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CORPORATE EVIDENCE-BASED PRACTICE and MARKETING FIND AN ARIZONA MEMBERSHIP and INSURANCE LAWS, ARIZONA STATE BOARD of CHIROPRACTIC EXAMINERS IMPORTANT REPORTS, ARTICLES, BOOKS and LINKS
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IMPORTANT REPORTS AND ARTICLES
TABLE OF CONTENTS
CHIROPRACTIC: EVIDENCE-BASED MODERN SCIENTIFIC RESOURCES AND OTHER ARTICLES
Note to ACS members: Contact ACS to find out how to get copies of any of the articles discussed below. We are here to help you.
What happens when you add chiropractic care to a large health plan like AHCCCS? This has been thoroughly researched and here is the answer: Reduced surgeries, hospitalizations, MRIs, x-rays and overall back care costs. Here is the evidence:
Methods A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit. Results Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year, P<.001). Having chiropractic coverage was associated with a 1.6% decrease (P = .001) in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared withthose without coverage, had lower utilization (per 1000 episodes) of plain radiographs (17.5 vs 22.7, P<.001), low back surgery (3.3 vs 4.8, P<.001), hospitalizations (9.3 vs 15.6, P<.001), and magnetic resonance imaging (43.2 vs 68.9, P<.001). Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode–related costs ($289 vs $399, P<.001). Conclusions: Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs. Click here to link to the full article at the publisher site.
What happens when chiropractors become primary care physician (PCP) gatekeepers? This has been thoroughly researched with results published in peer-reviewed medical literature: Clinical and Cost Outcomes of an Integrative Medicine IPA J Manipulative Physiol Ther. 2004 Jun;27(5):336-47. Abstract Results: Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame. Conclusion: In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone. While certainly promising, these initial results may not be consistent on a larger and more diverse population. Link to abstract and publisher site for full study by clicking here.
This study is the 3-year update to the above research and confirmed the earlier findings: J Manipulative Physiol Ther. 2007 May;30(4):263-9. Abstract Results: Clinical and cost utilization based on 70 Conclusion: During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population. Click here to link to the abstract and the full study at the publisher site. Attention policymakers: If you want to save money, consider chiropractors as PCPs.
“Conservative management of mechanical neck disorders: a systematic review,” published in the Journal of Rheumatology in 2007 (v. 34, p. 1083-102), provides scientific evidence to support the fact that exercise combined with spinal manipulation demonstrates benefits in whiplash patients. This article was not a single study. Instead, it is a systematic review. The authors surveyed all of the literature including Medline and the Cochrane Reviews over a ten year period of time. They found 88 unique randomized controlled trials on various types of physical medicine and neck disorders. Two independent authors selected studies, abstracted data, assessed methodological quality from computerized databases, calculated relative risks, standardized mean differences when possible, and calculated pooled effect sizes. The conclusion was that “exercise combined with mobilization/manipulation . . .” is effective for chronic mechanical neck disorders.
“Treatment of Neck Pain: Noninvasive Interventions” puts an end to the debate about whether spinal manipulation has any benefit. The preeminent journal for both chiropractors and medical orthopedic surgeons is The Spine Journal. In 2008, the journal published the results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. This article "systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article. Those judged to have adequate internal validity were included in our best evidence synthesis.” The study concluded: “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.” Manual therapy is defined as including both mobilization and manipulation. In regard to safety, the authors were impressed by the February 2008 Spine study on manipulation and stroke. The authors noted: “These findings suggest that the increased risk of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection (in the prodromal stage) seeking care before their stroke. Thus, although cervical spine manipulation cannot be ruled out as a potential cause of some VBA strokes, any potential risk is very small.” (Spine, v. 33, n. 4S, pp. S123-S152, 2008).
Another huge landmark study, “Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews,” was published in a peer-reviewed medical journal in 2007. The following is the conclusion of these authors who were completely independent of those above: “The evidence reviewed here provides support for the contention that the manual therapies which induce joint mobility—manipulation and mobilization—are effective in the treatment of neck pain, especially chronic neck pain and neck pain due to whiplash injury, in those subjects who have been randomized to receive these therapies.” (Europa Medicophysica, 2007;43:91-118).
To develop a clinical practice guideline for acute and chronic low back pain, evidence was reviewed and then published for the American Pain Society/American College of Physicians in the prominent peer-reviewed Annals of Internal Medicine.The only non-pharmacological therapies found effective were as follows: "We found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain. . . We found fair evidence that acupuncture, massage, yoga, and functional restoration are also effective for chronic low back pain. For acute low back pain (<4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat (good evidence for moderate benefits) and spinal manipulation (fair evidence for small to moderate benefits). Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine 147:492-504, 2007. This is strong validation for chiropractic care. Also found at this link -- click here.
The "Silent Epidemic" of NSAIDs Why not just put all patients on NSAIDs? Here's why. From The New England Journal of Medicine, June 7, 1999: "It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin's disease. (Fig. 1). If deaths from gastrointestinal toxic effects of NSAIDS were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects, a largely "silent epidemic," with many physicians and patients unaware of the magnitude of the problem. Furthermore, the mortality statistics do not include deaths ascribed to the use of over-the counter NSAIDs. "Gastrointestinal Toxicity of Nonsteroidal Antiinflammatory Drugs," M. Michael Wolfe, MD, David R. Lichtenstein, M.D., Gurkirpal Singh, MD, The New England Journal of Medicine, June 17, 1999, v. 340, n. 24.
Why not just put all patients on narcotic pain-killers? Here's why. (AP) In 16 states and counting, drugs now kill more people than auto accidents do, the government said Wednesday. Experts said the startling shift reflects two opposite trends: Driving is becoming safer, and the legal and illegal use of powerful prescription painkillers is on the rise. For decades, traffic accidents have been the biggest cause of injury-related death in the U.S., and they are still No. 1. But drug overdoses are pulling ahead in one state after another. "People see a car accident as something that might happen to them," said Margaret Warner, an epidemiologist with the Centers for Disease Control and Prevention. But as for death from a drug overdose, "maybe they see it as something that's not going happen to them." The drug-related death rate roughly doubled from the late 1990s to 2006, according to the most recent CDC data . . . While cocaine and heroin continue to be significant killers, most of the increase is attributed to prescription opiates such as the painkillers methadone, Oxycontin and Vicodin . . . Read entire article by clicking here.
Prescriptions now biggest cause of fatal drug overdoses By Liz Szabo, USA TODAY 10/02/09 Debra Jones didn't begin taking painkillers to get high. Jones, 50, was trying to relieve chronic pain caused by rheumatoid arthritis. Yet after taking the painkiller Percocet safely for 10 years, the stay-at-home mother of three became addicted after a friend suggested that crushing her pills could bring faster relief. It worked. The rush of medication also gave her more energy. Over time, she began to rely on that energy boost to get through the day. She began taking six or seven pills a day instead of the three to four a day as prescribed. "I wasn't trying to abuse it," says Jones, from Holly Springs, N.C., who has since recovered from her battle with addiction. "But after 10 years, I couldn't help what it did to my body or my brain. It was hard to work without it." Addiction to prescription painkillers — which kill thousands of Americans a year — has become a largely unrecognized epidemic, experts say. In fact, prescription drugs cause most of the more than 26,000 fatal overdoses each year, says Leonard Paulozzi of the Centers for Disease Control and Prevention. The number of overdose deaths from opioid painkillers — opium-like drugs that include morphine and codeine — more than tripled from 1999 to 2006, to 13,800 deaths that year, according to CDC statistics released Wednesday. In the past, most overdoses were due to illegal narcotics, such as heroin, with most deaths in big cities. Prescription painkillers have now surpassed heroin and cocaine, however, as the leading cause of fatal overdoses, Paulozzi says. And the rate of fatal overdoses is now about as high in rural areas — 7.8 deaths per 100,000 people — as in cities, where the rate is 7.9 deaths per 100,000 people, according to a paper he published last year in Pharmacoepidemiology and Drug Safety. "The biggest and fastest-growing part of America's drug problem is prescription drug abuse," says Robert DuPont, a former White House drug czar and a former director of the National Institute on Drug Abuse. "The statistics are unmistakable." Debra Jones, of Holy Springs, N.C., had become addicted to prescription Percocet, which she was taking for rheumatoid arthritis, and had to seek substance abuse treatment. She's been clean two years. Click here to link to the full article on the USA Today webpage.
Is there scientific evidence to support chiropractic for nonmusculoskeletal conditions? Read here. "Chiropractic Care for Nonmusculoskeletal Conditions: A Systematic Review with Implications for Whole Systems Research" concluded that evidence supports chiropractic care as providing benefits for asthma, cervicogenic vertigo and infantile colic. The review found evidence for chiropractic to be promising for care of children with otitis media and elderly with pneumonia. This study was published in the peer reviewed Journal of Alternative and Complementary Medicine, v.13, n.5, 2007, p. 491-512, Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW.
The National Board of Chiropractic Examiners has published a literature review regarding chiropractic treatment of asthma, infantile colic, fibromyalgia, premenstrual syndrome, back pain, neck pain and headache. NBCE is the national organization of all of the 50 state boards which license and regulate chiropractors. Click here to read the entire downloadable NBCE literature review in PDF format.
Chiropractic boycott must cease, Editorial by Alan M. Immerman, D.C. Phoenix Business Journal, August 20, 1999
Many more peer-reviewed Medical Journal articles regarding Chiropractic
GROSS OVERUTILIZATION OF SPINAL INJECTIONS AND SURGERY
The following are excerpts from the invaluable highly referenced 2009 online medical journal article "Overtreating Chronic Back Pain: Time to Back Off?" The authors include Richard A. Deyo, MD, MPH; Sohail K. Mirza, MD, MPH; Judith A. Turner, PhD; Brook I. Martin, MPH. The link to the full article is http://www.medscape.com/viewarticle/58695. This study documents gross overutilization of invasive, highly expensive epidural injections and spinal surgeries. In most cases, inexpensive and relatively safe chiropractic procedures would make far more sense. AbstractChronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain. Spinal InjectionsThe efficacy of spinal injections is limited. Epidural corticosteroid injections may offer temporary relief of sciatica, but both European and American guidelines, based on systematic reviews, conclude they do not reduce the rate of subsequent surgery.[57,58] This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates.[59-62] Facet joint injections with corticosteroids seem no more effective than saline injections.[57,63] Despite the limited benefit of epidural injections, Medicare claims showed a 271% increase during a recent 7-year interval (Figure 1C).[2] Facet joint injections increased 231%.[2] Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates.[12,64] For patients with axial back pain without sciatica there is no evidence of benefit from spinal injections[57]; however, many injections given to patients in the Medicare population seemed to be for axial back pain alone.[2] Charges per injection rose 100% during the past decade (after inflation), and the combination of increasing rates and charges resulted in a 629% increase in fees for spinal injections.[2] During this time, the Medicare population increased by only 12%. Spine SurgeryAlthough spine fusion surgery has a well-established role in treating fractures and deformities, 4 randomized trials indicate that its benefit is more limited when treating degenerative discs with back pain alone (no sciatica).[65] Despite no specific concurrent reports of clarified indications or improved efficacy, there was a 220% increase in the rate of lumbar spine fusion surgery from 1990 to 2001 in the United States (Figure 1D).[3] The rise accelerated after 1996 when the fusion cage, a new type of surgical implant, was approved.[3] Their promotion may have contributed to both the rise in fusion rates and increased use of implants. In the last 5 years of the 1990s, Medicare claims demonstrated a 40% increase in spine surgery rates, a 70% increase in fusion surgery rates, and a 100% increase in use of implants.[66] Higher spine surgery rates are sometimes associated with worse outcomes. In the state of Maine, the best surgical outcomes occurred where surgery rates were lowest; the worst results occurred in areas where rates were highest.[67] Multiple randomized trials suggest that adding surgical implants to bone grafting slightly improves rates of solid bone fusion but may not improve pain or function.[68-70] Implants increase the risk of nerve injury, blood loss, overall complications, operative time, and repeat surgery.[68,69] In a large study of injured workers, the rapid increase in the use of intervertebral fusion cages after 1996 was associated with increased complications but not with improved disability or reoperation rates.[71] We recently found that reoperation rates after initial spine surgery were higher in the late 1990s than earlier in the decade, despite greater use of fusion procedures and implants.[6] The link to the full article is http://www.medscape.com/viewarticle/58695.
Special investigative article on back surgery by Harvard Medical School Professor and writer for The New Yorker, Jerome Groopman, M.D., from April 8, 2002: Surgeons have often touted procedures that ultimately proved to be disappointing. In the nineteen-fifties, many patients with angina and coronary-artery disease had an operation that involved tying off an artery that runs under the sternum. The idea was that it would increase the flow of blood to a heart that was being starved of its normal supply. Then, at the end of the decade, a clinical trial demonstrated that patients who underwent a sham operation did just as well as those who had the real one; the placebo effect apparently accounted for the fact that so many patients felt better afterward. The radical mastectomy, pioneered a century ago, used to be routinely performed, too. Physicians believed that breast cancer spread in a contiguous, stepwise fashion from the primary tumor, and that the only way to eradicate the disease was to remove the entire breast and the underlying muscles. By the nineteen-eighties, it had become clear that tumor cells could spread throughout the body early in the disease, through lymph channels and blood vessels. A lumpectomy, followed by local radiation, proved as effective as a radical mastectomy in treating the cancer, and was far less traumatic to the patient. Last year, approximately a hundred and fifty thousand lower-lumbar spinal fusions were performed in the United States. The operation, which involves removing lumbar disks and mechanically bracing the vertebrae, is of tremendous benefit to patients with fractured spines or spinal cancers; more frequently, however, it is performed to alleviate chronic lower-back pain. But how effective is it? That’s a question that many of the doctors who perform the fusions, and the insurers who pay for them, appear reluctant to ask. Read entire article by Jerome Groopman, a writer for The New Yorker, by clicking here.
CANCER: EVIDENCE-BASED MODERN SCIENTIFIC RESOURCESThe former editor of JAMA recently stated that most treatment of metastatic cancer with chemotherapy is virtually useless and only gives 'false hope" together with more "real suffering." He added that the motivation is often "profit" and that such behavior is "almost unthinkable." The time has come for chiropractic physicians to become knowledgable about cancer. Here is an excerpt plus a link to his full article:August 11, 2009How to Rein in Medical Costs, RIGHT NOWBy GEORGE LUNDBERG MD
The New York Times recently did an in-depth investigation into the progress, and/or lack thereof, in cancer survival rates over the past forty years in spite of the ballyhooed "war on cancer" funded with billions after billions of dollars. The series is called The Forty Years' War and is in four parts. Each article is carefully sourced to standard scientific literature. After you read these articles, you will know which cancers respond to treatment and which do not. You will also know which cancers should be screened for, and in which populations of patients. FORTY YEARS' WAR; Advances Elusive in the Drive to Cure Cancer FORTY YEARS' WAR; Weighing Hope and Reality in a Cancer Battle FORTY YEARS' WAR; In Push for Cancer Screening, Limited Benefits FORTY YEARS' WAR; A Place Where Cancer Is the Norm
Every few years, one book comes along that seems to say it all, simply and scientifically. Take a look and decide for yourself. Dr. Immerman highly recommends this as the "one" book to give to your cancer patients for the most helpful guidance. Source: http://www.anticancerways.com/
http://www.anticancerways.com/ A fifteen-year journey from disease to health When David Servan-Schreiber, a dedicated scientist and doctor, was diagnosed with brain cancer, his life changed. Confronting what medicine knows about the illness and the little-known workings of his body’s natural cancer-fighting capabilities, and marshaling his own will to live, Servan-Schreiber found himself on a fifteen-year journey from disease and relapse into scientific exploration and, finally, to health. Combining memoir, concise explanation of what makes cancer cells thrive and what inhibits them, and drawing on both conventional and alternative ways to slow and prevent cancer, Anticancer is revolutionary. It is a moving story of a doctor’s inner and outer search for balance; radical in its discussion of the environment, lifestyle, and trauma; and compelling and cautionary in its proposal that cancer cells lie dormant in all of us—and that we all must care for the “terrain” in which they exist. Advocating a sea change in the way we understand and confront cancer, Anticancer is a radical synthesis of science and personal experience, an inspiring personal journey, and certainly a guide to “a new way of life.” Anticancer tells us:
Attention Chiropractors: Now, more than ever, don't stand by the sidelines with cancer patients. Read all of the documents linked to on this page and get involved. Obviously, it is no longer appropriate to leave supervision of these matters to other professions.
A few more articles that are you must read about cancer prevention, treatment and screening: Cancer Patients, Lost in a Maze of Uneven Care. The first doctor gave her six months to live. The second and third said chemotherapy would buy more time, but surgery would not. A fourth offered to operate . . . Read entire NY Times article by clicking here. In Health Reform, a Cancer Offers an Acid Test from the NY Times, all about prostate cancer and the screening test, the PSA. Cancer Screening: Doing More Harm than Good? Screening tests can find cancer early -- so why do some experts say they can do more harm than good? Read this before your next mammogram, PSA test, or colonoscopy. Cancer Fight Goes Nuclear, With Heavy Price Tag: There is a new nuclear arms race under way — in hospitals. Pummeling Cancer With Protons -- Investing in Treatment, With Eye on Returns. Medical centers are rushing to turn nuclear particle accelerators, formerly used only for exotic physics research, into the latest weapons against cancer. Some experts say the push reflects the best and worst of the nation’s market-based health care system, which tends to pursue the latest, most expensive treatments — without much evidence of improved health — even as soaring costs add to the nation’s economic burden. Obesity Nears Smoking As Cancer-Causer: "Eye-Opener" Major Report Analyzed 7,000 Clinical Trials And Took 5 Years To Complete. The Cancer Project: The Cancer Project promotes cancer prevention and survival through a better understanding of cancer causes, particularly the link between nutrition and cancer. Through research, education, and advocacy, we are saving lives. Vitamin D Appears to Cut Breast and Colorectal Cancer Risk: Researchers say that raising vitamin D levels may prevent up to half of all breast and two thirds of colorectal cancer cases in the United States. Based on the results of 2 separate studies, the investigators recommend a daily intake of 2000 IU of vitamin D 3 and, when possible, moderate sun exposure. Vitamins aren't a cure-all -- latimes.com. In fact, taking them does nothing to fight cancer, studies find. Cure Cancer? Not Without a Course Correction: Time to Research Oncology Treatments for Efficacy. President Obama wants to double the National Cancer Institute’s budget and representatives in Congress on both sides of the aisle are supportive. But before our elected leaders escalate the long-running war on cancer, the Obama administration might want to review the past performance of cancer research, which emphasized finding new cures, not fine-tuning existing oncology treatments. Read full article in Science Progress by clicking here. Healing Heat: Harnessing Infection to Fight Cancer. Modern immunology plus historic experiments suggest a better way to gear up the human immune system to battle malignant disease. Read entire article in American Scientist by clicking here. Note to ACS Members: There is considerable additional valuable information available to you. Contact Dr. Immerman personally by phone or email for this information.
CARDIOVASCULAR DISEASE: EVIDENCE BASED SCIENTIFIC RESOURCESThe former editor of JAMA recently stated that many coronary bypass surgeries and angioplasty/stenting procedures are not needed and that patients could instead be treated with "intensive medical therapy." This means drugs and dietary changes. Many need only dietary changes. The time has come for chiropractic physicians to become knowledgable about cardiovascular disease. Here is an excerpt plus a link to his full article:August 11, 2009How to Rein in Medical Costs, RIGHT NOWBy GEORGE LUNDBERG MD
Reading List January 28, 2009The New Science of Vascular DiseaseBy William H. Bestermann M.D. Vascular disease and the conditions that produce arterial problems consume roughly one- third to one-half of the $2 trillion annual spend in American health care. The science and systems exist today to dramatically improve the quality and cost related to cardio-metabolic conditions but almost nothing has been done to implement these new tools since the Institute of Medicine (IOM) published “Crossing the Quality Chasm” in 2001. Read entire article from The Lundberg Institute by clicking here and then searching on the site for the article "The New Science of Vascular Disease" by name. "The Collapse of Cardiology: A Time to Rejoice?" by Caldwell B. Esselstyn, Jr., M.D., a surgeon at The Cleveland Clinic, 2007 Resolving the Coronary Artery Disease Epidemic through Plant-Based Nutrition (with photos of disease reversal) In Cholesterol Lowering, Moderation Kills Prevent and Reverse Heart Disease A groundbreaking program backed by the irrefutable results from Dr. Esselstyn’s 20-year study proving changes in diet and nutrition can actually cure heart disease Heart disease remains the leading cause of death in the United States for men and women. But, as Dr. Caldwell B. Esselstyn, Jr., a former internationally known surgeon, researcher and clinician at the Cleveland Clinic, explains in this book it can be prevented, reversed, and even abolished. Dr. Esselstyn argues that conventional cardiology has failed patients by developing treatments that focus only on the symptoms of heart disease, not the cause. Based on the groundbreaking results of his 20-year nutritional study—the longest study of its kind ever conducted—this book explains, with irrefutable scientific evidence, how we can end the heart disease epidemic in this country forever by changing what we eat. Here, Dr. Esselstyn convincingly argues that a plant-based, oil-free diet cannot only prevent and stop the progression of heart disease, but also reverse its effects. The proof is in the results. The patients in Dr. Esselstyn’s initial study came to him with advanced coronary artery disease. Despite the aggressive treatment they received, among them bypasses and angioplasties, most were told by their cardiologists that they had less than a year to live. Within months on Dr. Esselstyn’s program, their cholesterol levels, angina symptoms, and blood flow improved dramatically. Twenty years later, they remain free of symptoms. Here are the documented results: Drop in cholesterol levels: After 5 years on Dr. Esselstyn’s plant-based diet, the average total cholesterol levels of his research group dropped from 246 milligrams per deciliter to 137 mg/dL (Above 240 mg/dL is considered “high risk,” below 150 mg/dL is the total cholesterol level seen in cultures where heart disease is essentially nonexistent.) This is the most profound drop in cholesterol ever documented in the medical literature in a study of this type. Source: http://www.heartattackproof.com/ Note to ACS Members: There is considerable additional valuable information available to you. Contact Dr. Immerman personally by phone or email for this information.
INFLAMMATION, TOXEMIA AND DETOXIFICATION: KEY TO UNDERSTANDING HEALTH AND DISEASERobbins Basic Pathology, the classic text used in medical schools, states that inflammation is "fundamentally a protective response, designed to rid the organism of both the initial cause of cell injury (e.g., microbes, toxins) and the consequences of such injury (e.g., necrotic cells and tissues). Without inflammation infections would go unchecked, wounds would never heal, and injured tissues might remain permanent festering sores." Inflammation is "essential to the survival of organisms is their ability to get rid of damaged or necrotic tissues and foreign invaders, such as microbes." No one has explained theoretically how it makes any common sense to suppress or oppose the inflammatory process with drugs such as NSAIDs knowing that inflammation is "fundamentally a protective response . . ." Nonetheless, inflammation is suppressed with drugs as a standard practice in the medical world today. Inflammatory diseases include osteoarthritis, rheumatoid arthritis, gastritis, rhinitis, neuritis, and every other disease with a name ending in "itis." When inflammation is present, it would seem far more logical to help the body rid itself of the "initial cause of cell injury (e.g., microbes, toxins) and the consequences of such injury (e.g.,necrotic cells and tissues)" than to chemically suppress the process of inflammation which was deliberately created by the immune system for healing. The initial cause of cell injury, by definition, is microbes or toxins. What are these toxins referred to by Robbins? Where do they come from? In 1935, an MD published a book with his opinions on the subject. It became a classic which you should read. Here's the link to the online free full text version: Tilden, J. H., M.D. Toxemia Explained. Dr. Tilden's Health School, Denver, Colorado, 1935. Available in both html and PDF versions. In 1981, Dr. Immerman decided to investigate Dr. Tilden's hypothesis and see if it was scientifically valid. Here are the key questions: Do toxins of many types build up in the body and cause disease? Is inflammation then turned on to destroy or eliminate these toxins? Is inflammation a widespread problem? Does the body initiate inflammmation because of the presence of toxins in many common conditions? Is it important to detoxify? What is the best way to detoxify? Many of these questions are addressed in the following article: "Scientific Basis for the Concept of Toxemia" by Alan M. Immerman, D.C., ACA Journal, June, 1981 Read and learn the truth. Toxins are at the root of many common illnesses. Detoxification can restore health more often than not. Further avoidance of toxins can maintain good health without medical intervention in many cases. Most of the answers to your questions can be found on this page. LA Times: Battling inflammation through food: Though it's an emerging field, proponents of anti-inflammatory diets point to growing evidence that foods like vegetables and fish can ease an overactive immune system. LA Times: Inflammation and how it relates to chronic diseases: Discusses cardiovascular disease, Alzheimer's disease and cancer. Testing the hypothesis of inflammation, toxemia and detoxification in practice with rheumatioid arthritis RA is a classic autoimmune inflammatory disease of the joints. It does not involve microbes and so, according to the definition of inflammation, must involve toxins. Theoretically, the body must initiate the process of inflammation as a protection function to destroy and/or eliminate toxins which lodge in the joints. Medical treatment is aimed at suppressing the painful inflammatory process. It would seem to make far more sense to help the body rid itself of the toxins which the body is trying to get rid of with inflammation. Is there scientific evidence to support this approach and, therefore, the entire concept of toxemia as an underlying cause of inflammation and many chronic diseases? If the toxins come from a bad diet, then eating a good diet would alleviate symptoms in RA. The body is able to clear toxins by itself through detoxification functions primarily by the liver, kidneys, lymphatic and immune system, etc. Here is what peer-reviewed scientific studies have found: Arthritis Research & Therapy 2008, 10:R34: "Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a Makes you wonder why elite rheumatologists are treating RA patients with potentially deadly anti-cancer drugs like methotrexate when all they have to do is tell them to stop eating meat. Read on. Scandinavian Journal of Rheumatology: "Fasting followed by vegetarian diet in patients with rheumatoid arthritis," Muller H, Toledo FW, Resch KL, 30(1): 1-10, 2001. This systematic review analysed more than 30 studies of fasting and vegetarian diets for rheumatoid arthritis and concluded that they were all successful because they spared the body of a key compound found in animal foods, eicosanoids, formed from an Omega-6 fatty acid called arachidonic acid. Vegetarian diets contain no arachidonic acid and so result in formation of no eicosanoids, thus no need for inflammation to destroy these irritating toxins in the joints, thus no pain of rheumatoid arthritis. Purveyors of Omega-3 products would prefer you to sell their substance to balance the Omega-6 acids in your patient's body. This may be superior for the vendor's profit margin, but it is superior for the patient's health to eliminate the Omega-6 acid intake altogether. European Journal of Clinical Nutrition: Anti-Inflammatory Diet in Rheumatoid Arthritis -- Review, O. Adam, v. 49:730-717, 1995. Conclusion: Arachidonic acid, found only in animal foods, is the cause of the inflammation in RA. Avoiding animal foods results in reduction of symptoms. The Journal of Alternative and Complementary Medicine: "Effects of a Very Low Fat, Vegan Diet in Subjects with Rheumatoid Arthritis," John McDougall, MD, B Bruce, G Spiller, J Westerdahl, M McDougall, v.8, n.1, p. 71-75, 2002. Conclusions: Patients with moderate-to-severe RA who switch to a vegan diet can experience significant reduction in RA symptoms. Conclusion: The theory has proven true. Toxins build up in the body from ingesting actual toxins or too much of any type of food, causing general toxemia. Inflammation is created to protect the body from toxins and is an underlying theme in cardiovascular disease, cancer, arthritis and many other diseases. Anti-inflammatory treatment makes no logical sense even with rheumatoid arthritis. Detoxifying by removing the source of the toxins with plant-based nutrition is the only sound solution. ACS provides personal guidance to members who wish to pursue these methods in their practices. Call or email ACS for more information and get started today.
KEY RESOURCES ON FEVER
"Fever Phobia Revisited: Have Parental Misconceptions About Fever Changed in 20 Years?" Michael Crocetti, MD*, Nooshi Moghbeli, BA*, and Janet Serwint, MD PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1241-1246. Objectives. Fever is one of the most common reasons that parents seek medical attention for their children. Parental concerns arise in part because of the belief that fever is a disease rather than a symptom or sign of illness . . . Read entire article free online at publisher site by clicking here. Conclusions. Fever phobia persists. Pediatric health care providers have a unique opportunity to make an impact on parental understanding of fever and its role in illness . . . Read entire article free online at publisher site by clicking here.
FEVER: NEW VIEW STRESSES ITS HEALING BENEFITS By JANE E. BRODY Published in The New York Times, December 28, 1982 THE ancient Greeks, who regarded disease as an imbalance of ''humors,'' believed fever cured the sick by cooking the bad humors and helping the body get rid of them. The notion of fever as beneficial persisted for more than 2,000 years, and countless patients were actually treated with ''fever therapy'' to aid their recovery from such ailments as syphilis, tuberculosis and even mania. Then, in the mid-1800's, aspirin compounds that rapidly reduced fevers became commercially available and the medical view of fever changed abruptly. For the next hundred years, physicians and patients focused on bringing down fevers, sometimes with such drastic measures as cold baths and alcohol rubs. Now, the view of fever is undergoing yet another about-face, thanks to recent research that has in essence documented the benefits suspected by the Greeks. Fever, the studies indicate, evolved at least 300 million years ago in cold-blooded vertebrates as a means of helping the body fight off invading organisms. Read the full New York TImes article by clicking here.
What You Need To Know About Fevers (CBS) The first thing we do when a child is feeling under the weather is take his or her temperature. But how much do we really understand about the reading we get from that thermometer? On The Early Show Saturday Edition, Dr. Mallika Marshall quizzed co-anchor Chris Wragge, to sort out facts and myths about fevers. You can take the quiz, too! Click here and go to the CBS website.
ACS SCIENTIFIC JOURNAL STUDY LIBRARY
ACS has accumulated many key peer-reviewed scientific journal studies for members. The studies are stored in the ACS library in Arizona. Members may get copies of these valuable studies for no charge by contacting ACS. A complete and frequently updated list may be found here. These studies are the essential articles needed to prove that chiropractic care is safe and effective for a wide variety of conditions. ACS also has the essential up-to-date studies on whiplash, low speed impacts, soft tissue healing, and many other issues. Another invaluable resource for members from ACS! Note to ACS Members: There is considerable additional valuable information available to you. Contact Dr. Immerman personally by phone or email for this information.
HEALTH UNLIMITED -- A FULL TEXT GUIDE ONLINEAlan M. Immerman, D.C. Section One – The Basics 1. Introduction Section Two – How Trouble Develops Section Three – The Problems Section Four – How To Unleash Your Body’s Healing Power 31. To Supplement or Not Bibliography Click here to read full text book online in PDF format.
HEALTH ARTICLES
Health Unlimited! by Alan M. Immerman, D.C. A complete book online. This guide to health was used as a text at Parker College of Chiropractic. Go to http://soilandhealth.org/02/0201hyglibcat/HlthUltd.pdf. "Can Diet Prolong Lifespan?" by Alan M. Immerman, D.C., ACA Journal, February 1982 "Evidence for Intestinal Toxemia" by Alan M. Immerman, D.C., ACA Journal, April 1979 "Scientific Basis for the Concept of Toxemia" by Alan M. Immerman, D.C., ACA Journal, June, 1981
INSURANCE ARTICLES
"In Tough Hands at Allstate" 2006 Business Week article The Business Journal 2001 article on ASHN Key quotes from State Farm and Allstate cases "There's fraud all right, committed by automobile insurance companies!" State "Snake" Farm attacked by Snake Killer lawyers "Auto insurers play hardball in minor-crash claims" CNN 2007 "California fines Blue Cross Blue Shield $1 Million" 2007 Note to ACS Members: There is considerable additional valuable information available to you. Contact Dr. Immerman personally by phone or email for this information.
LINKS
True North Health Education and Fasting Center at http://www.healthpromoting.com/index.htm Dean Ornish M.D. Lifestyle Program on WebMD at http://www.webmd.com/diet/ornish-diet-what-it-is International Association of Hygienic Physicians at http://www.iahp.net/index.htm National Health Association and the American Natural Hygiene Society at http://www.healthscience.org/component/option,com_frontpage/Itemid,1/ The Bruce Levine Home Page for responsible critical commentary on psychiatry and psychology at http://www.brucelevine.net/www.brucelevine.net Dan Murphy, D.C. Home Page at danmurphydc.com Spine Research Institute of San Diego and Arthur Croft, D.C. at http://www.srisd.com/index2.htm
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274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame.
Caldwell B. Esselstyn, Jr., M.D. 
From the * Department of Pediatrics, Johns Hopkins Bayview Medical Center, and 
The Johns Hopkins Children's Center, Baltimore, Maryland.