The Whitcomb Technique: A Skeptical Look
Stephen Barrett, M.D.
Paul Whitcomb, D.C., who operated Fibromyalgia Relief Centers in South Lake Tahoe, California, claims to have discovered the cause of fibromyalgia and to have achieved great success in treating it. His Web site, which is no longer posted, contained video testimonials from more than 100 patients. In July 2009, the California Board of Chiropractic Examiners revoked his license after finding him guilty of (a) repeated acts of clearly excessive treatment, (b) multiple acts of gross negligence (c) repeated incompetence, (d) defective charting, (e) disseminating false and misleading statements for the purpose of inducing patients to use his services .
According to the clinic Web site:
- The primary cause is head or neck trauma that results in changes in the alignment between the base of the skull (occiput) and the topmost neck vertebra (atlas) that narrows when the opening at the base of the skull through which the spinal cord passes.
- This "pulls" the membranes (meninges) that surround the cord, which knocks the sympathetic nervous system" out of whack and results in symptoms that, together, are labeled as fibromyalgia.
- The Whitcomb Technique aims to reduce the subluxation that causes the symptoms. . . . by freeing up the neurological structures that are being encroached upon, thus allowing the brain and spinal cord to return to normal function.
- The typical three–times–a–week treatment the average chiropractic patient receives is not sufficient to accomplish this for Fibromyalgia patients. Two or three times a day over a period of eight to ten weeks (eight weeks usually works the best and is the standard for most patients).
- Patients experience 90 to 100% relief, follow-up care is not needed in most cases.
Whitcomb claims that the symptoms of fibromyalgia include insomnia, anxiety, fatigue, emotional instability, depression, irritability, nervousness, mild to severe body pain, headaches, irritable bowel syndrome, rashes, trigeminal neuralgia, calcium deposits under the skin, and communication problems. He further claims that all of the glands can be affected, and that "because the nervous system controls the body and can affect all the systems," a "whole galaxy" of other symptoms can occur. Whitcomb's treatment protocol involves 14 neck manipulations per week for 8-12 weeks, with three on Mondays, Wednesdays, and Fridays, two on Tuesdays and Thursdays, and one on Sundays. In 2008, the cost was $7,000 in advance for the first two months and $3,500 for each additional month.
Whitcomb's self-published book, Fibromyalgia: Finally Solving the Mystery, contains a table based on questionnaires completed by 15 patients who were asked to rate about 180 symptoms on a scale of 1 to 10 for frequency and intensity. The table contains numbers said to reflect each patient's the total scores upon arrival at the clinic and "at the date of their last report." No raw data, time frames, or criteria for patient selection are provided, which makes the numbers uninterpretable. Nor does the survey appear to reflect how patients felt after they return home.
The "Whitcomb Test"
Whitcomb's Web site also described a test for fibromyalgia that consisted of pressing on the back of the neck:
To test for Fibromyalgia (while lying on back) apply firm pressure to the back of the Atlas (just below the skull, on the upper back of the neck) pushing forward. This can produce a change in symptoms within seconds. About half of FMS patients will experience dizziness, nausea, numbness or some other increase in their symptoms. Sometimes this test will not increase symptoms but will relieve pain and other symptoms, depending on how the C-1 vertebra has moved. But any noticeable change is a positive finding for Fibromyalgia, whether the symptoms increase or decrease. This test is best performed by someone other than the patient.
Remember, this test is only accurate about 50% of the time, and like other orthopedic tests is not the last word, but when effective can be one more indicator that helps to confirm the diagnosis.
In other words, no matter what the test shows, you might (or still might) have fibromyalgia. I don't know of any medically recognized test that is considered positive if an intervention can make symptoms either better or worse. Nor do I see how a test that is only 50% accurate (no better than flipping a coin) can provide meaningful information.
Many former patients have complained that although they felt better during the period when Whitcomb was treating them, their symptoms returned full force within a few weeks after they left. The Fibro Friends Web site has posted critical reports from several such patients, some of whom say that they know of others who had the same experience [2,3]. Many critical comments have been posted to the Amazon Books Web site where Whitcomb's book, Fibromyalgia: Finally, Solving the Mystery, is sold. However, most of these comments were removed in response to a complaint (presumably from Whitcomb or his staff).
Susan Uribe, whom Whitcomb treated for two months in 2007, was initially satisfied with her results because she felt well when her activity level was low. In 2008, she persuaded Whitcomb to hire her to provide follow-up support after patients returned home—mainly by reminding them to restrict their activities. She also phoned patients who had been treated between 2005 and 2008 to determine how long their improvement lasted. She placed approximately 60 phone calls and found that a few felt fairly well provided they restricted their activity level. Most of the patients either did not return her phone call or were very upset because their symptoms had returned shortly after returning home.
After working at Whitman's call center for eight 8 days, Susan became very disillusioned, quit, and asked that her video testimonial be removed from Whitcomb's Web site. Despite two such requests, the video is still there .
In November 2008, ABC-TV aired an investigative report in which medical experts said that the cause and cure for fibromyalgia remain unknown and that Whitcomb's methods have no scientific support .
In November 2008, the California Board of Chiropractic Examiners accused Whitcomb of incompetence, gross negligence, and unprofessional conduct, based on his management of seven patients. The accusation states that he (a) administered excessive treatments, (b) failed to provide adequate structural examinations, (c) failed to develop treatment plans that were medically necessary, (d) failed to perform sufficiently detailed follow-up examinations to gauge patient progress, and (e) advertised with sensational statements that were intended to deceive the public. The number of neck manipulations ranged from 60 to 143 .
In June 2009, an administrative law judge concluded that revocation was appropriate. The report's section on "mitigation and rehabilitation" stated:
Respondent appears dedicated to relieving the suffering of fibromyalgia patients and feels that he holds the key to their recovery. Any mitigation from these noble feelings, though, is tempered by respondent's raging entrepreneurial spirit. He engaged in extensive and hyperbolic efforts to market his "discoveries;" he paid commissions to employees and former patients who brought in patients; he insisted that patients pay for treatments in advance and in cash; he charged patients $62.50 for each of multiple daily adjustments; he was reluctant and slow to return monies when patients left before completing their treatment; and he charged patients approximately $1,000 for a week of monitoring their conditions once he determined they were well. On balance, respondent’s devotion to relieving the suffering fibromyalgia patients does not mitigate his conduct. . . .
The factors that militate against granting a probationary license are the breadth of respondent's failures to abide by the standard of care, his hubris and zealotry, his inability to recognize that he has harmed patients and his contempt for these patients, his inability to recognize that his treatments have the potential to harm other patients and his inability to recognize the importance of routine responsibilities; such as appropriate charting. Essentially, respondent has indicated repeatedly, by word and conduct, that he has discovered a cure for fibromyalgia and that nothing should stand in the way of his disseminating information about this cure and profiting from his discoveries. It would be difficult, if not impossible, to fashion restrictions under a probationary license that would put these concerns to rest. Additionally, respondent has twice been disciplined: for failing to abide by board requirements to refrain from practicing with an expired license and for failing to accrue continuing education credits prior to license renewal. Although he characterizes these disciplines as minor, and not patient related, they demonstrate that respondent does not take his professional responsibilities seriously and is not likely to comply with probation .
On July 31, 2009, the Board accepted the judge's report and revoked Whitcomb's license, effective August 31, and ordered him to pay $23,502.50 for the cost of its investigation .
Whitcomb shut down his clinic and Web site shortly after the charges were filed against him. However, Daniel Brady, D.C., who worked for Whitman as an independent contractor, now operates the Tahoe-based Integrated Wellness Center and Spa, which offers a fibromyalgia treatment program that his Web site describes as "bar-none the most advanced in the country to help people who suffer from Fibromyalgia." The program includes "Neurological-Reseting Technique (NRT)," which Brady says he "pioneered and developed." Although the details have not been posted, NRT appears to be similar or identical to the Whitcomb technique. When testifying for Whitcomb at the administrative law judge's hearing, Brady acknowledged that Whitcomb's treatment plan was the same for all patients and was based on "an average of how patients respond."
Whitcomb is now associated with David Singer, D.C., a chiropractic practice-building consultant headquartered in Florida. Documents on the Florida Secretary of State's Web site indicate that (a) in March 2009, Singer registered Fibromyalgia Relief Centers of America LLC, listing himself as manager and Whitcomb as managing member and (b) in June 2009 the company name was changed to Neurologic Relief Centers LLC. For several months, months, Singer has been offering to teach chiropractors how to have a high-fee cash practice by learning how, "within minutes you could greatly reduce the symptoms of such serious diseases as peripheral neuropathy, fibromyalgia, Parkinson's, rheumatoid arthritis, MS, post stroke symptoms, lupus, RSD, migraines and many others." In November 2010, the NRC Web site said there were more than 225 NRC clinics in North America. The Web site also offered about 80 video testimonials, many of which were ported to Whitcomb;s Web site two years ago.
The Bottom Line
Whitcomb claimed that fibromyalgia is caused by misalignment of the topmost spinal bone and can be relieved in about 95% of cases with frequent neck adjustments. There is no scientific evidence to support his theories. As far as I can tell, he did not monitor patients after they returned home. Although many patients reported improvement, most experienced return of their symptoms within a few weeks. Because neck manipulation carries some risk of stroke , it is very foolish to undergo the procedure without strong evidence of benefit.
- Decision and order. In the matter of the accusation against Paul Whitcomb. California Board of Chiropractic Examiners, Case No. 2007-598, July 31, 2009.
- Stories from fibromyalgia patients of Dr. Paul Whitcomb. Fibro Friends Web site, accessed Nov 16, 2008.
- Burns D. Paul Whitcomb - Friend or foe? Fibro Friends Web site, accessed Nov 16, 2008.
- Uribe S. Telephone interview by Dr. Stephen Barrett, Nov 17, 2008.
- Chiropractor claims to cure fibromyalgia. ABC News, KGO-TV, San Francisco, Nov 2008.
- Accusation. In the matter of the accusation against Paul Whitcomb. California Board of Chiropractic Examiners, Case No. 2007-598, filed Nov 10, 2008.
- Sarli AE. Proposed decision. In the matter of the accusation against Paul Whitcomb. California Board of Chiropractic Examiners, Case No. 2007-598, June 26, 2009.
- Barrett S. Chiropractic's dirty secret: Neck manipulation and strokes. Quackwatch, July 31, 2008.
This article was revised on November 16, 2010.