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Chiropractic

w/ Dr. Christine Goertz – Chiropractic Research, What Does The Science Say, And Where Are We Going?

Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information. 

But first, here’s that “oh how sweet it is” bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have bounced your way into Episode #68 and we are so glad you did. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier. 

Store

Part of that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Guest Introduction

Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. 

Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.

She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States. 

Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast. 

Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?

I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?

Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?

Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that. 

In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?

In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain – Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?

In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?

I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?

In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?

You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers. 

Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?

I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning? 

I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?

In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” 

The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.” 

The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!

I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?

I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”

As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?

What has been your favorite project or finding you have been a part of so far?

What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?

What conclusion have you had to draw at the end of a paper that surprised you the most?

How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?

A tie-in question here, where do you see the profession in 10 years?

I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?

In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on? 

Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?

Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts. 

And I thank you so much. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger


Inflammation and Cognitive Decline

Today we’re going to talk about brain inflammation, cognitive decline, your brain and your patients’ brains and we’ll talk about my brain. Scary stuff here. Plus we’ll talk about ALS and concussion. What’s the research saying?

But first, here’s that “hell yeah”  bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have stuttered into Episode #66

Introduction

We’re here to advocate for chiropractic while we also make your life easier.  

Store

Part of that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link

DACO

Let’s talk a bit about the DACO program which is the Dipolomate of the Academy of Chiropractic Orthopedists. Still trucking along and hauling a big load of knowledge nuggets in my big 18-wheeter trailer. I don’t know where that came from. 

Recent classes for me have been Managing preganncy-related SI pain, diagnosing thoracic facet joint pain, managing Scheuermann’s disease, and diagnosing merlagia paraesthetica. 

I have told you before that I’m no guru. I learn all the time because I clearly don’t know it all. I have no problem admitting that I’m not, nor have never been, particularly knowledgable on meralgia paraesthetica. I am crapping you negative, folks, when I tell you that the very day after I had the drill on it, it shows up in my office. I swear, unbelievable. 

I’m not above admitting that I’ve been missing it for all these years. It hurts me a bit to admit but facts are facts and if I’m not honest with you, well then, what’s the point in all of this anyway?

If I can get you pointed in the right direction to get started with the DACO, shoot me an email at dr.williams@chiropracticforward.com. I’m happy to help. I get nothing out of it. No discounts on hours, no special considerations, nothing. I just think it’s that important. 

Personal Happenings

Front desk hunt….still a go. Still no rock star. Still not settling. There’s your update. 

Item #1

On with it. This one is called “Systemic inflammation during midlife and cognitive change over 20 years: The ARIC Study.” It was authored by KA Walker, RF Gottesman, DS Knopman, and a slew of rascally cohorts(Walker KA 2019). It was published in Nuerology in February of 2019. Hot stuff….comin’ through. Brand new people. 

Why They Did It

They wanted to examine the associaiton between systemic inflammation measured during midlife and 20-year cognitive decline. 

You know speaking of cognitive decline……..what the hell was I saying? Why did I even come into this room? : )

Anyway, here’s how they did it

This is REALLY dumbing it down a bit for the purpose of brevity but, within the atherosclerosis risk in communities cohort study, inflammatory biomarkers were measured during middle adulthood. they worked some math magic using the biomarkers, creactive protein, and cognition periodically over 20 years. 

12,336 participants

What They Found

Participants with a midlife inflammation composite score in the top quartile had a 7.8% steeper cognitive decline, compared to participants in the lowest quartile; CRP in the top quartile was associated with an 11.6% steeper cognitive decline. In cognitive domain-specific analyses, elevated midlife inflammatory markers were most consistently associated with declines in memory.

Wrapping It Up

The authors concluded, “Our findings highlight what may be an early pathogenic role for systemic inflammation as a driver of cognitive decline in the decades leading up to older adulthood.”

The weirdest thing. As soon as I went over this article, I went home that night and opened up the lates version of Chiropractic Economics magazine. It’s issue 3: February 22, 2019. 

Anyway, there’s an article in there on this exact very thing because my mind is creepy like that. Seriously, you might do this too but, I can think of a patient I haven’t seen in a little while and Bazinga….that week or the next they show up in my office staring me in the face in live real life and it freaks me out every time to know I have gravitational mind powers like that. Lol. 

Evidently my gravitational mind powers work in the information world as well because that’s the way it happened my friends. 

Now, there was all kinds of research citations present in this article but I did not look them up. I don’t know the quality of them. I just don’t have the time but, in short, if we want to decrease the kind of inflammation we see for cognitive decline, the kind in the paper we just talked about, then we need to look at making sure we have good levels of Curcumin/turmeric as well as good serum levels of vitamin D. 

They say the curcumin plays a role in regenerating neurons, creating new brain cells (lord knows I need that), and refreshing cells that may have once been considered irretrievable. So, all the damage I did in young adulthood….maybe there’s some hope after all. 

And are you realizing all of the information that has come out about Vitamin D in the last several years? There is also data refuting the use of ANY supplement but, knowing there’s no harm in a Vitamin D supplement, why WOULDN’T you consider taking it regularly? Worst case scenario, you lost a very minimal amount on a supplement that did nothing. 

Best case, you’re near superhero level. 

Item #2

Continuing with our brain stuff this week, here is item #2 titled, “Contact Sports as a Risk Factor for Amyotrophic Lateral Sclerosis: A Systematic Review” authored by R Blecher, MA Elliott, E Yilmaz and a plethora of associates(Blecher RA 2019). It waspublished in Global Spine Journal in February 2019 because the new stuff makes the folks tickle. And why not? I love information but there’s just something warm and fuzzy about  NEW informaiton isn’t there?

Why They Did It

They say that environmental factors for ALS have remained largely unknown and recent evidence suggests that participation in certain types of sporting activities are….not may be….but ARE associated with increased risk for ALS. They wanted to test the hypothesis that competitive sports at the highest level that involve repetitive concussive head and cervical spinal trauma result in an increased risk of ALS.

How They Did It

They searched electronic databases adn reference lists of key articles from inception to November 22, 2017.

They used 16 studies fitting the criteria for inclusion. 

The sports they looked at were of course, American football, basketball, cycling, triathlon, and skating. I’m wondering where hockey or rugby is in the mix. 

What They Found

I hate to say it but here’s what they found, “Our review suggests that increased susceptibility to ALS is significantly and independently associated with 2 factors: professional sports and sports prone to repetitive concussive head and cervical spinal trauma. Their combination resulted in an additive effect, further increasing this association to ALS.”

While we love our sports and we hate seeing the sissy-fication of the world in general, we also don’t want people to knowingly and purposefully put themselves in danger like this. 

Certainly not our children. We have to pay attention to this stuff. 

I played from 3rd grade up into college and only had my bell rung one time but I’m thinking I’m the exception, not the rule. I was always taller and bigger than most of the others on teh field so that may be why I escaped. Or at least I think I escaped. I’m 46. I still have time to lose my mind I suppose. 

Anyway, food for thought. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Blecher RA, E. M., Yilmaz E, (2019). “Contact Sports as a Risk Factor for Amyotrophic Lateral Sclerosis: A Systematic Review.” Global Spine J 1: 104-118.
  • Walker KA, G. R., Knopman DS, (2019). “Systemic inflammation during midlife and cognitive change over 20 years: The ARIC Study.” Neurology.

CF 060: Medical Marketing & Integration Care Expectations



Tinnitus & New Guides For Neck-Related Headaches

Today we’re going to talk about a couple of papers touching on tinnitus as well as a paper that just came out on practice guides for persistent headaches associated with neck pain. We’ll have some fun learning some new info if you stick around. 

Chiropractic evidence-based products

But first, here’s that ‘better than a back rub’ bumper music

Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have drifted into Episode #65. And I don’t mean drifted like a feather or a piece of wood in the ocean. No, I’m talking about dangerous, careless, speedy drifting in the car around a curve, man. That’s the drifting I’m talking about. I talk like I’ve drifted before. I haven’t. Well, at least not intentionally. We won’t talk about that one time down in Alpine, TX. Lol. Hey, I used to be in a touring band. What do you want from me? I used to be on the on’ry side. That’s all I’m saying. 

I’m still a little ornery but age has settled me quite a bit. Which is a good thing. I look at kids these days. My son is a teenager and really, for the most part, he’s just so good. No drugs, no drinking, loving as he can be. I think back to when I was his age. I was legitimately a menace to society. I mean that literally. It’s a wonder I’m alive but, as with most from my generation, we made it didn’t we? In spite of the lead paint, lack of bicycle helmets, and all that stuff. 

I want to take just a few seconds to thank Dr. David Graber. He gave The Chiropractic Forward Podcast a shout-out to a room of about 1000 chiropractors during his talk at the Parker Seminar in Vegas a week or so ago. While that doesn’t seem like that big of a deal, I’ll just say that, when you feel like a lot of times, you’re on your own and everything depends solely on you and your actions or, in-actions, it is a blessing to have others help share the word. When you guys share or help get the message out in any little way, it’s like I breath a little easier if that makes any sense. It’s like I’m part of a team rather than out here on an island shouting through a megaphone hoping a ship passing by hears me. 

Anyway, I know I thanked you in our private Facebook group but wanted to do so here as well. Very much appreciated, Amigo. 

Introduction

Let’s get on with it here. We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.

DACO

Let’s talk a bit about the DACO program. That’s the Diplomate of the Academy of Chiropractic Orthopedists. Why do the DACO? Because, if you want to integrated, you need to certificate. Or more accurately, you need to specialize and get accredited. That’s what the Diplomate is about. Bells, whistles, letters behind your name….yes. More importantly, you’ll be leaps and bounds beyond where you were prior to do it. 

Recent classes have been Tinnitus which we’ll talk about in a moment, carpal tunnel syndrome as part of a double crush syndrome, and managing hip osteoarthritis. Fascinating stuff. 

I saw a chiropractic student upset on Facebook the other day. He was upset because of some video that popped up on social media. It was an anti-vaccination speech and, honestly, it was pretty vile and hateful in the stance against vaccines. Look, you have whatever opinion you want on vaccines, we’re never going to get into that here. That’s not why I mention it. 

The student clearly did not agree with this speech from CalJam and was wondering what kind of profession he’s spending all of this money to be a part of. He was basically questioning what kind of future he’s going to have when you have a profession that is getting continuing education hours for speeches like that. 

I could confidently tell him, and you by the way, that there has never been a better time to be a chiropractor. At least not in the last 35-40 years anyway. We’ve all heard about the Mercedes 80’s. They sound real nice but they’re a pipe dream at this point. 

Right now, there has never been the research backing up what we do. We have it overflowing. Not only in our effectiveness either. We have research on how we’re more effective than PT and MDs. We have research on how our patients are more satisfied with our outcomes than any other practitioner. We have research on how we do all of that while costing less. 

Never before have we had a national epidemic. This little thing we call the opioid epidemic that is driving every healthcare practitioner to look for non-pharma means of treating their patients. That means you and me. 

And never before have we had the capability or opportunities that we have now to integrate with our medical colleagues and become more and more a part of a team of healthcare practitioners. 

We are moving more to the center rather than staying out on the fringes of healthcare like the red-headed step child. 

No offense to red-heads or step-children. 

Anyway, Diplomate programs are more than letters behind a name. They’re about progressing you and your profession. Building knowledge and respect. 

I get nothing for talking about the DACO. I just think certification and professional standardization are important things. Email me at dr.williams@chiropracticforward.com if you have some questions about getting started.

Personal Happenings

And the hunt for a front desk rock star continues. I want to share with you the fact that indeed.com and Facebook work ads are great at netting you about 1.3 million resumes but not good, well-qualified candidates. Every damn time I post a job listing, I’ll get around 150 recipients. Only a very limited few are worth anything. Most aren’t even qualified for the job. 

For instance I got a resume yesterday from a dude that can run a fork lift. Hey, I like forklift drivers fine but that won’t get it done at the front desk of a healthcare facility, right? It’s an insane waste of time going through all of these but, what the hell else are you going to do? you have to have an employee. And I’m not going to my friends to ask if they know of anyone because I don’t want my friends hitting me up for a job. Lol. If that doesn’t work out, not only have you lost an employee but you’ve also lost a friend. 

No thanks!

Item #1

I have had an increase in tinnitus in my left ear after a plane ride I took back from Austin a couple of weeks ago. Bad enough that I went to a specialist for it. Turns out, she said I have, in some frequencies, moderate loss. I said, “What?” Lol. 

Well, I’ve been a touring musician before so, what’s new? I could have told you that. But, it’s been bad in just the past couple of weeks so something changed in that window of time. I started taking some DACO classes and noticed one on tinnitus so jumped to that drill for obvious reasons. 

I don’t want to go into details of the class but I do want to talk about some of the research cited for the class and we’ll start with this one called, “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” It was authored by S Michiels, P Van de Heyning, and a bunch of other very difficult names and published in Manual Therapy in 2016(Michiels S 2016). 

Why They Did It

Tinnitus can be related to many different etiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus (CST). Knowing that case studies have suggested a positive effect of cervical spinal treatment on tinnitus, this study wanted to dive a little deeper on it. 

How They Did It

It was a randomized controlled trial of subjects having a combination of tinnitus and neck pain. Like a combo meal, instead of a burger and fries, it was neck ache and ear ringing. Make that two please, thank you. 

Each subject received cervical physical therapy for 6 weeks which equaled 12 sessions. 

What They Found

Cervical physical therapy can have a positive effect on subjective tinnitus complaints in patients with a combination of tinnitus and neck complaints.

Pretty cool stuff there. 

Item #2

Let’s double down with this one from Oostendorp, et. al. called “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept” published in 2016 in Manual Therapy(Oosterndorp RA 2016). 

The Big Idea

Tinnitus can be evoked or modulated by input from the somatosensory and somatomotor systems. This means that the loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, transcutaneous electrical stimulation or joint movements.

Interesting yeah? I think so. 

They go on to say, “The neural connections and integration of the auditory and somatosensory systems of the upper cervical region and head have been confirmed by many studies. These connections can give rise to a form of tinnitus known as somatosensory tinnitus. 

Broadening the current understanding of somatosensory tinnitus would represent a first step towards providing therapeutic approaches relevant to manual therapists. Treatment modalities involving the somatosensory systems, and particularly manual therapy, should now be re-assessed in the subgroup of patients with cervicogenic somatosensory tinnitus”

And that’s just what they’re doing. Fascinating stuff considering that you’ve always heard, “you’ll just have to live with it.” Basically, if you can change the intensity, quality, or frequency of the ringing, by moving your jaw or stressing the cervical spine in different directions, there’s more than a solid chance that you can change it completely through cervical manipulative or manual therapy. 

If I remember correctly the guesstimate was around 65% of the cases may be affected by chiropractors for the positive. 

Hell yeah and pass the potatoes people. 

Item #3

Our last thing today is called “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration” written by Pierre Cote, Hainan Yu, Heather Shearer, et. al. and published in European Journal of Pain in February 2019(Cote P 2019). 

Hot off the presses and I know you like it served hot like that. Cold or lukewarm education just isn’t as good as piping hot brain nuggets.

Why They Did It

To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic).

How They Did It

This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations.

What They Found

When managing patients with headaches associated with neck pain, clinicians should: 

  1. rule out major structural or other pathologies, or migraine as the cause of headaches; 
  2. classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 
  3. provide care in partnership with the patient and involve the patient in care planning and decision‐making; 
  4. provide care in addition to structured patient education; 
  5. consider low load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 
  6. consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension‐type headaches; 
  7. do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches; 
  8. consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 
  9. reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.

All of this is just a part of making us all better day to day. Those paying attention have the leg up. No doubt. 

Here’s the problem with being patient-centered instead of doctor-centered. We have to be OK with watching the high volume practices running through like cattle….we have to be OK watching them make millions while we have an average case treatment of only 7-10 visits. 

So what? Big deal. I always say that I could have a bigger house and more vacations but I sleep very well at night and, being a Christian as I’ve mentioned before, I’m at peace knowing I’m square with my maker and treat people the way they should be treated. 

Religious or not, patient-centered doctors can always take comfort in the fact that they’re doing what is in the best interest of their patients. 

It’s a lovely thing isn’t it? Honesty, ethics, love, cumbaya, and all that tom foolery….. They’re just little bricks that are the building blocks of an excellent life and career. 

Integrating Chiropractors
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Chiropractic evidence-based products

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

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https://player.fm/series/2291021

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https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Cote P, Y. H., Shearer HM, (2019). “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.” European Journal of Pain.

Michiels S, V. d. H. P. (2016). “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” Man Ther: 125-135.

Oosterndorp RA, B. I., Mikolajewska E, (2016). “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept.” Man Ther: 120-123.

https://www.chiropracticforward.com/proven-means-to-treat-neck-pain/?v=7516fd43adaa

https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/








Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

CF 064: Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

Today we’re going to talk about how chiropractic and spinal manipulative therapy win again, we’ll talk about how push ups may tell us more than what you see on the surface, we’ll discuss some new information on low back discs and how they’re affected by low iron, and then we’ll gloss over a paper on physical therapy to toss you some thought nuggets. 

Chiropractic evidence-based products

But first, jsut for my friend and collegue, Dr. Michael Henry down in Austin, here’s that ‘you know you love it’ bumper music. He’s a big fan. 

Integrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have shimmied all 60’s like into Episode #64

Introduction

We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. I noticed an error on the shipping charge. That has been corrected now. 

Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if somehting is out of sorts or isn’t working correctly. 

DACO

Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedists probgram also known as the DACO. I finished up all 50 of the required live hours this weekend down in Austin, TX during the Texas Chiropractic Association’s legislative seminar. 

Not only did I get all of the hours wrapped up but I also got to see a lot of colleagues I have been doing battle along side with for the last 8 years or so. You may or may not know that the Texas Medical Association is particularly aggressive and attacks at will for anything and everything. Which means we have to constantly raise funds to defend the attacks. 

It’s this cute thing we do with each other from year to year. It’s really a special relationship chiropractors have with the TMA. I keep thinking one day they’ll start listening to their own profession and leave us the hell alone but nope. Not so far. Not until they have full and complete control of chiropractic care in Texas. Which is not going to happen. Just so you know.. 

They sued us because 2 docs in texas who were Neuro Diplomates were doing VONT testing. I’d never even heard of VONT until this last time we got sued by TMA. IF you can give me a good reason why a neuro diplomate cannot do VONT testing, I’ll send you a candy bar or some chicklets or something like that. 

It’s enough to make a guy crazy. I got to meet a lot of bright new people ready to help the TCA fight and overcome. Andrea Ohmann recently moved to Texas from Minnesota. She is in a hospital setting if I understood correctly. She’s a bright star to keep an eye on. I also need to thank Dr. Jamie Marshall for listening to us down in Conroe, TX. I really appreciate it!

I got to see Staff Sergeant Shilo Harris speak. I mentioned him a couple of episodes ago but I have to tell you, this man is a hell of a speaker and he’s in our corner specifically. He gives chiropractic care all of the credit for helping him get through all of his injuries and surgeries. He was blown up by an IED in Iraq and has been through absolute hell to get to where he is now and chiropractic was key to getting him there. 

Very emotional and very impactful. I can’t imagine a legislator being confronted by him and his story and not being forced to see it our way. It’s powerful. Thanks to Shilo for eveything he’s doing for this profession. I hope you’ll go to http://shiloharris.com and see what he’s about. 

Beyond that our DACO hours were taught by Jeffrey Miller who is a chiropractor on staff at the University of Missouri medical school. He’s not as sharp as a tack. He’s actually sharper than a tack and told me he’d love to join us on the podcast so I’m going to do us all a favor and get that set up. We also have Dr. Christine Goertz’s episode coming up quickly so keep your eyes peeled for that one too. 

This get on with this deal here. 

Item #1

Our first item here is called “Manipulative Therapies: What Works” and is authored by Dr. Michael Smith, an MD, and his herd of collegues. It was published in American Family Physician on Febraury 15, 2019(Smith M 2019). I got this one from Dr. William Lawson in Austin, TX who is a DABCO and a swell dude on top of that. 

In case you missed it, this herd of authors are medical doctors. They start by saying that manipulative therapies include things like osteopathic manipulative treatment which is the same as chiropractic manipulative treatment. 

They say that, when you compare manipulative therapy to oral analgesics, cervcial manipulation and/or mobilization appears to provide better short-term pain relief and improved funciton in patietns with neck pain. 

They go on to say that manipulative therapy may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intesity of pain. 

While there is some evidence showing that manipulative therapy can reduce length of hospital stays for preterm infants, there is ZERO research for some of the other reasons we see chiropractors treating infants. Things like otitis media, colic, allergies, and respiratory conditions. 

That was all in the abstract. That’s the medical world starting to take note. Can you hear it? When do the insurance companies start to take note as well?

THAT’S REALLY when our lives start changing. Oh happy day….I have a dream. A dream where we are no longer pursecuted for being right all the damn time. A dream that chiropractors don’t go around saying crazy crap and making the rest of us look bad. I have a dream people. I’m not going to pretend to be as good of an orator as Martin Luther King Jr. but you get the point. 

You know that the more of these articles that come out, the more they have to start gathering steam. Turn on a light bulb at night in South Texas and see what happens. The bugs start swarming. Turn on this kind of light and you’ll see these articles begin catching more and more attention until we finally have a consensus in the medical field. A consensus that says, “Hell, looks like they’ve been onto something this whole time. We better take another look at it.”

This is an excellent paper. And we need to keep seeing this more and more. Even if they’re talking specifically about osteopathic manipulative therapy, we know that chiropractors do it too and, in fact, chiropractors do almost all of it these days. DO’s have moved almost completely to medicine. We are the ones moving joints. Make no mistake about it. 

Item #2

Pushups…what can they tell us? Well, it appears they can tell us quite a lot from an article in StudyFinds called “Men Who Can Do More Than 40 Push-ups Far Less Likely To Develop Heart Disease.(Finds 2019)”

This article covers a new study that showed that men posessing the ability to perform 40 push-ups in one attempt are much less likely to suffer from heart disease wihtin the next 10 years. 

They showed where middle-aged men who can put in more than 40 in a single try have a 96% less chance of having heart disease when compared to those who could complete no more than 10 push-ups. 

So, it appears, to me…..that it’s time to start doing some push-ups muy pronto. 

Item #3

This one comes to us from the American Journal of Translational Research and is called “Iron defficiency accelerates intervertebral disc degeneration through affectring the stability of DNA polymerase epsilon complex(Zhang C 2015).” 

It was published in November of 2015 and appears to be mostly Chinese researchers. Could be Japanese, Korean, or Vietnamese but the name of the lead author is Chungiang Zhang and whole host of names that appear to be just as difficult to pronounce. 

We will not get deep into the details here because I’m not too proud to admit that the information here goes far above my head in many ways. I’ve said it before, I’m no guru. I’m like Alex Trebec on Jeopardy. He delivers the info but I promise he’s no expert on every question coming across his lips. Lol. 

But, when we stick with the basics, we see that iron serves as an important cofactor of iron-containging proteins that play critical roles in the maintenance of DNA stability and cell cycle progression. They say that disturbed iron homeostasis gives rise to things like cancer and anemia. 

In addition, they say that they found clear correlation between iron deficiency and intervertebral disc degeneration. 

They wrapped up their paper by saying, “In summary, our study suggests that iron deficiency is an important factor in the aggravation of IDD. Proper iron supplementation may be an effective strategy to alleviate the symptoms of patients with intervertebral disc degeneration.”

Item #4

Our last on the list, it has to do with PTs and is called “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review,” authored by Heidi Ojha and a gaggle of others and published in Physiotherapy Theory and Practice in February 2019(Ojha H 2019).

This was a systematic review to compare the effects of minimal physical therapy utilization (two visits or less) vs. typical physical therapy utilization consisting of 3 or more visits on patient-important outcomes for patients with low back pain. 

They say this research is needed because there is such variation in physical therapy use for those with low back pain. 

Interestingly, they found that, when compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up.

Even more interesting was that the conclusion of the paper said the following, “While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.”

So, what the hell is that? It’s not going to make you any difference to see us a lot but the price point is agreeable so, by all means, we’d like to see you a crap load. Which isn’t as much as a crap ton. By the way. But I think you see what I mean. 

I have noticed so many papers that basically cast a lot of doubt on PT in general while all we seem to find in regards to manipulative therapy are positive reaffirmation of the chiropractic profession. 

It just makes me wonder where the tipping point is to be honest. When does the medical industry start to look at chiropractic as being more effective for these conditions that PT and making those referrals accordingly? I had some insight on a PT private group on Facebook a couple of weeks ago. 

The PTs were piling on a chiropractor’s advertisement techniques. Let’s be fair, the DC was a knucklehead and wasn’t being honest and identifying himself as a chiropractor in his marketing but, for discussion purposes here, that’s beside the point. 

They were bashing not only on that chiropractor but our profession as a whole. I bash on aspects of my profession as well but, where the rubber hits the road, we average better patient outcomes, we are safe, we are effective, and we average higher patient satisfaction. Even if some in our profession would win a county craziness competition. 

Don’t believe me? Go listen to Episode #49 of this podcast where we go over the Parker-Gallup poll. Very interesting episode and there are some valuable marketing nuggets in that one for you as well. Definitely worth the listen. 

Also Episode #26 talks about PTs and DCs. The age old grudge match. Go check them out and see what you think. 

Some in our profession are simply imbeciles. That sounds harsh but for a time after graduating, I held no interest in furthering my education. I wanted to coast. I’d done the hard work, right? I was so smart already after all those years of college. Well, you don’t know what you don’t know. And, I can admit that for a few years there, I was an imbecile. 

They learned enough to pass but that doesn’t make them smart or ethical and that’s sad. But again, when said and done, our profession consistently proves itself and is proven by insurance companies, governments, polls, surveys, and universities. 

From what I’ve seen recently, I can’t say the same for them and I just can’t see where they feel they have some moral high ground or platform to stand on and spout a bunch of denigrating thoughts at us. 

I thought it’d be a good idea once to refer to a PT. I had a car wreck patient and thought they could use PT and at that time, I wasn’t equipped to do much rehab. So onto the PT they went. In two damn weeks, the PT ran up a bill that would have literally taken me 4 months to run up. I was astounded. And, in that two week period, there was little to no improvement for the patient. 

On a separate occasion, I had a disc patient finally settled down and doing great. She was very active and very much into working out. I had her disc settled down to a point that she thought she’d go get PT on top of what I was doing. She did not talk to me about it. She just did it. Her thought process was that it would just be that much better to combine the two. Chiropractic and PT. Honestly, that’s not bad thinking in theory. 

She came back after one visit almost unable to walk or function. We tried and tried to get it to settle back down but she ended up taking herself to a surgeon to get our of pain. Sorry PTs. Quit talking smack and work with us instead of against us.

Ideally, PTs and chiropractors work hand in hand and complement each other. Many offices can and should operate in this manner. In reality though, I see PTs as great for post-operative rehab and rehab after certain types of injury. When it comes to joints and spines in general though, they can’t touch us. They talk bad about us, they steal services from us, they think they have the moral ground on us, but they can’t touch us.

Those of us practicing in an evidence-informed manner anyway. Those not practicing evidence-informed actually continue to provide them with whatever moral ground they believe they have. 

I for one would like to move on from the beginnings and progress our profession much like the MDs have done over the last 150 years. They went from blood-letting, leeches, and labotomies to what they can do now. Yet, there’s still a part of our profession wanting to hold on dearly to our originations of 100+ years ago. 

Chiropractors, let go. Progress. Practice current, in the current day and age. Practice evidence-informed. It’ll help you and it’ll help the profession in general. 

That’s my opinion anyway. Take it or leave it. 

This week, I want you to go forward with

  1. Chiropractic wins and wins and wins again. We made the right decision. We just need to only use our powers for the good. 
  2. Push-ups….let’s get to doing them!
  3. Iron deficiency for disc degeneration is something worth looking at. 
  4. When we are practicing evidence-informed chiropractic care, PTs only wish they could get the results we can get.

Subscribe Button

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Finds, S. (2019) “Men Who Can Do More Than 40 Push-Ups Far Less Likely To Develop Heart Disease.” StudyFinds.

Ojha H, M. M., Johnston M, (2019). “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review.” Physio Theory Practice.

Smith M (2019). “Manipulative Therapies: What Works.” AMerican Family Physician 99(4): 248-252.

Zhang C (2015). “Iron deficiency accelerates intervertebral disc degeneration through affecting the stability of DNA polymerase epsilon complex.” Am J Transl Res 10(11): 3430-3442.

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel syndrome. 

But first, here’s that “goes down so smooth” bumper music.

Chiropractic evidence-based productsIntegrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have Frankenstein-shuffled into Episode #63 all creepy like

Introduction

Why does this podcast even exist? We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. 

This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice. 

Evidence-based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. My goal is to get enough pre-orders to pay for all of the initial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running. 

https://www.chiropracticforward.com/shop/

We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all. 

I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day, folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?

DACO

DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them. 

Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures – Recognizing the Clues. 

I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)

I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it.

Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife. 

Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out.

I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then.

So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?

When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week.

Easy peesy. 

If I can get you started, email me at dr. williams @chiropractic forward.com

Personal Happenings

In personal happenings, it’s been a little crazy around here as you all might can gather if you follow along. If you remember we had a front desk issue back in August and just couldn’t get the position filled. Well, my amazing wife stepped in, got trained on insurance, billing, and all of that lovely mess of crap. She is literally the smartest person I’ve ever met in my life. Some may question her decision to marry me and her intelligence in making that decision but, I think she’s freaking Einstein basically. 

Anyway, that has turned into us getting to work at 8 am and now, because she’s a perfectionist and still maintains her work responsibilities from her other job….which she does from home….we’re literally here until about 8 pm every night and I’m just about done with that people. Being busy is a good problem to have but there is a point where it’s just too much. 

I think a nurse practitioner can take some of the load off and I think maybe bringing in a new young hungry associate would be really nice. But, while I can talk about evidence and research, I’m afraid I’m not particularly skilled at hiring associates or setting up a medical entity but, that’s the direction I’m moving in because this workload is not sustainable for me to have a happy life. It’s just not. Example: on Wednesday of last week, in one day, as a solo practitioner, we had 12 new patients. Now, 6 were just intakes from one car wreck and it went efficiently but, you get the point. 

While it is do-able, for me, it’s not necessarily desirable to have the stress of being piled up on. I’m more like 3 or 4 new patients per day spread evenly throughout the week with some periodic re-exams and a bunch of happy patients just getting better and better every time I see them. THAT’S my idea of a happy workday. That’s not what we have right now. Lol. Good problem to have, admittedly but, still stressful. 

We’re hiring right now to help take some load off of the wife and, before long, I’ll be turning my attention to integrating. You know I’ll be sharing my experience as we go through it all. 

Item #1: Government-regulated Rehab

This first item we’re going to talk about is titled “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial(Cote P 2019)” written by Pierre Cote, Eleanor Boyle, Heather Shearer, and a plethora of others. It was published in the British Medical Journal Open in 2019 and is cited in our show notes for episode 63. 

Why They Did It

They wanted to evaluate the effectiveness of a government-regulated guidelines line when comparing it to education and activation by general practitioners and to a preferred-provider insurance-based rehab program on self-reported global recovery from acute whiplash-associated disorders Grades 1-2. 

As mentioned in the title of the paper, it was a pragmatic randomized controlled trial. 

What They Found

Here’s what they decided, “Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.”

Item #2: Rotator Cuffs & Need For Repair

This one is called “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears(Boorman RS 2018).” Twas written by RS Boorman, KD More, RM Hollinshead, and a gaggle of others. Published in Journal of Shoulder and Elbow Surgery in March of 2018. 

Why They Did It

They wanted to look at the 5-year outcomes in patients enrolled in a nonoperative rotator cuff tear treatment program. What happened with them?

How They Did It

They took patients with chronic, defined as greater than three months, full-thickness rotator cuff tears on MRI that were enrolled in the nonoperative study from 2008-2010. 

They started a nonoperative, home-based treatment program and they were followed up with after different time intervals. 

What They Found

Check this out, at 5 or more years follow-up, approximately 75% of patients remained successfully treated with nonoperative treatment and had a quality of life score of 83 out of 100. 

Between years 2 and 5, only 3 patients thought to have a successful outcome regressed and had surgery

The operative and the nonoperative groups at the 5-year follow-up were not significantly different. 

Wrap It Up

The authors concluded, “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time.”

Pow. Snap. Bam. Smash. Kapow!

I don’t know why I take such joy in seeing that surgeons have less reason to do surgery but it give me a tickle in my belly and a warm fuzzy feeling. Who wants a hug, people? I’m feeling the spirit here. 

Item #3: Carpal Tunnel Syndrome

Our last item here is called “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial(Wolny T 2018)” and is written by T Wolney, et. al., published in Journal of Manipulative and Physiological Therapeutics in October of 2018. 

Why They Did It

They wanted to check the influence of manual therapy, including neurodynamic techniques, when compared to no treatment on overall health status in those with mild to moderate carpal tunnel syndrome. 

Again, as the title says, it was a randomized controlled trial with 189 subjects. 

They underwent treatment twice weekly. 

What exactly is meant by the term ‘Neurodynamic Technique’? Well, have you ever heard of nerve flossing? That is a type of neurodynamic technique. Gliding or sliding the median nerve in the case of carpal tunnel. Tensioning, relaxing basically. Pull out your Google machine. You’ll find some great YouTube examples of Neurodynamic Techniques to help you with your carpal tunnel patients. 

Now, what did they find?

The authors were able to conclude the following, “Manual therapy, including neurodynamic techniques, had a positive effect on overall health status in this group of individuals with carpal tunnel syndrome.”

Key Takeaways

  • The government doesn’t do a particularly better job than you can do on your own if you’re educated and stay evidence-informed
  • Even full-thickness tears of the rotator cuff do not mean surgical intervention in most patients
  • Carpal Tunnel Surgery doesn’t require surgical intervention in most mild-moderate patients if you learn some take-home exercises and implement neurodynamic techniques
  • Surgeons are going to need to start down-sizing those houses and maybe forego buying that private plane as they will be less and less busy in the years to come. 

Again, before you disappear this week, consider going to chiropracticforward.com and clicking on Store and pre-ordering our spanking brand new evidence-informed brochures. We are looking to gather up pre-orders and ordering all of them in bulk around March 29th. We would appreciate your help in making this happen. Team Chiropractic Forward!

https://www.chiropracticforward.com/shop/

 

Chiropractic evidence-based productsIntegrating Chiropractors

The Evidence-based Chiropractic Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Home

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

  • Boorman RS, M. K., Lollinshead RM, (2018). “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.” J Shoulder Elbow Surg 27(3): 444-448.
  • Cote P, S. B., Shearer HM, (2019). “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial.” BMJ Open 9(e021283).
  • Wolny T (2018). “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial.” J Manipulative Physiol Ther 41(8): 641-649.

CF 033: Did You Need Proof That Chiropractors Help Headaches?

CF 041: w/ Dr. William Lawson – Research For Neck Pain

 

 

 

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

Today we’re going to talk about chiropractic prevalence, a new article in JAMA with some pretty terrible projections for opioid use and deaths, and new information on kiddos and the time they spend on screens. 

But first, here’s that bumper music

Chiropractic evidence-based productsIntegrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #62

Introduction

We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Evidence-Based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. 

DACO

Let’s talk a bit about the DACO program. Man, this is how it goes with the DACO: just yesterday morning, I had a patient come in, mid-’60s and literally everything hurt. Restless leg syndrome was her main complaint but her GP just yesterday already started her on Vitamin D and iron supplements so she’s going in the right direction there. I have heard of acupuncture being good for it as well but have not seen any research on that so can’t make that claim. 

Anyhooo…literally everything hurt, couldn’t sit down and basically, a general overall look of being unwell for a lack of a better word. She just didn’t look healthy. I started asking her about bone scans and she’d never had one. Well, this guy just gets feelings and when I get a feeling, they get sent out. I sent her out for a bone scan. 

No kidding, that afternoon I sit down for a class. The next one up? Yep, diagnosing osteoporosis. Lol. Wouldn’t you know it? Anyway, had I had this class before the encounter with the new patient, I might not have sent her. I’m not sure.

But, it’s just funny how in tune with clinical practice the classes really are. Also, as a consequence of the class, I have a quick sheet made up that changes the way I deal with potential osteoporosis patients from here on out. Forever and ever amen. 

Personal Happenings

So far, not a lot of blowback on my recent episode covering my thoughts on faith-based practices. Sometimes I’m mouthy, right? I get it. Who the hell cares what I have to say? I don’t know who cares honestly. Lol. But, we’re growing and growing so at least some of you identify with my way of thinking.

I’m religious and I think that’s what makes me feel that I can be credible in critiquing certain things in regard to religion. I just have a hard time with management companies coaching their impressionable doctors how to use the bible to manipulate scared patients looking for answers. When I think about it, it makes my pee hot. 

Anyway, it turns out that you guys agree with me and that makes me like you even more. Before you know it, we’re all going to be besties and share milkshakes with two straws and all of that mumbo jumbo. 

I’m glad you’re here with me today as we dive into the information I have for you this week. Here we go. 

Item #1

I want to start with one that had some conclusions I found surprising and somewhat encouraging……sort of. This new paper from The Journal of Alternative and Complementary Medicine published January 18, 2019, and authored by Stephanie Taylor, Patricia Herman, Nell Marshall, and colleagues called “Use of Complementary and Integrated Health: A Retrospective Analysis of US Veterans with Chronic Musculoskeletal Pain Nationally[1].”

Due to time constraints on me, I didn’t go beyond the abstract here so….freaking sue me. I’ll have it cited in the show notes at chiropracticforward.com so you can go get it and dive in you over-over-achiever you with all that time sitting around. Must be nice pal. 

Why They Did It

The authors say that little is known regarding the use of complementary and integrative health therapies for chronic pain in the VA system which is the nation’s largest integrated healthcare system. We will get into chiropractic prevalence briefly.

In my experience, I can echo this paper’s sentiment that the VA is at the forefront of the movement away from opioids and toward alternative healthcare. 

They researched this paper over 2 years for the use of 9 types of alternative therapies that included meditation, yoga, acupuncture, chiropractic, guided imagery, biofeedback, tai chi, massage, and hypnosis. 

What they found

27% of younger veterans with chronic musculoskeletal pain use alternative healthcare

The most used for was meditation at 15%. I found that surprising. Meditation means slowing down, sitting still, relaxing, and all that good stuff. In this day and age, I just have a hard time seeing that as the most prevalent form of alternative healthcare. 

We all think we’re so busy and, for us chiropractors, a lot of us really ARE too busy to stop and meditate. I may just be taking my own personal experience here and assuming everyone else on the planet is like me and, of course, that’s not true. Still, meditation was the most prevalent in this study. 

Yoga was next at 7%. Again, I guess I haven’t realized how popular yoga is getting these days but, I know the VA is pushing it so that may be playing a part in it. 

Coming in in 3rd place we have acupuncture. Once again, it’s surprising to me but, the VA is directing the recommendations and, in the real world, outside of the VA, acupuncture does not out-pace chiropractic. I do believe the VA is seeing it’s use for PTSD and chronic pain though and is responding appropriately. 

Finally, here comes Chiropractic care coasting in in 4th place for chiropractic prevalence.

Ugh. We know outside the enclosed ecosystem of the VA, chiropractic care is not less prevalent than yoga, meditation, and acupuncture. But, being within the VA, we know that medical doctors, PA’s, and nurse practitioners are making these recommendations and referrals so we still clearly have a lot of work to do. We are still a world away from where we need to be in regard to chiropractic prevalence,

You know what else that means though right? There are incredible potential and opportunity. If the VA is an example of the rest of the allopathic world, we could say that even fewer than 5% of chronics get referred to us from the GPs and orthopedic surgeons. I think that’s fair because most of them are unaware of Dr. Christine Goertz’s work that was published in JAMA not long ago.

If you’re unfamiliar with that, go listen to Episode 25 of this podcast. In short, she showed how veterans with chiropractic care mixed in with their traditional care had better outcomes. That’s when we started seeing the referrals from the VA

Also, you’ll notice that all of the nine therapies tracked here were on the list of first-line therapies that came from the updated recommendations by the American College of Physicians in February of 2016[2]. 

I guess my point on the paper here is that the medical world, or at least the VA part of it, is paying attention to research regardless of whether it goes against their previously held biases. They are absolutely trying to reverse the opioid epidemic. And we have a lot of work to do to gain that trust and get those referrals. When they’re recommending meditation before chiropractic care for chronic pain, then there is a ton of room for us to shine. So go shine it up all you shiny happy people out there. 

Item #2

On to item numero dos, number 2 for our non-Spanish speaking population out there. This one is discouraging and…..well….awful if I’m being honest.

This one is from JAMA called “Prevention of Prescription Opioids Misuse and Projected Overdose Deaths in the United States” published on February 1, 2019, and authored by Quiushi Chen, Marc Larochelle, David Weaver, and colleagues[3].

Why They Did It

In JAMA, they always start with the question being answered here. The authors wanted to answer this one: “what is the projected effect of lowering incident non-medical prescription opioid use on the future trajectory of the opioid overdose crisis in the USA?

I’m just going to cut to the chase on it and leave a bunch of details out. Here’s why. I don’t want us getting bogged down in the details and methods and all that stuff.

I want you to be able to retain just a few numbers and not be distracted by the rest of the minutiae. You like that word? I know you do. Minutiae, You say that to the right fellow nerd and you may just get you a date, people.

It’s a powerful word so take it, use it, enjoy it. I swear I’m undiagnosed ADHD. I swear it. 

Anyway, here’s the deal, although we as a nation, as a world, now see the issues with opioids and are now trying to address the issue, It’s not getting better and it won’t get any better according to this paper. 

Check it out, according to this paper, the annual number of opioid overdose deaths is projected to increase from 33,100 in 2015…..then we know that 72,000 died in 2017….all the way up to 81,700 deaths projected 2025. 

They are projecting from 2016-2025 to lose a total of approximately 700,400 people to opioid deaths. They say about 80% of that will be due to illicit opioids. I don’t know how the hell they can tell that but that may be a little bit of, “yeah it’s happening but it’s not our fault,” BS going on there but who knows? In this paper, they’re assuming that the illegal use of opioids will increase from 61% in 2015 to 80% by 2025. I don’t know. Sounds like fuzzy math to me but I’m not a researcher. 

I think their numbers are fuzzy because we know 2015 saw about 36,000 die, but then 2016 saw around 63,000 die if I remember correctly. Then, 2017 saw 72,000 die. Are you seeing the graph there in your mind? It’s not only up and to the right on this deal, but its up and to the right like it’s climbing Mt. Everest. The numbers have harnesses fastened tightly and ropes and expert climbing guides and they’re going straight up the face like pros! 

These guys are guessing that by 2025, in 9 years, the deaths will only have increased a total of 9,000 per year, so….they’ll only increase an average of 1,000 deaths per year. Do you see why I think they’re crazy? The deaths increased by 9,000 just last year. Do you see what I’m saying? I’m not saying they’re wrong but….they’re wrong. Lol. 

They then say that across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3%-5.3%. 

Their quoted conclusion is, “This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.”

So what do we take from this exactly? Here’s my deal. On the surface at least it smells like a steaming pot of shoo shoo caca doody, 

Instead of recognizing the fact that unnecessary surgeries were many times the reason people got addicted in the first place, and that there are amazing opportunities outside the allopathic world to prevent those unnecessary and financially motivated surgeries, they say, “Hey look, a lot of this is done illegally and that’s just going to get worse and our part of this is really very small.

In fact, we can lower the prescriptions of opioids but it’s really not going to do a lot of good and, in fact, we think we should still be able to prescribe them as much as we are right now….blah blah blah poop coming out of the mouth and falling onto the floor with a splat. 

They are making guesses 9 years in the future what addict behaviors will be. I think that’s presumptuous and ultimately impossible. I just thought it was entertaining and that you all might enjoy this group trying to minimize responsibility or what role they can really play on decreasing opioid use.

I could totally be mischaracterizing this and they may have the best intentions in mind. While I trust my GP and I trust the friends of mine that are surgeons personally….I just don’t trust stuff like this. 

Obviously, I don’t agree with them but I’m a bumpkin chiro on the Texas Plains. I wouldn’t listen to me if I were them either. Lol. 

Item #3

OK, last item for this week and it’s something I’m admittedly fascinated with and I think that’s because I have a high schooler and a 5th grader and this stuff hits home any time I see it or read about it. 

This one was in JAMA too and called, “Association Between Screen Time and Children’s Performance on a Developmental Screening Test” written by Sheri Madigan, Dillon Browne, Nicole Racine and colleagues[4] published January 28, 2019. 

Why They Did It

The main question they were trying to answer was this, “Is increased screen time associated with poor performance on children’s developmental screening tests?” Basically, does screen time have a direct effect on child development?

They had 2,441 kiddos in it. A random-intercepts, cross-lagged panel model revealed that higher levels of screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months. 

What They Found

Their conclusion was, “The results of this study support the directional association between screen time and child development. Recommendations include encouraging family media plans, as well as managing screen time, to offset the potential consequences of excess use.”

Yes, it’s easy to just hand them a device and hope they’re quiet long enough to get a nap in. Guilty as charged. Guilty as charged. 

But, turns out as we may have guessed if we really thought about it 8-9 years ago when all of this really started….this isn’t in their best interest in the long run. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

http://www.chiropracticforward.com

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

https://twitter.com/Chiro_Forward

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

1. Taylor S, H.P., Marshal N,, Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med, 2019. 25(1).

2. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

3. Chen Q, L.M., Weaver D,, Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Network Open, 2019. 2(2): p. e187621-e187621.

4. Madigan S, Association Between Screen Time and Children’s Performance on a Developmental Screening TestAssociation Between Screen Time and Child DevelopmentAssociation Between Screen Time and Child Development. JAMA Pediatrics, 2019.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

CF 052: Chiropractic Forward Podcast Year One Review

 

 

 

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

Today we’re going to talk about another aspect or group that I find particularly troubling in my profession I call faith-based chiropractic, we’ll talk about some lawmakers in Ohio, and then we’ll gloss over a paper on chronic neck pain and balance. Stick around, it might get interesting. 

But first, here’s that ‘yummy in your tummy’ bumper music


Chiropractic evidence-based productsIntegrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have streamed you way into Episode #61

Before I make people mad, let’s talk a bit about the DACO program which is the Diplomate of the Academy of Chiropractic Orthopedists. I’m on it, I’m on it. I’m on it like stink on my teenager’s socks. You know what I’m talking about. I won’t even enter his room. It just has a certain smell that I want no part of. 

Continuing on with the eLearning episodes through the CDI group, I recently wrapped up one on Lateral Epicondylalgia just this morning and a few days ago finished up one on Fibromyalgia. Did you know the literature is pointing to those two conditions as being partly due to the central nervous system and what is termed central sensitization? 

It’s excellent information. If you want some guidance getting started on it, shoot me an email at dr.williams@chiropracticforward.com No, I don’t get a thing out of helping you or out of talking about it. Nothing at all. It’s just something I’m currently doing so it’s top of mind and I see the incredible value daily and am sharing that information with you. That’s about the total of it. 

I want everyone, as soon as you get to a computer, to go to chiropracticforward.com and click on the STORE link. You will find Posters and Brochures. The posters have some of my favorite and often-used sayings from the podcast. The brochures are evidence-based and are something I have been working on for some time now in my spare time. Now, if I can get some pre-orders ready to rock, we’ll get them ordered and sent on their way to you. 

I’d love to get your feedback on them at dr.williams@chiropracticforward.com

Introduction

Everyone on the planet knows there are two things you don’t talk about and they are POLITICS and RELIGION. 

For me, this here, what we’re about to go into….it has very little to do with the nuts and bolts of religion but more to do with the use of it. I’m going to touch on a very touchy subject and I hope that you won’t do the “poor me, I’m offended by everything on the planet” bit and get mad and leave and never return.

Rather, I hope you’ll hear what I have to say and hear it objectively and then, we either agree or disagree and we move on with our days with a common goal of getting people better. In the end, it’s just one dude’s opinion so let’s not get too worked up, OK? 

Faith-based Chiropractic

OK, let’s talk openly and honestly and hope we don’t make everyone mad. Here’s my deal people, I’m a Christian and have been all of my life. In fact, when I was younger as in junior high and high school, typically if the doors were open, I was there. Sunday morning, Sunday evening, and Wednesday night. Yep. Southern Baptist even although, now, I’m non-denominational. I found out I’m not as much of a fan of organized religion as I am of religion in general. When it gets too organized, I get less interested if that makes sense. 

Anyway, I’m a proud Christian but I’m not a loud or a bully Christian at all. If you come to my office, I’m not sure I have one cross in the whole place. That doesn’t mean I frown on you if you have Christian music playing through the speakers and you have scripture written on the walls. I honestly have no problem with that if it’s there for the right reasons. I don’t believe people are coming to my office for religion so it’s not right for me personally. 

I will admit, I’m a sculptor so several of my pieces are here. One of my pieces is called Road To Damascus and is about a story found in the Bible. I’ll post a picture in the show notes at www.chiropracticforward.com and you can just go to episode 61 if you want to check it out and see it. 

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

I feel like, since I AM one, I can talk about other Christians.

Lately, I’m seeing more and more posts and have been hearing more and more about Christian Chiropractors. I think the idea or concept of being a Christian Chiropractor is just fine. Honestly, I do. There are indeed people that would rather go to a like-minded practitioner rather than a Satan-worshipping chiropractor for example. Wouldn’t you agree? ‘Birds of a feather flock together’ is more than just a saying.

Much in the same way that some patients would just as likely AVOID a Christian Chiropractor if they themselves are not Christians. If someone wants to identify themselves as Christian, honestly, I’m cool with that. I don’t but I don’t care if you do. Not at all. 

Fair play to ya. That’s why we have different strokes for different folks and I’m so OK either way. There are Christian MDs, Muslim plumbers, Christian brothers car mechanics, Jewish this, and Buddhist that…. Whatever melts your butter and feathers your fancy. 

My Issue

My issue today isn’t one of religion vs. non-religion in all honestly. My problem lies in practitioners USING their religion to build their businesses and, in a most undesirable move, using religion to manipulate vulnerable patients for the purpose of padding their wallets. 

That’s a next level no-no in my book. Who cares about my book, right? Maybe nobody at all. Maybe around 8,000 people so far though so, it’s possible some actually DO care about my book so let’s keep rolling here. 

I want to make a distinction here. a Christian, according to the New Testament is charged with going and preaching the gospel. Save souls. There are some that truly feel that, if they are not doing that, they’re not fulfilling their mission. 

OK, fair enough. Who am I to argue that you’re wrong and who the hell am I to judge? If I were to say you’re wrong, I’d be arguing against the Bible and I’m certainly not going to do that. I have faults so I do what I can to stay in the good graces when at all possible. 

If it is honest and well-meant and you feel it in your heart to save your patients, rock on brothers and sisters. Amen & Hallelujah. 

But, if you mix religion into your business practices and protocols as a way to build your business by manipulating desperate and many times scared patients into seeing you, that’s where our paths go separately.

I cannot reconcile it in my mind how it would ever be right or permissible. I’ve never in my life gone to church to pick up business. I’m not there for that. It would be disingenuous and would defeat the purpose of being in the building in the first place. 

In the same way, I don’t use it to build my business in my office. I would not feel honest. I wouldn’t feel genuine. At the end of the day, if I’m anything, I’m those two things. Again, we’re all different but for me personally, it just doesn’t feel right. 

Example

Let me give you exhibit #1 for an example so you can see for yourself what I’m talking about. Here is an actual script folk.

“Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

That is a script used by a  popular company. They tell their members to say stuff like that. I’m not even kidding and, as I said, that’s some next level BS for me personally, in my practice. 

As a Christian myself I’m telling you, someone says something like that to me while I’m trying to get my issues resolved, the next thing they’re seeing is my ass as I walk out the door. 

First, I’m not there to be preached to. I go to church for that. Second, it’s obvious you’re trying to manipulate me into treatment using my religion and that just straight up pisses me off. Third, if God wants to heal a patient, why on Earth would he need a chiropractor to make that happen? 

Honestly. Think about it honestly. God moved heaven and earth. All-knowing. All powerful. But needs a chiropractor to facilitate your improved health? That’s insane in the membrane to me. 

What If

What if they said, “Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

And all the people said, Amen. Literally, every single one of them agrees that it is indeed fair. 

Of course, I also tell them that if they love what we do for them and they get to feeling better, we’d love a great review on Google and Facebook but, if you don’t like us, just keep your mouth shut.” Of course, they know I’m kidding. Or am I?…..

The way I see it, I’m a specialist in what I do and that’s why a patient is here to see me and that’s what they will get. They’re not going to get politics and they’re not going to get religion either. 

As I said in episode #56 when I talked about the magical mystical disappearing arthritic osteophytes, although in many areas of the world it’s getting better, we are still in a battle with a medical community that wants to do away with us. We need to ask ourselves an honest question. Does this sort of stuff, put us at risk of continued ridicule? 

I doubt medical doctors are sitting around all over the country saying, “Mary, I’m concerned about you. If you don’t get this chemo followed by months of radiation, God can’t express himself fully in your body and your healing will not be complete, and you’re going to die.” “Mary, if you don’t take this oxcy, God won’t be able to calm down that issue long enough for us to make any progress in your healing.”

And, if you ever DO find one that does (there are always exceptions to the rule right?) if you find an MD that does that, the whole world is going to think he’s a coo coo loco and you might even see him on 60 Minutes one Sunday night. 

God, faith, religion, and spirituality are wonderful things. They’re the #1 things in the lives of so many people including ME. Just don’t dirty them or the profession by using them as marketing and worse of all….tools to work patients and manipulate them. Please….

I love your religion and I love your passion as long as it’s genuine. Once it becomes about business and becomes a tool to work people, you lose me. That’s all I’m saying. 

Hopefully, not too many of you lost the cheese off of your cracker on that. Let’s keep moving. 

Resource #1

I want to cover a recent article I noticed from WSAZ NewsChannel 3 up in Charleston, WV. It was written by Kaitlynn LeBeau called Ohio Lawmakers, doctors suggest chiropractic care instead of opioids(LeBeau 2018) and was posted on March 21, 2018. 

https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html

It’s in WV but talking about Ohio and here’s what they had to say. The Ohio Attorney General and lawmakers held a press conference last March to talk about the need for alternatives to pain meds. The Attorney General, Mike DeWine, said: “More and more people are looking for new and innovative ways to treat pain.” 

Yes, we already know this but he also went on to speak about community health centers that include medical, fitness, social and educational services. We’ve already talked about chiropractors getting integrated into the Federally Qualified Health Centers and, yes….you have one near you whether you know it or not. Just Google the term “FQHC” and then the name of your city or region and see what pops up. 

Here’s what I really wanted to point out: we chiropractors have a powerful ally in American soldier, Staff Sergeant Shilo Harris. If you are not familiar with Sgt. Harris, he is located in San Antonio, TX last I heard unless he’s relocated. 

Anyway, on his second deployment to Iraq, he was injured by a roadside bomb. When I say injured, I mean big time. Go do a google search on Shilo Harris and you’ll see immediately what I’m talking about. 

Bless his heart and thank you for your service, Sgt. Harris. Heroes don’t play on a basketball court or football field. They fight selflessly and give of themselves for our freedom. For complete strangers, many of which don’t even like them. They fight for the love of country too, right? Just amazing people. 

He is quoted in the article as saying, “I’m here to tell you that chiropractic care saved my life. I became addicted to my medications, naturally, in a sense because I had had so many back to back surgeries.”

Sgt. Harris has presented at Texas Chiropractic Association’s events and will be at another TCA event in just a couple of weeks down in Austin that I’ll be at. I’m looking forward to hopefully meeting him myself. 

Resource #2

OK, next item: this one called “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests(Gomes P 2018)” It was authored Amy Pamela Karine Alvino Gomes, et al. and published in October of 2018 in the Journal of Manipulative and Physiological Therapeutics. 

Why They Did It

The purpose of this study was to correlate measurements of chronic neck pain with the balance and mobility of the lower limbs and to compare these variables between individuals with chronic neck pain and asymptomatic participants.

How They Did It

It was a blinded, cross-cross-sectional study

They had chronic neck pain patients as well as asymptomatic people. 

Outcome assessment tools were used to measure the difference in the groups. 

What They Found

“Young adults with chronic neck pain present changes in static balance measured by means of the Functional Reach Test; that is, the higher the intensity of pain, the lower the anteroposterior excursion of the body during the execution of the test.

This week, I want you to go forward with this: again, I’m all for religion. Ultimately, you do you. Just do it proudly, honestly, and genuinely. Always try to be someone your family can be proud of and be above reproach. 

I want you to know that Staff Sgt. Shilo Harris is awesome and he’s on our team so look him up and book him for your next association event or seminar or legislative effort. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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TuneIn

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Gomes P (2018). “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests.” Journal of Manipulative and Physiological Therapeutics 41(8): 658-664.

LeBeau, K. (2018). https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html. WSAZ News Channel 3.

CF 052: Chiropractic Forward Podcast Year One Review

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

 

 

 

CF 060: Medical Marketing & Integration Care Expectations

CF 060: Medical Marketing & Integration Care Expectations

Today we’re going to talk about medical marketing scoundrels and about what the multidisciplinary world expects of us chiropractors. 

But first, here’s that ‘goes down so smooth’ bumper music

Integrating Chiropractors

And we’re back. .Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We are honored you’re spending some time with us and we hope we give some entertainment and some value in return. 

Introduction

You have disco’ed your way into Episode #60 just like John Travolta in Saturday Night Live. Kids, go Google that. It was cool back then. You could walk down the street in a Staying Alive strut man. Travolta was the bee’s knees back then wasn’t he? From Mr. Kotter, to Grease, to Staying Alive. Then turned kookoo wacko on everyone. He got so open-minded that his brain fell out and went splat. 

Let’s talk a bit about the diplomate of the Academy of chiropractic orthopedists quickly. That’s also known as the DACO program that I’m currently going through. I’ve officially hit the halfway point for the online hours and only have one class left for the live hours which I’ll get in less than a month down in Austin. Basically, out of 300 hours, I have about 125 left and have just been serious about this thing since October. Recent classes have been A Neurological Approach to Scoliosis, and the Neck and a Sense of Well-Being. 

I feel like it’s scooting fairly quickly at this point. It’s funny to watch my staff when I’m performing an exam these days. They’re familiar with the way I do exams and have done them for years. Just about every week, including this week, I’m adding or taking away from what I normally do. They don’t really know how to handle it. Lol. These classes really do change what you do almost immediately. 

If I can help you get started and rocking and rolling on your DACO, shoot me an email at dr.williams@chiropracticforward.com and I’ll be glad to point you in the right direction. 

New Year

How’s your new year starting? By the time this episode goes live, we’ll have been in it for a little over a month. I have to say that I’m confused this year. This is typically our slowest time of year. But, it’s going a little crazy this year for whatever reason. I have literally had 35 new patients in the last two weeks. It’s all I can do to get this podcast written each week, to be honest, but I’m committed. 

I actually had to come in on a Saturday to record the last episode because I just didn’t have the time available during the week to get it done. I’m not trying to brag. I think if you have a good staff, which I do, and you have them spaced appropriately, which I do, you can make your way through them while giving them the best care possible. Especially when you’re using post-graduate educations like the DACO to guide your exam and diagnosis. 

Crazy Busy

And, 35 new patients for my practice looks different than it may in a lot of clinics. I don’t see how many times we can run them through the doors. I don’t convince them their lives are at stake if they don’t see me 50 times this year. 

I used ChiroUp for all of my patients which I highly recommend. An additional $150/month seems like a lot. I know. But this programs is worth even more than that and they’re not paying me anything at all to say that. One of the things it does is track your patients through follow up emails. 

That’s how I know my case average, which is the number of times I typically see a person, stands at around 8 times while their national average stands at about 7 times. 

I know that my average improvement rating is 79.43% for ALL cases and that included everything from cervical radiculopathy and lumbar stenosis to cervicogenic headache and greater trochanteric bursitis. Their national average for improvement is 71.8% so I’m doing good there. If I’m getting 80% of my patients well, I’m happy. 

They have also tracked me at having a 98.6% likely to refer from my patients. Meaning, our patients are 98% happy to refer us to their family and friends and that makes me feel warm and fuzzy inside. I’d still like to know what I can do to make that other 1.4% happy but I think some people cannot be made happy at all. 

Even if you get them well and gave them free ice cream. They’d still gripe because the ice cream didn’t have chocolate syrup on it. You know those people. You know who I’m talking about, don’t you?

Anyway, the point was….I hope your 2019 has started off like my 2019. If it sustains, I’m going to have to get me some help in here! Including a nurse practitioner. Ahhhhh, the day I finally make that leap I may have a few hundred beers. Lol. 

Paper #1

The first item of research I want to get to is on medical marketing. Why do we care what the medical field is doing for marketing? Well, because they’re the main stakeholders in healthcare and it’s important to know what they’re doing. Either we can copy it or we can go 180 degrees from it depending on what we’re talking about. 

This paper we’ll talk about was in the Journal of the American Medical Association also known as JAMA on January 1, 2019, so it’s hot off of the press. It is called “Medical Marketing in the United States, 1997-2016” and was written by Lisa Schwartz, MD and Steven Woloshin, MD[1].  Please remember, if you’d like to see the paper, the methods, and that good hulabaloo….I always cite the papers at the end of the show notes over at chiropracticforward.com. This show is episode 60 just so’s you’s knows. 

Why They Did It

They wanted to answer the question, “How has the marketing of prescription drugs, disease awareness, health services, and laboratory tests in the United States changed from 1997 through 2016?” I think that’s a great question. 

Let’s find out, shall we? I say hell yes we shall!

As far as medical marketing goes, they say, “From 1997 through 2016, medical marketing expanded substantially, and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.”

Let’s dial down into that just a bit. 

As you are probably already guessing because you see this trash on TV every time you turn it on but the most rapid, crazy increase in medical marketing advertising was in the direct-to-consumer advertising. It went from $2.1 billion in 1997, which was 11.9% of the total marketing….it went from $2.1 billion all the way up to $9.6 billion and now, marketing meds directly to the consumer now make up 32% of the total spending. I say NOW….that was 2016’s numbers. Probably worse now.

They broke it down even further and highlighted the prescriptions that are marketed directly. The drugs you need a prescription for ….ads for them went from $1.3 billion in ’97 which was 79,000 ads, all the way up to $6 billion dollars and 663,000 ads in 2016. 

All I have to say here is, “Dayum.”

Then, I’m not done yet….hold my beer and watch this….Lol. That’s what I feel like here. Then, they say that medical marketing straight to healthcare providers like the MDs, DOs, etc….that marketing went up from $15.6 billion to 20.3 billion in 2016 but here’s what’s crazy when you think about it, folks, $13.5 billion of that was for free samples….OK, whatever. Then $979 million went to payments to physicians for speaking fees, meals, and things like that that were related to specific products. So they paid almost a billion damn dollars to MDs to go around medical marketing & touting their drugs.  

It’s insane. You cannot tell me no way no how that with that much money in the hopper, that we don’t have some nefarious skunky smelly dirty crap snaking around and messing with people for the worse. You can’t convince me of it and I’m not a conspiracy guy either. 

Like, when they say we didn’t land on the moon, it was shot in a studio in Hollywood? Yeah, they need a kick in the nuggets. Really? The Earth is flat? Are you sure? I’ve seen a lot of pics from outers space and round is what I’m getting people!! 

You see what I mean here but I also know people and I know what greed does to people. It’s insane, honestly. 

Pharmaceutical Commercials

Let’s talk about those medical marketing commercials for a minute. Let’s make up a name that sounds a little like a prescription. How about Killyametrix? Yeah, sounds good. OK, here’s how it usually goes, “Have you been having a hard time getting into your life? Are you just tired? No energy, no drive, no ambition anymore? Wouldn’t you like to have more energy? You’re too young for this. Killyametrix has been shown to increase energy and get patients back to enjoying their lives quicker and faster than any medication in the history of man that was ever made. There are some side effects. You’ll want to talk to your doctor if you experience any of the following symptoms: gout, liver failure, tumors coming out of your eyeballs, if your foot falls right off in mid-stride, high blood pressure, going cross-eyed, bleeding from the ears and fingernails, if your hair curls, if all of your hair falls out, or if your knee cap pops right off as you sit down and shoots straight across the room knocking someone out. Other than those issues, it’s a great drug. Try Killyametrix. Ask your doctor about Killyametrix and if it might be right for you.”

Here’s the deal, when I was growing up, did you realize whiskey, bourbon, scotch, …..the hard stuff…..it was never advertised on TV because they knew it was damaging to the population so why promote it nationally. I believe it was actually illegal to advertise the hard stuff but I’m not 100% on that. 

But, now, or at least in 2016, it’s OK to advertise prescription drugs straight to the consumer to the tune of 663,000 ads at a cost of $6 billion dollars. It’s lunacy. 

How about you go to your doctor with no preconceived idea of what’s wrong with you and he or she plays doctor, figures out what’s going on with you, and the DOCTOR, the actual doctor, decides what medication you need if any at all. 

Why don’t we try that crap out in America for a change? 

If I were an MD or DO, I’d be livid every time I saw one of those stupid commercials on TV. Hell, I’m a DC and I’m livid when I see them. 

Make me a crazy person. Makes me want to go live in a rubber room for a couple of weeks to decompress.

Paper #2

Let’s get to the last thing here. This one is called “Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study” by Zacariah Shannon, et. al[2]. published in BMC Complementary and Alternative Medicine in December 2018. 

Why They Did It

They say that few studies exist on what the expectations of chiropractic care really are within a multidisciplinary setting so they wanted to add to the literature on this topic. 

What They Found

They found that expectations for the chiropractic program in this study were mostly positive. Good news. The idea of the patients making progress was the overriding theme for the group. They expected the addition of chiropractic to help patients progress by improving pain management and physical functioning. 

In addition, they also expected indirect effects of chiropractic on healthcare integration. Things like increasing the patient participation in other providers’ treatments which would lead to improved care for the patient across the board. 

I wonder if those other providers were or will be helping increase the chiropractor’s load as well? That’s a good question to ask. 

Wrap It Up

They summed it up by saying, “Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge.”

Not bad, not bad. It’s a helluva lot better than we had going on for us before the opioid crisis. I’ll give them that. I think the only part of this I really don’t like is their expectation of the chiropractor helping feed the rest of them while, in my biased opinion, they should be feeding the chiropractor first in an effort to keep people off of meds. 

Their stated goals are pain management and physical function. Well…that’s sort of right in our wheelhouse so why wouldn’t we be getting those first? I think the stakeholders have been fed quite enough. They’re fat as hell and slobbering. 

Bring the evidence-informed chiropractors in and watch your patients shine with happiness, leave amazing reviews, and go out and tell your city about all of the good things your clinic is doing. 

If they get the right evidence-based chiropractor in there, that’s the way I see it playing out because the research we covered several weeks ago shows us that chiropractors have the highest patient outcome satisfaction when compared to MD and DO’s, in fact, we wipe the floor with those people in regard to musculoskeletal issues. Not only that but we beat out the PTs as well on outcome measures. 

But we should feed them, right? They should be thankful to have us. 

Integrating Chiropractors The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

1. Schwartz L, W.S., Medical Marketing in the United States, 1997-2016. JAMA, 2019. 321(1): p. 80-96.

2. Shannon Z, S.S., , Gosselin D, Vining R,, Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. BMC Comp Altern Med, 2018. 18(316).

 

https://www.chiropracticforward.com/cf-025-vets-with-low-back-pain-usual-care-chiropractic-vs-usual-care-alone/

https://www.chiropracticforward.com/cf-032-how-evidence-based-chiropractic-can-help-save-the-day/

 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain