Most helpful critical review
Useful for Insurance Company Lawyers and Doctors Who Golf
on April 6, 2003
I am always disheartened when physicians become pawns of the insurance industry, sometimes unknowingly. Dr. Malleson appears to have prostituted himself in this way quite knowingly, however. Like one of the reviewers from Barbados (who can be found easily using a Google search of his name--he is an insurance company executive), Malleson is yet another representative of the automobile insurance industry whose views of whiplash-related disorders are not only biased, but quite outdated. Malleson appears to be second-guessing the millions of injured persons in the United States and abroad and accusing them of secondary gain. However, several scientific studies have clearly shown that litigation has absolutely no effect on the long-term prgnosis and outcome of whiplash-injured persons.
Malleson, in a very predictable way, places a grossly distorted emphasis on studies which support his preconceptions about whiplsh injuries. These studies, such as one which looked at demolition derby drivers (Berry, 2000) subjected to multiple impacts over the span of their careers, or one that supposedly simulated a rear-end collision (it didn't) using fear tactics to intimidate and frighten research subjects (Castro et al., 2002), actually have very little to do with the phenomenon of a rear-end collision in the real world, where significant forces are produced in unaware and unbraced occupants who are struck by 3000-lb. objects.
Malleson, and many physicians, especially those in neurology and psychiatry circles, attribute chronic pain after a rear-end, whiplash-producing collision, to be purely psychological or societal. This theory, a "psychosocial" theory of chronic pain after whiplash, not only has never been proved, but has never even been studied or tested.
I suppose that if you want to treat whiplash as a psychiatrist, it probably helps to couch a diagnosis in the psychiatric realm. But the lack of quality of research for a psychosocial theory in whiplash is glaring, and this paucity has not been commented on by Malleson. This is a great flaw of this poorly-researched book.
The proponents and founders of the "psychosocial theory" of chronic pain after whiplash, Drs. Robert Ferrari and Anthony Russell of Canada (where funding for pro-insurance research has reached a worldwide high), have called their theory instead a "biopsychosocial" one. That is a misnomer, however, since Ferrari and Russell allow for no biological explanation for chronic pain after whiplash. In other words, they do not believe that chronic pain after whiplash is possible from damage to injured human tissues such as cartilage, ligament, muscle or muscle tendon, brain, spinal cord, or other nervous tissues. Unfortunately for injured persons, Dr. Malleson also subscribes to this psychosocial theory, although there is no good scientific evidence for it.
What Dr. Malleson's book ignores are the monumental studies from medical and engineering journals in the past few years. The reviewer who states that Malleson misses the mark is correct. Kaneoka and Ono and their colleagues from Japan have indeed changed the way we look at the biomechanics of a rear-end collision with their brilliant studies using human subjects and cineradiography. What is amazing is that their work supports and agrees with data coming from other studies, both clinical and medical, and other engineering studies.
The Japanese researchers have shown us that the cervical spine takes on an "s-shaped configuration" where the lower neck hyperextends, and the upper neck hyperflexes beyond normal physiologic ranges. The possibility that cartilage in the neck is permanently damaged is very high. This cartilage has also shown to be damaged in clinical whiplash studies performed by Australian research (Bpgduk and colleagues). That the auto insurance industry and its representatives should so easily dismiss the overwhelming majority of studies in the last decade comes as no surprise to me. However, when a physician ignores the importance of this research, or ignores the research altogether, then that is surely disheartening. It is also surprising to many in the lay public (although not as surprising to those of us in medicine).
The doctors who work for the insurance companies and testify in court are clinging desperately to a very small number of studies (less than 30) which deny the existence of chronic pain after whiplash from a biological (that is, injured human tissue) source. The vast majority of studies show the opposite is true: chronic pain is not the result of secondary gain, litigation or cognitive difficulties (over 50 good studies support this), but are the result of good old-fashioned tissue injury (studies number in the thousands in support of this).
Yet, voices like Malleson's, Ferrari's, Berry's, and other physicians, especially neurologists, will continue to bark the loudest, as if by barking louder they will be able to somehow overturn the majority of scientists and researchers in both the medical and engineering worlds who disagree with them. Malleson's views simply do not hold up in the face of the research which he conveniently either ignores or distorts in his book.
There is a great advantage to writing a book like this: your future as a physician working for the insurance industry is virtually guaranteed. You will be able to reap great profits from defense (insurance company bought-and-paid-for) work, performing "expert" testimony for a fantastic income, and insurance medical exams (so-called "IME" exams) at a handsome profit. One doctor I know (most physicians I know refer to him as the local insurance company whore) literally made over $250,000 last year on Wednesdays performing these exams. He's got a lot of time left over for golf!
Nice work schedule! A quarter-mil on Wednesdays, looking for nothing in these patients, and surprise--not finding anything. Since he cannot find anything (he doesn't look for anything wrong), there must not be anything wrong with these patients! The insurance company, based on its own incestuous representative (or its representative once-removed), gets to legally deny payment for any further treatment to the injured patient! It is gone this far, don't let the supporters of this book lie to you any more. Thay all work for the insurance industry.
I wonder how Dr. Malleson's golf game is...?