Should Liability Shielding be Present?

 Liability shielding can be a bit of a mis-understood concept. What is it and why is it important? As defined by Merriam-Webster Dictionary: Legal immunity, or immunity from prosecution, is a legal status wherein an individual or entity cannot be held liable for a violation of the law, in order to facilitate societal aims that outweigh the value of imposing liability in such cases IE there exists legal immunity from civil liability, also known as "liability shield."  The big question of this Blog, primarily related to healthcare,  is whether or not any company or person, should have exemption from liability for damages incurred by their product or service? What would or should be the necessary parameters whereby they are indemnified?  

Not to over-simplify, however as an example, should Ford Motor Company have legal immunity such that those buying the Pinto have no ability to sue for damages due to a faulty product? Should Patients be able to sue Johnson and Johnson for a medication that caused them physical damage? Without getting into the weeds on economic policy or political views, the ability of the public to sue for damages is somewhat a natural stop-check that places responsibility on the part of the company to create the safest product or service possible, if nothing else, so as to avoid unnecessary risk of exposure to law suits. Clearly, corporations work on the concept of a "profit-margin" for their share holders. Seeking strong profit-margin can be a strong inducement to heavily minimize expenses. The number of  successful lawsuits in this country over faulty products is striking. As with the afore mentioned Ford Pinto, All too often it is later discovered that a company had indications of faulty product, yet proceeded. For those not aware, Ford Motor Company was found guilty in Federal Court of conspiring to withhold information that the company knew ahead of time that there was a deficiency in the production of the Pinto's gas tank and that cars could possibly explode if hit at the wrong angle from behind. Federal Court found that Ford omitted this information because they had actually done the math on their margin of profit and loss. Ford found that the $11/ car Recall correction for that model was going to cost more than the wrongful death lawsuits they knew would happen. Ford sought immunity from suit, however the Court denied and found them guilty and fined them - of which, monies went to families of victims driving the Pinto when they were hit from behind and the car caught fire, severely injuring or killing the occupants.  An important point to make, is that here in the United States, we have the ability for discovery and civil lawsuit in instances such as this, whereas not all countries do. Is it safe to suspect that if a Corporation is given immunity from Lawsuit, that they might place more money and effort in marketing research, than they do Safety research? There are ample examples of what people and Corporations might do for the bottom line if there is no accountability for their actions. In the above example, Could Ford have been "trusted" to produce the safest car possible, or to satisfy the bottom line - I.E. , fulfill their fiduciary responsibility to their investors? How might this scenario have panned out if they were granted immunity from suit? Would they have made the Pinto even less safe due to the fact that they couldn't be sued? This does not mean that all people and Corporations are inherently evil and self-serving, certainly there are also many examples of both people and Corporations being dedicated to responsible and ethical actions - I would argue that most people actually seek out businesses and individuals they believe to be morally responsible and ethical as a natural order of facilitating relationships based in trust.

Getting more specific, in the field of healthcare, should physicians and corporations have immunity from civil liability? Are there some that might cut corners with safety and more, in an effort to maximize profit if there were no sense of accountability? What are the circumstances in which a healthcare worker, provider, corporation etc should not have accountability? Is there a time and place where Benefits of immunity outweigh the risks? Keeping in mind that this is not the concept of "informed consent" whereby the patient is "informed" or made aware of both risks and benefits of a product or procedure, thereby making a decision on their own informed recognizance. A patient signing informed consent paperwork, in no way bars them from filing for discovery in a civil lawsuit, as many institutions and physicians well know. 

Lets get really specific and take onus here. Should I, as a healthcare provider, have the ability to have liability shielding for any service or product I offer? If  I am concocting an herbal elixir at my office and then selling it to the public, should the public have the ability to sue me if people start getting sick, or worse - dying? If every patient signed paperwork for informed consent, listing such reactions as "hair loss, vomiting, rash, fever, suppressed immune function, and even death", should this remove my accountability / liability? What if there are numerous reactions and mounting deaths, that I simply choose not to investigate ......because I don't "have" to if granted immunity. What if I choose to ignore the reactions and deaths and simply not do the research to implement a safer product.....because I don't "have" to if granted immunity? This quickly becomes a question of moral, ethical and responsible/accountable action on my part. This is the reason for 3rd party boards of oversight and regulatory agencies....... to protect the interests of the public. Without going too deep down the rabbit hole, lets make it very simple, should the public be able to sue me if I provide a service or product that appears in the public eye,  has become suspect of causing harm, regardless of signed informed consents? Should I be protected regardless of mounting injurious data? To add icing to this cake....should I be able to pass a law that forces every person in the country to take my elixir once per month? What might be the outcome in safety of such combined actions..... if I am immune from lawsuit, and the public is legally mandated to buy and use my product? Would you, as the reader and member of the public, feel this combination of circumstance would inherently make my product better and safer, or otherwise? If my marketing department touted that my product is "safe and effective" , yet never studied safety further, would this be believable? Would it stand to reason for the public to question, that if my product is actually as safe and effective as my marketed message states, why do I have need for immunity from law suits from its use? Wouldn't this become the next logistical question by the public, especially if they were legally mandated use of the very same product? 

Although it is possible for specific circumstances in which immunity is feasible, such as an EMT providing life saving medication that has a reaction with an unknown drug in the victim's system and therefore died as a result. In general, it is my opinion as a healthcare provider that legal immunity should not exist broadly within healthcare, especially as it relates to healthcare products.  In Particular, there is the potential for a "perfect storm" of negative consequence when indemnification is paired with mandate of the same product or service. This would seem to place the public at greater risk without the natural barriers of bearing risk in the market place. 

To be clear, in the healthcare realm, rarely do products or services enjoy such immunity from lawsuit. Largely only one area of healthcare has attained such a feat; this is vaccinology. Which begs the question that if other drugs coming to market do not have immunity, then why do vaccines? We are collectively told (marketed to) that for example, the co-vid vaccine is completely safe and effective. If this is the case, then why are all vaccine manufacturers and healthcare personnel administering them, protected with immunity from lawsuit? Could one not infer that (as an example) if the product OxyContin does not have immunity from suit, however that a co-vid vaccine does have immunity from suit, that perhaps the protection is in place specifically due to the increased relative risk of co-vid vaccine compared to OxyContin? One does not have to be "anti-Vax" in order to question scientifically and ethically the legitimacy of immunity/indemnity in vaccinology, especially when there is also legal mandate for such a Medical Product/Procedure. It is responsible science to ask tough questions such as this. Is this indemnification justified, and if so, how? Also, by pairing mandate and lawsuit immunity, are we inadvertently facilitating unnecessary exposure to risk on the part of the patient, of which, they have no real recourse? 

Article for reference: Covid vaccine: You can't sue Pfizer or Moderna over side effects (cnbc.com)

Therefore, the question is posited to the reader. Should Healthcare providers, institutions, and manufacturers enjoy legal immunity from the very services and products they manufacture or offer to the public? In particular should the same product or service have both legal immunity and mandated use? Is this fair, does it erode public trust, and is it safe? 

With great power, comes great responsibility. Where there's Risk, there must be choice.

Exploiting the Placebo Effect! Advanced healing with Procebo(TM)

Recent studies elucidate the Placebo effect as accounting for potentially 60-80% of outcomes as of 2019. This is a dramatic up-swing from decades past when Placebo was considered to account for potentially 30% of outcomes. What is "Placebo" and why is it important? In short, placebo ( Latin- Biblical: "I shall Please") is the idea that a person's thoughts about a treatment, can effect the treatment given them. Placebos are inert substances given patients that ideally should have no noteworthy physiological effect----- however for an increasing number, they do! The idea in testing against Placebo is that the "medicine" has a reproducible effect greater that Placebo ( double blind randomized placebo-based studies are the gold standard in research) in order to verify effectiveness of the treatment, medicine, intervention, beyond that of the patients expectations alone. 

Its amazing to note that patients undergoing such physical treatments, such as knee surgery, also appear to see above 50% positive effects, in some studies,  of a "sham" or Placebo. It is immensely noteworthy to consider the ramifications of patients undergoing both pharmacological as well as surgical intervention and seeing positive results from Placebo. Where attention goes, energy flows is the old saying regarding the fact that what we place our attention and effort upon, seems to facilitate change. We also know Medically that if we take blood and vitals on a person that was just having a dream of running from a cougar, that their heart rate will be high, stress hormones high, respiration high........all variables of that person's physiology will represent a person in  high stress. The body will respond accordingly whether those stressors were real or simply perceived. The interesting part in current research, as stated above, shows that the same often holds true with healing.....that if a person perceives that the medication or treatment is "real" and they are programmed (told) to expect beneficial outcomes, then they do. For some, it appears a far stretch to liken a stressful dream and its effects upon the body to that of  "healing by intent." However, the research appears to be showing us that this is possible in some circumstances. Science often studies ideas and concepts that we might currently believe to be impossible or highly unlikely. Often through this process of measure, proving, trial and error, we find that the magic of yesterday is the science of today. Just look at our current technological advances that only 60 years ago, or less, were thought to be impossible. 

Interesting also, is the concept of "Nocebo," whereby a negative or detrimental effect upon the body has been shown to be elicited by programming or telling the patient ahead that they should anticipate a negative outcome from a specific treatment. Whether we understand "how" the placebo or nocebo effects are possible, we can in fact see that they are experientially. Therefore, these concepts are notable and valuable in research with regards to patient outcomes in healthcare. This author would propose the concept of a "Procebo Effect," Whereby in a proactive manner, patients are intentionally pre-framed for a positive outcome from a particular treatment. I would argue that in many circumstances that this has already been being used to varying degrees over the years, however that it hasn't been referenced within a defined context. The difficulty lies in both appropriate methods and measure of such a process. Initially, the process would need to begin with "defining" the process with appropriate context to its meaning and use. For example: historically the placebo effect was known to have somewhere between 15% - 30% effect in pharmaceutical trials, however as the concept has become more widely understood and accepted particularly in western culture, the latest studies on placebo effectiveness ( Harvard et.al.) in western cultures show that it now accounts for roughly 60% + of outcomes. This effect appears to be therefore pronounced in cultures whereby the definition and context for the term and process has been well established. Therefore the use of the term "Procebo" defined within context, meaning a process of "intentionally or pro-actively facilitating or pre-framing the idea of a positive outcome of a treatment or procedure" could be the initial action step in overall effective use to the benefit of all patients. In doing so, it is arguable that the patient's belief or perception could be intentionally exploited in a manner so as to effect the treatment outcomes in a manner beneficial to the patient. 

Corona Virus Concerning you?

While it is debatable "where" this strain of Corona Virus ( SARS-CoV2) has come from, it is a real thing to pay proper attention to. Just as with any Virus, there is no "magic bullet" cure out there. There are definitely some treatments, as we have learned, that work better than others, this is why it is called the "Practice" of  Healthcare/ Medicine/ Chiropractic, etc. We are always learning better and more efficient ways to treat a myraid of conditions that people have. I would like to focus for a moment however on the fact that as humans, we have been in contest with various infectious agents such as bacteria, viruses, mycoplasmas, for a millennium. One has to believe that over the hundreds of thousands of years, that our species has learned to adapt to all of these challenges...... your parents and all of theirs before them have successfully accomplished this or you would not be alive to read this document, much less any other function of life. We all know this to be true, however somehow in today's information age, we act as though we have forgotten. For example, we all know that a child's fever is actually a very good thing (within an acceptable range) for fighting bacterial and viral infections, yet how many times do parents reflex at the first sign of fever with Ibuprofen or the like? And why? To protect their child of course! However, this is a great example of a common procedure performed with the best intentions of helping that actually ends up being often more detrimental than beneficial. There are many examples of how we need to slow down and take some common-sense steps towards health, lest treatments unintentionally end up worse than the conditions they are designed to treat. 
Where am I headed with this? I strive every day to guide my patients on the path of the Foundations of Health. There are Foundational Steps/ Actions that are vital for every person, regardless of various infectious agents out there. While some viruses can certainly be more virulent than others, the rules are generally the same. This is why with ALL infections (viral, bacterial, etc), those that are most immuno-compromised are the ones that are most likely to fall ill or even suffer fatality. This means that the determining variable to health in general...... is INDIVIDUAL IMMUNE COMPETENCE. Your health and well-being is not determined by the virus so much as your ability to fight it. We all intuitively and experimentally know this, however we often live as though we have forgotten this fact.
The greatest challenges to health are largely 1. Clean Water  2. Malnutrition  3. Appropriate sewage and refuse management. This is why in today's 3rd world areas where these items are not in balance, they have more endemic disease, unfortunate as it is. If a person is malnourished, has no clean drinking water and is around sewage and disease-infested surroundings, this person is most likely to fall ill at least at some point. We should all be thanking our plumbers for the steady decline in disease over the last 2 hundred years......plumbers and food-suppliers!
Viruses and Bacteria don't prefer one person to another, nor do they kill people equally. The virus is the same regardless of the person, it will simply affect some people more severely than others based upon the IMMUNE RESPONSE OF THE INDIVIDUAL. To run this point home further is the fact that each of us has known  times in our lives that we were more likely to get sick than others. That is, times we haven't been eating right, and have been stressed out with perhaps little sleep facilitated a greater opportunity for us to become ill than times we were exercising, eating right, getting good sleep and de-stressing.
So what should we all be doing to minimize our changes of getting sick? We should be taking care of our body by giving it what it needs to function optimally. As a society we should be more reliant upon educating and providing positive opportunity and resources to the individuals that make up the society, and less reliant upon outside interventions unless they are needed. These ideas are not patentable, nor is the air, ,water, sleep, and relaxation we all need, however this does not change the truth of their necessity.
So, what are the basic components and some additional things to consider?
1. Drink appropriate amounts of clean water - the average American is dehydrated
2. Get appropriate sleep - the average American gets 6 hours or less of sleep / night ( 7-8 is best)
3. Have a time/space for active De-Stressing, such as Meditation.
4. Eat a Balanced Diet of "Good" foods - this part is particularly important point as all too often the American Diet consists of foods that are "empty calories" and not "nutrient - rich" foods. Many fast and pre-prepared foods are full of sugar and other components that can actually be harmful, making a person more likely to become ill. Sugars should be primarily in the form of fruits and a very low percentage of one's diet. The average American eats lots of sugars in pre-prepared foods and ends up with something called insulin-resistance along with type 2 Diabetes........ all precursors for a weakened immune response to any virus.
5. Supplements can be very useful and often necessary - As American food sources are often devoid of necessary vitamins and minerals, "supplementing" is very often necessary. There are some supplements in particular that I will quickly list in a general sense for maximizing the average persons health and immune function towards greater homeostasis (Balance.) This is not intended to be a comprehensive list. This is also not designed to diagnose any person or institute a doctor-patient relationship. No specific quantity recommendations are listed as this can vary by the individual and anyone reading this list should consult their healthcare provider prior to making changes.

Vitamin D3 - helps improve immune competence, necessary for health.
Zinc - necessary for enzymes to work correctly. Helps maximize immune function.
Vitamin A - great for optimizing respiratory health.
Vitamin C - great antioxidant and maximizer of immune function. 
N-acetylcysteine (NAC) - antioxidant, helps break down mucus bonds, helps produce            Glutathione. 
Selenium - shown to help suppress progression of viral burden.
Glycyrrhiza (Black Licorice) - shown to have antiviral properties and help inhibit replication of SARS-associated viral strains in research. 

Clearly the idea here is that illness in general, not withstanding Coronavirus, is determined by each individual and how healthy they are or are not. Those that are already sick or predisposed, are the ones with the greatest risk. While compromised individuals should take necessary extra precautions, they as well as ALL individuals should take the necessary foundational actions/steps towards being as healthy and strong as possible as there is no "magic-bullet" to health, simply a common sense approach that has gotten us this far.....hopefully in balance with our environment.

Why Your Medical Doctor Loves your Chiropractic Doctor

To some, this title, may sound inconsistent with stories they hear. Myself coming from a family that was not Chiropractically-aligned, I find this title not so much "provocative" as it is actually "true." This context of thought comes with 16 years of practice experience, literally coming from a childhood  instilled with  thinking that Chiropractors were quacks, etc, to being the Primary Health Care Provider for many of my patients as a Chiropractic Doctor.

Since Chiropractic's inception in 1895, there have been periods divisiveness between Medical and Chiropractic perspectives, however not initially as much as many may think as there was actually a good amount of collaborative care with patients as Medical and Chiropractic natural treatment methods and philosophies were initially similar, excepting Adjustive ( Manipulative) therapy of the spine. Chiropractors were cutting edge in the early 1900s with X-ray, respirometery, and more as these new sciences developed. Also, it is a little known fact that "Homeopathic Medical Doctors" used to be very prevalent in the US, which caused in-fighting as 2 factions of Medical Doctors took sides as naturalists or pharmacologists in a sense. As time moved forward and the Medical model approached more of a purely pharmacological model, there came to pass a period from the early 1900's through the 1960's primarily, that the face of Healthcare went through tumultuous changes. Many "variant" (non-pharmacological) forms of healthcare were attacked in an interest to unify Medical care in general. Chiropractors, Homeopaths, Osteopaths, etc were persecuted as "unscientific" and for practicing "medical treatments" with out the proper education or licensing. Over the years, many Osteopaths as well as Homeopaths often got absorbed into the typical Medical practices we see today.

Without getting further into the depths of the "history" of healthcare, how can I make the statement that Medical Doctors love Chiropractic Doctors? Certainly there are many "opinions," so taking on the subject from this perspective is dauntless at best, especially when dealing with so many opinions, often having no technical experience with a subject, creating an in-valid/ non-experienced "perspective" alone. However, when taking into consideration the number of Medical Doctors over the years that have taken pause to understand and evaluate the knowledge base, training and scope of Chiropractic practice, there appears a well-documented favoring. When it comes to the neurophysiologic/ neuropathologic/ neuroplastic basis of the body's functions and the Chiropractic model, we find that with ever-growing volumes of data, that there is overwhelming evidence for "how" Chiropractic works. Essentially, our scientific understanding of the body has come far enough to better understand Chiropractic effects, whereas in the early stages, the science was scant, but it was known to "work." The problem therein lying in any-thing that is known to "work," however without the exact depth of then-current scientific understanding to better explain its dynamic function. Again, this was a problem decades ago, however especially from the realm of MD neurophysiologists, the Medical world at large is gaining a much better grasp of the "why" behind Chiropractic success.

I have personally met a number of neurophysiologists over the years, starting in my Palmer education, that were highly supportive of the Chiropractic Method, and this has always come down to the fact that these specialists deeply understand the nervous system in a way that few others do. These specialists understand the finite workings of the nervous system and how the Chiropractic Adjustment stimulates the intersegmental joint complex, recurrent meningeal nerve pathways, spino-cerebellar pathways, somato-viscero pathways, viscero-somatic pathways, afferent and efferent pathways, proprioceptive input and cortical processing, and much more that have a balanced functional effect on nervous system input and output that create the physiologic/mental/emotional experience of the individual.

In the end, my assertion as to why the Medical community at large over time has come to find a current place of mutual respect, referral, learning and co-care with the Chiropractic community, is in fact based on scientific study and observation. The research performed within the Medical community itself supports and validates the effects of  Chiropractic Care and Treatment. Moreover, there are numerous MD's that are staunch supporters of Chiropractic, such as Joseph Mercola, DO, Jack Wolfson, DO, Andrew Weil, MD, to name only a few. The Following portion of this particular BLOG is a list of articles and research that supports the viewpoint I am asserting. This is done in order to "cite" sources to these claims. All cited references may be largely sourced through PubMed itself or other Medical reference sites via the copy and past method.
As always, we welcome any and all questions and commentary of a positive and constructive nature, therefore please do not hesitate to contact us.
* Disclaimer 1: In healthcare, there are many fields and these may be likened to "tools." whereby different tools are appropriate for different situations. In no way is this piece designed to make the reader feel as though Chiropractic is always the most appropriate course of action. One must always consult appropriate healthcare professionals to determine their best options for treatment and thereby make the best choice for themselves as an individual.
* Disclaimer 2: Within the field of Chiropractic alone, there are literally hundreds of "techniques" and treatment modalities. The research presented has largely been performed via the "biomechanical" treatment methods within Chiropractic. This DOES NOT construe these particular methods to be the only effective methods of treatment and effective patient care. Different methods of Chiropractic treatment are effective for different patients and their personal situation, making many effective  models and no one-size fits all model.
* (~) = my terminology and interpretation given.

Reference Citations: (Basic synopsis in parentheses ( ) )
1.Manga et al. The Manga Report 1993 An Independent Report Commissioned by the Ontario        
   Provincial Government ( Canadian Government Supporting Chiropractic Method/Findings)

2.Risk of Carotid Stroke after Chiropractic Care: A Population Based Study. Journal of Stroke  
   Cerebrovascular Dis. 2017 Apr; 26(4): 842-850. National Stroke Association (No greater risk of  
   Carotid Artery stroke after Chiropractic care than Medical care)

3.Early predictors of lumbar spine surgery after occupational back injury: prospective study of  
   workers in Washington State. Spine 2013 May15;38(11):953-64 (42.7% of workers seeing a   
   Surgeon first had surgery compared to only 1.5% who saw a Chiropractor first prior to surgical    
   consult)

4.Alterations in Cortical and cerebellar motor processing in subclinical neck pain following spinal
  manipulation. Journal of Manipulative Physiol Ther. 2013 Oct;36(8):527-37 (Improvement in       
  cerebellar task performance with 19% decrease mean reaction time in spinal manipulation  
  (~Adjustment)  groups)

5.Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in  
   Chronic Pain Patients.Journal of Manipulative Physiol Ther. 2017 Mar - Apr;40(3):127-138
   (Chiropractic care improving function and decreasing Pain in chronic Pain sufferers via reduction      of somatosensory evoked potentials)

6.British Medical Journal June 1990 p.1431-37
   Canadian Family Physician 1985 ; 31: 535-40
   (Chiropractic Treatment was more effective for low back pain (LBP) than care offered by Medical  
     clinics)

7.The spine as the Causative factor of Disease. Fundamentals of Chiropractic From the Standpoint of
    a Medical Doctor, copyright for the English Language 1959. Friedmut Biedermann, MD
   (Subluxation and Malposition of the vertebrae, and straightening of physiological curves can result 
    in disturbance in function of the gall bladder, kidney, bladder, sex organs, etc.)

8.~Multiple Citations here on Visceral (Organ) reflexes and function~
  A)Neurol Clin 1999;17:91-111.
  B)J Manipulative Physiol Ther 2003;26:108-15
  C)Neville Usher, MD, FACP, “The Visceral Spinal Syndrome a New Concept of Visceral Motor  
      and Sensory Changes in Relation to Deranged Spinal Structures.”
  D)Lewitt MD, Dsc “Manipulative Therapy in rehabilitation of the Locomotor System” (1985)    
  E)Butterworth and Company London and Boston. P. 261-62.
  F)H. Kamieth, “Pathogenic Importance of the Thoracic Portion of the Vertebral Spine,” Journal of 
     the   Am Med Assoc (Nov. 15, 1958), p.1586.
  (Multiple sources citing cases whereby symptoms of appendicitis, gallbladder disease, and other       
  viscera (~organs) were relieved by correction of spinal curvature, associated myositis, and by  
  mechanical correction of posture at the level of the articular facet (~ misalignment/subluxation))

9.The Epidemiology of Low Back Pain in and Adolescent Population. Olson, TL, Anderson RL, et
  al. 1992 American Journal of Public Health
  (In Study of 108 students, 88% had SI dysfunction which further confirms the relationship of SI  
  dysfunction and LBP. There is a common clinical experience of obtaining symptomatic relief by SI
  manipulation (~ Adjustment).)

10.First Interdisciplinary World Congress on Low Back Pain. The Chiropractic Report: Smith,
   Editor,JAN 93, Vol 7 #8 ("We have come to realize that every paient with low back pain also has  
  significant mechanical dysfunction in the cervical and thoracic spine." Joseph Shaw, MD. 
  - significant to the idea of "Full Spine" Chiropractic Care when appropriate.)

11.Menstruation Pain and Sterility
   Butterworth and Company London and Boston. Manipulative Therapy in Rehabilitation of the
   Locomotor System 1985, p263.(Over 75% of women in study having diminished menstrual pain  
   symptoms and favorable results with non-organic infertility issues with manipulative (~Adjustive)
   therapy particularly to pelvic and coccygeal regions.)

12.The effect of sacroiliac joint manipulation on feed-forward activation times of the deep abdominal    musculature.  Marshall P, Murphy B.J Manipulative Physiol Ther. 2006 Mar-Apr;29(3):196-
   202. (Sacro-iliac adjustments improve function and timing of core musculature) 

13.Changes in proprioception and pain in patients with neck pain after upper thoracic manipulation. 
   Yang, Lee & Kim Journal of Phys Ther Sci 2015, 27:795-798. Palmgren et al. JMPT, 2006:29
  (100-106) (Spinal adjusting has been shown to positively influence proprioception function and
  Pain)

14.~ 3 Citations regarding how Chiropractic Adjustments positively change brain control~
   A)Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group
   study. Lalanne, Ufond & Descarreaux JMPT,2009:32 (203-209).
   B)Eduardo et al. Manual Therapy,2010 15(5):469-475.
   C)Murphy, Haavik, Taylor & Marshall JMPT,2010:33(3);168-177
   (All 3 citations show that spinal adjustments positively change the way that the brain controls neck 
   low back musculature)

15. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk
   in Older People: A Randomized Controlled Trial. JMPT 2016 May;39(4):267-78 (Spinal adjusting 
   helps diminish fall risk in the elderly by improving sensory-motor function)

16.RF Gorman DO, (Franz vonKurkel) “Chiropractic for Rejuvenation of the Mind.” Academy of
   Chiropractic Medicine (8 Budgen Street, Darwin Australia 1983).  “It is not surprising that 
   Chiropractic manipulation lifts depression. It is possible that chiropractic 
   maneuvers will become an important tool in psychiatric treatment.” –  ( Chiropractic care shown
    to help in Depression Disorder)

17.Life Toronto Star: Life section, Peter Rothbart, MD December 28, 1995. "It appears that 
  Chiropractors have been right all along. A team of doctors and Syracuse University have  
  established  with scientific, anatomical proof, that damaged structures in the neck (subluxations) are   the cause of many chronic headaches." (Chiropractic Subluxations can often be the cause of chronic 
  headaches)

18.Australian Case Study :
   “Spinal manipulation was determined for visual disorders by four
   opthamologists independent of the other. Patients were examined before and after manipulative
   treatment. In all cases, the vision improved (in either visual field and/or visual acuity).” – R.F.  
   Gorman DO. “An Observers View of the Treatment of Visual Perception Deficit By Spinal 
   Manipulation.” A Survey of 16 Patients. Sydney, Australia. 1991.(Chiropractic Adjustments 
   appeared to help vision in all individuals)

19.Cranial Trauma and Head Joints (German Medical Weekly), 80, 1503 - G. Guttman, MD
   Many discomforts subsequent to head trauma remain latent for a considerable length of time and 
   were unexplainable until now. They are due to subluxations of atlas and axis. They consist of 
   muscular reflectoric, radicular and sympathetic N.S. symptoms. Chiropractic treatment aimed at 
   realigning cervical vertebrae is the recommended course of action and can relieve all symptoms   
   completely. – G. Gutmann MD, (1955) (Upper cervical Chiropractic shown to be beneficial in 
   cases of head trauma and Neurological symptoms)

20.East Germany Case Study: 
  “In 1970, Vitek showed that these symptoms were linked to the upper cervical spine and not 
   vascular disease. Manual therapy (spinal adjustments) proved successful in 77% of cases.” –  
   "Manual Therapy in Internal Medicine” E.G. Metz @ Bezirkskrankenhaus Postdam, (Formerly 
  East) Germany, 1976. ( Heart Symptoms can be related to Upper Cervical Subluxation)

21.“EMG evidence shows it is clear that manipulation of the upper cervical joints affects overall 
  body  posture” – “Influencing Postural Reflexes by Way of Joints” G. Gutmann MD and Vele, F. 
  (1971) Neurological Clinic of Karlsuniversitat in Prague Zeitschrift fur Physiotherapy 5, 71.
  (EMG study showing that Chiropractic Adjustments directly affect postural musculature)

22.Infantile Head Joint Blckage. Seifert, 1: 1975. Functional Pathology of the Motor System 
   Rehabilitation Suppl. 10-11, p 53. Eds, Lewitt, K. and Guttmann, G Braitslava, Obzor
   (Likely link to birth trauma and upper cervical (C1, C2) blockage)

23. Beal; Myron C, FAAO, July 1983, Journal of AOA, Vol  82 (11), 822/23.
  “The selected findings, muscle tension over the tip of the transverse process and reduction of 
  costovertebral (cardiac) motion in the left upper thoracic region, were accurate in indicating the 
  presence of cardiac or gastrointestinal disease in 76% of cases.” – Beal; Myron C, FAAO, July 1983,
  Journal of AOA, Vol  82 (11), 822/23. (Chiropractic Subluxation in the left upper thoracic Spine 
  has been seen to be consistent with cardiac and GI diseases.)

24.Osteochondrosis of the Cervical Spine and Coronary Infarction. Bruckmann, W. (1956) German 
  Medical Weekly, 81, 1740. “Degenerative disease affecting bone and cartilage of the cervical spine 
  and coronary infarction. Various extensions and mobilization techniques for the cervical spine 
  seems to bear proof of the alleged correction, when they result in prompt elimination of cardiac 
  pain.” (Chiropractic care shown to be beneficial in Heart Pain)

25.Manual Therapy in Internal Medicine. E.G. Metz @ Bezirkskrankenhaus Postdam,
  (Formerly East) Germany, 1976.“According to studies by Rychlikova, Schwartz, and Metz a
  comparison of EKG’s taken before and after manual therapy shows telesystolic changes as well as
  cured heart rhythm disorders.” 
  (Chiropractic Care shown to help with arrhythmia disorders of heart)

26.W. Kunert, 1965 Functional Disorders of Internal Organs Due to Vertebral Lesions, CIBA 
   Symposium 13 (3): 85-96 “Records of numerous cases including myocardial ischemia showed 
  lesions of the spinal column are perfectly capable of simulating, accentuating, or making a major
  contribution to (organic) disorders.There can in fact, be no doubt that the state of the spinal column  
  does have a bearing on the functional status of the internal organs.” (somato-viscero responses;
  Spine issues can and do cause neurologic and therefore organ system issues)

27. Manual Medicine 16:95. F. Becker, MD. 1978 “A Discussion of Dizziness Symptoms with a
  Focus on Manual Therapy Viewpoint.”Vertigo (dizziness) can come from dysfunction of the spinal 
  column. He reports the success of manual therapy (spinal adjustments) in treating vertigo.” 
  ( Chiropractic Care shown to be beneficial in correcting some causes for Vertigo)

28.Manual Therapy In Internal Medicine,  E.G. Metz @ Bezirkskrankenhaus Postdam, (Formerly 
  East) Germany, 1976.
  Patients with peripheral circulatory hypotension and a tendency for asthenia and postural disorders   
  are grouped under the category of vasomotor headaches. Based on our experience I would say that 
  over half of these patients can be helped instantly and lastingly with the means of manual therapy 
  (spinal adjustments). (Chiropractic Care shown to be beneficial in over 50% of Vascular-oriented
  Headaches)

29.Comparative analysis of individuals with and without Chiropractic coverage: patient 
  Characteristics, utilization, and costs. Archives of Internal Medicine, 2004 Oct 11; 164(18):1985-92
  ( Access to Chiropractic Managed Care shown to reduce Health Care Costs and use of Invasive 
  procedures)

30.Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential
  study.Clin Neurophysiol. 2007 Feb;118(2):391-402. Epub 2006 Nov 29- Haavik-Taylor et al.
  (Chiropractic neck adjustment seem to alter brain sensory integration, perhaps explaining reduction
  of pain and restoration of function.)

31.Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Altern
  Ther Health Med. 2011 Nov-Dec;17(6):12-7 -Ogura T¹, Tashiro M, et al. (Chiropractic
  Adjustments affect regional cerebral glucose metabolism related to sympathetic relaxation and pain
  reduction.)

32.Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain
  intensity in patients with nontraumatic chronic neck pain. J Manipulative Physiol Ther. 2006 Feb;29
  (2):100-6 -Palmgren PJ¹, Sandström PJ, et al. (Chiropractic Care has been show to alter chronic 
  neck pain by altering proprioceptive (sensory) input from the neck to the brain.)

33.Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in
  better long-term outcome? Spine (Phila Pa 1976). 2011 Aug 15;36(18):1427-37- Senna MK¹, 
  Machaly ,SA. (Chiropractic Adjustive care is effective for the treatment of chronic nonspecific
  LBP,  also that long-term benefits are attainable with "maintenance care.")  

Archetype of Health

Defintion: ar·che·type

ˈärkəˌtīp/

noun

 noun: archetype; plural noun: archetypes

      a very typical example of a certain person or thing.

 

"    What does it mean to be the "Archetype of Health"? The reason for this article is that most people would believe that an individual representing the Archetype of Health is that perfect person that never seems to get "sick" no matter what, or that they have no health "problems." On the surface, this could appear true, however this idea alone takes on an incorrect context of what "health" really is. Is health really never being sick, which most people connotate with never having symptoms, or your ability to naturally cope with and adapt your environment in a balanced way. Enter (2) terms: 1. Homeostasis and 2. Allostatic Load, which better represent what an Archetype of health might look like. Homeostasis is an organisms ability to properly adapt and therefore remain in balance in a particular environment. Allostatic Load ( term borrowed from Dr Jamses Chestnutt, DC) is the amount of stressors in your environment that you might have to contend with in order to maintain balance and homeostasis. Dr Chestnutt uses and analogy that I like, he likens allostatic load to the number of rocks in your backpack that you are wearing while swimming. These rocks represent stressors such as toxins, medications, injuries, mental stress, etc. The more rocks, the harder it is to tread water before you sink and die. Basically, the more stressors in life in various forms, the harder it is to remain in homeostasis and the more sick and likely we are to manifest symptoms of illness. In the example above, there are definite "symptoms" (signs) of impending death while watching a person drown. I would argue that the "archetype" of a healthy individual is not simply the one whom never elicits symptoms, rather is the one that has appropriate response to their environment and maintains balance in their overall function. Hence, that archetypal individual will still get a fever as a natural and appropriate response to infection. Problem is, all too often we believe that we have to suppress symptoms of illness rather than focus on supporting the body in a healthy response and healing on its own. We therefore end up with a model of health that represents symptom free and over medicated, all the while this pictured individual just may be one of the sickest around. Now, just to be clear, this in no way means that I don't believe in the use of Medications or antibiotics, rather I believe in supporting the individual immune system so that it functions as optimally as possible, and only when necessary will there be the intervention of Medication that alters body-chemistry in a synthetic manner. As Americans, our Archetype is symptom-free, rather than Homestatic and this image is failing us. This is why I educate my patients daily on a proper paradigm of what it means to be "healthy." The Archetype of health is the individual that works to maintain Homeostasis and reduce Allostatic Load as much as possible, thereby portraying, not the person that is never ill, but rather the individual that is seldom ill, has high energy levels and is active, and has a positive demeanor and perspective on their life.

Chiropractic for our Nation's Heroes

How do we properly "serve" those that have served us with such devotion? The United States spends more on Military and Defense than any other country, and you only need see one "person" in uniform to see a small cog in a very large machine that we call our Military complex. As a society, then shall we be defined partially by how well we take care of those that have sacrificed so much as an individual for our country as a whole? On a personal level, I respond with an adamant yes. As a Chiropractic Physician, I also resound with yes. The question, however is regarding just how well we perform this act of service to those that have served. How "well" do we, as a country, take care of those that return back home to their wives, husbands, and children in order to continue a "normal" life of happiness? I will openly recognize the overt complexity of such a topic, as unfortunately many return home broken, shot, stabbed, or otherwise both physically and/or mentally/emotionally changed or damaged. I feel it is our duty and obligation to support those returning home in every way possible! I believe Chiropractic to be an integral part of this larger puzzle.

How does Chiropractic Care fit into this discussion? I believe Chiropractic care should be more readily provided to all servicemen and servicewomen. This is based on the extreme physical nature of military service and the fact that not withstanding personal experience, there is a plethora of research on the benefits of Chiropractic Care with regards to the very same or similar stresses and injuries that are likely to occur with military service. There are numerous citations regarding both the cost-effectiveness and efficacy of Chiropractic Care, ranging from the Magna Report, multiple state worker's compensation boards, to general Low Back Pain and Pain Management studies conducted over the last few decades. As a blanket-statement, Chiropractic has been repeatedly shown to return injured individuals to work in 1/2 the time and at 1/2 the cost of many traditional Pharmacological programs when provided. Do I believe that Chiropractic Care should replace traditional forms of care? No, rather we must look at each healing art as a "tool", and for every job, there is the more appropriate tool or combination of tools in order to effectively complete the task at hand. Chiropractic is a very effective and efficient tool, and it can be applied in many ways. Unfortunately, however, it is a "tool" that is often not available enough in order to be as effective as it could be. What I am advocating for here is this: that Chiropractic as a proven effective tool, should be made more readily available to all of our military personnel. Although I applaud increasing utilization,  currently Chiropractic is only available on a limited basis to sparing Bases around the Country and world, and certainly much more limited to those in active combat zones. A number of my patients have directly told me that while in an active duty, the only form of Chiropractic care they were able to receive was from another soldier present as a reservist that just happened to be a Chiropractor. I strongly advocate for a well-rounded "Health Care Team" that is available to both active, disabled, and retired military personnel that they have access to, consisting of a combination of both traditional and proven non-traditional forms of choice. I believe that an increasingly used combination of Chiropractic and Medical care to our military would offer substantial benefits that are already being seen on a limited basis. Currently, Chiropractic seems to be in a "proving grounds" phase in the Military and VA, I believe that as we move forward over the years, that Chiropractic will see its way into Military and VA direct-provider ship roles. I feel that there is strong potential for locum-based resident/ internship roles with the co-care of young Medical and Chiropractic Doctors from various Medical and Chiropractic Schools to be integrated into military bases and VA facilities all over the world to both aide in overburdened programs as well as create a functional operating structure of co-care from the ground up.
In 15 years of practice, I have always taken care of active duty and retired Military at a "Military" rate in order to better provide care to the Chiropractic-ally under served Military community. I do this to give back to those that keep my family safe and free in appreciation, I also do this to help them get the care they need when it is not always yet available to them as a part of their existing care options. I see success with this time and time again and will continue to do so until I stop practicing. I would call for all Chiropractors to make a place for our Military in their practices on a discounted basis to say thank you and give back to them. I am certain that as we do this, we will inherently see an increasing availability of Chiropractic services within the Military itself, if only due to the self-reported successes that service men and service women are and will report back so that it becomes a more functional part of their existing options for care.  

How Important is the "Placebo Effect" in Health Care? Proposing Questions for a Paradigm Change.

Technical Definition: 

pla·ce·bo ef·fect

noun

noun: placebo effect; plural noun: placebo effects

1. a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment.

   Why is the "Placebo Effect" important in Healthcare? It has to do with a very seemingly difficult part of healthcare that is largely left out of patient care, yet has provable tremendous effects on the outcome of care!  That is.........the patient's "belief" about a treatment or proposed outcome. Placebo effect is known to have around a 30% effect, give or take. What this means is that roughly 1 in 3 patients (or 30 % of the time.....or more) will respond to a treatment by simply "believing" it will work even when given a fake/ sham treatment. For Example: Drug companies will test "pill X" against a "fake or Placebo - sugar pill" and what is found is that even if a patient is given the sugar pill and not the real medication (say for High Blood Pressure) that somehow roughly 30% + of patients will respond favorably as though given the actual medication. The effect of Placebo is beginning to take a real foothold in some schools of thought in healthcare, both positive and negative as its effects are undeniable. Medical Schools such as Harvard Medical School are in the forefront of these types of studies. Individual MD's, such as Bernie Siegel, MD (ref) are also taking the positive effects of Placebo into effect in active practice. Dr. Siegel's book "Love, Medicine, and Miracles" (1986) is a very well-known text on this topic and compassion and miracles in the healthcare of his patients.

   If the concept of Placebo has been so vigorously tested that we know the belief of an individual has a 30% or better effect on the outcome of their care, then doesn't the Placebo effect in and of itself prove as strong influence on the effectiveness of care in general? If we trust enough in the Placebo Effect and we actively test against this effect on patients, then why do we not actively "use" it in helping patients get better with any care rendered? The Placebo effect is proof that we are not just machines like cars where parts can be removed and replaced without any attention to the thoughts, and emotions. To the contrary, it would seem that Placebo may be as high as 30% +/- of effective patient care in a more well-rounded Health care model. Unfortunately it is all too often taboo to address "belief systems" as a part of patient care. This leaves a major part of healthcare unaddressed all-together. Each patient comes to us with "hope, " therefore why do we not better use this hope in an effective manner to help the healing process? We would like to believe that the medication or treatment either works or doesn't in an effective and predictable manner and that the patient's thoughts, feelings, or emotions has nothing to do with it.........many patients actually hear a version of this from many of their healthcare providers even today. The fact is that patients are still too often treated like unfeeling machines when we know better scientifically. Even in fields such as Conceptual Physics, Quantum Mechanics, etc, we have a testable, yet little understood, knowing that Consciousness itself is one of our largest frontiers in all fields of science. For the most part, the only field of Healthcare that seems to attempt to regularly address this component of the individual is psychology and psychiatry. If an individual's consciousness has such a powerful effect on their entire being, much less how well they do or do not heal, then how do we focus that consciousness on the in-born power and ability for the patient to be the primary component of healing themselves. How do we make this a more effective part of effective patient care in our current healthcare system? Or do we continue to leave it out as a mere benchmark indicator for testing purposes alone?

   It is my opinion that every health care practitioner in some way encounters the Placebo effect in each of their patients whether the know it or not and whether they address it or not. What I mean here is that every patient has both an emotional involvement as well as expectations and hope regarding any procedure or treatment they may be undertaking due to some condition they "have." In this sense it becomes obvious that I believe "Placebo" exists in each treatment at some level regardless, and this is due to the fact that we are ALWAYS encountering a Patients "belief system" regarding any treatment that might be administered. 

    The question then becomes "How do we work positively with a patients expectations and hope to more effectively attain the desired outcome of improved patient health?" The first step would likely begin with simply asking what the patient's "expectations" are of any treatment. The most difficult part might then be the second part of actively using the hope and determination of each patient to structure or optimize the desired outcome. Again, Dr Siegel has an interesting approach of effectively using forms of "visualization" to actively aid in the "benefit" of therapies such as Chemo-therapy. Third, is how do we effectively create a "system" of the expectation/ hope dynamic for "different" patients? Forth, how do we then implement what will likely be a varied "system" based upon different fields of healthcare? 

   To begin with, many patients are not "neutral" to a particular treatment and have a particular and deeply help "belief" about  treatment X, Y, or Z. Therefore, if we have a way of determining those patients with certain beliefs Pro or Con ( As both can be powerful aids or detractors from the intended outcome of health), perhaps certain treatments can be "paired" with patients seeing / believing more strongly in the benefits of these treatments. Perhaps we can begin with "pairing" patients with treatments they believe in more powerfully. What then is also the potential for influencing a patients "perception" of a treatment to maximize the benefit? 

   In the end it would seem that as health care providers we are actively interacting with a patients "choice" regarding any treatment. We acknowledge this more and more across all the forms of healing. Will we be able to more specifically "structure" programs in order to more positively impact patient choices for the best possible outcome and more proactively utilize the "placebo effect?"