The Works Not Done!

Randall Hammett, DC

INTRODUCTION

At a recent family gathering at my home, some nephews and nieces were playing around the house, one of them brought me a paper--I wish you could have seen it. It was written by an 11 year old girl. On the top of the paper, it read Medical Form, then first name, last name, reason: it said my thought is that I can’t talk because I have a cold. Time in and time out, doctors recommended medicine for head and neck aches is Advil. Then it said healthy or not healthy and next to it said okay.

The Prescription

Now I wish I could’ve shown you this 2x4 piece of paper because it was written out like a prescription. This 11-year-old's mother and father are not doctors, and when I asked her what this was about, she said that this is what doctors do when you have a cold, they write down which route to follow with your name. Then, they give you some pills that make you feel better and this is how it looks when it is written out and given to you!

The Real Fight

You see with all the battling from within and without of chiropractic a lot of us begin to lose sight of what BJ Palmer DC said so many years ago. That we are all born into a medical medicine bottle and we all learn from seeing what others do and how they react when it comes to healthcare. The mission of chiropractic is much more than removing subluxation; although that is a major job. The real fight with the chiropractic profession and the world is to educate our public on what they thought they have been educated on. The powers of the control of media, the public idea and what healthcare is, this is now stronger than the one BJ Palmer lived in.

Even with our own profession there are those who think that we need to prescribe drugs to help the body heal itself. I know for me it is getting harder and harder after 30 years of private practice to continually try to reeducate patients about the truth and facts of health and what they can do to sustain it. But, it is a fight worth fighting for, even if you have just saved one life, extended one life, and prevented future disease and systems from affects of drugs and surgery. Then you can call yourself a chiropractic excavation point.

The Danger

All the therapies, medication, and surgeries in the world do not get people well. If you really want to help someone in your community and the world you have to go about it in a different way. In my 30 years of practice I’ve seen the chiropractic profession become more conservative over time, more leery of examining boards, attorneys and the public opinion. The chiropractic profession has spent the last 50 years trying to make itself respectable in the eyes of the medical community and the public. This is an admirable goal, but is fraught with danger.

The danger is losing the identity of chiropractic and the promise that it holds to help the sick and the dying world. If history teaches us anything, it is the radicals, the dreamers and the ones who step outside the box and into the parameters of chiropractic that will tell the world what we really do and how we do it. If this profession is to survive and to thrive it must become united, it must have a basic understanding and agreement of what chiropractic is and is not. It must be written into law and enforced by legislative bodies to hold the chiropractic profession accountable for its own rules. There always will be those within the profession that will do odd things, especially in times of financial or economic chaos.

SUMMARY

The chiropractic profession has survived by telling the truth about healthcare, by working outside of the medical mainstream of third-party insurance interference, and unethical chiropractors whose review from insurance companies only allows eight visits to correct a retro lordotic cervical spine. It is a balance that you must tread each day, but understand in the end it is your patient that holds you accountable and not the insurance industry, the medical profession and not even your peers. It is your patients and their understanding of what you do and why you do it, what’s in it for them and this ultimately, controls their destiny and that of our profession.

So, the next adjustment you perform, the next life that you enhance or that you save may very well be your own, and that of your profession. Till next time.

Motivation or Business Systems?

Vince Covino

Legacy Consulting

Boise, ID

vince@SuccedwithLegacy.com

Mr. Vince Covino is a Chiropractic Consultant with Legacy Consulting, they currently work with 200 doctors in 37 states creating personal and financial success. Note: Investment advisory services provided by Prospera Financial Services, Inc. an SEC registered investment advisor.

INTRODUCTION

The majority of chiropractors have at one time or another attended a chiropractic seminar, but have never attended business seminars that are frequently held for dentists or physicians. At these events, no one is preaching to fill more cavities, nor will you hear anyone ranting on the need to perform more root canals. Instead you would hear detailed advice on how to develop an efficient and effective business model by thinking and acting like a business owner. The sad irony is that most chiropractors would benefit more by attending business “boot camp” than just another traditional trade seminar.

If you have been to the variety of chiropractic conventions like I have, you've probably witnessed (at least once) a parade of overly-enthusiastic motivational coaches. The rally cry of such presentations is that you simply need to see more patients. Ostensibly saving more lives which requires putting in longer hours, in essence, work harder and you might make more money. In the end these “rocky moments” can be very inspirational, but the inspiration eventually tends to wane and soon dies out when faced with the rigors of the day leaving you to reflect, wondering why things haven’t improved the way the presenter passionately described.

Work Smarter not Harder

The fact is that working harder does not always equal better results. For example, you could put all the electricity you want to a lamp with a burned out bulb and not get any light. If the system itself is impaired, it may in fact take more and more energy to get the same results, or may even lead to diminished results. You have heard the old adage “work smarter not harder”, but what does that really mean? It’s a fact of life that unskilled labor generates less capital for the organization than skilled labor. Why is the person on the line paid less than the person running the organization? It’s not because she is expending anymore energy, it is because she knows how to use the energy proficiently in a systematized way, so that all the effort put into work at the end of the day actually creates the desired outcome. Granted this is basic, but when a system (or office) is poorly organized, more labor has to be invested and more energy consumed just to sustain it. The outcome in this scenario is frequently organizational inefficiency and decline.

Motivation vs. Business Systems

Not recognizing the need for office systems, many chiropractors find themselves perpetually trying to motivate their staff. As you well know, this effort is seldom effective and short lived at best. The obvious solution therefore, is to hire motivated staff, easier said than done I realize. Hiring self-motivated people into an office that has structure, accountability and measurement (key performance indicators) is the foundation for any successful practice. A motivated staff is then taught to work on recognizing duty prioritization within the workflow of your practice. These focused efforts allow staff to be effective in their roles and is in it-self a motivator as they see themselves accomplishing tasks on a daily basis. Real inspiration and motivation then result; both are essential to vibrant practice.

They know that empowering themselves to do better business, taking care of themselves and their families, actually frees them to not only offer the best service to their patients, but to do more good for the wellness of their communities.

SUMMARY

Chiropractors can take a page from dentists, doctors and other professionals that embrace solid practice management techniques. Health comes from strength, and strength comes from empowerment of knowledge. The smarter you organize your practice business systems, the more effective you and your office will be in helping the people in your community. Most Chiropractors I know are not “all about the money”, but remember, that profit does matter.

How Much Money Should You Make?

Eric Huntington, DC

Co-Owner Developer of the Chiropractic Business Academy

drhuntington@chirobizacademy.com

INTRODUCTION

How much money should a chiropractor earn? I get asked this question fairly often and in speaking to chiropractors from all over N. America, I realized that there are some basic misunderstandings which can lead chiropractors into confusion on this topic.

The answer sorts out fairly easily once you realize that it is vital to further clarify the question. A “chiropractor” is, of course, someone who has a DC degree—and we probably can assume that if the chiropractor refers to him as a chiropractor, that they have some involvement with the profession. For the purpose of this discussion, that eliminates those people who have a DC degree but work in a completely different field.

DISCUSSION

Within the field of chiropractic, there are those who work outside of private practice, but inside the profession. This would include chiropractic college staff, researchers, and those that own or are employed by companies that supplement chiropractic practice—such as insurance carriers, consulting companies, and chiropractic supply companies. The income of these doctors can vary widely, depending on their position and relative success at what they do. This group comprises a relatively small percentage of chiropractors and so the rest of this article will focus on those chiropractors that are associated with private practice.

The typical categories that most of us consider regarding chiropractors in private practice are “owners” and “associate doctors”. There is naturally a significant divide in the income of owners versus associates for the simple fact that an owner carries the typical risks and responsibilities inherent to running a business. In the end, everyone else can jump ship, except the owner. It’s simply the concept of risk versus reward which drives the income difference.

Amongst owners of chiropractic clinics, there is a very wide range of incomes. This is because some chiropractors choose to wear all (or almost all) the hats in a clinic whereas others delegate duties to staff.

The Chiropractic Executive works on his practice(s) and not in his practice(s). His time is spent developing and improving the clinic(s) which allows for greater expansion and greater income. He is very skilled in administration and the handling of people. For these reasons, the Chiropractic Executive is generally the highest paid of all DCs.

The owner who works in his clinic and has an associate, is often the next highest paid of all chiropractors. This is because there are so many other income generating hats in a chiropractic clinic which need to be worn effectively in order for the clinic to be very profitable. By having an associate, the owner can concentrate on these other key income generating actions such as marketing or report of findings. Those that are able to pass the treating doctor hat and help their associate become successful can be greatly rewarded with time and money.

The next highest income earner is generally the owner chiropractor who wears the doctor hat in the clinic. This is the most common scenario in our profession. Because treating patients is very time consuming, it limits the owner’s ability to grow his income beyond a certain point. This problem has led chiropractors to all sorts of odd solutions—such as doing everything themselves, only accepting cash, unusual insurance billing strategies, limiting patient services to the very minimum, or whatever other time or money saving solution can be imagined. These solutions in and of themselves may not be wrong, but when they are only done because the owner doctor can’t figure out a better solution, they can becomes problematic.

The first tier associate income is generally the doctor who not only treats the patients but also manages the clinic. This is often a satellite location or small operation. This associate usually takes on all the typical responsibilities of running an office, outside of finance and future planning. I see this arrangement more often, but not exclusively, in personal injury or work comp practices. Often, the owner has the relationships with lawyers and simply needs someone else to run each of several locations. The extra income enjoyed by this associate is earned from the managerial responsibilities—and maybe the fact that he has to deal with the typical hassles of some personal injury or work comp cases.

The next level for associate doctors is the “practice builder”. This is the associate who is able to not only treat the patients, but also to generate a flow of new patients into the practice that supports the day to day volume of the clinic. This can be highly desirable to the owner, but also can be highly unstable as this type of associate often decides to leave an open his own clinic.

The next category of associate pay is the doctor who is responsible for patient treatment only. Someone else handles all other aspects of the practice. This is the dream job for most chiropractors, since the vast majority of us go to school because we want to take care of people--and for the typical doctor, that means hands-on care.

The key factor in determining your future is to decide what you want to have. This means everything from how you spend your days, to how much money you make, to the amount of responsibility for others you’d like to shoulder. Deciding what you want to have now, and in the future is the first step.

Next, you’d have to decide what actions you would need to do in order to obtain whatever it is that you’d like to have. This would mean determining the actual activities, when done would eventually lead to those things you want to have. For example, if you want to have several clinics, then you will need to do the actions necessary to achieve it. Most likely, being pinned down at the adjusting table is not the actions that will lead to owning several clinics, as an example.

Lastly, you should choose which of the chiropractor hats described above that you need to be in order to do what you need to do the necessary actions, so you can achieve what you want to have.

For example, if you decide you want to have a million dollars a year of income and go on vacation for one week every month, then you probably can’t be an associate or be the owner of your practice and also treat all the patients.

However, if what you want to have is lots of patients to treat daily, a good income that allows you to support a family, and a place to go to work every day, then you can probably be an owner or associate who treats all the patients.

What you want is exactly right because it’s right for you! The only mistake you can make is wanting to have something, but not doing what you need to do, or being what you need to be, in order to get what you want. Get that all sorted out and you’ll do just fine.

SUMMARY

Every day at the Chiropractic Business Academy, we help doctors sort this out and get them on the path to achieving their goals. In fact, the material in this article is from one of the courses we teach to our clients.

If you’d like more information on these concepts, or help of any kind with your practice, call-- we are here to help you!

The Chiropractic Business Academy teaches workable, time-tested business principles and chiropractic marketing strategies. If you are good at delivering high quality chiropractic service but want to see more patients or have more time off with a staff driven practice, then we can definitely help you!

888-989-0855 or online at www.ChiroBizAcademy.com

Transforming Your Patient’s Perspective From Pain to Posture into Organs and Overall Health on Day #1 PREDICTIBLY!

Fred DiDomenico, DC

Practice Coach and Mentor

www.elitecoachingllc.com

INTRODUCTION

As spinal corrective doctors we become so focused on correcting spinal structure and restoring curves we can forget what matters most to the patient, the progressive, even rapid degeneration of their health from a weakened posture. Our responsibility is NOT to correct their spine. Our responsibility is to teach them how a strong spinal structure and optimal curves leads to an optimally functioning body with the system to attain health for life! This purpose is NOT related to pain or how they “feel,” which is very temporary. Correcting their spinal structure is merely the first step in this process. Many patients quit during their program or when they complete corrective care because you may have not created a long term vision for them past spinal correction. We can transform their perception of spinal function as the foundation of the core strength and health of their body along with the desire to have optimal health for life immediately on Day #1, PREDICTIBLY!

The 4 Step Consultation originating in Elite Coaching IS that immediate shift from pain into posture and organs. DO this and you will see amazing transformations in your patients.

• Step #1: Finding Organ Problems.

After you address their pain area, you also say, “Postural distortions also weaken the nerves to organs in that area causing…..” Give 3 health problems for each organ related to that area of the body. Repeat this statement with each organ as you move through the body. If they ask why you are asking about organ problems when they may believe they are there for pain, you respond from the scripts in the Pre-Consultation (not covered in this article), “Remember, when one area of the spine shifts from its normal position it weakens the rest of the structure of your spine and distorts your overall posture. Did you know many causes of back pain DIDN’T originate in your low back? If your problem began in another area of your spine would that be important for me to know where it began for me to get directly to the cause of your problem?” This will bring them into agreement. You may add, “Did you know that many postural distortions don’t cause any pain, so we are using organ problems to discover where your posture and nervous system may be weak.” This will transform their perspective toward the cause of their problem. These facts are truth when you learn postural coupling patterns in CBP.

Reframe the organ symptoms

Reframing is changing the meaning of each health condition, especially since ALL patients minimize their conditions. For example, if they say, “I had allergies as a kid and now they are gone.” Your reframe may be, “It may be your cervical spine never developed normally as a child weakening your immune system, if you had allergies. Many back problems are a result of long standing neck problems regardless if you had neck pain. Now your whole spine may be weakening since you are now having low back pain.” This is also an opportunity to get a referral. You can say, “I see on your forms you have a child. Do they have allergies? It may be they are developing the same spinal problems as you. We can check them on your next visit.” You can build your practice with your systems getting many referrals.

Another example of reframing is when you discover a patient complains of fatigue for the last 3 years. You also discover they were in a car accident 4 years ago. You say, “You injured your spine in the accident and your metabolism and energy has been progressively weakening since that time.” When they agree they are admitting more problems than they expected. With every organ problem you can reframe to show the correlation between posture and their overall health. When you have completed this step their focus will shift toward their health rather than their pain.

• Step #2: Review symptoms

In this step, connect the health problems to the spine and speak in a tone that sounds like an extensive grocery list of health problems using the language of the reframes from Step #1. For example, “You came in with back pain and we discovered the nerves in your low back are weakening your bladder because you’re having recurrent bladder infections. You damaged your spine and posture in your neck in that accident 4 years ago because you’re experiencing fatigue and a weakened immune system with recurrent colds and flus.” Listing the health problems and clarifying the effect of their spine on their health will create an immediate shift in their thinking. Do this for ALL the health conditions.

• Step #3: Impression

The list of health problems in Steps #1 & 2 are like pieces to a puzzle. When you put all the pieces of the puzzle together they make a picture, your overall impression of their health. You must give a FULL spine/OVERALL health impression and they MUST agree with your impression. You may say something like, “You injured your neck in that accident 4 years ago and you now have organ problems related to ALL areas of your spine. It looks like you’ve weakened your WHOLE spine and now your overall health is breaking down.” You can say, “You originally came in with back pain and we discovered you have pain in every area of your spine and 15 different health problems at 35 years of age. That’s the health profile of someone at least 10 years older than you. How do you feel about that?” They will say something like, “I know, I feel like an old woman sometimes.”

When they agree with your impression you have just shifted their perspective from pain into posture and organs. They now become more concerned with their health rather than their pain.

• Step #4: Get them to a “Yes.”

You want to bring them into agreement for the next step, the exam. You may have offered them a complimentary consultation and they now have to pay for the exam and x-rays. Either way, getting them to say “yes” to the next step begins to release their barriers and objections. When they give you permission they will become more willing and open to listening. This step consists of one sentence, “Do you want to find out what’s causing this?” This is a crucial “yes.”

Master this 4 Step Consultation and you will see incredible changes in the perspectives, commitment and follow through with your patients who will pay you for something MUCH bigger than back pain, their overall health. This is the principle Chiropractic was founded on. The general public just hasn’t been taught. Now there is a system that can teach your patients the truth of spinal correction and health.

You can receive training on the Day #1 procedures and this 4 Step Consultation to master these perspective shifts in your communication systems at Elite Coaching boot camps, www.chiropracticunited.com, Quarterly seminars and more. Please visit www.elitecoachingllc.com or call Dr. Fred DiDomenico personally at 253-851-8353 to answer any questions. Your patients’ health is waiting.

At the 33nd CBP® Annual

 

September 23-25, 2011 in Phoenix, AZ

The 33^rd CBP Annual conference will be held at the historic Biltmore Resort/ Spa in Phoenix, AZ Sept 23-25, 2011. We are anticipating a great attendance this year and will ensure that this event will be “one of the finest conferences you’ve ever attended”. Here's a highlight of what will take place at this year's event:

• Several Outstanding Presenters & Topics
  • Dr. Deed Harrison, DC--Review the latest spine research that impacts corrective Chiropractic practices. CBP Technique case studies and new CBP Non-Profit research updates.
  • Dr. Chintan Desai, MD Radiologist-- 2 hours of Radiology CE Hours for CA and other states. Advances in X-Ray & MRI Technology to Better Determine Cervical Spine Injury: The Perspective of a Neuro-Radiologist Working with Corrective Care Chiropractors.
  • Dr. Billy DeMoss, DC-- Chiropractic principles meets Chiropractic science and art.
  • Dr. Sandy Haas, DC-- The model of the future is here: corrective chiropractic health and wellness practices incorporating spinal rehabilitation, nutrition, physical-functional rehabilitation, and more.
  • Dr. Joe Ferrantelli, DC-- Advances in technology that improves efficiency-accuracy of subluxation analysis. Get your I-pads ready!
  • Dr. Stu Currie, DC--Update on foot biomechanics, disorders, and identifying the need for custom foot orthotics.
• 3rd Annual CBP Golf Event

The 3rd annual CBP Golf event will be held Friday the 23rd at the Biltmore from 7:30am-Noon. Email Dr. Deed if attending (drdeed@idealspine.com). The scores will be tallied and the winner will be honored with a custom plaque. Each player will receive a sleeve of custom CBP Logo balls.

• Best Chiropractic T-Shirt Contest

New for this year will be the best Chiropractic T-shirt contest. Conference attendees enter by being present and wearing their chosen Chiropractic relevant T-shirt Friday night at the wine social hour from 6pm-7pm. Best T-shirt voted on by a panel will receive a complimentary gift valued at over $500.

• Catered Lunch, Social Hour, and Breakfast

As always, all attendees will be welcome at our wine social hour Friday evening from 6pm-7:30pm in the Biltmore lawn courtyard. A hosted lunch will be provided Saturday afternoon for all guests. And new for this year, a hosted breakfast will be offered on Saturday morning from 7:30am-8:30am.

• The 2011 CBP Chiropractor and Chiropractic Researcher of the Year Will be Announced

Each year CBP NonProfit, Inc. acknowledges outstanding Chiropractors in the community who selflessly donate their time and energy for the advancement of chiropractic in general and CBP Technique specifically.

We hope to see you there.

CBP® NonProfit, Inc. Research Update

Paul A. Oakley, M.Sc., DC

CBP Research & Instructor

Private Practice New Market, Ontario, Canada

CBP Technique Case Report in JVSR 2011

In June, Drs. Curtis Fedorchuk and Andrew St. Bernard, had their case study published in the Annals of Vertebral Subluxation Research. This is one of many case reports that Dr. Fedorchuk has authored evidencing the utilization of CBP Technique procedures in the resolution of a variety of chronic diseases and conditions. Here's acknowledging a job well done to Drs. Fedorchuk and St. Bernard--keep up the good work.

This recent article is:

Curtis Fedorchuk DC and Andrew St. Bernard DC. Improvement in Gastro Esophageal Reflux Disease Following Chiropractic Care and the ALCAT Procedure. Annals of Vertebral Subluxation Research ~ June 23, 2011 ~ Pages 44-50

ABSTRACT
Objective: The chiropractic care of a patient with chronic back pain and gastro-esophageal reflux disease is described.

Clinical Features: A 42 year-old female with chronic gastro-esophageal reflux, chronic mid-back pain and vertebral subluxations.

Intervention and Outcomes: High velocity low amplitude spinal adjustments and Chiropractic Biophysics (CBP) technique were applied throughout patient care. Extension traction of the cervical spine was assigned to the patient to perform at home. In addition, the Antigen Leukocyte Cellular Antibody Test (ALCAT) procedure and dietary plan was introduced. The persistent complaints of GERD and mid-back pain were resolved and the patient also showed marked improvement in quality of life as demonstrated by SF-36 scores. 

Conclusion: A combination of chiropractic care focused on reduction of vertebral subluxations and dietary modification resulted in resolution of this patient’s chronic back pain and GERD.

Foot Orthotics and Muscle Activity

Stuart Currie DC,

Director of Research, Sole Supports.

www.solesupports.com

INTRODUCTION

A 2008 critical review of lower limb muscle activation examined the evidence for changes in muscle activation patterns while wearing a foot orthotic¹. This should be of great interest to clinicians treating lower extremity pathology with foot orthotics.

Questions to consider when considering the clinical implementation of a foot orthotic include:

· How does a device that is placed in the shoe affect muscular function?

· Which muscles are involved?

· In which patients, and when?

The kinematic (movement) and kinetic (force) effects of foot orthotics on the human body are often widely discussed and debated with broad conclusions being difficult to draw. In addition to the forces and motions involved, as chiropractors, we are interested in the resultant changes in muscle activity. The reaction of muscles (whether activated or inhibited) is a core component of treatment making it very important to know what a foot orthotic does (if anything) to the lower limb musculature.

DISCUSSION

Given the wide variety of foot orthotics, the variable construction, and the different biomechanical theories the literature on muscle activity and foot orthotics can be hard to generalize. A systematic review of the literature revealed that peroneus longus and tibialis anterior EMG amplitude and tibialis anterior duration is greater when wearing foot orthoses². The duration effects may suggest a greater fatigue reduction with a foot orthotic. This review also concluded there is evidence that foot orthotics affect lower back EMG muscle function. This information can be considered with EMG studies that reveal inverter muscles are increased and evertor muscles are decreased in amplitude with a pronated foot posture². Tibialis posterior, a stabilizer and supporter of the arch, was demonstrated to be selectively activated in adults with pes planus to a level equivalent to those with a normal arch index while wearing a foot orthotic.³

It is important to keep in mind that any increase or decrease in the measured EMG variables could be beneficial or detrimental, depending on patient specifics such as pathology, foot type, activity levels, and overall condition of the musculoskeletal system.

Do not overlook the role of sensory system in the control of muscles. Changes to muscle activation may be altered by sensory input on the plantar aspect of the foot. One investigation that altered only the texture of the shoe insert found alterations in lower limb muscle activity⁴. In other words, by changing the texture without changing the geometry of the orthotic, the gait pattern and muscle activity was altered by sensory feedback. This underscores the notion that a full-contact or isomorphic orthotic may be of benefit. Isomorphic contact refers to a custom device that is in contact with the bottom of the foot in a corrected posture during the entire gait cycle, in contrast to an extrapolated or low-arched device that only contacts the plantar surface of the foot after it has pronated significantly. The more contact, the more opportunity to affect change. If the rate or temporal firing patterns of populations of sensory afferents are to be influenced, it makes sense to do this as early in the gait cycle as possible. This also concurs with EMG findings that show a molded orthotic has different EMG findings than a posted orthotic alone⁵.

Shoe wear is another factor that needs to be considered when relating EMG findings to gait. The recent popularity of various minimalist running techniques leads to a discussion of whether the foot orthotic is a brace. This concept is not new to chiropractors who generally do not prescribe back braces indefinitely with the assumption that it may inhibit the body’s own natural muscular bracing, but in the case of a foot orthotic is generally not supported by the EMG literature which shows an increase in muscle activation with foot orthotics in many cases. Masai Barefoot Technology (MBT) shoes are designed to strengthen the lower limb by providing an uneven surface challenging the muscles to be more active. One EMG analysis showed only tibialis anterior activity was increased during standing and no significant differences were seen walking when normalized to control shoes.⁶

Heel lifts are another orthotic modification that are prescribed regularly and warrant consideration for the muscular effects involved. Heel lifts have been shown to have an earlier onset of muscle activity in erector spinae during gait and a delay in on the onset of gluteus medius activity⁷.

We must also consider this research in light of the human body as a whole, with antagonist and agonist muscle groups working together to improve efficiency or decrease tissue stress. It is currently unclear to what degree changes in any one isolated muscle affects the system as a whole. In addition, not all orthotics are created equally. There are different theories and different manufacturing processes that result in different final products. Therefore the literature trends must be interpreted with caution considering differences in subjects (injured vs. healthy), the construction of the device (flexible vs. rigid) and the activity measured (walking vs. running).

SUMMARY

In summary, the following are considerations when evaluating both EMG research articles and your patients:

1) Different foot orthotics can affect the EMG activity in different ways.

2) The results may be specific to a specific patient population or foot type

3) The temporal nature of the EMG change must be considered.

4) The EMG results may be related to very different clinical outcomes depending on the pathology involved.

References

1. Hatton A. Physical Therapy Reviews 2011;13(4):280-93.

2. Murley GS. Gait Posture 2009 February;29(2):172-87.

3. Kulig K. Med Sci Sports Exerc 2005 January;37(1):24-9.

4. Nurse MA. J Electromyogr Kinesiol 2005 October;15(5):496-506.

5. Mundermann A. Gait Posture 2006 April;23(3):295-302.

6. Nigg B. Clin Biomech (Bristol , Avon ) 2006 January;21(1):82-8.

7. Bird AR. Gait Posture 2003 October;18(2):81-91.

The MMR Vaccine and Autism: An Interview with Dr. Andrew Wakefield

Dan Murphy, DC—

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

In 1998, Dr. Andrew Wakefield and 12 colleagues from the Inflammatory Bowel Disease Study Group, University Department of Medicine, Royal Free Hospital and School of Medicine, London, UK, published a study in the journal Lancet. Twelve children with a normal history developed behavioral symptoms including loss of acquired skills, including language, together with diarrhea and abdominal pain. In 8 of 12 cases, parents associated their child’s symptoms with receiving the measles, mumps, and rubella vaccination (MMR). These children (all twelve) then underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Additionally, ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture was performed. All 12 children showed intestinal abnormalities of various types. Dr. Wakefield and colleagues interpreted their results as:

'Scientific' Persecution

Even with such an innocuous interpretation, a persecution against the authors, especially Dr. Wakefield began. The persecution was often driven by UK journalist, Brian Deer. The ultimate consequence was the retraction of Dr. Wakefield’s 1998 study by the editors of Lancet along with a public discrediting of Dr. Wakefield and his colleagues.

I went to the National Library of Medicine and typed “Wakefield AJ and Vaccine” into the PubMed search engine (www.pubmed.com). Sixteen publications were identified spanning 1995–2009. All 16 of these publications pertained to various problems associated with vaccinations.

In an effort to exonerate his reputation and that of his colleagues, and to protect the health of children worldwide, Dr. Wakefield wrote a book titled Callous Disregard; Autism and Vaccines—The Truth Behind a Tragedy, which was published last year 2010 (Skyhorse Publishing). This book tells a very different story as to the persecution of Dr. Wakefield and his colleagues by the pro-vaccination medical establishment, and exposes the official spinning of unpopular science and conclusions.

I believe that all parents should read this book prior to vaccinating their children.

MY INTERVIEW WITH DR. WAKEFIELD

On March 3, 2011, I interviewed Dr. Andrew Wakefield on the relationship between the MMR vaccination and autism. These are his responses to my queries.

· Is the MMR vaccine necessary?

No. The measles might be, but the MMR together is not. The mumps in particular is never necessary. This is not my opinion, it is also the position of the Centers for Disease Control (CDC) in the United States, and the Department of Health UK. The mumps vaccine pushes the age of susceptibility upwards, with greater adverse consequences in the adult population. The MMR vaccine has never been tested for safety. The MMR vaccine is dangerous.

· Do you believe the parents who claim that MMR vaccine caused their child’s autism?

Yes, I believe those parents.

· Is there any proof that MMR vaccine causes autism?

No, there is no proof. That issue requires further investigation.

· There are studies that claim that the MMR vaccine is not a cause of autism. Do you have any comment on those studies?

Yes, I am aware of those studies. Those studies were not performed well and those studies were not fairly reported. In fact there is evidence in studies that are reported as a negative association between MMR vaccine and autism that actually show that the younger the child at time of vaccination the greater the risk of autism.

· Why is there so much controversy pertaining to the MMR vaccine? Why would medical authorities and public health officials push so hard for all children to receive the MMR vaccine and so vigorously attempt to discredit opposite cautionary opinions such as yours?

This occurs primarily for three reasons:

1. Fear of accountability,

2. Blind faith,

3. Commercial imperative,

[We discussed how there is literally billions of dollars at stake on this issue].

· Please comment on the criticism of the ethics of your research:

I have been criticized for not securing proper ethical approval for the investigations I performed on the initial 12 children subjects. This is completely false in that what I did was a clinical trial, and ethical approval is not necessary for a clinical trial.

The biopsies I performed did require ethical approval, and I have parental signed ethical approvals on 100% of the children who were subjected to biopsy.

· Why does reporter Brian Deer claim that you did not have these ethical approvals?

Brian Deer knew I had the appropriate ethical approvals, he has copies of them. I believe he did not tell the truth about them because it would kill his story. Brian Deer withheld this information from the medical board [GMC = General Medical Council].

· Why would Brian Deer do such a thing?

I am unsure, other than understanding that Brian Deer has a close relationship with drug maker GlaxoSmithKline. [GlaxoSmithKline is a global pharmaceutical, biologics, vaccines and consumer healthcare company headquartered in London, United Kingdom. It is the world's third largest drug company].

NOTES FROM DAN MURPHY:

Autism officially afflicts 1/110 children in the United States.

Autism officially afflicts 1/64 children in the United Kingdom.

A recent (2011) interesting review article titled Theoretical Aspects of Autism: Causes—A Review was published January 2011 in the Journal of Immunotoxicology. The author notes a spike in autism worldwide following the release of the MMR II vaccine, and proposes a scary mechanism to explain the spike. I have posted my review of this article to my Article Review service.

On the top of the copyright page of Dr. Wakefield’s book, in a large font and in bold capitol letters is a box containing these words:

NOTE TO ALL CUSTOMERS:

NOT FOR SALE IN THE UNITED KINGDOM

In the United States, Dr. Wakefield’s book can be purchased from many sources, including from the bookstore at Life Chiropractic College West: (510) 780-4500, and ask for the bookstore, or dial the bookstore direct at (510) 780-4502.

References

1. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Lancet. 1998 Feb 28;351(9103):637-41.
2. Wakefield, A. Callous Disregard; Autism and Vaccines—The Truth Behind a Tragedy, Skyhorse Publishing, 2010.
3. Ratajczak HV. Theoretical aspects of autism: Causes—A review. J Immunotoxicol. 2011 Jan-Mar;8(1):68-79.

Subluxated Chiropractic Curricula in North America

A recent study published in the journal Chiropractic & Manual Therapies¹, sought to “examine current North American English language chiropractic college academic catalogs and determine the prevalence of the term subluxation in the respective chiropractic program curricula.” This paper (more of an editorial with limited data) authored by Drs. Timothy Mirtz and Stephen Perle perfectly reflects the growing chasm splitting our profession into halves.

A little background on the authors seems relevant. Dr. Timothy Mirtz has been an outspoken critic of the chiropractic profession as it exists outside his vision. Mirtz was lead author on an article from the National Association for Chiropractic Medicine (NACM) published in 2002.² This group of crusaders has perceived ties to Stephen Barrett, MD (of quackwatch fame) through one of Barrett’s websites, chirobase.com, of which Charles DuVall, Sr. is a founder. Dr. Stephen Perle, of course, is the self-appointed chief of the ethics police within the chiropractic profession. We at the AJCC proudly espouse sound ethics within chiropractic practice. However, reading through Perle’s never ending poppycock, it becomes apparent that he firmly believes subluxation based chiropractic is itself an ethical problem.

In their most recent diatribe, the minds of Mirtz and Perle¹ come together to report on a review of internet catalogs and academic bulletins of 18 North American Chiropractic Colleges to record the prevalence of subluxation as a term. These authors discovered that all but 3 of the colleges included the term “subluxation” in their college course descriptions. The 3 colleges, comprising the vast minority (20%), that have removed subluxation from their curricula were:

1. Canadian Memorial Chiropractic College,
2. Southern California University of Health Sciences, and
3. National University of Health Sciences.

After a tirade about the shortcomings of the “theoretical construct” of the subluxation, these authors¹ reason that the 80% of colleges using the term “subluxation” are the ones with the quandary being non-evidence based. Accroding to Mirtz and Perle¹, somehow, what the majority of chiropractic schools teach the majority of chiropractic students in North America is non-scientific, non-evidence based, and not 'Chiropractic'.

In contrast, the astute reader / reviewer, would find that since 15/18 of the North American Chiropractic Colleges include subluxation in their course descriptions, the 3 minority schools that don't are the SUBLUXATED ones.

Curiously, Mirtz and Perle¹ also propose that the newly established Standards by the Council on Chiropractic Education (CCE) should move chiropractic colleges away from teaching subluxation in anything but a historical (make-believe) context, à la Europe’s General Chiropractic Council decree. This is ironic since the CCE Standards allow a college to teach a curriculum consistent with its own Mission…not the mission of Mirtz, Perle and the National Association for Chiropractic Medicine (NACM)³.

What can be done about the movement, seen in specific Chiropractic curricula, to abandon subluxation teachings in the educational arena? Since most Chiropractic Colleges are still privately subsidized to some degree, Chiropractic clinicians, leaders and organizations should strongly consider which Colleges to endorse and support with student referrals and resources. In the end supporting the educational institutes who share your vision of Chiropractic is the right choice.

It is the editorial position of the AJCC, that the minority viewpoints espoused by the (NACM), will not overtake the major premise of Chiropractic. Chiropractors will continue to practice “chiropractic” long after Mirtz, Perle, DuVall Jr., and the rest of the former NACM leaders pass. The obvious disdain this group has for the Chiropractic profession is actually sad. Perhaps Mirtz, Perle (and the rest of the NACM types) should choose to move onto another profession…orthopractic round 2? Or perhaps they would benefit from subluxation correction...

References

1. Mirtz TA, Perle S. The prevalence of the term subluxation in North American English-Language Doctor of Chiropractic Programs Chiropractic & Manual Therapies 2011, 19:14. http://chiromt.com/content/19/1/14/abstract Accessed June 25, 2011.
2. Mirtz TA, Long P, Dinehart A. Slaughter RL, DuVall Jr., CE, Bryson R, Kourmadas F. Campo J. NACM and its argument with mainstream chiropractic health care. Journal of Controversial Medical Claims 2002;9(1):11-25.
3. For information on the National Association for Chiropractic Medicine (NACM) see http://en.wikipedia.org/wiki/National_Association_for_Chiropractic_Medicine. Apparently this group has self imploded.

Recent Articles Question Safety of Pediatric Vaccines

Infant exposure to ethylmercury (EtHg) has increased in the past 2 decades and alarmingly, is starting earlier in life. Both of these issues are due to the current immunization schedule that uses thimerosal containing vaccines. Thimerosal is an organic compound that contains mercury and, for decades, has been used as a preservative in a number of products, including several vaccines. Originally, the use of thimerosal was promulgated to help prevent potentially life threatening contamination with harmful microbes in the vaccines.

Although vaccination schedules vary considerably between countries, infants worldwide are being exposed to vaccinations in the first 24 hours post delivery. Specifically, Dorea and colleagues¹ found that over a 5 year period, there was a significant increase in vaccinations within hours of birth (on same day), from 7.4% (in the year 2001) to 87.8% (in 2005). According to their findings, "nearly 94.6% of infants are now being vaccinated within the first 24 hours."¹

Two recent articles by Hewitson and colleagues^2,3 have used primate models in an attempt to understand the possible detrimental consequences on neonate neurological development when exposure to thimerosal occurs. These articles establish a possible harmful effect of early vaccinations on the growth and development of the brain.

• In a longitudinal, case-control pilot study in rhesus macaque infants receiving the complete US childhood vaccine schedule (1994-1999), Hewitson et al² examined amygdala growth and developmental abnormalities. Their results identified maturational changes in amygdala volume and the binding capacity of diprenorphine in the amygdala in infant macaques receiving the vaccine schedule. Importantly, the amygdala is thought to play a key role in the expression of emotions and the development of social and emotional behaviors in early life.
• In a related investigation, Hewitson et al³ identified delayed development of neonate reflexes in newborn primates receiving a hepatitis B vaccine containing thimerosal. Specifically, in the animals exposed to the vaccine, "a significant delay in acquisition of root, snout, and suck reflexes, compared with unexposed animals", was found.
• "The infant mortality rate (IMR) is one of the most important indicators of the socio-economic well-being and public health conditions of a country. The US childhood immunization schedule specifies 26 vaccine doses for infants aged less than 1 year—the most in the world—yet 33 nations have lower IMRs. Using linear regression, the immunization schedules of these 34 nations were examined and a correlation coefficient of r = 0.70 (p < 0.0001) was found between IMRs and the number of vaccine doses routinely given to infants. Nations were also grouped into five different vaccine dose ranges: 12–14, 15–17, 18–20, 21–23, and 24–26. The mean IMRs of all nations within each group were then calculated. Linear regression analysis of unweighted mean IMRs showed a high statistically significant correlation between increasing number of vaccine doses and increasing infant mortality rates, with r = 0.992 (p = 0.0009)."

If these two studies aren't enough to alarm parents and health care providers, a more frightening piece of data just emerged identifying a statistically significant association between number of vaccine dosages given in the first year of life and Infant Mortality Rates (IMR's). From this study's abstract:

The topic of childhood vaccination is a complex one; it can trigger heated debates around pro's and con's as well as eliciting emotional, social, and religious viewpoints. However, the studies presented here should be convincing enough to seriously question whether routine and multiple vaccines are safe for our children.

References

1. Dorea JG, et al. Neonate exposure to thimerosal mercury from hepatitis B vaccines. Am J Perinatol 2009; 26(7):523-527.
2. Hewitson L, et al. Influence of pediatric vaccines on amygdala growth and opioid ligand binding in rhesus macaque infants: A pilot study. Acta Neurobiol Exp 2010;70:147-164
3. Hewitson L, et al. Delayed acquisition of neonatal reflexes in newborn primates receiving a thimerosal containing hepatitis B vaccine: influence of gestational age and birth weight. J Toxicol Environ Health A 2010;73:1298-313.
4. Miller NZ, Goldman GS. Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity? Hum Exp Toxicol 4 May 2011. Published online: http://het.sagepub.com/content/early/2011/05/04/0960327111407644.