Category Archives: News

Off The Shelf Medications – Regulatory Bodies – Caveat Emptor!

04/22/16

Whereas it is preferable to wish people success in their endeavours, particularly those that will benefit others, while hopefully adhering to the truth, unfortunately in our current culture events contrary to these objectives do occur. Schadenfreude is not high on my list of aspirations but sometimes it conveys a benign sense that perhaps truth still extends to some corners of our society.

To wit – a recent newspaper article indicated that a class action had been filed against ColdFx, a concoction that has been marketed more than vigorously in Canada, and presumably other jurisdictions, over the past 10-15 years.

Canadians alone have spent more than a billion of their hard earned dollars on this apparently worthless medication, which for over a decade had been touted as a cure for colds. There were also references to the preventative factor, reducing the symptoms of infections, along with shortening the duration of the problem – none of which are evidently true.

At one time a well-intentioned salesperson representing that company brought samples to my office and I had the opportunity to review the components. Although I am no expert on reviewing the ingredients and contents of medications, this one appeared to be primarily just another form of ginseng, along with a number of other obscure materials. Clearly there appeared to be nothing within the compound that should confer specific health benefits, yet regulatory bodies approved its sale.

Immediately all the large pharmacies, including the chains, had displays close to their front entrances where you could not miss the ColdFx presence. A banner boldly stating that colds, viruses, etc. were conquered, along with many articles reporting that patients who used the compound fared significantly better than those who did not. What could be more convincing?

Again, in our culture where an overwhelming avalanche of false advertising in all channels of communications exists, it is sometimes heartening to see that retribution in some form can still occur, punishing deliberate falsehood and hopefully its perpetrators, if they are still around.

So much for placing your trust in pharmacists, regulatory bodies and the machinery employed in promoting fraud. Events of this nature do not provide a sense of comfort when relying on the so-called “watchdogs” and selective regulatory bodies controlling the protection of our state of health.

Clarification of Controversy – Class III vs. Class IV Lasers

02/5/16

 

Clarification of Controversy – Class III vs. Class IV Lasers

The article below hopefully will permanently put to rest the inappropriate claims made for the efficacy of Class IV vs. Class III or IIIB Lasers. The article clearly delineates the controversy utilized in advertising these forms of Laser Therapy which creates significant confusion for begineers attempting to find their way in the field of Laser Medicine.

Dr. Jan Tuner’s objective summary of this matter should clarify the facts involved and enable clinicians to make appropriate choices with regard to the therapy systems they acquire for optimal benefit to their patients.

 

Low Level Lasers in Clinical Practice – Jan Tunér DDS

The use of low level lasers is increasing in medical applications. This treatment modality offers several advantages by promoting wound healing, reducing inflammation, edema and pain. But for those thinking about adding a low level laser to their clinic, it is wise to look for unbiased information before any investments are made.

There are many different lasers on the market with different wavelengths, different combinations of wavelengths and output power. Most of these lasers are in the so called Class 3B, meaning lasers with a maximum power of 500 milliwatts (mW). Lasers with higher power are in the Class IV and having powers between 501 mW up to 15 000 mW (15 W) or more. The classification has nothing to do with the therapeutic effects but is solely based upon the risk of retinal damage. Which type of laser is then the best buy? To answer this question, we need to look at some facts.

Manufacturers of Class IV lasers often claim that the high power increases the depth of penetration into tissue. This is not correct. Several of these lasers have a 980 nm wavelength, and the penetration of this wavelength is considerably less than that of the more conventional 808 nm wavelength. Since the penetration at 980m nm is poor, this means that there is more heat buildup at the skin. And laser phototherapy is not about heat but about photochemical reactions. As for the high power, it causes no increase of the penetration depth. The study by Joensen et al. [1] showed a static depth of penetration of 810 nm over time. It is true that high power quicker produces more photons at the level of the maximum penetration, but this is not necessarily beneficial. Studies have shown that low doses and long time is more effective for the reduction of inflammatory processes [2], whereas high power and short time are inhibitory. Inhibition is actually a part of LLLT. By using high energies, the pain transmission in nerves is temporarily slowed down [3]. This is a useful option in many situations of acute pain. But on the other hand, the inflammatory background of the pain is also inhibited and the actual healing is slower.

Another aspect of the depth of penetration is the heat produced by strong lasers. This is particularly a problem in patients with dark skin or dark hair. The therapist needs to use a sweeping motion over the target to avoid pain. With a non-contact technique you lose upwards of 50-85% of the incident light through reflection and back-scattering from the skin [4], which means that only 15-50% of the light leaving the laser aperture is actually making it into the tissue. A Class3B laser does not cause any pain reaction due to heat, so it can be used with contact and with pressure. With contact, more light it forced into the tissue. And by using pressure, blood, being the main absorber of the light, is reduced in the area and the light can more easily penetrate the ischemic tissue. The pressure will also lead the laser probe closer to the target. Thus, a Class 3B laser can penetrate deeper into tissue than a Class IV laser and can therefore saturate the target faster. The heat buildup by Class 4 is negative and some manufacturers add cooling to the beam. Others offer pulsing to allow for heat dissipation. The latter actually lowers the energy, so the suggested advantage of the high power is contradicted.

Proponents of Class IV lasers often claim that a larger area can be treated much faster. A cluster of Class 3B lasers can do the same thing and with the advantages mentioned above. The target area of physiotherapeutic problems is frequently rather small in size, but certainly often larger in chiropractic procedures. However, it does not necessarily take 15 W lasers to cover large areas. The goal of such therapy is to identify the precise locations of the problems and to apply a sufficient energy to that area, rather than to cover a large area and hope for the best.

Manufacturers of Class IV lasers frequently make references to the literature. Remarkably, these references are generally Class 3B studies. The Class IV studies are still few and sometimes surprisingly biased. One paper (5) claims that Class IV laser produced better healing of oral mucositis than “a standard Class 3B laser”. But the “standard Class 3B laser” turned out to be a very weak laser pointer. There are still no studies where the effects of traditional Class 3B lasers have been reasonably well compared to Class IV lasers.

Class IV laser manufacturers often claim that this type of laser saves time. It ain’t necessarily so, as Porgy sings. In the epicondylitis study by Roberts (6) the time spent was 5 minutes. Using a 3B laser in firm contact over tender points and a sweeping motion over the actual condyle (being very superficial), sufficient energy at the targets can be applied in 2-3 minutes. The authors swept over an area of 45 cm2. By spreading the light over a large area, using a wide beam area and irradiating from a distance, the dose became 6.6 J/cm2 and the power density only 22 mW/cm2, which is very low. So in spite of using 10 000 mW and an energy of 3.000 J, the power density was low and the time long. This shows that high power does not necessarily save time.

In the study by Kheshie (7), Class 3B and Class IV lasers are compared in their potential efficacy on knee osteoarthritis. At least that is what the authors and the average reader would believe. However, this is another case of apples and oranges. The “high intensity laser” disperses its light over a large and not well defined area, but quite large. If supposed to be 100 cm2, the intensity would be in the level of a regular LED, 15-25 mW/cm2. Hardly within the known therapeutic window. In comparison, a 3B cluster of 4 x 200 mW laser diodes with small apertures (= high local intensity) is held over the patella. Not a very good approach for knee OA, but what is worse is that the laser was held stationary for 30 minutes! This is bioinhibition, for sure! (Around 1500 J over a knee). The conclusion of the abstract is: “HILT combined with exercises was more effective than LLLT combined with exercises, and both treatment modalities were better than exercises alone in the treatment of patients with KOA.” Yes, obviously, and two inadequate protocols managed to result in positive outcomes. Says something about the potential of LLLT. But it says nothing about any advantages of Class IV over Class 3B lasers. And the flaw cannot be identified in the PubMed abstract due to shortcomings in the reporting of parameters.

Summing up, any Class IV laser used within its limitations can be a positive addition to a clinic. However, there are several therapeutic limitations and a suitable Class 3B laser can do whatever the Class IV laser can, and at a lower cost. Low level laser in itself is very rewarding, so keeping to the facts should be enough to impress any customer.

class 3 vs class 4 lasers

class 3 vs class 4 lasers

References

  1. Joensen J, Ovsthus K, Reed R K, Hummelsund S, Iversen V V, Lopes-Martins R A, Bjordal J M. Skin Penetration Time-Profiles for Continuous 810 nm and Superpulsed 904 nm Lasers in a Rat Model. Photomed Laser Surg. 2012; 30 (12): 688-694.
  2. Castano A P, Dai T, Yaroslavsky I, Cohen R, Apruzzese W A, Smotrich M H, Hamblin M R. Low-level laser therapy for zymosan-induced arthritis in rats: Importance of illumination time. Lasers Surg Med. 2007; 39 (6): 543-550.
  3. Chow R T, David M A, Armati P J. 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst. 2007; 12 (1): 28-39.
  4. Al Watban FAH (1996) Therapeutic lasers effectiveness and dosimetry. Biomedical Optical Instrumentation and Laser-Assisted Biotechnology, NATO ASI Series E Applied Sciences, Vol 325, 171-183.
  5. Ottaviani G, Gobbo M, Sturnega M, Martinelli V, Mano M, Zanconati F, Bussani R, Perinetti G, Long C S, Di Lenarda R, Giacca M, Biasotto M, Zacchigna S. Effect of Class IV Laser Therapy on Chemotherapy-Induced Oral Mucositis: A Clinical and Experimental Study. Am J Pathol. 2013; 183 (6): 1747-1757.
  6. Roberts D B, Kruse R J, Stoll S F. The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis. Lasers Surg Med. 2013; 45 (5): 311-317.
  7. Kheshie A R, Alayat M S, Ali M M. High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci 2014; 29 (4): 1371-1376.

 

Author CV at http://tuner.nu/curriculum-vitae

 

The Truth, The Whole Truth and Reality

02/5/16

This article was recently forwarded to me by Dr. L. Rudnick, an experienced Laser Therapist and retired chiropractor in Tucson, Arizona. The article certainly provides food for thought and establishes a number of points that are in my opinion, meritorious.

The Truth, The Whole Truth and Reality

For decades, it has been stated that chiropractic and then light therapy were not science-based like mainstream medicine. According to physicians, medicines are termed an evidence-based scientific therapy.

During the course of taking care of patients, I most frequently found that they were taking prescribed medications to deal with their chronic pain. These include, among many, naproxen, methocarbamol and amitriptyline. Naproxen is described as a non-steroidal anti-inflammatory, methocarbamol is a muscle relaxant and amitriptyline is an antidepressant.

I am always interested in the possible side effects of all medications, therefore I checked my trusty Physician’s Desk Reference (PDR), which contains all information regarding pharmaceuticals from the companies producing these medications. More interesting than the side effects was a section that dealt with how the medications actually work. For naproxen it states “it isn’t known how this medication works to decrease pain, inflammation and fever. It may help reduce swelling by lowering levels of prostaglandin, a hormone-like substance”. For methocarbamol it states “the mechanism of action of methocarbamol in humans has not been established”. For amitriptyline it states “its mechanism of action in man is unknown”.

The fact is that the use of pharmaceuticals is more of a trial and error process than so called “science”.

“Take this several times a day for 10 days and let me know how you are feeling” can hardly be classified as scientific.

Evidence-based medicine that relies on medications for which there is no understanding of how they work is not science. In reality and truth if you will, healthcare and all of its many disciplines involves the art of applying scientific principles, not scientific facts, and all too often, little truth. It would appear that some doctors are simply more artistic than others.

 

Dr. L. Rudnick

 

References:

Physician’s Desk Reference, 69th Edition, 2015.

Medsave.govNZ

www.drugs.com

 

Commentary: Hospitals ‘deeply sorry’ for lung cancer misdiagnosis

12/15/14

This commentary is in reference to a recent article published in the Toronto Star:

http://www.thestar.com/life/health_wellness/2014/11/14/hospitals_deeply_sorry_for_lung_cancer_misdiagnosis.html

The press or media, as it is commonly termed, whether indulging in sensationalism or good investigative reporting, definitely has a sacred place in our society, and deservedly so, as the case cited in this instance illustrates. In my recent memory, at least over the past decade, we have had the debacle at Sick Children’s Hospital in Toronto, where a number of cardiac deaths occurred under circumstances which have never been fully explained. Then there was the frenzy over a drug undergoing clinical trials for the treatment of sickle cell anemia which involved a major generic pharmaceutical manufacturer. My interpretation of that situation was that the manufacturer attempted to force the principal researcher in charge of the trials to alter the results. Many lawsuits resulted and may still be operative. The same manufacturer has recently been charged by Health Canada with producing contaminated drugs under substandard conditions. Many lawsuits have ensued and are still ongoing. Then we heard about the major mix-up with the incorrect pathological interpretations of breast cancers in Newfoundland and now this matter of a lung tumour. It is certain that the latter is not an isolated instance. Periodically we hear about the incompetent pathologist who may be undergoing personal stress, utilizing inappropriate drugs or may even be suffering from a mental illness. Clearly, as history would indicate, these cases are never simple, however they indicate a persistent and probable growing trend.

How many radiological studies, pathological interpretations and routine blood tests are reported incorrectly on a daily basis? If I may hazard a guess, probably somewhere between 3-10%; at the same time, even 1% would be too high and validates the growing hazard of lack of care and responsibility and today’s gold standard of mediocrity. Realistically the percentage, whatever it may be, is undesirable, particularly if one is the patient involved.

Fortunately, the individual in this instance had the intelligence and the resources to obtain another opinion, which for the average individual is generally not possible. The move the patient made clearly saved his life. Most importantly, it demonstrates again the lack of care and attention and the substandard fashion in which our society functions.

In a medical system controlled by governments, insurance companies and the pharmaceutical industry, primarily interested in their individual vested interests, this trend is hardly surprising. Unfortunately, no one is taking the necessary steps to counter this trend. Only education and legislation can arrest and reverse these occurrences and no one appears to be interested in these processes.

For the individual physician, it is still of the utmost importance to listen to the patient tell their story and to perform a thorough physical examination. Invariably, this will provide the correct diagnosis, which can then be confirmed, if necessary, by the appropriate studies and tests. This simple and effective approach to healthcare has long fallen by the wayside. No significant medical education reviews have been carried out since the Rockefeller Report (the Flexner Study), was performed between 1910-1915.

Further evidence of the deterioration of health care is portrayed by the banners with their bold slogans adorning the hospitals on University Avenue in Toronto. Much is stated that is simply not true. The banners advertising these fundraising efforts which promise to help sick children, provide cures for cancer, etc. appear to be primarily directed to generate the millions of dollars required by the propagators of these efforts under the guise of helping the sick and underprivileged. The money being mined by these industrial fundraisers, after their not inconsiderable portion has been amputated, ends up in the same government financial pool as our tax dollars, which are treated as the politician’s personal hoard, to disburse at their discretion. Clearly, this is an inappropriate manner in which to fund healthcare and unless our leadership changes, or at least changes course, these events will become more prevalent. Why have these inappropriate and, from my perspective, adverse activities enmeshed the healthcare system? The answer: excessive regulation devoid of intellectual input, along with the destruction of independent thought and the status of the individual. Everything must become systematized and conform to the frequently inappropriate regulations of the bodies that control all activities in this area. 1984? — more like 3084. Fundraising has become an enterprise that only serves its own interests and the patient is merely used as a pawn to achieve their objectives.

At this time, it is best for the independent practitioner to focus on preventative medicine, encourage the ingestion of a healthy diet, exercise in moderation and avoid the politics and misrepresentations of the health, food and nutritional industries.

Protect your health through education and the adoption of an appropriate lifestyle.

Nilo Schonfeld Wins Long Drive Competition Using BioFlex Laser Therapy System

06/13/14

Nilo Schonfeld, a graduate of the University of Toronto, led a Canadian contingent to a championship win at the el Torneo Internacional Long Drive Challenge competition in Mexico last November.

Recently, I had the opportunity to play a round with him and he drove a 336 yard uphill, par 4 at Angus Glen Golf Club. He missed the eagle putt by less than 4 inches- quite impressive to say the least.

Nilo is pleased to state that he has been utilizing a Bioflex Laser Therapy System for home use for 6 years and uses it prior to competitions and subsequently for 20 to 40 minutes. He credits frequent application to the areas of involvement for his asymptomatic status, despite a rigorous physical training schedule.

When he first presented at our clinic 6 years ago, he had severe pain in both shoulders, the neck and frequently, the lower back. Nilo has learned how to apply Laser Therapy on a preventative basis, in order to help him continue to compete at high levels in golf and the other sporting activities he pursues.

We congratulate him on his singular achievement!

NOTES RE CLASS IV LASERS:

05/21/14

Although these devices are currently highly touted by individual manufacturers and their paid proponents, they need to be regarded with a critical eye.

First of all, these systems operate at high energy levels and may therefore be bioinhibitory and I quote the Arndt Shultz Law which states that a small dosage of light may have no biological effect, a moderate dosage may have a biostimulatory effect, and a large dosage may have a bioinhibitory or even cytotoxic effect. Moreover, Class IV devices do not reduce the severity of the inflammatory process so essential to therapy and do not accelerate the regeneration of individual cells. Indeed in review, they have proven to slow wound healing and accordingly their advertising hype never mentions the healing of wounds. It should be observed that the healing of wounds does not differ from the healing of other tissues, notwithstanding the existing degree of pathology. The generation of the heat imposed also detracts from the effectiveness of therapy.

Wavelengths from the 900-1000 level are primarily absorbed by lipids and water and therefore have minimal effect on the cells involved in the pathological process. Once again, it should be noted that Class IV Lasers are not applied directly to the tissues because to do so would cause burns using the high powered settings recommended. The 980 nm diodes incorporated in Class IV Lasers do not increase penetration, as much of the light energy is absorbed superficially and more rapidly, leading to heat generation. This diminishes the physiological benefits so essential to cellular activity.

It should be noted that Tuner and Hode, who have a good grasp of the physics of laser light, do not recommend Class IV Lasers and state that Class IIIB devices, properly engineered, are most appropriate for cellular healing (excerpted from an article, “No Cure from LiteCure” by Jan Tuner).

However Lasers may be classified, whether Class II, III or IV, it is an extensive combination of factors that are essential to promote cellular healing and the production of optimal clinical outcomes. These include malleable parameters such as pulse frequency, duty cycle, waveform, wavelength, energy density, duration, etc. The diodes utilized must be minimally degradable and applied directly to tissue to achieve maximum benefit. The benefits derived from Class IV Lasers generally, removed some distance from the tissues and covered by either a plastic or glass protective barrier, are negatively affected by the refraction of light as it transverses the atmosphere and reflection as it strikes the epidermal surface.

While curtailing the so-called benefits of higher powered lasers, the degree of power cannot be accurately determined and effects on tissue will therefore be random, unpredictable and potentially produce serious adverse effects.

The Unravelling of Obama

11/29/13

Another example of the outcome of poor leadership. As I always say, everything that goes wrong or right begins at the top. Unfortunately most of the time it goes wrong.

For concision and precision in describing Barack Obama’s suddenly ambivalent relationship with his singular — actually, his single — achievement, the laurels go to Rep. Steve Scalise (R-La.).

After Obama’s semi-demi-apology for millions of canceled insurance policies — an intended and predictable consequence of his crusade to liberate Americans from their childish choices of “substandard” policies sold by “bad apple” insurers — Scalise said Obama is like someone who burns down your house. Then shows up with an empty water bucket. Then lectures you about how defective the house was.
What is now inexplicably called Obama’s “fix” for the chaos he has created is surreal. He gives you permission to reoccupy your house — if you can get someone to rebuild it — but for only another year.
At least he has banished boredom from millions of lives. Although probably not from his.

The place to begin understanding the unraveling of his presidency is page 274 of “The Bridge: The Life and Rise of Barack Obama.” The author, David Remnick, editor of the New Yorker, quotes Valerie Jarrett, perhaps Obama’s closest and longest-serving adviser, on her hero’s amazingness:

“He knows exactly how smart he is. . . . I think that he has never really been challenged intellectually. . . . He’s been bored to death his whole life. He’s just too talented to do what ordinary people do. He would never be satisfied with what ordinary people do.”

Leave aside the question of whether someone so smitten can be in any meaningful sense an adviser. About what can such a paragon as Obama need advice? (Although he did recently say, “What we’re also discovering is that insurance is complicated to buy.” Just to buy.) It is, however, fair to note that what ordinary people ordinarily do is their jobs, competently. Obama’s inability to be satisfied with anything so banal has plunged him into Jimmy Carter territory.

Carter’s presidency crumbled when people decided they still liked his character but had no confidence in his competence. Obamacare’s misadventures, and Obama’s response to them, have caused people to doubt both his character and his competence.

The White House, disoriented by adoration — including the self-adoration — of its principal occupant, sits in a city that has become addicted to its own adrenaline. It is in a perpetual swivet stoked by media for which every inter-institutional dust-up is a crisis.

This year began with the “fiscal cliff” crisis. (You may have forgotten, there having been so many supposedly epochal events to keep track of: All the Bush tax cuts were set to expire; the “crisis” ended when only those cuts for the wealthy were allowed to lapse.)

Then came spring and the “sequester crisis,” meaning discretionary spending “slashed” by “draconian” cuts of . . . 2.3 percent. Autumn brought the crisis of the shutdown of (part of) the government and the crisis surrounding the inevitable raising of the debt ceiling. The ostensible crisis was that the Obama administration might choose to default on the nation’s debt even though government revenues were 10 times larger than required to service the debt.

Good grief. The 1854 passage of the Kansas-Nebraska Act was a crisis. As was the 1857 Dred Scott decision, the Great Depression and Pearl Harbor. But as for 2013’s blizzard of supposed crises: Arguments between the houses of Congress, or between the executive and legislative branches, about money should not be called crises; they should be called politics. The separation of powers that is the essence of the constitutional system assumes rivalrous institutions. When, however, the conflict is not about money but about the nation’s constitutional architecture, perhaps the language of crisis is apposite.

The New York Times reports that last March Henry Chao of the Centers for Medicare and Medicaid Services, which superintended creation of the HealthCare.gov Web site, told a conference that he had worries: “Let’s just make sure it’s not a third-world experience.” When such an embarrassing experience occurred, Obama responded like a ruler of a banana republic unfettered by constitutionalism and the rule of law. Although no president has even a line-item veto power (which 44 governors have), this president asserts the power to revise the language of laws by “enforcement discretion,” and suggests no limiting principle.

But even this is a crisis only if Congress makes it so by supine acquiescence. Congressional Democrats are White House poodles. They also are progressives and therefore disposed to favor unfettered executive power. Republicans are supposed to be different.

MEDICAL PRACTICE & LASER THERAPY – REFLECTIONS

07/23/13

Today, it is of the ultimate importance that healthcare professionals have an overview of medicine as practiced internationally − not just as it is practiced in Canada. Around the world, it has been demonstrated that governments and medicine seldom mix. Accordingly, all healthcare professionals, particularly physicians, must be independent practitioners who have only the best interests of the patient at heart and must therefore focus their efforts on this objective.

Unfortunately, system administrators seem to sprout ever enlarging bureaucracies often advised by physicians who are motivated by exercising political clout and their own pecuniary interest, rather than the welfare of patients.

Pharmaceutical companies, with their extensive lobbies and the support of government bureaucracies, are primarily driven to generate profits but nevertheless exert an excessive and unwarranted degree of influence in formulating healthcare policies, extending even to the educational process.

Insurance companies, as is increasingly evident, again are economically oriented and pose one of the most pernicious influences in healthcare today. Claims adjusters and low-level administrators frequently impose incredible hardship on patients desperately in need of funds to pay for both their specialized and routine health care, for which they have contributed premiums over many years.

The combination of gatekeepers consisting of governments, HMOs, Wall Street corporations, etc., further muddy the waters. There is no clarity existing with all the vested economic interests that at this point almost totally control healthcare delivery systems, whether in England, Cuba, Canada or Sweden.

In many instances, unfortunately, no healthcare at all may be preferable to what is actually provided. For example, wounds secondary to diabetes, atherosclerosis, and other etiological factors often show rapid improvement with simple elevation of the extremity and saline compresses to the wound 24/7, as compared to the utilization of multiple dressings, antibiotics and analgesics that are provided in such abundance, accompanied by rising costs. All too often, the latter approach leads to the eventual amputation of the afflicted limb.

Does anyone really care about these issues? Not as long as the care provided is perceived to be ‘free’. And what of the latter fact? A perfect excuse to levy more taxes, to expand the bureaucracy and order more diagnostics and consumables, all excluding the most important item – the correct therapy designed to cure the patient’s problem.

To elaborate on the insurance situation: each day, we see new patients at our clinics and invariably, at least initially, the priority item they wish to discuss is their insurance plight – rather than their medical condition. These patients rant on about how the insurance companies keep reneging on the promise to pay for their care. How can you blame them? This premise, after all, is why they bought insurance in the first place.
I recently uploaded on my blog the story of one particular family which serves as an excellent example of this growing problem. The husband was severely injured in an automobile accident over five years ago and has been unable to work since. The couple went broke paying their medical bills and were recently evicted from their home. Several insurance policies had been purchased by this individual, who owned a number of businesses that were thriving prior to the accident. Financial failure ensued after the trauma as the wife was busy taking care of her husband and two children and could not continue to manage their affairs.

Over five years later, the insurance companies are still fighting about who should pay for what. Anyone familiar with this paradigm knows that it can go on for many years, or at least until the patient expires.

At the same time, insurance companies spend considerable funds on diagnostics and these are seldom questioned, no matter how expensive they may be. They also spend unlimited funds carrying out assessments, investigations, etc., which allow them to renege on claims, aided and abetted by a hoard of assessors, bought and paid for by the carrier. The latter almost invariably find that there is no objective evidence to substantiate the disputed claim.

As for pharmaceuticals, these in many instances confer significant benefit. For example, insulin, thyroxin, cortisone, and analgesics, along with many other drugs, provide viable solutions – primarily in the short term, although often only by masking symptoms. Furthermore, drugs do have limitations and can produce adverse effects. In some instances, the latter may be significant. However, because the pressing need for these medications may override the objection to prolonged use, dependence becomes ‘justifiable’. That is certainly the case with diabetes and insulin, ACTH for adrenal insufficiency, thyroxin for hypothyroidism and a number of similar situations.

On the other hand, alternative therapies can and do provide highly effective solutions in the treatment of a plethora of medical conditions and do not produce adverse effects, either long or short-term, particularly in the treatment of arthritis, back problems and most conditions with the common factor of inflammation, a major component in most disease processes.

I first learned about Laser Therapy in 1988, having injured my right shoulder in a skiing accident in 1986. The injury included a complete tear of the supraspinatus tendon and a fracture of the humeral head generating chronic inflammation of the shoulder joint. Subsequent to this episode, I consulted a number of orthopedic surgeons and the general consensus was to perform an arthrogram to be followed by immediate surgery. Being a trained surgeon, I resisted the temptation to follow this approach, based on past experience, notwithstanding the fact that both orthopedic surgeons I consulted were highly competent and had the best of intentions. My conclusion was that this intervention, fully approved by the regulatory bodies, would not substantially benefit me and I therefore pursued an alternative course. Above all, I did not wish to be subjected to an additional trauma.

Unfortunately, prior to Laser Therapy, from 1986-1989 I was unable to play golf or swim on a regular basis, secondary to the discomfort and pain. Analgesics and anti-inflammatory medications produced undesirable side effects; moreover, I objected to them on basic principles. Periodically, when the symptoms became unbearable, I submitted to cortisone injections which, when properly placed, provided temporary relief. A permanent cure proved elusive.

Finally, I found a therapist equipped with a primitive European Laser device and in a short period of time, my shoulder pain subsided significantly. Inspired by this turn of events, I began my pursuit of self-education in the emerging technology of Laser Therapy. Over the course of two years, I read over 300 articles and 13 texts on this topic and participated in many national and international meetings exploring the subject.

Here are some observations noted on this journey:

 How little was really known about this therapeutic medium at that time.
 How much remained to be learned.
 How we must open our minds to new ideas, thoughts and solutions.
 How we must question tradition and “the way things have always been done”.
 How we must be critical of the massive amount of information and disinformation coursing through the net. This is extremely challenging and reminds me of my mother who often said, “I read the following in the newspaper.” My usual response would be, “I know that this is not true.” Her invariable retort was that “It would not be in the newspaper if it were not true!” She also believed in the infallibility of physicians, with the exclusion of myself. Unfortunately, that was the cause of her demise at the age of 93. Had it not been for a series of hospital blunders, she might still be alive today.
 We must always be aware of how the internet disseminates a mountain of data, all of which is of course documented by humans, many of whom have a vested interest in benefiting the propagator of the information provided.
 Creativity and independent thought must be encouraged. In a civilized world, these qualities inevitably lead to progress.
 Never be afraid to question or criticize authoritarianism in its varied forms.
 Do not permit economic conventions, inappropriate regulations, and other obstructions to get in the way of implementing better therapeutic solutions.

To cite some recent advances, I refer to:
o Stem Cell Therapy
o Genetic Modification (gene splicing)
o Robotic Surgery
o Laser Therapy, etc.

 All healthcare professionals should be encouraged to make the patient’s clinical status the focus of their endeavors.
 Most significant of all, are the advances in Laser Medicine over the past decade and the wide impact this should have on the quality of medical care, now and in the future.

When asked how he conducted research surveys indicating what product the company should build, Steve Jobs, the late departed CEO of Apple, stated, “Surveys of that type have no interest to me. I know what people need and that is what I give them.” To me, this represents a greater wisdom than the many aphorisms espoused daily by the leaders of the corporate world.
Steve Jobs may have been, in the eyes of some, a “son of a bitch” but he is one of the few who had the vision and courage to nurture his original concepts and ideas and translate them into reality. All of us should adopt this type of guidance to a greater degree. Personally, I like to think that in many ways Laser technology is developing along a similar trend.

At our clinics, the most significant results produced are in the treatment of arthritis, musculoskeletal problems, particularly the spine, dermatological conditions including wound healing, along with the all too common soft tissue and sports injuries, many of which have acquired the characteristics of chronicity.

In addition, we have discovered and are learning that Laser Therapy has the potential to treat more complex systemic conditions, particularly in situations where conventional methods have been ineffective.

In the past several years, stimulated by several neurological researchers, we have developed and refined some exciting new applications in the field of neurology, particularly with regard to the following conditions:

• Concussion
• CVAs
• Dementias
• Multiple Sclerosis
• Depression
• Anxiety Disorders
• Nerve Regeneration
• Spinal Cord Injuries
• Demyelinating Diseases (Gene 7 Paresis)

While only a relatively small number of these conditions have been treated, it must be noted that we have achieved a greater degree of success than anticipated. In keeping with the conventional one-line disclaimer so common in academic circles, “more studies are indicated”. At the same time, I must emphasize that we continue to meet, if not exceed, our expectations.

The constant road block? Insurance companies. They may be willing to pay for diagnostic services, but refuse to pay for actual therapy that may not yet be “authorized”. Again, this is one of the regressive forms of behaviour dictated by managed healthcare systems in the interest of economic considerations. While the focus is on diagnostics, there is a clear lack of enthusiasm for selecting and applying therapies designed to actually benefit the patient. This is commonly described as “risk management”.

Another problem I mentioned is that pharmaceuticals are generally paid for by the management systems in place. Whereas prescriptions are often written under the mystique of providing instant benefit, the reality is that an undetermined number of prescriptions are never filled, which may be a blessing in disguise. Two-hundred and ninety patient deaths are reported daily in North America – the result of pharmaceutical utilization. In reality there are probably thousands!

In 1998 an article in the Journal of the American Medical Association concluded that prescriptions legally written by physicians are the 4th leading cause of death.
In his 2012 book, Unaccountable, Dr. M Makary, a Johns Hopkins School of Medicine researcher, shows how “mining sickness for profit” makes everybody “unaccountable” – hence the book’s title. The book illuminates a description of how hospitals are a major cause of death and how at least 30% of conventional “healthcare” is unnecessary and leads to deadly results.

From my personal perspective, effective therapeutic solutions have always been integral to the agenda of any ethical medical practice. Again, instituting immediate treatment when the disease process begins, circumvents the obstructive process of bureaucracies in the treatment of both routine and complex medical conditions, while substantially reducing the cost of healthcare.

Remember that administrators and other gatekeepers have no real interest in finding the best possible medical solutions but focus instead on cost controls and their primary interest remains the bottom line.

For a good clinician, defining the correct diagnosis does not require a major effort. In most instances, it can be accurately determined by taking a detailed history and performing an equally thorough physical examination. This aspect of medical practice, unfortunately, is no longer de rigeur.

Diagnostic studies, which can be expensive and harmful, should only be employed when the practitioner is unable to arrive at a working diagnosis or to confirm the clinical diagnosis, if this is essential.

All too frequently, prolonged diagnostic studies, the prescription of inappropriate pharmaceuticals, cross consultations, and other non-relevant assessments delay the initiation of therapy and therefore the healing process. This approach is wasteful and one must remember that no pathology can be cured without initiating appropriate treatment, preferably immediately.

It is therefore paramount that Laser Therapy, which can be easily administered by therapists with a modicum of medical training, can and should be more widely implemented, particularly in situations where urgent and effective treatment is essential.

Today, evidence-based medicine is all too often related to double-blind studies, peer reviews and the literature. Sometimes these imply or provide automatic approval of therapies that may have minimal benefit at best. In view of this, one must always ask:
• Who finances these studies?
• How relevant are they?
• Who conducts them?
• And for what purpose?

My personal view is that when a patient presents with a problem and has undergone many studies and treatments without any measurable improvement that is clear evidence of failure. Unfortunately, in healthcare systems today there is no real accountability and supervision of progress may be spurious or even non-existent.
Confusion surrounding terminologies such as “evidence-based”, “scientific”, “double blind”, etc. may often be categorized as time based illusions. Healthcare professionals must adopt therapies that cure the problem rather than focusing on the modulation of symptoms and physician compensation codes. The latter is comparable to following a road leading to nowhere.

In our clinics, the problems that we treat most frequently include multi-level degenerative disc disease and single disc herniations, often accompanied by stenosis, radiculitis, etc. The success rate in these situations is over 90% and no adverse effects are produced. In a select number of cases we have performed follow-up MRIs and were not surprised to see that the problem had been resolved (i.e. the disc herniation could no longer be visualized).

Contrary to current concepts, we frequently encounter young athletes with dysfunctional knees. The basis of these pathologies consists of varying degrees of disruption of the anterior cruciate and/or other ligaments, meniscal tears, contusions, etc. Currently, these are almost invariably treated with surgical intervention, which can lead to complications and permanent dysfunction.

As the number of patients presenting at our clinic with these types of injuries has increased over the past several years, we have again been able to conduct follow-up MRI studies and complete healing has been reported most notably in cases where the original MRI read complete anterior cruciate ligament tear. It is my belief that in these instances, a portion of the anterior cruciate ligament remains intact, perhaps only 10%. Again, further studies are indicated and we are conducting these on an ongoing basis.
Without question, if my knee were injured I would use the conservative Laser Therapy approach and surgery could always be instituted at a later date if necessary; this is rarely the case.

It should be noted that frequently patients are successfully treated with Laser Therapy for conditions that have not improved with traditional therapies. Nevertheless, some physicians will comment that they do not believe in this therapy, and this often repeated statement stimulates some reflection on my part.

I believe that our planet sustains approximately 7 billion people and that over 90% of the entire population, I am informed, believes in some God, religious power or tradition. Without invoking blasphemy at any level, I have never been informed that anyone has actually had a conversation, discussion or meeting with a God. Nevertheless, a God of some form exists in almost everyone’s mind and historically the belief in a Dogma survives, particularly in the face of political repression attempting to dissuade citizens from maintaining this practice.

Obviously some remediation of the medical profession is indicated. It should be noted that in all cultures ignorance and non-believers exist. These have always been a mainstay of the human condition and the effort to maintain this status is sacrosanct to many. It feeds their ego, as they have established an opinion – right or wrong – and free-choice philosophy dictates that individuals can choose to be ignorant and incompetent if they wish and there is really nothing that can be done about that. Eventually, these non-believers may become extinct, hopefully replaced by those with more open and educable minds.

Needless to say, progress will require some leadership from educational institutions and governments. Hopefully this process will stimulate further reflection on our ethical and moral values. And then there is always the matter of mass conditioning. For instance, several years ago when a flu epidemic was rampant in Canada, people dealt with infinite lines to obtain the vaccine. Individuals lined up day and night to receive the shots and information was rapidly circulated about the clinics that had the shortest wait times. This persisted for several weeks. As soon as the flu vaccine became widely available, the lines almost instantly evaporated.

CONCLUDING COMMENTS:

• My vision is to exchange a Laser Therapy Unit for every prescription pad in existence.

• To take control of healthcare away from governments and other vested interests and return it to properly educated and trained healthcare professionals who possess an understanding of quality healthcare.

• Everyone reviewing this article should strive to become a creative and effective Laser Therapist.

• Embracing these concepts will improve every citizen’s healthcare immeasurably and wide application can reduce costs of delivery by billions of dollars.

LASER THERAPY

07/22/13

Pain is the most frequent symptom that brings patients to doctor’s offices. At the same time, the majority of therapeutic solutions for the treatment of pain consists of modulators, counterirritants and a variety of pharmaceuticals designed to suppress or mask symptoms. Essentially none of these address the causative factors or the existing pathology responsible for the pain, along with other symptoms. At Meditech we have always been aware of this problem and our efforts are directed to cure the pathology causing the pain. Once again, it must be clearly understood that pain is merely a symptom, not a disease, and in order to eliminate it, the causative factors must be resolved.

BioFlex Laser Therapy Systems present a non-invasive, therapeutic solution that has been approved by Health Canada, the FDA and the European Economic Union for the treatment of many conditions, including musculoskeletal problems, arthritis, sports, soft tissue injuries, etc. Over the past decade particularly, we have expanded the applications to other diseases, providing effective clinical solutions when conventional therapies are ineffective.

Our educational opportunities based on scientific research and clinical applications address the advantages of Laser Therapy and more recently we have expanded the number of conditions to the list of diseases that can be effectively treated.

If you require information regarding our technology, please request the information pertinent to your needs. Many thanks for your interest in the BioFlex Laser Therapy Systems.

Fred Kahn, MD, FRCS(C)

INTERNATIONAL FINANCIAL INSTABILITY & HEALTHCARE

07/12/13

Financial instability, a growing constant in commercial activities since World War II, has embarked on a path of unpredictable and accelerating variables.

As the most recent and rather murky events in Cyprus have clearly demonstrated, uncertainty and instability are the prevailing keynotes at this time. Aside from continuing unreasonable and punitive taxation, beginning with parking meters in our cities, to the promotion and sale of bad paper by major financial institutions, this trend will eventually impoverish everyone.

Unfortunately these events impact healthcare from many perspectives. Ideally a high level response should be everyone’s right, however, we must consider who will pay for this right? Like untying the gorgonian knot, no one is in the position to answer this question at this time. Despite this, we remain trapped in a downward spiral. Diminishing incomes among the masses, rising costs and higher penalties are the order of the day. Unless dramatic and positive change occurs to reverse this trend, it will engulf everyone over the next decade or perhaps even sooner. The poor will not become rich, the middleclass will disappear and the rich will become poor. Neither rhetoric nor adversely inflaming the masses will bring crucial change to this scenario.

Currently there is no strong leadership existing in the individual countries and the world governments, which enlarge without cessation struggling to survive with a shrinking tax base. Rhetoric notwithstanding, they are currently unable to fund themselves and have no evident solutions other than printing more money and thereby further debasing their own currencies and increasing their debt load.
One change that should be considered, and is probably the simplest in the long-term, is the improvement of educational systems. At this stage moral values and standards of integrity can be instilled at the formative level. However, this can only be accomplished when the funding, monitoring and mentoring of teachers enables them to move forward in this direction.

All those engaged in delivering healthcare appear to be more concerned about compensation codes than ensuring that healthcare will be delivered in a prompt effective manner. This has created another maelstrom of confusion deliberately infusing a level of conflict between physician and patient that is unprecedented.

Governments are increasingly focused on diminishing and restricting healthcare provisions, along with their budgets, further inducing instability into the system. In this current of negative forces, the patient often floats on a sea of despair, particularly when emergency care is required. Again, no bureaucratic resolutions are apparent on the horizon. Leadership to reverse this course must be found and implemented immediately.