A dangerous curve: the role of history in America's scoliosis screening programs

Abstract

In 2004, the US Preventive Services Task Force called for an end to scoliosis screening in US public schools. However, screening endures, although most nations have ended their screening programs. Why? Explanations range from America's unique fee-for-service health care system and its encouragement of high-cost medical specialism to the nation's captivation with new surgeries and technologies. I highlight another, more historical, reason: the persistence of the belief that spinal curvature is a sign of a progressive disease or disability. Despite improved health and the mid-20th-century discovery of antibiotics and vaccines that all but eradicated the diseases historically associated with scoliosis (e.g., polio and tuberculosis), the health fears associated with spinal curvature never fully dissipated. Scoliosis is still seen as a "dangerous curve," although the exact nature of the health risk remains unclear.

Example of a posture wall chart produced and manufactured by the American Posture League. Source. “Posture Wall Charts,” R. Tait McKenzie Papers, Box 4, Folder 76. University of Pennsylvania Archives, Philadelphia.

1976 depiction of an Adams Forward Bend Test with a 12-year-old girl bending over with a health care professional looking on. Note. Many autobiographical accounts attest to the fact that teenage girls, in particular, found the Adams Forward Bend Test to be psychologically traumatic. In Off Kilter, Linda Wisniewski recounts undergoing the test in eighth grade, when her scoliosis was first detected. “I did the bend-over-from-the waste routine… . I wore no bra, only panties … I was self-conscious and embarrassed. My breasts were buds on my chest, my body in transition from girl to woman.” Linda Wisniewski, Off Kilter (Nashville, Tenn: Pearlsong Press, 2008). Source. John E. Lonstein, Robert B. Winter, John H. Moe, Anthony J. Bianco, Ronald G. Campbell, and Mildred A. Norval, “School Screening for the Early Detection of Spine Deformities: Progress and Pitfalls,” Minnesota Medicine 59 (1976): 51– 57.

One of Dr. John H. Moe's patients pictured wearing the Milwaukee brace. Source. Robert B. Winter and John H. Moe, “Idiopathic Scoliosis: Current Concepts in the Treatment,” Minnesota Medicine 55 (1972): 529–35.

Scoliosis pro-screening campaigns during the 1970s and 1980s—“The Dangerous Curve!” and the “Straight as an Arrow?” health messages. Source. Marie Balzer, Scoliosis: An Annotated Bibliography (Raleigh, NC: The Scoliosis Association, 1989), 26.

Scoliosis pro-screening campaigns during the 1970s and 1980s—“The Dangerous Curve!” and the “Straight as an Arrow?” health messages. Source. Marie Balzer, Scoliosis: An Annotated Bibliography (Raleigh, NC: The Scoliosis Association, 1989), 26.