March 17, 2003
Mr. Lee Kravitz
711 Third Ave.
New York, NY 10017
RE: Dr. Isadore Rosenfeld’s article, “If it’s Natural, It’ll Work…Right?”
In your March 16, 2003 edition of Parade magazine, I must object to Dr. Rosenfeld’s lack of journalistic objectivity in his article, “If it’s Natural, It’ll Work…Right?”
I realize as a senior medical doctor and the leading media spokesman for the American Medical Association, Dr. Rosenfeld will have a natural bias against any treatment that is not typically medical such as drugs and surgery. But it’s one thing for Dr. Rosenfeld as an MD to be biased, and it’s another issue as a journalist to be so slanted as to mislead your many readers.
Rather than an even-handed account of complementary healthcare, Dr. Rosenfeld appeared to ridicule alternatives, inflame their dangers, or to ignore popular alternative methods completely. He makes no reference to the polls done at Harvard by David Eisenberg, MD on the usage of alternative healthcare that showed Americans make more visits to non-MDs than to MDs. Instead, his article focused primarily on the negative rather than the positive attributes of alternative healthcare.
For example, in regard to the treatment of low back pain, Dr. Rosenfeld could only bring himself to recommend acupuncture, disregarding the entire profession of chiropractic and spinal manipulative therapy that has proven itself to be the treatment of choice in the vast majority of cases according to many prestigious research panels like the US Public Health Service’s Agency for Health Care Policy and Research that published its recommendations as far back as 1994. This was without question the most detailed study on back pain ever done and it recommended spinal manipulative therapy as a “Proven Method.” It also noted that back surgery was found to be helpful in only one in 100 cases of back pain, much to the chagrin of back surgeons, nor did it recommend the typical pain pill/muscle relaxers treatment, yet Dr. Rosenfeld chose to ignore these facts altogether.
More recently, Orthopedics Today recognized chiropractic care in its February 2003 issue. This magazine, dedicated to “current news in musculoskeletal health & disease,” featured an article entitled, “Time to Recognize Value of Chiropractic Care? Science and Patient Satisfaction Surveys Cite Usefulness of Spinal Manipulation.” The article includes powerful commentary in support of spinal manipulation from Scott Haldeman, DC, MD, PhD, co-author of several studies on the safety of spinal manipulation; Jack Zigler, MD, orthopedic spine surgeon with the Texas Back Institute; and Andrew Cole, MD, associate clinical professor of rehabilitation medicine at the University of Washington and recent past president of the American Academy of Physical Medicine and Rehabilitation.
The article notes that Drs. Zigler, Haldeman and Cole joined other spine experts in attempting to debunk misconceptions about spinal manipulation, at the North American Spine Society’s 17th Annual Meeting, and also references a recent Harvard University study in which low back pain patients who received conventional and “alternative” treatment, including spinal manipulation, were significantly more satisfied with alternative than conventional care.
“About 10 to 12 international guidelines have suggested that there is some benefit to manipulation,” says Dr. Haldeman. “If we look at their basic guidelines, manipulation has consistently been accepted by independent government and scientific bodies as being a valid form of treatment.”
Dr. Cole offered the most striking endorsement of chiropractic, suggesting instances in which spine surgeons should refer patients to DCs. He emphasizes that manipulation can provide short-term pain relief for acute low back pain and modest relief for chronic low back pain. According to the article, his endorsement goes a step further: Cole said that, “overall, manipulation has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities.”
The article in Orthopedics Today is significant not only because of its positive depiction of spinal manipulation and chiropractic, but because it comes at a time when several other questionable media sources have portrayed DCs in much less favorable light, or have chosen to ignore chiropractic altogether as Dr. Rosenfeld has done.
The epidemic of back pain in America is huge—a nearly $100 billion annual expense, back pain is the second-leading reason for visits to doctor offices, back surgery is the third-leading hospital procedure (much of which is unnecessary), low back pain is the leading on-the-job injury, the leading cause of disability for people under 45, the second-leading cause of disability overall (second to vascular disease), and upwards of 90% of adults will suffer a severe back pain problem sometime in their lifetime.
Back pain is a major problem throughout all industrialized nations, and a plethora of research from around the world has confirmed spinal manipulation is the best form of treatment for the vast majority of these disabling conditions, yet Dr. Rosenfeld could not bring himself to even mention “chiropractic” in his article.
I ask you: is this a typical case of medical bias in journalism, or has Dr. Rosenfeld chosen not to let the facts sway his opinion? In either case, he did no favors to your readers or my profession by this obvious simple omission.
I suggest in the future that your fine magazine might write a more balanced report on alternative healthcare by someone more objective and informed about this issue. Indeed, having an MD write an article about complementary healthcare is equivalent to allowing the DNC to write an article about President Bush. As you know, healthcare is very political, and by allowing Dr. Rosenfeld’s remarks to go unchallenged by those who hold opposing viewpoints smacks of unfair journalism.
For further information, let me refer you to the American Chiropractic Association in Arlington, VA @ 703-276-8000 to learn of the many studies that confirm chiropractic’s clinical and cost-effectiveness with this epidemic of back pain. Your readers deserve to know the truth about complementary healthcare regardless whether or not Dr. Rosenfeld chooses to give it to them.
JC Smith, MA, DC
 Eisenberg, DM et al. Unconventional Medicine in the United States. New England Journal of Medicine. 328(4): 246-252 (Jan. 28, 1993).
 Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994.
 Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today February 2003:23(2), pp14-15.
 Haldeman S, Chapman-Smith D, Petersen DM Jr. Guidelines for Chiropractic Quality Assurance and Practice Parameters. Proceedings of a consensus conference commissioned by the Congress of Chiropractic State Associations, held at the Mercy Conference Center, Jan. 25-30, 1992. Gaithersburg, MD: Aspen, 1993.
 Haldeman S, Cole A, Zigler J, et al. Spinal manipulation in spine care: who? why? when? Presented at the North American Spine Society 17th Annual Meeting, Oct. 29-Nov. 2, 2002, Montreal.
 NASS learns about chiropractic. Over 2,400 surgeons and other specialists learn how to work with DCs. Dynamic Chiropractic, Dec. 16, 2002.
 Plane and Pilot editorial grounds chiropractic. Dynamic Chiropractic, March 24, 2003
 Penn and Teller take cheap shot at chiropractic, alternative medicine. Dynamic Chiropractic, March 24, 2003.