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A Real Medical Condition Is Trivialized in this Useless Book
on November 8, 2002
One must seriously question Andrew Malleson's research skills, as his inclusion of relevant and modern scientific research (1990-2002) on the topic of whiplash is virtually non-existent in this book. While it is true that surveys of jurors and the general public (including freshman law students) reveal a nationwide skepticism of the validity of whiplash claims in the United States (a recent University of Delaware article quoted a law student who opined that probably only "20% of whiplash claims were valid"), it is not layperson opinion that matters when it comes to whiplash injury. Science must play the defining role in whiplash injury litigation, not hearsay, anecdote, or public opinion.
But Malleson's book offers little beyond public opinion.
While it is true that insurance fraud is a major problem in the whiplash claims according to insurance groups (the Insurance Institute for Highway Safety estimates fraud in whiplash claims MAY be as high as NEARLY 40% of bodily injury claims where sprain OR strain is the ONLY injury, see IIHS Status Report, 1997), clearly even the insurance industry sees that greater than 60% of whiplash claims involving sprains OR strains as the only injury (a statement which, of course, says nothing about crashes producing whiplash injuries other than, or in addition to, sprains and strains, such as nerve injuries, spinal disc herniations, ligament ruptures, concussions or brain injuries, fractures, cartilage contusions and many others documented in the medical literature).
The medical literature speaks very clearly to the injuries sustained in whiplash. There are literally thousands of studies which document the myriad types of injuries (simply go the United States National Library of Medicine website and search PubMed under "whiplash"), a list too exhaustive to list here. There are also several excellent medical textbooks (see Foreman and Croft's textbook on amazon.com, or Yoganandan and Pintar's textbook, or a number of other medical textbooks found on this website such as those by Malanga and Nadler (Eds.), Gunzburg and Szpalski (Eds.), Nordhoff, Melton, and others) on the topic listing the multitude of injuries possible, including, but not limited to, sprains and strains. These textbooks are by authors and editors who understand the seriousness of whiplash injuries.
Clearly, Malleson's book cannot compare to these.
Any assumption, such as the one posed by another reviewer (the only one to date as of 11-08-02), that "... no objective test has been able to demonstrate any pathological lesion in those who have suffered moderate intensity rear impacts...", is simply a ludicrous and uneducated statement. Here is why:
Flexion-extension x-rays (where the whiplash victim bends his head forward and then back for the x-rays, which are taken in side-view of the neck), as well as the more modern flexion-extension MRI (including motion study MRI in weight-bearing positions, i.e., upright posture, where the weight of the head and the position of the neck show disc and ligament problems in whiplash patients not seen with conventional MRI, where the patient is supine or laying flat, face-up, with no weight on the neck), are showing indisputable lesions.
Seen on flexion-extension x-rays and MRI's are substantial ligament injuries, injuries severe enough to cause "ligamentous instability", a diagnosis that can be found in the American Medical Association's 4th and 5th Edition Guides to the Evaluation of Physical Impairment. The AMA Guides lists cervical spine (neck) instability as a "25% whole-person impairment", which is equal in severity to "amputation of the leg, 3 inches or more below the knee", according to the Guides (5th Ed.). Ligamentous instability is a serious injury to the cervical spine, seen in even low-speed rear-end collisions.
Disc herniations are seen on MRI after low and moderate speed rear-end collisions. These are objective findings.
The list of injuries goes on and on.
Cadaver crashes performed by Yoganandan and reported in the journal SPINE in the past year show serious injuries to the ligaments and cartilage of the cervical spine that cannot be seen on x-rays, CT scans or MRI. Cadaver necks were dissected and frozen after exposure to low-velocity, rear-end collisions, then analyzed for injury after the crashes. Multiple injuries were found. While there are problems comparing cadavers to real-world occupants, these studies may be the best at showing the hidden injuries which real sufferers have endured in spite of a hostile medicolegal environment. Doctors and scientists must never forget that just because medical tests and imaging do not always find the injuries DOES NOT MEAN the injuries do not exist. Further, it DOES NOT MEAN that these patients are necessarily suffering from "litigation neurosis" (research does not support this notion anyways), are malingering, are "cognitive underperformers", exaggerators, or hoping for big settlement money (indeed, most of the medical research on this last topic shows that the majority of whiplash patients continue to have chronic pain long after their legal claims settle).
This review cannot possibly cover the vast amount of research dealing with the topic of whiplash, but suffice it to say that a thorough reading of this book will not advance one's knowledge of the topic in any meaningful way. Coherent science is but a distant dream for Andrew Malleson.