Onus on medical profession to stop supporting myth of whiplash

Whiplash is one of a family of disorders which the medical profession created in the second half of the 20th century. The scientific or pathological evidence for the existence of any of these conditions is poor. But labelling people as suffering from whiplash or soft tissue injury provides them with secondary gain in the form of cash from compensation claims.

Whiplash helps to provide a good living for a large number of professional people. Among their number are physicians from many specialities, physiotherapists, chiropractors, osteopaths, spinal surgeons, dentists, psychiatrists, psychologists and, of course, lawyers. Whiplash in some affluent countries is big business, a multibillion dollar gravy train for the medical profession, victims and lawyers.

Curiously, Lithuanians, Greeks and demolition derby drivers appear to be immune to whiplash and recover from rear-end shunts and other minor road traffic accidents in a few days or weeks.

In Lithuania, a Norwegian neurologist set up two studies of crash victims after discovering there was no epidemic of compensation claims after vehicle collisions there, unlike in Norway. He showed that Lithuanians had no awareness that whiplash could cause chronic pain and disability. Collision victims were simply not claiming compensation for neck and back pain precipitated by road traffic incidents. Chronic whiplash syndrome did not exist there. Doctors, insurance companies and lawyers did not acknowledge its existence.

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In his first study none of 202 subjects involved in a rear-end shunt one to three years earlier had pain that could be linked to the collision. Thirty-one recalled acute neck pain. In 29 of them it lasted a week or less, while the remaining two had pain which lasted more than a month.

There were no differences between the 202 victims and a control group on symptoms such as neck pain, headache and cognitive dysfunction – which are all, seemingly, frequently caused by rear-end shunts in Ireland.

His second study, a prospective one, found that 47 per cent of 200 rear-end shunt victims had initial pain. The symptoms mainly disappeared in a few days and no one reported collision-associated pain three weeks later. After one year there was no difference in the incidence of headache or neck pain between collision victims and a control group.

Secondary gain

In Greece, 96 per cent of 130 people who had had a rear-end shunt recovered fully in four weeks ; the remainder recovered within three months. Greeks and Lithuanians had no expectation of secondary gain from whiplash.

Forty demolition derby drivers in North America who had taken part in an average of 30 events, with an average of 52 collisions per event, were interviewed in detail. Just two drivers reported that their worst episode of post-participation neck pain had lasted more than three months and in one it lasted more than a year.

Thirty-seven out of 40 reported no chronic neck pain at all, but a majority had had at least one bad episode of neck pain after an event, on average lasting less than three weeks. These guys had had an average of 1,500 collisions each over a couple of years.

In Ireland motor insurance premiums rose by an average of 32 per cent in the 12 months to March 2016. Neck, back and whiplash injuries account for over 80 per cent of all motor injury claims here.

The Irish boss of AIG (the world's biggest insurer) pointed out that the average cost of motor insurance in France and Germany is less than €500 compared to €700 in Ireland and €600 in the UK. The average award for injury claims here is €15,000 compared with €2,000 to €3,000 in France and Germany or €5,000 to €6,000 in the UK.

Irish spines seem to be more fragile than those of our European neighbours.

Since 2004, all contested injury claims must go through the Injuries Board, although 40 per cent of these awards are appealed to the courts. Legal fees then account for 46 per cent of all claim costs.

The Injuries Board has a Book of Quantum applied to whiplash claims. “Minor whiplash” is worth up to €14,400. “Moderate whiplash” (substantially recovered within 24 months) is worth €11,500 to €17,400. Severe, serious and permanent whiplash injuries will receive €59,000 to €78,000.

Non-existent

If we believe the Lithuanian studies, all whiplash is minor. Moderate or permanent whiplash is simply non-existent.

A tiny proportion of collision victims may sustain a slipped disc in the spine as a result of their jolting injury, but the two Lithuanian studies found no long-term sufferers among their subjects, suggesting that slipped discs occur in fewer than one in 400 cases.

The whipping boys who are held responsible for this state of affairs are the lawyers. We accuse them of encouraging the public to make dishonest claims, particularly because both solicitor and barrister numbers have doubled in the past 20 years.

But there are others equally or more to blame. The motor insurance industry often seems to be colluding in the rise and rise of compensation culture. The logical response to the huge increase in compensation claims after collisions should be the funding of high-powered studies to prove that chronic whiplash syndrome does not exist. No moves have been made in this direction to my knowledge.

The insurers are also guilty of making unsolicited offers of compensation for whiplash before any medical examination records have been provided. It is cheaper to offer small sums to settle claims rather than face long legal battles.

Which brings me to those most responsible for the smooth operation of the whiplash gravy train: the medical professionals who write the reports detailing the mainly non-existent injuries.

Moving with the herd

In my first 20 years as a consultant I wrote many reports which were economical with the truth – the truth being that there was very little wrong with the vast majority of compensation claimants that I saw. I was moving with the herd.

But then in 2010 I read a superb book, Whiplash and Other Useful Illnesses, by Dr Andrew Malleson, published in 2003. It was the big game-changer for me. He blew away the fog of mystery surrounding these soft-tissue injuries and chronic whiplash syndromes.

I suddenly realised that the emperor had no clothes, and that whiplash and soft-tissue injury is a myth. I was almost 40 years in medicine before I appreciated this.

Like many doctors before me, I was not good at remaining vigilant. As a profession we ask too few questions, and too often follow the herd in our thinking.

Dr Charlie Marks is a retired neurosurgeon and lecturer in surgery in University College Cork