Bye Bye Barrett

This is one of the few times I did not have to give much thought about what my next column in Dynamic Chiropractic would be. A few weeks ago, a longtime friend and health reporter from the Allentown Morning Call phoned me to let me know that Dr. Stephen Barrett was leaving Allentown, Pa. Bottom line: The town that Billy Joel made famous in his song is now minus one famous - or should I say infamous - resident.

When I was speaking to the reporter about this, it obviously created a multitude of emotions, since Stephen Barrett and I have been battling for nearly 40 years now. However, there was this eerie sense of bereavement that was felt for a few short moments - and I mean short. Needless to say, this nemesis of chiropractic, who had caused considerable harm, frustration and negative press to my profession, was moving.

While reflecting on Barrett's impending move from Allentown to North Carolina, I took out the huge "Barrett file" of almost 40 years and reviewed it for nostalgia. The information dated back to 1969, when Barrett first started his group The Lehigh Valley Committee Against Health Fraud, whose mission was cleverly disguised with a magnanimous sounding name to hide the fact that it was really about "How to Eliminate Chiropractic." In one of his unabashed interviews in USA Today, he proudly proclaimed his "basket of bad eggs," including:

• Acupuncture - "Utter nonsense, total drivel."
• Vitamins - "If you eat a proper diet, you don't need vitamins."
• Chiropractic - "Chiropractic theory is not scientific. There are a lot of rotten apples in the barrel."
• Homeopathy - "The ultimate nothing, a $250 million a year scam."

As you can see from the above comments made in the article published as recently as 1994, nothing has been able to change the mind of this individual despite evidence to the contrary. There are some lessons to be learned and I will make some observations, but in the meantime another interview on Barrett resulted.

John Weeks, editor of The Integrator Blog, recently wrote an excellent column on Dr. Barrett (aka, "Quackbuster") and brought in some interesting observations on how this entire 40-year saga fits into the 1963 AMA Committee on Quackery. I have taken the liberty of reprinting a substantial portion of this excellent column below. If you are not receiving the very informative Integrator Blog, you can subscribe at no cost.

Regarding Quack-Buster Stephen Barrett, Chiropractic Leader Lou Sportelli and Covertly-Delivered AMA Papers Written by John Weeks Friday June 22, 2007

Early June brought news in the Allentown Morning Call that the anti-alternative medicine and anti-chiropractic self-styled quack-buster Stephen Barrett, MD, founder of Quackwatch, was moving from his base of Allentown, Pennsylvania. Barrett claims he's not retiring. He said he's taking his 6,000 books and 44 file cabinets with him, but does acknowledge he'll be cutting back.

Another longtime Allentown resident, Lou Sportelli, DC, sent me the link to the story. Sportelli, who is president of the NCMIC Group, an Integrator sponsor, has many times taken the pro-chiropractic and pro-natural health care positions on panels in which others have paired him with Barrett. Sportelli is quoted in the Morning Call story: "This marks the end of a non-illustrious career. I shed no tear."

First, Some Sportelli Recollections of Barrett

I contacted Sportelli for some comments on his relationship with Barrett. Sportelli reflected on the years of their exchanges: "We maintained over the years, at least a respectful relationship. He used to tell audiences: 'Dr. Sportelli is not really a chiropractor. He doesn't do what chiropractors do. They just wind him up and send him out."

There is truth in Sportelli being atypical. From the beginning of his practice and leadership of his profession 45 years ago, Sportelli has formed healthy relationships with medical specialists and urged members of his profession to do so. He has served for years on the board of trustees in a hospital in his local area - a hospital to which he was able to send patients for a blood test, urinalysis or an X-ray even in the heyday of the campaign of the American Medical Association to stop professional relationships between medical doctors and chiropractic.

Yet clearly, Sportelli got his own licks in. He laughs as he recalls their exchanges: "(Barrett) scoffed at the role of food and nutrition in health. I told him on numerous occasions that today's unorthodox procedures become tomorrow's standard of care. He opposed spinal manipulation and I'd always say: 'So then why do physical therapists and other disciplines want to have it in their scope?' He wasn't a man who wanted to change and irrespective of clear and compelling facts, his opinions rarely did. I likened him to a member of the flat earth society."

Sportelli continued: "Thank God (Barrett) was the anti-chiropractic person. His demeanor and personality never lent itself to achieving much credibility, particularly when there was an opportunity for full debate." Then Sportelli laughs: "When I heard he was moving to North Carolina near the Research Triangle, I thought, too bad. It would have made more sense had it been the Bermuda Triangle. In all honesty, I really feel sorry for Stephen Barrett. I reflect on what it would feel like to be opposed to nutrition, organic foods, chiropractic and other forms of alternative medicine and have every one of your belief systems evaporate before your very eyes in the enlightenment of the 21st century and compelling research to document the value and benefits of these approaches."

He adds: "Here is a man who spent his whole life climbing the anti-chiropractic and anti-whatever ladder only to find it against the wrong wall. The world has simply passed him by and he is locked into a time warp that will not permit the light of information and the evidence of efficacy to enter into his world. To me that is a sad moment for anyone to have wasted so much time and effort on a cause that was not in the public's best interest. My thought often reflected on how many patients did he prevent from seeking chiropractic care, taking nutritional products or seeking alternatives to their current mode of treatment? That would haunt me."

A Tale of AMA Documents #1: Barrett's Access to the AMA's Anti-Quackery Files

Reflecting on the careers of these two men who co-habited the same Pennsylvania town, I recalled that while they were adversaries, they had something special in common. Each of them had documents from

inside the American Medical Association covertly shared with them. The delivery of both sets of these AMA documents - one sent intentionally, the other surreptitiously - significantly influenced the integrative medicine dialogue in the United States.

The Barrett story runs something like this. In 1963, the AMA established a Committee on Quackery which chiefly targeted the chiropractic profession. In 1975, the Committee was disbanded. But this happened only after Barrett had started the Lehigh Valley Council Against Health Fraud. Barrett was, according to author P.J. Lisa and others, given access to all of the AMA's anti-quackery and anti-chiropractic files. The AMA now had an external group to carry its campaign against chiropractic and other natural health care. Many of the CAM-oriented investigators of the AMA-Barrett relationship believe that copies of the AMA's files are quite likely part of the 44 file cabinets Barrett plans to move to his new home in North Carolina.

Barrett later became a founding board member of the National Council Against Health Fraud, started by William Jarvis, PhD. Whether Barrett merely gained access to the AMA's files or had them delivered to his office wholesale may be in dispute. What is not in dispute is that from 1970 until the present, Barrett has continued to lambaste virtually everything non-allopathic. While his influence has declined, there was a decades-long period when most media accounts of natural health care of any kind were accompanied by quotes from Barrett, Jarvis or one of their two other self-appointed anti-quackery colleagues, John Renner, MD and Victor Herbert, MD, JD. Barrett told the Allentown Morning Call that he plans to stay at it from his new home.

A Tale of AMA Documents #2: The "Sore Throat" Documents Stimulates an Anti-Trust Lawsuit Against the AMA

Quackwatch maybe should keep a better eye on itself.

Sportelli's relationship to covert documents from inside the AMA had an opposite origin and opposite impact on dialogue in the United States. In his case, an individual inside the AMA upset with AMA's pattern of repressive behavior, secretly copied numerous documents and had them mailed to a limited number of individuals in the chiropractic profession. Sportelli was one of them. Arguably, the first real opening of the integration exchange in the United States began when these individuals received these bundles in 1978.

The packet Sportelli received documented what Barrett likely already knew given his close relationship with organized medicine: the AMA had an ongoing campaign to boycott chiropractic. These documents led to a decade-long, anti-trust battle which the chiropractic profession waged against the AMA. Known as Wilk, et al., v AMA, the ultimate finding from U.S. District Court Judge Susan Getzendanner was that:

"(The AMA had engaged in) a lengthy, systematic, successful and unlawful boycott, designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic as a competitor in the U.S. health care system."

The court decision required the AMA to cease fire. They could no longer work to maintain an utter segregation between conventional medicine and chiropractic. The message was the same for AMA actions relative to other emerging disciplines such as acupuncture and Oriental medicine, naturopathic medicine and massage therapy. A little turf was opened to allow some exchange.

Sportelli speaks of a "feeling of liberation" that came to him and others on learning of the information in the covertly mailed document, and then through "the magnificent discovery and trial and undertaken so brilliantly by attorney George McAndrews" as the reality of what was happening truly sunk in: "No longer would the chiropractic profession have to be embarrassed or denied access to legitimate facilities for their patients. No longer would the profession have to wonder why the health care glass ceiling could never be broken. After the lawsuit, the Barretts of the world became insignificant because the truth indeed set the profession and all of alternative health care free in this country."

It was into this legally-mandated shift in culture, this forced door opening, that David Eisenberg, MD, and his team at Harvard University Medical School delivered his data in early 1993 on the consumer use of unconventional medicine. Our present dialogue, traumatized in the womb, began.

Comment: To count Barrett out of the picture now is quite likely, like the too-early report of the death of Mark Twain, an exaggeration. Yet one can take comfort that to the extent that paradigms shift when the old die, Barrett's awfully polarizing voice, disrespectful to science even as he sold himself as science's defender, will be less heard. Meantime, when we think of how challenging the last 15 years of integration activity have been, it may be useful to note that somewhere in Allentown this dialogue had a shotgun birth.

I must admit that getting this two-foot-thick file out caused me to browse through it for several hours and reflect on the events, challenges and criticisms against the profession which have occurred over the years. I reflected on how much has changed since those issues on which Barrett commented 40 years ago and more importantly, what if anything can we learn from them.

The newspaper articles were yellowed from age, the ink on some of the articles had almost faded away, but there was a pattern of commentary from the early 1970s to the early 2000s that are worthy of comment.

Barrett issued his BEWARE OF list in a number of articles which have been published. Here are a few, in no order of priority. In an article in 1982 Barrett comments: "Whenever chiropractic is attacked by an outsider, it claims that its attacker is biased. Whenever it is embarrassed by quotes from within its own profession, it claims they are not representative."

Dr. Barrett, along with reporters from Consumer Reports and Mark Brown of the Quad-City Times, attended some of the popular seminars of the 1970s and 1980s. Here are a few quotes, exposing some of the seminar's concepts: A popular instructor stated: "During the consultation, throw in a few knowing 'Mmmmmmms,' and 'Mmmmmma' and 'Hmm,' interspersed with big smiles and small nods." Another instructor wrote a book explaining, "Never go anywhere without being paged. This affixes your name in people's minds." "Write notes on literature and in phone books stating this doctor helped my (insert name of ailment)."

I could write for hours about the embarrassing and indefensible items that have been used by Dr. Barrett to denounce the chiropractic profession in the past. However, it is now 2007. How far have we really come when we can still see in our current publications advertising and promotional programs designed to provide anything but a patient-centered practice? My question always goes to the issue of how would each of us as practitioners, or the originators of those schemes and scams defend those actions in a court of law. Where would the defense of how those gimmicks and schemes come from? Each member of the jury is a potential patient and would view unreasonable and irrational commentary as potentially harmful and in their minds, "I could be one of those patients."

We talk about ethics and cultural authority and why the profession's market share has eroded over the past decade. Perhaps Barrett's move should cause us to STOP and review the basis of his opposition. Some of it has been due to outlandish statements, based upon unsupported documentation and research. Some of it is simply an unethical approach to patient recruitment and solicitation, and still other criticism is due to our lack of a unified message to the public.

What that message should be has now been discussed, debated, disputed and deliberated ad nauseam. There is no doubt that the public already has made a determination about what they will use a chiropractor for. Some will refer a friend for a similar condition they once had, which is common. For example, low back patients usually refer low back patients, sinus patients refer sinus patients, pregnant mothers usually refer pregnant mothers, and so on. All of that is excellent, but have we really established our core competence as a profession and concentrated on what we do best?

The chiropractic profession must carefully walk that delicate line of not being perceived by the public as being so out of the mainstream that it is viewed as fringe, or becoming so identical to the mainstream that it has lost its identity. Being "against" disease is not the same as being "for" health, any more than studying "failure" will identify why people are "successful."

The main comments from the Barretts of the world really boil down to overclaim, and the relevance of the statement by C.O. Watkins again bears repeating: "Let's be bold in what we hypothesize, but cautious and humble in what we claim." That should truly become the mantra for the profession. By the profession assuming that posture does not denigrate the value of chiropractic or what each of us does in our offices every day as clinicians, but it serves to elevate the profession in terms of incorporating the legitimate language of science into our lexicon.

Many good, honest, legitimate clinicians are caught between the rhetoric of those who are irrational and the caution of those who are science captives. As clinicians, we "practice" using methods which are unproven, every day of our clinical lives. This is the privilege we obtain when we become licensed doctors of chiropractic.

We embrace a philosophy of the science of chiropractic and incorporate the art form to formulate a basis upon which we treat patients. We can justify treating individual patients with methods which have not been scientifically validated. What we cannot do however, is to make claims for unproven methods employed, despite the fact that in the case of the individual patient it may have appeared to be successful.

This is our dilemma as clinicians. We see many patients each day and employ a regimen we decide is best for that patient in concert with the agreement of the patient. Often, this course of action produces almost seemingly miraculous results.

Then we make the fatal error of attempting to extrapolate that individual single patient encounter to an entire class of patients or disorders. As clinicians, we want to offer hope. However, using unproven methods in clinical practice versus "making claims" for unproven methods is a distinction often lost upon the practitioner but not upon the challenges Stephen Barrett has been using against us for years.

It is difficult to fully understand and internalize the distinction because on the surface, it may appear as double talk, but when carefully examined, it meets the only criteria for responsible practice. We need to rethink our explanations and reframe them in language consistent with the universal language of science. We need to rid ourselves of the rhetoric; abandon the supernatural suppositions; eliminate the anatomical anomalies, which serve only to isolate the profession from science; and incorporate the bold hypothesis, tempered with restraint and moderation, in the delivery of our message.

When we do that, Barrett and his ilk will have little to say, and perhaps those who foster the kind of patient-exploitation model espoused by those seminar stars of yesterday will find themselves with no one in the audience.

Maybe Barrett did some good by shining the light on those exploiters, so they are easier to identify in the high-tech commercialized world of blogs, bull and baloney. As for the self-proclaimed consumer advocate, well, they will just have to find some new windmills at which to tilt. The chiropractic and alternative medicine world has won!