Whiplash and Other Useful Illnesses

Whiplash and Other Useful Illnesses

Andrew Malleson
Copyright Date: 2002
Pages: 544
https://www.jstor.org/stable/j.ctt7zn6h
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  • Book Info
    Whiplash and Other Useful Illnesses
    Book Description:

    Malleson details the evolution of whiplash from a common, short-lived disorder into a world-wide epidemic that has left millions permanently disabled. He exposes how some medical healthcare and legal professionals prey on the anxieties and greed of their clients. He argues that whiplash is only one of a long list of largely fabricated illnesses and injuries that will drain resources from the health care system.

    eISBN: 978-0-7735-6999-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
    Andrew Malleson
  4. Preface
    (pp. xi-2)
  5. Healthcare Entrepreneurs in Search of Work
    (pp. 3-6)

    Healthcare systems are in trouble. Although more and more public and private money is being poured into healthcare, it is never enough. Medicine has had some astounding successes, and histories of medicine paint glowing pictures of its victories over ignorance and disease. The shadier side of medicine is usually quietly forgotten.

    Healthcare is now the world’s largest industry. Just as the lumber industry depends upon trees for its existence, so the healthcare industry depends upon illness. The lumber industry worries about a shortage of trees, but the healthcare industry is confronted by an even greater problem. Never before, at least...

  6. PART ONE: FINESSING WHIPLASH INTO A PERMANENT DISABILITY
    • 1 Making Whiplash Sound Serious: Caveat Lector
      (pp. 9-16)

      It is true that some physicians are excellent scientists. During their years at medical school, however, most doctors are not trained in the scientific method; they are apprenticed into the tradition of diagnosing and treating illness. Then, faced with earning a living, they need to recruit patients. To do so, they must provide the services that patients want. Doctors who decide to manage whiplash patients must let potential patients, lawyers, and other doctors know of their interest, and one way to do this is to write an article on whiplash for a medical journal. Although such articles adopt a neutral...

    • 2 Whiplash and Poor Science in Medical Journals
      (pp. 17-29)

      As a prelude to its investigation of whiplash, the Quebec Task Force on Whiplash-Associated Disorders planned to review all the whiplash literature. The members of the task force were soon overwhelmed. They decided to focus their attention on whiplash material published between 1980 and 1993, but even with nearly three decades of whiplash publications discarded, 10,382 publications remained. Of these, they found only 62 to be “relevant and scientifically meritorious.”¹

      In the past two decades the scientific quality of many medical journal articles has improved greatly. Editors of reputable journals have become much more particular about scientific methodology and the...

    • 3 Bumper Kisses and Whiplash Severity
      (pp. 30-42)

      It might reasonably be supposed that the severity of an auto collision neck injury would bear some relationship to the severity of impact, and in severe impacts it does. A person is much more likely to be killed or sustain a severe neck injury if his car is rear-ended by a bus travelling at 50 mph than if a preoccupied driver in a mini-compact rearends him while dawdling down the road at 5 mph. However, in common everyday minor rear-end collisions there is no correlation between the size of the impact and subsequent whiplash complaints.¹ In North America about a...

    • 4 Sanitizing the Symptoms of Distress
      (pp. 43-51)

      Many patients complain to their doctors of symptoms for which no physical explanation can be found. Such symptoms are described assomatoform, and an understanding of somatization and somatoform illness helps make sense of whiplash and many problems of medical care. Soma is Greek for the body, and somatization implies the conversion of mental distress into symptoms generally associated with a physical disorder. A somatoform or psychosomatic disorder is psychological distress masquerading as a physical illness. Since the symptoms are psychologically engendered, no actual physical disease is present.¹

      Epidemiological studies indicate that the majority of symptoms seen in family practice...

    • 5 Copycats and Fashionable Illnesses
      (pp. 52-74)

      Just as germs spread diseases, so do ideas. Like some microbes, ideas can be so virulent in their pathogenicity that they soon create epidemics.³ Copycat pseudo-illnesses thrive in the work place but, as the so-called “fashionable illnesses,” they are common in the community at large. “Occupational mass psychogenic illness” usually occurs against a background of anxiety and resentment. The first recorded outbreak of an epidemic of this type illustrates how dramatic such illnesses can be. It occurred in a Lancashire cotton mill the year after the introduction of the power loom, an innovation that caused great concern and financial distress...

  7. PART TWO: THE QUEST FOR THE MYTHICAL WHIPLASH INJURY
    • 6 The Enigmas of the Human Spine
      (pp. 77-92)

      Injury to the spine is held responsible for a great deal of trouble. Whiplash is blamed for disabling pain at the top end of the spine and industrial injury for disabling pain at its lower end. The two conditions have so much in common that I will examine them together.

      First, I cannot emphasize strongly enough that both low back pain and neck pain are extraordinarily common. Up to 60 per cent of adults experience at least one episode of back pain each year.⁴ In Ontario, my own neck of the woods, at any given time, one out of ten...

    • 7 The Medico-legal and Psycho-social Spine
      (pp. 93-101)

      As a small boy I sometimes stayed in the country with my very Victorian grandmother. When it was time to return home she would put me on a train to London. I wanted to be in the first carriage, as close as possible to the smoke, noise, and soot of the steam engine, but she insisted that the carriages in the middle of the train were much safer, an opinion that seemed far in excess of acceptable grandmotherly concern. Having read about nineteenth-century train crashes and the Victorian preoccupation with “railway spine,” I now understand better her protective zeal.

      Whiplash...

    • 8 Putting the Bite into Whiplash
      (pp. 102-116)

      Temporomandibular joint disorder, more recognizable as tmj, is a fashionable illness and, like other fashionable illnesses, it paired up with another one – whiplash. A quarter of the whiplash plaintiffs I assessed had an additional diagnosis of accident-induced TMJ disorder. The marriage of tmj disorder and whiplash was bad for the jaw. The more lawyers exercised their jaws on the vulnerability of the tm joints, the more debilitated their clients’ jaws became. Ms T’s TM joints make the point. I reproduce her history word for word from a summary in her medico-legal chart.

      Ms T is a 28-year-old married receptionist who...

    • 9 Whiplash Rescues Some ENT Surgeons
      (pp. 117-128)

      This wonderful epigraph was written about the rise and fall of empires; it is perhaps flippant to apply it to the fluctuating dreams of medical practice, yet even in this realm such dreams arise and fall away. Ear, nose, and throat surgeons were once the financial princes of the profession. Tonsils and adenoids made them rich; anxious parents brought their coughing and runny-nosed children to ENT surgeons (laryngologists) to have them out. In the 1930s and early 1940s between one-half and three-quarters of both North American and British children had had tonsillectomies, or, as they have been dubbed, “remunerectomies.”¹ Then...

    • 10 Whiplash: Head Injury or Legal Headache?
      (pp. 129-150)

      In the 1950s, when Aspirin was still a standard cure for headaches, Americans consumed more than forty tons of it every day, an adequate testimony to how common headaches are.2 Headaches that occur following rear-end collisions are attributed to whiplash, and whiplash headache has grown into a big topic the book Whiplash and Related Headaches is over 1000 pages long.3 It is true that whiplash can cause headache, but, as days turn into weeks and weeks into months, other causes of headache become more likely. At least a dozen explanations have been put forward for the persistence of whiplash headache,...

    • 11 Accidents, Illness Behaviour, and Chronic Pain
      (pp. 151-164)

      Accidents most often happen because people make mistakes. An estimated 80 per cent of all accidents are due to human rather than machine error.² A World Health Organization study found that on average a driver commits one error every two miles.³ Even people especially trained to be careful make mistakes. A study of hospital pharmacists showed that they made 1,371 errors in dispensing 9,846 prescriptions, an error rate of 12.5 per cent.⁴ Community pharmacists do even worse. Investigators disguised as patients monitored 100 randomly selected community pharmacies; they detected 24 errors for every 100 prescriptions dispensed.⁵

      Some people are constantly...

    • 12 Fibromyalgia: A Tender Point?
      (pp. 165-179)

      Fibrositis’s rise from rags to riches is an illuminating story. Sir William Gowers, a distinguished English physician, first introduced the term “fibrositis” in 1904 to describe the hypothetical inflammatory changes in the fibrous structure of lumbar muscles as the supposed cause of backache.³ In the same year, Ralph Stockman, an Edinburgh pathologist, described a group of patients with aching, stiffness, a readiness to feel muscular fatigue, interference with free muscular movement, and often a want of energy and vigour. He reported that biopsies from this group of patients all showed inflammation of the fibrous intermuscular septa. He thus established fibrositis...

    • 13 Fibromyalgia: A Case in Point
      (pp. 180-196)

      The case heard before Mme Justice Rawlins was a run-of-the-mill whiplash suit.¹ The injury sustained by the plaintiff appears to have been small, yet its effects are alleged to have lasted nearly a decade. The plaintiff had a typical pre- and post-accident whiplash history, and many specialists got in on the act. What is unusual about the trial is the care and thoughtfulness with which Mme Justice Rawlins considered the case. In her ninety-five-page judgment she quoted the findings and opinions of the various expert witnesses, and of course provided her own opinion as well.

      I have extracted relevant material...

    • 14 Whiplash: An Eye to the Main Chance?
      (pp. 197-208)

      Sometimes everything goes wrong – three collisions all in the same week. Faced with this kind of expensive misfortune, which of us has not been tempted to attribute the broken headlight, the dented fender, and the bent bumper all to the same accident, the one covered by insurance? The body shop owner might think it odd that a small accident should have damaged both sides of the car at the same time, but what does he care? He might even suggest it! He will get generously paid and, without insurance coverage, the car owner would probably just stay with the dents....

  8. PART THREE: FRAUD AND THE MEDICAL-LEGAL QUAGMIRE
    • 15 Post-traumatic Turbulence
      (pp. 211-221)

      Lawyers no longer learn Latin, but they certainly know the meaning ofpost hoc ergo propter hoc:“This followed that, therefore this was caused by that.” Anything that follows an accident becomes attributable to it.Post-traumaticis one of the most succulent words in an accident litigation lawyer’s vocabulary. Plaintiff experts use it liberally – post-traumatic headache, post-traumatic depression, post-traumatic anxiety, post-traumatic fibromyalgia, post-traumatic neurosis. One Toronto psychiatrist, who makes a specialty of plaintiff whiplash reports, managed on one occasion to put ten different post-traumatic conditions in the same report.

      Although any causal relationship with trauma is often dubious, so compelling...

    • 16 The Inverse Paradox and the Period of Meditation
      (pp. 222-236)

      My computer typing-tutorial provides aphorisms as practice material for playingallegroon the keyboard. While my fingers still insist on playinglento,I have learned a lot of aphorisms, one of which is particularly germane to whiplash: “He who cries the loudest is often least hurt.” This paradox implying the inverse correlation between the severity of the initial injury and the severity of the subsequent complaints is well recognized, but it confuses the lay public and often physicians as well.¹ If someone appears in constant pain and distress and needs constant treatment and a cane to get around with, then...

    • 17 Lawyers, Junk Science, and Chicanery
      (pp. 237-252)

      Without inordinate disrespect towards an august profession, I am perhaps entitled to relate lawyer jokes because there are probably even more jokes about psychiatrists, and, while lawyers are customarily portrayed as sharks, psychiatrists are depicted as stumblebums, and I would rather be seen as a shark. Such lawyer jokes reflect a longstanding disgruntlement with the legal profession. Nevertheless, as most of us, when we are in trouble, hire a lawyer as our verbal Rottweiler, it is perhaps unseemly to complain if we happen to get bitten.

      Not that I have an aversion to all lawyers; an esteemed aunt and a...

    • 18 Pain and Suffering: Calculating the Incalculable
      (pp. 253-264)

      Drivers cause damage to themselves, their cars, other people, and other people’s property, and it is in everyone’s interests that the cost of such damage be covered by insurance. There are two categories of auto insurance systems, tort liability and no-fault; the systems are often combined. “Tort” just means “wrong.” If someone does wrong by causing an accident, the injured party goes to court, and presents his case in an effort to be awarded damages. Even though most cases settle out of court, this kind of system can involve endless arguments as to who caused the accident and therefore whose...

    • 19 Jumpers and Add-ons; Slippers and Yankers
      (pp. 265-280)

      To be a contented psychiatrist, although not necessarily a good one, it helps to be a voyeur of people’s lives. Although a psychiatrist is privileged to hear all manner of interesting things, most patients still prefer to put their best foot forward; even in a psychiatrist’s office, as with priests in the confessional, there are lots of things that a person prefers not to mention. Divorce mediation is a different matter. The contending partners reveal horrendous behaviours about each other as justification for their marital break-up. It was in one such situation, about twenty years ago, that I first learned...

    • 20 Hysteria and the “M” Diagnosis
      (pp. 281-303)

      Milton may have been correct about the mind, but sometimes a few days on Prozac can also change the hell of despair, if not to a life of heaven, at least into one of earthly satisfaction. A distraught young husband whose emotional state is tied to the roller coaster moods of his wife’s menstrual cycle complains that it is difficult to know what is mental and what is physical. Philosophers, with amazing mental gymnastics, have tried over the centuries, usually rather unconvincingly, to define the relationship, or even the non-relationship between mind and body. Nowadays, at least scientifically, it is...

    • 21 “Cured by a Verdict?”
      (pp. 304-314)

      If there is money to be made from something, someone will probably make some. Do people claim injury and even remain disabled because they can make money from compensation? The people who go to the trouble of jumping onto crashed buses, makingpaper accidents, and staging crashes certainly do, but what about the ordinary person in the street – you and me? If we were in a car accident, would we complain of symptoms simply because compensation was available? I have presented enough information about whiplash to make the answer to this question, at least for most of us, an unhesitating,...

  9. PART FOUR: TREATING THE TREATMENT
    • 22 Making Victims of Ourselves
      (pp. 317-334)

      The alacrity with which we now seek to turn ourselves into victims has made victimhood a contemporary epidemic.Timemagazine writes that the United States has become “a nation of finger pointers” and that “twin malformations are cropping up in the American character: a nasty intolerance and a desire to blame everyone else for everything.” Cry-babies pronounce themselves victims of anything from the Universe down. “The cry-baby is the abject, manipulative little devil with the lawyer and, so to speak, the actionable diaper rash ... Victims become addicted to being victims: they derive identity, innocence and a kind of devious...

    • 23 Treatment Exuberance and Serendipity
      (pp. 335-351)

      Healthcare, as you must certainly realize by now, has much to do with providing its practitioners with a living, and nowadays patients have to support many more of them. In the early years of the eighteenth century, Boston (then North America’s most populous city) had six physicians per 100,000 inhabitants.¹ There are now 240 physicians for every 100,000 Americans, a figure that is expected to rise to 290 in the next seven years.² The numbers of alternative practitioners are expanding even more quickly. Healthcare practitioners, conventional or otherwise, have always created new illnesses from which their patients can suffer, but...

    • 24 Medical Decision-Making: Getting It Right
      (pp. 352-358)

      The practice of medicine has always been full of pitfalls and it is getting worse as an ever-increasing number of medical interventions becomes available. How do doctors decide which one of these interventions to choose when so many of them are likely to be wrong? Essentially, a doctor has four basic criteria for deciding on a treatment:

      Personal habit and the practices other members of the profession customarily use;

      The blandishments of the pharmaceutical industry;

      Scientific or pseudoscientific speculation;

      Evidence-based medicine and the findings of randomized controlled trials.

      We are all creatures of habit and doctors often continue to do...

    • 25 Faith, Magic, and the Search for Alternative Care
      (pp. 359-368)

      Turf wars between competing factions for the spoils of questionable but-lucrative occupations are inevitable, and the healing professions are no exception. Nowadays fights over which profession can have the right to prescribe treatment and then to bill insurance or government health plans for doing so are particularly acrimonious. For instance, my own discipline is particularly exercised over clinical psychologists who are seeking to prescribe psychotropic drugs.

      For years there has been little love lost between the medical profession and chiropractors and osteopaths. Such alternative practitioners have always encroached upon the doctors’ realm, but in the last decade or so, new...

    • 26 Medicine: “A Disabling Profession”?
      (pp. 369-378)

      Healthcare practitioners with their treatment and advice loom large in the subject of health, but in fact, their activity is only one of many factors that contribute to the level of our well-being. Healthcare practitioners have seldom shown much interest in these other factors.

      The rampant killing diseases of the past had already stopped being major killers before effective medical interventions were introduced for either their cure or their prevention. You may find this difficult to swallow since doctors and patients alike share a profound belief in the decisive role that medical practice plays in keeping us alive and kicking.³...

    • 27 Cutting Healthcare Down to Size
      (pp. 379-386)

      After World War II, when medicine began its first years of spectacular success, many governments established publicly funded healthcare services to bestow its benefits on all their citizens. These services were created with great optimism. In Britain the authors of the Beveridge Report, which fathered the National Health Service, finding the health of the nation was poor, readily accepted that the initial cost of the health service would be high. They assumed that once the “backlog” of needy cases had been eliminated its cost would decline. They assumed also that the savings accrued from anticipated reduction in days lost through...

  10. APPENDIX 1: GLOSSARY OF ACRONYMS
    (pp. 387-388)
  11. APPENDIX 2: THE USE OF PROSPECTIVE STUDIES AND RTCS
    (pp. 389-390)
  12. APPENDIX 3: EVIDENCE AGAINST RESIDUAL BRAIN INJURY BEING THE CAUSE OF POST-CONCUSSION SYNDROME AFTER MINOR HEAD INJURY
    (pp. 391-393)
  13. APPENDIX 4: OVERVALUATION OF HEALTHCARE
    (pp. 394-394)
  14. Notes
    (pp. 395-454)
  15. References
    (pp. 455-512)
  16. Figure Credits and Permissions
    (pp. 513-514)
  17. Index
    (pp. 515-528)