Written by TAC Staff
Sunday, 01 April 2012 00:00
Interview with Dr. Glen Bobker, Certified iMRS/Mediconsult Health Technician
Dr. Glen Bobker received his undergraduate degree from SUNY at STONY BROOK (1976) and his Doctorate (1981) from New York Chiropractic College (NYCC). Graduating from NYCC with honors, he was inducted into Phi Chi Omega, the International Chiropractic Honor Society.
He has established two successful practices (New York and Florida) in his well respected 30 year career. Dr. Bobker is currently in solo practice in Fort Lauderdale, Florida.
Like many practitioners, he has added many novel therapeutic modalities such assist his patients achieve wellness (i.e., therapeutic ultrasound, low level laser therapy, I.M.S, E-Stim, Kinesiology Tape and Whole Body Vibration Therapy, Currently, Dr. Bobker is very excited about incorporating the modern and powerfully therapeutic modality of Pulsed Electromagnetic Field (PEMF) therapy into his practice. Dr. Bobker has become a passionate enthusiast and advocate of this revolutionary approach to health and as such, has taken upon the mission of becoming the liaison to the chiropractic profession as a Certified iMRS/Mediconsult Health Technician.
TAC: Tell us in depth about how or why PEMF therapy fits into the services offered by the chiropractic profession.
GB: The concept of incorporating energy medicine as an adjunctive therapeutic modality to relieve pain and optimize healing is not new to chiropractic. Prior to acquiring the iMRS PEMF system I used low level laser (light energy) and ultrasound (vibration energy) to speed local injury healing. Despite its unique property of not being felt or seen I have found PEMF therapy as provided by the iMRS technology to be profoundly more effective and quicker at providing the therapeutic results of injury recovery. In my practice, this powerful energy medicine has added a new level of confidence as we often witness immediate patient satisfaction, felt as reduce pain and swelling. These dramatically speedy and gratifyingly positive outcomes in treating both acute and chronic conditions have made PEMF therapy an integral therapeutic addition to my practice.
PEMF therapy as produced by the iMRS system technology represents an exciting revolutionary advance in energy medicine. It supplies the body with a vital dose of the healing power of nature; by emulating earth’s biologically compatible low energy pulsating magnetic field. Research has proven that exposure to nature’s energy field in the biologically compatible low frequencies and intensities (“biological window”) are a necessary component for life on earth to thrive. This natural energy has been proven to have an energizing effect on our cells serving as a spark-plug promoting homeostasis and optimum wellness. In modern society we are enclosed by concrete, steel, pavement, autos and wear shoes. All of which serves to disconnect or dissociate us from nature and deprive us of the proper dose of earth’s health enhancing energy. As such, by reproducing nature and supplementing the body with a dose of earth’s PEMF therapy aligns with the chiropractic principle of natural health. From a chiropractic prospective, I have come to the understanding that PEMF therapy serves to provide the body with a vital dose of “UNIVERAL INTELLIGENCE” (earth’s natural energy) effectively optimizing the body’s “INNATE INTELLIGENCE” (inherent recuperative ability).
From my experience, a profound advantage to utilizing PEMF therapy over other chiropractic therapeutic modalities is its versatility in how it can be applied to the body. The iMRS system is able to provide powerful localized or regional treatment utilizing the probe or the pillow application as well as allowing for whole body global wellness with the mat application. Additional advantages are that patients do not need to disrobe as the therapy penetrates through clothing and is safe as well as user friendly. The iMRS technology is so easy to use that many of my patients are easily trained to operate and apply the therapy to themselves. Patients have even purchased the system through me for home use!
TAC: What is it about Pulsed Electromagnetic Field Technology that appeals to you?
GB: What’s most appealing to me about PEMF therapy, as provided by iMRS technology, is that it emulates and supplies a vitally important natural component for life on earth to thrive. Until my introduction to this powerful therapeutic modality I was unaware of the important role earth’s electromagnetic energy field plays in our health and well being.
It has been a revelation to learn that like air, water, sun, and gravity, proper exposure to earth’s PEMF is an elemental biological ingredient for life to thrive. The world’s scientific community, including NASA and the Russian Space Program, has long established the important impact that exposure to earth’s naturally occurring PEMF has on our health and wellness. Most of us are unaware that the early astronauts returned to earth very ill from being deprived of exposure to earth’s natural energy field. As a result, all space suits and space capsules have since been equipped with high-tech devices that supply this vital health enhancing energy in biologically friendly frequencies/intensities emulating nature. I must admit that as an earth and space science major in college I find this information to be especially profound and thought provoking! In our post-industrial modern society, it can be said that we (much like the early astronauts) are no longer tied to the earth. We too are deprived of direct physical contact with the earth. We are surrounded by concrete, steel, pavement, drive autos and walk in shoes. With our computers, iPads, and smart phones, (devices which expose us to potentially harmful unnatural PEMF frequencies/intensities called “electro-smog”), we rarely go outside anymore.
Technical devices and equipment (such as iMRS) that functionally emulate earth’s PEMF serve to supplement our nature-deprived health. It is becoming more and more apparent with clinical use of this technology to treat the body that a wide range of physical and emotional ailments may result from our disconnect from the power of nature.
It is possible that many modern illnesses helped by PEMF therapy such as chronic fatigue, insomnia, acute/chronic pain and depression may be attributed to deficiency of exposure to earth’s natural magnetic field. It should be noted that PEMF therapy is already FDA-approved to treat non-healing bone fractures, wounds, injuries, and depression.
TAC: How did you first get involved in using this technology?
GB: Like many opportunities in life, it was very serendipitous how I got involved. The industry leader in this technology, as we are in fact world market leader in PEMF devices, Mediconsult, which produces the iMRS system, opened its USA headquarters down the road from my practice and a principal of the corporation just happened to come in for chiropractic care. When his business was mentioned I expressed interest in trying PEMF therapy. He generously lent me his unit while he went out of town for two month period. I proceeded to take the unit home and “experiment” on my wife and me, applying a dose of magnetic resonance stimulation (the process of applying PEMF therapy) 2-3x/day. It was very soon (~10 to so days) after initiating this therapeutic regime that we realized its wonderful health enhancing effects. It became invaluable and I purchased one for clinical application. My wife, I, and many of my patients have come to make PEMF therapy a regular part of our wellness routine.
TAC: Do you ever receive skepticism when you suggest its use to patients?
GB: Not much. I have found most patients to be intrigued and interested to learn about novel approaches to wellness. They are usually hungry to feel better without the use of medications and as such are open to alternatives. We usually apply the PEMF therapy prior to the chiropractic adjustment and have found most patients to be rewarded by the immediate gratification of improved symptoms and function. The positive therapeutic results achieved by this modality serve to diffuse any skepticism.
Any safety concerns are allayed by noting the relatively few contraindications (i.e., pregnancy, pacemaker or embedded electronic pump device, and epilepsy) for magnetic resonance stimulation as provided by the iMRS system. We always refer patients to watch the extremely positive endorsement received on a recent episode of Dr. Oz and PEMF therapy on YouTube, as seeing such provides further validation of its health enhancing impact.
TAC: How do you respond to other chiropractors or professionals in healthcare delivery that would say there is no scientific evidence that any form of magnets are beneficial?
GB: We point out to skeptical health professionals that there is a major difference between the body of scientific evidence supporting the biological value of PEMF therapy verses static magnets worn on the body as bracelets, pendants, or necklaces. To date, there is little evidence touting the health benefits of static magnets in credible scientific journals. Conversely, currently there are many thousands of research articles in respectable journals worldwide endorsing the powerful health enhancing benefits of low frequency/low intensity electromagnetic fields. The physiological benefit from pulsed electromagnetic fields is attributed to their dynamic and time-varying frequency, easily producing the desired therapeutic benefit of cellular membrane induction or ionic exchange. Static magnets are not as beneficial to health because they produce no frequency and only one field strength thus allowing cells to habituate or fatigue, negating any physiological benefit. The lack of scientific evidence in support of static magnets has unfortunately prejudiced and undermined the clinical acceptance and advancement of PEMF therapy. Prejudice can only be overcome by education so I encourage all interested health professionals to learn as I have from the abundance of scientific literature available on the topic of PEMF therapy.
Upon investigation of the research, one comes to learn that PEMF therapy has successfully been used to treat pain, edema and a wide array of illnesses for over 60 years. In fact, unbeknownst to many physicians a number of PEMF therapeutic devices are FDA approved to treat pain and promote healing. The value and importance of exposure to earth’s PEMF for our health and well-being is researched and accepted by NASA and the Russian Space Program and applied to all astronauts to ensure their health in orbit. PEMF therapy as supplied by the iMRS technology serves to compensate for the fact that in our post-industrial modern society we too are deprived of exposure to the earth’s natural magnetic field and is testament to over 1 Million users/day worldwide.
TAC: What is the most common problem you see among chiropractors today?
GB: I see the most common problem faced by chiropractors today as being able to adapt to the challenges of practicing in a tough economic environment. The current poor economic conditions should serve as a call for all chiropractors to better distinguish themselves in this competitive healthcare environment by offering the most up to date and effective alternative natural medicine. Incorporating the system into my practice has served to accomplish this.
TAC: What is the biggest problem or challenge you see in the chiropractic profession today?
GB: Insurance! It has become more and more apparent to me that the insurance based reimbursement business model is broken and does not work anymore. The trend of reduced reimbursements couple with higher deductibles and co-pays looks to continue even with the implementation of the Affordable Care Act by 2014. This trend has prompted me and many other physicians, over the past few years, to opt out of being a participating provider in all HMO’s and PPO’s as well as no longer accepting Medicare assignment of benefits. Rather, I have converted my office to a payment-at-time of service practice where along with the vitally necessary spinal adjustments, patients are provided safe, effective, innovative, and affordable modalities (neuromuscular massage, low level laser therapy, kinesiology tape, custom/pre-made foot orthotics, whole body vibration therapy and most recently iMRS, PEMF therapy).
All these modalities fit extremely well into the drugless, natural, non-invasive chiropractic paradigm and are powerfully efficacious in fulfilling the patient’s health needs. From a business viewpoint most of these health enhancing add-ons are affordable and not insurance reimbursable, thus providing value-added services and additional income streams to the practice.
TAC: Can you think of one change that a chiropractor can do to significantly impact his/her practice’s growth immediately?
GB: Begin to include value-added therapeutic modalities or services that you feel passionate about; ones that benefit the health needs of your patients. The best way to discover passion for a new therapeutic service is to experiment or try it out on you, family, or friends. I have taken it upon myself to become a foot orthotic, kinesiology tape and Certified iMRS Health Technician by first personally benefiting from their profound health benefits. I have found my personal enthusiasm for these therapeutic additions combined with their powerfully perceived patient health enhancing benefits to be contagious in stimulating practice growth by generating patient referrals as well as additional income streams.
TAC: How does chiropractic fit into this paradigm?
GB: Chiropractic celebrates things that are based on nature and as such is perfectly situated as a profession to teach prevention and provide the best non-invasive, safe, and effective naturopathic modalities available. PEMF therapy as supplied by the iMRS system represents an advancement of such a modality by naturally fortifying and fostering the body’s inherent recuperative ability.
TAC: Where do you see the future of chiropractic headed?
GB: I see the future of chiropractic as the champion of safe, natural, and effective wellness therapies such as exemplified by PEMF therapy. I encourage all physicians to enlighten themselves and update their practices with this novel and revolutionary approach to providing health and wellness. I see the inclusion of energy medicine as exemplified by this powerfully exciting therapeutic modality, into practice, as serving to expand the chiropractic paradigm into the realm of longevity and rejuvenation healthcare.
TAC: Any final words for our readers?
GB: My patients, my family and I (as well as hundreds of thousands of users worldwide) have found this revolutionary energy medicine to be invaluable at improving health and wellness. I encourage all physicians to try this therapy on themselves and family as it will not take long to feel its health benefits. Mediconsult, the company that manufactures iMRS wellness systems makes this easy by offering a low cost rent-to-buy program where you can try the device for one month for a small rental fee. If you would like to keep the system after the four week trial period, the security deposit and rental fee are deducted from the purchase price and you are only charged the difference. If you do not like the system after the 4 weeks of use you send it back and the security deposit is credited to your charge card.
I strongly recommend all doctors take advantage of this opportunity to allow you, your family and your patients to experience the undeniably powerful health benefits provided by iMRS PEMF therapy. Learn more about this therapy or the rent-to-buy program by going to the company website (www.iMRS.com
). Feel free to use me as your contact person (CLSC#-4149) or contact me if you should have questions.
Dr. Glen Bobker, Chiropractic Physician
The Downtown Chiropractic & Orthotic Center
1601 East Broward Blvd., Suite B
Ft. Lauderdale, Fl., 33301
Written by TAC Staff
Saturday, 28 January 2012 02:36
Scott Haldeman DC, MD, PhD, FRCP(C), FCCS(C), FAAN holds the positions of, adjunct Professor, Department of Epidemiology, School of Public Health, University of California, Los Angeles, Clinical Professor, Department of Neurology, University of California, Irvine and Visiting Professor at both the Southern California University of Health Sciences and the Shanghai University of TCM. He is Past President of the North American Spine Society, the American Back Society, the North American Academy of Manipulative Medicine, and the Orange County Neurological Society. He is currently chairman of the Research Council of the World Federation of Chiropractic. He serves as President of World Spine Care, a non-profit organization with the goal of helping people in underserved regions of the world who suffer from spinal disorders. He sits on the editorial boards of eight journals. He has published over 200 articles or book chapters, over 70 scientific abstracts, and has authored or edited 8 books.
He is certified by the American Board of Neurology and Psychiatry, is a Fellow of the Royal College of Physicians of Canada and a Fellow of the American Academy of Neurology. He served on the US department of Health AHCPR Clinical Guidelines Committee on Acute Low Back Problems in Adults as well as 4 other Clinical Guidelines Committees. He presided over The Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders. He was awarded an honorary Doctor of Humanities degree from the Southern California University of Health Sciences and an honorary Doctor of Science degree from the Western States Chiropractic College. He received the David Selby Award from the North American Spine Society and the Lincoln Research Award. A resident of Santa Ana, California, he maintains an active clinical practice. In an interesting interview with The American Chiropractor (TAC), Dr. Haldeman tells what he's been up to with the World Spine Care program, as well as the role chiropractors should be looking to occupy with regard to spinal care.
TAC: Dr. Haldeman, what inspired you to become a chiropractor? Do you have a specific story?
Dr. Haldeman: I grew up in a chiropractic family. My father was a chiropractor and my grandmother was a chiropractor. As a matter of fact, my grandmother is considered the first chiropractor ever to practice in Canada. She obtained her chiropractic diploma in 1905 and practiced in Minnesota and then in Saskatchewan.
TAC: I'd imagine most people aren't aware of that.
Dr. Haldeman: My father was very active in chiropractic professional activities all his life. He was on the first Board of Directors of the Canadian Memorial Chiropractic College and was very active in establishing legislation in Canada. On moving to South Africa he took an active leadership role in the South African Chiropractic Association. I used to help in my father’s clinic and the whole family received regular adjustments. It was always assumed that I would follow in his footsteps and become a chiropractor.
TAC: So you followed that up and became a medical doctor. What were some of the influences that made you want to pursue that?
Dr. Haldeman: When I graduated from Palmer College, I was only 22 years old. On return to South Africa, I decided to further my studies and enroll at the University of Pretoria where I received a bachelor’s degree and then a master’s degree. After the master’s degree I decided that I wanted to spend more time doing research. I hoped that research would provide some of the answers to questions that continued to come up in discussions on chiropractic theory and philosophy and which were not adequately explained during my studies at Palmer. My master’s thesis was on nerve compression. I then decided to continue with my studies and was accepted for a Ph.D. in neurophysiology at the University of British Columbia, Canada. When I was completing my Ph.D. I was told that it was unethical for a medical physician to work with a chiropractor in any research or clinical setting. It became obvious that if I was interested in clinical research I had to get a medical degree.
TAC: So based on your experience how do you view the role of chiropractic in the current delivery of health care?
Dr. Haldeman: My feeling is the world has changed substantially. Chiropractic is in a period of transition, trying to figure out what it wants to be, what its scope of practice should be and how the profession should be identified by the public. I believe that there is an opportunity right now for chiropractic to become the primary care clinician for people with spinal disorders.
TAC: Does that involve recommendations for surgery or performing surgery?
Dr. Haldeman: No, it’s clearly not in the scope or training of chiropractors to offer surgery or prescribe medication to patients. The primary spine care clinicians would be the first physician seen by patients with a spinal problem. The clinician assuming this role would be expected to have more expertise in the field than anybody else. The expertise would exceed the classic role of chiropractic which has often been limited to providing adjustments. If the chiropractor is to assume this role he or she will be responsible for the first-level care of all patients with spinal disorders. Current evidence based guidelines suggest that exercise, manipulation, and advice are the treatment approaches that should be considered as first level care for patients with uncomplicated spinal pain syndromes.
These treatments all fall within the realm of chiropractic. It is therefore reasonable to consider a chiropractor the first choice clinician for the management of people with spinal problems. This, however, requires chiropractors to be able to diagnose all conditions related to the spine and make recommendations about all treatment options to patients who present with spinal disorders. The primary spine care clinician would be expected to conduct a clinical examination and order diagnostic testing when indicated, be the most skilled clinician in spinal manipulation, exercise training and education and to be able to make appropriate referrals. The primary spine care clinician would have the responsibility to inform patients about their options, and become the patient advocate, for whatever treatment is appropriate even if this includes surgery or medical care.
TAC: Getting off of the subject of primary spinal care clinician, what impact does the chiropractic adjustment have on the patient?
Dr. Haldeman: We do not have full understanding of the impact of the adjustment on the spine and nervous system but there are a few observations that are increasingly clear. For example, we know that manipulation or adjustment has the capacity to reduce back pain, neck pain and headache in a significant portion of patients. This seems to be fairly well accepted and is supported by multiple studies. Most national and international guidelines for back pain and neck pain recognize that spinal manipulation is a reasonable option. We also have evidence that spinal manipulation has a number of biomechanical and neurophysiological effects that have been recorded in both animal and human experiments. The exact clinical importance of these effects is not quite clear yet, but there are a number of theories that are being developed to explain the physiological impact of adjustments. I anticipate that we’ll have considerably greater understanding of the importance of the physiologic and biomechanical role of the adjustment over the next few years as further research is published.
TAC: Can you tell me how Primary Spine Clinicians would assist with informed consent for care?
Dr. Haldeman: What we are talking about is shared decision making, which is somewhat more than informed consent. Informed consent is only one component of shared decision making. Decision making is the process whereby patients make decisions based on all available knowledge on all spine care options. In this situation doctors have the duty to help patients make the decision as to the treatment approach that they prefer.
TAC: Informed decisions...
Dr. Haldeman: Informed decisions. The situation we aretalking about is based on the assumption that chiropractors are acting as primary spine care clinicians. When a patient seeks the care of a chiropractor the most important service is to determine the nature of his or her problem. Most patients will then ask “What do I do next?” It is up to the chiropractor to have sufficient knowledge to provide information regarding all the potential options to the patient. The patient, with the understanding and knowledge of the chiropractor, can then make appropriate decisions about their care.
TAC: What you’re saying is it’s a professional way of representing a service.
Dr. Haldeman: It is also what patients are starting to demand. There are over 200 treatment options available to people with spinal pain. Currently the most frequent approach to this dilemma is to say to a patient, “There are multiple different types of doctors and specialists who offer treatment to patients with spinal disorders. Everybody considers themselves an expert but doctors rarely agree on what the appropriate treatment approach should be. There is very little communication between doctors with different ideas and you, as a patient, have to decide which treatment approach you want to try". That clearly is not a very professional way of helping patients. The recommended approach is for a doctor to discuss all treatment options with patients. This is not just an issue within the chiropractic profession. Similar discussion can be seen in medical and surgical journals. As noted in the presentations at this meeting, the role of the doctor is to examine the patient, reach a diagnosis, inform a patient about the consequences of that diagnosis, how accurate it is then discuss treatment options. As the doctor works through these steps with the patient at each point the patient is informed what the harms are for each of the options, the benefits of the different approaches as well as the likelihood of getting better or prognosis. This information is no more than a reasonable person would normally require if he or she was shopping for some other product. There’s nothing unique any more about health care, it used to be whatever the doctor told you that’s what you did, but patients today are now demanding that they have a say in what decisions are made.
TAC: What is the World Spine Care Mission?
Dr. Haldeman: World Spine Care is a multinational, charitable, non-profit organization bringing effective spine care to communities in need worldwide. World Spine Care has been created to fill the profound gap in the treatment of musculoskeletal conditions that exists in the developing world. It consists of health professionals – chiropractors, medical specialists, surgeons, physiotherapists and others – coming together to build a sustainable capacity for effective spinal care in communities around the globe. World Spine Care was conceived in 2008 and officially launched in early 2010. WSC is planning to build sustainable capacity for effective spinal care in the communities in which it works, combining primary care with education and outreach. WSC is also developing the fundamental clinical tools needed to bring effective spine care to the developing world.
TAC: What are the components or programs that World Spine Care is establishing to achieve these goals?
Dr. Haldeman: There are 4 basic programs that the World Spine Care are instituting:
- Establishment of clinics in underserved communities. The clinics will initially be staffed by volunteer clinicians. The primary spine care clinicians would include chiropractors who will be asked to spend 3-12 months at the clinics. Surgeons and medical specialists will be asked to spend 2-4 weeks offering their services to those patients with more severe pathology. The WSC clinics will be the focal point for the delivery of primary care, the training of front line health care workers, advanced training of local health care professionals, and a conduit between clinic patients and specialized WSC-delivered medical intervention as required. Over time, WSC will transition the operation of clinics over to host health care systems, with the continued partnership and support of WSC.
- Development of a universal evidence based model for spine care. This will be based on the concept of a primary care spine clinician who will be responsible for examination of patients with spinal disorders, provide non-surgical, non-pharmaceutical care, order appropriate testing and make referrals to surgical and medical specialists when appropriate. WSC is developing the primary tools needed for the delivery of effective spine care in underserved communities. The first and fundamental tool in the WSC toolkit is the WSC clinical model of care which provides integrated, inter-professional protocols for screening, assessment and treatment of the full spectrum of spinal disorders. The WSC clinical model of care could be a primary tool used by health care professionals for the delivery of spine care in all communities.
- Education of local communities and health care professionals on the management and prevention of spinal disorders. This will involve general education of patient populations and the communities in which WSC works on simple self-care approaches to spine care and injury prevention and the training of front line health care workers in the use of WSC spinal care protocols. WSC is also planning to provide scholarships to exceptional students from host regions, to obtain professional accreditation in chiropractic, physical therapy or spinal surgery from collaborating academic institutions.
- Research. There are a number of specific research projects currently being contemplated. This will include an initial epidemiological study evaluating the prevalence, burden and care of spinal disorders among residents of Shoshong. There is also an integrated research component tracking the nature and frequency of musculoskeletal conditions occurring in patients who are living with HIV / AIDS. The WSC research team will also evaluate the efficacy of the screening, assessment and treatment protocols used in this community and the model of care delivery.
TAC: Is this project in need of funding, or is this something that needs participants to volunteer their time and energy?
Dr. Haldeman: All of the above. If we don’t get enough funding we won’t be able to continue, so right now we’re in a strong fundraising mode and trying very hard to get the resources necessary to make this work. With sufficient funding the program cannot function without volunteers willing to spend time in the clinics. We, however, have received sufficient funding to have people on the ground. We have clinicians who are currently seeing patients in Botswana and on their way to India. This is not a start-up operation anymore; we are actually actively seeing patients.
TAC: So chiropractors would be considered spinal care physicians in this model and would be acceptable as applicants.
Dr. Haldeman: Right now the clinicians who have initially volunteered to staff the clinics as primary care clinicians and provide treatment are chiropractors. In the facilities where the primary spine care clinicians will be seeing patients, they are given all the rights and privileges of other physicians in these communities. There has been no difficulty getting this commitment from the hospitals where the clinics are being established. The WSC clinicians are very well accepted into the community of health care clinicians in these facilities.
TAC: Who are some of the most prominent figures sponsoring World Spine Care?
Dr. Haldeman: There has been an amazing interest and commitment in the WSC program. Archbishop Tutu, Nobel Prize laureate, agreed to serve on the WSC advisory board and support the program. Elon Musk, co-founder of Paypal and current CEO and founder of SpaceX and Tesla Motors is currently serving on the WSC board. WSC has been endorsed by the Bone and Joint Decade, the International Society for the Study of the Lumbar Spine, the North American Spine Society, the European Spine Society, the World Federation of Chiropractic and a number of other organizations. Funding has been received from the Skoll Foundation, Musk foundation and the Bechtel Trust, the British, Kootenay and Ontario Chiropractic Associations as well as CMCC and Palmer College. The amount of support has shown that there is a real interest and support for the goals of World Spine Care.
TAC: So, what are some of the long-term goals for the World Spine Care Mission?
Dr. Haldeman: The long-term goal is to improve the health of people with spinal disorders in underserved communities and to provide a model of care that could be used in other settings. It is a broad and all-encompassing program. Jeff Outerbridge, a chiropractor volunteer from Ottawa, Canada is currently in Botswana and seeing patients. He is the WSC clinical coordinator and is establishing the clinical protocols with the assistance of faculty from Palmer College and CMCC. The government of Botswana has given WSC all the space needed at the hospital and has also given World Spine Care clinics all the staffing we need for translation and similar administrative needs of the clinics.
TAC: How does one support or become a member?
Dr. Haldeman: World Spine Care will only succeed if there is widespread support by individual clinicians, institutions, organizations, foundations and companies. It is a volunteer organization and will only succeed if volunteers come forward and offer support and services. World Spine Care has instituted a program where individual clinicians or their patients can support the program by becoming a non-voting member. The support through membership can be done online by going to the World Spine Care website. An interested chiropractor could also volunteer on a committee, consider fundraising for WSC by contacting philanthropists or industry leaders, or volunteer time in one of the clinics or centers. There are many ways in which a chiropractor can become involved. Anyone who wants to be involved should just contact WSC and serve in any way they can.
TAC: What is the website to learn more information?
Dr. Haldeman: www.worldspinecare.org
TAC: Dr. Haldeman, could you tell me about your experience seeing patients?
Dr. Haldeman: I practiced as a chiropractor for 14 years in South Africa and in Canada. I am a neurologist by medical training and have never been a surgeon. My main interest at this time is to help people with spinal disorders and I strongly believe that this can only be achieved with a multidisciplinary evidence based approach to the problem. Such an approach, as noted during the presentations at this meeting, requires the active participation of chiropractors, their associations and institutions.
TAC: Thanks for your time Dr. Haldeman.
This interview followed the FCA National Seminar in Orlando, 2011, and makes some references to the informed consent seminar presented.
Written by TAC Staff
Saturday, 17 December 2011 22:00
latinum System chiropractic software is one of the innovative success stories in the chiropractic profession worldwide. Today, we are interviewing Mr. Claude Cote, owner and founder of Platinum System E.H.R. software.
TAC: Mr. Cote, for the benefit of our readers, could you introduce yourself and speak about your company:
MR. CLAUDE COTE: I am the founder and president of Platinum System C.R. Corp. I am the innovator of the famous Platinum System which is a fully automated Electronic Health Record system. Some of the modules I have innovated are the automated calling system which takes control of the chiropractor waiting room, the Chiropractic Health Card for patients, the automatic billing system where the billing is entered automatically from the doctor's screen, the “one click” appointment generator, SOAP notes generated from a special touch-pad design, a very unique USA insurance management and automatic payment posting system in each patient file, an automated and fully integrated credit card processor system, and many more.
TAC: Since when has your company been in business and how was the evolution?
MR. CLAUDE COTE: Platinum System has been in business since 1989. As any other software of the time, it was only a billing and scheduling system for chiropractors. The constant growth started right from the beginning. In 1996, billing and scheduling was not enough for me. I knew I could do much more for chiropractors. I created a personal challenge for myself to make chiropractic the most advanced technology profession for office management. This in mind, I worked full time for years in designing and programming, with my development team, a full automated software system. The system was used for the first time in a chiropractic clinic on September 9th, 2001, exactly 10 years ago. This new revolutionary system was an instant and huge success. Since then, it has been installed in 18 countries over 5 continents and nationwide in the USA.
TAC: How did you come to work for the chiropractic profession only, as you could have many more opportunities in other health professions?
MR. CLAUDE COTE: I have 2 passions in life: Chiropractic and computers. I could not do anything else for chiropractic other than creating an extraordinary software system and could not do anything for computers other than programming for the chiropractic profession. I just had no other option. It was and still is the perfect match for me. Passion has run all my life and luckily I could combine both of my passions for one single purpose, serving the chiropractic profession to the best of my ability. Although Platinum System could be used by other practitioners, I do not plan to serve any other health profession other than chiropractic. Chiropractic has supported me during my entire career and I will be loyal to chiropractic forever. Honesty and loyalty are my 2 most important values in life.
TAC: In today's world, many companies tend to automate their service and reduce operating cost by eliminating jobs. Your solution and help center answers the phone instantly for 99% of the calls. How can you achieve this hard task?
MR. CLAUDE COTE: Speaking for myself, I am sick and tired of waiting on line for service and hearing “Your call is important to us...” Well, if my call is that important, why don't you answer me right away then? I hate wasting my time on the phone, waiting for someone to talk to. So the answer is very simple. I don't treat other people how I don't like to be treated. Money and savings is not everything in life. You need to commit to your promises. And we do.
This is part of my core values in life. Not only are clients answered instantly, but they are answered by an experienced and knowledgeably trained agent. Our clients love our service and it is one reason, among others, that they switch to our products and service and never leave us then after. My Solution Center team becomes part of their chiropractic team and both of us together lead to success for both sides of the partnership. We create a win-win situation.
TAC: What do you think about the stimulus package and the remittance of $44,000 from the government to chiropractors who will use a certified software system?
MR. CLAUDE COTE: I will give you my humble and very personal opinion on this topic. First, let me tell you that I have personally installed and trained hundreds of chiropractic clinics. I know very well how chiropractic works and how doctors run their offices efficiently. Many doctors are presently thinking that, if they buy a certified software system and install it in their clinic, they will automatically be paid back $44,000.00 from the government. This is not true.
TAC: What are the requirements to get the $44,000 then?
MR. CLAUDE COTE:
To be paid, chiropractic doctors will need to show all the meaningful use objectives which apply to chiropractic using a full certified software system. Basically, it is not because you buy a certified software system that you will get paid, it is the way you will change how you practice chiropractic. As a very simple example, do chiropractors ask their patients if they smoke now and maintain the answers in a database? They will now have to in order to get the $44,000. My advice to doctors is to get familiar with all the required meaningful use objectives they will have to meet. The list of meaningful use objectives required is long. Doctors can find and read them on the internet at www.platinumsystem.com
and click on “List of all meaningful use objectives”. Doctors, please go on that link and get informed on what you will need to do if you aim to get some incentive payments.
Also, doctors will need to show meaningful use for a period of 10 years or will be subject to reimburse the compensation
Many doctors think they will have to show meaningful use objectives for Medicare patients only. This is false. They will have to show meaningful use objectives for all patients in their office, including cash patients. Also, doctors will need to show meaningful use for a period of 10 years or will be subject to reimburse the compensation. Chiropractors are to be very cautious with the $44,000 incentive. In my personal opinion, good chances are that it will cost much more than $44,000 for a doctor to operate his office in a meaningful use environment for 5 years. Doctors who want to do it have to do it for other considerations than money incentive or they may have a deception. Don't get me wrong, I am not saying not to go certified. I am advising doctors to get informed well before committing to changing the way they practice.
TAC: Will it be mandatory to use a certified software system to bill Medicare?
MR. CLAUDE COTE: No. Absolutely not. Again there is a big confusion around the Medicare billing. Doctors will be able to bill Medicare with paper if they wish to. Medicare is talking about a penalty of 1% starting in 2015 with a maximum of 3% in 2017 for non certified doctors. Financially, I figure doctors will save much more than 3% of their Medicare billing by not supporting the cost of a certified software system.
TAC: The chiropractic profession is submerged with promotions about the $44,000 incentive. What do you think about all these advertisements?
MR. CLAUDE COTE: Lately, I went on the website of a certified software system. I read: “At …., we don’t think any doctor should buy practice software simply to take advantage of the government’s up to $44,000 incentive.…. For a limited time, D.C.s are eligible to receive incentive money from the government by implementing a certified EHR (Electronic Health Record) system within their practice.”
There are two major interpretations that need to be said about this statement. First, they tell you something like “There is no guarantee that you will get paid, but if you don't get paid, don't be angry about us because we told you”. And second, they use the word “implementing”. For most people and doctors, the verb “implementing” means more like “installing” a certified software system. This looks very simple to do. But, in this case, implementing means much more. It means buying a certified software system, installing it, learning it and using it the way the government told you by showing all the meaningful use objectives.
TAC: As a software developer for over 22 years, what is your opinion about the structure of a certified software system?
MR. CLAUDE COTE: I see a major problem with this certified system project. The problem resides in the fact that every office will have its own database. As an example, a patient who will see 20 different health professionals (chiropractors, medical doctors, etc.) within 20 years will have 20 different patient files with different information in each one of them. None of the professionals will have the entire health history of the patient. Let’s say a new patient goes to your office and you ask him “What is your smoking status?” The patient answers “Non-smoker”. While in real life he could have smoked for 25 years and quit 6 months ago, he may have stopped and restarted smoking 50 times during the last 20 years, etc. To be useful, a database needs to be updated and kept accurate.
TAC: Does a certified software system have the function to exchange patient information with other professions and other chiropractors?
MR. CLAUDE COTE: Yes, absolutely. When was the last time a chiropractic doctor received a referred patient from a medical doctor? With a certified software system, how many patients do you expect from medical doctors? Since 2003, the chiropractic profession has the possibility to exchange chiropractic patient files electronically between them with our Platinum System. Chiropractic is way ahead of the stimulus package with a certified software system on this function. Last year, I saw over 4,000 Platinum System patient files exchanges between chiropractors who work in 18 different countries. Chiropractic is a long-time leader in patient files exchange.
TAC: Financially, don't you think the $44,000 will help chiropractors?
MR. CLAUDE COTE:
Ok, let's talk about money only. My answer to this question will surprise many readers. NO, no and absolutely not. The $44,000 stimulus is a great marketing help for
software companies. Let's say a doctor buys a certified software system. Then, after, he will have to pay for service. After he is in with certification, the doctor cannot back off or he will have to reimburse the incentive. Then, what prevents software companies from raising his service fees to maintain certification? A new job called HIT, which stands for Health Information Technology, has been created to help doctors implementing all the meaningful use objectives with their certified software system. But these guys are not free.
Doctors will have to pay for this service too. What about if the government adds some meaningful use objectives in the future or changes the way they are now? The certified software companies will have to spend big money to keep up and guess who will pay the bill at the end? Sorry but this $44,000 will not be given free by the government.
Have you ever seen your government send you a check for nothing? Personally, I can see Medicare saving tons of money if they can audit certified offices electronically and remotely. I would guess they can ask doctors with a certified software system to send them patient files electronically for reviews. They could save a tremendous amount of money there. What do you think?
Chiropractors need to promote the benefits of chiropractic and need to get new patients in their clinics to go through this bad economy. Doctors need to get their monthly bills paid on time. In my opinion, this is what doctors really need.
TAC: At the end, do you think all or most chiropractors will adhere to the stimulus package and certified software?
MR. CLAUDE COTE: No. Nobody really knows how many chiropractors will go for it or not. Right now, for all these reasons above, less than 5% of all the doctors I know are going certified. And most of the doctors who go for certification are doing so for the $44,000 incentive. What will be the use of this project if less than 80% get their certification?
Again, these questions about the stimulus package reflect my own and very personal opinion. My dream project would have been a central database, where every patient gets one single health file and all doctors get the updated file as well as a complete patient health history. This central database would not be used for financial audition in any way and would serve for health purposes only.
In this software certification project, I see chiropractors as being the judge and they will have the final answer. This interview is giving me the opportunity to give chiropractors the other side of the medal about the stimulus package. This is my humble opinion on this subject and the future will give us the final answer.
TAC: To end this interview, what would you like to say to the chiropractic profession?
MR. CLAUDE COTE: Being a chiropractor is not an easy task right now. The economy is bad and it does not seem like tomorrow will be much better. Lately, we have heard we could face another recession. Insurance companies are more and more demanding in order to get paid. Doctors have pressure to spend more time on administrative tasks, thus reducing time to do what they love; helping patients to restore their health. The good news is technology is growing and is assisting more and more doctors to achieve what they need. Help is just around the corner.
Claude Cote is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years. He has installed EHR system in 18 countries over 5 continents and nationwide in USA. He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com). For comments or questions, please email to
Written by Melissa Lee
Saturday, 17 December 2011 21:05
|ACA’s Legislative Conference to Focus on the Importance of Cultural Authority, Staying Essential in Health Care Reform
icture it: Washington, D.C., 2012. While much debate next year will focus on the upcoming presidential election, health care reform will continue to be a hot topic. As with the election, many questions about the implementation of the Patient Protection and Affordable Care Act (PPACA) hang heavy over the nation’s capital—and the chiropractic profession. Questions about the essential benefits package, filling gaps in our country’s primary care workforce and the establishment of health insurance exchanges on the state level are contentious and divisive across the country and inside the Beltway.
To ensure that the voice of the chiropractic profession is heard by lawmakers, the American Chiropractic Association (ACA) will host the 2012 National Chiropractic Legislative Conference (NCLC) with the Chiropractic Summit Feb. 15-18 in Washington, D.C. In a historic first, the 41 organizations that make up the Chiropractic Summit will come together to help set the direction of NCLC.
Immediately following the conference (Feb. 18-19), ACA’s specialty councils will present “The Ultimate Head, Shoulder & Neck Symposium.” Participants can earn 16 continuing education units (CEUs) while learning from leaders in the chiropractic profession.
The theme of this year’s conference, "The Power of Cultural Authority—Staying Essential in Health Care Reform," will explore the challenges awaiting the chiropractic profession as implementation of the health care reform law continues on the national and state levels. Enhancing the cultural authority of DCs by getting individual DCs placed on key committees will help set the stage for the full inclusion of the profession as PPACA provisions are put into place.
NCLC is the chiropractic profession’s most important public policy and educational event. For more than 30 years, doctors of chiropractic and chiropractic students from across the country have gathered in Washington, D.C. annually to meet with members of Congress and discuss the issues that matter most to DCs and their patients. In addition to the advocacy on Capitol Hill, NCLC offers DCs information on new opportunities in Medicare, military and veteran’s health care, national health care reform and other federal initiatives.
Over the years, a list of political dignitaries and pundits have appeared at NCLC, including political strategist and CNN contributor Paul Begala; political pundit and Daily Caller owner Tucker Carlson; political strategist and media personality James Carville; Ret. Brig. Gen. Becky Halstead, spokesperson for the Foundation for Chiropractic Progress; and perennial chiropractic supporters such as Sens. Tom Harkin (D-Iowa) and Charles Grassley (R-Iowa); and Reps. Mike Rogers (R-Ala.) and Bob Filner (D-Calif.).
“So many important issues are vying for attention in Washington, D.C. right now,” said ACA President Dr. Keith Overland. “Our profession needs a particularly strong display of force and unity right now to ensure that we have the greatest possible impact on Congress. I urge every DC that can to come to Washington for NCLC and lend their voice on behalf the profession and our patients to do so.”
Chiropractic and Health Care Reform – the Current Landscape
In short, there is some good news and a lot of unknowns.
The good news is that the health reform law contains three important pro-chiropractic provisions, the first deals with provider discrimination and prevents health insurers from discriminating against any health care provider who is acting within the scope of their license or certification under applicable state law. The second provision specifically includes DCs as potential members of interdisciplinary community health teams. And the final provision establishes a National Health Care Workforce Commission to examine current and projected needs in the health care workforce.
The commission specifically includes DCs by defining them as part of the health care workforce, and includes them in the definition of health professionals. In addition, chiropractic colleges are included among the health professional training schools to be studied.
What don’t we know? Aspects of the law are still being written, and the chiropractic profession still has mountains to climb. Most notably, the contents of the essential benefits package—the benefits that all insurers will be required to cover once PPACA is fully implemented—is a critical issue for DCs and all provider groups. The inclusion of chiropractic care as an essential benefit would remove many artificial barriers in the way of patient access to DCs, and inclusion would help ensure that chiropractic physicians receive fair reimbursement for the services they provide.
Additionally, as PPACA is implemented the primary care workforce shortage in this country will have to be addressed. When the law is fully enacted, it is estimated that an additional 32 million previously uninsured Americans will begin seeking health care. Furthermore, the Institute of Medicine (IOM) estimates that between 2005 and 2030 the number of adults aged 65 and older will almost double from 37 million to more than 70 million. A 2008 IOM report also stated that “while this population surge has been foreseen for decades, little has been done to prepare the health care workforce for its arrival.”
To address this health care workforce shortage and to ensure that patients have access to the care they need, the IOM report recommended that “steps need to be taken immediately to increase overall workforce numbers and to use every worker efficiently (i.e., to each individual’s maximum level of competence and with an increased flexibility of roles).”
“Congress needs to hear that the nation’s more than 70,000 chiropractic physicians are well-positioned to help fill the workforce gap that will exist in the coming years,” said John Falardeau, ACA’s vice president of government relations. “Congress needs to know that the chiropractic health care model has always been heavily focused on providing essential services and promoting healthy lifestyles for the prevention of disease and injury, and they need to hear it directly from passionate and informed members of the chiropractic profession.”
Crucial State Reform Initiatives Underway
In addition to the work being done in Washington, the implementation phase moves a lot of the action to the state level. Most notably, by 2014 states must create “American Health Benefit Exchanges.” An exchange cannot be an insurer, but will provide eligible individuals and small businesses with access to insurers’ plans in a comparable way. Falardeau explained that the exchanges would function much like “Orbitz” or other online airline booking services. Except instead of flights, people will go online and be able to compare and purchase insurance plans.
With ACA’s support, three bills were introduced in Congress last year to expand access to chiropractic care in the VA and the military.
The exchange will consist of a selection of private plans as well as “multi-state qualified health plans” administered by the Office of Personnel Management (OPM). Individuals will only be eligible to enroll in an exchange plan if they are not enrolled in Medicare, Medicaid or acceptable employer coverage as a full-time employee. Based on income, certain individuals may qualify for a tax credit toward their premium costs and a subsidy for their cost sharing; the credits and subsidies will be available only through an exchange. States will have the flexibility to establish basic health plans for low-income individuals not eligible for Medicaid. Individual and small group coverage will be allowed to be offered through nonprofit, member-run health insurance companies. Such nonprofit insurers will be eligible for grants and loans distributed through the new Consumer Operated and Oriented Plan (CO-OP) program.
“We must open the door to these exchanges for DCs at the state level. Doctors of chiropractic must be included on provider panels so that fee parity is maintained. To do this, we must work with state agencies to ensure that chiropractic services are considered an essential component of any health care plan,” said Falardeau. “Talking about this issue with your representatives in Washington can also provide another foot in the door. This kind of work by doctors of chiropractic will really increase the cultural authority of DCs across the country.”
More Than Just Health Care Reform
Aside from health care reform, at NCLC doctors and lawmakers will talk about other pressing legislative issues, such as:
- Expanding access to chiropractic care for members of the military and for military veterans through the U.S. Department of Defense (DoD) and the Department of Veterans Affairs (VA). DCs are available at 60 military bases around the country; however, according to a 2005 Government Accountability Office report, only 54 percent of servicemen and women eligible for chiropractic care can reasonably access the benefit. Within the VA, chiropractic care is available at approximately 30 major VA treatment facilities within the United States. Unfortunately, the VA has taken no action to provide chiropractic care at approximately 120 of its major medical facilities.
With ACA’s support, three bills were introduced in Congress last year to expand access to chiropractic care in the VA and the military. They are:
- The Chiropractic Care to All Veterans Act (H.R. 329), which would require the VA to have a DC on staff at all major VA medical facilities by 2014. It would also ensure that chiropractic benefits are included in the U.S. Code of Federal Regulations and therefore cannot be denied.
A Senate companion bill to the House legislation was introduced in early June. S. 1147, mirrors H.R. 329, by requiring a DC on staff at all major VA medical facilities by 2014.
- The Chiropractic Health Parity for Military Beneficiaries Act (H.R. 409) would extend chiropractic care to U.S. military retirees, dependents and survivors as part of the TRICARE program. The legislation would require the Secretary of Defense to develop a plan to allow any beneficiary covered under TRICARE to select and have direct access to a DC. Currently, only active-duty members are afforded the chiropractic benefit.
- Including (via H.R. 6032) DCs as officers in the U.S. Public Health Service (USPHS) Commissioned Corps. The bill would require the president to appoint no fewer than six DCs to the Commissioned Corps. Although the Commissioned Corps includes representatives from many diverse health care professions, no DCs have ever been appointed to serve—ACA and the Association of Chiropractic Colleges have been working to advance this legislation, which specifically addresses this long-standing deficiency. The Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualified public health professionals dedicated to delivering the nation’s public health promotion and disease prevention programs and advancing public health science. Officers in the Corps provide health care services in a variety of locations and venues, including care to members of the U.S. Coast Guard and at community health centers.
- Expanding access to chiropractic and providing an opportunity for DCs to work in exchange for student loan relief through H.R. 531, the Access to Frontline Health Care Act 2011. Many areas in the country lack providers of various health care services. H.R. 531 would establish a student loan repayment program that would ensure that medically underserved communities across America have access to a wide array of health care services and an expanded range of provider types from which patients in these communities can choose to receive their care.
New Leadership at the Helm
As ACA and the chiropractic profession storm Washington, D.C., they will do so under new leadership. Last fall, members of ACA’s House of Delegates elected a new president, Keith Overland, DC, of Norwalk, Conn., to lead the association during this pivotal period. Dr. Overland brings a wealth of political experience to the position, having served previously as ACA vice president and as chair of the ACA’s Political Action Committee. In his home state, he served as co-chair of the Connecticut Governors Committee on Physical Fitness, was a member of Sen. Joseph Lieberman’s (I-Conn.) Health Care Task Force and was also a member of Rep. Christopher Shays’ (R-Conn.) Task Force on Human Services. In his first remarks as president of the association, Dr. Overland called for continued efforts to unite the profession and urged HOD members to “recommit with passion and enthusiasm to ACA.” He stressed that “failure is not an option for this team.”
Joining Dr. Overland on the association’s Executive Committee are Vice President Anthony Hamm, DC, of Goldsboro, N.C., and Chairman of the Board of Governors Robert Mastronardi, DC, of Warwick, R.I. Both doctors also have a strong history of advocacy on behalf of the chiropractic profession on the federal level. Dr. Hamm was the first DC to be elected co-chair of the American Medical Association’s (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). In this role, he also serves on the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC makes annual recommendations on relative values regarding new and revised services to CMS and performs broad reviews every five years of the Resource-Based Relative Value Scale (RBRVS), which determines Medicare provider reimbursement. Dr. Mastronardi is an active member of ACA’s Health Care Reform Task Force and the chairman of the CHAMP (Chiropractic Health Advocacy and Mobilization Project) Committee.Network with Colleagues, Lawmakers and Earn 16 CEUs
There will be no lack of opportunities to mingle with colleagues—and elected representatives—during NCLC. The congressional reception will be held on Wednesday, Feb. 15 on Capitol Hill in the Cannon Caucus Room. Previous congressional representatives in attendance include: Rep. Howard Coble (R-N.C.), Rep. Walter Jones (R-N.C.) and Sen. Tom Harkin (D-Iowa). On Thursday, Feb. 16 there will be a dinner and comedy show featuring the Capitol Steps for attendees and guests. Finally, on Feb. 18-19, ACA’s specialty councils will present “The Ultimate Head, Shoulder & Neck Symposium.”
Featured sessions and speakers:
- “Nutritional Support and Treatment in the Acute Stage of Healing” (presented by the ACA Chiropractic Board of Clinical Nutrition)--Juanee Surprise, DC, DCBCN, BCIM
- “Diagnosis and Treatment of Acute Shoulder Injuries” (presented by the ACA Council on Sports Injuries & Physical Fitness)--Guillermo Bermudez, DC, CCSP
- “Advanced Evaluation and Treatment of the Head, Neck and Shoulder: Movement Disorders of the Head, Neck and Shoulder” (presented by the ACA Council on Neurology)--Frederick Carrick, DC, PhD, DACNB
- “Congenital Torticollis: Chiropractic Management including Cervical and Thoracic Spinal Adjusting Techniques” (presented by the ACA Council on Chiropractic Pediatrics)--Elise G. Hewitt, DC, DICCP, FICC
- “Recognizing and Treating Organic Causes of Pain” (presented by the ACA Council on Diagnosis and Internal Disorders)--Philip Arnone, DC, DABCI
- “Rehabilitation of the Shoulder in the Chiropractic Practice” (presented by the ACA Council of Chiropractic Physiological Therapeutics and Rehabilitation)--George Petruska, DC &
- “Evidence Based Approach in the Assessment of Neck and Shoulder Disorders” (presented by the ACA Council on Chiropractic Orthopedics)--Larry L. Swank, DC, MS, FACO
NCLC is the chiropractic profession’s opportunity to tell its story to congressional representatives and to make them aware of how efficiently and cost-effectively DCs help their patients. Now more than ever, Congress needs to hear the profession’s message—and they need to hear it directly from doctors of chiropractic in their districts and states. Too many people in this country are sick and too many people can’t access the health care they need. It’s time to make sure Congress knows that the chiropractic profession has some of the answers that our health care system is looking for.
The Chiropractic Summit and its 41 member organizations, including the ACA, ACC, COCSA, and ICA encourage members and affiliates of each organization to join in the lobbying effort at this critical time in chiropractic and healthcare history. To learn more about the Chiropractic Summit, visit www.chirosummit.org. To learn more about attending this years NCLC conference in Washington D.C., (703) 276-8800 or go to www.acatoday.org.
Written by TAC Staff
Saturday, 19 November 2011 02:56
dward (Ned) Hallowell, M.D., ED. (Hon., 2005), a child and adult psychiatrist, author and graduate of Harvard College and Tulane Medical School, is the founder of The Hallowell Centers in Sudbury, Massachusetts and New York City. He was a member of the Harvard Medical School faculty from 1983 until he retired from academics in 2004 to devote his full professional attention to his clinical practice, lectures, and the writing of books.
Dr. Hallowell is a highly recognized speaker around the world and has presented to thousands on topics such as ADHD, strategies on handling your fast-paced life, the Childhood Roots of Adult Happiness, family and health issues and how to help your employees SHINE. Dr. Hallowell has also authored eighteen books on various psychological topics, including his national best sellers on ADD, Driven to Distraction, Answers to Distraction and Delivered from Distraction.
Dr. Hallowell lives in the Boston area with his wife, Sue, a social worker, and their three children, Lucy, Jack and Tucker. His greatest loves is spending time with them, doing whatever they want to do. Each year the family spends one month at the aptly-named Lake Doolittle where they connect and slow down.
The American Chiropractor (TAC) finally caught up with Dr. Hallowell to discuss the program he is putting together to teach chiropractors how to better deal with this fragile demographic in the following interview.
TAC: Dr. Hallowell, thank you for taking the time to meet with us. Can you tell us some of the basic understandings that you have about ADD and how you’ve come to those findings?
DR. HALLOWELL: I’m a child and adult psychiatrist, I’m sixty-one years old, and I’ve been in practice now for some thirty years. I have both what’s called ADHD and dyslexia myself, and over the course of three decades of working with individuals who have it, I’ve come to see these conditions more as traits than disabilities. Depending upon how you manage them they can disable you or, quite the opposite, they can actually have beneficial aspects that prove to be assets. Therefore I now say to people, “I don’t treat disabilities, I help people unwrap their gifts.”
TAC: So your position is this is a genetic predisposition that one has. Have you heard some of these other theories that it’s from toxic exposure or environmental issues? And how would you respond to someone who says that’s the cause?
DR. HALLOWELL: The evidence is clear that in about ninety percent of instances, this trait is genetically transmitted. You can also acquire it through head injury, through anoxia at birth, through lead poisoning, but the vast majority of ADHD is simply a trait you’re born with. If you learn to manage it properly it can serve you very well. But if you don’t, well, at its worst, that’s the prison population. What makes this trait so interesting is that it can lead a person in a positive direction or a very negative one. You can rise to the heights with ADHD or you can live a marginalized, underachieving existence.
One of the reasons I’m so excited to bring what I’ve learned about ADHD to chiropractors is that people are increasingly going to chiropractors to get help. Not being a chiropractor myself, I don’t know how chiropractic works with ADHD, but I do know that more people are looking to chiropractors for help with this condition than ever. So it’s exciting for me to take what I know and hand it to chiropractors and say, “Let’s work together.”
TAC: You mentioned that you like to focus mostly on the modification of how to treat individuals with ADD. Could you explain a little about those procedures?
DR. HALLOWELL: The starting point is make the diagnosis. Think of ADHD when you see a child or adult who is underachieving, who is frustrated, who can’t get organized, can’t stay on track, where grades in school or performance in the work place are less than inborn talent would dictate, for example, a sixth grader who’s constantly getting comments to “try harder” or “you’re so much smarter than your grades reflect, we know you have talent, why don’t you get organized and get your act together,” or an adult who’s getting the same feedback in the workplace, “You’re our most creative person, why can’t you ever show up on time?” or “Why do you have to blurt out such annoying remarks” or “Why can’t we rely on you? You’ve got so much talent.” Those kinds of comments are not helpful, and they reflect what I call a “moral” diagnosis, variations on the theme of ‘you’re defective, you’re weak, you need to try harder’ and it’s a ‘character problem’ you’ve got. That’s very, very damaging. These people over time gradually can get beaten down. They can become depressed, angry, turn to drugs, and become marginalized. It’s tragic to see.
The first step is to say, “No, look, this is a neurological issue, this is a wiring issue that has nothing to do with will power and character and has everything to do with wiring.” Just that basic reframing makes a huge difference. You see kids stand up taller, their parents lean back, and it’s the same with adults. I say, “You’re very lucky, you’ve got a Ferrari engine for a brain. You’ve got a racecar up there, an incredibly powerful brain. The problem is you’ve got bicycle brakes, so you can’t control this incredibly powerful engine that you’ve got, so you crash into walls, you run through stop signs, you miss things you’d like to see.” And I say, “Well, I’m a brake specialist. I’m going to help you learn how to stop; I’m going to help you learn how to control the incredibly powerful engine you’ve got.” And that really is what ADHD is all about, it’s essentially a condition of disinhibition. You can’t inhibit incoming stimuli, hence you’re very distractible, and you can’t inhibit outgoing impulses, hence you’re impulsive and sometimes disruptive or hyperactive. So the trick is—without sacrificing the power of the engine—to help children or adults learn to control the racecar, learn how to modify and modulate their central nervous system so they are able to win races instead of crashing into the wall.
TAC: Are these methods of dealing with individuals with ADHD easily learned by any group of people, like mothers, or is this something that only healthcare professionals can participate in?
DR. HALLOWELL: Everyone can learn how to help unwrap the gifts. I’m just now making a series of instructional videos for school teachers, for example. Absolutely, teachers should learn about it, parents should learn about it. Then there is the role, of course, for professionals, and that’s where I’m eager to see what chiropractors will do with this in terms of the holistic approach they take. The majority of the interventions anyone can learn. They have to do with the obvious—sleep, diet exercise, meditation, positive human contact (people often forget the importance of positive human contact. Often these folks get nothing but reprimands all day long) and then structure. The critical importance of adding structure to your life: a get up time, a time to go to bed time, lists, reminders, staying on track. These folks, regardless of whether they’re six years old or sixty, they know what to do, they just don’t do it because they forget or they get sidetracked, or they get distracted. So structure in its various forms—and you need to be creative to fit the person’s individual needs—structure makes a tremendous difference.
TAC: Because it sounds to me that almost everybody falls into this category at some point or another. How do you really effectively diagnose who really has it and who doesn’t?
DR. HALLOWELL: A good analogy is the difference between sadness and depression. Everyone is sad now and then, but only a small fraction of the population is depressed. So it’s the intensity and the duration of the symptoms that makes the diagnosis. Everyone is distractible or impulsive at times, but the question is how distractible compared to a cohort of your peers, how impulsive compared to a cohort of your peers, and is it getting in your way in life, are you underachieving because of it? Again, the analogy with depression: if you’re very sad for a long time and it’s causing you to lose ground in school or work, we call that depression. If you’re sad for a few days because something bad happened in your life, we call that normal life. The same is with the symptoms of ADHD: are you much more distractible or impulsive than a cohort of your peers and is it leading you to underachieve? If the answer is ‘yes’, then that’s ADHD. It’s a question of intensity and duration of symptoms and are they leading you to underachieve in your life.
ADHD is a really good news diagnosis because this is a diagnosis where people turn their lives around, whether in school with children or adults in marriage. They go from struggling to soaring. It’s really quite a remarkable turnaround when you see it happen. Folks go from feeling downtrodden and frustrated, and angry, and being told constantly to shape up to suddenly being able to go from a ‘D’ to an ‘A’, or an adult going from being the night watchmen, as one of my patients did, to being the manager of the plant. You can really turn your life around with this diagnosis, and that’s why I say it’s a good news diagnosis. Once the diagnosis is made the worst is over, things will only get better.
TAC: How do you view the role of Ritalin as a treatment method in the model that you use?
DR. HALLOWELL: You know, people ask me if I believe in Ritalin and my answer is, “It’s not a religious principal.” It’s not a matter of belief, it’s an option that’s available, and obviously chiropractors are offering an option that does not include medicine. This is great, because many, many people are eager to find solutions without using medication. There’s a great deal of need these days for effective interventions, effective treatments that do not involve medication.
TAC: Would you say the incidence of ADHD is becoming more frequent, or are we diagnosing it more frequently?
DR. HALLOWELL: I don’t think the incidence of true ADHD is on the rise. It’s a combination of factors: number one, due to better education we are diagnosing it properly more often. On the other hand, there’s modern life—we’ve really seen such dramatic change even in the past decade. We live in an age of distraction and interruption, so I think there’s a lot of what I call ‘pseudo-ADD’ out there, not true ADD but it looks like it, and I think we’ve got to be careful not to assume those people have ADD. You can do the Vermont test: take someone and put them on a farm in Vermont and come back in a month. If they’re quietly plowing the fields then it wasn’t ADD, but if they’ve turned the farm into an amusement park then it was ADD. The point being that one is context dependent. You can basically say that modern life is ‘ADDogenic’—you can look like you have it and not have it at all. So turn off your cell phone, turn off your Blackberry, and have family dinner instead of sitting in front of the television and suddenly you will start focusing.
TAC: What could a chiropractor expect in using this program your proposing?
DR. HALLOWELL: I think that’s where I’m leaving that in the hands of the chiropractors. In other words, I can tell you what I’ve learned, and that’s what I’ve put into the videos, and then you build on that. We both offer each other what we’ve got and then we say, “Why don’t you try this with that?” and I say, “Why don’t you try that with this?” and I think in the collaboration we’ll discover things that neither group knew before. The key to it all is to be open-minded and not territorial, and I think that separated for too long MDs from chiropractic, and I think it’s sort of a turf issue, and that, I think, is ridiculous. We’re all in this life together trying to help people and there’s plenty of business to go around. We want to pool our knowledge. Everybody should offer the best they’ve got, and then everybody wins.
TAC: Absolutely. It’s all for the benefit of the patient. Now, how profoundly do you recognize diet as being a factor?
DR. HALLOWELL: It’s tremendous. Nutrition is huge, sleep is huge, and physical exercise may be the single most important thing of all, and meditation as well. These physical factors are huge, absolutely huge.
TAC: Do you also have extra reading material?
DR HALLOWELL: I urge people to get my book called Delivered from Distraction. If they don’t have time to read the whole book, the first chapter is called “The Skinny on ADD: Read this if you don’t have time to read the whole book.”
TAC: Is there anything else you can think of that you’d like to make sure our doctors or their patients know?
DR. HALLOWELL: I’d like them to learn more. If your article can whet their appetite, go to one of my books or get the program, because this is a really fun condition to work with. These patients improve, and they’re grateful. Everybody wins. As opposed to some chronic pain syndrome that may be not so much fun, these folks are really, really fun to work with because they improve by leaps and bounds, and they’re usually adventurous, fun people. I would urge chiropractors to learn about this and make it a subspecialty, because it’s very, very rewarding.
TAC: How can people learn more about the program you’re putting together for chiropractors?
DR. HALLOWELL: We are creating a website, and we’re going to be presenting at some chiropractic meetings. We haven’t started marketing it yet because we’re still in the process of creating the videos. I’m thrilled to be doing this; it’s something I want to bring to practitioners of all kinds. I’d like to reach people who are working in many different fields because this is a common trait, depending upon what numbers you look at we’re talking between five and fifteen percent of the population, so it’s common, and the good news is that when it’s dealt with properly these folks can be extraordinarily productive, but when it’s not they languish, they struggle. As I stated, at its worst untreated ADHD leads to violence, crime, and prison.
TAC: Fabulous. Well, we’re excited. Thank you for your time, Dr. Hallowell.
DR. HALLOWELL: Thank you. Take care.
Page 4 of 9