... fight on with the truth, to practice what we preach, be persistent, and be proud of who we are.
Dear Editor:
Just finished reading "Courage vs. Cowardice" (7-1-94 issue) by Dr. John Hofmann of Allen Park, Michigan. What a wonderful analyses of the current conditions that now exist in the health care industry. Thanks John.
Dr. Hofmann has sounded the "wake up call" for all and any doctors of chiropractic who deserve the honor and privilege of having his or her name associated with DC. To those of us who are mighty proud to be known as chiropractors, as I have been for 57 years, it is most assuring to know we have someone like Dr. Hofmann call a "spade a spade."
As we celebrate our centennial next year I would remind our chiropractic brethren that we have had crisis after crisis during these first 100 years, and we have met the challenge each time. That is why the most wonderful profession in the world is still here with a pure principle record and is serving the people of the world in record numbers.
I have been at the forefront on many of these battles, such as chairman of NCAC for 20 years, Wilk vs. AMA lawsuit, and other big battles. Now we only ask that those who are ashamed of chiropractic, ashamed of its philosophy, ashamed of the word "subluxation," and yes, ashamed of the word "chiropractic," that they quietly bow out and leave us alone.
Mr. Petersen, the world is discovering, as you said in your article, the benefits of chiropractic adjustments.
The vicious media attacks by our powerful opposition know also the great value of chiropractic. This is their big, frightening concern. They know the facts as to our great record of results and on the very cases they failed on.
My lessons from my 57 years of doing battle are to fight on with the truth, to practice what we preach, be persistent, and be proud of who we are.
To those of you who would disagree, then we wish you well and would have you go your way rejoicing. Just drop the names and/or word reference to your heritage of chiropractic, which you hold in disgrace.
Again, thanks to Dr. Hofmann, you have given our people a much needed message. Also, thanks Mr. Petersen and to Dynamic Chiropractic for carrying such a great message by Dr. Hofmann and others.
Clair W. O'Dell, DC, PhC
Southgate, Michigan
The Reality of Managed Care Dear Editor:
I would like to respond to Dr. Gary Pirnat's letter to the editor (6/17/94 issue) regarding managed care.
In Dr. Pirnat's letter he attacks Dr. Arnold Cianciulli's understanding of the health care issues which our great nation presently faces. With all due respect to Dr. Pirnat I would submit that it is he, not Dr. Cianciulli, who either doesn't comprehend the reality of managed care or chooses to ignore it. A small portion of my work day is literally spent taking care of people who are willing to pay for my services out of their own pockets because they aren't getting the care they want and need from their managed care plans. These patients typically fit one of the following scenarios:
a) Their managed care/HMO plan doesn't cover chiropractic services; b) Their pain level precludes waiting (sometimes four weeks) for their case to be reviewed by committee for approval of chiropractic referral as required by some of the health care plans; c) They get tired of seeing the "nice doctor" who utilizes all kinds of physical therapy modalities but "won't adjust me"; d) They want an alternative conservative approach for nonmusculoskeletal complaints, i.e., treatment for internal disorders, nutritional, dietary, and lifestyle counseling, and preventative health care that their health care plan doesn't provide.
Some people choose my office because I am also a provider for their managed care/HMO plan, and they appreciate the personal attention and caring attitude demonstrated by my staff, both in the office and over the telephone which apparently is sometimes lacking in large medical organizations.
I see a significant number of managed care patients as a provider for what I believe is the largest chiropractic managed care organization in the state of California. I will acknowledge that in an unbiased arena, it is rather easy (although time consuming) to get approval for the care my patients need for musculoskeletal problems when their cases are documented accurately and thoroughly. Unfortunately the reality is that even a good managed care organization is bound by the constraints placed on it by the payer. Also unfortunately, and it's our own fault, there hasn't been enough research done to document the efficacy of chiropractic care for nonmusculoskeletal conditions which will be a prerequisite to third parties paying for such care.
I would agree wholeheartedly with Dr. Pirnat when he states that the managed care setting has allowed him to treat patients who otherwise might not have considered chiropractic care or had access to it with third-party reimbursement. I believe the managed care arena has provided one of the avenues for chiropractic to become more socially and scientifically acceptable to the world. I also believe that in the reality of today's health care market, managed care has a rightful place and provides some good benefits. I do not, however, believe it to be manna from heaven as far as the national health care crisis is concerned, primarily because it eliminates the one thing that my patients hold dear, CHOICE!
One big concern, which I think a lot of us share, is that this newfound social and scientific acceptance will pigeonhole us into diagnosis and treatment of musculoskeletal conditions only. Now I am not suggesting that every doctor of chiropractic be forced into primary care. Certainly there is a need for musculoskeletal/orthopedic specialists in chiropractic just as there is a need for specialists in radiology, neurology, nutrition, etc. I do believe that there is also a place for the broad scope primary care chiropractor, not based on historical dogma with the adjustment as a cure-all, but based on scientific data supporting a more holistic, preventative approach such as that taught by Texas Chiropractic College in their diplomate course and espoused by the ACA's Council on Diagnosis and Internal Disorders.
Dr. Cianciulli, thanks for the good work -- keep it up!
Blair T. Butterfield, DC
La Habra, California
Flawed Grandfather Clause Dear Editor:
During the 1994 Florida legislative session, Rep. Alonzo Reddick was successful in passing House bill 1025, allowing for limited reciprocity in Florida, following meeting certain requirements for a restricted license. One of the requirements is that the doctor of chiropractic must have graduated on or before 1979.
It is this provision of the new law which I feel is flawed. Reciprocity, if offered, should be offered to all qualified graduates, not to a limited group of people. Am I not as qualified because I graduated in 1981 instead of 1979? I think I am.
If there are any other doctors who feel as I do, let's organize a movement to go before the Attorney General's office, the Board of Examiners, and the Courts of Florida to address the constitutionality of House bill 1025.
Feel free to call me with any suggestions.
To Rep. Reddick, I thank you for your effort and intent, hopefully we can change this to make it equal for all.
T.M. Nosser, DC
335 Southfield Shreveport, LA 71105
(318) 868-6508
"We should stay focused on chiropractic..."
Dear Editor:
I'm glad Dr. Chris Turchin has the insight to see what a waste of effort it would be to spend valuable chiropractic resources on changing our scope to primary care providers. Portal of entry providers we are and shall always remain, but it is folly to think that we can change government and health care insurers' attitudes about DCs as primary care providers. We have spent 100 years convincing the U.S. about our specialty called chiropractic. Look how long it took for the majority of people to be aware of what we do. To think that we can change these attitudes by increasing chiropractic clinical education is unrealistic. Dr. Turchin is right on in his assessment of where we are and should be going. Few DCs are comfortable having DCs treat these diseases. We should stay focused on chiropractic and get the health systems of America to see the value of what we do. Thank you Dr. Turchin for an excellent article.
Steven Brodbeck, DC, DABCO
National City, California
"Acupuncture ... is a complete profession and should be respected as such."
Dear Editor:
In "Warning: This article is Not for the Weak of Heart" (May 20 issue), the author summarizes the status of acupuncture/oriental medicine in the US. While some of the information was quite interesting, other opinions can be viewed with a different eye.
Oriental medicine, including acupuncture, is quickly rising in popularity in the US. The multitude of benefits coupled with its cost-effectiveness, make it a very appealing option in this era of health care concerns. Despite its growing appeal, significant concerns arise from the profession. Arguably the most important concern is that of the fragmentation of the oriental medical profession, the major albatross today.
This notion is clearly reflected in the article when the author states: "The chiropractic profession needs to include the practice of acupuncture within its scope ..." and "now is the time to become proficient in acupuncture therapeutics." This approach is representative of the core of the problem. Acupuncture is not a modality to be taught in a weekend course or a 200-hour "certification" program. It is a complete profession and should be respected as such. The high quality oriental medical practitioner utilizes acupuncture, moxibustion, tui na, herbal therapy, nutritional therapy, and a host of electrodiagnostic and treatment devices in states where they are approved. To practice acupuncture without herbology, for example, would be similar to practicing chiropractic without using adjustments. Such ideas are never mentioned in the weekend "certification" trainings.
(Note: Many states do not require chiropractors or medical doctors to test for competency with acupuncture. Acupuncturists, on the other hand, are required to pass a state and/or national examination for licensure.)
In states such as Florida, for example, virtually every health care practitioner advertises "acupuncture services." This has caused significant two-fold problems. First, because these 100 or 200 hour programs pale in comparison to the 2,800 hour oriental medical school training, the quality of care suffers. As such, the patient is the eventual loser. This leads to the second significant problem. When a patient receives poor care from a dentist, the typical response is "the dentist was incompetent." The typical response to poor care with acupuncture is, "Acupuncture doesn't work." Thus, the properly trained acupuncturist ends up on the short side, through no fault of their own.
Fair competition benefits all. Having a competent, well-trained licensed acupuncturist competing with another competent, well-trained L.Ac. is mutually beneficial. When a weekend "certified" MD or DC advertises acupuncture services, this type of "competition" is destructive to the majority of practitioners and patients, for it creates misconceptions about the medicine. Practitioners of all styles are certainly encouraged to expand their clinical repertoire, but only in a responsible manner. Oriental medical schools are the responsible manner -- weekend "certification" trainings are not.
Finally, the author writes, "Acupuncturists will no doubt become greedy, begin to fight within themselves, suffer association and organizational problems, and will weaken their position as a result." Unfortunately, this has become true. A major split has occurred. On the one side, the vast majority of acupuncturists support high standards and the elimination of fragmentation of the profession. On the other side, schools and the major political entities and accreditation agencies are supportive of substandard training, advertising this as "diversity." The former's position would benefit the majority and the profession itself, while the latter is (financially) beneficial for the few.
This author has a significant amount of respect for chiropractors. They have accomplished a great deal and have helped pave the way for other natural health care practitioners. Their educational standards should serve as a model for acupuncturists, as well as their active involvement in the political arena. Winning a suit against the AMA was certainly the coup de grace. Respect was earned and continues to grow.
Just as respect is present within the chiropractic profession, we in oriental medicine hope that the same respect is given in return. There are no weekend or 200-hour "chiropractic certification" programs for acupuncturists, homeopaths, or naturapaths, etc. As such, the vehement arguments from chiropractors opposing these "certification programs" are the same types of arguments acupuncturists use against "acupuncture certification programs." Respect is a two-way street.
David Orman, AP, MTOM
Annandale, Virginia
Is Dental Amalgam the Culprit? Dear Editor:
I read with interest the article by Dr. Douglas Andersen (Chronic Fatigue Syndrome, Part I, June 3, 1994). It surprises me that the suspected culprit for this problem was not known to Dr. Andersen.
Amalgam, a mixture of mercury and silver used by dentists for filling teeth cavities, is suspect. When amalgam is removed and replaced by porcelain, the patient's symptoms seem to disappear.
Various symptoms associated with mercury (the cause of pink disease years ago) are identical with those of CFS. I find many dentists will vigorously oppose any complaint against amalgam. I would suggest that anemia, leukopenia, along with stomatitis, liver and renal dysfunction, headache, and mental changes are common effects of mercury poisoning, and are the same, or similar, to those of CFS sufferers. Silver toxicity causes similar symptoms.
I would suggest that CFS sufferers be advised of the dangers of amalgam, and replace it with porcelain, and be prepared for a quick return to normal health. Severe, or long-term sufferers may have a delayed or partial recovery only.
Keith J. McDowall, DC
Curtin, Connecticut
Weightlifting Is Safe for Adolescents -- with the Proper Training Dear Editor:
This letter is in response to the article written by Peter Fysh, DC, about spinal injuries and associated sports (7/1/94 issue). Specifically, I am responding to one particular section: weightlifting.
First, while it is true that excessive and sometimes violent hyperextension of the lumbar spine of adolescents can be the culprit in them developing spondylolysis and/or spondylolisthesis, if proper form and technique are taught to these young individuals, these problems would not arise.
Secondly, generally stating that the rule is to "discourage squats and powerlifting in adolescents" shows the author has an incomplete knowledge of proper weight training for adolescents. Along with being a DC, I am also a certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). The NSCA has set up guidelines for proper weight training for pre and postpubescent athletes. When setting up these guidelines, the NSCA consulted various health professionals and other experts in the field or exercise physiology. These guidelines are for use by any strength coach or physician involved in sport injuries.
In my own experience, I have seen some adolescents at various gyms and high school strength training facilities that were not taught proper form and technique and had the potential to hurt themselves. This is the fault of strength coaches and trainers not properly supervising these young athletes and "nipping in the bud" their mistakes at the beginning of their training.
In reference to the squat, if it is taught properly, it is a great exercise for developing athletes. It has been shown that athletes who do squats properly can have a reduced incidence of knee injuries, while at the same time developing good leg and back strength.
In conclusion, as a DC and a CSCS, I advocate strength training for adolescents as long as proper form and technique are taught and proper supervision is given to these young athletes.
Michael A. Hartle, DC, CSCS
Seymour, Wisconsin
