Whiplash, Koro, and Other Mythical Conditions
By JOSE PUJALTE JR., MD
 Mention "whiplash" and what comes to mind to most locals is a defunct 1980s dance group by that name. "Whiplash" was raved about in the short time that it existed.
Dr. Andrew Malleson raves about whiplash too, but he talks about the injury that is a "largely fabricated psychosocial" illness. This is the kind of worldwide chronic epidemic that allows "some medical and legal professionals [to] prey on the anxieties and greed of patients." In the United States, whiplash is estimated to cost $13 to $18 billion dollars a year.
Malleson knows from where he speaks. He is a psychiatric consultant to the Canadian Government's Occupational Health and Safety Agency. He is also a specialist in internal medicine and a psychiatrist with Toronto's University Health Network. He must be the proverbial "good man" who did something for evil not to succeed, or in the case of whiplash, for evil not to keep on succeeding. He must be a man with a mission, too, for he has a thick 527-page book to prove it.
What is Whiplash?
This is a subject that "remains clouded in confusion." It was an American orthopedic surgeon, Harold Crowe, who first described whiplash to relate to neck injury in 1928.
As it is generally understood, whiplash is the result of the head being violently jerked backwards and forwards by forces that can sufficiently damage the neck and brain, even without any direct blow. This mechanism is commonly satisfied in a rear-end car collision in which the driver or passengers emerge with painful necks.
A list of whiplash neck injuries appears endless in medical literature: "fracture of the vertebrae, rupture of the intervertebral discs, painful separation of the intervertebral discs from the vertebral end plate," and so on.
The problem, Malleson notes however, is that such injuries cannot be demonstrated. The symptoms of whiplash are, in fact, attributable only to "a musculoligamental sprain or strain of the neck." A sprain is a sprain is a sprain, in whatever part of the body. People sprain ankles and knees, shoulders, elbows, even wrists. A sprain is painful at the beginning but over time, muscles and ligaments recover and heal. The neck shouldn't be any different.
Whiplash has also mutated, much to new claimants' delight, to "chronic whiplash" which is more than six months of this presentation: "neck pain, headaches, memory and thinking problems, fatigue, anxiety, and depression." These are the kind of symptoms, one would say, that would delight lawyers or at least, the shysters among them, too.
WADS
To objectify whiplash, a Quebec Task Force on Whiplash-Associated Disorders was established. In 1995, the four-year study ended and whiplash was divided into the following grades:
" O = no complaints about neck; no physical signs
" I = neck complaints of pain, stiffness, or tenderness only; no physical signs
" II = neck complaints and musculoskeletal signs (limitation of movement and point tenderness)
" III = neck complaints and neurological signs
" IV = fracture and dislocation
The task force noted that majority of injuries were only Grades I to III. These were the injuries that required little treatment and recovered within days to weeks only.
Koro
This brings us to "koro," an imagined illness that struck Singapore in October of 1967. Koro is the imagined conviction that the penis is disappearing into the abdominal cavity.
An alarm was raised after a newspaper reported that eating pork from pigs inoculated with antiswine fever vaccine caused koro. Immediately, the Singapore General Hospital listed 97 cases of koro.
The government countered. An expert medical panel announced that koro was "the result of fear and not physical disease and that none of the victims seen then had come to any harm." Within a month, cases of koro disappeared.
To Malleson, koro fizzled out because "there was nothing in it for the professions." Unscrupulous doctors and lawyers could not make a killing. No insurance company or health maintenance organization would have found anything lucrative in it. This would be the complete opposite of whiplash where clinic visits and litigation can take years. What could be the price of one paid vacation can even balloon to the price of an early retirement-for plaintiffs, that is.
Other Illnesses
The author includes "useful illnesses" such as chronic fatigue syndrome, fibromyalgia, repetitive injury strain, and posttraumatic stress syndrome. Indeed, some health professionals would call these "wastebasket diagnoses." With the lack of concrete clinical findings, some doctors obfuscate. What better way than say something that he too doesn't understand?
In the end, Malleson comes across as a refreshing voice in the medical (and legal) wilderness. Some may read into him a necessary activism that positions him and his views as antiestablishment. However, he is a medical sleuth first and only a whistle-blower second. It's just too bad that whiplash may not go the way of koro. It might as well be that it is the good psychiatrist's advocacy that is mythical. Go ahead, ask your ambulance lawyer.
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