The Gary Null Show - 05.30.18

Medical Despotism, the AMA's and Wikipedia's Offensive Against Chiropractic

Richard Gale & Gary Null
Progressive Radio Network, May 30, 2018

"Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Proponents claim that such disorders affect general health via the nervous system, claims which are demonstrably false.... Its foundation is at odds with mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and "innate intelligence" that reject science." - Wikipedia

With tens of millions of Americans suffering from discomfort and chronic pain, particularly musculo-skeletal and lower back pain, it would seem reasonable to look for non-opiate therapies. One of the most popular websites to access quick information on health is Wikipedia. However, based upon Wikipedia editor's entries on Chiropractic and other modalities of natural health, it would be reasonable for a person with chronic pain to continue searching for relief and/or continue relying upon non-steroidal anti-inflammatory or opiate drugs. We are now certain about the life-threatening risks of opiates. So at a time when more people are dying from legal opiate use than from gunshots and automobile accidents, any proven, non-invasive and non-pharmacological approach can be lifesaving. Therefore, the accuracy of Wikipedia's editors needs to be seriously questioned as well as their motivations for posting gross unscientific misinformation. And this is why.

For over one-hundred years, conventional modern medicine has been antagonistic towards Chiropractic practice. We would have hoped that during that time that attitudes would have changed course and that chiropractors would finally receive recognition for the contribution they provide to the millions of patients receiving chiropractic treatment annually. Unfortunately, within the higher echelons of the medical establishment Chiropractic remains a target of ridicule. This pathos is most ardently expressed by the American Medical Association (AMA) and its internal divisions that support Chiropractic's and alternative medicine's enemies such as the network of Skeptic organizations and the followers of Science Based Medicine. And these prejudices are all parroted by Wikipedia.

Chiropractors have always faced fierce opposition by the conventional drug-based medical dynasty. Chiropractic's founder, Daniel David (DD) Palmer was jailed in 1907, as were hundreds of other chiropractors during the practice's early decades. Even in our own times, the AMA has labeled chiropractic as an "unscientific cult."

If one were to read the condemnations of DD Palmer, the impression would be given that spinal manipulation is a more recent form of therapy. However, Chiropractic’s origins predate the common era. Hippocrates in the third century BC wrote about treating scoliosis with a rather primitive spinal manipulation technique. In the 2nd century BC, the Roman surgeon Claudius Galen 's manuscripts included diagrams for properly manipulating the spine, and the great Muslim "doctor of doctors" Avicenna likewise recommended it for certain physical health conditions. Nor is treating musculoskeletal conditions manually limited to the West. The practice is found among the Balinese in Indonesia, Lomi-Lomi in Hawaii, and throughout the South Pacific islands. Captain Cook wrote in his diary of being treated through spinal manipulation by Tahitian healers. India, China and Japan, the shamans of Central Asia and the bone-setters of Nepal, Russia and Norway have manipulated the spine to eliminate pain and discomfort, malformations, relax muscles and treat maladies for centuries. In other words, the underlying principles of Chiropractic have been acknowledged and utilized as a viable therapy long before its founder.[1] [2]

Modern Chiropractic's successful reputation and growth tell a different story at odds with Wikipedia's fabrications. According to the American Chiropractic Association, there are over 77,000 chiropractic doctors practicing in the US today and 2,500 new graduates from the 20-plus leading chiropractic schools enter the workforce annualCarely.[3] The statistics for spinal manipulation therapy's popularity speaks for itself and should alone quell doubts about chiropractic’s' benefits. A joint Gallup-Palmer College poll in 2015 estimated that over 35 million people visit chiropractors.[4] The profession is a state-licensed healthcare discipline, with government accredited colleges, workers' compensation insurance and coverage by Medicare and Medicaid. Each of the 32 teams in the National Football League employ chiropractors for players' frequent back and neck problems as well as for overall conditioning.[5]

Chiropractors maintain that by manually manipulating the spinal column, they can relieve pressure on nerves, thus allowing the resumption of a normal flow of energy to the body or an afflicted organ. During the course of its development, chiropractors have systematized a regimen of hundreds of physical corrections which in turn provide relief for a host of ailments. The keyboard to the nervous system is the spine, which chiropractor Dr. Julius Dintenfass explained as "the most vital portion of the body... the axis formed by the brain, the spinal cord, and the vertebrae which support the body."[6]

Important to note is that Chiropractic medicine has never regarded itself as a replacement for drug-based medicine. Dr. Dintenfass continues, "Chiropractic does not treat the following conditions: cancer, coronary disease, diabetes, kidney disease, pneumonia. It doesn't deal with any of the conditions that develop a state of pathology (structural and functional changes caused by disease) which might be irreversible.... we refer these cases to a physician."[7]

Noted at the start of this article, Wikipedia states that Chiropractic's premise that "disorders [that] affect general health via the nervous system" are "demonstrably false," and that Chiropractic "ideas" are "pseudoscientific."[8] And listed under "Spinal Manipulation," Wikipedia reads "spinal manipulation was no more or less effective than other commonly used therapies such as pain medication, physical therapy, exercises, back school or the care given by a general practitioner. There is not sufficient data to establish the safety of spinal manipulations."[9]

Much of Wikipedia's erroneous claims are taken out of Skeptic textbooks, such as Eric Swanson's Skeptical Science and Society, a seriously flawed diatribe that regards anything outside of conventional medicine as quackery.[10] Swanson happens to be a professional physical astronomer, which evidently makes him a qualified expert among Skeptics to write about human biology and medicine.

The Skeptic community of Science-Based Medicine scientists promote the clinically unfounded belief that "in over a century, chiropractic research has produced no evidence to support the postulates of chiropractic theory and little evidence that chiropractic treatments provide objective benefits." If we ignore the numerous clinical cases of millions of people successfully treated by spinal manipulation, Skeptics might have sound argument; otherwise, their claims are unfounded at best. Nor do they rule out that the millions of cases where patients found relief is simply a matter of the placebo effect.[11] Dr. Harriet Hall, a contributor to the SBM website categorically denies Chiropractic is a science and defines it as a "cult." She refutes that it has any basis in neurology, anatomy and physiology. In fact, for Hall, it is a completely useless exercise: "There is no published evidence to support that idea [that Chiropractic improves health].... Despite enthusiastic claims, there is no evidence that preventative or maintenance adjustments do anyone any good." She does acknowledge "spinal manipulation therapy is effective for some kinds of low back pain," but claims "it is no more effective than other treatments"[12], ignoring large population studies showing the contrary. If she had followed the court case indicting the AMA for conspiracy (discussed below), she would recognize the scientific facts are unquestionably in Chiropractic's favor.

According to a 2017 study published in the Journal of the American Medical Association, which was once Chiropractic's most aggressive and formidable enemy and threat, spinal manipulation has been proven as the first line of treatment for acute back pain[13] and consumer surveys show chiropractic outperforms other back pain treatment modalities, including pharmaceutical drugs, massage, and yoga.[14] Back in 2007, 20 million adults and children saw a chiropractor within 12 months, hence there has been a substantial increase in chiropractic's invaluable role in its therapeutic treatments.

One of the Skeptics' pet arguments is that there is insufficient research in Chiropractic, particularly double-blind controlled studies, to warrant its legitimacy as a viable and vital form of medical intervention. This is an old argument the AMA has leveled against Chiropractic for decades. However, back in the 1970s when the AMA conducted a full frontal assault to eradicate Chiropractic, the US Congress' Office of Technology Assessment released a report that only 10-20 percent of approved therapies in the medical establishment had been shown to be effective in controlled trials. Therefore, upwards to 90% of conventional medicine at that time was “unfounded.”[15] We might think that the pharmaceutical industry has improved upon its past dismal record; however, with conventional medical protocols, pharmaceutical drugs and physician error now the third leading cause of death in the US, it is too much hope for.

One obstacle carrying the strongest controversies, not only by the Skeptics and opponents of Chiropractic, but within the chiropractic community itself, is the validity of the "chiropractic" or "vertebral" subluxation complex. The theory is simply: nerve impingement from a subluxated vertebra can shut off the vital nerve energy flowing through the central spinal channel to the periphery.[16] It is not the case that vertebral subluxation is always visible in an x-ray. Wikipedia calls vertebral subluxation as having "no biomedical basis, lacks clinical meaningfulness, and is categorized as pseudoscientific."[17] We are not arguing either for nor against the chiropractic's theory of subluxation. However, in our opinion, the debate is still open. Repeatedly, science is discovering new findings that before were hidden, and therefore cryptic, denied or never considered. One obstacle Chiropractic has faced for decades was a workable definition for vertebral subluxation that could make the theory testable. That definition has only come into fruition recently through the Australian Spinal Research Foundation. In 2016, 59 leaders, researchers and academics within the Chiropractic profession from nine countries conducted a 9-month global consultation project to redefine the term. It has been the case within the Chiropractic community that past definitions for "vertebral subluxation" were insufficient. They still carried old baggage from the past and were not adequate for explaining the successes chiropractics have had, especially during recent decades.[18]

Although Chiropractic is attempting to address its perceived weaknesses, particularly in its definition of terms that correspond with our postmodern understanding of neurology and spinal physiology, it is still regarded as broadly nonsensical by the Skeptics.

The AMA--the largest and most powerful organization speaking on behalf of the medical industry, physicians and drug-based medical treatments--has largely continued to view Chiropractic with suspicion, as nonsensical quackery. In 1965, the AMA institutionalized the position that Chiropractic medicine was in violation of medical ethics and allopathic doctors should distance themselves from any association with chiropractors. Physicians who trespassed this boundary could even lose hospital privileges. If doctors referred a patient to a chiropractor it could result in the loss of their medical licenses and practice. One reason has been the incessant anti-chiropractic lobbying of the AMA, which perceived it as a threat to its repressive medical regime.

As we will see, the AMA is a thoroughly corrupt institution with a history of engaging in illegal activities. Its mission for the entire 20th century has been to establish absolute control over the dissemination of medical and health information in the US. The AMA has always held a phobia towards anything outside its purview. At one time even Sears' catalog was targeted for persecution for having included alternative health remedies. In 1911, it published a text highly esteemed by Skeptics: the 500-page tome Nostrums and Quackery: Articles on the Nostrum of Evil and Quackery. This early 20th century text to help identify and root out medical heresies is what the Malleus Maleficarum, translated as the "hammer of witches," was for 15th century Inquisition Church interrogators and torturers to diagnose and exterminate witches and sorcerers. Skeptics’ paranoia about alternative medicine today is little different than Pope Innocent VII's mania about enchanters seducing the public and leading the population into sinfulness.

In 1986, the courts ruled that the AMA was implementing a conspiracy, a "systematic, long-term wrongdoing and long-term intent to destroy a licensed profession [eg. Chiropractic medicine]." It was discovered that both the American College of Surgeons and the American College of Radiology also participated in the AMA's seditious plot. Later, the judge ruling the case commented that the AMA's Committee on Quackery, founded in 1963 as a division of the AMA's 1906 Department of Investigation, was solely focused on destroying the chiropractic profession.[19] In a 1971 Committee memo to the AMA's board of trustees, it reads "your Committee has considered its prime mission to be first the containment of Chiropractic and ultimately the elimination of Chiropractic."[20]

The legal case involved the filing of five chiropractors, led by Chicago chiropractor Dr. Chester Wilk, against the AMA and ten other medical organizations for violating the Sherman Antitrust Act, with the intent to eliminate the chiropractic profession and establish a monopoly over everything that concerned the treating of disease and disorders. Among the plaintiff's claims were that 1) the AMA held a mission to contain and eliminate Chiropractic, 2) the organization colluded with other medical organizations to boycott chiropractors thereby marginalizing them from the healthcare industry and patients, 3) collusion with other private groups to bar chiropractors from access to hospitals, medical facilities and universities, 4) the AMA cherry-picked government research to discredit Chiropractic, and 5) colluded and abetted with insurance companies to deny chiropractic coverage. After four years of collecting hundreds of thousands of documents, the trial began in late 1980.

Fortunately, the published science was on the chiropractors' side. A California study of over 1,000 patient cases found that it took chiropractors half the time (15.6 days) to return the average injured work compared to the established medical profession, which took 32 days on average. Another study by the Oregon Workman's Compensation Board found that chiropractic got twice as many injured workers back on the job within a week as medical doctors.[21]

After the court's ruling, the presiding judge ordered, "a permanent injunction against the AMA, forcing them to print the court's findings in the Journal of the American Medical Association." Other defendants settled out of court, paying the chiropractors' legal fees and being forced to donate to Chiropractic non-profit homes for disabled children."[22] The AMA's subsequent attempts to overturn the decision in the US Courts of Appeals and the US Supreme Court failed. In fact, on four separate occasions Chiropractic has won legal battles against the AMA (1978, 1980, 1986 and 1990).

For the past 100 years, the AMA has had one single agenda: manipulate and brainwash the public to only place its trust in conventional licensed medical physicians.

During recent decades, the AMA increasingly functions as a private lobbying entity aligned with special private interests. It has returned to its origins as a bankers' project for the Rockefellers and Wall Street. In 2017, the organization spent $21.5 million lobbying legislators and over $347 million since 1998.[23] Consequently, healthcare has taken a back seat to profiting the pharmaceutical and insurance industries, shareholders and party politics. Physicians increasingly view the AMA as an opponent to their professional careers. In the 1950s, 75% of physicians held membership in the organization. Today it is less than 25%. Only a small fraction continue to pay AMA dues.[24] Doctors are also dropping their association and membership because the institution is progressively kowtowing to political legislators' demands by their constituents who fund their election campaigns. Nevertheless, the AMA claims it recognizes and supports over 190 medical organizations, mostly focused on specialized medical practices who do not endorse all of the AMA's policies.

But the AMA has always been more about politics than health and medicine. It opposed the inclusion of health insurance in the 1935 Social Security Act and became President Truman's arch enemy against his national health insurance plan in the 1940s. Later, it opposed the founding of Medicare and Medicaid in the 1960s.[25]

With the arrival of Trump, the AMA faced a new scandal infuriating the medical community by endorsing Trump's choice of Secretary of Health and Human Services, Tom Price, who is determined to trash Obamacare. Dr. Christian Pean, a surgeon at New York University Hospital and earlier an honored recipient of the AMA's leadership award stated that the organization's allegiance to corporate interests over patient care "felt like a slap in the face and many physicians aren't sure if the organization really stands for us any longer"[26] Over 5,500 physicians signed a petition accusing the AMA of disregarding patients’ needs.

Shortly after the creation of the Committee on Quackery, the AMA launched its Coordinating Conference on Health Information (CCHI), a secretive, covert organization that operated without institutional oversight or scrutiny, governmental or otherwise. The CCHI later gave birth to the National Council Against Health Fraud (NCHF), co-founded by Dr. Stephen Barrett, one of the saints of the Science-Based Medical community and one of Wikipedia's favorite sources for demonizing alternative medicine and natural health practitioners. This was all within the scope of the AMA, although Barrett and his supporters unanimously deny any association between Barrett, his Quackwatch and their witch hunts.[27] However, the CCHI was a far larger surreptitious operation that included the Federal Trade Commission, FDA, the US Postal Service, American Pharmaceutical Association, the IRS, the Attorney General's office, US Office of Consumer Affairs, and the Better Business Bureau. All were assigned the task to keep an eye and gather information about the practice and use of Chiropractic, acupuncture, homeopathy and naturopathy, vitamin therapies, non-conventional medical modalities, and books on alternative health released to the public and report back to the CCHI.[28] It is a well known fact that totalitarian, fascist and inquisitional institutions are obsessive about data collection as a suppressive weapon to target real and imagined threats. The AMA has also worked with the FDA and Pharmaceutical Advertising Council to feed false information to insurers such as Blue Cross/Blue Shield, Medicare, Aetna and others to black list doctors who may have provided patients with treatments outside the AMA's approval.[29] The AMA had even reached its tentacles to strangle Bill Clinton's failed Health Reform bill. Originally it had written into the bill penalties of up to $50,000 per offense to both doctors and patients who offered or took advantage of alternative medical treatments.[30]

Many books have been published exposing the AMA's legacy of corruption and criminal activities, including some classics such as Dr. Robert Mendelsohn's Confessions of a Medical Heretic, Dr. James Carter's Racketeering in Medicine, Joseph Lisa's The Assault on Medical Freedom, and Joseph Beasley's Betrayal of Health. Since then there has been a flurry of research, publications and books painting the conventional medical paradigm championed by the AMA as the nation's number one enemy to health and well-being. According to Lisa, who gained access to the AMA's Department of Investigation files at its headquarters in Chicago, the AMA has actively sought the creation of a "totalitarian medical pharmaceutical police state."[31]

Between 1924-1949, the AMA's leading publication was run by Morris Fishbein, an over-zealous propagandist who transformed the AMA from a toothless creature into a poisonous fanged beast of despotic bureacracy. While at the AMA's journal he was Chiropractic's most vicious opponent and credited with starting campaigns to suppress its practice, calling its doctors "rabid dogs" and "killers." As early as 1938, he was indicted along with the AMA for Sherman Anti-Trust violations.[32]

But on the darker side, as a paid consultant for the Lorillard Tobacco company, Fishbein was instrumental in coaching the tobacco industry to conduct junk science in order to show cigarettes' benefits and safety. As a racketeer, which he was later convicted of, Fishbein turned the AMA's journal into a solicitor of "protection fees"for manufacturers to receive the AMA's stamp of approval on products sold the public.[33] Yet there is a caveat to Fishbein, which puts him into a similar class with Quackwatch founder Stephen Barrett. Viewing themselves as exorcists to eradicate non-conventional practice, both men saw the medical world as a struggle between good medicine and evil cults practicing medicine without drugs. In 1927, Fishbein published his Encyclopedia of Cults and Quackery, his own version of the AMA's earlier Nostrums and Quackery. According to Kenny Ausubel, author of When Healing Becomes a Crime, during court cross-examination under oath, Fishbein failed anatomy in medical school, never completed his internship, nor ever practiced medicine a single day in his life before taking the helm at the AMA's journal. And yet Fishbein's definition of a quack, noted by Ausubel, was "one who pretends to medical skill he does not possess."[34]

Dr. James Carter, a professor at Tulane University's School of Public Health and Tropical Diseases, has written that Stephen Barrett's NCHF kept just enough of a distance from the AMA to give the perception of "lots of plausible deniability to the mother organization, the AMA, which gave birth to it."[35] The sole purpose of these shadow factions, including the Skeptic movement, is to assure the AMA monopoly and dominance over medicine and healthcare and to slowly whittle down and extinguish competing systems of healthcare. Nothing more and nothing less. Although the NCHF is largely inactive today, its mantle, or at least the NCHF's prime directive, has been take up by the cult of Science-Based Medicine.

Barrett received an award from the AMA, which is rather ironic because the guy never contributed anything constructive for the advancement of healthcare. He never invented a drug nor a new medical intervention. He was never recognized as a brilliant doctor or scientist who contributed to our understanding of disease.

Today, Science Based Medicine are the inheritors of the legacy left by the AMA's Committee on Quackery, the National Council on Health Fraud and Stephen Barrett's Quackwatch. The 2012 re-release of the Consumer Health: A Guide to Intelligent Decisions (for a bargain $147 if you have the patience to wade through this screed) as co-written by Barrett and Science Based Medicine advocates such as Harriet Hall, William London and Robert Baratz. Although there is no definitive evidence that Science Based Medicine's leaders collude with repressive organizations such as the AMA, the federal health agencies or the pharmaceutical industry, which they repeatedly deny, we cannot rule it out based upon their denials alone. Barrett's Quackwatch denied the same until the truth emerged in the courtroom. As for Science Based Medicine and the Skeptic organizations, we just need to find the smoking gun.

Ultimately what is not being given proper attention is the human cost when patients are denied honest, accurate and objective information about natural, non-toxic medical modalities, such as Chiropractic, that can relieve pain. Therefore, why are the Skeptics and anonymous editors trolling Wikipedia permitted to decide what is legitimate medical science when by every normal standard and common sense they are sorely prejudiced and biased.

NOTES
1 MCP Livingston. "The mystery and history of spinal manipulation." Can Fam Physician. 1981 Feb; 27(2): 300–302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2538670/
2 E Pettman. "A History of Manipulative Therapy" J Man Manip Ther. 2007; 15(3): 165–174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620/
3 "Key Facts About the Chiropractic Profession" American Chiropratic Association. https://www.acatoday.org/Patients/Why-Choose-Chiropractic/Key-Facts
4 Gallup-Palmer College of Chiropractic Annual Report: Americans' Perceptions of Chiropractic. Gallup and Palmer College of Chiropractic. http://bit.ly/2jrr7TG
5 "Chiropractors are used by all 32 National Football League teams" The Good Body. https://www.thegoodbody.com/chiropractic-statistics-facts/
6 Gary Null. "Chiropractic Health Care Without Drugs. Caveat Emptor.
7 Ibid.
8 Wikipedia. "Chiropractic," https://en.wikipedia.org/wiki/Chiropractic
9 Wikipedia. "Spinal Manipulation," https://en.wikipedia.org/wiki/SpinalManipulation
10 Eric Swanon. Science and Society: Understanding Scientific Methodology, Energy, Climate and Sustainability. Spring: New York, 2016
11 "Overview of Chiropractic" Science-Based Medicine. https://sciencebasedmedicine.org/reference/chiropractic/
12 Harriet Hall. "Science and Chiropractic" Science Based Medicine. March 11, 2008. https://sciencebasedmedicine.org/science-and-chiropractic/
13 Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., … Shekelle, P. G. (2017). Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA, 317(14), 1451–1460. https://doi.org/10.1001/jama.2017.3086
14 Consumer Reports Health Ratings Center. Back-Pain Treatments. ConsumerReports.org; July 2011.
15 Office of Technology Assessment. "Assessing the efficacy and safety of medical technologies." Publication No. 052003-00593-0. Government Printing Office, Washington DC, 1978
16 Frank Painter. "Review of the literature supporting a scientific basis for the chiropractic subluxation complex." J. Manipulative Physiol Therapy. 1985 (Sep); 8(3): 163-174, http://www.chiro.org/LINKS/ABSTRACTS/Review_of_the_Literature.shtml
17 Wikipedia. "Vertebral Subluxation." https://en.wikipedia.org/wiki/Vertebral_subluxation
18 "The Vertebral Subluxation: Conceptual Definition for Research and Practice." Australian Spinal Research Foundation. 2017. https://spinalresearch.com.au/wp-content/uploads/2017/06/The-Vertebral-Subluxation.pdf
19 "US Judge Finds Medical Group Conspired Against Chiropractors" New York Times. August 29, 1987. https://www.nytimes.com/1987/08/29/us/us-judge-finds-medical-group-conspired-against-chiropractors.html
20 "History of Quackery." Wellness Director of Minnesota. http://www.mnwelldir.org/printable/quackery.htm
21 Gary Null. "The War on Chiropractic" Penthouse. October 1985.
22 "American Medical Association" Open Secrets. Center for Responsive Politics. https://www.opensecrets.org/lobby/clientsum.php?id=D000000068&year=2017
23 Ibid.
24 Judith Graham. "Like a slap int he face: dissent roils the AMA, the nation's largest doctor's group. Stat News. December 22, 2016. https://www.statnews.com/2016/12/22/american-medical-association-divisions/
25 Ibid.
26 Ibid.
27 JP Carter. "If EDTA chelation therapy is so good, why is it not more widely accepted." Journal of Advancement of Medicine. Vol 2. 1/2, Spring/Summer 1989. pp 213-226
28 SourceWatch.org "American Medical Association." https://www.sourcewatch.org/index.php/American_Medical_Association
29 Ibid.
30 Townsend Letter for Doctors, November 1994.
31 Stephen Cooter. "Review of PJ Lisa's Assault on Medical Freedom." The Family News. Volume IV, No 1, pp 21-23
32 Wikipedia. "Morris Fishbein." https://en.wikipedia.org/wiki/Morris_Fishbein
33 M Adams. "What the American Medical Association hopes you never learn about its true history." Natural News. June 23, 2005. https://www.naturalnews.com/008845_American_Medical_Association_the_AMA.html
34 K Ausubel. When Healing Becomes a Crime. Healing Arts Press, 2000. p. 117.
35 "History of Quackery." Wellness Director of Minnesota. http://www.mnwelldir.org/printable/quackery.htm