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 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."¹ 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.

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. 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. 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.² 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."

This condemnation demonstrates that NCAHF cannot be counted on for objectivity. 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."³ 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.

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."⁴ 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.⁵

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.⁶ 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,"⁷ 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."⁸

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,⁹ 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.

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.¹⁰ 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.¹¹ 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.¹²

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.¹³

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.¹⁴

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.

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.

Sincerely,

Daryl D. Wills, DC
President

cc: Wayne Godwin, Executive Vice President & Chief Operating Officer Jacoba Atlas, Senior Vice President & Co-Chief Program Executive Pat Hunter, Senior Vice President, Programming Services John F. Wilson, Senior Vice President & Co-Chief Program Executive Laura Nichols, Senior Vice President, Corporate Communications & Public Affairs Tina Vaz, Press Contact, Scientific American Frontiers Graham Chedd, Chedd-Angier John Angier, Chedd-Angier Alan Alda

 

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1. NCAHF's History. Retrieved June 5, 2002, from http://www.ncahf.org/about/history.html
2. Inglis BD, Fraser B, Penfold BR. Chiropractic in New Zealand report: commission of inquiry into chiropractic. 1979; 105-106.
3. About PBS. Retrieved June 5, 2002, from http://www.pbs.org/insidepbs/
4. Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical practice guidelines no. 14 AHCPR Pubilcation No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.
5. Shekelle, et al. The appropriateness of spinal manipulation for low back pain: project overview and literature review. RAND, R-4025/1-CCR, 1991.
6. McCrory DC, Penzlan DB, Hasselbad V, Gray RN. Evidence report: Behavioral and physical treatments for tension-type and cervicogenic headache. Des Moines, IA: Foundation for Chiropractic Education and Research, 2001.
7. Manga P, Angus D, Papadopolous C, Swan W. A study to examine the effectiveness and cost-effectiveness of chiropractic management of low back pain. Kenilworth Publishing, Richmond Hill, Ontario, 1993.
8. Meade T, Dyer S, Browne W, Townsend J, Frank A. Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from an extended follow up. British Medical Journal 1995; 311:349-351.
9. Texas Back Institute: About us. Retrieved June 5, 2002, from http://www.texasback.com/index.html
10. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996; 21: 1746?59.
11. Terrett AGJ. Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. Journal of Manipulative and Physiological Therapeutics 1995; 18(4): 203-210.
12. Haldeman S, Carey P, Townsend M, Papadopoulous C. Arterial dissection following cervical manipulation: a chiropractic experience. Canadian Medical Association Journal 2001;165(7):905-06.
13. Lazarou JL, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. A meta-analysis of prospective studies. JAMA 1998; 279: 1200-5.
14. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. New England Journal of Medicine. 1999; 340(24); 1888-1899.