Whiplash And Other Useful Illnesses (Paperback)

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Editorial Reviews

From The New England Journal of Medicine

The term "whiplash" conjures up images of a violent encounter between two automobiles, spider-webbed windshields, broken bones, and twisted metal. In fact, whiplash claims are just as likely to result from low-energy "bumper thumps" as they are from more destructive collisions. Ten percent of persons who make whiplash claims report a substantial permanent disability. So how can whiplash be considered a "useful" illness? In Whiplash and Other Useful Illnesses, Andrew Malleson details the evolution of whiplash, from its innocuous beginnings in 1928, when Harold Crowe first used the term at a meeting of orthopedic surgeons to describe eight cases of neck injury, to its present medicolegal standing, which results in costs of $13 billion to $18 billion annually in the United States. Spine specialists have long known that patients with secondary gains -- workers' compensation claims or lawsuits -- have significantly worse outcomes than those who do not. In fact, in scientific studies designed to judge the efficacy of interventions, investigators must exclude such patients or report their results separately. Of course, such considerations are not limited to spine-related injuries. In a broad sense, Whiplash and Other Useful Illnesses is about the way in which illnesses for which patients may receive compensation are created and sustained for the benefit of a few at the expense of many. Malleson chooses to write about whiplash, the condition he has spent the most time researching and with which he is most familiar. But his observations are applicable to a broad spectrum of manufactured medicolegal illnesses. Malleson writes with a self-admitted bias from years of working as a defense expert in legal cases involving whiplash and other illnesses for which patients may be compensated. He meticulously conveys his thesis in this thoroughly referenced and documented book. The book includes 59 pages of chapter-by-chapter notations and 56 pages of references. In a somewhat tedious manner, Malleson initially details the "junk science" that has given whiplash the status of a legitimate (and thereby compensable) illness. A psychiatrist by training, he particularly faults physicians for publishing poor scientific work in an effort to advertise themselves as experts in the field. This advertising allows them to secure an additional lucrative source of income in the face of a contracting health care market. He points out the insidious effort to legitimize the condition and discusses the interactions of medicine, lawyers, and the media that create "epidemics" by taking advantage of people's suggestible nature. Malleson draws parallels with other illnesses that were "fashionable" in other periods, such as "railway spine" and "repetitive strain injury," which reached nearly epidemic proportions in other countries until laws allowing compensation were rescinded. After the revocation of these laws, the ailments virtually disappeared. Whiplash claims, however, continue to multiply relentlessly, shifting vital resources and money away from where they are truly needed within the health care system to the benefit of a select few "victims," doctors, and lawyers. Malleson faults this conspiracy for its role in perpetuating the concept of whiplash as a form of prolonged disability. He scathingly criticizes many subspecialties within medicine for jumping on the "whiplash bandwagon" and perpetuating the pretense of lasting harm in the face of what should be an innocuous event. His portrayal of physicians as driven primarily by greed and self-interest under the guise of their patients' best interests, however, appears to be unwarranted and unsubstantiated. Lawyers are singled out for attempting to enrich themselves by means of the "whiplash lottery" and simultaneously allowing their clients to become professional patients who will not ultimately be cured by the verdict. Furthermore, lawyers continually fight to maintain the current adversarial system, which wastes valuable legal and health care resources. Malleson believes that many patients use whiplash as a convenient diagnosis to mask preexisting depression. It is socially more acceptable to be the victim of another person than to admit to being depressed, since depression comes from within. In this manner, an accident can be viewed as a reputable and rewarding escape from a difficult situation. Finally, Malleson faults insurance companies for not doing enough to combat fraudulent claims, instead using the losses incurred to justify further rate increases for all customers. Malleson's writing style is somewhat dry, and the individual chapters do not seem to flow into one another, making the reading slow and the book difficult to pick up at times. Nonetheless, his thesis is credible and well substantiated. He provides the perspective of someone who has spent many years of practice inside a medicolegal system that he feels is fundamentally flawed and in need of immediate reform. With the health care system in crisis, we can no longer afford expensive, ineffective therapies that are often used only to meet an arbitrary minimal monetary threshold for bringing suit or demonstrating long-term disability. Malleson's repeated call for randomized clinical trials to substantiate the efficacy of medical interventions is shared by most in the field of medicine. Whiplash and Other Useful Illnesses isfor anyone involved with persons seeking care or compensation for illness. Brian Grottkau, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.

Review

"A brilliant exposition of how the interaction of medicine and the law creates whole new maladies." 2003 Books of the Year, The Sunday Telegraph "This delightful book examines the evidence supporting me-too disorders and - citing chapter and verse - demolishes the diagnoses (but not the symptoms)." Journal of the American Medical Association "This delightful book examines the evidence supporting whiplash, fibromyalgia, chronic fatigue syndrome, and similar me-too disorders and - citing chapter and verse - demolishes the diagnoses (but not the symptoms)." Journal of the American Medical Association "How often do you find a medical book that you can read like a thriller? Wonderfully cynical, well referenced and easy to read, it is full of good sense. I would make it essential reading for all medical and law students. Indeed, instead of the ghastly medical 'soaps' which flood our television sets, Whiplash and Other Usefull Illnesses could be turned into a long running TV series to rival CSI or Law and Order." Spinal Cord

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Product Details

• Paperback: 527 pages
• Publisher: McGill-Queen's University Press (June 2005)
• Language: English
• ISBN-10: 0773529942
• ISBN-13: 978-0773529946
• Product Dimensions: 8.8 x 5.9 x 1.6 inches
• Shipping Weight: 1.6 pounds (View shipping rates and policies)
• Average Customer Review: 3.4 out of 5 stars  See all reviews (9 customer reviews)
• Amazon.com Sales Rank: #1,496,133 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

11 of 13 people found the following review helpful:

5.0 out of 5 stars cold water and real research poured onto a xontentious topic, July 7, 2002

By	myer s leonard (minneapolis, mn United States) - See all my reviews

This review is from: Whiplash and Other Useful Illnesses (Hardcover)

this is a scholarly and meticulously researched and referenced text by a clinician of great experience,insight and acumen.
Mallenson does not hide behind euphenisms and he eschews 'weasel "words and phrases.He examines the nature of the entity of 'whiplash' and emphasises that despite the legions of sufferers and their claims ,no objective test has been able to demonstrate any pathological lesion in those who have suffered moderate intensity rear impacts.Patients who have had extensive surgery of the neck appear to recover with little of the morbidity of whiplash sufferers.He also highlights the numerous cases of fraud by lawyers,chiropractors and physicians.This is a MUST read for M.D.s who examine claimants and the lawyers and Insurance people who should be cognisant of recent research in
this area.

10 of 12 people found the following review helpful:

5.0 out of 5 stars A gem of a book on this controversial subject, November 16, 2002

By	C. M. Grant "CMAG" (Carribean) - See all my reviews (REAL NAME)

This review is from: Whiplash and Other Useful Illnesses (Hardcover)

An excellent book on the subject of whiplash associated disorders (WAD). Dr. Malleson brings the subject of WAD to life and is able to present his thoughts in a structured, coherent yet entertaining manner.

On page 31 of this scholarly work he presents the findings of Dr. Henry Berry's findings of the presence of, or rather absence of, WAD in demolition derby drivers. In short, WAD does not exist in demolition derby drivers. Surely, such a finding cannot be explained by simply applying biomedical principles.

Those with a vested interest in promoting late WAD as a distinct biomedical entity have unsuccessfully attempted to debunk the writings/ research of Berry, Robert Ferrari and now Malleson. While no one is disputing the existence of the acute/ early WAD the dispute comes when one tries to explain away the findings of studies coming out of Singapore, New Zealand, Germany, Greece, Saskatchewan and Lithuania - which essentially undermine the existence of the phenomenon of the late whiplash syndrome.

From the writings and meta-analysis of Malleson et al is should be patently obvious to all of us managing these VICTIMS that we need a significant paradigm shift in the management of WAD - i.e. we should be adopting a biopsychosocial approach to its management thereby improving the clinical outcomes, both quantitatively and qualitatively, in the VICTIMS who are all too often mismanaged by those practitioners who exclusively subscribe to a biomedical approach. More works like Mallerson's are needed on this very contentious subject.

For additional reading, I'll recommend THE WHIPLASH ENCYCLOPEDIA - The Facts and Myths of Whiplash by Dr. Robert Ferrari (1999) to anyone with an open mind on the subject of WAD.

To Dr. Malleson I'll like to take this opportunity to not only congratulate you, but thank you for such a fine book. I've had the opportunity to read most, if not all of the textbooks that have been published on the subject of WAD over the last 5 years and this ranks amongst the finest. I'll remind Dr. Ferrari and yourself that it was Margaret Mead who one said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has".

PS (August 7th 2003): Having reviewed this page for the first time in six months, I was once again pellucidly reminded how emotive the subject of WAD can get, especially for those having a vested interest in profiting from the WAD VICTIM'S pain and suffering.

The reference line for all MDs involved in the management should be the INJURED PATIENT and the INJURED PATIENT ONLY and this ethical and fiduciary duty must override any other obligation to the persons from whom one may have received instructions or payment (e.g. Insurance companies, plaintiff attorneys, etc.).

To the reviewer from Boston (April 6th 2003), who erroneously stated that I was an insurance company executive, I'll like to take this opportunity to point out that I am a MD who has spent over 15 years in the trenches managing the WAD VICTIMS' pain and suffering.

While in the earlier years of my career a fair percentage of my patients did not respond to the traditional biomedical model, however, over the last 4 to 5 years I've had the opportunity to apply the biopsychosocial model to the management of my patients suffering from Grade 0 to Grade III WAD and I'm pleased to announce that the results have been extremely heartening, to say the least.

The authors of books like "Whiplash and Other Useful Illnesses" must be commended for literally sticking their necks out and challenging the old paradigm that FAILED to benefit the WAD VICTIM.

It must be pointed out to the skeptics that Dr. Malleson goes onto show in his commendable textbook where and how the insurance companies, yes the insurance companies, benefit from WAD. Hence, it is somewhat disingenuous, to say the least, for anyone who has read "Whiplash and Other Useful Illnesses" to classify it as a pro-insurance industry text.

To those contemplating purchasing this text, if your reference is the patient's physical well being I'll commend this book to you, on the other hand if your primary interest lies in how you can profit from the patient's pain and suffering I'll suggest that you look somewhere else.

Just a concluding thought, how is it that those causing the accidents, that is those who have little to gain psychosocially from such, never seem to go onto to suffer from more than a transient neck pain?

5 of 7 people found the following review helpful:

5.0 out of 5 stars an excellent overview, August 19, 2003

By	MS (Toronto, Ontario Canada) - See all my reviews

This review is from: Whiplash and Other Useful Illnesses (Hardcover)

This book clearly illustrates the true nature of whiplash injuries - as a vehicle to help ne'er-do-wells exist without actually contributing anything to society.

Well done!