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:

“We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.”

'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.

Sadly, caught in the middle of this debate is the health of the world's children.

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.

The Obituary of Dr. Donald D. Harrison

Donald D. Harrison, DC, PhD, MSE, (also known as Deed by his family and early life friends) passed away 2 weeks ago on Wednesday, July 20th, 2011. He was 65 years old residing in Wyoming with his loving wife Dr. Sang Harrison. Due to complications from Type II Diabetes, he passed peacefully with his wife Sang, his son Deed, and his daughter Holly by his side.

Don Harrison was born May 11th, 1946 in Port Angeles, WA to his parents, the late Robert (Whitey) and V. Earlene Harrison. He was the second born of four children including his elder sister Linda, younger brother Glenn, and his younger sister Kitty; he is survived by each of his three siblings. Don was fortunate to have numerous high quality friends throughout his life and he remained in contact with many of them until the end.

Don's Personal Family--

Don was a lucky man in as much as he found 3 women in his adult life to love, share with and marry. He married his first wife Linda Minish-(now Springob) in the late 1960's and they had two children together; Deed and Holly. In the late 1970's he met Deanne L. J. Harrison and they married a short time after. In the mid-1980's, his second wife Deanne passed away. Don then met his 3rd and final life's love Sanghak O. Harrison whom he stayed with until his passing. From a pre-existing marriage, Sang had her son Erin Molyneux who Don happily raised as one of his own children showing no favoritism to his two blood related children.

Don regarded education as one of the most important life achievements a person could pursue. To this end, he earned a joint BS in Mathematics at the University of Washington in 1968. Later he earned his MS in Mathematics at the University of Texas at El Paso in 1971. Next he also received a secondary teaching degree from Western Washington University in 1973.

Don's Pre Chiropractic Work History--

Prior to becoming a well-known-Chiropractor and spine researcher, Don Harrison

had a significant and diverse work history. From 1964-67, he worked vacation relief at Crown Zellerbach Paper Mill (Port Angles, WA). From 1968-1969, Don worked as a Ranger for the Department of Interior (Olympic National Park). In 1969-71, he was drafted into the Vietnam War and worked as an E5 for the US Army. After his service in the War, he was a Grad Teaching Assistant  (1971-72) at Washington State University (Pullman, WA. Next he taught Math at Peninsula Community College and at Stevens Junior High (Port Angeles, WA) from 1973-1975 followed by a 2-year stint as the Math Instructor at Mount Hood Community College in Portland, OR (1976-1977).

Don's Chiropractic Path--

After struggling with a back injury as a result from back packing out a WA. state black tail deer for several miles, Don sought out Chiropractic care from the late Dr. Hansen in Port Angeles, WA. He was so impressed with the recovery of his back injury due to Chiropractic care (when standard medical management had failed for him) as a patient that he wanted to become a Chiropractor. He earned his Chiropractic degree in 1979 from Western States Chiropractic College. He lectured as an Assistant Professor from 1979-80 at Northern California College of Chiropractic and as a Part Time Instructor Life Chiropractic College-West (1984-1985)

Some of the best years of  Don's life were spent practicing Chiropractic. From 1979-1985 he and his partner at the time, Dr. Dan Murphy, owned and operated Bell Plaza Chiropractic Office in Sunnyvale, CA. In 1985 he sold Bell Plaza and moved to Evanston, WY with his Wife Sang and his boys Erin and Deed. Part of Don's decision to move to WY was for the love of the outdoors and he wanted his boys to grow up in a smaller town environment where they could learn to hunt, fish, and appreciate nature. Together, Don and Sang started Evanston Chiropractic Center (1986-1992)

At the age of 47, in 1993, Don and Sang made the decision to concentrate on spinal research and he went to graduate school and received his MSE in Mechanical Engineering in 1997 from the University of Alabama in Huntsville, and a PhD in Applied Mathematics in 1998 from the University of Alabama in Huntsville (UAH).  Don had to get special approval from the UAH education board to work on these two difficult degrees simultaneously; his tenacity and unmatched work ethic allowed him to persevere.

Dr. Don's Professional Activities and Accomplishments.

Don's political professional affiliations were never in question. He was a Member of the Board of Directors of the International Chiropractic Association, was an ICA member since 1977, was nominated as a Fellow of the ICA (FICA in 1990), and received the ICA's Chiropractor of the Year award in 2006. Don was also the ICA Representative for the state of Wyoming in the years 1986-1993, 2001-2004. And he was the past President of the Wyoming Chiropractic Society in the late 1980's.

Don once told his son, Deed, that the only professional goal he did not achieve was becoming the President of the ICA; this was likely due to his onset of illness in early 2008.

Dr. Harrison was an Extension Faculty member for several Chiropractic Colleges including: Life Chiropractic College-West, Life University, National Chiropractic College, Cleveland CCKC, and the Universite du Quebec a Trois-Rivieres.

Don's professional accomplishments were not just limited to the Chiropractic profession. Dr. Harrison's dedication to advancing the Chiropractic profession through quality research, led him to becoming one of the most published Chiropractic researchers in the history of the profession; with over 80 peer-reviewed publications to his name. These publications were not limited to Chiropractic journals and have appeared in the top physical medicine, orthopedic, biomechanics, and spine research journals around the world. Due to his dedication to spine research, and specifically the lumbar spine, Dr. Harrison was voted in as member of the prestigious orthopedic research society: The International Society for the Study of the Lumbar Spine (ISSLS). For several years, Dr. Don acted as a reviewer for one of the top Chiropractic journals, the Journal of Manipulative and Physiological Therapeutics.

Don's Greatest Professional Achievements and Living Legacies

1. Arguably one of Dr. Harrison's greatest achievements and his greatest legacy for the Chiropractic profession is the fact that he was the primary origin of Chiropractic BioPhysics^® (CBP®) Technique (1980), with its Mirror Image^® methods. Of course he was not alone in the effort to develop CBP Technique; his brother Dr. Glenn Harrison was a founding member of the technique and Don indicated that to decipher what Glenn developed compared to what he did was not possible due to their close relationships as brothers and business partners. Also, instrumental in the development of CBP Technique were Dr. Dan Murphy, his late wife Dr. Deanne L.J. Harrison, and his current widow Dr. Sang Harrison. For CBP Technique methods, Don's background in mathematics and mechanical engineering influenced his choice of Linear Algebra methods applied to the human spine and posture.

In the 1980's Don hit the road as he developed and taught CBP Technique Seminars to Chiropractors around the world. Don authored and edited several text books for Chiropractors including the widely known: CBP Technique: The Physics of Spinal Correction (now in its 7th edition) and Spinal Biomechanics: A Chiropractic Perspective, (4th Edition).

1. One of Don's greatest frustrations was the slow acceptance of CBP Technique by the Chiropractic profession and the lack of engineering-biomechanics education in the Chiropractic professional's training. To this end, in 1991, Drs. Don and Sang Harrison started a quarterly trade journal called The American Journal of Clinical Chiropractic (AJCC). The AJCC is now in its 21st year and is owned and operated by Don's son Deed.

1. Also, out of a frustration with the direction of Chiropractic research, Don and Deanne founded a non-profit spinal research foundation dedicated to the advancement of Chiropractic and spine sciences. CBP research foundation was founded in 1982 and was registered as CBP Non-Profit, Inc. in 1989. Through this organization Dr. Don and colleagues first published in 1993 and since then have funded and published more than 140 peer-reviewed spine and Chiropractic research publications. Further, CBP Non-Profit, Inc. funded many scholarships as well as donated chiropractic equipment to many chiropractic colleges always trying to support chiropractic advancement and education.  Dr. Don was the acting president of CBP Non-Profit, Inc. since 1982.

1. Lastly, from the years 2005-2008, Dr. Don Harrison and his son, Dr. Deed, spearheaded a team of Chiropractic researchers and clinicians who produced two monumental Chiropractic practice guidelines. The first of these guidelines is the ICA Practicing Chiropractors Committee on Radiology Protocols (PCCRP) document. The PCCRP Radiography guideline has and will enhance the quality of care for countless millions of Chiropractic patients. This document identified and emphasizes that routine spinal radiography is the Standard of Practice in Chiropractic and has been for nearly 100 years and that Chiropractors can utilize Plain Film Radiography to detect and measure subluxations. The PCCRP document provides thousands of scientific references, indications on radiation safety and quality control as well as clinical indicators for imaging children younger than 10 years old (This document has been accepted for inclusion in the National Guideline Clearinghouse (NGC)). The guidelines are available for review at http://www.PCCRP.org.

Dr. Don's final 'gift' to the Chiropractic profession was the second of these clinical guidelines known as the ICA Best Practices and Practice Guidelines (ICA Guides). Dr. Don was a founding Co-Chair of the ICA Guides and this is the only guideline in the chiropractic profession to include ALL levels of evidence while excluding personal/consensus opinion. Instead of ignoring research on specific Chiropractic Techniques, ALL papers published by ANY Technique were included in the ICA Guides. Over 1400 original clinical papers were included in the database, dating back to the early 1900’s. Over 300 health conditions were shown to be successfully managed with chiropractic care. The ICA Guides serves as a valuable clinical reference tool for practicing Chiropractors to learn which methods have been found to be beneficial for various health conditions. The findings of the ICA Guides serve to protect the principles and tenets of the practicing ICA and all Chiropractors worldwide.

Don's Hobbies, Interests, and Personal Attributes

Don Harrison was an avid sportsman and outdoorsman. He enjoyed hunting, fishing, backpacking, exploring nature, and horseback riding. He loved both dogs and cats and even brought a stray cat across the country from Mississippi to Wyoming when he found the cat at a hunting camp. Don and Sang owned 4 quarter horses in Wyoming in the late 1980's-early 90's and in his later years, for a hobby, he and his wife, Dr. Sang Harrison, fed up to 200 mule deer through each winter in their back yard.

Don was known by his friends as one of the greatest story tellers of all time. He loved practical jokes and innocent tricks. More importantly, Don was one of those old school men of this world--- he was a man of his word and his hand shake meant more to him than any legal proceedings or contract. He'd go to the end for the sake of the truth and give the shirt off his back to a friend or a stranger if he thought they'd need it more than him. Don was a family man, a father and a husband. In the end, Don left Chiropractic and the world better than he found it. For this he will always be remembered by his family and friends.

Don's Surviving Immediate Family

Regarding his immediate family, Don Harrison is survived by his wife Sang Harrison and his three children: Holly Glebe of Bonney Lake, WA, Deed Harrison of Eagle, ID and Erin Molyneux of New York, NY. He is also survived by his grandchildren: Zachary and Alexandria Glebe, Aden and Damien Harrison, and Nina Molyneux.

Don's Memorial Service

A memorial service and celebration of Don Harrison's life is being held in Eagle, ID on Saturday Sept. 3rd. This event is for personal friends and family members of Don. If you would like to attend this event you may inquire further with Don's son, Deed Harrison (drdeed@idealspine.com).

Don's Memorial Funds or Donations

In lieu of flowers and cards, the family of Dr. Donald Harrison is establishing a memorial fund in his honor to further Chiropractic education and research. To this end, the family requests that any donations to be made in his name be sent to the NonProfit research foundation that Don established and ran: CBP NonProfit, Inc. P O Box 1590, Evanston, WY 82931-1590.

If you would like further information on this, please call 1-800-346-5146 or you can go online and donate specific numerical amounts; enter for 'Dr. Don Harrison Memorial Fund' in the comment box:  http://www.idealspine.biz/c-25-cbp-non-profit-research-cd.aspx

Thank you for your attention.

Drs. Sang, Deed and Shirlene Harrison, and Holly Glebe and Erin Molyneux

Are you kidding me?

R.J. Hammett, DC

INTRODUCTION

In the last month I’ve attended several chiropractic seminars, both clinical and philosophical. The best part of the seminars that I found wasn’t just the context of the program being presented, but the conversations in the hallways amongst the doctors. A common theme has run through the last few seminars that I’ve attended. The most heard of conversation is one about insurance and third party pay, the second most prevalent conversation is about patient volume and the lack of new patients. The last frequent conversation is about the economy and where chiropractic is heading in the future.

In this article, I would like to address each one of these three topics that I have heard time and time again from different groups and factions within chiropractic.

Third Party Pay

The first concern is about insurance and third party pay. Every conversation heard is about how much are you getting or how you are losing from the insurance companies? Or, it’s about which insurance is still paying well and which one doesn’t. In 1980 when I started my practice in Wisconsin there was no insurance coverage for any type of chiropractic care. In fact, we didn’t get halfway decent coverage until 1984 / 85. Listening to these conversations amongst the doctors reminds me of the joke “how many doctors does it take to change a light bulb”. Lots of bitching and moaning and no true answers is what I hear a lot of.

Where Are the New Patients?

The second comment thread that I hear discussed in the hallways is about the lack of new patients and low volume. I find it curious that when chiropractic was just correcting subluxations without the use of physical therapy, vitamin therapy, emotional therapy, hair removal, massage therapy, and a host of over 100 different other procedures or therapies, they were easily adjusting 50 and 100 patients per day. With the onset of the greed gland salivating for third party payment and the paperwork, time and aggravation to provide all of these ancillary preparatory and post adjustment treatments has caused the chiropractors to lose focus on what provides the patient with the most for the patient’s dollar—The adjustment.

Chiropractic’s Future

The last conversation heard in the hallways is about the future of chiropractic. Depending on the group of chiropractors you hang out with you hear two different stories. The groups that appear to have stable and growing practices are those chiropractors solely focused on one thing, that one this is each and every patient that comes before them for help outside of mainstream medical care. The other group is more concerned about money, politics and who’s controlling their life from the outside in. It’s not that we should not be concerned about whom our chiropractic leaders are and where they’re going, especially in light of the recent CCE goings-on. However, as with all things in life you cannot control what is outside your own grasp.

My Advice

So the advice I have for you is the same advice that I received at Life Chiropractic College so many years ago, that Doctor Gonstead spoke about when I visited him. The only concern that you have is the patient before you, if your focus has become one of what therapies they need, and how you’ll be paid, when you’ll be paid and who’s paying you, than your practice will reflect exactly that. The only way that chiropractic in the past has survived the attacks from the government, for the medical profession, and even from our own people was to take care of each and every patient as if that patient was their own family member, to provide a great service, to charge a fair fee, to believe in chiropractic and its ability to get sick people well in a way that no other profession does. And then, let the public decide what was most important to them.

SUMMARY

For chiropractic to prosper, to grow, to be more accepted, it must come first from service to the patient and their community. Patients you see, only want one very simple thing from you, answers and results to their healthcare concerns, they want it fast, reasonably priced and caring. If you truly want your practice, yourself, your patents and family to move forward and not just survive but to thrive, look to where your focus has been and ask yourself is your head in the right place?

Till next time…

management, philosophy

VACCINES AND THE BRAIN

Jennifer Brandon Peet, DC

Thomas D. Pound, MEd

INTRODUCTION

Our present generation of children is subjected to more than fifty vaccines before the age of seven.¹ One has to wonder what are the long-term effects on the child’s brain and ability to function in school and beyond. Documented neurological damage from commercially dictated, government-supported (or mandated) medicines and vaccines is duly reported in scientific journals. The Centers for Disease Control and Prevention (CDC) states the medical practitioner often underreports many vaccine complications.

BACKGROUND

Since 1988, the National Vaccine Injury Compensation Program has paid nearly $2 billion to petitioners for injuries related to immunizations.² Some side effects are common, such as redness and swelling at the site of the injection, but in some cases the side effects are as great as death. CDC mandated infant vaccinations have more than tripled from 1983 to 2004. During this period, there has been an explosion in neurological disorders such as ADHD and autism, particularly in boys, who represent four out of five cases. Today most children in the United States receive at least 50 individual vaccines, many of which are grouped into one shot.

EFFECTS ON EDUCATION

This article will emphasize the impact vaccines have had on our children in regard to their scholastic achievement. This area has not been of great enough concern. Most research has concentrated on the immediate effects of immunizations and few studies have studied long-term consequences. One such study states:

"The odds of receiving EIS [special education services] were approximately nine times as great for vaccinated boys as for unvaccinated boys, after adjustment for confounders. This study found statistically significant evidence to suggest that boys in United States who were vaccinated with the triple series Hepatitis B vaccine with thimerosal, were more susceptible to developmental disability than were unvaccinated boys." ³

DECLINING SCHOLASTIC ACHIEVEMENT

In 1948, a national vaccine schedule was developed for children ages 0-6 that included immunizations for diphtheria, pertussis, tetanus, and smallpox. In 1992, when most of the 2010 college bound seniors were born, the vaccine schedule included eight vaccines.⁴ Given this, it is important to see how scholastic achievement, as determined by the composite (Verbal/Critical Reading and Math) SAT average score may be affected by the changing vaccine schedule. This SAT composite average is used as a dependent variable in a multiple regression with the number of scheduled vaccines and national wealth as independent variables. For this study, the annualized growth rate of the S&P 500 Index during the 18 year period that represents the life span of a typical college bound senior is used as the wealth indicator.

SUMMARY

The multiple regression yields a significant model showing the impact of the national wealth and the vaccine schedule on the results of the SAT. Important for this research though, is how the vaccine schedule may be impacting scholastic achievement. Based on this model, each time a vaccine is added to the schedule, the SAT scores are lowered by an average of 8.255 points for college bound seniors. Therefore, vaccines have a significant negative relationship with student achievement.

Chiropractors are dedicated to optimizing nerve supply and brain function. It is important for the members of the chiropractic profession to share this kind of information with the patient community and show the lasting impacts that vaccines may have on the young minds of our children. While this is just an initial finding, it does shed light on the possible permanent effects vaccines have on developing brains years later.

REFERENCES

1.     “2010 Child & Adolescent Immunization Schedule for Persons Aged 0 through 6 Years—United States, 2010,” Centers for Disease Control and Prevention, last modified August 24, 2010, http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2010/10_0-6yrs-schedule-pr.pdf.

2.     “National Vaccine Injury Compensation Program,” United States Department of Health and Human Services: Health Resources and Services Administration, last modified October 12, 2010, http://www.hrsa.gov/vaccinecompensation/statistics_report.htm#post_1.

3.     Carolyn Gallagher and Melody Goodman, “Hepatitis B Triple Series Vaccine and Developmental Disability in US Children Aged 1-9 Years,” Toxicological and Environmental Chemistry 90 (September 2008): 997-1008.

4.     “History of Vaccine Schedule,” Children’s Hospital of Philadelphia, last modified June 2010, http://www.chop.edu/service/vaccine-education-center/vaccine-schedule/history-of-vaccine-schedule.html

5.     “Historical Prices: S&P 500 Index,” Yahoo Finance, accessed 11/02/2010.

6.     “Digest of Education Statistics”, National Center for Education Statistics, accessed July 1, 2010, http://nces.ed.gov/programs/digest/

vaccines

FCLB’s New ‘Model Practice Act’: A Slippery Slope

Donald D. Harrison, DC, PhD, MSE

Originator of Chiropractic BioPhysics Technique

President of CBP NonProfit, Inc.

INTRODUCTION

The leadership of Chiropractic’s main organization’s who regulate, manage and direct the chiropractic profession, are once again pursuing a path down the slippery slope of expanding the professions’ scope into prescriptive rights. As you likely recall, the profession recently spoke out (with a rumored 4000 responses) against the Council on Chiropractic Education’s (CCE) recent schema to remove subluxation (and adjustment of the spine) from educational requirements, and allow schools to adopt the Doctor of Chiropractic Medicine (DCM) degree, among other complaints.¹ The reader may also recall the actions within the state of New Mexico to give DCs prescriptive rights under the guise of a licensing board designation of “Advanced” Clinical Practice.²

THE FCLB    

Now another organization has begun pushing the profession down the same slippery path. The Federation of Chiropractic Licensing Boards (FCLB), led by its President Daniel Saint-Germain, DC, has posted a document for review by stakeholders. This document is titled, “MODEL PRACTICE ACT FOR CHIROPRACTIC REGULATION” and has been posted by Life Chiropractic College West on their website for review.³ For those of you not familiar, the FCLB is a non-profit entity that serves as a collective resource for state regulatory boards. Your state licensing board likely pays dues to the FCLB, but only to the tune of $400-$1300 annually, depending on the number of licensees in your state. This is not much money, so the FCLB gets additional support from outside their members.

Additionally, the FCLB gets funding from the National Board of Chiropractic Examiners (NBCE). Yes, the NBCE who gets their funding from students who pay for the administration of FOUR different national board tests. For example, the FCLB website states, “The National Board provides the FCLB with office space, at the token rent of $2 per year [emphasis mine].”⁴ The website continues, “The NBCE has frequently met the Federation's needs for office equipment and furniture.”⁴ Besides indirectly funding their crusade with student dollars, the reader should also be aware that the FCLB has gotten additional funding from NCMIC Insurance Company and annual reported donations from the ACA.⁴ The “Chiro Cartel” of our profession can be studied in Figure 1 as I personally envision it to exist. Notice that nearly all money funding the Cartel comes from field DCs and students. In my opinion, the resultant collusion is to advance the profession toward the model of allopathic medicine.

            Now that you are beginning to understand the incestuous nature of the multi-headed beast within our own profession, I will focus on the FCLB’s “Model Practice Act” (MPA) and the problems contained therein.

FCLB’s Model Practice Act Quandary

1.     FCLB’s MPA defines “Chiropractic” in Section 102 (Statutory Definitions) as, “a primary care health discipline that recognizes the inherent recuperative power of the body, whose practitioners promote and facilitate health through the evaluation, diagnosis and management of structural conditions or other disorders of the body that interfere with physiological function or neural integrity.”

2.     Of importance, they continue, “Chiropractic practice does not include the use of legend pharmaceuticals or operative surgery” [emphasis mine].

These first two points are great and, in my opinion, a couple of the core components essential to defining the essence of the Chiropractic profession.

However, later in the document, they propose as part of their “Model Act” to include a “Formulary”, a concept right off of the page of New Mexico’s recent move into allopathy. This MPA appears to set the stage for the Chiropractic and Pharmacy boards to appoint a committee to decide what substances chiropractors can prescribe and administer (including by injectable means).

3.     In the section on Scope of Practice [Section 5.01: (A) (3) (d)] it states that the practice of chiropractic would include, “the performance of needle insertion therapy, or the authority to dispense certain non-pharmaceutical agents contained within the Chiropractic Formulary, pursuant to the requirements of the chiropractic practice Act, Article IV (Specialty Chiropractic Practices) and regulation Section 5.02”.

Clearly there is little worry about DC’s recommending neutra-ceuticals, as this is and has been a part of mainstream chiropractic for years.

The Problems

In my opinion, the problem is that this becomes a slippery slope where prescription pharmaceuticals could later be approved by a small group of appointed individuals (self proclaimed ‘experts’), who may not represent mainstream chiropractic.

There is also another problem with what is presented by the FCLB in this Model Practice Act. Recall that the Chiropractic Statutes and Board Rules in New Mexico fabricated an “Advanced Practitioners” designation. Through either an unimaginably coincidental or perhaps well-orchestrated series of events, the FCLB seems to indiscriminately introduce another fabricated term to describe these so-called “Advanced” chiropractors. The “Specialty Chiropractic Practices” is named in this Model Practice Act, although the exact description of this group is left out of the document; it is available on the Life Chiropractic College West’s website.³

So, in addition to what may appear to be an agenda to go down the slippery slope of expanding the scope of chiropractic into prescriptive drug rights, at the same time certain “special” doctors will get a board-regulated designation of being “Advanced” (in New Mexico) and being “Special” by any states that adopt the FCLB’s MPA. In many states this would seem to be illegal according to current statutes, as insinuating that you are somehow better than other chiropractors is generally not statutorily permitted. But these “Special/Advanced”, super-duper chiropractors may soon be coming to a corner near you and will certainly be letting everyone know how “Special” and “Advanced” they are.

SUMMARY & WHAT CAN BE DONE

If you are opposed to the direction the “Cartel” of our profession is seemingly headed, you need to speak out. It can be stopped and reversed. I don’t believe that the FCLB is accepting profession-wide comment at this time, but we will let everyone know when they do. Ultimately mainstream chiropractors need to work to position themselves to obtain a state licensing board seat (generally through a governor appointment) or association board seat (through member voting) in your state. Get involved and get active in your state. You can no longer sit on the sidelines as our great profession is pushed towards a model of ‘sick care’ and prescriptive drug rights.

REFERENCES

1. Betz JW. CCE “Cartel” is at it again. AJCC 9/15/2010. http://tinyurl.com/CCE-Cartel
2. Welsh SP. New Mexico “Chiropractic Advanced Practice” Law Raises Questions of National Significance. The Chiropractic Choice. December 2009. http://tinyurl.com/ICA-NewMexico-Article
3. Life West website. Accessed December 19, 2010. http://www.lifewest.edu/FCLBdraftMPA.html
4. FCLB website Accessed December 19, 2010. www.fclb.org/AboutFCLB/tabid/387/Default.aspx

NCMIC, ACA, FCLB Chiro Cartel Flow Chart

PostureRay®: More Than a Great Radiographic EMR- A Relationship Builder!

Joseph Ferrantelli, DC

Private Practice New Port Richey, FL

CTO CBP^® Seminars

CEO PostureCo.

INTRODUCTION

Many chiropractors have already started to appreciate the benefits of utilizing the PostureRay® Radiographic EMR system in their practice, but fail to fully maximize one of the biggest advantages their office – outside MARKETING! Sure, once the x-rays are analyzed by PostureRay a doctor can quickly perform a digital report of findings using the digital view box, quickly and efficiently pull up any and all x-rays while at the adjusting table (with all the pertinent subluxation analysis), or export the marked up x-rays into their SOAP note software. However, few doctors use the reports generated by PostureRay to their full marketing potential.

What I mean by this is simple. You must set your office apart from everyone else in your area.

Establishing Effective Referral Relationships

Many doctors that I speak with, have found establishing relationships with medical doctors and attorneys to be difficult. For my office, this is one of our biggest referral sources are medical doctors. But how do you go about this? Well it is simple. Your office staff needs a ‘reason’ to go in and meet with the staff, doctors, and attorneys. PostureRay reports are an integral part of this equation.

On your next new patient, your office must find out who their general practitioner is, when the last time they consulted them, when are they due back to their office, and if you have your patient’s permission to send records regarding their spinal care to their doctor. Simply have the patient sign a medical release.

But here is the gem – your office staff, must personally hand deliver the reports on the new patient (normal intake narrative reports as well as PostureRay Impression reports). Thus, your reason to go in and meet them –community relationship building 101.

Your office should make a day of hand delivering to select doctors and attorneys (if you work up injury type cases). When doing so, you must present these reports on high quality paper and in color. Next, when delivering the reports, your staff member must point out how your office does detailed analysis of their patient’s spine – they should open up the reports, show the staff, and ask their staff to show it directly to the doctor or attorney. Your staff should reiterate that the chiropractor has identified several spinal conditions of concern for which chiropractic can benefit the patient.

Even better is when the patient has a consult within the same week your staff delivers their reports. If the patient is scheduled to go to their office for a follow up visit, encourage them to bring their “Report of Findings Packet” to their appointment. The doctor/PA may not have time to read through everything, but here is the key – they will see how professional it is, and note your office’s name! It’s simple marketing 101. Additionally, the doctor’s office usually copies the patient report of findings packet for their file, so be sure to have your short bio attached.

Now, in most cases, general doctors or attorneys rarely see the actual x-ray images, so this will be a good educational experience for the doctor/attorney, especially, when they can see their patient/client’s spine compared to normal, with red and green lines, and all the thorough analysis – making your office then look like the most sophisticated chiropractic facility in your area! After a few trips to their office, your staff member grows a working relationship with their office, becomes on first name basis with them, and eventually at this point, your staff member should ask if it is ok for you to schedule a quick meeting with their office and the doctor or attorney –maybe offer to cater lunch.

At this point, your staff member is already friends with their staff – so this meeting is very low stress for both offices. At this time, you can quickly, succinctly, and most of all scientifically – relate your office’s version of chiropractic – CBP® Technique to the staff doctors or attorneys in the case of a law office. Be sure to have several pre/post cases to discuss and some relevant scientific research papers, your CV, a chiropractic referral script pad and business cards. Best of all, they usually never referred you the patient to start with! Be patient though, relationships grow slowly – this may take several months to foster.

SUMMARY

These techniques are simple and common sense, but are often a forgotten method of building a practice and if you are looking to grow your practice, you should consider these simple marketing strategies. The PostureRay Radiographic Specific EMR can help jump start your community relationships in 2011.

For more information, or sample reports – please visit www.postureco.com. Be sure to ask about our new AMA Method of instability analysis and all new 3D Patient Educational Modules.

PostureCo, PostureRay, PostureRay, x-ray digitization software, x-ray digitization software, x-ray digitization software

Scoliosis: Is “High Side of the Rainbow Adjusting” Really Enough?

Dr. Joe Betz, B.S., D.C

ICA Board Member,

PCCRP Board Member

Private Practice Boise, ID

Idaho Chiropractic Association Board Member

CBP Instructor

INTRODUCTION

Scoliosis is the most common “spinal deformity” that presents to a chiropractic office. Although “scoliosis” is traditionally defined as a “lateral curvature of the spine” (as seen in Figure 1), it is more appropriately described in terms of its 3-dimensional configuration, including coronal and sagittal plane changes.

As a student I became interested in learning about scoliosis and how chiropractors manage this common condition. However, when I attended Chiropractic College, practically all of my clinical training concerning management of scoliosis patient could be summed up in the phrase: “Adjust on the ‘high side of the rainbow”. I assumed this was woefully inadequate and with the guidance of Dr. Don Harrison, I began investigating the background of the biomechanics of scoliosis and began to learn the application of Chiropractic Biophysics methods in the management of the scoliotic spine.

Don Harrison taught that in order to effectively manage scoliosis, you must first have a thorough understanding of the underlying biomechanics of the structural scoliosis. I read prominent research articles and textbooks, dating back to the mid 1800’s, and worked forward to present studies. To say that there is a significant amount of literature on the topic is a dramatic understatement. I still have boxes full of the thousands of articles I collected on the topic.

One thing that attracted me to the “old” articles was their extensive knowledge of the 3-dimensional nature of the scoliosis deformity. Also, the scoliosis practitioners of the late 1800’s and early 1900’s didn’t have “braces” (in modern day terms) nor did they have surgical techniques. They used exercises and what could be described as traction methods. They only abandoned these methods in the 1940’s with the development of the lucrative Milwaukee braces and what has proven to become ever-evolving, and even more lucrative surgical procedures.

The Sagittal Plane

The sagittal configuration of the spine has been of interest to scoliosis researches for many years. It is commonly accepted that when you view the true lateral image of the apex of a thoracic scoliosis on an X-ray, described in 1965 as the plan d’ election view¹, a lordosis will always be present…yes a “thoracic lordosis”. Many spine doctors have described this and corresponding non-surgical (and non-bracing) methods many years ago.² With a thorough understanding of the 3-D nature of scoliosis, the sagittal alignment of the scoliotic spine becomes increasingly important.

Whereas the lordotic nature of the thoracic spine (at the scoliosis apex) is well understood, the sagittal presentation of the lumbar spine has less congruency. This is likely due to the varying measurement methods used to determine extent of lumbar lordosis, including flawed assessment procedures such as a flexible ruler or spinal pantograph.

The implication of scoliosis on the sagittal alignment of the cervical spine is well established. In 1975 Winter, etal³ reported a loss of lordosis in the cervical spine in scoliotic patients with associated loss of thoracic kyphosis. However, they reported no data. The authors did state, “thoracic lordosis was usually accompanied by a compensatory cervical kyphosis”.

In 1989, Cruikshank, et al⁴ reasoned that an area of lordosis, for example in the thoracic spine, must be balanced by a kyphosis above and below. This is what Hilibrand et al⁵ found in their excellent study on the sagittal configuration of the cervical spine in idiopathic scoliosis patients. They report, “we found the greatest cervical kyphosis in patients with thoracic hypokyphosis”. Most recently in 2009, Morningstar and Stitzel⁶ found similar results.

So, although the effect of the 3-D scoliotic deformity is most pronounced in the thoracic and lumbar regions, there are consequences for the sagittal cervical spine as well. However, these changes in cervical curvature are most certainly secondary to the thoracic scoliosis (and lordosis), NOT a primary etiological factor.

SUMMARY

An understanding of what a scoliosis actually looks like in a real patient is the most crucial aspect of clinical decision making when managing these patients. The biggest mistake clinicians make is relying upon 2-D representations of the deformity on radiographs without understanding the actual 3-D configuration of the spine itself.

For decades, CBP® doctors have the goal of restoring normal spinal alignment in three dimensions. Scoliosis is a mechanical problem. CBP® provides a rational biomechanical explanation for effective clinical treatment of the scoliotic deformity. Any chiropractors interested in managing scoliosis more successfully should consider learning CBP® technique.

Dr. Deed Harrison and I will be teaching two scoliosis seminars on CBP® management of scoliosis in 2011:

• April 9-10 in NY/NJ, and
• August 13-14 in Seattle.

For details and to register visit www.idealspine.com or call CBP Seminars at 800-346-5146.

REFERENCES

1. Peloux J du, Fauchet R, Faucon B, Stagnara P. Le plan d’election pour l’examen radiologique des cyphoscolioses. Rev Chir Orthop 1965; 51:517-524.
2. Steindler A. Diseases and deformities of the spine and thorax. St Louis, CV Mosby Company, 1929.
3. Winter RB, Lovell WW, Moe JH. Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis. J Bone Joint Surg [Am] 1975;57:972-6.
4. Cruickshank JL, Koike M, Dickson RA. Idiopathic scoliosis in three dimensions. J Bone Joint Surg [Br] 1989:71:259-63.
5. Hilibrand AS, Tannenbaum DA, Graziano GP, Loder RT, Hensinger RN. The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Spinal Dis 1995;15:627-32.
6. Morningstar MW, Stitzel CJ. The Relationship between cervical kyphosis and idiopathic scoliosis. J Vertebral Subluxation Res. October 13, 2008; 1-4.

Chiropractic BioPhysics, Scoliosis

Are Airport Security Full-Body Scanners a Threat to Public Health?

Paul A. Oakley, M.Sc., DC

CBP Research & Instructor

Private Practice New Market, Ontario, Canada

INTRODUCTION

As you have likely heard or already have experienced, the Transportation Security Administration has implemented new full-body scanners in the largest airports in an attempt to thwart off terrorist attacks. This was in response to last Christmas’ underwear bombing attempt, where a Nigerian man was wearing ‘hard-to-detect’ explosives. The TSAs goal was to have 500 body scanners deployed by the end of 2010; 1000 body scanners deployed by the end of 2011. As of November 20, 2010 there had been 385 full-body scanners in use at 68 US airports.^1,2

The new full-body scanners use either ‘millimeter wave’ or ‘backscatter x-ray’ technologies. Millimeter wave technology reflects extremely high frequency radio waves off the body which forms an image. Backscatter x-ray technology produces an image by measuring the reflections of low-intensity x-rays. Both technologies work by producing body contour images of the body in order to see objects that could be hidden under clothes.

Terrorism vs. Human Rights

Although these new anti-terrorism screening procedures have been considered both invasive and harmful, the TSA states that these are “safe and necessary sacrifices to ward off terror attacks.”² Travelers who do not want radiation exposure from the new scanners would have to then face an ‘enhanced pat-down’ that includes checks inside the thighs and buttocks by someone of the same sex.

There has been much controversy in the deployment of these body scanning techniques as many organizations contend that the governments forced use violates basic human rights. In fact, the Electronic Privacy Information Center (EPIC) filed a lawsuit in July, 2010 to ‘suspend the deployment’ of full-body scanners at airports in the US as they claim the government has violated the Administrative Procedures Act, the Privacy Act, the Religious Freedom Restoration Act, and the Fourth Amendment as citizens are subjected to virtual strip searches without any evidence of wrongdoing!^1,3

The Radiation Exposure Issue

Regardless of the many levels of controversy, the issue regarding the scanners from a radiation exposure point of view is whether the backscatter x-ray technology delivers detrimental levels of ionizing radiation exposures to airport travelers and pilots. The backscatter x-ray has an emitter which emits low intensity x-rays and its detectors measure reflected x-rays to create an image.

The TSA states that the exposure is about 1/1000^th of that received from a chest x-ray. However, according to Peter Rez, a physics professor from ASU, the calculated exposure levels are more in the line of 1/50 - 1/100^th of a chest x-ray. Rez stated that the risk of causing DNA damage, thought to cause cancer, would be estimated to be about 1/30,000,000 (yes 30 million). The TSA screens about two million travelers a day. This indicates, according to these estimates, that one passenger in 15 days, or about two passengers a month, or about 24 passengers a year could have a cancer develop due to being screened at the airport.

On the surface it may seem a very risky, health-costly sacrifice to provide security for the American public. For this reason, a letter^4,5 was sent from a few professors at the University of California, San Francisco (UCSF) about the health risks associated with the new scanners as estimates are actually much higher than estimated by the TSA as the dosage is focused on the skin and surrounding tissues. Estimates are usually calculated as if the dose is distributed throughout the whole body. Other opponents have suggested that the risks to pregnant women and children are also significantly higher than the estimates given by the TSA.⁶

In a press release, the National Council on Radiation Protection (NCRP)⁷ has stated that cancer risk estimates are completely inaccurate as reported by ‘scanner opponents’: “the summation of trivial average risks over very large populations or time periods into a single value produces a distorted image of risk, completely out of perspective with risks accepted every day, both voluntary and involuntary.”

The NCRP⁷ also states the effective dose from these new airport scanners is limited to 0.01 mrem or less per scan. This would allow a given individual to be able to safely receive 2500 scans per year (assuming each scan is less than 0.01mrem without exceeding the administrative control of 25mrem to a member of the general public for a single source or set of sources under one control). Thus, assuming a 250 workday year, this safety margin would correspond to 10 scans per day – which would likely not occur!

Putting this into better perspective, the TSA has also set the limit of the dose of exposure from the backscatter x-ray scanners to be no more than the equivalent of 2 minutes of the expected exposure time while flying in the airplane. Other estimates have determined that the exposures are about 42-60 minutes of ‘background’ radiation^7,8 – that is, radiation we are constantly exposed to, unknowingly for most people every day, that we cannot ever possibly escape!        

Assuming a cervical series x-ray pair is 44mrem, and a lumbar series x-ray pair is 130mrem, then it would take 4,400 and 13,000 x-ray scans at the airport, respectively, to contribute the equivalent of these radiation exposures of common x-rays that many chiropractors take every day of their patient populations! According to the Health Physics Society (1996), risks of health effects below 100mSv (227 Cervical series or 77 Lumbar series⁹) that is, 50 to 100 times the exposure levels from x-rays) health risks are nonexistent (too small to observe).¹⁰ This equates to 1,000,000 body scans! Suffice to say, this will never happen.

SUMMARY

In conclusion, the risk of the miniscule amounts of ionizing radiation from the backscatter x-ray technology employed in the full-body scanners should be considered zero – and unfortunately, not even in the range of ‘hormesis’ – where there could be a health enhancement effect. The largest threat about this new scanning technology lies in the privacy domain. For example, despite the TSA denying the ability to save naked images of travelers, on November 16, 2010, 100 of an apparent 35,000 saved body scan images were leaked onto the internet!²

REFERENCES

1. http://en.wikipedia.org/wiki/Full_body_scanner
2. HTTP://MSNBC.MSN.COM
3. Lawsuit challenges airport full-body scanners — The Boston Globe. Boston.com (2010-08-04).
4. UCSF letter to Holdren concerning health risks of full body scanner TSA screenings 4-6-2010. Scribd.com.
5. Carmichael, Scott. (2010-05-18) Scientists question safety of airport full body scanners. Gadling.com.
6. Full-Body Scanners to Fry Travelers With Radiation. Prisonplanet.com (2009-12-31).
7. http://www.ncrponline.org/Press_Rel/Commentaries/Comm_16_Press_Release.pdf
8. http://www.hpa.org.uk/Topics/Radiation/UnderstandingRadiation/UnderstandingRadiationTopics/BodyScanners/
9. Oakley PA, Harrison DD, Harrison DE, Haas JW. Evidence-Based Protocol for Structural Rehabilitation of the Spine and Posture: Review of Clinical Biomechanics of Posture (CBP®) Publications. JCCA 2005;49(4):270-296.
10. Mossman, K. L., Goldman, M., Masse, F., and et al. Radiation risk in perspective: Health Physics Society position statement. 1996. Idaho state University Dept of Physics and Health Physics Web site: (www.physics.isu/radinf/hprisk.htm).

Airport Security full-body scanners safety

The Flat Foot – A Closer Look

Stuart Currie DC,

Director of Research, Sole Supports.

www.solesupports.com

INTRODUCTION

It would be quite easy to characterize the flat foot as a simple pathological entity however, what is more difficult is a thoughtful analysis of what the literature tells us, and what the everyday clinician should consider in their evaluation and treatment protocols. Although the flat foot appears to be a simple clinical finding upon first glance, delving into the details can provide useful insight into its etiology, pathophysiology and prevalence.

Pes Planus is a general term used to describe the flat-footed condition. It is also referred to as pesplanovalgus, fallen arches, and over pronation.

There is a general consensus that pes planus is a common clinical finding; however, the incidence of pes planus is difficult to ascertain for a variety of factors not the least of which is a consensus on a grading or measureable definition. Foot posture has been correlated with factors such as age, presence of pathology, obesity and gender although the literature is inconclusive.

DISCUSSION

The pathophysiology of pes planus is widely debated. Adult acquired flatfoot deformity (AAFD) has received attention, with a historical focus on the posterior tibial tendon (PTT) insufficiency or dysfunction as the primary contributing cause¹. Information now available also illustrates that PTT dysfunction does not happen in isolation, and ligament involvement (most frequently the spring ligament complex) is extensive in PTT dysfunction².

Other causes of pes planus that should be considered are: arthridities (both degenerative and inflammatory), congenital abnormalities, trauma, Lisfranc dislocation, rupture of the spring ligament or plantar fascia, and neuropathically induced causes such as Charcot’s arthropathy.

What the literature tells us about the flat foot and how it relates to pathology is telling. Investigations have shown that an increase in plantar surface contact area, associated with pes planus can be a risk factor for the development of overuse injuries^{3, 4}.

It has also been shown that arch structure plays a role in lower extremity kinetics and kinematics⁵, and that different arch structures lead to different injury patterns in runners.⁶ From a muscular perspective there is some evidence that pronated feet demonstrate greater activation of inverter musculature and a decreased activation of everter musculature.⁷ Although there is some lack of agreement between studies evaluating the association between foot posture and injury, it is widely accepted that foot posture, in combination with other factors, influences the risk of injury in sport⁸.

Having established the role of foot posture in function and injury, the next step is to begin to quantify a pathologic and corrected foot posture, and while on the surface this seems simple there is more to the story that warrants exploration.

Consider that there is currently debate and variation in the definition of a flat foot, and that person-to-person variation can lead to subsets of either flat or high arched feet that operate at different levels of functionality.

One clinical assumption that is often made is that the plantar surface area (footprint) can be used to predict the height of the arch. While this would be clinically ideal due to the ease of measurement, this is a dangerous assumption given that one study revealed that only 27% of the height of the medial longitudinal arch during walking can be predicted from plantar contact area⁹. This is important because it illustrates a potential disconnect between what is seen as a flat foot (increased plantar contact area) and what happens dynamically during walking.

What all of this literature tells us is that the flat foot requires some thought. Other than simple inspection, there are clinical measures and tools available for the clinician to quantify the pes planus condition and foot posture overall.

The Foot Posture Index (FPI)¹⁰ is a tool that can be used to classify foot posture based on several clinical measures of the foot.

The Arch Height Index which is calculated as the ratio of the dorsum of the foot (at 50% of foot length) to the truncated foot length has been shown to have good intra-tester and inter-tester reliability¹¹.

The Longitudinal Arch Angle (LAA) is measured by using the intersection of two vectors, one from the medial malleolus to the navicular tuberosity and the other from the navicular tuberosity to the midpoint of the first metatarsal joint. The LAA, as assessed in static standing, has been shown to be predictive of the arch height at midstance during walking¹² notably correlating a static measure with dynamic foot posture.

The Foot Mobility Magnitude (FMM) is another measure showing promise. It takes into account both the vertical and medial-lateral mobility of the midfoot¹³. Weight bearing and non weight bearing arch height and foot width differentials are also compared; using normative values for this measure in the clinic may give the clinician an additional tool to determine appropriate intervention, and also assist in determining when preventative treatment may be appropriate.

SUMMARY

The observation of a flat foot is a good clue that pathology may be on its way and warrants further investigation and quantification by the clinician. Once the clinician has determined that treatment is reasonable various strategies can be applied. These can range from addressing specific tissue pathologies or muscular weaknesses to providing corrective support to the posture of the foot through the use of a foot orthotic. Given the previously mentioned ligamentous stress that can accompany arch collapse, the medial longitudinal arch and its underlying bony architecture becomes an area of focus for an effective strategy aimed at postural restoration of pes planus.

REFERENCES

1)   Arai K. Clin Biomech 2007 June;22(5):592-8.

2)   Deland JT. Foot Ankle Int 2005 June;26(6):427-35.

3)   Kaufman KR. Am J Sports Med 1999;27(5):585-93.

4)   Levy JC. Foot Ankle Int 2006 December;27(12):1060-4.

5)   Williams DS. J Appl Biomech 2001;17:153-63.

6)   Williams DS. Clin Biomech 2001;16(4):341-7.

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

8)   Murphy DF. Br J Sports Med 2003;37(1):13-29.

9)   McPoil TG. J Am Podiatr Med Assoc 2006;96(6):489-94.

10)         Redmond A. The Foot Posture Index: User Guide and Manual. http://www leeds ac uk/medicine/FASTER/fpi htm 1998.

11)         Williams DS. Phys Ther 2000;80(9):864-71.

12)         McPoil TG. J Am Podiatr Med Assoc 2005;95(2):114-20.

13)         McPoil TG. J Foot Ankle Res 2009;2:6.

SoleSupports, Flat Foot

Pediatric Cervical Lordosis: Values, Disorders, and Interventions

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

INTRODUCTION

The adult cervical lordosis has received considerable attention in the spine literature; where both average and idealized values and geometric shape of the cervical lordosis have been reported. The average adult cervical lordosis was 34° ± 9°between C2-C7 posterior vertebral body lines. In a follow-up paper in 2004, Harrison and colleagues² modeled the adult cervical lordosis (using a curve fitting method known as the least squares error) as a piece of a circle from C2-T1. Furthermore, they demonstrated statistically significant differences in adult cervical lordosis between normal subjects, acute neck pain subjects and chronic neck pain subjects.

Problematically, adult data for the cervical lordosis may not readily apply to children between the ages of birth to early adolescents and many clinicians may be incorrectly applying adult data to pediatric patients and outcomes.

Pediatric Normative Data

In many anatomy texts, it is often claimed and/or assumed that the cervical lordosis is a secondary curve and is not present during intra-uterine life. However, as early as 1977, Bagnall et al³ demonstrated that the cervical lordotic curve is formed in intrauterine life (9.5 weeks). In 195 fetuses, Bagnall et al³ found that by 9.5 weeks, 83% of fetuses have a cervical lordosis, 11% have a military configuration, and only 6% of fetuses are in the typically described kyphotic position of the cervical spine. This means that by 9.5 weeks, 94% of the fetuses are starting to use their posterior cervical muscles to pull the cervical curve away from the fetal “C”-shape. Fetuses have a cervical lordosis before birth, however, the lordosis increases during post-natal life at ages 3 months-9 months as the infant raises his/her head and begins to sit up.⁴

There is adequate information to suggest that the cervical lordosis increases from birth until about 2 years of age^3-6 and then decreases up until the age of 9 or 10, after which time the cervical curve increases until reaching early adulthood.⁵

In 1996, Kasai et al⁵ presented information on the development of the cervical lordosis in 360 Japanese children (180 boys and 180 girls) equally distributed in the age groups 2-18 years old. Subjects did not have neurological deficits or fractures, but were examined due to mild injury and symptoms in the neck. Radiographs were taken in the seated position and analyzed using the 4-line Cobb angle from C3-C7. It might be that sitting cervical lordosis is reduced compared to standing lordosis. Cervical lordosis was found to steadily decrease from the age of 2 years up to 9 years and then increase from 9 years up to 18 years of age. No differences were found between the sexes. Table I presents the means and Standard Deviations for cervical lordosis in each of the age ranges from this study.^5-6

Table 1.

Cervical lordosis values in Pediatrics and Adolescents between the ages of 2-17 years of age. There are 20 subjects in each age group and the posterior tangent method from C2-C7 is reported using data from Kasai et al⁵ and Harrison et al⁶ (Chapter 3).

2 yrs old	32.1°†
3 yrs old	30.6°†
20/4 yrs old	30.4°†
20/5 yrs old	27.8°†
20/6 yrs old	26.6°†
20/7 yrs old	23.4°†
20/8 yrs old	22.5°†
20/9 yrs old	21.5°†
20/10 yrs old	22.7°†
20/11 yrs old	23.8°†
20/12 yrs old	24.4°†
20/13 yrs old	25.3°†
20/14 yrs old	26.5°†
20/15 yrs old	25.8°†
20/16 yrs old	26.4°†
20/17 yrs old	27.5°†
20/18 yrs old	28.0°†

Abnormal Lordosis and Pediatric Health

Car accidents, falls, and poor posture might all contribute to abnormal cervical lordosis in pediatric populations. Ultimately, abnormal cervical lordosis may lead to a number of health-related disorders in children or childhood. For instance, in infants, the cervical lordosis has been found a necessity for proper respiration and opening of the velo-epiglotic and velo-glossal sphincters.⁷ According to Shatz et al,

“The most important anatomical parameter found to facilitate the switch from nasal to oral ventilation in human infants is a cervical extension, creating a physiological lordosis of the neck that results in an opening of the veloglossal and veloepiglottic sphincters.”⁷

In children aged nine years and up, McAviney et al⁸ found that reduced cervical lordosis was correlated to the presence of sub-acute and chronic cervico-genic pain. Also, evidence in the Chiropractic literature, suggests that correction of abnormal cervical lordosis in children may improve disorders such as ADHD, Asthma, Ear Infection, Headaches, and Neck Pain.^9-11

Conservative Interventions for Pediatric Patients

            Conservative interventions for rehabilitation of the abnormal pediatric cervical lordosis are multi-modal and can include adjustments, exercises, and spinal remodeling (traction) techniques. In CBP Technique, these procedures are performed using mirror image® methods. Figure 1 depicts a CBP Technique mirror image adjustment and Denneroll spinal remodeling orthotic device.

·      Pediatric Spinal Remodeling-Traction

Problematically, adult equipment for rehabilitation of the cervical lordosis on the market today is not specifically designed for the pediatric patient’s body size. Adult equipment applies considerable forces-loads to the spine and these loads may not be appropriate for pediatric spines. Lastly, adult devices can be cumbersome to use in children and they will not sit still in these devices; thus their bodies do not remain in neutral postures when in traction.

            For the above reasons, the pediatric Denneroll orthotic device was developed for pediatric specific use. (Figure 1). In Figure 2, a pediatric male’s x-ray is shown with a mid-cervical curve reversal. The child presented to my clinic with chronic cervico-genic pain that was unresponsive to previous chiropractic care at a separate facility. After 6 weeks (3-4 x per week) of intervention using the methods in Figure 1, a revaluation was performed. Follow up radiographs were obtained a minimum of 2-days since his last treatment and complete correction of the cervical lordosis has been achieved; the patient was now asymptomatic (Figure 2).

SUMMARY

            Pediatric cervical lordosis values can vary from that of the adult due to developmental changes in the spine and changing distribution of body masses. Preliminary evidence exists providing both normative data for cervical lordosis across ages and a relationship between abnormal cervical lordosis and pediatric health disorders. Adult ‘spinal remodeling’ devices may not be appropriate in size or forces for many children. It is for this reason that the pediatric Denneroll device was developed.

Though the evidence is preliminary, I would encourage Chiropractors interested in structural rehabilitation of the pediatric spine to utilize this device in selected cases as it appears to be reasonably effective for its purpose.

REFERENCES

1. Harrison DD, et al. Spine 1996; 21: 667-675.
2. Harrison DD, et al. Spine 2004; 29:2485-2492.
3. Bagnall KM, et al. J Anat 1977;124:791-802.
4. Kure S. J Tokyo Med Collage 1972;30;453-470.
5. Kasai T, et al. Growth. Spine 1996;21:2067-2073.
6. Harrison DE, Harrson DD, Haas JW. Evanston, WY: Harrison CBP Seminars, Inc., 2002, ISBN 0-9721314-0-X.
7. Shatz A, et al. Acta Anat 1994;149:141-145.
8. McAviney J, et al. J Manipulative Physiol Ther 2005;28:187-193.
9. Bastecki A, et al. ADHD: A CBP Case Study. J Manipulative Physiol Ther 2004; 27(8):e14.

10.   Fedrochuk C, Wheeler G. J Ped Maternal & Family Health-Chiropractic. 2009;4:1-7.

11.   Fedrochuk C, et al. J. Pediatric, Maternal & Family Health - June 17, 2009:1-8.

cervical lordosis, Chiropractic BioPhysics, pediatric normal lordosis values