Over the past few days, three papers have come out proving what I have been saying all along --- that mandatory flu vaccines for healthcare workers are not in any way, shape, or form, "EVIDENCE-BASED".  Even just a little bit.  And never have been. 

The first is a study from PLoS One (Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement), the second is by Helen Branswell writing for the medical daily, STAT (Contentious Flu Vaccine Policies at Hospitals Are based on Flawed Research...), and the last is by Dr Mike Edmond, writing for his blog, Controversies in Hospital Infection Prevention --- the post itself is called It's Really Time to Fix This.  I would agree with Edmond's assessment. It really is time to fix this debacle.  And for those of you who may not realize how severely and unfairly many HEALTHCARE WORKERS have been affected by this law (HERE is an example from someone I know personally), we can only hope that this situation is rectified soon.

The PLoS One study is something we've seen before.  The authors (nine Canadians and one French researcher) looked at four large trials that had all come to the conclusion that vaccinating healthcare workers against influenza provided great benefit to patients in the form of less flu.  In Cherry-picked fashion (my usual modus oporandi), we see that the authors of today's study thought otherwise. "Realistic recalibration based on actual patient data shows that at least 6,000 to 32,000 hospital workers would need to be vaccinated before a single patient death could potentially [emphasis on potentially] be averted.  The impression that unvaccinated healthcare workers place their patients at great influenza peril is exaggerated.  Current scientific data are inadequate to support the ethical implementation of enforced healthcare worker influenza vaccination."  Again, nothing new, although it's vindicating to see it coming up in the medical community again and again and again.  Of the three papers being discussed today, the best by far comes from Dr. Edmond.

Edmond is, by any measure, a sharp guy.  He's authored over 350 papers, abstracts, and book chapters.  He is an MD with masters degrees in both public health (MPH) and public affairs (MPA).  And according to his bio he is currently Chief Quality Officer and Associate Chief Medical Officer for University of Iowa Health Care as well as being the Clinical Professor of Infectious Diseases at the University of Iowa Carver College of Medicine.  Not surprisingly, he's held a whole bunch of prestigious positions in other states he's lived in (Virginia and Pennsylvania) as well.  Like I said, sharp guy.

What he discusses in HIS SHORT BLOG POST is similar to what I have shown you over and over again on my site. Seven years ago, SHEA (the Society for Healthcare Epidemiology of America) proposed new guidelines "suggesting" that if you want to work in a healthcare facility, either get vaccinated against the flu or get out.  CMS (Centers for Medicare & Medicaid) took this paper and ran with it in ways that look rather foolish in light of what peer-review actually says on the matter. 

Much of it has to do with the fact that some of the people who created these guidelines stood to profit handsomely from a flu vaccine mandate.  Edmond wrote about this back in 2010 saying, "If you are a guideline author recommending a vaccine and have received money from a vaccine maker, that IS a conflict of interest, not a potential COI or the appearance of COI.  Other sources define COI differently, but I do agree that the conflict clearly exists in the case of the vaccine guideline. Whether it had impact is a different question. I do think it looks bad, and gives the anti-vaccine crowd ammunition.  By the way, I think the guideline is based more on emotional arguments than real data."

We see a couple of things in Edmond's quote.  The first is that he is definitely not one of those evil "ANTI-VAXXERS" like many would call me.  He is actually a very pro-vaccination physician who is, unlike most, being honest about the science.  And secondly, we can't trust guidelines that authors are making money off of --- potentially huge money --- even when they TRY AND CLAIM the money does not influence their decisions, which they always do.  In fact, on many different occasions I've dealt with the crazy number of financial conflicts of interest that can be found in our NATION'S NUMEROUS MEDICAL GUIDELINES --- Guidelines that are all too often for sale to the highest bidder. 

The rest of his paper discusses the PLoS One study, showing that the data SHEA originally used for their recommendations had been cooked.  And here's the thing folks; when it comes to research, cooking the books is simple, with ANY NUMBER OF WAYS to get results to come out exactly how you want them to, which is exactly what SHEA did (and if they don't come out as planned, HERE'S WHAT BIG PHARMA DOES WITH THEM).  Remember the stats I showed you a few paragraphs ago showing how many people would need to be vaccinated to "potentially" prevent a single death from influenza?  Dr E shows how bad things are.

"Estimates of numbers needed to vaccinate were so flawed (off by as much as 4,000-fold) that if extrapolated to all healthcare workers in the US, more deaths would be averted than occurred in the 1918 influenza pandemic.  Here's the bottom line per the authors: 'Each of the four cluster RCTs used to champion compulsory healthcare workers influenza vaccination policies reports benefits that are mathematically impossible under any reasonable hypothesis of indirect vaccine effect. It's hard to imagine a stronger conclusion'.   As I see it, unless SHEA cites alternative facts, it has three choices: change its position to recommending (not mandating) annual influenza vaccine for healthcare workers, articulate a damn good reason to support its current policy despite the evidence (hard to imagine what that would be), or simply retire the guideline (as it has quietly done for the 2003 highly controversial MRSA/VRE search and destroy recommendation)."

Next comes Branswell's piece in STAT.  The best part of her article is definitely the comment section, where one individual chimed in with a long list of the studies showing flu vaccine to be ineffective.  She did, however, shed some light on a point brought up by Dr. Edmond.  Branswell provides a first-hand glimpse of how the evidence was "cooked" for this particular study, and how far from the truth their results really were.

"One the studies, from Britain, calculated that one influenza death would be averted for every eight staff members vaccinated. But if that were correct, vaccinating the estimated 1.7 million health care workers employed in long-term care [nursing homes] in the United States should prevent 212,500 flu deaths a year among residents. There’s an obvious problem though, the paper noted. Nowhere near that many people die from flu in the US [HERE].  If the calculation is applied to the 5.5 million hospital workers, mandatory flu shots should avert 687,500 deaths each year — more than the number of Americans who died in the 1918 Spanish flu..."

Today you get a bonus fourth paper.  The same issue of PLoS One carried a misguided defense of their work by one of the authors of one of the original nursing home studies that was being attacked by all comers.  Other than admitting that nursing home studies cannot be extrapolated to healthcare settings like clinics or hospitals, the author desperately clung to his refuted research, saying that, "Influenza vaccine is effective at preventing influenza in healthy young adults. The strategy to encourage influenza vaccination for health care workers is partly based on the simple notion that this can reduce the risk of staff acquiring and transmitting influenza to vulnerable patients and thereby reduce associated morbidity and mortality.  Despite high levels of resident vaccination, low vaccine efficacy in the elderly means that they remain vulnerable to influenza and its complications. Residents have very high rates of mortality and hospitalization especially during periods of influenza circulation."  Want to see how false this simple cherry-picked paragraph really is?

First, according to the gold standard of gleaning the main conclusions from lots of studies and data, then crunching it into something usable --- COCHRANE --- it takes seventy one "healthy" people being vaccinated to prevent a single case of flu (HERE).  Secondly, when we factor in the elderly and most particularly the "frail elderly," although their rate of vaccination is relatively high compared to the rest of the population, the rate of vaccine efficacy hovers around the level of placebo / sugar pills --- just slightly better than zero (HERE).  In other words, vaccine efficacy for the elderly is admittedly far worse than for healthy adults.

Thus, you can see how adding these two facts together could not possible bring anyone with even an iota of intelligence to the conclusion that vaccinating healthcare workers could somehow prevent flu in the elderly. In fact, every single metric available shows how futile it really is to vaccinate any group against the flu (CHILDREN, healthcare workers, PREGNANT WOMEN, etc).  For the studies backing this up, you can either click these links, read through my FLU VACCINE POSTS one at a time, or you can see them altogether, crunched into my FLU VACCINE SUPER-POST.

On occasion I take a few minutes, head over to PubMed, comb through the latest research on any given topic, and then give you a synopsis of what's relevant as far as solving chronic conditions (pain included) is concerned.  Today I'm doing that with FASCIA.   Let's get right down to business and see what the experts have to say about Fascia over the course of the past few months.

• When I treat people with FACE OR SKULL PAIN, they have often been written off as "crazy".  Although there are any number of reasons for this (remember, Fascia does not image with standard medical testing -- HERE), much of it has to do with the way they so often describe their problem.  Invariably, they will use adjectives such as "crinkling or rustling leaves," "the sound of wadding paper into a ball," "a constant, low grade, Rice Krispies crackling, with each and every movement," or like Brenda described YESTERDAY, "eyebrows so tight on my face you couldn't pull them away."   I have talked about these sounds before (HERE), but it's not so much the sounds people hear that I am interested in, as much as what's causing them.  Last month's issue of Anatomical Record published a study pertaining to this topic called The Mobility of the Human Face: More than Just the Musculature, whose authors concluded, "The human face has the greatest mobility and facial display repertoire among all primates. However, the variables that account for this are not clear. Humans and other anthropoids have remarkably similar mimetic musculature. This suggests that differences among the mimetic muscles alone may not account for the increased mobility and facial display repertoire seen in humans.  This study was undertaken to clarify the morphological underpinnings of the increased mobility and display repertoire of the human face by investigating the Superficial Musculo-Aponeurotic System, a connective tissue layer enclosing the mimetic musculature located between the skin and deep fascia / periosteum.  This connective tissue layer may be a factor in the increased facial mobility and facial display repertoire..."  For the record, the PERIOSTEUM is the membranous layer of Fascia that covers bones, while APONEUROSES are flattened tendon-like structures virtually indistinguishable from Fascia.

• A study from last September's issue of Anatomy and Cell Biology (Histological and Biochemical Study of the Superficial Abdominal Fascia and its Implication in Obesity) provides us with a primer on Fascia. "The superficial fascia is formed of collagen fibers, loosely packed and mixed with abundant elastic fibers and adipose tissue.  The collagen fibers have great tensile strength. It can resist considerable tensile forces without significant increase in their length and at the same time they are pliable and can bend easily.  Elastic fibers run singly, branch and anastomose [run together and connect with] with other fibers. They are usually thinner than collagen fibers. Elastic fibers stretch easily with perfect recoil. These fibers are numerous in membranes that stretch periodically. Superficial fascia covering the anterior abdominal wall has high proportions of elastic fibers.  In abdominal obesity, fat cells lie between various layers of multilayered abdominal fascia."  What does this mean to the average American, considering that about 70% of us are overweight or obese?  Only that the more ABDOMINAL OBESITY you have, the greater the chance of stretching your Fascia past the point of no return (HERE).  By the way, this study pertained to PLASTIC SURGERY, which I have numerous times seen mess people up in severe and debilitating ways.

• In a very cool study on CANCER as it relates to Fascia and bodywork, November's Cancer Research (Connecting Tissues and Issues: How Research in Fascia Biology Can Impact Integrative Oncology) dealt with similar subject matter to what DR. INGBER of Harvard has been talking about for years (not to mention DR A.T. STILL) --- the fact that health of your Fascia plays a huge role in your overall health.  "Complementary and integrative treatments, such as massage, acupuncture, and yoga, are used by increasing numbers of cancer patients to manage symptoms and improve their quality of life. In addition, such treatments may have other important and currently overlooked benefits by reducing tissue stiffness and improving mobility. Recent advances in cancer biology are underscoring the importance of connective tissue in the local tumor environment. Inflammation and fibrosis are well-recognized contributors to cancer, and connective tissue stiffness is emerging as a driving factor in tumor growth. Physical-based therapies have been shown to reduce connective tissue inflammation and fibrosis and thus may have direct beneficial effects on cancer spreading and metastasis."  Wow, that doesn't sound like any cancer doctors I know (HERE)!  And this from a mainstream journal.  If you are interested in the relationship between INFLAMMATION & FIBROSIS, just click the link.

• Last October's issue of Manual Therapy (Mechanical Deformation of Posterior Thoracolumbar Fascia After Myofascial Release in Healthy Men: A Study of Dynamic Ultrasound Imaging) showed that after receiving bodywork on their low backs, "The primary finding included a decrease in the stiffness index of the Posterior Thoracolumbar Fascia and a greater difference in deformation of the Posterior Thoracolumbar Fascia between 50% and 100% maximum voluntary contraction."  How big was the difference in the "stiffness" of the THORACOLUMBAR FASCIA from pre-bodywork to post-bodywork?  Almost a quarter.  One more interesting fact in this study; since MRI does not do a good job of imaging Fascia (excepting maybe the PF), the authors used advanced ultrasound technology as seen in the thoracolumbar link (click for a side-by-side comparison of five second videos --- healthy Fascia -vs- damaged Fascia).

• November's issue of the Journal of Sports Sciences (Is Remote Stretching Based on Myofascial Chains as Effective as Local Exercise? A Randomised-Controlled Trial) actually talked about "myofascial chains" (ANATOMY TRAINS) in regards to stretching distant tissues to get local effects.  What do I mean?  "Lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM)...  ....both lower limb stretches and cervical spine stretches increased cervical ROM compared to the control group in all movement planes and at all measurements.  Lower limb stretching based on myofascial chains induces similar acute improvements in cervical ROM as local exercise. Therapists might consequently consider its use in program design."  What does this tell me?  It tells me that a good stretching protocol will address the whole body --- not just the spot you hurt.  Can anyone say YOGA?

• Next month's issue of Insights into Imaging carried a study (Imaging of Plantar Fascia Disorders: Findings on Plain Radiography, Ultrasound and Magnetic Resonance Imaging) that showed that the most common imaging finding for PLANTAR FASCCITIS is a "thickening," which has been referred to elsewhere in the scientific literature as "DENSIFICATION".  I bring this up only because some people want to split hairs and say that densification is different from FIBROSIS or SCAR TISSUE FORMATION.  Call it whatever you want, the October issue of the Journal of Bodywork and Movement Therapies (Long-Term Impact of Ankle Sprains on Postural Control and Fascial Densification) addressed this issue in a study where, "20 young, healthy subjects with a history of significant (Grades 2, 3) lateral ankle sprains and 20 controls with no history of ankle sprains were recruited to cross-sectional case-control study.  The ankle sprain study group -vs- the control group exhibited significant differences... significantly high prevalence of fascial densification for the talus internal rotation, talus retromotion, talus lateral and pes external rotation.  There are long term effects of an ankle sprain on postural control and on the sensitivity and movability of the fascia in the calf and foot."  As a person who suffered for the better part of a decade after roaching my ankle several times playing basketball (at least two Grade III's, with two avulsion fractures), I can attest to this both personally and professionally.  HERE is our ankle sprain page, as well as our page on LIGAMENT INJURIES.  Thanks to Dr. Michael Miller, I also learned the importance of using a drop-table to work through and mobilize each joint in the foot / ankle, through all their different ranges of motion.

• The October issue of the Chinese Journal of Gastrointestinal Surgery carried a fascinating study called The Third Component in Surgical Anatomy and its Impacts.  The first two components of surgery were described by the authors as the organs and their blood vascular supply respectively.  Guess what the third component was?  That's right; Fascia.  "The third component is omitted by surgeons for many years. The omitted reasons are failed recognition and unknown function. Re-understanding of the third component in surgical or local anatomy will make some changes in the local anatomy, tumor pathology, oncology surgery and operations....  Many aspects will change with surgical developments, especially with the membrane anatomy, the third component."  Holy Toledo!  I've been saying for two decades that far too many doctors think of Fascia merely as the 'stuff' that has to be removed in order to get to the goodies --- the organs, muscles, bones, etc (HERE), not fully comprehending the magnitude of what happens when FASCIA GETS INJURED and people subsequently develop FASCIAL ADHESIONS.

• I happen to be the guy who has been talking about RIB TISSUE PAIN (not to be confused with RIB SUBLUXATION) for the better part of the past twenty years.  Why is it such a big deal?  Only because anything wrong with your ribs will literally make you think you are dying (I have seen untold numbers of people air-evac'd because someone confused their rib pain with a heart attack).  A study in last month's issue of Cureus (The Forgotten Lumbocostal Ligament: Anatomical Study with Application to Thoracolumbar Surgery) helped shed some additional light on this issue.  Although the study was aimed at surgeons, this ligament lies underneath the THORACOLUMBAR FASCIA, and is described as a, "constant structure of the thoracolumbar junction."  The authors also said it was a potential factor in 12th Rib Syndrome.  One more reason I always pay close attention to the TL spine when adjusting patients (I thank Dr. Jim Teachworth for that one).

• A study of last month's issue of the Journal of Craniofascial Surgery looked at what the study itself was named for --- the Anatomy of the Platysma Muscle.  Although the PLATYSMA MUSCLE is, as it's name implies, a muscle; in many ways it actually acts more like Fascia.  "The aim of this paper was to review the anatomy the platysma systematically."  But unlike injured Fascia that tends to thicken or "densify," "The most common aging-related change of the platysma was shortening, followed by thinning."  When you start to grasp the relationship of FHP to any number of pain syndromes, including CHRONIC NECK PAIN and HEADACHES, you start to see why a "shortened" Platysma is such a huge deal.  If you'll take a moment to click the first link in this bullet, you can take a look at pics of this muscle you've probably never heard of, and see why it's incredibly important as far as people with WHIPLASH are concerned.  Not as important as the SCM maybe, but important nonetheless.

• The November issue of the European Journal of Histochemistry (Hormone Receptor Expression in Human Fascial Tissue) talked about the ways that hormones affect Fascia --- especially in women.  That's right folks; as I've shown you before, when it comes to almost any sort of ill health, including injuries to the Fascia, women are much more likely to take it on the chin than men --- and this study could shed some light on this part of the puzzle.  Here are some of the cherry-picked findings from this study.  "Many epidemiologic, clinical, and experimental findings point to sex differences in myofascial pain in view of the fact that adult women tend to have more myofascial problems with respect to men.  It is possible that one of the stimuli to sensitization of fascial nociceptors [pain receptors] could come from hormonal factors such as estrogen and relaxin [the hormone that causes pregnant women's ligaments to loosen], that are involved in extracellular matrix and collagen remodeling and thus contribute to functions of myofascial tissue.  We can assume that the two sex hormone receptors analyzed are expressed in all the human fascial districts examined and in fascial fibroblasts....  Our results are the first demonstrating that the fibroblasts located within different districts of the muscular fasciae express sex hormone receptors and can help to explain the link between hormonal factors and myofascial pain. It is known, in fact, that estrogen and relaxin play a key role in extracellular matrix remodeling by inhibiting fibrosis and inflammatory activities, both important factors affecting fascial stiffness and sensitization of fascial nociceptors [pain receptors]."  Although systemic inflammation is bad news, local inflammation (THIS POST explains the difference between the two) supplies the growth factors needed to stimulate FIBROBLASTIC ACTIVITY.  Thus, in the same way that too much estrogen causes something called ESTROGEN DOMINANCE --- extremely common here in America --- too little estrogen can lead to problems as well. "It is well known that relaxin is a multifunctional factor which contributes to collagen tissue remodeling by inhibiting fibrosis and inflammatory activities and that a longer duration of estrogen deficiency is associated with increased fibrosis. In this respect, estrogen inhibits fibrosis, reducing TGFβ expression, connective tissue growth factor production and function, matrix metalloproteinases 2 and 9 expression and activity, the conversion of fibroblasts to myofibroblasts and the production of collagens I and III. All these factors are also important to define fascial remodeling and fascial tension. If fascial stiffness is increased, the nociceptors within the fascia could be sensitized causing the underlying muscles to be stiffer."  By the way, metalloproteinase dysfunction is associated with abnormal scar formation and stretch marks (HERE).
  

If you have struggled with CHRONIC PAIN, addressing the body's Fascia System probably makes as much sense as anything you've heard.  And if you like what you're hearing, feel free to show us some love on FACEBOOK, which actually helps you get this message into the hands of those you love and care most about.

A patient I'll call "Brenda" sent me the following history in response to a recent post on CHRONIC LOW BACK PAIN.  I told her I would answer her publicly so that everyone could read, since what she is dealing with is extremely common (I do this ON OCCASION).  Scenarios like Brenda's are not only dog common, but have the potential to take a person who has worked hard to be active, fit, and healthy, and destroy their life.  Thus, the biggest question on the table is whether there is anything Brenda can do at this point to potentially help her cause?  I guess another way of putting it might be, what would I do if I were in a similar situation? My responses are in between her paragraphs.

"I was in a car accident just short of 2 years ago and I'm still getting treated. I was hit by someone who ran a red light traveling at least 55mph while I was stationary. I was hit on the front passenger side of my vehicle. The whiplash I incurred went sideways.  My accident happened on a Sunday, I was sore afterwards, but on the following Wednesday I woke up in pain from head to toe."

The first thing I want you to understand is that every study that comes out, shows that healing takes longer than the study that came out before it.  Although insurance companies love to tell their insured that "research says" healing of soft tissues takes no more than 4-6 weeks, this is patently untrue as seen in the latter part of THIS LINK.  Although the FIBROSIS (the medical word for SCAR TISSUE) is laid down in that amount of time, your body must remodel said tissue into something functional, which takes much longer --- current research says as long as two years or more.  Furthermore, Brenda has at least two of the biggest factors that potentially make WHIPLASH INJURIES worse working against her --- she's female and her impact was from the side as opposed to coming from either the front or the back (both found HERE).  On top of everything else, having pain show up days or even weeks after the accident is not at all an uncommon phenomenon (HERE).

"I suffered from daily migraines, blurred vision, sensitivity to light, could not sit, stand or lay comfortably. My whole body felt like I was plugged into an electrical outlet. The immediate care doctor I saw the day after my accident prescribed muscle relaxants and ibuprofen. By Friday I was at my doctors office. He is an integrative medicine doctor, therefore no more muscle relaxants, no pain meds prescribed. As much as I laid wishing I had them, I'm grateful I did not. The amount of pain I was in I'm sure I would have become addicted. I saw a chiropractor 3 times a week for 3.5 months with a 1/2 hour massage once a week. My eyebrows were so tight on my face you couldn't pull them away. I was told the muscles in my back were like ropes with knots underneath. I have bulging discs from T4-5 to T10 and broad base to moderate disc bulges in my lumbar/sac."

The first sentence tells me that you had a MTBI / TBI, as all symptoms you list --- including MIGRAINES --- are well known sequelae of such.  It is extremely common for people who are in these sorts of accidents become heat-intolerant as well.  Typical pharmacological fare for these sorts of injuries includes THE BIG FIVE (with the ANTI-DEPRESSANTS usually coming a bit later).  In the acute part of the injury, you'll need lots of care, including massage.  As for your "tight eyebrows," make sure you look at my articles on FACIAL FASCIA.  As for the discs, some of these may or may not be a source of your pain.  And as to the argument that they were pre-existing (invariably this is what the insurance company will say), how can this be proven one way or another without a previous MRI?  Even if these disc injuries were pre-existing, the accident took a stable situation (HERE) and destabilized it (HERE).

"Still to this day my legs still buzz. I can feel it in the back of my upper legs and then it encompasses both lower legs from the knee to my toes with my left side worse. Sometimes I also have tingling on the back of my left arm and into my last 2 fingers. I also have issues with my left knee that comes from my tight hip flexors. After seeing the chiropractor for so long and eventually being told, "I can't fix you (and it's not because he didn't give it 125%) I saw a myofascial release therapist. I finally starting getting some relief. The treatments were painful; I screamed at times, had tears from the pain but the next day I felt relief."

Let me take this time to address your low back pain.  Many insurance companies will tell you that low back pain after motor vehicle accidents is rare.  Hogwash!  According to any number of studies (not to mention notes from Dr. Dan Murphy's 24 hr Whiplash Seminar), it's the third leading symptom of these sorts of accidents, just behind NECK PAIN and HEADACHES.  Also, RADICULAR PAIN and SCIATICA can take on many forms, often leading to paresthesias ("abnormal nerve sensations").  As for the tight HIP FLEXORS, adjustments, while extremely important, don't, in and of themselves, have the ability to solve this or any of the other major "SOFT TISSUE" components of the injury.  The soft tissue parts of the injury will almost always require some sort of bodywork. 

When it comes to bodywork, there are two different kinds.  There is what I call rub-a-dub, which is the feel-good stuff you can get at the spa to help you relax.  This is great for people not experiencing any majorly painful problems.  However, as I have talked about previously (HERE, HERE, HERE, and HERE), bodywork often needs to be harsh, because if it's not, the threshold for breaking the adhesed fascia is not being met.  Thus, sub-threshold treatment is not breaking down the Fibrosis / Scar Tissue, which is why I sometimes say of this sort of treatment, 'a whole lot of nothing is still nothing' (see links).

"I tried working for the 1st three months after my accident, but sitting all day (and trying to learn a new job), I eventually had to go on Medical Leave for six months, or risk losing my job due to call offs. Since I had no pain meds prescribed, I would take 3 ibuprofen upon waking, then 2 extra strength Tylenol at noon, followed by 3 more ibuprofen early evening and then 2 Tylenol pm's to fall asleep. I did this for 9 months, before I said enough."

In many cases, especially cases where you are able to constantly move around without having to do heavy or repetitive jobs (especially on CONCRETE), the best thing you can do is go back to work. However, so many jobs require people to spend their days hunched over a desk or computer screen (or an assembly line) that it creates it's own set of problems (CHRONIC TRUNK FLEXION and FORWARD HEAD POSTURE).  And as for the TYLENOL and NSAIDS (Ibuprofen), clicking on the links reveals their own unique sets of associated problems, many of which can be deadly or at least debilitating.

"The myofascial release was helping until insurance said no more visits. What do they know?  And how could they judge me and my condition sitting at desk wherever they are?  I eventually ended up back with my myofascial therapist a few months later for another 12 visits they OK'd. Once again, I was getting better, then insurance stopped it. I tried going back to the activities I enjoyed prior to my accident. Aquatic exercises. Tried riding my bike, and would have mid back spasms later in the day. I have a horse and have enjoyed riding for 45 years. I got back to the barn again to enjoy everything that comes with caring for a horse, mucking stall, brushing, riding and once again back spasms and soreness. I love hiking/walking. I'm a photographer."

What do they know?  Insurance is evil.  In our society it's a necessary evil, but an evil nonetheless, whether run by private enterprise or our government (a government that has proved time and time again that they are incapable of most of what they are charged with --- HERE for instance).  Sounds like there was a huge amount of ADHESED FASCIA created by this accident.  This is a good time to mention that as unfortunate as it is, a significant number of those injured in MVA's (some studies actually say as great as 25%) never fully recover, being left to deal with varying degrees of CHRONIC (TYPE III) PAIN. My goal is always to keep my patients from falling over that precipice into the pit of despair.

"I now felt as if my ovaries hurt, my left knee was bothering me, I would get up all stiff and sore and limp for several steps. I saw my PCP and asked him should my ovaries hurt if I'm in menopause? My left knee is bothering me too and I still have the buzz in my legs. He has me get up on the table and raises my legs up and down. The left leg was turned "on" I experienced a large electrical current throughout my whole leg with buzzing, pins & needles and tingling all the way to my big toe. He said you might have piriformis syndrome. That leg raise must of woke up a nerve somewhere. Within a couple of days I experienced daily headaches again, culminating into a migraine, my knee hurt worse and the buzzing was worse. I ended up seeing a different chiropractor that specializes in Active Release Technique (ART). It's working and I'm getting a full body deep tissue massage weekly. I'm feeling better but still have the same issues."

Depending on how much nerve irritation you have (PIRIFORMIS SYNDROME can certainly be a factor), this could not only cause the radicular symptoms, but the abdominal pain as well since nerves from your LOW BACK control your sex organs (HERE).  Also be aware that right along with the hip flexor issue, it's not uncommon to end up with FASCIAL ADHESIONS of the lower abdomen (HERE).  By the way, ART is fantastic stuff for lots and lots of people.

"The buzzing in the legs to my toes is still here but my knee does feel better most of the time. Forgot to mention along with the knee pain I was also experiencing plantar fasciatis too. My chiro thinks I should get an EMG. I go to a 3rd neurologist and he tells me he thinks my issues go deeper than any of the medical equipment locally could read and suggests I try a university setting. Do I need a referral? No; well yes I do, or insurance will not pay. Three weeks later I'm still waiting on the referral."

Your neurologist is probably a fantastic individual.  He / she is also likely leading you on about your local university having "special" equipment that is going to show this problem.  Unfortunately, the most abundant, pain-sensitive, and commonly injured tissue in the body does not show up with standard imaging, including MRI (HERE).  And as for an EMG providing an "ah ha" moment.... Not to be a party-pooper, but after 25 years of practice, I would go "all in" betting against it.  As far as a neurologist is concerned, because you are so close to Chicago, you should have no problem finding a Functional Neurologist trained by DR. TED CARRICK to at least evaluate you.  DR. JAY ROHLEDER is in your state and I would consider him to be tops in his field.  I've sent patients to him with great results, and know him personally as he was the Valedictorian of our chiropractic class of 1991.  Great guy; great doctor.

"The last couple of my massage visits she could feel my knots or lumps whatever you call them. She tried working them out, and it was painful. My right side of my back still has the stringy rope going down it and I could feel it all the way into my elbow. The lump of tissue on the left side of thoracic is still here 2 years later and is very stubborn. I would really like to get to the root of these problems, I don't want a doctor to tell me 10 years from now, that you should have done this or that. Is there any hope for me? By chance do you have any insight on what I should do next?  I'm going to be 57 in a couple of months, prior to my MVA I was very active, limber, felt as if I could do anything I wanted. I wanted to go into my senior life with a younger body. You know the saying "move it or lose it"."

The knots you are referring to Brenda are called TRIGGER POINTS and are miserable by anyone's definition.  I commend you for wanting to get to the root of the situation.  However, it can be tough to do --- even if you know exactly what's wrong.  Which brings me to the next part of this post; what would I do if I were in your shoes?

Firstly, because head injuries are associated with crazy things like LEAKY BRAIN SYNDROME, INFLAMMATION, and autoimmunity (HERE), I would take a long hard look at doing an ELIMINATION DIET, which I think is far more accurate than any sort of sensitivity testing.  Secondly, a middle-of-the-road WBV MACHINE might prove invaluable as far as a way to both exercise and stretch (it actually provides exercise to your brain).  Thirdly, because the cost of virtually all technology continues to plummet, a LASER for home use might prove invaluable for you.  Otherwise, I would read THIS POST (as well as looking at the links I provided for you today).  Certainly, not everything I've included is going to pertain to you, but some of it will.  If you can possibly find a hidden source of inflammation, it could prove highly beneficial as far as getting to that "root cause" of your problem.

Because I have family members and friends who are MD's, I have some idea of the bureaucratic BS they are forced to go through all day long with each and every patient.  Why does it matter to you?  Mainly because not only is EVERYONE BEING AFFECTED BY A SIMILAR PHENOMENON, but how much does it affect your care knowing that national polls have repeatedly shown that over fifty percent of physicians hate their job and dread going to work? 

Writing for the blog over at Kevin MD, Dr. Jordan Grumet, an internist doing a guest column (Why This Doctor no Longer Loves Being a Physician) stated, "I no longer love being a physician.  I suppose the change happened sometime after we started using electronic medical records. It happened with meaningful use. And MACRA. And Medicare audits. And ICD-10. And face-to-face encounters. And attestations. And PQRS. And QAPI. And the ACA. And MOC. And on and on.  What I do today is no longer practicing medicine. Instead it’s like dancing the waltz, tango and salsa simultaneously to a double-timed techno beat. It’s sloppy, rushed, unpleasant to look at and often leaves my partner more confused and anxious than when we started.  I have become ineffective. Not by the weight of ever expanding medical knowledge or even the complexity of the human body. Instead, my hard drive is being spammed by thousands of outside servers."

If you want to get an idea of what your doctors are going through every time they come in the room to examine or treat you, you can read THIS POST.  And if you think that it's not affecting the quality of your care (or the quality of the research coming out of the field), I've got some ocean front property in Arizona you just might be interested in.  I would suggest you take one minute to read Dr. Grumet's short article (that's all it will take).  As is frequently the case, the comment section is better (and more telling) than the post itself.

That bastion of truth and knowledge, Wikipedia, says of NIGHTSHADES, "The Solanaceae, or nightshade family, are made up of over two thousand different species of flowering plants, herbs, vines, lianas, epiphytes, shrubs, and trees, and includes important agricultural crops, medicinal plants, spices, weeds, and ornamentals. Many members of the family contain potent alkaloids, and some are highly toxic, but many cultures eat nightshades, in some cases as staple foods."  The first thing I want to get across to my patients and readers is that the vast majority of you reading this have no problem whatsoever ingesting foods from the Nightshade family.  But.... For some of you, Nightshades can be a continual source of occult (hidden) inflammation.  Which begs the question, what edible plants are from the family of Nightshades?

• Tomatoes (including Ashwagandha, Tomatillos, and Tamarillos)
• Potatoes (but not Sweet Potatoes)
• Peppers (both sweet and hot, as well as black pepper, whose active ingredient, Piperine, has actually been used as an insecticide)
• Eggplant
• Paprika
• Okra
• Certain Kinds of Berries (Goji, Garden Huckleberries, Cape Gooseberries, and to a small -- small --- extent, blueberries)
• Poke (around here it grows everywhere and is considered a weed; people call it "ink berry plant," and although the purple berries are toxic, the leaves are less so and can be eaten early in the Spring --- as long as you boil them twice and pour off the water)
• Tobacco
• Others (although there are any number of others, most are relatively uncommon in the US)

The best way to determine whether or not you are sensitive to Nightshades?  An Elimination Diet of course.  When doing an ELIMINATION DIET, I not only urge you to cut out GLUTEN CROSS-REACTORS, but Nightshades as well.  The cross-reactors are self-explanatory if you look at the provided link, but why Nightshades?  Simply because some people are sensitive to them --- especially people whose biggest problem happens to be JOINT PAIN & ARTHRITIS.  They've also been shown to cause intestinal inflammation (HERE), which invariably leads to a "LEAKY GUT" and fouled up MICROBIOME (aka "DYSBIOSIS") --- two hallmarks of chronic illness,  This can be highly problematic considering that 80% of your body's total immune system is found in the Gut (HERE).  From my experiences, I would say that the second most common symptom of Nightshade Sensitivity would be IBS.

But again, why are Nightshades so potentially toxic to certain people?  It has to do with the fact that they all contain chemical compounds known as alkaloids.  Wiki says of this class of compounds; "they are known to have an intense physiological action on animals even at low doses.  Solanaceae are known for having a diverse range of alkaloids. To humans, these alkaloids can be desirable, toxic, or both."  Some of the alkaloids you have quite possibly heard of include Nicotine (the active ingredient in Tobacco), Scopolamine (a plant-based motion sickness and anti-nausea compound), Atropine (highly toxic, but used in the medication "BELLADONNA" at extremely low doses), Solanine (found in both potatoes and tomatoes, especially when unripe or green --- extremely toxic; actually deadly at as little as 2mg per kg of body weight), Capsaicin (not as toxic as the others; is what gives hot peppers their 'heat'), Quinine (the most famous of the anti-malarial drugs, from the bark of the cinchona tree), Morphine (from opium poppies), Ephedrine (part of any number of medications as well as being used to manufacture METH; known as Ma Huang in Chinese Medicine), Cocaine (from the leaves of the coca bush), Caffeine (from coffee and tea) and any number of others.

Once more; the point is not to suggest that most people --- or even a significant minority --- are sensitive to Nightshade edibles.  Just be aware that there is a mountain of evidence, both anecdotal and empirical, showing that for some people --- most of whom have no idea --- this is a legitimate and potentially severe problem.  And for the rest of us......?  Nightshades can actually have some pretty good health benefits.  In fact, when I went to PubMed to research the topic, I found just as many or more studies touting the benefits of Nightshades as I found touting their inflammatory properties.  But.....

If you are one of the tens of millions of Americans struggling with CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, AUTOIMMUNITY, or CHRONIC PAIN, it would serve you well to read THIS POST, and strongly consider doing an Elimination Diet (ED).  A well-done ED allows you to pluck the low-hanging fruit as far as your health troubles are concerned.  In other words, there will be some of you reading this who end up needing some sort of Functional Testing to figure out what's wrong with you.  But for the rest --- the vast majority --- you can actually solve many of your health-related problems on your own by following some of the simple steps outlined on this site (HERE).

The large red "X" above is at the IVF of the fifth lumbar disc --- the lowest disc in the spine.  Although this disc should be the thickest disc in the spine, after 25 years of practice I can authoritatively say that in people with any degree of low back issues, this is rarely the case.  In fact, I would dare say that in most of the over-40 crowd, the fifth lumbar disc (the lowest disc in the low back) is the thinnest disc as opposed to the thickest.  Although I was taught and used to believe this thinning was purely a mechanical phenomenon caused by the immense stresses and loads the spine is under so much of the time (every time you bend forward the movement mostly occurs at the fifth lumbar disc), I've come to realize that this is not completely true.

Much of this has to do with studies showing OSTEOARTHRITIS or "Degenerative Arthritis" (in the extremities this is called DJD or Degenerative Joint Disease, while in the spine it's referred to as DDD or Degenerative Disc Disease) is largely a function of inflammation.  This is the biggest reason that study after study after study has shown that whether we are talking about disc herniations, degenerative discs, or deterioration of joints elsewhere in the body (HERE and HERE), there is little correlation between the amount of pain a person is having and the severity of findings as seen on their x-rays and MRI's.  The silver lining is that you can use this information to your advantage when dealing with chronic low back pain. 

When the medical community treats people with chronic low back issues, they address it three different ways.  Firstly, they deal with the pain by prescribing various sorts of PAIN MEDS.  While there is certainly nothing wrong with this approach for the short haul --- especially if the person is in horrendous pain --- it's never a good thing, and especially not for more than a few weeks at the most.  Secondly, they deal with inflammation --- kind of.  I say "kind of" only because what they are doing is masking inflammation as opposed to actually stopping it at the source (EXPLAINED WELL HERE). And thirdly, they (including alternative practitioners) are attacking these sorts of problems mechanically (CHIROPRACTIC ADJUSTMENTS, THERAPY, EXERCISE, STRETCHES, VARIOUS SORTS OF BODYWORK, SPINAL DECOMPRESSION THERAPY, INVERSION, WBV, etc, etc).  For the record, BACK SURGERY is also a form of mechanical intervention, albeit an invasive one.

Don't get me wrong; this approach has proven successful for many individuals.  However, for many it misses the mark --- sometimes miserably. While the three steps mentioned above might be necessary, they all fail in one critically important area --- stopping the inflammation unrelated to the injured or degenerative disc itself.  You see, while a certain amount of INFLAMMATION is required to heal damaged tissues, too much leads to a variety of serious serious and systemic problems, including chronic pain.  The problem is that tissue damage can occur via any number of reasons, including things such as your DIET and your level of GUT HEALTH.  There are many other possibilities. 

The really cool thing about dealing with your chronic back pain in this manner, is that it's the best way to deal with almost any health problem you can imagine (I'll show you why in a moment).  When Larry thought he was going to have to have back surgery because of the severe low back pain he had dealt with for half a year, it was dealing with systemic inflammation that "cured" him (HERE).  And love him or hate him (did you watch last evening's game?), it's no coincidence why TOM BRADY continues to play at a level rarely seen by anyone, let alone by someone approaching their 40th birthday.  Both these cases have one thing in common --- going all out to control inflammation.  Which leads us to something really amazing for those of you struggling with chronic health issues, including low back pain.

Whether you have CHRONIC BACK PAIN, CHRONIC INFLAMMATORY DISEASES, or any of the AUTOIMMUNE DISEASES on this list (click the link), you can address them in an almost identical fashion.  And you don't have to wait to get your doctor's permission to start much of what's found on this protocol (HERE).  People are using the information on this site to create their own EXIT STRATEGIES to get off the MEDICAL MERRY-GO-ROUND.  HERE it is, and it's totally free.  It might not solve each and every health issue you are dealing with (including your back problem), but it will at least give you a fighting chance as well as a starting point.  Click the links to see why.

When it comes to embryological development, the first thing to form is your nervous system --- brain and spinal cord.  It's so important that it ends up encased in protective bone.  The skull is essentially a fixed structure (no offense to the craniosacral people here), while the spinal column is made up of 24 moveable vertebrae.  In between most of these vertebrae are spinal discs, which act as cushions or bushings.  The nerves travel throughout the body after exiting the spinal cord through small "windows" along either side of the spinal column.

The discs are of critical importance for any number of reasons, with one of the biggest being that the height of the window (known as the IVF or Intervertebral Foramen) where the nerves exit the spinal column, is directly proportional to the height of the disc (see picture below).  This means that things that cause disc thinning in any capacity have the propensity to diminish the size of the IVF.  Considering that this is where the nerve roots live, you can guess how big a problem this presents.

"Although the cause of increased prevalence of wheat sensitivity over the last several decades remains unknown, modern wheat processing techniques may have increased consumer exposure to immunoreactive compounds."  From the February 1015 issue of Comprehensive Reviews in Food Science and Food Safety (A Grounded Guide to Gluten: How Modern Genotypes and Processing Impact Wheat Sensitivity)

"One of the issues of whole wheat flour production is the lack of well-established milling procedures. Whole grain flours are produced by a variety of techniques and result in flours with widely different particle sizes and functionalities.  Another issue with whole wheat flour utilization is shelf-life.  Whole wheat flour is highly susceptible to rancidity due to the presence of lipolytic enzymes."  Andres F Doblado-Maldonado from his 2012 Masters Thesis at the University of Nebraska, New Technologies for Whole Wheat Processing Addressing Milling and Storage Issues

I already know that this post is going to create a firestorm of controversy.  That's OK.  Understand that it's not geared towards everyone --- only those who are chronically ill (HERE), chronically overweight (about 80% of the US population when you factor in the 8-10% who are "SKINNY FAT"), or dealing with CHRONIC PAIN --- according to estimates, as many as 100 million Americans.  The fact that people question that grains could be part of their health problem(s) is legitimate --- I've asked some of the same questions myself.  For instance, how can common grains from the Bible (wheat, corn, barley, rye, oats, millet, emmer, etc) somehow be bad?  I will get to that, but for the time being, realize that the grains we are consuming today are radically different from the grains your grandparents were consuming --- let alone Moses or Jesus.

The first thing I want everyone to realize is that not everyone is sensitive to GLUTEN or other grains, which, by the way, are virtually all GLUTEN CROSS-REACTORS.  Some of you can handle these with no apparent problems.  But also understand that just because a problem is not "apparent" does not necessarily mean it doesn't exist.  This is especially important one you realize that when it comes to NON-CELIAC GLUTEN SENSITIVITY (NCGS), the majority of the symptoms don't manifest like we've always been taught they do --- bloating, gas, CONSTIPATION, DIARRHEA, IBS, etc, etc).  They manifest "extra-intestinally" or outside of the Gut.  For example, numerous studies show that over half of all NCGS manifests neurologically (HERE and HERE).  But Gluten is only part of what makes grain a potential Burmese Tiger Pit waiting to destroy unwary (or uneducated) victims. 

Grains can be divided into two large categories; these are legumes, which include all types of BEANS (UNFORTUNATELY, SOY) and the cereal grains (wheat, rye, barely, corn, etc, etc, etc).  All have three main parts; the bran, the germ, and the endosperm.  The bran, or "husk" of each kernel, is where MOST OF THE FIBER is found. It's also where part of the B-VITAMINS and most of the minerals are found, as well as the majority of the oils (it's the oils that tend to go rancid fairly quickly once the grain is milled).  The bran also happens to be where the phytates, one of the "ANTI-NUTRIENTS" found in many grains, are found (other anti-nutrients that may or may not stimulate health problems such as LEAKY GUT include Lectins, Saponins, Oxolates, Lippopolysacharides, and potentially several others).

The germ is the part of the grain that actually sprouts and becomes a new plant.  The rest of the B-Vitamins are found here, as well as ANTIOXIDANTS and the rest of the oils.  It contains several vitamins and minerals, as well as being made up of about one third protein.  The endosperm is not only the by far the biggest part of the grain, it's where the majority of the starchy carbohydrate meant to feed the "germinated" seed is found.  When compared to the rest of the grain, the endosperm has little nutritional value other than providing a source of simple carbohydrate.

The USDA, which as I have told you previously, is an organization whose chief concerns have little to do with health, but rather the promotion of US agriculture both domestically and around the world, says on their website (Choose My Plate) that, "Most Americans consume enough grains, but few are whole grains."  What's the difference?  "Whole grains contain the entire grain kernel ― the bran, germ, and endosperm.  Refined grains have been milled via a special process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins.   Most refined grains are enriched."   Once the grain has been refined, chemicals, including bleach, are used, not to whiten the flour or to kill bugs as most people believe, but to destroy any living part of the grain remaining from the milling process.  This is because in virtually all cases, manufactures need dead flour made from dead starch. You'll see why this is so important in a moment.

First and foremost, the quote above shows that most Americans are not eating whole grains (and when they do, they are largely being duped as you'll also see shortly).  Secondly, the grain-based products they are eating are usually highly refined (the bran and germ are removed).  Why?  Because flour that is not heavily refined not only spoils and goes rancid quickly, it tends to attract weevils and other critters (those of you who are old enough know what I am talking about).  By removing or killing the vital, living, and nutrient-rich part of the grain, food manufacturers can provide retailers and consumers flours and products that in many cases have an almost unlimited shelf-life.  For instance, breakfast cereal might get a bit stale once the bag has been opened, but left in your pantry for a decade, it will not spoil or rot. And what about the whole "enrichment" thing I mentioned earlier?

Enrichment is what politicians do at the expense of the citizens they are supposed to represent.  It's also one of the many ways food manufactures dupe people who don't know better.  I have a friend who is in the pet food manufacturing industry.  He tells me that synthetic vitamins & minerals are not only widely available, but dirt cheap.  This is why manufacturers can advertise that radically unhealthy breakfast cereals such as Count Chocula, Coco Puffs, Donutz, Captain Crunch, Golden Grahams, Froot Loops, Trix, Super Sugar Crisp, Apple Jacks, Honey Smacks, METH & CRACK, and a myriad of others, are "fortified" with the whole day's supply of a dozen or so essential vitamins and minerals.  If you aren't familiar with the difference between nutrition that comes from food and the synthetic garbage added to these products so industry can make absurd claims about nutrition (for instance, Total Cereal claims to supply, "100% of the Daily Value of 11 vitamins and minerals"), then you need to read THIS.

I think that our "smoking guns" can be boiled down to three main categories, hybridization / GMO, modern milling methods, and chemical saturation. How big a deal has hybridization and GMO been as far as health problems are concerned?  Despite what we keep hearing from our government; huge for susceptible individuals.  This is mostly due to the fact that modern hybrids and GMO's (or funky combinations of the two) can not only contain larger amounts of certain proteins than older (ancient) varieties of grain did, but in some cases, have been shown to contain proteins that did not used to exist at all.  Either way you slice it, people's bodies are reacting to these as foreign and then mounting immune system attacks against them, which as strange as it may seem, is a known trigger for the body mounting immune system attacks against itself in the form of autoimmunity.  This is not a new or novel concept, having been known since the 1930's --- HERE & HERE.  What are some of America's leading authorities saying on the subject?

Renowned Naples neurologist, DR. DAVID PERLMUTTER of NYT bestseller Grain Brain fame, stated that, "The problem with gluten is far more serious than anyone ever imagined. Modern…structurally modified, hybridized grains contain gluten that’s less tolerable than the gluten that was found in grains cultivated just a few decades ago."  FUNCTIONAL MEDICINE expert, Dr. Mark Hyman (MD) says of these modern grains, "This new modern wheat may look like wheat, but it is different in three important ways that all drive obesity, diabetes, heart disease, cancer, dementia and more. It contains a super starch, amylopectin A, that is super fattening, a form of super gluten that is super inflammatory, and acts like a super drug that is super addictive and makes you crave and eat more." Can anyone say GLUTOMORPHIN?  Dr William Davis (MD) who wrote the legendary book Wheat Belly stated that, "This stocky little high-yield plant, a distant relative of the wheat our mothers used to bake muffins, biochemically light-years removed from the wheat of just 40 years ago."

And to top it all off, my mom's first cousin, DR. JAMES BRALY, a nationally respected expert on the immune system and natural allergy relief (not to mention, long-time physician to the rich and famous) was lecturing and writing about the health problems associated with grains clear back in 2002.  In his hit book, Dangerous Grains, he lists on the back jacket some of the health problems connected with the consumption of modern grains via peer-review.... 

• CANCER
• AUTOIMMUNE DISEASES (A list of the more common ones can be found HERE.)
• BRAIN DISORDERS
• OSTEOPOROSIS
  
• INTESTINAL DISEASE (This covers a lot of ground, including not only pathological issues such as IBS and IBD, but "FUNCTIONAL ISSUES" such as LEAKY GUT and the screwed up MICROBIOMES we collectively refer to as "DYSBIOSIS".  For those of you with IBS, it is critical you understand FODMAPS.) 
  
• DIGESTIVE DISORDERS (One that's been related to grain that plagues a huge segment of our population is something called HYPOCHLORHYDRIA.  If you are on ACID BLOCKING DRUGS you really need to understand this bullet.)
  
• CHRONIC PAIN
  
• INFERTILITY & PROBLEM PREGNANCIES

"Even orthodox nutritionists now recognize that white flour is an empty food, supplying calories for energy but none of the bodybuilding materials that abound in the germ and the bran of whole grains.  Problems occur when we are cruel to our grains—when we fractionate them into bran, germ and naked starch; when we mill them at high temperatures; when we extrude them to make crunchy breakfast cereals; and when we consume them without careful preparation.  Grains require careful preparation because they contain a number of antinutrients that can cause serious health problems. Phytic acid, for example, is an organic acid in which phosphorus is bound. It is mostly found in the bran or outer hull of seeds. Untreated phytic acid can combine with calcium, magnesium, copper, iron and especially zinc in the intestinal tract and block their absorption. This is why a diet high in improperly prepared whole grains may lead to serious mineral deficiencies and bone loss. The modern misguided practice of consuming large amounts of unprocessed bran often improves colon transit time at first but may lead to irritable bowel syndrome and, in the long term, many other adverse effects." Sally Fallon and Mary Enrig from the WESTON PRICE FOUNDATION (Be Kind to Your Grains And Your Grains Will Be Kind To You)

"Our rallying cry is 'Bake Like it’s 1869'. That's because, in the 1870’s, the invention of the modern steel roller mill revolutionized grain milling.  Instead of just mashing it all together, one could separate the component parts...  And, beyond being cheap and wildly popular, this new type of flour shipped and stored better, allowing for a long distribution chain. In fact, it kept almost indefinitely. Pest problems were eliminated because pests didn’t want it. Of course, we now know that the reason it keeps so well is that it has been stripped of vital nutrients.  The steel roller mill became so popular, so fast, that within 10 years nearly all stone mills in the western world had been replaced. And thus was born the first processed food and the beginning of our industrial food system: where vast quantities of shelf-stable 'food' are produced in large factories, many months and many miles from the point of consumption."  Fron Zivot's GrainStorm site (the article mentioned earlier)

"Stone mills are the oldest attrition mills used for making whole grain flours, which simultaneously use compression, shear, and abrasion to grind wheat kernels between two stones and produce a theoretical extraction rate of 100%. Modern stone mills are metal plates with composition stones attached and generate considerable heat due to friction. This can result in considerable damage to starch, protein, and unsaturated fatty acids in comparison with other milling techniques.  Furthermore, in large, continuous milling operations, heat generated from stone milling can pose a fire risk.  Interestingly, there appears to be a marketing advantage by using the term 'stone ground' with consumers."  From Andres F Doblado-Maldonado's 2012 Masters Thesis, New Technologies for Whole Wheat Processing Addressing Milling and Storage Issues at the University of Nebraska

"A report written under the guidance of the American Association of Cereal Chemists International Whole Grain Working Group (WGWG) asserted existing data comparing the two principal means of manufacturing whole wheat flours and meals — single-stream milling and multiple-stream milling with recombination — do not show any strong advantage for either milling method with regard to maintaining the nutritional value of the whole grain. Whole grain.. meals and flours mostly were manufactured by mills using a multiple-stream with recombination process.   Some sources have voiced concerns that milling processes that separate and combine millstreams may capture fewer whole grain components and their nutrients, fiber and micro-constituents than milling processes that never separate millstreams.  In multiple-stream milling with recombination, the grain is crushed, and different grain fractions are channeled into separate millstreams. When crushed and separated products of milling, specifically the bran, germ, endosperm, and minor milling fractions (from the same grain), are reunited at the point of use by the food manufacturer, the process is called reconstitution.  The contribution of single-stream milling to whole grain foods in Western diets is minimal...   Manufacturers reconstituting whole grain flour in the manufacture of their whole grain food products must exercise diligence to ensure that the proportions of the various components meet the standards set by the AACCI whole grain definition."  Cherry-picked from a 2015 paper by Josh Sosland on World-Grain (Comparing Whole Grain Milling Methods)

The second "smoking gun" has to do with the way that our modern grains are milled.  For thousands of years grains were milled between pieces of wood, stones, or both.  The nature of this flour was that it was coarse --- often times very coarse.  It was also common to soak grains, sprout grains, and sour the dough; all processes that made digesting them easier.  Today we take grains that have often times been stored in bins or grain elevators with an array of seriously toxic chemicals (next smoking gun), and then we mill it at extremely high speeds (I've seen some that claim tens of thousands of RPMs).  Not only is this product not being mixed with beans, nuts, and other grains, it is frequently being ground to the consistency of talc. Understand that none of this guarantees you are going to have health problems because of the grain, but numerous experts believe it dramatically increases your chances.  This increased probability that grains are problematic is a combination of individual genetic makeup and the way they are affected by their environment.

Why do some people have such serious trouble digesting and assimilating grain while others remain --- at least seemingly so --- unfazed?  Much of it has to do with something called epigenetics.  Interestingly enough, I showed you this back when I showed you how Gluten Sensitivities (CELIAC DISEASE Included) start (HERE).  It seems that Sayer Ji, author of The Dark Side of Wheat would agree.  Pay attention to the fact that EPIGENETIC FACTORS far outweigh the genetic factors when it comes to developing grain sensitivities (as I've told you over and over again on this site, you can no longer blame mom or dad for your health problems, even though Big Pharma wants you to believe otherwise (HERE)).

"It Is Not In the Genes, But What We Expose Them To.  Despite common misconceptions, monogenic diseases, or diseases that result from errors in the nucleotide sequence of a single gene are exceedingly rare. Perhaps only 1% of all diseases fall within this category, and Celiac disease is not one of them.  The "blueprint" model of genetics: one gene → one protein → one cellular behavior, which was once the holy grail of biology, has now been supplanted by a model of the cell where epigenetic factors (literally: "beyond the control of the gene") are primary in determining how DNA will be interpreted, translated and expressed. It is the epigenetic factors, e.g. regulatory proteins and post-translational modifications, that make the determination as to which genes to turn on and which to silence, resulting in each cell’s unique phenotype. Moreover, epigenetic factors are directly and indirectly influenced by the presence or absence of key nutrients in the diet, as well as exposures to chemicals, pathogens and other environmental influences. In a nutshell, what we eat and what we are exposed to in our environment directly affects our DNA and its expression.  The implications of these findings are rather extraordinary: epigenetic and not genetic factors are primary in determining disease outcome. Even if we exclude the possibility of reversing certain monogenic diseases, the basic lesson from the post-Genomic era is that we can’t blame our DNA for causing disease. Rather, it may have more to do with what we choose to expose our DNA to."

Industry will, for the most part, tell you that none of this really matters, trying to convince you that the power is all in the gene; all the while pumping out studies showing their products in a favorable light.  In lots of ways it's almost identical to the phenomenon of "HOMEGROWN RESEARCH" coming out of the sugar industry; or the tainted studies being pumped out by the PHARMACEUTICAL INDUSTRY.  As I've shown you time and time again (HERE), trust peer-review at your own peril.   Which brings us to that final smoking gun.

Although a case could be made for several more, my third and final smoking gun has to do with the CHEMICALS, HERBICIDES, AND PESTICIDES that all modern grain production requires (can anyone say GLYPHOSATE?).  Modern grains are hit with NASTY CHEMICALS a minimum of twice; once in the field and again during storage.  I'll not spend time on this as most of you are aware that exposure to synthetic chemicals is bad for you --- it's one of those rare things in healthcare that we can all agree on (not sure why that doesn't seem to translate over to DRUGS and VACCINES?).  And not only are these chemicals carcinogenic, most have the ability to act as XENO-HORMONES, feminizing the males of every species (HERE), while causing something called ESTROGEN DOMINANCE not only in women, but in men as well.

What should you do?  Like I said, grains are not a significant health issue for some people.  However, if you are one of the people I mentioned at the beginning of today's post (or have a strong family history of certain chronic diseases), I would strongly suggest you do an ELIMINATION DIET, which will entail cutting grains out of your diet for at least a month.  An Elimination Diet is the most accurate way to determine what foods you might have problems with, including grains.

Let me leave you something to think about while contemplating today's post.  When I was growing up in the FLINT HILLS of extremely rural Kansas, ranchers whose beef grazed the prairie would take their livestock to the feedlots in the western part of the state to be "finished".  This is where the beef is given copious amounts of grain the last couple months of their lives.  Why?  Sure, everyone raves about the taste of grain-fed beef ---- after all, it's the fat that largely gives meat it's flavor.  But where's all that fat come from? Largely from the grain --- I'll not even go into the whole LOW-DOSE-ANTIBIOTICS-FOR-FATTENING-YOUR-LIVESTOCK thing here).   It's important for you to be aware that commercially-raised, grain-fed beef is often referred to in peer-review as "obese".

Although there are literally dozens of reasons that a grain-based diet might not be in your best interest if you have chronic health issues OR A FAMILY HISTORY OF SUCH (HERE, HERE, HERE, HERE, HERE, HERE, and HERE are some reasons, as well as hundreds you can look up yourself on the sites of ROBB WOLF, MARKS SISSON, ART AYERS, or any number of others), the biggest has to be that modern grains are inflammatory as opposed to anti-inflammatory (HERE).  Why is this a big deal?

OBESITY is one of the numerous health problems caused by inflammation (HERE), which in turn causes inflammation.  And the doubly crazy thing is that excessive adipose tissue (PARTICULARLY IN THE FORM OF BELLY FAT) is not only itself inflammatory, it actually creates estrogen (HERE), which is the hormone commercial livestock producers give animals to make them fatter (click the link found in the paragraph underneath the pic above).  It's a big round-robin of inflammation, obesity, and increasing ENDOCRINE FUBAR (CARDIOMETABOLIC SYNDROME, ADRENAL FATIGUE / FIBROMYALGIA, LOW T --- or for you women, HIGH T --- THYROID ISSUES, all sorts of "LEAKIES", etc, etc, etc, etc) that may or may not be a culprit in your chronic health conditions.

"Renowned gluten intolerance researcher, Dr. Kenneth Fine, believes 1 in 3 Americans are gluten intolerant and 8 in 10 has the genetic wiring to develop it."  Mike Sheridan's article (Grains – What’s the Upside?) From Robb Wolf's website.  BTW, Dr. Fine is an MD who founded Enterolab.  For the record, I think Cyrex is significantly better than Enterolab.

"Cows naturally do not have so much fat, but in the USA most are fattened before slaughter. They are placed in feed lots their last 4 to 6 months of life and fed 20 to 25 pounds of various grains and soybeans every day, and the result is a huge increase in body fat. Cows slaughtered directly from pasture have far less fat between their muscle fibers and that overlying them."  From Baylor University Medical School Proceedings (Twenty Questions on Atherosclerosis)

Not only does the OZARKS have an overabundance of DEER (these are acorn-fed as we do not have grain in these parts), fortunately there are any number of ranchers in this neck of the woods getting with the program by raising beef (or chicken) that is healthy and delicious in every sense of the word.  In our neighborhood, make sure to talk to FRESCOLN RANCH or CLUCK RANCH about their beef (the Clucks have sheep and goats as well).   Speaking of farm animals, let's talk for a moment about the effects that grains have on them.  It's really quite simple, feed a ruminant copious amounts of grain, and they gain copious amounts of weight.  While the same thing is true of people, what I want to discuss today is what it does to Gut Health.   Because your health starts in your Gut, anything that fouls Gut Health is going to foul your overall health (HERE).

According to the Alabama Cooperative Extension System (Digestive System of Goats), "Mature goats are herbivorous ruminant animals. Their digestive tracts, which are similar to those of cattle, sheep, deer, elk, bison, and giraffes, consist of the mouth, esophagus, four stomach compartments, small intestine, cecum, and large intestine."  What I want to discuss is what happens when herbivores (animals designed to eat foliage, vegetation, plants, etc; not grains) are instead fed large amounts of grains (60-65% grains).

The April 2013 issue of Anerobe (Grain-Rich Diets Differently Alter Ruminal and Colonic Abundance of Microbial Populations and Lipopolysaccharide in Goats) said that, "High grain feeding has been associated with ruminal pH depression and microbial dysbiosis in cattle."  This dysbiosis is likely due to increased lipopolysaccharide concentrations in the Gut.  What are lipopolysaccharides (LPS) and why does it matter?  LPS are found on the membrane of gram negative bacteria and frequently lead to serious immune system reactivity.  They act as endotoxins, not only causing the release of pro-inflammatory cytokines, but inducing "superoxide / hyperoxide" production (high-powered, cancer-causing Free Radicals).  Furthermore, because parts of these LPS look similar enough to human cellular molecules, having large amounts of them running around your system tends to cause two distinct problems.  They can hide and not be properly dealt with by your immune system.  Or the immune system starts attacking them, and accidentally starts attacking self because of the similarities (autoimmunity).

A study published four months later in the August issue of the American Journal of Physiology: Regulatory, Integrative, and Comparative Physiology had a "massively" interesting title ---- A High-Grain Diet Causes Massive Disruption of Ruminal Epithelial Tight Junctions in Goats.  How massive is the Leaky Gut issue here?  After seven weeks of feeding goats a high grain diet, "free LPS in the peripheral blood was detectable, while not detectable in the control, suggesting a leakage of LPS into the blood in the high grain group. Correspondingly, the high grain goats showed profound alterations in ruminal epithelial structure and tight junction proteins, depicted by marked epithelial cellular damage and intercellular junction erosion, down-regulation of tight junction proteins.  These results demonstrated for the first time that the high grain diet caused disruption of ruminal epithelial tight junctions was associated with a local inflammatory response in the rumen epithelium."  When tight cellular junctions become loose, the corresponding "leakiness" allows particles of God-knows-what to freely move from the Gut to the circulating blood where they become immuno-reactive.  There were so many studies on this topic I could have written a book.  Allow me to hit you with one more that was published in August of 2017.

The journal Applied Microbiology and Biotechnology (High-Grain Diets Altered Rumen Fermentation and Epithelial Bacterial Community and Resulted in Rumen Epithelial Injuries of Goats) looked as seven weeks of high grain diet and concluded that, "levels of volatile fatty acids and lipopolysaccharides were higher in the high grain group than those in the hay group."  To see how severely this affected inflammatory response in an epigenetic manner, take a gander at this.  Along with the dysbiosis, "the high grain group had a higher relative abundance of gene families related to energy metabolism [potential weight gain]; folding, sorting, and degradation; translation; metabolic diseases; and immune system [making them more prone to autoimmunity]. Furthermore, high grain feeding resulted in epithelial injury and upregulated the gene expressions of IL-1β and IL-6, and the upregulations were closely related to the rumen pH, LPS level, and rumen epithelial bacteria abundance."  In other words, grain was the trigger for leaky epithelial barriers, which led to rampant inflammation.

The bottom line is that today's grains are nothing like yesterday's grains.  And furthermore, consuming these grains has great potential (key word here is potential) to put you on what I call THE UNIVERSAL CYCLE OF SICKNESS, PAIN, AND DISEASE (click and scroll to circular diagram).  If you are struggling with chronic pain or chronic conditions, an important part of your recovery will be getting off grains.  Period.

Dr. Horst Conrad, in chapter 123 (Vertigo and Associated Symptoms) of his text, Clinical Methods: The History, Physical, and Laboratory Examinations, describes Vertigo thusly, "an abnormal sensation of motion. It can occur in the absence of motion or when a motion is sensed inaccurately. Spinning vertigo is usually of inner ear origin. Disequilibrium is a sensation of impending fall or of the need to obtain external assistance for proper locomotion. It is sometimes described as a feeling of improper tilt of the floor, or as a sense of floating. This sensation can originate in the inner ear or other motion sensors, or in the central nervous system. Positional vertigo is a sensation of spinning that occurs after the patient's head has moved to a new position with respect to gravity." Furthermore, as stated by Britain's public health system (NHS), Vertigo is, "a symptom, rather than a condition itself."   Seeing people diagnosed with Vertigo kind of reminds me of people being diagnosed with "SCIATICA" or "HEADACHES".  Great, but since it they are symptoms rather than problems unto themselves, the question that must always be answered pertains to cause? 

According to Mayo Clinic, the difference between Vertigo and "dizziness" has to do with levels of specificity.  For instance, "Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady.  Dizziness is one of the more common reasons adults visit their doctors. Frequent dizzy spells or constant dizziness can significantly affect your life. But dizziness rarely signals a life-threatening condition."   In other words, dizziness is an extremely vague definition, meaning something --- could be anything --- that is affecting equilibrium or balance. Experts tend to agree that most (emphasis on most) actual Vertigo comes from the inner ear.  Although they list a number of potential causes of Vertigo, the Mayo Clinic states, "BPPV (Benign Paroxysmal Positional Vertigo) is the most common cause of vertigo."  Which begs another question.  What the heck is BPPV?  Johns Hopkins states on their website that,

"Benign Paroxysmal Positional Vertigo (BPPV) is the most common of vestibular disorders and the most easily treated. In most patients, it can be cured with a simple physical therapy maneuver.  BPPV occurs when small, microsized calcium crystals called otoconia become dislodged from their normal location on the utricle, one of the inner ear sensory organs. These otoconia are usually embedded in a gelatin like material on top of the utricle. If the otoconia become detached, they are free to flow in the fluid filled spaces of the inner ear, including the semicircular canals which sense the rotation of the head. If there are enough otoconia floating around, they can aggregate into a larger clump. Because they are heavy, they migrate into the lowest part of the inner ear, the posterior semicircular canal. Once in the semicircular canal, they may still move when the head changes position, such as looking up or down, over the shoulder, or when rolling over in bed. It is the movement of these stones that causes an unwanted flow of fluid in the semicircular canal even after the head has stopped moving. This leads to a false sense that the head and body are spinning around or that the world around you is spinning around."

The "maneuver" Mayo speaks of is called the Epley Maneuver.  Be aware that if you look up the Epley Maneuver on YouTube, you'll find dozens of slight variations on how it's done.  Naturally, people have sought to find or create a DIY version of the Epley.   Here's an interesting example from 25 years ago. My first year in practice I had a woman come see me who had already seen a neurologist for her Vertigo.  His suggestion? She was told to sit on the bed and throw herself violently onto her bed to both the left and the right, over and over again, as fast as she could do it until the symptoms cleared or she vomited.   A few years ago, Dr. Carolyn Foster came up with a better way.

Dr. Foster is the Director of the Balance Laboratory at the University of Colorado Hospital in Denver, where she is also a professor.  Having been severely affected by dizziness herself (first Ménière's Disease ---- a combination of Vertigo, Tinnitus (ringing), hearing loss, and the feeling of the ear being full of fluid --- and then BPPV), she had more at stake than most others in her field.  The Ménière's Disease was so bad she had a surgery for it, which took care of her Vertigo until she came down with BPPV, for which she developed her now famous DIY HALF SOMERSAULT MANEUVER, which she successfully used to cure herself.  But what if your Vertigo has nothing to do with tiny stones in your inner ear?

The truth is, there are lots of potential causes of Vertigo, with BPPV believed to account for between 70 and 80%.  While that covers a lot of people, it still means that there are huge numbers of individuals who have Vertigo of other origins.  Frankly, the raw numbers are astonishing.  MedScape has a two month old article on their site by a pair of MD / Ph.D's from Egypt's Balance Clinic, called Dizziness, Vertigo, and Imbalance.  The authors state....

"The overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it reaches 40% in patients older than 40 years. The incidence of falling is 25% in subjects older than 65 years. A report reviewing presentation to US emergency departments (EDs) from 1995 through 2004 indicated that vertigo and dizziness accounted for 2.5% of presentations. The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million.  Migraine is more prevalent (10%) than Ménière disease. About 40% of patients with migraine have vertigo, motion sickness, and mild hearing loss."

Besides migraines which we'll talk about in a moment, some of the more common causes of non-BPPV Vertigo include ......

• BRAIN DYSFUNCTIONS (There are a wide array of potential culprits here --- frequently in the brainstem and CEREBELLUM.  You may need to see a FUNCTIONAL NEUROLOGIST trained by Ted Carrick's organization to get things figured out.)
• CERVICAL SPINE DYSFUNCTIONS (DEGENERATION or SUBLUXATION has the potential to cause Vertigo as verified by 25 years of practice, as well as peer-review.  Upper cervical techniques can sometimes be very effective in this class, particularly when coupled with POSTURAL RETRAINING)
• MULTIPLE SCLEROSIS & PARKINSON'S
• CERTAIN KINDS OF EAR INFECTIONS (For instance, Labyrinthitis -- also called Vestibular Neuritis --- is an INFLAMMATION of the inner ear caused mostly by viral infections, but by ALLERGIES as well)
• POST-STROKE SYNDROME & CERTAIN KINDS OF TUMORS
• OTHERS (The list is almost unlimited)
• REACTIONS TO MEDICATIONS

How common are reactions to medications?  The part of the iceberg that we actually see --- the part above the water --- shows that they are crazy common.  According to DrugWatch (Prescription Drug Side Effects), "With record numbers of patients suffering or dying as a result of prescription drug side effects, many wonder why medications that are considered dangerous are allowed on the market.  Each year, about 4.5 million Americans visit their doctor’s office or the emergency room because of adverse prescription drug side effects. A startling 2 million other patients who are already hospitalized suffer the ill effects of prescription medications annually."  One of the most common of these side effects happens to be dizziness.  But you have to remember that the vast majority of the iceberg lies unseen below the water's surface.

Because Vertigo is so widespread, and because only about 1% of drug Adverse Events (AE's) are ever reported (HERE & HERE), this Adverse Drug Reactions are by far the most overlooked of the list above.  In 2013 a group of eight MD / PH.D researchers published a study the Journal of Pharmacology and Pharmacotherapeutics (Vertigo/Dizziness as a Drug's Adverse Reaction) agreeing with this assessment and then going farther.  "Spontaneous reports of vertigo or dizziness, as side-effect of certain drugs, received at our Pharmacovigilance Center, represented the 5% of all reports in 2012. Considering the high incidence of this ADR for several drugs’ classes, it can be speculated that under-reporting also affect vertigo and dizziness."  Although they essentially said that dizziness can be problematic with almost any class of drug, the ones they mentioned by name as part of this "impressive list" were "anti-convulsants, anesthetics, anti-depressants, analgesics, anti-diabetics, contraceptives, anti-inflammatory drugs, cardiovascular drugs, sedatives, tranquillizers, cytotoxic agents, and anti-hypertensive agents."   I have any number of articles about each of these classes (HERE).  By the way, the authors said of the anticonvulsants that, "half of these reports comes from the use of anti-epileptic drugs."  This provides a perfect segue in to the final section of today's post.

Getting AN ACCURATE DIAGNOSIS is great, but as with any health problem, the question that requires needs answering is what can be done about it.  Non-BPPV Vertigo is no different.  What can be done about some, if any, of these various non-BPPV cases of Vertigo?  The truth; for most of them, probably far more than you have been led to believe.  for starters, under its listing for 'Vertigo,' Wikipedia says, "The characteristics of an episodic onset vertigo is indicated by symptoms lasting for a smaller, more memorable amount of time, typically lasting for only seconds to minutes. Typically, episodic vertigo is correlated with peripheral symptoms and can be the result of but not limited to diabetic neuropathy or autoimmune disease."  I would argue that this is at least partly true for most neurological problems (HERE) as blood sugar dysregulation is a common starting point for all manner of chronic illness (DIABETES / NEUROPATHY).

Were you aware that when it comes to seizure-disorders such as Epilepsy, one of the single most effective ways of treating it happens to use the same method that was used 120 years ago ---- THE KETOGENIC DIET?  The truth is, when you can control carbs and blood sugar, you will solve lots and lots of health problems (click the link to see just how many).  While this might be true of at least some cases of Vertigo, we still have to contend with GLUTEN. 

We've known for decades that Gluten is associated with Autoimmune Diseases --- that would be all Autoimmune Diseases (HERE).  We also know that Gluten is heavily associated with MIGRAINE HEADACHES --- a major factor in non-BPPV Vertigo.  For example, head injuries (TBI / MTBI) are linked to autoimmunity, which is linked to both Gluten and Vertigo (click the links).  I am not going to get into it due to lack of time, but I would challenge you to simply Google, Gluten Vertigo and see what comes up.

Add this to the fact that numerous medical researchers and practitioners are coming to the conclusion that Gluten is heavily linked to any number of hardcore neurological problems (HERE, HERE, and HERE), and it's no wonder people are looking to diet as a potential solution to a wide array of health issues, including Vertigo. Here's the really cool thing about any or all of this; you can quite possibly kill multiple birds with one stone by going PALEO.  Why does the Paleo Diet work for so many different problems?  Because it does an amazing job of solving the blood sugar conundrum, while simultaneously cutting the most potentially reactive (inflammatory) foods from your diet (HERE).

According to Webster's 1928 edition, 'Filthy' is defined as, "Dirty; foul; unclean; nasty.  Polluted; defiled by sinful practices; morally impure.  Obtained by base and dishonest means; as filthy lucre."  While certainly a start, this definition barely begins to scratch the surface when it comes to the filth being revealed in BIG PHARMA as shown by brand new studies from one of the most prestigious medical journals on the planet, BMJ (the British Medical Journal), one of the many publications of the AMERICAN MEDICAL ASSOCIATION (JAMA Internal Medicine), and that pinnacle of truth and honesty, the American Diabetes Association.  Let's see what these have to say about the FINANCIAL COI (Conflict-of-Interest) going on in the biomedical field.

The BMJ study that came out only yesterday (Financial Ties of Principal Investigators and Randomized Controlled Trial Outcomes: Cross Sectional Study) looked at almost 200 randomly chosen RCT's (Randomized Controlled Trials) ---- the epitome of the gold standard of medical research --- concluding that, "Financial ties between principal investigators and the pharmaceutical industry were present in 67.7% of the studies. Of 397 principal investigators, 58% had financial ties, 39% reported advisor/consultancy payments, 20% reported speakers’ fees, 20% reported unspecified financial ties, 13% reported honorariums, 13% reported employee relationships, 13% reported travel fees, 10% reported stock ownership, and 5% reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% among positive studies and 49% among negative studies.  Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base."  Gulp!

In other words, if the research they happened to be working on showed the drug they were studying in a favorable light, they were 27% more likely to be cashing in.  Cha Ching!  The JAMA IM study (Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest), which also came out yesterday, came to similar conclusions concerning a slightly different area.  "This study found that 67% of a national sample of patient advocacy organizations, virtually all of which were not for profit, reported receiving funding from for-profit companies. Twelve percent received more than half of their funding from industry; a median proportion of 45% of industry funding was derived from the pharmaceutical, device, and/or biotechnology sectors."  In English this means that.....

"Patient advocacy organizations (PAOs), such as the American Cancer Society, the American Heart Association, and the National Organization of Rare Disorders, are influential stakeholders in health and health care. In addition to intervening at the individual level, many PAOs fund or conduct medical and health services research, influence national policy, and play key roles in allocation decisions made by legislatures and government agencies. Patient advocacy organizations need to secure financial support, which may come from many sources, including for-profit entities. However, relationships between PAOs and industry might influence PAOs’ activities in ways that might not align with the interests of the constituencies they represent. There is increasing evidence that financial relationships can create bias in medical research and physicians, and PAOs may be subject to the same concerns."

Not to be outdone, the medial daily STAT ran a piece by Sheila Kaplan yesterday called Behind Patient Advocacy Groups, Donors are Exerting a Powerful Force.  In it she mentioned something I have been hollering about for a very long time --- the fact that sugar industry and JUNK FOOD manufactures are actually supporting and funding research coming out of the American Diabetes Association (HERE). Funny enough, it was only YESTERDAY I mentioned a doctor who was talking about all the "fake news" coming out of the medical community, much of it having to do with the lies perpetrated by the ADA as far as effective treatment of Diabetes is concerned. 

All three of these papers mentioned can be found in their entirety online.  The problem is, it's more of the exact same problem(s) I've been showing you for years (HERE), and instead of getting better, it's becoming exponentially worse.  Oh; in case you actually decide to read these studies, make sure you have a trash can nearby so as not to mess up the floor when you invariably sicken yourself.

I just happened to catch KEVIN M.D.'s post by guest blogger Dr. Matthew Anderson a couple days ago called If You Think Fake News is Bad for Politics, You Should Try Being a Physician.  Some of the things the good doctor specifically mentioned as being a big deal in the "Fake News" scene included NUTRITIONAL SUPPLEMENTS (he talked about Ginko and Vanadyl Sulfate by name), APPLE CIDER VINEGAR, and vaccines --- especially VACCINES as related to AUTISM ("A quick look at Twitter for #vaccines, and the news of vaccination harms is overwhelming." --- I wonder why?).  Anderson went on to tell his readers how he combats this disgusting problem.  "As a physician, I try to be a steward of medical information.  I want my patients to seek out good quality medical information on their own.  I steer them to reputable websites..."  Which begs the question --- what constitutes a "reputable" website?  WebMD?  Yeahright.

We could spend a day answering the previous question, but I want you to forget about it for now --- it's not important to the real topic at hand.  Like so many articles on the web, the best part of Dr. Anderson's article was the comments.  It's uncanny how his readers --- most of which are obviously doctors or at least work in the medical community --- brought up some of the very same things that I've brought up on numerous occasions in the EVIDENCE-BASED MEDICINE (EBM) section of my site. For fun, just click the link and skim the titles.  The comments pertained to....

• There were several sarcastic / frustrated comments pertaining to EHR's (Electronic Health Records) as well as MARCA & MIPS.
• Doctors are so buried in said paperwork they can't even look at their patients for the crazy amount of typing they are doing to document a routine office visit (HERE).
• Professor "BigDwag" (probably a researcher of some sort) ripped the entire medical system every which way but loose (HERE).
• The fact that most medical news is itself fake (start thumbing titles of my posts on EBM as I couldn't possibly list them all).  In fact one poster who identified himself as an MD stated, "According to Ionaddis, almost everything you read in journals is fake news too. I expect patients to be misinformed, I used to not expect academics and publishers to constantly lie, fudge and misrepresent to advance their careers. It is very hard for the average doctor to differentiate between medical research, and crazy nonsense. The doctor in practice should not read any original research. Odds are it will lead to mistakes."  For the articles I've written about Drs. IOANNIDIS and ANGELL, click the links.
• The FDA doesn't follow their own rules and regs.
• Drug companies are frequently a huge scam (the commenters mentioned PFIZER by name, but could have mentioned ANY NUMBER of others).
• The fact that Diabetes care is not in any way, shape, or form, "evidence-based" (HERE, HERE, or HERE).
• Mercola (a DO) and Axe (a DC) are, "dangerous crackpots".  I suppose I would fall into that category as well.
• One commenter thanked the author for "educating" her about Vandyl Sulfate so that she could start taking it for her DIABETES.
• The fact that studies reveal that many, if not most, doctors are so BURNED OUT by all this daily crap they would quit tomorrow and retire if they were financially able.
• And finally, the author himself admitted that, "I agree, we as physicians do not self-police well enough. That includes healthcare policy as well."  Judging from the comments, I would say this is probably an understatement.  Truthfully, this author was barking up the wrong tree for the substance of this article.   His patients using vinegar or Ginko is the last thing in the world he needs to worry about.

The bottom line is this folks; as the government tries harder and harder to put the practice of medicine under its thumb via any and all means possible, the quality of your care will continue to erode.  It has to.  If your doctor wakes up every morning dreading his / her job, they might be able to fake fake that smile for a while, but it won't be very long before the apathy starts shining through and the quality of their work goes south.  It's a bad enough scenario for anyone and any job, but if you are putting people's lives in your hands as a treating physician, it's downright dangerous.