Articles by JCS

Reform or Revolution

 

 “If we do not fix our health care system,

America may go the way of General Motors;

paying more, getting less, and going broke.” [1]

President Barack Obama

Reform or Revolution

Arguably, the medical armamentarium of wonder drugs and heroic surgery has led to limited success with crisis care in America’s emergency rooms. Although this apparent success sensationalized by dramatic television programs embellished the positive aspects of medical care, it also has it downside. The out-of-control nature of medical profiteering has also led to massive prescription drug usage, abuse, and addiction; the overuse of antibiotics has led to super germ infections; and the high percentage of unnecessary, ineffective, and costly surgeries that makes one question the overall value of this so-called modern era of medicine that has taken America to the brink of bankruptcy.

The amount spent per person increased 77 percent between 1995 and 2005 according to the California Health Care Foundation.[2] The government statisticians estimated that health costs will reach $13,100 per person in 2018, accounting for $1 out of every $5 spent in the economy.

Health care reform is undeniably urgent to stave off the impending national bankruptcy, but what is eventually required is a revolution on how Americans perceive health care itself. Until this important paradigm shift occurs, we will only be throwing good money in after bad.

Moreover, television programs and the news media have created a public illusion that sickness care is health care when, actually, this is a misnomer inasmuch as allopathy has little to do with health maintenance and disease prevention. At best, allopathy offers early diagnostic detection such as PAP smears, mammograms, PSA tests, etc., but these are not preventative. Even vaccines that are deemed preventative were principally the creation of homeopathy, not allopathy. The recent emphasis on nutrition came after decades of indifference by medical care after decades of suppression of naturopathy, the original hygienic healthcare profession that Fishbein and the Flexner Report condemned as quackery.

President Obama said during his March 24, 2009 press conference that solving the healthcare crisis is imperative to solving the country’s overall financial crisis; “in fact, the biggest driver of long-term deficits are the huge health care costs that we’ve got out here that we’re going to have to tackle …”[3]

If President Obama and Americans are to “tackle” this healthcare dilemma, first we must realize the present healthcare crisis is not by accident but the design of a powerful medical cartel consisting of AMA, Inc. and its allies, the HMOs, Big PHARMA, and Big Hospital chains like Hospital Corporation of America (HCA, Inc.), all stakeholders in the present private healthcare system making billions in profits at the expense of sick patients forced into an expensive medical system rated low by the World Health Organization (WHO).

Undeniably, there are many issues involved in the healthcare reform:

  • expense (1 of every 5 dollars will be spent on healthcare),
  • inaccessibility (75 million are uninsured or under-insured),
  • inflation (double-digit increases on insurance premiums),
  • deniability (restrictions for pre-existing conditions),
  • restrictions (limits in service and types of providers) and, most of all,
  • the general ineffectiveness of the allopathic methods that have led to the WHO’s dismal statistics.

Indeed, for all the research, money and effort put into healthcare in America, we certainly do not have much to brag about and the medical cartel is not saying much either. Just as Detroit had great difficulty steering away from gas-guzzling SUVs, so too has the AMA had trouble swallowing the fact that more drugs and more surgeries are not the answer to this healthcare crisis.

The U.S. is in dire straits according to The Commonwealth Fund, a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency:

“Even more troubling, the U.S. health system is on the wrong track...Of greatest concern, access to health care has significantly declined. As of 2007, more than 75 million adults—42 percent of all adults ages 19 to 64—were either uninsured during the year or underinsured, up from 35 percent in 2003. At the same time, the U.S. failed to keep pace with gains in health outcomes achieved by the leading countries. The U.S. now ranks last out of 19 countries on a measure of mortality amenable to medical care, falling from 15th as other countries raised the bar on performance. Up to 101,000 fewer people would die prematurely if the U.S. could achieve leading, benchmark country rates.”[4]

Obviously the medical profession must admit, just as Wall Street and Detroit executives pled guilty, to the fact that under its control, the American capitalistic healthcare industry is in shambles.

The consequences for the lack of evidence-based treatments in the U.S. are disturbing. This nation spends 2 1/2 times as much as any other country per person on health care. Yet middle-aged Americans are in far worse health than their British counterparts, who spend less than half as much and practice less intensive medicine, according to a new study.[5]

“The investment in health care in the U.S. is just not paying off,” argues Gerard Anderson, director of the Center for Hospital Finance & Management at Johns Hopkins’ Bloomberg School of Public Health.[6]

“A lot of things we absolutely believe at the moment based on our intuition are ultimately absolutely wrong,” says Paul Wallace, of the Care Management Institute. “There is a massive amount of spending on things that really don’t help patients, and even put them at greater risk. Everyone that’s informed on the topic knows it, but it is such a scary thing to discuss that people are not willing to talk about it openly.” [7]

Tom Delbanco, chief of general medicine at Beth Israel Deaconess Medical Center answered that question: “We are beginning to see a battle for the dollars.”[8]  

The present healthcare reform is proof of this battle for dollars. The AMA was clear from the beginning it opposed comparative effectiveness studies that would reveal which treatments worked best. In the past when these studies were complete and medical methods proved least effective, AMA, Inc. cried out, “We’re not going to let bureaucrats tell us how to practice medicine.”

The proof now shows that the medical management of back problems — drugs, shots, and surgery — are for the most part ineffective, costly, and adding to this huge waste of money. It is also no secret among the public that back surgeries are risky, expensive and disabling, but often people are forced into them because their insurance does not cover chiropractic care.

Patients often ask why their insurance company and workers’ compensation programs discriminate against chiropractic care; even when included in the coverage, only chiropractic care is severely limited. For example, the federal Blue Cross/Blue Shield allows only 12 office visits to chiropractors, but 75 to physical therapists and unlimited to MDs for drugs or to surgeons to treat the same condition of low back pain.

This discrimination has nothing to do with clinical or cost-effectiveness. Just a few years ago, the insurance companies told patients chiropractic care was not covered because it was allegedly “unproven, dangerous, or experimental.” Now that research has disproved all three allegations, the real reason has surfaced; in fact, the biggest rap against chiropractors now is, ironically, they are too cheap.

This broaches an issue that is the root cause of healthcare reform in America – money as the main motivator rather than scientifically-based evidence guidelines.

As all business owners know, workers’ compensation insurance is a very expensive program and, when used, employers are penalized with higher rates. This is especially true if the workers’ compensation carrier is a “for-profit” insurer as opposed to “self-insured.” Most employers do not realize that these carriers work on a “cost-plus” basis, which explains why these insurers are not concerned about increasing expenses. They simply charge higher premiums to cover their cost that, in turn, gives them more money to invest, which is where they make their profits in this capital market.

This for-profit, cost-plus incentive is the leading economic reason why the better mousetrap concept is being ignored in health care. Medical economists such as Clement Bezold, PhD, of the Institute for Alternative Futures, deem this incentive as a “perverse motivation.”[9]  This cost-plus, perverse motivation is one reason why workers’ compensation insurance is so expensive — there is no real incentive on the insurers’ parts to decrease costs. Simply put: higher gross cash flow = higher percentage take.

Not only do insurances dislike the “ounce of prevention,” but they also dislike the “ounce of cure.” It appears for-profit insurance companies are willing to pay for expensive procedures that lack evidence, but refrain from non-medical methods like manipulative therapy because in the perverse for-profit system, the more they pay out for drugs, shots or surgery, the more they can charge in premiums to invest, so the more they profit. Indeed, there is no incentive to use the cheaper mousetraps in medicine, and there is no incentive to slow down the number of surgeries in our for-profit healthcare system.

In 2006, doctors performed at least sixty million surgical procedures of all types, one for every five Americans. No other country does nearly as many operations on its citizens. Over hundred thousand people die each year from complications of surgery — far more than die in car crashes; deaths from prescription drugs now ranks 4th only to cancer, heart disease, and diabetes, and when added to deaths from botched surgery, over 3,000 Americans die weekly, making medical malpractice the third-leading cause of death in America.[10]

The looming question Congress must ask these “guardians of health” during this healthcare reform: why are American health statistics so poor considering we spend more money per capita than any other country and have supposedly the best doctors, the best medical schools, and the best teaching hospitals in the world?

It would seem logical if Americans spend the most on healthcare that we would have the healthiest citizens and best healthcare system in the world, but we do not. But, according to the World Health Organization, in 2000 the USA ranked #1 in cost, #72nd in population health, #37th in healthcare delivery and the fact that 48 million Americans have no coverage. [11]

In contrast, France ranked #4, #4, and #1, with only 1% uninsured.[12] Obviously the French are getting more bang for their francs than we are getting for our dollars despite the fear-mongering in the media about socialized medicine.

A 2010 analysis by The Commonwealth Fund, a nonprofit fund that conducts research into healthcare performance, found America at the bottom of its list of six nations. The Fund concluded Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system. The United States ranked last when compared to six other countries -- Britain, Canada, Germany, Netherlands, Australia and New Zealand. The U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia.

The current report used data from nationally representative patient and physician surveys in seven countries in 2007, 2008, and 2009. In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey. Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.

This is a big rise from 2007, which found Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product. The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage.[13]

Julie Gerberding, MD, MPH, former director of the Centers for Disease Control and Prevention (CDC), estimates of the $2.4 trillion spent on health care in the U.S. each year, the overwhelming majority goes toward treatment of ill patients, and less than 5% goes toward keeping Americans healthy.[14] Is it any wonder Americans are so sick when there is no financial support for the ounces of prevention or cures?

Obviously our system is reactive rather than proactive — ostensibly like dentistry without toothpaste. If the $20 billion spent on painkillers by Medicare and insurance companies was spent on better nutrition, preventative spinal care, and anti-inflammatory supplements, imagine the improvement we would see in healthcare instead of a drug-laden, addicted society on Vicadin and OxyContin.

Whether or not a capitalistic profit motive can produce a healthcare delivery system that benefits the patients rather than the medical cartel consisting of doctors, hospitals, HMOs, and drug companies, will be seen after healthcare reform is implemented, but if history has taught us anything with the current healthcare system, the patient will again come out on the short end.

If you recall, Morris Fishbein’s two main compulsions were to fight socialized healthcare and quackery. His battle during the 1940s with Kaiser’s community-based healthcare system was threatening to the AMA’s goal to maintain a for-profit system that benefited the physicians to the demise of the patients, and that battle continues today in the healthcare reform. Fishbein also fought against “quackery” which in today’s terms would be wellness and holistic methods aimed at disease prevention espoused by naturopaths and chiropractors.

In both cases, Fishbein’s policies proved to be detrimental to the overall health of Americans. Indeed, it has become more obvious that the AMA, Inc. is not interested in helping more patients with treatments that are evidence-based and cost-effective, but solely interested in more profits. As history has shown, according to AMA, Inc. there are right ways to get well (drugs and surgery), and wrong ways to get well (everything else).

Also quite obvious during the health care debate on Capitol Hill was the absence of any public hearing with the executives of the medical cartel as we saw with the grilling of the Detroit automotive executives and Wall Street tycoons. This glaring omission begs the question why these medical executives in the AMA and its cartel were not embarrassed by holding their feet to the fire and asked why Americans pay the most for poor health results.

The medical cartel has never admitted its failings similar to the Detroit auto manufacturers who built gas-hog SUVs during an oil crisis or the tycoons on Wall Street who watched their industry collapse from their shady sub-prime mortgage deals or its risky derivatives and credit default swaps. Just as the American public bailed out both Detroit and Wall Street, now we find ourselves bailing out AMA, Inc. in this healthcare reform paying literally with high insurance premiums and figuratively with poor health statistics.

The AMA has been strangely quiet in this healthcare debate by avoiding the media and offering no explanations or solutions publicly, but we can be certain this fourth branch of government is twisting arms behind the scenes on Capitol Hill to keep the present system in tack; like the oil industry, it pays to be a monopoly that influences Congress with hundreds of millions in lobbying donations.

ATM for Wall Street

As the healthcare reform debate heated up, few news analysts still ignored the single largest factor that drives medical costs — the proverbial 800-pound gorilla that everyone seems to pay no heed to. We chiropractors know of its omnipotence because of its constant fighting with us little monkeys as patients throw billions of bananas to keep it fed and happy – the powerful Health Maintenance Organizations (HMOs).

Not only is this 800-pound gorilla insatiable, it also is an oxymoron since HMOs want nothing to do with real health maintenance rather than controlling a huge capital market for their own profit. In fact, HMOs refuse to pay for maintenance care! This irony is also prevalent in Medicare despite the call for preventative measures by the Obama administration.

Section 2251.3 of the (Medicare Carriers) Manual states that:
 “…[a] treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition is not a Medicare benefit. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered to be medically necessary under the Medicare program."[15]

This Medicare policy speaks volumes about the nature of the American “sick-care” policy as Senator Tom Harkin [D-Iowa] described.

“For many years I’ve been saying that we don’t so much have a health care system in America as a sick-care system.  If you’re sick, you get care.  Up to the point of sickness or disease -- you’re pretty much on your own. To date, wellness and prevention have been the missing pieces in the national conversation about health care reform.  It’s time to make them the centerpiece of that conversation.”[16]

Obviously Medicare like the HMOs has no interest in disease prevention and shuns the ounces of prevention or even the ounces of cure, such as chiropractic care for low back pain. This is more evident in the monies spent on sickness vs. wellness care. Last year, $2.4 trillion dollars were spent in this country on medical care, or 16.5% of the gross national product, and 95 cents of every dollar were spent to treat disease after it had already occurred.

 To put this into perspective, the U.S. spent twice as much on health as it did on food in 2006 — and more than China’s citizens consumed altogether. In addition, the increase in U.S. health care spending in the three-year period is more than the amount U.S. consumers spent on oil and gasoline during all of 2006 when energy prices began to reach new heights.[17]

Until America emphasizes and incentivizes preventative care, this nation will continue to see no light at the end of the healthcare tunnel no matter how many people are covered by insurance.

Author Stephen Covey in his book, The Seven Habits of Highly Successful People, wrote of the predicament that plagues American healthcare today:

It’s easy to get caught up in the “busyness” of life – an activity trap.  To work harder and harder at climbing the ladder of success only to realize it's leaning against the wrong wall.  If the ladder is not leaning against the right wall, every step we take just gets us to the wrong place faster.[18]

Indeed, medical care has been climbing up the wrong ladder (allopathy) on the wrong wall for decades now, focusing on crisis care rather than holistic, preventative methods.

Whistleblowers have now revealed the underbelly of this conundrum – the unethical dealings of HMOs – and now Mr. Wendell Porter has exposed the spurious actions of this seedy health insurance industry. Mr. Potter is the Senior Fellow on Health Care for the Center for Media and Democracy in Madison, Wisconsin, and he testified before the U.S. Senate Committee on Commerce, Science and Transportation on June 24, 2009.

Mr. Potter worked previously for CIGNA for 15 years and left last year after reading President John F. Kennedy’s “Profiles in Courage” and one of JFK’s favorite quotes by Dante that said, “The hottest places in hell are reserved for those who, in times of moral crisis, maintain a neutrality.” When he read that, he said to himself, “Oh, jeez, I’m headed for that hottest place in hell unless I say something.”

He had an epiphany when he realized “We have more people who are uninsured in this country than the entire population of Canada. And, if you include the people who are underinsured, more people than in the United Kingdom.”

He told Congress that the insurance industry has hijacked our health care system and turned it into “a giant ATM for Wall Street.” “I saw how they confuse their customers and dump the sick so they can satisfy their Wall Street investors.”[19]

The amount of misinformation stemming from the news pundits and politicians sponsored by the HMOs has made the reform debate virtually impossible to discuss since emotions belie the facts.  Whether it is cable news programs twisting the truth or vocal radicals disrupting town hall meetings, the opponents of progress will use any tactic to prevent reform.

As predicted by Wendell Potter, a campaign on conservative talk radio/TV has sparked fear among senior citizens that the healthcare bill will lead to end-of-life “rationing” and “euthanasia” to promote “death care,” and, in the words of anti-abortion leader Randall Terry, an attempt to create “death panels to kill Granny.”[20] None happen to be true, but they do cause emotional backlash, which is exactly what the insurance barons want.

To illustrate the power of the medical cartel, while the Wall Street bankers and Detroit auto manufacturers were pulled before Congress to have their feet held to the fire to explain why their industries failed, the medical cartel escaped similar accountability and embarrassment. Here are a few questions Congress should have asked but did not have the opportunity; as everyone knows, money speaks on Capitol Hill and money also maintains silence when necessary.

Congress needs to ask the insurance industry why its premiums are rising at double-digit inflation annually. Like pouring salt in a wound, the HMOs take 25-55% profit off the top[21], the top six HMO health plans paid 37 executives an average salary of $7.5 million [22], and then implemented a policy of “squeeze care to expand profits” to deny patient care and overwhelm practitioners with paperwork as they cut fees.

Considering what is at stake in the U.S. healthcare system, influencing Congressmen is foremost among the medical cartel. The following graph obtained from OpenSecrets.org shows the huge amount of money spent on lobbying over the last ten years (1999-2008). It should stagger your mind:

American Medical Assn

$208,472,500

American Hospital Assn

$172,940,431

PHARMA

$154,533,400

Blue Cross/Blue Shield

$120,491,385

Pharmaceutical Research and Manufacturers of America (PHARMA) has also spent $40 million lobbying Congress in the first few months of the Obama healthcare reform brokered a deal with the White House to give $80 billion in drug discounts to lower costs and, in return, PHARMA got an agreement that patients cannot import drugs from Canada and the American government will not negotiate drug prices as the Canadian government now does.[23]

Congress might also have asked about the extravagant spending on compensation packages for top pharmaceutical executives. The executive with the highest compensation package in the year 2000, exclusive of unexercised stock options, was William C. Steere, Jr., Pfizer's Chairman, who made $40.2 million. The executive with the highest amount of unexercised stock options was C.A. Heimbold, Jr., Bristol-Myers Squibb's Chairman and CEO, who held $227.9 million in unexercised stock options.[24] The seven top drug kingpins had an average salary of $20. 2 million.[25]

Congress should also have asked why medications were so expensive, such as 569,958% markup for Xanax 1 mg and a 224,973% markup for Prozac 20 mg.[26] Considering this profit margin, it does not come as a surprise that drug stores abound on prime lots in every town.

Congress needed to ask the hospital executives why almost no other business in America has such abusive pricing power as hospitals, including the power to keep charges secret from customers until they get their bills.

The Wall Street Journal described how non-profit hospitals have accumulated billions of dollars of untaxed profits on the theory that they are providing a public service while providing very little actual care to the uninsured. These hospitals also have little incentive or competitive pressure to be competent or cost effective as they live high on the hog of a captive audience.[27]

Another question Congress should have asked is why the top three hospital kingpins averaged $15.9 million each.[28] Most people cannot imagine the executive salaries in the HMO world. For example, Dr. William McGuire of United Health Care (UHC) earned an obscene $124.8 million per year plus a ridiculous $1.6 billion in unexercised stock options for 2005.[29]

Since the president of the USA makes only $400,000, which means McGuire made 312 times more money than the president of the United States, who runs much larger organizations — the entire U.S. federal government and the U.S. military — than UHC. Is this fair or is it just an example of the Ponzi scheme in American health insurance that has bankrupted the system?

The Wall Street Journal noted the huge incomes in healthcare in an article on April 3, 2009: “Health care industry top executives led the 2008 pay parade. The typical health care CEO took in $12,446,800 in total direct compensation for the year,”[30] which is 31 times what the U.S. president makes. Does this appear odd that such inequity exists or does it perfectly illustrate the cash cow of the insurance cartel?

This egregious compensation did not escape the comments of columnist Steven Pearlstein of The Washington Post:

Isn't it odd that a company could be so persnickety when it comes to pinching pennies from doctors and patients, and so cavalier when it comes to lavishing executives with hundreds of millions of dollars of shareholders' money? Or maybe it's not. Maybe what we have here is the most outrageous corporate scandal since Enron and WorldCom.[31]

The same greedy mindset on Wall Street prevails in the American capitalist version of healthcare where the goal is profits, not quality or affordable healthcare with access for all and safety nets for the poor—the premise of socialized medicine where governments believe, like public education, health care is for everyone, not just the wealthy.

According to Medscape writer Nancy Terry,

The single most important factor in the atrociously high cost of healthcare in the United States is the rapacious, money-hungry insurance companies and their fat cat CEOs. Commercial, for-profit health insurance is one of the greatest Ponzi schemes ever foisted on the public. The executives are the ones that benefit to the detriment of everyone else. How else does the president of one of the largest insurance companies get to be a billionaire? By being at the top of the pyramid of companies' and individuals' premium payments.[32]

The public remains unaware of these shysters since the health care insurance industry has not collapsed, yet. Instead of a $700 billion loan from Congress to keep Wall Street afloat, the HMO industry has been propped up by double-digit increases in healthcare premiums since 2000 as it “squeezes care to expand profits.”

U.S. Senator Daniel Patrick Moynihan during the Clinton Healthcare Reform testified that "there is no health care crisis" by stating "there is an insurance crisis."[33]

While “fat cat CEOs” are definitely to blame for the high costs in healthcare, they are not alone since other elements of the medical cartel including  AMA, Inc. that has virtually eliminated any healthcare competitors, as well as Big Pharma and Big Hospitals executives who all profit greatly from the inflated world of medical care.

To illustrate life at the top of this pyramid, consider again these salaries:

  • The top six HMO health plans paid 37 executives an average salary of $7.5 million.[34]
  • The 7 top drug kingpins had an average salary of $20.2 million. [35]
  • The top 3 hospital kingpins averaged $15.9 million.[36]

 

Considering the average salaries of these drug, hospital, and HMO kingpins, any surgeon’s compensation is pale in comparison although still shocking compared to working class salaries:[37]

  • Orthopedic Surgery $670,000
  • Foot & Ankle $791,000
  • Hand & Upper Extremities $770,000
  • Hip & Joint Replacement $715,000
  • Spine Surgery  1,352,000
  • Sports Medicine  $762,000
  • Anesthesiology/Pain Management $651,000

To put these salaries in perspective, in 2009, the mean salary for chiropractors was $94,454 according to a survey conducted by Chiropractic Economics magazine.[38]

This medical cartel is the 800-pound gorilla in this reform effort that will not simply let go of the billions of bananas it now consumes, which explains why the AMA has been strangely quiet on reform.

 

America is Not #1

Some mistaken cable news pundits still tell the public that the U.S. has the best healthcare system in the world. They claim America has arguably the best doctors, the best medical schools, and the best hospitals. But high-tech medical diagnostic tools or highly trained surgeons is not the issue. The real question is how well does the American healthcare delivery system actually work?

Inexplicably, these pundits failed to mention to their viewers that the United States ranks 43rd in infant mortality, 20th in life expectancy for women, and 21st in life expectancy for men, which is down from first in 1945 and 17th in 1960. While the United States has the most expensive, high-tech healthcare system in the world, the general health of the U.S. population is lower than most industrialized countries. [39]

Research articles on for-profit healthcare systems actually show when “the need for profits drive healthcare decision-making, mortality rates increase.” Research backed by The Commonwealth Fund compared the U.S. healthcare system with other nations and found the USA was far behind. [40]

In establishing their ranking, the researchers considered deaths before age 75 from numerous causes, including heart disease, stroke, certain cancers, diabetes, certain bacterial infections and complications of common surgical procedures. France did best with 64.8 deaths deemed preventable with timely and effective health care per 100,000 people. Japan had 71.2, and Australia had 71.2 such deaths per 100,000 people, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece Austria, Germany, Finland, New Zealand, Britain, Ireland and Portugal, with the United States last.

All of the countries except the United States have some form of a public healthcare system. “The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference” states Commonwealth Fund Senior Vice President Cathy Schoen. [41]

These facts did not escape the attention of President Obama:

Today, we are spending over $2 trillion a year on health care - almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren’t any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.”[42] (emphasis added)

President Obama has expressed the need of preventative care to offset the development of chronic disorders:

The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.

It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That's a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that's a lesson that we should work with local school districts to incorporate into their school lunch programs. [43]

Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. (emphasis added)

 

       This may be a challenge for many MDs who are not trained in preventative healthcare methods. In fact, the opposite is true – they have mocked and ridiculed those professions that are schooled in these concepts, such as chiropractors and naturopaths.

Now the need for preventative care is more important than ever according to President Obama.

Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions - cancer, cardiovascular disease, diabetes, lung disease, and strokes - can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. [44]

Again, only a few progressive MDs are interested in wellness care. Other than lip service, most MDs are content prescribing drugs and doing surgery because that is where the big money lies.

 As well, the epidemic of back pain should be added to his list of costliest disorders at $100 billion annually. The chiropractic profession has already saved billions of dollars in treatments and disability costs by treating millions of patients throughout the world with their low-cost and highly effective care for spinal and neuromusculoskeletal disorders.

Just imagine if the AMA had been successful in its goal to eliminate the chiropractic profession, the costs of the pandemic of pain would be astronomical today considering in the United States, musculoskeletal disorders (MSDs) alone currently effect 44.6 million Americans[45] and cost our society an estimated $267.2 billion every year, and when combined with all persons with MSDs in addition to other medical conditions, the cost of treatment in the 2002-2004 time period was estimated to be $849 billion per year.[46]

The problems facing America’s healthcare reform are not new nor are they likely to be solved as long as Americans are swayed by the medical profession that preaches the path to better health is paved with more drugs and more surgeries. Throwing more money at this medical mess will only lead to financial bankruptcy until Americans make a paradigm shift in its attitude about health.

President Obama spoke on the fear to change:

“To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact.

“And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There's a sense out there among some that, as bad as our current system may be, the devil we know is better than the devil we don't. There is a fear of change - a worry that we may lose what works about our health care system while trying to fix what doesn't.

“I understand that fear. I understand that cynicism. They are scars left over from past efforts at reform. Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made - such as Medicare, Medicaid, and the children's health insurance program - efforts at comprehensive reform that covers everyone and brings down costs have largely failed.

“Part of the reason is because the different groups involved - physicians, insurance companies, businesses, workers, and others - simply couldn't agree on the need for reform or what shape it would take. And another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists - opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.”[47]

       Most Americans fail to realize not only the huge economic impact of healthcare on this country, but many do feel the crunch from unpaid medical bills that caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers.[48] That was a 50% increase in the number of bankruptcies blamed on medical expenses since a similar study in 2001.  To the surprise of even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.[49]

The Harvard study underscored President Barack Obama’s argument for health-care reform legislation. In a letter to Democratic Senate leaders, the President said:

Health-care reform is not a luxury. It’s a necessity we cannot defer. Soaring health-care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need. [50]

“This study provides further evidence that the U.S. health care system is broken,” according to James E. Dalen, M.D., M.P.H., University of Arizona College of Medicine, Tucson. “Medical bankruptcy is almost a unique American phenomenon, which does not occur in countries that have national health insurance. These long-time advocates of a single payer system give us another compelling reason to work toward this goal as a nation.”[51]

Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard commented: “Unless you’re Bill Gates you’re just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick.”

Today’s health insurance policies -- with high deductibles, co-pays, and many exclusions -- offer little protection during a serious illness. Uncovered medical bills averaged $13,460 for those with private insurance at the start of their illness. People with cancer had average medical debts of $35,878.

“The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

“With national health insurance (‘Medicare for All’), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick.”

Despite the hyperbole from the AMA that America has the best healthcare system in the world, a decree also told all too often during the healthcare reform debate from the right-wing media, the facts belie that claim. The present system is, in effect, simply throwing good money in after bad as described by TIME magazine: “… what a sinkhole the country’s health-care system has become: the U.S. spends more to get less than just about every other industrialized country.” [52]

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, also addressed the question whether or not America has the best health care in the world, a mistaken belief held by many people.

“Let’s bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name.”[53]

The dismal state of the American healthcare delivery system also became a public relations conundrum during the reform effort. President Obama and his administration believed the more they unraveled the healthcare mess to the public, and the more Americans learned how he proposed to reform the system, they expected that the public would become more skeptical about the American healthcare delivery system. They assumed incorrectly due to the backlash fomented by the medical cartel and its right-wing cable new media.

In reality, the more the public heard, the less it seemed to understand. According to TIME magazine,  “The hard part is making sure that in transforming a system that is bankrupting the country, Washington doesn’t create a new one that does it even faster.[54]

Both the public perception of implementing nationalized healthcare reform and the political reality how to reign in a medical cartel was confusing to the public, the mainstream media, and legislators. They also found it difficult to understand that the medical cartel was responsible for this medical mess. After all, the AMA purported to be the “guardians of health” when, in reality, it was acting as the guardian of its own wealth behind the scenes.

One problem involved debunking the image of the medical profession itself as the so-called 4th branch of government. In effect, AMA, Inc. laid the seeds of this malady by eliminating free enterprise by suppressing competitors in the marketplace. Without free enterprise and a level playing field for open competition among all health care providers to offer the best services, health care became exclusively medical care in the minds of many.

Indeed, AMA, Inc. had more interest in maintaining sole control as the medical hegemony than in reforming itself and used its cultural authority to lean on the president’s reform plan. Morris Fishbein would be smiling from the grave to see his tactics still in effect.

Little did the public know that AMA had opposed every effort in the past to reform medical care, and little did the public understand the medical war was responsible for this state of affairs as a virtual monopoly that had restricted freedom of choice in healthcare services and eliminated a free marketplace where the best mousetrap would prevail.

In an interview in the Oval Office with a reporter from TIME magazine, President Obama spoke of his frustration to clearly explain the problems of the American healthcare system.

This has been the most difficult test for me so far in public life, trying to describe in clear, simple terms how important it is that we reform this system. The case is so clear to me. And when I sit with our policy advisers, when you start hearing the litany of facts, what you say to yourself is, “This shouldn’t be such a hard case to make, because the American consumer is really not getting a good deal” ... It leads me to spend a lot of time thinking about how can I describe this in clearer terms, so that we can get the health care that the American people deserve. [55]

The present failure of the healthcare delivery system is not by chance, but it is the outcome of a century of warfare by AMA, Inc. under the reign of the Medical Mussolini, Morris Fishbein, and his followers.

CAM to the Rescue

While many critics of a nationalized healthcare option decried the “single payer” system, for too long the present medical healthcare system has been virtually a “single-provider” system that emphasized the “pound of cure” rather than the “ounce of prevention,” or even the “ounce of cure” that chiropractors have offered for over a century.

Despite the resistance to change by the medical cartel, there is a growing undercurrent by many people who seek these “ounces” to take charge of their own health, indicating a growing disenchantment by patients with the present medical treatments and vote with their feet to seek non-allopathic help.

The medical image that chiropractic and other complementary and alternative health care providers (CAM) are small cults of quacks utilized by only weirdoes and occult folks was originally suggested by the Medical Mussolini himself, Morris Fishbein in his 1925 book, Medical Follies, when he opined “Credulity, unfortunately, is not limited to any single class” of people who used non-MDs:

Learned person with one-track minds can always be found who will endorse the most ridiculous hocus-pocus in matters of health. … Unmindful of the history of quackery, many physicians have expressed surprise that men who have made superlative successes in business, in the arts, and in the learned professions, become the victims of New Thought, Christian Science, Abramism, and what-not. Credulity, unfortunately, is not limited to any single class. There is a pride of learning and accomplishment that is more dangerous than the most abject ignorance. [56]

This image of CAM as “hocus-pocus” came to a crashing halt when two landmark studies by Dr. David Eisenberg from Harvard’s Osher Institute stunned the medical world. He revealed more Americans were seeking non-drug, non-surgical solutions and made more visits to 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.[57]

These two studies stunned the medical world, bewildered why Americans would choose alternative “quacks” over “modern medicine.” Dr. Eisenberg noted how his own view of chiropractic has changed from his early days to the present. He was taught in medical school that chiropractic was “irrelevant, worthless, a waste of money, and dangerous.” In the 1980s it was “unproven, unorthodox, and unconventional.” After his study showing the huge usage of CAM, he noted that the terminology has changed from “complementary and alternative” in the ‘90s to “integrative” in 2000-05 to the present use of “comprehensive.”[58]

Dr. Eisenberg concluded, “Maybe ‘alternative’ isn’t so alternative anymore,” [59] and be sure the political medicine kingpins hate it when he talks like that.

Another similar study in 2007 by the Centers for Disease Control (CDC) confirmed this trend to CAM: approximately 38% of adults in the United States aged 18 years and over and nearly 12% of U.S. children aged 17 years and under use some form of CAM, according to this nationwide government survey.[60]

Considering this trend to CAM, it still remains a small part of total health care costs. At $33.9 billion, CAM accounts for approximately 1.5% of total health care expenditures and 11.2% of total out-of-pocket expenditures on health care in the United States.[61]

The $14.8 billion spent on non-vitamin, non-mineral, natural products is equivalent to approximately one-third of total out-of-pocket spending on prescription drugs ($47.6 billion), and the $11.9 billion spent on CAM practitioner visits is equivalent to approximately one-quarter of total out-of-pocket spending on physician visits ($49.6 billion).  

Imagine the cost savings if more people used CAM preventative measures as religiously as they brushed their teeth or popped their meds. These surveys showed Americans made more visits to CAM providers, yet the out-of-pocket costs were only a fraction of the costs associated with medical care. Indeed, it does appear an ounce of prevention is worth a pound of cure to many proactive Americans.

This reform will hopefully herald in not only accessibility into the healthcare delivery system, but it may herald a new sensibility to health care itself.  Chiropractors and CAM providers have long preached the shortcomings of the allopathic crisis care methods as failing to address preventative measures. Like the Dutch boy with his finger in the dam, chiropractors knew philosophically the allopathic methods could not hold back the tide of increasing degenerative diseases.

Paradigm Shift

Perhaps the table has finally turned on the medical boycott of chiropractic and CAM methods in general when the president of the USA calls for preventative methods in mainstream healthcare.

The fallacy of this healthcare reform is to think our health statistics will improve by simply providing insurance coverage for all. What is needed is a serious paradigm shift — a true health revolution — about our cultural attitudes and healthy lifestyles. Until we do, a real healthcare reform is impossible — it would be equivalent to dentistry without toothpaste.

This paradox was not missed by President Obama who called for “preventative” health care to lower costs. He acknowledged that such proposals would “cost money on the front end,” but he maintains that they offer “the prospect of reduced costs on the back end.”

It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. [62] That’s a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that’s a lesson that we should work with local school districts to incorporate into their school lunch programs. (emphasis added)

Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. [63]

These preventative measures have been historically the domain of CAM doctors such as chiropractors, naturopaths, and homeopaths. If it were not for the medical war against these professions, these programs of prevention would certainly be far advanced and more popular than they are today.

It is refreshing to hear our new president speak of preventative care:

Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions - cancer, cardiovascular disease, diabetes, lung disease, and strokes - can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. [64]

Another fundamental problem many people understand is the fact that the American health-care system is not a health care system at all; actually it is a sick-care system — it does not teach people how to become or to stay healthy, and other than early detection tests, most HMOs refuse to pay for preventative care.

Senator Harkin [D-Iowa] recognizes the U.S. has “a sick-care system.”

For many years I’ve been saying that we don’t so much have a health care system in America as a sick-care system.  If you’re sick, you get care.  Up to the point of sickness or disease -- you’re pretty much on your own.

 

To date, wellness and prevention have been the missing pieces in the national conversation about health care reform.  It’s time to make them the centerpiece of that conversation. [65] (emphasis added)

Last year, $2.4 trillion dollars were spent in this country on medical sick-care, or 16.5% of the gross national product, and 95 cents of every dollar were spent to treat disease after it had already occurred. [66]

To put this into perspective, the U.S. spent twice as much on sick-care than it did on food in 2006 — and more than China’s 1.3 billion citizens consumed altogether. In addition, the increase in U.S. health care spending in the three-year period is more than the amount U.S. consumers spent on oil and gasoline during all of 2006 when energy prices began to reach new heights. [67]

“It’s impossible to make our drug-intensive, technology-centric, and corrupt system affordable,” according to Andrew Weil, MD, founder and director of the Arizona Center for Integrative Medicine.

Functional, cost-effective health care must be based on a new kind of medicine that relies on the human organism’s innate capacity for self-regulation and healing. It would use inexpensive, low-tech interventions for the management of the commonest forms of disease. It would be a system that puts the health back into health care. And it would also happen to be far less expensive than what we have now.” [68]

      

Given that we all want health and spend trillions to ‘care’ for it, it’s sobering how little thought we give to its true meaning. When I ask, the response I receive is typically ‘the absence of disease.’ Health is much more interesting and consequential than this. To define it in this negative sense is no more accurate than to define wealth as the absence of poverty.[69] (emphasis added)

It is refreshing to hear Dr. Weil speaking the language of CAM providers; at least it is getting more attention from the press and politicians than it did when chiropractors chanted the same mantra of self-healing via natural methods. Ironically, those healthcare practitioners like chiropractors and naturopaths who have always championed wellness-preventative oriented practices were ridiculed by the traditional disease-management MDs.

Dean Ornish, MD, founder and President of Preventive Medicine Research Institute wrote of this challenge for Americans to embrace a healthier lifestyle rather than relying upon the sick-care model.[70]

Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions. If lifestyle interventions proven to reverse as well as prevent many chronic diseases are reimbursed along with other strategies for improving cost-effectiveness across the U.S. healthcare system, then it may be possible to provide universal coverage at significantly lower cost without making painful choices, and the only side-effects are good ones.

Heart disease, diabetes, prostate/breast cancer, and obesity account for up to 75% of these health care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle.

According to Dr. Ornish, large-scale studies have shown that changing lifestyle could prevent at least 90-95% of all heart disease.[71] Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.

If the insurance industry would incentivise wellness care by CAM providers as well as it covers sick-care by MDs, a real health reform is possible to change the course of diseases in this country. Despite the obvious wisdom of a preventative approach, ironically the so-called Health Maintenance Organizations (HMOs) refuse to pay for maintenance spinal care, for example, although research shows the positive effects of preventive chiropractic treatment in maintaining functional capacities and reducing the number and intensity of pain episodes after an acute phase of treatment.[72] 

Not only do private insurance carriers prohibit maintenance care, so does Medicare according to Section 2251.3 of the Medicare Manual that states:

…a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition is not a Medicare benefit.[73]

Does this sound odd that a so-called health organization opposes “a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life”? Considering Medicare is the bellwether for other insurance programs, its policy to exclude ounces of prevention certainly does not bode well for the hope of improving American healthcare.

Obviously this policy to exclude maintenance care flies in the face of Obama’s desire to include preventative care in order to avoid inevitable crisis care later on; plus it flies in the face of simple logic to help people prevent disease. This is a clear example of the “sick-care” system that we have in America rather than a program aimed to teach people the ounces of prevention or the ounces of cure like chiropractic care.

In retrospect, a case can be made that the AMA’s strategy to kill off the CAM professions starting over a century ago has led to this present crisis.

Too bad the entire healthcare system had to nearly collapse before preventative care got attention, but it was inevitable under Fishbein’s plan. Undoubtedly, if the medical boycott of chiropractors and CAM providers had not nearly succeeded over the last century, the message of prevention and proactive healthcare would have surfaced sooner in popularity.

The present medical cartel has been not only a monopoly of health treatments, but more so a monopoly of ideas.  Since a free marketplace in healthcare was replaced by Fishbein and AMA, Inc. years ago with his medical hegemony, the influx of new and exciting ideas has only flourished when it came to new drugs or surgeries when, in reality, many wonder drugs have led to a  ne set of problems – the overuse of antibiotics creating super germ infections as well as abuse and addiction of pain medications like Vicadin, Percocet, and OxyContin.

       This monopolization of ideas in healthcare has led not only to the boycott of different methods and viewpoints; it has also led to a state of cultural iatrogenesis. Ivan Illich coined this concept where cultural ideas and habits are getting people sick, rather than clinical iatrogenesis where doctors’ mistakes cause accidents or social iatrogenesis when HMOs exclude people from entering the healthcare delivery system as we now see for 75 million Americans who are under-insured or uninsured.[74]

       Just as we saw the AMA, Inc. look the other way when the tobacco industry offered millions to advertise in medical journals to promote their deadly products via medical endorsements, so has the so-called guardians of health looked the other way at junk foods that has led to the present epidemics of diabetes, obesity, cancer, and heart disease.

Sadly, the AMA, Inc. has fostered a severe case of cultural iatrogenesis with Fishbein’s strategy to demonize all alternatives as quackery. This was a forewarning of the present healthcare crisis by discouraging the use of these preventative methods. Slowly, as Dr. Eisenberg found, Americans are awakening to the need for the ounces of prevention and the ounces of cures instead of relying upon the pound of medical cure.

President Obama also mentioned the need of preventative care to offset the development of chronic disorders:

The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. [75]

He is reiterating what many in the public have already known. According to the National Cancer Institute:

Scientists estimate that as many as 50–75 percent of cancer deaths in the United States are caused by human behaviors such as smoking, physical inactivity, and poor dietary choices.[76]

This may come as a surprise to people who think they catch cancer or inherit it, but the majority of cancer victims develop their cancer from unhealthy habits, especially smoking that will kill 169,000 according to the American Cancer Society.[77]

Research by Dr. Ornish et al. have shown that lifestyle changes also may beneficially affect gene expression in only three months, turning on genes that prevent disease and turning off genes that promote heart disease, prostate cancer, breast cancer, and other illnesses.[78]

“Often, people say, ‘Oh, it’s all in my genes, there’s not much I can do about it,’” but this is not true, according to Ornish.

For many people, it captures their imagination to know that changing lifestyle changes their genes for the better.

 

Last year, my colleagues and I published the first study showing that these intensive lifestyle changes significantly increase telomerase, and thus telomere length, in only three months. Telomeres are the ends of your chromosomes that help control aging -- as your telomeres get longer, your life gets longer. [79]

Although many Americans ignore this advice, more and more Americans are listening and acting on this information. Apparently you are your own doctor since health maintenance is in your own hands, certainly not the responsibility of the government, the HMO, or your own doctor.

Senator Harkin, an Iowa Democrat where Palmer College of Chiropractic is located, has been at the forefront of the effort to win insurance coverage for chiropractic and other types of complementary and alternative medicine (CAM) providers as part of national healthcare legislation. Sen. Orin Hatch (R-Utah) is also a strong supporter who has two daughters both married to chiropractors.

Sen. Harkin has been a strong advocate for chiropractors in the federal government and has become increasingly involved in the research funding by the National Center for Complementary and Alternative Medicine at the National Institutes of Health.

During the Clinton Health Care Reform Act in 1993, Sen. Harkin, who began the Office of Alternative Medicine, chaired a committee hearing on CAM at which Dr. David Eisenberg testified. [80] Their emphasis on prevention was evident 16 years before the Obama healthcare reform began in 2009.

         Senator Harkin mentioned:

At a time when America is evaluating the quality and effectiveness of conventional health care, I think we have an obligation to do the same for alternative treatments. The Government should not play big brother, but I believe it does have an obligation to ensure that the information that consumers receive about treatments is accurate. So that is the mission of the Office of Alternative Medicine. Hopefully, it will separate the wheat from the chaff, get rid of quacks and find ways to bring alternative treatments safely into the mainstream.

I want to make one final point. Our traditional health care system emphasizes high-technology medicine and I think too often dismisses approaches that may be less costly and more preventative in nature. One of the interesting aspects of many alternative therapies is the emphasis on prevention and education. One of the short-comings of the training of physicians in this country is the lack of attention paid to prevention, even clearly accepted ideas, such as diet and nutrition.

 

One of my hopes for the Office of Alternative Medicine is that it results in greater communication between conventional and alternative providers. I believe that there are many areas where they can learn from each other, and prevention is one of those areas. (emphasis added)

Senator Barbara Mikulski from Maryland was also on the panel and testified about her experience with CAM and the Fundamental Flaw of the medical world toward alternatives.

My own experience with alternative medicine is probably like many other Americans. It is not about Western medicine versus alternative modalities. It is about a third way; a way that values both practices. That is why I prefer the term “complementary medicine” to “alternative medicine” because, as a citizen in a Western democracy, I believe we turn to both worlds.

When we look at these modalities, if we think of a complementary world where we use the best of both, but we do not close our minds or close doors to those alternative methods. There is no doubt that Americans are turning to alternative methods. This has been articulated in the Eisenberg study.

And I felt when you talked in the body-mind area, which has been shocking to me that based on Freud, Jung, all of the great psychological and psychiatric thinkers, we have accepted the notion that the mind can hurt. But then we refuse to believe that the mind can heal, which is the corollary. 

But what so shocks me about NIH and the medical community is the very people who are scientists, who pride themselves on having an open mind, have closed doors to the people in these alternative fields who are themselves professional and who ask for a clear approach to research. That is why your Office of Alternative Medicine is so important at NIH.  (emphasis added)

 

         Dr. David Eisenberg also testified at this hearing:

First, on a personal level, the one aspect of Chinese medicine that attracted me to it 20 years ago was the notion that the superior physician prevented illness, the inferior physician tried to intervene. So I share with you that premise.

The data from The New England Journal showed unequivocally that about one-third of the alternative medicine use in this country was not used for people’s most serious medical conditions. We do not know why they used them. But our hypothesis is these were people, tens of millions of them, who used them for disease prevention and health promotion. I think that is a big portion of this alternative medicine use.

Senators Harkin and Mikulski, along with Dr. Eisenberg and millions of Americans who use CAM on a regular basis, agree to the value of alternatives to the allopathic sick-care approach.

Medical Witch Hunt

Despite the public support of CAM, the AMA still maintained there was little evidence to confirm the safety or efficacy of most alternative practices — its typical scare tactic used over the past century, including during the Wilk trial that did not convince the federal court in Chicago.

“Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious,’’ the AMA said in a July, 2009 policy statement.[81] Again, the AMA has turned a blind eye to many comparative research studies that threatened its income stream and willingly misled the media and governmental bodies to thwart any threats.

The AMA denied trying to stifle competition and said it was only trying to ensure that medicine was based on science, according to an article in the Boston Globe, “Senators Seek Coverage for Alternative Therapies.” [82] This alibi was similar to the smokescreen excuse used in the Wilk trial of “public safety.”

Undeterred, Sen. Tom Harkin came to the defense of CAM when he said at a congressional hearing that “It’s time to end the discrimination against alternative healthcare practices.”[83]

Of course, this met with strong criticism from medical chauvinists like Dr. Harriet Hall, a retired Air Force flight surgeon, who said she worried that “ill-informed members of Congress will elevate practitioners of alternative medicine to the same level as medical doctors.” [84]  As chairman of the Office of Alternative Medicine for the past 16 years, undoubtedly Sen. Harkin must have been rather offended at her remark that he is “ill-informed.”

Certainly, it must be foggy to see the truth from the rarified air atop her medical pedestal. Dr. Hall continued to show her bias when she said, “If it were shown to be truly effective, it would be part of regular medicine.’’ Once again we hear Morris Fishbein speaking and, ironically, if medicine were “truly effective” as she suggests, we would not be in the present healthcare crisis.

If this is not proof of the medical prejudice that still prevails in healthcare, what would better illustrate this lingering discrimination against CAM health providers? Obviously integration cannot be left to the whim of the medical society, just as desegregation could not be left in the hands of white supremacists.

         Joseph J. Jacobs, MD, Director, Office of Alternative Medicine, broached this lingering issue back in 1993 during the Clinton Health Care Reform Act at a hearing in Washington. [85]

Claims of a lack of scientific validity of alternative medicine must be equally applied to conventional medicine as well. Congress recognized this fact by creating the Agency for Health Care Policy and Research to help sort out the issues… [note: AHCPR was attacked after its 14th guideline on acute low back pain recommended spinal manipulation over medical methods.]

We obviously cannot eliminate all bias, but alternative medicine must be evaluated on a level playing field … The proponent who claims that he or she can cure all diseases with a particular therapy must be approached with the same level of healthy skepticism that would be applied to claims that penicillin is a wonder drug that will cure all infectious diseases in all patients all of the time. I am sure many physicians harbored this belief in the early days of penicillin use. Today, we know full well the limitations of penicillin…

Finally, we are coming into an age of enlightenment whereby we are beginning to recognize the limitations of technology and what I would characterize as a decline in technological arrogance. A major hallmark of American medicine has been what I would call its ethnocentricity. The prevailing attitude seems to have been that clinical studies that have not been done on American soil are immediately suspect. As a minority, I wince when I have to deal with this type of bias. The bias extends further to that which is not done in major medical centers is also suspect. 

Dr. Jacobs was correct when he decried the medical chauvinism that rejected dissident viewpoints because they came from outside the medical profession. This bias has not only hindered the development of health care treatments, it has hampered the health of patients.

Despite the need for healthcare reform, the medical media continued its historic model to oppose change as we saw in the Operation Coffee Cup with Ron Reagan when the AMA, Inc. opposed John F. Kennedy’s plan for Medicare/Medicaid.

Obama noted the same trend when he mentioned:

“We know the moment is right for health care reform. We know this is an historic opportunity we’ve never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what - who will use the same scare tactics and fear-mongering that’s worked in the past. They’ll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We’ve heard it all before - and because these fear tactics have worked, things have kept getting worse.” [86]  (emphasis added)

He describes the typical demagoguery tactics used by fear mongerers to scare people into action by misrepresenting the facts, and then playing on the fears and worries to thwart a change that may actually do them more good than harm.

The AMA is not interested in a true clinical reform that utilizes “best practices” or “evidence-based methods” or “comparative effectiveness studies,” to lower costs and improve outcomes. In fact, the medical cartel actually enjoys the rising costs of health care. This perverse motivation keeps the money flowing despite the apparent illogic of using less effective and more expensive methods, such as surgery for back pain instead of chiropractic care.

This perverse motivation has not been lost on President Obama:

The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I’m talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can’t spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it’s not truly necessary. It is a model that has taken the pursuit of medicine from a profession - a calling - to a business. [87] (emphasis added)

Perhaps this is the bottom line in healthcare reform: can it be reformed as an ethical for-profit business rather than the current capitalistic format where excessive surgical and drug excesses prevail, insurance rates increase at double digit inflation, where uninsured people are denied care, and where the lack of regulation in capital markets has allowed the same obscene salaries by HMO executives similar to what we see on Wall Street?

As chiropractors, we see this skewed perspective daily.  For example, the reason why chiropractors are excluded from the staffs at most hospitals has nothing to do with the lack of scientific proof or clinical ineffectiveness; in fact, there is more proof of the clinical effectiveness of spinal manipulation than drugs, shots, or surgery. The issue of science validating spinal manipulative therapy is no longer the focus of debate — as Dr. Pran Manga admitted, “The evidence is overpowering.” Today, it is all about money.

The sick-care model does not come without a huge price tag as we now see. Duke University found that its severely obese employees are very costly in that they:[88]

  • filed twice as many workers’ compensation claims
  • had seven times higher medical costs
  • lost thirteen times more days of work

On the other hand, a healthy lifestyle can

  • reduce cancer risk 60%,
  • reduce diabetes risk 90%,
  • reduce heart disease by 80%[89]

Researchers also found

  • exercise is more effective than cholesterol medicine in preventing a second heart attack[90]
  • 70% of premature death is lifestyle-related
  • 50% of all illness and injuries in the last third of life can be eliminated by changing lifestyle[91]

 

 

Healthy Lifestyles[92]

This graph indicates how few Americans are willing to adhere to a healthy lifestyle to avoid the inevitable chronic degenerative diseases — only 1.5% of men and 4.2% of women. And we wonder why we have a healthcare crisis?

Until these unhealthy and deadly attitudes are changed, nothing will improve the dwindling health statistics in America, which explains why President Obama now calls for “preventative” health care to lower costs. He acknowledged that such proposals would “cost money on the front end,” but he maintains that they offer “the prospect of reduced costs on the back end.”

 

Just as Congress cannot legislate morality, nor can it legislate a healthier country. Certainly having a minimal universal sick-care system would help, but less than people might think, according to doctors and public health experts who have studied the issue.

Indeed, throwing more money at healthcare insurance for all is unlikely to send America to the top in health statistics until a cultural revolution occurs.

“If you want to see dramatic changes in health, you’re not going to get there even by doubling the efficiency and effectiveness of the health care system,” said Dr. Richard Kravitz, a University of California, Davis, professor of medicine whose research interests include quality of care. [93]

“When you need it, you really need it ... but in general, the benefits of medical care to populations are a little bit overrated,” he said. Across large populations, numerous studies suggest that medical care contributes only modestly to overall health, perhaps somewhere between 10 percent and 25 percent.

According to Dr. Kravitz, “When taken all together, other factors that play a bigger role include education, income, toxins in the environment, crime, violence, family structure, stress, obesity, nutritious food and exercise.”

I might add to his list two more criteria — a healthy spine and a realistic health responsibility.

Health care for all would provide a “very large” improvement for some deprived populations, Kravitz said, but “a surtax on high fructose corn syrup would probably be more effective ... than anything we could do for the health care system, just because of obesity.”

At the core of our nation’s healthcare problem remains cultural iatrogenesis — how bad habits and attitudes make people sick. The junk food epidemic and tobacco addiction are good examples of this. The reliance upon the proverbial wonder drugs also has contributed to demise in Americans’ health. Is it really a wonder why Americans lead the world in every category of chronic degenerative diseases when you consider our lifestyles and sick-care medical system?

After a half-century of junk foods and an inactive, sedentary lifestyle, Americans lead the world in every category of chronic degenerative diseases due to its gluttonous lifestyle problems, and not due to germs, poverty or war. Diseases of the circulatory system and cancer are the main killers, accounting for approximately two-thirds of all deaths. [94]

In contrast, these diseases account for only one-third of deaths in the less developed world. Overall, chronic and degenerative diseases predominate in the West, whereas the infectious and parasitic diseases (along with childbirth-related deaths) associated with much younger ages prevail in less developed countries.

       It may take three generations of Americans before this paradigm shift occurs. The research alone won’t change the public’s conception of healthy habits. It will take another public service campaign just as we saw about tobacco to persuade people against junk foods.

American Rx

Any reform in healthcare is a huge task considering the power, money, and cultural attitudes involved. Even if healthcare insurance were made available to everyone, as long as adults think the road to wellness is paved with only drugs and surgery, this attitude will continue to lead to a costly dead-end.

The healthcare reform crisis is not just an insurance problem; it is a conceptual problem about what constitutes real health care rather than crisis, disease or sick care. It is also a problem about taking responsibility for your own health and having access to CAM providers who can help you think out of the medical bag of drugs, shots, and surgery.

Dr. Ornish agrees that there is more to preventative care than just avoiding disease.

What is sustainable is joy, pleasure, and freedom, not deprivation and austerity. When you eat a healthier diet, quit smoking, exercise, meditate, and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. The latest studies have shown that your brain may grow so many new neurons that it may get measurably bigger in only a few months -- this was thought to be impossible only a few years ago. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- the same way that drugs like Viagra work. For many people, these are choices worth making -- not just to live longer, but also to live better. [95]

I agree with Dr. Ornish, but did you notice that again he failed to include any mention of a strong backbone? Considering back pain and arthritis are the leading causes of disability in the country and upwards of 90% of Americans can expect a back attack sometime in their lifetime, his omission is glaring to me as a chiropractor, indicative of his own bias. Indeed, the medical Fundamental Flaw is so well ingrained that even the most progressive MDs overlook the obvious need for a well functioning spine and nerve system.

Also, he fails to mention anything about a healthy nerve system or the impact of neuromuscular disorders, spino-visceral reflexes that mimic organic problems, spino-somatic reflexes that cause back pain, or even the epidemic of low back pain itself. Indeed, it illustrates how even progressive MDs ignore the role of the spine in our health.

Nonetheless, at least these progressive MDs like Dean Ornish, Andrew Weil, Deepak Chopra, and Richard Kravitz, to name a few of the better-known liberal MDs, are on the right track when it comes to wellness and preventative care.

Perhaps if they listened to the advice of chiropractors and fitness guru Jack LaLanne who studied chiropractic and has blazoned this trail for nearly a century, they might know more about health care that included spinal care too.

“‘You’ve got to work at living — 99.9% of Americans work at dying!’ he said in an interview in USA Today with “a cadence that is part old-time preacher and part carnival barker. ‘You’ve got to eat right, exercise and have goals and challenges. Exercise is king; nutrition is queen. Put ‘em together and you’ve got a kingdom!’ said the 95-year old godfather of fitness.” [96]

“What’s really fascinating is how far ahead of his time he really was,” said John Eliot of Rice University, who studies the psychology of fitness and health.[97]

In a 2007 interview with The American Chiropractor magazine, LaLanne spoke of his early interest in healthcare that sounds similar to the paradox today.

I had visions of becoming a medical doctor, but I wanted to help people before they got sick. So, in 1936, I opened the first modern health club in the United States in downtown Oakland, California, paying $45.00 a month rent. And, at night, I attended Oakland Chiropractic College and obtained a Doctor of Chiropractic degree. Many of my students were sent to me from MDs, therefore, I was reluctant to put my chiropractic into practice, because, in those days, chiropractors and MDs were not exchanging patents like they do today.[98]

Hopefully the healthcare reform and public awareness about the need for change in America’s healthcare paradigm will end this medical war with political medicine that LaLanne and every chiropractor has experienced.

The rest of the story on healthcare reform may not be written for a few more years once the dust has settled from the current battle on Capitol Hill. Hopefully the medical cartel is reigned in and the legislators realize that America is capable of so much more than its present low health care ratings. This is not an option any longer as President Obama said in his speech to the AMA:

“If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.” [99]  

It is past time for the American people to think outside the box or, in this case, to think outside the doctor’s little black bag since this crisis cannot be solved with what is in the bag; more drugs and more surgeries are not the answers to this crisis.

America has been there, done that, did not work, which explains why we have a healthcare crisis today. This is a tough admission for a government that has enabled the medical monopoly, a ruthless trade association, to manage the nation’s healthcare delivery system by its own design and for its own profit posing as the unelected 4th branch of government.

The real solution includes not only universal coverage, but a complete overhaul of the philosophy of our healthcare delivery system, the breakup of the stranglehold by the  medical cartel, as well as the incorporation of CAM treatments the AMA, Inc. has fought long to destroy.

         Dr. Philip Maffetone spoke of the need for reform on behalf of the foundation for Allied Conservative Therapies Research. 
  The unquestionable popularity of alternative medicine, the formation of the Office of Alternative Medicine, and other complementary developments are occurring within the broader context of the accelerating national interest in reforming the entire health care delivery system. In this sense, credible alternatives, which are both clinically effective and cost effective, can make -- indeed, have already made -- a major impact on a public and a system that are prepared for substantive, innovative change. It should be obvious that our nation needs more than “reforms” that amount to little more than the equivalent of rearranging deck chairs on the Titanic. [100]  (emphasis added)

In reality, what America needs is a healthcare revolution, not merely a reform. Simply rearranging the deck chairs will not stop this medical Titanic from sinking. We need a new captain like President Obama at the helm and a new course of direction and not just free passage if America is to improve its dire situation in healthcare.

America needs a new ladder leaning against a different wall – the health and wellness wall.

President Obama summarized the current situation to his cynics:

“You know this isn’t about politics. This is about people’s lives. This is about people’s businesses. This is about our future.”[101]


It is time to stop the medical cartel, it is time for a healthcare paradigm shift, and it is past time to give power back to the patients.

 



[1] Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch

[2] “Health Care Costs 101,” California Health Care Foundation, 2007, http://www.chcf.org/documents/insurance/HealthCareCosts07.pdf

[3] President Obama’s News Conference, NY Times, March 25, 2009.

[4] The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008, The Commonwealth Fund, July 2008.

[5] Ibid. p. 3

[6] Ibid.

[7] Ibid.

[8] Larry Tye, “Reports Rekindle Medical Debate: MDs Challenge Alternative Care,” Boston Globe, (October 11, 1998)

[9] C. Bezold, “The future of chiropractic: Optimizing Health Gains” Institute for Alternative Futures. National Chiropractic Legislative Conference, July 1998.

[10] Atul Gawande, “The Cost Conundrum,” The New Yorker magazine, June 1, 2009.

[11] World Health Organization, “The World Health Report 2000: Health Systems—Improving Performance, 2000.”

[12] Victor G. Rodwin, PhD, MPH, “The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States,” Am J Public Health. 2003 January; 93(1): 31–37.

[13] Karen Davis, Ph.D., Cathy Schoen, M.S., and Kristof Stremikis, M.P.P., “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update,” June 23, 2010, Copyright 2010 © The Commonwealth Fund, http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=1

[14] JL Gerberding, “CDC Campaign Hopes to Make USA a Healthier Nation. USA Today.” USA Today, July 7, 2008.Online document at: www.usatoday.com=news=health=2008-07-07-CDC-gerberding_N.htm.

[15] http://www.cms.hhs.gov/Transmittals/Downloads/R1805B3.pdf

[16] Harkin Statement to the National Farmers Union, March 9, 2009.

[17] Diana M. Farrell, Eric S. Jensen, and Bob Kocher, “Accounting for the Cost of U.S. Health Care: A New Look at Why Americans Spend More,” McKinsey Global Institute, November 8, 2008.

[18] Stephen R. Covey, The Seven Habits of Highly Effective People, Free Press, 1989.

[19] Testimony of Wendell Potter Before the U.S. Senate Committee on Commerce, Science and Transportation, June 24, 2009

[20] Ceci Connolly, ‘Kill Granny’ Media Campaign Alarms Seniors,” Washington Post, Sat., Aug 1, 2009

[21] R  Kuttner, “Market-Based Failure — A Second Opinion on U.S. Health Care Costs,”  NEJM, 358/6 (Feb. 7, 2008):549-551

[22] http://www.harp.org/hmoexecs.htm

[23] Pharma Industry Keeps Hand In Health Care Bill, NPR’s Morning Edition with Linda Wertheimer, July 30, 2009.

[25]www.theindustryradar.com/index.cfm?account=radar&page=Healthplan_Executive_Compensation

[26] Sharon Davis and Mary Palmer, “The Real Cost of Your Prescription Drugs,” Insight Journal, Jan 8, 2007 http://www.anxiety-and-depression-solutions.com/articles/conventional/pharmaceutical/realdrugcosts.php

[27] Jon Basil Utley, “How Hospital Costs Ran Amok,” August 4, 2008

[28]www.theindustryradar.com/index.cfm?account=radar&page=Healthplan_Executive_Compensation, 2008

[29] Neal St. Anthony, “McGuire's Payday Is A Shame, If Not A Crime,” Star Tribune, April 21, 2006.  

[30] “Motorola Co-CEO Tops Pay Survey,” Wall Street Journal, April 3, 2009.

[31] Pearlstein, Steven, UnitedHealth's Options Scandal Shows Familiar Symptoms, Washington Post, October 18, 2006.

[32] Nancy R. Terry, The Ponzi Scheme That Is Health Insurance, Medscape Family Medicine, Posted 03/12/2009

[33] http://en.wikipedia.org/wiki/Clinton_health_care_plan

[34] http://www.harp.org/hmoexecs.htm

[35]www.theindustryradar.com/index.cfm?account=radar&page=Healthplan_Executive_Compensation

[36]www.theindustryradar.com/index.cfm?account=radar&page=Healthplan_Executive_Compensation

[37] Allied Physicians, Inc.,  Los Angeles Times and Rand McNally  *Updated  June, 2006http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

[38]“Chiropractors,” Occupational Outlook Handbook, 2010-11 Edition , Bureau of Labor Statistics, accessed at http://www.bls.gov/oco/ocos071.htm

 

[39] Sara R. Collins, Rachel Nuzum, Sheila D. Rustgi, Stephanie Mika, Cathy Schoen, and Karen Davis, “How Health Care Reform Can Lower the Costs of Insurance Administration,” The Commonwealth Fund, July, 2009.

[40] Ibid.

[41] Ibid.

[42] Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch

[43] Text of President Obama's health-care speech, MarketWatch, June 15, 2009

[44] Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch

[45] 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.

[46] Ibid.

[47] Text of President Obama's health-care speech, MarketWatch, June 15, 2009.

[48] David U. Himmelstein, MD, Deborah Thorne, PhD, Elizabeth Warren, JD, Steffie Woolhandler, MD, MPH, “Medical Bankruptcy in the United States, 2007:Results of a National Study,” The American Journal of Health, 122/8, (August 2009): 741-746

[49] 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.

[50] Catherine Arnst, ibid.

[51] Harvard Study: 60% of Bankruptcies Caused by Health Problems, Consumer Affairs, June 4, 2009, www.consumeraffairs.com/news04/2009/06/bankruptcy_medical_costs.html#ixzz0kh6UJmko

[52] Karen Tumulty, “Can Obama Find a Cure?” TIME  174/5 (August 10, 2009)

[53] Ezekiel Emanuel and Shannon Brownlee, “Myths About Our Ailing Health-Care System,” Washington Post, (November 23, 2008): B03.

[54] Karen Tumulty, ibid.

[55] Karen Tumulty, ibid.

[56] Morris Fishbein, MD, Medical Follies, New York, Boni & Liveright (1925): 24-5

[57] 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.

[58] DM Eisenberg, “Practicing within Mainstream Healthcare,” seminar held at the Massachusetts Medical Society headquarters, Boston, Nov. 18, 2006.

[59] Eisenberg, Ibid.

[60] PM Barnes, B Bloom, R Nahin. CDC National Health Statistics Report #12. “Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007.” December 10, 2008.

[61] National Health Expenditure Data for 2007. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services Web site. Accessed on June 25, 2009.

[62] Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch

[63] Ibid.

[64] Ibid.

[65] Harkin Statement to the National Farmers Union, March 9, 2009.

[66] Ibid.

[67] Diana M. Farrell, Eric S. Jensen, and Bob Kocher, “Accounting for the Cost Of U.S. Health Care: A New Look At Why Americans Spend More,” McKinsey Global Institute, November 8, 2008.

[68] Andrew Weil, MD,  “The Wrong Diagnosis,” The Huffington Post, August 10, 2009.

[69] Andrew Weil, MD, “The Question No One Asks About Healthcare,” The Huffington Post, August 25, 2009.

[70] Dean Ornish, Medical Editor, “Resuscitating Health Care Reform,” The Huffington Post, August 10, 2009.

[71] S Yusuf, S Hawken, S Ôunpuu, et al. “Effect of Potentially Modifiable Risk Factors Associated With Myocardial Infarction In 52 Countries,” (the INTERHEART study). Lancet 364 (2004):  937-52.

[72] Martin Descarreaux,a Jean-Se´bastien Blouin, Marc Drolet, Stanislas Papadimitriou and Normand Teasdalea, “Efficacy Of Preventive Spinal Manipulation For Chronic Low-Back Pain And Related Disabilities: A Preliminary Study,” Journal of Manipulative and Physiological Therapeutics, 27/ 8 (October 2004): 509-514.

[73] Revisions to the  Medicare Carriers Manual issued on May 28, 2004, further clarify the definition of maintenance care. Since our inspection focused on services provided in 2001, we cite here the definition effective during that year

[74] Ivan Illich, Medical Nemesis: The Expropriation Of Health, Pantheon Books, New York, Copyright© 1976 by Random House, Inc

[75] Text of President Obama’s health-care speech, June 15, 2009, by MarketWatch

[76] Cancer Trends Research Report: 2007 Update. http://progressreport.cancer.gov/doc.asp?pid=1&did=2007&mid=vcol&chid=71

[77] Cancer Facts and Figures: 2009. http://www.cancer.org/downloads/STT/500809web.pdf

[78] D Ornish, MJ Magbanua, G Weidner, et al. “Changes in Prostate Gene Expression In Men Undergoing An Intensive Nutrition And Lifestyle Intervention,” Proc Nat Acad Sci USA 105 (2008): 8369-8374.  

[79] D Ornish, J Lin, J Daubenmier, et al. “Increased Telomerase Activity And Comprehensive Lifestyle Changes: A Pilot study,” Lancet Oncol 9 (2008): 1048-1057.  

[80] Alternative Medicine Hearing Before A Subcommittee Of The Committee On Appropriations United States Senate One Hundred Third Congress First Session, 1993

[81] Kranish, ibid.

[82] Ibid.

[83] Michael Kranish, “Senators Seek Coverage For Alternative Therapies,” Boston Globe, July 24, 2009

[84] Kranish, ibid.

[85] Alternative Medicine Hearing Before A Subcommittee Of The Committee On Appropriations United States Senate One Hundred Third Congress First Session, 1993

[86] Text of President Obama’s health-care speech, June 15, 2009, by MarketWatch

[87] Ibid.  

[88] Duke University Study. Obesity and Workers’ Compensation. Arch Intern Med. 2007;167:766-773

[89]Reeves, Healthy Lifestyle Characteristics Among Adults in the United States, 2000, Arch Intern Med, 2005.

[90] Crowley & Lodge, Younger Next Year,  Workman Publishing Company, 2004

[91] The EPIC-Norfolk Prospective Population Study. PLoS Medicine Vol. 5, No. 1, e12 doi:10.1371/journal.pmed.0050012

[92] The EPIC-Norfolk Prospective Population Study. PLoS Medicine 5/1  e12 doi:10.1371/journal.pmed.0050012

[93] Carrie Peyton Dahlberg, “Health Care Reform Alone Won't Make U.S. Healthier, Experts say,” The Sacramento Bee, August 16, 2009.

[94] Ellen M. Gee, “Causes of Death,” Macmillan Encyclopedia of Death and Dying,  2003.

[95] D Ornish, The Spectrum. New York: Random House/Ballantine Books, 2008.

[96] Elizabeth Weise, “LaLanne, Still The Muscle Man,” USA TODAY, 9/26/2004

[97]Weise, ibid.

[98] TAC Staff, “Godfather of Fitness,” The American Chiropractor,  29/08, January 6, 2007.

[99] Text of President Obama’s health-care speech, Jun 15, 2009, by MarketWatch

[100] Alternative Medicine Hearing Before A Subcommittee Of The Committee On Appropriations United States Senate One Hundred Third Congress First Session, 1993

[101] Health care progress reported in Congress, AP, MSNBC, July 29, 2009.


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