse events are common, and patients have chronic, recurrent complaints, many patients responded quickly to chiropractic care, and seemed to benefit from treatment. Based upon these findings, we suggest that the benefits outweigh the potential risks.
Déjà Vu Down Under
The aim of this Chicken Little journalism is simply to create more paranoia about spinal manipulation, not about the best treatments in spine care. But it came as no surprise to the chiropractic profession since this attack is one in a long line of unfounded attempts to create mass hysteria.
Just last year another baseless attack in Australia by a rogue group of MDs who sent a nasty letter to the deans at Central Queensland University over the proposed chiropractic program that caused another stirrer in the media.
We (the undersigned) are doctors, clinical and basic scientists and clinical academics who, in our professional lives have, in one-way or another, become involved in attempts to protect health care consumers from the dangers associated with unscientific clinical practices. In so doing we have shared with each other our concern about the increasing numbers of universities that are allowing non-evidence based “pseudo” disciplines to be offered to their students. It is difficult to counter the massive amount of misleading, often fraudulent, information provided to consumers through the media and Internet.
My response to this medical mob’s letter can be read in total online at my website, but one paragraph best paraphrased this Chicken Little medical letter:
This letter is profoundly biased toward chiropractic, subtly intimidating to you, clearly misleading in details, an affront to academic freedom, and scientifically incorrect on many levels. Indeed, this letter by this medical mob smacks of professional demagoguery at its worst. I daresay as fair-minded academicians you should reject on principle the totality of their letter.
In the recent hit-and-run journalism by O’Connell, the United Chiropractic Association in the UK used my article, Piling on Chiropractic, to formulate a response, “Chiropractic Care is Safer than going to the Hairdressers!” to the Daily Mail newspaper. This is exactly the type of response our worldwide profession must do to counter the medical Chicken Little journalism whenever it appears.
Stop All Treatments!
I daresay if the hysteria over O’Connell’s comments are truly as disconcerting to the public as he and the medical associations might hope, let’s go on the offensive and call a moratorium on all spine care treatments. Imagine calling O’Connell’s hand in this poker game and upping the ante to call his bluff.
Let’s vet every major method to determine cost and clinical effectiveness as well as analyze the iatrogenic problems with each methods. We know every comparative analysis done on back pain places conservative chiropractic care among the best if not at the very top of the list for the 85% of mechanical LBP and neck pain cases.
Even an analysis of the adverse effects of each treatment finds chiropractic care the least problematic:
- A chiropractic adjustment causes one fatality in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.[iv]
- Opioid drugs like Oxycotin that caused 14,800 deaths last year and untold cases of addiction.[v]
- Epidural Steroid Injections at $1,000 each that were found to be no more effective than placebo. The Doctors Company collected and reviewed 13 anesthesiology claims involving allegations of arachnoiditis, paralysis, anoxic brain damage, or death following cervical epidural steroid injections. These claims were accumulated over a three-year period and were generated by approximately 2,800 insured anesthesiologists, only 64 of whom self-identified as full-time pain management physicians.[vi]
- Spine Surgery: In one recent study, the death rate was .03 percent, (10 out of 3475 patients), while 7.6 percent (263 out of 3475 patients) experienced complications within 30 days after surgery.[vii]
Let’s call for a worldwide moratorium on all spine methods until the safety and effectiveness can be determined. Of course, the Chicken Little people don’t want these facts to see the light of day because they know damn well the medical methods are ineffective, costly, addictive, and disabling in many cases. Even the much heralded disc theory has been pronounced dead, but kept alive by a greedy spine surgery society hell bent on misleading patients into more spine fusions.
This is not the first time the medical misinformers have raised unwarranted concern for strokes caused by manipulation. This hit-and-run attack journalism smacks of the tactics used by the AMA’s Committee on Quackery’s propaganda campaign.
Attorney George McAndrews of the Wilk case commented on a similar Chicken Little attitude he encountered back in 1987 when he gave his closing statement:
This is the evil that is still permeating this country. Every medical physician in this country has been exposed to that from the first day of medical school on. That’s all we need, is the medical school students being told they [chiropractors] are rabid dogs and killers, and not mentioning the fact that the medical students aren’t getting the proper education in the musculoskeletal system.
They have drummed into the medical physicians of this nation, not only their 260,000 members, but everyone down into the medical schools, that not only are you unethical, but you are almost anti-human if you would dare entrust health care even in a cooperative setting to a chiropractor.
He [Dr. Sabatier] said he felt “chiropractors were nice people, but they killed people.” They couldn’t possibly find evidence of that, and if they could have found it, it would have been here in court. After 25 years they haven’t been able to find any evidence of that. They only evidence they had was that they [chiropractors] helped people and they ran funny ads.
Now the medical media is running “funny” Chicken Little articles aimed to embarrass chiropractors. It’s time to turn this ship around and send a few shots across the bow of the medical spine ship.
Another recent hit-and-run swipe at chiropractors occurred on NPR on February 15, 2012, in a segment on Morning Edition by Blake Farmer that featured an article on military health services focusing on the military’s new use of complementary and alternative healthcare—chiropractic, acupuncture, and massage therapy: Military Pokes Holes In Acupuncture Skeptics’ Theory.
In this article, former flight surgeon Harriett Hall spewed a malicious epithet at these professions, which isn’t her first. She’s become the heir-apparent to Morris Fishbein, H. Doyl Taylor, Stephen Barrett, her infamous predecessors in medical propaganda.
Here’s the offensive excerpt:
But Harriet Hall, a former Air Force flight surgeon, shares the skepticism found in many corners of the medical community.
“We call that ‘quack-ademic’ medicine when it gets into medical schools,” she says.
The way she reads the science, acupuncture does no more than a sugar pill. To offer a placebo, she says, is unethical.
I can adamantly say she is willfully ignorant of the science. Her “quack” comment is wrong on many levels; it is unethical and misleading in light of the recent research supporting CAM methods. For example, the 2007 American College of Physicians/American Back Pain Society Guidelines on the Diagnosis and Treatment of Back Pain endorsed acupuncture, manipulation, and other CAM treatments for low back pain.[viii]
The hit-and-run tactic is not interested in the evidence. Indeed, her goal is to take a cheap shot at non-MDs, then hide tail and run before chiropractors can make any comment. Never has she debated this issue with CAM providers, certainly none who know the research and guidelines. These media bandits are not interested in fair play as much as assassinating their opponents.
This stroke issue was revived in 2010 by perhaps the most notorious hit-and-run article from England, “Deaths After Chiropractic: A Review Of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter, that raised the level of fear over chiropractic care when he noted that “Twenty-six fatalities were published since 1934 in 23 articles.”[ix] Just his title, Deaths After Chiropractic” emblazoned in print frightened headline scanners who failed to realize the irony of his article.
That is, his own findings belied his hope to denigrate SMT. Considering his study found 26 deaths in 76 years, this equates to 0.34 deaths per year. Instead of sounding an alarm to scare people as Ernst attempted, he should have praised chiropractic care for its obvious safety since this is an extremely low rate in comparison with equivalent medical methods for the same diagnostic condition.
Ernst’s paper drew quick criticism from leading medical and chiropractic scholars. According to SM Perle, S French, and M Haas:
Ernst ignored the evidence against a causal relation between spinal manipulation and death. Instead, he went boldly along a path of fear mongering and propaganda that we expect was predetermined to establish the dangers of CSM (cervical spinal manipulation).[x]
Another review from The Dartmouth Institute for Health Policy and Clinical Practice was equally critical:
Three deaths were reported during the last 10 years of the study, so for that most recent time period, the absolute risk could be estimated to be 3/10 per 100 million, or three deaths for every billion chiropractic encounters…This rate is so low that it cannot possibly be considered significant…An interesting flip side to the research question might be: by undergoing a course of chiropractic spinal manipulation, how many patients were able to avoid death by avoiding complications of surgical intervention?[xi]
What to Do?
The letter to the Daily Mail editor from the United Chiropractors Association in the UK will have probably little impact compared to the viral global distribution of the original article featuring O’Connell. Hopefully the Daily Mail will make it more than another small letter-to-the-editor, but that is doubtful if previous experience indicates the media’s effort to bury positive chiropractic replies.
Nor will the ACA’s response strike a nerve among the public. According to the ACA’s news release:
“President Keith Overland, DC had the opportunity to contribute to an ABC News story about the debate. Dr. Overland put the risks associated with spinal manipulation in context by stating that, “There’s still a lot of residual bias against the profession … Yes, there’s risk of every medical procedure, but we need to move away from health in a bottle.”
Indeed, the “pill for every ill” approached hasn’t worked, but this comment will not stop this trend until we crack the nut of skepticism with the hard evidence by striking back at the Chicken Little journalism.
Until the chiropractic profession creates a cognitive dissonance in the public’s mind—make them uncomfortable about medical spine care, we will continue to be victimized by these periodic hit-and-run articles.
We must address this propaganda directly to make our case in the court of public opinion. Someone in the chiropractic profession must challenge O’Connell to a public debate to showcase the new research supporting SMT for back and neck pain cases, to reveal the many positive public polls in favor of chiropractic care, as well as the new policies by the North Carolina BC/BS and the University of Pittsburgh Medical Center Health Plan that now mandates conservative/chiropractic care for at least 3 months before a surgical consultation is permitted.
As for more positive proof, the trend to alternatives is growing due to public demand, not just the demand by chiropractors. Despite the AMA’s goal to boycott chiropractors in public hospitals, which was the salient issue in the Wilk case, research now shows 42% of 714 surveyed hospitals offered at least one complementary or alternative therapy in 2010, as compared with 27% just five years earlier.
“What we’re seeing is that the patient demand is driving this movement in a big way,” says Sita Ananth, a director at the Samueli Institute.[xii]
Another shocking fact revealed many medical professionals are turning to CAM for care. In 2007, 83% of American health care workers used complementary or alternative medicine, as compared with 63% of the general population. They were also two times more likely to seek out practitioner-based complementary or alternative therapy and three times more likely to self-administer such therapy.[xiii]
Despite the many positives in chiropractic treatment, until we have the PR breakthrough by confronting this Chicken Little mindset and squash it hard as medical propaganda and hate speech, if you will, the public will continue to suffer through more medical misinformation and our profession will continue to wither on the vine.
But this cognitive dissonance must include the majority of chiropractors who still want to “make love, not war” with the AMA and medical bigots. It’s past time for every DC to find the courage to confront this hate speech wherever you find it—in the international media or in your community whenever a local MD lashes out at chiropractic. Even in my own little town, a local osteopath-turned-MD was telling mutual patients that SMT broke his wife’s neck. My letter inquiring into this allegation went unanswered because it was untrue and for now has stopped with his slander.
It’s past time to turn our cheek, swallow our pride, and bite our tongues when we see or hear this medical hit-and-run attack journalism.
History of Medical Misinformation
This ploy to frighten the public with unsupported accusations is unethical journalism that has a long history in the medical profession.
Since the days of Morris Fishbein’s propaganda campaign as head of the AMA, editor of JAMA, author of many books, and a syndicated columnist in nearly 700 newspapers, in the first half of the 20th century, chiropractic care was unfairly branded as an “unscientific cult” despite the lack of any credible proof.
History has shown this campaign to defame the chiropractic profession was the AMA’s assault alone–not a public or governmental outcry–that fueled an undeserved negative public image that has haunted chiropractic for nearly a century.
Fishbein was upfront with his hatred of chiropractic and all other alternative methods when he said, “Scientific medicine absorbs from them that which is good, if there is any good, and then they die.” [xiv]His goal was not to create open competition on a level playing field as much as it was to create the medical monopoly we now have today, and one way was to defame the medical competitors via the media.
After Fishbein was removed in 1949, the AMA created another more extensive propaganda campaign against chiropractors headed by Joseph A. Sabatier, MD. As chairman of the Committee on Quackery, he also vilified chiropractors: “Rabid dogs and chiropractors fit into about the same category…they killed people.” [xv]
The Committee’s attorney, Robert Youngerman, announced that chiropractors “…present a clear and present danger to the health and welfare of the public, and it would seem that as guardians of our nation’s health, doctors of medicine should be dedicated to the total elimination of any such unscientific cult.” [xvi]
Again, no proof was given for these vile statements.
In 1971, H. Doyl Taylor, the Director of the AMA Department of Investigation and Secretary of its Committee on Quackery, submitted a memo on his equivalent “Showers of Auschwitz” policy to the AMA Board of Trustees stating: “its prime mission to be, first, the containment of chiropractic and, ultimately, the elimination of chiropractic. Your Committee believes it is well along with its first mission and is, at the same time, moving toward the ultimate goal.”[xvii]
This professional antitrust campaign of sabotage of the chiropractic profession and defamation to the reputation of chiropractors was finally confronted during the Wilk et al. v. AMA et al. antitrust trial in Chicago District Court. As well, half-way around the world, the New Zealand government convened a Commission of Inquiry into Chiropractic in 1978-79. Although the Wilk trial was the most detailed investigation of the legal aspects of the medical war against chiropractors, the New Zealand Inquiry would surpass the trial material on many other fronts.
In both instances, the attorneys and investigators finally put the medical leadership’s feet to the fire on the witness stand. These medical witnesses proudly proclaimed that chiropractic was “absurd,” “unscientific,” “quackery,” and “dangerous.” When asked to prove their allegations, the court and investigators found they had no proof whatsoever. This slander was simply hearsay and lies repeated so often among the medical professionals that they actually believed them.
The Wilk antitrust trial evidence was clear the AMA et al. had based their war against chiropractors on falsehoods created by its own COQ. They presented no proof that chiropractic was a danger to the public, they refused to investigate chiropractic education or practice methods, and they refused to do research of their own despite the urging of one of its own board members, Dr. Irwin Hendryson. It became clear this was a war based on politics and greed, and certainly not on science, safety, or clinical effectiveness.
The claim of SMT being dangerous was heard by the New Zealand government that convened a Commission of Inquiry into Chiropractic in 1978-79 and commented on the alleged harm done by chiropractors:
The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record.[xviii]
Mr. McAndrews, Wilk attorney, also remarked at the lack of witnesses supposedly harmed by chiropractors or those AMA leaders condemning chiropractic who were not called by the attorneys for the medical defendants:
None of them have come through that door. Dr. Sabatier, who called the chiropractors killers and rabid dogs, is a defendant in this action. Where is he? Dr. Tom Ballantine: they extolled his virtues, head of the Committee on Quackery, a defendant in this action, his name is on all of these letters going back and forth. Every one of the letters all in the web of combining and conspiring to destroy the profession of chiropractic, where is Dr. Tom Ballantine?
They were not brought in so you [the jurors] could see them testify. Not one of them was brought in…none of these people that are central to this thing were brought in here. None of them.
And they haven’t brought in a patient. You’d think if all of these patients have been injured, some would come in here and say they were taken by a chiropractor. Not one walked through the door.[xix]
Mr. McAndrews addressed one of the main points of the defense–the issue of quackery. Again, no expert witnesses were provided to prove this point. Instead of bringing in experts in the field of spinal mechanics, neurophysiology, or orthopedic medicine to testify against the art or science of chiropractic, the best the medical attorneys could do was produce tacky and hyperbolic chiropractic ads:
I have counted up the exhibits of the ads and there is no doubt that some of the ads were distasteful. I have seen one where the chiropractor has an ad that says “the only thing that can’t be cured by spinal adjusting is rigor mortis itself.”
I do notice, though, that for the AMA that claims it had a full-time committee for eleven years to produce approximately 50 ads from an entire profession, says something about the fact that they may not have found as many chiropractors behaving in an aberrant fashion as they would like the Court to believe.
There were fringe practitioners and anyone that doesn’t think that there are fringe lawyers, fringe medical doctors, fringe dentists, fringe podiatrists, psychologists and chiropractors just is ignoring common sense. There are charlatans wherever you go, and the chiropractors have tried to help themselves.
They use the definition of quackery: somebody who pretends to knowledge they do not have. Chiropractors that pretend to medical knowledge are quacks. And medical physicians who pretend to universal knowledge of human anatomy and biomechanics on this record should be called quacks if the definition is: somebody who pretends to knowledge they don’t not have. That’s quackery. We all agree on that. [xx]
McAndrews showed by definition that many MDs are quacks when it came to spinal care. Mr. McAndrews also pointed out there was no effort by the AMA to incorporate the skills of chiropractors into the mainstream healthcare to help patients:
And what has happened here is that the might of a $60 million a year budget at the AMA was directed against eliminating the second largest health care profession in this country, not helping it, not joining hands, not sitting down and getting together and saying: you have certain skills, there’s no doubt about that. Congress wouldn’t include you in Medicare unless there is an over-whelming grass roots response from patients. They’re getting some sort of help that they’re not getting from the medical profession.
Indeed, the defendants’ organizations responded to that. The way they responded was: we’re not going to improve that health care group. We’re not going to even talk to them. We won’t debate with them. We won’t help their colleges, we will oppose any effort they do to upgrade their educational base and then we’ll call them stupid. What kind of concern and how does the name “physician” apply to someone that would do that? You can’t do it.
The first scientific review in 1992 in the USA that endorsed spinal manipulation for low back pain was done by RAND Corporation, one of America’s most prestigious centers for research.[xxi] Despite this acknowledgement, the yellow journalists in the mainstream media twisted its results.
Paul Shekelle, MD, PhD, MPH, primary investigator of the RAND study, assessed the results: “Both panels [one interdisciplinary and the other only chiropractors] agree that spinal manipulation is appropriate for low-back pain without the indication of sciatica.”
Rather than finally giving credit to the much-maligned chiropractors, the media misrepresented and distorted the RAND study. Shortly after the RAND announcement, Timothy Johnson, MD, the ABC Evening News medical spokesman, after minimizing the significance of the RAND study, reported that some medical doctors, osteopaths, and physical therapists also do spinal manipulation, neglecting to add that 94 percent of spinal manipulation is done by chiropractors.
In light of the historical condemnation of spinal manipulation by medical doctors and the capitulation by osteopaths to stop doing manipulative therapy, it was surprising when Johnson suggested to viewers that medical doctors and osteopaths were just as competent as chiropractors to adjust the spine. In fact, they are ill-trained in this area. Many are afraid to venture into manipulative therapy for fear of reprisal, and most still hold it in contempt to this day. Indeed, after decades of berating manipulative therapy, it is ironic that any medical practitioner would now claim to practice this art.
Dr. Johnson continued his report on the RAND study by saying chiropractors were doing manipulation under anesthesia, and that it could lead to strokes, which was not an issue the RAND study dealt with at all. He offered no proof, just proffered speculation to scare the public with his version of Chicken Little journalism.
After hearing this accusation myself, I telephoned my malpractice insurance company about this likelihood since I had never read of any chiropractor causing a stroke. The spokesman there told me, “We’ve never had a case of stroke filed.”
Aside from his misrepresentation of this study, Johnson’s real ploy was to take the luster off chiropractic’s obvious victory by once again scaring the public that manipulation is dangerous, which has been proven to be remote and no more dangerous than medical care; in fact, manipulative therapy has fewer risks and side effects than drugs or surgery.
Obviously Dr. Johnson could not give credit where credit was long overdue. After nearly a century of bashing chiropractic and spinal manipulation, research had proved its effectiveness and safety for low back pain. Not only did the medical hypocrites now want to jump on the spinal manipulation bandwagon, they wanted to be in the driver’s seat and throw chiropractors under the wagon.
No longer could the AMA slander chiropractic as an “unscientific cult” since the RAND researchers found chiropractic spine care to be effective. This change was further supported in 1994 after the Agency for Health Care Policy and Research (AHCPR) conducted the most extensive examination of treatments and recommended SMT as a “proven treatment” for acute low back pain in adults.
The AHCPR panel also recommended that manipulation only be done by an experienced practitioner which, of course, was an endorsement of the chiropractic profession since it does 94% of all spinal manipulation according to the RAND study.[xxii]
This guideline states:
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.[xxiii]
Since this American federal guideline struck down the AMA’s ministers of misinformation notion that chiropractic was “an unscientific cult,” the AMA changed tactics to chiropractic causing strokes despite little proof. In fact, this notion also has been proven false, but the medical media in regards to chiropractic has taken the attitude, “Don’t confuse us with the facts.”
Undoubtedly the most glaring example of media misrepresentation of the AHCPR’s findings occurred on NBC’s Today Show when their in-house medical spokesman, Art Ulene, MD, presented the results of this impressive two-year study on back pain. In a week-long series, Ulene mentioned the startling results of this study:
- Only one in 100 back surgeries is helpful;
- physio-therapeutics such as ultrasound, TENS, hot packs, and other standard treatments by physical therapists were also short term at best and considered ineffective to change the underlying causes; and
- spinal manipulation was the preferred initial professional treatment.
To his credit, Dr. Ulene detailed the findings accurately, but he could not contain his medical bias after Today Show host Matt Lauer concluded, “So, if you have a back problem, then you should see a chiropractor first.”
“Oh, no,” said Ulene, “I would never recommend a chiropractor. Go see an osteopath instead.”
There was an immediate pause on the show; Matt Lauer looked stunned and confused. You could have heard a pin drop on the stage since his condemnation stood in direct opposition of the AHCPR findings, and everyone knew it.
In one fell swoop, Ulene thwarted the possible upsurge of interest in chiropractic in the minds of millions of viewers. He should have known that most osteopaths today do not do spinal manipulation as a routine treatment and that chiropractors do the vast majority (94 percent) of all spinal manipulation according to RAND.[xxiv]
Indeed, if not for the courage and stamina of the chiropractic profession for over 100 years, the healing art of spinal manipulation therapy could have been lost due to the likes of Fishbein and Taylor, but these facts were lost to Ulene altogether.
In the long line of medical misinformers, Ulene’s bias was obvious. He still conveyed his message that the public should boycott chiropractors even when recommended by RAND and the U.S. Public Health Service. Ulene’s misrepresentation of the guideline was a great disservice to both the suffering public and to the chiropractic profession; this was exactly his goal.
The mere fact of the infrequency of good articles about chiropractic care in this epidemic of back pain is shocking considering the money involved, the new supportive research, and the call for reform in medical spine care.
Dr. Tim Johnson, ABC World News medical spokesman (and no friend historically to chiropractors) in 2006 asked the obvious question about the abundance of back surgeries in the USA:
“So why are so many back surgeries performed in this country? It could be a combination of too many surgeons who are too eager to operate and the impatience of many patients who want results quickly. The truth is that 90 percent of back pain can be resolved without surgery if both doctors and patients are willing to try other treatments that basically help the back to heal itself.”[xxv]
This statement is as close as Dr. Johnson will ever come to mentioning chiropractic on his television program; even he cannot deny the obvious that spine surgeries are ineffective. Just as Dr. Ulene could not muster the decency to admit chiropractic care is appropriate in most back pain cases, his ally Dr. Johnson cannot admit the truth, either.
Indeed, chiropractic is Missing in the Media, except when it is attacked. It seems the only time this profession is mentioned occurs when there is a negative issue, such as insurance fraud, sex abuse, or, once again, the reviving of the stroke issue. When was the last time we read an article about the millions of patients we help without drugs, shots, or surgery? When was the last time the media covered the supportive research? Or when the scientists bashed the outdated disc theory as “irrelevant incidentalomas”?
Instead of these important issues, we see the resurgence of critical articles from the Chicken Little medical professionals that chiropractors may cause strokes or paralysis. The medical-media remains convinced to once again try this case in the court of pubic opinion with more salacious articles supported by weak evidence.
 McAndrews, closing arguments, Wilk v. AMA, June 26, 1987, p. 3093-97.
[i]AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, (2001)
[ii] Hoving, JL et al. Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial, Annals of Internal Medicine, 2002 (May 21); 136 (10): 713–722
[iii] S Haldeman, L Carroll, JD Cassidy, J Schubert, Å Nygren, “The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary,” 33/ 4S (February 15, 2008): Neck Pain Task Force Supplement.
[iv]AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, (2001)
[viii] Chou et al., Annals of Internal Med., 2007, vol. 147 no. 7
[ix] E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162–1165
[x] SM Perle, S French, and M Haas, “Critique of Review of Deaths after Chiropractic, 4” Letters to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.
[xi] JM Whedon, GM Bove, MA Davis, “Critique of review of deaths after chiropractic, 5” Letter to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.
[xii] Jordan Fallis, “Patients driving alternative medicine boom,” CMAJ June 12, 2012 vol. 184 no. 9 First published April 30, 2012, doi: 10.1503/cmaj.109-4151
[xiii] Jordan Fallis, “Patients driving alternative medicine boom,” CMAJ June 12, 2012 vol. 184 no. 9 First published April 30, 2012, doi: 10.1503/cmaj.109-4151
[xiv] M Fishbein, Medical Follies, New York, Boni & Liveright, (1925): 43.
[xv] Minutes from the “Chiropractic Workshop,” Michigan State Medical Society, held in Lansing on 10 May 1973, exhibit 1283, Wilk.
[xvi] Memo from Robert Youngerman to Robert Throckmorton, 24 September 1963, plaintiff’s exhibit 173, Wilk.
[xvii] G McAndrews, “Plaintiffs’ Summary of Proofs as an Aid to the Court,” Civil Action No. 76 C 3777, Wilk, (June 25, 1987):21.
[xviii] BD Inglis, B Fraser, BR Penfold, Commissioners, Chiropractic in New Zealand Report 1979, PD Hasselberg, Government Printer, Wellington, New Zealand, (1979):78
[xix] G McAndrews closing argument, ibid. p 7076-88.
[xx] Ibid. p. 3051-52.
[xxi] Paul G. Shekelle, et al., The Appropriateness of Spinal Manipulation for Low-Back Pain (Santa Monica, CA: Rand Corporation Report, 1992).
[xxii]PG Shekelle, et al, RAND Corporation Report, The Appropriateness of Spinal Manipulation for Low-Back Pain
[xxii] S Bigos, ibid, Patient Guide, (1992):7.
[xxiii]Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994) Patient Guide, pp. 7.
[xxiv] PG Shekelle, et al, RAND Corporation Report, The Appropriateness of Spinal Manipulation for Low-Back Pain (1992)
[xxv] Timothy Johnson, MD, “Back Surgery Not Always the Cure for Pain; U.S. Leads the World in Procedures That Some Experts Say Could Be Avoided,” ABC World News, May 23, 2006