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Neurologists Strike

Dear Editor:

While a chiropractic student in the mid-70s, I did my public service by forever checking out from our public library the anti-chiropractic book, At Your Own Risk. This was a blatant anti-chiropractic piece of dribble that was cast upon the public as the gospel truth. As a health care consumer, I would hesitate to consider chiropractic a viable healing art, and probably consider it a sham, so too with the recent investigative reports and national news releases.

Medical specialists jockeying for position in this unhealthy health care reform climate, will be protecting all perimeters of their turf. How best to solidify their position than to eliminate any competition. How best to accomplish this than to create fear and doubt in those that will be keepers of the gate ... consumers and their political advocates.

The Wall Street Journal article and the follow-up "20/20" piece on children are only a passing thought, and can easily be handled one on one with patients. In fact, very few of my patients read the article, or viewed "20/20." The recent American Heart Association symposium, with their ridiculous charge that chiropractors cause vascular rips and eventual strokes, is another issue. The article was one thing, but the editorial headlines, which differed from paper to paper, were more damaging. In Atlanta it read: "Warning: A simple, sudden neck twist can trigger stroke." Doctors see risk in chiropractic snap. While scanning through the chiropractic section in the Holistic Health Forum section on Compuserve, it was clear that headlines were more or less as dramatic throughout the country.

They have a handle on the pulse of America. They have a fix on what makes us shiver and twitch. They can generate panic and joy with the stroke of a pen, or a belch of rhetoric. If they wish us to believe in a new diagnostic and treatment procedure, no problem, feed the information to the media and hype it. If they get some bad press, no problem, shift the attention to natural foods, chiropractic, etc. It's well though out, and definitely well planned.

You thought Wilk vs. AMA decision took care of this problem. Think again. Yes it did slow their blatant obsession to destroy a competitor. It did stifle their immediate quest for more, but it only hibernated their frenzy to protect their equity ... patients, and all the pieces of the pie.

They have it easy to collect their data, no matter how frivolous and arbitrary it may be. Data concerning the risks of chiropractic care, our practice methods, and diagnostic skills, etc., are but a symposium away. To date we've been reactive only; the time has come to be proactive and take some offensive steps to protect our turf and those that depend on us.

Joel Margolies, DC
Tucker, Georgia

Dear Editor:

The major vessels that supply oxygen to the brain are called the carotid and vertebral arteries. These arteries are so strong that tearing them through chiropractic procedures is ludicrous. If this was so, strokes would be epidemic with any athlete in any contact sport, yet alone chiropractic patients.

Most strokes either through a clotting or bleeding mechanism are usually due to long term hypertensive vascular disease. Blood vessels like the majority of other functions in the human body are under neurological control.

Paul Stefanelli, DC
Board eligible chiropractic neurologist
Belleville, New Jersey

Dear Editor:

Cerebral chiropractors will not argue with Dr. Craig Nelson's eloquent elaboration of the urgency for a clearly defined SOP. Unfortunately, the chiropractic bureaucracy and its institutions have selectively eliminated or discouraged these critical thinkers from taking a position of leadership or decision making. Until the collective mind of the profession recognizes this ostensible deficiency, Dr. Nelson and others of his caliber will have little influence on the prevailing attitude. We desperately need Dr. Nelson to take the lead. Let's hope it's not too late.

Robert Falco, DC
Weehawken, New Jersey

Dear Editor:

I read with great interest Dr. Marc E. Chasse's indictment of lumbosacral support belts used in an industrial setting and your admission that you were unaware of any studies which deal with the efficacy of using these belts. I have in my possession, specifically a study done in 1990, published in the Journal of Physical Medicine and Rehabilitation, which discusses the use of prophylactic work belts. I believe the point is very adequately made. In understanding the use of these belts, the purpose is not support of the back muscles but the main purpose of these belts is for supporting abdominal muscles, and as we all know, biomechanically, increased abdominal pressure stabilizes the lumbar spine. These belts do very little in my opinion and in my experience, to limit, weaken or adversely affect the lumbar paraspinal musculature.

Whereas I certainly agree that hard bracing for long periods of time will adversely affect the muscles, as in when a person is wearing a cast, soft support such as these belts have a very beneficial effect in reducing the daily avoidable microtrauma to which many jobs subject the lumbar spine. I have mainly noted this in my patients who are roofers, or have similar jobs where there is very little way to modify their work to protect their back. When this belt is worn loosely (which, because of the suspenders, increases patients' compliance), it reminds the patient to maintain an upright posture. When increased loads are placed on the back, the patient can increase the support of the belt to protect them from strain or trauma. I certainly see this as a beneficial adjunct to the work that we do in terms of instructing in proper lifting, instructing in proper lifting, instructing in proper exercise when off the job, and of course, spinal manipulation to maintain proper mechanical integrity of the lumbar spine.

I hope the information that I have included is beneficial in expanding your understanding of these belts. I do want to state that I have no particular financial interest in the companies that make these belts nor do I sell these belts out of my office. I do believe their a reasonable and worthwhile adjunct to the work that we do in terms of preventing industrial back injury and therefore I support their use.

Elliot Eisenberg, DC
Richmond, Virginia

Dear Editor:

The CliniCorp Directory of Exclusive Providers list that the Motion Picture Industry Health Plan sent to patients specifically says that no claims will be recognized (and therefore reimbursed) unless they are done by these CliniCorp chiropractors. Last year they had a PPO contract with chiropractic services, but the patient still had the right to see DCs outside the PPO list -- they just had to be responsible for co-payments and deductibles, etc. This CliniCorp plan is exclusive. All TV and Motion Picture employees are covered by this plan. Therefore this will have a major impact for DCs in West L.A., Santa Monica, L.A., Hollywood, and Burbank areas. I noticed that in my area, West L.A., there are only a few DCs on the list. CliniCorp never contacted me or any other DCs that I know of to join them. Now they will probably tell us that even if you want to join, it will have to be next year, if they have any openings left.

I know that Dr. Faye and Dr. Perry practice in my area as well, and other MPI doctors.

I propose that some DCs join together and perhaps approach this insurer and discuss this. Maybe we can say we will all agree to be paid in the same amount they pay CliniCorp DCs, but do not want to join them, so if their excuse is money savings, that can be addressed. Also point out to them that we were not even given a change to join this PPO. I know that many patients are also very angry about this.

Vincent Tokatlian, DC
Los Angeles, California