Scandal Under the Media’s Nose
Mark Twain once warned not to “pick a fight with people who buy ink by the barrel.”
His comment explains perfectly the situation the chiropractic profession has experienced over the past century fighting against the medical media.
For example, let me ask you a question that illustrates my point: When was the last time you’ve seen an in-depth article in the mainstream news media touting the benefits the chiropractic profession brings to a disabled world overwhelmed by opioid painkillers and back surgeries?
I can answer that question for you: “Never.”
And this comes at a time when back pain is the #1 disabling condition in the nation, military, and in the world.
This question also comes after twenty years of scientific research has demonstrated that chiropractic care is a “proven treatment” for this pandemic of back pain that you’ve never been told by the media.
Moreover, the accumulating spine research has concluded that medical spine care is a “national disaster” that has led to the current Hillbilly Heroin epidemic of opioid painkiller addictions and deaths, the ineffectiveness of epidural steroid injections, and the tsunami of unnecessary spine fusions based on an outdated ‘bad disc’ theory.
But the public has not heard one word about this paradigm shift in spine care because chiropractors have not been buying ink by the barrel, too, like the medical profession.
Unfortunately, there has been no ‘fair and balanced’ reporting or whistleblower exposés when it comes to the medical persecution of chiropractic care. Too few medical reporters and news programs have broached this issue because it reveals the prejudice and power of political medicine, the inefficiency of medical spine care, as well as shows the enormous influence Big Pharma and the AMA wield in the media.
If you're interested in learning about the sordid medical war against chiropractors, you'll enjoy this website and my book.
Op-Ed in the Macon Telegraph newspaper
MARCH 28, 2017
New guidelines in spine care
BY J.C. SMITH
Special to The Telegraph
Low back pain is epidemic in the nation with nearly 100 million sufferers that has led to the pandemic of prescription opioid painkiller abuse. Medical officials at the CDC and NIH as well as professional health associations have recently changed their guidelines to manage this pandemic of back pain and opioid addiction.
On Feb. 14, the American College of Physicians updated its clinical guidelines on the management of back pain, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.”
Overall, the ACP guidelines emphasize nondrug conservative “hands-on” treatments such as spinal manipulation and therapeutic massage as first-line treatments. The guidelines also state over-the-counter nonsteroidal anti-inflammatories or muscle relaxants should be considered only after nondrug therapy fails. The ACP guidelines strongly discourage the use of opioids for chronic pain as did the CDC guideline released last year.
This new guideline comes on the heels of other significant medical studies on low back pain:
In 2010 the North American Spine Society also recommended spinal manipulation— five to 10 sessions over two to four weeks — should be considered before surgery.
In 2012 the NASS also found “patients with lumbar radiculopathy due to lumbar disc herniation, 60 percent will benefit from spinal manipulation to the same degree as if they undergo surgical intervention. For the 40 percent that are unsatisfied, surgery provides an excellent outcome.”
The FDA found off-label use of epidural steroid injections 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.
Recent research found Ibuprofen to be no better than placebo for back pain and can increase heart attack risk by 31 percent.
New research also found 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.
Researchers now 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 for both pain control and functional improvement.
This revelation is a big problem considering over 60 percent of prescription opioid use involves various musculoskeletal disorders, such as chronic low back (30 percent) and neck pain (5.2 percent), extremity pain (22.5 percent) and headaches (4.1 percent), conditions that chiropractors may help with nondrug treatments.
Dr. Scott Boden, director of the Emory Spine Center noted: “Many, if not most, primary medical care providers have little training in how to manage musculoskeletal disorders.” He suggested “The best thing is to have an organized, integrated approach that uses state-of-the-art and cost-effective care.”
People suffering from back pain should consider following the new guidelines and seek nondrug help from a local chiropractor before using any drugs, shots, or spine surgery.
J.C. Smith, M.A., D.C. is a practicing chiropractor in Warner Robins.
“Nobody knew that health care could be so complicated.”
The chiropractic profession was handed a Valentines gift on February 14, 2017, when the American College of Physicians (ACP) updated its Clinical Guidelines on the management of back pain, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.”[i]
Certainly President Trump needs help to understand the complexities of America’s for-profit healthcare, and there’s no better place to start than with two HUGE issues—the opioid crisis and the new ACP guidelines for spine care.
The fact there is an opioid Pharmageddon is no longer news although it will remain a huge problem for decades, but the role of chiropractors should play as primary nondrug spine providers would be novel and newsworthy. The ACP guidelines verify our position to use conservative care first.
Medical spine care has been a “national disaster.” Indeed, the medical spine care industry has had its chance to help, but their opioids, epidurals and spine fusions have “left a wake of disability” unprecedented by any other health problem.
Now is the time for the chiropractic profession to step up to the media plate to state our position at the forefront of this national narrative on opioids and back pain, two of the most important issues facing this country in terms of sheer numbers and cost.
It’s past time to have a voice in this national tragedy with alternative facts to medical spine care concepts that have been proven ineffective, costly, addictive and dangerous.
A brief dissertation on the controversies in spine care would certainly help President Trump as well as the media at the NPC conference better understand the how the paradigm shift in spine care to our nondrug treatments will improve outcomes, lower costs, and enhance patient satisfaction, just as the new ACP guidelines suggest.
Enjoy my latest article, Alternative Facts in Spine Care.
Another Chiropractor Assassination
Just as we witnessed
when a pediatric chiropractor was assaulted in the media in
Long before the facts were known indicating she most likely was in midst of a stroke from a previous photo shoot, the hapless DC was charged and convicted in the court of public opinion as we watched this sad story go viral around the world—within days, this story appeared in over 100 newspapers and TV news programs.
Of course, there was no mention that this accident was a one in 5.85 million occurrence. Nor was there any mention of medical iatrogenic accidents for spine care that amount to over 2500 per one million cases.
None of that matter—all the public knows is a chiropractor killed a sexy woman as I wrote about in my Katie May Op-Ed. “Don’t confuse us with the facts” is the motto of the media since the emotions of both this case and the infant case Down Under supersedes reality—the ‘truthiness’ we face in chiropractic.
Despite the rarity of such adverse events in chiropractic care, our image took a huge blow that will resonate for years in the public and press. Unfortunately, the ACA and F4CP issued two small press releases apologizing for this accident and mentioned supportive research, but that will do little to remove the smear on our image.
Not only are we on the defensive once again, but it shows our lack of an effective PR program that would have counter-balanced this accident. Certainly the F4CP will claim its print program of newspaper ads and WOC celebrity testimonials should be viewed as a proactive approach, but unfortunately none of these articles have ever gone viral in the social media or in the earned media.
Although 2500+ per
million medical spine patients are seriously injured or die from drugs and
surgery, rarely does this go viral. If the victim in this accidental stroke
incident had been a plumber from
Indeed, the media is rigged against chiropractors and very much rigged in favor of medical care, which is to be expected considering MDs control news content, such as Sanjay Gupta, MD at CNN, and Big Pharma pays the bills in the media. Certainly the medical reporters will never bite the hand that feeds them as I mentioned in Rigged Media.
We will remain in the cross-hairs as a target of media misinformation until we develop a strong PR program to discuss these issues as I discussed in Media Muckraking—both the facts of the matter as well as the ‘truthiness’ of these issues.
Let me challenge the international chiropractic community and its leadership—when will you develop a PR campaign by developing relationships in the Earned Media? Today we have the scientific support and we have the budget from donations to the F4CP unlike ever before.
Now we need to change our strategy to develop a national conversation in the earned media. We need a media program as Jonah Berger wrote in his book, Contagious: Why Things Catch On. Chiropractic will never catch on as long as our medical enemies define us in the media.
Making this even sadder is the fact we could help save millions of people from drugs, shots, and surgery and in the process help save billions of dollars. Until someone in the media does a ‘fair and balanced’ article or program about the benefits we offer our nation and the world suffering a pandemic of pain, people will be victimized by opioid drugs, epidural shots, and disc surgery based on an outdated concept.
Changing the public image of our profession will not improve with only celebrity WOC endorsements or periodic newspaper ads citing an occasional positive chiropractic study. Although both have been the mainstay of our profession's image due to the lack of PR in the media, neither will crack the nut of skepticism we experience from medical misinformation.
The tipping point in the public’s perception of chiropractic care will happened when the public’s “click/whirr” about our profession’s image is transformed to the emerging facts rather than a function of the years of medical defamation that forms the “chirophobia” we now face.
For example, we’ve seen this transformation most recently when the LBGT community rallied the support of the media and government officials who finally jumped on their bandwagon for fairness and equality. Stephen Colbert mentioned this paradigm shift on his TV show: “Five year ago the LBGT community was in the closet; today if you’re not gay, something’s wrong with you!”
Indeed, wouldn’t it be great if the public were to assume a new “whirr” about our profession, such as “Chiropractors were right all along,” especially about the pandemic of back pain? Although the benefits of chiropractic spinal care far exceeds only back pain, but considering low back pain is the leading disability in our nation, it's a good place to start.
Of course, challenging core beliefs in the public’s mind to stir cognitive dissonance for change is difficult. Old attitudes like racism or sexism die hard, and so do people’s chirophobic attitude about chiropractors. Like any bias , chirophobia is deeply ingrained after 115 years of medical propaganda spewing from the AMA, MDs, and the medical media.
For example, on September 30, 2016, I presented a 4-hour class on the Sociology of Chiropractic at the Life U. Fall Conference. To illustrate the point of cognitive dissonance, I mentioned my own transformational experiences while a student at the University of California at Berkeley in the ‘60s.
Arriving as a crew-cut naïve high schooler from SoCal just after the Free Speech Movement began, I immediately experienced my core beliefs challenged by many new political issues aside from the rigors of university academia, such as the demonstrations for Civil Rights, Voting Rights, Women’s Rights; the assassinations of MLK, Jr. and RFK, as well as protest against the Vietnam War and draft.
The People’s Park confrontation certainly fueled my cognitive dissonance about state power v. civil rights. Led by Gov. Ronald Reagan for political gain, the conversion of a muddy lot into a community park resulted in mass arrests of innocent bystanders by the Alameda County Sheriff Goon Squad. I lived just a stone’s throw from this park during this conflict and was swept up in this ordeal that was a rude awakening for me that political power is often corrupt.
As I mentioned to the room of DCs at the Fall Conference, an education at Cal was much more than classrooms, exams, football games and fraternity parties. Indeed, my experiences at Berkeley made me think deeply of these greater social/political issues than simply my own class work or sports. Indeed, when I had to dodge tear gas canisters from the county deputy sheriffs, I never thought my track skills as a sprinter would be so important.
To my surprise while discussing the development of my own cognitive dissonance and personal transformation while at Cal, a DC attending my class suddenly shouted out, “If you’re from Berkeley, you must be a leftist.”
In fact, he had no idea what my beliefs were, but that did not stop him from expressing his prejudice and displeasure. As a Cal grad living in middle Georgia, I’ve encountered this prejudicial attitude many times. Actually, I prefer the terms “liberal” or “progressive” rather than “leftist,” which suggests an underground rebel group.
So I asked him if he had ever attended Cal or visited Berkeley. Of course not, he told me, as if it would taint his conservative ideology. I suggested his prejudice about Cal was the “click” of Bill O’Reilly at FOX News, not a learned viewpoint about the role Berkeley has played as the hub of student activism and as a leading academic institution in this country.
Fortunately, an erudite class member spoke up, “Berkeley is one of the greatest universities in the world.” Her comment was hard to swallow for our irate colleague, so he suddenly left the room. “Love it or leave it” echoes still today among these haters, so he left.
Although I was briefly annoyed at his “whirr” about Berkeley, it was a blessing in disguise because he exemplified my point exactly about the same dilemma chiropractic faces—although he had no accurate or personal experience about Cal, he was committed to his viewpoint, right or wrong.
In the same manner, millions of Americans have formed their opinion of chiropractic with the same narrow-mindedness gleaned from medical haters. This is the same attitude we must confront about our profession. We cannot let the haters go without any pushback with the facts. It’s past time we used the media to our advantage by developing a program of transformational articles in the earned media.
But this transformation in the public's mind begins with our own professionals understanding the historical issues, the players and events that have shaped our profession. It requires "getting up the learning curve" about the new scientific research and paradigm shift in spine care.
Indeed, my books and this website will make you the smartest chiropractor you've ever been and perhaps among the smartest chiropractor you know. Once you've gotten up the learning curve, then it's time to get the public and press up the curve, too.
Déjà Vu Down Under
Here’s a nightmare that could happen to any DC anywhere in the world; in fact, it is happening now in Australia where a pediatric chiropractor is being skewered in the court of public opinion.
What will you do when a hostile news reporter shows up at your office demanding an explanation why you are assaulting babies with your barbaric “back cracking”? What proof do you have to justify your “cruel process”?
What will you say when the reporter also accuses you of causing strokes in adults, handing to you a 2010 study from England, “Deaths After Chiropractic: A Review Of Published Cases,” by Edzard Ernst of the Medical School at the University of Exeter, noting twenty-six fatalities were published since 1934 in 23 articles.[i]
If that isn’t enough proof, he may then asked for another explanation of an August 7, 2014, article by the American Heart Association/American Stroke Association Scientific Statement that issued another piece of yellow journalism, “Neck Manipulation May Be Associated With Stroke,” by José Biller, MD, lead author and professor and chair of neurology at the Loyola University Chicago Stritch School of Medicine.
So, now you’re accused in the court of public opinion as both a baby abuser and the source of strokes for potentially hundreds of people. Indeed, you now resemble Typhoid Mary reincarnated!
Are you prepared to fight in this medical war of words? Or will you cave in explaining you’re just a practitioner unaware of history, research and guidelines, instead offering testimonials from satisfied patients to give a word of mouth endorsement?
Most likely you will simply turn a blind eye hoping this nightmare will go away. But it won’t stop as long as we continue taking a spoon to a knife fight.
This scenario could happen to any chiropractor in the world as we’ve previously seen in Canada, the UK, the US, and now Down Under. What was initially an educational YouTube video of Dr. Ian Rossborough adjusting a colicky infant suddenly turned into a sensational news item stoking apoplectic fear in the public sector with deranged rhetoric by news reporters and medical demagogues.
The recent attack on pediatric chiropractic in Australia may seem to be a new issue to most when, in fact, it is just another battle front in the medical war against chiropractors. Once again we see history repeating itself and hopefully we can learn a lesson from history to help in the present media skirmish Down Under.
[i] E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162–1165
White House Denounces
In a stunning rebuttal to the March 15, 2016, “Guideline for Prescribing Opioids for Chronic Pain — United States, 2016” by the Centers for Disease Control and Prevention (CDC), President Obama signed an Executive Order today, April 1st, rescinding the CDC’s recommendations to rein in the flood of prescription opioid painkillers flowing from medical offices.
The White House released the following news release from the President:
“After reviewing the partisan make-up of the CDC’s ten-member Opioid Guideline Workgroup, the lack of diversity on the panel was evident in that it failed to include one chiropractor or any CAM professional. This exclusion is clearly intolerable in today’s bipartisan environment to include, not exclude, the diverse fabric of our American society.
“Furthermore, the guidelines themselves made little sense in this era of evidence-based healthcare that seemed to turn a blind eye to many previous guidelines that endorse CAM providers.
“Although well-intentioned, the CDC’s panel also failed to place any responsibility for this opioid disaster on the very people who created it — the medical physicians and pharmaceutical industry that dole out opioid painkillers like candy, profiting greatly at the expense of our country that has never before experienced the epidemic of medicinal heroin we now see ravaging our nation.
“As one expert from the National Safety Council said, ‘Opioids do not kill pain. They kill people.’ It’s time to take the smoking gun out of the hands of these medical cowboys.
“Instead of any punishment or repudiation, the CDC panel actually rewarded MDs by maintaining their position as portal of entry for the millions of Americans suffering from chronic pain such as musculoskeletal disorders like back pain, the main complaint and cause of opioid consumption.
“The CDC panel also overlooked the fact that MDs are untrained in these conditions. Many experts including CDC Director Tom Frieden admit most MDs are promiscuous prescribers who are inept in their educational training and knowledge of chronic pain cases.
Most notable is the problem the CDC’s guideline is not legally binding, so these voluntary recommendations will most likely fall on deaf ears by MDs and the 13 million Americans already dependent on opioids for their pain management. Indeed, the CDC’s guideline may actually be ‘too little, too late’ to stop this epidemic of medicinal heroin.
“As a result of these many oversights in the CDC guideline, I have no option but to reject this report and replace it with my own.
“First and foremost, I will appoint a new panel of experts headed by Dr. Scott Haldeman, MD, DC, PhD, which will also include nondrug professionals who deal with chronic pain, such as chiropractors, acupuncturists, and massage therapists. Studies confirm these natural healers are very successful with many types of chronic pain cases and their treatments, unlike opioid painkillers, have no adverse side effects.
“Indeed, the only addiction patients may develop with CAM treatments stems from the fact they feel so good, but not because of any chemical dependency as we now see with prescription painkillers.
“I will also recommend that the portal of entry for musculoskeletal chronic pain disorders that constitute the vast majority of pain patients will not be headed by MDs who have relinquished that privilege with their unabashed irresponsibility, but by DCs, doctors of chiropractic. Americans must learn while MDs are good for many problems, they are not good for chronic pain cases.
“As a man from a minority background, I can identify with the plight of chiropractors, a minority profession. After a century of medical suppression, the facts suggest if the illegal medical war against chiropractors had never occurred, we might not have this opioid crisis today.
“If we are to make America’s healthcare system great, we must end the medical discrimination that has suppressed proven and natural treatments. Indeed, the era of a ‘pill for every ill’ must end.
“Just as Americans are striving for equality in all aspects of our society, it is past time we see equality in healthcare, too. Certainly this epidemic of opioids caused by the AMA and Big Pharma that has made billions of dollars while killing thousands of our neighbors and causing addictions for millions of Americans, it is past time to start afresh with a new approach to the pandemic of chronic pain.
“As Martin Luther King, Jr., said in his stirring ‘I have a dream’ speech at the Lincoln Memorial, “Do not judge a man by the color of his skin but by the content of his character,” I believe the same message can be said in healthcare.
“MLK, Jr., spoke of the day when “little black boys and black girls will be able to join hands with little white boys and white girls and walk together as sisters and brothers," I wonder when MDs and DCs will practice together in every pubic hospital, in the VA, military health services, workers’ compensation, and in every HMO for the betterment of all patients. After all, their mutual enemies should not be each other, but pain and disease. Unfortunately, the AMA does not share my belief nor does the CDC report reflect it.
“Somewhere in the fray this point of mutual respect and responsibility to give Americans the best in healthcare has been missed as evident in the CDC report. So, with these points in mind, I must veto the CDC guideline on opioid prescribing.
“Thank you and have a nice April Fool’s Day!”
The Lost War on Pain
If you recall, One Flew Over the Cuckoo’s Nest starring Jack Nicholson revealed the medical madness within psychiatric hospitals, literally with an assortment of mentally-ill patients and, figuratively, with inept medical staff and dubious, dangerous treatments.
Now we see the same lunacy in the medical mismanagement of chronic pain wrought by a blitzkrieg of narcotic prescription painkillers that have overwhelmed an unsuspecting public causing rampant addiction and thousands of deaths never experienced before by any civilization in the history of the world.
This medical horror is Pharmageddon, an apocalypse caused by opioid prescription painkillers. Without question, today the most abused drugs are opioid pain relievers laced with medicinal heroin such as OxyContin, Percocet, Hydrocodone, Vicodin or Fentanyl that have left millions of Americans addicted, hundreds of thousands dead and millions of families living with despair.
Similar to the genre of horror shows like The Walking Dead, although this medical-horror story is not science-fiction; in fact, it’s too real and happening right now throughout this country, perhaps to someone you know.
In the TV series The Walking Dead, people bitten by zombies degenerated into mindless shells; today we find a similar effect with opioid painkillers turning patients into mindless addicts – if you will, “The Walking Drugged.”
In the past Americans have fought many health “wars,” such as the war on cancer, smoking, obesity, and Nancy Reagan’s “Say No to Drugs” campaign. Considering those efforts were unsuccessful, the current opioid onslaught to control chronic pain is just as hopeless.
Chris Iliades, MD, in his article, “Rethinking Strong Opioids for Noncancer Pain,” asks an important question. “The ‘war on pain’ that began over 20 years ago has relied heavily on opioids. Isn’t it time to say that opioids have lost the war on pain?”[i]
In fact, opioids have not only lost the war on pain, they have created is an entirely new war of opioid painkillers that our nation is also losing rapidly.
Realistically, both the Church of Modern Medicine and the public need our help. Indeed, there is no other way to wean millions of “The Walking Drugged” zombies off opioid painkillers without the help of chiropractors and CAM providers to provide nondrug alternative care. This is the simple truth the public must hear.
The first step in solving this Pharmageddon is the day when government, the AMA, and the media admit “those damn chiropractors were right all along” in the treatment of chronic back pain cases as Judge Getzendanner suggested. Just one program in the mass media could begin a tipping point the chiropractic profession needs to break the stigma against our profession.
Just as the current political campaigns show the public’s dislike of conventional career politicians and are turning to antiestablishment candidates, we chiropractors need to jump on the same bandwagon of dissent against the Church of Modern Medicine.
Certainly the AMA and inept promiscuous prescribers will balk at endorsing nondrug chiropractic care and, most of all, Big Pharma has no interest to see its revenues decline, but 30 years is long enough to show the medical approach is futile. In fact, it’s dangerous and deadly drug onslaught with millions of Americans suffering as collateral damage in the war against chiropractors.
There is no happy ending to Pharmageddon as long as MDs are in charge of “pain patients” doling out opioids like candy and the complicit and biased medical mass media such as Dr. Sanjay Gupta @ CNN sponsored by Big Pharma censor our good news. This is a story of problems so deeply rooted in the healthcare system and our society that would take a revolution to reverse, more than merely a healthcare reform that simply rearranges the deck chairs on this medical Titanic.
[This article is an excerpt from my upcoming book, The Media War Against Chiropractors.]
It’s often shocking what chiropractors see as the proverbial ‘last resort’ in healthcare.
What would you say to a grandmother taking care of her grandchild because its mother is in rehab due to opioid addiction that began with an episode of back pain?
What would you say to a patient with failed back surgery that was based on the debunked ‘bad disc’ premise?
What do you say to the people misdiagnosed and mistreated by the medical spine care industry after their lives are turned upside-down, now living in chronic pain and permanently disabled?
Are you prepared to deal with the collateral damage in the medical war against spine patients? These are situations every chiropractor faces but are not taught how to handle them in graduate school.
When I’ve spoken to students, I am shocked to learn they are clueless they will soon enter a cold war against the AMA, once dubbed “the most terrifying [and wealthiest] trade association on earth.”[i]
Students seem ill-prepared to comprehend the medical opposition they will soon face. They are ignorant of the major historical issues, health politics, and the major political players who have shaped American healthcare. Even understanding and implementing the various acronyms they will face are daunting tasks—HMO, CMS, EHR, PPO, ACO, WC, DVA, TRICARE, to name a few, whew!
I recall at a speaking engagement when a student afterwards asked me, “Why don’t they teach us this in our classes?” When I relayed that question to the provost of the college, he said the instructors didn’t have room in the curriculum for political science or my book. I suggested that was equivalent to West Point sending new officers unprepared into a war they didn’t understand.
Don’t Rock the Boat
Although I believe the history of the medical war is a fundamental issue every student and the public need to know, however, some in our profession apparently disagree, including many of our ‘thought leaders’, association leaders, and chiropractic educators. Without a doubt, rocking the boat often makes some people sick to their stomachs.
Whenever I write of the historical events that have shaped this profession such as the Medical Mussolini, Wilk, or AHCPR, and the role of politics, history, and mass-psychology upon our image and market share, many DCs yawn because they simply don’t understand the impact of chirophobia and political shenanigans upon their practices.
“That’s old history,” as if medical war has disappeared. I then ask if racism is ‘old history’ that is gone from our society, too? Indeed, to think the medical war has ended is foolish and there are many DCs with their heads in the sand.
Other naïve DCs say, “But my patients love me.” As long as these field practitioners stay busy seeing their patients, they think everything is okay allthewhile ignoring the fact we only see 14 percent of the population, never realizing the impact of medical dominance severely restricts our market share as well as putting every patient at risk with opioid painkillers and unnecessary shots and surgery.
We simply cannot advertise ourselves out from underneath this PR dilemma, nor will WOM change our national image. Plus, this will take more than a 30-second radio/TV PSA or a 140 character tweet or the WOC testimony from any sports celebrity or an infrequent ad in The Wall Street Journal.
We’ve tried all of these, yet can we honestly say any of them have ‘moved the needle’ to increase our market share or improve our national image?
To understand this dilemma, log on to my article, Headline News.
[i] MS Mayer, “The Rise and Fall of Dr. Fishbein,” Harper’s Magazine, (Nov. 1949): 76-85.
Bob Beckel, a Fox News host who has struggled with prescription drug addiction, was let go Thursday in a move that a top executive blamed on Beckel's "personal issues."
Beckel, a former Democratic consultant who had become the most prominent left-leaning voice at the conservative cable news outlet, had been off the channel for several months. In March, Fox News said that Beckel was off the air recovering from back surgery. Beckel said on Twitter at the time that he hoped to return soon to "The Five," Fox's highly rated evening panel show on which he often served as the lone liberal commentator.
A month later, the channel released a statement indicating that Beckel had checked into a rehab facility to receive treatment for a prescription drug addiction.
Beckel is the second member of Fox's on-air talent stable to be treated for substance abuse in the last year. Fox News anchor Gregg Jarrett was arrested at the Minneapolis-St. Paul airport in May of 2014, right after checking out of a rehab facility, for exhibiting disorderly and intoxicated behavior.
Time to Change Tracks
The prescription opioid epidemic is rampant, reaching many people including folks at FOX.
Numerous national media outlets, including CNN, NPR, Time magazine, Sport Illustrated, to name a few, have reported on the massive campaign to drug Americans with opioid painkillers as you can read in my article, the new Dr. Frankenstein.
Considering musculoskeletal disorders are the leading causes of disability in the nation, military, and in the world, chiropractic is a big part of the non-drug solution to this deadly problem of drug abuse and addiction.
Unfortunately, too many MDs track patients into drugs, shots, and surgeries despite the poor outcomes and possible addiction. I’m sure you all know someone addicted to OxyContin or Hydrocodone who may be helped with our brand of care instead.
Again, where is the chiropractic voice to teach the public and press that we are one big part of the solution to this deadly problem of drug abuse and addiction considering musculoskeletal disorders are the leading causes of disability in the nation, military, and in the world?
Indeed, we are the answer to a question that is not being asked.
Now that I’ve gotten your attention, let me introduce you to the new Dr. Frankenstein.
How many times have you heard your new patients say, “I have discs up and down my spine that are bulging and ready to burst.” It's amazing that the 'bad disc' folklore still exists despite being disproved 25 years ago.
And these confused patients are not those who would never enter a chiropractor’s office because most have been given the “voodoo” diagnosis by unethical MDs who tell them, “and whatever you do, don’t go to a chiropractor who will paralyze you.” Those who still come to see us as the proverbial "last resort" are the patients still searching for hope there is a better way than narcotics, shots, or surgery and who are brave enough to overcome the chirophobia implanted in them by unethical MDs.
People with back pain often become convinced that their ‘bad disc’ confers a grim prognosis—a lifetime of increasing pain and disability. And they opt for what they think are effective medical treatments—from long-term opioids to a continual regimen of steroid injections to heroic reconstructive spine surgery, or so they think. Little do they know how wrong they are.
There is more evidence this medical myth is untrue and it comes from an authority most people recognize, the Mayo Clinic, yet no one in the public has heard of this game-changing research because the medical media reporters refuse to tell their viewing audiences. Indeed, when was the last time you heard Dr. Sanjay Gupta, a neurosurgeon-turned-CNN broadcaster tell his viewers that the 'bad disc' theory was pronounced dead 25 years ago by Dr. Scott Boden who works elbow-to-elbow alongside Gupta at Emory University? Okay, stop laughing because Gupta will never 'rat out' his spine surgeons buddies making millions, nay billions, off this debunked 'bad disc' theory.
Recently researches at the Mayo Clinic performed a systematic review that once again confirms the death of the ‘bad disc’ theory. Waleed Brinjikji, MD, and colleagues performed a systematic review of all studies that reported on the prevalence of lumbar degenerative findings on MRI or CT scans among individuals with no history of low back pain. The researchers found 33 studies of 3110 individuals published through April of 2014 and found the vast prevalence of ‘bad disc’ in pain-free people.
Yet, according to experts at the Mayo Clinic, most of the changes they are describing are “no more significant than gray hair or crow's feet around their eyes.” In other words, they are not the cause of the back pain despite what the family physician or spine surgeon says—they are just a natural part of the aging process. As Rick Deyo, MD, has long said, they are "incidentalomas" because they are secondary or incidental to the pain process.
As proof that pathoanatomic problems are secondary to the pain process, we chiropractors know that after we adjust those patients with 'bad discs' and they feel improved, but the fact remains they still have 'bad discs.' Indeed, pathophysiology drives pathoanatomy, a fact lost on every MD and certainly the public. As Donald Murphy, DC, wrote, 'bad discs' are "red herrings" used by unethical surgeons to convince patients to the need for surgery when, in fact, they are not the driving force for pain.
According to the editors of The BACKLetter, “The largest systematic review to date drives home the point that spinal degeneration visualized on imaging scans often has no relationship to low back pain—and should not be routinely viewed as evidence of the source of low back symptoms.”
In other words, the common sales pitch of ‘bad discs’ has again been proven wrong, but that hasn’t stopped MDs from convincing uninformed patients of their wares of drugs, shots, and surgery. There is just too much money for them to stop, plus most people are convinced of the ‘bad disc’ folklore since 1934 when the ‘bad disc’ diagnosis was invented. Indeed, if you tell a lie often enough, everyone begins to believe it, even the surgeons who should know better but turn a blind eye.
This systematic review found:
“Our study suggests that imaging findings of degenerative changes such as disc degeneration, disc signal loss, disc height loss, disc protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention,” according to the reviewers.
The bottom line for anyone with back pain diagnosed with a ‘bad disc’ is to follow the guidelines that call for conservative (non-drug, non-surgical) chiropractic care first. This includes nearly 90% of cases; the only people who need drugs, shots, or surgery are those who suffer from cancer, fractures, serious infection like TB or staph, cauda equina (loss of bladder control), or the one in 100 disc case that doesn’t respond to chiropractic care.
This Mayo review is one of many in a long line of MRI studies that began in 1990 by Scott Boden who found ‘bad discs’ in pain-free people. Yet this string of similar studies has not slowed down the spine surgery gravy train nor the ‘pill mills’ that do epidural steroid injections and dispense opioid painkillers like Halloween candy.
This scandal remains right under the nose of both the medical profession and the media that refuse to tell the public of this paradigm shift in spine care. Nor has most of the media revealed the downside of medical spine care, the placebo effect of drugs, shots, and surgery that fail to correct the underlying mechanical dysfunction.
This obvious oversight is due to chirophobia, conflict of interest, or just shoddy journalism, but the disconnect between the research journals and the lay publications remains wide and naïve people are continually railroaded into this medical mess.
So the next time you hear someone way, “I have a slipped disc and need surgery,” tell them the truth that ‘you don’t slip discs, but you can slip joints,’ and encourage them to seek chiropractic care before drugs, shots, or surgery as the guidelines recommend.
 Brinjikji W, et al., Systematic literature review of imaging features of spinal degeneration in asymptomatic populations, American Journal of Neuroradiology, 2014, prepub ahead of print; www.ajnr.org/content/early/2014/11/27/ajnr.A4173.long.
 Painless Aging, BackLetter: February 2015 - Volume 30 - Issue 2 - p 13–22
Over the past few months we’ve seen more media attacks on the chiropractic profession such as the online version of Forbes as well as USA Today. In both instances, the typical yellow journalism was clearly evident, especially by Steven Salzberg, the author of the Forbes article that was beyond the pale. As someone claiming to be a professor at Johns Hopkins, his demeanor seemed more appropriate for a street thug.
What made these two cheap shots most notable were the responses to the Forbes and USA Today articles from the public and chiropractors who stood toe-to-toe with these medical trolls. I was proud of their intelligent responses citing research rather than merely getting mad and ugly. Finally the chiropractic professionals are maturing in their own understanding of the science behind our profession as well as developing the backbone to stand up to these medical bullies.
It was also entertaining to read the numerous responses to the Forbes article by Mr. George McAndrews, the lead attorney in the Wilk v. AMA lawsuit. His judicial insights were enlightening as well as spot on to the numerous erroneous comments made by Mr. Salzberg. I doubt there is anyone more astute to this medical war against chiropractors than George McAndrews.
As a lifelong NPR member, I was again saddened by the professional amnesia exhibited by Weekend Edition—Sunday that discussed an issue that we chiropractors should have been included—the growing abuse of opioids for pain. Considering chronic back pain is the leading reason for painkillers, obviously our brand of non-drug treatments should have been included, but once again the chirophobia at NPR prevailed.
Another of my favorite NPR programs, Science Friday, also discussed an issue we chiropractors can attest to—the lack of an open mind in regards to science. Certainly in medical care, despite its appearance as scientific, the medical profession is intransigent in many ways as we see with its attitude about chiropractic that is cemented in stone from the 1930s.
As fate would have it, I encountered an unexpected event that showed me any respite is not possible in the on-going medical war since unforeseen skirmishes await at any time around every corner.
Actually, this turn of events began on a positive note when I watched a video with Christine Goertz, DC, PhD, from Palmer Research who aired a short presentation on QuantiaMD website titled, “Talking to Your Patients About Chiropractic Care.
Despite the excellent presentation by Dr. Goertz, the very first response on the blog took a serious cheap shot when a psychologist labeled chiropractors as “snake-oil salesmen who lacked professionalism and any scientific grounding for their practice.”
After reading Ms. Olbrisch’s salacious comment, I enrolled at QuantiaMD.com to respond to her cheap shot on the blog but, to my surprise, I was denied enrollment because I am a DC.
When I complain it was discrimination, a Mr. Anthony Rosati replied: “Dr. Smith, it is not a discrimination against DC’s, it is simply our company policy.”
Apparently medical discrimination is so ingrained into these medical groups they can’t even see it when pointed out clearly.
These recent examples of media bias led me to coin a term to describe this mental lockjaw, if you will, where it is too difficult for journalists and MDs to discuss fairly chiropractic care. Hence, I coined the term “Chirophobia” as the irrational fear, antipathy, contempt, prejudice, aversion, or hatred of chiropractors instilled by decades of medical bigotry.
Every chiropractor has witnessed such bias whenever someone says, “I don’t believe in chiropractic” or “My wife is afraid to be adjusted” or “My MD said you could paralyze me.”
I wrote a synopsis of my book to succinctly explain the source of this medical bigotry, “I don’t believe…” I feel like Fredrick Douglas explaining the harm of slavery for the very first time or MLK, Jr. pleading for an end to racism. I’ve found once people understand the history of chirophobia, they are relieved, not unlike anyone freed from any lifelong bigotry.
Yet there is too much money in spine care for MDs and the medical industrial complex to suddenly relinquish their iron-grip on chiropractic no matter the benefits we bring to the table. This multi-billion dollar enterprise is too profitable to allow a free market on a level playing field. Nor do these spine surgeons want to follow the guidelines that call for conservative care first as we’ve seen lately with Medicare Accounting Contractors who denied payments for spine fusions that did not use conservative care beforehand. I wrote about this controversy in my cover story, Climbing the Ladder of Opportunity.
I still keep hoping that someone in the mainstream media will see the fascinating story of this medical war against chiropractors that will lead to the breakthrough we need to help millions of people and save billions of dollars.
Just think of the sudden change toward homophobia—just a few years ago the LGBT community was still hiding in the closet of disrespect. But within a few years, everything suddenly changed once the media and public sentiment began to change to overthrow the chains of bias.
So, we chiropractors must keep our hope alive that sometime soon the social psychology—the click, whirr—that creates public sentiment will soon understand the benefits we bring to an ailing society by overcoming chirophobia.
A lot has happened over the last two years since I began this website. Not only have over 12,000 visits been made to this site, it has gotten the attention of many in the media as well as the medical trolls who have attacked me in their usual fashion of ridicule and condemnation.
Nonetheless, there has been a huge shift in medical spine care as more information about the dangers, cost, and ineffectiveness of traditional medical care accumulates in the mainstream media and among insurance payers such as CMS. After running amok since 2000, finally the curtain has dropped.
On March 6, 2014, The Daily Show with Jon Stewart did a segment, “America has the Best Health Care System in the World!” that I had to comment on considering I have written extensively on this debunked concept in an article, Healthcare Reform or Revolution.
Please take six minutes to view this enlightening and humorous Daily Show segment as the spokesman for the medical cartel trips over his own words: Third World Health Care - Knoxville, Tennessee Edition.
Despite the failings of American medicine, medical chauvinism is a strong factor in American healthcare to the extent of being a quasi-religion when patients "believe in" medicine without any real understanding and while ignoring these poor clinical outcomes.
fact remains the chiropractic profession is the Mystery Science
profession that rarely gets fair and balanced reporting despite the
epidemic of back pain and the research that shows our brand of spinal
care is superior to the medical treatments of addictive pain drugs,
ineffective epidural shots, or expensive and disabling spine surgery
based on an outdated disc theory.
discussed the history of the medical demagoguery and warfare against
chiropractic as well as the new paradigm in spine care in my new book, The Medical War Against Chiropractors: the untold story from persecution to vindication.
This 262-page book has 755 footnote references to support my
contentions; obviously anything I said would be attacked by the medical
bigots who will demand proof. If proof is what they want, then I will
give it to them, but I doubt any scientific proof will change their
bigotry and bias. "Don't confuse us with the facts" seems to be their mantra now. It is shameful.
is my hope to bring this problem to the forefront and demand equal time
in the media.This inequality in the media will only stop when we bring
it to the attention of the fair-minded public.
As you can see in the above two cartoons, the inequities in healthcare and in the news media is not a new phenomenon. Today, we find the same media boycott of chiropractic newsworthy items as they saw back in 1949 when the one cartoon was first published.
the Committee on Quackery’s goal to have chiropractic “wither on the
vine” is not only evident in insurance limitations, but in the media
with the virtual absence of attention despite the fact we are the
third-largest physician-level profession in the nation.
As well, chiropractors are now deemed to be America's primary spine care providers by virtue of their superior education in musculoskeletal disorders. Did you know only half of all medical schools teach only one four-hour class in this area whereas chiropractors study nearly 2,000 hours in this field? Don't be fooled by inept MDs who pose as expert in back pain; all they know is everything is either a "pulled muscle" or "slipped disc" that require painkillers, muscle relaxers, shots, or surgery. Poppycock, I say.
in no way do we get an equivalent amount of media exposure for our expertise. Indeed,
unless it’s a story about some DC committing insurance fraud or sexual
abuse, we remain the Mystery Science profession or stand accused of
being a “pseudo-science” by our medical critics. Despite being
unsupported by evidence, this medical slander prevails in the mind of
many because we chiropractors have never had the opportunity to refute
This widespread medical slander is easy to illustrate. During the Wilk et al. v. AMA et al. trial in 1976, the AMA leadership accused chiropractic of being quackery, dangerous, or pseudo-science. Our attorney, George McAndrews, asked them for proof for their accusations, but they had none. They were simply parrotting the same propaganda that they heard a thousand times from their own Committee on Quackery. Again, it was shameful for a supposed evidence-based profession to be so stupid and biased.
The New Zealand Commission on Chiropractic in 1978, perhaps the most in-depth investigation into chiropractic at that time, found the same thing--the medical critics had no proof whatsoever for their defamation. In both instances, however, proof was presented by medical witnesses that chiropractic care was safe, effective, and had better clinical results than medical care. These "admissions against interest" were, in effect, confessions that persuaded both the trial judge and the commission. Yet the public has never been told of these facts. To this day, many MDs continue to parrot this propaganda.
When there are relevant topics discussed in the media, such as the overuse of spine surgery, rarely is chiropractic mentioned as the leading alternative. When pain pill drug addiction and deaths are discussed, never has chiropractic been shown to be an alternative to this drug madness we now see. When CAM is mentioned in regard to general health issues, rarely is chiropractic’s concept of neurophysiology touted as non-drug option to Type M or Type O disorders.
My point is clear: we chiropractors have no voice in the media today. We are constantly insulted in the media such as the recent NPR story on military health services when it quoted Harriett Hall, a former Air Force flight surgeon, who also fought against Obama’s healthcare reform that called for non-discrimination. According to the NPR report, she “shares the skepticism found in many corners of the medical community. ‘We call that 'quack-ademic' medicine when it gets into medical schools,’ she says.”
a bigot! This is what I refer to as Chicken Little journalism.
And where was the chiropractic input or response? Again, this was another example of unfair journalism that enables medical slander of our profession without any response.
Dr. Sanjay Gupta broadcasted on CNN a 2008 video stating chiropractic causes
hundreds of strokes annually, where was the chiropractic response? When I
filed a complaint, the video came down but I got no response or apology
from Gupta; indeed, the damage was already done.
A more recent example of Gupta's bias occurred on Nov. 18, 2012 when he aired an expose, Deadly Dose, concerning the 38,000+ deaths annually in the US from narcotic painkillers. Ostensibly, after reviewing the situation where 75% of these chronic pain patients are taking these narcotics like OxyContin for back pain, a viewer might assume Gupta was searching for a non-drug solution to back pain, right?
Yet, in this one hour program, Gupta did not mention chiropractic care even once. To my amazement and to the millions of viewers who use chiropractic care, his oversight was obvious medical bias, shoddy journalism, or a bad case of professional amnesia. Indeed, Dr. Gupta has no objectivity when it comes to chiropractors, the main rivals for spine surgeons.
My question is obvious: where is his "fair and balanced" reporting? Okay, stop laughing again!
But wait, that's not CNN's motto, but that of FOX News that has also ignored chiropractic care. Indeed, as long as Big Pharma pays their bills, no TV commentator will attack their drugs. Have you noticed the primary advertisers on TV are drug makers? Forget about beer, truck, IT products, or junk food purveyors, drugs dictate what will be sponsored on commercial TV when it comes to healthcare issues.
When I wrote yet another complaint to CNN and to former President Bill Clinton's Global Initiative since he asked Gupta to do this report after a friend's son died from mixing OxyContin with alcohol, there were no responses. My book publicist phoned both men to find more bias at CNN when he was told I was "blackballed" due to my "baseless accusations."
Are the people at CNN nuts or what? Since CNN touts itself as "the most trusted name in news," I find it odd that when Gupta makes a huge blunder by omitting chiropractic care from a discussion on deaths by opioid drugs for back pain, it shows more clearly than what I could ever write concerning the bias in the medical-media.
Dr. Gupta is not alone with his medically-biased reporting. When Edzard Ernst publishes “Deaths After Chiropractic” in Medscape, nothing is said about his biased reporting. I responded, but once again, got no comment by the editors for this sensational article. In fact, this article ranked among the most popularly read articles on Medscape, no doubt feeding the fuel of medical bias among other medical bigots.
This is reminiscent of the FSU fiasco when Raymond Bellamy lashed out in similar terms against the inclusion of chiropractic into the curriculum that was passed by the Florida legislature by a vote of 151-1. Throughout the many newspaper articles, rarely was there any feedback by Alan Adams or Jay Triano, the two DCs who were to head this graduate level program. Again, the public was awash in medical propaganda without any effective response from the chiropractic community.
my book I recount other infamous examples of the Spin Doctors in the
media, such as columnist Ann Landers, so I won’t cover that ground here
again. Daily we see similar examples of misinformation, but it appears
no one in the chiropractic community has stood up to defend our
profession, unless you consider a sternly worded one-page response from
the ACA’s PR staff. I have made this point to the ACA and F4CP for years
without any response other than me undoubtedly appearing petulant to
the leadership. I have also offered a new type of ads that were ignored.
Nonetheless, my plan is to bring this issue to a head by starting a new website named “Chiropractors for Fair Journalism.” Some think I might call this website “Chiropractors Fighting Against Medical Misinformation.” I daresay that if there were fair journalism in the media, there would not be medical misinformation to fight.
Here are my goals:
1. Post examples of medical misinformation in the recent news along with a chiropractic response.
2. Become a source of news information for the media and public by posting notable articles, such as the recent paper concerning DCs as primary spine care providers written by Donald Murphy, Brian Justice, Ian Paskowski, Stephen Perle, and Michael Schneider that I thought was a great idea.
3. Encourage local DCs to become proactive and responsive to their local news media.
4. Promote journalism in our chiropractic colleges. Although some students are trained in producing academic/scientific papers, we need future journalists to write popular articles for the lay media and to monitor the media when it publishes one-sided articles. We need to encourage our academicians to develop courses for credits in this arena.
We must become a voice in the news media with clout, so whenever any news journalists writes or broadcasts an article concerning spine care or healthcare reform in general, we need to be the source of their information. As well, we must monitor the media and respond to unfair journalism such as the recent NPR broadcast.
Just as the Jewish Anti-Defamation League protests against biased statements or articles in the media, we need to do the same—be that voice to respond to future attacks by medical misinformers. It is past time to call out these medical propagandists and to hold the media’s feet to the fire when they purposely omit chiropractic from any discussion in our field. It is past time we are ignored or defamed in this national discussion on health and spine care.
Ideally, chiropractic needs a cable TV program featuring the variety within our profession; teach the public of the value of our brand of natural healthcare, and to promote a better image. I’ve written to CNN about starting such a series of Chiropractic & Alternative Healthcare but, of course, got no response. As long as MDs like Sanjay Gupta are in sole control of the health news programming and Big Pharma pays his bills, we can expect this boycott.
However, if we had power from numbers and an organization dedicated to promoting fairness in journalism, a similar request would have more clout and credence and certainly gain more media attention.
If we are to win in the war against the medical misinformers, we need to develop an effective and long lasting information bureau of aggressive journalists knowledgeable of the recent research and politics of healthcare.
long as someone states, “chiropractic might be good for some people, but
I wouldn’t want my daughter to marry one,” we have a huge image problem.This is simply a sign of chirophobia, the unwarranted fear of chiropractors.
in this age of evidence-based healthcare, we have the research to back
up our claims that chiropractic spine care is the most cost and
clinically-effective brand of spine care on the market. Now if we can
overcome the skepticism and slander bred by the medical profession, we
can help reduce pain and suffering to a public addicted to drugs and
subjected to unnecessary shots and spine surgery.
Indeed, spine research is now on chiropractic's side.
Medical spine care consisting of drugs, shots, and surgery that have been proven dangerous, addictive, expensive, ineffective, and deadly. Mark Schoene, editor of an international spine research newsletter, The BACKLetter, could not be clearer when he said: “Spinal medicine in the US is a poster child for inefficient spine care.”[i]
Indeed, this plethora of spine research reveals the paradigm shift away from “bad discs,” a concept disproved by researchers such as Scott Boden, MD, and even chided by Rick Deyo, MD, MPH, who labeled them irrelevant and dubbed them “incidentalomas.”
Furthermore the recent deaths caused by epidural shots contaminated by meningitis and the 38,000+ deaths from prescription narcotic painkillers, mostly taken for chronic back pain, illustrate the ineffectiveness of these medical methods kept alive by a greedy medical profession.
On the other hand, chiropractic care has proven to be at the top of the heap as Dr. Tony Rosner, PhD, testified in 2003 before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[ii]
The historic spine studies, such as the AHCPR guideline, Manga Reports, UK BEAM, and the New Zealand Inquiry, as well as more recent seventeen recent international guidelines, have also recommended our brand of spine care over medical care in the majority (85%) of cases—the so-called “non-specific” mechanical cases where joint dysfunction is the main problem.
The medical mismanagement of this pandemic of back pain is enormous and, when low back pain is combined with neck pain, these [iii] These painful
spinal disorders are second only to ischemic heart disease in its
impact on the global burden of disease according to Scott Haldeman, MD,
DC, PhD, a leading spine expert.
This is yet another way the 80,000 chiropractors could improve this dire U.S. health disadvantage with their superior diagnostic and clinical skills in spine care.Chiropractors now must assume the mantel of America's primary spine care providers due to our superior training and clinical treatments.
[i] The BACKPage editorial vol. 27, No. 11, November 2012.
[ii] Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.
[iii] Scott Haldeman DC, MD, PhD, FRCP(C) and Simon Dagenais DC, PhD. A supermarket approach to the evidence-informed management of chronic low back pain. The Spine Journal, vol. 8, Issue 1, January-February 2008, Pages 1-7.