Articles by JCS

Liberty or Death




Give Me Medical Liberty

             or

Give Me Medical Death

                          By

                         JCS

Never would I have imagined a presidential inauguration would pique my interest as a chiropractor. As a citizen who favors diversity, I certainly enjoyed President Obama’s second inaugural address, coinciding on MLK, Jr. Day, that resonated among Americans concerning his quest for equal rights for all citizens.

During a CNN interview the day before the inauguration, Dr. Deepak Chopra said Obama’s administration represented a doctrine of fairness. “Throughout his four years, he's wanted fairness, whether it's in economics or health reform or looking at the environment.”[1]

During his inaugural speech, the president equated watershed moments of women's rights and African-American rights to gay rights. No other president has ever mentioned gay rights alongside other movements that forged a more equal America.

Specifically, he mentioned three seminal events on the road to equality:

  1. Seneca Falls, New York, was where the first women's rights convention was held in 1848 that led to political rights for women, including the right to vote.
  2. In Selma, Alabama, state troopers fired on civil rights marchers in 1965 that solidified support for passage of the Voting Rights Act. 
  3. Stonewall was a gay bar in New York' s Greenwich Village where in 1969, patrons stood up to harassment in a police raid and became the signature moment of the gay rights movement.[2]

I would like to add another watershed moment in health rights that began in 1976—the Wilk et al. v. AMA et al.—when four brave chiropractors led by a bold attorney won an antitrust trial that broke the AMA’s grip of segregation in America’s public hospitals.[3]

Despite this seminal legal event, it did not translate into a free marketplace for chiropractors or freedom of choice for patients, not unlike the discrimination against African-Americans did not end with the Civil Rights Act of 1964.

Historically, the call for healthcare equality literally began in 1776 with Dr. Benjamin Rush, a Founding Father and Signer of the Declaration of Independence. He warned of the rise of a medical monarchy and thus the need for an amendment for medical freedom in the Constitution.

Dr. Rush, regarded as the father of American medicine, wrote:

"The Constitution of this Republic should make specific provision for medical freedom as well as for religious freedom. To restrict the practice of the art of healing to one class of physicians and deny to others equal privileges constitutes the Bastilles of our science. All such laws are un-American and despotic. They are vestiges of monarchy and have no place in a republic." [4]

As a chiropractor, I am extremely keen on the issue of medical freedom, an issue that will materialized in our society with the implementation of the Patient Protection and Affordable Care Act, aka, Obamacare, if the medical monarchy does not have its way, that is.

Just like other minorities fighting for equality, it is a little known fact that chiropractors have been the most prominent fighters for freedom of choice in healthcare and, for nearly a century, it was a war chiropractors were to fight alone.

According to historian Russell W. Gibbons, chiropractors felt the brunt as one of the first grass roots movements in America:

"…like abolitionists, chiropractors were systematically persecuted and driven from town to town. Like the feminists and suffragettes, chiropractors were made objects of ridicule. And like the civil rights workers of more recent times, chiropractors were intimidated and subverted by agents and provocateurs. In the finest tradition of reform movements, they were imprisoned for their beliefs." [5]

Few Americans realize 12,000 chiropractors were arrested 15,000 times in the first half of the 20th century, which was more than the number of black protestors arrested at Selma who marched with MLK, Jr.[6] Indeed, few people realize the price chiropractors paid in order to give patients a semblance of freedom of choice in healthcare.

Two Patient Protections

The Wilk v. AMA antitrust revealed the extent of illegal tactics used by the AMA’s infamous Committee on Quackery to “contain and eliminate chiropractic” and its policy to have competitors “wither on the vine” in terms of insurance coverage. The rise of political medicine was not a matter of being the best mousetrap in healthcare as much as having the strongest trap when Big Tobacco funded the AMA’s war chest beginning in 1930 until 1986. indeed, the AMA has many skeletons in its closet that the public as rarely seen.

But a new and more powerful turning point may finally materialize with the full implementation of two items in Obamacare with the so-called 80/20 Rule and Section 2706.

The Medical Loss Ratio provision of the Affordable Care Act, also known as the “80/20 rule”, requires insurers to spend at least 80% of each premium dollar on medical care and quality improvement, rather than on administrative costs, advertising, or executive salaries that cannot exceed 20%.

In some extreme cases, insurance plans spent more than 50 percent of every premium dollar on administrative costs that found many HMO CEOs making $10-14 million in salaries.[7]

Mr. Wendell Porter, the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin, testified before the U.S. Senate Committee on Commerce, Science and Transportation on June 24, 2009. Mr. Potter told Congress that the insurance industry had hijacked our health care system and turned it into “a giant ATM for Wall Street.”

 This exploitation typified the HMO’s creed during the past decade to ‘squeeze care to expand profits’. Mr. Porter testified, “I saw how they confuse their customers and dump the sick so they can satisfy their Wall Street investors.”[8]

With Obamacare, this 80/20 rule will end this downward spiral of payment for essential services, including chiropractic spinal care with the implementation of another patients’ rights guarantee, Section 2706.

Fundamentally, §2706 guarantees that the availability of essential services provided by a Doctor of Chiropractic, and other CAM providers, is equal to the availability of traditional medical care in all federally established or regulated plans in the new exchanges, and that any discriminatory policies adverse to patients and providers are eliminated.

In other words, Obamacare seeks to have free enterprise for the first time when all licensed practitioners compete fairly, a factor never before seen in healthcare. Indeed, equality is not a term the medical monarchists look upon favorably.

President Obama mentioned in his inauguration speech, “Together, we discovered that a free market only thrives when there are rules to ensure competition and fair play.”

The implementation of the 80/20 Rule and Section 2706 will bring fairness and diversity in the healthcare market place to increase treatment options for millions of Americans with rules of non-discrimination.

AMA Opposes Diversity

Certainly a conflict of ideas between MDs and chiropractors was inevitable, just as there are differences among religions, but this medical war turned malicious from the beginning because it was never fought in a professional manner with scholarly seminars, comparative clinical research studies, or inter-professional debates.

Instead, no leaf was left unturned in this campaign to “contain and eliminate chiropractic” the chiropractic profession.

Political medicine first used the courts to prosecute chiropractors for practicing without a license; it lobbied state legislatures until 1975 to resist licensing of chiropractors; fought against chiropractic educational improvements and student loans; and swayed the media via payola schemes to disparage the reputations of chiropractors.

According to Dr. David Stevens, member of the AMA’s illegal and subversive Committee on Quackery, “We weren’t out to be fair. We were advocates. Our job was to destroy chiropractic.” [9]

During his speech, Obama mentioned the injustices in healthcare: “We understand that outworn programs are inadequate to the needs of our time…We must make the hard choices to reduce the cost of health care and the size of our deficit…”[10]

But this redemptive action is now being threatened by the monolithic AMA in its opposition to the non-discrimination clause in Obamacare, namely Section 2706.

Despite the doctrine of fairness of the Obama administration or the will of Congress that passed the bill as well as the Supreme Court that ruled in favor of Obamacare, the American Medical Association continues to resist this diversity program with yet another anti-competitive position.

As evidence, the AMA’s House of Delegates at its annual meeting in June of 2012 adopted Resolution 241 to repeal Section 2706 of the Patient Protection and Affordable Care Act.

AMA Resolution 241 reads:

"[We ask that] our American Medical Association promptly initiate a specific lobbying effort and grassroots campaign to repeal the provider portion of the [Affordable Care Act’s] ‘Non-Discrimination in Health Care’ language, including direct collaboration with other interested components of organized medicine."

Once again the AMA finds itself on the wrong side of history. It’s rather peculiar that any organization nowadays would openly oppose a non-discrimination effort, but the AMA has never been known for its fairness, diversity, or egalitarian attitude toward other healing arts. Indeed, the AMA’s outward antagonism can be viewed as un-American by today’s standards of equality.

This action also proved Dr. Rush was prophetic when he said, “To restrict the practice of the art of healing to one class of physicians and deny to others equal privileges constitutes the Bastilles of our science.”

This anti-diversity stance has been the policy of the AMA for nearly a century, not unlike the white supremacists who opposed the Civil Rights Act of 1964. The similarity to white racists is not without merit since this is not the first time the AMA has openly exhibited its discriminatory policy.

In 2008, with then Senator Barack Obama’s impending election, the AMA finally apologized to black physicians for its history of excluding black physicians from membership, for listing black doctors as "colored" in its national physician directory for decades, and for failing to speak against federal funding of segregated hospitals and in favor of civil rights legislation.[11]

Albeit a contrite but late political gesture, I find it odd that the AMA’s apology did not automatically extend to all healthcare providers who have been subjected to the medical Bastilles, primarily the 12,000 chiropractors arrested on bogus charges.

In effect, while black physicians were forced to sit in the back of the medical bus, chiropractors were thrown under the same bus. Now Section 2706 will allow all CAM providers to sit wherever they want.

AHCPR Revisited


Resolution 241 also called for a “specific lobbying effort and grassroots campaign” to influence legislators. This is not the first time political medicine lobbied Congress after an apparent threat to its dominance by chiropractors.

During the President George H.W. Bush administration in 1989, the US Public Health Service created the Agency for Health Care Policy and Research (AHCPR) that was charged by an act of Congress to be a federal arbiter of evidence-based, clinical-practice guidelines for many common treatments, including acute low back pain, and to make recommendations.

The agency promised to improve the quality of health care by helping to ensure that doctors would give patients the treatments evidence-based treatments and refrain from giving them care that could harm them.

By 1994, AHCPR issued its 14th guideline, a 170-page study entitled “Acute Low Back Pain in Adults.”[12] What angered political medicine the most about the AHCPR study was its findings confirmed the rare need for surgery (1 in 100 cases) except in the most severe cases (fractures, cancer, serious infections, or cauda equina) or those cases that did not respond to conservative care. Moreover, spinal manipulation was recommended as a “proven treatment.”

After the AHCPR study, the “back surgeons went wild” according to author Shannon Brownlee:

"But when the AHCPR’s panel concluded that there was little evidence to support surgery as a first-line treatment for low back pain, and that doctors and patients would be wise to try nonsurgical interventions first, back surgeons went wild." [13]

The surgeons in the North American Spine Society (NASS) could not accept the shocking recommendation by a federal agency for spinal manipulation over traditional medical treatments (narcotic drugs, epidural injections, disc surgery).  To rub salt in this NASS wound, the AHCPR panel was headed by an orthopedic surgeon, Stanley Bigos, MD, so they could not vilify him with trash talk as they might have any other type of doctor.

Furious at the release of the AHCPR guidelines, the NASS created a bogus third-party advocacy group, the Center for Patient Advocacy, whose main goal was to get it de-funded.  In reality, this was not an actual “patient” group, but were members of NASS formed by Neil Kahanovitz, MD, a back surgeon from Arlington, Virginia.

The surgeons found sympathetic ears among House Republicans, led by Speaker Newt Gingrich, who were prepared to believe the worst about the agency after the failed Clinton Health Care Reform Act in 1993-1994. The AMA used its political punch to gut the AHCPR, which today is out of the guideline business and reauthorized with a new mandate and name—the Agency for Healthcare Research and Quality (AHRQ).

Despite the mounting evidence against spine surgeries based on an outdated discogenic theory, once this AHCPR recommendation was killed, between 2002 and 2007 back surgeons again “went wild” with a 15-fold increase in the most complex type of back surgery[14] and pain management clinics went wild with another discredited treatment, opioid narcotic painkillers, evident by a 600 percent increased between 1997 and 2007.”[15]

With this political overthrow of AHCPR in mind, it came as no surprise that the AMA once again would defy the will of Congress with Resolution 241.

While the Wilk trial, AHCPR, and Obamacare were steps in the right direction to cast off the chains of medical oppression, medical monarchists still actively oppose such fairness and diversity in healthcare. Just as racism and sexism linger on in our culture, so does medical dominance to thwart evidence-based healthcare, provider equality, and patient choice.

As Dr. Rush might have said if he were alive today, “All such laws [resolutions] are un-American and despotic.”

Trend to CAM

This non-discrimination clause was championed by Sen. Tom Harkin (D-IA), a long-time friend of CAM who was instrumental in the creation of the Office of Alternative Medicine, which later became the National Center for Complementary and Alternative Medicine in 1992.

The AMA’s objection to competition was to ensure that medicine was based on science, according to an article in the Boston Globe, “Senators Seek Coverage for Alternative Therapies.”[16] This alibi was similar to the smokescreen excuse of “public safety” used by the AMA in the Wilk trial that the judge opined was not “objectively reasonable.”

Senator Harkin came to the defense of CAM in Obamacare when he said at a congressional hearing that “It’s time to end the discrimination against alternative healthcare practices.”[17]

Of course, this met with strong criticism from medical chauvinists like Dr. Harriet Hall, a retired Air Force flight surgeon and a member of the notorious Institute for Science in Medicine, a sham organization that produces only anti-CAM articles while ignoring the unscientific nature of medical care itself. She worried that “ill-informed members of Congress will elevate practitioners of alternative medicine to the same level as medical doctors.” [18]

As chairman of the Office of Alternative Medicine for the past 16 years, undoubtedly Sen. Harkin must have been rather offended at her chauvinistic remark that he is “ill-informed.”

Apart from Sen. Harkin, the non-discrimination clause was also the result of public demand evident by the growing popularity of CAM by people who seek non-medical care despite the lack of insurance coverage in many cases that forces them to pay out-of-pocket.

Obamacare is not the first time the popularity of CAM practitioners has been revealed. The first surveys concerning CAM usage in the 1990s shocked the medical profession after a landmark study by Dr. David Eisenberg from Harvard’s Osher Institute revealed Americans made more visits to complementary and alternative (CAM) providers than MDs.

Baby Boomers made 427 million office visits to non-MDs in 1990 compared to 388 million visits to MDs; the follow-up survey in 1997 revealed that the numbers to non-MDs rose to 629 million while the numbers to MDs went down to 386 million.[19]

These two studies stunned the medical world, shocked why Americans would choose, in their own words, alternative “quacks” over “modern medicine.” Apparently the threat to the monolithic medical profession was bigger than anyone had imagined once the Harvard researchers took a closer look.

Upon seeing the huge number of Americans using CAM practitioners, Dr. Eisenberg admitted, “Maybe ‘alternative’ isn’t so alternative anymore.”[20]

The U.S. Health Disadvantage

If this trend to CAM continues, the medical profession may finally take a back seat in the medical bus, reminiscent of Jackie Robinson who broke the segregation barrier in Major League Baseball that has led to a radical change in the racial diversity of players.

Perhaps for the first time, an ounce of CAM prevention will be worth more than a pound of medical cure. Indeed, once the AMA’s “wither on the vine” policy is eliminated by Section 2706, CAM may surpass the medical profession as the America’s foremost healthcare providers as the stats show.

And it could not come any sooner considering the dire situation of American healthcare.

While the United States may have the most expensive, high-tech healthcare system in the world, the general health of the U.S. population is lower than most industrialized countries, a trend established since the 1980s. The countries in the comparative analysis include Canada, Japan, Australia, France, Germany, and Spain.

This sad fact was confirmed again in a 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council that compared death rates and health measures for people of all ages, including American youths.

The panel dubbed the pattern of higher rates of disease and shorter lives “the U.S. health disadvantage.” American men in 2012 now rank last in life expectancy among the 17 countries in the study, and American women rank second to last.[21]

“Something fundamental is going wrong,” said Dr. Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University. “This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”[22]

Without a doubt, the core of this huge health problem can be laid at the doorstep of the AMA itself as the foremost hindrance to free enterprise, diversity, and progress in healthcare. The era of “wonder drugs” and “heroic surgery” has simply not panned out as clinically or cost-effective as solutions to American healthcare problems.

What Dr. Woolf inexplicably fails to see—the proverbial 800-pound gorilla in healthcare—is the medical monopoly over the past century with its limited perspective on healthcare has fought tooth and nail against any and all competition with different ideas that might allow for a better mousetrap.

This is not the first time American healthcare has taken a blow from researchers.  The World Health Organization released on June 21, 2000, the “World Health Report 2000—Health Systems: Improving Performance.”[23]

This study ranked America 37th out of the 191 countries in the United Nations in overall healthcare delivery systems, 72nd in overall population health, while #1 in overall cost.

President Obama addressed this problem in 2009 when he stated, “If we do not fix our health care system, America may go the way of General Motors; paying more, getting less, and going broke.” [24]

At least GM has survived, but if the AMA succeeds with its Resolution 241, Americans will have no choice in treatment alternatives, they will continue to pay more while getting lesser results than most countries, and going broke considering medical bills are now the second-leading cause of personal bankruptcy.[25]

Chiropractors to the Rescue


Ostensibly, Resolution 241 appears politically-incorrect and reprehensible in this era of equality and flies in the face of Obama’s effort to improve the dismal medical system now in place.

Americans desperately need medical liberty or else we will continue to see more medical deaths if Resolution 241 is successful. Indeed, this “U.S. health disadvantage” will remain embedded in the unsuspecting American society as long as the AMA opposes freedom of choice in healthcare.

President Obama noted this impasse when he declared, “We understand that outworn programs are inadequate to the needs of our time…”[26] In terms of spinal care, certainly the medical methods of narcotic painkillers, epidural shots, and spine surgeries are “outworn programs” that have failed miserably for the 85% of mechanical back pain cases.

Mark Schoene, editor of an international spine research newsletter from Georgetown University also criticized the outworn medical spine methods when he wrote, “Spinal medicine in the US is a poster child for inefficient spine care.”[27]

Just as with global warming, the science is in and chiropractic care has proven to be at the top of the heap as Dr. Tony Rosner, PhD, testified before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[28]

Chiropractors will come to the rescue once Obamacare reaches full implementation since it will require 100,000 more primary care physicians to handle the influx of another 50 million patients into an already over-burdened and broken healthcare system, an increase the medical profession has already said it is unable to handle.

The enormity of back pain is more than people realize according to Scott Haldeman, MD, DC, PhD. “Spinal disorders have a greater impact than HIV/AIDs, malaria, lower respiratory infections, stroke, breast and lung cancer combined, Alzheimer’s disease, diabetes, depression or traffic injuries.”[29]

Back pain will strike most of the 250 million American adults sometime in their lifetime.[30] For example, nearly one-third of adults will suffer daily with low back pain, which equates to 92.5 million people; two-thirds of adults will have a back attack within the year, which equates to 190 million; and 85% or 212.5 million adults will have a severe back attack in their lifetime, 20% will describe their pain as severe and crippling.[31]

When low back pain is combined with neck pain, these painful spinal disorders are second only to ischemic heart disease in its impact on the global burden of disease according to Dr. Haldeman, a leading spine expert.

This is yet another way the 80,000 chiropractors, which today constitute the third-largest, physician-level health profession in the country, could improve this dire U.S. disadvantage with their superior diagnostic and clinical skills in spine care.

Due to the historical medical antipathy
by medical schools toward manipulative spine care, many spine researchers have stated that medical primary care physicians are typically inept in their training on musculoskeletal disorders,[32] prone to ignore recent guidelines that do not recommended narcotics,[33] and more likely to suggest spine surgery than surgeons themselves.[34]

As America’s primary spine care providers[35], chiropractors can ease this burden of musculoskeletal disorders, helping millions of patients that, in turn, will save billions of dollars.

Give Me Liberty, Finally

Since President Obama seeks to “make the hard choices to reduce the cost of health care and the size of our deficit,”[36] the role of chiropractors has become more important than ever before.

This era of fairness symbolizes the Obama administration for many minorities—women in the military, gay/lesbian, racial minorities—and now will include CAM practitioners once Section 2706 takes effect.

As shown, this will not come without a continued battle by the “medical monarchy.” Dr. Rush also foresaw what has materialized today in American healthcare—the formation of a medical “undercover dictatorship”—that prophetically described his own profession:

"Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship." [37]

Ironically, even George Washington fell victim not to an English soldier’s bullet or an officer’s sword in combat, but to the medical “undercover dictatorship” that Dr. Rush cautioned.

Dr. Rush, a surgeon in the Continental Army, may have attributed to Washington’s death because one of Rush's students was at Washington’s bedside.[38] Like many allopaths at that time, Rush was a proponent of blood-letting and convinced that all diseases were essentially caused by fever—the roots of the “bad blood” mindset that still prevails today.

At Mount Vernon you can visit Washington’s bedroom where he succumbed while suffering from a sore throat, still staged with blood-letting implements as it was when he died.[39] Perhaps if President Washington had medical freedom he might not have died so soon after retiring as president.

Just as hundreds of thousands of Americans today are injured or die from medical iatrogenesis, the example of Washington’s death illustrates that even our most notable president was not immune from medical mistakes, the unscientific nature of medical care itself, or the lack of medical freedom.

An American Revolutionary leader and orator, Patrick Henry, had the makings of a chiropractor opposed to medical tyranny when he said, “Give me liberty or give me death.” Little did he know his challenge was to be taken both literally and figuratively 237 years later in American healthcare.


 

 

 

[1] CNN, More Coverage of Inauguration Preparations and Events; Obama Sworn in for Second Term; Inaugural Events in Full Swing, January 20, 2013
[2] Moni Basu, Obama embraces key social justice movements in inaugural address, , CNN, January 21st, 2013
[3] Chester A. Wilk, James W. Bryden, Patricia A. Arthur, Michael D. Pedigo v. American Medical Association, Joint Commission on Accreditation of Hospitals, American College of Physicians, American Academy of Orthopaedic Surgeons, United States District Court Northern District of Illinois, No. 76C3777, Susan Getzendanner, Judge, Judgment dated August 27, 1987.
[4] ER Booth, History of Osteopathy and Twentieth Century Medical Practice, Cincinnati: Caxton Press, 1905 (1924):312.
[5] Russell W Gibbons, “Go to Jail for Chiro,” Journal of Chiropractic Humanities 4 (1994): 61–71.
[6] Russell W Gibbons, “Go to Jail for Chiro,” Journal of Chiropractic Humanities 4 (1994): 61–71.
[7] Medical Loss Ratio: Getting Your Money's Worth on Health Insurance, HealthCare.gov, Sept. 15, 2012.
[8] Testimony of Wendell Potter Before the U.S. Senate Committee on Commerce, Science and Transportation, June 24, 2009
[9] Ibid. p. 3055
[10] Obama: 'It is now our generation's task to carry on what ... pioneers began', Obama’s Inaugural Speech, Posted by CNN Political Unit , January 21st, 2013
[11]Kevin B. O'Reilly, AMA apologizes for past inequality against black doctors, Black physician leaders welcome the apology but call for more efforts to diversify the physician work force and reduce racial health disparities, amednews.com July 28, 2008.
 [12] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)
[13] S Brownlee, “Newtered,” Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, http://overtreated.com/extras01.html
[14] J Silberner, “Surgery May Not Be The Answer To An Aching Back,”  All Things Considered, NPR (April 6, 2010)
[15] CNN Presents: Deadly Dose, aired November 18, 2012
[16] M Kranish, “Senators Seek Coverage For Alternative Therapies,” Boston Globe, (July 24, 2009)
[17] Ibid.
[18] Ibid.
[19] DM Eisenberg, RC Kessler, C Foster, FE Norlock, DR Calkins, TL Delbanco, “Unconventional  Medicine In The United States--Prevalence, Costs, And Patterns Of Use,” N Engl J Med 328 (1993):246-252.
[20] DM Eisenberg, “Practicing within Mainstream Healthcare,” seminar held at the Massachusetts Medical Society headquarters, Boston, Nov. 18, 2006.
[21] Sabrina Tavernise, For Americans Under 50, Stark Findings on Health, NY Times, 1/15/2012.
[22] Sabrina Tavernise, ibid.
[23] WHO: The World Health Report 2000—Health systems: Improving performance. June 21, 2000.
[24] Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch
[25] Catherine Arnst, “Study Links Medical Costs and Personal Bankruptcy, Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance,” Business Week, June 4, 2009.
[26] Obama: 'It is now our generation's task to carry on what ... pioneers began', Obama’s Inaugural Speech, Posted by CNN Political Unit , January 21st, 2013
[27] The BACKPage editorial vol. 27, No. 11, November 2012.
[28] Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.
[29]  Scott Haldeman, Analysis of Global Burden of Disease Study 2010 Impact of Spinal and MSK Disorders
[30] The Burden of Musculoskeletal Diseases in the United States Bone and Joint Decade, Copyright © 2008 by the American Academy of Orthopaedic Surgeons. ISBN 978-0-89203-533-5, pp. 21.
[31] Scott Haldeman DC, MD, PhD, FRCP(C) and Simon Dagenais DC, PhD. A supermarket approach to the evidence-informed management of chronic low back pain. The Spine Journal, vol. 8, Issue 1, January-February 2008, Pages 1-7.
[32] Elizabeth A. Joy, MD; Sonja Van Hala, MD, MPH, “Musculoskeletal Curricula in Medical Education-- Filling In the Missing Pieces, The Physician And Sports Medicine,” 32/ 11 ( November 2004).
[33] PB Bishop et al., “The C.H.I.R.O. (Chiropractic Hospital-Based Interventions Research Outcomes) part I: A Randomized Controlled Trial On The Effectiveness Of Clinical Practice Guidelines In The Medical And Chiropractic Management Of Patients With Acute Mechanical Low Back Pain,” presented at the annual meeting of the International Society for the Study of the Lumbar Spine Hong Kong, 2007; presented at the annual meeting of the North American Spine Society, Austin, Texas, 2007; Spine, in press.
[34] SS Bederman, NN Mahomed, HJ Kreder, et al. In the Eye of the Beholder: Preferences Of Patients, Family Physicians, And Surgeons For Lumbar Spinal Surgery,” Spine 135/1 (2010):108-115.
[35] Donald R Murphy, Brian D Justice, Ian C Paskowski, Stephen M Perle, Michael J Schneider, The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States, Chiropractic & Manual Therapies 2011, 19:17
[36] Obama: 'It is now our generation's task to carry on what ... pioneers began', Obama’s Inaugural Speech, Posted by CNN Political Unit , January 21st, 2013
[37] Ibid.
[38] http://www.fandm.edu/benrush/who-was-benjamin-rush
[39] http://www.fandm.edu/benrush/who-was-benjamin-rush


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