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16 The Inverse Paradox and the Period of Meditation

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Whiplash and Other Useful Illnesses
This chapter is in the book Whiplash and Other Useful Illnesses
16The Inverse Paradox and the Period of MeditationAs long as people believe in absurdities they will continue to commit atrocities.– VoltaireMy computer typing-tutorial provides aphorisms as practice materialfor playing allegroon the keyboard. While my fingers still insist on play-ing lento,I have learned a lot of aphorisms, one of which is particular-ly germane to whiplash: “He who cries the loudest is often least hurt.”This paradox implying the inverse correlation between the severity ofthe initial injury and the severity of the subsequent complaints is wellrecognized, but it confuses the lay public and often physicians as well.1If someone appears in constant pain and distress and needs constanttreatment and a cane to get around with, then surely he must have suffered an injury. No matter that the accident was small and all thewondrous modern imaging techniques cannot find anything amiss.Failure to understand this paradox results in large awards being grant-ed for little injuries and inadequately small awards for large ones.When a person is visibly injured in a traffic accident, an ambulancearrives and takes the victims to hospital; there is little choice aboutwho goes. Lots of people have small collisions – gentle little taps inparking lots and small bumps at stoplights. After a quick reassurancethat their vehicle is neither dented nor scratched, and perhaps with aglare at the offending driver, most people drive off and get on withtheir lives. However, a few people, say xper cent of the population –either because they need to justify what they perceive as unacceptablesymptoms of psycho-social distress, or because they are simply out tomake an easy buck (or perhaps both), do not just drive off. They arethe small percentage of people who are on the constant lookout tocapture any fashionable illness that happens to be flybutteringby – asmall collision, and a whiplash injury is in the net. They opt to takethemselves off to the hospital or to their family doctors, sometimeseven visiting their lawyer first. Inevitably their symptoms are here tostay – symptoms that will soon develop into bigger and better ones.Healthcare Entrepreneurs in Search of Work222CH16.QXD 2/8/2002 8:44 AM Page 222
© McGill-Queen's University Press

16The Inverse Paradox and the Period of MeditationAs long as people believe in absurdities they will continue to commit atrocities.– VoltaireMy computer typing-tutorial provides aphorisms as practice materialfor playing allegroon the keyboard. While my fingers still insist on play-ing lento,I have learned a lot of aphorisms, one of which is particular-ly germane to whiplash: “He who cries the loudest is often least hurt.”This paradox implying the inverse correlation between the severity ofthe initial injury and the severity of the subsequent complaints is wellrecognized, but it confuses the lay public and often physicians as well.1If someone appears in constant pain and distress and needs constanttreatment and a cane to get around with, then surely he must have suffered an injury. No matter that the accident was small and all thewondrous modern imaging techniques cannot find anything amiss.Failure to understand this paradox results in large awards being grant-ed for little injuries and inadequately small awards for large ones.When a person is visibly injured in a traffic accident, an ambulancearrives and takes the victims to hospital; there is little choice aboutwho goes. Lots of people have small collisions – gentle little taps inparking lots and small bumps at stoplights. After a quick reassurancethat their vehicle is neither dented nor scratched, and perhaps with aglare at the offending driver, most people drive off and get on withtheir lives. However, a few people, say xper cent of the population –either because they need to justify what they perceive as unacceptablesymptoms of psycho-social distress, or because they are simply out tomake an easy buck (or perhaps both), do not just drive off. They arethe small percentage of people who are on the constant lookout tocapture any fashionable illness that happens to be flybutteringby – asmall collision, and a whiplash injury is in the net. They opt to takethemselves off to the hospital or to their family doctors, sometimeseven visiting their lawyer first. Inevitably their symptoms are here tostay – symptoms that will soon develop into bigger and better ones.Healthcare Entrepreneurs in Search of Work222CH16.QXD 2/8/2002 8:44 AM Page 222
© McGill-Queen's University Press

Chapters in this book

  1. Front Matter i
  2. Contents vii
  3. Acknowledgments ix
  4. Preface xi
  5. Healthcare Entrepreneurs in Search of Work 1
  6. Finessing Whiplash Into A Permanent Disability
  7. Making Whiplash Sound Serious: Caveat Lector 9
  8. Whiplash and Poor Science in Medical Journals 17
  9. Bumper Kisses and Whiplash Severity 30
  10. Sanitizing the Symptoms of Distress 43
  11. Copycats and Fashionable Illnesses 52
  12. The Quest For The Mythical Whiplash Injury
  13. The Enigmas of the Human Spine 77
  14. The Medico-legal and Psycho-social Spine 93
  15. Putting the Bite into Whiplash 102
  16. Whiplash Rescues Some ENT Surgeons 117
  17. Whiplash: Head Injury or Legal Headache? 129
  18. Accidents, Illness Behaviour, and Chronic Pain 151
  19. Fibromyalgia: A Tender Point? 165
  20. Fibromyalgia: A Case in Point 180
  21. Whiplash: An Eye to the Main Chance? 197
  22. Fraud And The Medical-Legal Quagmire
  23. Post-traumatic Turbulence 211
  24. The Inverse Paradox and the Period of Meditation 222
  25. Lawyers, Junk Science, and Chicanery 237
  26. Pain and Suffering: Calculating the Incalculable 253
  27. Jumpers and Add-ons; Slippers and Yankers 265
  28. Hysteria and the “M” Diagnosis 281
  29. “Cured by a Verdict?” 304
  30. Treating The Treatment
  31. Making Victims of Ourselves 317
  32. Treatment Exuberance and Serendipity 335
  33. Medical Decision-Making: Getting It Right 352
  34. Faith, Magic, and the Search for Alternative Care 359
  35. Medicine: “A Disabling Profession”? 369
  36. Cutting Healthcare Down to Size 379
  37. Appendices
  38. Appendix 1: Glossary Of Acronyms 387
  39. Appendix 2: The Use Of Prospective Studies And Rtcs 389
  40. Appendix 3: Evidence Against Residual Brain Injury Being The Cause Of Post-Concussion Syndrome After Minor Head Injury 391
  41. Appendix 4: Overvaluation Of Healthcare 394
  42. Notes 395
  43. References 455
  44. Figure Credits & Permissions 513
  45. Index 515
Readers are also interested in:
https://doi.org/10.1515/9780773569997-019

Chapters in this book

  1. Front Matter i
  2. Contents vii
  3. Acknowledgments ix
  4. Preface xi
  5. Healthcare Entrepreneurs in Search of Work 1
  6. Finessing Whiplash Into A Permanent Disability
  7. Making Whiplash Sound Serious: Caveat Lector 9
  8. Whiplash and Poor Science in Medical Journals 17
  9. Bumper Kisses and Whiplash Severity 30
  10. Sanitizing the Symptoms of Distress 43
  11. Copycats and Fashionable Illnesses 52
  12. The Quest For The Mythical Whiplash Injury
  13. The Enigmas of the Human Spine 77
  14. The Medico-legal and Psycho-social Spine 93
  15. Putting the Bite into Whiplash 102
  16. Whiplash Rescues Some ENT Surgeons 117
  17. Whiplash: Head Injury or Legal Headache? 129
  18. Accidents, Illness Behaviour, and Chronic Pain 151
  19. Fibromyalgia: A Tender Point? 165
  20. Fibromyalgia: A Case in Point 180
  21. Whiplash: An Eye to the Main Chance? 197
  22. Fraud And The Medical-Legal Quagmire
  23. Post-traumatic Turbulence 211
  24. The Inverse Paradox and the Period of Meditation 222
  25. Lawyers, Junk Science, and Chicanery 237
  26. Pain and Suffering: Calculating the Incalculable 253
  27. Jumpers and Add-ons; Slippers and Yankers 265
  28. Hysteria and the “M” Diagnosis 281
  29. “Cured by a Verdict?” 304
  30. Treating The Treatment
  31. Making Victims of Ourselves 317
  32. Treatment Exuberance and Serendipity 335
  33. Medical Decision-Making: Getting It Right 352
  34. Faith, Magic, and the Search for Alternative Care 359
  35. Medicine: “A Disabling Profession”? 369
  36. Cutting Healthcare Down to Size 379
  37. Appendices
  38. Appendix 1: Glossary Of Acronyms 387
  39. Appendix 2: The Use Of Prospective Studies And Rtcs 389
  40. Appendix 3: Evidence Against Residual Brain Injury Being The Cause Of Post-Concussion Syndrome After Minor Head Injury 391
  41. Appendix 4: Overvaluation Of Healthcare 394
  42. Notes 395
  43. References 455
  44. Figure Credits & Permissions 513
  45. Index 515
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