A friend of mine, Dr. James Teachworth, of Superior, Nebraska, gave me a copy of the September 4th issue of Dynamic Chiropractic.
What interested me most was the article concerning the episacral lipomas, using reports that are all from the MDs. I would like to add an additional insight that might receive an airing in a publication like yours. There is a basis for considering these episacral lipomas as a cause of discomfort. But there is a different explanation for them. Understanding how they come about and how they fit into patterns of back pain may interest you and your readers.
The question that immediately comes up is "Why would a lipoma hurt?" The answer is - "It doesn't." There are manifestations of the neuroelectric phenomena of the returning bioelectric energy from the central nervous system coming through the mechanics of the paraspinous muscle fascia. There is a capacitor interaction between the skin that is conductive, and the fascia, which is also conductive. All connective tissue is piazoelectric, generating current from stretch or distortion of collagen fibers, which are highly conductive and electrically active.
The input from the fascia around the sacrum and the paraspinous muscles contributse ground circuits, supplying the feedback from the central nervous system. There is an energy transformation from the neural electrical energy, back through muscle mechanical changes, which then drains electrical activity into the channels, which the Chinese have clearly defined. In this area they are called the "bladder meridians." Indeed, if you look at where these lipomas occur, they are directly along those meridians and the accupoints associated with them.
Why does this occur? There is a marked disruption of this bioelectric flow in an arching pattern between the skin and the fascia. This then initiates a tissue reaction that results in a lipoma that is non-conductive. Fat acts as an insulator. This is an attempt on the part of the tissue to re-establish the normal capacitor isolation of this electrical flow from the surrounding areas. The pain comes from an energy flow into tissues where it doesn't belong. This aberrant electrical energy is the cause of pain. The lipoma is only secondary.
There is an additional phenomenon, which has been called "stretch marks." There are no such reactions in the spine in contrast to the abdomen. The skin, when it becomes overloaded with energy, is partially dissolved and its underlying collegenous pattern is changed by excessive neuroelectric flow. This comes off the crest of the ilium, through the bony structures of the pelvis, and is mediated through the ligaments of the sacrum. This creates patterns of electrical flow, an alternative to the development of these lipomas.
Thus, with these lipomas, as well as what might be called "lightning" in the skin, you must realize that you're dealing with a basic phenomenon of body bioelectricity that is the cause of most of the symptom patterns concerning the painful spine.
Current chiropractic professionalism can be applied with a more rational scientific basis when understanding and applying such accurate observations and mechanisms. Perhaps the information can be of significant help. This improves the accurate involvement with patients and brings more trust with effective treatment. This doctor-patient trust has begun to disappear from many other types of medical care, to the harm of both the doctors and their patients.
Charles J. Nowacek,MD
Amityville, New York
Protecting Innocent Eyes from Chiro-Violence
This is my first visit to http://www.chiroweb.com. I am a DC for three years now and am terrified by what I saw on the poll page. Many other sites on the web are edited for violent and vulgar content, and I plead that you do the same. I was about to list this website in my practice newsletter for Nov., and was considering moving my website here, thinking it would reduce the amount of time I spend doing research for the site. But I do not want my patients seeing the threats of violence on this site. They may or may not have been from a DC, but please edit them. I'll check again in January, and if it's not cleaned up, I'll leave my site where it is and spend the hours it takes to provide my patients with the best of the profession, facts, and health tips.
(Editor's note: As with most things in life, it only takes a few to ruin something. The discussion forums on ChiroWeb were originally open to all. This same problem caused them to be password-protected so that only doctors of chiropractic could read the posts. This kept the "vulgar" content from the eyes of the public and allowed ChiroWeb the ability to restrict the access of abusers. The same is being designed for ChiroPoll and additional services soon to be launched. Those who visit ChiroPoll will soon be required to enter their personal user ID and password. Unfortunately, this will eliminate student participation, but it will also prevent "violent" posts.)
Three Responses to Dr. Cuneo's Call for Unity
"We are ... one party... split into factions"
I sent the following letter to Mr. Cuneo as a response to the e-mail version of his article, "It Doesn't Make Any Sense" in August, 2000. I submit it to you for the interest of your readers:
Thank you, Dr. Cuneo, for your recent editorial, "It Doesn't Make Any Sense" that you have sent out via e-mail. I must agree with you on almost all your major points, except one: the myth of the two-party system in Chiropractic. Dr. Chester Wilk has alluded to this mistaken analogy in the past, and I have my own viewpoint that has grown out from that.
In reality, we are not like the two-party Republican/Democrat system in politics. We are in fact like one party that is split into factions, like the conservative Democrats and the liberal Democrats, or the social conservative Republicans and the Libertarian Republicans. They are, in reality, quite different, and united in name only. If we were like the two-party system, then one of us would win over 90% of the time as does any candidate running on one of the party's tickets. We, are in reality, one party that is fractionated, and our opponents are using this against us.
Until we learn the lesson of a unified front, as is being demonstrated by this year's presidential election, we will not progress to our potential. The Republication national convention was a show of "unity" and "inclusiveness," even if in image only. The extreme factions of the party were kept out of the limelight, and acted in support of their party's ticket. Whether this was done voluntarily or not is immaterial. The result is a strong leap in the polls and in the minds and hearts of many. The Democrats are following suit.
They all know that the party that appears more divided loses. They are keeping their own houses in order, rallying the "tribes" under one tent, and presenting a unified front. Each faction is giving in on some platform issues, so as to win the opportunity to have a greater voice, power and control that an election victory will bring. Call it "mutual self-interest" or "interdependence," or a variation of game theory's "prisoner's dilemma" (in which the only way to assure victory is for each party to cooperate, and each win small gains together, rather than each having a potential "all-or-nothing" outcome).
There are those who say that any compromise with their platform issues is unacceptable, and even immoral. Conversely, there are also those who seem all too willing to compromise in order to get some crumbs of the health care economic pie. Both views are shallow, narrow and more self-serving than profession and public- serving. They are unproductive, no matter how logical the arguments appear, or how emotional the appeals.
I wonder-how naive, shortsighted or just plain stupid are we as a profession? I remember reading the summaries of the Wilk case and how shocked I was at how effective the AMA successfully pitted us against ourselves. I don't fault some of the DCs in the past for holding passionately to partisan positions, unknowingly being used by the AMA and their associates. But what is our excuse today, when the same strategy of encouraging our profession's internal divisiveness is still being used, now that the evidence is plainly out in the open in black and white? I believe it was a Confucian philosopher that said, "When families fight, outsiders take advantage."
Most chiropractors I know are united in their desire to serve, their drive for success (whatever their definition of success is), and their focus on subluxation correction; body rehabilitation; health promotion; restoration; and maintenance through natural means. They are also committed to an autonomous separate and distinct primary care profession with specialized and unique skills, training, and services.
I could go on, but I feel I've made my point. In closing, as a former student ICA college representative and an ACA member for over 15 years, I hope that unity can be achieved. If unity is truly desired by both organizations, then I am personally convinced that they will do whatever it takes to make it happen. We need the membership numbers, money, vision, and talent that such a unification can bring.
David I. Graber, DC, DACBSP
Denville, New Jersey
"...one association will become absorbed by the other."
I found Dr. Cuneo's article on unity very interesting. The only problem in unifying that I see is one association will become absorbed by the other. This is not an acceptable situation for the association that is being absorbed. They fear losing their identity, membership, careers, etc. A possible solution might be to form a new association with a new name, such as the "Unified Chiropractic Association." All things must adapt or they die. An organization must also adapt, or it will become disorganized and die. Certainly it is foolish to think that an organization will willingly become absorbed into another organization - losing its identity, its voice, its independence and its purpose. Unity is imperative for the survival and advancement of this profession. It is my feeling that if these two organizations cannot come to an agreement and create a unifying association, they are both being very selfish.
Unfortunately, I see this selfishness throughout our profession. I have worked as a respiratory therapist for nine years; four years in critical care in a hospital; and five years in nursing homes. As compared to respiratory therapy; physical therapy; occupational therapy; speech therapy; and medicine, we in chiropractic have the most unique and disorganized form of licensor. This is not something to be proud of.
We are a unique profession, and offer a unique and profound approach to health care that gets results, quite often much better than with other professions. Many in chiropractic find our approach to licensors bewildering. You can imagine how people outside our profession think. For the purpose of professional organizations and licensors, we should not be unique and different. I become astounded when I read that the bankers in New Jersey came together with the insurance industry in N.J. and changed the way chiropractors are able to practice in N.J. That is unbelievable! We should have come together from across the entire country and crushed that initiative, and we still should - for the sake of our patients and those patients in N.J. Benjamin Franklin said, "We must all hang together, or we shall all hang separately." Each year I feel the squeeze getting tighter and tighter.
Lee Levine, DC
"I think he is right on!"
Thank you so much for your publication; it keeps us updated. Kudos to Garrett Cuneo for his article on unity. I think he is right on!
I had a subluxation-based practice for 37 years and belonged to the ICA for 17 years. I was a "straight" DC, so I thought I should be an ICA member, but eventually the concept of two national associations became nonsensical, so I joined the ACA and remained a member until I retired.
I strongly believe that we need to combine our resources if we are to survive. Maybe more than 30 percent of our profession would join if we had only one association. A split profession is what the AMA wants.
The same issue of Dynamic Chiropractic features an article describing a lack of an increased role for chiropractic in the Veterans' Administration. Surely a lack of unity (on our part) played the major role in their policy, and the scenario will not change until chiropractic speaks with one voice. Maybe we have too many egos in the profession for unity to be a reality, but it's time for that to change.
I feel blessed that I have two sons who are DCs, and that both have subluxation-based practices. If we want our children and grandchildren to consider entering the chiropractic profession, we had better heed Garret Cuneo's advice and strive for unity and one national association.
George R. Ruddell,DC
Son of Medical Review Saga
In the October 16th edition of DC, you published a letter from a chiropractor who questioned the credibility of the review process utilized by Medical Review Institute of America (MRI).
MRI reviews patient treatment records for chiropractic and all other specialties, to evaluate the medical necessity for initial or continuing patient care. If documented evidence supporting the need for care is submitted by the treating provider, MRI will provide an opinion, rendered by a practicing peer, which will indicate that treatment is medically appropriate for the patient. MRI's client then makes the final coverage decision based upon this input.
MRI's first responsibility is always to the patient, acting in our clients' best interests. For over 18 years, MRI has provided specialist peer reviews to over 600 clients nationwide, including health insurance organizations, third-party payers, employers and directly for patients and providers.
MRI currently provides review service in states with newly passed state legislation mandating external appeal review. We comply with same-state reviewer requirements across the country as well. MRI anticipates certification in early 2001 from the American Accreditation HealthCare Commission (URAC), which only recently made its certification process available to independent peer review organizations. Accreditation by URAC certifies that a review company has met and passed the most rigorous scrutiny for providing objective review by experienced, practicing peers, while maintaining strict confidentiality of all patient records.
It has always been MRI's policy to have each case reviewed on a "matched-specialty" basis. Therefore, we utilize only practicing chiropractors that meet strict credentialing guidelines to review chiropractic treatment. Our company provides same-specialty reviews in all other medical/dental specialties as well.
MRI does not release the names of reviewers with its initial reviews. Although in some states, work comp guidelines require the name of the doctor be included on the review, this is not the standard for health benefits reviews. Anonymity is essential to protect the reviewer from possible repercussions in his/her own practice due to the review of a colleague. Reviewers who document objective medical findings from the patient records provide credible opinions that reflect the standard of care within their specialty field. A curriculum vitae for the reviewer is included with each MRI review.
None of the states in which MRI is certified as an independent review organization require the name of the reviewer to be included with an initial review, unless the case is involved in governmental administrative proceedings or litigation. The many new state laws protecting patient rights do not require the name of the reviewer to be released either. URAC guidelines also do not require the name of the reviewer to be included on a review for any specialty.
The amount and type of documentation submitted by practitioners is always a key to thorough case review. MRI assesses all submitted documentation immediately upon receipt of a case and communicates the need for any additional documentation back to the client requesting the review. This process helps assure the most accurate assessment of the patient's current condition. All documentation guidelines used by MRI have been developed in coordination with practitioners in the same specialty field being reviewed. When MRI's clients are unable to obtain sufficient documentation from a provider, it is more difficult to accurately establish the medical necessity for continued care.
MRI provides appeal review options for providers and patients, including a phone consultation with the reviewing peer. This assures that the treating provider is given the opportunity to adequately represent the patient's need for continued care.
Medical Review Institute of America, Inc.
Salt Lake City, Utah
Maharishi - Madman or Messiah?
The October 16, 2000 issue of Dynamic Chiropractic ran a letter by Edward Klein,DC, titled "The Natural Law Party: A Political Party for Chiropractors." There were several glaring omissions that Dr. Klein chose not to tell readers about the "Natural Law Party."
First, the NLP is the political organ of the Maharishi Mahesh Yogi and his transcendental meditation (TM) cult. They seek to increase political power in order to promote and disseminate the Hindu teachings of TM. In its web site, the NLP is not open about its connection to the Maharishi or the TM cult.
The Maharishi is also the main promoter of the dubious practice of ayurveda, or as it is now called, Maharishi Vedic Medicine, a trademarked name.
The Natural Law Party philosophy has nothing to do with "natural law." Though it's presidential candidate, long-time TM advocate, John Hagelin, is indeed a PhD physicist, he advocates the counter culture, metaphysical "subjective reality" agenda, which, simply stated, is that "thought" or "consciousness" creates or alters physical realities of time, space, matter and energy. He supports this with reams of physicist-babble, incomprehensible to most readers, and totally nonsensical to mainstream physicists.
Though, in recent years, the Maharishi has backed off from his claims that TM allows gurus to levitate, become invisible, and dematerialize (in order to walk through walls, of course), a manifestation of the "subjective reality" paradigm is evident in NLP presidential candidate Hagelin's recent claim to Meet the Press' Tim Russert, on national television, that meditating yogis can alter crime rates through transcendental meditation (altering other peoples behavior through meditation). The Maharishi has also claimed that groups of yogis meditating together can change the weather.
Dr. Klein suggests his readers learn more by logging in to www.natural-law.org. I recommend the same thing, and I would also recommend the Committee for Scientific Investigation of Claims of the Paranormal, www.csicop.org, for some reliable information. Anyone thinking of associating with this group needs to understand what it is they are truly selling.
Fred Kourmadas, DC, MS