Merchants of Misinformation
“The truth is, he’d probably have been cured if
he had fanned himself with goofus feathers.”
Ann Landers, syndicated columnist
The impact of Morris Fishbein’s viral journalism attacking chiropractic planted the seed for others to follow in his footsteps to misrepresent the value of manipulative therapy as well as mischaracterize chiropractors. With Fishbein’s extensive media exposure as a columnist in 700 newspapers, his many books, and as editor of the AMA’s many publications including its flagstaff, the Journal of the American Medical Association, he and the AMA recognized the power of the press to dissuade the use of alternative healthcare providers by branding them as cultists, unscientific, and dangerous.
What the medical war never had during this era was transparency or the close examination under a magnifying glass by the media. There were no renowned investigative reporters like Bob Woodward and Carl Bernstein of Watergate fame to expose the underbelly of the medical war and the damage it did to chiropractors. When a few newsmen did speak out against the obvious bigotry, they too met the wrath of the medical establishment. After all, everybody knows chiropractic is an unscientific cult was the prevailing mindset nurtured by the AMA to the media.
To be sure, most reporters suffering from professional amnesia have taken the same stance as the proverbial three wise monkeys—“see no evil” (blind to the AMA’s attack on chiropractic and manipulative therapy), “hear no evil” (ignore the call for reform in spine care), and “speak no evil” (refuse to acknowledge or to recommend manipulative therapy), which can also be seen as “speak no chiropractic.”
Despite the AMA’s solid hold of the media during its chiropractic witch hunt, a few brave journalists spoke out against this unfair persecution. An editorial in the Valley Morning Star from Harlingen, Texas, in 1966 wrote a reasonable and insightful response to the AMA’s accusation of quackery thrown at chiropractors. “As long as there are human beings there will be ‘quacks,’ persons who make false claims,” wrote the editor who recognized, “And some of them may even belong to that sacrosanct American Medical Association.”
AMA Tries To Discredit Nation’s Chiropractors
The American Medical Association, one of the strongest unions of ’em all, has made another attempt to discredit chiropractors, a rival group engaged in the healing arts.
It’s too bad the practitioners of medicine and chiropractic can’t get along and may be they could if the AMA would tend to its business and let the chiropractors alone. It looks like there should be room for both groups.
The AMA recently staged its third “Congress on Medical Quackery,” in which an effort was made to show that chiropractors are making false claims about their ability to help the sick, the generally accepted meaning of quackery.
We also know that medical doctors have been known to seek help from chiropractors, on occasions. However, they probably enter the chiropractor’s office through the back door. But no matter.
On the other hand there is a definition of the verb “quack” which is “to talk pretentiously without sound knowledge of the subject discussed.” In that case, one might say that a spokesman for the AMA was doing a bit of quacking.
“The confrontation between medicine and chiropractic is not a struggle between two professions,” said the spokesman, Dr. Thomas M. Ballantine, Jr. of the Harvard Medical School. “Rather it is more in the nature of an effort by an informed group of individuals to protect the public from fraudulent health claims and practices.” Among other things, Ballantine accused chiropractors of treating cancer patients, and he said patients suffering from serious illness risk death when treated by a chiropractor.
We suppose there are chiropractors who do claim to be able to help patients suffering from cancer. But we have been told of medical doctors who are treating cancer patients without benefit.
We do not know whether chiropractic is of aid to cancer patients, just as we do not know whether there are benefits to some other products the AMA and American Cancer Society and their partners in the state and federal health bureaucracy claim are quackery. We do know there are people who claim to have been helped by unorthodox methods of treatment. And we contend the AMA has no right to deny those persons their right to choose a method of treatment.
As long as there are human beings there will be “quacks,” persons who make false claims. And some of them may even belong to that sacrosanct American Medical Association.
The AMA is doing no service to humanity to use every trick to attempt to show that its members have the only answer to healing the sick. Some people still want to choose their own means of treatment, regardless of what the medical men say. To devote a public forum to attacking others the AMA members disapprove, smacks something of quackery itself. (emphasis added)
It is refreshing to see that one journalist during the height of this medical boycott could see through the AMA’s smokescreen, although he undoubtedly drew the ire of the local medical society. Since there never was a public outcry against alternative methods of treatment, state governments, licensing boards, and district attorneys had no cause to act against chiropractors without provocation from the medical societies, so the AMA continued to use the media to twist and distort the truth in the court of public opinion.
This yellow journalism is not only a historical issue, but one that continues to this day with not only the misleading defamation, but today the disingenuous journalism consists of ignoring the research that supports chiropractic care and omitting chiropractic from discussion on the epidemic of back pain. “Speak no evil” now seems to be the approach of many journalists to omit inclusion of chiropractic care.
For example, on June 7, 2010, the Associated Press began a six-part series on overtreatment in the United States. The second installment on June 8 was titled “Back Pain Widely Overtreated in the U.S.” A similar article appeared October 14, 2010, with the lead headline on MSNBC.com that read, “Back Surgery May Backfire on Patients in Pain.”
Of course, chiropractors were in total agreement with these articles and expected an honest analysis of this epidemic of back pain and unnecessary surgery. But to our dismay, neither article mentioned chiropractic care as the solution to surgery. Both articles did, however, properly site Dr. Richard Deyo’s research of the excessive spine surgery, the high rate of disability, and the high costs, but once again the writers failed to mention the primary alternative to spine surgery–spinal manipulation. Alas, the professional amnesia of chiropractic care in the mass media continues, even when it broaches the same failings of the medical methods.
The depths of political medicine’s control over the media is now better understood after the Wilk trial revealed instances where the Committee on Quackery demonized chiropractors through the press via such notables as advice columnist Ann Landers and hired freelance writers like Ralph Lee Smith, author of the infamous exposé, At Your Own Risk: the Case Against Chiropractic (Pocket Books, 1969).
The public has had little understanding of the true magnitude of the yellow journalism tactics used to influence the public opinion about chiropractic. As both the New Zealand Commission and the evidence at the Wilk trial showed, the negative opinion of chiropractic never came from the public itself, but it was traced back to the AMA’s Department of Investigation and its Committee on Quackery, and ultimately to the originator—Morris Fishbein.
Despite the Wilk victory in the courtroom, in the court of public opinion the case against chiropractic is still out due to the media’s bias, financial interests, and misinformation proffered by the AMA. To think the public has ever been given a fair and balanced opinion about chiropractic by the mainstream media is ridiculous and this remains true today.
Indeed, when was the last time a chiropractor was featured on national TV as a spokesperson on health concerns like Dr. Sanjay Gupta on CNN or Dr. Isadore Rosenfeld on FOX News? When has a chiropractor ever been questioned on healthcare reform or as an expert speaking on spinal health care matters? Few, if ever, has there been a chiropractor TV character hero like the original medical sitcom, Marcus Welby, MD, played by Robert Young, or a character on the TV hit shows like M*A*S*H* or Scrubs?
At best, the chiropractor role portrayed in the TV sitcom “2 ½ Men” by actor John Cryer is that of the neurotic boob compared to his cousin, a handsome playboy played by Charlie Sheen. This portrayal is not too distant from the chiropractor role of the loser played by Burt Lancaster in the 1952 movie, “Come Back, Little Sheba.” Apparently this emasculated image is the standard in Hollywood for chiropractors, an image Morris Fishbein would be pleased to know since he was the initial creator of this stereotype. Certainly if the media truly understood the staunch character required to be a chiropractor, instead of the wimpy John Cryer, a more accurate image might be that of a John Wayne.
Considering chiropractors constitute the third-largest physician-level group in the nation, obviously there remains a virtual blackout on chiropractic care in the media. Not only has the image of chiropractors been distorted, the important historical events like the Wilk trial, AHCPR guideline, Manga Reports, and the New Zealand Report have been ignored by the media. In effect, the media was also duped by the medical misinformers, but never realized they too had been deceived by the AMA as it continues in its role as gullible PR agents for the medical profession.
AMA Tactic: The 3rd Party
Morris Fishbein and H. Doyl Taylor fully understood the power of the press to spread misinformation about their chiropractic rivals when he comprised the “Quack Packs” with defamatory articles written by hired hands that were given to the public as proof from supposedly objective third parties.
In 1962 General Counsel Robert B. Throckmorton in his Iowa Plan, “What Medicine Should Do about the Chiropractic Menace,” clearly spelled out the deceptive nature of the Committee On Quackery: “Action taken by the medical profession should be firm, persistent and in good taste [and] behind the scenes whenever possible.”
Certainly, behind the scenes meant using the mass media as a co-conspirator with the AMA’s plan to eliminate chiropractic. Even after the Wilk trial exposed the illegal underbelly of the medical cartel, the medical ploy to suppress positive information about chiropractic went unreported by the press.
For example, attorney George McAndrews pointed out at the Wilk trial, the AMA’s attorneys failed to produce anyone who had been hurt by chiropractors despite its repeated claim that chiropractors were dangerous and posed a threat to “public safety.” The AMA and the media also totally ignored the evidence that showed chiropractic care had a 2:1 effectiveness rate over traditional medical methods of drugs, shots, and surgery for low back pain.
Any objective journalist might have thought these were two important points–safety and effectiveness–that the public ought to know, but not one TV or newspaper journalist disseminated this information to the court of public opinion. Indeed, these two smoking guns were doused by the biased media that turned a blind eye to this attempted professional holocaust, another example of its “see no evil” about medicine and “speak no good” about chiropractic.
The reason for this oversight was because the AMA used public safety as one reason for the attack on its chiropractic competitors. Recall that in the first Wilk trial, Judge Bua, told jurors they should not find the AMA guilty of wrongdoing if its actions were merely designed to inform the public about defects in chiropractic, adding that the AMA’s advocacy was protected if it were aimed at lobbying for changes in law. The facts showed the “defects in chiropractic” were few, false, and misleading, and the AMA’s advocacy was not to protect the public as much as to “contain and eliminate” the entire chiropractic profession to protect its market control.
When the AMA’s executives’ feet were held to the fire of cross-examination by McAndrews to prove chiropractic was quackery or dangerous, they had no proof whatsoever. Yet the media failed to print one story about the obvious lack of proof by the AMA to support its claims against chiropractors. They were caught in a lie, but the media continued to “see no evil” in the AMA’s own propaganda.
After the second Wilk trial when Judge Susan Getzendanner was dissuaded by this patient safety argument, one might think the media would have realized it had been hoodwinked by the AMA’s argument and were, in effect, co-conspirators in the humiliation of chiropractors in the court of public opinion. Instead, the media ignored its complicity and its attitude since then appears to be one of staying “politically-correct” to ignore chiropractors despite the facts showing the superiority and safety of manipulative therapy over medical methods for the epidemic of musculoskeletal problems. Indeed, “speak no evil” remains the media’s blindness toward manipulative therapy.
Although the Wilk federal court decided the AMA’s patient care defense was unsupported by evidence or testimony, the media failed to recognize the same lies and false accusations as unsubstantiated. Nor did the media give chiropractors the opportunity publicly to refute these unproven allegations. Indeed, the media cover-up continued.
Such action is contrary to the Fairness Doctrine implemented in 1949 by the United States Federal Communications Commission (FCC), which requires the holders of broadcast licenses to present controversial issues of public importance and to do so in a manner that is honest, equitable and balanced. By using third-party journalists to speak for the AMA, this allowed the media to forego its “equal response” doctrine to allow chiropractors equal space to respond to medical criticism. Clearly the AMA’s campaign to eliminate chiropractors cleverly used third-parties to argue its case under the patient care guise so the media took a blind eye to the Fairness Doctrine rule.
Apparently whether or not chiropractic actually posed a threat to public safety was too important to leave open to debate; consequently, chiropractic was rendered mute in its own defense. Sadly, “hear no evil” was the belief of editors who refused to give chiropractors feedback in the character assassination by the AMA.
Before and after the Wilk trial, the AMA has continued its unholy alliance to damage the reputations of chiropractors through the media with degrading articles or misrepresentation of the guidelines that were to follow. In reality, the media has also been a victim as well as the purveyor of Fishbein’s and Taylor’s ploy to lie to anyone about the value of chiropractic. After all, as the AMA spouted for decades, “everybody knows chiropractic is an unscientific cult,” and, for the most part, it was the media who taught this to the public, including one of the most famous journalists in the nation.
The Mistress of Medical Misinformation
“Just possibly, Ann Landers was the most influential American woman of the second half of the 20th century. Her claim rested not on political achievement or pioneering social reform – but on her unchallenged status as the most widely read agony aunt of her age,” read her obituary when she died on June 22, 2002 at the age of 84.
Over her 47-year career, she was awarded more than 30 honorary degrees. The Ann Landers column appeared in over 1,000 US newspapers, in some of them for seven days a week, and was considered the most prominent newspaper columnist in America, (whose real name is Esther Pauline “Eppie” Lederer).
Unbeknown to most people, she was also used by the AMA to ridicule chiropractors in her Ask Ann Landers syndicated advice column in exchange for compensation from the AMA, including a paid vacation to China. The AMA used her to show that “third parties” were attacking chiropractors, not just the AMA PR hacks like Doyl Taylor who supplied her and the media with informational kits called the Quack Packs.
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 turned to the AMA for help in writing responses with talking points written by Taylor.
Under oath during the Wilk trial, Dr. Ernest K. Howard, the AMA president, admitted, “It is possible I would prepare something, not for her to print, but to look at … We sent her material to prepare the article…Ms. Landers is very prominent in medical circles and programs relating to health.” Considering she had no academic training in any health profession, her only prominence was as a spokeswomen for the AMA agenda in the syndicated newspapers.
While Ann Landers hoodwinked millions of Americans with her anti-chiropractic columns, occasionally some readers would respond and accuse her of “being in cahoots with the American Medical Association.” Although this allegation proved to be true, Landers publicly denied it in her column.
“Many who wrote to express shock and anger accused me of being in cahoots with the American Medical Association. This is an interesting accusation in the light of the fact that I have repeatedly said in print and from the lecture platform that I am appalled by the degree of incompetence in some sectors of medicine, that some physicians are a disgrace to their profession, that every day someone dies from an unnecessary or botched operation, that one reason for pill-popping and drug abuse is that some physicians find it easier to prescribe medicine than to make a house call.” 
Rather than admitting her cozy relationship with the AMA, Landers continued to mislead her readership by using the AMA’s tactic suggesting that any benefits from chiropractic care was simply psychosomatic:
To all who wrote in praise of chiropractors, I say, “help is where you find it.” Many people keep well through religious faith alone, and I have no quarrel with them either. But in the name of common sense I urge my readers to recognize that the power of suggestion can play an enormous part in the success of any cure. Through the centuries faith healers have restored sight to the blind and hearing to the deaf and exhorted the crippled to throw away their crutches. Miracles? The cured will say “yes,” but medical authorities know these disorders were psycho-generated, and not organic…so in conclusion, I repeat, “To each his own—be it religion, chiropractic, witch doctor or whatever. Just don’t wait so long that a medical doctor can’t help you. (emphasis added)
Landers suggested the same medical rationale that any positive affect of spinal manipulation was psychosomatic, likening it to faith healing and witchcraft. Undoubtedly she had spoken with Dr. Howard or Doyl Taylor, her mentors at the AMA, to espouse this talking point.
In a court deposition, Landers finally acknowledged she had also been a member of the AMA Advisory Committee and admitted she had regular luncheons with Howard; both resided in Chicago where the AMA’s headquarters and Lander’s Chicago Sun-Times newspaper were located.
In deposition, Dr. Howard admitted he and Landers often lunched together “once every two or three weeks for lunch to discuss innumerable subjects.” He admitted that “Ann Landers is probably the most prominent writer in the country in terms of columns with a daily audience of about 50 million.”
One would expect a nationally-known newspaper columnist would get her facts straight, but not in the case of Ann Landers. Not only were her columns without scientific merit, she often resorted to ridicule to make her point, such as her infamous “goofus feathers” comment in 1971.
Chiropractors are wonderful—if you have a tired back, and nothing else. But if you are sick I hope you will go to a physician who has been licensed by his state’s Board of Medical Examiners.
Many illnesses are self-limiting. This means they disappear without treatment. A person who has been massaged by a chiropractor and gets well often credits the chiropractor with having cured him. The truth is, he’d probably have been cured if he had fanned himself with goofus feathers. (emphasis added)
Massaging the spine will not cure a brain tumor, cancer, diabetes or gallstones. Nor will it cure a skin disease or a throat infection. The following testimony was given to a congressional committee considering the question, “Should chiropractors be included in Medicare?”
“It is the universal opinion of health experts that chiropractors lack the proper training and background to diagnose and treat human disease. The education of chiropractors is sub-standard and unscientific and the theory on which treatment is based is medically unsound.”
Her column parroted the exact talking points of the AMA with her own sarcasm thrown in like “goofus feathers.” She wrote that chiropractors had substandard training and were unscientific, but like her AMA mentors, offered no proof, just her opinion. She cited the HEW Report concerning the exclusion of chiropractic into Medicare, but failed to mention the claim by the chiropractic associations’ White Paper that the Medicare committee’s conclusion was “fixed” months before the committee convened due to the AMA’s intervention behind the scenes. As a reporter, she failed to do her homework or had a bias that superseded the truth.
She repeated the AMA’s allegation of patient safety, but offered no proof that patients were unduly harmed by chiropractors. Her reference to brain tumor, cancer, diabetes, or gallstones was also misleading in that mainstream chiropractors did not seek such patients for care; some patients may seek chiropractors for relief of concurrent back pain, but this argument was clearly a medical non-sequitur in that it was created primarily from the AMA’s Committee on Quackery to discredit chiropractors–if they’re not good for everything, then they’re no good for anything.
She resorted to the standard fear-mongering used by many MDs that patients waste money on “this poppycock” until they “get smart” and seek medical care. Never did she do the opposite and suggest that patients who were unresponsive to medical care for spinal problems are misdiagnosed, mistreated by drugs and surgery, and should seek treatment by chiropractors. Indeed, where was her doctrine of fairness to give chiropractors equal time?
Every year millions of dollars are spent on chiropractors before the patient gets smart and switches to a physician or an osteopath. Unfortunately, too many people keep going to chiropractors until their illness becomes so advanced that an MD or a DO can’t help them.
The basic concept of chiropractic is that most illness is caused by spinal misalignments (subluxation) and can be cured by spinal adjustments. This theory has been greatly discredited, yet millions of people continue to believe in it and they shell out a great deal of money on this poppycock. (emphasis added)
She did admit once needing help from the AMA to answer her malicious remarks about chiropractic after receiving thousands of angry letters to her snide remarks:
I know I’ll be inundated after my column of August 5th. Can you supply me with a good response, which I will, of course, re-write?
Ann Landers’ cozy relationship with the AMA was clandestine and clearly misleading considering she supposedly represented only her own views rather than those of a paid sponsor. Her conflict-of-interest did not go unnoticed by a professional trade journal, Editor & Publisher, in an editorial critical of Lander’s subsidized trip to China while employed by Publishers Hall Syndicate which was owned by Field Newspapers. At issue was, first, the subsidization of syndicated writers by outside interest groups and, secondly, the responsibility of the parent syndicate to inform its subscribers of the subsidization and possible conflict-of-interest.
Publishers Hall executive vice-president Richard Sherry responded that it was “ridiculous” to consider that “an outfit as upright as the AMA” would try “to buy Ann Landers.” He also said the syndicate did not find it necessary to notify Landers subscribers of her subsidization, which was an obligation outlined by the National News Council.
She traveled to China with an AMA delegation as “volunteer advisor” although the AMA paid for the trip, but when criticized, she responded sarcastically, “I need a free trip like a giraffe needs a sore throat.” She did admit she was “the first American journalist to get into The People’s Republic in nearly a year and considered herself very lucky, indeed.” She bemoaned the accusation of her conflict-of-interest in her letter to Mr. Robert U. Brown, president and publisher of Editor & Publisher Year Book (Oct. 8, 1974):
I was stunned to read the piece by Jane Levere in E&P.
I need a free trip like a giraffe needs a sore throat.
I am enclosing the same material that went out yesterday to all our client papers. As you can see, the promotion material states clearly my connection with the AMA as a volunteer adviser. Also, note that in the columns I stated that I was acting as an official member of the AMA delegation.
The E&P article is an assault on my integrity. You have done a grave injustice, not only to your friend, Eppie Lederer [Ann Lander’s real name], but also Publishers-Hall Syndicate, the Chicago Sun-Times and the 800 newspapers that print my column… I believe this letter should be printed in E&P along with the facts as presented in the enclosed material.
The “enclosed material” was, in fact, selected material from the Quack Pack kit Doyl Taylor provided. Allthewhile Landers and her publisher were decrying the conflict-of-interest allegation, they both knew it was absolutely true. Dr. Howard admitted under oath that “Yes, she was concerned from the beginning that serving on an AMA committee, being identified as serving on the committee might be construed by some as suggesting that she was responsive to AMA thinking. Yes, as a columnist, she was concerned about that.”
The reasons why Dr. Howard and the AMA nurtured a relationship with Ann Landers were twofold: first, swaying the most prominent journalist in American to their political viewpoint was helpful to besmirch their chiropractic rivals and, secondly, as a supposed third-party, using Ann Landers to disseminate misinformation would avoid the equal time and Fair Doctrine issue among newspapers and television.
Mr. McAndrews in his deposition of Dr. Howard broached this issue when he asked “Did you in your memorandum seek to let the chiropractors receive equal time?
I said I did not think the AMA should conduct itself in such a way, in a public relations effort of this kind to stimulate more publicity for chiropractors, more time or equal time for that matter. The equal time idea, that decision has to be made by the UPI reporter and the newspaper. They have to decide how much time they want to give to the opposing forces. I can’t determine equal time really. It is up to the reporter and the writer of the newspaper.
Mr. McAndrews also asked Dr. Howard: “Was it your feeling that chiropractors should be eliminated?”
It was my feeling then and it is my feeling today that the best way, one of the best ways to promote the public’s health is to reduce the minimum possible quackery of all kinds including chiropractic, which I consider quackery.
Dr. Chester Wilk noted in a 1991 newspaper interview that one example of the AMA’s propaganda campaign against chiropractors involved Ann Landers, who wrote columns ridiculing the practice. “That’s just one example—the AMA getting Ann Landers to write a `goofus feather’ article,” he said. “The AMA put in writing that it was their intent to contain and eliminate the chiropractic profession,” Wilk said. “They were either arrogant or stupid enough to even put in writing how they were going to do it.” 
One would think Ann Landers had learned her lesson about being a paid mouthpiece for the AMA propagandists, but apparently not since she continued her campaign to misinform the public. In 1993, she wrote a Foreword for the book, The Health Robbers: A Close Look at Quackery in America, a similar anti-chiropractic book written by two known medical misinformers, Stephen Barrett and William Jarvis. In her Foreword, Ms. Landers wrote:
PT Barnum was right. There’s a sucker born every minute…
The saddest letters of all come from the relatives of the desperately ill, those who are dying of cancer or kidney disease. “Our family doctor said there was nothing more he could do, so we took mom to this wonderful chiropractor. She seems a little stronger today. Do you think, Ann that we should have brought her to the chiropractor from the beginning and not wasted all that time and money on a specialist with a fancy diploma from Harvard hanging on his office wall?”
Every letter gets a personal reply in the mail if there’s a name and address. I urge my readers to beware of quacks and phonies. I warn them against the charlatans and fakers. More often than I care to admit, I have received in return a seething reply: “How dare you take away our hope! I’ll bet you are on the payroll of the American Medical Association. The medical doctor didn’t do anything but send us big bills…”
How can the public be protected against phonies, quacks, and unscrupulous money-grubbers who prey on the insecure, the frightened, and the sick? The answer is education. And that is what this book is all about. (emphasis added)
Of course, Landers was aware of the Wilk trial and did not directly condemn chiropractors as quacks in her Foreword as she might have beforehand, but she did insinuate as much when she failed to answer the question asked if the writer was correct in taking her mother to the “wonderful chiropractor.” Instead, Landers ignored the letter-writer’s comment about her ineffective “medical doctor didn’t do anything but send us big bills,” and continued with her inference by attacking “against phonies, quacks, and unscrupulous money-grubbers,” clearing suggesting chiropractors fall into that category and alluding to the fact that these satisfied chiropractic patients were “suckers.”
This type of patient ridicule continues to this day when patients ask their MDs if they should see a chiropractor. Typically the response: “If you’re stupid enough to go to a chiropractor, don’t come crawling back to me when you’re paralyzed.” This prejudice certainly stems from the AMA’s propaganda that “everybody knows that chiropractic is an unscientific cult,” implying that if you don’t agree, then you must be stupid, too.
Although Landers promoted this book, it is imperative to add that the authors of The Health Robbers have been denounced by authorities as so-called experts on quackery. Indeed, the team of Stephen Barrett and William Jarvis were disciples of Fishbein and Taylor. The chapter on chiropractic in The Health Robbers (entitled “The Spine Salesmen”) was written by Stephen Barrett, MD, of the Lehigh Valley Committee Against Health Fraud, a renowned medical opponent of chiropractic who periodically raises his voice to bash the profession, and his association with the AMA is now well known.
A complete review of yellow journalism would be too voluminous to show the many instances where chiropractors were ignored or cast by the media as the black sheep in healthcare. Until recently, journalists have also ignored the mounting evidence against the use of drugs, shots, MRIs, and back surgery. Indeed, the intransigence of the medical profession and its media allies have made for a media mess. Just as racism in the media took decades to change, so has the antipathy toward chiropractors when the medical media continues its policy to “speak no chiropractic” by ignoring significant legal, political, and scientific events that support chiropractic care.
AHCPR: The Shot Heard Around the Medical Profession
Unquestionably the biggest example of non-coverage occurred when an agency of the U.S. Public Health Service endorsed spinal manipulation. The medical world was stunned by the Agency on Health Care Policy and Research (AHCPR) on December 8, 1994, after a federal appeals court ended an injunction sought by the North American Spine Society (NASS) and the manufacturers of spinal fusion surgery hardware (such as pedicle screws) that was issued in the summer of 1994 to prevent its release.
The study on acute low back pain was the fourteenth study conducted by the Agency for the purpose of establishing clinical care guidelines. This Congressional empowerment of the AHCPR was part of the growing national movement to begin evidence-based care through linking practitioner choices to scientific evidence. While this may have sounded reasonable to Congress, it was not to the AMA.
The AHCPR’s responsibility was to choose conditions, focusing on high-cost, high-use conditions like back surgery for low back pain. The AHCPR convened multi-disciplinary panels consisting of 18-25 highly-regarded researchers to create guidelines that were to be updated as new evidence was discovered. The goal was to improve the quality and cost-effectiveness of care.
In 1994, AHCPR issued a 170-page study entitled “Acute Low Back Pain in Adults,” along with an accompanying 30-page “Quick Reference Guide for Clinicians” entailed “Acute Low Back Problems in Adults: Assessment and Treatment.”
The low back pain study was conducted by a multidisciplinary panel comprised of twelve medical physician experts, other healthcare professionals, and consumer representatives, who were brought together by the AHCPR to perform an evidence-based analysis of all research trials on all treatment approaches to acute low back pain in adults. Abstracts of over 10,000 research papers were reviewed, and almost 4,000 articles were retrieved and the study took nearly two years to complete.
This multidisciplinary study by experts from every profession that treated back pain was the most comprehensive analysis of acute low back pain in adults ever compiled by any governmental body in the U.S. The chiropractic and medical professions waited with bated breath for the results and when the results were announced, the medical profession was livid. After this two-year investigation of over 10,000 published articles, the AHCPR concluded that spinal manipulation was a “proven treatment” for acute low back pain in adults and was the preferred initial professional treatment for acute low back pain. Since the RAND Corporation previously had concluded that chiropractors performed 94% of the manipulation services in the U.S., this recommendation was, in effect, an endorsement of chiropractic care. 
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.
This federal agency made history when it recommended spinal manipulative therapy as an effective treatment for low back pain, concluding that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with, or as an alternative to, non-steroidal anti-inflammatory drugs, as well as heat or cold packs for temporary relief.
The Associated Press and major newspapers throughout the country immediately recognized that the AHCPR study was a boon to chiropractors and a setback for medical doctors. Announcements in the Chicago Sun-Times, Washington Post, and Chicago Tribune touted chiropractic care over medical care:
- Chicago Sun-Times, December 8, 1994
“When it comes to lower back pain, think twice before resorting to the usual remedies and bed rest. Try a chiropractor instead.”
- Washington Post, December 9, 1994
“A panel of medical experts yesterday threw out bed rest and endorsed exercises and spinal manipulation as treatments with proven effectiveness for episodes of acute lower back pain…it found that spinal manipulation, a treatment often performed by chiropractors and osteopaths was safe and effective…many doctors have long discouraged their patients from trying such treatments.”
- Chicago Tribune, December 9, 1994
“Chiropractors get a boost in new government-backed guidelines on how to treat low back pain.”
After years of condemning chiropractic as an “unscientific cult” and manipulation as “dangerous,” the medical society simply did not want this new found research information and guideline that refuted the AMA’s propaganda made available to the public. Ironically, after decades of calling for research, when completed, the medical society used the courts to suppress it for nearly six months because this study discouraged spinal surgery as well as recommended spinal manipulation for the treatment of acute low back pain in adults.
Incensed by the AHCPR’s findings, the North American Spine Society (NASS) went on the offensive to once again contain and eliminate its opponent; this time its victim was not the chiropractic profession, but the AHCPR itself. This battle was the AMA’s equivalent to “Shock and Awe” with its blitzkrieg in Congress never seen before or after with strong AMA arms twisting Congressmen, political debts being called in by AMAPAC, and conservative ideologues who were “not about to allow government bureaucrats tell them how to practice medicine.”
And it was a battle never told to the public; once again, “see no evil” about the AMA was the policy of the media, even when it attacked a Congressional mandate created by President George H. W. Bush. The U.S. Public Health Service was ordered to be an ongoing partner with the health professions in an effort to improve medical care in America. They were charged by Congress in 1989 during the first Bush Administration to be a federal arbiter of evidence-based, clinical-practice guidelines for not only back pain treatment, but for many common treatments and tests; thus the birth of the AHCPR to study and make recommendations.
Democrats and Republicans alike hoped that the AHCPR’s research would help rein in costs by giving doctors better direction, and offering payers—especially Medicare—the ammunition they needed to make evidence-based coverage decisions. More significantly, the agency promised to improve the quality of health care by helping to ensure that doctors would give patients the treatments they really needed and refrain from giving them care that could harm them. Under the leadership in the House of Newt Gingrich (R-GA), this goal came to a screeching halt. 
The most shocking recommendation focused on back surgery. The panel of experts found back surgeries were costly, were sometimes based on misleading tests such as MRIs, and were generally ineffective, which would have been a dagger in the pocketbooks of many spine surgeons.
AHCPR entered this fray when it reviewed the research on low back pain and concluded there was no evidence to support spinal fusion surgery and that such surgery commonly had complications, which came to no surprise to MDs since these findings were published in JAMA in 1992 by J. Turner, et al., “Patient Outcomes after Lumbar Spinal Fusions.”
In the section on Spinal Fusion from the AHCPR’s Clinical Practice Guideline that clearly summarizes the research.
There appears to be no good evidence from controlled trials that spinal fusion alone is effective for treatment of any type of acute low back problems in the absence of spinal fractures or dislocation. . . . Moreover, there is no good evidence that patients who undergo fusion will return to their prior functional level.
What angered traditional medicine the most about the AHCPR study was its finding that confirmed the rare need for surgery except in the most severe cases that did not respond to conservative care. Stated in its Patient Guide, Understanding Acute Low Back Problems:
Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.
People with certain nerve problems or conditions such as fractures of dislocations have the best chance of being helped by surgery. In most cases, however, decisions about surgery do not have to be made right away. Most back surgery can wait for several weeks without making the condition worse.
If your health care provider recommends surgery, be sure to ask about the reason for the surgery and about the risks and benefits you might expect. You may also want to get a second opinion.
According to author Shannon Brownlee, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer:
But when the AHCPR’s panel concluded that there was little evidence to support surgery as a first-line treatment for low back pain, and that doctors and patients would be wise to try nonsurgical interventions first, back surgeons went wild. 
The surgeons in the NASS could not accept the thought that their spine surgeries were touted as ineffective, based on a suspect premise, and the recommendation for spinal manipulation over traditional medical treatments by a federal agency was too much to bear. To rub salt in this NASS wound, this panel was headed by an orthopedic surgeon, Stanley Bigos, MD.
This study also showed the enormity of the low back pain (LBP) epidemic in America.  Although back pain is not a killer like cancer or heart disease, it does afflict more people during their lifetime.
- 80-90% of all adults will suffer with acute low back pain sometime in their life;
- LBP is the leading workers’ compensation injury;
- LBP is the leading cause of disability for people under the age of 45;
- LBP is the second-leading cause of visits to doctors’ offices;
- LBP is the third-leading cause for hospital admissions;
- LBP the second-leading cause of surgery other than heart surgeries.
Standard forms of passive care by physical therapists were also not recommended for lower back pain. The Patient Guide published by the U.S. Public Health Service also states:
A number of other treatments are sometimes used for low back symptoms. While these treatments may give relief for a short time, none have been found to speed recovery or keep acute back problems from returning. They may also be expensive. Such treatments include: Traction, TENS, massage, biofeedback, acupuncture, injections into the back, back corsets, ultrasound.
The AHCPR guideline also stated spinal manipulation was the preferred initial treatment of choice. The Patient Guide lists three “Proven Treatments”:
- Over-the-counter NSAIDs, which “have fewer side effects than prescription medicines.”
- Heat or cold applied to back.
- Spinal manipulation. 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. 
Of course, this recommendation implies chiropractic care, but the panel was forced to state “spinal manipulation” since some other practitioners also attempt this healing art. RAND earlier had reported that 94% of all manipulative care is delivered by chiropractors, with osteopathic physicians delivering 4%, and general practitioners, physical therapists, and orthopedic surgeons accounting for the remainder.
Considering chiropractors have carried the banner of manipulative therapy since 1895 during this medical war while, for the most part, the osteopaths relinquished, physical therapists ignored this treatment, and medical physicians have chosen to vilify this form of care, it is obvious that chiropractors are the professionals who lay claim to have the most experience in manipulation by far. 
More importantly, the AHCPR study specifically defined spinal manipulation as the type of manipulation used by all chiropractors.
- Spinal manipulation includes many different techniques. For this guideline, manipulate is defined as manual therapy in which loads are applied to the spine using short and long lever methods. The selected joint is moved to its end range of voluntary motion, followed by application of an impulse loading. The therapeutic objectives of manipulation include symptomatic relief and functional improvement.
Perhaps most significantly, the guidelines stated that unlike non-surgical interventions, spinal manipulation offered both pain relief and functional improvement. This “functional improvement” is what gets patients back to work faster and at less expense, whereas drugs, shots, and spine surgery are primarily interested in pain control.
But the resounding conclusion of the AHCPR guideline for acute low back pain not caused by fracture, tumor, infection, or cauda equina syndrome, spinal manipulation was clear: the treatment of choice was chiropractic care.
Because acute low back pain is the most prevalent ailment and most frequent cause of disability for persons younger than 45 years of age in the United States, adherence to these practice guidelines would have substantially increased the numbers of patients referred for spinal manipulation to chiropractors. As Louis Sportelli, DC, noted: “If the doctors of chiropractic only cornered the market on one condition, back pain, there would not be enough [chiropractors] now to handle the volume.”
While the chiropractic profession took great pride in this guideline’s recommendation for spinal manipulation as a federal endorsement, the medical profession was not about to take it so lightly. Although the most knowledgeable medical researchers ever convened were convinced of chiropractic’s effectiveness, the medical profession chose to ignore the new research guideline and initiated a counter offensive.
Assault on Capitol Hill
Perhaps the most notorious untold story in the medical war occurred after the AHCPR guideline was released and political medicine organized an attack on the AHCPR by the medical demagogues who launched a scheme to destroy the AHCPR for its recommendation of spinal manipulation for acute low back pain in adults. This backlash reinforced its reputation as the “most terrifying trade association on earth.”
This assault on Capitol Hill by the medical profession illustrated the wrath of special interests never seen before, and never told to the public, either.
We, the North American Spine Society, feel that this document should not be published in its present form. Instead, a new consensus should be sought, with appointed input from all relevant medical specialties dealing with low back pain issues, and with AHCPR staff that is responsive to the criticisms of the methodology raised in this letter. 
Inexplicably, the consensus the NASS sought is exactly what AHCPR had done. The panel members were selected from nominees of all medical, osteopathic, physical therapy, and chiropractic associations. Instead of these phony excuses, the real objection by NASS was the panel’s conclusion about unnecessary spine surgery.
Unable to accept the experts’ criticisms of spinal surgery, NASS took their attack to Capitol Hill and protested the findings of this study, citing the research team was biased and inept, despite the fact that the team was headed by Stanley Bigos, M.D., an orthopedic surgeon along with 22 other spine experts. It was interesting to note that the NASS criticized only one guideline and only one of the preferred forms of therapy: spinal manipulation.
An historical review of the battle between AHCPR and NASS, Health Affairs: The Policy Journal of the Health Sphere, summarized how and why AHCPR was attacked and lost a sizeable amount of its budget after this firestorm over low back treatments, illustrating once again that the AMA is “the most terrifying trade association on earth.”
Unlike the first thirteen guidelines produced by AHCPR that received little condemnation by the medical profession, the fourteenth guideline on acute low back pain in adults and its criticism of back surgery posed a much more serious threat to the spine surgeons. Opponents to the report attempted to shut down the agency by eliminating its funding. The surgeons found sympathetic ears among House Republicans led by Speaker Gingrich who were prepared to believe the worst about the agency after the failed Clinton Health Care Reform Act in 1993-1994. They were also very beholding to the donations made by the medical special interests to their campaigns.
NASS argued that AHCPR was redundant, inefficient, and wasteful. They noted that medical societies and HMOs had already turned out 1,500 guidelines. They told the Republican Congress that came into power in 1995 that AHCPR was inappropriately meddling in what doctors should do and was inefficiently turning out guidelines, only fifteen in five years.
AHCPR was also confronted in 1995 with a bogus third-party advocacy group, the Center for Patient Advocacy, whose goal was to get it de-funded. In reality, this was not an actual “patient” group, but were members of NASS formed by Neil Kahanovitz, MD, a back surgeon from Arlington, Virginia. They organized a letter-writing campaign to gain congressional support for its attack on AHCPR, which was reminiscent of Operation Coffee Cup.
NASS also created an ad hoc committee which attacked the literature review and the subsequent AHCPR practice guideline on acute care of low back pain. In a letter published in 1994 in their journal Spine, the committee not only criticized the methods used in the literature review and expressed concern that the conclusions might be used by payers or regulators to limit the number and types of spinal fusion procedures, its real agenda.
On January 9, 1995, Eric J. Muehlbauer, executive director for NASS, sent out a memorandum to NASS members regarding the release of the clinical practice guideline from AHCPR on acute low back problems in adults. The front page of the 1995 summer edition of NASS News proclaimed, “AHCPR Guidelines Disputed,” suggesting that “this has become a political, and not a scientific document.” Ironically, the NASS made it a political issue since the panelists were diverse, apolitical, and scientific in their approach.
The article made many statements to rationalize its objection to the guideline, such as:
- patients should not have treatment selected or denied based on the guidelines [the point of the guideline was to determine evidenced-based treatments rather than the whimsy of individual practitioners];
- that the guidelines relied upon limited scientific information [how can 10,000 published articles be considered “limited”?];
- that the consensus method does not necessarily identify the best forms of treatment or diagnosis [if not, then what does?]; and,
- that clinical judgments made by the AHCPR panel should be balanced with those of relevant medical societies [every spine profession was represented on the panel; in other words, what the NASS really meant was the panel should consider the vested interests of NASS before making recommendations]. 
Obviously the NASS criticism was simply a smokescreen of misinformation considering the original reason why Congress created AHCPR was to establish goals to help improve healthcare outcomes and reduce costs in America. The multidisciplinary panel accomplished all four goals stated by NASS although the surgeon’s methods were criticized by medical researchers on the best available research.
Most inconsistent was the NASS response letter that criticized reliance on randomized control trials (RCTs), the gold standard for research. It seems odd for NASS to protest the strict reliance on RCTs, given its history of demanding hard science as evidence, a demand put upon chiropractic for decades.
But it also charged that AHCPR had wasted taxpayer dollars on the study. Republican Congressman Sam Johnson (R-TX) proposed elimination of the agency and mocking referred to it as the “Agency for High Cost Publications and Research.” The point was lost that by avoiding unnecessary back surgeries, billions of wasted taxpayer dollars would be saved and millions of disabled patients suffering from failed back surgery syndrome would be saved.
The AHCPR found more supporters in the Senate than in the House. A letter by Edward Kennedy (D-MA), Jay Rockefeller (D-WV), James Jeffords (R-VT) and Orrin Hatch (R-UT) called for the maintenance of FY 1995 funding for the agency. It observed that “there has been some misunderstanding about the role, purpose, and mission of AHCPR,” and argued that “it is essential to have a federal agency that works with the private sector to provide consumers with information to make informed choices, measure, and improve the quality of care, and improve the cost and effectiveness of our health care system.” 
The Senate Appropriations Committee and the Senate itself approved a reduced budget figure for the agency ($127,310,000) that was similar to the amount that had been approved by the House Appropriations Committee. In the conference committee, the House leadership, as promised during the floor battle months before, supported the Senate’s figure. On April 26, 1996, almost seven months into the fiscal year, President Clinton signed the appropriations bill that, after a final small across-the-board reduction, was only slightly less than the amount approved by the Senate. The agency had survived, but with a 21 percent budget cut, and it had been gutted of making treatment recommendations.
The new name for this body is the Agency for Healthcare Research and Quality (AHRQ) charged with “improving the quality, safety, efficiency, and effectiveness of healthcare,” but it can no longer make recommendations for treatment. Indeed, the AHCPR had been castrated by the spine surgeons.
Flip-Flopping on Guidelines
The AHCPR panel’s guideline was published in 1994, but ignored by many surgeons who were emboldened by the Republican smack-down of the AHCPR.
The reaction of American spine surgeons was certainly heated, but also mixed. On one hand, they were incensed that their biggest money-maker, spine fusion, was criticized and they were afraid insurance might stop paying for them. The endorsement of spinal manipulation infuriated many surgeons. On the other hand, their own reviewers admitted a strong agreement with the AHCPR guideline. Of course, with any conflict between money and ethics, money will win out in the medical profession.
“Perhaps the NASS experience typifies the evolution most groups undergo as they wrestle with practice guidelines,” the editorial staff of Dynamic Chiropractic journal opined. “Could it be that rage, denial, review, and grudging acceptance are all part of the guidelines experience for most health care providers?”
The AMA also feared the next AHCPR publication (#15) on cervicogenic and tension headaches that reportedly also was prepared to endorse spinal manipulation. This headache study was also killed by political medicine after thwarting the implementation of guideline #14 on acute low back pain. However, it must be repeatedly that the AMA never complained about the first thirteen guidelines issued by AHCPR. Only when it hurt the pocketbooks of the spine surgeons did the AMA propagandists use their dirty political tricks to kill this federally-mandated program.
The Headache Report study was later continued by Duke University in 2001 with the sponsorship of the Foundation for Chiropractic Education and Research (FCER) and became perhaps the most notable publication that endorsed manipulative therapy for headaches.
Imagine if the public were told by the federal government and the media that according to the AHCPR experts and the office of the U.S. Public Health Service–the best medical minds in America–that if you have low back pain or headaches, go see your chiropractor first. Certainly the AMA would never allow this to happen without a fight despite the facts. The AMA used its political acumen to gut the AHCPR, which today is out of the guideline business.
As a result, AHCPR had its guideline development work curtailed, even though it was originally ordered to develop guidelines by a 1989 Congressional mandate. It would seem the wishes of special interest groups like AMA’s political action committee or NASS superseded Congress’ wish to determine the best treatments for common ailments.
The lawsuit to stop the release of the AHCPR guideline on acute low back pain by the Center for Patient Advocacy, the NASS bogus advocacy group, also had the effect to intimidate present and future critics by eliminating the messengers who may report the many ineffective and costly medical procedures that have driven up health care costs to the $2,000,000,000 (that is two trillion dollars) range annually.
A member of the AHCPR panel, Richard Deyo, MD, MPH, co-authored an article in The New England Journal of Medicine, “The Messenger Under Attack: Intimidation of Researchers by Special Interest Groups.”  In it, he commented of this heavy-handiness to thwart progressive researchers:
Attacks on health researchers are not new. Pierre Louis, for example, was vilified nearly two centuries ago for suggesting that bloodletting was an ineffectual therapy.1 In an open society such as ours, controversy is common and often socially useful. The fact that scientists are sometimes challenged by special-interest groups should be no surprise. However, with widening media coverage of health research, growing public interest in health hazards, and expanding research on the outcomes of clinical care, such attacks may become more frequent and acrimonious. The huge financial implications of many research studies invite vigorous attack. . . Intimidation of investigators and funding agencies by powerful constituencies may inhibit important research on health risks and rational approaches to cost-effective health care.
For decades political medicine has called chiropractic unscientific and demanded research from the chiropractic profession to prove itself. Yet when it is finally done by the most universally accepted and acclaimed expert group of researchers ever assembled (AHCPR), the standard medical methods fell short of the same proof.
“Even if you take all of the research at face value, you have to conclude that spinal fusion is only modestly effective,” says Dr. Deyo. “It’s not a slam dunk.”
Despite the admonition from ACHPR and other medical experts, these warnings fell on deaf ears among the surgeons. In fact, it seems to have been a green light to do more spine surgeries, not less. Between 1997—just three years after the AHCPR’s guidelines were published—and 2006, the number of spinal fusions went up 127 percent, from a little more than 100,000 a year to 303,000 annually.
Once again the political machinery of the AMA fought any reform effort to improve healthcare in America. “We’ve been set back a decade in reforming this system, thanks in part to the handiwork of Gingrich’s House,” according to Brownlee.
Just as the potential loss of authority and income moved the NASS to action, the economic opportunity was not lost on the chiropractors.
AMA Handbook on Back Pain
The AMA was not content to let its hired hands in the media or the henchmen at the NASS to undermine the AHCPR report alone, so it fabricated its own patient guide to offset the AHCPR’s official guidebook to further muck up the confusion.
The AMA published its own version in 1995, entitled Pocket Guide to Back Pain: The Latest Information on All Treatment Options, Including Medications, Physical Therapy, and Surgery.
It came as no surprise that this pocket guide took a “speak no chiropractic” tactic and excluded any mention spinal manipulation that the AHCPR guidebook recommended as a “proven” treatment. Although it does state that there are “more than 100 separate joints connecting the bones of the spine to each other and to other bones,” no mention is made of spinal joint dysfunction as a cause of pain or manipulative therapy as a recommended treatment.
Despite the fact that spinal manipulation therapy had already been recommended by the New Zealand Report in 1979, or by AHCPR in the United States in 1994, by Meade in 1990 in the United Kingdom, and by Manga in 1993 in Canada, neither chiropractic care nor spinal manipulation therapy were even mentioned by the AMA’s Pocket Guide. In addition, their pocket guide included many recommendations that totally contradicted the findings of the AHCPR guidelines!
This AMA pocket guide was a pitiful effort by the AMA to circumvent the AHCPR guideline; it basically made a mockery of the research by endorsing the same medical methods that were strongly criticized by the AHCPR research staff. However, the mass media failed to report this obvious misrepresentation of the research in spine treatments, nor did it notice the deception by the AMA’s Pocket Guide. Imagine if the AMA had done the same to radical mastectomies or lobotomies–the outrage would have been overwhelming. But when the same oversight occurs in the spine treatments, nothing is said. Once again, this was an example of “speak no chiropractic;” more so, it was certainly a boldface lie.
The AHCPR recommendations had been the most significant recognition to date in the U.S. of the many unnecessary spine surgeries and the importance of manipulative therapy for the epidemic of low back pain. Instead of being heralded as champions helping this epidemic of pain and suffering, chiropractors got short shrift by the spokesmen in the media who virtually ignored this landmark study, ignored the NASS backlash against Congress, distorted the AHCPR findings, and ignored chiropractors with the Speak No Evil attitude.
Examples of media misinformation occurred on several occasions after the AHCPR report was released in December of 1994. After the median initially acknowledged the endorsement of chiropractic manipulation, by the time it reached the news talk programs, and magazines, many elite media reporters twisted the conclusions of this thorough study to misrepresent the findings about chiropractic care. Consumer Reports, Parade magazine, NBC’s Today Show, to name but a few of the more prominent sources, all belied the actual thrust of the AHCPR report which endorsed spinal manipulation as the initial professional treatment for acute low back pain in adults.
NBC’s Today Show
Undoubtedly the most glaring example of media misrepresentation of the AHCPR’s findings occurred on NBC’s Today Show. After the AHCPR guideline on low back pain was released in 1994, the Today Show’s in-house medical spokesman, Art Ulene, MD, presented the results of this impressive two-year study on back pain.
In a week-long series on back pain, Ulene mentioned the startling results of this study: Only one in 100 back surgeries is helpful; physio-therapeutics like ultrasound, TENS, hot packs, and other standard treatments by physical therapists were also ineffective; and spinal manipulation was the preferred initial professional treatment.
To his credit, Dr. Ulene detailed the findings accurately, but his medical bias became evident when Today Show host Matt Lauer summarized the findings when he 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. You could have heard a pin drop on the set of the show 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 chiropractic in the minds of millions of viewers. He also knew full well that most osteopaths today do not do spinal manipulation as a routine treatment and chiropractors do the vast majority (94 percent) of all spinal manipulation according to RAND. 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 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, but he still got his point across to the public to boycott chiropractors even when the research supported what they did and the U.S. Public Health Service recommended this brand of care. Ulene’s misrepresentation of the guideline was a great disservice to both the suffering public and to the chiropractic profession, which was exactly his goal.
In a September 1995, another article appeared in Consumer Reports, “Back Pain: The Best Treatment is Surprisingly Simple,” that confirmed most back pain was not caused by disc problems. By the headline, we chiropractors hoped that Consumer Reports, which had previously written negative stories about chiropractic (see New Zealand Report), would admit the newfound guideline and promote chiropractic care.
Once again, the biased journalists failed to acknowledge that most back pain treatment does not require drugs or surgery or that spinal manipulation was considered a “proven treatment” by the AHCPR panel of experts.
Instead the writer speculated on his own personal view of the cause of back pain.
But what, precisely, causes people’s lower backs to seize up in pain remains a mystery to this day. (emphasis added) Since the 1950s, blame has tended to fall on the discs, the spongy gel-filled cushions between some of the backbones, which can bulge, i.e., the familiar herniated or ‘slipped’ disc. The assumption was that when the bulge pressed on a spinal nerve, it caused back pain.
Now the assumption is crumbling in the face of new studies showing that when people with no back pain whatever are examined with magnetic resonance imaging scans, about a third of younger adults and virtually all older ones have some bulging discs. In fact, a back full of completely ‘normal’ discs is the exception, not the rule, even among healthy people. ‘Given the high prevalence of these findings and of back pain, the discovery of bulges or protrusions in people with back pain may frequently be coincidental,’ conclude the authors of one such study.
Other possible explanations, also still speculative, are that the lower back muscles somehow go into spasm or that the spinal nerve roots are being compressed by arthritic spurs or bony overgrowth.
Although the cause of back pain remains a mystery to the Consumer Reports writer, back pain is not a mystery to the thousands of chiropractors who have been treating millions of patients for a century with spinal adjustments for joint dysfunction. It should no longer be a mystery that spinal joint dysfunction is the major cause of back pain, yet Consumer Reports could not bring itself to this conclusion despite the overwhelming research, ignoring instead the fact that the only doctor-treatment recommended in the AHCPR new guidelines was spinal manipulation.
Many people felt that the last word in unbiased consumerism was espoused by that fortress of integrity, the Consumer’s Union, and their distinguished publication, Consumer Reports, but its article on chiropractic proved that assumption wrong, proving again the power of the AMA to influence the media and public opinion.
Richard H. Tyler, DC, then-associate editor of Dynamic Chiropractic, a leading chiropractic publication, criticized this duplicity:
How wrong I was. The report they came up with was dictated by the AMA, complete with all their stock phrases. It was filled with half truths and outright lies. They were, of course, flooded with letters, not the least of which was quite a lengthy and detailed answer by the ACA. Since they had already decided on their official policy, they printed no constructive replies … So much for unbiased reporting—they had been bought. (emphasis added)
Ignoring the truth about chiropractic was not new for Consumer Reports, which had never before given a positive review of chiropractic. Shockingly, it took another fourteen years for Consumer Reports to finally tell the truth in a poll of 14,000 subscribers to overcome the bias of the editorial staff.
In May of 2009, Consumer Reports published a favorable article about chiropractic care:
About 80 percent of US adults have at some point been bothered by back pain. The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. More than half said pain severely limited their daily routine for a week or longer, and 88 percent said it recurred through the year. Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weight.
Back pain can be tough to treat. Most of our respondents tried five or six different treatments. They rated the helpfulness of the treatments tried and their satisfaction with the health-care professionals visited.
Hands-on therapies were among the top-rated. Fifty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were “completely” or “very” satisfied with their chiropractor. (emphasis added) Massage and physical therapy were close runners-up. 
Although certainly not noted for scientific journalism, Parade magazine is a popular Sunday morning newspaper magazine-insert read by seventy million Americans. In the January 14, 1996 edition of Parade magazine, writer Earl Ubell also distorted the findings of the AHCPR report in his article, “What Works Best For Back Pain.” His article discounted chiropractic care as “controversial treatment . . . still under debate.” One would think after the AHCPR, New Zealand Commission, Meade, and Manga reports that few informed journalists would still consider chiropractic care as controversial; obviously Mr. Ubell’s personal bias from decades of medical propaganda weighed more than the research guidelines.
At best, he could only give chiropractic spinal manipulation a left-handed endorsement: “[T]he health-care study reported that it can work well in certain situations.” Ubell then focused the remainder of his article on the surgical solution to sciatica (which he also admits occurs in only two percent of back pain cases), while completely ignoring chiropractic’s success in similar cases.
Ubell neglected to mention AHCPR’s recommendation that spinal manipulation was the preferred initial form of professional care; AHCPR’s conclusion that only one in 100 back surgeries is helpful; and, two MRI studies by orthopedic surgeons (Scott Boden and Maureen Jensen) which undermined the basic premise of disc abnormalities as the cause of back pain in the majority of cases.
Ubell’s article simply sang the same old medical song of back surgery as the best solution, despite the findings of numerous studies to the contrary. When a panel of twenty-three experts in their field researched over 10,000 articles on back pain, then recommended spinal manipulation as the preferred initial form of care and further concluded that only one percent of back cases needed surgery, it is unclear how anyone could still endorse spinal surgery to the extent Ubell did. Indeed, if any treatment should be considered “controversial,” it is spine surgery.
According to author Shannon Brownlee,
Back pain patients would probably do well to think about that, because the surgery they’re about to undergo poses real risks, including infection, continuing pain, pseudoarthrosis, a condition called “failed back syndrome,” and occasionally even death.
One day medical historians will look back at many current medical practices and see 21st century equivalents of bloodletting and leeches. … Spinal fusion surgery serves as the poster child for much of what’s wrong with the current debate over what to do about health care costs; it may, according to Dr. Jerome Groopman, be “the radical mastectomy of our time.”
It is one thing to win an antitrust trial in the legal courtroom or to convince fair-minded investigators in the New Zealand Commission or AHCPR, but until the media acknowledges the new paradigm shift to hands-on therapy, the jury will still be out in the court of public opinion. After decades of misinformation, the media’s skepticism remains a powerful problem for people to learn the truth of the benefits of chiropractic spinal care. The longer we wait, the more people continue to suffer.
Modern Medical Misinformers
In 1975, the Committee on Quackery was disbanded once the Wilk trial began, but the goal to disseminate misinformation about chiropractic and all alternative healing arts was kept alive by Stephen Barrett, MD, who started the Lehigh Valley Council Against Health Fraud. Barrett was, allegedly, given access to all of the AMA’s anti-quackery and anti-chiropractic files, quite likely part of the 44 file cabinets Barrett kept privately. The AMA now had another third-party to carry its campaign against chiropractic and other natural health care providers.
Barrett later became a founding board member of the National Council Against Health Fraud, started by William Jarvis, PhD. From 1970 to the present, Barrett has continued to attack virtually everything non-allopathic regardless of the scientific proof or public support.
According to TIME magazine in 2001, Barrett retired from his psychiatric practice in 1993 to devote himself full time to “quack busting.” Touting his new fame, Barrett said, “Twenty years ago, I had trouble getting my ideas through to the media. Today I am the media.” Sounds eerily reminiscent of Morris Fishbein, doesn’t it?
Dr. Barrett’s propaganda war against chiropractic has been a battle which has been discredited by many respected authorities such as the New Zealand Inquiry. Unfortunately, his misinformation to the public about alternative medicine has been printed in numerous consumer magazines, including Redbook, American Health, and Self, and he has been the health editor of Nautilus magazine and a consultant for Shape and Prevention magazines.
Rather than a medical man of science, he represents the same old apartheid mindset of the AMA to denigrate all alternatives, including nutrition. Inexplicably in this day and age about the damage caused by junk food, Dr. Barrett wrote that readers should “ignore any practitioner who says that most diseases are caused by faulty nutrition,” and he stated that “there’s no reason to believe organic foods are safer or any more nutritious than ordinary fare.” Obviously, his expertise about nutrition is just as wrong as his view about chiropractic care.
Dr. Barrett, formerly a practicing psychiatrist, demonstrated his lack of objectivity about chiropractic in 1978 when he testified against the profession before the New Zealand Commission on Chiropractic, which at the conclusion of the Commission hearing endorsed the inclusion of chiropractic in that country’s national health-care system. After the session with Barrett, the commission concluded, “It is plainly propaganda.”
We have considered material published in Barrett’s name. It is plainly propaganda. What we have seen of the rest of his writings on chiropractic has the same tone. Nothing he has written on chiropractic that we have considered can be relied on as balanced.
It is clear that the enthusiasm of the Lehigh Valley Committee Against Health Fraud is greater than its respect for accuracy, at least in regards to facts concerning chiropractic. We are not prepared to place any reliance on material emanating from the Lehigh Valley Committee.  (emphasis added)
Not only did the New Zealand Commission ignore Barrett’s remarks as biased, American attorneys representing the victims of Barrett’s attacks also came forth in legal action against this “quackpot.”
According to reporter Tim Bolen, Barrett has had a series of legal setbacks in his role as quackbuster:
Barrett has problems accepting reality … I think that Stephen Barrett has deep-seated psychological problems that will not allow him to act within the bounds of normal behavior. It appears to me that his world is one of his own making where he, and he alone, makes up all the rules. For instance, Barrett describes himself as a “Retired Psychiatrist,” when, in fact, he could never pass even the basic testing to become Board Certified in that specialty. More important is that Barrett has been officially declared, in a published Appeals Court Decision, to be “biased, and unworthy of credibility,” yet there he is blithely offering his writings as though they had any merit.
I believe that Barrett has his own made-up version of what US law is all about. For instance, I think that in his mind, he is in charge of US law. Several years ago Barrett and Robert S. Baratz MD, DDS, PhD, using the National Council Against Health Fraud (NCAHF), sued Homeopathic manufacturers in California under a section of law called B&P 17200, claiming, among other things, that the science of Homeopathy was fraud because it hadn’t been proven, blah, blah, blah.
Of course they lost the cases for many different reasons.
It was one of those cases (NCAHF v King Bio) where Barrett and another NCAHF Board Member Wallace Sampson, were declared to be “biased and unworthy of credibility.” More though, in that case and others, the Court pointed out that the NCAHF was using its own Board Members as supposed expert witnesses, and as the Court pointed out, you cannot be the Plaintiff and your own expert witness.
In another of those Homeopathic cases the NCAHF, because of Barrett and Baratz’s activities, was ordered to pay over a $100,000 in the Defendant’s legal fees—which, of course, they never paid. That Judgment still sits there uncollected.
On October 13, 2005, Judge J. Brian Johnson, of the Lehigh County Court of Common Pleas, handed self-proclaimed “consumer medical advocate” Stephen Barrett another loss in court. Barrett had filed a defamation lawsuit against Tedd Koren, DC, and his company, Koren Publications, Inc. The lawsuit, filed in August 2002, sought unspecified damages against Koren and his company for statements he wrote in his newsletter in 2001 about Barrett that he was “de-licensed,” “in trouble because of a $10 million lawsuit” and a “quackpot.” In his defense, Koren contended that the statements were true and not defamatory, and that he had a First Amendment right to print them in his newsletter.
In making the ruling to throw out the case, Judge Johnson found there was insufficient evidence to support Barrett’s claims. Attorneys James Turner and Carlos F. Negrete represented Dr. Koren in the action against Barrett. Mr. Turner remarked that “Barrett has been a gadfly, a thorn in the side of new ideas in health for over 30 years.”
It is very important that a responsible judge in Barrett’s hometown recognized that he was making false allegations and dismissed the case. Our interviews with jurors also revealed that they too saw through Barrett and felt that he was a litigious, ungrounded and biased denier of the truth. Barrett has been a gadfly, a thorn in the side of new ideas in health for over 30 years. He has cost untoward numbers of consumers pain, anguish and probably serious harm by his misrepresentation of the facts about subjects as diverse as acupuncture and zinc. It is time that his activities see the light of day under objective scrutiny. Because once they’re seen for what they are, they will have no more impact.
Attorney Carlos Negrete characterized Barrett and his allies as “skinheads with stethoscopes around their necks”:
Frankly, I am not certain who the supporters of the so-called Quackbusters are comprised of, but they seem to me to be just skinheads with stethoscopes around their necks. They are distinguished by the narrow and simple-minded intolerance of chiropractic. Chiropractors have brought no harm to them, why then do they feel it is so important to minimize the benefits of an entire, well-established healing art? These people have, for years, threatened, intimidated and harassed anyone that is not obedient and accepting of their banter. Finally, there has been a loud voice to silence their bullying tactics. All chiropractors can take in a breath of fresh air.
The New Zealand Commission also investigated another example of yellow journalism involving Barrett’s group that occurred in 1975, a year before the Wilk trial began; a two-part article published in September and October 1975 for Consumer Reports, “Chiropractors: Healers or Quacks?” The report was based on a 6-month investigation by Mr. Joseph R. Botta, senior editor of Consumer Reports who specialized in medical reporting. His flip-flop on chiropractic typified the influence of these medical misinformers attempting to thwart the truth about chiropractic. (Speak no evil)
This report was brought to the attention of the New Zealand Commission in 1979, but the Commission rejected its reliability after it was found Mr. Botta changed his opinion after speaking with Dr. Murray Katz, another member of the Lehigh Valley Committee Against Health Fraud:
The Commission has another reason for its reservation on the weight to be placed on the Consumers Union report. That is because of evidence which was given before us by Dr. Murray S. Katz, a Canadian medical practitioner and colleague of Stephen Barrett of the Lehigh Valley Committee Against Health Fraud, Inc, told the Commissioners that he had played some part in influencing the emphasis of the CU report. In the course of orally presenting his submissions he volunteered this comment:
“The Consumers Union started off very much in favor of chiropractic. After hearing what the AMA had to say about chiropractic, they were even more in favor of chiropractic, considering they had a vested interest, but it was only after Joe Botta came to Montreal and discussed this issue over many hours and many telephone calls [with me] that the Consumers Union in the United States completely reversed their stand on the chiropractic issue and went exactly the other way.”
Next, Dr. Katz was very frank about how he came by certain material and information regarding chiropractic. It appears that he so strongly felt the need to investigate chiropractic from the inside that he adapted a series of dishonest stratagems to enable himself to do so. (emphasis added)
The New Zealand Commission determined:
He said he was independent. He may well have believed he was when he gave evidence before the Commission. But in fact he was in no position to be independent…If it is true that Dr Katz was instrumental in convincing the author of the Consumers Union report to “completely reverse his position on chiropractic,” then we must record that we are provided with further ground for placing little reliance on the report. 
The New Zealand Commission also investigated another misrepresentation of chiropractic that began in 1969 with Ralph Lee Smith’s book, At Your Own Risk: A Case Against Chiropractic, which was the AMA’s effort to condemn chiropractors with nothing more than anecdotal scare tactics. Ralph Lee Smiths’ book was a biased attack on the profession of chiropractic based on his experiences while under the pay of the AMA. Much of the book’s contents are from articles he had written for AMA publications. 
During its investigation, the New Zealand Commission made the following statement: 
We mention this book to show that we have not overlooked it. Some reliance was placed on it, and extracts from it, in the course of our inquiry. It comes down heavily against chiropractic.
It cannot in the Commission’s opinion be regarded as a text on which any reliance can be placed. It was published in the United States and Canada in 1969. It is a piece of special pleading. There is no true attempt of objective appraisal of chiropractic. It emphasizes the sensational.
The author does not appear to have any particular qualifications except a desire to present chiropractic in the worst possible light. The Department of Investigation of the American Medical Association seems to have had something to do with encouraging Smith’s investigations; certainly the American Medical Association took a considerable hand in disseminating the book once it was published. It appears to have been published shortly before the United States Senate’s Finance Committee’s investigation into whether chiropractic treatment should be included in social welfare aid programs. The Senate Finance Committee disregarded it and so do we.  (emphasis added)
While the AMA wanted the public to believe this was written solely by an independent third-party author, Wilk trial evidence showed that Smith wrote this book from inside the AMA’s headquarters, he was paid by the AMA, and research was done by Robert Youngerman, Doyl Taylor, and Smith.
With the behind-the-scenes “cooperation” between the Committee on Quackery and Smith, the AMA still had the audacity to bill his book as an “independent work” to support their contention of third-party support against chiropractic. Doyl Taylor of the Committee on Quackery mentioned, “we believe this independently written, privately published book will be another major tool that can be used in medicine’s continuing attempts to inform the public, in general and the legislators, in particular, about the evils of chiropractic.”
As discovered during the Wilk trial, the AMA and its allies like Barrett and Katz were professional liars when it came to their attack on chiropractic. Actually, the Sore Throat character who revealed the AMA’s files now published in the book, In the Public Interest, characterized the AMA as a “self-perpetuating propaganda factory” in his letter to chiropractic leaders, Drs. Jerry McAndrews and Louis Sportelli, and nationally syndicated newspaper columnist Jack Anderson:
…the biggest tool the AMA has against chiropractic is the sheer volume of discrediting material written about chiropractic that is quoted and re-quoted even though it has no basis in fact. This self-perpetuating propaganda factory will never disappear until the source of the propaganda is brought to task.
Another question I am often asked, and perhaps the most significant question is, “Won’t the AMA attempt to smear chiropractic as a justification for the restraint of trade activities they have been involved in?” In other words, what about those chiropractic skeletons in the closet—whether real or the figment of some AMA executive’s imagination?
Realistically, chiropractic has been smeared for decades by the AMA. Do you really feel that the AMA can present much more evidence against chiropractic? From what I have seen they have used up any ammunition they may have had, and manufactured a good deal of ammunition in the bargain. 
Unquestionably, it has been unethical medical zealots like Barrett, Jarvis, and Katz who have kept the volley of misinformation in the news as unofficial spokesmen for the AMA hiding behind phony “public awareness” groups. This task became more difficult in the 1990s once researchers found that chiropractic was not only effective, but superior to many medical methods.
It’s time for the media to stop the Speak No Evil mindset—stop ignoring chiropractic’s benefits and stop parroting the medical propaganda. It’s time to tell the whole truth about the reform in spinal care.
 Ask Ann Landers, Chiropractors Eyed, January 28, 1971, The Times-Picayune, New Orleans, LA.
The Watergate scandal resulted from the break-in to the Democratic National Committee headquarters at the Watergate office complex in Washington, D.C. Effects of the scandal ultimately led to the resignation of the President of the United States Richard Nixon on August 9, 1974.
 Editorial, “AMA Tries to Discredit Nation’s Chiropractors,” Valley Morning Star (Harlingen, TX), November 1966.
 Lauran Neergaard, “Back Pain Widely Overtreated in the U.S.” Associated Press, June 8, 2010.
 Linda Carroll, “Back Surgery May Backfire On Patients In Pain,” msnbc.com, 10/14/2010
 Ibid. PX-172 November 11, 1962.
 Ibid. p. 127.
 Rupert Cornwell, The Independent, June 22, 2002.
 Deposition, Dec. 15, 1980 of Ernest K. Howard by George McAndrews, p. 1053.
 Letter to Mr. Robert U. Brown from Ann Landers, Oct. 8, 1974, PX-1687.
 Ask Ann Landers, Chicago Sun-Times, “Clearing the Air On Chiropractic,” Mar. 9, 1971.
 Deposition, Dec. 15, 1980 of Ernest K. Howard by George McAndrews, p. 1054
 Ask Ann Landers, “Chiropractors Eyed,” January 28, 1971, The Times-Picayune, New Orleans, LA.
 Ask Ann Landers, “Dog in Chiropractor’s Office?” The News and Observer, Raleigh, NC. August 5, 1974,
 Letter to Ernest Howard, MD (Executive Vice President of the AMA), August 12, 1974. Wilk v AMA Trial Exhibit 1407
 Jane Levere, “Editorial Raps Ann Lander for Taking Free Trip,” Editor & Publisher, October 5, 1974, p. 25.
 Levere, ibid. p. 25
 Letter to Mr. Robert U. Brown from Ann Landers, Oct. 8, 1974, PX-1687.
 Deposition, Dec. 15, 1980 of Ernest K. Howard by George McAndrews, p. 1515.
 Deposition, Dec. 15, 1980 of Ernest K. Howard by George McAndrews, p. 1517.
 Ibid. p. 1540.
 Ibid. p. 1541.
 Tom Paulson, “Chiropractor Describes Fight For Respect With The AMA,” Seattle Post-Intelligencer Reporter, Friday, March 1, 1991.
 Stephen Barrett, M.D.and William T Jarvis,. Ph.D. The Health Robbers: A Close Look at Quackery in America, Foreword by Ann Landers, Amherst, N.Y.: Prometheus Books, 321-335, (1993): vii.
 Trever, Ibid. p. 11.
 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.
 Paul G Shekelle, et al, RAND Corporation Report, The Appropriateness of Spinal Manipulation for Low-Back Pain, 1992
 Bigos, ibid, Patient Guide, p. 7.
 technically known as rapid dominance, is a military doctrine based on the use of overwhelming power, dominant battlefield awareness, dominant maneuvers, and spectacular displays of force to paralyze an adversary’s perception of the battlefield and destroy its will to fight.
 Shannon Brownlee, “Newtered,” Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, http://overtreated.com/extras01.html
 J. Turner, et al., “Patient Outcomes after Lumbar Spinal Fusions,” Journal of the American Medical Association 287/7 (August 19, 1992): 907–11.
 S. Bigos, ibid. p. 90.
 S Bigos, ibid. p. 8.
 S. Bigos, ibid. p. 90.
 S. Bigos, ibid.
 Ibid. p. 7.
 Paul G. Shekelle, Alan H. Adams, Mark R. Chassin, Eric Hurwitz, Rolla Edward Park, Reed B. Phillips, Robert H. Brook, “The Appropriateness of Spinal Manipulation for Low-Back Pain: Project Overview and Literature Review,” RAND (1991): 3. Santa Monica, Calif.
 Bigos, ibid.
 Louis Sportelli, DC, “AHCPR: It Did Not Happen By Accident,” Dynamic Chiropractic 13/2 (January 16, 1995).
 Bradford H. Gray, Michael K. Gusmano, and Sara R. Collins, “AHCPR and the Changing Politics of Health Services Research: Lessons From the Falling and Rising Political Fortunes of the Nation’s Leading Health Services Research Agency,” Health Affairs: The Policy Journal of the Health Sphere (June 25, 2003); http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.283v1/DC1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=bradford+gray&fulltext=politics&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
 John Weeks, “Back Surgeons, Chiropractic, and the Murder of a Federal Agency on Evidence-Based Medicine,” theintegratorblog.com (June 11, 2006).
 A. White, et al., Letter to the Editor, Spine 19/1 (1994): 109–10.
 Congressional Record, 3 August 1995.
 Bradford H. Gray, et al., “AHCPR and the Changing Politics of Health Services Research: Lessons From the Falling and Rising Political Fortunes of the Nation’s Leading Health Services Research Agency,” Health Affairs: The Policy Journal of the Health Sphere (June 25, 2003); http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.283v1/DC1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=bradford+gray&fulltext=politics&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
 Bradford H. Gray, ibid.
 Editorial Staff, “North American Spine Society: Flip-Flopping on AHCPR Low Back Guidelines?” Dynamic Chiropractic 13/23 (November 6, 1995).
 Editorial Staff , “North American Spine Society: Flip-Flopping on AHCPR Low Back Guidelines?” Dynamic Chiropractic 13/23 (November 6, 1995).
 D. McCrory, et al., Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache (Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research; Durham, NC: 2001).
 Richard A Deyo, B.M. Psaty, et al., “The Messenger Under Attack: Intimidation of Researchers by Special Interest Groups,” NEJM 336/16 (April 17,1997): 1176-79.
 Joanne Silberner, “Surgery May Not Be The Answer To An Aching Back,” All Things Considered, NPR, April 6, 2010
 Shannon Brownlee, “Newtered,” Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, http://overtreated.com/extras01.html
 American Medical Association Pocket Guide to Back Pain. Random House, copyright 1995 by AMA.
 S. Bigos, ibid.
 T.W. Meade, S. Dyer, W. Browne, J. Townsend, A.O. Frank, “Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment,” British Medical Journal 300/1 (1990): 1431-37.
 P. Manga, et al. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain (Ontario, Canada: Ontario Ministry of Health, 1993).
 Paul G Shekelle, et al, RAND Corporation Report, The Appropriateness of Spinal Manipulation for Low-Back Pain, 1992
 “Back Pain: The Best Treatment Is Surprisingly Simple,” Consumer Reports (September 1995).
 Richard H. Tyler, “Questions and Answers,” Dynamic Chiropractic 8/9 (April 25, 1990).
 No Author, “Relief for aching backs,” Consumer Reports (May 2009).
 Earl Ubell, “What Works Best for Back Pain,” Parade Magazine (January 14, 1996): 12-13.
 S.D. Boden, et al., “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects,” Journal of Bone and Joint Surgery (American edition) 72/3 (1990): 403-408.
 Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross, “Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain,” New England Journal of Medicine 331/2 (July 14, 1994): 60-73.
 Shannon Brownlee, “Newtered,” Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, http://overtreated.com/extras01.html
 Louis Sportelli, “Bye Bye Barrett,” Dynamic Chiropractic. 25/18 (August 27, 2007)
 L Jaroff, “The Man Who Loves To Bust Quacks,” TIME magazine, Apr. 30, 2001
 BD Inglis, Chiropractic in New Zealand: Report of the Commission of Inquiry into Chiropractic. Government Printer, Wellington, New Zealand, 1979.
 Editorial staff, Stephen Barrett Loses Major Defamation Trial in Hometown, Dynamic Chiropractic 23/25 ( December 2, 2005)
 JR Botta, “Chiropractors: Healers or Quacks?” Consumer Reports XX 542-47 (September and October 1975): 606-610.
 Inglis, ibid, p. 104.
 William Trever, “in the Public Interest,” Scriptures Unlimited, Los Angeles, Calif., 1972. p. 41.
 Inglis, ibid. p. 106.
 Ralph Lee Smith, At Your Own Risk: The Case Against Chiropractic (Simon & Schuster, 1969).
 George McAndrews, closing argument, Wilk I, p. 7073.
 Ibid. p. 42.
 Letter to chiropractic leaders from Sore Throat, postmarked 12-16-76, p. 21-22.