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Medical Guesswork
From heart surgery to prostate care, the health industry knows little about which common treatments really work
The signs at the meeting were not propitious. Half the board members of Kaiser Permanente's Care Management Institute left before Dr. David Eddy finally got the 10 minutes he had pleaded for. But the message Eddy delivered was riveting. With a groundbreaking computer simulation, Eddy showed that the conventional approach to treating diabetes did little to prevent the heart attacks and strokes that are complications of the disease. In contrast, a simple regimen of aspirin and generic drugs to lower blood pressure and cholesterol sent the rate of such incidents plunging. The payoff: healthier lives and hundreds of millions in savings. "I told them: 'This is as good as it gets to improve care and lower costs, which doesn't happen often in medicine,"' Eddy recalls. "'If you don't implement this,' I said, 'you might as well close up shop."'
The message got through. Three years later, Kaiser is in the midst of a major initiative to change the treatment of the diabetics in its care. "We're trying to put nearly a million people on these drugs," says Dr. Paul Wallace, senior adviser to the Care Management Institute. The early results: The strategy is indeed improving care and cutting costs, just as Eddy's model predicted.
For Eddy, this is one small step toward solving the thorniest riddle in medicine -- a dark secret he has spent his career exposing. "The problem is that we don't know what we are doing," he says. Even today, with a high-tech health-care system that costs the nation $2 trillion a year, there is little or no evidence that many widely used treatments and procedures actually work better than various cheaper alternatives.
This judgment pertains to a shocking number of conditions or diseases, from cardiovascular woes to back pain to prostate cancer. During his long and controversial career proving that the practice of medicine is more guesswork than science, Eddy has repeatedly punctured cherished physician myths. He showed, for instance, that the annual chest X-ray was worthless, over the objections of doctors who made money off the regular visit. He proved that doctors had little clue about the success rate of procedures such as surgery for enlarged prostates. He traced one common practice -- preventing women from giving birth vaginally if they had previously had a cesarean -- to the recommendation of one lone doctor. Indeed, when he began taking on medicine's sacred cows, Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence.
A great many doctors and health-care quality experts have come to endorse Eddy's critique. And while there has been progress in recent years, most of these physicians say the portion of medicine that has been proven effective is still outrageously low -- in the range of 20% to 25%. "We don't have the evidence [that treatments work], and we are not investing very much in getting the evidence," says Dr. Stephen C. Schoenbaum, executive vice-president of the Commonwealth Fund and former president of Harvard Pilgrim Health Care Inc. "Clearly, there is a lot in medicine we don't have definitive answers to," adds Dr. I. Steven Udvarhelyi, senior vice-president and chief medical officer at Pennsylvania's Independence Blue Cross.
What's required is a revolution called "evidence-based medicine," says Eddy, a heart surgeon turned mathematician and health-care economist. Tall, lean, and fit at 64, Eddy has the athletic stride and catlike reflexes of the ace rock climber he still is. He also exhibits the competitive drive of someone who once obsessively recorded his time on every training run, and who still likes to be first on a brisk walk up a hill near his home in Aspen, Colo. In his career, he has never been afraid to take a difficult path or an unpopular stand. "Evidence-based" is a term he coined in the early 1980s, and it has since become a rallying cry among medical reformers. The goal of this movement is to pierce the fog that envelops the practice of medicine -- a state of ignorance for which doctors cannot really be blamed. "The limitation is the human mind," Eddy says. Without extensive information on the outcomes of treatments, it's fiendishly difficult to know the best approach for care.
The human brain, Eddy explains, needs help to make sense of patients who have combinations of diseases, and of the complex probabilities involved in each. To provide that assistance, Eddy has spent the past 10 years leading a team to develop the computer model that helped him crack the diabetes puzzle. Dubbed Archimedes, this program seeks to mimic in equations the actual biology of the body, and make treatment recommendations as well as figure out what each approach costs. It is at least 10 times "better than the model we use now, which is called thinking," says Dr. Richard Kahn, chief scientific officer at the American Diabetes Assn.
WASTED RESOURCES
Can one computer program offset all the ill-advised treatment options for a whole range of different diseases? The milestones in Eddy's long personal crusade highlight the looming challenges, and may offer a sliver of hope. Coming from a family of four generations of doctors, Eddy went to medical school "because I didn't know what else to do," he confesses. As a resident at Stanford Medical Center in the 1970s, he picked cardiac surgery because "it was the biggest hill -- the glamour field."
But he soon became troubled. He began to ask if there was actual evidence to support what doctors were doing. The answer, he was surprised to hear, was no. Doctors decided whether or not to put a patient in intensive care or use a combination of drugs based on their best judgment and on rules and traditions handed down over the years, as opposed to real scientific proof. These rules and judgments weren't necessarily right. "I concluded that medicine was making decisions with an entirely different method from what we would call rational," says Eddy.
About the same time, the young resident discovered the beauty of mathematics, and its promise of answering medical questions. In just a couple of days, he devoured a calculus textbook (now framed on a shelf in his beautifully appointed home and office), then blasted through the books for a two-year math course in a couple of months. Next, he persuaded Stanford to accept him in a mathematically intense PhD program in the Engineering-Economics Systems Dept. "Dave came in -- just this amazing guy," recalls Richard Smallwood, then a Stanford professor. "He had decided he wanted to spend the rest of his life bringing logic and rationality to the medical system, but said he didn't have the math. I said: 'Why not just take it?' So he went out and aced all those math courses."
To augment his wife's earnings while getting his PhD, Eddy landed a job at Xerox Corp.'s (XRX ) legendary Palo Alto Research Center. "They hired weird people," he says. "Here was a heart surgeon doing math. That was weird enough."
Eddy used his newfound math skills to model cancer screening. His Stanford PhD thesis made front-page news in 1980 by overturning the guidelines of the time. It showed that annual chest X-rays and yearly Pap smears for women at low risk of cervical cancer were a waste of resources, and it won the most prestigious award in the field of operations research, the Frederick W. Lanchester prize. Based on his results, the American Cancer Society changed its guidelines. "He's smart as hell, with a towering clarity of thought," says Stanford health economist Allan Enthoven.
Dr. William H. Herman, director of the Michigan Diabetes Research & Training Center, has a competing computer model that clashes with Eddy's. Nonetheless, he says, "Dr. Eddy is one of my heroes. He's sort of the father of health economics -- and he might be right."
Appointed a full professor at Stanford, then recruited as chairman of the Center for Health Policy Research & Education at Duke University, Eddy proved again and again that the emperor had no clothes. In one study, he ferreted out decades of research evaluating treatment of high pressure in the eyeball, a condition that can lead to glaucoma and blindness. He found about a dozen studies that looked at outcomes with pressure-lowering medications used on millions of people. The studies actually suggested that the 100-year-old treatment was harmful, causing more cases of blindness, not fewer.
Eddy submitted a paper to the Journal of the American Medical Assn. (JAMA), whose editors sent it out to specialists for review. "It was amazing," Eddy recalls. "The tom-toms sounded among all the ophthalmologists," who marshaled a counterattack. "I felt like Salman Rushdie." Stanford ophthalmologist Kuldev Singh says: "Dr. Eddy challenged the community to prove that we actually had evidence. He did a service by stimulating clinical trials," which showed that the treatment does slow the disease in a minority of patients.
By 1985, Eddy was "burned out" by the administrative side of academia, he says. Lured by a poster of the Tetons, he gave up his prestigious post. He moved to Jackson, Wyo., so he could climb in his spare time. He and a friend even made a first ascent of a new route on the Grand Teton, now named after them. Meanwhile, he carved out a niche showing doctors at specialty society meetings that their cherished beliefs were dubious. "At each meeting I would do the same exercise," he says. He would ask doctors to think of a typical patient and typical treatment, then write down the results of that treatment. For urologists, for instance, what were the chances that a man with an enlarged prostate could urinate normally after having corrective surgery? Eddy then asked the society's president to read the predictions.
The results were startling. The predictions of success invariably ranged from 0% to 100%, with no clear pattern. "All the doctors were trying to estimate the same thing -- and they all gave different numbers," he says. "I've spent 25 years proving that what we lovingly call clinical judgment is woefully outmatched by the complexities of medicine." Think about the implications for helping patients make decisions, Eddy adds. "Go to one doctor, and get one answer. Go to another, and get a different one." Or think about expert testimony. "You don't have to hire an expert to lie. You can just find one who truly believes the number you want."
More important, the lack of evidence creates a costly clash. Americans and their doctors want access to any new treatment, and many doctors fervently believe such care is warranted. On the other hand, those beliefs can be flat wrong. As a consultant on Blue Cross's insurance coverage decisions, Eddy testified on the insurer's behalf in high-profile court cases, such as bone marrow transplants for breast cancer. Women and doctors demanded the treatment, even though there was no evidence it saved lives. Insurers who refused coverage usually lost in court. "I was the bad guy," Eddy recalls. When clinical trials were actually done, they showed that the treatment, costing from $50,000 to $150,000, didn't work. The doctors who pushed the painful, risky procedure on women "owe this country an apology," Eddy says.
Is medicine doing any better today? In recognizing the problem, yes. But in solving it, unfortunately, no. Take prostate cancer. Doctors now routinely test for levels of prostate-specific antigen (PSA) to try to diagnose the disease. But there's no evidence that using the test improves survival. Some experts believe that as many cancers would be detected through random biopsies. Then, once cancer is spotted, there's no way to know who needs treatment and who doesn't. Plus, there is a plethora of treatment choices -- four kinds of surgery, various types of implantable radioactive seeds, and competing external radiation regimens, notes Dr. Eric Klein, head of urologic oncology at the Cleveland Clinic. "How is a poor patient supposed to decide among those?" he asks. Most of the time, patients don't even know the options.
VESTED INTERESTS
"Because there are no definitive answers, you are at the whim of where you are and who you talk to," says Dr. Gary M. Kirsh at the Urology Group in Cincinnati. Kirsh does many brachytherapies -- implanting radioactive seeds. But "if you drive one and a half hours down the road to Indianapolis, there is almost no brachytherapy," he says. Head to Loma Linda, Calif., where the first proton-beam therapy machine was installed, in 1990, and the rates of proton-beam treatment are far higher than in most other parts of the country. Go to a surgeon, and he'll probably recommend surgery. Go to a radiologist, and the chances are high of getting radiation instead. "Doctors often assume that they know what a patient wants, leading them to recommend the treatment they know best," says Dr. David E. Wennberg, president of Health Dialog Analytic Solutions.
More troubling, many doctors hold not just a professional interest in which treatment to offer, but a financial one as well. "There is no question that the economic interests of the physician enter into the decision," says Kirsh. The bottom line: The conventional wisdom in prostate cancer -- that surgery is the gold standard and the best chance for a cure -- is unsustainable. Strangely enough, however, the choice may not matter very much. "There really isn't good evidence to suggest that one treatment is better than another," says Klein.
Compared with the skepticism Eddy faced in the 1990s, many physicians now concur that traditional treatments for serious illnesses often aren't best. Yet this message can be hard for Americans to believe. "When there is more than one medical option, people mistakenly think that the more aggressive procedure is the best," says Annette M. Cormier O'Connor, senior scientist in clinical epidemiology at the Ottawa Health Research Institute. The message flies in the face of America's infatuation with the latest advances. "As a nation, we always want the best, the most recent technology," explains Dr. Joe Thompson, health adviser to Arkansas Governor Mike Huckabee. "We spend a huge amount developing it, and we get a big increase in supply." New radiation machines for cancer or operating rooms for heart surgery are profit centers for hospitals, for instance (see BW Online, 07/18/05, "Is Heart Surgery Worth It?"). Once a hospital installs a shiny new catheter lab, it has a powerful incentive to refer more patients for the procedure. It's a classic case of increased supply driving demand, instead of the other way around. "Combine that with Americans' demand to be treated immediately, and it is a cauldron for overuse and inappropriate use," says Thompson.
The consequences for the U.S. are disturbing. This nation spends 2 1/2 times as much as any other country per person on health care. Yet middle-aged Americans are in far worse health than their British counterparts, who spend less than half as much and practice less intensive medicine, according to a new study. "The investment in health care in the U.S. is just not paying off," argues Gerard Anderson, director of the Center for Hospital Finance & Management at Johns Hopkins' Bloomberg School of Public Health. Speaking not for attribution, the head of health care at one of America's largest corporations puts it more bluntly: "There is a massive amount of spending on things that really don't help patients, and even put them at greater risk. Everyone that's informed on the topic knows it, but it is such a scary thing to discuss that people are not willing to talk about it openly."
Of course, there are plenty of areas of medicine, from antibiotics and vaccines to early detection of certain tumors, where the benefits are huge and incontrovertible. But if these effective treatments are black and white, much of the rest of medicine is a dark shade of gray. "A lot of things we absolutely believe at the moment based on our intuition are ultimately absolutely wrong," says Dr. Paul Wallace, of the Care Management Institute.
The best way to go from intuition to evidence is the randomized clinical trial. Patients with a particular condition are randomly assigned to competing treatments or, if appropriate, to a placebo. By monitoring the patients for months or years, doctors learn the relative risks and benefits of the treatment being studied.
But such trials take years and cost many millions of dollars. By the time the results come in, science and medicine may have moved on, making the findings less relevant. Moreover, patients in a clinical trial usually aren't representative of real people, who tend to have complex combinations of diseases and medical problems. And patients often don't stick with the program.
Such difficulties are highlighted by an eight-year study of low-fat diets that cost upward of $400 million. Most subjects failed to stick to the low-fat regimen, making it tough to draw conclusions. In addition, the study failed to take stock of different kinds of fats, some of which are now known to have beneficial effects. Many trials fall into similar traps. So it's no surprise that up to one-third of clinical studies lead to conclusions that are later overturned, according to a recent paper in JAMA.
Even when common treatments are proved to be dubious, physicians don't rush to change their practice. They may still firmly believe in the treatment -- or in the dollars it brings in. And doctors whose oxen get gored sometimes fight back. In 1993, the federal government's Agency for Health Care Policy & Research convened a panel to develop guidelines for back surgery. Fearing that the recommendations would cast doubt on what the doctors were doing, a prominent back surgeon protested to Congress, and lawmakers slashed funding for the agency. "Congress forced out the research," says Floyd J. Fowler Jr., president of the Foundation for Informed Medical Decision Making. "It was a national tragedy," he says -- and not an isolated incident. The agency's budget is often targeted "by special interest groups who had their specialty threatened," says Arkansas' Dr. Thompson.
With proof about medical outcomes lacking, one possible solution is educating patients about the uncertainties. "The popular version of evidence-based medicine is about proving things," says Kaiser's Wallace, "but it is really about transparency -- being clear about what we know and don't know." The Foundation for Informed Medical Decision Making produces booklets, videotapes, and other material to put the full picture in the hands of patients. Health Dialog markets the information to providers and companies, addressing back pain, breast cancer, uterine fibroids and bleeding, coronary heart disease, depression, osteoarthritis, and other conditions.
In studies where one group of patients hears the full story while other patients simply receive their doctors' instructions, a key difference emerges. The well-informed patients opt for more invasive, aggressive approaches 23% less often, on average, than the other group. In some cases, the drop is much bigger -- 50% to 60%. "Patients typically don't understand that they have options, and even if they do, they often wildly exaggerate the benefits of surgery and wildly minimize the chances of harm," says Ottawa's O'Connor, a leader in this field of so-called decision aids.
Eddy's computer simulation could help more patients attain appropriate care. His approach is to create a SimCity-like world in silicon, where virtual doctors conduct trials of virtual patients and figure out what treatments work. After getting funding from Kaiser Permanente in 1991, Eddy hired a particle physicist, Len Schlessinger, who knew how to write equations describing the complex interactions in biology. The pair selected diabetes as a test case. In their virtual world, each simulated person has a heart, liver, kidneys, blood, and other organs. As in real people, cells in the pancreas make insulin, which regulates the uptake of glucose in other cells. And as in the real disease, key cells can fail to respond to the insulin, causing high blood-sugar levels and a cascade of biological effects. The virtual patients come down with high blood pressure, heart disease, and poor circulation, which can lead to foot ulcers and amputations, blindness, and other ills. The model also assesses the costs of treating the complications.
Eddy dubbed the model Archimedes and tested it by comparing it with two dozen real trials. One clinical study compared cholesterol-lowering statin drugs to a placebo in diabetics. After 4 1/2 years, the drugs reduced heart attacks by 35%. The exact same thing happened in Eddy's simulated patients. "The Archimedes model is just fabulous in the validation studies," says the University of Michigan's Herman.
STANDARD OF CARE
The team then put Archimedes to work on a tough, real problem: how best to treat diabetes in people who have additional aliments. "One thing not yet adequately embraced by evidence-based medicine is what to do for someone with diabetes, hypertension, heart disease, and depression," explains Kaiser's Wallace. Doctors now typically try to treat the most pressing problems. "But we fail to pick the right ones consistently, so we have misdirected utilization and a great deal of waste," he says. Kaiser Permanente's Dr. Jim Dudl had a counterintuitive suggestion. With diabetics, doctors assume that keeping blood sugar levels low and consistent is the best way to ward off problems such as heart disease. But Dudl wondered what would happen if he flipped it around, aiming treatment at the downstream problems. The idea is to give patients a trio of generic medicines: aspirin, a cholesterol-lowering statin, and drugs called ACE inhibitors.
Using Archimedes and thousands of virtual patients, Eddy and Schlessinger compared the traditional approach with the drug combination. The model took about a half-hour to simulate a 30-year trial, and showed that the three-drug combination was "cost- and life-saving," says Kaiser's Wallace. The benefits far surpassed "what can be achieved with aggressive glucose control." Kaiser Permanente docs switched their standard of care for diabetes, adding these drugs to other interventions. It is too early to declare a victory, but the experience with patients seems to be mimicking Eddy's computer model. "It goes against our mental picture of the disease," says Wallace. But it also makes sense, he adds. "Cardiovascular disease is the worst complication of diabetes -- and what people die of."
Eddy readily concedes that this example is a small beginning. In its current state of development, Archimedes is like "the Wright brothers' plane. We're off the sand and flying to Raleigh." But it won't be long, he says, "before we're offering transcontinental flights, with movies."
The modeling approach allows each of us, in essence, to have an imaginary twin. We can use our twin to predict what our lives and state of health are likely to be with different lifestyles and approaches to care. Companies could create virtual clones of each employee, predicting what will occur with current care or with added prevention or treatment programs. "They can see what happens to such things as the complications suffered by diabetics, the lost time from work, the amount of angina or the rate of heart attacks, the number of deaths, and the cost of new employees if one dies," Eddy explains. "Our mission is that in 10 years, no one will make an important decision in health care without first asking: `What does Archimedes say?"'
By John Carey
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The signs at the meeting were not propitious. Half the board members of Kaiser Permanente's Care Management Institute left before Dr. David Eddy finally got the 10 minutes he had pleaded for. But the message Eddy delivered was riveting. With a groundbreaking computer simulation, Eddy showed that the conventional approach to treating diabetes did little to prevent the heart attacks and strokes that are complications of the disease. In contrast, a simple regimen of aspirin and generic drugs to lower blood pressure and cholesterol sent the rate of such incidents plunging. The payoff: healthier lives and hundreds of millions in savings. "I told them: 'This is as good as it gets to improve care and lower costs, which doesn't happen often in medicine,"' Eddy recalls. "'If you don't implement this,' I said, 'you might as well close up shop."'
The message got through. Three years later, Kaiser is in the midst of a major initiative to change the treatment of the diabetics in its care. "We're trying to put nearly a million people on these drugs," says Dr. Paul Wallace, senior adviser to the Care Management Institute. The early results: The strategy is indeed improving care and cutting costs, just as Eddy's model predicted.
For Eddy, this is one small step toward solving the thorniest riddle in medicine -- a dark secret he has spent his career exposing. "The problem is that we don't know what we are doing," he says. Even today, with a high-tech health-care system that costs the nation $2 trillion a year, there is little or no evidence that many widely used treatments and procedures actually work better than various cheaper alternatives.
This judgment pertains to a shocking number of conditions or diseases, from cardiovascular woes to back pain to prostate cancer. During his long and controversial career proving that the practice of medicine is more guesswork than science, Eddy has repeatedly punctured cherished physician myths. He showed, for instance, that the annual chest X-ray was worthless, over the objections of doctors who made money off the regular visit. He proved that doctors had little clue about the success rate of procedures such as surgery for enlarged prostates. He traced one common practice -- preventing women from giving birth vaginally if they had previously had a cesarean -- to the recommendation of one lone doctor. Indeed, when he began taking on medicine's sacred cows, Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence.
A great many doctors and health-care quality experts have come to endorse Eddy's critique. And while there has been progress in recent years, most of these physicians say the portion of medicine that has been proven effective is still outrageously low -- in the range of 20% to 25%. "We don't have the evidence [that treatments work], and we are not investing very much in getting the evidence," says Dr. Stephen C. Schoenbaum, executive vice-president of the Commonwealth Fund and former president of Harvard Pilgrim Health Care Inc. "Clearly, there is a lot in medicine we don't have definitive answers to," adds Dr. I. Steven Udvarhelyi, senior vice-president and chief medical officer at Pennsylvania's Independence Blue Cross.
What's required is a revolution called "evidence-based medicine," says Eddy, a heart surgeon turned mathematician and health-care economist. Tall, lean, and fit at 64, Eddy has the athletic stride and catlike reflexes of the ace rock climber he still is. He also exhibits the competitive drive of someone who once obsessively recorded his time on every training run, and who still likes to be first on a brisk walk up a hill near his home in Aspen, Colo. In his career, he has never been afraid to take a difficult path or an unpopular stand. "Evidence-based" is a term he coined in the early 1980s, and it has since become a rallying cry among medical reformers. The goal of this movement is to pierce the fog that envelops the practice of medicine -- a state of ignorance for which doctors cannot really be blamed. "The limitation is the human mind," Eddy says. Without extensive information on the outcomes of treatments, it's fiendishly difficult to know the best approach for care.
The human brain, Eddy explains, needs help to make sense of patients who have combinations of diseases, and of the complex probabilities involved in each. To provide that assistance, Eddy has spent the past 10 years leading a team to develop the computer model that helped him crack the diabetes puzzle. Dubbed Archimedes, this program seeks to mimic in equations the actual biology of the body, and make treatment recommendations as well as figure out what each approach costs. It is at least 10 times "better than the model we use now, which is called thinking," says Dr. Richard Kahn, chief scientific officer at the American Diabetes Assn.
WASTED RESOURCES
Can one computer program offset all the ill-advised treatment options for a whole range of different diseases? The milestones in Eddy's long personal crusade highlight the looming challenges, and may offer a sliver of hope. Coming from a family of four generations of doctors, Eddy went to medical school "because I didn't know what else to do," he confesses. As a resident at Stanford Medical Center in the 1970s, he picked cardiac surgery because "it was the biggest hill -- the glamour field."
But he soon became troubled. He began to ask if there was actual evidence to support what doctors were doing. The answer, he was surprised to hear, was no. Doctors decided whether or not to put a patient in intensive care or use a combination of drugs based on their best judgment and on rules and traditions handed down over the years, as opposed to real scientific proof. These rules and judgments weren't necessarily right. "I concluded that medicine was making decisions with an entirely different method from what we would call rational," says Eddy.
About the same time, the young resident discovered the beauty of mathematics, and its promise of answering medical questions. In just a couple of days, he devoured a calculus textbook (now framed on a shelf in his beautifully appointed home and office), then blasted through the books for a two-year math course in a couple of months. Next, he persuaded Stanford to accept him in a mathematically intense PhD program in the Engineering-Economics Systems Dept. "Dave came in -- just this amazing guy," recalls Richard Smallwood, then a Stanford professor. "He had decided he wanted to spend the rest of his life bringing logic and rationality to the medical system, but said he didn't have the math. I said: 'Why not just take it?' So he went out and aced all those math courses."
To augment his wife's earnings while getting his PhD, Eddy landed a job at Xerox Corp.'s (XRX ) legendary Palo Alto Research Center. "They hired weird people," he says. "Here was a heart surgeon doing math. That was weird enough."
Eddy used his newfound math skills to model cancer screening. His Stanford PhD thesis made front-page news in 1980 by overturning the guidelines of the time. It showed that annual chest X-rays and yearly Pap smears for women at low risk of cervical cancer were a waste of resources, and it won the most prestigious award in the field of operations research, the Frederick W. Lanchester prize. Based on his results, the American Cancer Society changed its guidelines. "He's smart as hell, with a towering clarity of thought," says Stanford health economist Allan Enthoven.
Dr. William H. Herman, director of the Michigan Diabetes Research & Training Center, has a competing computer model that clashes with Eddy's. Nonetheless, he says, "Dr. Eddy is one of my heroes. He's sort of the father of health economics -- and he might be right."
Appointed a full professor at Stanford, then recruited as chairman of the Center for Health Policy Research & Education at Duke University, Eddy proved again and again that the emperor had no clothes. In one study, he ferreted out decades of research evaluating treatment of high pressure in the eyeball, a condition that can lead to glaucoma and blindness. He found about a dozen studies that looked at outcomes with pressure-lowering medications used on millions of people. The studies actually suggested that the 100-year-old treatment was harmful, causing more cases of blindness, not fewer.
Eddy submitted a paper to the Journal of the American Medical Assn. (JAMA), whose editors sent it out to specialists for review. "It was amazing," Eddy recalls. "The tom-toms sounded among all the ophthalmologists," who marshaled a counterattack. "I felt like Salman Rushdie." Stanford ophthalmologist Kuldev Singh says: "Dr. Eddy challenged the community to prove that we actually had evidence. He did a service by stimulating clinical trials," which showed that the treatment does slow the disease in a minority of patients.
By 1985, Eddy was "burned out" by the administrative side of academia, he says. Lured by a poster of the Tetons, he gave up his prestigious post. He moved to Jackson, Wyo., so he could climb in his spare time. He and a friend even made a first ascent of a new route on the Grand Teton, now named after them. Meanwhile, he carved out a niche showing doctors at specialty society meetings that their cherished beliefs were dubious. "At each meeting I would do the same exercise," he says. He would ask doctors to think of a typical patient and typical treatment, then write down the results of that treatment. For urologists, for instance, what were the chances that a man with an enlarged prostate could urinate normally after having corrective surgery? Eddy then asked the society's president to read the predictions.
The results were startling. The predictions of success invariably ranged from 0% to 100%, with no clear pattern. "All the doctors were trying to estimate the same thing -- and they all gave different numbers," he says. "I've spent 25 years proving that what we lovingly call clinical judgment is woefully outmatched by the complexities of medicine." Think about the implications for helping patients make decisions, Eddy adds. "Go to one doctor, and get one answer. Go to another, and get a different one." Or think about expert testimony. "You don't have to hire an expert to lie. You can just find one who truly believes the number you want."
More important, the lack of evidence creates a costly clash. Americans and their doctors want access to any new treatment, and many doctors fervently believe such care is warranted. On the other hand, those beliefs can be flat wrong. As a consultant on Blue Cross's insurance coverage decisions, Eddy testified on the insurer's behalf in high-profile court cases, such as bone marrow transplants for breast cancer. Women and doctors demanded the treatment, even though there was no evidence it saved lives. Insurers who refused coverage usually lost in court. "I was the bad guy," Eddy recalls. When clinical trials were actually done, they showed that the treatment, costing from $50,000 to $150,000, didn't work. The doctors who pushed the painful, risky procedure on women "owe this country an apology," Eddy says.
Is medicine doing any better today? In recognizing the problem, yes. But in solving it, unfortunately, no. Take prostate cancer. Doctors now routinely test for levels of prostate-specific antigen (PSA) to try to diagnose the disease. But there's no evidence that using the test improves survival. Some experts believe that as many cancers would be detected through random biopsies. Then, once cancer is spotted, there's no way to know who needs treatment and who doesn't. Plus, there is a plethora of treatment choices -- four kinds of surgery, various types of implantable radioactive seeds, and competing external radiation regimens, notes Dr. Eric Klein, head of urologic oncology at the Cleveland Clinic. "How is a poor patient supposed to decide among those?" he asks. Most of the time, patients don't even know the options.
VESTED INTERESTS
"Because there are no definitive answers, you are at the whim of where you are and who you talk to," says Dr. Gary M. Kirsh at the Urology Group in Cincinnati. Kirsh does many brachytherapies -- implanting radioactive seeds. But "if you drive one and a half hours down the road to Indianapolis, there is almost no brachytherapy," he says. Head to Loma Linda, Calif., where the first proton-beam therapy machine was installed, in 1990, and the rates of proton-beam treatment are far higher than in most other parts of the country. Go to a surgeon, and he'll probably recommend surgery. Go to a radiologist, and the chances are high of getting radiation instead. "Doctors often assume that they know what a patient wants, leading them to recommend the treatment they know best," says Dr. David E. Wennberg, president of Health Dialog Analytic Solutions.
More troubling, many doctors hold not just a professional interest in which treatment to offer, but a financial one as well. "There is no question that the economic interests of the physician enter into the decision," says Kirsh. The bottom line: The conventional wisdom in prostate cancer -- that surgery is the gold standard and the best chance for a cure -- is unsustainable. Strangely enough, however, the choice may not matter very much. "There really isn't good evidence to suggest that one treatment is better than another," says Klein.
Compared with the skepticism Eddy faced in the 1990s, many physicians now concur that traditional treatments for serious illnesses often aren't best. Yet this message can be hard for Americans to believe. "When there is more than one medical option, people mistakenly think that the more aggressive procedure is the best," says Annette M. Cormier O'Connor, senior scientist in clinical epidemiology at the Ottawa Health Research Institute. The message flies in the face of America's infatuation with the latest advances. "As a nation, we always want the best, the most recent technology," explains Dr. Joe Thompson, health adviser to Arkansas Governor Mike Huckabee. "We spend a huge amount developing it, and we get a big increase in supply." New radiation machines for cancer or operating rooms for heart surgery are profit centers for hospitals, for instance (see BW Online, 07/18/05, "Is Heart Surgery Worth It?"). Once a hospital installs a shiny new catheter lab, it has a powerful incentive to refer more patients for the procedure. It's a classic case of increased supply driving demand, instead of the other way around. "Combine that with Americans' demand to be treated immediately, and it is a cauldron for overuse and inappropriate use," says Thompson.
The consequences for the U.S. are disturbing. This nation spends 2 1/2 times as much as any other country per person on health care. Yet middle-aged Americans are in far worse health than their British counterparts, who spend less than half as much and practice less intensive medicine, according to a new study. "The investment in health care in the U.S. is just not paying off," argues Gerard Anderson, director of the Center for Hospital Finance & Management at Johns Hopkins' Bloomberg School of Public Health. Speaking not for attribution, the head of health care at one of America's largest corporations puts it more bluntly: "There is a massive amount of spending on things that really don't help patients, and even put them at greater risk. Everyone that's informed on the topic knows it, but it is such a scary thing to discuss that people are not willing to talk about it openly."
Of course, there are plenty of areas of medicine, from antibiotics and vaccines to early detection of certain tumors, where the benefits are huge and incontrovertible. But if these effective treatments are black and white, much of the rest of medicine is a dark shade of gray. "A lot of things we absolutely believe at the moment based on our intuition are ultimately absolutely wrong," says Dr. Paul Wallace, of the Care Management Institute.
The best way to go from intuition to evidence is the randomized clinical trial. Patients with a particular condition are randomly assigned to competing treatments or, if appropriate, to a placebo. By monitoring the patients for months or years, doctors learn the relative risks and benefits of the treatment being studied.
But such trials take years and cost many millions of dollars. By the time the results come in, science and medicine may have moved on, making the findings less relevant. Moreover, patients in a clinical trial usually aren't representative of real people, who tend to have complex combinations of diseases and medical problems. And patients often don't stick with the program.
Such difficulties are highlighted by an eight-year study of low-fat diets that cost upward of $400 million. Most subjects failed to stick to the low-fat regimen, making it tough to draw conclusions. In addition, the study failed to take stock of different kinds of fats, some of which are now known to have beneficial effects. Many trials fall into similar traps. So it's no surprise that up to one-third of clinical studies lead to conclusions that are later overturned, according to a recent paper in JAMA.
Even when common treatments are proved to be dubious, physicians don't rush to change their practice. They may still firmly believe in the treatment -- or in the dollars it brings in. And doctors whose oxen get gored sometimes fight back. In 1993, the federal government's Agency for Health Care Policy & Research convened a panel to develop guidelines for back surgery. Fearing that the recommendations would cast doubt on what the doctors were doing, a prominent back surgeon protested to Congress, and lawmakers slashed funding for the agency. "Congress forced out the research," says Floyd J. Fowler Jr., president of the Foundation for Informed Medical Decision Making. "It was a national tragedy," he says -- and not an isolated incident. The agency's budget is often targeted "by special interest groups who had their specialty threatened," says Arkansas' Dr. Thompson.
With proof about medical outcomes lacking, one possible solution is educating patients about the uncertainties. "The popular version of evidence-based medicine is about proving things," says Kaiser's Wallace, "but it is really about transparency -- being clear about what we know and don't know." The Foundation for Informed Medical Decision Making produces booklets, videotapes, and other material to put the full picture in the hands of patients. Health Dialog markets the information to providers and companies, addressing back pain, breast cancer, uterine fibroids and bleeding, coronary heart disease, depression, osteoarthritis, and other conditions.
In studies where one group of patients hears the full story while other patients simply receive their doctors' instructions, a key difference emerges. The well-informed patients opt for more invasive, aggressive approaches 23% less often, on average, than the other group. In some cases, the drop is much bigger -- 50% to 60%. "Patients typically don't understand that they have options, and even if they do, they often wildly exaggerate the benefits of surgery and wildly minimize the chances of harm," says Ottawa's O'Connor, a leader in this field of so-called decision aids.
Eddy's computer simulation could help more patients attain appropriate care. His approach is to create a SimCity-like world in silicon, where virtual doctors conduct trials of virtual patients and figure out what treatments work. After getting funding from Kaiser Permanente in 1991, Eddy hired a particle physicist, Len Schlessinger, who knew how to write equations describing the complex interactions in biology. The pair selected diabetes as a test case. In their virtual world, each simulated person has a heart, liver, kidneys, blood, and other organs. As in real people, cells in the pancreas make insulin, which regulates the uptake of glucose in other cells. And as in the real disease, key cells can fail to respond to the insulin, causing high blood-sugar levels and a cascade of biological effects. The virtual patients come down with high blood pressure, heart disease, and poor circulation, which can lead to foot ulcers and amputations, blindness, and other ills. The model also assesses the costs of treating the complications.
Eddy dubbed the model Archimedes and tested it by comparing it with two dozen real trials. One clinical study compared cholesterol-lowering statin drugs to a placebo in diabetics. After 4 1/2 years, the drugs reduced heart attacks by 35%. The exact same thing happened in Eddy's simulated patients. "The Archimedes model is just fabulous in the validation studies," says the University of Michigan's Herman.
STANDARD OF CARE
The team then put Archimedes to work on a tough, real problem: how best to treat diabetes in people who have additional aliments. "One thing not yet adequately embraced by evidence-based medicine is what to do for someone with diabetes, hypertension, heart disease, and depression," explains Kaiser's Wallace. Doctors now typically try to treat the most pressing problems. "But we fail to pick the right ones consistently, so we have misdirected utilization and a great deal of waste," he says. Kaiser Permanente's Dr. Jim Dudl had a counterintuitive suggestion. With diabetics, doctors assume that keeping blood sugar levels low and consistent is the best way to ward off problems such as heart disease. But Dudl wondered what would happen if he flipped it around, aiming treatment at the downstream problems. The idea is to give patients a trio of generic medicines: aspirin, a cholesterol-lowering statin, and drugs called ACE inhibitors.
Using Archimedes and thousands of virtual patients, Eddy and Schlessinger compared the traditional approach with the drug combination. The model took about a half-hour to simulate a 30-year trial, and showed that the three-drug combination was "cost- and life-saving," says Kaiser's Wallace. The benefits far surpassed "what can be achieved with aggressive glucose control." Kaiser Permanente docs switched their standard of care for diabetes, adding these drugs to other interventions. It is too early to declare a victory, but the experience with patients seems to be mimicking Eddy's computer model. "It goes against our mental picture of the disease," says Wallace. But it also makes sense, he adds. "Cardiovascular disease is the worst complication of diabetes -- and what people die of."
Eddy readily concedes that this example is a small beginning. In its current state of development, Archimedes is like "the Wright brothers' plane. We're off the sand and flying to Raleigh." But it won't be long, he says, "before we're offering transcontinental flights, with movies."
The modeling approach allows each of us, in essence, to have an imaginary twin. We can use our twin to predict what our lives and state of health are likely to be with different lifestyles and approaches to care. Companies could create virtual clones of each employee, predicting what will occur with current care or with added prevention or treatment programs. "They can see what happens to such things as the complications suffered by diabetics, the lost time from work, the amount of angina or the rate of heart attacks, the number of deaths, and the cost of new employees if one dies," Eddy explains. "Our mission is that in 10 years, no one will make an important decision in health care without first asking: `What does Archimedes say?"'
By John Carey
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Tuesday, July 27, 2010
Improvement in Quality of Life in a Patient with Depression Undergoing Chiropractic Care
Improvement in Quality of Life in a Patient with Depression
Undergoing Chiropractic Care Using Torque Release
Technique: A Case Study
Theo Mahanidis BA (Sports Ed),1 B(Chiro) & David Russell BSc (Psych), B(Chiro)2
__________________________________________________________________________________________
ABSTRACT
Objective: To report on a female patient who presented for chiropractic care with depression.
Clinical Features: 49 year old female who presented with a history of depression, asthma, high stress, mood and gastrointestinal changes.
Intervention and Outcome: Over a period of 7 months, a specific, conservative chiropractic adjustment regimen for the correction of vertebral subluxation was administered to the patient. The care plan was altered in accordance to outcome
measures and over this time period the patient exhibited a considerable decrease in presenting symptomology alongside a substantial increase in self rated quality of life. Self-rated health/wellness (SRHW) surveys were taken prior to care and at
subsequent progress visits assessing four domains of health(Physical state, Emotional/Mental state, Stress and Life Enjoyment) as well as Overall Quality of Life. Static and Thermal EMG were performed using the Chiropractic
Leadership Alliance (CLA) Insight􀂌 surface EMG and thermal scanning technology. Improvements were noted in SRHW and surface EMG and thermal scanning over the 7 months of care.
Conclusions: While under chiropractic care subjective and
objective improvements in physical, mental and social wellbeing were documented in a patient with a history of depression,asthma, high stress, mood and gastrointestinal changes
Keywords: Chiropractic, subluxation, depression, quality
of life, Stress, Torque Release Technique (TRT), Insight􀂌
surface EMG and thermal scanning
____________________________________________________________________________________________________________
Introduction
Mood disorders affect approximately 1 in 7 New Zealanders
within their lifetime with 1 in 5 experiencing some kind of
serious mood disorder by the age of 25 with females reporting
a higher incidence of depression than males.1 The most
common types of mood disorders include Major Depression,
Dysthymia and Bipolar Disorder. Some of the more common
symptoms of these disorders are loss of interest or pleasure in
hobbies and activities, decreased energy (fatigue), feelings of
worthlessness, anxious or 􀂳empty􀂴 mood, difficulty
concentrating, insomnia, thoughts of death and or suicide.1
The common pathway of depression involves biochemical
changes in the brain. This is believed to be due to the roles of
serotonin, GABA, dopamine and opioid peptides which when
imbalanced or deficient can cause mood disorders.2 There is
also evidence suggesting a correlation between cervical
trauma and the onset of social disorders although there is still
debate about the true cause of social and mood disorders.3
Chiropractic care aims to optimize health and wellbeing
through removing interference from the nerve system.
Chiropractic follows the notion that the correction of any
interference in the nerve system is an essential component of
personal enhancement and health maintenance. This
professional objective is achieved through the correction of
vertebral subluxations.4 The Association of Chiropractic
Colleges defines subluxation as follows: 􀂳A subluxation is a
complex of functional and/or structural and/or pathological
CASE STUDY
1. Private Practice, Wollongong, NSW Australia
2. Centre Director, New Zealand College of Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 1
Depression & Chiropractic
articular changes that compromise neural integrity and may
influence organ system function and general health.􀂴4 Thus,
reduction of vertebral subluxation is thought to promote
overall health by contributing to the proper function of the
body􀂶s inherent adaptive abilities, many of which appear
linked to neurological function.5
Case Report
A 49-year-old caucasian female presented for chiropractic care
at a private practice in Auckland, New Zealand in January
2006. Initial examination revealed a history of depression,
asthma, high stress, mood and gastrointestinal changes
(flatulence) and a generalised loss of lust for life. It was also
noted that she had been prescribed Aropax by her General
Practitioner 14 months prior for her depression. Over a period
of seven months from the date of presentation a specific
conservative chiropractic adjustment regimen for the
correction of vertebral subluxations was delivered to the
patient.
This consisted of a series of adjustments using the Torque
Release Technique (TRT), developed by Jay Holder, D.C.
TRT uses various indicators of vertebral subluxations and also
prioritizes their correction into a system called Non/Linear
Testing Priorities. The main focus of TRT is detecting areas of
subluxation at locations of dural attachment being the upper
and lower cervical spine (C1, C2 and C5), sacrum, coccyx and
the pelvis. The use of an adjusting device called an Integrator
is used for the correction of vertebral subluxations. It features
a pre-cocking, pressure sensitive tip with an automatic release
mechanism that includes a torque and recoil component.6
The care plan was altered in accordance to outcome measures.
Self-rated health/wellness (SRHW) surveys were taken prior
to care and at subsequent progress visits assessing four
domains of health (Physical state, Emotional/Mental state,
Stress and Life Enjoyment) as well as Overall Quality of Life.7
Over this time period the patient exhibited a substantial
increase in quality of life ratings alongside a considerable
decrease in presenting symptomology.
The survey instrument used has been specifically developed
by Blanks et al. to analyze wellness. Aptly named 􀂳Survey of
Self-Rated Health, Wellness and Quality of Life􀂴 (HWQL) the
questionnaire aims to record health, wellness and quality of
life levels by having the subject self-rate (fill out personally)
fifty-five items within five domains.7 Self assessment using
the 􀂳HWQL Survey􀂴 was used at the initial consultation prior
to commencing the chiropractic care to gain a baseline of the
patient􀂶s perceptions and again at intervals thereafter as
indicated for the duration of the study (7 months).
Spinal thermal and surface electromyography (sEMG) scans
were completed at the initial consultation. These initial sEMG
and thermography scans revealed areas of asymmetrical motor
and autonomic function respectively throughout the entire
spine. See figure 1. The scans were performed using the
Chiropractic Leadership Alliance (CLA) Insight􀂌 7000
sEMG and thermal scanning technology.
The intervals for progress exams (periodical re-examination)
were set specifically for the patient in relation to presentation
and were taken at week 4 and 11 within the care plan. The
frequency of care was reassessed at each progress exam with
an initial frequency of 3 visits per week for the first 8 weeks.
At the 4 week progress exam the plan was altered to twice a
week for 14 weeks with a subsequent progress scheduled for
14 weeks.
Comparable thermal and sEMG scans were taken at progress
exams 1 and 2 following the onset of care. Increased balance
and symmetry were noted on the 1st progress in both motor
and autonomic function. This further improved on the 2nd
progress scans. Figures 2 and 3.
Table 1 shows the calculated results as recorded from the
initial examination and two subsequent progress exams as well
as their correlating percentage improvements. Figure 4, 5 and
6 further illustrate these improvements. It can be seen that at
initial progress examination there were positive changes (from
9-28% improvement) in all aspects of the survey calculated
except for the section in regards to the ability to handle stress
which presented a negative result. It was stated by the patient
that after 6 weeks of care she had stopped taking the antidepressants.
This may correlate to the improvements seen in
subsequent progress exams. According to the patient: 􀂳After 6
weeks I have been able to come off the anti-depressants
already.􀂴
At progress exam two, the results varied from that of progress
one ranging from 0-46% improvement. Most significant
improvement was seen in Physical Score with 46% and the
most significant percentile change was in the Quality of Life
Score.
Overall there was an increase on average of 23.2% with the
most change noted on Wellness Scores (44%) and least with
Quality of Life Score (8%).
Figure 6 and Table 2 illustrate the change over time between
categories within the survey. This clearly displays that each
area of the survey improved yet at very differing values and
times within care.
Discussion
The purpose of this case study was to document the changes
that occurred while under chiropractic care and the positive
affect on the patient􀂶s quality of life in relation to a patient􀂶s
self-rated health perceptions as measured by the Health,
Wellness and Quality of Life survey.
All domains of the completed survey have showed notable
increases in ratings between initial and follow-up with the
most significant being the physical domain.
As this study is of the patient􀂶s perception of their health, all
answers are relevant to the way they interpret the question.
The patient may have adapted her answers according to
expected benefit, social willingness and their current mood. It
was suggested that the patient be completely honest when
filling in the survey.
J. Vertebral Subluxation Res. January 31, 2010 2
Depression & Chiropractic
Increasingly, health care providers are being encouraged to
adopt an evidence-based approach to delivering the services
they provide.8 The approach of wellness oriented outcome
assessments are not yet widely adopted in the area of health
care where it would be most applicable, i.e., non-medical
practices that have as their primary clinical goal the
enhancement of over-all health. This is perhaps due to the
disease-specific orientation found in most recently developed
surveys.
Historically there is not adequate scientific evidence into the
effects of the vertebral subluxation in relation to its ability to
interfere with well-being. More recent studies however
describe the correction of vertebral subluxation as having an
impact on the improvement of general health, brain function,
quality of life and well being.7,9,10
Blanks et al described the profound effects chiropractic has
had on patients well being in the self􀂱reported retrospective
study of 2818 people. After 3 years of chiropractic care
patients found their quality of life was maintained and did not
plateau.7
Although depression is associated with biochemical changes it
is impossible to say whether improvements in quality of life
observed in this case are related to changes in biochemistry
caused by antidepressant use or due to the correction of
vertebral subluxations or another mechanism altogether. It is
fair to say that by providing care to this patient the interaction
with the chiropractor may also have been a positive influence.
Conclusion
This report outlines the history and symptomology of a 49
year old women suffering from a history of depression,
asthma, high stress, mood and gastrointestinal changes. The 7
months of chiropractic care and the women􀂶s physical, social
and mental response to the correction of vertebral subluxations
were discussed. This report supports previous literature
regarding chiropractic care and its positive effect on physical,
mental and social well-being.
References
1. Strock M. Depression: NIH, 2000.
2. Nemeroff CB. The neurobiology of depression.
Scientific American. 1998 Jun;278(6):42-9.
3. Jelinski SE, Magnusson JE, Becker WJ. Factors
associated with depression in patients referred to
headache specialists. Neurology. 2007 Feb
13;68(7):489-95.
4. Association of Chiropractic Colleges. The
Association of Chiropractic Colleges Position Paper
# 1. July 1996. . ICA Rev.
1996;November/December.
5. Leach RA. The chiropractic theories: a textbook of
scientific research. 4th ed. Baltimore: Lippincott
Williams and Wilkins; 2004. 18-20, 137, 251, 359 p.
6. Nadler A, Holder JM, Talsky MA. Torque Release
Technique (TRT): A technique model for
chiropractic's second century. Canadian Chiropractor.
1998;3(1).
7. Blanks RHI, Schuster TL. A retrospective assessment
of network care using a survey of self-rated health,
wellness and quality of life. Journal of Vertebral
Subluxation Research. 1997;1(4):1.
8. Sackett DL. Evidence-based medicine. Seminars in
perinatology. 1997 Feb;21(1):3-5.
9. Boone WR, Oswald P, Holt K, Beck R, Singh K,
Ashton A. Physical, physiological, and immune
status changes, coupled with self-perceptions of
health and quality of life, in subjects receiving
chiropractic care: A pilot study. Journal of Vertebral
Subluxation Research. 2006;July 5:1-6.
10. Taylor HH, Murphy B. Altered sensorimotor
integration with cervical spine manipulation. J
Manipulative Physiol Ther. 2008 Feb;31(2):115-26.
J. Vertebral Subluxation Res. January 31, 2010 3
Depression & Chiropractic
Initial SEMG Scan 2nd SEMG Scan
Final SEMG Scan
Initial Thermal Scan 2nd Thermal Scan
Final Thermal Scan
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 4
Table 1
Initial Progress 1 Progress 2
Score Score Difference Improvement Score Difference Improvement Overall
Improvement
Combined wellness 0.48 0.56 0.08 14% 0.74 0.18 24% 35%
1. Physical state 0.25 0.35 0.10 28% 0.65 0.30 46% 61%
2. Mental/Emotional
state
0.38 0.55 0.17 30% 0.75 0.20 26% 49%
3. Stress Evaluation 0.63 0.60 -0.03 - 0.78 0.18 23% 19%
4. Life Enjoyment 0.68 0.75 0.07 9% 0.77 0.02 3% 12%
Overall quality of
life
0.64 0.83 0.19 23% 0.83 0 0 23%
Table 2
Date Physical (P) Mental/Emotional (M/E) Stress Evaluation (S)
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
31.01.2006 5 5 5 2 5 2 5 4 4 3 4 2 3 4 5 5 2 5 4 1 1 4 3 4 3 3 3 2 1
28.03.2006 5 4 5 2 4 2 5 4 3 2 4 2 2 1 3 4 2 2 5 3 2 1 4 3 4 3 2 3 2 2
10.05.2006 4 3 3 1 2 2 4 3 1 1 3 1 2 3 1 3 1 1 4 1 2 1 2 2 3 3 3 1 1 1
Life Enjoyment (LE) Overall Quality of Life (QoL)
1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14
31.01.2006 3 3 4 4 5 5 5 2 5 2 3 7 5 3 5 3 6 4 5 7 7 7 7
28.03.2006 4 3 4 4 5 5 5 3 4 4 3 7 7 6 4 6 3 6 6 5 6 7 7 7 7
10.05.2006 4 4 4 4 5 5 5 3 5 3 3 7 7 6 4 5 3 7 7 4 6 7 7 7 7
Figure 4
Results from SRWH Survey after Initial Progress Exam (31/01/06)
4
3.5
2.5
3.727272727
4.857142857
0 1 2 3 4 5 6
Physical
Mental/Emotional
Stress Evaluation
Life Enjoyment
Quality of Life
Figure 5
Results from SRWH Survey after second Progress Exam (28/02/06)
3.6
2.8
2.6
4
6
0 1 2 3 4 5 6 7
Physical
Mental/Emotional
Stress Evaluation
Life Enjoyment
Quality of Life
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 5
Figure 6
Wellness Scores
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Health Domains
Scores
(1) 31.01.2006 0.25 0.31 0.63 0.68 0.75 0.47
(2) 28.03.2006 0.35 0.55 0.60 0.75 0.83 0.56
(3) 10.05.2006 0.65 0.75 0.78 0.77 0.83 0.74
P M/E S LE QoL W
Key:
P - Physical Score
M/E - Mental / Emotional Score
S - Ability to Handle Stress
LE - Life Enjoyment Score
QoL - Quality of Life Score
W - Combined Wellness Score
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 6
Undergoing Chiropractic Care Using Torque Release
Technique: A Case Study
Theo Mahanidis BA (Sports Ed),1 B(Chiro) & David Russell BSc (Psych), B(Chiro)2
__________________________________________________________________________________________
ABSTRACT
Objective: To report on a female patient who presented for chiropractic care with depression.
Clinical Features: 49 year old female who presented with a history of depression, asthma, high stress, mood and gastrointestinal changes.
Intervention and Outcome: Over a period of 7 months, a specific, conservative chiropractic adjustment regimen for the correction of vertebral subluxation was administered to the patient. The care plan was altered in accordance to outcome
measures and over this time period the patient exhibited a considerable decrease in presenting symptomology alongside a substantial increase in self rated quality of life. Self-rated health/wellness (SRHW) surveys were taken prior to care and at
subsequent progress visits assessing four domains of health(Physical state, Emotional/Mental state, Stress and Life Enjoyment) as well as Overall Quality of Life. Static and Thermal EMG were performed using the Chiropractic
Leadership Alliance (CLA) Insight􀂌 surface EMG and thermal scanning technology. Improvements were noted in SRHW and surface EMG and thermal scanning over the 7 months of care.
Conclusions: While under chiropractic care subjective and
objective improvements in physical, mental and social wellbeing were documented in a patient with a history of depression,asthma, high stress, mood and gastrointestinal changes
Keywords: Chiropractic, subluxation, depression, quality
of life, Stress, Torque Release Technique (TRT), Insight􀂌
surface EMG and thermal scanning
____________________________________________________________________________________________________________
Introduction
Mood disorders affect approximately 1 in 7 New Zealanders
within their lifetime with 1 in 5 experiencing some kind of
serious mood disorder by the age of 25 with females reporting
a higher incidence of depression than males.1 The most
common types of mood disorders include Major Depression,
Dysthymia and Bipolar Disorder. Some of the more common
symptoms of these disorders are loss of interest or pleasure in
hobbies and activities, decreased energy (fatigue), feelings of
worthlessness, anxious or 􀂳empty􀂴 mood, difficulty
concentrating, insomnia, thoughts of death and or suicide.1
The common pathway of depression involves biochemical
changes in the brain. This is believed to be due to the roles of
serotonin, GABA, dopamine and opioid peptides which when
imbalanced or deficient can cause mood disorders.2 There is
also evidence suggesting a correlation between cervical
trauma and the onset of social disorders although there is still
debate about the true cause of social and mood disorders.3
Chiropractic care aims to optimize health and wellbeing
through removing interference from the nerve system.
Chiropractic follows the notion that the correction of any
interference in the nerve system is an essential component of
personal enhancement and health maintenance. This
professional objective is achieved through the correction of
vertebral subluxations.4 The Association of Chiropractic
Colleges defines subluxation as follows: 􀂳A subluxation is a
complex of functional and/or structural and/or pathological
CASE STUDY
1. Private Practice, Wollongong, NSW Australia
2. Centre Director, New Zealand College of Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 1
Depression & Chiropractic
articular changes that compromise neural integrity and may
influence organ system function and general health.􀂴4 Thus,
reduction of vertebral subluxation is thought to promote
overall health by contributing to the proper function of the
body􀂶s inherent adaptive abilities, many of which appear
linked to neurological function.5
Case Report
A 49-year-old caucasian female presented for chiropractic care
at a private practice in Auckland, New Zealand in January
2006. Initial examination revealed a history of depression,
asthma, high stress, mood and gastrointestinal changes
(flatulence) and a generalised loss of lust for life. It was also
noted that she had been prescribed Aropax by her General
Practitioner 14 months prior for her depression. Over a period
of seven months from the date of presentation a specific
conservative chiropractic adjustment regimen for the
correction of vertebral subluxations was delivered to the
patient.
This consisted of a series of adjustments using the Torque
Release Technique (TRT), developed by Jay Holder, D.C.
TRT uses various indicators of vertebral subluxations and also
prioritizes their correction into a system called Non/Linear
Testing Priorities. The main focus of TRT is detecting areas of
subluxation at locations of dural attachment being the upper
and lower cervical spine (C1, C2 and C5), sacrum, coccyx and
the pelvis. The use of an adjusting device called an Integrator
is used for the correction of vertebral subluxations. It features
a pre-cocking, pressure sensitive tip with an automatic release
mechanism that includes a torque and recoil component.6
The care plan was altered in accordance to outcome measures.
Self-rated health/wellness (SRHW) surveys were taken prior
to care and at subsequent progress visits assessing four
domains of health (Physical state, Emotional/Mental state,
Stress and Life Enjoyment) as well as Overall Quality of Life.7
Over this time period the patient exhibited a substantial
increase in quality of life ratings alongside a considerable
decrease in presenting symptomology.
The survey instrument used has been specifically developed
by Blanks et al. to analyze wellness. Aptly named 􀂳Survey of
Self-Rated Health, Wellness and Quality of Life􀂴 (HWQL) the
questionnaire aims to record health, wellness and quality of
life levels by having the subject self-rate (fill out personally)
fifty-five items within five domains.7 Self assessment using
the 􀂳HWQL Survey􀂴 was used at the initial consultation prior
to commencing the chiropractic care to gain a baseline of the
patient􀂶s perceptions and again at intervals thereafter as
indicated for the duration of the study (7 months).
Spinal thermal and surface electromyography (sEMG) scans
were completed at the initial consultation. These initial sEMG
and thermography scans revealed areas of asymmetrical motor
and autonomic function respectively throughout the entire
spine. See figure 1. The scans were performed using the
Chiropractic Leadership Alliance (CLA) Insight􀂌 7000
sEMG and thermal scanning technology.
The intervals for progress exams (periodical re-examination)
were set specifically for the patient in relation to presentation
and were taken at week 4 and 11 within the care plan. The
frequency of care was reassessed at each progress exam with
an initial frequency of 3 visits per week for the first 8 weeks.
At the 4 week progress exam the plan was altered to twice a
week for 14 weeks with a subsequent progress scheduled for
14 weeks.
Comparable thermal and sEMG scans were taken at progress
exams 1 and 2 following the onset of care. Increased balance
and symmetry were noted on the 1st progress in both motor
and autonomic function. This further improved on the 2nd
progress scans. Figures 2 and 3.
Table 1 shows the calculated results as recorded from the
initial examination and two subsequent progress exams as well
as their correlating percentage improvements. Figure 4, 5 and
6 further illustrate these improvements. It can be seen that at
initial progress examination there were positive changes (from
9-28% improvement) in all aspects of the survey calculated
except for the section in regards to the ability to handle stress
which presented a negative result. It was stated by the patient
that after 6 weeks of care she had stopped taking the antidepressants.
This may correlate to the improvements seen in
subsequent progress exams. According to the patient: 􀂳After 6
weeks I have been able to come off the anti-depressants
already.􀂴
At progress exam two, the results varied from that of progress
one ranging from 0-46% improvement. Most significant
improvement was seen in Physical Score with 46% and the
most significant percentile change was in the Quality of Life
Score.
Overall there was an increase on average of 23.2% with the
most change noted on Wellness Scores (44%) and least with
Quality of Life Score (8%).
Figure 6 and Table 2 illustrate the change over time between
categories within the survey. This clearly displays that each
area of the survey improved yet at very differing values and
times within care.
Discussion
The purpose of this case study was to document the changes
that occurred while under chiropractic care and the positive
affect on the patient􀂶s quality of life in relation to a patient􀂶s
self-rated health perceptions as measured by the Health,
Wellness and Quality of Life survey.
All domains of the completed survey have showed notable
increases in ratings between initial and follow-up with the
most significant being the physical domain.
As this study is of the patient􀂶s perception of their health, all
answers are relevant to the way they interpret the question.
The patient may have adapted her answers according to
expected benefit, social willingness and their current mood. It
was suggested that the patient be completely honest when
filling in the survey.
J. Vertebral Subluxation Res. January 31, 2010 2
Depression & Chiropractic
Increasingly, health care providers are being encouraged to
adopt an evidence-based approach to delivering the services
they provide.8 The approach of wellness oriented outcome
assessments are not yet widely adopted in the area of health
care where it would be most applicable, i.e., non-medical
practices that have as their primary clinical goal the
enhancement of over-all health. This is perhaps due to the
disease-specific orientation found in most recently developed
surveys.
Historically there is not adequate scientific evidence into the
effects of the vertebral subluxation in relation to its ability to
interfere with well-being. More recent studies however
describe the correction of vertebral subluxation as having an
impact on the improvement of general health, brain function,
quality of life and well being.7,9,10
Blanks et al described the profound effects chiropractic has
had on patients well being in the self􀂱reported retrospective
study of 2818 people. After 3 years of chiropractic care
patients found their quality of life was maintained and did not
plateau.7
Although depression is associated with biochemical changes it
is impossible to say whether improvements in quality of life
observed in this case are related to changes in biochemistry
caused by antidepressant use or due to the correction of
vertebral subluxations or another mechanism altogether. It is
fair to say that by providing care to this patient the interaction
with the chiropractor may also have been a positive influence.
Conclusion
This report outlines the history and symptomology of a 49
year old women suffering from a history of depression,
asthma, high stress, mood and gastrointestinal changes. The 7
months of chiropractic care and the women􀂶s physical, social
and mental response to the correction of vertebral subluxations
were discussed. This report supports previous literature
regarding chiropractic care and its positive effect on physical,
mental and social well-being.
References
1. Strock M. Depression: NIH, 2000.
2. Nemeroff CB. The neurobiology of depression.
Scientific American. 1998 Jun;278(6):42-9.
3. Jelinski SE, Magnusson JE, Becker WJ. Factors
associated with depression in patients referred to
headache specialists. Neurology. 2007 Feb
13;68(7):489-95.
4. Association of Chiropractic Colleges. The
Association of Chiropractic Colleges Position Paper
# 1. July 1996. . ICA Rev.
1996;November/December.
5. Leach RA. The chiropractic theories: a textbook of
scientific research. 4th ed. Baltimore: Lippincott
Williams and Wilkins; 2004. 18-20, 137, 251, 359 p.
6. Nadler A, Holder JM, Talsky MA. Torque Release
Technique (TRT): A technique model for
chiropractic's second century. Canadian Chiropractor.
1998;3(1).
7. Blanks RHI, Schuster TL. A retrospective assessment
of network care using a survey of self-rated health,
wellness and quality of life. Journal of Vertebral
Subluxation Research. 1997;1(4):1.
8. Sackett DL. Evidence-based medicine. Seminars in
perinatology. 1997 Feb;21(1):3-5.
9. Boone WR, Oswald P, Holt K, Beck R, Singh K,
Ashton A. Physical, physiological, and immune
status changes, coupled with self-perceptions of
health and quality of life, in subjects receiving
chiropractic care: A pilot study. Journal of Vertebral
Subluxation Research. 2006;July 5:1-6.
10. Taylor HH, Murphy B. Altered sensorimotor
integration with cervical spine manipulation. J
Manipulative Physiol Ther. 2008 Feb;31(2):115-26.
J. Vertebral Subluxation Res. January 31, 2010 3
Depression & Chiropractic
Initial SEMG Scan 2nd SEMG Scan
Final SEMG Scan
Initial Thermal Scan 2nd Thermal Scan
Final Thermal Scan
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 4
Table 1
Initial Progress 1 Progress 2
Score Score Difference Improvement Score Difference Improvement Overall
Improvement
Combined wellness 0.48 0.56 0.08 14% 0.74 0.18 24% 35%
1. Physical state 0.25 0.35 0.10 28% 0.65 0.30 46% 61%
2. Mental/Emotional
state
0.38 0.55 0.17 30% 0.75 0.20 26% 49%
3. Stress Evaluation 0.63 0.60 -0.03 - 0.78 0.18 23% 19%
4. Life Enjoyment 0.68 0.75 0.07 9% 0.77 0.02 3% 12%
Overall quality of
life
0.64 0.83 0.19 23% 0.83 0 0 23%
Table 2
Date Physical (P) Mental/Emotional (M/E) Stress Evaluation (S)
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
31.01.2006 5 5 5 2 5 2 5 4 4 3 4 2 3 4 5 5 2 5 4 1 1 4 3 4 3 3 3 2 1
28.03.2006 5 4 5 2 4 2 5 4 3 2 4 2 2 1 3 4 2 2 5 3 2 1 4 3 4 3 2 3 2 2
10.05.2006 4 3 3 1 2 2 4 3 1 1 3 1 2 3 1 3 1 1 4 1 2 1 2 2 3 3 3 1 1 1
Life Enjoyment (LE) Overall Quality of Life (QoL)
1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14
31.01.2006 3 3 4 4 5 5 5 2 5 2 3 7 5 3 5 3 6 4 5 7 7 7 7
28.03.2006 4 3 4 4 5 5 5 3 4 4 3 7 7 6 4 6 3 6 6 5 6 7 7 7 7
10.05.2006 4 4 4 4 5 5 5 3 5 3 3 7 7 6 4 5 3 7 7 4 6 7 7 7 7
Figure 4
Results from SRWH Survey after Initial Progress Exam (31/01/06)
4
3.5
2.5
3.727272727
4.857142857
0 1 2 3 4 5 6
Physical
Mental/Emotional
Stress Evaluation
Life Enjoyment
Quality of Life
Figure 5
Results from SRWH Survey after second Progress Exam (28/02/06)
3.6
2.8
2.6
4
6
0 1 2 3 4 5 6 7
Physical
Mental/Emotional
Stress Evaluation
Life Enjoyment
Quality of Life
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 5
Figure 6
Wellness Scores
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Health Domains
Scores
(1) 31.01.2006 0.25 0.31 0.63 0.68 0.75 0.47
(2) 28.03.2006 0.35 0.55 0.60 0.75 0.83 0.56
(3) 10.05.2006 0.65 0.75 0.78 0.77 0.83 0.74
P M/E S LE QoL W
Key:
P - Physical Score
M/E - Mental / Emotional Score
S - Ability to Handle Stress
LE - Life Enjoyment Score
QoL - Quality of Life Score
W - Combined Wellness Score
Depression & Chiropractic
J. Vertebral Subluxation Res. January 31, 2010 6
Wednesday, June 30, 2010
Thursday, June 3, 2010
CHIROPRACTIC REDUCES FOOTBALLER INJURIES
CHIROPRACTIC REDUCES FOOTBALLER INJURIES
SAMANTHA NORRIS, MACQUARIE UNIVERSITY
A new Macquarie University study involving two Australian Rules football clubs has found that chiropractic treatment can significantly reduce the risk of players succumbing to hamstring injuries and lower limb muscle strain. Two semi-elite Victorian Football League (VFL) clubs participated in the research, which is the first Australian study to examine the role of chiropractic treatment in
minimising injury in elite footballers.The study was undertaken by sports chiropractor Wayne Hoskins as the basis for his PhD project on hamstring
injuries and has just been published in the journal BMC Musculoskeletal Disorders.
"Hamstring and lower limb muscle strains are the most common injuries in the AFL," Dr Hoskins said. "The AFL's injury survey shows no change in injury rates in the last
15 years and management of these injuries has remained a source of frustration for players, clubs, medical staff and fans alike."Dr Hoskins' research showed that hamstring and lower limb muscle strain injuries can be dramatically reduced through
the inclusion of a sports chiropractor in the traditional injury management programs adopted by clubs, which generally involve a mix of physiotherapy, massage and strength and conditioning management.He said the results suggest that the inclusion of chiropractic treatment would boost player performance whilst saving clubs money.
"The study lasted an entire season and involved 59 players from two VFL clubs," Dr Hoskins said. "The group which included chiropractic management had a 4% chance
of a hamstring injury and a 4% chance of a lower limb muscle strain. The group which received the traditional management only had a 17% chance of hamstring injury
and a 28% chance of a lower limb muscle strain.
CHIROPRACTIC TREATMENT DECREASES PLAYER INJURIES.
In addition, the chiropractic group missed just four matches during the season through hamstring or lower limb muscle strains. The group not receiving chiropractic treatment missed 14 matches through hamstring injury and 21 matches through lower limb muscle strain.The group receiving chiropractic treatment also had
significant reductions in non-contact knee injuries, low back pain and improvements in physical components of health,although this was not the goal of treatment.
The study was carried out under the supervision of Associate Professor Henry Pollard from Macquarie University's Department of Chiropractic.
For the full article go tohttp://www.biSlmedcentral.com/1471-2474/11/64
Sunday, May 16, 2010
The Cookie Thief
The Cookie Thief
Valerie Cox
A woman was waiting at an airport one night,
With several long hours before her flight.
She hunted for a book in the airport shop,
Bought a bag of cookies and found a place to drop.
She was engrossed in her book, but just happened to see
That the man beside her as bold as could be
Grabbed a cookie or two from the bag between,
Which she tried to ignore to avoid a scene.
She munched cookies and watched the clock,
As the gutsy cookie thief diminished her stock.
She was getting more irritated as the minutes ticked by,
Thinking, “If I wasn’t so nice, I’d blacken his eye.”
With each cookie she took, he took one too,
When only one was left, she wondered what he’d do.
With a smile on his face and a nervous laugh,
He took the last cookie and broke it in half.
He offered her half as he ate the other.
She snatched it from him and thought, ‘Oh, Brother...
This guy has some nerve and he’s also rude,
Why he didn’t show any gratitude.’
She hadn’t known when she had been so galled
And sighed with relief when her flight was called.
She gathered her belongings and headed to the gate,
Refusing to look back at that thieving ingrate.
She boarded the plane and sank in her seat,
Then sought her book which was almost complete.
As she reached in her baggage she gasped with surprise.
There was her bag of cookies in front of her eyes.
“If mine are here”, she moaned with despair,
“Then the others were his and he tried to share.”
Too late to apologize she realized with grief
That she was the rude one, the ingrate, the thief.
Where are You a "Cookie Thief" when it comes to Your Own Health?
In “The Cookie Thief” the woman in theairport just knew that the gentleman beside her
was stealing her cookies. She had a false belief about what was really happening and it affected her in a negative way.We often hold on to false beliefs which are
detrimental to us as well. Our society firmly believes in an ‘outside in’ approach to sickness and health. We’re taught that something ‘out there’ makes us sick - a virus, bacteria, pollutant,stress. When this something from outside of us makes us sick, we then need to turn to another something outside of ourselves to make us well -a drug, surgery, remedy, etc. This belief places our power outside of ourselves and makes us ‘victims’ of disease dependant upon the intervention of something external in order to be‘well’.Health and healing are really ‘inside out’ jobs.Louis Pasteur, the father of the germ theory stated toward the end of his life “It’s the soil, not the seed that matters”. This means that it’s the state
of your body, not the germ which determines whether you’ll be sick or healthy. Germs and bacteria do not cause disease! A sick weak body is susceptible to pathogens (bacteria and viruses associated with illnesses), just like rats congregate
at the garbage dump because the garbage is already there. If it’s clean, there’s nothing for them to eat and you won’t see them.Even with degenerative and autoimmune
disorders, it’s the state of our body which will determine the state of our health more thananything else. It makes much more sense to spend our time and energy doing all that we can to increase the state of our health and trust the healing power within our body than to hope we can dump solutions into the problem once it occurs.
Chiropractic is so wonderful because it offers an inside out solution. If our health is less thanoptimal, Chiropractic adjustments allow the full healing potential of our body to be realized.Health and healing is our birthright. We have the ability within our body to heal. Often that ability is blocked. One major block to our body’s ability to heal is subluxation. When the brain and the body are unable to clearly and effectively communicate, the body works less efficiently.One of the major jobs of the brain and nerve system is to keep the body balanced internally
and to properly adapt it to its environment. It is this adaptation process which is so greatly enhanced by chiropractic adjustments.Studies show that there is more efficient functioning of the brain and nerve system when subluxation is reduced. It takes less brain energy to perform simple tasks such as wiggling a foot or a finger after subluxation is corrected than before.How much easier must it be for the immune
system or the hormonal system to function normally when their communication channels
with the brain are clear?Examine your outlook about health and see where some of your beliefs might be causing you harm. Doesn’t it make the most sense to take
care of your body and keep it healthy, rather than try to fix it after it’s broken? Who else do you know who could benefit from greater health from within?
Most of society are “Cookie Thieves” when it comes to chiropractic. They have the false belief that Chiropractic care is something they might use if they have back pain or neck pain or headaches.In reality, Chiropractic care is much bigger than
pain relief. Chiropractic ALWAYS works to improve the health and functioning of the body,rather than being merely for pain relief.Chiropractic care is for everyone, from the cradle to the grave. All people are better off with a good nerve supply. Period. Subluxations are caused by physical, chemical and mental/emotional stresses. we are all subjected to these in our society. Therefore, we all need help, we all
need to have our subluxations corrected to allow us to achieve our maximum level of health.So, yes, people with back and neck pain can benefit from chiropractic care. People with serious health conditions can also benefit from having interference to their nerve system removed. Most will see vast improvement in their health as a result. People who want to prevent illness will be taking a major step to avoid
problems in the future. People who want the most out of their life and health will also be thrilled to see the great changes Chiropractic can make by allowing them to live free of interference!
© Weekly Handouts
Valerie Cox
A woman was waiting at an airport one night,
With several long hours before her flight.
She hunted for a book in the airport shop,
Bought a bag of cookies and found a place to drop.
She was engrossed in her book, but just happened to see
That the man beside her as bold as could be
Grabbed a cookie or two from the bag between,
Which she tried to ignore to avoid a scene.
She munched cookies and watched the clock,
As the gutsy cookie thief diminished her stock.
She was getting more irritated as the minutes ticked by,
Thinking, “If I wasn’t so nice, I’d blacken his eye.”
With each cookie she took, he took one too,
When only one was left, she wondered what he’d do.
With a smile on his face and a nervous laugh,
He took the last cookie and broke it in half.
He offered her half as he ate the other.
She snatched it from him and thought, ‘Oh, Brother...
This guy has some nerve and he’s also rude,
Why he didn’t show any gratitude.’
She hadn’t known when she had been so galled
And sighed with relief when her flight was called.
She gathered her belongings and headed to the gate,
Refusing to look back at that thieving ingrate.
She boarded the plane and sank in her seat,
Then sought her book which was almost complete.
As she reached in her baggage she gasped with surprise.
There was her bag of cookies in front of her eyes.
“If mine are here”, she moaned with despair,
“Then the others were his and he tried to share.”
Too late to apologize she realized with grief
That she was the rude one, the ingrate, the thief.
Where are You a "Cookie Thief" when it comes to Your Own Health?
In “The Cookie Thief” the woman in theairport just knew that the gentleman beside her
was stealing her cookies. She had a false belief about what was really happening and it affected her in a negative way.We often hold on to false beliefs which are
detrimental to us as well. Our society firmly believes in an ‘outside in’ approach to sickness and health. We’re taught that something ‘out there’ makes us sick - a virus, bacteria, pollutant,stress. When this something from outside of us makes us sick, we then need to turn to another something outside of ourselves to make us well -a drug, surgery, remedy, etc. This belief places our power outside of ourselves and makes us ‘victims’ of disease dependant upon the intervention of something external in order to be‘well’.Health and healing are really ‘inside out’ jobs.Louis Pasteur, the father of the germ theory stated toward the end of his life “It’s the soil, not the seed that matters”. This means that it’s the state
of your body, not the germ which determines whether you’ll be sick or healthy. Germs and bacteria do not cause disease! A sick weak body is susceptible to pathogens (bacteria and viruses associated with illnesses), just like rats congregate
at the garbage dump because the garbage is already there. If it’s clean, there’s nothing for them to eat and you won’t see them.Even with degenerative and autoimmune
disorders, it’s the state of our body which will determine the state of our health more thananything else. It makes much more sense to spend our time and energy doing all that we can to increase the state of our health and trust the healing power within our body than to hope we can dump solutions into the problem once it occurs.
Chiropractic is so wonderful because it offers an inside out solution. If our health is less thanoptimal, Chiropractic adjustments allow the full healing potential of our body to be realized.Health and healing is our birthright. We have the ability within our body to heal. Often that ability is blocked. One major block to our body’s ability to heal is subluxation. When the brain and the body are unable to clearly and effectively communicate, the body works less efficiently.One of the major jobs of the brain and nerve system is to keep the body balanced internally
and to properly adapt it to its environment. It is this adaptation process which is so greatly enhanced by chiropractic adjustments.Studies show that there is more efficient functioning of the brain and nerve system when subluxation is reduced. It takes less brain energy to perform simple tasks such as wiggling a foot or a finger after subluxation is corrected than before.How much easier must it be for the immune
system or the hormonal system to function normally when their communication channels
with the brain are clear?Examine your outlook about health and see where some of your beliefs might be causing you harm. Doesn’t it make the most sense to take
care of your body and keep it healthy, rather than try to fix it after it’s broken? Who else do you know who could benefit from greater health from within?
Most of society are “Cookie Thieves” when it comes to chiropractic. They have the false belief that Chiropractic care is something they might use if they have back pain or neck pain or headaches.In reality, Chiropractic care is much bigger than
pain relief. Chiropractic ALWAYS works to improve the health and functioning of the body,rather than being merely for pain relief.Chiropractic care is for everyone, from the cradle to the grave. All people are better off with a good nerve supply. Period. Subluxations are caused by physical, chemical and mental/emotional stresses. we are all subjected to these in our society. Therefore, we all need help, we all
need to have our subluxations corrected to allow us to achieve our maximum level of health.So, yes, people with back and neck pain can benefit from chiropractic care. People with serious health conditions can also benefit from having interference to their nerve system removed. Most will see vast improvement in their health as a result. People who want to prevent illness will be taking a major step to avoid
problems in the future. People who want the most out of their life and health will also be thrilled to see the great changes Chiropractic can make by allowing them to live free of interference!
© Weekly Handouts
Wednesday, May 5, 2010
Chiropractic Improves Brain Function
Chiropractic improves brain function
The sixteenth annual upper cervical conference was held at
Life University in Marietta, Georgia in November 1999. A
study presented at the conference found that patients under
chiropractic care experienced a measurable increase in brainfunction.
Microcog is a computer administered and scored test that
serves as a diagnostic tool to determine cognitive (brain)
function. It measures activity in nine categories:
attention/mental control, memory, reasoning/calculation,
spatial processing, reaction time, information processing speed,
information processing accuracy, general cognitive functioning
and general cognitive proficiency.
A total of 40 patients had their brain function measured by
Microcog. 30 of these patients received upper cervical (neck)
chiropractic adjustments and 10 served as a control group
receiving no adjustments. Four weeks later, all 40 patients
were tested by the Microcog system again.
According to the study, "significant improvements were
observed in neurocognitive [brain] function in the group
receiving upper cervical care. The control group did not
demonstrate a similar trend. This study suggests that upper
cervical chiropractic care may positively affect neurocognitivefunction."
The World Health Organization defines "health" as 100%
physical, mental and social well-being. A nervous system free
of interference is vital to the full expression of all these aspects
of your health potential. Chiropractic works to restore health
by removing interference to your nervous system.
The sixteenth annual upper cervical conference was held at
Life University in Marietta, Georgia in November 1999. A
study presented at the conference found that patients under
chiropractic care experienced a measurable increase in brainfunction.
Microcog is a computer administered and scored test that
serves as a diagnostic tool to determine cognitive (brain)
function. It measures activity in nine categories:
attention/mental control, memory, reasoning/calculation,
spatial processing, reaction time, information processing speed,
information processing accuracy, general cognitive functioning
and general cognitive proficiency.
A total of 40 patients had their brain function measured by
Microcog. 30 of these patients received upper cervical (neck)
chiropractic adjustments and 10 served as a control group
receiving no adjustments. Four weeks later, all 40 patients
were tested by the Microcog system again.
According to the study, "significant improvements were
observed in neurocognitive [brain] function in the group
receiving upper cervical care. The control group did not
demonstrate a similar trend. This study suggests that upper
cervical chiropractic care may positively affect neurocognitivefunction."
The World Health Organization defines "health" as 100%
physical, mental and social well-being. A nervous system free
of interference is vital to the full expression of all these aspects
of your health potential. Chiropractic works to restore health
by removing interference to your nervous system.
Thursday, April 15, 2010
Should You Get A Flu Shot? (Take This Quiz And Find Out)
Please answer each of the following questions, then check your answers on the back.
1. What is the desired effect of a Flu shot?
2. How does a Flu shot supposedly work?
3. What system controls your immune system (and every other system in your body)?
4. If your immune system is functioning properly, should your body be able to resist a Flu virus?
5. Knowing that your nerve system controls your immune system, what could make your immune system weak?
6. What causes subluxations in your spine?
7. Are there chemicals in a Flu shot other than a Flu virus?
8. Are some or all of these "extra" chemicals harmful to your body if injected into your blood stream?
9. Might the chemical stress from a Flu shot be difficult for your body to adapt to?
10. Might it cause negative stress on your nerve system and/or cause subluxations?
11. What effect might that negative stress have on your body and its immune resistance?
12. What removes stress in your nerve system and allows it to function optimally?
13. Knowing that chiropractic adjustments remove nerve interference and allow improved function of your nerve system, how do adjustments affect your immune response?
14. What can you do to keep your immune response high as possible?
15. Are Flu shots harmful?
16. Should you get a Flu shot? ANSWERS:
1. Q: What is the desired effect of a Flu shot? A: Prevent the Flu.
2. Q: How does a Flu shot supposedly work? A: By "boosting" the immune system.
3. Q: What system controls your immune system (and every other system in your body)? A: Your Nerve System.
4. Q: If your immune system is functioning properly, should your body be able to resist a Flu virus? A: YES.
5. Q: Knowing that your nerve system controls your immune system, what might make your immune system weak? A: anything that would affect the function of the nerve system, especially subluxations in your spine.
6. Q: What causes subluxations in your spine? A: Physical stress, chemical stress and mental stress (especially body impacts, chemical toxins and emotional stress).
7. Q: Are there chemicals in a Flu shot other than a Flu virus? A: Definitely YES.
8. Q: Are some or all of these "extra" chemicals harmful to your body if injected into your blood stream? A: Definitely YES.
9. Q: Might the chemical stress from a Flu shot be difficult for your body to adapt to? A: Definitely YES.
10. Q: Might it cause negative stress on your nerve system and/or cause subluxations? A: Definitely YES.
11. Q: What effect might that negative stress have on your body and its immune resistance? A: Your immune resistance would be decreased.
12. Q: What removes stress in your nerve system and allows it to function optimally? A: Chiropractic adjustments.
13. Q: Knowing that chiropractic adjustments remove nerve interference and allow improved function of your nerve system, how do adjustments affect your immune response? A: Adjustments increase your immune response and resistance. A study published in 1994 showed that specific chiropractic adjustments increased the CD4 white blood cell counts in HIV positive patients by 48% over the six-month duration of the study.
14. Q: What can you do to keep your immune response high as possible? A: Keep your family's nerve system clear of stress through regular visits to your Chiropractor, eat healthier, exercise more, get sufficient rest and reduce stress levels…especially during the flu and cold season.
15. Q: Are flu shots harmful? A: They most definitely can be. There is major concern in the scientific community right now that the astronomical rise in Autism rates and other disorders are directly related to vaccines.
16. Q: Should you get a Flu shot? A: That is a decision that only you can make. Know all the facts first. For more info visit the National Vaccine Information Center* at http://www.909shot.com/PressReleases/prfluvaccine.htm.
*The National Vaccine Information Center is a non-profit, educational organization founded in 1982 by parents whose children were injured or died from reactions to the DPT vaccine and is dedicated to preventing vaccine injuries and deaths through public education.
1. What is the desired effect of a Flu shot?
2. How does a Flu shot supposedly work?
3. What system controls your immune system (and every other system in your body)?
4. If your immune system is functioning properly, should your body be able to resist a Flu virus?
5. Knowing that your nerve system controls your immune system, what could make your immune system weak?
6. What causes subluxations in your spine?
7. Are there chemicals in a Flu shot other than a Flu virus?
8. Are some or all of these "extra" chemicals harmful to your body if injected into your blood stream?
9. Might the chemical stress from a Flu shot be difficult for your body to adapt to?
10. Might it cause negative stress on your nerve system and/or cause subluxations?
11. What effect might that negative stress have on your body and its immune resistance?
12. What removes stress in your nerve system and allows it to function optimally?
13. Knowing that chiropractic adjustments remove nerve interference and allow improved function of your nerve system, how do adjustments affect your immune response?
14. What can you do to keep your immune response high as possible?
15. Are Flu shots harmful?
16. Should you get a Flu shot? ANSWERS:
1. Q: What is the desired effect of a Flu shot? A: Prevent the Flu.
2. Q: How does a Flu shot supposedly work? A: By "boosting" the immune system.
3. Q: What system controls your immune system (and every other system in your body)? A: Your Nerve System.
4. Q: If your immune system is functioning properly, should your body be able to resist a Flu virus? A: YES.
5. Q: Knowing that your nerve system controls your immune system, what might make your immune system weak? A: anything that would affect the function of the nerve system, especially subluxations in your spine.
6. Q: What causes subluxations in your spine? A: Physical stress, chemical stress and mental stress (especially body impacts, chemical toxins and emotional stress).
7. Q: Are there chemicals in a Flu shot other than a Flu virus? A: Definitely YES.
8. Q: Are some or all of these "extra" chemicals harmful to your body if injected into your blood stream? A: Definitely YES.
9. Q: Might the chemical stress from a Flu shot be difficult for your body to adapt to? A: Definitely YES.
10. Q: Might it cause negative stress on your nerve system and/or cause subluxations? A: Definitely YES.
11. Q: What effect might that negative stress have on your body and its immune resistance? A: Your immune resistance would be decreased.
12. Q: What removes stress in your nerve system and allows it to function optimally? A: Chiropractic adjustments.
13. Q: Knowing that chiropractic adjustments remove nerve interference and allow improved function of your nerve system, how do adjustments affect your immune response? A: Adjustments increase your immune response and resistance. A study published in 1994 showed that specific chiropractic adjustments increased the CD4 white blood cell counts in HIV positive patients by 48% over the six-month duration of the study.
14. Q: What can you do to keep your immune response high as possible? A: Keep your family's nerve system clear of stress through regular visits to your Chiropractor, eat healthier, exercise more, get sufficient rest and reduce stress levels…especially during the flu and cold season.
15. Q: Are flu shots harmful? A: They most definitely can be. There is major concern in the scientific community right now that the astronomical rise in Autism rates and other disorders are directly related to vaccines.
16. Q: Should you get a Flu shot? A: That is a decision that only you can make. Know all the facts first. For more info visit the National Vaccine Information Center* at http://www.909shot.com/PressReleases/prfluvaccine.htm.
*The National Vaccine Information Center is a non-profit, educational organization founded in 1982 by parents whose children were injured or died from reactions to the DPT vaccine and is dedicated to preventing vaccine injuries and deaths through public education.
Wednesday, March 24, 2010
Exciting News and Developments In Practice
WELCOME TO OUR NEWS SECTION! Please take some time to read on, or come in store and catch up with us in person and find out what's happening at ChiroWorks!
WEBSITE UPDATES
Extensive updates to our websites, now sees a vast array of easily available educational information for you to access, and even pass on to your friends and loved ones.
On the homepage, you can now see a short video titled ‘The Big Idea’.
We highly recommend you take a short 7 minute break and watch this clip, which will help remind you of some of the amazing benefits that come with your chiropractic care, and exactly what’s happening in your body with each adjustment.
This is also a great tool for showing your friends and family whom you think may benefit from chiropractic care, exactly what it’s all about.
Still on the homepage, you will find access to an article entitled ‘Chiropractic Care for Children’, extracted from a fantastic best-seller “Well adjusted Babies”. This is a must-read for any parent (or parent-to-be) and can be downloaded and printed for your keeping. We also have copies of this book for purchase at the practice. We have a few loan copies to look at too.
On a fun note, we have recently joined Twitter and Facebook, and while we’re still updating our ‘profiles’ would love to see you on there, so look us up and add us to your account!
HEALTH WORKSHOPS
You may have heard us talking about the Human Potential Program workshops which are now running here at the practice. If not, let us explain briefly. These 45 minute workshop sessions cover a range of health and wellbeing topics, aimed at educating and inspiring you to live a healthy and full life. They will help you get the most out of your chiropractic care, and allow you to get results faster and easier (which means less visits, and therefore less cost to you!).
The workshops are FREE and open to current and new patients and their guests. Bookings are essential, so please contact us for more information.
They are held on Tuesday evenings at 6.30pm and Friday mornings at 11.00am
REFERRALS
We are still running our referral offer, of which you have probably received a letter and a couple of cards. These have no expiration so please feel free to leave them in your wallet until you run into that certain someone who you know would greatly benefit from chiropractic. Alternatively if you’re going through them like hotcakes as some of our patients are, then feel free to ask us for a handful on your next visit – we have plenty stashed away!
We hope you enjoy having a browse through the website and seeing all the new additions. If you have any questions or comments please remember we’re always here with open ears!!
WEBSITE UPDATES
Extensive updates to our websites, now sees a vast array of easily available educational information for you to access, and even pass on to your friends and loved ones.
On the homepage, you can now see a short video titled ‘The Big Idea’.
We highly recommend you take a short 7 minute break and watch this clip, which will help remind you of some of the amazing benefits that come with your chiropractic care, and exactly what’s happening in your body with each adjustment.
This is also a great tool for showing your friends and family whom you think may benefit from chiropractic care, exactly what it’s all about.
Still on the homepage, you will find access to an article entitled ‘Chiropractic Care for Children’, extracted from a fantastic best-seller “Well adjusted Babies”. This is a must-read for any parent (or parent-to-be) and can be downloaded and printed for your keeping. We also have copies of this book for purchase at the practice. We have a few loan copies to look at too.
On a fun note, we have recently joined Twitter and Facebook, and while we’re still updating our ‘profiles’ would love to see you on there, so look us up and add us to your account!
HEALTH WORKSHOPS
You may have heard us talking about the Human Potential Program workshops which are now running here at the practice. If not, let us explain briefly. These 45 minute workshop sessions cover a range of health and wellbeing topics, aimed at educating and inspiring you to live a healthy and full life. They will help you get the most out of your chiropractic care, and allow you to get results faster and easier (which means less visits, and therefore less cost to you!).
The workshops are FREE and open to current and new patients and their guests. Bookings are essential, so please contact us for more information.
They are held on Tuesday evenings at 6.30pm and Friday mornings at 11.00am
REFERRALS
We are still running our referral offer, of which you have probably received a letter and a couple of cards. These have no expiration so please feel free to leave them in your wallet until you run into that certain someone who you know would greatly benefit from chiropractic. Alternatively if you’re going through them like hotcakes as some of our patients are, then feel free to ask us for a handful on your next visit – we have plenty stashed away!
We hope you enjoy having a browse through the website and seeing all the new additions. If you have any questions or comments please remember we’re always here with open ears!!
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