Welcome to Dr. Armand Rossi`s email newsletter:
Kid`s Unlimited
May 26, 2006
Kid`s Unlimited is a monthly newsletter of various articles, funnies, tidbits and opinions relating to our children and chiropractic. My opinions will always be in red and italicized. Please feel free to share the appropriate articles with patients, friends and other chiropractors. I never buy any lists or put names on my email list unless the names were given to me directly. If you wish to be removed from the list, just type the word "remove" in the subject line and reply back to me.
Together we will make a difference.
Yours in Chiropractic,
Armand M. Rossi
I just recently attended a talk by a representative from IBM. He was talking about their recent association with Scripps down here in Florida. They are putting together a multi-billion dollar computer and program with billions of dollars invested in it to isolate and predict the bird flu virus.
They hope to be able to predict how the virus will mutate (which it does approximately every 2 weeks) and then be able to isolate and treat the virus, thus protecting mankind from this latest scourge.
The computer they are building is called "Blue-Gene" and can perform up to a trillion functions per second. To get a better reality on that, if a person can do 100 functions per second, it would take approximately 14 lifetimes to duplicate the function of 1 second of that computer.
Although the technology is very impressive, and the motive is admirable, we once again see the "outside-in" paradigm at work. Let`s find the bug and kill the bug so we don`t get it! And let`s spend billions of dollars in the process.
We could probably do alot better if we spent one-tenth the amount of money on ways to improve the immune functions of our bodies. How about researching ways of improving adjustments, eating better, exercise more efficiently, and developing better rest habits.
You see, these researchers, don`t believe that the body has the capability to take care of itself. They also get their paychecks directly or indirectly by the drug companies that have a vested interest in this type of treatment.
I know it certainly creates more jobs. But how many lives will be hurt or injured in the process of finding that next cure. Then when the disease goes through it`s life cycle and the virus mutates to a milder form, the big companies can pat themselves on the back once again and claim victory.
Watch and see what happens....
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This article is a bit long, but well worth the read:
Pill Pushers
Robert Langreth and Matthew Herper, 05.08.06
How the drug industry abandoned science for salesmanship.
Novartis (nyse: NVS - news - people ) employs some of the best medical researchers in the world, and they have created such lifesavers as Gleevec, which treats a deadly form of leukemia. But what is the fourth-biggest seller in the Novartis medicine cabinet? No lifesaver. It`s Lamisil, a pill for--horrors!--toenail fungus. The main effect of the fungus is that it turns the toenail yellow; it can hurt, but no one has died of this inconvenience. But a few people may have died taking Lamisil. Federal regulators have linked the drug to 16 cases of liver failure, including 11 deaths. Novartis says most of the patients had preexisting illnesses or were also on other drugs.
Yet 10 million Americans have taken Lamisil, which costs $850 for a three-month treatment. They have been lured by a grotesque cartoon creature called Digger the Dermatophyte, a squat, yellow fellow with a dumb-guy New York accent. In TV ads he lifts a toenail as if it were the hood of a car, then creeps beneath it to declare, "I`m not leavin`!"
TNS Media Intelligence calculates that Novartis has spent $236 million on Lamisil ads in three years (Novartis says it has spent only $100 million). The first run, which featured Digger being crushed by a giant Lamisil tablet, so overstated the drug`s benefit that regulators objected and the company had to pull the spots; the drug fully cures the problem in only 38% of patients. But the ad blitz undeniably was effective: Lamisil sales jumped 19% to $1.2 billion worldwide in 2004 and held steady last year.
Lamisil`s rise points up what is wrong with the drug industry today: the triumph of salesmanship over science. The industry spends a fortune to create and sell a raft of me-too remedies aimed at quelling sometimes trivial maladies, even as research pipelines run dry, patents on old drugs expire and critical areas of medicine go underserved. Sometimes the marketing improves health; Americans would probably be better off if more of them were hounded into taking pills to lower cholesterol and blood pressure. Sometimes the result is the reverse, as when side effects from an overhyped and overprescribed medicine are fatal.
"The dominance of marketing over research has done real damage to company pipelines," says Jurgen Drews, former research chief for Roche. A decade ago he predicted a research slump; it has arrived. A total of 87 major drugs with $31 billion in combined annual sales have lost patent protection since 2002, but new drugs aren`t arriving fast enough to replace them. Only 20 were cleared by the Food & Drug Administration last year, down from 53 a decade ago.
Drugmakers, says Maryland psychiatrist Jack E. Rosenblatt, editor of Currents in Affective Illness, "don`t seem to realize that this is not toothpaste or shampoo, that they are dealing with something that can really hurt people."
The industry`s malaise is certainly visible on Wall Street. The ten largest drugmakers have lost $130 billion in combined market value in two years, a 12% decline at a time when the S&P 500 Index is up 12%. They have endured scandal after scandal over drug safety and dubious sales practices. A total of 17 drugs have been recalled in the past decade. Wyeth (nyse: WYE - news - people )`s withdrawal of diet drug Redux in 1997 led to $22 billion in damages and counting (FORBES, Apr. 10).
Vioxx could yet eclipse that. Merck (nyse: MRK - news - people )`s new-generation painkiller--touted to consumers at a cost of $550 million over five years--was recalled in September 2004 when a study showed that patients on it for 18 months had double the risk of heart attacks. In the ensuing legal onslaught 10,000 suits have been filed, seeking billions in damages and accusing the company of misleading doctors and the feds. Last month Merck lost a $13.5 million verdict to one heart attack survivor, its second defeat in five cases tried. There are more potential lawsuits lurking where these came from.
The drug industry, of course, rejects the criticisms. Novartis says its Lamisil spending "absolutely" "in no way" has taken away resources from research into more serious diseases and that it spends far more on its cancer drugs. "Absolutely, marketing doesn`t trump science--this is a science-driven industry," says Scott Lassman, a lawyer for Phrma, the industry trade group. He says makers have taken steps to curb any excesses and give ads a "more sober tone." Pfizer (nyse: PFE - news - people ) research chief Martin Mackay says, "We are thought of as monsters, but I don`t know of a single case where we have been driven to take risks on a compound because of a marketing push. I would not let it happen."
Says Bristol-Myers Squibb (nyse: BMY - news - people ) Chief Executive Peter Dolan: "The biggest disconnect for me is between how the industry is portrayed and how people in it actually feel about what they do."
Yet Big Pharma`s focus on marketing is undeniable, and it spends hugely on it. The top ten drug firms invest $42 billion a year on research, 14% of sales--yet they plow more than twice that much into marketing and administration. In a decade drug firms have almost tripled the ranks of salespeople calling on physicians, to 100,000, according to Verispan. That`s one seller for every 9 docs; in 1996 it was one for 18. Often they encourage unauthorized off-label uses or sponsor "continuing medical education" sessions to stoke more prescriptions and broaden a drug`s patient base.
Even the research lab is more marketing-driven than ever. More than $9 billion a year in research spending goes to clinical trials of drugs that are already approved or may soon be--often to snare new ad slogans. That is up 90% in four years, says Goldman Sachs. Some of these ad-driven trials are skewed to pit the sponsor`s full-strength product against a weaker dose of a rival pill. Yet drugmakers have failed to begin two-thirds of the 1,200 post-marketing trials required by the FDA.
The slogan-geared trials provide fodder for an explosion in consumer advertising of drugs, which had been highly restricted for decades before rules were eased in the 1990s. Ad spending in the U.S. has soared eightfold in nine years to $4.8 billion, says Nielsen Monitor-Plus, TV spots ply supposed low-risk, quick fixes to millions of people: Try Zoloft to get happy; gobble a state-of-the-art pain pill when aspirin would work fine. Drugs designed for narrow sets of patients end up in the hands of a far broader audience.
"It creates demand where there`s not even disease there," complains internist Robert Centor of the University of Alabama. Drug giants "do it in a devious way," he says. "I wish they didn`t spend all that money on marketing."
Merck`s marketing of the painkiller Vioxx was, in retrospect, all too successful, contributing to the multibillion-dollar liability now looming over the company. Vioxx, part of a new class of drugs known as COX-2 inhibitors, had been intended for only the small slice of patients who can`t stomach aspirin. But it ended up in the hands of 20 million people, driven by ad spending of $550 million in five years, says ad tracker TNS. Some spots had 1970s Olympic figure skater Dorothy Hamill twirling on the ice.
Vioxx`s chief rival, Celebrex from Pfizer, also reached a far broader market because of splashy ads. About 60% of patients on the drugs had low ulcer risk and might have fared just as well on older generics, say researchers at the University of Chicago and Stanford. Pfizer says most gastrointestinal complications occur in patients who are not at high risk.
"People would come in asking for--demanding [a COX-2 inhibitor]--and sometimes threaten to find a new doctor if I didn`t prescribe it," says physician John Abramson, a clinical instructor at Harvard Medical School who has consulted for plaintiff lawyers. "Vioxx wasn`t a bad drug for everyone, it was a bad drug for certain patients," says Chris D. Robbins of Arxcel, which consults to pharmacy benefit managers. "Unfortunately, people saw the ads and started demanding the drugs from their doctors."
TV ads for prescription drugs were rare until Aug. 12, 1997, when the FDA lifted restrictions to let spots run without lengthy disclaimers of nasty side effects. Three days later Schering-Plough began a prime-time campaign for its antihistamine Claritin, featuring smiling folks frolicking in hay fields to the tune of Irving Berlin`s "Blue Skies." Schering upped the ante in 1998 with one of the first celebrity pitches, by TV personality Joan Lunden. Claritin sales climbed 50% in 1997 and 30% more in 1998, hitting $2.3 billion. Schering`s stock-market value approached $90 billion by mid-1999. Claritin lost patent protection in 2002. No problem: Schering was ready with Clarinex, a look-alike successor that still brings in $646 million in annual sales, even though its predecessor is sold over-the-counter at one-tenth of the price. The shift didn`t help enough: Schering had a mediocre pipeline, and today its market cap is down by two-thirds to $27 billion.
Other companies followed with ads for antidepressants, heartburn drugs, painkillers and impotence pills. Pfizer found its erectile dysfunction pitchman in Senator Bob Dole, then age 75. Wall Street cheered the changes. "We had the whole financial community focused on blockbusters and maximizing the revenues and aggressive marketing," says Daniel Vasella, chief executive of Novartis, which TNS Media Intelligence says has spent $235 million in three years advertising Zelnorm. (Novartis disputes the amount.) The drug, which treats irritable bowel syndrome, costs $200 a month.
In the rush to find big sellers, many companies fell into a herd mentality and focused on the same few common ailments, says Genentech Chief Arthur Levinson. "Everyone was doing the same thing, so the chances of success got smaller and smaller." Big Pharma "said we were nuts" to test a cancer drug that targeted only 25% of breast cancer patients, Levinson recalls. Now the drug, Herceptin, is near $1 billion in annual sales. "If you are developing novel drugs, you don`t need sales forces of tens of thousands."
Some drug firms stopped researching in critical areas even as they focused on pop pills. Eli Lilly & Co. had dominated the antibiotic field for decades, and new remedies are badly needed to kill drug-resistant superbugs. Yet in the 1990s the company sold off three promising antibiotics and antifungals, two of which went on to win approval. Lilly exited antibiotic research entirely in 2002, believing the chances of success were higher with antivirals. The next year Lilly and partner Icos spent $243 million launching their me-too pill for erectile dysfunction, Cialis. Barry Eisenstein, who headed Lilly`s antibiotic program from 1992 to 1996, says drugs for chronic conditions, like Prozac, are seen as "a much better and easier business proposition." Lilly says that any contention that it didn`t pursue antibiotics to chase mass-market blockbusters is simply not valid.
The "easiest profits" come from me-too drugs, says John Santa, medical director at Oregon Health & Science University. Genuine discovery is a risky business, "more like drilling for oil." Instead of prospecting for real cures, some companies repackage old drugs with the minimal tweaks needed to get a new patent. Then they stage exhaustive trials aimed at unearthing some slender advantage that can be cited in advertising.
One throwback, the Lunesta sleeping pill from Sepracor that came out early last year, is based on a remedy first approved in Europe two decades ago. It is very similar to Ambien, which is made by Sanofi-Aventis and racks up U.S. sales of $1.6 billion annually (on an ad budget of $130 million). Lunesta garnered $330 million in sales in its first nine months on the market thanks to TV spots featuring a diaphanous cartoon butterfly flitting in and out of moonlit bedrooms. Tagline: "Leave the rest to Lunesta." Sepracor spent $215 million last year advertising Lunesta, says TNS.
To differentiate Lunesta from Ambien, Sepracor tested its drug versus a placebo in 1,600 patients for six months, something Ambien`s maker hadn`t bothered to do. The trials let Sepracor claim in print ads that Lunesta "is the first and only hypnotic approved for long-term use."
Prescriptions for sleeping pills are up 48% in five years to 43 million prescriptions annually, driven by the huge ad spending for Ambien and Lunesta. Sales are up 140% in the same period to $2.76 billion. Yet the newer drugs "are no better than older ones costing about one-tenth as much," says John Abramson of Harvard. "Has insomnia become an epidemic in the past five years? Or are the makers skillfully leading Americans [to] an expensive drug?" he asks. Sepracor points to an Institute of Medicine report highlighting insomnia as a serious problem.
Astrazeneca, faced with patent expiration on its blockbuster for acid reflux, Prilosec--touted as "the purple pill"--tweaked it a bit to create "the new purple pill," Nexium. AstraZeneca studied high doses of Nexium in five trials totaling 12,000 patients. All this to show the drug helped the esophagus heal in an extra one in 20 patients, compared with Prilosec or competitor Prevacid.
The payoff: Nexium now is touted as "the healing purple pill," hawked in ubiquitous TV spots. In one, a sterling-haired man in black cites the "exciting news" from one of the studies and concludes, "Better is better." Nexium is the third-best-selling drug in the world, according to IMS Health, with $5.7 billion in sales and an ad budget of $226 million last year. Never mind that some of the trials were stacked: In three of the big trials AstraZeneca pitted high doses of Nexium versus half the dose of Prilosec; it never bothered to test whether twice the Prilosec dose would be equally effective. AstraZeneca says there are "clear differences" between the two purple pills and notes that one equal-dose study showed a statistical advantage for Nexium in esophageal healing.
In another instance AstraZeneca staged trials that fizzled but used them for a new ad claim anyway. Before it won approval in August 2003, AstraZeneca studied its Lipitor look-alike, Crestor, for cholesterol reduction, in 24,000 patients, hoping to prove superiority. But the only dose of Crestor that clearly beat Lipitor turned out to cause kidney problems and never won fda approval. Nonetheless, after Crestor`s debut AstraZeneca used ads featuring a voiceover by the stentorian actor Patrick Stewart of Star Trek: The Next Generation, in Seussian rhyme: "When Crestor performed in a head-to-head test, its lowering effect was clearly the best."
That claim brought a rebuke from the FDA in March 2005. The company halted the ads, but it now is testing Crestor in 30,000 more patients. AstraZeneca notes that Crestor is the only statin shown to clear plaque out of the arteries.
The drug industry has begun to restrain its own advertising. Last June Bristol-Myers Squibb took a first step, announcing that it would wait a year after drugs hit the market to begin running ads, leaving time for doctors to learn about a medicine and for side effects to crop up. Companies are now submitting ads to the FDA before they run and are more clearly stating big risks.
But myriad drugmakers have plenty of ways to game the system. In the market for new schizophrenia treatments Lilly and Johnson & Johnson and others have run 21 head-to-head trials--and 90% of the time the conclusions favor the sponsor`s drug, according to research in the American Journal of Psychiatry. Nine studies compared Lilly`s Zyprexa to Johnson & Johnson`s Risperdal. All five Lilly-paid trials favored Zyprexa; three of four J&J studies favored Risperdal. Lilly stands by its high scientific standards and says the results highlight the need for more independent studies. Another analysis, in Archives of Internal Medicine, tallied 56 studies of painkillers; not once was the sponsor`s drug deemed inferior.
"The comparative studies are a joke. They are comical. A lot of the scientific literature these days is worthless," says psychiatrist Jack E. Rosenblatt. "The whole process has been corrupted," says British bone researcher Aubrey Blumsohn. "It is getting worse as the financial stakes are rising."
Blumsohn contends procter & gamble for years refused to supply raw data for a 2003 study he led comparing its drug Actonel to Merck`s competing drug, Fosamax, even after he became suspicious that Procter`s analysis was skewed in favor of Actonel. "It was a process of intimidation," says Blumsohn, who was suspended from his job at the University of Sheffield after he complained to the British press. (He recently left after agreeing to an undisclosed settlement.) Procter & Gamble says it "always" provided Blumsohn with "unfiltered access to all of the data that was relevant." "This issue is about a relationship fraught with misunderstanding, and we regret that," a spokesman says. Procter is now providing Dr. Blumsohn with additional data.
Despite the profusion of dubious trials, drugmakers often don`t conduct crucial studies to ensure new drugs are truly safe as they move out to a mass market. This year Trasylol, a Bayer drug used to prevent bleeding during heart surgery, has emerged as yet another problem medication. In December Bayer promised annual sales of the drug, then at $280 million, would surge to $600 million.
But a study of 4,000 surgery patients found that the drug, at $1,400 per dose, posed more than twice as much risk of kidney failure as cheaper generic alternatives, as well as more heart attacks and strokes. Replacing Trasylol with generics would prevent 10,000 cases of kidney failure each year, says clinical researcher Dennis Mangano, who led the study at the nonprofit Ischemia Research & Education Foundation in San Bruno, Calif.
Bayer says its own studies of 6,500 patients haven`t found any link between the drug and kidney failure, heart attack or stroke, and that it is working with the FDA to evaluate the Mangano report and another study linking the drug to serious adverse events. "Bayer`s highest priority and concern is patient safety," says a spokeswoman.
Mangano, who also did the first study to raise concerns about the cardiovascular risk of Pfizer`s Bextra (pulled from the market in April 2005), spent $35 million of his foundation`s endowment to painstakingly gather the Trasylol data over four years. Few independent researchers have the money to perform such definitive safety studies. His foundation used to do clinical trials for the industry, but drug companies don`t call much anymore, he says. "There is no incentive for companies to find problems with safety once a drug is approved. It is just downside risk," he says. The result is worrisome:
"We find out a drug is unsafe when the bodies accumulate."
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The Washington Post
Tuesday, May 9, 2006; C01
ABC Spreads The Germ of A Disturbing `Bird Flu`
By Tom Shales
Washington Post Staff Writer
ABC`s "Fatal Contact: Bird Flu in America" is just what the doctor
ordered -- Dr. Frankenstein, that is. Who else would find it entertaining to
watch 25 million people drop dead as the result of a fanciful worldwide
plague?
No one can say the film, airing [last night] on Channel 7, isn`t topical.
The
producers hired a big-time expert on monstrous disease to make sure its
vision of a global nightmare is plausible. A disclaimer notes, "This film is
a fictional examination of the question, `What if?,` " but the docudrama
style carries an aura of awful, if not awesome, authority.
It`s a question that isn`t just being asked by alarmist TV movies. According
to published reports, a White House study on pandemic flu envisions a nation
overtaken by "social and economic chaos" if the bird-flu virus should mutate
into an influenza that can be passed from human to human and country to
country.
Not overlooking practical aspects, The Washington Post says the report not
only "assumes" as many as 2 million dead in the United States alone, but
also a 40 percent rate of "workforce absenteeism." Good heavens! Maybe
preparedness demands that we all start staying home, oh, let`s say, this
morning. Just to be on the safe side.
"Fatal Contact" argues persuasively that mass suffering, death and, of
course, workforce absenteeism are anything but unimaginable; after all, the
producers imagined them and put them on film. ABC then irresponsibly slotted
the frightening movie at 8, early enough to scare the kiddies right out of
their wits.
The film opens with a poultry roundup in Guangdong, China. Workers in
protective garb destroy dozens of the little cluckers in the hopes of
preventing the spread of whatever they`ve got. From there, the movie hops
all over the world, with stops in Hong Kong, New York, Washington, Atlanta
and Angola -- except that all those places are really either New Zealand or
Australia, where "Fatal" was filmed.
In Richmond, a husband returning from a trip abroad hugs his wife. Uh-oh!
Shouldn`t-a done that! He`s spreading a germ that we`ve seen travel via
everything from handshake to cough to smooch to martini olive -- all these
contacts and many others eventually arranged into a checkerboard screen
filled with very infectious images.
The poor chap in Richmond, unaware he`s ill, goes to his son`s Little League
game and shakes hands with a friend. He might as well have shot the guy in
the head, at least according to the movie`s depiction of the flu`s
contagiousness. And as the illness spreads, so do rioting, looting, panic
and hysteria.
At least it won`t be dull.
Every movie about a medical crisis has to have a medical hero -- if
possible, a superwoman in a white smock and stern spectacles who tries to
straighten out all the misguided, mixed-up men. In "Fatal Contact" it`s
Joely Richardson ("Nip/Tuck") as Dr. Iris Varnack, an official of the
Epidemic Intelligence Service. She logs many a mile chasing chicken flu and
arguing with those so blind (not literally) they cannot see -- mostly other
medical authorities and pesky politicians.
Singled out as particularly wrongheaded is Mike Newsome, the (fictitious)
governor of Virginia, played with stern stubbornness by Scott Cohen. Newsome
decides that the best prevention is to quarantine everybody in the state,
and he rushes his own family and staff to a germ-proof shelter. It`s
important, he explains, that there be "continuity of leadership" if the
outbreak reaches the pandemic level.
One can see his point. Heaven knows people wouldn`t know what to do without
bureaucrats to guide them.
Later, when a vaccine is finally developed, those in charge decide that
"essential medical personnel" should be first to get it -- in other words,
them. That`s somewhat reminiscent of the bureaucrats in Stanley Kubrick`s
"Dr. Strangelove," who decide it would be best for the country if they all
took refuge in an underground shelter stocked with wine and women, if not
song, and wait out the nuclear war raging above.
Plagues, of course, are not something to be made light of, but the movie is
so brutally relentless in depicting the effects of the disease -- replete
with shots of mass graves, blood-soaked human organs and "CSI``-like
close-ups of germs -- that it becomes more numbing than alarming. It`s a
cautionary tale with no recommendations on what precautions to take.
There`s no time to develop any of the characters. Dr. Varnack marches around
issuing warnings, advice and recommendations but doesn`t seem to have a
life. The mutated virus, H5 in the film, is compared to the Spanish Flu of
1918, believed responsible for up to 100 million deaths. As the movie ends
(semi-spoiler alert), there`s nary a peep of hope in sight.
"Fatal Contact," written by Ron McGee and directed by Richard Pearce, is
horrific but dubiously useful. And as insensitive as it might sound, the
death tolls and harrowing developments begin to seem repetitious and
prosaic. Then there are the less-than-hideous side effects, like a raging
coffee shortage in New York. The horror, the horror!
For reasons not made clear but covered by the term "chaos," looters grow
violent, and teams of hooligans set trucks on fire. Society is breaking
down, people are behaving like animals and gas is probably up to 100 bucks a
gallon.
Despite the seeming urgency of the subject matter, I think I`d skip the
movie if I hadn`t already seen it -- maybe opting to wait for the Broadway
musical.
So this is how the world ends -- not with a bang or a whimper, but a
bluck-bluck-bluck. Thank goodness Colonel Sanders didn`t live to see it.
We are very pleased to have Dr. David Millman as a contributing writer to Kid`s Unlimited. Dr. Millman has a vast knowledge of radiography, and writes for various journals and newsletters around the country. He will be contributing articles for us most every month. Enjoy...
HELPFUL HINTS IN RADIOLOGY
David D. Millman, D.C., D.A.C.B.R.
Patient Motion worst deterrent to optimal film quality
X-raying infants and children is generally more difficult to produce optimal quality films than adults. The main reason is patient motion. Sometimes the children are terrified when they are taken into the x-ray room. A good procedure is to show the child how it is done by positioning the parent while the child watches. Most state laws forbid office personnel from holding the patient in order to prevent movement. The parent or whoever brings the child or infant is the designated holder if it is necessary to hold the patient.
Breath holding
The parent or older person should be taught how to breathe just as if he/she is the patient and then to hold their breath while the child watches. Sufficient time must be utilized to make sure that this is impressed on both the parent and the child. If possible, try to make a game of it because most children will be amenable to this procedure. After the parent or older person masters the breathing technique, it is the child’s turn to duplicate the positioning and breathing. Once satisfied that the child is going to hold their breath long enough to get an exposure without movement, the film can be taken. It is usually best to position the older person before each exposure of the child so they can see what will happen to them and so they are not apprehensive that something bad will occur.
Reduce radiation exposure to infants and children
It is an accepted “fact” among radiation scientists that all ionizing radiation carries some potential harm. This has been disputed by some. However, it is better to err on the side of caution. Here is how you can reduce the radiation exposure to your infants and children. Take the Kvp which you would normally use on the particular patient and multiply it by 15%. If you would use 70 Kvp, it then becomes 80. Next reduce the Mas that you would have used by 50%. This method serves to produce a shorter exposure which, in most instances, will result in a better x-ray. Another way to reduce the harmful radiation to the male gonads is to place the patient in the P.A. position for the frontal lumbar film. In females, young or old, radiation to the breasts can be reduced by 80% in the P.A. position. You may reduce radiation to the patient also by increasing the focal film distance to 72 inches. Some harmful radiation does not reach the patient from this distance.
X-raying infants
There are instances when infants must be x-rayed. One of my chiropractor-clients sent me some films of an infant that had been propelled out of the back door of a moving car. I discerned the youngster had a fractured tibia and fibula. I have seen some tumors and cancers in infants. There are some infants that are battered by their parents and should be x-rayed to reveal the extent of the fractures, if any. Infants and young children may fall down stairs or may be hurt by their older siblings during play.
If you do not have an x-ray table, how do you x-ray an infant or a child who can’t stand? Here is the simple solution:
The Millman innovation
Place a portable chiropractic adjusting table or a desk parallel to the cassette carrier. Place the patient on his/her back on the table. Lower the tube, which is horizontal, to the level of the patient. Measure the patient, calculate the exposure factors, have the parent hold the child or infant to prevent motion and make the x-ray exposure. The position of the direct ray depends on the size of the patient. THIS IS A LATERAL LUMBAR OR LATERAL THORACIC VIEW. To then take an A.P. film of the lumbar or thoracic region, place the patient on his/her side, knees bent. Use a pillow for the neck or a rolled up towel. Again, measure the patient, calculate the exposure factors, ask the parent to hold the child to prevent motion, practice the child in breath holding and make the exposure. Use the largest Ma station to enable you to make the shortest exposure to prevent motion.
Some chiropractors do not use x-ray to determine how or what segments of the spine they will adjust. If one does not need upright spine films, use of the above described procedure will produce a more detailed group of radiographs. In the event that a patient is very large or obese to the degree that your equipment will most likely not produce adequate penetration, using the supine position for the lateral film will many times result in much better penetration and overall better film quality.
An Interesting Case
When I was the head of the X-ray department of Life Chiropractic College in 1980, the assistant clinic director received a call from his brother, a chiropractor in Florida. His twelve year old son was playing Little League baseball, slid into second base and complained of pain in his neck. His father x-rayed his neck and was alarmed because C4 vertebral body was deteriorated. The boy was taken to a world famous teaching hospital in Florida and the family was told it probably was cancer. The films were sent to me and I disagreed with their diagnosis.It was most likely that this was an eosinophilic granuloma which proved to be the case. Most cases of eosinophilic granuloma recover the normal vertebral body height without treatment, although medical treatment does consist of radiation therapy. This case is displayed in Essentials of Skeletal Radiology by Yochum & Rowe, Volume II, Page1064, copyright 1987.
David D. Millman, D.C., D.A.C.B.R. confines his practice to film reading. His office is located at 1592 Valley Stream Drive, Marietta, GA. 30062.. Ph 770 977-3304..Please call prior to sending film studies.
Why our country is in trouble
Perhaps this will explain it all:
A Washington, DC airport ticket agent offers some examples of why our country is in trouble!
1. I had a New Hampshire Congresswoman ask for an aisle seat so that her hair wouldn`t get messed up by being near the window.
2. I got a call from a candidate`s staffer, who wanted to go to Capetown. I started to explain the length of the flight and the passport information, then she interrupted me with, "I`m not trying to make you look stupid, but Capetown is in Massachusetts," Without trying to make her look stupid, I calmly explained, "Cape Cod is in Massachusetts, Capetown is in Africa," Her response - click.
3. A senior Vermont Congressman called, furious about a Florida package we did. I asked what was wrong with the vacation in Orlando. He said he was expecting an ocean-view room. I tried to explain that`s not possible, since Orlando is in the middle of the state. He replied, "Don`t lie to me, I looked on the map and Florida is a very thin state!"
4. I got a call from a lawmaker`s wife who asked, "Is it possible to see England from Canada?" I said, "No." She said, "But they look so close on the map."
5. An aide for a cabinet member once called and asked if he could rent a car in Dallas. When I pulled up the reservation, I noticed he had only a 1-hour layover in Dallas. When I asked him why he wanted to rent a car, he said, "I heard Dallas was a big airport, and we will need a car to drive between gates to save time."
6. An Illinois Congresswoman called last week. She needed to know how it was possible that her flight from Detroit left at 8:30 am and got to Chicago at 8:33 am. I explained that Michigan was an hour ahead of Illinois, but she couldn`t understand the concept of time zones. Finally, I told her the plane went fast . . . and she bought that.
7. A New York lawmaker called and asked, "Do airlines put your physical description on your bag so they know whose luggage belongs to whom?"
I said, "No, why do you ask?" She replied, "Well, when I checked in with the airline, they put a tag on my luggage that said (FAT), and I`m overweight. I think that`s very rude!"
After putting her on hold for a minute while I looked into it (I was laughing) I came back and explained the city code for Fresno, CA is (FAT), and the airline was just putting a destination tag on her luggage.
8. A Senator`s aide called to inquire about a trip package to Hawaii.
After going over all the cost info, she asked, "Would it be cheaper to fly to California, and then take the train to Hawaii?"
9. I just got off the phone with a freshman Congressman who asked, "How do I know which plane to get on?" I asked him what exactly he meant, to which he replied, "I was told my flight number is 823, but none of these planes have numbers on them."
10. A lady Senator called and said, "I need to fly to Pepsi-Cola, Florida. Do I have to get on one of those little computer planes?" I asked if she meant fly to Pensacola, Fl. on a commuter plane. She said, "Yeah, whatever, smarty!"
11. A senior Senator called and had a question about the documents he needed in order to fly to China. After a lengthy discussion about passports, I reminded him that he needed a visa. "Oh, no I don`t. I`ve been to China many times and never had to have one of those." I double checked and sure enough, his stay required a visa. When I told him this he said, "Look, I`ve been to China four times and every time they have accepted my American Express!"
12. A New Mexico Congresswoman called to make reservations, "I want to go from Chicago to Rhino , New York." I was at a loss for words.
Finally, I said, "Are you sure that`s the name of the town?"
Yes, what flights do you have?" replied the lady.
After some searching, I came back with, "I`m sorry, ma`am, I`ve looked up every airport code in the country and can`t find a Rhino anywhere."
The lady retorted, "Oh, don`t be silly! Everyone knows where it is. Check your map!"So I scoured a map of the state of New York and finally offered, "You don`t mean Buffalo, do you?"
The reply? "Whatever! I knew it was a big animal".
Now you know why Government is in the shape that it`s in!
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I am Thankful :
FOR THE WIFE
WHO SAYS IT`S HOT DOGS TONIGHT,
BECAUSE SHE IS HOME WITH ME,
AND NOT OUT WITH SOMEONE ELSE.
FOR THE HUSBAND
WHO IS ON THE SOFA
BEING A COUCH POTATO,
BECAUSE HE IS HOME WITH ME
AND NOT OUT AT THE BARS.
FOR THE TEENAGER
WHO IS COMPLAINING ABOUT DOING DISHES
BECAUSE IT MEANS SHE IS AT HOME,
NOT ON THE STREETS.
FOR THE TAXES I PAY
BECAUSE IT MEANS
I AM EMPLOYED.
FOR THE MESS TO CLEAN AFTER A PARTY
BECAUSE IT MEANS I HAVE
BEEN SURROUNDED BY FRIENDS.
FOR THE CLOTHES THAT FIT A LITTLE TOO SNUG
BECAUSE IT MEANS
I HAVE ENOUGH TO EAT.
FOR MY SHADOW THAT WATCHES ME WORK
BECAUSE IT MEANS
I AM OUT IN THE SUNSHINE
FOR A LAWN THAT NEEDS MOWING,
WINDOWS THAT NEED CLEANING,
AND GUTTERS THAT NEED FIXING
BECAUSE IT MEANS I HAVE A HOME.
FOR ALL THE COMPLAINING
I HEAR ABOUT THE GOVERNMENT
BECAUSE IT MEANS
WE HAVE FREEDOM OF SPEECH..
FOR THE PARKING SPOT
I FIND AT THE FAR END OF THE PARKING LOT
BECAUSE IT MEANS I AM CAPABLE OF WALKING
AND I HAVE BEEN BLESSED WITH TRANSPORTATION .
FOR MY HUGE HEATING BILL
BECAUSE IT MEANS
I AM WARM.
FOR T HE LADY BEHIND ME IN CHURCH
WHO SINGS OFF KEY BECAUSE IT MEANS
I CAN HEAR.
FOR THE PILE OF LAUNDRY AND IRONING
BECAUSE IT MEANS
I HAVE CLOTHES TO WEAR.
FOR WEARINESS AND ACHING MUSCLES
AT THE END OF THE DAY
BECAUSE IT MEANS I HAVE BEEN
CAPABLE OF WORKING HARD.
FOR THE ALARM THAT GOES OFF
IN THE EARLY MORNING HOURS
BECAUSE IT MEANS I AM ALIVE.
AND FINALLY, FOR TOO MUCH E-MAIL
BECAUSE IT MEANS I HAVE
FRIENDS WHO ARE THINKING OF ME.
TOP TEN INDICATORS THAT YOUR EMPLOYER HAS CHANGED TO A CHEAPER HEALTH CARE PLAN:
(10) Your annual breast exam is done at Hooters.
(9) Directions to your doctor`s office include "Take a left when you enter the trailer park."
(8) The tongue depressors taste faintly of Fudgesicles.
(7) The only proctologist in the plan is "Gus" from Roto-Rooter.
(6) The only item listed under Preventative Care Coverage is "an apple a day."
(5) Your primary care physician is wearing the pants you gave to Goodwill last month.
(4) "The patient is responsible for 200% of out-of-network charges," is not a typographical error.
(3) The only expense covered 100% is "embalming."
(2) Your Prozac comes in different colors with little M`s on them.
AND THE NUMBER ONE SIGN YOU`VE JOINED A VERY CHEAP HEALTH CARE PLAN:
(1) You ask for Viagra, and they give you a Popsicle stick and duct tape.
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A man was flying from Seattle to San Francisco and the plane had a layover in Sacramento. The flight attendant explained that there would be a delay, and if the passengers wanted to get off the aircraft, the plane would re-board in one hour. Everybody got off the plane except one gentleman.
Another man had noticed him as he walked by and could tell the gentleman was blind because his Seeing Eye dog lay quietly underneath the seats in front of him throughout the entire flight.
He could also tell that he had flown this very flight before because the pilot approached him, and calling him by name, said, "Keith, we`re in Sacramento for an hour, would you like to get off and stretch your legs?"
The blind man replied, "No thanks, but maybe my dog would like to stretch his legs."
Now picture this:
All the people in the gate area came to a complete standstill when they looked up and saw the pilot walk off the plane with a Seeing Eye dog! The pilot was even wearing sunglasses. People scattered. They not only tried to change planes, but they were trying to change airlines!
True story.... Have a great day and remember... Things aren`t always as they appear.
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ARE YOU LOOKING FOR GUIDANCE?
· Do you dream of a more fulfilling, successful, joyous practice and personal life?
· Would you like to find the internal reasons that hold you back?
· Does the idea of allowing yourself to grow at your own pace, being gently pushed rather than shoved around appeal to you?
· Does the concept of a long-term financial contract frighten you?
If so, then it sounds like you could use some guidance.
There are a multitude of coaches in our profession. Everyone has their own style and regimen. This is fine if you want someone to totally take over and transform your practice.
I am not one to “hold your hand”. I will work with you to get to the inner blocks that are holding you back, and then guide you through them. Let me help facilitate your personal growth.
If you would like to know more please email me at drrossi@rossichiropractic.com
Or call my office at 954-971-6800.
Thanks,
Armand Rossi D.C.
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Here are a list of my upcoming talks and seminars. Please note that these may change.
June 10 - 11, 2006 San Juan, Puerto Rico.............ICPA Chiropractic Care for the Family
July 13 - 16, 2006 Atlanta, Ga..................................Dynamic Essentials
This newsletter does not replace pure, principled chiropractic care!!