Customer Reviews

Whiplash and Other Useful Illnesses

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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?

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.

I have only read the synopsis of the book and the customer reviews. I have 11 years experience as an Industrial Nurse Case Manager. I wholeheartedly assure the secondary gain issues listed are quite true from 3rd party liability cases, workers' compensation cases and medical malpractice. There are a lot of unethical physicians who will causally relate anything to everything, continue treatment when none is warranted, (one case of mine had physical therapy for 15 years and never improved) and keep persons out of work for no objective reason. This is blatant fraud. Other physicians may innocently do this because they lack knowledge of secondary gain and/or symptom magnification. I try to stay away from this type as well as the hired gun physicians who do reap the financial benefits from insurance companies and are not objective either. The plaintiff attorneys coach their clients to drive up medical costs for increased settlement. All claims are greatly increased when pre-existing psychological conditions/disorders (i.e. depression, anger issues, borderline personality disorder) are present. There is a very significant direct cost to the taxpayer (i.e. federal workers' compensation cases,such as postal workers, shipyard workers, any civil service, etc.)and indirect cost, by our increased purchase costs due to the burden of risng insurance premiums which the company or individual must pay. Thus this affects all of us in a very direct way both monetarily and psychologically (decreased co-worker morale when they see a co-worker getting away with this, increased false claims, again because others see how easy it is for false claims, and anxiety caused by job loss when the company closes because they can no longer afford their premiums). I also think other factors color this situation as the general population's work ethic has spiraled downward while their sense of entitlement has sharply increased. This is the real world, not embellished opinion.

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!

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...?

I would rather prefer that those denying the science behind Dr Malleson's statements would declare their conflict of interests, as it is usually done in scientific papers. Maybe we could have a broader view about their opinions.

This is an extensive, wonderfully documented discussion of a spectrum of illness that effects a large part of our society (not just in the United States, but in most of the developed world). Malleson does a fine job of keeping it readable with a combination of incisive wit and piercing insight.

Apart from the issue of whiplash itself the author explores the effect of this spectrum of disease on the medical profession (my profession) and the effect of my profession on this spectrum of disease. His insights are clear and revealing.

Malleson further points out relationships between the healthcare system of the developed world and these "useful diseases". His insights and discussions in this regard are, once again, germain and well presented.

In the discussion as to what form of healthcare system we should develop in this country, the subject matter of this book is key.
If legeslators and healthcare planners are unaware of these relationships our healthcare system is doomed.

This book is appropriate reading for any healthcare professional, attorney, and anyone in the insurance business. Legeslators and others involved in healthcare planning should have this material as required reading. The concepts contained in this work are critical to the future of our healthcare system.

I recently borrowed this book from a colleague of mine. From my experience I believe this illusion of psychosocial sensitization prevents the patient from understanding the true causes. It becomes a sort "badge-of-honor." We need to quit allowing every person in America to believe they are messed up in their heads. I believe this is just poor doctoring.

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. Those who claim this book is "fair and balanced" probably would say the same about FoxNews. Those who site "cold water" and "real research" haven't read the research. These reviewers are probably also insurance representatives or insurance company defense lawyers weighing in. The nurse reviewer may have to deal with secondary gain issues (we all do in medicine), but the reality is that for whiplash injuries, it is a minor issue compared with the larger issue of real injury.

It is an all too common phenomenon for nurses, physicians and others in clinical medicine to turn to psychiatric issues like secondary gain when a lesion can't be found. Shame on those who revert to this age-old ploy! This is the same level of mentality that used to say low back pain was completely psychological before the days of MRI and better diagnostic techniques for LBP in general. Shame! The research is out there for those willing to read. You will not find it in this book, which uses the "if I can't find it, it must be psychological" mentality. Shallow.

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. When it comes to science, law students are most definitely laypersons. Science must play the defining role in whiplash injury litigation, not hearsay, anecdote, or public opinion.

The fact that juries are so skeptical means the auto insurance industry has the lay public right where it wants us. Think about it: the word "insurance" isn't even allowed in the courtroom in most states, since juries would realize that the elderly Mrs. Jones with no money who caused the collision isn't actually the one who has to pay damages to the crash victim. In court, the driver at fault can be made to look like the victim, and no one on the jury is supposed to know that the at-fault driver is protected by the insurance company, and that her lawyer is bought and paid for by her insurance company. The jury has the idea that most plaintiffs are simply out to get money, when in fact most whiplash victims simply want validation that their injuries are real, and their pain is not psychological.

While the research that currently exists on whiplash is unequivocal that the injuries are real and physical, Malleson appears to be stuck in the past, seeing the world through his insurance company goggles, and unwilling to present what the majority of current medical, engineering and clinical literature agrees on: whiplash is more of a physical injury than anything, and a verdict does not cure the pain. Whiplash patients continue to suffer after they receive their settlements. Their pain is not psychological; it simply cannot be found easily with current medical tests and imaging.

So-called "independent" medical examining physicians like Malleson cannot be held accountable for any gross lack of medical competence when performing exams for the auto insurance company they work for. An "independent" medical exam really isn't independent. The examination the patient is subjected to is not a medical proceeding. It's a legal one. If the doctor doesn't look for injury, or spends only 5-6 minutes with you, the patient, or is grossly negligent or incompetent, you as a patient have no recourse with the medical state board.

The reviewer who wants writers to claim conflict of interest ought to take note of Malleson's conflict-of-interest as a career insurance company doctor (the term "independent" is a lie, misleading at best, and is fortunately not allowed as a descriptor in some courts in the U.S. that understand the nature of the problem). Malleson is an insurance company representative, and we should not be fooled.

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. Of course, if we consider 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 others, that percentage is much higher. Therefore, we should not be as concerned as physicians with malingerers as we should be with the majority of truly injured persons.

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.

Assumptions such as the one posed by another reviewer 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. Again, that is what the auto insurance industry wants us to believe. But the medical research is very clear on the number and type of injuries that exist in auto crashes. I encourage readers to skip past this book and spend your money on books that review ALL the literature on the subject. Malleson has little more here than some very tired arguments that fail in light of the brilliant newer research on the topic of whiplash. I invite the jaded nurse to review ALL of the literature available in 2005 as well. Try searching "whiplash" and "central sensitivity", "alar ligaments", "ligamentous instability", "facet cartilage", "instantaneous axis of rotation", "cadaver studies", "transverse ligament", "atlanto-occipital ligament", "s-shaped", or many other search terms that will open your eyes.

Lastly, I invite everyone to volunteer for a rear-impact crash of delta V = 15-20 mph. Make sure to turn you head just before the crash, and wear headphones so you cannot brace for the crash. Wear you lap belt and shoulder harness. Try to be in a small car, even a 5-star rated one (it will be stiffer)! Get hit by a larger vehicle. Make sure your head restraint is in the down position with at least 6 inches between the back of your head and the head restraint. Oh, and lean forward a little with your torso twisted a bit. Hopefully, your seatback won't break; you'll "feel" the force of the collision more that way. Being female will help, and if you have arthritis already or a pre-existing neck condition, that's a bonus. Don't forget to call the nurse reviewer and Dr. Malleson to let them know you have no physical injury and that it's all in your head. Wait! If you have a concussion (the risk is 50% if the impact speed of your rear-end crash is 10 mph), it WILL be in your head! Never mind!