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Commentary
• Recently, we had a patient with a back problem who found that applying coconut oil to the low back enhances the efficacy of Laser Therapy significantly.
• In the past, we have noted that many patients after laser treatment sleep much better and many insomnia sufferers develop normal sleep patterns. This leads one to conclude that perhaps insomnia should be treated with Laser Therapy.
• Depression also has been relieved markedly, particularly in patients with chronic pain syndrome.
FK/sg/cn
The Many Aspects of Health Care
The article below is an excerpt from The Toronto Star dated August 16, 2010.
Read the article on The Toronto Star web site
Once again, this article clearly demonstrates the consistently bad judgment exercised by political parties no matter what their stripe.
First, the Liberals criticize the Tories when they are in power and vice-versa – same with the NDP if they had the opportunity. These matters are therefore of no particular import.
The natural reaction of the politician faced with a problem is to deflect criticism. This result in the appointment of a commission or another administrative body, who pretend to resolve the dilemma; this is known as a diversionary tactic.
It would never occur to our political masters that patient care is best delivered when required and that the appropriate therapy be instituted.
Bureaucrats and their organizations have no comprehensive understanding of what medical care should be and invariably complicate delivery at an exceedingly high cost.
Perhaps one day it might dawn on them that it would be best to leave healthcare to the professionals who understand the problems and maintain a sense of commitment with regard to their resolution.
No matter what profession, unless one has an understanding of the problem and the experience to deal with these situations in a capable manner, all efforts even if well-intentioned, will fail.
The tax payers of this country of whom I am one, should take note and steps to rectify these problems.
FK/sg/cn
Meditech Receives Ontario Centres of Excellence Interact Grant Funding
Meditech is continuously looking at ways to improve its products in terms of optimal performance, clinical efficacy, expanding clinical applications and being user-friendly. With this in mind, Meditech applied for and received, an Interact grant from the Ontario Centre of Excellence (OCE) at The University of Toronto, to study the optical and thermal properties of the LEDs utilized in its treatment arrays.
The Interact Programme was designed to initiate new industry-academic interactions that create collaborative research partnerships between industry and Ontario universities, colleges and research hospitals.
Meditech is working with the Institute for Optical Studies (IOS) to better understand the characteristics of both the diodes utilized and the materials incorporated in the treatment arrays.
The Institute for Optical Sciences (IOS) is a cross-disciplinary research and commercialization centre, embedded in the University of Toronto. It utilizes faculty and students from the departments of chemistry, physics, materials science, polymers, nanotechnology, photonics, and advanced engineering to deliver consulting services to industry. Meditech will use the results obtained from the research project to continue the improvements of the arrays and laser probes for its next generation systems. The new arrays will have a greater range of power output, improved reliability and longevity and utilize state-of-the-art technologies.
Meditech remains committed to providing the most technologically advanced and clinically effective laser therapy systems globally.
Fred Kahn, M.D., F.R.C.P. (C)
The Age Old Salt Controversy
The two articles enclosed are realistic commentaries, pertaining to the ingestion of salt.
The conclusions stated, with which I concur completely, indicate that salt is essential in our diet for the maintenance of good health. Restriction of the use of salt can lead to physiological imbalances and accomplishes little of merit.
Salt is a vital ingredient in the maintenance of the body’s physiological functions. Specifically, it is integral to the maintenance of hydration and electrolyte balance. It has always been my presumption that unless one has significant renal or cardiac dysfunction, the liberal if not excessive use of salt is totally safe and probably essential.
The normal ingestion of fluids will invariably eliminate any excess that may remain. Without question, the restriction of salt in the diet creates more problems than it cures.
Many physicians advise salt-free regimens without adequate reflection. This trend is sometimes based on the commercial aspects of marketing salt-free products. In addition, the confusion that exists with regard to the treatment of hypertension is a significant factor. Hypertension is generally associated with an increase in age and is sometimes necessary in order to permit adequate arterial perfusion of the peripheral areas of the body including the brain. Focusing on the removal of stress in the environment undoubtedly is the best anti-hypertensive therapy available.
It must also be understood that most individuals’ blood pressures are highly labile, depending on circumstances. At rest, blood pressures generally return to normal, whereas in the stressful atmosphere of the physician’s office for example, they are invariably and inordinately elevated. Frequently, anti-hypertensives are prescribed on the basis of the prevalent, almost hysterical approach to what may be termed the “temporary” elevation of blood pressure and over the past decade particularly, this has become somewhat ingrained in routine medical practice.
Many patients monitor their blood pressures with devices purchased at their local drug store (some of which are highly inaccurate) many times each day and develop an obsession with the readings, resulting in a self-fulfilling prophecy. They may then consult a specialist who may prescribe an additional anti-hypertensive drug, resulting in the inappropriate management of hypertension, whether real or imaginary.
The controversy over salt utilization and the ingrained treatment of hypertension is not that dissimilar to the recent H1N1 crisis. These matters should provoke independent thought and one should be cautioned against the literature promulgated by pharmaceutical companies and governments. “Do not believe everything you may hear or read”; instead cultivate the ability to research widely and interpret correctly.
Whereas inoculation for polio and the other childhood diseases is extremely important, flu vaccination programs have a checkered history at best. Personally, I have never submitted to a flu shot and have been fortunate enough to avoid contracting these multiple disease entities, despite interacting daily with people who are infected and sometimes seriously ill. These contacts strengthen the immune system, much like inoculation.
It was interesting to note that during our recent flu epidemic, when the vaccine was unavailable to the public, panic reigned supreme. Stimulated by the media, the poorly informed clamored for the vaccine incessantly; once it became widely available, the demand evaporated instantly.
Medical fashion varies from one decade to the next as is well-illustrated by the history of the treatment of tonsillitis leading to almost routine tonsillectomies and once upon a time appendectomies were performed to prevent appendicitis. Today, fortunately these trends have fallen by the wayside.
Over the past hundred years, the management of psychiatric patients almost invariably resulted in long-term institutionalization. Beginning in the forties the advent of psychotherapy became the elitist approach. From an economic perspective however, it was problematic to apply this form of therapy widely.
Over the past twenty years, psychiatrists have found it easy to utilize psychomimetic drugs, as patient response can sometimes be dramatic and appears to be beneficial on a short-term basis. This trend, hopefully appears to be nearing its end as the complications engendered by this widely utilized and poorly monitored method are becoming better recognized.
Finally, rest assured that it is totally appropriate to use salt as required and no undue restriction is necessary, except in extreme circumstances.
Fred Kahn, MD FRCS(C)
Amputating Costs
(Globe and Mail Editorial Section)
Medicare has been called the Pac-Man that survives by eating all other social programs. The $128-billion system consumes about 40 per cent of provincial program spending. And yet it is so ingrained in the Canadian identity that it seems untouchable.
It is refreshing, then, that several health leaders have put out a report called “Bending the Health Care Cost Curve,” which provides ways to eradicate waste. It’s about time. The report has suggestions so obviously necessary, it seems shocking to see them in print.
Take the case of wound care, a decidedly unglamorous medical problem but a costly one: If hospitals, nursing homes and home care followed best practices in dealing with these pressure ulcers, venous leg ulcers and diabetic foot ulcers, they could save as least $100-million in Ontario alone in preventable amputations, infections, repeat visits and hospitalizations.
For home visits, nurses are paid on a per-visit basis, not based on whether the wound has healed or the treatment is working – something they want to change.
“What we want to move to is an outcome-based payment process that actually looks at a course of treatment,” said Margaret Mottershead, chief executive officer of the Ontario Association of Community Care Access Centres, an author of the report. “And you will be paid for the treatment and the outcome, rather than on a one-off that gives you no guarantee every time you do a visit that you are actually improving the outcome or fixing the problem or helping the wound heal.”
Other suggestions including reducing medical mistakes, allowing palliative-care patients to die at home and finding alternatives for patients who are waiting in hospital for nursing-home beds.
The report from the trio of groups, including the Ontario Hospital Association and the Ontario Federation of Community Mental Health and Addiction Programs, comes at a welcome time, particularly as the province tries to rein in costs.
But tough economic times should not be the impetus to make change: providing the best patient care should be.
Why are these common-sense solutions, which are best for patients, not being widely implemented today?
The health-care system is complex and even the brightest minds struggle to manage it. It is built around process, so change is never dramatic, but incremental.
It has also been a recession-proof business with no consequences to those who do a job inefficiently. Pay-for-performance measures exist to some degree, but not enough to spawn widespread change.
What is missing in health care are quality, accountability and value for money. Canadians do not need another royal commission to tell them that; they have been hearing it for almost two decades.
Medicare need a champion, a strong arm that can make transformative change. Without it, the system is doomed to become increasingly inefficient, unmanageable, and like Pac-Man, virtually obsolete.
______________________________________________________________
The article enclosed, titled “Amputating Costs” was published in The Globe and Mail on April 16, 2010. It is timely and written with considerable comprehension of the facts. Moreover, it clearly defines the problems encountered in wound healing, so often leading to amputation. It stresses inefficiencies that serve only to increase the costs of treatment, along with a total disregard of the outcomes.
Managed health care, in essence, imposes relatively rigid parameters which have long been outdated. Personally, I would be embarrassed to treat a wound that did not heal in a timely fashion. Yet, the present system incentivizes prolonged and ineffective care, all too frequently, leading to negative results.
At Meditech over the past decade, we have been aware of the inadequacies of the present conventional approach to wound healing. This sector has therefore become one of the more compelling targets in our efforts to bring about change.
We have always questioned the prevalent methods applied in wound healing that are almost universally enforced.
At the same time, we have developed methodologies that are highly effective in this area.
To illustrate –
• Instead of using bandages of various descriptions, we treat the wounds with open exposure permitting access to the oxygen in the atmosphere.
• Instead of antibiotics, we use saline compresses which have no adverse reactions, are potent bactericidals and are inexpensive.
• Instead of surgical debridement, we use dilute hydrogen peroxide to remove non-viable tissue.
• When available, we also utilize hyperbaric chamber therapy.
The basic approach of our treatment platform is Laser Therapy customized for the individual patient. With this method, the need for analgesics is rapidly eliminated.
We fully endorse the treatment of wounds with an outcome based on resolution and agree that remuneration should be based on clinical results.
In closing, I make one final statement – “bring on the wounds and we will heal them!”
Fred Kahn, MD, FRCS(C)
Clarification Re Insurance Industry Policy vs. The Administration of Laser Therapy
Insurance carriers appear to demonstrate an undue level of concern with the designation of healthcare professionals administering Laser Therapy. This article is designed to clarify this issue. First it should be noted that Laser Therapy can be administered by a duly trained physician, physiotherapist or chiropractor, based on the knowledge and expertise acquired at our certification course, complemented of course with subsequent experience. Moreover, the above designated healthcare professionals can perform an assessment and prescribe the protocols as required. They can then administer Laser Therapy directly or delegate it to any certified laser therapist under their supervision, someone who may not be licensed to diagnose. Despite this, some carriers will pay a physiotherapist but not the other designations and other carriers will pay the chiropractor but not the other two professionals and so forth. To anyone with a functional IQ, this would appear to be irrational and indeed qualifies under that category. In essence, there is no logical or legal foundation for this position.
At Meditech, a team of healthcare professionals participate in the process of assessment, protocol prescription and the actual administration of the therapy. All the individuals involved in the process are qualified laser therapists and are able to integrate this technology into their therapeutic programmes, as clinically indicated. At our facility, laser therapy is generally utilized as the basic treatment platform, although sometimes complemented by other technologies.
Within the team concept, the various disciplines work collaboratively to provide the “best practice” standard in order to achieve an optimal clinical outcome. It is important that everyone, particularly insurance carriers, clearly understand this process, designed to protect the patients best interests.
To summarize – At Meditech, we offer a comprehensive therapeutic programme designed on an individual basis in order to achieve an optimal clinical outcome. This may include periodic participation by the physician, the physiotherapist and/or the chiropractor, along with those who apply the therapy under supervision. The latter include kinesiologists, laser therapists, massage and exercise therapists, again working on a collaborative basis.
A Commentary on the Professional Fundraising Industry
Each year the National Post, the Globe and Mail and other national newspapers contain an eight page insert, advertising the wonderful works performed by the Arthritis Society. I always review these publications with great interest, particularly as our clinic administers up to eight hundred treatments each week, many of them for the treatment of arthritis. Despite this and the fact that Laser Therapy is currently being adopted by clinicians who are passionate about wanting to help their patients, laser therapy has never been mentioned in any of these elegant treatises. Indeed, over 70% of the patients that we treat at our clinic suffer from degenerative osteoarthritis, rheumatoid arthritis, systemic arthritis and a number of arthritides of varying etiologies.
Our technology is currently utilized in over forty countries worldwide including hospitals, clinics, rehabilitation centres and other health care facilities. Moreover, our organization conducts a significant body of scientific research and annually contributes thousands of dollars to worthwhile organizations anonymously. In addition, we provide many thousands of dollars of treatment annually without charge, primarily to needy, elderly citizens, who are often neglected.
It should not be a surprise that I am somewhat perplexed by these newspaper ads whose intent, after many years of reading, I am unable to grasp. I expect it is designed to increase the funds raised for reasons that are largely undisclosed. This organization, much like other fundraising groups, maintains an extensive staff, spends considerable resources on advertising and like most corporations attempts to increase their annual gross, presumably to reward management with generous bonuses, commensurate with their fundraising efforts. At the same time my research and experience leads me to believe that the not inconsiderable contributions, do not appear to provide any direct or indirect benefits to arthritis sufferers. Does anyone ever question what happens to these funds, i.e. where do they end up and why? – nor have I ever seen explanations provided by management. For instance, the most recent insert in the National Post dated January 2010, on its cover features an elegant sketch of the skeletal outline of the spine. At the bottom of the same page, it recommends the use of Rub A535, described as the #1 pharmacist recommended brand. Moreover, it is advertised as being recognized as the most arthritis friendly product and is recommended by the Arthritis Society. What is Rub A535 and what benefit does it actually provide?
On Page 2, it begins with an article written by the President and CEO of the Arthritis Society. In essence, it states that “arthritis is a problem” in our society. It quotes a number of statistics which are meaningless. On most of the pages, there are advertisements which may be misleading, repetitive and appear to have no relevance. Osteoporosis is extensively discussed and we all know that this is a disease associated with aging, lack of activity and poor dietary habits. There are many simple preventative measures that can be followed on a daily basis, to effectively counteract the negative aspects of this condition; i.e. a healthy balanced diet, some vitamin and mineral supplements and a minimum of 30 minutes or more of vigorous daily activity, yet none of these are stressed.
The 8-page compendium in the newspaper reveals nothing that is unknown, provides no effective solutions and concludes with a full page ad sponsored by Abbott Immunology. This infers that Abbott Pharmaceuticals can provide help in these situations, although there is nothing included that specifically states how.
Six years ago, a member of my organization made contact with the CEO of the Arthritis Society. After several discussions, a representative from the society was sent to our offices to explore our technology. Clearly, this was not someone at a significant managerial level and this individual spent most of an hour bemoaning the fact that her boyfriend was moving out of their joint residence and she did not know how to deal with this. She had no knowledge whatsoever of arthritis, laser therapy or medicine.
If the Arthritis Society were truly focused on helping people with arthritis, they would be exploring new therapeutic avenues and actually attempt to help the afflicted, rather than simply raising funds, which to all intents and purposes seem to disappear into the great nowhere.
The Global Crisis in Healthcare
Insurer Steps Up Fight to Control Health Care Cost, by ANEMONA HARTOCOLLIS
Recently an article in the New York Times dated January 25, 2010 caught my attention; the title – “Insurer Steps Up Fight to Control Health Care Cost”. With regard to this publication, I state as President Obama did in his healthcare speech late last year, “that this issue must be resolved before healthcare can be delivered with the primary objective of providing the best possible care available, directly to patients.”
Increasingly, in my office practice the single most pervasive and negative factor each day are the therapeutic restrictions imposed by insurance carriers. In my personal opinion, patients are entitled to the best care available for any particular problem. This should be the basic platform of quality healthcare, yet insurance carriers have become increasingly obstructive in allowing this process to take its course. If the proposed mode of treatment is not covered, permission to initiate treatment is invariably delayed. Consequently, the healing process is prolonged, is generally less effective, the condition may become chronic and the cost of care is substantially increased. Currently, my office requires one full-time secretary to assist patients in attempting to resolve these issues in order to permit the initiation of proper treatment.
For example – just 3 weeks ago, a patient presented on a Saturday morning having sustained a severe skiing injury to the right shoulder on the previous day. At the resort where this occurred, an X-ray had been taken and interpreted as being normal. The patient was provided with analgesics and a sling and was sent home. On the Saturday morning following the injury of the previous day, the patient presented at our clinic in acute distress. Over the next 3 weeks, 12 laser therapy sessions were administered. This resulted in complete resolution of the problem.
An orthopedic consult, requested initially, has still not reached the head of the waiting line. An MRI performed 2 weeks after treatment had been initiated, reported the presence of a Hill-Sachs fracture and extensive ligamentous and other soft tissue damage.
If the parents of this 15 year old boy had not been willing to short-circuit the system, institution of therapy would have been delayed, the course of treatment prolonged with undoubtedly a less than an optimal outcome. This is a clear-cut example where early treatment consistently applied and monitored can achieve an optimal result, devoid of any other considerations. It has still not been determined whether there is insurance coverage although both parents are high level professionals and are “supposedly” covered by several insurance policies. Incidentally, the patient has made a complete recovery, including a normal pain-free range of motion of the left shoulder, while the insurance battle rages on.
The hours of secretarial time wasted on paperwork and telephone calls required in order to stimulate carriers to honour their obligation is becoming increasingly complex and invasive. As we all know from personal experience insurance companies and their sales minions are happy to sell policies and collect premiums. Their glowing ads promise security, unlimited benefits and infiltrate the media at all levels. At the same time, the series of hurdles imposed on the way to compensation is becoming insurmountable. These imposed economics overshadow the need for both urgent and high quality care, which should be the primary concern. The result – an impasse in the delivery of healthcare, strangled by carriers primarily interested in profit margins. The ramifications of this state of affairs are negative from every perspective, particularly when an immediate and positive approach is so essential. No one appears to be pro-active in the struggle to correct these deficiencies, which play a major role in the breakdown of healthcare delivery systems. Before we can continue to move forward in a positive manner, this impediment must be removed.
Rehabilitation Concepts
An article titled “Some physical therapy may be a stretch” by Gina Kolata in the Globe & Mail published January 8th, 2010, refers to some of the misconception and impediments in the rehabilitation industry today.
First of all, one must remember that nature cures most medical problems given time and rest. For this reason, when any therapy is applied coincidentally, the credit is generally attributed to the treatment, which may be totally erroneous.
Additionally, the economic equation all too frequently encroaches on matters and dictates the type of therapy applied, whether appropriate or not. The gatekeepers who generally restrict prompt initiation of treatment, the selection of the correct treatment, increase costs, negatively impact results and are increasingly intrusive in the healing process.
At this time in my practice, I see approximately fifty new patients each week, many with acute sports injuries and/or chronic musculoskeletal conditions. Most have been subjected to prolonged courses of ineffective therapy, but are forced continue the course imposed by insurance carriers and other influences, non-relevant from the medical perspective.
It must be understood that success can be best achieved if all irrelevancies are eliminated. The focus should always be on establishing a correct diagnosis and the prompt institution of treatment that provides a curative effect.
In our organization over the past twenty years, we have utilized Laser Therapy with appropriately engineered delivery systems, along with scientifically developed protocols that are effective in the rehabilitation process as the basic therapeutic platform. This approach invariably achieves optimal clinical outcomes. Health care professionals, please take note!