Truth in Treatment

More Anti-chiropractic Silliness from Chirotalk

2009-04-10T22:44:00.009-05:00

Having seen the way the Chirotalk forum would attack anything and everything chiropractic in their "skeptical" and "anti-chiropractic" fashion, and having seen the changes over the past few weeks, I find this interesting.

It seems that the owner of the site, Mr Allen Botnick, has devised a spinal realignment system that he claims cures asthma. After all of their posturing, apparently in the name of making a buck, Mr Botnick is willing to re-clothe himself in the chiropractic regalia, and promote his "technique" for spinal realignment to "cure" a condition which is, by their own rants, not within the chiropractic scope of practice, much less, realm of treatment.

And one of their staunchest spokesman, Nemo, who by admission likes to bash chiropractors for the sheer fun of it, as, in his own words, it is like a video game, a way to unwind after a long day at the office, defends his guru now.

I give you three posts regarding this change in the "skeptics" attitude:

By chilkatkid on Chirotalk -

"There is this ex chiropractor. His name is Allen Botnick. He actually believes that you can cure asthma of some type with fixing the spine! He has no evidence based studies but he just has anecdotal alleged evidence from one person and that is him! He has no studies but he wants to market the device. He believes it works but has no real evidence to support it. Additionally there is no rational mechanism by which asthma may be caused through aberrant spinal function. He also believes that supplements can help fix the asthma as well.

I mean think about it. He says he fixed one patient. HIM!!!! And now he wants to market the device. I mean what would ever possess a person to believe that they could cure asthma through the spine?? And to jump to conclusions with no evidence based studies. And this is chiropractic even though Botnick holds no license in anywhere I can find. And on this one interview he even says a rib can misalignment at the sternum. There is no proof of that.

I don't know who Botnick is but this is very extreme. I men if Botnick says that asthma can be caused from a spinal alignment problem then what will stop him from saying heart problems can??I am shocked by this."

By Nemo -

"Hey FancyPants!

Did you know that, according to the National Board of Chiropractic Examiners, chiropractic is, in fact, a treatment for Asthma? Why 60% of the time the diagnosis is a subluxation....and 70% co-manage this condition. You can check it out in Chapter 9 of the 2005 Job Analysis Bulletin. You wouldn't call the NBCE stupid, would you?

They claim that "adjustments' not only increase mobility for asthmatics, but stimulate the "psychoneuroimmune" system for relief.

Now go back and read your Gatterman like a good little chiro and leave Allen alone. What chiropractic planet are you from anyway? "

Also by Nemo -

"Wait!.....Hold on FancyPants!.....I forgot to tell you that the NBCE
( the people who legally certified you as a DC) also treat heart conditions. In fact, the following quote was taken right off the business website of National Board Examiner Ted Scott:

"Dr. Scott helped me understand that treating the spinal area from which the heart receives it’s nerve energy, had restored my heart and my health - "Just another daily miracle." said Dr. Scott. Thank you so verrry much! ~Elaine" "

Now I ask you, is this sarcasm or just plain hypocrisy?

But this one is by far the most classic. A direct response from Mr Botnick himself to chilkatkid -

Botnick - "Ribs dislocate so if they can dislocate they certainly can translate enough to lock out the joints.Your bias notwithstanding, there is nothing wrong with speculating and using personal experience to come up with a testable theory provided one doesn’t take the alternative med approach of never testing it."
chilkatkid - "Joint instability causing pathology like asthma. Do you realize how off base that is?
Botnick - "You have no proof that it can’t cause it. You are speculating. Further, costochondritis is idiopathic."
chilkatkid - "Oh and I find it so funny you moved my post and relabeled it. I mean just step back and look at the big picture. Botnick is saying that subluxation causes asthma. Pure and simple. He is basing it on his one "experience". He then muses about nutrition being able to help asthma. I tell you that correlation does not imply cause. But seriously. Bones in the back that are unstable do not cause asthma.
Botnick - "You are biased.
chilkatkid - "Oh and as far as the physicians at the New York University School of Medicine. Support in what sense and what are their names and phone numbers? I will call them right the heck now. I want them to tell me where they stand and how they are "supporting" you. "
Botnick - "Given your lack of objectivity, I doubt you would be able to help the research so there’s no point in wasting their time with you. At least I'm testing the theory. "

Amazing isn't it. Especially the comment, "You have no proof that it can't cause it". Isn't this the very argument these anti-chiro skeptics have been shooting down and hammering with insults when presented by chiropractors defending their trade on the chirotalk forum? Isn't it exactly what they were banning chiropractors from the Chirotalk forum for? The classic response from Chirotalk was that there is no evidence for patients positive response to chiropractic treatments; that it could be nothing but placebo; that chiropractors were quacks for having no evidence and using anecdotal stories as their only evidence.

Once again, as always, the anti-chiros and "skeptics" become the pot calling the kettle black, using the same arguments they themselves have been condemning when used by chiropractors. Total hypocrisy! And it is rampant in the anti-chiro/skeptical world.

Mr Botnick, you sound strangly like a chiropractor. Too bad you have no license.

I, personally, have seen how chiropractic manipulation can effect asthma. I hope that any research for this "technique", shows it to be as effective as Mr Botnick says it is. What a great testimony it would be for the potential of chiropractic, and that, coming from the leader of the skeptical, anti-chiro, Chirotalk community.

Informed Consent or Full Disclosure

2009-03-28T09:40:00.014-05:00

Recently a bill was introduced in Connecticut which would have required chiropractors to give informed consent to all patients prior to any treatment, specifically cervical spinal manipulation, which is perceived by some to represent a stroke risk to patients. The bill was defeated which has many proponents of the legislation up in arms, claiming that chiropractors don't want to divulge the dangers of cervical manipulation to the public, thus exposing patients to a "dangerous" procedure without adequate disclosure.

On various forums I have seen it said that the bill would have required informed consent from all providers, not just chiropractors. If so, then the bill was defeated not just by a chiropractic movement, which actually might not have been involved, but by others who had an interest in defeating this bill.

I personally don't have a problem with letting patients know it has been suggested there might be a very slight risk, albeit unproven, of stroke after spinal manipulation, but I do believe the "informed" part of consent should be required across the board by all health care providers.

It would appear that the medical community does not want to put the risks associated with medications, both prescription and over the counter, into plain language that the average person would understand. Nor do they seem to want to do so with medical procedures.

But lets face facts about true risks to patients. The risk of stroke due to cervical manipulation is now estimated to be 1 in 5 million or so. The studies to date even suggest that patients who have suffered stroke were probably in the process of having the stroke already and had they gone to their PCP and never received cervical spinal manipulation, would still have had the stroke. Essentially, there is little or no true evidence that any cervical manipulation has ever caused a single stroke. Some "science based" bloggers have suggested that there is the equivalent of a "smoking gun" to suggest a danger, but that is just an anti-chiropractic bias coming to the forefront, in an attempt to continue the denigration of non-medical associated health care. It is a weak attempt at best, but appears to be satisfying among their other "science based" cronies.

The fact of the matter is, if anyone should be afraid of informed consent it should be the medical health care providers and the pharmaceutical companies. A brief search of the Internet will reveal article after article, many from respected medical journals like JAMA, stating the risks and dangers of medical procedures, drug reactions, pharmaceutical errors and medical mistakes. All combined, un-necessary deaths caused by the afore mentioned is estimated to be the number three cause of death in the US. It might possibly be higher.

The medical community claims to give informed consent (apparently not in Connecticut) but I simply do not see the "full disclosure" that they and the anti-chiropractic community are asking of chiropractors with respect to spinal manipulation.

One simple example I have seen mentioned many times on the Topix forums is the risk of death due to ibuprofen, estimated to be about 3000 deaths per year. Various bureau's of statistics give the number of deaths per year due to all non-steroidal anti-inflammatory medications (acetaminophen, ibuprofen, naproxen, etc) to be nearly 8000 deaths per year. As was pointed out, this statistic is not found on any bottle of ibuprofen found in the local drug store.

Given the extreme risks due to these over the counter medications, adding in the dangers associated with prescription medications, which must be significantly greater, as well as the dangers associated with medical procedures and medical errors and mistakes, one would think that the true need for "full disclosure" of medical risks, namely death, would fall on the medical community. Any call for full disclosure of the minuscule risks due to spinal manipulation would be almost non-sequitur by comparison.

Yet the anger and venom of those calling for informed consent from chiropractors is extreme, to say the least. Why, when faced with the dangers of medicine? To me, it is nothing more than anti-chiropractic bias, grasping at straws in their efforts to limit and decrease chiropractic utilization, ultimately hoping to eliminate it altogether as an alternative to medical treatment.

There is no "higher calling" by these individuals who want to appear to have the "safety" of the public in mind; not when faced with the facts related to the dangers and true risk of death at the hands of medical science. No, they have an agenda; an anti-chiropractic agenda and nothing more. Whether they perceive chiropractors as quacks or just a threat to their income, so to speak, they are, ultimately not concerned for public safety. Not in the least.

I say let ALL health care providers give full disclosure in their "informed" consent, and not just get "permission" to treat, which is essentially what is done at present.

Post written by Mark Rayshell

Hospital Bills in Dallas

2009-03-04T18:44:00.005-06:00

I wanted to get this up today. I had a patient in an MVA a few weeks ago and she brought in her hospital bill for me to fax out to her attorney for her. She is about 4 months pregnant and only had low back pain when she came to me.

Radiology - just over $500 (She said they took one shot of her low back and used shielding. How, I don't know.)

other radiology - just over $1200 (I think two sonograms.)

Routine chemistry - just under $100 (One tube of blood was drawn, no UA.)

Special chemistries - just over $700

ER bill - just under $1300 (She was there about 6 hours.)

transfusion - just over $500 (Don't know what that is.)

pharmacy - just under $600 (She was given pre-natal vitamins, had to pay $8 for those and told to take tylenol.)

This is a medical hospital in Dallas. I was born there.

A Quote from Chirotalk

2009-03-02T16:21:00.004-06:00

Today A J Botnick said - "It's a dirty little secret that if you remove the quackery from chiropractic there is nothing unique left. "

Funny as it sounds, I could actually agree with this to a certain extent. In many ways chiropractors such as myself are really not much more than glorified PT's. We treat musculoskeletal problems with physical medicine.

But much more than PT's, we can take in patients without referral, we are responsible for examination and diagnosis, we can order x-rays and interpret them, we can order MRI/CT and some of us can interpret them, we can order all manner of diagnostic testing as an extension of our exams, we formulate treatment plans, implement them and manage the patients care through all of it's aspects. We make referrals to specialists, review and discuss their findings and recommendations with our patients, and basically oversee literally all aspects of the patients care. We can even do blood work and urinanalysis if we want to, or order it out.

As to the quackery Mr Botnick is referring to, I would assume he means the dreaded subluxation and other off the wall, on the fringe, types of treatments, some less scientific than others. One has to admit, there is that element out there giving us a bad name. (Too bad so many weak minded individuals get into chiropractic because they actually thought they could remove "subluxations" and cure disease. They must have thought they were going to be little Christs or something, laying hands on folks and letting their faith heal them. I mean really, how could you have bought into that Mr Botnick?)

But nothing unique? Hardly.

Too Typical

2009-02-28T13:01:00.002-06:00

I have commented before that these anti-chiro zealots are the typical unsuccessful chiropractor, who went into the profession with the idea that they were going to strike it rich. Most were so uneducated and weak minded that they couldn't see through the "subluxation" cause of disease. In their own words they bought into it hook, lone and sinker.

And many times their anti-chiro rants swing to the threat of God's wrath against those who still practice chiropractic.

This pattern of "seduction" to unrealistic, illogical and un-scientific beliefs permeates the anti-chiro world. Take for example one segment of one comment on chirotalk today:

"""For me...16 years in chiropractic...struggled to make ends meat...attended chiropractic seminars...Parker and DE...to learn how to do what it took to succeed...already aware that patients were not flocking to my office...and for me...eventually seeing what I had also bought into and why it was a scam...I had to leave...and the reason for me was this...I could find no way to practice chiropractic honestly.

Now for those of you whose beliefs embrace the Bible...as well as all others...and what their beliefs or lack of beliefs may be...to me...when it comes to what I believed regarding the "subluxation" and what it was and what it caused...to me...to continue to believe these thungs...amounted to believing a lie. AND THAT WAS WHY I LEFT.

SO THIS IS A STORY OF WHAT ATTRACTED ME AND A STORY OF WHY I LEFT. A decision that I made based on my understanding of chiropractic...not someone elses...and I say this because it is important that whatever you do...you will have solid ground or reason that you chose to stay or leave...and hopefully it will be...if you are a christian...a reason God will accept when the day comes and you will have to give an account. """"

Although apparently free of the "seduction" of the belief in subluxation as a cause of disease, it would appear that this anti-chiro commenter has found a new seduction. For this person, has one "cult" been replaced by another?

Corruption in PI, Workers Comp and Health Care in General

2009-02-27T15:40:00.008-06:00

Of all the things I get to do in my practice, doing PI and Workers Comp is by far the most fun. The patients are truly injured and their pain is real, at least the ones who are actually hurt.

But as in all aspects of everything, there are levels of corruption which can be a discouragement and even represent a deterrent to an injured patient being able to get good care and treatment.

Of course the worst of these in the PI arena are the money patients, the one's who want to get "paid" so to speak, for their injuries. One extreme case recently being a person who walked into my clinic stating that they were in an MVA a few days ago, the insurance company had settled out for the damage to the car and they were working to settle out the "PI" portion of the case, as this patient referred to it. Of course the "patient" was referring to the money the insurance company would apparently give for their injury, pain and suffering. The problem for this patient was that they worked, had little time to come to a clinic but needed to "generate some bills".

Needless to say, I was not interested in being involved in any "bill generating" activities. I informed the patient that I treat injured people who come to me for help. I also indicated that the use of the term "generate bills" was a signal to me that this person was not going to even be evaluated, on any basis. A couple of grunts and huffs later the patient left the clinic.

This example illustrates a major problem in PI work and also why so many look down on both the PI doctor and the PI patient. Additionally, in workers comp, much the same occurs with just a slight twist on the common theme: fake an injury and get some form of monetary award or payment for it. A dishonest form of entitlement, basically.

As providers we have the responsibility to document our patients history, exam findings and treatment, attributing these to a history of occurrence usually associated with a certain date of injury. If we cannot, then we bow out and send the patient on their way.

Is this the only form of corruption we see? Certainly not. Health care is riddled with examples of various forms of corruption associated with defrauding an insurance company or patient of money for services, rendered or not.

I knew a girl once who went to work for an MD's office. Her job was to call patients insurance companies in order to find out what they were most likely to reimburse the doctor for. The doctor used that information to determine the treatment for his/her patients. If the service was not typically reimbursed for by the insurance company then the doctor would, coincidentally, not recommend that service. Basicly, the insurance company determined services to patients indirectly by having patterns of coverage that the doctors apparently would exploit to maximize their reimbursement rates for patient treatments, exams, etc. Needless to say, the person I am referring to left the company and went elsewhere to work. We spoke with her about filing a complaint against the doctor but she was reluctant to get involved to that degree.

The anti chiro's like to point out the corruption that occurs in the chiropractic practice. They like to use this as a weapon against the profession as if health care corruption only exists in chiropractic. Nothing could be further from the truth. It is simply in the nature of the beast, the human beast that is. Where man is involved, if a way can be found to get something for nothing, it will be found and exploited, PI cases, workers comp cases or what ever, including major medical practices.

In the PI world this probably happens quite a bit and so doctors have to beware of it and be careful to get good histories, perform good evaluations and not offer treatment where it is not needed.

The involvement of attorneys is also a problem,especially when they try to dictate care and influence the doctor in his duties to the patient, or when they cause the doctors to have to reduce their bills in order to accommodate the attorney in the attainment of their legal fees. Insurance companies should try being more compliant with paying for services they are responsible for and stop fighting with the health care providers over the medical necessity of services. Otherwise the attorney's will continue to be a "necessary evil", so to speak, for the patients to avoid being hit with medical bills which they cannot afford and should not have to pay.

Insurance company's unwillingness to pay medical bills is especially true in workers compensation cases as well as PI cases. One tactic is to hire corrupt, insurance whore doctors to write phony, idiotic reports stating that the patients treatment was not needed; basically paying the whore/prostitute doctor to say exactly what the insurance company wants them to say, then use this "expert" opinion to base their denial upon. Real class act for sure.

But all that aside, PI and W/C is the way to go if you want to see patients with more than sore shoulders after a long day at the office. The patients who are really hurt and injured need good doctors to manage their care. Their PCP's usually won't see them and apparently some health insurances have stipulated that the doctors can't treat injuries due to MVA and only a few actually treat work injuries. It is definitely an under served branch of health care.

The patients who have been helped are usually very grateful and although I am probably not the best there is, I have had some truly great successes.

Anti-chiropractic Nonsense - But Maybe there is Something to this Thing Called Chiropractic

2009-02-23T19:34:00.006-06:00

Is it me or do the anti-chiro wacko's just keep saying the same things over and over again? I keep waiting for something new to come up that has any substance at all.

It seems that they all want to be nurses or something and just can't get over not being able to be real doctors.

What amazes me is that they actually thought they would go to chiropractic school and come out with a way of treating diseases like colds, flu, etc. just like a PCP. Get real boy's and girls. Are you going to have us believe that you bought into that when it is perfectly clear that chiropractors do physical medicine for the most part?

When you looked into what chiropractic was, did you actually believe that nonsense about subluxations curing diseases?

In my case I was looking to go into PT as I was interested in physical medicine and rehab. I was actually steered into chiropractic by a PT who new all too well that chiropractors did much the same work they do but were free of the bondage of medical referrals.

How could you have possibly thought there was any more to it than that?

Now, having treated so many patients I can actually see how some of the subluxation theories came about. I have seen plenty of changes in non-musculoskeletal conditions as a result of manipulation of the spine. I can truly see that there might actually be something to the effects which the more "radical" chiropractors, as I view them, claim. Hopefully there will be more research into at least some of this.

In the mean time, I stand amazed that so many "believed" the hype, bought into to it hook, line and sinker, failed at it and now have nothing better to do than to obsess over it and try to harm it in a juvenile attempt to get back at it. Surely some of their inability to succeed should fall on their own shoulders and their own misguided motivations.

The Hypocrisy of anti-Chiropractic Bias

2009-02-10T13:43:00.008-06:00

A few years ago, listening to the radio, I heard a report on some stats associated with drinking and driving. Of course, being an occasional consumer of the fermentation of wheat, I perked up. The announcer, speaking with indignant reproach and scathing/slashing tones, proceeded to describe the situation from 6:00pm Friday evening until 6:00 pm Sunday. Apparently, during that time 80% of the drivers on the road have been drinking. Concurrently, during the same time period, 60% of the wrecks that occurred involved at least one drinking driver. Horrendous was the word the announcer used to describe the situation.

Reaching for my glass and reflecting on the situation, it occurred to me that the 20% of the drivers who were not drinking, were causing 40% of the accidents. That's two for one where as the drinking drivers, 80% according to this report, were causing only 60% of the wrecks, less than one for one from what I could tell. Interestingly, the non-drinkers seemed to be causing more than their fair share of the wrecks from 6 o'clock Friday till 6 o'clock Sunday.

An interesting situation here. The stats being presented here were being interpreted to support the notion that people who have been drinking should not drive, but from a different perspective, it shows the non-drinker to be more dangerous on the road than the drinker, at least from a different perspective than the anti-drinker.

Not identically but in a similar fashion, studies showing the risk of stroke associated with chiropractic manipulation as opposed to visiting your PCP (MD) are also being interpreted based upon bias perspectives.

In a previous study:

Risk of Vertebrobasilar Stroke and Chiropractic Care, Results of a Population-Based Case-Control and Case-Crossover Study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.by Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.(5)

Dr Cassidy concluded that the risk of stroke after visiting a chiropractor was the same as the risk of stroke after seeing a PCP (MD), where of course, no manipulation would have been performed. It was suggested that the occurrence of the stroke might have already been in progress which might have prompted the visit to the DC or the PCP(MD) and that no matter the treatment which resulted from the visit, the stroke was on it's way to occurring anyway. Depending upon your perspective, this study reflects well or ill on your particular field, just as the stat's above reflect good or ill on your position as a drinker or not.

Now, once again the topic of strokes caused by chiropractic cervical manipulation has reared it's ugly head, specifically on the Science Based Medicine Blog of Dr Harriet Hall. More than once have they heaped criticism onto the chiropractic community regarding this rare event. Obviously it is an area which needs attention as would any risk to patients from any procedure. But it seems Dr Hall and her following want to lead the way to save an unsuspecting public from this ravage of society.

My point is this: given that medical mistakes (not difficult cases) cause 500 deaths a day in the US alone, who are these people to raise the indignant flag of reproach against chiropractors when they can't clean up their own house, even a little bit. With medical mistakes there really is no risk vs benefit consideration, unless you want to weigh the benefit of the procedure your doctor wants done in a hospital, for instance, versus the risk of actually being admitted, which is apparently high.

Sure, if your position is that cervical manipulation has no benefit, then why perform it ever. If your position is that there is benefit, then the risk is extremely small and the procedure is not necessarily to be avoided. Additionally, if the risk can be further reduced by altering how the manipulation is performed and avoided completely in high risk groups, then it becomes even safer and continues to be a viable option for the chiropractor treating patients.

But don't go crowing about the hazards of something as safe as manipulation in a back drop of 500 deaths per day due to medical errors, not to mention the risks and reactions of the pharmaceuticals and surgical procedures. Your concerns become a bit disingenuous.

The Subluxation - Fact or Fiction: Treatment or Fraud

2009-02-04T12:01:00.002-06:00

The subluxation seems to be central to what many view as Chiropractic. Many of those opposed to chiropractic are opposed specifically because of the presumption and belief by many chiropractors that the root of all disease or rather, dis-ease, is due to subluxations interference with the function of the nervious system with the resultant loss of the bodies ability to resist and fight off diseases.

Many of those who oppose this hypothesis do so because, as they say, there is no scientific evidence to support it and thus they feel that Chiropractors who treat patients based upon removing subluxations are committing a fraud against the patient and, of course, anyone who is paying for the service.

This is the place where those with opposing views can present their arguments and evidence, either way, for or against; scientifically or philosophically.

Posted on Chirotalk Today By Mr Botnick

2009-01-29T07:13:00.006-06:00

Posted today, 1/29/09 at 7:25 am by Mr A J Botnick on Chirotalk

Here it is by Mr Botnick himself:

---I'm actually starting to like that blog because it is so illustrative of the paranoia and irrational beliefs of people entrenched in chiropractic. They make no attempt to discern truth from assumptions and most of the blog's posts are justifications of why they must be right and critics wrong. They even call our anti-cult site a cult! Talk about irony.

As a patient the thing I would take away from it is how seedy the writers are by rebutting patient safety and insurance fraud concerns with boasts about how successful they are...successful at unethical practices? That's not something most people would want to boast about. It's no different than organized crime except for the licensure.---

I am assuming Mr Botnick is referring to this web site, Truth in Treatment, although considering their contest to locate and identify the worst chiropractic web site, he might actually be referring to one of the ones they have singled out so far in this on-going example of "mature and ethical" behavior. For now I will assume he is speaking of this site since he started a campaign to have Truth in Treatment removed from the web by E-mailing all of the chirotalk members to flag this blog.

Let's take a look:

Botnick - "that blog" -

Why not just name the blog? I would guess that he doesn't want to point the way here to any more than he has already done with the E-mail campaign. (Assiming he means this blog)

Bornick - "because it is so illustrative of the paranoia and irrational beliefs of people entrenched in chiropractic"

If allowing opposing points of view to be heard on a forum is paranoia, then what is the banning and censure of opposing points of view? Irrational beliefs? I guess some have beliefs which could be considered irrational, depending upon your point of view and your own level of paranoia.

Botnick - "most of the blog's posts are justifications of why they must be right and critics wrong"

Does this remind anyone of Mr Botnick's own wesite? I'm just asking.

Botnick - "They even call our anti-cult site a cult!"

Hmmm.

Botnick - "how seedy the writers are"

The pot calls the kettle black once more.

Botnick - "rebutting patient safety and insurance fraud concerns with boasts about how successful they are"

I think Mr Botnick should elaborate on what he means by this. Rebutting patient safety? You're kidding right? Rebutting insurance fraud concerns? Who has committed insurance fraud Mr Botnick?

Botnick - " It's no different than organized crime except for the licensure."

"It" is? What is? Be specific Mr Botnick. What in this blog are you referring to? If not this blog then who's?

Again, he offers that he is referring to "that blog". I guess he could mean any one of which he (and they) have singled out as the worst chiropractic web sites in his "Find the Worst Chiropractic Website Contest".

I guess we'll see.

Chirotalk - 2

2009-01-28T17:31:00.002-06:00

On today's chirotalk I noticed a new thread created by Mr Botnick himself. I placed this comment on the first chirotalk thread but decided to bring it into a new thread. Here is the comment I made today -

---I would also like to bring to your attention a new thread on chirotalk today called "Find the worst Chiropractic Website Contest".

Mr Botnick's first victim can be viewed even as I type this comment.

Now, having been accused of libel and slander by Mr Botnick, it would seem that the pot indeed has been calling the kettle black.

As he states in his opening comment - "Esteemed Chirotalk members,I thought it would be fun to start a contest to uncover Chiropractic websites with the most outrageous claims and see what the worst is."

Is it me or is this hypocrisy in action?---

Getting the Truth Out

2009-01-27T22:09:00.003-06:00

When I started this blog a couple of years ago, I wanted a forum where I could talk about the trial we were subjected to by Allstate Insurance Company back in 2004 and their accusations of fraud against both the company and the chiropractors who worked in their clinics. I wanted all to see that we were not fraudulent but were just very hard working and had the sole purpose in mind to help injured people who were in need of our services.

Our company was very large and due to that was particularly unpopular with the chiropractic community as well and the insurance community.

Although we lost the trial, which never should have occurred, we won the appeal when appeals judges stated that there was no fraud and exonerated us of these accusations. We have continued on but have never fully recovered what we lost in this ordeal.

Thanks to the boys over at Chriotalk, this forum has life now and will be read by a great many chiropractors who might have once thought ill of us and others who have the same sort of practice and now can at least say that there is one group who has stood up to the big boys and prevailed. They could not put us out of business and we continue to provide medically necessary services for a severely under served portion of the public; those who are injured by others and those who are hurt at work.

We don't cheat and we don't defraud anyone. We simply work very hard at what we do and that is what has made us who we were and who we are. Most of our new patients either come from referral from previous patients (internal referral) or they respond to advertising. We do not pay for referral from others, we do not solicit from accident reports and we do not have any form of that type of unethical service going on the bring patients into our clinics. We have a compliance program which watches over what we do and insures that we only provide medically necessary services. If mistakes are made we are the first to admit it and the first to correct it.

Our owners do their best to help us have what we need to provide for our patients what they need and only insist that we perform at our best for the sake of the patient, insisting that the doctors oversee patient care in an ethical manner. They have been and still are very strong advocates of chiropractic.

Our case was somewhat of a landmark in that it was the first time an insurance company was allowed to bring in an "expert" to make the claim that the treatments we provided for our patients were not medically necessary in order to support their claim of fraud; his "paid for" opinion versus ours as to what treatment our patients needed. Had they prevailed, then the door would have been opened for insurance companies to attack any provider they wished to attack; DC, MD , DO or PT, based solely upon their wish not to pay for services and an "expert" whom they paid, to come in and say exactly what they wanted him or her to say. All health care would have been potential targets for any entity who might decide that they could fare better financially by suing rather than paying for services for which they were responsible for.

I am not an attorney and do not understand all of the legal E's of this case, but I know that we prevailed in the end and continue on for the betterment of both chiropractic and health care in general.

Thanks again for the help from Chirotalk for their helping me to bring this to light.

Chiroweb

2008-03-05T11:48:00.002-06:00

Ever since Allstate sued Accident and Injury Chiropractic and myself, Mark Rayshell, for fraud, the Internet has been filled with websites displaying copies of the lawsuit and Allstate's allegations against us. If any type of web search is performed on any of the defendants, myself included, some of the top returned search results will inevitably be links to websites showing the original lawsuit. One such link that continually comes up is the Chiroweb page in which they had previously published a copy of the lawsuit.

Now that we have won the appeal against Allstate Ins Co many of the same people who were so proud to publish the original lawsuit have, at least, published something about the appeal and the results. What is interesting is that the web search of the defendants still returns with links to the original lawsuit but not to the articles about our having won the appeal.

I E-mailed Chiroweb about this and they simply answered that they have published an article about the appeal and provided the link:

http://www.chiroweb.com/archives/25/26/18.html

This link to Chiroweb at least shows the article they published about how we, Receivable Finance, Accident and Injury Chiropractic and myself, Mark Rayshell DC, won our appeal against Allstate Ins Co in which the 5th Circuit Court of Appeals stated that there was no fraud and reversed the jury's decision. They fail to mention in the article that the appeals court judges stated that the issue of fraud should have never gone to the jury in the first place which means the lawsuit should probably never have gone to court.

Although I had asked about the tendency of the link about the original lawsuit to come up on the searches but not the one shown above, no answer was forthcoming. I suppose that if you want people to see the original lawsuit and not the outcome of the appeal that there are things you can do to have that link come up as opposed to the other. Chiroweb has shown their "unbiased" reporting by publishing an article about the appeal, but are still, apparently, doing all they can to have the original lawsuit come up on the web searches and not the article about the appeal.

Since the beginning of the Allstate Ins Co vs Receivable Finance law suit, scavengers everywhere were quick to get the word out, as if to aid Allstate in their efforts to kill our business. Even after winning the appeal against Allstate in this matter, the scavengers continue to try to use it against us.

Chirotalk

2008-02-29T22:22:00.005-06:00

Chirotalk is an anti-chiropractic forum put together by former chiropractors who, angered by their inability to make it as a doctor of chiropractic, have decided it is best to bash the profession and steer all clear of it who might decide to pursue it as a career. I think they secretly are trying to build up some kind of evidence to support their eventual lawsuit against the government or student loan lenders, in an effort to escape the sword of student loans hanging over their heads as are virtually every other chiropractor in the country.

As I understand it, the founder, Dr Allen Botnick, has already tried that and having failed, has put together this forum, Chirotalk, to garner support and bash the profession in anyway they see fit. And that leaves nothing out. They bash it at every turn and with every logical and illogical argument they can muster. From what I can tell, having read their posts for some time now, they are arrogant, self serving, self important, intellectual want-to-be's who continually and almost daily, display their ignorance of literally a plethora of topics both related to and not related to chiropractic.

The "administrators" of the forum, those who in their infinite wisdom oversee the posts as they come in, monitor their content, welcoming any who oppose chiropractic and banning from the forum any who would stand in their way. Understandable since it is an anti-chiropractic forum, but the sheer idiocy of their logic and their continual reference to the ad homonym argument and the fallacy argument can become tiring at best.

For example, anything, literally, anything which is opposed to their point of view is shot down as fallacy. Any retort to their insults for having brought in any logical argument to their position is met with cries of "ad homonym" while they themselves employ it with grace and dexterity. If you like reading ignorance in action I would invite anyone to monitor the forum as I have.

Not that their position is out of bounds or without merit, but that they themselves are simply not up to the task of arguing against the chiropractic profession in a way which has credibility or substance. Continually blowing out your brains on the intellectual ladder simply won't cut it.

For example, they continually argue about the "dangers" of chiropractic and the benefits of medical science and medical health care, but when confronted with the dangers of present day health care, which surmounts chiropractic dangers by tens of thousands of fold, they simply dismiss it and argue that it has nothing to do with their position against chiropractic and then, in the blink of an eye, ban the new member from the forum, accusing them of "trolling" through their web site. Much of the time they get ugly, calling the new member an idiot and if the new member is a chiropractor, simply apply the "ad homonym" argument that they couldn't make any sense because they are a chiropractor, or if the new member is a previous chiropractic patient who has had a good experience with chiropractic, that they couldn't possibly be better off and are therefore just mis-informed or ignorant because chiropractic has no scientific validity, at least in their "expert" opinion. Their position is much the same as the guy who would complain about the speck of dust in your eye while denying the clump of dirt in his own.

I entered the forum under my aka as Dr Vertebrae, and presented such evidence of extreme risk in medical health care as opposed to chiropractic manipulation, and was promptly banned by one of their administrators/monitors, known as TEO, a former chiropractor now turned pharmacist who denies the dangers of drugs and medications. But not only did this guy react negatively to my opposing data, he reacted with vehemence and wrath. Very much the psycho. As I read his response, I was astounded by the anger and malice in his statements. I literally wondered if he might show up on my door step and physically attack me it was so harsh.

I thought I might copy and paste a few of TEO's responses to mine as DrVertebrae, but they have been removed. From what I can tell, most of DrVertebrae's comments and their responses have been removed. I wonder why.

As a diversion, I find Chirotalk to be both enjoyable and enlightening. As another of their administrators, a guy named Nemo (Ken Niemann) stated in a previous post, delving into Chirotalk is a way to unwind after a long day; kind of like playing video games:

Posted Dec 18, 2007 on Chirotalk by Nemo, aka Ken Niemann: Re: Compliance Programs - Do They Cost or Pay?
----Ok, I'm sorry......You must understand that, having long abandoned hope for this profession, fighting chiropractors and chiropractic is entertainment for me- like playing a video game. It's how I relax after a long day.----

Allstate Ins Co vs Receivables Finance et al, myself included

2008-02-19T20:22:00.004-06:00

I just looked at the search for myself on Google. The Allstate case comes up, but not one article about having won the appeal. Figures. I guess it is easy to manipulate the search engines to prevent those from coming up.

One such article was in Fraud Digest. I checked their archive and found no mention of the appeal we won in the case, totally reversing the jury's decision. So I E-mailed them. Just thought I would let them know.

Again for the record, Allstate lost and we won. The appeals court said there was no evidence of fraud.

Allstate lost the appeal. We won the appeal.

The trial was a joke played on the public and the jury in an effort to put us out of business. It did not work.

We are still in business, taking care of patients who so many others will not take care of, despite Allstate's efforts to put us out of business.

Allstate lost and we won.

Allstate lost.

Allstate lost.

Accident and Injury and myself, Mark Rayshell, aka Dr Vertebrae, won the appeal and the appeals court, the 5th Circuit Court of Appeals, said there was no evidence of fraud. None.

No evidence of fraud. Allstate and their attorney, David Kassabian, lost the appeal. They fooled a jury, but could not fool the appeals court.

And speaking of fraud, why does the "money back for a good driving record policy" cost more than a regular policy. I spoke to my agent who said that I could get that policy, but it would cost me more. By the way, I have no accident on my policy in over 30 years. And the "money back policy for good driving record" would cost me more than my regular policy. How stupid!

My youngest daughter says the guy in the Allstate commercial is a liar. I think she might be right.

Peer Review Doctors, Expert Witnesses

2008-02-13T06:39:00.003-06:00

One of the more interesting aspects of doing healthcare in the Personal Injury/Workers Compensation arena is the insurance companies use of peer review doctors and expert witnesses. The idea is that they bring in (hire) a doctor to objectively (right!) review the records of a patient, objectively and based upon the record (right!) form an opinion as to aspects of the patient's care such as medical necessity or appropriateness of care, and in many cases make a recommendation about payment for the services rendered by the doctor or give approval or dis-approval for a treatment recommended by the treating doctor. Of course the fallacy here is that behind the scenes the insurance company could hire many doctors and then use the one that supports their position which is, as always, not to pay for services. The very idea that the insurance company selects the doctor and pays the doctor is patently absurd.

There is a bit of an exception in workers comp in Texas where the doctor chosen to review the case is designated by the Insurance Commision (TDI) and thus not biased about the treatment (At least in those cases, however, peer reviewers for pre-authorization of care are paid by the insurance company). This is partially acceptable except that MD's are allowed to review DC cases but not visa versa. Aside from that, it usually works pretty well for the doctor and the patient. The real trouble is when the insurance company adjustors try to play "attorney" and misinterpret the rules of the system, but that's another story.

The real idiocy of the "peer review doctor/expert witness" system is in the realm of personal injury and liability insurance companies. What an utter joke. In these cases the insurance companies hire doctors who in most cases do not see patients or receive any income from patient treatment. These are doctors who's sole source of income is the income from an insurance company for doing "objective" reviews and offering their "expert" opinion about the care given to a patient.

In the case of Allstate vs. Accident and Injury Chiropractic (which we won on appeal) Allstate hired Dr Bill Timberlake DC to testify about medical necessity of care. When asked to define medical necessity, he stated that medically necessary care is care which, if withheld from a patient, could result in death or severe injury to the patient. (Even with that difinition, he said that some of our treatment was medically necessary.) All other treatment is considered "medically optional". This is a term totally unheard of in the medical world.

Think about it, based upon his definition, most doctors do not perform "medically necessary" services. And if, as was implied, providing only "medically optional" care is fraud, then almost all doctors, be they MD, DO or DC, are commiting fraud on a daily basis. It doesn't get much more absurd than that. It helped to fool a layperson jury, but could not fool the 5th Circuit Court of Appeals. You see my point.

And how long do you think insurance companies would continue to hire a doctor who gives a truly honest, objective and un-biased opinion? Not very long that's for sure. So these doctors, who have virtually no income other than by writting reports that say exactly what the insurance company wants them to say, are highly motivated to say exactly that, what the insurance company wants them to say. Utter bull shit!

I was testifying about the care of one of my patients a few years ago and the judge made the comment that you could hire a doctor to say anything you want him to say. He was absolutely correct. It is done in almost every single personal injury case that goes to trial or is contested by the insurance company. But it gets even worse than this.

Some of these guys make comments against the doctor who treated the patient, give opinions about property damage and basically say anything and everything to impune and defame the treating doctor. We had copies of reviews done by one doctor in particular in which he used a template for his reviews in which he stated that the property damage was only "x" amount and thus the patient could not be injured. If memory serves, "x" ranged from a few thousand up to 20 and 25 thousand dollars. In each case, no matter what the property damage was stated to be, the report said the same thing. "The patient could not have sustained injury." The real humor in his/her reports was that a typo occured in all of the reports and like I said, no matter the property damage to the vehicle, the same comment appeared; the patient could not be injured. In one of the accidents he/she did a review on, the vehicle actually rolled over after the impact.

Some of these doctors are so bad that they are referred to as insurance whores or insurance prostitutes. They sell out their peers, if you could actually call them doctors, and sell out their profession, over and over again. A jury sees them only once and the judges in each case won't let the patients attorney tell the jury about the many other times this same doctor has testified that the patient could not be injured. Nope. They don't get that information.

So, going back to a previous post, if you can afford it, get your own insurance, preferably PIP coverage, and if you get hurt, no matter who caused it, you have the coverage for treatment.

Victim cont.

2008-02-08T21:51:00.000-06:00

At this point I would just like to point out a few things. For one, I should know what it is I am talking about. I have treated about 10 to 12 thousand personal injury cases so I guess that makes me an expert, so to speak. I have been sued by an insurance company, Allstate vs. Receivable Finance, or rather Allstate sues Accident and Injury Chiropractic for fraud. Lost in court and finally won on appeal because Allstate did not show any reliance on what ever it was that they would rely on. Your guess is as good as mine at this point. But non the less, we won the appeal in the 5th Circuit Court of Appeals and thus everything about the case was reversed. Totally.
So at this point I should know a little about what insurance companies are like and how they treat victims as well as doctors. They are not the only ones I have had to deal with but the only ones I have been sued by.
Allstate's intention was, to put it very simply, to put us out of business. We were big. We had been investigated by the FBI and found to be an outstanding company filled with hard working doctors treating real patients as they should be.
Allstates big beef was that we were big, they could not get at us, so to speak, we worked our asses off for our patients, we were getting bigger because we worked our asses off constantly to help our patients get the best health care, we audited our selves looking for signs of fraud and lack of medical necessity, looking for problems with doctors and patient care, examined our selves to make sure that we were giving our patients the best care we could possibly give, probing for ways to improve patient care, making sure the doctors were not letting patients slip through the cracks, etc, etc. We were basically being the very best doctors we could possibly be to our patients and they were responding to us by referring to us their friends and family, relying on us to help them and treat them, and to be perfectly honest, doing exactly what Allstate did not want us to do as doctors because it made it difficult for them to find anything we were doing that was not right for our patients and appropriate for their care and well being.
Allstate did not like paying medical bills for injuries caused by their clients and simply put on a big show for a jury which initially looked good but in the end was found to possess not one wit of fraud. We won the appeal, not on a technicality, but because Allstate did not prove anything they set out to prove. There was no fraud, they knew exactly how to show it and they failed. They fooled a jury and a judge, but could not fool the 5th Circuit Court of Appeals. They failed.
They did manage to put us near to financial ruin, myself included. Forcing me to suffer the loss of about 65 to 70% of my income, forced me back into teaching in an effort to maximize my time spent with my family to balance out with the finacial gain I received from my job. (Which due to the law suit by Allstate was greatly reduced.) Yes they did some damage, as I suspect they wanted to, but they did not kill us. We survive and I will tell much more of this story in future posts.

Car Wreck Victim Cont.

2008-02-08T11:56:00.000-06:00

What now? A good idea at this point would be to find an attorney to help you out. Sounds wierd but some doctors, including me, will treat a patient on what is known as a "letter of protection" or LOP. The LOP says that the attorney represents you, the injured person, and will work to get the clinic bills paid when and if there is a settlement with the insurance company of the person who caused the injury. (Or any other way for that matter.) It is no guarantee, but it might be the only way an injured person could get treatment what with the reputation 3rd party insurance carriers have for not paying bills based upon what they say is lack of medical necessity (a decision usually made by persons not qualified to make that determination, or a determination made by a doctor, hired by the insurance company to say that there is no injury or that treatment was not medically necessary. "Hired by the insurance company" is the key to that type of "reverse fraud".).
I have personally sat in on a deposition of an insurance adjustor who admitted to denying payment for doctors services based upon lack of medical necessity and then a moment later admit to being unable to define medical necessity. This adjustor fully admitted to this even though the file had not been reviewed by a doctor or nurse, even though if it had it would have been one hired by the insurance company and thus a crock of BS anyway. (This is why insurance companies don't like their adjustors to testify about medical bills or represent the insurance company in any way, form, shape or fashion.)
So you decide to find an attorney you can hire and go get treatment using the LOP method I just described. What attorney do you hire? How do you know who is good, ethical and honest and will not leave you hanging with unpaid medical bills? This is the tuff part by far aside from finding a doctor who will give you good care in this sort of situation. Many times you just have to take a chance. A good way is to speak with friends who have been in a similar situation. I like that way. A big part of my clinic business is referral from former patients whom I have treated and found me to be a good, caring doctor who took care of them in their time of need, accepted the LOP and paid attention to treatment and not payment. I would say that fully a third of my Oak Cliff patients were referred by former patients who had treated at the clinic.
In many cases I would refer the patient to an attorney. The patient would come to me and talk to me about their injuries and we would discuss how they would take care of their medical bills. In many cases we would determine that outside of paying cash on a day to day basis (a method they were most of the time unable to do because of simple lack of funds) an attorney's LOP was the only way I would be able to treat them.
I would ask them if they knew any attorneys or if they would like a referral to one. And why not? I have been doing this since 1996. I should be able to give some examples of attorneys who my patients seemed to have liked and some who they did not seem to like. I guess I could refer them to an attorney that patients seem to have been dissatisfied with but it makes more sense to refer them to one that in the past has proven to be an attorney the patients were satisfied with. Right? Absolutely.
And is there anything wrong with having attorney handle this for you? Certainly not. Not in the least. It is only the insurance companies that I have found to object to this. Why? Because they end up having to take care of the medical bills they are responsible for, that's why. Their hired gun doctors who are hired to say you are not hurt (they say this without ever having seen you or any other real patients -they are insurance whores) will even say that having an attorney in a situation like this proves that you are faking. I have sat in on a deposition of a whore, insurance hired doctor, who testified under oath, to that very thing. Having an attorney is a sign of faking an injury according to him. What a
'load".
You see now where all of this is going? By denying payment for medical bills, they have, over the years, scared the medical profession off, so to speak. They have driven them out of the injury business. Just ask your family doctor if he or she is willing to accept third party insurance coverage for your medical bill. It has all been an effort on the part of the insurance companies to get out of paying for what they are responsible for and in essence, denying health care to regular people, some impoverished and some just regular middle class, "working hard to take care of their families" type of people. Even worse, most doctors will not accept letters of protection, because, as I stated, even having an attorney is no guarantee that you won't be left hanging with unpaid bills (that you now have to pay).
As a former teacher I have observed that every year more students learn less and fewer learn more. The same can be said of health care. Fewer can afford good health care and more and more can afford less. In other words, if you can't afford it, you most likely aren't going to get it.
If you get an attorney to help are you automatically faking injury, only trying to get money out of an insurance company? No. Not in the least. As a doctor I must assume that you came to me because you are hurt and need care. You, the injured person, recognize that although you are not the one who caused your injury, are ultimately responsible for the cost of treatment and as such, take the steps necissary to cover that cost. If you had PIP coverage would I accept it. You bet. And do many times. If you wanted to pay cash on a day to day basis would I accept that method of payment? Absolutely. I can easily provide, for you, receipts to show what you have had to spend on your treatment. What you do with those is, of course, your business. If you have health insurance will I accept that for payment. Again, absolutely. But remember, if there is a deductable or co-pay then I must collect it. It is considered fraudulent to waive the co-pays and deductables so there will be some out of pocket costs. That's the way health insurance is. BUT, will I accept third party insurance coverage? Not unless you are represented by an attorney and that attorney can provide an LOP. That is my choice for the reasons articulated here and I am fully within my rights as a health care provider to set limits on how I will accept payment from patients, just as I am fully with in my rights as a health care provider, to accept a patient for care or not to accept a patient for care.

Car Wreck Victim

2008-02-06T21:10:00.000-06:00

It's a typical day, you are driving along and Wam! you're hit on the side by an idiot driver who was more interested in what was being said on his/her cell phone than payng attention to the red light they just passed. Your car is slammed sideways and spins to a stop. You feel shocked and scared but not really hurting there and then.
You manage to get out of the car and are able to exchange information with the other driver and move the vehicles off the road, all without the help of the police, who do finally show up but do not write a report since no one was bleeding or apparently injured and in need of ambulatory care.
That evening and throughout the night your neck starts hurting. You start having headaches and feel sick to yur stomach. The next morning you are hurting all over, not only your neck but your head, lower back and shoulder. You even notice a small contusion on your left cheek and it is tender. As the day progresses you feel steadily worse and finally take something for the pain. The next day it is even worse.
If your are pretty well off you might go to your doctor and get seen or even go to the hospital, using your health insurance to cover the cost, assuming you have health insurance and assuming your doctor will actually see you for injuries sustained in an MVA, which many won't. But what if you are not so well off and you don't have health insurance, like about most of the not so well off population. Well, maybe you have PIP coverage on your vehicle, after all, you have full coverage, right? Possibly not, since your car is old and not worth too much and you elected to reduce to only liability coverage in an effort to save money better spent on the kids clothes. What now? Cash for treatment?
A trip to the hospital would run you about a grand easy. Can't afford that in the blink of an eye, right? There is one more option. The person who hit you, luckily, had liability coverage, just as the law says they should. The accident was their fault and that is exactly what liability insurance coverage is all about, right? So you go to your doctor and he won't see you for an MVA or he just won't take 3rd party insurance. (The other guy's liability coverage.)
You go from doctor to doctor and can't get help because they all have too much experience with 3rd party liability and have found it impossible to get bills paid by them. You call them and they tell you to go to the doctor. He asks them to put in writing that they will pay the bills and of course they won't. (Since 1996, I have seen it happen one time only out of literally thousands of cases.) Why won't they? They told you to go to the doctor, right? I guess that means they won't necessisarily pay the bills doesn't it?
In fact, they call you and ask you to take 500 dollars to let them off the hook, so to speak, and never bother them again with this incident. That certainly won't cover the hospital bill and only might cover the cost of a doctors exam and x-rays and medications maybe. What about advanced imaging or therapy. Nowhere close, not to mention the lost time at work and other costs associated with this accident.
What now?

Off Topic Again

2008-02-01T20:52:00.000-06:00

Again off topic, but to those guys at Chirotalk who think they have cornered the market on knowledge, who scoff at the chiro's who give false info to patients, I would just like to say that I am tired of having to explain to my patients that the MD who told them they have a pinched nerve based upon their X-rays, was as full of BS as any chiro I have ever met.
I once made a comment on Chirotalk about the number of times I had found fractures in my patients when the hospital records stated there was none. It boggles the mind really. The return comment by Dr Botnick was that it is easy to see fractures on X-rays so why bother. I guess he's right. Easy for the chiro's but not for the MD's at the hospital. He totally missed my point.
Sometimes when they, the guys and administrators at Chirotalk, speak with an attempt to reflect knowledge of some real science or medical issue, I am reminded of the commercial where the guy is accused of "talking sports out of his ass". It is pretty obvious that they really don't have a clue about what it is they are saying. The examples are too numerous but I will try to post them as they occur.

Off Topic - Chirotalk

2008-02-01T16:14:00.000-06:00

This is just the third post and I am already off topic but I just had to insert this into the matrix.
I enjoy reading this anti-chiropractic forum called Chirotalk. It consists of, from what I can tell, a bunch of fanatics who have failed at being chiropractors or are so brain washed by the medical model that they cannot be objective about the evidence, either way, regarding chiropractic or medicine.
Their contention is that there is little evidence to support chiropractic and that chiropractic is extremely dangerous. This is the area in which I find interest. If a chiropractor causes a death in 8 million visits, then according to them this is totally hanus and thus chiropractic should be banned. When confronted with the dangers of medicine, they, in essence, disregard it and imply ignorance and stupidity on the part of the presenter and then ban him/her from the forum.
Another doctor just submitted a study from Canada showing that there is not greater correlation between chiropractic care and stroke from vertebral artery dissection than there is from medical care. See below:

From Spine, Feb. 15, 2008, online before print. Part of a special supplement to Spine reporting the findings of the Task Force on the Neck for the Bone and Joint Decade 2000-2010.Mitch Miglis, DC, Cert. MDTRisk of Vertebrobasilar Stroke and Chiropractic CareResults of a Population-Based Case-Control and Case-Crossover StudyJ. David Cassidy, DC, PhD, DrMedSc,*†‡ Eleanor Boyle, PhD,* Pierre Coˆte´, DC, PhD,*†‡§Yaohua He, MD, PhD,* Sheilah Hogg-Johnson, PhD,†§ Frank L. Silver, MD, FRCPC,¶and Susan J. Bondy, PhD†Study Design. Population-based, case-control and case-crossover study.Objective. To investigate associations between chiropracticvisits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.Summary of Background Data.Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headacheare common symptoms of VBA dissection, which commonly precedes VBA stroke.Methods. Cases included eligible incident VBAstrokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and controlexposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted astheir own controls.Results. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged 45 years, cases were about three timesmore likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was noincreased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBAstroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.Conclusion. VBA stroke isa very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patientswith headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropracticcare compared to primary care.Key words: vertebrobasilar stroke, case control studies, case crossover studies, chiropractic, primary care,complications, neck pain. Spine 2008;33:S176–S183

This is a summary but it catches the essence. It should be interesting to see if they will acknowledge it, ridicule the doctor for posting it or just ban him.

Film at eleven.

2008-01-23T19:56:00.000-06:00

I have been thinking of where to begin in this discussion of PI and Workers Comp practice. Beginnings are a bit of a catch but today, during a typical work day I had a new patient come in who was in a car wreck a couple of days ago. This person had been to the hospital and had been subjected to a host of testing and imaging (CT head, CT Chest, CT neck, x-rays of the neck and back), was given a prescription of something I had never seen before and turned loose to fend for his/herself.
This patient was somewhat typical of the clientele one sees in this business. No health insurance, no PIP insurance on the vehicle the patient was in, big question marks about who was at fault in the accident, abandoned by the person driving the vehicle, no job, not enough money to fill even part of the prescription, no money to pay for any further health care, dealing with obvious pain and difficulty, possibly a previous drug habit, no true home, no friends to call on for help, but does, at least, have an attorney who is willing to look into the case to see of there is any chance of a settlement with some insurance somewhere to cover the costs of any further care and me, a DC, willing to trust the attorney to hopefully cover the cost of the care I am going to give to this patient to ease the pain and promote the healing process to, hopefully, help this person to be able to get on with their life, and be able to work and live as close to a normal life as they had before they were so severely injured.
Of course, for helping this patient and for trusting this attorney, I will be automatically viewed as an accomplice to some sort of crime or scam to get money out of the insurance companies. Not a real doctor, certainly not. Real doctors will not care for people like this or be involved with patients who are represented by attorneys who treat under what is called a "letter of protection".
In fact, insurance companies hire "doctor whores" to tell juries that doctors such as myself, and patients such as this, are faking their injuries; that it is an automatic that they are faking since they are represented by an attorney. Doctor whores, dare I name some, who are paid by insurance companies to say there is no injury and any treatment represents a part of the "scam" between the doctor and the attorney and the patient; faked and fraudulent unnecessary treatment, X-rays or what ever, not needed and manufactured to run up bills for the insurance company to pay as part of this fraudulent scam.
So if I treat the patient, which I will since I am given the means by the owners who hired me. The means that is, to treat anyone I choose to treat, despite the very real risk of never being re-imbursed for services rendered. I treat the patient with good case management, medically necessary referrals and recommendations as needed, physical medicine equal to any a patient might receive from a physical therapist and superior with the addition of chiropractic spinal manipulation (non-subluxation based manipulation) knowing very well that as far as the clinic is concerned financially, I am spinning my wheels.
Yep, that's about it. Of course, in the long run and ethically, I know that I will do a lot of good for that patient and many more like that. This is PI and Work Comp basically. Not all but a lot of what I run into.
Yes of course, not all of my patients are so bad off, but the point is that I get to treat them, positively effect their lives, and help them to get back to what ever it is that they do. No scam involved, just the guts to work in a world where people are jaded to think the scam exists, who think we are crooks and openly ridicule us in statements and accusations of fraud, refusal to pay bills, denial of bills based upon "lack of medical necessity" as deemed by adjusters who can't even define it, innuendo statements made by insurance company lawyers to juries, innuendo and insulting accusations by "doctor whore" peer reviewers who in many cases have not even seen even half the medical records and have never seen the patient and don't even practice as doctors, and in fact lie about having an active practice.
The tale is so thick with twists of story line that it is quite understandably, difficult to understand and even more difficult to believe. It is no wonder that so many doctors, MD, DC and DO alike, have abandoned the treatment of these people. I like it because the patients are so very much hurt and injured and the moral fight allows me to put on my armor of indignation, for lack of a better description. At one time I would wear the same armor in the field of education, improving the world through better education, despite the difficulties and the pressure to be mediocre. Now I do it as a doctor of chiropractic, in an area of practice that is largely neglected and shunned by much of the profession and public alike.
It is both fun and frustrating. It is also challenging and fulfilling, some of the time. More to come.

Introduction

2008-01-16T20:08:00.000-06:00

Welcome to my blog. I am Mark Rayshell, aka, Dr Vertebrae. Being a Doctor of Chiropractic I like to talk about aspects of the practice I have been involved in since 1996, that being personal injury and workers compensation, both highly prejudiced and seen with somewhat jaded eyes by much of the public and most doctors.
I want to talk about that and dispel some of the myths about that type of practice. I want to talk about why this is a health care niche that is under served (and why) and is shunned by much of society. Thousands of people each year are injured and yet receive little care. I want to talk about this.
As a chiropractor I like it because I get to treat real injuries as both a doctor and, very much like, a physical therapist. I don't treat people who have sore shoulders from sitting around at work or have headaches from who knows what cause; people who want a massage and some “feel good” neck “popping” from their doctor or people who need their “subluxations “cleared so as to free up that “innate intelligence” of the body to heal “dis-ease”. Nope, I'm not into that. I treat injuries. Real ones.
The clinic I managed in Oak Cliff of Dallas was like an ER for people who didn't have the means to pay for a great deal of medical attention; people who were many times desperate for some type of care and guidance regarding their injury which they could not get, or did not get, from the local ER since they didn't appear to be dying at the time. Many times they would come in barely able to walk, cut up and bruised up; dizzy and nauseous from unexamined head injuries and many times, having broken bones either undiagnosed or misdiagnosed and basically in need of medical care.
I want to talk about why they didn't just go to their own doctor or PCP and why they won't use their health insurance. I want to talk about why they didn't go to the hospital in the first place, or why they aren't taking any medications or haven't gotten some basic over-the-counter meds at the very least.
And with that in mind, I want to talk about why insurance carriers like to paint an evil picture of the doctors who treat these cases. I want to talk about why it is so easy for the insurance carriers to get “experts” to say that your treatment was not needed and that they should not pay the medical bills. Having been sued by a rather large insurance company (I/we ultimately prevailed) and having testified in court a few times about my patients injuries and treatment (and been subjected to the insurance carriers harassing innuendo while on the stand and in front of a jury) I would say that I have at least a little experience in this. Having treated as many as 8 to 10 thousand patients over the years and having trained the many associate doctors who helped me in that regard, yes, I would say that I could talk about it in quite a bit of detail.
Having said all this, I look forward to “letting it out” so to speak. I and others have done a lot of good in this arena and hope to continue. I am looking forward to your comments and questions.