Beware the Legal Spinal Trap

I'd post the unedited version of Simon Singh's article previously available on the Guardian web site. But people smarter than me, such as PZ Myers and Steve Novella, are posting the edited version. They wouldn't do that unless bad legal shit could maybe really happen.

Worry about what might befall the tufted titmouse if she were to post an article on her tiny blog which is read by all of four people --that's the thing that really pisses me off. That worry should not be there.

I do not have time for law suits. I have a sailboat what needs me.

BEWARE THE SPINAL TRAP
(with minor edits to original version)

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in The Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

Dr. Vitaminista Hates the Rhinos and Tigers

Treehugger has a slide show depicting animals that will be extinct in our lifetime.

Notice that alternative medicine is killing a fair number of them.

"Those who can make you believe absurdities can make you commit atrocities." --Voltaire

Yes, it's a package deal. Corrupt the rules of evidence to allow something seemingly harmless like Reiki and homeopathy in the door, and you've no rational check against people using ground rhino horn for impotence.

If "in my clinical experience" is good enough, the tigers are toast.

APA Blues

The American Psychiatric Association meeting in San Francisco this year has left me depressed. The vast majority of my colleagues are either believers or shruggies. Academics I respect and admire feel that fighting quackery is a bad idea.

I related my problem with MDs promoting chelation and other unproven therapies for autistic children to Paul Applebaum. He agreed with my statement to parents, that experimental or unproven therapies must be done in the context of a registered clinical trial so we can learn more about their safety and effectiveness. But when I asked how we as a profession might fight quackery, he shook his head. "I don't know about 'fight'," he said. He seemed to feel that it's enough to limit one's own practice to science-based therapies.

I had a similar conversation with Howard Zonana, who said that there have always been promoters of fringe ideas in medicine. What counts as evidence can be a matter of opinion.

Yes, I said. There are gray areas. But some ideas contradict established basic science. For example, homeopathy-- with remedies so dilute no active ingredient is present-- if it works, we need to re-write physics and chemistry. For that reason we can reject it.

Zonana pointed out that homeopathy was pretty useful in its day when medicines were often quite toxic. He mentioned that the osteopaths, who once held some pretty odd beliefs, have become mainstream.

I started to argue that the shift in osteopathic practice was no natural evolution but the result of the Flexner report.

Zonana interrupted, saying the Flexner report was devastating to a lot of communities. "It closed all the black medical schools. The AMA was politically powerful and really, pretty awful toward blacks."

The implicit point in all this seemed to be: political battles against bad ideas can have unintended, negative consequences.

Chill. Be a lover not a fighter, they seem to say.

And yet Applebaum quite effectively fought against psychiatric involvement in coercive interview settings with military detainees. He said, "not ethical," and snap! Case closed.

Oh, if only. If only he'd take a look at autism quackery and say, "not ethical," in the same way.

Makes me weep. Srsly.

How Bacteria Cause Disease

I've been reading and watching a lot of CAM material lately. So when I bumped into a non-woo health lecture, I felt as though someone had opened a window. Ah, words that have actual meanings! Facts that fit together and make sense! Knowledge presented clearly, without any effort to convince me of "New Medicine" or "wellness" or "empowerment"!

The real world is really real, and we can know stuff about it! Awesome!

This talk by UCSF's Warren Levinson MD, is designed for a lay audience. It's a great overview of infection and immunity for anyone who doesn't know much about germs. I recommend you watch it then go watch something by Weil™ or Chopra. The manipulative, cultish rhetoric of the latter will be immediately apparent.

I'm not a doctor on TV

I saw my dentist yesterday for a chipped crown. As he whirred away polishing the rough edges of my tooth, I tried to imagine what a visit to a holistic dentist would be like.

But before I could conjure any kind of mental picture, he was done and I was on my way. Bloody efficient man.

Who may trace the limits of the set named CAM? It includes prayer, tai chi, smelling nice things, listening to nice music, etc. Who would deny the humans such pleasures? I say, let the humans seek out experiences exotic or familiar that might provoke good feelings and hope for the future.

Seriously, I don't mind any of the hobbies. It's the pretention that the hobby will measurably improve some defined medical condition that I can't abide. We're just not allowed to pretend-play like that, even though it might be fun.

If we lower our evidential standards so marginal effects due to noise are good enough, we'll soon find ourselves overwhelmed with art. How will we cope? We'll likely divide into sects. Some will needle; some will trance. Some will like country. Some will like rock 'n roll.

Aren't we busy enough keeping up with the journals? Why can't we leave the theater to the artists? Must we do everything?

Your Daily Rant: "Wellness Model"

There's something in the language typical of healthcare debates that makes a lot of people zone out. I sense a pervasive attitude of, "wake me when they get to the part about keeping insurance affordable."

Confusion comes in two flavors: the kind that prompts you to ask a question and the kind that makes you feel so lost and stupid you don't dare say anything --i.e. "please clarify" verses "totally over my head."

Healthcare issues provoke a lot of the latter. Some topics are quite technical --e.g., stem cells, anti-retrovirals, cancer risks. If you don't have a basic familiarity with the science, it's probably best for all concerned if you STFU.

However much of the confusion lately can be chalked up to vague or meaningless verbiage. Speakers often go on for paragraphs saying nothing at all to an audience apparently listening respectfully. Truly amazing to behold.

Case in point:

There are many physicians working at the front lines of health care delivery that embrace both the wellness model and clinical outcome based science. In many cases they have chosen their specialties because they consider understanding medical science an essential part of their professionalism and hold ethical decision-making a higher priority than financial profit. Seems obvious, but it may inform arguments that consider the middle ground in this debate negligible. Certainly, generalization, sensationalism and vilification of physicians is less likely to lead to the improved health status all parties seem to want to argue for.

Reading the above you might think to ask, what does the speaker mean by "wellness model"? But estimating the odds that the answer will bore you to tears while leaving you none the wiser, you probably won't bother.

Here's my model: we figure out the risks and benefits of some intervention, then base our recommendations on that.

I call it the "what is true" model. It kicks the wellness model's ass then steals its lunch money.

Complementary and Alternative Medicine: Ayurvedic Medicine

Integrative Medicine: Can We Truly Integrate Care?

My question: How do I collaborate with someone who feels vaccines are poison, autism is caused by thimerosal, and chelation is the answer?

How?

Bernard Osher

Bernard Osher and his wife, Barbro Sachs-Osher are respected philanthropists who have donated millions to worthy causes.

They've also infused many millions into the wooly headed notion of "integrative medicine." Their donations helped to found centers of integrative medicine at the University of California at San Francisco School of Medicine, at Harvard Medical School, and at Karolinska Institutet in Stockholm.

My pal Google told me a little about the Oshers. They seem like nice people. It's my impression that they have a soft spot for the underdog.

I wish I could sit down with the Oshers for a chat. Seriously. Biddeford's not far for me nor is San Francisco.

My patients are the under-doggest of them all. And "integrative medicine," sadly, isn't helping.

Why NCCAM Reminds Us of Tampons

Women older than, say, fourteen will recognize this scenario:

You're off to school or getting ready to meet friends at the mall or are otherwise engaged in something consuming every ounce of your attention. Suddenly the metaphorical phone rings. It's Aunt Flo! She's letting you know she'll be by a little sooner than expected. You make a quick search of your bags and the bathroom only to realize that you're out of Aunt Flo's favorite euphemisms. So it's a mad dash to the grocery store ASAP.

Standing before a wall of pastel colored feminine protection on isle three, you grab the box you want and head for the checkout.

But wait! Strangely, everyone in the store seems to be glancing in your general direction. A voice overhead announces, "Attention shoppers. Look 'n LOL on isle three. Eighth grade girl getting her period. OMG, how embarrassing! HAHAHA!"

Ok, maybe that part doesn't actually happen.

You have a plan. You put the box of tampons back on the shelf and get a shopping cart. You grab a loaf of bread, a roll of paper towels, a bag of candy, and that box of tampons.

Ah, so much less obvious now. Clearly you're not necessarily getting your period. You might just be picking up a few things for the house.

Homeopathy, subluxations, and energy healing are nutty ideas. Standing up for these notions in a room full of scientists should provoke a sense of mortification, not unlike the embarrassment of a young teen holding onto a box of tampons in public.

Little wonder then, that the CAM proponents of NCCAM defined their scope of practice as somehow including a number of reasonable therapies alongside the wacky bits. Herbal remedies, dietary supplements, relaxation methods such as yoga and meditation are examples of the more reasonable topics commandeered by NCAAM.

Yes, much to the irritation of the pharmacognozy, nutrition, and medical psychology communities, history has been re-written such that none of this stuff was ever studied pre-NCCAM.

How depressing.

The recent NCCAM debates around the blogosphere fit this pattern:

1. Someone says NCCAM causes more harm than good by promoting quackery.
2. Someone else says that lots of Americans spend money on alternative medicine, so we ought to be studying it.
3. The first party feels the second party doesn't get it.

What's going on? Why is communication so difficult?

I think that awful word "alternative" is to blame. It's defined in such a ways as to mire us all in confusing equivocations. It's defined by what it is not: something called "conventional medicine." And conventional medicine is defined as those therapies with evidence of safety and efficacy. But this dichotomy doesn't really work.

Are all therapies lacking evidence of safety and efficacy "alternative"? No, for that huge set would include everything from novel chemotherapy strategies to new surgical devices and more.

Are all treatment decisions by medical doctors based on evidence of efficacy and safety? Not entirely. There's a tremendous amount of trial-and-error within medicine. Group data apply imperfectly to individuals. Even so, the process of starting and stopping trials can be justified rationally, or not. And irrational justifications are very much frowned upon on the conventional side of the fence.

So what separates the conventional world from the alternative world? Not herbs or yoga or meditation or dietary supplements. No, the real fight is more fundamental. The real fight concerns how we set the boundary between that which is plausible and that which is implausible. One side sees this as a political question. The other sees this as a function of the scientific method.

Unproven Quackery MANDATED for US Vets!

H.R. 1017:
"To amend the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001 and title 38, United States Code, to require the provision of chiropractic care and services to veterans at all Department of Veterans Affairs medical centers and to expand access to such care and services."

This bill mandates the coverage of "periodic and preventative chiropractic examinations and services."

I wonder, How periodic? And what do these services prevent? And, uh... evidence?

Sponsors:
Rep Filner, Bob [CA-51] (introduced 2/12/2009)
Rep Boswell, Leonard L. [IA-3] - 3/4/2009
Rep Chandler, Ben [KY-6] - 3/4/2009
Rep Diaz-Balart, Lincoln [FL-21] - 3/4/2009
Rep Gordon, Bart [TN-6] - 3/4/2009
Rep Loebsack, David [IA-2] - 3/4/2009
Rep Michaud, Michael H. [ME-2] - 2/26/2009
Rep Ros-Lehtinen, Ileana [FL-18] - 3/4/2009
Rep Walz, Timothy J. [MN-1] - 3/4/2009
Rep Young, C.W. Bill [FL-10] - 3/9/2009

Latest Major Action: 2/12/2009 Referred to House subcommittee.
Status: Referred to the Subcommittee on Health.
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Here's an idea, Mr. Legislator:

SCIENCE!

Why allow a certain anti-MD, anti-vaccination cult a means of bypassing the rules of evidence that others must respect?

Legislating the notion that a medical claim about the body is true, or that some intervention has been proven safe and effective --when the evidence simply isn't there-- is a form of Lysenkoism. Lysenko's example illustrates how political interference in the scientific process can profoundly cripple a scientific community for decades.

Your health, my health, and the health of all Americans deserve no less than medical therapies tested according to sound scientific methods.

Please don't blur the boundary between medicine and pseudo-medicine. Please support the nascent but growing science-based medicine community in the United States by opposing H.R. 1017.
***************

If you enjoy Whack-A-Mole-ing nonsense, do visit the Library of Congress. More:

H.R.484
Title: To require the Secretary of Defense to develop and implement a plan to provide chiropractic health care services and benefits for certain new beneficiaries as part of the TRICARE program.

This bill includes language to limit chiropractic services to chiropractors. Not that I care, but there are some medical doctors and osteopaths out there willing to crack your back, so this might matter to them.

Sponsors:
Rep Rogers, Mike D. [AL-3] (introduced 1/13/2009)
Rep Abercrombie, Neil [HI-1] - 1/13/2009
Rep Aderholt, Robert B. [AL-4] - 1/13/2009
Rep Bachus, Spencer [AL-6] - 1/13/2009
Rep Barrow, John [GA-12] - 3/5/2009
Rep Bartlett, Roscoe G. [MD-6] - 1/13/2009
Rep Boswell, Leonard L. [IA-3] - 1/13/2009
Rep Brady, Robert A. [PA-1] - 1/13/2009
Rep Diaz-Balart, Lincoln [FL-21] - 3/2/2009
Rep Gordon, Bart [TN-6] - 2/26/2009
Rep Harper, Gregg [MS-3] - 2/3/2009
Rep Israel, Steve [NY-2] - 1/13/2009
Rep Jackson-Lee, Sheila [TX-18] - 1/13/2009
Rep Latham, Tom [IA-4] - 2/12/2009
Rep Latta, Robert E. [OH-5] - 3/9/2009
Rep LoBiondo, Frank A. [NJ-2] - 1/13/2009
Rep Loebsack, David [IA-2] - 3/5/2009
Rep Paul, Ron [TX-14] - 1/13/2009
Rep Paulsen, Erik [MN-3] - 3/5/2009
Rep Wamp, Zach [TN-3] - 3/5/2009
Rep Young, C.W. Bill [FL-10] - 3/6/2009

Latest Major Action: 2/6/2009 Referred to House subcommittee.
Status: Referred to the Subcommittee on Military Personnel.

Dear Medical Students: You've Been Had

AMSA, or the American Medical Students Association does not represent your interests. Look at this: http://www.amsa.org/naturopath.

Your "medical" organization is promoting naturopathy, that credulous crowd of anti-science, anti-vaccination, anti-pharmaceutical loons. Now what do you think about "PharmaFree"?

From where I sit, PharmaFree looks like a marketing project designed to discredit MDs and "BigPharma." The parties behind this conspiracy-mongering campaign are not disinterested. And, I suspect, they are not your friends (ok, that's conspiracy mongering on my part, but click the link!).

Why do drug manufacturers pay for research? Why do they pay for educational lunches? Because the onus is on the drug or device maker to prove that their product is safe and effective. It's always been thus and will be thus.

If drug company money for post-graduate education dried up, I have no idea who would pay for it. Think about that. And remember: the biases we can't see are the most dangerous.

Take a few pens. Eat a turkey wrap. Then go care for your patients. No one is stupid enough to believe that a ballpoint will corrupt you, for fuck's sake.

Note the politics promoted by AMSA. You're asked to support the expansion of primary care, so all Americans have access to good health care. You're asked to support preventive health care, to help keep costs down.

Just FYI:
1. "Expanding primary care" is sometimes code for: "mandate that health insurers recognize chiropractic and naturopathic physicians as primary care physicians."

2. "Preventive health care" is sometimes code for, "mandate that health insurers cover the cost of dietary supplements."

Read the fine print.

Once upon a time, there was an organization known as the "Cult Awareness Network." It was established by friends and family members of people suckered into cults, and served to provide information about some of the dubious activities of these groups. Then one day, the Church of Scientology bought the organization.

Addendum: As usual, Orac is way ahead of me.

Integrative Medicine: Just Like Medicine, Only Better!

In a previous post I explained my objection to "integrative medicine": if some CAM therapy works, why not prove it and so remove the need to "integrate" it with the set of proven therapies we call "medicine"?

Lately in my trolling runs 'round the intarwebs, I've noted a shift in the meaning of "integrative." Instead of the original meaning, "integrating conventional and alternative therapies," it appears in many contexts to mean, "integrating both mental and physical factors in our understanding of disease and wellness." The new science of integrative medicine is allegedly more wholistic and less reductionistic.

Alas, the Tufted Titmouse still must poop on "integrative," even though the newer spin is less irrational than the original definition. Why? Because "integrative" poops on Dr. Titmouse, and what goes around comes around.

Dr. Integrative, do you seriously believe that doctors didn't notice that patients had feelings and existential concerns before you came along and helpfully pointed that out?

Srsly?

Well then. Allow me to helpfully point out that you're a complete wanker.

The Other BigPharma

From Medical News Today 5-2-2008.

I submit that if this shit worked, all this advocacy would be unnecessary. Look at the bills these guys want. They want parity with prescription and OTC drugs, stuff proven to work. But these products would be OTC drugs if proven to work.

Industry Members Rally In Washington, D.C. For The Natural Products Association's 11th Annual Natural Products Day

More than 175 natural products industry stakeholders from 35 states and the District of Columbia gathered on Capitol Hill for the Natural Products Association's 11th annual lobbying event, Natural Products Day. Natural Products Association members representing every component of the natural products industry educated members of Congress and their aides about the association's legislative priorities, all of which promote consumer access and awareness of natural products.

"Nothing is more important that face-to-face meetings to establish relationships and a dialogue about the importance of natural products to the health of all Americans," said Debra Short, president of the Natural Products Association. "I'm pleased to report that we once again had a series of productive meetings with legislators and staff and a capacity crowd on hand at our Congressional Champions Awards Reception."

Short was referring to a packed evening reception where nearly 500 legislators and staff were able to sample a wide variety of natural products including health and beauty aids, dietary supplements, natural pet products and natural snacks and beverages, all donated by industry members (complete list of sponsors follows). The highlight of the reception was the presentation of the Natural Products Association's Congressional Champion Awards. On hand to receive their Industry Members Rally In Washington, D.C. For The Natural Products Association's 11th Annual Natural Products Day

As in past years, the event consisted of an early morning briefing session and breakfast before participants adjourned to attend pre-arranged meetings with various congressional leaders. Attendees then spent the afternoon in meetings with lawmakers and key staff members from their districts and states.

During their meetings with House members, the constituents asked legislators to support Rep. Edolphus Town's Dietary Supplement and Healthy Meal Replacement Tax Parity Act, H.R. 1107, which would ensure that natural products are given the same tax treatment as drugs and over-the-counter medications. Attendees also asked legislators to support H.R. 1363, introduced by Rep. Lynn Woolsey, which would raise the standards for school lunch programs. In addition, participants also asked lawmakers to oppose H.R. 1249, a bill to ban the safe, effective supplement DHEA.

In their meetings with senators, Natural Products Association members asked lawmakers to support S. 771, a companion bill to H.R. 1363 proposed by Sen. Tom Harkin, which would raise the standards for school lunch programs, and S. 770, a bill that would allow disadvantaged individuals to purchase dietary supplements with their food stamps. The members also emphasized the importance of defeating S. 762 and S. 2470, bills that would restrict or prohibit the use of DHEA.

Also this year, the association offered a "virtual march on Washington" for members and allied groups. Participants who could not come to Washington were encouraged to contact their members of Congress by phone, by mail, or by e-mail, and to create and post videos on YouTube. Allied organization Seniors Coalition collaborated with the association on H.R. 1249, encouraging their members to join association members in contacting their representatives and senators.

Sen. Tom Harkin Speaks in Support of Herbal Supplements

Yet more evidence that Senator Tom Harkin is not the appropriate person to lead healthcare reform, if "evidence" matters.

Copypasta from some propaganda piece. Can you find the enthymemes?

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If you attended the Herbalife Extravaganza*, you had the opportunity to hear Senator Tom Harkin (D-Iowa) speak on the status of preventive healthcare in the U.S. One of the principal authors of the Dietary Supplement Health and Education Act (DSHEA) of 1994, which gave Americans the freedom and choice they enjoy in buying our products, and a long-time friend of Herbalife and Mark Hughes, Sen. Harkin recently spoke to Herbalife regarding his beliefs about the need for continued access to products like those made by Herbalife.

Q: Senator, our Distributors were very excited by your appearance in New Orleans. Why do you feel such a strong connection to Herbalife?

A: I strongly believe in helping people help themselves, and that’s what Herbalife’s all about. I’m also a long-time champion of preventive healthcare and good nutrition. I believe that by helping people take charge of their health, we’ll save lives and cut costs. Nearly half of the almost trillion dollars spent treating sickness annually goes toward helping people recover from illnesses that could have been prevented! We can all play a role in turning that around.

Q: As one of the chief architects of DSHEA, what do you see as the major challenges and threats facing our industry?

A: DSHEA, which passed both the Senate and House unanimously in 1994, has been crucial to protecting our access to healthful vitamins and nutritional supplements. It prevents the government from requiring Americans to get a prescription before purchasing the products they want and requires that all claims made on supplements be truthful. Unfortunately, there are people and organizations actively working to undermine support for DSHEA and supplements.

Q: DSHEA has come under attack at recent Congressional hearings. Doesn’t Congress understand the benefits of supplements and the safeguards DSHEA provides?

A: This points out how much work we have cut out for us in educating our elected officials. Supporters of natural healthcare and supplements must get involved in the process. Did you know that there are more highly paid lobbyists for the big drug companies than there are members of Congress? That’s more than 535! Clearly we need a grassroots effort on behalf of natural products. Without one, we’ll see a return to more paternalistic government policies that limit our freedom of choice.

Q: Do you have any words of advice for our Distributors as they pursue their dreams of building their businesses and improving their health?

A: Let me tell you something about my background because it has a lot to do with why I support who you are and what you do. My father was a coal miner, and my mother was an immigrant. She died when I was young. My family never had much money, but we were rich in values. The values my parents taught me helped me get ahead so I know the importance of opportunity–the kind of opportunity that Herbalife provides. I want to get rid of any obstacles in your path that keep you from climbing that ladder and reaching the American dream.
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*LOL. Can people actually talk about their "extravaganza" without feeling silly?

ACA Biggest Winner 2002 US Elections

Dynamic Chiropractic 1-14-2003 (link taken down; available in Google cache.)

The Republican Party regained control of the U.S. Senate and gained more seats in the House of Representatives in November's midterm elections, but the biggest winner may have been the American Chiropractic Association (ACA). Of the 109 political races in which the ACA was involved, candidates endorsed by the ACA won 100 of those races - a victory rate of nearly 92 percent.

Among the winners on election night were Senators Tim Johnson (D-SD) and Tom Harkin (D-IA). The ACA purchased radio ad spots for Harkin and Johnson, and played a crucial role in the re-election of both candidates.

"While I enjoyed support for my reelection from a broad range of organizations and individuals from around Iowa and the country, the support and counsel of the American Chiropractic Association and its members throughout Iowa were especially critical to my re-election victory," acknowledged Sen. Harkin. "I look forward to building on our strong friendship and working together to ensure fairness and equal treatment for doctors of chiropractic throughout the country."

Sen. Harkin is a longtime supporter of complementary and alternative medicine. Among his legislative accomplishments, he helped draft the Dietary Supplement Health and Education Act of 1994, and played an important role in the creation of the National Center for Complementary and Alternative Medicine (NCCAM), which now has an annual budget of over $100 million. He was also the first senator to officially support Acupuncture and Oriental Medicine Day (October 24, 2002).

"We are not only delighted at the prospect of continuing our friendship with Senator Tom Harkin, but we are thrilled to have a number of new friends in Congress with whom we will forge relationships as well," observed ACA President Daryl D. Wills, DC.

Sen. Johnson, while not as well-- known as Sen. Harkin, has been no less of an advocate of the chiropractic profession. He is a supporter of patients' rights - including the right of a patient to see a doctor of chiropractic - and has worked with other members of Congress to gain support for the inclusion of a chiropractic provision in the Medicare system.

In other states, the ACA sent targeted mailings to voters showing their endorsement for candidates with strong records of support for the chiropractic profession. This tactic proved successful in Missouri, where Republican candidate Jim Talent, who has led efforts to increase the availability of chiropractic care in the military, defeated incumbent Jean Carnahan (D-- MO) by more than 20,000 votes to win a seat in the Senate.

ACA's political action committee, ACA-PAC, spent approximately $250,000 on the 2002 congressional elections, with $90,000 directed toward pro-chiropractic Senate campaigns and $160,000 toward campaigns in the House.

The election victories for the profession come on the heels of the passage of the Health Care Safety Net Improvement Act, which includes doctors of chiropractic in the National Health Service Corps' student loan reimbursement program. President Bush signed the act into law on October 26.

Harkin Chiro Pork Party '98

From Dynamic Chiropractic – March 23, 1998, Vol. 16, Issue 07

Palmer College Will Headquarter Research Consortium
Nat'l Institutes of Health Cofunds

Iowa Senator Tom Harkin: " ... it is important that the federal government also spend money in chiropractic research as well, and we will continue to try to increase that funding."

Gary Mohr, Palmer's executive director of institutional advancement: "This is one of the biggest legislative victories this profession has ever had."

The Palmer Center for Chiropractic Research will be the hub of a five-year, multi-institution, $2.7 million program to research chiropractic care.

The National Institutes of Health Office of Alternative Medicine (OAM) and the National Institute for Arthritis, Musculoskeletal and Skin Diseases (NIAMS) have teamed up to co-fund a five-year, $2.7 million dollar grant to fund the establishment of research program designed to study the effectiveness of chiropractic care.

The grant brings about the formation of the Consortial Center for Chiropractic Research (CCCR), which along with Palmer College, is comprised of Kansas State University; the University of Iowa; Los Angeles College of Chiropractic; National College of Chiropractic; Northwestern College of Chiropractic; and Western States Chiropractic College.

The establishment of the Consortial Center for Chiropractic Research makes it the 11th specialty research center funded by the NIH's Office of Alternative Medicine.

The Palmer Center for Chiropractic Research has been named the headquarters for the program. The foundation of such a program marks a substantial and historical achievement for the chiropractic profession.

Iowa Senator Tom Harkin, a longtime supporter of chiropractic, announced the establishment of the study. "I am pleased to have played a role in this center that will bring recognition not only to Iowa, but also to the chiropractic profession, both on a state and national level."

Senator Harkin applauded the efforts of the Association of Chiropractic Colleges and the ACA for their roles in helping the federal government recognize the chiropractic profession. He added: "Because the federal government spends $13 billion on medical research in national institutions, it is important that the federal government also spend money in chiropractic research as well, and we will continue to try to increase that funding."

"This is one of the biggest legislative victories this profession has ever had," said Gary Mohr, Palmer's executive director of institutional advancement. "It's not just the funding. It's the first time the NIH will be spending their money on an ongoing basis to recognize the value and significance of chiropractic."

The CCCR's position is unique among the other research centers supported by the NIH in that it will be the only one focused on a system of care, rather than a disease or condition. The Consortial Center will examine the effectiveness of chiropractic health care and assist chiropractic researchers in developing high-quality research projects and significant scientific projects worthy of independent funding.

The CCCR aspires to achieve:

- establish a linkage of academic centers along with a network of chiropractic clinicians and investigators;

- develop a program to provide clinical, scientific and technical assistance to potential chiropractic investigators;

- offer research workshops, seminars and educational materials;

- be the focal point for training in research methodology, bioethics, biostatistics, clinical trial design, epidemiological and health services studies, and basic laboratory methods;

- link investigators to the technical expertise necessary to achieve research goals;

- evaluate the feasibility of using data from practicing chiropractors for research projects; and

- develop a review mechanism for scientific and technical merit of research proposals and implementing those proposals selected.

Before formation of the CCCR was officially announced, key investigators also met and drafted a list of priority criteria specific to the center's mission and goals. Key among those are the needs of the patients, clinical capabilities, and scientific methodology. This list will add support to chiropractic research that advances the profession's knowledge base, promotes patient health and recovery, and fosters chiropractic research that can hold up under close scrutiny.

Dr. William Meeker, who led a team-written proposal to establish the CCCR, will be the Consortial Center's principal investigator. Co-investigators include Cheryl Hawk, DC, PhD; Cynthia Long, PhD; Alan Adams, MS, DC; Gert Bronfort, DC, PhD; Gregory Cramer, DC, PhD; Maria Hondras, DC, MPH; Joel Pickar, DC, PhD, Joanne Nyiendo, PhD; and Malcom Pope, PhD, Dr. of Medical Science.

"This is for the entire profession," said Dr. Meeker, who directs research for the Palmer colleges through the Palmer Center for Chiropractic Research. "It is housed at Palmer, but all the other institutions are integral to the success of it. The individuals involved all bring expertise in their areas. We're all gearing up to do a lot of training and seminars."

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Ok. Anyone know what this pork party aka "research" produced?

The ChiroVoice Initiative

Science asks, "what is true?" not "what do you want?" Advocacy has no role in determining what is true.

Subluxations do not exist. Sorry. Writing your congressman won't change reality. Although it can fuck up US Healthcare for a generation.

FOR IMMEDIATE RELEASE: March 10, 2009

With the prospect of health care reform making news headlines, chiropractic leaders from across the nation recently gathered in Washington, D.C., to meet with Congressional leaders and to stress the importance of chiropractic’s role in effective patient care. The group came together for the American Chiropractic Association’s (ACA) National Chiropractic Legislative Conference (NCLC).

Almost 600 doctors of chiropractic, students and supporters converged on the nation’s capital Feb. 25-28 to hear speeches from government leaders, to receive advocacy education and training, as well as to urge elected officials to support pro-chiropractic measures and provide patients with direct access to the essential services delivered by doctors of chiropractic.

“I’m proud to report that during this year’s NCLC, ACA representatives visited virtually every congressional office here in Washington. During these visits, our doctors presented a specific statement on national health care reform that emphasized the essential role chiropractic should play in any health care reform plan,” said ACA President Glenn Manceaux, DC. “ACA will continue to urge Congress to make the necessary investments to put America on the path to a health care system that maximizes chiropractic’s potential to provide high-quality, patient-centered care, while at the same time, saving the system money.”

Throughout NCLC, a recurring theme was the power of grassroots lobbying and the positive impact of patient voices. ACA leaders called for chiropractic offices nationwide to actively support the ChiroVoice initiative, the association’s national database of chiropractic patients and supporters. Launched in January 2009, ChiroVoice will allow ACA to mobilize coordinated campaigns to lobby Congress and the new administration on issues vital to patients’ access to chiropractic services.

“ACA’s campaign to create a national, secure database of patient contact information is active and growing. Thousands of patients have joined, but this is only the beginning,” Dr. Manceaux said. “The best way individual doctors of chiropractic can add momentum to ChiroVoice is to personally discuss the program with their patients and ask them to join at www.ChiroVoice.org.”

Keynote speaker and famed political consultant Paul Begala echoed the importance of leveraging the influence of chiropractic patients and grassroots lobbying efforts. He advised attendees to be visible, vocal, and accessible to their Congressional representatives.

“We have plenty of very good lobbyists who come with statistics and charts. Don’t do that. Tell stories about what [your] constituents are getting from you and your services,” Begala advised. “Facts tell, but stories sell.”

Known for his role on CNN’s “Situation Room” and other political programs, Begala predicted that major health care reform will happen during the Obama presidency—possibly in the first year. He commented that unlike in 1993, the insurance industry seems ready for real reform, which may speed the process on Capitol Hill.

Sharing similar sentiments was longtime chiropractic supporter Sen. Tom Harkin (D-Iowa), who noted that the prospect of true health care reform was music to his ears. “But friends,” he said, “I can’t win this fight all by myself. I am going to count on ACA to mobilize its members and share three simple messages with every member of Congress.

“First, we need to replace the current sick care system with a genuine health system. We need a health care system that integrates the very best scientifically-based medicines—whether conventional or alternative. And, we need to end the discrimination against chiropractic,” Sen. Harkin asserted.

Several other members of Congress visited with NCLC attendees, including: Sen. Bob Casey (D-Pa.), Rep. Bob Filner (D-Calif.), Rep. Gene Green (D-Texas), Rep. Charlie Melancon, D-La., Rep. Michael Michaud (D-Maine), and Rep. Bill Posey (R-Fla.).

ACA House of Delegates Meeting
Each year, NCLC is held in conjunction with an official business meeting of the ACA Board of Governors (BOG) and ACA’s House of Delegates (HOD).

“During these challenging economic times and as we face the likelihood of unprecedented changes to health care, the ACA Board of Governors remains committed to providing leadership not only for ACA, but the entire chiropractic profession,” said ACA Chairman John Gentile, DC. “The Board will continue to place a high priority on expanding chiropractic services within Medicare and ensuring chiropractic inclusion in any health care reform plan, and we will work with the Chiropractic Summit and other chiropractic organizations to present a united front on the issues of grave importance to our viability.”

The HOD portion of the event included a presentation by Christine Goertz, DC, PhD, about the importance of DC participation in the Physician Quality Reporting Initiative (PQRI). Dr. Goertz explained that the intention of the PQRI is to enhance the value of care provided to Medicare beneficiaries. Specifically, the PQRI authorizes a financial incentive for eligible professionals who voluntarily report on quality measures.

Calling PQRI “an amazing opportunity” to level the playing field, Dr. Goertz warned that, “if no one participates, [chiropractic will] fall further and further outside the health care delivery system.”

In other business:
More than 380 Student ACA (SACA) members from all 18 colleges attended the Student Leader Meeting.
Prominent women from the chiropractic profession offered their unique perspective to students through the SACA Women’s Forum.
As part of the State Association Roundtable, ACA shared its perspective and efforts on health care reform with representatives from more than 20 state associations.
Additional coverage of both NCLC and the House of Delegates meeting will be available in the April 2009 issue of ACA News, the association’s flagship publication.

Harkin Commissions Chiropractors in Armed Forces

A concurrent resolution expressing the sense of Congress that the Secretary of Defense should take immediate steps to appoint doctors of chiropractic as commissioned officers in the Armed Forces.

- Whereas the urgent needs of military personnel in the field of operations include access to the widest possible range of health care options, especially in the area of care of the spine and related structures of the body;

- Whereas providing military personnel in the field of operations with access to chiropractic care will increase the cost effectiveness of military health care expenditures by taking advantage of the conservative, drugless, and non-surgical care option offered by chiropractic care;

- Whereas back injuries are the leading cause of lost service time and disability in the Armed Forces;

- Whereas military personnel in the field of operations or on shipboard can access chiropractic care only through commissioned chiropractic officers;

- Whereas access to chiropractic care through commissioned chiropractic officers will enhance the combat readiness of military personnel by offering a non-pharmaceutical option for the health care needs of such personnel;

Now, therefore, be it Resolved: That the Secretary of Defense should take immediate steps to establish a career path for doctors of chiropractic to be appointed as commissioned officers in all branches of the Armed Forces for purposes of providing chiropractic services to members of the Armed Forces.

Source: S.CON.RES.75/H.CON.RES.294 08-SCR75 on Apr 10, 2008

Tom Harkin Addresses Chiropractors

Tom addressing the American Chiropractic Association


10-26-2006 Meeting of the American Chiropractic Association.

Of course MDs do not know everything. And it does seem that chiropracters can help people with certain back problems.

But we can't decide what works and what does't work based on anecdotes and recollections. If that's our standard, we'll be spending a lot of federal funds on E-meters and cow urine next year.