Hopsital Based Chiropractor Ian Paskowski on the Podcast!

Ian Paskowski, DC is the medical director of the medical spine care program at Jordan Hospital.  In this episode of On The Other Hand, he discusses delivering high quality spine care in a community based hospital and the future of this type of multi-disciplinary program.  He stresses that the program’s success hinges on patient centered care and in following the NCQA Back Pain Recognition Program guidelines as well as implementing best practices from the medical literature.  Practicing in an environment where medical specialties work together and chiropractors act in back pain triage has proven itself successful for Dr. Paskowski and his medical back pain program.

Find the podcast on iTunes or wherever fine evidence influenced podcasts are offered.  Direct link.

Podcast interview conducted by me, Dr. Brett L. Kinsler, skeptical Rochester chiropractor, blogger and one generally curious cat.

BMJ Writer Discovers Head Up Ass

photo of a kid on the beach with a clenched fist and the caption "I hate sandcastles."

John C. McLachlan is a professor of medical education who wrote an article in the British Medical Journal (BMJ 2010; 341:c6979) called “Integrative medicine and the point of credulity.”  McLachlan proposed that integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. He worries that failure to detect an obvious hoax is not an encouraging sign.

The author, upon seeing a request for presenters at an integrative medicine conference in Jerusalem, submits a paper posing as an embryologist who discovered a new version of reflexology. He explains that he has identified a homunculus represented in the human body, over the area of the buttocks. The homunculus being inverted, such that the head is represented in the inferior position.  As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping.

He stops short of telling the conference organizers he has discovered a system whereby the head is up the ass and responds to needles.  Funny, right?  Well, after submission of an abstract with some sciency sounding references, the proposal gets accepted for presentation.  The author declines to present and, instead, publishes the correspondence in the BMJ.

Now, I’m all for having a good laugh at the expense of wacko alternative medicine practices but my goal is clear — I want to help clean up the field in order to highlight the people who are actually doing some good, honest, logical research.  I actually have a problem with what Dr. McLachlan has done.  By poking fun from a distance and walking away without letting the conference organizers in on the joke, the author misses a huge opportunity to educate and possibly improve that which he criticizes. It would have been far better if he accepted a slot at the conference and awaited to see if people would point out the errors in his “research” or simply used the platform to show what bad science is.

The only thing that makes him not a 100 percent coward is that he published his story. Someone who asks difficult questions so that when you answer incorrectly you will learn is called a teacher.   To ask difficult questions and then tell your friends how stupid someone is without letting them in on where their error was is called by a different name entirely.

Remember Smith’s article about how parachutes aren’t evidence based? That one is funny and brilliantly illustrates its point. This article, while funny with its head-up-ones-ass ha ha I get it humor, is really only about as funny as watching your kids get their math homework wrong and, instead of helping them, you call all of your friends and laugh at your kids’ ignorance. Nothing was learned. Nothing was improved and we all feel a little bit sick for participating in the joke.

Yes, it was a hoax but science relies on some degree of honesty and trust.  It is impossible for one scientist to be at the apex of all fields and know all that is known from every discipline.  Isn’t that why we have specialists?  Could it be that the scientific committee accepted McLachlan’s proposal simply in order to learn whether or not this revolutionary discovery was plausible or bunk?  Unlikely, but possible.  Today, I would rather lend the benefit of the doubt to the conference organizers rather than the scientific playground bully.

 

Brett L. Kinsler is a chiropractor in Rochester, NY who writes the RochesterChiro blog and produces the podcast On The Other Hand.

 

Chiropractic’s Relationship With Research

 

Chiropractor Shawn Thistle discusses chiropractic's relationship with research on the On The Other Hand Podcast.

Chiropractor Shawn Thistle discusses chiropractic's relationship with research on the On The Other Hand Podcast.

Chiropractors have an interesting relationship with research. Some part of the profession uses it to properly guide the manner in which we make clinical decisions.  Some chiropractors only use research when it agrees with what we are already doing to reinforce our decisions. Some use it as marketing tool — no matter how weak the evidence may be.  And some chiropractors ignore research entirely.

I had to opportunity to speak with Dr. Shawn Thistle from Research Review Service.  His company acts to distill down some of the more important research for field practitioners and translate it into a format that is easier to understand and use.  Something like an electronic journal watch personalized for chiropractors. Since he straddles the line between active practice and research liaison, he sits in a unique vantage point.

Dr. Thistle and I spoke on an episode of the On The Other Hand Podcast which can be found on iTunes or here. He also offered listeners to the podcast a discount code if they are interested in his review service subscription.  Enter “OTOH” (which stands for the title of the podcast) during checkout and you can save 25% on subscription fees.  I have no part of this arrangement  –I’m  just passing it along as a friendly thank you to my blog readers and podcast listeners. Enjoy.

Podcast interview conducted by Dr. Brett L. Kinsler.

Just take your vitamin D so we can stop talking about it already

cool hand luke egg scene

"No man can eat fifty eggs"

I know, I know. We’re all sick of vitamin D.  Headline after headline tells us that we don’t get enough, we need to make sure our levels are adequate, that our kids get enough….yada, yada, yaaaawn.

Americans tend to overdue things.  As a nation, we eat too much, we watch too much television, we take too many meds and in general, rely too heavily on ‘supplements’ to catch up with our dietary shortcomings.  And for the most part, the benefits are too few anyhow.  Deep down, we know what to do and study after study confirms what is essentially common sense: eat good food, exercise and don’t smoke.  And that works really well, providing everything the body needs in the right doses and combinations.  What did you say? You knew there was a catch? Yes, you’re very smart.

Take your seats, class.  We’re going to have a quick review of the benefits of Vitamin D:

  • important for bone strength (helps calcium get into and stay in our bones)
  • reduces the risk of seemingly unrelated disease processes like cardiovascular disease, diabetes and cognitive impairment
  • may reduce risk of childhood asthma

Wow. That sounds like some really important stuff.  I rather like my bones unbroken, my heart beating properly, my pancreas unsweetened, my kids non-asthmatic and my cog to be unimpaired (unless purposely impaired with a nice single malt scotch).

How do we know if we need vitamin D and how can we get it? Sorry to pop your gym going, vegan diet eating non-smoking balloon but if you live north of say, Los Angeles or Atlanta, chances are you need it from April to September and really need it from October to March.  Those living in sunnier climates can get enough from sun exposure (about 15-30 minutes a day depending on the pigmentation level of skin).  The rest of us need to get it from our diet or through supplements.  As a general rule, we need 1000-2000 IUs per day.  Some experts recommend less and to just prevent vitamin D deficiency you can take less.  Some recommend taking larger doses but it can build up in the body so for most people, staying in the 1000-2000 IUs per day range will probably give you all the benefits.

Okay, let’s go with the dietary route then.  Usually that’s a better idea than taking supplements, right? What do you have to eat?   According to my  reliable information sources the list of Vitamin D rich foods looks like this: egg yolks, cod liver oil, salmon and other oily fish.  Uh oh.

Remember when eggs were healthy, and then they weren’t and now they are sometimes in small amounts for some people?  For a moment let’s forget about the 212 mg of cholesterol in a large egg and forget about the 5 g of total fat, and completely ignore the link between animal protein and cancer and let’s just look at vitamin D, okay?  One large egg provides (the yolk is where the vitamin D is so egg whites don’t count)…..18-20 IUs.  How can that possibly be a good source of vitamin D?  You would have to eat more than 50 eggs (everyday!) to even come close to 1000 IUs! Didn’t we learn anything from Cool Hand Luke? Ain’t nobody ever eat 50 eggs!  Yet, there they are — on the “top ten foods for vitamin D” lists.  As Miles Monroe might have told us, that’s a big omelette.

Salmon, then, we can eat some salmon.  A three and a half ounce serving of (farmed) salmon has about 245-320 IUs of vitamin D.   Should you decide to splurge and buy wild salmon the same size serving can give you up to 988 IUs.   Although, I don’t think there is any responsible nutritional source that suggests eating any kind of fish everyday or even every other day.   The FDA states that nearly all seafood and shellfish have traces of mercury and/or methylmercury.  Many have more than a trace and can contain unsafe levels of contaminants and are often high in mercury and other environmental toxins that have no place in a healthy diet. Fish also contain no fiber and are high in animal protein, and often, in saturated fat and cholesterol. Hmmm….sounds like a fishy plan to me.

Other sources of vitamin D: fortified foods.  In other words, foods that have nutrients added back in when they are done processing it.  One cup of fortified milk or orange juice has about 100 IUs.  Again, no one should be drinking 10 cups of either of these a day.

No matter how you do this math, you cannot eat your way out of a vitamin D deficiency.  Unless you live in the right climate year round and spend part of everyday walking in the sun with no sunscreen, make a vitamin D supplement part of your daily habit — at least during the darker parts of the year.

Brett L. Kinsler and Michalene Elliott are Rochester Chiropractors who take vitamin D supplements but will happily be guest speakers in tropical locations so they don’t have to.  Their website is www.rochesterchiro.com

Where are we going? Where have we been?

I had my eyes opened a little bit wider during a conversation with a true chiropractic guidepost.  Dr. Richard Vincent is truly a rich resource of information. He has served as Chairman of the Massachusetts Board of Chiropractic Examination and Registration, President of the Federation of Chiropractic Licensing Boards and President of the National Board of Chiropractic Examiners. He is currently the President of Integrated Health Care Practice Resources (IHCPR).  I had a great talk with him on the podcast about where chiropractic has come from and what needs to be done in the name of progress.

He talks about the days before licensing in Massachusetts, the development of cultural authority and where the horizons of opportunities are for chiropractors right now.  He also illuminates some issues that existed — some much improved yet many remain unchanged.

The interview with Richard Vincent, DC and Brett L. Kinsler, DC can be heard here.

Limited Prescription Authority for Chiropractors?

Should chiropractors be allowed to prescribe some pharmaceuticals or over the counter medications with proper training?  Some say yes, others disagree. Some regions are actually changing their laws to permit this limited prescription ability.  I spoke with Dr. John J. Triano, Dean of Graduate Education and Research at Canadian Memorial Chiropractic College and one of the best known chiropractic researchers. He’s also a former clinician at the world renowned Texas Back Institute. I wanted to gain some prespective on this issue.  Dr. Triano discussed his views on chiropractors prescribing medications but also talked about rational chiropractic and why subluxation may be the cause of the downfall of chiropractic in the United States.

The podcast episode is located on iTunes (search for “On The Other Hand” or just click here.

Chiropractic prescription authority interview with John J. Triano, DC PhD conducted with Dr. Brett L. Kinsler.

Not All Apples Keep the Doctor Away

Those of us in healthcare often can’t help but follow distressing trends. One of these trends indicates that as the nutritional science recommendations for fruits and vegetables increases, Americans inexplicably seem to consume less of these important foods.  It’s like we are a bunch of rebellious teens trying to do the opposite of what our parents tell us. But how bad is it? According to the CDC’s Behavioral Risk Factor Surveillance System (big brother, anyone?), of adults surveyed only 32.5% ate 2 or more fruits a day in 2009 and only 26.3 % ate 3 or more vegetables a day.  Despite millions of dollars spent in marketing, fruit consumption in the US fell by almost 2% from 2000 to 2009 while vegetable consumption remained unchanged.  It should be noted that Idaho was the only state that showed a slight increase in both fruit and vegetable consumption while 10 states (who shall remain nameless) showed a decrease.  So chances are unless you live in Idaho, you are eating no better than you did in 2000 — which was probably not so good to begin with.

Sure, it can be hard to eat all those fruits and vegetables. Every day.  But there is some good news:  Last year, the relative healthiness of apples was studied in the form of phenolic profiles and antioxidant properties of apple skin extracts. Plant phenols include such beneficial compounds as cinnamic acids, benzoic acids, flavonoids, proanthocyanidins, stilbenes, coumarins, lignans and lignins. These are strong antioxidants and might prevent oxidative damage to DNA, lipids and proteins and therefore reduce the likelihood of developing things like cancer and cardiovascular disease.  So if you eat the right apples, you don’t have to eat as many to get the antioxidant benefits.  In the United States, apples alone account for 22% of our phenolic intake, we would do well to be choosy about those apples.

Which apple should we be eating?  Crabapples ranked highest with approximately 2.5 times the benefit as the lowest ranking apples, the golden nugget and the macintosh.  Also very near the bottom were the gala and the empire.  Firmly in the midrange were the granny smith, honeycrisp, and red delicious.  The top ranking palatable apple was the ……Idared.  Idareds showed twice the benefit as the ‘losers’.  A recent trip to a popular local grocery store revealed not one single solitary Idared in sight.  However, there were plenty of conveniently pre-bagged ‘mini-macs’.  Resist the temptation. Bag yourself a few honeycrisps or granny smiths and you will get nearly fifty percent more benefit for the same amount of apple.  If you are lucky enough to find an Idared, even better. Remember, the study measured the relative amounts in apple skin so making applesauce or juice doesn’t count!  How do ya like them apples?

 

Dr. Michalene Elliott & Dr. Brett Kinsler are apple-loving Rochester NY chiropractors.

New Podcast Episode: Alternative Dentistry

Ellie Phillips, DDS spoke frankly with me about the dental profession and how it can and must adapt from a drill and fill to a systemic and truly preventative model.  She is the author of the book Kiss Your Dentist Goodbye and a most interesting person to listen to.  I assure you, you have never heard a dentist like Dr. Ellie.

Find this episode in the podcast section of iTunes by searching for “On The Other Hand” or go to our podcast site here.

Podcast Episode: What Do Athletic Trainers and Physical Therapists Think About Chiropractors?

 

Timothy Mirtz, DC PhD from the University of South Dakota chatted with me about what athletic trainers and physical therapists think about chiropractors and what can be done to change the interprofessional relationships.

Find it on iTunes by searching for OnTheOtherHand or go here.

This is our first episode with our new sponsor. It’s very cool that a great business sees the value in our podcasts and wants to help us continue to make them.  I would appreciate if you would check out coldlasertherapy.us I’ve used them for years to buy all of my cold laser equipment. They have really fair prices and excellent customer service.  Complete cold laser setup with two pairs of safety goggles for under $1600.  For real!  Plus, listeners to the podcast get $50 off their order by using coupon code: PODCAST

Lowering the Chiropractic Doom and Gloom Meter

A colleague has a “meter” by which he predicts the current level of doom and gloom facing the chiropractic profession.  Whenever something untoward occurs, he bumps up the “meter” a bit. I think if the meter ever fully registers 100%, the entire profession will explode like the world’s largest bottle of Diet Coke enveloping the world’s biggest Mento.

I am pleased to report that the doom and gloom-o-meter can be reduced a titch. As of today, our podcast “On The Other Hand” has had over 1000 downloads in it’s first two weeks of existence!  There is proof that people are interested in hearing about evidence oriented chiropractic from a scientific perspective.

It’s either that or they want to hear if I sound weird pumped directly into their skull through ear buds.  I’m cool with whichever one it is.  Thanks for listening, downloading and subscribing.  If you are so inclined to rate the podcast and leave us a review on iTunes, that would also be great.

Brett L. Kinsler, DC is a Rochester chiropractor, blogger, podcaster and, with your help, is responsible for lowering the chiropractic doom and gloom meter just a little bit.

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