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Barefoot Running

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A reader brought to my attention the growing trend of barefoot running, given fuel recently by this study:

Foot strike patterns and collision forces in habitually barefoot versus shod runners.

Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y.

Department of Human Evolutionary Biology, 11 Divinity Avenue, Harvard University, Cambridge, Massachusetts 02138, USA. danlieb@fas.harvard.edu

Comment in:

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

It's an interesting idea, and certainly has its appeal, falling in line with other fitness trends such as functional strength training and the naked warrior concept. I've known people who have been running barefoot since the mid-90s.

But I suspect the faddishness of the trend, and I see some real problems with the research. The first is that it was not until last fall, with the Wolf study, that a decent examination of the consistency of lower extremity kinematics was even performed (to my knowledge, at least). Without that base consistency data, drawing conclusions from a comparison of shod versus barefoot kinematics is perilous. How do we know that the data from the Lieberman study (and others) even falls outside the range of normal variation? The fact is, we do not. So to to make conclusions about technique from such studies is rash.

While the research does show some force reduction at the joints, from that data the researchers are *presuming* a reduction of injury. There are not any studies which actually show a reduction of injury, and it is quite possible that none will be found. Lieberman admits this limitation in his study. What is most probable is that barefoot running may tend to reduce the risk of certain types of injuries, while increasing the risk of others, and as I note below, the benefits are likely to vary widely based on individual biomechanics. There truly is no such thing as a free lunch.

Similarly, performance has not been evaluated. The argument held forth thus far is the "Ethiopian runners do it and they are the best," which is an argument beset with obvious problems, from cardiopulmonary functioning to femorotibial ratios. Until I see some good studies, I am inclined to dismiss barefoot running performance claims.

Interestingly, the kinematics of shoeless running point to the fact that, in all likelihood, the runners who do benefit most from shoeless running are those that are free of foot dysfunction in the first place. Which makes sense.

It is important to note that the foot scans I'm providing are not with the intent to provide a rationale to fit every athlete with orthotics, but more to detect those individuals whose foot dysfunction or pathology tends to increase their risk of injury or hinder their performance. For such individuals, there is absolutely no data to suggest that they would benefit from barefoot running and a wealth of research to suggest that custom orthotics would be beneficial.

I'm not a one-size-fits all kind of doctor, and I may happily recommend seemingly contradictory advice to two different patients with the same (apparent) problem, because I think that any protocol needs to account for the huge individual variability in physiology and biomechanics. It is one of the core ingredients missing in most of mainstream medicine.

So I'm not going to utterly dismiss barefoot running out of hand, because it may have some genuine utility for some people. But the majority of runners, I suspect, will continue to benefit from a well-made shoe and proper foot support.

Free Digital Foot Scan, March 12

I'm very happy to be able to do this. For 15 years, I've been putting my patients into custom orthotics for a variety of reasons, most typically chronic low back or knee pain. I have also used them quite frequently on my athlete patients, as the research has found that custom orthotics can curtail the risk of training injuries.

And in the case of at least one sport -- golf -- there is research that shows that using custom orthotics actually increases performance! Yep, you read it right. Slip these things in your golf cleats and strip a couple of strokes off your game. Can't beat that with a stick (so to speak).

Having made a short story longer, here's the point: I've arranged for the orthotics lab that I've been using for the past 15 years, Foot Levelers, to bring in one of their technicians. She will be spending the day on Friday, March 12, doing digital scans of people's feet to see if you need orthotics. Did I mention that this is free?If it turns out that you do need orthotics and you order them that day, I'll give you 15% off.If you order two pairs, you get 30% off. Sweet.

Here's a linky that takes you to a pretty web page about it.

You can always check out my website to read much of what you've read here, only with more formal wording.And, as always, if you have questions, email me, or call me at (860)567-5727.

Do this. It's free, and it will make you so happy.

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It’s Not The Winter Blues, It’s Your Winter Diet!

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That's the name of this year's first podcast, and it is up and available now. The feed for all my podcasts is here. And, as promised, here are the show notes:

Br J Community Nurs. 2009 Oct;14(10):422, 424-6. Dietary factors and depression in older people.

Williamson C. British Nutrition Foundation, London. c.williamson@nutrition.org.uk

Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression.

Dietary pattern and depressive symptoms in middle age.

Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK. tasnime.akbaraly@inserm.fr

 BACKGROUND: Studies of diet and depression have focused primarily on individual nutrients. AIMS: To examine the association between dietary patterns and depression using an overall diet approach. METHOD: Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: 'whole food' (heavily loaded by vegetables, fruits and fish) and 'processed food' (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). CONCLUSIONS: In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective. 

If you are interested in more information about diet and depression, contact me by clicking here.

Thanks for listening, and as always, your feedback and comments are very much appreciated!

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Comment of the Week

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One of the things I like about being the type of doctor that I am is that patients feel free to speak their mind to me. As happened today, while I was performing trigger point therapy (a highly effective but admittedly somewhat painful technique for some muscle problems), my patient said to me:

Patient: "Doc, that #$%^&! hurts!

Me: "Yeah, I know, sorry about that."

Patient: "That's your bike out front, right?"

Me: "Yeah. Rode it in this morning."

Patient: "Yeah, well, when you're done with me, I'm taking care of it. You're walking home tonight."

Music Therapy in Litchfield

There is some very good news today for parents of special needs children in the Litchfield area. I received an email today from Krizta Moon, a very talented musician, music teacher and musical therapist, which said that she will be offering a music therapy program at the Litchfield community center. If you are unfamiliar with music therapy, it is  "the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program," according to the American Music Therapy Association website.

Anyone who has fallen in love, lost a loved one, grieved or celebrated -- that is, all of us -- knows the power that music has to influence our mood and our minds. Amazing, isn't it, how a few bars from a half-forgotten song bring back to us in 3D living color the gestalt of a period in our lives?

Well, music is capable of far more than that. In the right hands, music therapy can not only help children cope with pain and stress, but also speed their progress in physical therapy programs. Music therapy can reach out and touch the untouchable, engage the unengaged.  In fact, a recent Cochrane Review, largely considered the gold standard of evidence-based medicine, found that "music therapy may help children with autistic spectrum disorder to improve their communicative skills."

Ms. Moon said that she will be having an introductory "meet and greet" session open to everyone on Sat., January 23 at the Litchfield Community Center.

Music therapy sessions are specifically designed around the child's age and developmental abilities, Ms. Moon said. Sessions will be held each Saturday between the hours of 9am-1pm. Each session runs for 45 minutes, starting on February 20th and will conclude on April 10th for a total of 8 sessions. Total cost is $150.00. Sign-up for this event will begin at 10am at the Litchfield Community Center. From 11-11:45, be there to participate in a large group session for parents and special needs children ages 4-18.

"An advantage of music therapy," Ms. Moon's email said, "is that it is an inherently nonthreatening and inviting medium. It offers a child a safe haven from which to explore feelings, behaviors and issues ranging from self-esteem to severe emotional dysregulation. Music therapy techniques can be designed to address more complex issues such as grief, abandonment or deeply conflicted emotions. As a medium, music therapy has enormous range and scope in targeting multiple clinical needs across the gamut of childhood developmental stages. It can set the occasion for a child to establish a meaningful relationship with an adult through musical play and interaction. Music therapy can also facilitate the development of pro-social skills, trust and feelings of positive attachment. Developmentally, almost all children respond to music. This greatly assists in laying a strong foundation for engaging in deeper therapeutic work. A child's natural interest in music is enhanced by the fact that they are occupied in stimulating motor and auditory activities more associated with play or fun than work or therapy. The careful and repetitious orchestration of such multi-sensory experiences, in the context of a skillful and nurturing relationship, has a remarkable range of clinical benefits."

On a personal note, I would just like to add that Krizta Moon has been my daughter's singing teacher for several years. I know whereof I speak when I say that she is an extraordinarily talented, caring and skilled teacher, and I am glad that she has extended her talents into the realm of music therapy. I have no doubt that she will be of great benefit to many children here.

If you would like to attend, please call 860-484-9080 to confirm. You can also contact Ms. Moon via email, at lunazsoul (at) hotmail.com.

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Public Agrees With Chiropractic Doctors: No Special Regulation Needed

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In a classic set-up, the Hartford Courant published an online poll asking readers if chiropractic patients should be required to sign special consent forms, as I mentioned in a previous post. The poll question was placed directly across from a Rick Green anti-chiropractic screed, in which Mr. Green manages to disclose both an appalling lack of understanding of scientific research as well as feeble rabble-rousing skills in his attempts to mislead the public about this topic.

I wouldn't mind so much about the anti-science bent of his column if Mr. Green was at least able to generate some fire underneath his supporters.

But, alas, he could not even do that. Normally, the placement of a survey as the Courant did in this situation virtually guarantees that the results are skewed in favor of the opinion of the columnist. Not so in this case. Here are the most recent poll results:

Rick Green rant fails to persuade public

I'm sorry, Mr. Green, but it looks like the public has spoken.

And they think you, and the proposed regulation, is wrong.

Cosmo Unveils The Secret Behind Good Health. Maybe.

That fount of modern female wisdom, Cosmopolitan magazine, inadvertently highlighted the fundamental problem with modern healthcare in its recent online article, Hairstyles Men Love. Next to this picture of an undeniably-photogenic Anna Faris:

Anna Faris is evolutionarily advanced

The article notes that "From an evolutionary perspective, guys subconsciously like hair that looks clean and healthy, like Anna Faris's blond locks. "Hair that's in top condition shows that you have a balanced diet and good health — signs of an ideal mate," says biological anthropologist Helen Fisher PhD."

So far, so good. Sociobiology, or the description of human behavior from a evolutionary perspective, has come a long way since its introduction 40-odd years ago, and is now a widely accepted (if oft-misused) theory. It is quite probable that in matters as fundamental as procreation, we are hard-wired to respond in certain ways just as much as the female Western Tanager will always go for the guy with the big red top.

But then Cosmo blows the lid off of the secret behind looking healthy:

"Work a silicone-based straightening serum through damp hair before blow-drying," Cosmo advises. "Clip locks in 4-6 sections depending on how thick your hair is. Then tackle one at a time with a paddle brush and a blow-dryer equipped with a nozzle pointed straight down. Finish with a light shine spray."

Ok, let me see if I've got this right. The secret to attracting guys, Cosmo says, is to develop that healthy glow, which presumably indicates a fecund future of healthy, bouncing babies to carry the genetic line forward. And the secret to attaining that health is a silicon-based straightening serum?!?

Not a word about the things that I associate with good health, like, maybe, good nutrition, exercise, sanitation -- all that stuff that actually does give a person that healthy glow, instead of simply imitating it.

In the same way, mainstream medicine mistakes appearing healthy for looking healthy. Instead of looking at the person, they look at the numbers:

Cholesterol low?                   Check.

Thyroid hormone normal?     Check.

BMI "normal"?                      Check

All well and good. But the fact of matter is, manipulation of the numbers does very little to change a person's health. You can have a normal body mass index and still be highly prone to cancer and heart disease. You can have normal thyroid hormone levels, yet still have a thyroid that is dysfunctional. And don't even get me going on cholesterol. Cholesterol levels are no indicator of any kind of health whatsoever.

So, by manipulating the numbers, the modern MD thinks they are creating health in their patients. But, like the two ounces of straightening serum, they are only creating the appearance of health.

Reducing your cholesterol level has no effect on your overall lifespan. None. Zero. Zip.

Normalizing your thyroid hormones does not mean your "thyroid" symptoms will go away.

A normal BMI does not mean you are fit.

Just like two ounces of straightening serum will give the appearance of health without the reality, the statin drug or the synthetic hormones will make pretty pictures -- but, in the long run, won't change your health for the better.

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An Open Letter to the Connecticut Chiropractic Board

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I am writing regarding the hearings in Hartford on the requirement for chiropractic physicians to disclose to patients the risk of harm from cervical manipulation.

I am troubled in two ways by the legislation. First, I am concerned that the legislation is based on unsubstantiated fear and rumor rather than established science. Second, I am troubled by the way in which it singles out one medical provider among all others for this invasion into the doctor-patient relationship.

Stroke due to cervical manipulation is an exceedingly rare event. In fact, the most in-depth examination of this topic, a study published in the journal Spine in 2008, concluded that stroke due to chiropractic manipulation may be a non-event. The authors of the study reviewed 10 years worth of hospital records, involving 100 million person-years. Those records revealed no increase in stroke risk with chiropractic.

Even if you argue that spinal manipulation can result in injury, it is exceedingly rare. Another study, reviewing 10 years' worth of malpractice claims in Canada, concluded that the risk of stroke following chiropractic treatment could be only 1 in 5.85 million cervical manipulations. Another way of looking at this number is that it would occur only once in a chiropractor's lifetime if he were in practice for 1,430 years. And even then, the study did not find that chiropractic manipulation caused stroke.

Thus, I must ask the question: Will the government require that chiropractic physicians lie to their patients about the risks of chiropractic-induced strokes, when, in fact, the best science available shows that none exists?

Any good doctor, whether chiropractic or medical, cares sufficiently for his patients to inform them of the significant risks and consequences of their chosen course of treatment. This is simply good patient care, respectful of the patient and his rights and the doctor and his responsibilities. And any therapeutic intervention carries with it some degree of risk, although, as in the case of cervical manipulation, it may be extremely small, and the injury typically limited to a pulled muscle.

There is no need whatsoever for the legislature to involve itself in this process and begin the micro-management of the doctor-patient relationship, nor should it single out one single provider for its intrusiveness. The legislature would never even consider mandating that every medical specialty disclose in writing specific but rarely occurring abreactions to their treatment.  Why then would chiropractors be held to a different standard? 

Or, if a 1in 5.85 million risk of injury is sufficient to require specific notification, will the legislators also require an MD to obtain specific written consent every time he tells a patient to take an anti-inflammatory? That is not a low-risk treatment. Anti-inflammatory medications are the 15th leading cause of death in the country today.

Will the thousands of other procedures conducted by medical doctors with much higher risk of serious injury or death also come under the scrutiny of the legislators?

After all, during the two days in which your hearings were held, 4,296 people died as a direct result of their medical care.

Who provided the informed consent for that?

Very Truly Yours,

 

Avery L. Jenkins, D.C.

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My Christmas Gifts

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Probably the best thing about this holiday, in my mind, is that it gives us all the opportunity to be grateful. As a friend of mine recently pointed out, when you spend your time being grateful, you don't have a lot of room in your life for stuff like anger, or fear, or jealousy. It's hard to be grateful and angry simultaneously. Try it. See? Weird, it just can't happen. So I'm feeling really grateful today, as I sit and type this beside a wood stove cranking out the heat and eating a clementine. I'm grateful for the warmth of the stove. The children upstairs still sleeping. The deliciously healthful food made possible by a civilization which, for all of its many faults, gives me the capability to eat an orange in the middle of a cold New England winter. And I'm very grateful to the patient who brought me the fruit.

It is always somewhat surprising to me, when holiday season comes around, and patients bring such wonderful gifts to share with Teresa and me.  Diets be damned, they say, and bake with abandon, creating the most  delicious concoctions enticing me to keep my energy up with a quick midday sugar fix. Or two. Or three. (Hmm. I'm pretty sure I'll be doing the Center's New Decade - New Me weight loss program in lead-by-example format!). I am touched by these gifts, as I know that they signify my importance in their lives. And when I realize that, I am immediately humbled and awed by the trust which my patients place in me.

There were two gifts this year which particularly moved me.

One of my patients, whom I know is no stranger to philanthropy, took her largesse to an entirely new level this year. In honor of me, she said, she gave the gift of a cataract operation (through Seva, a charity devoted to restoring sight and preventing blindness in the developing world)  so that another person might see again. When she told me, it brought tears to my eyes. To be the inspiration for such magnaminity is overwhelming. Thank you, Joan.

Another gift came in the form of an email from a grateful patient whose holiday was brightened by a new addition to the family -- whose presence, she said, was the result of the care which I provided.  I was deeply moved by her thanks as well, and reminded of the joy I experienced many years ago when my first child arrived.

So has it been a good Christmas? You bet! New eyes, new life, tasty treats and fruits and honey. My cup runneth over.

I hope your Christmas has been equally  joyful.

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A Common Conversation

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I had a conversation with a patient the other day, one that I've had all too frequently in the past. The patient, someone with chronic neck pain, had gotten impatient with the length of time it was taking her to heal, and had discontinued care. Now she was back in my office, after visits to the MD, PT, and the radiologist.

"I finally found out what was wrong with my neck," she said.

"That's great," I replied. "What is it?"

"I have arthritis!" she said. "My doctor took x-rays." She pulls out a manila envelope and hands it too me. "Maybe if I'd known a little sooner, I could have gotten this fixed."

I left aside for a moment the concept, always a little odd to me, that somehow I wasn't her doctor. I know, it's a chiropractic thing.

"Yeah, you probably do," I said. I ignored the manila envelope. "Doesn't really make any difference, though."

"What do you mean?" she said.

"Look, Sarah, you're 50 years old," I said. "Of course you have arthritis, everybody does by 50. Arthritis is just a medical term for wear and tear on the joints, and if after 50 years you don't have any wear and tear, that would be the surprising thing."

She just looked at me, clearly upset that I didn't share her enthusiasm for her newfound diagnosis and her (real) doctor's "discovery."

"Here's the thing of it," I said. "Those of us who treat a lot of this stuff know that there is often very little correlation between what an x-ray or MRI tells us and the pain and symptoms patients experience.

"Heck, studies show us that 30% of the population is walking around with a bulging disk in their lumbar spine, but most of them have no back pain. I've seen x-rays that showed massive amounts of 'arthritis' and disks that are virtually missing in action, but those findings had absolutely nothing to do with the patient's pain," I said.

"That's why I rarely bother with x-rays or CT scans or MRIs unless I see a red flag when I examine you. In most cases, it's not worth the radiation exposure or cost, because the 'arthritis' isn't the source of your problem."

"That's not what my doctor said," Sarah replied.

"I know," I said. "Let me ask you this -- what did your other doctor do after he found the arthritis?"

"He prescribed some painkillers for me, and I've been going to see the physical therapist."

"Great," I said. "How's it working out?"

"Well, sort of ok," Sarah said. "The painkillers were giving me a stomach ache, so my doctor put me on a different pill, but they aren't really much better than Tylenol. The physical therapy really helped at the beginning, but it's not been doing so much lately."

"Ok," I said. "Here's the thing. The wear and tear you've got isn't really the problem. Chronic pain like yours rarely comes from a single source. It's usually 2, 3, or 4 things all going on at once. If you don't tackle all of them at once, you won't really find a solution."

From that point, I went on to describe a suggested treatment plan -- one that I would have implemented a couple of months ago, had the patient not withdrawn from treatment prematurely.

The problem with this treatment plan is that it requires some lifestyle changes. Regular rigorous exercise, not a few lifts and stretches under the supervision of a mildly bored PT aide. Changes in diet, giving up some favored foods.

These protocols do work for chronic, degenerative conditions. But for so many people, the mental/emotional pain of change -- even healthy change -- is greater than living with physical pain.

By the time I was finished, I could tell Sarah was still unsatisfied with me and my answers. I understand her reluctance. It is much easier to hang your hat on a simple diagnosis -- "I have arthritis" -- than it is to tell your friends "I have a metabolic/muscle movement pattern dysfunction with inflammatory overlays."

Despite my 30 minutes of explanation, Sarah left that day without making any further appointments. I don't know if I'll see her again, but it's likely that if I do, her condition will be that much more farther advanced and more difficult to treat.

Over the years, I've had many patients like Sarah. And sometimes they do come back, and often, with committed efforts on both of our parts, we make inroads.

Sometimes, it's just too late.

Bigger, Badder, Scarier!!!

Coming on the heels of revelations that the CDC cooked the books to make the H1N1 (formerly known as Swine) virus look far more dangerous than it was, comes the latest  scare tactic to get people to stick those needles in their arms: The H5N1 Virus! Omigod! It must be 5 times as deadly as the H1N1!!!!

Scientists have already detected the virus in poultry in Indonesia, Egypt, Thailand and Vietnam, and warn that it is only a few mutations away from posing a threat to human life!!!

Good grief. More and more these days, what passes for public health in this country resembles a poorly-plotted zombie movie.

What a weekend!

I have always maintained that more education is better, which is why I am one of only a handful of doctors statewide who is board-certified in both clinical nutrition and acupuncture. My recent appointment to the Board of Directors for the national nutrition specialty board is also a natural outgrowth of this emphasis on ongoing professional enhancement. This weekend, I received another certification which, while not a physician-level postgraduate degree, is a certification of which I am equally proud.

Today, I can happily state that I am a League Certified Cycling Instructor. I have been certified by the League of American Bicyclists   to teach courses in all phases of bicycle riding, road and traffic skills, and bicycle maintenance, to both adults and children.

Getting this diploma is a nontrivial task, beginning this summer, when I took the prerequisite class for my certification course. I then had to apply to take the certification course itself by completing a cycling resume which established my bona fides for having the necessary experience to even take the course, absorbing a stack of reading material, and then proving that I had done so by taking a test which took me -- no kidding -- 3 hours to complete.

All that was just to get in the door.

The class itself started at 5:30 Friday night, going until 10:00 that evening; resuming at 8 a.m. on Saturday, and wrapping up around 9:30 at night; and a final, "short" day on Sunday, again starting at 8 a.m. and wrapping up at 6 p.m., after which I got to go home and reintroduce myself to my kids. The dog, fortunately, remembered me.

It wasn't all sitting around, thankfully. During this time, I gave two short classes on various cycling education topics (Night Riding and Cadence, Gear Shifting and Power Output) went on one educational road ride, led and taught a portion of a second road ride, and extemporaneously taught and demonstrated a number of bicycle handling drills, all while receiving feedback from my instructors and fellow students. When I wasn't learning by doing, I was learning by watching my classmates and providing critiques of their performance.

It was, by anyone's standard, an exhausting weekend.

At the same time, it was one of the most rewarding experiences I have had. I learned a tremendous amount, not so much about cycling -- the admission process assured that my cycling knowledge was a given -- but about teaching, learning and community building. I gained far more than I expected to this weekend, and the spillover into other professional areas is obvious to me.

One question I have been asked, is why did I spend so much time and effort to achieve such a high level of competence in a field which is really outside of my professional realm?

It's a good question, but a question that is flawed by its premise. My overarching concern is with my patients' health, and I constantly preach the virtues of an active lifestyle.

But, honestly, most people are loathe to begin an "exercise program" or to continue one that they have started, unless they are faced with extraordinary circumstances (impending diabetes or heart disease, for example) . To my mind, it is more effective to find ways that allow people to incorporate exercise into their daily activities than it is  to set up a structured exercise program that will be abandoned in a month or two. (That said, I refuse to classify vacuuming a house as "exercise," as did one recent -- and exceedingly flawed --  study.)

Cycling fills that niche perfectly. It is an age-free activity (using the new, sporty trikes (check some out here), even older people or those with balance problems can safely hit the roads under their own power). It is a physical activity that most people have at least some passing pleasant experience with. Finally, cycling provides a tremendous return on investment in heart, lung and muscle performance -- which in turn, translates into decreased illness and disease, longer lifespan, decreased dependence on drugs...need I go on?

So by becoming certified to teach cycling to others, I am also improving my ability to help my patients in what I see as a very fundamental way.

The second reason I chose to take this course is that I am hoping, by providing cycling classes to adults and children in the area, to give back a little to the Litchfield community of which I am so fond and which, for the past decade or so, has given my children wonderful schools, mentors, and coaches under whose tutelage they have thrived.

I hope that, by teaching families successful cycling strategies, that I can help them enjoy this area's quiet and extraordinary beauty in an entirely new way -- while at the same time, giving them alternative activities that are healthier and more rewarding than time in front of the television or under the spell of a video game.

And, I have found increasingly over the past several years that a quote from India's famous sage and politician Mahatma Gandhi has become a governing principle in my life.

"We must be the change we wish to see in the world," Gandhi said. More and more, I am trying to live by that standard.

The (Swine) Flu Season Is Upon Us!! (yawn)

Unless you are living in a cave in the furthest reaches of the Andes, you are probably aware that FLU SEASON IS COMING! The media has certainly gone into chicken little overdrive to keep you utterly misinformed about the flu and the allegedly proper precautions to take to avoid it.

This is what is known as FUD (Fear, Uncertainty and Doubt) marketing. It was employed by IBM during the 60s and early 70s to maintain it's near-monopoly (at the time) over computer systems, which back then were the size of small garages and were fairly pricey. The technique is to scare you into buying the product by capitalizing on the customer's fears.

In IBM's case it was the fear executives had of switching to upstarts like Digital Equipment Corp., even though DEC's computers were faster, smaller, cheaper and better. In the case of mainstream medicine, the fear they inculcate is that you will die unless you buy their products. Now that's what I call purchase motivation!

The problem is, of course, is that the fear that they are selling is not backed by the facts, and we expect a little better ethics out of the health care system than we do out of a bunch of computer salesmen from New York.

Nonetheless, pharmaceutical companies have FUD marketing down to an art form that IBM marketeers back in the day could only have dreamed of. Today's vaccine makers have public health officials from the federal level to village health departments hustling their goods for them. (I wish chiropractic had an army of salesmen like that, it would reduce national healthcare costs dramatically.)

The fact of the matter is, epidemiological studies have repeatedly shown that flu vaccines historically have a very low success rate, and in fact, make little difference in the course of the disease. In short, they are failures.

Although it's a bit of a comparison between rotten apples and tasty, fresh oranges, I would like to mention that a follow-up study done of the people who attended my flu clinic a couple of years ago found that 97% of them remained flu-free for the season.

The marketing hand of the flu FUD machine was also visible in the renaming of the virus. Anybody else notice how the “swine flu” was suddenly renamed the “H1N1 virus”? The main objective here was to remove any similarities in the popular mind between the similarly hapless swine flu “epidemic” of the 70s and it's attendant lethal vaccine, and the current public health travesty.

Here's why I think the H1N1 virus epidemic is similarly overrated: A virus, to be successful, can do one of two things. It can be fairly lethal, or it can be relatively benign and spread easily. A lethal virus is unlikely to spread easily because it kills its hosts before they can infect a large number of people. A benign virus can spread easily, because it doesn't make you sick enough to put you down for the count, so you walk around infecting everybody around you.

The only virus in recent history to escape the Viral Dichotomy is HIV. It managed, through its transmission method and long latency, to be both lethal and readily transmissable.

And to those who are arguing that the swine flu is the overdue pandemic, I would point them back to HIV/AIDS. That virus did create a pandemic, though it still has problems being recognized as such because prejudice rendered its initial victims invisible and, in many countries, too many people found open and honest discussion of its transmission methods to be distasteful.

The swine flu virus hasn't managed to achieve anything near the success of HIV in either lethality or transmissibility. The swine flu virus has taken the latter course, of being easily spread, over the former course. So, even if you do get it, the consequences are unlikely to be more than a couple of days of inconvenience – and, remember, the vaccine is unlikely to prevent that from occurring.

So, here's my take-home on the H1N1 (the virus formerly known as Swine) epidemic: Meh.

My recommendations for this flu season are no different than any other:

  1. Wash your hands frequently. This, according to the Centers for Disease Control is the number one way of reducing your risk of catching the flu.

  2. Exercise. Regular exercise has been shown to enhance immune system function.

  3. Eat well. The proper diet has been shown to enhance immune system function. (If anybody wants a list of immune-enhancing foods, just send me an email.)

  4. Have two chinese herbal remedies on hand: Bi Yan Pian and Yin Chiao. The first is used in traditional chinese medicine for colds, and the latter is is used for the flu.

And the fifth piece of advice I have goes beyond flu prevention: Ignore the FUD. If you do not buy the fear, uncertainty and doubt that they are selling you, you won't need the attendant, frequently dangerous, medicines.

A Video Is Worth How Many Words?

Apologies to my readers: The link to the video on this post got broken, and I have not been able to re-locate it. I will insert the new link as soon as I find it.

Alternative medicine is under attack as it hasn't been since the 1st District Court found the AMA guilty of antitrust violations in its ongoing war against chiropractic.

Pharmaceutical companies and "mainstream" medicine are feeling insecure as the sands of health care reform shift under their feet. And one thing they want to avoid at all costs is allowing chiropractic physicians an even playing field -- because they know that will unlock  the floodgates, allowing patients who are seeking alternatives to drugs and surgery to freely find the assistance they so desperately need. As a result, the distortions about alternative health care in general and chiropractic physicians in particular are piling up again.

This video sets the record straight. Although I am not its producer, many of the facts presented in this video are data that I have used frequently in my own writing and seminars. But, as they say, a picture is worth a thousand words.

Please watch it. And pass along the link to this page to anyone who you know who cares about the future of healthcare.

Ghosts In The Research

As a doctor, I rely on research to inform my decisions and help formulate treatment plans for my patients. Research tells me what works and what doesnt' work. In addition, when doing acupuncture, I stand on the shoulders of many generations of doctors who have come before me, and I can rely on their experimentation and observations to guide me.

And when it comes to research on Western nutrients and chiropractic advances, I am assured that the research is free from the influence of big money. Because, let's face it, nobody is becoming a millionaire by selling Vitamin B.

Pity the poor MD, then. There has been mounting evidence for years that the research that MDs use to decide which drugs to prescribe has been tainted. And, finally, the crows are coming home to roost.

The Journal of the American Medical Association has revealed that up to 10 percent of the articles in the most prestigious medical journals were written by unacknowledged, industry-funded ghostwriters. Some 7.8 percent of named authors of 630 articles admitted contributions from ghostwriters who weren't named, with the highest percentage found in the New England Journal of Medicine (10.9 percent) and the lowest in Nature Medicine (2 percent).

In another story just reported by the AP, GlaxoSmithKline commissioned sales reps to recruit doctor-authors for ghostwritten articles supporting Paxil use. And this story followed another revelation, that Wyeth used ghostwritten reviews to push its hormone replacement therapy.

You remember hormone replacement therapy, right? The anti-cancer, anti-heart disease miracle cure for women that turned out to cause breast cancer and stroke?

And just to top it all off, it appears that the pharma companies are turning to ghostwriters once again, in this case to have the FDA change its rules to allow pharma to use journal articles (you know, the ones they wrote) to push their drugs for off-label uses.

You know, I really wish I was making this stuff up. But I'm not. And the biggest problem is that nothing will ever come of these revelations. Like the big banks, Big Pharma is too big and too wealthy to fail.

All I can do is try to remind people that the companies that make drugs are far more interested in your wallet than your health.

But I'm a tiny voice in a very large, and largely craven, industry.