Everett Chiropractic Center Blog

February 3, 2018

The Opioid Crisis: Who Is/Is Not Guided By The Guidelines?

As far back as 1994, spinal manipulation has been a leading approach for managing low back pain in national care guidelines, and chiropractic care was the only approach that was also noted to improve function. (AHCPR Clinical Guideline #14: Acute Low Back Pain for Adults)

The 2017 American College of Physicians guidelines continued to point to spinal manipulation as a preferred initial non-drug therapy selection for chronic low back pain, along with other chiropractic services such as exercise, mindfulness, and low-laser therapy. (Annual of Internal Medicine; February 24, 2017)

So what percent of medical providers recommend spinal manipulation? Two. (OPTUM Insurance Study 2012 (retrospective review of 16,000,000 musculoskeletal cases)

“259 MILLION opioid painkiller prescriptions were written in 2012 – enough for one bottle for every adult in the U.S. 2016 data suggests that opioid problem is WORSENING, not improving.” (Centers for Disease Control; https://www.cdc.gov/vitalsigns/opioid-prescribing)

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May 2, 2017

American Healthcare is an American Sickness: A Medscape Commentary on a “God-awful Mess”

You have to be a member of Medscape to get this or get access to it… so I copied it for you.

By: 

Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

Medicine has always been both a business and a profession. Chaucer wrote about it; so did George Bernard Shaw. Balance has always been the key.

By 1985, the balance began to tip toward business—a development I chronicled in JAMA in 1990 with the visual metaphor “medicine’s rocking horse.”[1] This editorial got me into a bunch of trouble with the Illinois State Medical Society, among others. But I was right. Twenty-seven years later, it has never rocked back, and this imbalance has created the god-awful mess with which we are now burdened.

What could rescue us and set this toppling horse straight? Back in 2012, I blamed “the MBA” in total.[2] [Editor’s Note: “MBA” refers to “master’s in business administration,” which Dr Lundberg used as shorthand for the use of business models in healthcare.] But, I was wrong. MBAs are simply tools used by the medical money culture.

So many books have been written about this issue. How many books will it take? Here are nine that I recommend.

  1. Money-Driven Medicine, by Maggie Mahar[3];
  2. How We Do Harm, by Otis Brawley[4];
  3. Overdiagnosed, by H. Gilbert Welch[5];
  4. Epidemic of Care, by George Halvorson and George Isham[6];
  5. Too Much Medicine, by Dennis Gottfried[7];
  6. Stabbed in the Back, by Nortin Hadler[8];
  7. Hope or Hype, by Richard Deyo and Donald Patrick[9]; another
  8. Money Driven Medicine, by David Cundiff[10]; and my book,
  9. Severed Trust: Why American Medicine Hasn’t Been Fixed.[11]

In aggregate, these books did not make a dent. The system just roared on.

Could super-journalist Dr Elisabeth Rosenthal’s brand-new book, An American Sickness,[12] be the one that finally makes the difference? Could it activate Malcolm Gladwell’s “tipping point”?[13]

Take a look at Rosenthal’s list of 10 economic “rules” that are guaranteed to make money, but not to improve outcomes:

  1. More treatment is always better. Default to the most expensive option.
  2. A lifetime of treatment is better than a cure.
  3. Amenities and marketing matter more than good care.
  4. As technologies age, prices can rise rather than fall.
  5. There is no free choice. Patients are stuck. And they’re stuck buying American.
  6. More competitors vying for business doesn’t mean better prices; it can drive prices up, not down.
  7. Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more.
  8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all.
  9. There are no standards for billing. There’s money to be made in billing for anything and everything.
  10. Prices will rise to whatever the market will bear.”

And I add number 11: Always seek consultation; each consult can bill, add more specialized procedures, and refer back.

To her credit, author Rosenthal has provided a ton of actions that consumer patients can take to defend themselves. That is great for individuals. Do it. But even with social media and crowdsourcing, it would probably require something like 100,000,000 Americans taking these actions, in concert, to actually make a dent in this entrenched money-driven establishment. I hope it works, but I doubt it.

In his first inaugural address, Ronald Reagan famously said, “Government is not the solution to our problem; government is the problem.” For some things, he was right. Applied to American healthcare in 2017, however, Reagan’s dictum is dead wrong. Government is the only force strong enough to put the American healthcare system on a necessary budget. It will be done, sooner or later. Why not now?

That is my opinion. I am Dr George Lundberg, At Large at Medscape.

January 25, 2016

A Patient Came in Today Wondering Why All That Medical Care Didn’t Help

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A patient came in (limping) this morning after a month of moderate to severe lower back and leg/hip pain. She told a story about seeing her medical doctor who gave her medication, then referred her to a physical therapist. The patient saw the physical therapist who recommended and supervised a series of exercises. Her pain is about the same after a couple of weeks of that. (The medication knocks her out at night, so she sleeps, but she is groggy all morning after, doesn’t feel rested, and can’t fully function… so she stopped that.)

The answer is simple. First off, health care providers look for what they can “treat”. And they treat with whatever they treat with. (Put another way, we sell what we sell and when we decide we can help, we do it by doing what we do.)

Medical doctors prescribe medications for back pain, they may also recommend physical therapy (and some now recommend chiropractic care). They expect that to do it AS IT RELATES TO “BACK PAIN”. The PAIN is the patient’s problem (in the patient’s mind and in the medical doctor’s mind). If the pain doesn’t go away, the medical doctor will (1) increase the strength of the medication, and/or (2) combine medications, and or refer to a “spine specialist” who will examine and recommend, usually (first) and injection, and then, eventually, surgery. That’s just what you get when you go that route, ask anybody who knows anything about it.

But why didn’t that work?

(In this case, “work” means relieve the pain.)

In this patient’s case, as in most every other case where the usual medical approach fails and chiropractic care works, it didn’t work because the patient was subluxated (it’s “alternative” remember?). Spinal subluxations are characterized by 5 things: 1) joints not moving right (they are usually not moving enough – i.e., restricted), 2) abnormal reflexes from those same joints, 3) altered muscle function in the muscles served by the abnormal reflexes coming from those same joints , 4) altered motion/alignment involving nearby and related joints, and 5) inflammatory reactions in the abnormal stressed tissues surrounding and related to those same joints.

Let’s keep this really simple: When joints are not moving, they have to be freed up to move normally or whatever dysfunction caused will persist. Medication isn’t targeting joint restrictions – it’s targeting an effect: inflammation and pain. Exercises don’t usually target joint restrictions (well our first 6 do, but that’s a different story), and if the exercising doesn’t somehow result in the restricted joints becoming unrestricted, the inflammation (and pain) will be increased (a common occurrence).

It didn’t work because the cause was (and often is) miss-diagnosed

When a patient tells a medical doctor that they have low back pain, and the doctor says it back to them in Latin, that doesn’t help much. Not really. (In the world of back pain diagnosis is universally understood to be meaningless as it relates to effective treatment – but don’t take my word for that, talk to a bunch of researchers. The doctor is hoping that the medication takes away the pain. If it does, the patient is happy and so is the doctor; both think that they have done their job.)

The patient was subluxated; the medical doctor doesn’t know how to look for that, isn’t used to thinking such a thing exists, and doesn’t have a cure for it anyway: so, in their mind, it doesn’t exist.

It didn’t work because exercise and medication doesn’t (always, sometimes it does) remove joint restrictions.

I adjusted a half a dozen joints that were subluxated. She got up feeling better, and left without limping. (She will use ice now instead of heat – think inflammation.) I will see her again on Friday. Chiropractic doctors are trained to look for and correct spinal subluxations which are very often the cause of back pain, neck pain, headaches, and other conditions. See a Chiropractic doctor to find out if you need chiropractic care. They are the only one who would know that! (And if you don’t think that you can trust them, then go somewhere else and see someone who you can trust.)

November 13, 2015

Research Shows Shift In Hospitals’ Financial Risk

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I wondered why I would get a newsletter entitled “Pulse” in the mail from my Collection Agency. Then I read the first article. Here’s the gist:  Since the Affordable Care Act went into effect in October, 2013 things have changed. Less people are uninsured. More people are insured. And many of those who are “newly insured”, as well as many of the rest of us, have high deductible health plans (HDHP), which translates into much higher costs out-of-pocket for patients. “… the expanding insured self-pay patient volume and A/R highlights the need for providers to focus on this area of growing financial risk.” (Then I knew why they sent me the newsletter.)

“The replacement of traditional health plans with HDHPs is creating more patients who are not only newly insured, but who bear significant financial responsibility via copays and high deductibles,”… “This has created more financial risk from the insured self-pay population.”  More information: http://bit.ly/1Mhoxe6 and http://1.usa.gov/1W333nb.

All of this will be old news to those who have followed this Blog much over the years.

Another article in the newsletter had the title “Quality of Care”. It wasn’t about that, but here is a noteworthy quote: “All of the recent trends and changes in healthcare are leading some providers to consider an earlier retirement, according to the report.” Not having a lot of fun I guess.

June 24, 2015

Sx + Ex + Xr -> Dx -> Tx = The War On (Name the disease): How Is That Working For You?

Sx – stands for Symptoms (in this case you can include Signs), as in you go the doctor and tell them your story. In our culture you don’t go until you have a story, and that story is usually a sad one. We have talked at length here about the story (and natural history – which means recurrent story) of those with back pain. When you tell your story you have expectation about what it means to the doctor; when the doctor hears your story they make all kinds of judgements about you and your story as well as their own situation (employer), your insurance coverage, their values and your values, etc.

Ex – stands for Examination. After you have interviewed your doctor and they have asked questions to better understand your story, they are supposed to do an examination. I will spend another entire Blog Post on the thought processes inherent in that some other day. At this point the point is the entire health care system you are accessing has a pre-determined mental picture embodied in the formula Sx + Ex = Dx -> Tx. It’s the model that modern medicine was founded on: the war against disease. Filled with presuppositions and assumptions, this model is partly what got us where we are. Ask yourself, who benefits from things being just the way they are; is an accident?

Xr – this just stands for any testing done to assist the doctor in determining what the Diagnosis is. I used Xr for X-ray because we can all relate. (When you contemplate this element of the formula, think MONEY and motivation.)

Dx – This is the big ticket item. The major goal of the all earlier efforts. This is such a big deal that all insurance reimbursement hinges on it (well, not really, but I am trying to make a point – contemplate how crucial the “diagnosis” is to both doctor and patient. Forget for a minute that in the realm of back pain (and many if not most other conditions) an accurate diagnosis that actually means anything is a very rare thing – of course if you wait until the condition develops into it’s later stages, well.. “If your symptoms persist, then come back.” (Don’t take my word for any of this, check into…)

Tx – This stands for Treatment. Treatment is a loaded word. Historically our health care system is build on the fantasy that with the “right” diagnosis there should be a preferred, highly predictable, infallible in fact, treatment that offers a solution. Science was supposed to give us that perfect treatment choice. So much for that.

One could talk all day about each of the components of the above formula, so I think I will let what I’ve written so far sink in, and Post on each component separately so that this doesn’t turn into a novel-length Post. Ask yourself what you know about each of those as they relate to your health care experience. Think in terms of your insurance coverage, your employer’s point of view in selecting the options that you then select from. If you have any concept of the terms Medically Necessary, ask yourself where that fits it.

May 27, 2015

Another Broken System Victimizing Those It Is Supposed To Serve

Does that remind you of anything…(the next big bubble?) Anyway, here is Seth Godin’s Blog Post for today: Degrees of freedom 

Does a college degree confer the ability to choose, to open the door to find a way to matter? Three years ago I gave this TEDx talk about the future of education. And the students who graduated from college this month each have an average of $35,000 in debt. For many people, this debt is debilitating. Instead of opening doors, it slams them shut. Talented teachers and passionate students are the victims of an industrialized educational system, one that cares a great deal about standardized tests and famous brand-name institutions. It’s time to ask why. And to keep asking why until we figure out what school is actually for. The education system continues to head in one direction, but each day, more of those it proclaims it seeks to serve (students, parents, taxpayers) are realizing that the system ought to be doing something quite different. And differently.

August 31, 2014

Why (ordinary) Doctors Are Sick Of Their Profession – The Wall Street Journal

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Helen asked me if we should put this article up on the bulletin board in the office. I will put a few excerpts below in case you don’t want to read the whole thing. What do you think? Should we put it up at the office?

“When I look at my career at midlife, I realize that in many ways I have become that doctor I never thought I’d be: impatient, occasionally indifferent, at times dismissive or paternalistic. Many of my colleagues are similarly struggling with the loss of their professional ideals.”

“In a 2008 survey of of 12,000 physicians, only 6% describes their morale as positive. Eighty-four percent said that their incomes were constant or decreasing. Most said that they didn’t have enough time to spend with patients because of paperwork, and nearly had said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.”

“I feel like a pawn in a moneymaking game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade.” (emphasis mine)

“Perhaps the most serious downside however, is that unhappy doctors make for unhappy patients.”

“For many of us, it is rare to find a primary physician who can remember us from visit to visit, let alone come to low us in depth or with any meaning or relevancy.

…Insensitivity to in patient-doctor relationships has become almost normal.”

I don’t know. May be this has something to do with our office has been busier in the past eight months than in the past twenty-eight years. A steady flow of people have been showing up, happy to pay for their care, and get what they can’t get anywhere else. We thought is was Obama Care, people are certainly discovering that even though they have insurance it doesn’t mean much when it comes to taking care of their health. They are on their own for that. And for that they come in for chiropractic care. Imagine.

August 7, 2014

Not Another Typical Drug Company Law Suit

Here is the article.

Here is the excerpt:

Under the Heading 3. Marketing & Influencing Patients

The drug companies allegedly used multiple means to get non-cancer patients to request opiods. This concerted effort to expand their market increased sales dramatically.

“In 2010, 254 million prescriptions for opioids were filled in the U.S. – enough to medicate every adult in America around the clock for a month. Twenty percent of all doctor’s visits result in the prescription of an opioid (nearly double the rate in 2000). Opioids – once a niche drug – are now the most prescribed class of drugs – more than blood pressure, cholesterol, or anxiety drug.”

July 31, 2014

Dr. Oz And The “Glare Of Publicity”

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Interesting developments in the field of media medicine…

June 17, 2014

It Is Reversible: Stop Fighting Disease and Start Pursuing Health At All Levels

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Medication or meditation?

May 15, 2014

Myth or Con?

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The recent AARP article on the high cost of cancer prescription drug research costs calls it a “Myth”. You decide.

Here are some excerpts

“Eleven of the 12 new cancer drugs approved in 2012 were priced above $100,000 annually, and a 20 to 30 percent copayment can make them unaffordable even for well-insured patients.” [No kidding! And people complain about the high cost of healthy choices.]

The article says that when asked, and when any answer at all is provided by the industry, the answers center around two things: the “high cost of research” and the “precious added benefits of curing or controlling cancer.” The article then goes on to say, “We find neither explanation plausible.”

“Only one of the 12 new cancer drugs approved in 2012 helps patients survive more than two months longer.” [And that’s a measure of progress. How the conversation of success is manipulated is a whole other story.]

Anyway, “cost also does not hold up.”

“Indeed, the actual dollars that companies have put into research from 1995 to 2010 have generated six times more revenue – a sign that they are charging too much for a little benefit.”

Industry sponsored estimates claim the costs of research and development are, on average, $1.3 Billion to develop a new drug and get it approved. “Half that estimate, however, is not research cost at all, but rather a high figure for profits that companies would have made if they had invested their research money in stocks and bonds instead.” It’s not real cost. By the time the article gets done dismantling the industries numbers, the net median cost is about $125 Million. “Overall, investment in basic research by pharmaceutical companies to discover new drugs is quite small – about one-sixth of overall company research costs and about 1.3 percent of revenues after deducting for taxpayer subsidies.”

“In the case of cancer drugs, company research costs are even lower, because most of the basic research and thousands of clinical trials are paid for by the National Cancer Institute and foundations. In sum, we find no credible evidence that the real research costs to major companies themselves for cancer research are higher than for developing other drugs.”

Yet…. “In the past decade, they have almost doubled their prices for cancer drugs.”

“We call this the ‘market spiral pricing strategy’ – continually raising prices across the whole market, regardless of value or cost.” “… No other industry raises prices on last year’s cars or cellphones.”

“Claims justifying the high price of cancer drugs don’t add up.” No kidding.

September 21, 2013

Bordering on Bizarre

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Just When You Think It Can’t Get Any Worse

The news on modern medicine is generally dismal. But the more you know the worse it seems to get…

I heard about this on the radio as I was going for lunch today. You might not want to look until after you’ve eaten.

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