The Curious Case of the Concussion Chiropractor
The Rhode Island Integrated Medicine clinic appears an unlikely spot for medical innovation. And yet people travel from distant places to get treatment here.
It’s a chiropractor’s office in a two-story white house located right off the highway from Providence, in the city of Cranston. The clinic’s neighbors are a half-dozen houses of similar height and siding but in lesser condition. At the nearest intersection are two churches, a gas station, and a boarded-up building alongside an empty lot scattered with trash.
The chiropractor is Victor Pedro, and he says he’s developed a unique and powerful method of treating brain disorders. This includes learning disabilities and neurological issues such as ADD, speech problems, Tourette’s syndrome, vertigo, migraines, concussions, and other forms of traumatic brain injury.
Pedro’s treatment doesn’t involve drugs, surgery, or even brain scans. Instead the chiropractor says he can “stabilize and repair brain function” by putting people through customized audio, visual, and movement exercises — like having them clap in time with a metronome or focus on a grid of squares on a computer screen. Pedro calls his method Cortical Integrative Therapy and says he’s used it to treat more than 1,000 people — both children and adults — since 2000. He claims people often improve during their first day with him.
Many psychiatrists and neuroscientists find it implausible that any single therapy could effectively address so many complex disorders that are notoriously hard to treat. These are medical problems that continue to stump the world’s top neuroscience institutions. Pedro’s method hasn’t been independently validated in peer-reviewed studies. Melissa Jenkins, a neuropsychologist who is an assistant professor at Brown University’s medical school, says that when she looked into Pedro’s work last summer, “all the red flags came up right away.” One thing that troubled her was the broadness of Pedro’s claims: “Pretty much anything that’s wrong with your brain is miraculously treated by these techniques?”
Instead of clinical trials, Pedro boasts glowing anecdotes on his website from people he has treated. A Major League Soccer player in Ohio and several high school athletes have gushed that Pedro lifted their debilitating post-concussion fogs. One young woman delivered a TEDx talk about the experience, marveling at his kindness and thoughtfulness. The entertainer Paula Abdul raved about how Pedro had helped her deal with a painful syndrome called reflex sympathetic dystrophy. “He’s doing GROUNDBREAKING WORK!” she tweeted in 2013.
Such testimonials have inspired key lawmakers in Rhode Island to send $1.9 million Pedro’s way since 2004. Some of it came in the form of grants, but most of it came in state Medicaid reimbursements beginning in 2015. The average cost of the treatments Pedro billed to the state was more than $3,000, although one recent invoice was for $6,000.
When Rhode Island’s 2020 state budget was proposed in June, another $1 million was earmarked for Cortical Integrative Therapy. That is, until a local journalist spotted it. When he and other journalists asked why an obscure treatment was getting a special dispensation, it quickly became clear that Pedro’s supporters in the legislature had overlooked big warnings.
The Providence Journal reported that lawmakers were requiring the state Medicaid program to shoulder the cost of Cortical Integrative Therapy even though a medical advisory committee had determined that it is “neither evidence-based nor focused on a well-defined disease entity or condition.” In 2017, the federal Centers for Medicare and Medicaid Services refused to fund a pilot program to test the cost-effectiveness of the therapy because it was “broadly described” and hadn’t gone through “standard clinical evaluation processes.” A private insurance provider told WPRI-TV that it had reimbursed the cost of Cortical Integrative Therapy on rare occasions but stopped because it “has not seen long-term effectiveness from this treatment.”
Jenkins, the Providence neuropsychologist, and 23 other neurologists, psychologists, and psychiatrists in Rhode Island signed an open letter urging the Rhode Island Legislature to instead spend the $1 million on programs that could “demonstrably benefit” people with brain disorders, “including lead exposure prevention, school meals, and the child care assistance program, all of which are facing cuts.” The funding for Pedro’s services was pulled before the budget passed.
Soon after, news broke that a federal grand jury had subpoenaed state records related to the chiropractor. The nature of the investigation isn’t clear; a spokesman for the U.S. Attorney’s Office in Providence would not comment when contacted by Elemental.
Regardless of how that case plays out, the tale of Victor Pedro and his brain program raises questions that matter far beyond Rhode Island. About three million people in the U.S. suffer concussions and other traumatic brain injuries every year, according to the Centers for Disease Control and Prevention. Mild concussions generally go away after a week or two of rest. But for many other people, a blow to the head sets off months or years of memory, sleep, and attention problems; anxiety, depression, and sensitivity to noise; dizziness, light-headedness, headaches, and neck pain. Physical therapies and pharmaceutical prescriptions sometimes help in these circumstances, but researchers are still trying to come up with what the National Institute of Neurological Disorders and Stroke calls “dependable and measurable” solutions.
Brain injuries remain poorly understood and lack reliable treatments, making them an easy target for alternative therapies cloaked in mumbo jumbo. So how can struggling people distinguish between legitimate experimentation and pseudoscience?
And why do some people insist Pedro’s therapy works?
Pedro used to let TV crews into his office to capture stories about people recovering from concussions under his care. But he hasn’t given interviews since last summer’s funding controversy. He did not respond to multiple messages seeking comment for this story.
Steve Ahlquist, an independent journalist, broke the news about the $1 million earmark for Cortical Integrative Therapy on his news site Uprise RI in June. He also pointed out that Pedro had donated $6,100 since 2003 to Rhode Island lawmakers, including powerful Democrats who funded Cortical Integrative Therapy over the objections of multiple governors. When Ahlquist approached Pedro for comment outside the chiropractor’s office, he asked if the funding was “some kind of quid pro quo” for those campaign donations.
“No,” Pedro said, before disappearing into the office. “You can look on our website and see the research that we do.”
It’s easy to see why Pedro’s website may appeal to people who are desperate for help with chronic conditions. In addition to testimonials from patients and their families, the site purports to offer eight “case studies” of the therapy in action.
But Pedro’s critics don’t find his material very meaningful. They say he’s only vaguely describing his methods and probably overstating what he is doing to people’s brains. “Maybe there’s some real science in there somewhere,” Jenkins says. “All pseudoscience starts that way.”
Take, for example, the eight case studies. While Pedro has built much of his reputation by seeing people with concussions, there isn’t a concussion case study available. And key details are absent even from the write-ups that do exist. Most of the text just describes the person’s diagnosed condition, including the history of when scientists first identified that particular disorder. When it comes to describing how he treats that condition — the part that would be especially useful for outside medical practitioners — Pedro offers hardly any information. In six of the eight cases, he provides just one sentence: “12-week Cortical Integrative Therapy program.” That’s followed by a short section on results, which are generally qualitative and subjective. For example: “At the conclusion of the 12-week treatment program, A.D. showed considerable gains in his ability to persevere in academic pursuits.”
The impact of Cortical Integrative Therapy, according to Pedro, differs from person to person. Pedro says he customizes a treatment plan for each patient after examining their eyes and other physical characteristics to determine — thanks to a “proprietary algorithm-based approach” — which spots in their brain are damaged. He then comes up with visual, auditory, and balance exercises that target those areas.
It’s true that eye movements and variations in pupil size can indicate some neurological problems, including traumatic brain injury. Factors other than brain damage can affect those eye measurements, too. So it’s not necessarily the case that every damaged portion of the brain can be pinpointed without an MRI or CT scan. But Pedro also says he’s initiating a more general kind of healing on the brain. In a summary he once provided to a neurology conference in Portugal, he said Cortical Integrative Therapy can “initiate neuronal resynchronization, restore hemispheric balance in functions, and drive neuronal plasticity so that long-term positive changes are implemented and maintained.” There’s no evidence to support that claim, however.
And while other concussion researchers also have experimented with having people do vision and balance exercises, Pedro implies his method is nearly a sure thing — not only for concussion but for a variety of brain problems as well. In one flyer, Pedro claimed an “84% success rate.” Who knows where that figure comes from, or what counts as success.
One of Pedro’s eight case studies sheds light on a possible origin of some of his methods. It’s a write-up of his work with a 14-year-old girl with Landau-Kleffner Syndrome, a severe neurological disorder. According to his report, this girl was reading at a kindergarten level before 12 weeks of Cortical Integrative Therapy. Afterward, it says, she had showed “overall improvement in her language, auditory, and motor skills.”
This report nearly matches one originally published in 2005 in the International Journal of Neuroscience by Pedro and Gerry Leisman, whose credentials are unclear and who now directs the National Institute for Brain and Rehabilitation Sciences at the University of Haifa, Israel. However, in that paper the method was called Hemispheric Integrative Therapy, and it had some additional details.
For four and a half hours a week, the girl was offered “optokinetic, visual, vestibular, olfactory, auditory, and somatosensory stimulation,” plus extensive “rhythmicity” training on a device called an Interactive Metronome. It has two sensors — one in a glove and another in a pad on the floor. While she listened to a metronome beat through headphones, she was instructed to clap her hands or tap a foot in time. The system measured the accuracy of her rhythm and guided her to improve it — all so as to strengthen “her ability to attend for extended periods without interruption by internal thought or extraneous distractions.” The Interactive Metronome appears to be a key part of Pedro’s therapeutic arsenal; a TV news report in 2013 showed one of his patients using this device as well.
Why did Pedro strip out this information and change “Hemispheric” to “Cortical” Integrative Therapy in the version that’s on his site? Leisman, the co-author, offered a clue. He told me that he has “no idea what Cortical Integrative Therapy is” because he hasn’t worked closely with Pedro. Back in 2005, he says, he merely analyzed data Pedro sent him and helped get the paper published. But, Leisman added, “there may be some relation” to the work of one of Leisman’s colleagues, a chiropractor named Robert Melillo.
Melillo is a founder of Brain Balance Achievement Centers, a chain of more than 100 franchises where children with learning disabilities and behavioral issues are given “physical exercises, nutritional guidance, and academic training,” as National Public Radio put it in an extensive profile last year. Because Melillo believes that much neurological dysfunction results from a lack of synchronization between the brain’s two hemispheres — which is a questionable premise — one of the exercises used in the centers involves “syncing actions with a computerized metronome.”
Melillo and Victor Pedro were classmates at New York Chiropractic College in the 1980s. Has Pedro dressed up Melillo’s ideas for a supposedly only-in-Rhode Island innovation? Melillo says he doesn’t know because he and Pedro haven’t spoken in at least 15 years. “Perhaps he has read one of my books,” Melillo told me, “but I can’t say.”
Brain scans indicate that placebos modulate activity in parts of the brain that are involved in generating such symptoms.
Neurologist Robert Cantu, a concussion specialist who has advised the NFL and co-founded the CTE Center at Boston University, recalls meeting Pedro several years ago. Based on what he heard at the time, Cantu thought Pedro’s ideas sounded potentially intriguing but urged him to get funding for rigorous controlled trials that would make it possible “to honestly see if these therapies work.” Cantu says he told Pedro that anecdotes from his patients aren’t convincing on their own because about one-third of people tend to have a positive response to any treatment just because of the placebo effect.
Cantu is referring to decades of evidence that sham surgeries, sugar pills, and other empty medical procedures all can activate the reward centers in our heads. The sense that help is on the way creates positive expectations and decreases anxiety. Sometimes this is true even when the person knows they are taking a placebo, probably because of the power of a positive interpersonal relationship between doctor and patient.
Pedro appears to be a master at that.
“He really listened to what I was saying, and he hadn’t given up on me,” said Cara Griffith, a former high school goalie who came to Pedro while deeply sick and depressed after two concussions, in a TEDx talk about the experience. Pedro was so kind and thoughtful that Griffith’s mother told ParentingNH magazine: “She even felt better after her evaluation.” Later, in between her sessions, Pedro would call or text Cara to check in.
Something similar stands out in the story of Cydney Menihan. In 1994, Menihan slipped on ice and hit her head. Over the following 24 years, she says she saw 27 medical specialists for help with dizziness, pain, fatigue, and other serious symptoms. Then she began visiting Pedro. “To hear him say, ‘I was thinking about your treatment last night’ made me speechless,” she says in a video Pedro released. “He was thinking about me, and how to make me feel better. This is what sets him so far above most of the health care providers that I have seen in the past 24 years.”
David K. Johnson is an athletic trainer in Connecticut who teaches coaches and athletes about concussions and began referring people to Pedro after observing his work. He told me Pedro gives patients time to express frustration and anger. He’s like a “good teacher,” Johnson says. “He has the interactions that we would like most of our doctors to have.”
I relayed these stories to Matthew Burke, a cognitive neurologist who is the director of the Traumatic Brain Injury Clinic at Sunnybrook Hospital in Toronto and an active researcher in a Harvard program studying the placebo effect. Burke was careful not to issue a verdict on Pedro from afar, and he cautioned that the neurological mechanisms of placebos are still being studied.
But he said that our “current understanding” is that placebos change the brain in ways that affect some conditions much more than others. They aren’t considered effective against infections and cancer, Burke says, but they do seem to work particularly well against pain, depression, and other post-concussion symptoms. Brain scans indicate that placebos modulate activity in parts of the brain that are involved in generating such symptoms. Then the onset of some relief can start a positive feedback loop, as patients start sleeping better or getting more exercise.
Some of Burke’s colleagues pointed out in a 2018 study in the Journal of Neurotrauma that placebos have performed remarkably well in clinical trials of pharmaceutical treatments for traumatic brain injury, known as TBI. In one study, fake pills reduced irritability for two-thirds of people with TBI. In another study, a placebo reduced cognitive impairment for nearly half of patients. “Placebo is not no treatment, but rather a series of psychological and neurobiological actions that deserve attention when considering TBI treatment,” the researchers wrote.
Burke points out another factor that could work in Pedro’s favor. Different people respond to different placebos. Some people will expect better results from an expensive treatment in a fancy office with a doctor in a lab coat. Other people, however, are disillusioned with mainstream medicine — especially people who have been in and out of doctor’s offices for years and have been told that there isn’t an easy way to address their insidious concussion symptoms.
For people in those situations, a chiropractor in a house in Cranston, Rhode Island — a man who is definitely not endorsed by the medical establishment — may have exactly the outsider credentials they need to restore their faith.
Pedro says he does an initial evaluation to determine whether his method can help a given patient. For the people he agrees to treat, something is finally going their way. “It was the first time in eight years that a doctor told me, ‘This is what’s wrong with you, and this is how we can fix it,’” a concussion patient from Pennsylvania, Tracy Yatsko, said in a TV news report in 2013.
The ethics of placebos are tricky. Jenkins, one of the doctors who signed the open letter protesting funding for Pedro, points out that $6,000 would be a “very expensive placebo,” especially when it’s taxpayer money. But as Burke notes, a high cost and the perception of innovation often generate the necessary expectation that a treatment will work.
Burke is eager for more research. Would “a fully transparent technique,” delivered by compassionate doctors who openly discuss the limits of their knowledge of what’s happening in the brain, generate some of the effects produced in Pedro’s office? The answer would be valuable when it comes to evaluating other treatments that might be promising for brain injuries, including stem cell injections, that have not yet been validated and thus are likely to be oversold to people.
It might seem that there’s little harm from people seeking out unproven treatments for themselves. But Bryan Jones, a neuroscientist at the University of Utah, says it’s especially dangerous to let claims about the brain go unchallenged, given that so many of its workings are still a mystery.
“Neuroscience is hard,” he says, and yet it’s common for humans to trust people who say they’ve got it figured out. Jones says that’s why organizations like the Food and Drug Administration, the National Institutes of Health, and the National Science Foundation were developed: “To get people who are versed in how to actually ask questions to establish some rules, some guideposts, and some barriers to prevent people from being exploited,” he says.
“There are things we want to believe, particularly when we’re hurting, particularly when we’re wounded or vulnerable and we’re willing to drop our guard a little bit,” he says. “But that’s why we have the scientific process.”