January 7, 2010 by Avery Jenkins.

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 15^th 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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December 25, 2009 by Avery Jenkins.

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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December 16, 2009 by Avery Jenkins.

I’ve been saying this for years!

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December 15, 2009 by Avery Jenkins.

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.

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December 11, 2009 by Avery Jenkins.

Obesogenic: Enviromental conditions which lead people to be overweight.

Example: “Modern America is an obesogenic society.”

Usage: “Dude, this burger is  freakin’ obesogenic! Are there any more?”

My personal goal is to use this term three times in conversation today.

It’s good to have goals.

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December 8, 2009 by Avery Jenkins.

When I saw this, I didn’t know whether to laugh or cry.

I settled for laughter. It didn’t hurt as much.

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November 25, 2009 by Avery Jenkins.

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.

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October 26, 2009 by Avery Jenkins.

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.

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October 9, 2009 by Avery Jenkins.

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.

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September 23, 2009 by Avery Jenkins.

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.

Posted in politics, medical folly, allopathic medicine | Print | 1 Comment »