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Medicine, chiropractic, acupuncture, and nutrition: a hopeful vision of the future.

For the past three years I have been working on obtaining my MD through the University of Health Sciences-Antigua. I have been a licensed chiropractor for about 16 years and certified in acupuncture for about 13 years. Occasionally, someone asks if I plan to keep my chiropractic license, believing that I am changing professions.

I find this strange because this additional training is not a change in professions, it is growing my profession. When I received my acupuncture training, people would comment, "Oh, and you are an acupuncturist, too." But I did not see it that way; I simply had a better understanding of health and sickness and additional tools at my disposal. A decade or so ago I went through training with the ACA Council on Diagnosis and Internal Disorders, and I found some chiropractic colleagues felt I had become a "medipractor" and was abandoning the profession. Again, I never saw it that way--I simply had more knowledge and ability.

I have roughly a year left to finish the program. Then, if I pass all three parts of the national boards, if I complete a three-year residency, and if the state board finds all my clinical hours in order, I would be eligible for full licensure as a medical doctor. My experiences in medicine over the past three years have added hope in regards to a brighter future for health care, despite some very real obstacles. Additionally, my experiences have given me a deeper respect for chiropractic (acupuncture, nutrition, and alternative methods), both as a business and as a healing profession.

The strength of chiropractic as a business became evident to me as I completed a pediatric rotation. I was eating lunch in the doctors' cafeteria at Phoenix Baptist Hospital with my pediatric mentor when I overheard a group of MDs talking about the financial woes they faced, and one of them said, "You know, if I really wanted to make some money, I would be a chiropractor. Those guys have it made."

While all doctors face a myriad of financial concerns, and even surgeons making $500,000 a year are facing substantial decreases in the volume of their incomes, chiropractic does offer a significant benefit--low over-head. Medicine comes with a high price attached. The drugs, the equipment, the higher malpractice insurance, the more expensive licensure, and other expenses make it more difficult to make a profit. Speaking of chiropractic purely as manual manipulation of the musculoskeletal system, the overhead costs can be minimal: tables, face paper, and malpractice insurance of about $1,000 per year. In contrast, an obstetrician with costs on items ranging from equipment, such as sutures, speculums, colposcopes, microscopes, fetal monitors, and ultrasounds, to malpractice costs in the tens of thousand of dollars per year, has to make a pretty penny before he starts to show a profit.

If a chiropractor adds additional services such as vitamins or acupuncture, the cost of doing business is far outmatched by the reimbursement on these services. A sterile acupuncture needle costs pennies at most, but the acupuncturist stands to make $30-60 per treatment. A simple vaginal swab and culture requires lab expenses, microscope, speculum, and autoclave just to begin with (about $2,000-3,000), and the reimbursement for a routine vaginal exam may not be much more than the acupuncturist would receive for a treatment using needles costing a nickel. Despite all the problems of the current health care environment, chiropractic and the various holistic alternative methods of treating patients are cost effective and profitable in a strictly business sense.

Furthermore, these holistic methods are effective in getting patients better as well, and MDs are realizing it. When I was doing my pediatric rotation, my mentors had read studies published in their pediatric journals about the effectiveness of cervical manual adjustments in helping patients with ear infections. They had me demonstrate cervical manipulation on neonates and pediatric patients. They were highly interested in the possibilities of using cervical manipulation to benefit their pediatric patients.

My mentor teaches for other medical and osteopathic schools as well, and is the neonatology instructor for the family medicine program at Phoenix Baptist Hospital. He told me about studies indicating that pediatric patients treated with antibiotics fared no better than patients who did not receive antibiotics. I found this interesting and ironic.

I can remember about 10 years ago when not a few MDs were up in arms because some chiropractors were suggesting that antibiotics were not needed in some pediatric ear infections, were causing an increase in antibiotic resistant bacteria, and that a chiropractic adjustment might be of help. These MDs protested that chiropractors who believed such things were of great danger to patients because they caused the patient to delay getting the proper medical care of antibiotics. Here we are a decade later, and MDs are saying essentially the same things as those "crazy" chiropractors were saying 10 years ago.

Nonetheless, it gives me great hope that chiropractic and medicine can soon operate on common ground. Indeed, it is only inevitable that they work together because they share the common goal of promoting health in patients. Both contain valuable treatments, and both could learn a lot from each other.

Medical treatment is valuable, but more is not better. More diagnostics, more treatments, and more intervention is not always a good thing. Drugs are a powerful thing, always have side effects, need to be treated with the utmost respect, and used only when absolutely necessary. As a chiropractor, prior to medical training, I felt that MDs were like drug missionaries on an evangelical mission to make sure everyone was taking as many drugs and getting as many surgeries as possible.

In fact, I have found this is not the case. All of the MDs I have worked with have shown high interest in conserving resources, keeping the patient on as few drugs as possible, keeping them out of hospitals, and avoid unnecessary diagnostic tests. However, they often do not know anything else to do for a patient, as they are untrained for the most part in nutrition and other holistic treatment methods. Left with a prescription pad and a desire to do something to help a patient, they often end up writing a prescription out of lack of alternative choices. But, nonetheless, the MDs I have trained under are very receptive to, and even interested in, other methods of treatment. I have yet to do a clinical rotation with an MD that did not want to see chiropractic or acupuncture demonstrated on his/her patients. One of the medical doctors who mentored me went through acupuncture training while I rotated with them.

MDs are often aware of the short comings of a medical approach as a stand alone. It is common in obstetrics to monitor the fetal heart rate to look for heart patterns associated with hypoxia and umbilical cord compression. Uterine contractions represent a stress for the fetus, and the alteration in fetal heart rate correlates with fetal oxygenation. Prior to doing my obstetric/gynecological rotation, I had read in my medical textbook that using an electronic fetal monitor during delivery did not reduce the most serious complication (cerebral palsy) of hypoxia, and in fact, using the fetal monitor only increased the risk of unnecessary C-sections. It should also be noted that fetal scalp abscesses and soft tissue injuries as a result of electronic fetal monitoring runs slightly less than 5%.

"In 12 prospective, randomized, controlled trials involving more than 55,000 infants worldwide, electronic fetal monitoring appears to have little benefit with respect to perinatal mortality and long-term neurologic outcome. The prevalence of intrapartum fetal asphyxia is in the order of 2%. Most of these children have no evidence of brain damage. Despite the 'intensive obstetrics' of the past 25 years, with increasing attention to perinatal care, reduction of birth trauma, the greater use of Cesarean section for high-risk deliveries, the frequency of cerebral palsy remains unchanged. There is a pressing need to inform the public, as well as medical professions, that cerebral palsy is not often caused by events during labor, and that the cause in most cases is unknown." (1)

Armed with this knowledge, I was ready to convince my obstetric mentor that he needed to change his ways to a more holistic approach (i.e., less medical approach). I brought up the fetal monitor subject, ready to show him the error in his ways, when he commented how unnecessary it usually was. He mentioned how he felt there was an overemphasis on using the fetal monitor in lieu of using clinical judgment and that he felt this led to errors, especially in assuming a failure to progress and shuttling a woman into the surgical room prematurely.

He told me about specific times when nurses would be freaking out over some reading on the fetal monitor when he knew good and well everything was all right, based on his three decades of clinical experience. He would try and insist the nurse turn off the fetal monitor so as to not let the mechanical readings of the machine distract them from the goal of a good delivery. But often the agitated nurse would threaten him, and he would end up complying, simply out of pressure regarding malpractice, and perform C-sections that he believed were not necessary.

Many MDs who would be open to holistic ideas and treatments often avoid them out of worry about legal repercussions in terms of medical board complaints and malpractice lawsuits. Some of the obstacles that exist in the integration of medicine and holistic methods lies not with the MDs themselves, but with the medicolegal authorities that seek to control the practice of medicine. Doctors perform their jobs within the stringent parameters set for them by governing boards and voracious attorneys ever ready to sink their teeth into their pocketbooks with claims of malpractice.

I admit the medical doctors I have worked with are involved in medical education and, therefore, are more current in their knowledge. They are also open to learning new things, so their willingness to understand and work with chiropractors may not reflect the profession as a whole. However, medicine has progressed in many ways in the past decade, and by and large this openness to holistic healing did not exist 10 years ago. MDs who disregarded everything holistic a decade ago now are quick to recommend glucosamine sulfate and other vitamins with a "more holistic than thou" attitude.

But many MDs are well-versed in holistic natural methods of healing. My undergraduate degree is in nutrition, and I consider myself well-versed in nutrition. But it was during one of my medical rotations that I learned about policosanol and its effects on cholesterol. An MD that I shadowed during my diagnostic hours used policosanol instead of Lipitor as an initial treatment for cholesterol.

Policosanol is an extract from sugar cane wax (the policosanol extracted from wheat does not appear to be effective for some reason). Numerous studies have proven its efficacy. One study showed that patients on policosanol found their LDL lowered 31.8%, their total cholesterol lowered 20.1%, and their HDL-C elevated 24.6%. When compared to various statin drugs, policosanol was more effective at lowering cholesterol while at the same time doing some things the cholesterol drugs were unable to do, such as reducing claudication, improving the ankle/brachial index, and reducing fibrinogen levels. (2,3) The most effective dose seems to be 20 mg/day. (4) However long-term studies on a high risk group (type 2 diabetics) over the course of a year, using only 5 mg/day, found similar results. (5) Policosanol has proven to be safe, effective, and well tolerated. While it's still not the norm, some MDs in clinical practice are using these natural methods before resorting to drugs.

Some nutrient therapy is as mainstream as it gets. Nacetyl cysteine (NAC) is used in every hospital and is available in every health food store in the country. It is used as a mucolytic in pulmonary medicine. It is also the gold standard for treating Tylenol poisoning in the emergency setting to prevent liver failure. (6) It has also proved effective in treating liver failure due to other types of poisoning, such as iron pill poisoning. (7,8) It also has been shown in several studies to improve lung function such as in cases of COPD (9) and pulmonary fibrosis. (10) Other studies show NAC offers hope in preventing acute renal failure. (11,12) However, despite this universal use of this specific nutrient, many MDs still are opposed to vitamin therapy as a main treatment, and it has not been many years since medicine as a whole was opposed to vitamin type therapy.

In contrast, nowadays more than ever, MDs are knowledgeable in nutrition and holistic methods. One can find well-respected MDs who are learning acupuncture and who know quite a bit about nutrition. Many of the others are eager to work with doctors who can perform spinal adjustments, acupuncture, and prescribe nutritional protocols. Also, many doctors are looking away from drugs to solve all patients' problems. Many MDs I have observed will discuss sleep hygiene instead of simply prescribing a pill to make a patient sleep, or discuss life-style changes to benefit type 2 diabetes, hypertension, anxiety, and constipation instead of simply handing out medications. Although it is simpler to whip out the prescription pad, lifestyle changes stand to benefit a patient more and result in fewer side effects and more control being placed in the patients' hands.

In some regards, perhaps MDs are less ready to prescribe than even holistic doctors might be. Many MDs are very reticent to prescribe strong pain medications in situations that I might feel more liberal in helping control a patient's severe pain. Indeed, in some regards the pendulum is shifting in terms of MDs being mere pill pushers. As research casts doubt on the efficacy of certain pharmacologic treatment regimens, doctors are becoming less ready to prescribe pills as a sole method of treatment. As mentioned previously, since current research casts doubt on the efficacy of antibiotic treatment of inner ear infections over the long run, (13) some pediatricians are moving away from using antibiotics as the treatment for some ear infections. This is a huge turnaround from standard medical treatment a decade ago.

The program by UHSA (University of Health Sciences-Antigua) has been a good method for me to get this additional training and insight. This training is advancing my chosen career path as a healer to patients. UHSA accepts some basic sciences as transfer credits from chiropractic school in subjects such as anatomy, microbiology, etc. Chiropractors must take some additional courses in the basic sciences such as diagnosis, pharmacology, and pathology before beginning the clinical training. Dentists, oral surgeons, veterinarians, and podiatrists have less basic sciences since they have already taken extensive training in pharmacology and similar courses.

Beyond basic sciences, the clinical section of the UHSA program itself totals 4,400 hours of which about 700 hours are done online via the internet as real-time interactive classes with instructors, classmates, and homework. The remaining 3,700 hours are hands-on supervised clinical hours performed in hospitals, covering subjects such as surgery, pediatrics, obstetrics, gynecology, family medicine, internal medicine, psychiatry, and various electives. Graduates do well on national boards and are having little problem getting into residencies all around the country. UHSA graduates are licensed in most states. My medical instructors have rated me highly and deemed me as competent as any of the other medical students they teach. My mentors have stated my clinical ability is higher than most medical students they have taught, in large part due to the decade plus of clinical experience I have already had as a chiropractor. The program is ideal for a chiropractor who wants to gain additional training in a medical-based learning environment. Also, the training I received from the Council of Diagnosis and Internal Disorders has served me well in terms of knowledge on clinical diagnosis and testing. I feel the program will produce some excellent integrative doctors in the long run because it often attracts professionals who already have years of experience such as chiropractors.

I believe this integration of medicine and "alternative" methods will only continue as a trend, and soon DCs and MDs will work side-by-side on cases, value each other's opinions, and be of mutual benefit to patients. At present though, many MDs are still very resistant to chiropractors and holistic methods of treatment. But as evidence in support of these methods mounts and consumers eschew the side effects of drugs, many MDs will be willing to combine these methods into their patients' treatments.

The current buzzwords in medicine are "evidence-based care." In essence, this means that clinical research determines the best paradigms for treating patients, regardless of theory and assumptions. This is a relatively new approach to medicine. Some older and more common methods of treatment are being dropped, and new ones are being added as clinical results prove or disprove them. I find it ironic that a decade ago, the Council on Diagnosis and Clinical Disorders taught methods of treatment based on clinically based, peer-reviewed treatments; the majority of which were nutritionally based. In some ways, perhaps chiropractic was ahead of the curve in health care.

There is still much common ground to be gained between traditional medicine and holistic natural methods of health care. As they find this common ground, a synthesis no doubt will occur, perhaps resulting in a new brand of treatment protocols. Based on real-life clinical science and developing technologies, profound benefits await future patients.

REFERENCES

1) Hacker, Neville; et al. Essentials of Obstetrics and Gynecology, 3rd edition. W.B. Saunders and Co., 1998.

2) Castano G, Mas R, et al. "Effects of policosanol and lovastatin in patients with intermittent claudication: A double-blind comparative pilot study." Angiology, 2003; 54(1):25-38.

3) Castano G, Menendez R, et al. "Effects of policosanol and lovastatin on lipid profile and lipid peroxidation in patients with dyslipidemia associated with type 2 diabetes mellitus." Int J Clin Pharmacol Res, 2002; 22(3-4):89-99.

4) Arruzazabala ML, Molina V, et al. "Antiplatelet effects of policosanol (20 and 40 mg/day) in healthy volunteers and dyslipidaemic patients." Clin Exp Pharmacol Physiol, 2002; 29(10):891-7.

5) Mas R, Castano G, et al. "Long-term effects of policosanol on older patients with type 2 diabetes." Asia Pac J Clin Nutr, 2004; 13(Suppl):S101.

6) Hay JE. "Acute liver failure." Curr Treat Options Gastroenterol, 2004; 7(6):459-468.

7) Daram SR and Hayashi PH. "Acute liver failure due to iron overdose in an adult." South Med J, 2005; 98(2):241-4.

8) Eisen JS, Koren G, et al. "N-acetylcysteine for the treatment of clove oil-induced fulminant hepatic failure." J Toxicol Clin Toxicol, 2004; 42(1):89-92.

9) Guerin JC, Leophonte P, et al. "Oxidative stress in bronchopulmonary disease: Contribution of N-acetylcysteine (NAC)." Rev Pneumol Clin, 2005; 61(1):16-21.

10) Lukas R, Scharling B, et al. "Administration of Nacetylcysteine and vitamin C to augment antioxidant protection in patients with chronic bronchitis." Dtsch Med Wochenschr, 2005; 130(11):563-7.

11) McCullough PA and Soman SS. "Contrast-induced nephropathy." Crit Care Clin, 2005; 21(2):261-80.

12) Venkataraman R. "Prevention of acute renal failure." Crit Care Clin, 2005; 21(2):281-9.

13) Mandel EM and Casselbrant ML. "Antibiotics for otitis media with effusion." Minerva Pediatr, 2004; 56(5):481-95.

by Dr. R. Lindsay Anglen
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Author:Anglen, R. Lindsay
Publication:Original Internist
Geographic Code:1USA
Date:Jun 1, 2005
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