The Conflicted Dr. Gupta

The Conflicted Dr. Gupta

 

Sanjay Gupta, MD, is the multiple Emmy^®-award winning chief medical correspondent for CNN who rubs elbows with US presidents, such as President Obama who proposed him as Surgeon General and, more recently, he was asked by former President Clinton to expose the dangers of prescription pain drugs.

Dr. Gupta is undoubtedly among the most notable MDs on cable news with his extensive appearances on CNN documentaries and his weekend medical affairs program, Sanjay Gupta, MD.  His personable demeanor is disarming and his information is generally accurate, but he is not without his critics, conflicts, and bias.

Press Problems

While CNN touts itself as “the most trusted name in news,” it had to admit Dr. Gupta fudged facts on key issues concerning Mike Moore’s film, Sicko, or the revelation that twice before Dr. Gupta has been called on the carpet for promoting two controversial drugs—Gardasil and Vioxx, both manufactured by Merck, an advertiser on his program.[1]

His latest CNN special, Deadly Dose, that originally aired on November 18, 2012, focused on the growing prescription pain pill abuse (Oxycodone, Percocet, OxyContin, Hydrocodone, Methadone, Morphine, Fentanyl), euphemistically called the Hillbilly Heroin epidemic.

Dr. Gupta was urged by former President Clinton to report on this topic after one of his friend’s son died from an overdose of pain killers mixed with alcohol—a deadly concoction for thousands annually. Clinton’s interview on this documentary was palpable as he called for “a national conversation” to make this problem better known.[2]

As a journalist I am only too eager to add to this national conversation by asking about the most obvious omission in Deadly Dose—the absence of chiropractic care as a non-drug alternative to the addictive and deadly prescription pain killer drugs that Gupta bemoans.

Gupta reported the magnitude of this drug problem: “Car crashes are no longer the number one reason people die accidentally in the United States. Nowadays it’s actually prescription drugs. That’s because on any given day people take more than the recommended dose, mix and match, or take medications not prescribed to them. Many take pills with alcohol, and all of it can make for a deadly dose.” [3]

Gupta admits this is a bigger problem than most people realize. “In fact, the most recent data shows 37,000 drug overdose deaths in one year, mostly accidental. About 21,000 involved prescription drugs and of those 75 percent were pain killers.”[4]

These deaths, however, cannot be considered “accidental” like a car accident when most patients are prescribed these narcotics by their primary care physicians. Dr. Stephen Anderson also confessed in Gupta’s exposé, “We have seen absolute skyrocketing of overdose deaths that correlate directly with the number of prescriptions that are written.”[5]

Rather than a conservative distribution of these dangerous and profitable drugs, “pain management” clinics are exploding in medical practice. These “pill mills” are widespread today where doctors prescribe these drugs with virtually no impunity despite no medical history being obtained from the patient nor is any type of actual therapy rendered—it is solely a “cash and carry” transaction.  In other words, give the pill mill doctor the cash and carry out the drug of your choice.[6]

The proliferation of pill mills recently led Thomas Frieden, MD, director for CDC, to admit that physicians have supplanted street corner drug pushers as the most important suppliers of illicit narcotics.[7]

Dr. Gupta failed to mention that pill mills are dispensing narcotics like candy on Halloween although he  did mention the glut of these prescription drugs. “The problem, in part, is that here in the United States, we are being flooded with painkillers. Consider this, Americans take 80 percent of the world’s painkillers…that increased by 600 percent between 1997 and 2007.”[8]

While he admits there is the abuse of pain medications, he fails to hold responsible the source of this flood of painkillers—on the shoulders of medical dispensers and not on street corner drug dealers.

No Pot or Pops

Another glaring omission from Gupta’s exposé is his failure to mention any non-prescription drug solutions to this tsunami of deaths and addictions, including medical marijuana, which was odd considering Washington State is where Gupta filmed much of his exposé.

The benefit of medical marijuana for chronic pain is not new, but it appears Gupta has chosen to ignore this alternative to opioids. His endorsement might have been too controversial for CNN or too conflicted with Big Pharma if this leading medical TV commentator were to recommend cannabis over their profitable narcotics.

 Moreover, Dr. Gupta certainly would be in the medical doghouse if he were ever to endorse chiropractic care. Apparently biased Gupta’s reporting could become a compelling ethical issue considering every guideline on back pain now recommends non-drug treatments like chiropractic care before drugs, shots, or spine surgery for non-specific, mechanical low back pain.[9]

In 2010, even the North American Spine Society admitted spine fusion should be a last resort and recommended spinal manipulation—5 to 10 sessions over 2 to 4 weeks—should be considered before surgery or narcotics.[10]

This is the most notable puzzlement to me as a 33-year practitioner who specializes in back pain relief—Dr. Gupta’s failure to mention the benefits of America’s primary non-drug spine care providers, chiropractors.[11] This omission is exactly the answer to the problem he addresses in Deadly Dose.

Mismanaged Back Pain Causing Drug Abuse

Dr. Gupta, like many MDs, initially believed the people who overdosed on pain pills were common drug abusers, but he found most were suffering from back pain who innocently followed their doctor’s advice only to become addicts by default, not by choice.

“We thought these are guys on the street, maybe using heroine,” said Dr. Bill Hurley who is the medical director of the Poison Control Center and a trauma doctor in Washington State.[12]

Gupta also agreed, “But looking deeper, he realized they weren’t junkies, not at all. It usually began with a back sprain.”

Again this admission begs the question: how can anyone, especially a renowned neurosurgeon and respected reporter  like Dr. Gupta have a discussion on drug abuse caused by back pain and fail to mention as a reliable non-drug solution the main health profession most closely affiliated with effective back pain treatment—chiropractic care?

Although Gupta ignored chiropractic care or medical marijuana as solutions, he then inexplicably recommends other unproven medical treatments. During same period his Deadly Dose aired, CNN also aired a segment on Ecstasy as a treatment for post-traumatic stress disorder, Experimental treatment for PTSD: Ecstasy.[13]

He also mentioned in Deadly Dose the off-market use of methadone, a treatment for heroin addicts, as a popular painkiller prescribed by doctors.[14]

Many of the viewers may be bewildered by these recommendations while he ignored other proven and safe alternatives for chronic pain like chiropractic, massage therapy, acupuncture, and medical marijuana.

Untrained MDs

This mismanagement of chronic pain comes at a time when researchers acknowledge that the majority of MDs are untrained in the diagnosis and management of back pain and other musculoskeletal disorders. This lack of education combined with the historical antipathy of MDs toward CAM providers makes for a deadly dose of bias.

The public is unaware that the majority of MDs are untrained in the diagnosis and management of back pain and other musculoskeletal disorders. Researchers revealed that medical primary care physicians are actually the least educated to diagnose and treat musculoskeletal problems.[15]  Inexplicably, it was found that 50% of all medical schools do not even teach classes in this subject.^[16]

The opinion that most MDs are untrained in musculoskeletal disorders is not a surprise nowadays. Gupta’s Emory University faculty colleague and spine expert, Dr. Scott Boden, has admitted, “Many, if not most, primary medical care providers have little training in how to manage musculoskeletal disorders.”[17]

Other researchers revealed medical primary care physicians are typically inept in their training on musculoskeletal disorders,[18] proned to ignore recent guidelines that do not recommended narcotics,[19] and more likely to suggest spine surgery than surgeons themselves.[20]

These glaring issues in medical spine care led Mark Schoene, editor of an international spine research newsletter, to state “Spinal medicine in the US is a poster child for inefficient spine care.”[21] Unfortunately, his opinion is not reaching the public because medical newsmen like Dr. Gupta have been strangely silent on this matter.

Fallacy of the Bad Disc

In fact, a case can easily be made this epidemic is mostly physician-made caused by an often untrained medical profession that refuses to fully utilize chiropractic care while it continues to prescribe dangerous drugs, epidural shots, and spine surgery based on an outdated premise.

Dr. Gupta over the years has ignored the ground-breaking research that disproved the basis of the “bad disc” rationale for spinal fusion surgery. This obvious omission is startling coming from a neurosurgeon at Emory University who should be aware of one of the biggest discoveries in spine research in decades.

The seminal research in spine care essentially began in 1990 when MRI research by Scott Boden, MD, now director of the Spine Center at Emory University, debunked the discogenic theory when he found many people without back pain had herniated or degenerated discs, too.[22]

Richard Deyo, MD, MPH, also agreed that “many of these disc abnormalities are trivial, harmless, and irrelevant, so they have been dubbed incidentalomas,” equivalent to “finding gray hair” since both are part of the normal aging process.[23]

Nor has Dr. Gupta mentioned the huge escalation of back surgeries. Despite this research undermining the “bad disc” theory began in 1990, spinal fusion procedures covered by Medicare escalated to $2.24 billion in 2008—nearly a 400% increase since 1997.[24]

Back surgery has become a booming business with about 800,000 Americans undergoing back surgery each year, but not without serious consequences as researchers have stated emphatically.

In 1989, Gordon Waddell, MD, orthopedist, and author of The Back Pain Revolution, admitted, “Low back pain has been a 20th century health care disaster…back surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”^[25]

In 1994, the U.S. Public Health Service’s Agency for Health Care Policy & Research (AHCPR) concluded, “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.”^[26]

Those patients suffering from failed back surgery often turn to the same dangerous opioids Gupta criticized in his exposé. Some may find refuge in chiropractic offices for their pain if they have not been discouraged by biased MDs, but for many, a life of disability and drug addition awaits them.

Many experts now believe the cost of medical care will decrease substantially when unnecessary spine surgeries are avoided. In 2006, the Dartmouth Institute of Health Policy also suggested 30-40% of spinal fusion surgeries (and the associated hospitalization costs) were unnecessary.^[27]

Considering the estimated cost of back pain is $267.2 billion annually[28], a 40% reduction would save $106 billion, which is equivalent to the cost of the war in Afghanistan for one year.[29]

This research has finally struck a chord among some insurance payers. In 2011, North Carolina Blue Cross/Blue Shield announced it will no longer pay for spine fusion if the sole criterion is an abnormal disc, which they consider a clinical finding, not a diagnosis.[30]

Regrettably, Dr. Gupta has never told his CNN audience of these historic changes in spine care. As a neurosurgeon who works alongside Dr. Boden at Emory, Dr. Gupta is certainly familiar with the MRI research and guidelines on spine care, but he has never mentioned this paradigm shift in spine care to his viewers on CNN.

Several other news sources have exposed the new evidence in spine research that debunks the disc theory. As well, many news outlets, such as The New York Times[31] and The Wall Street Journal[32]^,[33], NPR radio[34], MSNBC.com[35], and Bloomberg[36] internet news have all suggested wholesale changes are needed in spine care treatments.

Even the editor of ^The BACKLetter believes that “Spinal medicine in the US is a poster child for inefficient spine care.”[37]

Dr. Gupta, intentionally or unintentionally, as a journalist may be accused of perpetrating a cover-up for his failure to mention the substance of these articles concerning the debunked disc theory and the over-use of spine fusion surgery.

He has also avoided mentioning the payola corruption among MDs and drug companies as revealed by recent litigation by the Justice Department. He has also been mute about the recent Senate investigation into device manufacturers bribing spine surgeons.[38]^,[39]

Now as we witness in Deadly Dose, Dr. Gupta completely ignores the ascendancy of chiropractic care in this back pain epidemic.  Are these omissions merely the result of bad journalism, willful ignorance, or medical bias in reporting?

Conflicted Conclusion

At the end of his exposé on deadly drugs, Dr. Gupta concluded, “In a nation overflowing with so many pills, with so many patients wanting and expecting a quick fix, so many truly naive prescribers, users and misusers of medications, we have to find a way to prevent people from taking a deadly dose.”[40]

Let me suggest to Dr. Gupta the most obvious way to prevent many people from taking a deadly dose is to utilize chiropractic spine care as the first avenue of treatment as the guidelines already recommend for the majority of back pain cases.

Hopefully in the near future Dr. Gupta will feature another exposé on the alternatives to the Deadly Dose with a program, A Healthy Approach, to deal with the epidemic of back pain.