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Special Feature
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Special Feature
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Written by Ray Foxworth, D.C, FICC, MCS-P
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Monday, 25 March 2013 20:41 |
I can honestly say, after 27 years in practice, there has never been a better time to start a career in Chiropractic. Even with national healthcare reform moving forward, you can build a practice of your dreams by following some simple rules and taking time to look before you leap.
1. “Trust But Verify”
 It was President Ronald Regan who said, “Trust, but verify,” and it is still good advice today. You have so many things to consider in opening or joining a practice. Do not let the excitement of getting into practice lead you into making decisions that you may later regret. Take time to complete a careful review of associate agreements, building and equipment leases and provider agreements. Before you sign anything or join an existing practice, use your head and seek wise counsel from trusted colleagues and/or legal counsel. Never just take someone’s word for what you should and should not do, can and cannot do when it comes to running your practice or what is acceptable in operating a practice. This is not meant to be harsh toward those with good intentions who are offering advice to help you succeed, but it is meant to encourage you to protect your license to practice. As a medical compliance specialist, I have seen far too many cases where a doctor is facing fines and penalties and their only defense is, “Well, my buddy said it was okay and he does it all the time,” or “I heard my board of examiners said it was okay.” Verify what you hear about your state’s rules and regulations with your board of examiners, your state association, a trusted consultant, or established colleague with an impeccable reputation. When possible get verification in writing. This is most important when it comes to billing, coding, documentation and financial policy. Why? Because signing a bad lease can surely cost you money and aggravation. But improper billing, coding, documentation or faulty financial policies that lead to dual fee schedules or inducement violations can cause you serious financial harm, or worse, can cause you to lose your license. Game over. 2. Never forget, your license is a privilege to practice… not a right.Despite the years and thousands of hours devoted to completing chiropractic college and for some, hundreds of thousands of dollars spent, never forget, your license to practice is not a right but a privilege. And like any privilege, it can be taken away. Your license is extremely valuable and should be treated as such. Do not jeopardize your license by engaging in or participating in poor business practices or joining a practice that can clearly put you at risk. Violating rules and regulations from your Board of Examiners is bad enough, but the risks do not stop there. Make sure that your new practice, or the practice you join, is in compliance at all levels, from your State Board of Chiropractic Examiners or other licensing boards to the Department of Insurance for your state. Also, consider the rules and regulations from your Provider Agreements, State and Federal Anti-kickback Statutes, the Centers for Medicare and Medicaid (CMS/Medicare) and the Office of Inspector General (OIG). While this may seem overwhelming, it really is not that hard to accomplish with the proper guidance. If and when you find there are rules that conflict, and they do at times, take the safest and most conservative approach in determining your policy and document in your compliance manual what your decision was based on. Again, protect your license. It is, in essence, your passport for life to prosperity, so guard it carefully. 3. Remember, times are never good or bad, they are just different.You may have heard of the Mercedes ‘80s, a time when you could put anything on an insurance claim form, send it in, and a check appeared. Or perhaps you have heard the horror stories of managed care where only two visits were permitted by an insurance carrier. Having practiced through these times, as you might imagine, the truth lies somewhere in between. Never was it that easy in the 1980s, and if you documented properly to support medical necessity, rarely would you be limited to two visits. What is clear and beyond debate now is that you are entering practice at a time where all professions, including chiropractic, are under more scrutiny than ever before. There are more fraud and abuse investigations now than at any other time in history. Billions of dollars are being recouped by the federal government and insurance companies for fraudulent claims. It has been reported that the Office of Inspector General stated that for every dollar spent in healthcare fraud and abuse investigations, they recoup $17.00. So, do not look for audits to decrease; they are making money. Unfortunately, some of the scrutiny in chiropractic is warranted, and it will continue. My intent is not to instill fear, but to empower you with facts so you can minimize the risks of audits, fines and penalties and practice with some peace of mind. Here is the UPSIDE!
Again, protect your license. It is, in essence, your passport for life to prosperity, so guard it carefully. More doctors are taking a look at their billing, coding and documentation and are taking steps to be more compliant with all the layers of regulations. Make sure you start off the right way by knowing and following the rules. If you are joining an existing practice, make sure you know they are aware of the rules and regulations and are proactive in making sure they are running their practice in a compliant fashion. I can tell you, far too many docs like me who have been practicing for many years ignore the fact that the rules have changed, and we must change. If you run into a great opportunity to join a practice, but the doc’s head is in the sand, use the opportunity to help them bring needed change to their practices if they are open to it. If they are not, then it is simply not in your best interest to join that practice. 4. Know how joining an existing practice can put you at risk.When you treat a patient, whether in your own practice or not, you have an NPI number that is recorded on the claim form. The NPI identifies you as the treating/ordering doctor. Even if someone else owns the clinic, your NPI is on the claim form and you are responsible and accountable for what is on the claim form. Box 31 of the CMS 1500 form is an attestation that the information is accurate, and you agree to the statements on the reverse side of the form, including: I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished incident to my professional service by my employee under my immediate personal supervision, except as otherwise expressly permitted by Medicare or CHAMPUS regulations. So whether you are personally responsible for sending out the claims or not, you are held responsible because you have allowed them to use your NPI number as the treating/ordering doctor, and you are at risk if the practice is not operating in a compliant fashion.
5. Look and ask before you leap. If you have decided to join an existing practice, even the family practice, there are things to consider and respectfully ask about before signing on. Yes, it is okay to ask questions of mom and dad or other family members. As a second generation chiropractor who did, I can tell you it may not be easy, but you have a right and an obligation to know some key things about the practice. Here is a short list:
- Do you have sound financial and billing policies in writing? Ask for a copy and review them.
- Is there more than one fee schedule? If so, why? And is it legal? In some states, charging more to insurance patients than you do for cash patients is considered a “dual fee schedule” and could be illegal. Ideally, there should be one fee schedule. One of the safest policies is to only offer discounts when they are part of a written financial policy, which could include contractual or network discounts, mandated fees like those established by Medicare, or when there is a documented financial hardship. Other legal discounts could include a defensible time of service or prompt payment discount, if and only if permitted in your state. If you would like a copy of a simple, one page financial policy that is rock solid, send an email to
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and put FORM in the subject line.
- Does the clinic up code, or down code based on the type of insurance coverage? Meaning, do they bill a higher level of Evaluation & Management code for PI or Worker’s Compensation cases and a low-level code just because they are cash patients?
- Do you waive deductibles or co-payments? This is clearly a violation of rules and regulations and most provider agreements unless a true financial hardship is established by the clinic.
- Do you have a written financial policy that is covered with patients? Many complaints to Boards of Examiners seem to be triggered by a poor financial policy, which is easily eliminated by written policy.
- Does the clinic have a compliance plan in place to minimize the potential for fraud and abuse and to ensure compliance with all layers of regulations? There are many steps that can be taken today to minimize the potential for audits and mitigate potential fines and penalties.
- Has the practice ever been audited? If so, what was the outcome? Today, it is not a matter of if you will be audited, but when. And, keep in mind, just because there has been an audit does not mean someone did something wrong. It could just be their number came up.
For further advice on developing office financial policies, request a copy of our “7- Steps to a Sound Financial Policy,” recently published in The American Chiropractor. If you are a recent graduate or will be soon, start learning about compliance now. It is never too soon and never too late. I often say, compliance is not an event, it is a process, and it should be ongoing. Start learning more about billing, coding, and documentation and what a sound financial policy should contain. If you or the practice you are considering joining offers discounts to your patients, learn about the role of Discount Medical Plans and how they can help you help your patients by offering legal network-based discounts without putting yourself at risk.
Finally, despite what seems like a list of overwhelming decisions and concerns, you are embarking on a career as a doctor of chiropractic at a time that has opportunities like we have never seen before. Expect the best, give your best to the profession and your patients, and you will not be disappointed. Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. He founded ConservaCareCorp, the first chiropractic network selected by the State of Mississippi to serve over 195K covered lives in the State Health Plan. You can contact Dr. Foxworth at 1-888-719-9990,
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or visit the ChiroHealthUSA website at www.chirohealthusa.com
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Special Feature
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Written by John Leonesio
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Monday, 25 March 2013 18:29 |
H aving been in business for over 40 years and franchising for over a decade, I often get asked why would anyone buy a franchise when they could just open their own business. They will then go on to tell me about some friend or relative who invested a lot of money in a franchise just to lose it all or have the franchise go out of business. These are usually people who have no concept of what it takes to start a business and have not done any research on franchises. The facts speak for themselves; when you look at the statistical data provided by FranFinders, franchise consulting group, franchise businesses account for nearly 50% of all retail sales in the U.S. Franchise businesses employ more than 14 million Americans, with an estimated 5,000 franchise concepts in 75 different industry categories. To be even more concise, 1 out of every 12 businesses in the U.S. is a franchise and total sales for franchise businesses are approximately 2 trillion dollars annually.
 Even though you may hear reports of franchises closing in the media, the fact is that from 1971–1997, less than 5% of franchise businesses closed each year. A study conducted by the U.S. chamber of commerce found that 95% of franchises are still in business after 5 years, compared to just 47% of self-launching businesses. Buying a franchise more than doubles your chances to survive as a business owner, and by choosing the right franchise your likelihood for success can be greatly improved. So how do you choose the right franchise for you? Do you jump on the latest and fastest growing hot trends, or do you go with an older more established company everyone knows and that has a strong brand identity? Would you rather stay in your comfort zone and do something in a field you are more familiar with? Do you want a big business, small business, home based, or the chance to have multiple locations? What is the size of the market and how strong is the franchisor? The truth is, the reason most franchisors are successful comes down to just several things. First, the business model has proven to be successful and profitable and has the history and data to prove it is sustainable and not just a fad. Next, the franchisor is always striving to provide its franchisees with the best possible business tools to support them in all areas of the franchise business. The strongest franchise companies will take the time and money to reinvest in supporting their franchisees and develop ways to open communication and listen to their community. A good franchisor will make decisions that benefit all its franchisees equally, greatly increasing your chances for success. So back to the question, should you jump on the hot new franchise concept or not? Do so only if you believe and can prove it is sustainable and the franchisor has the support systems in place to help you while building a strong brand. Sometimes, new franchisors cannot grow or react fast enough to support their rapidly growing network. It takes a great deal of time and a good management team to create, develop and implement new, strong systems and establish a positive brand image all at once. However, if you are one of the first franchises and the brand explodes, the equity and value of your franchise could be huge in the future. Do your research carefully on new franchise concepts and talk to as many existing franchise owners as possible asking for their candid opinion on how the franchisor is handling their growth. More established franchise companies should look and feel like well-oiled machines and provide you the greatest chance for success, but often times it is hard to find good new locations and territories when the brand has been around for a while. Established franchise concepts can also be considerably more expensive because the brand has grown and become more valuable. Do you want to stay in your comfort zone? If the franchise culture doesn’t mesh with your personality, then your chance of success could be greatly reduced. If it requires a certain skill set like a strong sales background, and you don’t enjoy sales, don’t do it. If you are already trained in or are familiar with the franchise concept you are looking at, all the better. The franchisor will then just need to train you on their systems and culture and give you the tools to market and manage your business. No matter if you wish to have a small, home based franchise or a larger more established franchise, the process is the same. Do your homework; there is a saying in franchising— when you buy a franchise, you are in business for yourself but not by yourself. Before buying any franchise, a visit to the corporate office for a discovery day to meet all the different departments you should have at your disposal, is a must. Initially, you will incur the cost of a licensing fee which gives you the right to learn the systems, use the name, logos and intellectual properties developed by the franchisor and provide you with extensive training on the model and its systems. On an ongoing basis, you may also be paying a royalty fee back to the company to help support you and your franchise business. Always know what support is available to you and use it. That is what your royalties are for.
So if you think you can own a franchise and have control over the offer, message, pricing, look, and logos then franchising is not for you. With over 5,000 different franchises to choose from, you can take your time. You should never purchase a franchise you’re not certain about and the decision should be yours alone and never left to a salesperson or broker. I truly believe that buying a franchise is a wonderful way for first time business owners to learn many of the basic business skills they can use the rest of their lives. Marketing, accounting, time management, information technology, vendor relations, real estate, the list goes on. For those who are more experienced, many franchise companies have area or regional developers who represent and support a group of franchisees in a certain geographical area. Regional developers are franchisees who buy the right to sell, develop and oversee a defined geographic area and must be well-trained on the model and operating systems. They not only represent the franchisor’s interest, but also the franchisee’s. I believe that franchising definitely gives you the greatest chance for success, but I also know that franchising isn’t for everyone. Franchisors must protect their brand identity, story and image at all costs. So if you think you can own a franchise and have control over the offer, message, pricing, look, and logos then franchising is not for you. Franchising encourages entrepreneurial spirit but only to a point. A good franchisor will not allow franchisees to do their own thing as it will ultimately dilute the value of the brand for all who have invested in it. A good franchisor will have a feedback system already in place so they can listen and learn from their franchising community. This may include a franchise advisory board, focus group, steering committees, annual conferences and a help desk. Take your time, make the calls, visit the locations, ask for the latest up to date franchise disclosure document (FDD) that every franchisor is required to provide you and don’t forget to make that trip to visit the corporate office. The FDD will provide you with all the legal information about the franchisor. Franchisors are legally required to update their FDD each year with a current list of open, closed, and transferred franchises as well as a corporate audited financial statement required by the U.S. Security and Exchange Commission (SEC). The FDD will also contain estimated opening costs and in some cases earning claims for the average franchise and the highest and lowest producing units. Finally, if you have made the decision that a franchise is a good fit for you, have a qualified franchise attorney review the FDD as well as the franchise agreement to be certain you understand every fee you will be required to pay as well as your obligation to the franchise and the franchisor’s obligation to you. Owning a franchise can be a wonderful partnership with the right franchisor and create great relationships with your fellow franchise owners, with whom you share a common bond. In addition to making a good living, you can build value and equity in your business enabling you to someday sell it or pass it down. Just do your homework and enjoy the experience— it could reward you for a lifetime! John Leonesio is a recognized expert in the health, wellness and franchise industry. He is the CEO of The Joint…the chiropractic place . He co-founded Scandinavian Health Spas, growing it from one club to 40 clubs. In 1990, he founded The Q, the Sports Club, growing it to 20 units before selling to 24 Hour Fitness. In 2002, Leonesio founded Massage Envy. In just 6 years, he took it from concept to a $300 million operation with more than 800 licenses awarded. |
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Special Feature
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Written by Kira Bailey, DC with introduction by Edward Hallowell, MD
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Monday, 25 February 2013 22:39 |
C hiropractic patients consistently rate their care services very highly, and yet many chiropractors must work hard to find and keep patients. I argue that just because everyone needs chiropractic care, it doesn’t mean you should market to everyone. I have studied entrepreneurs for years, and have found that the most successful ones target specific groups and prequalify their target population. Niche marketing has proven successful in countless applications, but only recently has this concept been applied to the ADHD (Attention Deficit Hyperactivity Disorder) niche in the chiropractic profession.
 ADHD is a neurological condition that is usually transmitted genetically. It is characterized by distractibility, impulsivity, and restlessness or hyperactivity. These symptoms are present from childhood through adulthood, and with a much greater intensity than in the everyday person, so much that they interfere with daily functioning. The Centers for Disease Control indicate that over 5 million children in the United States have ADHD*. Most children carry this condition with them into their adult years.
In my opinion, I see ADHD as neither a disorder nor a deficit of attention. I see ADHD not as a disability but as a trait. When managed properly, it can become a huge asset in one’s life. Patrick Gentempo, DC, a highly revered chiropractor and founding partner of the CLA (Chiropractic Leadership Alliance), and I immediately recognized the opportunity to blend my strength-based ADHD protocols with the CLA’s clinical and neurological expertise. With the clinical guidance of Drs. David Fletcher, Kira Bailey, Steven Genopolous, and Patrick Gentempo, SHINE For Doctors—Special Help Integrating Neurological Experience—has become the profession’s leading program in the education and training of DC's aspiring to care for the millions of people with ADHD.
These highly gifted and often highly troubled individuals are actively looking for drug-free assistance with their symptoms. SHINE For Doctors is designed to train DCs how to address and assist in the management of ADHD in children and adults using holistic, natural techniques.
The SHINE For Doctors exclusive web-based,on-demand, educational training program is chock full of comprehensive information including: ADHD content derived from my more than thirty years of experience; attention and psychological profile assessment tools; cutting-edge information about neurological retraining; comprehensive evaluation tools including patterns of spinal neural tension, hemispherisity, and visual ocular motor capacity; and clinical integration and marketing support. This was all designed to help practitioners quickly and effectively provide ADHD support within their existing chiropractic practices.
Q: How are Chiropractors uniquely positioned to help people with ADHD?
A: DCs offer something unique to the spectrum of care for ADHD clients and their families. The chiropractic profession, founded upon a deep understanding of nervous system function and its potential effect on all facets of a person’s life, health, and behavior, has long been involved in pioneering research related to the underlying causes of ADHD. In addition, a great deal of research by some of the world’s leading chiropractic experts has been devoted to developing drug-free, holistic ADHD management strategies.
Chiropractors around the globe have reported phenomenal success when working with patients with ADHD. The effect of a chiropractic adjustment upon the nervous systems of patients with ADHD has proven to be efficacious in reducing the symptoms they experience.
Q: How can a DC benefit from the ADHD multi-million dollar health care industry?
A: The answer is by aligning with a professionally branded, holistic, drug-free, neurologically based, and powerfully effective program of ADHD management that boasts association with Dr. Hallowell's three decades of ADHD expertise. Becoming a SHINE certified practitioner automatically adds increased credibility with prospective patients and the medical community. Many of the people with ADHD have created support groups in their communities and this association will enable the DC to leverage the authority that my reputation provides. The DC is already pre-qualified with this well-educated ADHD community. In addition, aligning with SHINE For Doctors also increases the DC’s ability to expand their service offerings and reach into their community beyond the spinal care model.
Q: What commitment will this take and how will it fit into an existing practice?
A: SHINE for Doctors is a unique program of ADHD management that incorporates the knowledge, skills, and research of some of the world’s leading experts in ADHD and chiropractic technologies. It is intended for the practitioner who is dedicated to learning this intricate product, and willing to make the commitment to ensure consistent success. DCs must consider that an investment in advancing their skill sets and knowledge bases into such a growing and “in-demand” niche market serves to distinguish their practices from the rest of their competitors, establishing them as distinct and prestigious “experts” in their field.
This program incorporates easily into the scope and framework of the existing DC practice and is complete. It is composed of in-depth, on-line, and on-demand training that delivers a superior knowledge base, system of analysis, and clinical protocols designed to facilitate success using the latest in research and technologies surrounding ADHD. Some practices choose to offer the evaluations on particular days and at predetermined times so that the ADHD clinics become an add-on to their existing client base.
SHINE For Doctors does not train the DC to diagnose ADHD; rather it provides the DC with the tools to make assessments consistent for people with ADHD and to achieve success when working with this population.
SHINE For Doctors Clinical Overview
Q: What composes the clinical content of SHINE For Doctors?
A: The clinical content of SHINE For Doctors is based within the neurological model of chiropractic and also advances the practitioner’s knowledge into what can be termed “brain-based care.” The theory of neuroplasticity forms the root of the SHINE clinical protocols. Neuroplasticity refers to the brain's ability to reorganize itself by forming new neural connections and for the brain, nerves, and nerve pathways to adjust their activities in response to new situations or changes in their environment. This approach is very much in concert with a host of new research on ADHD labeling it a “neurobehavioral” disorder; the structure and function of the individual’s neural array is directly linked to the expression of the classic, hallmark symptoms (inattention, impulsivity, and motor hyperactivity) of ADHD. Interestingly, Autism and Asperger's syndrome are also being placed along the same “spectrum” as ADHD. The current perception is that these syndromes are all different facets of the same underlying pattern of neurosensory dysfunction that characterizes ADHD.
There are a whole host of neurosensory processing disorders whose outward symptomatic expression mimics ADHD; consequently, these systems must be carefully evaluated.
The neural pathways through which the body’s nervous system takes in, processes, and mounts an appropriate response to sensory stimuli can be affected by many factors during development and can be altered in response to their current environment as well. Exposure to stress, in the form of physical trauma (both macro and micro), poor nutritional habits, emotional trauma, radiation, heavy metals, drugs (prescription and nonprescription), alcohol, smoking (both first-hand and passive), and a host of other factors in combination with genetic predisposition all affect neurological development and the subsequent ability of the body to process and integrate sensory information. The symptoms that define ADHD are a direct result of the struggles of an individual’s nervous system and brain to process, coordinate, and respond appropriately to stimuli coming from the world around it. As such, ADD/ADHD is commonly misdiagnosed by professionals who perhaps do not understand or do not adequately screen for sensory processing disorders, including those related to vision, hearing, and sensory “over” or “under” responsiveness. There are a whole host of neurosensory processing disorders whose outward symptomatic expression mimics ADHD; consequently, these systems must be carefully evaluated. It is important to note that it is not the goal of a SHINE for Doctors practitioner to diagnose ADHD, but rather to evaluate and assess the individual’s strengths and weaknesses in order to understand the potential source of the behaviors being observed to the best of their abilities.  The base of the SHINE model is neurological rebalancing through the application of the chiropractic adjustment. Proprioceptors located in the joints and muscles of the spine provide the largest source of information coming through the cerebellum into the brain. It is therefore crucial to ensure that there is no neural or dural tension or stress being held in the spinal structures. Adjusting the spine affects brain and nervous system function through enhancing the quality and quantity of information being conveyed into the cerebellum and subsequently the prefrontal cortex. Therefore, it is critical that the chiropractor ensures that the spine is free of all forms of tension and stress; a structured program of neurologically balancing adjustments focused on restoring neural integrity in the patient with ADHD accomplishes this goal. The next layer of the SHINE model is an expansion upon the basic premise of the model’s foundation, an appropriately integrated neurological system. The SHINE doctor will use the results of their clinical analysis to create an individualized program of Neuro-Integrative Movements (NIM’s) designed to strengthen, balance and improve brain function. The NIM’s training exercises work precisely to strengthen specific neuro-sensory pathways, such as cerebellar function, balance and proprioception, vestibular function, basic visual and ocular-motor function, core strength and stability, and right vs. left hemispheric re-balancing. By isolating and strengthening specific pathways through consistent training protocols the individual’s ability to integrate and process information is improved. It is through this re-training process that the brain is able to better interpret incoming information and mount a more appropriate motor response, decreasing the outward expression of ADHD symptoms. The apex of the Life Essentials model is Metabolic Shift. There is a characteristic association of brain and gut dysfunction in those with ADHD that needs to be addressed in order to create positive symptomatic shift. Of course, the metabolic status and digestive function of each person is unique, but there is a wealth of scientific research into the characteristic patterns of gut function, inflammation, and food sensitivities of those with ADHD. The Metabolic Shift protocols of the SHINE program focus upon two principles: eliminating inflammatory and low nutritional status foods from the diet (gluten, casein, sugars, artificial preservatives, and colorants) and supplementing with nutraceuticals that augment neurological and digestive function while suppressing systemic inflammation (EFAs, probiotics, zinc, vitamin B6, magnesium to start). When the brain is given the appropriate fuel for optimal function, and pro-inflammatory elements are removed, we once again see an upshift in function and a downshift in symptomatic behaviors.  The SHINE for Doctors clinical care model is designed to create maximal healing and reorganization within an initial 90-day window of transformative shift. It was also created to integrate as seamlessly as possible into a chiropractic practice. The SHINE patient can be adjusted during the normal flow of patient interactions, with some coaching and monitoring of the NIMs exercise protocols and dietary changes delivered at measured intervals. Rebalancing a person’s neural and metabolic function in combination with Dr. Hallowell’s unique approach to coaching and facilitating success, provides a phenomenal platform for change within the patient with ADHD. Patients and those close to patients (parents, teachers, and coworkers) report improved school and work performance, better behavior, a happier home, better teacher, student, social, work, filial and romantic relationships, a sense of “feeling” better both emotionally and physically along with better sleep and increased ability to focus and improved self-esteem. SHINE For Doctors is the ADHD choice for the Chiropractic professionDr. Edward Hallowell is instantly recognizable within the medical and educator communities and his position as a co-creator endows credibility and prestige upon the DCs implementing SHINE for Doctors into their practices. It is the ideal program for practitioners who wish to offer superior service to the ADHD population, access an increased market share, generate new income streams, and distinguish themselves from the rest of the chiropractors in their region. This program is poised to be a game changer in the chiropractic profession; the goal is to change the lives of a million patients and families of those with ADHD. If you are a keen and self-motivated chiropractor who wishes to be a part of this phenomenal community, SHINE for Doctors is your best avenue to achieve unique practice success. To learn more, visit www.shinefordoctors.com or http://www.cdc.gov/nchs/fastats/adhd.htm
Edward Hallowell, M.D. a leading authority on ADHD, is the co-founder of the SHINE For Doctors program. He is a gifted psychiatrist, a NY Times best selling author, and was on the Harvard Medical staff for over 20 years. He is the founder of the Hallowell Centers in New York City and Boston, and has appeared on numerous national TV programs including Dr. Oz, Oprah, Dr. Phil and Good Morning America. You may contact Dr. Hallowell at
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or visit www.drhallowell.com.Kira Bailey, DC, the Clinical Implementation Director at SHINE For Doctors, is a co-contributor to the chiropractic clinical portion of the SHINE for Doctors program. She has a large family-oriented chiropractic practice, and has spent the last few years creating and operating a successful ADHD management center in Ontario, Canada. You may contact Dr. Bailey at
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or visit www.guelphchiropractic.com. |
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Special Feature
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Written by Curtis Turchin, D.C., M.A.
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Sunday, 25 November 2012 19:16 |
O ne of our jobs, as doctors of chiropractic, is to fight the wildly excessive use of prescription and recreational drugs. Do you realize that The National Institute on Drug Abuse has found that one in nine youths abused drugs in the past year? In addition, in 2011, seven percent of 8th graders, 18 percent of 10th graders, and 23 percent of 12th graders used marijuana¹.
 After marijuana, prescription and over-the-counter medications are the most commonly abused drugs among teenagers. These include Vicodin, Adderall, tranquilizers, cough medicine, MDMA, hallucinogens, oxycontin, and sedatives.²
There is no question that America is a drug-addicted nation. The U.S. has the highest level of illegal drug use in the world. Americans are four times more likely to report using cocaine in their lifetime than the next country with the next closest level of cocaine use.
But that is not all. Americans also lead the world in using doctor-prescribed drugs as well! A recent study, based on the consumption of prescription drugs for 14 different diseases in 14 different countries, showed the same result. Please note that this study was not looking at prescription drug abuse, but rather studying how much medicine was prescribed by doctors for diseases like cancer, neurological diseases, hepatitis, etc.
Americans took more medically-prescribed drugs per person than the inhabitants of any other country in the world! After the U.S., Spain ranked second and France was third. This means that the U.S. ranks number one in both drug abuse and use of medically-prescribed drugs!³ We have a big job on our hands to try to change this horrible situation.
As doctors of chiropractic we must view these statistics with alarm. The fact that American adults and young people use legal and illegal drugs at such an alarming rate means that we are in the midst of a serious problem. Yet, the laws that have been passed have not changed the situation. In fact, if you look at countries like the Netherlands where it is legal to use drugs, the abuse of prescription medication and recreational drugs is significantly lower than in the United States!4
To stem the tide of rising drug abuse we must promote natural healthcare and healthy living. Succeeding at this goal requires us to educate patients about the safety and efficacy of natural health care. Part of this natural health focus is to convince patients to use natural substances to replace prescription drugs, with their well-known and toxic side effects. Our first step is to understand the most popular prescription medications and the natural alternatives.
One of the main areas of concern for doctors of chiropractic is the abuse of prescription and over-the-counter medications for pain and inflammation. The most popular medications include ibuprofen, which is sold as Advil, Motrin, and Nuprin.5 Acetaminophen, which includes Excedrin, Aspirin and Tylenol, Aspirin, and naproxen (Aleve) are also extremely popular.6 It is common for patients to be prescribed muscle relaxants, prednisone, a corticosteroid, Celebrex, a cox-2 inhibitor,7 codeine, and Vicodin. What are the alternatives?
There are many proven remedies that can help pain and inflammation. The popular natural supplement turmeric is probably the most studied and possibly the most affective anti-inflammatory available. A component in turmeric, curcumin, which is an ingredient in Indian curry, reduces inflammation in many painful conditions such as arthritis and psoriasis. Like Celebrex and Vioxx, turmeric is a cox-2 inhibitor. There are a number of combination supplements that contain turmeric; it is commonly combined with ginger, holy basil, boswelia, bromelain, and white willow. Common dosages are 1,000 to 5,000 mg or more per day.
Fish oil, including a number of different types of omega 3 fatty acid supplements, also has powerful anti-inflammatory affects. It breaks down into chemicals called prostaglandins, which reduce inflammation. Studies have shown that by taking fish oil, many patients are able to reduce their anti-inflammatory medication significantly or stop entirely. Common dosages are 1,000 to 5,000 mg or more per day for the reduction of inflammation.
It is common for patients to be prescribed muscle relaxants, prednisone, a corticosteroid, Celebrex, a cox-2 inhibitor,7 codeine, and Vicodin.
For pain it is not uncommon for a patient to take 2,000 to 8,000 milligrams daily of Glucosamine Sulfate. Glucosamine Sulfate helps to restore synovial fluid and helps to regenerate cartilage. It is often combined with Chondroitin Sulfate and Methylsulfoneal Methane (MSM). This combination of three ingredients is a common remedy for inflammation and pain. There is a significant amount of research that has documented that individually or in combination these supplements can not only reduce pain but also improve the health and quality of cartilage.
Arnica is another popular remedy, although it is less well understood and does not have as much research behind it as turmeric and glucosamine sulfate. As a topical lotion or ointment, the arnica herb has been shown to be anti-inflammatory.
It is also used as a homeopathic remedy. However, because the mechanisms for homeopathy are so poorly understood, it is hard to find much quality research.
Doctors of chiropractic must also be aware of the fact that many of their patients could have pain from the side effects of statin drugs. Statins, the most widely prescribed medication for high cholesterol, can cause many types of joint and muscle pain. Most of us do not realize that approximately half of the men ages 65 and over and almost 40 percent of the women take statins! That is a startling statistic. In addition, 25 percent of the reported statin adverse side effects include muscle pain! Diagnosing pain from statins is difficult because the onset can be anywhere between four weeks and four years after starting statins.
There are alternatives to statins. Red rice yeast is probably the most popular and well-studied supplement to lower cholesterol levels. One to two grams of red rice yeast has been shown to significantly reduce cholesterol levels. In addition, four to thirteen grams of glucomannan, 3000 to 15000 milligrams of beta-glucan or 200 to 500 micrograms of chromium have all been shown to lower total cholesterol, triglyceride, and low-density lipoprotein-cholesterol.
For those doctors who are interested in laser therapy, there is also a growing body of research that indicates that laser therapy can potentiate the effect of drugs and supplements when the laser is focused on the area that requires regeneration.
In summary, there are many common problems where over-the-counter and prescription drugs can be replaced with natural, healthier nutriceuticals. By continuing to focus on alternatives to medication, doctors of chiropractic will be helping to thwart America’s addiction to prescription and over-the-counter medications.
Reference:
- National Institute of Drug Abuse, July 2012.
- WHO World Mental Health Surveys, 31 Mar 2009
- Extent and causes of international variations in drug usage: a report for the Secretary of State for Health, July 27, 2010.
- Extent and causes of international variations in drug usage: a report for the Secretary of State for Health, July 27, 2010.
- The Physician and Sports Medicine 38 (1): 132–138.
- WebMD Health News, April 20, 2011
- Food Funct. 2012 Jul 26.
- Br J Clin Pharmacol. 2012 Jul 6
- Ther Adv Musculoskelet Dis. 2012 Jun;4(3):167-80.
- BMC Complement Altern Med. 2011 Jun 27;11:50
- Int J Rheumatol. 2011;2011:969012.
- Holist Nurs Pract. 2008 Jul-Aug;22(4):237-9.
- Med Health Care Philos. 2012 Apr 27
- Harvard Health Publications, Statin use is up, cholesterol levels are down: Are Americans’ hearts benefiting?, April 15, 2011.
- J Cardiovasc Pharmacol Ther 2006; 11: 105-12.
- Ann Intern Med 2002; 137: 581-5.
- Evid Based Complement Alternat Med. 2012
Curtis Turchin, M.A., D.C. is an expert in the field of laser treatment, low force adjusting and therapeutic exercise. He has published 4 books and more than 20 journal articles on chiropractic and laser therapy. Dr. Turchin is the author of the best-selling book, Light and Laser Therapy: Clinical Procedures, the authoritative text on clinical laser treatment, as well as Veterinary Laser Therapy, and Treating Addictions with Laser Therapy. He has lectured at many chiropractic colleges and state associations. If you have any questions, please feel free to contact him. Contact him at:
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
or 650-224-8789. His teaching website is: http://www.innateadjusting.com
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Special Feature
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Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.
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Sunday, 25 November 2012 18:53 |
A s published by the University of North Carolina at Chapel Hill, "The most common definition of EBP [evidenced-based practice] is taken from Dr. David Sackett, a pioneer in evidence-based practice. EBP is 'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research'" (The University of North Carolina at Chapel Hill, 2010, http://www.hsl.unc.edu/services/tutorials/ebm/whatis.htm).
As the University of North Carolina at Chapel Hill goes on to explain, EBP is the integration of:
- Clinical expertise: The clinician's cumulated experience, education and clinical skills.
- Patient values: The patient's own personal and unique concerns, expectations and values.
- The best research evidence into the decision-making process for patient care: The best evidence is usually found in clinically relevant research that has been conducted using sound methodology.
 "The evidence, by itself, does not make a decision for you, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters, which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders. Evidence-based practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature" (The University of North Carolina at Chapel Hill, 2010).
Wilbeck, Murphy, Heath, and Thomson-Smith (2011) report acute-care nurse practitioners now have metrics to evaluate procedural competencies based upon evidence-based research and care (EBR). Cuellar, Rogers, and Hisghman (2007) report healthcare providers treating sleep disorders in older adults use EBR to provide implications for care. Brady and Smith (2012) report physiotherapists working with high-risk neonatal patients used EBR to achieve a standardized level of competence and enabled the identification of the learning needs required to ensure a certain level of competence. Miller and Skinner (2012) report midwives certify home birth as a less invasive process based upon EBR. These are just a scant few examples in the healthcare industry of how evidence-based research and practice is being used as a tool to improve the quality of care of practitioners along the broad spectrum of healthcare providers.
Evidence-based practice is not unique to chiropractic, only to many in concept and practice because as a profession, our culture and history have been based upon results in our individual offices with a poor infrastructure for research and reporting due to lack of funding. This can possibly be traced to "formal medicine's" continued attack on chiropractic and their having control over governmental research dollars. There are also large splinters in the profession moving in different directions, resulting in each faction independently seeking control.
Reggars (2011) reported a parallel in Australia: "The 1970's and 1980's saw a dramatic change within the chiropractic profession in Australia. With the advent of government regulation, came government funded teaching institutions, quality research and increased public acceptance and utilization of chiropractic services. However, since that time the profession appears to have taken a backward step, which in the author's opinion, is directly linked to a shift by sections of the profession to the fundamentalist approach to chiropractic and the vertebral subluxation complex. The abandonment, by some groups, of a scientific and evidenced based approach to practice for one founded on ideological dogma is beginning to take its toll" (p. 1). Although Reggars concluded that the root of chiropractic's "backward step" is the ideological dogma of the subluxation practitioners, he is both partially correct and concurrently omitting the other half of the equation.
The first step in moving forward and understanding the full spectrum of the issues is to take a stark look at the statistical facts versus beliefs and rhetoric. In 2010 Davis, Sirovich and Weeks reported that chiropractic utilization in the United States remained static at 12.1 million from 2003 until 2006. This represents 4.12% of the population according to the 2003 population reported by the Encyclopedia of the Nations. Davis et al (2010) also reported that in the early 1990s, chiropractic was utilized by 7.7% of the United States adult population, realizing a net loss of utilization of 3.58% in just a decade.
While Reggars lays blame on the "subluxation dogmatists," we cannot forget our heritage and history of what got us to caring for 7.7% of the population: Results through nothing more than the chiropractic adjustment. Treating patients with asthma, colitis, eczema, headache, migraine, scoliosis, ADHD and a host of other maladies resulted in both the chiropractors and their patients laying claim that chiropractic care resolved their health issues. I am not referencing or footnoting these claims because I have witnessed them firsthand and am reporting that these types of patients respond to chiropractic care in a repeated, systematized fashion. These types of patients, along with the multitudes of others that have realized pain relief from chiropractic care, have inspired generations to fight for chiropractic to attain our position in mainstream healthcare.
When one does a query in PubMed on "vertebral subluxation (VS)," there should be 100,000+ hits ...
In spite of the rhetoric from subluxation-based practitioners, when we look in PubMed and other scientific search engines, there is significant commentary but minimal reporting of evidence-based scientific conclusions. There is a growing body of low-value research in case reports, but the publishers have decided to hide that behind a curtain of profiteering, preventing the scientific community and the profession from accessing that information. In spite of the greed or lack of accepted evidence-based research, there is one underlying fact: Results. It doesn't take research to help patients get better—it only takes chiropractic care.
The other side of the argument is clear and powerful. Without the evidence, chiropractic will not evolve past 1895, and that is the second part of the core of the problem. When one does a query in PubMed on "vertebral subluxation (VS)," there should be 100,000+ hits on VS and asthma, colitis, eczema, etcetera, that show the evidence-based research in an accepted scientific format; i.e., how 800 patients in a controlled study showed evidence of a malady resolving with nothing but chiropractic care. We can say with a great degree of certainty that the pharmaceutical companies and many medical specialties will fight funding of any research that can lower their bottom line. These types of studies, without hospital populations of illnesses or teaching institutions associated with hospitals to funnel these populations of illnesses to a study, offer greater challenges for the chiropractic profession. In addition, the costs are significant, and chiropractic does not have the political leverage to garner governmental grants at that level. Therefore, without the evidence-based research and evidence-based practice, we will be stuck with ideology based upon empirical results in our offices: a practice designed for failure over time.
CONCLUSION: In spite of the loud rhetoric from the conservative far right fighting for subluxation only in the "1895 model" and the liberal far left fighting for severe expansion of scope in an evidence-based model only, those factions have to realize they are collectively responsible for the 4.12% of the population we now care for. The chiropractic message is so muddled that a confused public has already emigrated to alternative treatments.
PLAN: The only plan that is reasonable and that will move the profession to grow is for the evidence-based practitioners to stay the course and embrace the subluxation ideology until research catches up. Patients get well in spite of the research not being there. In addition, the subluxation practitioners must embrace the evidence-based providers and fight for and support financially real research, not just that designed to further the ideological causes, but the broad spectrum of research that will eventually conclude the truth of the true scope of what chiropractic has to offer. We must also support research by embracing our colleges and universities because, inherently, that is where the DCs, DC PhDs and others qualified to do research lend their careers. It is our only way up. Author's concluding note: The only way to remove the splinters and impediments for success is to have a single chiropractic organization in the United States with 50 chapters—no multiple national organizations and no state organizations. Combined, we are a political force with leverage. Splintered, we will continue to get more of the same: less and less every year.References:
- The University of North Carolina at Chapel Hill (2010, July). What is evidence-based practice (EBP)? Retrieved from http://www.hsl.unc.edu/services/tutorials/ebm/whatis.htm
- Wilbeck, J., Murphy, M., Heath, J., & Thomson-Smith, C. (2011). Evaluation methods for the assessment of acute care nurse practitioner inserted central lines: Evidence-based strategies for practice. Journal of the Association for Vascular Access, 16(4), 226-33.
- Cuellar, N. G., Rogers A., E., & Hisghman, V. (2007). Geriatric Nursing, 28(1), 46-52.
- Brady, A., & Smith, P. (2012). A competence framework and evidenced-based practice guidance for the physiotherapist working in the neonatal intensive care and special care unit in the United Kingdom. Journal of Neonatal Nursing, 18(1), 8-12.
- Miller, S., & Skinner, J. (2012). Are first-time mothers who plan home birth more likely to receive evidence-based care? A comparative study of home and hospital care provided by the same midwives. Birth, 39(2), 135-44.
- Reggars, J. (2011). Chiropractic at the crossroads or are we just going around in circles? Chiropractic & Manual Therapies, 19(11), 1-9.
- Davis, M., Sirovich, B., & Weeks, W. (2010). Utilization and expenditures on chiropractic care in the United States from 1997 to 2006. Health Research and Education Trust, 45(3),748-761.
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