The "20/20" segment on chiropractic had been expected to air as early as November of 1991, but because of the scheduling vagaries typical of television news programs, it was delayed. The long awaited program finally appeared on the evening of February 21, 1992. Fortuitously, the chiropractic segment would reach a much larger audience than a normal airing of "20/20," for it would run the same night as the much publicized exclusive "20/20" interview with Desiree Washington, the Miss Black America contestant that Mike Tyson was found guilty of raping.
The story on chiropractic was introduced by host Hugh Downs: "If you're suffering the pain of an aching back, you're willing to try just about anything for relief. But should that include a chiropractor? Do they know what they are doing? Well of late, there have been new studies about chiropractors. There is a changing attitude that you might not know about."
Timothy Johnson, M.D., medical editor for "20/20" presented the story on chiropractic, beginning with Deborah Mager, a chiropractor who practices just outside of Boston and sees over 100 patients daily. Dr. Mager was shown taking a patient's history, explaining the procedure she intended to following, and then adjusting that patient under the camera's eye. The patient was then interviewed telling the world about the healing benefit he received from chiropractic care.
The story shifted into a brief recounting of chiropractic's beginning and culminated with Dr. Johnson relating chiropractic's victory in Wilk et al. vs. the AMA. The words sounded sweet when Dr. Johnson said the AMA had engaged in "a nationwide conspiracy against chiropractic. The court ordered the AMA to tell its members it was ethical for MDs to cooperate with chiropractors."
Dr. Johnson told the "20/20" audience that the trial's outcome helped accelerate referrals from MDs to DCs. Before the trial, Dr. Mager had only one referral a month; now she gets several each week. Dr. Stephen Price, an M.D., who has been referring patients to Dr. Mager for years, concurred on the importance of referring to chiropractors.
A beautiful testimonial for MDs to refer to DCs was given by Dr. Arthur White, an orthopedist at the Spine Center in San Francisco. Dr. White, it was explained, was the surgeon who operated on San Francisco 49'er quarterback Joe Montana five years ago. "Hands on treatment of patients with back pain is a valuable tool. If you as a physician don't have that tool, you're short changing yourself and your patients." Dr. White, it won't surprise you, employs a chiropractor in his practice.
There were also ingredients to this report which kept it balanced and investigational. One of these was the inclusion of Dr. Charles Fager, a neurosurgeon at the Leahy Clinic near Boston and a leading critic of many types of back treatment, including unnecessary back surgery. Dr. Fager admitted: "The garden variety backache that comes to us (MDs), we're not that interested in treating." While he admits the system has failed many patients with back pain, Dr. Fager was not "jumping on the manipulation bandwagon," and was concerned with manipulation that "can make patients worse." His part of the segment reviewed a case where a patient underwent chiropractic manipulation for his low back pain even after the patient complained of leg pain that was symptomatic of a ruptured disk. It was later demonstrated that the patient may have been worse.
Dr. Timothy Johnson then directed the audience's attention to what research is saying about manipulation. "20/20" went to the RAND Corporation to speak with Dr. Paul Shekelle about the RAND study on low back pain. Dr. Johnson said the RAND study had "sent shock waves through the medical community." Dr. Shekelle spoke eloquently and to the point:
"There are now a handful of studies which I think are of an adequate to good quality which show a beneficial effect for spinal manipulation as a treatment for low back pain."
"To say that there is no scientific proof, I would say that there's considerably more randomized controlled trials which show benefit for this (chiropractic manipulation), than there is for many, many other things which physicians and neurosurgeons do all the time."
If you expected this to be strictly a PR piece for the chiropractic profession, you were in for some disappointment. If we want that, we have to buy air time. If you weren't prepared for the kind of pointed questioning and balance that this type of news program is famous for, you were fooling yourself. Ultimately, all we could ask for is an honest and fair report that could be presented to the public in thirty minutes. This is what we got. Anytime you can get this kind of exposure, it has to increase the awareness of our profession.
As a wrap-up, Medical Editor Dr. Timothy Johnson pointed out that currently 90 percent of all spinal manipulation is performed by chiropractors, but there is no reason why osteopaths, physical therapists, and even MDs can't provide a greater percentage of this type of care to the public. This gives us something to think about.
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