H aving written on this topic so often as to make my redundancies redundant. I at least wanted a fresh, provocative title to start. My father would often say after watching a commercial for the newest gadget. "Old scams for new eyes." Such a phrase comes to my mind regarding expensive decompression systems. The hyperbolic gibberish they use certainly suggests they believe many in the audience to be very gullible (as I once was as well). Those who have not been traveling on this road for nearly 20 years as I have arc certainly potential new and gullible eyes for marketers paw ning expensive traction tables as "dramatically superior technology." "technologically advanced." and "light years ahead" of mere traction tables. I always wonder who makes the decision to advertise to 60,000 professionally trained doctors with such ludicrous overstatements and unsupportable rhetoric. Typically, such nonsense is the exclusive territory of politicians and hair loss products. The reason I choose the $25,000 price tag is simple: Up to that point one can at least imagine some rationalization for the price ... perhaps higher production costs, engineering, more lucrative sales commissions, and so on. Above that price, however, the unctuous rhetoric and falsifications must begin to manifest because dozens of manufacturers have figured out how to make a substantial profit with a price-point well below that (and still be made in America). Above the $25,000 price ceiling. "Decompression" invariably ceases to be "traction" ... it takes on a wholly other incarnation where the "advanced technology" and ultracxpensive "servomotors" and like contrivances start to appear. Such headlines as Medical Technology Saves Chiropractic should have made us all shudder and recoil: instead, it led to the sale of over $20 million worth of $ 100.000 supine-only traction tables (DRX9000). On the upside, it did give eBay a whole new category: used spinal decompression systems. I know eleven doctors who have had to file bankruptcy because of the crushing burden of purchasing a piece of equipment that was ten to fifteen times more expensive than competitive traction tables. (A 7-scrics BMW would have made them look selfish and frivolous but would have avoided being branded as ridiculously gullible.) So why in 2013 are articles still necessary to help dissuade DCs from making untenable purchases of wildly overpriced traction (decompression) tables? I dunno is the simple answer. My degrees are in philosophy and biology not psychology, and I suspect psychology has much to do with it ... perhaps with the doctors" relatively limited worldvicw. ignorance of countermanding facts and research, or perhaps an unshakable (though misplaced) faith in human honesty. Lets look at the research and some personal experience again. I purchased a VAX-D in 1995 with an MD I was in practice with. We hired a PT shortly thereafter and had little reason to doubt our $ 125.000 purchase until about a year later. Though the PT was well trained he was a virtual tyro in regard to traction therapy. He had his suspicions, though, as to the underlying mechanism of action of the VAX. but we didn't share his skepticism until after a clandestine audit from some insurance carriers and Medicare. Also in 1996 the FDA began "dismantling" the advertising schemes VAT-tech was using involving unsupportablc and false claims. All of our marketing documents. VAX booklets, etc.. were usurped by the FDA and replaced with ultimately more tame documents. Contemporaneous was a six-figure payback (for inappropriate billing of an experimental procedure ... billing methods given us by VAX-D representatives). The Medicare auditors, though superficially sympathetic to our dilemma (they pointed out "we know we're asking fora lot of money back"), were ultimately incredulous as to what we were thinking to buy a $ 100.000 traction table. Our answer wasn't quick to come, especially because three months prior to signing our lease we met with a PT in Pittsburgh (the second individual in the United States to have purchased the VAX-D). The PT was "embarrassed"" to tell us he paid $50,000 (two years earlier) until we revealed what we were about to pay. He told us it was used occasionally but always as part of a total treatment plan, virtually never as a stand-alone therapy (the exact opposite of the official VAX-D information). So. given this unbiased and contemporaneous information (and warning), what did we do? We bought one. of course, for $125,000 ninety days later. (I only tell people I"m intelligent ... I've never had to prove it.) Next, we started consulting a very famous MD (physiatrist) who unsynipathctically called a spade a spade: "Congratulations, you boys paid $ 125.000 fora $10,000 prone-only traction table." or words to that effect. So a year later we inexplicably purchased a slightly used DRS (supine-only), a Lordcx system, a $9,500 "traction table and motor." and began diligently comparing them (because the VAX-D was on a closed-end five-year lease, selling it was extremely problematic). Yikes was our initial reaction when we compared the outcomes of sixty consecutive patients over three months. Double yikes if you eliminate the dyslogistic(s). You can believe me or not (I really have no reason to lie), but the results were identical, that is. the VAX or DRS had no discernible benefit over same-protocol/paramcters created on the "traction" machine. We submitted this information to VAT-tech (VAX-D) and perhaps not surprisingly it was completely ignored. Keep in mind the published trials on Decompression systems arc purposeful obfuscation ... they intend to exploit the (often) lack of clear benefit "traction" research has produced. By utilizing a more thoughtful, codified, and long-term approach. Decompression has often improved on traction's somewhat mercurial results (though they are the same treatment). They also exploit the natural human emotion of hoping there is truly a miraculous intervention. They create the illusion that their decompression-technology can trump traction ... but there is always a gaping hole in this theory: the mechanism of action of decompression (versus traction) must eventually be illuminated, and that is the spurious phenomenon called muscle-guarding ... which is simply untrue. Additionally, the equipment is always FDA classified as mechanical traction: "decompression, that is unloading due to distraction and positioning" as well as. "traction achieves its effects through decompression of spinal structures." So a traction machine becomes decompression via marketing prestidigitation so to speak. This was unarguably the case with the original DRS and the Shcalcy ct al.. study in 1997. The table was a split Henley traction table, and the motor (at least in mine) was a Tru-trac 401 ... unmodified in any appreciable way from the $ 1.500 unit available anywhere traction motors were sold. Magically, as it were, these traction components (and a metal-framed tower) morphed into a "highly" successful decompression system. Most magical was that these two components had to be sold to DCs at the exact same price as the VAX-D: $125,000. (Amazingly. Ford and GM have produced thousands of verisimilar cars over the last 75 years, but to my recollection none of them have been exactly the same price!) And of course the DRS (sharing the same marketers) also used the same rhetoric and advertising claims: "Decompression is not to be confused with traction." Of course, the VAX-D would have none of this and claimed exclusive ownersliip of the patented "decompression technology." And law suits began ... What has always interested me as I"vc studied traction research is this: How much arc a few extra "good to excellent" percentage results really worth to a sole practitioner? That is if a $40,000 to $140,000 "decompression" system could in fact show a 5% to 15% improved outcome response (which they can't) versus a $10,000 to $12,000 system, could that actually be rationalized as a reasonable business expense? Theoretically, in highly competitive markets, this benefit may well create a market edge as a 5% to 15% bump in clientele would invariably bring in more patients than the less-successful clinics. The problem is twofold, however: There is no such outcome edge and any edge that may exist is easily rectified via improved "technique" (both in patient education and physical traction parameters) and. of course, by adding other therapeutic modalities. Thus, when less-expensive systems move into "true Decompression systems" territory, they invariably defeat the hyperbole with equal outcomes and reduced patient treatment costs. This is a readily seen phenomenon everywhere in the U.S. market. Over 60% of purchases from the leading lcss-cxpcnsivc systems arc second (or third) tables, which is hardly possible if so few excellent outcomes were being generated. Having now done a traction seminar one to two times a month for eleven years. I can tell you with certainty that hundreds (if not thousands) of clinics replacing "true Decompression systems" costing $40,000 to $140,000 with $10,000 to $12,000 systems do not show any less positive results. (Many have told us they'll simply keep using their expensive system until eBay tells them they have a buyer for it ... which gets more unlikely every year.) In deference to Shealy et al.. their suggestion that housing a Tru-Trac 401 traction motor in a tower improves outcomes is simply implausible. What isn't implausible is the recognition that there are traction protocols and. more accurately, utilitarian parameters and features that better codify, streamline. and effectuate axial traction application. Both Dyer (VAX-D) and Shealy (DRS) pointed out these features in their trials ... though they doggedly continued to perpetuate their magic-machine hyperbole and inexplicable insistence on cither prone or supine positioning. VAX-D recognized that prone, intermittent traction without a restrictive thoracic restraint had benefits: DRS recognized that semi-fowler position and rope angula-tion may have benefits. Most dogmatically (and suspiciously) is that neither thought enough of the suffering patient to incorporate both (perhaps thinking if they did they'd have to charge $250,000(7)). When all the data are synthesized and digested (even in these biased studies) there is still only a less-than 20% improvement versus so-called traction (setting aside statistical manipulation and author bias). Now it is readily apparent to those creating these studies that a 10% to 15% improvement from a table costing $100,000 more would be impossible to justify to the average buyer ... thus they added their all-or-nothing rhetoric. They tell us that Decompression systems "work" ... traction doesn't, or can't ... end of story. As my grandfather would say. "If you're going to go over the falls do it in your underwear." So. as a profession, where do we go from here in regard to traction versus decompression? Should we support colleges that perpetuate these untenable claims from manufactured? Should we support those who perpetuate magic-machine nonsense instead of teaching real clinical protocols and skills as necessitated by clinically viable concepts: directional preference: form/force closure: instability: and so forth? Should we ask why the low back epidemic persists in the face of a magic-machine with a more than 92% success rate, or why the FDA simply doesn't buy any of it? Or should we adopt a rational and professional attitude that enough-is-cnough and begin to call out those who refuse to get out from the shadows of rhetoric and hyperbole ... making claims that arc not only unsubstantiated but damaging to our profession and our patients? I dunno.... Dr. Kennedy has developed, tested and taught an effective, easy to learn decompression therapy technique. His protocols have been taught to over 4,500 chiropractors and physical therapists. In over 20 years of practice, he has owned and operated most of the decompression therapy equipment offered by a range of manufacturers. This has afforded him the position of having done 100 s of cross-comparison treatments with these units. He believes that it is imperative to "put the doctor into decompression therapy. " This is the major reason for offering this technique certification course, to focus on skills, information, and awareness. The Seminars have been approved for continuing education through Logan C hllege ofChiropractic in various slates.
