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Daryl D. Wills, D.C., president of the American Chiropractic Association (ACA) has complained about a program broadcast June 4, 2002, by Scientific American Frontiers and posted to the SAF Web site. The program, which was outstanding, acknowledged that spinal manipulation might be useful for acute low back pain. But it also noted that chiropractic's basic theory is nonsense and that neck manipulation can be dangerous. Here is Dr. Wills's letter with my comments in bracketed red type. The producer's response and another rebuttal by Dr. David Ramey are posted elsewhere on this Web site.
June 7, 2002
Pat Mitchell, President & CEO
Public Broadcasting Service
1320 Braddock Place
Alexandria, VA 22314
Dear Ms. Mitchell:
As president of the American Chiropractic Association (ACA), I find it ironic that a program titled "Scientific American Frontiers" would completely ignore the scientific foundation of the chiropractic profession. The chiropractic portion of the June 4 episode titled "A Different Way to Heal?" irresponsibly characterized chiropractic care --a legitimate, research-based form of health care -- as a fraudulent hoax. [I don't believe the term "fraudulent hoax" was used on the show. While this may be true, I don't believe the show aired this epithet. Chiropractic is not scientifically legitimate because no testable hypothesis underlies its core beliefs. The fact that one does research on chiropractic does not make it "evidence-based." One can research scams and collect statistics on them. They are still scams.]
I am also disappointed that you chose a group of admitted chiropractic antagonists, representatives of the National Council Against Health Fraud (NCAHF), as your "expert" health care sources. The NCAHF Web site describes chiropractic as "America's homegrown health care cult." The producers of your program could not have expected objectivity from this organization. And as a viewer of public television, I expect more reliable information than what the program offered. [The National Council Against Health Fraud is a consumer protection group which tries to provide reliable information on health care methods and practices. NCAHF is not a group of "chiropractic antagonists." We are skeptics whose views are based on scientific evidence. Our position paper on chiropractic acknowledges that appropriate chiropractic care can be helpful. But it also notes that chiropractic's basic theory is absurd and that many things chiropractors do are senseless.]
I must also take you to task on the format of the program itself. The program did not offer any of your pro-chiropractic guests an opportunity to rebut the foolish statements made by the NCAHF group and former doctor of chiropractic John Badanes. This would be the legal equivalent to a jury trial in which the plaintiff's attorney is the only counsel permitted to make a closing statement to the jury. Secondly, through just a little research, you would have learned that an ACA representative would make the most logical pro-chiropractic guest for the program. [TV producers and reporters collect taped comments by various parties and then decide what will be in the show and what will not, and in what order. The editorial content of the show is up to those who make it. TV is not a trial or legal proceeding. Guests were not identified as "pro" or "anti." They were asked questions and answered them. Period.] Excluding the nation's largest chiropractic organization from the discussion is irresponsible.
The NCAHF is a private organization that has been discredited in the past for its lack of accuracy and objectivity. [Not being run by government, NCAHF is private. So is the ACA. So what? The NCAHF has not been discredited. It is highly credible. Its spokespersons are regularly sought for opinions and commentary by the media, government agencies, insurance companies, and attorneys.] The Lehigh Valley Committee Against Health Fraud (LVCAHF), one of the three constituents that eventually formed the NCAHF, was discredited as a source for information on chiropractic in 1979 in a report ordered by the New Zealand Governor General and presented to the New Zealand House of Representatives. [LVCAHF was not a constituent that formed NCAHF.] The report stated, "nothing [Stephen Barrett, then chairman of LVCAHF and current vice president of NCAHF] has written on chiropractic that we have considered can be relied on as balanced." The report went on to say, "It is clear that the enthusiasm of the Lehigh Valley Committee Against Health Fraud is greater than its respect for accuracy, at least in regard to facts concerning chiropractic. We are not prepared to place any reliance on material emanating from the Lehigh Valley Committee." [The New Zealand Commission was composed of three laypersons who used convoluted logic to dismiss every criticism of chiropractic it received. The criticism of Dr. Barrett was based on a book chapter about how chiropractors use unethical sales tactic. The chapter was not "balanced," because fraud is not a balanced subject. The criticism of LVCAHF (now called Quackwatch) was also unfounded.]
This condemnation demonstrates that NCAHF cannot be counted on for objectivity. [Even if the 1979 criticism had been justified, the idea that it would be sufficient to "demonstrate that NCAHF cannot be counted for objectivity" is preposterous.] A more balanced segment would have featured representatives from the ACA and the scientific community discussing the numerous studies throughout the world that have shown chiropractic care to be effective and safe for a variety of conditions. Instead, the program's aim clearly appeared to be to discredit chiropractic, with NCAHF operating as a more-than-willing partner.
People trust PBS to provide accurate, unbiased information. In fact, on your own Web site, you refer to PBS, a non-profit enterprise, as "a trusted community resource." By airing this unbalanced portrayal, you have done a disservice to viewers who rely on you for the truth.
During the program, Robert Baratz of NCAHF errantly claimed that there is no scientific basis for chiropractic care. This is simply not true. [Chiropractic is based on the notion that spinal problems are the cause or underlying cause of disease. This idea has no scientific basis. Note also that Dr. Wills does not refer to me as "Dr." even though I have three recognized doctoral-level degrees.]
In 1994, the Agency for Health Care Policy and Research (AHCPR), a branch of the U.S. Department of Health and Human Services, recommended spinal manipulation as an initial form of therapy for low back sufferers, finding it both "safe and effective." The statement by AHCPR was based on its scientific review of all the accumulated evidence on spinal manipulation. Spinal manipulation is the primary form of treatment performed by doctors of chiropractic. In fact, doctors of chiropractic perform 94 percent of all spinal manipulative therapy in the United States. [Although the AHCPR report said that spinal manipulation may be effective for some cases of back pain, only a few of the research studies on which its conclusions were based involved manipulation by chiropractors. Most were done by medical doctors and physical therapists whose practices are not identical to those of chiropractors. The AHCPR report did not recommend chiropractic care. It mentions chiropractors only in the passages about the make-up of the AHCPR expert panel.]
More recently, a study released in 2001 by the Center for Clinical Health Policy Research at Duke University concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headaches, or those that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication. Other positive studies include a 1993 report prepared for the Ontario Ministry of Health that found that chiropractic care is "the most effective treatment" for low back pain and that it "should be fully integrated in the government's health care system," and a study published in the 1995 British Medical Journal that found that for long-term low back pain, "Improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals." The study continued, "The beneficial effect of chiropractic on pain was particularly clear." [These reports have far less significance than this paragraph suggests.]
Your program also failed to cite any of the countless examples of chiropractic's successful integration into today's health care system. For example, the prestigious Texas Back Institute (TBI), the largest, freestanding spine specialty clinic in the United States of America, at one time included only surgeons and other MDs. Then, nearly 15 years ago, when TBI's medical doctors discovered chiropractic's success with low back pain, they hired their first doctor of chiropractic. Now, according to published articles, about 50 percent of the Institute's patients see a chiropractor first when beginning their treatment. Perhaps segments on the first two doctors of chiropractic to practice in the attending physician's office on Capitol Hill, the new chiropractic internship program at Bethesda, Maryland's, National Naval Medical Center, or the successful Complementary and Alternative Medicine (CAM) Center at the National Institutes of Health, would have made for more informative television. [The fact that something is mandated or legislated doesn't make it integrated. Many insurance plans limit or exclude chiropractic care. Chiropractic pales against such things as physical therapy that are integrated into the health care system.]
Despite such convincing evidence, some organizations such as NCAHF continue to question the legitimacy of chiropractic and other forms of alternative medicine.
For example, Baratz claimed during your program that "hundreds of people" are paralyzed each year from chiropractic neck manipulation. Not only is this incorrect assessment completely unfounded, it boldly ignores the scientific literature on the topic. A study by the Rand Corporation found that a serious adverse reaction from cervical (neck) manipulation may occur less than once in 1 million treatments. Studies have also shown that these rare adverse reactions more frequently occur after visits to health care professionals who are inexperienced or inadequately trained in spinal manipulation, rather than to licensed doctors of chiropractic. A more recent article in the Canadian Medical Association Journal found only a 1-in-5.85-million risk that a chiropractic adjustment of the neck may result in vertebral artery dissection. [There is good reason to believe that chiropractic estimates of injury are far too low. Moreover, even more cases may go unrecognized because of a time lag between treatment and the catastrophic event.]
To put these remote risks into perspective, a study published in the April 15, 1998 issue of the Journal of the American Medical Association found that more than 2 million Americans become seriously ill every year from reactions to drugs that were correctly prescribed and taken; 106,000 Americans die annually from those side effects. [This statistic is very misleading. More important, a discussion of deaths from prescribed drugs is irrelevant to the issue at hand, which is whether chiropractic has a testable scientific basis. Trying to redirect the discussion shows the weakness of the defense.]
Additionally, you should be aware that complications from non-steroidal anti-inflammatory drugs (NSAIDs) -- a group that includes prescription and non-prescription pain medications such as aspirin and ibuprofen -- are responsible for 16,500 deaths each year, according to the New England Journal of Medicine.
Far too many patients -- young and old -- have their pain treated with medication that may have side effects that do not correct the underlying source of their problem.
The ACA believes that patients have the right to know about the health risks associated with any type of treatment, including chiropractic. However, health care consumers should be aware that the risks associated with chiropractic treatment are infinitesimally low. [NCAHF believes that chiropractors should warn patients that neck manipulation can cause a stroke that can result in deathy or disability. The ACA does not.]
Finally, we are particularly concerned that your biased, misleading and malicious attack has severely and wrongfully damaged the reputation of the chiropractic profession and chiropractic colleges. We urge that you reconsider the assertions made in your program given the damaging effects they have had on the profession and on these institutions, and that you publicly withdraw the assertions with an apology to this association and to the nation's chiropractic colleges.
Daryl D. Wills, DC, President
American Chiropractic Association