CEO Newsletter 07 number 26
Home of Neurologically Based Chiropractic
Contents
1. AAADD .....Know the signs!
2. Drugs Are Not the Answer for ADHD
3. Taking the Third - Posted: Dec. 1, 2004
1. AAADD .....Know the signs! Forwarded - Thanks to DeDe Van Riper
Recently, I was diagnosed with A.A.A.D.D. - Age Activated Attention Deficit Disorder.Thank goodness there's a name for this disorder.Somehow I feel better, even though I have it!! This is how it manifests:
I decide to water my garden.As I turn on the hose in the driveway, I look over at my car and decide it needs washing.As I start toward the garage, I notice mail on the porch table that I brought up from the mail box earlier.I decide to go through the mail before I wash the car.I lay my car keys on the table, put the junk mail in the garbage can under the table, and notice that the can is full.So, I decide to put the bills back on the table and take out the garbage first.But then I think, since I’m going to be near the mailbox when I take out the garbage anyway, I may as well pay the bills first.I take my check book off the table, and see that there is only one check left.My extra checks are in my desk in the study, so I go inside the house to my desk where I find the can of Coke I’d been drinking.I’m going to look for my checks, but first I need to push the Coke aside so that I don’t accidentally knock it over.The Coke is getting warm, and I decide to put it in the refrigerator to keep it cold.
As I head toward the kitchen with the Coke, a vase of flowers on the counter catches my eye—they need water. I put the Coke on the counter and discover my reading glasses that I’ve been searching for all morning.I decide I better put them back on my desk, but first I’m going to water the flowers.I set the glasses back down on the counter, fill a container with water and suddenly spot the TV remote.Someone left it on the kitchen table.
I realize that tonight when we go to watch TV, I’ll be looking for the remote, but I won’t remember that it’s on the kitchen table, so I decide to put it back in the den where it belongs, but first I’ll water the flowers.I pour some water in the flowers, but quite a bit of it spills on the floor.So, I set the remote back on the table, get some towels and wipe up the spill.Then, I head down the hall trying to remember what I was planning to do.
At the end of the day: the car isn’t washed, the bills aren’t paid, there is a warm can of Coke sitting on the counter, the flowers don’t have enough water, there is still only 1 check in my check book, I can’t find the remote, I can’t find my glasses, and I don’t remember what I did with the car keys.
Then, when I try to figure out why nothing got done today, I’m really baffled because I know I was busy all day, and I’m really tired.I realize this is a serious problem, and I’ll try to get some help for it, but first I’ll check my e-mail....Do me a favor. Forward this message to everyone you know, because I don’t remember who I’ve sent it to. Don’t laugh—if this isn’t you yet, your day is coming
Editor's note: Remember that ADD kids grow up to be ADD adults - It is a "How we deal with STRESS problem" and that there is a link between PTSD and ADD. While this may appear as humorous it really isn't.If you live with an ADD individual I hope this can help you understand that they operate under good intentsion but lack the focus to complete a task.
2. Drugs Are Not the Answer for ADHD Source: - BBC News November 12, 2007 Department of Health Statement - Forwarded – Thanks to Dr. Ken Vinton
Research has shown that treating children who have Attention Deficit Hyperactivity Disorder (ADHD) with drugs is not effective in the long-term. After three years of treatment, drugs such as Ritalin and Concerta work no better than therapy.
Long-term use of the drugs can also stunt children's growth, and the benefits of the drugs have been exaggerated.
An influential 1999 study seemed to find that medication worked better than behavioral therapy for ADHD after one year of use. This finding caused a vast increase in prescriptions.
But now, after longer-term analysis, the report's co-author, Professor William Pelham of the University of Buffalo, has stated, "I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn't happen to be the case. There's no indication that medication is better than nothing in the long run." Pelham said that medication had "no beneficial effects" and that in fact, the drugs had a negative impact in terms of growth rate.
The National Institute for Clinical Excellence in England is currently revising their treatment guidelines for ADHD to include strategies that will likely involve training for parents as well as "behavioral interventions".
"The important thing is that we have an approach which doesn't focus just on one type of treatment," Dr. Tim Kendall, chair for the working group, said.
Editor's note: ADHD is now considered to be a division of ADD. Whathold for one division holds for both! Drugs are not the answer!!!!
3. Taking the Third – response prompted by a letter from WCA
Letter from the World Chiropractic Alliance and Terry Rondberg
First the WCA letter
The draft of the newest chapter of the "Best Practices" document released by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) contains statements and conclusions that could prove devastating to the chiropractic profession. In it, the CCGPP gives rogue regulatory boards the weapons they need to go after and sanction subluxation based chiropractors who provide this care, and third party payers the ammunition they need to deny reimbursement for subluxation care apart from NMS conditions.
The chapter, entitled "Chiropractic Management of Prevention and Health Promotion; Nonmusculoskeletal Conditions; And Conditions Of The Elderly, Children And Pregnant Women," makes it clear that, from the data the CCGPP members considered, there is not enough evidence to support the use of chiropractic care for patients who are not presenting with specific non‑musculoskeletal health issues. Shockingly, the CCGPP also ignored all case studies, regardless of how many patients were involved. It explained its decision only with the statement that "even though there are a large number of patients described in case reports, these reports can only provide evidence that patients with the conditions described have sought care from chiropractors; case reports cannot provide convincing evidence to support best practices."
“It takes little imagination to see what state boards and other regulators will do with this," he warned. "In today's politically charged atmosphere, a board could easily target a particular class of doctors and charge them with endangering patients by providing care unsupported by research and disavowed by the CCGPP guidelines.
What's really going on? There is a well‑choreographed plan to sculpt the future of the profession. It casts chiropractic as a profession that uses crude manipulation for the short term symptomatic treatment of a narrow range of spinal pain syndromes. It involves either denying the very existence of vertebral subluxation, or at best downgrading it to a local mechanical lesion. The use of objective assessments is dismissed. Instead, care is based primarily on symptomatic response, without regard for x‑ray or neurofunctional changes. Of course, lifetime wellness care is unthinkable in this model.
Thankfully, DCs who focus on subluxation and wellness care have a resource to defend themselves: the Council on Chiropractic Practice (CCP) guideline. The guideline is a compilation of the best available evidence concerning the detection, management, and correction of vertebral subluxation. It serves as a tool to empower DCs with the information needed to develop more effective clinical strategies, and objectively assess functional and clinical outcomes. The document also provides chiropractors with the intellectual ammunition needed to defend their practice style when challenged by regulators, policy makers, and in court proceedings.
The chiropractic guideline document, "Vertebral Subluxation in Chiropractic Practice," produced by the CCP was reviewed by an independent research agency (ECRI) which is a Collaborating Center of the World Health Organization (WHO). Based on this review, it was accepted for inclusion in the National Guideline Clearinghouse (NGC), a public resource for evidence‑based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services.
The CCP and its official published documents were accepted for inclusion in the Healthcare Standards Database and the printed version of the Healthcare Standards: Official Directory. Healthcare Standards (HCS) is a comprehensive list of published standards, guidelines recommendations, position papers, policy statements, technology assessments, and other authoritative documents. ECRI is the WHO's official health care standards and guidelines archive. HCS is used daily in legal and clinical settings by a wide variety of medical and legal professionals such as: risk managers, litigators, paralegals, legal nurse consultants, medical and legal librarians, patient safety officers, biomedical engineers, insurance carriers and more.
When challenged by regulators, policy makers, or in courtroom proceedings, where will you find the resources to defend your practice? If your vision of chiropractic embraces lifetime, subluxation‑based wellness care, you need CCP. The Council on Chiropractic clinical practice guidelines have been used to successfully support the ability of persons to receive chiropractic care for vertebral subluxations to improve function and quality of life. Care is based upon indicators of vertebral subluxation, not the presence of a short list of medical conditions.
Taking the Third response -
Editor’s notes: There is an old saying – “when faced with the decision of choosing between two paths - take the third!” It is never more applicable than here, in my view. This letter represents what could be the ultimate downfall of our profession. Not that I oppose what is being stated here in favor of the opposing side, but rather that either side is a no win situation for Chiropractic. There is more than adequate proof that Chiropractic works well at the pain relief and musculoskeletal care levels but to limit this profession to this would be a crime (and I mean that in every sense of the word), especially when the motivation is driven by inclusion in third party pay. If that is all we stand for, then the Chiropractic Oath we have taken is a sham at best.
On the other hand, to continue to take the position that all we need to do is defend the vertebral subluxation theory continues to hold the profession up to ridicule. Yes, I agree that a “thank you” to the CCP in at least offering an alternative to the CCGPP’s extremely limited guidelines for Chiropractic practice is warranted. So, Thank You! However, the continued concept that vertebral subluxation totally defines Chiropractic and any shift away from this would weaken the profession just proves the limitation of this thinking.
The “third path” for Chiropractic will require some trail clearing before we can walk it. Not much, just that there are a couple of boulders blocking the entrance and once we move those we can walk the profession into a new arena. One of the boulders, the largest in fact, lies in understanding the classification of the Chiropractic Adjustment. Is it a mechanical, psychological, neurological, or soft tissue therapy? Or could it be something else? The current divisions in the profession would have us fit into one camp or the other in a position of opposition and we are now well aware of the consequence of this division. There has to be more to the power of effectiveness of Chiropractic care than these two simplistic antagonizing approaches.
I suggest we view the adjustment within another set of laws - the laws of biofeedback. First we need to understand the definition of feedback, bio feedback and neurofeedback.
Feedback
A process whereby the results of action serve continually to modify further action. Isn’t this exactly what we claim we do. We do tell everyone that we deal with the nervous system which in turn continues to create change in the systems. Provable – YES
Biofeedback
Voluntary control by feedback of involuntary functions.
A system evaluating the biological signals produced by the body, specifically biological functions (i.e. heart rate, breathing rate, skin temperature, etc. ). Provable – YES
Neurofeedback
Neurofeedback is direct training of brain function, by which the brain learns to function more efficiently. We observe the brain in action from moment to moment. We show that information back to the person and we reward the brain for changing its own activity to more appropriate patterns.
Provable - YES
So if we can start with a new understanding of the Chiropractic Adjustment as a very powerful and specific form of bio/neurofeedback, then we can start to explain why such a wide range of approaches work in our profession. They are all forms of the feedback mechanism. The third path includes both the pain based musculoskeletal and the vertebral subluxation based concepts while making neither right nor wrong and expands the power of our care beyond these two positions.
The most important factors here are:
1. The research done in the biofeedback world is overwhelming in support of the effectiveness of this care. ( over 40 years of supporting research)
2. There is proof that the Adjustment has the power to alter brain wave activity
3. Research supports the effectiveness of Chiropractic to alter Autonomic Nervous system function.
4. This empowers the profession by broadening the scope of practice with proof rather then restricting it or trying to defend it through a dogmatic stance.
5. We can now demonstrate the functioning level of a nervous system under normal conditions, under stress, and its ability to recover from stress. This is a critical statement with the above letter in mind. Why?
A/ It can demonstrate the need for care outside of signs and symptoms that are pain based
B/ It can demonstrate the effectiveness of care in bringing about neurophysiological improvement
C/ It can demonstrate the effectiveness of a type of care to alter a person’s Neurological response
So, when we consider this information it seems to me that the positions of the CCGPP and CPP are both moot and that we have everything to gain and nothing to lose by just making a simple shift in the concepts of the Chiropractic Adjustment. I’ve been walking down this path for about 8 years now and the view is fantastic. Care to take a stroll? Visit our web site - ask for the free report or call me to find out more about great possibility for Chiropractic
Ad Summum Nitamur!
Contents
1. AAADD .....Know the signs!
2. Drugs Are Not the Answer for ADHD
3. Taking the Third - Posted: Dec. 1, 2004
1. AAADD .....Know the signs! Forwarded - Thanks to DeDe Van Riper
Recently, I was diagnosed with A.A.A.D.D. - Age Activated Attention Deficit Disorder.Thank goodness there's a name for this disorder.Somehow I feel better, even though I have it!! This is how it manifests:
I decide to water my garden.As I turn on the hose in the driveway, I look over at my car and decide it needs washing.As I start toward the garage, I notice mail on the porch table that I brought up from the mail box earlier.I decide to go through the mail before I wash the car.I lay my car keys on the table, put the junk mail in the garbage can under the table, and notice that the can is full.So, I decide to put the bills back on the table and take out the garbage first.But then I think, since I’m going to be near the mailbox when I take out the garbage anyway, I may as well pay the bills first.I take my check book off the table, and see that there is only one check left.My extra checks are in my desk in the study, so I go inside the house to my desk where I find the can of Coke I’d been drinking.I’m going to look for my checks, but first I need to push the Coke aside so that I don’t accidentally knock it over.The Coke is getting warm, and I decide to put it in the refrigerator to keep it cold.
As I head toward the kitchen with the Coke, a vase of flowers on the counter catches my eye—they need water. I put the Coke on the counter and discover my reading glasses that I’ve been searching for all morning.I decide I better put them back on my desk, but first I’m going to water the flowers.I set the glasses back down on the counter, fill a container with water and suddenly spot the TV remote.Someone left it on the kitchen table.
I realize that tonight when we go to watch TV, I’ll be looking for the remote, but I won’t remember that it’s on the kitchen table, so I decide to put it back in the den where it belongs, but first I’ll water the flowers.I pour some water in the flowers, but quite a bit of it spills on the floor.So, I set the remote back on the table, get some towels and wipe up the spill.Then, I head down the hall trying to remember what I was planning to do.
At the end of the day: the car isn’t washed, the bills aren’t paid, there is a warm can of Coke sitting on the counter, the flowers don’t have enough water, there is still only 1 check in my check book, I can’t find the remote, I can’t find my glasses, and I don’t remember what I did with the car keys.
Then, when I try to figure out why nothing got done today, I’m really baffled because I know I was busy all day, and I’m really tired.I realize this is a serious problem, and I’ll try to get some help for it, but first I’ll check my e-mail....Do me a favor. Forward this message to everyone you know, because I don’t remember who I’ve sent it to. Don’t laugh—if this isn’t you yet, your day is coming
Editor's note: Remember that ADD kids grow up to be ADD adults - It is a "How we deal with STRESS problem" and that there is a link between PTSD and ADD. While this may appear as humorous it really isn't.If you live with an ADD individual I hope this can help you understand that they operate under good intentsion but lack the focus to complete a task.
2. Drugs Are Not the Answer for ADHD Source: - BBC News November 12, 2007 Department of Health Statement - Forwarded – Thanks to Dr. Ken Vinton
Research has shown that treating children who have Attention Deficit Hyperactivity Disorder (ADHD) with drugs is not effective in the long-term. After three years of treatment, drugs such as Ritalin and Concerta work no better than therapy.
Long-term use of the drugs can also stunt children's growth, and the benefits of the drugs have been exaggerated.
An influential 1999 study seemed to find that medication worked better than behavioral therapy for ADHD after one year of use. This finding caused a vast increase in prescriptions.
But now, after longer-term analysis, the report's co-author, Professor William Pelham of the University of Buffalo, has stated, "I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn't happen to be the case. There's no indication that medication is better than nothing in the long run." Pelham said that medication had "no beneficial effects" and that in fact, the drugs had a negative impact in terms of growth rate.
The National Institute for Clinical Excellence in England is currently revising their treatment guidelines for ADHD to include strategies that will likely involve training for parents as well as "behavioral interventions".
"The important thing is that we have an approach which doesn't focus just on one type of treatment," Dr. Tim Kendall, chair for the working group, said.
Editor's note: ADHD is now considered to be a division of ADD. Whathold for one division holds for both! Drugs are not the answer!!!!
3. Taking the Third – response prompted by a letter from WCA
Letter from the World Chiropractic Alliance and Terry Rondberg
First the WCA letter
The draft of the newest chapter of the "Best Practices" document released by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) contains statements and conclusions that could prove devastating to the chiropractic profession. In it, the CCGPP gives rogue regulatory boards the weapons they need to go after and sanction subluxation based chiropractors who provide this care, and third party payers the ammunition they need to deny reimbursement for subluxation care apart from NMS conditions.
The chapter, entitled "Chiropractic Management of Prevention and Health Promotion; Nonmusculoskeletal Conditions; And Conditions Of The Elderly, Children And Pregnant Women," makes it clear that, from the data the CCGPP members considered, there is not enough evidence to support the use of chiropractic care for patients who are not presenting with specific non‑musculoskeletal health issues. Shockingly, the CCGPP also ignored all case studies, regardless of how many patients were involved. It explained its decision only with the statement that "even though there are a large number of patients described in case reports, these reports can only provide evidence that patients with the conditions described have sought care from chiropractors; case reports cannot provide convincing evidence to support best practices."
“It takes little imagination to see what state boards and other regulators will do with this," he warned. "In today's politically charged atmosphere, a board could easily target a particular class of doctors and charge them with endangering patients by providing care unsupported by research and disavowed by the CCGPP guidelines.
What's really going on? There is a well‑choreographed plan to sculpt the future of the profession. It casts chiropractic as a profession that uses crude manipulation for the short term symptomatic treatment of a narrow range of spinal pain syndromes. It involves either denying the very existence of vertebral subluxation, or at best downgrading it to a local mechanical lesion. The use of objective assessments is dismissed. Instead, care is based primarily on symptomatic response, without regard for x‑ray or neurofunctional changes. Of course, lifetime wellness care is unthinkable in this model.
Thankfully, DCs who focus on subluxation and wellness care have a resource to defend themselves: the Council on Chiropractic Practice (CCP) guideline. The guideline is a compilation of the best available evidence concerning the detection, management, and correction of vertebral subluxation. It serves as a tool to empower DCs with the information needed to develop more effective clinical strategies, and objectively assess functional and clinical outcomes. The document also provides chiropractors with the intellectual ammunition needed to defend their practice style when challenged by regulators, policy makers, and in court proceedings.
The chiropractic guideline document, "Vertebral Subluxation in Chiropractic Practice," produced by the CCP was reviewed by an independent research agency (ECRI) which is a Collaborating Center of the World Health Organization (WHO). Based on this review, it was accepted for inclusion in the National Guideline Clearinghouse (NGC), a public resource for evidence‑based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services.
The CCP and its official published documents were accepted for inclusion in the Healthcare Standards Database and the printed version of the Healthcare Standards: Official Directory. Healthcare Standards (HCS) is a comprehensive list of published standards, guidelines recommendations, position papers, policy statements, technology assessments, and other authoritative documents. ECRI is the WHO's official health care standards and guidelines archive. HCS is used daily in legal and clinical settings by a wide variety of medical and legal professionals such as: risk managers, litigators, paralegals, legal nurse consultants, medical and legal librarians, patient safety officers, biomedical engineers, insurance carriers and more.
When challenged by regulators, policy makers, or in courtroom proceedings, where will you find the resources to defend your practice? If your vision of chiropractic embraces lifetime, subluxation‑based wellness care, you need CCP. The Council on Chiropractic clinical practice guidelines have been used to successfully support the ability of persons to receive chiropractic care for vertebral subluxations to improve function and quality of life. Care is based upon indicators of vertebral subluxation, not the presence of a short list of medical conditions.
Taking the Third response -
Editor’s notes: There is an old saying – “when faced with the decision of choosing between two paths - take the third!” It is never more applicable than here, in my view. This letter represents what could be the ultimate downfall of our profession. Not that I oppose what is being stated here in favor of the opposing side, but rather that either side is a no win situation for Chiropractic. There is more than adequate proof that Chiropractic works well at the pain relief and musculoskeletal care levels but to limit this profession to this would be a crime (and I mean that in every sense of the word), especially when the motivation is driven by inclusion in third party pay. If that is all we stand for, then the Chiropractic Oath we have taken is a sham at best.
On the other hand, to continue to take the position that all we need to do is defend the vertebral subluxation theory continues to hold the profession up to ridicule. Yes, I agree that a “thank you” to the CCP in at least offering an alternative to the CCGPP’s extremely limited guidelines for Chiropractic practice is warranted. So, Thank You! However, the continued concept that vertebral subluxation totally defines Chiropractic and any shift away from this would weaken the profession just proves the limitation of this thinking.
The “third path” for Chiropractic will require some trail clearing before we can walk it. Not much, just that there are a couple of boulders blocking the entrance and once we move those we can walk the profession into a new arena. One of the boulders, the largest in fact, lies in understanding the classification of the Chiropractic Adjustment. Is it a mechanical, psychological, neurological, or soft tissue therapy? Or could it be something else? The current divisions in the profession would have us fit into one camp or the other in a position of opposition and we are now well aware of the consequence of this division. There has to be more to the power of effectiveness of Chiropractic care than these two simplistic antagonizing approaches.
I suggest we view the adjustment within another set of laws - the laws of biofeedback. First we need to understand the definition of feedback, bio feedback and neurofeedback.
Feedback
A process whereby the results of action serve continually to modify further action. Isn’t this exactly what we claim we do. We do tell everyone that we deal with the nervous system which in turn continues to create change in the systems. Provable – YES
Biofeedback
Voluntary control by feedback of involuntary functions.
A system evaluating the biological signals produced by the body, specifically biological functions (i.e. heart rate, breathing rate, skin temperature, etc. ). Provable – YES
Neurofeedback
Neurofeedback is direct training of brain function, by which the brain learns to function more efficiently. We observe the brain in action from moment to moment. We show that information back to the person and we reward the brain for changing its own activity to more appropriate patterns.
Provable - YES
So if we can start with a new understanding of the Chiropractic Adjustment as a very powerful and specific form of bio/neurofeedback, then we can start to explain why such a wide range of approaches work in our profession. They are all forms of the feedback mechanism. The third path includes both the pain based musculoskeletal and the vertebral subluxation based concepts while making neither right nor wrong and expands the power of our care beyond these two positions.
The most important factors here are:
1. The research done in the biofeedback world is overwhelming in support of the effectiveness of this care. ( over 40 years of supporting research)
2. There is proof that the Adjustment has the power to alter brain wave activity
3. Research supports the effectiveness of Chiropractic to alter Autonomic Nervous system function.
4. This empowers the profession by broadening the scope of practice with proof rather then restricting it or trying to defend it through a dogmatic stance.
5. We can now demonstrate the functioning level of a nervous system under normal conditions, under stress, and its ability to recover from stress. This is a critical statement with the above letter in mind. Why?
A/ It can demonstrate the need for care outside of signs and symptoms that are pain based
B/ It can demonstrate the effectiveness of care in bringing about neurophysiological improvement
C/ It can demonstrate the effectiveness of a type of care to alter a person’s Neurological response
So, when we consider this information it seems to me that the positions of the CCGPP and CPP are both moot and that we have everything to gain and nothing to lose by just making a simple shift in the concepts of the Chiropractic Adjustment. I’ve been walking down this path for about 8 years now and the view is fantastic. Care to take a stroll? Visit our web site - ask for the free report or call me to find out more about great possibility for Chiropractic
Ad Summum Nitamur!
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