"At least do no harm"
Hippocrates
This newsletter shares the stories of patients who were subjected to years of apparently unsuitable medical treatment as well as harm arising from that treatment as distinct from their disorder.
Australia's 1977 Webb Report noted this sequence of events; the majority of new patients attending chiropractors shared a history of failed medical treatment, sought chiropractic care for the same disorder and had satisfactory outcomes. By 2006, majority refers to millions of patients.
Patients who have experienced Webb’s sequence of events may ask the chiropractor why the GP failed to meet her/his ethical duty of care. Patients harmed by that failure may ask about a GP’s legal obligations.
J Law Med. 2003 Feb;10(3):271-84 “..it is important to facilitate access to the best of conventional and complementary treatments to ensure better health outcomes for the patient.” Webb's sequence of events is a snapshot of medical failure to facilitate access to, what later proved for many to be, successful chiropractic care for millions of patients.
Brophy E. Does a doctor have a duty to provide information and advice about complementary and alternative medicine? J Law Med. 2003; 10: 271-248 raises the issue of legal obligation to refer. “Indeed, while no cases yet exist where a doctor has been found liable for failure to advise a patient of CAM treatment options, it is arguable that a doctor's common law obligation to provide information requires that he or she has a duty to provide information about CAM therapy where that information would be material to a particular patient.”
Webb's sequence of events captures millions of moments when GPs failed to ensure better health outcomes for the patient by not providing information about chiropractic that would, as later events imply, have been material to those patients.
Remarkably, millions of Good Samaritans filled that role by providing information about chiropractic that would later prove to have been material to successful chiropractic patients.
Those patients and all chiropractors owe a heartfelt vote of thanks to these Good Samaritans.
The tattooed man’s thumb tip sketch of his spinal history was a well thought out summary.
“My back had been pretty good. When I hurt it the pain was severe, so severe that the doctor put me on a disability pension and morphine. Some years later someone advised me to see a chiropractor. I returned to work and overcame my addiction.
In the first place the medical diagnosis was wrong. That medical treatment was unnecessary, the morphine was inappropriate. I am sure that direct access to chiropractic would have saved me from years of unnecessary suffering addiction and expense. The only medical intervention should have either been advice to see a chiropractor or for the GP to have directly referred me to one. That did not happen.
Medicare paid for my years of medical failure, it did not pay for my chiropractic success. Prior to hurting my back I had not used addictive drugs.” After a thoughtful moment he asked me: “Why did that happen to me?”
His question made me aware that thousands of similar questions may fail to be well answered. To meet that need patients and I wrote an article, “Do you sense something is amiss?” It is on our web site under articles of interest. Our thanks to those who assisted to create that.
Chiropractic Care May Reduce Surgeries, X-rays
Treating Back Pain Less Costly With Chiropractic Care Oct. 12, 2004 -- Chiropractic care cuts health care costs, a new study shows. The report appeared in the Oct. 11, 2004 issue of Archives of Internal Medicine.
The study comes from American Specialty Health Plans Inc. of San Diego. The company provides employers with health insurance coverage for complementary medicine, including chiropractic care and acupuncture.
The company compared four years of back pain claims from two groups: 700,000 health plan members with chiropractic care coverage and 1 million members with the same health plan without chiropractic care coverage. It's the largest study yet of how chiropractic care affects the cost of health care, notes study co-leader Douglas Metz, DC, chief health services officer at American Specialty Health.
According to Mertz; "No matter how we perform the analysis -- whether we look at total costs to the health plan, at lower back pain care, at musculoskeletal care -- in each data set, the population covered for chiropractic had a lower overall cost to the health plan than the population without access to chiropractic benefits,"
Compared with doctor-only health plans, the study found that:
Chiropractic care cut the cost of treating back pain by 28%.
Chiropractic care reduced hospitalizations among back pain patients by 41%.
Chiropractic care reduced back surgeries by 32%.
Chiropractic care reduced the cost of medical imaging, such as X-rays or MRIs, by 37%.
Although the researchers did not look at patient satisfaction in this study, Metz says company studies show that 95% of chiropractic care patients are satisfied with the care they receive.
The Million Dollar Man
Some evenings at the end of a practice session I provide chiropractic care to a few four footed friends. Stewie, our last human patient for the day, watched and joined in the conversation which was about costs of veterinary care. He displayed the scar in his lower back declaring: “The government has spent more than a million dollars on me, and its not over yet.”
Prior to hurting his back Stewie was a fit and healthy young man. He played ten pin bowling at State levels and played indoor cricket for the local church side. Although he worked on average 12 hrs a day, he still worked out at his gym at least 5 times a week. That era ended following a slip on a tiled floor.
Later when he stooped Stewie could not get up again because of intense pain. That extreme degree pain continued for years in spite of visits to many medical practitioners. Stewie's story is as follows.
“My life went from totally on the go, to total stop. For the next three and a half years I spent about 80% of my day lying down. My life consisted of getting out of bed to go to the physio, twice a day. The rest of my day was spent in bed watching TV.
The unremitting intensity of the pain drove me to use a mix of many prescription analgesics and anti-inflamatories, as well as marijuana and alcohol. All of that did not stop the pain, it just reduced it.
I was sent from one doctor to another but they could not agree on what, if any, spinal damage I had. In desperation, I agreed to have a spinal fusion with screws and plates.
Although my unremitting intense back pain was greatly reduced I was left with an ongoing limited degree of quality of life associated with bad moods, low energy, high tension, positive\negative attitude, weight gain, few social contacts, low self esteem, with its negative effects on my family and my standard of living.
I then had to deal with gastro-intestinal pain, which one of the doctors said was due to my high use of drugs. That led to three operations in which my gall bladder and parts of my small and large intestines were removed.
Although I visited many medical practitioners none of them advised me about chiropractic, or referred me to a chiropractor. In my opinion, if I had seen some one of the calibre of a chiropractor, I don't think surgery would have been needed and I may have been cured a long time ago.
Nowadays, when I am subluxated I suffer from nagging headaches, insomnia, irritability, fatigue and back aches. Chiropractic care relieves me of that. I still have regular adjustments, just to stay on top of things.”
John Archer's 1995 book, Bad Medicine: How Safe is Modern Medicine was based upon some of the medical data about iatrogenesis. He estimated that in Australia about 50,000 deaths and 750,000 permanent injuries per year arise from medical treatment as distinct from the patient’s disorder..
Requiem to a Good Man
Gordon was the only member of George's shearing team who attended George Power’s funeral . Gordon told me that the others were ‘all too crook to come’, like George they too had taken 'heaps of pain killers'. Gordon said that he 'never touched the stuff'.
Back pain had cost George years of a productive, good quality life style.
George (left) claimed that medical practitioners had warned him not to attend a chiropractor.
As a patient George was unusual in that he was active in seeking to encourage the AMA to publicly declare its ethics based boycott of chiropractors had ended.
Writing to the AMA (7/5/1992) George outlined that, "Contrary to what the Dr. told me I did go and see a chiropractor. I might add that at this stage I was in very much pain and taking a lot of prescribed drugs to take away the pain and to continue to work. Also I had very bad headaches and high blood pressure. When I went to see the chiropractor I was just able to drag one leg after the other.
Within two weeks my headaches started to go away and my back pain became less. I was able to continue my work as a shearer for another few years. During these years I was a constant visitor to the chiropractic clinic.
Some 2 years ago I was admitted to the Fremantle hospital as a result of passing blood. On examination it was found that my right kidney was not working and should be removed. Also, that I had an enlarged aorta which if it got much larger would burst and would kill me.
The Dr. at that time asked me if I had taken any pain killing drugs. I said "Yes". He said, "That is why you are having trouble with your kidneys." I then told him that nearly all the drugs taken were under a prescription from different Drs. I asked "Why didn't the Drs inform me of the danger of prolonged use of these drugs for the back pain that I had suffered over the years". He then closed up like a clam and would not say any more.
It was then that I told him that I had not taken any drugs for well over 10 years, the reason being that I had no need to take any more after seeing a chiropractor.”
Before he died, the local paper printed a story about George's plight.
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How Do you Silence A Nation’s Journalists?
The arrangements causing Webb's sequence could not have become established nor remain entrenched without the allegiance of people in power and the silence of our mainstream media. Australia’s key media players share informed silence about those arrangements. Our nation’s journalists share a silence about the full spectrum of harm arising from medical treatment as distinct from the patient's disorder.