“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”
― author Malcolm Gladwell,
The chiropractic profession is enjoying a wave of new scientific support lately that should replace many ineffective medical spine care treatments (drugs, shots, surgery) while recommending spinal manipulation, the cornerstone of classic chiropractic care.
The new American College of Physicians guidelines for treating nonradicular low back pain published in the Annals of Internal Medicine on Feb. 14, 2017, were a big step that was quickly followed on April 11, 2017, by the JAMA study, “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis.”
Click to hear Dr. Marc Siegel at FOX News speak about the opioid crisis.
On March 13, 2017, the news media also reported Ibuprofen to be no better than placebo for back pain and can increase heart attack risk by 31%. On March 23, the media reported Pregabalin (Lyrica) for acute and chronic sciatica was no better than placebo; in fact, the incidence of adverse events was significantly higher in the pregabalin group than in the placebo group.
These shocking studies came on the heels of other paradigm shifting news about other medical spine care treatments:
- In 2010 the North American Spine Society (NASS) also recommended spinal manipulation—5 to 10 sessions over 2 to 4 weeks—should be considered before surgery.
- In 2012 the NASS also found “patients with lumbar radiculopathy due to lumbar disc herniation, 60% will benefit from spinal manipulation to the same degree as if they undergo surgical intervention. For the 40% that are unsatisfied, surgery provides an excellent outcome.”
- The FDA found off-label use of epidural steroid injections (ESI) to be no better than placebo, sometimes dangerous such as loss of vision, stroke, paralysis, and death, and ESI have never been approved by the FDA for back pain.
- Researchers Donald Murphy and Eric Hurwitz suggest 50 percent of low back pain and 69 percent of neck pain is joint pain, which explains why spinal manipulation and other manual therapies that restore normal joint motion work so well.
Hopefully with this string of events, the chiropractic profession may be approaching the elusive tipping point of scientific validation after decades of medical slander and obstruction by the AMA.
But not so fast, my friends.
Despite this optimistic outlook, there are cynics in the public, press and healthcare unfazed by this string of good news, still believing chiropractors remain the ugly stepchild in medicine and certainly not seen as the primary spine providers. This bias is an issue never fully vetted in the media to explain why this prejudice exists as the main hurdle in this tipping point to improve our image.
It was the AMA’S illegal boycott chiropractors with its Committee on Quackery campaign to “contain and eliminate” chiropractors that eventually led to an antitrust case in 1976 brought by four brave chiropractors led by attorney George McAndrews. The defamation campaign to discredit chiropractic as a “dangerous, unscientific cult” was proven, but the PR damage to the image of the chiropractic profession has never been addressed in the media and remains virtually in tact.
Judge Susan Getzendanner ruled, “By labeling all chiropractors unscientific cultists, injury to reputation was assured by the AMA’s name-calling practice,” which was exactly the goal of the medical curmudgeons — to defame its main competition, to invalidate chiropractic expertise/treatments, and to capture the healthcare marketplace.
Although the recent research dispels the superiority of medical care (drugs, shots, surgery) for most chronic spine-related disorders and the myth that chiropractic care is an “unscientific cult,” this wave of scientific support hasn’t diminished the stigma long associated with our brand of care.
Indeed, most people are unaware of these monumental new studies or the contrived stigma against chiropractors and simply yawn with a “so what!” attitude.
We see this “so what!” attitude elsewhere with a new president who should have been disqualified for his misogynistic behavior (“grabbing pussy,” supporting O’Reilly), his lack of transparency (IRS taxes, WH log, conflicts of interest, nepotism), making a mockery of the election process (name-calling, Russian hacking, debate charades) or his inability to tell the truth (fake news, alternative facts, flip-flopping, bogus tweets, no golf).
But to his supporters, they simply shrug, “So what!”
This indifference comes as no surprise since the chiropractic profession has long seen a “so what” attitude about breakthroughs vindicating chiropractic care in the epidemic of LBP and opioid abuse, starting with the 1994 AHCPR guideline #14 on acute low back pain in adults that was sabotaged by the NASS. An all-star panel of experts led by Stanley Bigos, MD, reviewed thousands of articles over two years before recommending three “proven treatments”:
- Spinal manipulation
NBC’s Today Show
Such media misrepresentation of good news about chiropractic should not come as a surprise since we witnessed the same yellow journalism in 1994 when the AHCPR’s findings were mentioned on NBC’s Today Show by its in-house medical expert, Art Ulene, MD, who presented the results of this impressive two-year study on back pain.
In a week-long series on back pain, Ulene did mention 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 ineffective; and spinal manipulation was the preferred initial professional treatment. Not only did the Public Health Service agency recommend spinal manipulation, its guideline also warns, “It should only be done by a professional with experience in manipulation.”
To his credit, Dr. Ulene detailed the findings accurately, but his medical bias became evident when show host Matt Lauer concluded, “So, if you have a back problem, then you should see a chiropractor first.”
“Oh, no,” said Ulene, “I would never recommend a chiropractor. Go see an osteopath instead.”
In one fell swoop, Ulene invalidated the healing art of chiropractic in the minds of millions of viewers, which was his goal. He knew full well that most osteopaths today do not do spinal manipulation. According to the 1992 RAND study on acute low back pain, chiropractors do 94 percent of all spinal manipulation therapy in this country, suggesting chiropractors are the leaders in this form of treatment.
But not Ulene who suggested osteopaths were preferable although he failed to mention that most osteopaths do not do manipulative therapy; it is now only an elective course in osteopathic schools.
Indeed, if not for the courage of the chiropractic profession for over 100 years, spinal manipulation therapy would have been a lost art as I wrote in an article, AHCPR: Gone with the Wind.
Banned at CNN
Other than the Dr. Marc Siegel segment at FOX News, the ACP and JAMA guidelines were ignored in the mainstream media, especially at CNN. On other hand, if a bad event with a chiropractor had occurred such as in the Katie May stroke case, it would have gone viral. What does it take to have good news about chiropractic go viral?
Indeed, when have you seen an in-depth, fair and balanced article about the nondrug benefits chiro care brings to a world wracked with chronic pain, opioid addiction, and unnecessary spine surgery?
Of course, never.
As it is now, the ACP and JAMA recommendations of SMT for LBP is met with a big “so what” by the press, consequently the response has been diminished.
The bottom line: after these news releases, the public has not rushed to chiropractors with their spine-related problems. Nor have MDs embraced Dr. Marc Siegel’s attitude to refer these cases to DCs. Nor have the insurance carriers seen the possibility to lower costs and improve outcomes by using DCs as the PCPs for spine-related disorders.
Chiropractic care remains the proverbial elephant in the room that everyone wants to ignore and not understand, especially Dr. Sanjay Gupta at CNN who has repeatedly slammed CAM.
One would hope after the ACP and JAMA reports the news media would jump on our bandwagon. We had the same hopes in 1994 after the ACHPR report was released, only to be disappointed how the medical men in the media twisted the findings.
This sabotage continues today. For recent examples, here is a short list of articles about the ACP guidelines:
· “The American College of Physicians integrates quackery with medicine in its recommendations for managing back pain,” David H. Gorski, MD, PhD – Managing Editor, Science-Based Medicine, February 14, 2017
· “Lower Back Ache? Be Active and Wait It Out, New Guidelines Say,” Feb. 13, 2017
- “Sore Back? Try Heat and Exercise First, Guidelines Say,” by Maggie Fox, NBC News, Feb. 13, 2017
If You Have Lower Back Pain, Don’t Reach for a Pill,” by Robert Glatter, MD“
· “Got Back Pain? Try Yoga or Massage before Reaching for the Pills,” NPR, February 20, 2017
· “Don’t Reach for Pills for Most Chronic Low Back Pain,” Reuters, February 15, 2017
· “Doctors Have Been Treating Lower Back Pain All Wrong,” by Sarah DiGiulio, Huffington Post, Feb. 15, 2017
· “Forget The Drugs, The Answer To Back Pain May Be Tai Chi, Massage,” by Mary Bowerman, USA TODAY Network, Feb. 15, 2017
As you can read, chiropractic is not mentioned in any headline. Instead, we see the preferences of the writers, such as “waiting it out,” “heat or exercise,” “try yoga or massage,” “don’t reach for pills,” and even “Tai Chi.”
Okay, I’ll admit those tips aren’t bad advice, but they certainly are secondary to the main cause of joint dysfunction as the primordial cause of most back pain.
Nor did any of these articles give credit where credit is due to chiropractors who have fought the good fight in this 100 year battle to keep SMT alive against the medical onslaught of drugs, shots, and surgery.
Why didn’t we see any articles in the media touting, “Chiropractors Were Right All Along” or “Chiropractic Care Best for Back Pain” or “Chiropractors Vindicated”?
Here are a few such articles I’ve written touting our brand:
- Chiropractors Blame AMA
- Chiropractors Cry Foul
- Chiropractors Call for Reform
- Chiropractors Have Your Back
- The Chiropractor as Hero
If not lengthy articles, why haven’t we created challenging ads to confront the medical misinformation about spine care and chiro care?
Instead of positive articles, you may have noticed one article that was blatantly biased, “The American College of Physicians integrates quackery with medicine in its recommendations for managing back pain” by David H. Gorski, MD, PhD.
It should not come as a surprise he is the Managing Editor of Science-Based Medicine, the bastion of medical trolls that include infamous chirophobes such as Harriett Hall, Jann Bellamy, and Steven Salzberg. Apparently this group of trolls is science-based only when the science suits their skewed outlook.
In the NPR report, “Got Back Pain? Try Yoga or Massage before Reaching for the Pills,” there was a small glint of hope when Dr. Steven Atlas, a bigwig internist and associate professor at Harvard Medical School who practices at Massachusetts General Hospital, said the study offers “more support for alternative treatments,” particularly for patients who are not getting better with self-care techniques such as heating pads, exercise and yoga.
Dr. Atlas (wouldn’t that be a great name for a chiropractor?) says further research could help identify patients who would benefit most from spinal manipulation therapy, making it easier for doctors to refer patients for treatment by a chiropractor or physical therapist.
Don’t we wish? Does he really think an MD born and bred into medical prejudice at med school will suddenly change his mind because of a new guideline? That’s equivalent to Dr. Jim Crow ending racism because of a speech by MLK, Jr. Nice idea, but just ain’t gonna happen.
Apparently Dr. Atlas is unaware MDs and PTs are not schooled in MSDs or SMT as well as DCs nor are PTs primary providers, but they will probably be the beneficiaries of the ACP and JAMA reports.
Even Dr. Siegel admitted during his NPC speech and on-air that PCPs have only 9 hours of training in “back,” but we don’t see them admitting this to patients or referring to DCs, exemplifying the real problem: too much money and too few ethics!
Since PTs already get MD referrals and don’t suffer the same boycott or stigma as do DCs, undoubtedly MDs will continue to refer these MSDs and “pain patients” to PTs despite their relative ineffectiveness.
- In 2015, The New York Times published “Physical Therapy May Not Benefit Back Pain” that reported “Physical therapy may provide little relief for recent-onset low back pain.”
- The 1994 AHCPR guideline also mentioned “physio-therapeutics like ultrasound, TENS, hot packs, and other standard treatments by physical therapists were also ineffective.”
Just as MDs knew opioid painkillers, ESI, and disc fusions were ineffective, dangerous, and addictive yet continued to use them, it probably doesn’t matter to them that PTs are rather inept in spine care as long as the money stays in the medical world.Indeed, “so what!”
Chiro Tipping Point
We DCs cannot hold our breath in anticipation of a sudden breakthrough in the image of chiropractic in the court of public opinion. Social change simply doesn’t happen like that.
Somehow we must find an avenue to tell our story with more than Tweets or WOC slogans; people need to understand the history of chirophobia before they can overcome their prejudice by understanding why they think the way they do–in other words, create a sense of cognitive dissonance.
For example, I liken our image tipping point to understanding racism—despite the Civil War victory, the Civil Rights Act of 1964, and the popularity of MLK, Jr., as a social icon, nonetheless racism, segregation, and Jim Crow laws didn’t vanish overnight.
The same can be said of the war against chiropractors—despite the positive research, evidence-based guidelines, and the ACP and JAMA articles endorsing SMT, we haven’t seen any sudden support for chiro care—no mea culpa by MDs for its boycott nor a call for tabula rasa by the media.
Nor have we seen worldwide coverage on cable news, especially CNN, which shouldn’t surprise anyone considering the history of chirophobia by Dr. Sanjay Gupta.
Until we have a breakthrough in the media, which is more than an occasional segment as we witnessed with Dr. Marc Siegel at FOX News, the negative image of chiropractic will remain embedded in the social consciousness of the public.
People may think, “Chiropractors may be right from some people, but not for me.”
Although the recent news releases about the new recommendations in spine care are encouraging, until we see two more tipping points in the media and among payers, the scientific tipping point will be slowed and the social tipping point delayed.
Indeed, Black Lives Matters arose due to the continual racism we see among too many police officers. Perhaps we need to begin another Chiropractors Matter social movement to improve the public’s awareness of medical bigotry, boycott, and the new guidelines.
Despite the recent good news, it appears our profession is still missing in the court of public opinion and in the court of insurance payers as the best buy for most neck and back pain problems.
Whether it’s attorneys looking for the highest medical costs via back surgery for MVA victims, or the hospitals wanting $30,000 back surgeries to fill their beds instead of $800 chiropractic-resolved LBP cases, or workers’ compensation railroading LBP patients in for surgery, what people fail to understand is the “perverse motivation” in healthcare in America.
Years ago I learned at former Gov. Roy Barnes’ workers’ comp convention, the main motivation of WC insurance carriers is: “If we pay out more, we can charge more in premiums, so there’s more money for everyone.” Yuk, yuk, wink, wink.
Chiropractic care in the Georgia workers’ compensation program had decrease by 70% in the last few years, now comprising less than one percent of the provider cost. Although Georgia’ WC law allows for chiropractic care, injured-workers are denied this care due to many reasons, just as I found at Robins AFB.
As proof of this boycott of chiropractic care in the federal workers comp program on base, in 2013 I requested a Freedom of Information Act to find there were 2,512 spine-related injuries for the fiscal year 2012 and none were referred to any chiropractor.
Although chiropractic care is authorized by TRICARE and the Federal Employees’ Compensation Act (FECA), Robins AFB has totally ignored these provisions over the years as my long string of letters to congressmen and RAFB commanding officers verifies.
On the other hand, there presently are three Army installations in Georgia that cover chiropractic care for its active service members: Fort Benning, Fort Gordon and Fort Stewart. Of the 59 Air Force bases in the US, only 20 have DCs on staff.
A GOA article mentioned the lack of DCs in TRICARE, “Defense Health Care: DOD Has Established a Chiropractic Benefit for Active Duty Personnel”:
“To implement its chiropractic benefit, DOD has opened chiropractic clinics at 42 of its 238 Military Treatment Facilities, worldwide, and does not plan to add any additional clinics at this time. All of DOD’s 1.8 million active-duty personnel are eligible for the benefit.”
But active-duty personnel are not getting chiro care when only 17% have access to DCs.
In a letter of December 6, 2010, the bottom line that the reason chiropractic care is not available to all military or TRICARE recipients is due to a few falsehoods as stated by Dr. S. Ward Casscells, MD, Assistant Secretary of Defense, Health Affairs:
“In addition, adding chiropractic care to the primary car model was estimated to increase the number of visits per episode of care. Ultimately, this increases the costs and delays a service member’s return to duty. These constraints have limited our ability to field chiropractic care beyond the 60 locations currently providing the service.”
In fact, the report did not say chiropractic was costly nor did it delay return to work. His summation ignored and contradicted the positive data from the two studies: Chiropractic Care Study and the Study Relating to Chiropractic Services and Benefits. It is obvious Dr. Casscells has misrepresented the DoD research to keep chiropractors limited. Again, “so what” is his attitude about misrepresenting chiro care.
As well, the DoD has ignored the 2013 Goertz study, Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study, that found 73% vs. 17% improvement comparing chiro plus medical care to medical care only.
Apparently the medical minds in the military ignore these facts. Obviously, being the fastest and cheapest form of LBP care is a disadvantage in the greedy world of healthcare. This odd revelation is due to what Dr. Clem Bezold from the Institute of Alternative Futures termed “perverse motivations.”
Aside from the medical men in the DoD, we should not expect the new Secretary of HHS, Dr. Tom Price, orthopedist, to acknowledge this string of positive events for the chiropractic profession and fully implement chiro care.
Dr. Arnold Milstein from Stanford’s Clinical Excellence Research Center mentioned in the Washington Monthly that Dr. Price is not an innovator in healthcare:
“The fee-for-service model is profitable for specialists, who get a handsome fee each time they perform a procedure. For primary care doctors, however, the only way to make more money is to see as many patients as possible, often in fifteen-minute slots. For medically fragile patients, fifteen minutes isn’t enough.
“The Affordable Care Act created the Center for Medicare & Medicaid Innovation, which supports new models of care delivery. But Tom Price, the new health and human services secretary, has made no secret of his disdain for the CMMI and any effort to reform fee-for-service payment.”
Once again, we see the “so what!” attitude.
Despite the call for healthcare reform, improved outcomes, lower costs, and increase in patient satisfaction, in the for-profit American healthcare system Dr. Price still believes in the old fee-for-service; in other words, he and his orthopedic friends like the status quo just the way it is, thank you very much.
Obviously we should not hold our breath or believe the tipping point has been reached as long as these perverse motivations prevail in healthcare. As one attorney told me, “The insurance companies don’t like chiropractors because you’re too cheap.”
“So what” can we do when the American healthcare system flies in the face of free enterprise on a level playing field? The research is clear, the laws have been passed, but we still face cynical medical elite that has no interest in giving DCs a fair chance as the guidelines recommend.
So what do you say?
 S Getzendanner, US District Judge, Permanent Injunction Order Against the AMA (Sept. 25, 1987), published in JAMA, 259/1 (January 1, 1988):81
 S. Bigos, et al., Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. (Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994): 90. P. 7.
 Paul G. Shekelle, et al., The Appropriateness of Spinal Manipulation for Low-Back Pain (Santa Monica, CA: Rand Corporation Report, 1992).
 Eccleston, S. et al. “The Anatomy of Workers’ Compensation Medical Costs and Utilization: A Reference Book.” Workers Compensation Research Institute, Cambridge, Mass. June, 2000