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  1. #1
    GbrdTbrd is offline Junior Member 510 points
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    Academic fight: Hunteradam vs. Gbrd

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    Hunteradam: I created this thread not to promote chiropractic. I created this to robustly debate the status quo in medicine and what we as a society (and a world) are willing to put up with as being cost-reasonable/result reasonable interventions. The ultimate question to be answered is this: Why isn't disease-care more affordable? Why can't healthy lifestyles/labs tests be documented to make disease care affordable? Why are certain drugs, surgeries, therapies, etc. allowed by insurance when they are neither cost-beneficial nor effective (and perhaps dangerous). People who do a modest amount of self-care don't need 95% of disease care interventions until they are in the latter stage of life (about 65+). Check the Hunza tribesmen in Tibet/Pakistan, no Western med, primitive, live to 100+ routinely.

    Since I'm not a real doctor, I'd like to approach this as a consumer (or perhaps an insurance underwriter instead of a chiro).

    Just off the wire: The number of serious drug rxns./deaths reported to gov. shot up in first 3 mos. of this year to set a record. FDA rec'd 21,000 repts of serious drug rxn incl. more than 4800 deaths. (ISMP recorded this). Heparin and Chantix were reported to be involved in a large number of claims.
    Last edited by GbrdTbrd; 10-24-2008 at 12:42 AM.

  2. #2
    hunteradam07 is offline Permanently Banned 511 points
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    Why isnt dis care more affordable? well have u been to a hospital recently? You know nursing staff, nursing assist, Doc, janitors, electricities, water and many many more expenses. You see running a hospital is a little more complicated than chiro office w one dc and one from desk person. Plus malpractice! So that is part of the affordablity issues.
    About drugs: Do you have any idea how much it cost to develop a drug? Research, Going through clincial trials, marketing? I would venture that billion easy per drug. Unlike subluxation or adjustment, these med have pharmacodynamic/kinetic, which mean they really going to do some for you body or to you body with the rite dosage. So the drug co must get their money back or their wont be any development of new drugs. What i have issue w is generic (post-patent), which should be more available to consumer and the patent shouldnt be as long. It's not a perfect system like i said many many times.
    Insurances issues: No MD in his or her right mind likes Insurance Co, but u got to blame the whole thing on Nixon (audio tape from Sicko) clearly created this mess! So yea get rid of the insurance Co and set up a national health care system w flexibilities that would be best.
    As for heparin and other drugs. Do you know how many lives heparin have saved? Think bout how many case of PE/DVT a year walking in the hospital. It's not Heparin itself it where it was produced-China-Where the purity issue occured. For every case that you site there are issues w the drugs i can give u 1000 more of hw different drugs saving lives everyday. Antibiotic, antiviral (jz think of HIV wout AZT), antiHTN, DM, HOW ABOUT VACCINES? Oh my yes every med has its Side effects, but think of the world without it. Remember all those nice plagues in 1800 or earlier? Hmm have u seen any plague recently! Just think all those kids who are not vaccined in this country because of advised from DC, they are healthy cuz of herd immunities.
    As of healthy people in Paki, well have u seen what American eat recently? Hw about 40 millions American wout insurances? How about children health care bills that veto by GWB? So that is why we are not as healthy here. And remember people are living longer compare to any other times in Hx of humanity in US and Euro and that is directly due to better med/surgeries.
    Unwarranted drug or surgery are wrong and no way to defend them. But jz like mantain care in Chiro rite! Bt if u look at the % of these issues are very small % in medicine unlike mantain care and chiros!
    BOTTOMLINE Medicine is not perfect and system needs reform, but we are trying and we take any suggestion you have. When is reform going to come for chiros? I m holding my breath.
    Last edited by hunteradam07; 10-24-2008 at 02:06 AM.

  3. #3
    GbrdTbrd is offline Junior Member 510 points
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    Chiro adj (the procedure) doesn't need reform, per se. It's an effective, safe, relatively low-cost procedure and is backed by numerous studies especially with regards to back pain. And people freely choose maintenance care in chiro and pay for it themselves because they like it and they stay healthier; I have numerous patients who have far fewer major episodes of back trouble when they stay maintained. But what do they know, they're just ignorant lay people who aren't participating in a double-blind study. But I digress, this thread was supposed to be about the justification of massive spending on medical procedures that don't improve health and only create higher disease care premiums that 50% of the country can't afford.
    Last edited by GbrdTbrd; 10-24-2008 at 10:41 AM.

  4. #4
    hunteradam07 is offline Permanently Banned 511 points
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    I gave you many reasons for cost of medical procedures (hospital/staff/insurances/many many more on this). Furthermore, i told you that insurances run the health care industry rite? And most MDs are being squeeze by them rite plus their is no flexible national health care plan for average citizen rite? So if you want to do something, Vote for the guy w a better health plan-Not jz 5G tax break/family when actually cost more than 12G for the same plan-. Furthermore, you should go to Nixon library and tell him what u think, because he (in his own voices) created this HMO mess! I think if you want to debate this issue-Medical cost- you should post this on medical school website forum not on chiro forum, because i m not certainly a representative of the AMA by any stretch of imagination. There are people w far better diploma like, you can address spefically issues on the cost of med.

    And your point on maintance cares and it's benefits. Here is what DC Homola wrote in his book:

    "Chiropractic Theory and Maintenance Care

    Chiropractic maintenance care consisting of regular spinal adjustments is an integral part of the chiropractic subluxation theory. Most chiropractors agree that such care is helpful in treating and preventing visceral and musculoskeletal problems in all age groups, with treatment sometimes beginning shortly after birth. One recent study reported that 90% of all chiropractors believe that maintenance care will optimize health, while 88% believe that such care will prevent conditions from developing. The average number of maintenance care visits was 14.4 per year, representing an estimated 23% of all practice incomes [32].
    In my opinion, use of spinal adjustments as a method of prevention is unnecessary treatment that subjects the patient to unnecessary risk. When used by chiropractors who treat every patient with upper cervical manipulation, the risk is much greater. In the case of children, such treatment should be considered fraudulent or illegal."

    So i dont know what data are u using to support your arguments, but this is from DC and author. Here is another former DCs turning MD, Dr. Elixir had to say about the subject in his other post:

    "I saw many other chiros essentially forcing people into the long term treatment plans and many saying that I will make something up to make sure they realize they need treatment. While I don't totally disagree with the treatment plans, that type of practice is not for me."
    This why i call for reform in chiro tx and marketing! From the mouth of own DCs! Not just DCs haters like me .
    Last edited by hunteradam07; 10-24-2008 at 08:31 PM.

  5. #5
    Chopdoc's Avatar
    Chopdoc is offline Senior Member 528 points
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    Quote Originally Posted by GbrdTbrd View Post

    Just off the wire: The number of serious drug rxns./deaths reported to gov. shot up in first 3 mos. of this year to set a record. FDA rec'd 21,000 repts of serious drug rxn incl. more than 4800 deaths. (ISMP recorded this). Heparin and Chantix were reported to be involved in a large number of claims.

    Interesting discussion.

    It costs well over a million dollars to educate a single physician. The resources, personnel, and facilities alone just to get one doc out the door are enormous....and that is just to produce a single graduate. It's expensive. Very expensive.

    Add to that the millions of bogus lawsuits and we segway into your comment:

    Drug "reactions":

    A recent case paid out over six million dollars to a woman who lost her arm. She sued the doctor, the clinic, and the drug company and is making all kinds of noise about drug labaling.

    The reality? The nurse missed the vein and shot the drug straight into her artery. It had nothing to do with anything she and her lawyers sued for.

    The sad thing is that this is very typical.

    My sister is at Stanford Law School right now. She has told me that they are openly taught that such suits are to be pursued not on the basis of any real damage, loss, injury, or compromise in care but rather on the basis of how deep the pockets are of the party to be sued. Period. The vast majority of cases are settled out of court simply because it is cheaper.

    You mentioned insurance companies and what they are willing to pay for and/or deny. Well, frankly, that's only part of the problem with insurance companies. They are also primarily responsible for jacking up the cost of care in all other regards.

    Medical malpractice premiums very often exceed the average income of DCs....sometimes they are actually multiples of that income.

    Drug companies cry about recovering their research and development investment, but have you seen how much money they blow on marketing and advertising? It should be illegal, as it is throughout most of the modern world.

    My dad used to forgive people's debt to him regularly. If they were sending a few bucks a month for a while, he would send them a paid in full notice. He was an anesthesiologist.

    Guess what? Such a thing is now illegal if you accept insurance. We can't do that, if we do, or if we extend any courtesy, we can get busted for INSURANCE FRAUD! Yes, and it does happen. That's right. If you actually give anybody any break you can pay heavy fines and GO TO PRISON! Why? Because of the insurance companies....no other reason.

    As for chiropractic......I don't believe medical insurance should pay for one dime of it, nor should any health plan created by the government. It isn't medical, they aren't physicians. I have no issue if people seek the services of a chiropractor, but I will advise them not to allow their neck to be touched at all. In addition, if the chiropractor attempts to diagnose or treat anything, I will advise them to not see that chiropractor.

  6. #6
    GbrdTbrd is offline Junior Member 510 points
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    I'm not sure if I missed something in what you wrote; I understand the cost of educating the MD (I'll trust you at your word on this about a million per MD). I understand what you said about frivolous lawsuits. My sister worked for Merck when it took the hit about Vioxx. It's OK with me if you think chiros shouldn't be paid by insurance although I'm not sure why my 99203 exam + Cspine xrays/interp are less reimbursable than yours are. I don't get the acid about why you wouldn't let a chiro touch your patient's neck and you would tell your patient to stop going to a chiro who attempts to diagnose and tx. What the heck meds were you sampling when you wrote this?
    Last edited by GbrdTbrd; 11-08-2008 at 07:45 AM.

  7. #7
    Chopdoc's Avatar
    Chopdoc is offline Senior Member 528 points
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    I said I don't believe it should be reimbursed by medical insurance. perhaps you missed the "medical" part.

    The 99203 requires a medical decision. Only a licensed physician is qualified to make any medical decision in my opinion, whether simple or complex. The fact that you cite what might be the most overused code is quite telling.

    As for the Cspine, same issue. IMHO there is nothing there for the Chiropractor to interpret for any reason except perhaps to refer to somebody (a licensed physician) in order for it to be interpreted. In such a case, I cannot agree with reimbursing in the same way or amount as for the licensed physician's interpretation. In addition, after witnessing the quality, or lack thereof, of images used in actual practice in a chiroprator's office, I am offended that they were paid for it and even more so that they expected to be.

    I advise people not to let a Chiropractor touch their neck simply because there are still too many Chiropractors out there using questionable practices involving the neck. The lay person would have a difficult time understanding who that might be or why that might be so the best practice would be to simply not let the DC touch one's neck.

    I advise people not to see a Chropractor who attempts to make any medical diagnosis or treat any medical diagnosis because I feel they are not qualified to do so. Perhaps I wasn't clear on that one. If they make something other than a medical diagnosis, I have no issue with it. I see that issue much like I do the nursing process and nursing diagnosis. Nurses do not tread into medicine with their diagnosis, in fact they are not allowed.

    I have no issue with insurances paying Chiropractors as long as it is in no way billed or paid for as a medical service.

    I have no issue with Chiropractors actually practicing medicine if they wish. In order to do that they will need only go to medical school, pass their boards, do a residency, and maintain a license to practice medicine. If that seems like a bit much then perhaps a PA license would suffice as they can make some limited medical decisions etc. If I wished to practice chiropractic I would fully expect to be compelled to get the education, training, and credentials to do so.

    I am quite happy to number Chiropractors among those of us who render health care to those who need or want it.

    As for "sampling" meds.....naw....never touch the stuff......ya never know....I might have a nasty drug reaction......scary stuff.......

  8. #8
    GbrdTbrd is offline Junior Member 510 points
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    I really get tired of the "don't let a chiro touch your neck" discussion. Why (if we're so dangerous) weren't we drummed out of existence many years ago? The point of my thread is that day-to-day medicine is really overvalued, like a bloated underperforming stock; the reality is that your training (while excellent) overqualifies you for what you see and do most of the time and is like letting a lawyer mow grasses for a living and still get paid $300 per hour. It simply isn't necessary but somehow everyone thinks it is. I hope you are really that valuable to justify the 1M just to train you. Your schooling is too long and most of the time, you're simply not worth it. Sorry.

  9. #9
    Chopdoc's Avatar
    Chopdoc is offline Senior Member 528 points
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    I believe that is a common misconception and one of the reasons that PAs and NPs are seen as a convenient replacement for the physician in many settings.

    IMHO they are not effective replacements for physicians in any setting.

    As for the implied notion that perhaps the Chiropractor might be an effective replacement in primary care, no, I'm sorry, that couldn't be further from the truth.

    That you might be tired of hearing something troubles me little. That you don't see why Chiropractors have endured does trouble me.

    I agree, day-to-day care is too expensive, but that isn't the fault of the physicians providing that care at all. To imply that because it is too expensive it should be replaced with something else, something less appropriate supplied by somebody less capable, really is not a solution. The solution is to bring that cost down to a more appropriate level.

    The day-to-day care that you talk about is what every MD is trained to do and qualified to do basically after PGY1. The reality is that it is almost impossible to practice as a general practitioner these days and few actually do. Even Family Practice is a specialty.

    What we need to do is create an economic environment friendly to the GP.

    The reality is that there are some PAs and NPs that are making more than some MDs, so I hardly wonder why it's hard to get docs in many primary care settings.

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