On Antibiotics and Childhood Asthma
Dear Editor:
The research study your article referenced concerning the relationship between antibiotic use and asthma appears to be well designed (see "Antibiotics = Childhood Asthma?" in the August 9, 1999 issue). It is important to note, however, that even though asthma and antibiotic usage appear strongly related, this does not establish causality. As the paper notes in its discussion, much of the findings can be accounted for by the use of antibiotics in response to the (often ambiguous) symptoms of asthma in infancy and childhood. All of the findings in this study, however, cannot be accounted for by this explanation.
The most impressive result with a strong confidence interval of statistical significance dealt with first symptoms of asthma that occurred after the use of antibiotics in infancy. This will undoubtedly lead to the more definitive prospective investigation.
Any recently trained medical physician is keenly aware of most of the problems with overuse of antibiotics. They certainly don't push these drugs on an unwary public. Patients more often demand antibiotics, requiring the doctor to walk a fine line between practice management issues, liability, and the knowledge that over 80% of otitis media, pharyngitis, bronchiolitis and infant pneumonia are viral in origin and not amenable to antibiotic treatment.
William Culbert Jr.,MD,DC
Springfield, Missouri
"Vital Roles to Play at Every Level" Dear Editor:
I am a member of ICA, and yet I have not received the incredible and beautifully written communication that was posted on Dynamic Chiropractic's website by the president of ICA. The information contained in that piece is vital and visionary. I feel thankful for the leadership represented, the ideas, and the position of the author.
The tiered organization of the profession into international, national, regional and local (associations) is vital to our survival as a political, educational and provisional force.
Membership is not an either/or thing. We are all part of an international community. Each belongs to a nation, a region and a local community. We each have vital roles to play at every level. We need to define these at a grassroots level and educate every DC about this vision.
We need a common voice and message as a profession, and the role of various tiers (organizational leadership and its members) should be to implement that message. When people can understand this, we can all work together in cooperation: international, national and regional groups toward common goals. Each organization can focus on its special challenges to get the vision across and the job done.
Michelle Trumps
Chiropractic student
Irving, Texas
Dr. Wiens Should "Stop Spreading Misinformation" about Vitamins and Homeopathy Dear Editor:
How in the world could you publish the article "A Call for Rational Chiropractic" by Craig Wiens? (North-Midwest Forum, July 12th issue.) Not only is the article completely misinformed, but the author elevates to "expert status" an individual who is traditional medicine's assassin concerning anything that is not medical, including -- and especially -- chiropractic.
The article attempts to portray applied kinesiology, vitamins and homeopathy as controversial and without scientific backing. As a practitioner who uses vitamins and homeopathy, nothing could be further from the truth. Having never studied applied kinesiology, I'll leave its defense to someone else.
Let's look at the fallacy and lack of reason that pervades the article. Stating that "... few people need to take vitamin supplements," the author quotes Your Guide to Good Nutrition by Dr. Stephen Barrett. Yes, that Stephen Barrett: top assassin for the medical establishment; author of Quackwatch.com; and subject of a front-page article in the July 26th issue of DC. The author continues to quote Dr. Barrett's "expertise" to assure us that optimal health is achieved through a balanced diet. He continues to say that there are 16 double-blind studies that prove vitamin C has no preventative effect on the common cold, and that excessive intake of vitamins A, C, D and B6 are toxic and can cause a variety of problems.
Let's get real. Virtually no one eats a balanced diet, especially the patients who are suffering from a chronic illness. One of the easiest ways for a chiropractic physician to start someone on the path to regaining their health is to suggest high quality supplements and therapeutic compounds. The good science that supports vitamin C won Linus Pauling a Nobel Prize. If the author had 16 studies to the contrary, why didn't he quote them at the end of his article?
Good science vs. bad science gets the unwitting every time. To simply state that excessive intake of A, C, D and B6 can cause side effects without quoting amounts show obvious bias. Of course, vitamin A at high amounts for prolonged periods can cause problems, but in amounts in excess of 50,000 IU per day. Do you have any idea how many pills you would have to swallow to take in that much? People with liver disease or who are pregnant should keep levels below 10,000 IU, but can tolerate much higher amounts of beta carotene. A quality multivitamin uses higher ratios of beta carotene, which has the same pharmacological effect as vitamin A and no side effects.
Vitamin C shows a side effect at doses over 25,000mg taken within 4-5 hours. It's called diarrhea. Again, no one takes this much. Vitamin D is toxic at levels over 65,000 IU per day over a period of years. I can't get my patients to remember to take their multivitamin every day, which contains only 400 IU of vitamin D. You get more from sunlight on your skin in the winter. Vitamin B6 can also be toxic over prolonged periods in amounts that the average consumer never approaches. My advice to the author is to stop drinking water. Too much of that can kill you, too.
Homeopathy is a favorite target of Dr. Barrett also. I recently debated him on this subject on a local radio show. The facts are that there are more studies on the efficacy of homeopathy than any of us could read in a lifetime published in journals such as Lancet, the British Medical Journal and the British Journal of Clinical Pharmacology. There are also studies on reproducibility.
The American medical arrogance doesn't accept foreign studies, but let's forget about science for a while. Ask this question: Considering you can go into any pharmacy in Mexico, Central/South America or Europe and buy a homeopathic remedy, is the author suggesting that these people have been sold a bill of goods for over a century, and thank God for good old American doctors who can set them straight?
Dr. Wiens quotes in his first paragraph the survey by Dynamic Chiropractic that found that 44% of chiropractors use vitamins, and 54% use homeopathy. Why? The public demands it, and they demand it because the therapies work. It is doctors like Dr. Wiens, Dr. Barrett, and the rest of the medical establishment (and their attitude) that are pushing patients into chiropractic offices around the world that may or may not be using any of these therapies.
Dr. Wiens, shame on you for being in the same sentence with Stephen Barrett. The science behind these two treatments is sound, and the studies exist. Stop spreading misinformation about studies that you don't understand simply because you haven't taken the time to study them. Chiropractors are in a unique position because the public views us as the alternative, and they are leaving traditional care in unprecedented numbers. Be a straight chiropractor if you want, but if the patient doesn't get well, refer them to one of us. Stay on our team: stop quoting someone whose sole purpose is to put you out of business.
David Dahlman,DC
Cincinnati, Ohio
Power to the Patients Dear Editor:
Politicians are arguing how to solve the health care crisis they created. Politicians on the left want the federal government to give us a "patient's bill of rights." Why is nobody asking how our natural right to choose a doctor got taken away in the first place?
If you think corporate health care is bad, wait until the federal government runs it. The government never gives anything without a million strings attached. Protecting HMOs, which stands for "Hand the money over," is also not the answer.
The only constitutional solution is to empower the patients. Why not let every American deduct their premium for health insurance and let them own their policy like all other kinds of insurance? Our tax code forces people to only get health insurance through the government or their employer, and it's un-American! Would you rather make our health care decisions with your doctor, or do you want to leave that to your employer or the government? If we leave it to the government or big corporations, all doctors will be replacing the Hippocratic Oath with the oath of a veterinarian. How much do you want to spend on Rover? Put him to sleep. Managed care is mangled care. Like a hospital gown, you think you're covered, but you're not. Tax deductible medical savings accounts for all Americans is the only sane solution.
Allen Unruh,DC
Sioux Falls, South Dakota
"Stop Blaming the Medical Doctors, Lawyers, Insurance Lobby and Managed Care for Our Problems" Dear Editor:
I have been a practicing chiropractor for the past eight years. Prior to entering the chiropractic profession, I was an emergency room RN for two years and a physician assistant for over 10 years. I believe that my 20-odd years of health care experience qualify me to make some observations regarding the state of the chiropractic profession.
Let's look at the rift which exists between the ICA and the ACA. Here in Florida, this could read FCS vs. FCA. On the one hand, we have a group who holds to the belief that the subluxation is the "root of all evil." They will tell you that they move the bone and God heals the body. Their tenets are a holdover from the times of B.J. Palmer. I am sure that the FCS camp truly believes in what they preach, and they are entitled to their viewpoint. I think it is detrimental to the overall survival of the profession to criticize those who espouse a different viewpoint.
On the other hand, we have the ACA (FCA). They will have you believe that we are quite well trained in primary care and should be part of the gatekeeper system in the managed care arena. I graduated from NYCC, and my education included courses in diagnosis, laboratory medicine, etc. I can assure you that the average chiropractor cannot tell the difference between mitral regurgitation and aortic stenosis. How many of you practicing chiropractors are able to differentiate between viral pneumonia and pulmonary hypertension on a chest x-ray? Let's face it: our diagnostic skills are limited. Are we able to diagnose musculoskeletal conditions? I sure hope so! We must be honest with ourselves and the public at large. Our clinical acumen outside of musculoskeletal medicine is limited. If you don't agree with me, let's talk medicine and see how adept you really are at general medical diagnosis.
The battle between these two factions continues. The FCS bashes the FCA and vice versa. It's getting old, and worse yet, it's destroying our profession. I speak with FCS members, and they criticize those of us who utilize physical therapy modalities. Listen: if it helps the patient, stop criticizing! If we do not use therapy but only adjust, are we doing a disservice to our patients by not providing pain relief? It depends on your point of view. According to FCS, our job is to remove subluxation, not relieve symptoms. Really? Is it wrong to get a patient out of pain? So again, who is correct?
Do what your heart tells you, but stop the in-fighting. If you don't believe in therapy, don't use it. However, please stop bashing those who use it. The public loves a good mudslinging session. Keep it up, guys: you'll ruin the profession (and the public has a ringside seat).
While I'm on the subject of therapy, how dare some of you come down on the physical therapists who are now learning spinal manipulation? Are we not practicing their profession (physical therapy) every time we use ultrasound or electric stim? This is a case of the pot calling the kettle black.
Far too many of you are hung up on the abundance of chiropractors (a.k.a. competition). You just don't get it. More chiropractors can be to our advantage. Educate the public and get more people under care if they need it. Generate some positive press for a change. I find that the only chiropractors who are concerned with the competition are the ambulance chasers. They know there are a finite number of attorneys and fender benders. Again, right on, FCS. This group comes from the heart and welcomes new doctors to the community. Maybe you don't agree with their philosophy, but they believe in their mission and set out to accomplish it.
Stop blaming the medical doctors, lawyers, insurance lobby and managed care for our problems. Our own worst enemy is ourselves. My personal belief lies somewhere between the tenets of the FCA and the FCS. If you want to preach to the choir and make the spinal adjustment akin to a religious event, fine with me. If you want to play Marcus Welby, that's ok, too. Just stop airing your dirty laundry in public. It's time we respected the beliefs of others in our profession.
In closing, our profession has overcome a lot of adversity. We need to continue to be strong. Take a look in the mirror. Do you sleep well at night? If your high standard of living is a byproduct of unethical practice, enjoy it while you can. The house of cards will come tumbling down as a result of your actions. And who suffers? The profession and the public at large. Clean up your act! If, on the other hand, you enjoy a high standard of living which is a result of ethical service to the community, congratulations. You have earned it. In unity we will survive and prosper. If we continue to fight like children, we will stumble, fall and slowly wither on the vine. Do the right thing. Take the moral high ground and start acting like a doctor, doctor.
Jay Klein,RN,PA-C,DC
Tamarac, Florida
