April 2017
The New Integrative Health Policy Playbook
By Beth Clay, ICA Chief Lobbyist
For most of 2016, I
woke up each day
during the election season wondering if I was in
the Twilight Zone.
Completely unpredictable events
seem to arise regularly. I often shook my
head in disbelief and then in the realization that the rules that used to apply to
candidates and their behavior seemed
not to matter anymore. We all watched
in amazement at this new power of
the pen, i.e. that without spending any
money, but by typing 140 characters in
a Tweet, the entire media’s attention
was immediately captured and focused
on the comments for days at a time.
President Donald J. Trump has been
sworn in as the 45th President of the
United States, with former Indiana Governor and Congressman Mike Pence as
his Vice President. Both the House of
Representatives and the Senate have
Republican majorities.
The health policy play book has been
rewritten this season. I will explain that
more after discussing the five prevailing health related issues talked about
on the campaign trail. The first, was the
need to reform or replace the Affordable Care Act, known typically as Obamacare; the second, the need to do a
better job providing quality patient-centered care to our nation’s veterans; the
third was abortion and federal funding
of the Planned Parenthood organization
for non-abortion related activities; the
fourth was the opioid addiction crisis,
and the fifth was vaccines and vaccine
injuries.
Between election night and the swearing in there was ongoing discussion between the Transition team and Robert
Continued on page 16
Large Scale Military Study by Palmer College
Earns Prestigious International Award
A study on the effect of chiropractic treatment for active duty
U.S. military personnel with low-back pain by the Palmer Center for Chiropractic Research at Palmer College of Chiropractic
was awarded the prestigious Scott Haldeman Award for Outstanding Research by the World Federation of Chiropractic
at its 2017 Congress held recently in Washington, D.C. The
Palmer Center collaborated with the RAND Corporation and
the Samueli Institute to conduct this large-scale, multi-site
clinical trial.
wide, but it’s even more prevalent in active-duty military personnel. More than 50 percent of all diagnoses resulting in
disability discharges from the military—across all armed services—are due to musculoskeletal conditions. Of these, lowContinued on page 9
NEW YORK! NEW YORK! NEW YORK!
Register at www.icapediatrics.com
This study was one of three included as part of a $7.4 million,
seven-year grant from the Department of Defense to these
three institutions and the largest randomized controlled trial
to focus exclusively on chiropractic care to date. The study included 750 participants across three military treatment facilities in the U.S., and compared 375 participants who received
medical care, only to 375 who received medical care plus chiropractic care.
The International
Association
Low-back
pain is the mostChiropractors
common cause of
disability world-
Page 1
You are invited to the
Leadership Line
An Interactive Teleconference
When: Every Wednesday
Time: 9:00 p.m. (EST)
6:00 p.m. (PST)
8:00 p.m. (CST)
Featuring:
●
chiropractic leaders,
●
well-known personalities
●
college presidents
●
experts on a variety of topics including:
education
practice management
wellness
pediatrics
philosophy
nutrition
techniques
and much, more more.
Call in: Listen, ask questions
No cost to you.
Phone: 641-715-3580
Passcode : 32600#
Another great service from the ICA to you!
Page 2
The ChiropracticChoice
April, 2017
In This Issue
Click on the article you want to read to jump to that page
NEWS
ICA BOARD OF DIRECTORS
George Curry, D.C., President
Stephen Welsh, D.C., Vice President
Hugo Gibson, D.C., Chairman of the Board
Selina Sigafoose-Jackson, D.C., Sec -Treasurer
Michael Mclean, Immediate Past President
Claire Welsh, D.C.
Southern Regional Director
Don Hirsh, D.C., Eastern Regional Director
Pinchas Noyman, D.C., International Director
Daniel Schaeffer, D.C., Canadian Director
Timothy Gay, DC
Joseph Betz, D.C.
Timothy Meng, D.C.
Ron Oberstein, DC
Max Reinecke D.C.
Tom Taylor, D.C.
EDITOR-IN-CHIEF
Molly Rangnath
Deputy Executive Director of Programs
Produced for the ICA by C&S Publishing
Online at www.ICAchoice.com
For advertising info: 916-729-5432
The Chiropractic Choice is published by the
International Chiropractors Association and
is designed to keep the doctor of chiropractic
informed with news useful and pertinent to the
practice of chiropractic as well as provide a forum
for debate and expression of opinion to encourage
critical thinking and sharing of ideas. Therefore be
it known that all statements of facts or opinions as
expressed by authors of articles published herein
are the personal opinions of the authors and
may not necessarily be in agreement with ICA’s
published policy statements or that of the ICA
Board of Directors. ICA takes no responsibility
for the accuracy of information about products
and services stated in paid advertisements and
unless stated otherwise, does not endorse these
products or services.
Copyright © 2017
International Chiropractors Association
6400 Arlington Boulevard, Suite 800
Falls Church, VA 22042 USA
Phone: 703-528-5000 • Fax: 703-351-7893
The New Integrative Health Policy Playbook
by Beth Clay, ICA Chief Lobbyist
Large Scale Military Study by Palmer College
Earns Prestigious International Award
Reaching out to Make a Difference:
Missionary DC Continues to Open Doors of Change in Africa
NEWSBRIEFS
● Barcelona College gets accredited
● Study raises questions on effects of antibiotics on behavior
● Women athletes more susceptible than males to get concussion
● Life University seeking volunteers for research study
● Adolescents with ASD use more emergency services than non-ASD peers
● Childhood cancer survivors living longer
● BCA survey points to tech devices as pain triggers
● Poor posture can lead to depression
ARTICLES
President’s Message: Identity Crisis
By George Curry, D.C., F.I.C.A.
Observations at the Craniocervical Junction Using Upright MRI
By Julie Mayer Hunt, D.C., D.I.C.C.P., F.C.C.J.P.
Do You Know the 5 Questions About Chiropractic You Have to Answer?
(Part 2)
By Stuart Hoffman, D.C., F.I.C.A.
Healthy Sleep—Healthy Aging
By Ronald M. Hendrickson
ADVERTISEMENTS
Leadership Line
ChiroSecure
Palmer College
Pediatrics 101 Seminar
ICA Membership Application
ICA Choice Display Advertising Rates
EMAIL: [email protected]
ICA WEBSITE: www.chiropractic.org
The International Chiropractors Association
Page 3
President’s Message
George Curry, D.C.
Identity Crisis
A recent gallop poll survey reported
that more than half of all Americans
have seen a chiropractor sometime
in their life. Also, that the number of
those polled who have seen a chiropractor within the last year is higher than previously reported. What
amazes me is that in spite of this
positive trend, there are those in our
profession who still have a major
identity crisis.
Our profession was founded on
a new idea that D.D. Palmer set
forth that was outside the practice
of medicine. The detection of the
vertebral subluxation and its correction by a chiropractic adjustment
was and is the cornerstone of chiropractic. Chiropractors had to fight
to be recognized and to be able to
practice their art. Many went to jail.
It took 61 years for DCs to get licensed in ALL U.S. states. It was
a long and arduous process. To be
licensed we had to demonstrate to
the lawmakers that we were not part
of the medical practice act and that
the DC license was based on a new
thought, a new idea and not a duplication of the allopathic model.
At a recent World Federation of
Chiropractic meeting held in Washington, DC I listened to a number
of representatives from countries
throughout the world who do not
yet have regulation, recognition, or
licensure. They all expressed the
same need — to be able to demonstrate to their country’s decision
makers that chiropractic is not a duPage 4
plication of medicine. Just as oral
cavities and the correction of dental
caries is the domain of the dentist
and not the general medical practioner, the analysis and detection for
the vertebral subluxation is unique
to the chiropractic profession.
Yet, sadly, there is a segment of our
profession who wants to abandon
our core principles which has been
the basis of chiropractic for 122
years.
At the same WFC conference I also
participated in a panel discussion
entitled, “Where to Draw the Line?
Must Chiropractic Have a Defined
Scope of Practice?” The other three
participants from Nambia, Canada,
and the U.K. all called for an expanded scope. The representative
from the United Kingdom’s Royal
College of Chiropractors even went
so far as to state that she thought
“subluxation is not an acceptable
diagnosis“ WOW! Identity crisis indeed.
A couple of days later, the same
WFC/ACA conference featured a
debate titled, “Science and Semantics: The future of subluxation.” Really?
Do I need to remind DCs in the U.S.
that the Medicare program necessitates the demonstration of a subluxation in order to participate? After
45 years and millions and millions of
claims documenting subluxation why
do we need to debate its validity?
The ChiropracticChoice
Last month I was invited to participate in another spirited panel at a
chiropractic college that focused in
large part on whether the concept of
subluxation should be abandoned.
It so happened I was sitting next to
a technique instructor who claimed
during the discussion that subluxation was a “ mythological concept”
and that he “can’t define it and can’t
find it.”
ICA will be holding the first
International Vertebral
Subluxation Summit
July 21 and 22 at Cleveland
College of Chiropractic
If I attended a chiropractic college
and graduated without the core
proficiency of how to detect a spinal subluxation and how to make
a specific chiropractic adjustment
to correct it, I would be inclined to
ask for my money back for failure to
properly prepare me for practice. It
is no wonder that many students fail
the technique section in Part IV of
the National Boards. An instructor of
a popular board review preparation
company that I spoke with revealed
to me that most of the students who
April, 2017
fail or have difficulty with this section
are from schools that don’t properly
teach subluxation detection.
But what gives me hope is a conversation I had with a student just
yesterday. She is from Palmer and
was anxiously preparing for her
Gonstead cervical chair exam. She
explained to me how she had to
demonstrate the set up preparation
for a specific cervical chair adjustment, including the doctor’s stance,
patient placement, hand placement
and contact point, segmental contact point, stabilization of the opposite hand, line of drive complete with
proper torque, etc. etc. I was heartened. That’s not instruction on how
to do a manipulation, that is specific
detailed education on how to make
a specific chiropractic adjustment.
When students, who have received
the appropriate education for chiropractors enter practice they will
know how to properly assess the
patient’s spine and whether chiropractic care is indicated or not. They
will know where to adjust, how to
adjust and most importantly, when
to adjust.
The confidence that comes from
having this certainty is the key to
having a successful practice. It is
no wonder the enrollment of the
schools that are subluxation/adjustment centered dwarf those that only
dabble in its instruction.
The ICA has always supported
subluxation centered chiropractic and the schools that teach it.
Those who graduate from institu-
The International Chiropractors Association
tions where they’re not taught how
to detect subluxations and perform
specific chiropractic adjustments to
correct them can gain valuable information from the ICA’s postgraduate programs.
I am excited to announce that ICA
will be holding it first “International
Vertebral Subluxation Summit” on
the campus of Cleveland College of
Chiropractic July 21 and 22. I invite
anyone who is interested in CHIROPRACTIC to come and join us. We
have some great speakers on the
program including Dr. Deed Harrison, Dr. Dan Murphy, Dr. James
Chestnut and Dr. Heidi Haavik.
For more information visit us on
Facebook at International Vertebral
Subluxation Summit.
Page 5
Observations at the
Craniocervical Junction Using Upright MRI
By Julie Mayer Hunt, D.C., D.I.C.C.P., F.C.C.J.P.
Abstract
The Craniocervical Junction (CCJ) is the most complex joint
region in the body. The CCJ is a collective term that refers to
the occiput (posterior skull base), Atlas, Axis and supporting
ligaments. It is a transitional zone between a mobile cranium
and a relatively rigid spinal column. It encloses the soft tissue
of the brainstem at the cervicomedullary junction (medulla,
brainstem and spinal cord). It is critical to fully understand
the neurology, biomechanics, soft tissue integrity including
ligaments(7), blood flow, and cerebral spinal fluid flow at the
junction between the brain and the body.(3) Magnetic Resonance Imaging (MRI) of the CCJ provides additional insights
to be considered when evaluating care or treatment for this
region. Performing imaging in an upright posture compared
to recumbent can reveal significantly different parameters.
The purpose of this paper is to illustrate observations on CCJ
imaging utilizing upright MRI.
Introduction
Chiropractors have always looked to perform upright X-ray
imaging to be able to observe functional spinal relationships
because gravity affects posture. Weight bearing is essential
in understanding spinal functional dynamics. The same applies to Magnetic Resonance Imaging (MRI). Looking at spinal
dynamics with respect to disc involvement, when the spine
is supine, the disc will be under less gravitational load when
compared to standing or seated.(4) Just as you would check
the air pressure in car tires while on the ground as compared
to on a lift, you want to see weight bearing effects on spinal
dynamics functionality.
The base of the brain has cerebellar tonsils which in large part
are responsible for our balance and coordination. The brain
and spinal cord are one unit, think of the spinal cord as a long
braided ponytail, it is an extension of the brain. When the
base of the skull and the Atlas/Axis become misaligned, the
dentate ligaments supporting and protecting the brainstem
can potentially produce caudal tension at the skull base creating a downward tug at the brain base. The CCJ is the main
circuit breaker neurologically as well as being the “mouth” to
the brain for fluid exchange – including both CSF and blood.
The CCJ is best imaged upright to observe true functional po-
Page 6
sitioning of key components such as the cerebellar tonsils.
When MRI imaging is done in a supine fashion the back of
the head can act like something of a “bowl” and the brain tissue tends to slide into the bottom of the bowl. When viewed
upright, the brain tissue may occupy a different position. Also
spinal misalignments can be observed and pictures are difficult to argue with.
Chiari Malformation is a serious neurological disorder where
the bottom part of the brain (cerebellar tonsils) descend into
the foramen magnum crowding the brainstem/spinal cord
altering CSF flow dynamics producing many disabling symptoms. Symptoms can vary greatly from one person to another, and some patients may be asymptomatic until a trauma
occurs.(2) The most common symptoms include neck pain,
headaches, visual abnormalities, poor coordination, difficulty
swallowing, nausea, dizziness, cognitive issues, anxiety and
depression. Cerebellar tonsil position is commonly measured
using the Basion-Opisthion Line (B-OL), also known as the
McRae Line), shown in Figure 1.
When the cerebellar tonsils descend five (5) mm or less below
the Basion-Opisthion line (skull
base) and into the spinal canal,
this is referred to as Cerebellar
Tonsular Ectopia (CTE), and may
be listed as Chiari 0 or borderline Chiari 1 depending on the
exact measurement. A Chiari 1
is measured as more than five
(5) mm descent of the tonsils Figure 1. Basion-Opisthion
(B-OL) Line
into the spinal canal.
With respect to the Craniocervical Junction (CCJ), most
standard MRI imaging does not
observe this region sufficiently.
Axial brain MRI imaging usually
will terminate a slice or two under the skull base.(5) Axial imaging of the cervical spine usually
begins at the C2 disc and proFigure 2. Typical Cervical
ceeds caudally to the C7 region
Spine Axial MRI Slices
as depicted in Figure 2. Sagittal
cervical MRI imaging are usually four (4) to five (5) millimeter
The ChiropracticChoice
April, 2017
slices which can miss detailed structures of the CCJ like cerebellar tonsils, which are small peg like structures at the base
of the brain, and CCJ ligaments which average two (2) mm
in diameter. Therefore the CCJ soft tissue has been routinely
overlooked. Most CCJ imaging in the past has utilized Computerized Tomography (CT) to rule out fracture.(6)
Methods
For CCJ MRI imaging, the patients are sitting or standing and
images were obtained on the
coronal, sagittal and axial planes
(depicted in Figure 3) using sequences as shown in Figure 4. In
these sequences:
• The slice thickness is these
cases is 2.8 mm.
• The axial slices were
obtained in proton density
(PD) which is best to see
ligaments.
• The sagittal slices were
Figure 3. MRI Imaging Planes
obtained in T1 (longitudinal
relaxation time) and T2 (transverse relaxation time).
• Coronal images were obtained in T1.
upright when they are known to have Chiari malformations.
Figure 5. Recumbent MRI Brain Imaging
Figure 6. Upright Cervical Spine MRI Imaging
Atlas Rotation Observations: When Atlas rotates, it is plausible
anatomically that the transverse process can abut the internal
jugular vein. Figure 7 depicts two examples of Atlas rotation
misalignment. The red line highlights the rotation. The yellow arrow points to an internal jugular which appears to have
been compressed by the misaligned Atlas. This compression
can potentially affect venous outflow from the brain causing
backup of venous metabolic waste blood in the brain which is
suggested in neurodegenerative brain diseases. Also note the
oblong shape of the spinal canal which plausibly can suggest
dentate ligament attachment tension at the brainstem.(8,9)
Figure 4. CCJ MRI Sequences in the Sagittal (left), Axial (middle)
and Coronal (right) Planes
Observations
Patient presented with neck pain, headaches, brain fog, and
occasional dizziness. The previously ordered recumbent brain
MRI (Figure 5) were unremarkable and included a statement
of “no observations of a Chari malformation.” An upright cervical spine MRI was ordered including the CCJ (Figure 6) and
this study finds a Chari 1 malformation in conjunction with
other findings.(2)
The comparative upright imaging shows increased involvement at the CCJ with respect to cerebellar tonsils, and the
patient’s headaches are better lying down and increase in the
upright position correlating with tonsillar position. Most patients with headaches report that lying down is better than
The International Chiropractors Association
Figure 7. Atlas Rotation Misalignment
C2 (Axis) rotation can be observed on CCJ MRI. Figure 8 provides several examples of Axial Rotational misalignment. The
standard cervical spine MRI misses this segment because the
slices start at the C2/C3 disc. When one considers the verteContinued on next page
Page 7
Observations at the
Craniocervical Junction Using Upright MRI
Continued from previous page
bral artery pathway, illustrated in Figure 9, the axial misalignment can plausibly correlate with vertebral artery insufficiency and also the misalignments can affect dentate ligament
tension of the spinal cord.(8,9)
Figure 10. Sagittal Atlas Misalignment (A – left),
Normal Alignment B – right)
Figure 8. Axis Rotational Misalignment
(B) depicts a normal positioning of the C0/C1 articulation.(1)
Figure 9. Vertebral Artery Pathways
Discussion
Observations that can be made through upright MRI have
the potential to clearly objectify spinal misalignment (Subluxation) and clarify patient care needs. The CCJ is a vulnerable region and merits special consideration for care and
treatment. There are many parameters for studying the CCJ
through MRI which can range from CSF and blood flow impedance, ligamentous laxity and or insufficiency, and Cerebellar Tonsular Ectopia as well as Chiari involvement.(1)
C1 misalignment can be observed in the sagittal view with respect to the occipital condyles and the Atlas lateral mass position. Figure 10 (A) suggest anterior misalignment of the Atlas
lateral mass with respect to the occipital condyle. Figure 10
In 2012, the Glymphatic system was postulated (10) with regards to lymphatic drainage and brain health. The Lymphatic
system that was discovered in the brain is dependent on CSF
flow. The CSF flow, when obstructed, appears to have nega-
References
1. Rosa, S., Baird J.W.; The Craniocervical Junction: Observations regarding the Relationship between Misalignment, Obstruction of Cerebrospinal
Fluid Flow, Cerebellar Tonsillar Ectopia, and Image-Guided Correction; The Craniocervical Syndrome, Smith, F.W. and Dworkin, J.S Editors; Karger;
2015; pages 48-66.
2. Flanagan, M.F.; The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions; Neurology Research
International, Volume 2015, Article ID 794829, 2015.
3. Freeman, M.D., Rosa, S., Harshfield, D., et al.; A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash); Brain
Injury; July 2010; 24(7-8): 988-994.
4. Smith, F.W.; Upright MRI in the study of the Cranio-cervical junction; presentation at the International Hydrocephalus Imaging Work Group Spring
2013 Conference; 2013.
5. Parizel, P.M., van den Hauwe, L., et al.; Magnetic Resonance Imaging of the Brain; Clinical MR Imaging, P.Reimer et al. (eds.); Springer-Verlag; 2010.
6. Riacos, R., Bonfante, E., et al.; Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know; RadioGraphics
2015; 35:2121-2134; 2015.
7. Kahn, A.N (Chief Editor), et al.; Upper Cervical Spine Trauma Imaging; Medscape; Online Article 397563; 2015.
8. Grostic, J.D.; Dentate Ligament – cord distortion hypothesis; Chiropractic Research Journal, vol. 1, no. 1, pp 47-55, 1988.
9. Eriksen, K.; Upper Cervical Subluxation Complex: a Review of the Chiropractic and Medical Literature; Lippincott Williams & Wilkins, 2003.
10. Iliff, J.F, et al.; A Paravascular Pathway Facilitates CSF Flow Through the Brain Parenchyma and the Clearance of Interstitial Solutes, Including Amyloid β; Science Translational Medicine; 15 Aug 2012:Vol. 4, Issue 147, pp. 147.
Page 8
The ChiropracticChoice
April, 2017
tive plausible effects on brain health. Therefore having the
CCJ aligned contributes to non-obstructed flow of CSF and
should contribute to improved brain health.
Conclusion
Trauma continues to be a major player in the disruption of
the CCJ integrity. Falls, motor vehicle crashes, sports injuries
and other traumas affecting the head and neck relationship
throughout our lives play into the ability of the CCJ to facilitate the brain/body connection. All patients deserve an appropriate evaluation of the CCJ for optimal brain health parameters and brain/body for our health. There is much more
that needs to be studied and understood to optimize brain
health. The upright MRI imaging is a platform that potentially
could allow Neurology, Neuroradiology and other medical
specialties to work together with board certified Chiropractic CCJ procedure specialists to benefit patients and families.
Understanding the complexities of the CCJ should compel all
health practitioners to study further and understand how to
optimize the function of the most complex joint region of the
body.
Acknowledgements
The author wishes to extend sincere appreciation to Dr. Scott
Rosa, D.C., B.C.A.O., Rock Hill, NY, a pioneer in advanced imaging of the CCJ for his mentoring and the opportunities to
participate in observing CCJ imaging at the Capital Upright
Imaging Center, Latham, NY.
Additionally, Dr. Richard Leverone , DC, DACBR has provided
invaluable insights into CCJ MRI imaging interpretation.
About the Author: Julie Mayer Hunt,
D.C., D.I.C.C.P., F.C.C.J.P., is a second generation upper cervical care chiropractor.
After graduating from Life University
in 1981 she started practicing with her
father, Dr David Mayer at Mayer Chiropractic Clinic in Clearwater, Florida.
Her son, Travis, joined the practice two
years ago after graduating from PCC-Florida. In 2000, Dr. Hunt
completed her Diplomate in Clinical Chiropractic Pediatrics and
began presenting seminars in upper cervical pediatrics across
North America for many state organizations. She has published
several papers in peer-reviewed journals and contributed chapters on upper cervical procedures to two textbooks. Very active
in the chiropractic community. Dr. Hunt serves on the Florida
Chiropractic State Board, is President for the Society of Orthospinology, Founding member and Secretary for the ICA Council
on Upper Cervical Care, and the co-chair of the Curriculum Committee for the Diplomate in Chiropractic Craniocervical Junction
Procedures (DCCJP). She received her Fellowship in Chiropractic
Craniocervical Junction Procedures (FCCJP) in 2015. Dr Hunt is
a Distinguished Fellow of the ICA, has received many awards
and named ICA’s Chiropractor of the Year in 2014 and the ICA’s
Council of Upper Cervical Care’s Upper Cervical Chiropractor of
the Year in 2016
Large Scale Military Study by Palmer College
Earns Prestigious International Award
Continued from front page
back pain is the most common
“We’re deeply honored to be recognized by our scientific peers for
our research efforts in the military,” said Palmer College of Chiropractic Vice Chancellor for Research and Health Policy Christine Goertz, D.C., Ph.D., who accepted the award on behalf of the research
team.
Once the winning presentation has received “press” status in a
journal, the researchers will be awarded the $10,000 prize.
The International Chiropractors Association
Page 9
Reaching out to
make a difference
Page 10
The ChiropracticChoice
April, 2017
Missionary DC Continues to
Open Doors of Change in Africa
This is the 2nd in the series of articles
featuring ICA members and/or ICA Pediatric Council member DCs reaching
out to make a difference. The first one
on the Bhogals and Peak Potential was
published in the September 2016 issue
of the The Chiropractic Choice.
At left, children line up at Olesti BornaAmbrseli National Park to get their
plate of food. Over 925 million people
in the world live with food scarcity and
hunger. Many are children in Africa.
ICA member, Pediatric Diplomate and
Chicago-based chiropractor, Dr. Warren Bruhl, has become accustomed to
the long journey to Kenya, East Africa.
Now he travels to that country two or
three times a year as the director for
the non-profit organization, Dreamweaver International. Though Bruhl
was not always invested in non-profit
work, he found a calling to serve the
impoverished and underserved people around the world when he left his
successful pediatric practice in 2011.
Bruhl, who has been a member of the
International Chiropractors Association
since 1986, enjoyed leading a pediatric
health care movement as one of the
first diplomates of the ICA Council on
Chiropractic Pediatrics in 1996. However, after nearly 25 years in practice he
felt he was being called in a new direction in his life. Further, he recognized
the work his mother and stepfather,
Ken and Sandy Taylor had created in Africa needed his assistance if it were to
survive and continue to help the people in that region.
Dreamweaver’s insightful mission and
approach to the alleviation of poverty and other global challenges of the
world hinges on the simple premise
On a recent trip to Kenya, Bruhl and
his team of chiropractors, including Dr.
David Neubauer from Minnesota, introduced a new program they hope will
catch on and solve the food problems
many schools suffer within this region.
Dr. Warren Bruhl, left, with Chief Jackson
(Olesiti Boma) in Kenya coming together as
leaders to help local schools feed children.
that “needy people have to become
needed in order for poverty to end.”
Bruhl adds, “The wise fable about giving a man a fish or teaching him how to
fish is closer to the truth about charity
than many realize. The fable goes, give
a man a fish today and he eats today,
teach him how to fish and HE EATS FOR
A LIFETIME.”
Dreamweaver has a mission that is spirited after this fable, “To Help the Needy
Become Needed.” To accomplish its
mission, the organization focuses its
projects in three areas, EDUCATION,
HEALTHCARE, and COMPASSION.
It is not uncommon for some children
in East Africa to not have any food at
home and to eat one meal a day, a
meal served at their school. But often
schools struggle to provide meals that
are nutritious with sufficient calories.
The reason they struggle is because
schools lack funding and don’t have
resources to provide anything beyond
what they presently have.
Dr. Neubauer and Dr. Bruhl’s idea was,
“What if we could come up with a way
to create a sustainable system for the
village to buy their own food on a regular basis?” Their thinking was that instead of an outside charity like Dreamweaver or other donors always helping
a local school with money to buy food,
what if the school was able to fund its
own food program? Bruhl and Neubauer then spoke to the local leaders,
Chief Jackson and Secretary Benson,
Continued on next page
Dr. David Neubauer explaining the Bulls and Billy Goats project to Chief Jackson and Secretary
Benson (Olesiti Boma).
The International Chiropractors Association
Page 11
Chiropractors as Agents of Social Change
Continued from previous page
of the Oliseti Boma and they agreed
they would rather fund their own food
program than depend on outside donations. Further, they recognized as
lifelong herdsmen, that developing a
community livestock business would
not only work for them, but would
The program aptly called “Bulls & Billy
Goats,” was launched recently. Leaders
of Dreamweaver went to the local market and personally purchased the animals with leaders of Oliseti. Then the
animals were presented to the Oliseti
Boma and goals and hopeful outcomes
were communicated so everyone was
in agreement and ready to get to work
and make the new program become a
success.
who are now working together with
Dreamweaver’s healthcare projects
believe we need to elevate chiropractic
around the world. Bruhl believes that
chiropractors are really Agents of Social
Change.
“We are carrying on what I believe B.J.,
D.D., and others in the early days of chiropractic recognized we were called to
do. Can you imagine,” he said, “what
Bruhl believes that chiropractors are really Agents of Social
Change. “We are carrying on what I believe B.J., D.D., and others
in the early days of chiropractic recognized we were called to do.”
Dr. Bruhl and local African Dreamweaver
leader, Joseph Nkaapa, in the livestock market
launching the Bulls and Billy Goats project.
also allow reinvestment. Moreover, the
project, if successful could be used as a
model for other communities allowing
Oliseti to offer help locally to schools
unable to operate such a program.
“While this may seem like a logical
solution to an ongoing food problem
in Africa, this idea of investing in livestock for the community to fund food
programs has never been tried there.
Many charities consistently spend
money on immediate needs and miss
the bigger picture about charity,” said
Bruhl. “Charity,” he adds, “was never
meant to be a sustainable hand-out for
a lifetime, it’s meant to give people a
lift and then encourage their own work
to sustain themselves.”
Bruhl and other leaders of Dreamweaver carefully consider the projects they
plan and execute. They are consistent
in examining each and every program
and asking themselves, “Does it help
needy people become needed and independent?” If the program moves
closer to that goal, then the team retains the project. But if it doesn’t they
make adjustments or discontinue the
work as ultimately it will fail anyway as
many outside aid projects have in Africa and other countries.
Dr. Pete Pfeffer (from Minnesota) in the livestock market keeping the goats together.
Page 12
Bruhl and other chiropractic leaders
The ChiropracticChoice
D.D. must have thought when he gave
Harvey Lillard the first adjustment and
his hearing returned? Did he think and
feel he had a calling to share this with
the world and possibly save others
from the suffering of deafness? Did he
believe he could help end human suffering? And imagine B.J. as he traveled
the globe, seeing the challenges people
Children often eat one meal a day and it is
usually served at a local school. Schools often struggle to provide this one meal and
it usually does not include fresh fruit, vegetables or sufficient protein.
April, 2017
for him. He can still provide chiropractic care to those who need it, but his vision is wider and more encompassing.
He feels that as chiropractic emerges in
this century, a revision of how we interpret our calling can result in a new
chapter in chiropractic’s history. He
believes that “as chiropractors and because of our basic premise of “serving”
and philosophy of “above down inside
out” we are not only important in this
world but are the ones most suited for
making changes in this world. Building
strong relationships with local people
is possible with chiropractic, leading to
opening more doors of hope for communities in need.”
Dr. Bruhl and his daughter Montana with some of the children at the Kimana Christian Academy, which now has 170 students.
faced, knowing he and others he was
training, have something special right
in the palm of their hands? We can’t
allow suffering and social issues to continue to stagnate and not be solved.
We are part of the solution!”
Moses is 105 years old and a former chief
of Olesiti. He is one of Dr. Bruhl’s regular patients. He loves chiropractic and the first time
he received an adjustment, he provided the
Maasai Blessing for Bruhl, something that
is rarely provided to white visitors. Building
strong relationships with local people is possible with chiropractic, leading to opening
more doors of hope for communities.
Dr. Warren Bruhl is happy to be where
he is today. He is enjoying serving the
underserved. He knows that having a
successful chiropractic practice for so
many years allowed him the means to
make the choice he did six years ago.
He chose a path not many would dare
take, but it seems it was the right one
Though Dr. Bruhl started off by getting
involved in charity work, he feels a revision and a new way of administering
charity has to evolve and he looks forward to being part of that revolution
in charity. His recent book, “Wavers &
Beggars – New Insight and Hope to End
Poverty and Global Challenges,” is part
of the effort he is using to educate and
shift the thinking in charity.
Continued on next page
Dr. Bruhl enjoying time with the kids at the Kimana Christian Academy.
The International Chiropractors Association
Page 13
Chiropractors as Agents of Social Change
Continued from previous page
Warren Bruhl, D.C., D.I.C.C.P., has practiced chiropractic for over 30 years,
leading thousands of families to inspired
health and helping others to discover
their purpose and calling. Dr. Bruhl has
been a member of the ICA since 1986
and was one of the first DCs to receive
the Diplomate in Clinical Chiropractic Pediatrics (DICCP) from the ICA Council on
Chiropractic Pediatrics in 1996. He left a
dynamic successful pediatric practice in
2011 to find ways to improve the lives of
the underserved millions. Bruhl is now
the executive director of Dreamweaver
International (www.dreamweaver911.
org) and the author of Wavers & Beg-
gars – New Insight and Hope to End Poverty and Global Challenges (WESTBOW
PRESS) (www.waversandbeggars.com).
He has traveled extensively since 2011
to Africa, Dominican Republic, Haiti, and
Guatemala as a missionary chiropractor, bringing hope with his hands and
heart to serve. He is the founder of the
Gear for Goals sports/arts project that
has helped over 700,000 children in 31
countries have sports, hope, and opportunity. Dr. Bruhl is also the director
for two schools in Africa. He teaches,
writes, and develops strategies to help
leaders solve global challenges utilizing
the philosophy of health chiropractic reveres that the body heals from “above
down inside out.” When asked today by
people around the world what he does
for a living, Bruhl responds, “I am a SOCIAL CHANGE ENGINEER and my highest calling is TO SEE THE BEAUTY IN THE
WORLD AND MAKE IT BETTER.”
Dreamweaver has a vision to end poverty and also be a catalyst for solving the major challenges of our world.
Illiteracy, gender inequality, poverty, ecological damage (depletion), poor leadership, waste management,
and many issues need our attention. Working with other organizations, Dreamweaver believes the most
important truth in charity work is not to focus on, “who gets the credit”, but instead on “THE IMPACT”. As a
result, we constantly analyze opportunities to form strategic partnerships with charities, educational institutions, businesses, and individuals to change the difficult circumstances of peoples’ lives.
Dreamweaver recognizes in order to end poverty and achieve lasting change in the world; policy discussions
and programs must fulfill a critical and necessary component. We must dedicate ourselves to empowering
people to raise their own standards and become self-sustaining. Billions of dollars have been invested in poverty alleviation programs and progress has been made.
But we are still woefully far from helping the 80% of the population who lives on less than $10/day and the
poorest who live on less than $1.25/day.
http://www.dreamweaver911.org/home.html
Dreamweaver International, P.O. Box 2491, Northbrook, IL 60065-2491
Page 14
The ChiropracticChoice
April, 2017
ICA Council on Chiropractic Pediatrics
Pediatrics 101
June 10, 2017  Marriott Tampa Airport  Tampa, Florida
Hours: 9:00 a.m. – 5:00 p.m.
Want to learn the basics of how to look after infants and children? Come to this one day seminar taught by Dr. Lora
Tanis, a full-time practitioner and one of the world’s foremost instructors in pediatric education.
WHAT YOU WILL LEARN
•
•
•
•
•
•
How to take a history
How to do an examination
Spinal anatomy review
Common pediatric conditions
How to adjust an infant
Red Flags in adjusting
WHO SHOULD ATTEND?
• DCs interested in advanced pediatric education but not sure
if they want to commit to a 3-year program
• DCs seeking to learn the right procedures of examination
and adjusting
• New practitioners
• DCs wanting to refresh their clinical knowledge and skills
• DCs caring for kids but not confident about adjusting neonates
7 hrs CE credits to be applied for by Palmer College only in FL, GA, SC, AL.
ABOUT THE SPEAKER
Dr. Lora Tanis is one of the foremost pediatric practitioners in the world. She has a passion for caring for
infants and chiropractic. She loves what she does
and her reputation as an excellent chiropractic
pediatrics practitioner has been built on integrity,
service and continual learning. A graduate of Palmer
College, Dr. Tanis was among the first group of DCs
in 1996 to graduate with a Diplomate in Clinical Chiropractic Pediatrics (DICCP). She currently serves as
Chair of the ICA Council on Chiropractic Pediatrics
and is an instructor for the DICCP program in the
US, Canada and Australia/NewZealand. A skilled
adjuster, Dr. Tanis believes that practitioners
should be educated in more than just technique
and that the care DCs provide this special patient
population should not only be appropriate but
always safe. Her lectures always get high ratings
because she is able to correlate the academic/
theoretical material to her extensive and unique
practice experience of more than 25 years
ranging from premature babies to kids with special needs. She enjoys teaching and sharing her
knowledge with colleagues. Dr. Tanis has a busy
private practice in W. Milford, New Jersey.
Limited seating. Register Early!
Page 15
The International Chiropractors Association
To register by phone call 571-765-7554 or 1-800-423-4690. Online at www.icapediatrics.com
The New Integrative Health Policy Playbook for 2017
Continued from front page
F. Kennedy, Jr., an outspoken advocate
for eliminating mercury in vaccines and
all drugs as well as to getting to the
truth on allegations of misconduct in
vaccine and autism related research. A
meeting was arranged in January during which President Trump invited Mr.
Kennedy to chair a White House Committee on Vaccine Safety and Scientific
Integrity. He was told it was okay to tell
the media this and shared the invitation with camera crews on his way out
of Trump Towers.
A timeline for the activity has not been
forthcoming out of the White House as
they continue building their staff and
implementing each of the President’s
campaign promises. This is an issue
that is not going away.
President Trump has announced his
intention to form a White House Task
Force to address the opioid addiction
crisis. He has asked Governor Chris
Christie of New Jersey to take a leading role. This crisis developed as a direct result of mainstream medicine’s
failure to refer patients to chiropractic
and other therapies that are proven
non-Rx pain management approaches.
The chiropractic and integrative health
community should engage with the
White House on this issue and ensure a
strong presence on the Task Force and
at meetings.
The issue of federal funding to Planned
Parenthood will be taken up by Congress and remains a volatile issue.
The Veterans Administration (VA) continues to struggle. The latest controversy is an interim report issued by the
VA Inspector General suggesting that
patients at the hospital in Washington,
Page 16
DC are at imminent risk because of mismanagement of the facility. There is an
inconsistent approach to integrative
health care within the VA, which will be
addressed in this administration.
The health insurance reform legislation,
i.e. the repeal of the Affordable Care
Act got off to a rocky start in the House
of Representatives. Building upon work
previously accomplished in Congress in
previous years, Speaker Ryan, and the
chairman of the committees of jurisdiction worked to draft what the Speaker
described as the first phase of a threephase process of repealing the law.
Conservatives in the Freedom Caucus
were unhappy with several provisions
in the bill and after weeks of wrangling,
the vote was postponed and the members returned to the negotiating table.
The legislation was silent on chiropractic or integrative health. However, the
original bill, and likely the next version,
will seek to expand the use of Health
Savings Accounts. This is a positive step
for consumers whose health insurance
does not provide adequate coverage
for chiropractic.
It is frustrating at many levels when reports are issued by government agencies on pain management and chiropractic and other non-Rx options are
not included. It is equally frustrating
when every news outlet runs stories on
the opioid crisis and fails to talk about
how we can safely and effectively treat
pain through chiropractic and not simply suppress the symptom of pain with
dangerous, addictive drugs. Each time
this happens, it gives us more reasons
to keep educating and advocating for
change.
The New Health Policy Playbook:
What is great about 2017 and the new
The ChiropracticChoice
We do not have to sit back and
be quiet. We all have the power
and ability to utilize our social
media (Facebook, Twitter, etc.)
and engage with our elected
officials to share our views and
information.
playbook is that we do not have to sit
back and be quiet. We all have the
power and ability to utilize our social
media (Facebook, Twitter, etc.) and engage with our elected officials to share
our views and information. In fact, even
the Center for Medicare and Medicaid
Services (CMS) is using one social media platform, YouTube, to provide their
required training on improving chiropractic billing practices in Medicare.
Congress required CMS to develop a
training program in the Medicare Access and CHIP Reauthorization Act of
2015 (MACRA), which was enacted on
April 16, 2015. Section 514 of the law
includes a requirement to develop educational and training programs that,
‘improve a chiropractor’s ability to
document services and increase compliance with Medicare’s policies.’ CMS
staff posted their instructional video
at https://youtu.be/tMiw1X9KvDA . To
date, just over 10,000 individuals have
viewed this – far fewer than the number of practicing chiropractors in the
United States. I urge all ICA members
to take the time to watch this video.
This law also established a medical review process in 2017 for chiropractors
providing spinal subluxation services
with Medicare patients to determine
whether such services are reasonable
and necessary. Congress instructed the
April, 2017
Government Accountability Office to
study the effectiveness of the medical
review process and report its findings
within four years. It is my understanding that the study is ongoing.
Parts of the New Playbook include:
1. Social media is a valuable tool we
can all utilize. Learn the value of the
Hashtag#. I am happy to collaborate
with the ICA and members who Tweet
and Facebook to organize efforts to get
a specific message ‘trending’. Local stories can go global thanks to social media.
2. It’s important to respond to fake or
negative news stories. Most news outlets are online and a story that fails to
accurately report on chiropractic, or is
intentionally negative can and should
be dealt with in a positive, accurate
fashion by members of the informed
public, including DCs.
It is frustrating when news outlets
run stories on the opioid crisis
but fail to talk about how we can
safely and effectively treat pain
through chiropractic and not
simply suppress the symptom of
pain with dangerous, addictive
drugs. Each time this happens,
it gives us more reasons to keep
educating and advocating for
change.
3. Personal interactions are vital. It is
why I am on Capitol Hill as often as possible. It is why you should visit with your
legislators if the opportunity presents
itself. In meetings this week, for example, one staffer shared that his wife used
chiropractic and had a very good expe-
rience. Another staffer raved about her
positive experience, and I learned that
one of our members of Congress has a
son-in-law who is a chiropractor.
4. Written communications matter.
Personal letters to Congress are still important, even in today’s digital world.
Today we tend to make them digital,
so we can speed delivery, but letters to
a member of Congress that are factual
and have a reasonable request such as
supporting legislation are important. If
you send your member of Congress a
letter, have the ICA email me a PDF of
the letter so I can personally get it to
the key staff involved.
Three topics are top priority right now
in my meetings for the ICA in Congress:
First, educating about the importance
to equalize the definition of physician
in Medicare so that the patients of chiropractors like all those other physician
level providers can have the freedom to
privately contract with their chiropractor. This educational interaction comes
with a legislative request.
Second, educating about the value chiropractic care offers and requesting
that the ICA have a seat at the policy
table on all health policy discussions.
Third, reminding staff about the importance of including chiropractic in the
pain management opioid avoidance
discussion. ICA has provided me great
data to share on the studies that have
been done to show benefit and cost
savings which is very helpful. When
we look at federally-funded health programs, the bottom-line matters. For
example, there are now approximately
57 million people covered in Medicare
and the cost annually exceeding $604
billion. The cost per person has gone
up ten percent in less than a decade to
over $12,000 per person. A good chunk
of that is prescription drugs. All the ex-
The International Chiropractors Association
perts agree that the program as it functions today is not sustainable.
The ICA is active in the Integrative
Health Policy Consortium through
which the request to members of Congress to reconstitute a Congressional Caucus on Integrative Health and
Wellness is being made. I anticipate in
the coming months the caucus to be
formed. Such a caucus creates a forum
for the ICA and other members of the
Consortium to host briefings where we
can bring a specific message to Capitol
Hill. We will keep you apprised of this
as it develops.
There are three bills currently introduced which mention chiropractic:
S.609/H.R.103 Chiropractic Care for
All Veterans Act of 2017 which calls for
the expansion of the availability of chiropractic care and services into all VA
facilities.
H.R. 1378 National Health Service
Corps Improvement Act of 2017 which
provides for the inclusion of doctors of
chiropractic in the National Health Service Corps scholarship and loan repayment programs.
H.R.676 - Expanded & Improved Medicare For All Act which calls for the creation of a program to provide all individuals residing in the United States
with free health care through Medicare. While this bill has 93 cosponsors,
they are all democrats and the bill is
not likely to move.
New Team, New Views: It is important to note as well that the new administration has two cabinet officials
with positive attitudes about dietary
supplements. Dr. Ben Carson, Secretary
of Housing and Urban Development,
spoke positively about the use of dietary supplements during a debate.
Continued on next page
Page 17
The New Integrative Health Policy Playbook for 2017
Continued from previous page
Secretary of Education Betsy DeVos is
the daughter-in-law of the co-founder
of Amway, a multi-level marketing firm
with a large dietary supplement product line. These new views will matter
as issues get discussed at the highest
level.
While President Trump has so far been
silent in the public forum on his and
his family’s use and views of integrative therapies such as chiropractic, acupuncture, and dietary supplements, his
business style of bringing the best team
together to achieve a desired goal sets
a promising tone for those of us working to see a truly integrative approach
in health care advance in the federal
arena. President Trump is adamant that
he wants the best health care possible
for the men and women of the armed
services both active duty and retired.
Patient-centered, integrative model
has significant evidence to support its
broader adoption and brings the added
benefit to the table of cost savings. The
inclusion of Health Savings Accounts in
the House’s health legislation sets the
stage for the third or more of Americans who have for a quarter century
been utilizing an integrative approach.
In my communications with the White
House staff in preparation for this article, I was not able to obtain a direct
statement specific to chiropractic, rather I obtained the following comments
on background:
• President Trump is committed to creating a better healthcare system for all
Americans.
• Just a few weeks ago, he met with
NIH Director Francis Collins to discuss
efforts to combat drug addiction and
Page 18
the opioid crisis, American innovation
in medical research and development,
and steps to take to help retain young
researchers in the scientific enterprise.
• The President will continue to have
similar meetings to receive input from
a wide range of experts to help advance the President’s agenda of creating a better healthcare system for the
American people.
• The administration is committed to
repealing and replacing Obamacare
with a law that will pursue patient-centered solutions and give the American
people more choice and flexibility to
access the care they need.
These background comments create
an opening for us to bring solutions to
patient choice and flexibility. It is an
opening that we will capitalize upon
soon! As hard as President Trump and
the White House team are working, if
the military medical staff have not yet
brought in a chiropractor, they need to!
Beth Clay is the chief lobbyist on federal legislative and regulatory issues
for the International Chiropractors Association and provides a daily ICA presence in Congress and with the various
federal agencies relevant to chiropractic in Washington, DC.
law and shepherd the first ever prevention demonstration project in Medicare
(the Ornish and Benson Cardiovascular programs) as well persuading the
NIH to conduct a large multi-site trial
evaluating for the first time the cardiovascular benefits of chelation therapy.
The health oversight portfolio would
expand dramatically within the first
year to include vaccine safety issues
including the possible link to the epidemic increase in autism, and concerns
about the continued use of mercury in
medicine.
After five years, Beth entered the private sector as a consultant to corporate
and non-profit organizations focused
primarily on CAM and autism health
policy issues and has served as the ICA’s
chief presence on Capitol Hill since January 2016.
The ICA Mission
To promote and protect
the chiropractic profession
throughout the world
as a distinct, drugless healthcare
profession based upon its unique
philosophy, science and art.
Beth holds the unique position of having served administratively in the original Office of Alternative Medicine at
the National Institutes of Health (NIH)
and being invited to lead the House of
Representatives Committee on Government Reform and Oversight’s health
investigations initially on the role of
complementary and alternative medicine (CAM) in our health system. During
this initial activity, she helped pass into
The ChiropracticChoice
April, 2017
CHIRO
TM
No Matter How Your
Patients Find You,
We are Reaching Out
to PROTECT YOU
using cutting edge
Technology!
Join our
FREE
Live Events
FREE DOWNLOAD
of the Risk Management
ChiroSecure App
@
For Details visit us at: www.chirosecure.com
The International
Chiropractors
CALL
USAssociation
TODAY 1.866.802.4476
Page 19
News Briefs
Barcelona College of
Chiropractic awarded full
accreditation by European CCE
The Barcelona College of Chiropractic
(BCC) has been awarded full accredited
status by the European Council on
Chiropractic Education (ECCE), the
international accrediting body for
chiropractic education in Europe. The
BCC is the latest college to earn this
award, and joins a select group of only
eight chiropractic ECCE-accredited
programs in Europe.
The BCC was founded in 2007 and
already enjoys a wide base of support,
which includes educators, industry
leaders, practicing chiropractors and
their patients. This support base
currently provides the college with
students from 19 nations world-wide,
making it one of the most diverse
student populations around.
“All of us in the International
Chiropractors Association (ICA) wish
to offer our heartfelt congratulations
to the BCC and its leadership upon
achieving this important status,” said
ICA President Dr. George B. Curry.
“We deeply respect and appreciate
their efforts and strongly support this
outstanding educational institution
and the vision both our organizations
share for a strong, growing and global
chiropractic profession.”
wide spectrum curriculum from which
to choose. This combination brings
great value to what the BCC offers,”
said BCC Head of Chiropractic Dr. Pablo
Martínez Jarque.
“The strong results obtained during
the ECCE accreditation process is
an endorsement of the hard work
and dedication put forth by our
management team, teachers, staff
and college supporters. The Board
of Governors and I are certainly very
proud of this achievement. We have
a fantastic group of people working
towards common goals,” said BCC
Principal Dr. Adrian Wenban.
Study raises questions
about long term effects
of antibiotics on behavior
In a landmark study, researchers at
St. Joseph’s Healthcare Hamilton and
McMaster University in Canada have
found that providing clinical (low) doses
of penicillin to pregnant mice and their
offspring results in long-term behavioral
changes. These changes include elevated
levels of aggression and lower levels of
anxiety, accompanied by characteristic
neurochemical changes in the brain
and an imbalance in their gut microbes.
Giving these mice a lactobacillus strain
of bacteria helped to prevent these
effects.
“It is fulfilling to witness the student’s
growth and progress as they become
the professionals they desire to be.
Much credit must go to the students
and their hard work, along with the
guidance of the dedicated team of
professors and staff, who offer them a
Page 20
The ChiropracticChoice
The study was published in Nature
Communications and was funded
by the United States Office of Naval
Research.
“In this paper, we report that low-dose
penicillin taken late in pregnancy and
in early life of mice offspring, changes
behavior and the balance of microbes
in the gut. While these studies have
been performed in mice, they point
to increasing concerns about the
long-term effects of antibiotics,” says
Dr. John Bienenstock, Director of the
Brain-Body Institute at St. Joseph’s
Healthcare Hamilton and Distinguished
Professor at McMaster University.
“Furthermore, our results suggest
that a probiotic might be effective in
preventing the detrimental effects of
the penicillin.”
“There are almost no babies in North
America that haven’t received a course
of antibiotics in their first year of life,”
says Dr. Bienenstock. “Antibiotics aren’t
only prescribed, but they’re also found
in meat and dairy products. If mothers
are passing along the effects of these
drugs to their as yet unborn children
or children after birth, this raises
further questions about the long-term
effects of our society’s consumption of
antibiotics.”
A previous study in 2014 raised similar
concerns after finding that giving
clinical doses of penicillin to mice
in late pregnancy and early life led
to a state of vulnerability to dietary
induction of obesity. The research
team plan to follow up their studies
by analyzing the effects of penicillin
on the offspring, if given only to the
pregnant mothers. They also plan on
April, 2017
investigating the efficacy of different
types of potentially-beneficial bacteria
in protecting offspring against the
behavioral changes that result from
antibiotic usage.
cover from the injury just as quickly as
men. The average return-to-play time
was 10 days for both men and women.
Men and women had similar symptoms
following a concussion, except when it
came to amnesia and insomnia. The
study found 44 percent of men experienced amnesia versus 31 percent of
women. It also found 42 percent of
women had insomnia compared with
29 percent of men.
Women athletes more likely
than male athletes to have
sports-related concussion
Women athletes are 50 percent more
likely than male athletes to have a
sports-related concussion, according to
a preliminary study released recently.
“Sports-related concussion is a significant public health problem and research has typically focused on male
athletes,” said author James Noble,
MD, of Columbia University and a
member of the American Academy of
Neurology. “Studies comparing male
and female college athletes have often
been limited in size and had incomplete
follow-ups.”
This study looked at 1,203 athletes from
2000-2014 at Columbia University and
included 822 men and 381 women who
participated in sports like soccer, basketball and football. Participants took
tests to measure thinking skills and processing speed before and after a concussion. The researchers also tracked symptoms and when participants returned to
play after a concussion.
A total of 228 athletes in the study suffered at least one concussion during
their college career, 88 women, or 23
percent, and 140 men, or 17 percent.
Women were 50 percent more likely to
have a concussion than men. Athletes
who had suffered a previous concussion were three times more likely to
have another concussion as those who
had never had a concussion. In the gender comparable sports of soccer and
basketball, women were more likely to
have had a concussion.
“It is unclear why women appear to be
at higher risk for sports-related concussions than men,” said Noble. “The findings from this study highlight the need
for more research on the gender differences in concussion.” While women
appear to be more susceptible to concussions, the study indicates they re-
Adolescents with ASD use
emergency services four times
more than non-autistic peers
Adolescents with autism spectrum
disorder (ASD) use emergency
department services four times as
often as their peers without autism,
according to Penn State College of
Medicine researchers. The findings
suggest that youth with autism may
need better access to primary care and
specialist services. The researchers
looked at private insurance healthcare
claims from 2005 to 2013 in 12 to
21-year-olds. Adolescents with autism
included in the study received at least
two separate diagnoses of ASD over
the timeframe. Two diagnoses reduce
the chance of including misdiagnoses.
Although there was no significant
Continued on next page
Life University seeking volunteers for research study
The Dr. Sid E. Williams Center for Chiropractic Research is looking for participants with prior concussions for an upcoming
study testing sensory integration care.
Participation in this study will require approximately two, one-hour sessions per day with a 3 ½ hour break for five
consecutive days. Plus, multi-step testing for 60 minutes including auditory, visual, balance and neurocognitive testing
1 week before, prior to the first one-hour session; the following Monday after the fifth day’s second session; and both 1
week after and 1 month after the five consecutive days.
We are looking for individuals who are 18 years of age or older to participate. If you are interested in taking part in this very
exciting study, please call 770-426-2636 for more information or to see if you qualify as a participant.
The International Chiropractors Association
Page 21
News Briefs
Continued from previous page
increase in autism rates among
adolescents in the study over the nineyear period, emergency department
use in adolescents with autism
increased five-fold, from 3 percent in
2005 to 16 percent in 2013. During
the same time period, emergency
department use in adolescents without
an autism diagnosis remained steady
at around 3 percent. The study results
were reported in the Journal of Autism
and Developmental Disorders.
On average, adolescents with autism
had a four-time higher risk of visiting
the emergency department than
adolescents without ASD. Older
adolescents with autism also visited
the emergency department more often
than their younger counterparts. A
third of middle and late adolescents in
this group had medical emergencies,
compared to just one-tenth of early
adolescents. Females and individuals
living in rural areas were more likely to
visit the emergency room than males
and those living in urban areas.
Guodong Liu, assistant professor of
public health sciences and lead author
of the study, said there could be a link
between this under use of preventive
care services and overuse of emergency
department services.
“We believe if their regular medical and
behavioral specialist services served
them better, a big portion of them
would end up with fewer emergency
department visits,” he said. In addition,
Liu said, changes related to puberty
and the transition to adulthood may
be more difficult to manage for youth
Page 22
with autism compared to their peers.
Some adolescents with ASD may injure
themselves physically during times
of stress, by cutting themselves, for
example. “The consequence is they’re
more likely to end up in the emergency
department,” Liu said.
Liu hopes the study brings more
attention to the behavioral and physical
health needs of autistic adolescents,
whom he said are both underserved and
understudied—especially compared to
younger children with ASD.
Good News:
childhood cancer survivors
living longer
Now research brings good news that
childhood cancer survivors are living
longer than before. The study also
shows these survivors are also less
likely to develop second cancers while
still young. The decline followed a sharp
drop in the use of radiation therapy for
treatment of childhood cancers.
Between the 1970s and the 1990s, the
percentage of pediatric cancer patients
treated with radiation fell from 77 to
33 percent. The average radiation dose
also dropped. Their chance of having
second cancers within 15 years of the
first fell as well.
The study included 23,603 five-year
survivors from the Childhood Cancer
Survivor Study. The survivors were
treated at 27 medical centers in the
U.S. and Canada. The federally funded
study is based at St. Jude was headed
by Gregory Armstrong, MD, of the St.
Jude Department of Epidemiology and
Cancer Control.
The ChiropracticChoice
“The most ominous late effect of
pediatric cancer treatment is a second
malignancy,” he said. “This study
shows efforts to reduce the late effects
of treatment are paying off. “The
risk of second cancers for survivors
increases with age, so it is good to
see the reduction emerging early in
survivorship while survivors are still
young.” The research is published
online in the February 28 edition of
the Journal of the American Medical
Association.
BCA survey points to use of
tech devices as pain trigger
A recent survey conducted by the
British Chiropractic Association (BCA)
of more than 2,000 UK adults who
currently suffer from back or neck pain,
or have done so in the past, found
that almost three in five (56%) people
experienced pain after using some
form of technological device. Despite
this, only 27% of people surveyed had
limited or stopped using their devices
due to concerns for their back or neck
health and posture.
The research showed people were most
likely to experience back or neck pain
after using the following technological
devices:
• Laptop computer (35%)
• Desktop computer (35%)
• Smart phone (22%)
• Tablet (20%)
• Games console (17%)
The age group most likely to experience
back or neck pain when using their
smart phone were 16-24 year olds,
while nearly half (45%) of young
adults 25-34 year olds) admitted to
April, 2017
experiencing back or neck pain after
using a laptop. One in seven (14%) 1624 year olds attributed their back or
neck pain to virtual reality headsets.
Poor posture can
promote depression
to count backwards from 1,022 in steps
of 13.
In both tests, the upright posture
group showed more enthusiasm, less
fatigue and fewer observable markers
of depression than the slouch group.
Those who had good posture were
more outgoing, exhibited less fear,
spoke more clearly and used more
words during their speech. They also
had fewer errors when counting down.
All of these behaviors and emotions are
signs their depression was reduced.
It was noted by the researcher that “For
severe, disabling depression, sitting
posture is not likely to make much of
a difference. But for mild or moderate
depression, sitting up straight may
help patients manage their mood and
be more productive.” “Sitting upright
can make you feel more alert and
enthusiastic, feel less fearful, and have
higher self-esteem.”
The findings are due to be published
in the Journal of Behavior Therapy and
Experimental Psychiatry.
It’s estimated that 10 million Americans
suffer from mild to moderate
depression. A new study done at the
University of Auckland in New Zealand
found that many people can get at
least some measure of relief simply by
improving their posture.
The researchers noticed that patients
suffering mild to moderate depression
typically sat in a more slumped posture
than non-depressed people. They
knew that better sitting posture eased
stress and wondered if it could also
reduce depression.
Sixty-one patients with mild to
moderate depression participated
in the study. Researchers randomly
divided the participants into two
groups. One group was asked to sit in
their normal slouched position. The
other group was told to sit upright
with straight backs, level shoulders and
to keep their neck and head straight.
Researchers used physiotherapy tape
on their backs to help keep them in an
upright posture.
The researchers then had the two
groups participate in two tests. In the
first test, they delivered a five-minute
speech. In the second they were asked
The International Chiropractors Association
Page 23
Do You Know the
5 Questions
About Chiropractic You Have to Answer? Part 2
By Stuart E. Hoffman, D.C., F.I.C.A.
ChiroSecure President
Let’s get right to it. In
the last issue we talked
about understanding
the WHY of the Five
Questions. Now let’s
look at the five questions:
1. Is it safe?
2. Does it work?
3. Are Chiropractors Real Doctors?
4. Who goes to Chiropractors?
5. Can Chiropractic help my neck
and back pain?
Some of you probably don’t even like
the questions, but the ability to answer
these is the difference between an office flooded with new patients and one
struggling to stay afloat.
Here are five more questions you have
to ask yourself before you can answer
the above questions.
1. Can I answer these?
2. How should I answer these?
3. Where should I answer these?
4. When should I answer these?
5. To whom should I direct my answers?
Assuming that everyone can answer
these questions, lets jump right to number two: how should I answer these?
Keep in mind when you answer a question you must understand how the
brain of your audience is wired.
Page 24
Harvard Business School professor
Gerald Zaltman says that 95% of our
purchase decision making takes place
subconsciously, and widespread agreement amongst neuroscientists is that
our conscious rational mind plays a minor role in decision making.
gardless of your politics, or your personal feelings about the outcome of our
recent election, the winner of the election understood System 1 and System 2
thinking, and you can learn a lot about
answering the five questions from that
understanding.
If the rational mind plays a minor role
in a patient’s or potential patient’s decision making process, why are we as
chiropractors obsessed with filling up
their minds with the latest chiropractic research thinking that will convince
them why they need to be under chiropractic care? Guess what? It doesn’t
work, or as Keven O’leary says on Shark
Tank, “Stop the Madness!”
Look at the debate about immigration.
As Nobel winner Daniel Kahneman explained in his book Thinking, Fast and
Slow, there are two neurological Systems people use to make decisions:
System 1 - thinking is fast, intuitive,
emotional, and energy efficient.
System 2 - thinking slow, logical, rational, and hard work for our brains.
People will avoid System 2 thinking at
all costs. In fact, almost every decision
that people make in their lives, from
their relationships, to their finances, to
their choice of doctors, are all based on
System 1 thinking. However, once they
make a System 1 decision, they use System 2 to justify it.
Let me give you a real life example. Re-
The ChiropracticChoice
Hillary Clinton - Her immigration policy
had nine bullet points. Here are the first
three:
1. Introduce comprehensive immigration reform. Hillary will introduce comprehensive immigration reform with a
pathway to full and equal citizenship
within her first 100 days in office. It will
treat every person with dignity, fix the
family visa backlog, uphold the rule of
law, protect our borders and national
security, and bring millions of hardworking people into the formal economy.
2. End the three- and 10-year bars.
3. Defend President Obama’s executive
actions—known as DACA and DAPA—
against partisan attacks.
There are six more and if I listed them
all, you (and everyone else) would tune
out and stop reading this article. Her
message was highly complex and has
to be decoded by System 2, which requires more focus and effort than most
people will give.
Donald Trump’s messag: I’ll build a wall.
System 1 decoding.
Patients only want to know three things:
April, 2017
Do you know what’s wrong with me?
Do you think you can help me? Have
you ever helped anyone with the same
problem? System 1 questions.
If you can answer yes to those three
questions in your Report of Findings,
they sign up for care and you can probably do that in ten minutes or less. In
fact, when they leave your office after that report and go home and their
spouse asks what did the doctor say,
they answer, “The doctor knows what’s
wrong with me, thinks he/she can help
me and has helped a lot of people with
the same problem.” The spouse says
great! All System 1 decoding.
Now let’s get back to the question at
hand: how should I answer the five
questions? With a fast, intuitive, emotional, and energy efficient response
appealing to their System 1 thinking.
Is there a time to use System 2 thinking?
Of course, and if you have a copy of ChiroSecure’s Informed Consent Packet*
you will see how it is written intentionally for both System 1 and System 2
thinking which is why it is in such high
demand by the doctors just like you.
Next time I’ll talk about the where and
when of your answers. In the meantime, start working on your answers to
the Five Questions About Chiropractic
You Have to Answer.
If you want a copy of ChiroSecure’s Informed Consent Packet, text the word
CHIROSECURE to (480) 500-6574 and
we will send it to you.
*
Stuart Hoffman, D,C,, F.I.C.A., is a successful 34-year practitioner who owned
and operated 14 chiropractic offices
and employed many associate DCs.
For the past 26 years he has served as
founder, owner and operator of ChiroSecure, a malpractice insurance company that he personally spearheaded to
become the 2nd largest program in that
market. His expertise and love for chiropractic allow him to stay on the cutting
edge of risk management. Dr. Hoffman
was honored as ICA’s Chiropractor of
the Year in 2015, named Chiropractor
of the Year by the Michigan Council and
recognized by Life University for his success, leadership and vision through his
contributions supporting the mission
of the President’s Circle. Dr. Hoffman
has and continues to labor tirelessly for
chiropractors and chiropractic, making extraordinarily positive and significant contributions to the profession in
many vital dimensions. Please direct
any questions to (866) 802-4476 or visit
ChiroSecure’s website at:
http://chirosecure.com
Patients only want to know
three things: Do you know
what’s wrong with me? Do
you think you can help me?
Have you ever helped anyone
with the same problem?
The International Chiropractors Association
Page 25
Page 26
The ChiropracticChoice
April, 2017
Healthy Sleep – Healthy Aging
By Ronald M. Hendrickson
We never outgrow our need for ample
healthy sleep. Ongoing research continues to document that a person’s sleep
needs do not decline as we age but remain constant throughout adulthood.
In fact, sleep becomes even more important as we grow older because it is
vital to maintaining concentration and
memory formation and allows our bodies to repair any cell damage that occurred during the day. It also is vital to
maintaining a healthy immune system
which is key to disease prevention.
A recent study indicated that getting
even a few less hours sleep each night
can significantly increase your risk of
coming down with the common cold.1
Studies clearly indicate that the better the quantity and quality of sleep,
the better health and quality of life of
older adults tends to be. As well, older
adults who regularly sleep seven to
nine hours nightly are reported to enjoy more positive moods and a more
positive outlook on their lives. That
amount of regular sleep also serves to
support a more active and outgoing
lifestyle which in turn, better supports
a healthy sleep experience.
Aging does not inherently bring sleep
difficulties with it. Too many of our seniors just assume that insomnia, frequently waking up during the night,
feeling tired during the day, often in
need of a nap, or waking up feeling
un-rested are just part of getting old.
While those patterns are very common, they are the result of factors
most of us are fully able to control and
Consciously adopt a positive,
can-do attitude towards healthy
sleep. Since sleep is so vital,
like good nutrition and healthy
exercise, it can add years to your
life and life to your years, so it is
really worth it.
not part of an inevitable or even normal part of the aging process. Research
data does show, however that elderly
people have significant sleep problems
with one study indicating that 44 percent of elderly persons surveyed in the
United States having significant insomnia problems.2 One scientific paper
states that half of all elderly persons
suffer from insomnia.3
The International Chiropractors Association
If sleep problems are not normal or
inevitable in elderly persons, why is it
then so difficult for elderly people to
attain regular healthy sleep? There is
a long list of items and behaviors that
can contribute to problems sleeping,
including:
• An inactive, sedentary lifestyle cen-
tered indoors, around the television,
• A pattern of daytime napping,
• An unsuitable sleep surface or other
environmental issues such as room color, light and clutter,
• Medications for a wide variety of conditions common in the elderly that can
have a negative impact on sleep,
• Chronic pain from such conditions as
arthritis, heartburn or discomfort from
health issues or a skin condition,
• Poor diet and eating at times less favorable to healthy sleep,
• Excessive or poorly timed caffeine
consumption,
• Emotional and psychological issues
such as a feeling of isolation or stress
related to separation from or the loss
of loved ones and depression,
• Alcohol consumption or even abuse,
• A feeling of a need to frequently use
the toilet during the night,
Continued on next page
Page 27
Healthy Sleep – Healthy Aging
Continued from previous page
The good news is that while sleep problems are common, relatively few elderly
people have genuine, serious sleep disorders and a conscious effort to identify
and eliminate as many causes of sleep
disruption as possible can have a major impact in the quantity and quality
of sleep. Get a healthy sleep program
organized for yourself and your spouse,
and get your friends and family members involved since they may need help
with their sleep problems too.
• Exercise! Get moving because movement supports every aspect of healthy
sleep, from respiration and circulation
to a feeling of being tired, exercise is
sleep’s most natural ally. Swim, dance,
golf, visit a gym or fitness center, garden or at the very least, walk. Vigorous
walking once or more every day will
cover the basic needs for movement.
Go with a friend or group of friends and
make it a social outing.
• Plan and maintain a regular sleep
schedule. Unless other opportunities
or demands call for variations, which
are ok and can even help expedite sleep
once you go to bed, set a specific target
time to begin sleeping and set a time to
wake up every day, even on weekends
and when you travel.
• Take conscious steps to ensure you
have a sound, sensible sleep environment. Make sure your mattress gives
you the support and comfort you need.
If it does not, change it. Make sure your
room temperature is appropriate; cool
but not too cool is best for most people. A dark, quiet room facilitates sleep.
Having the television on produces both
sound and light and draws your concentration at a time when you want to
be letting go of issues and objects that
Page 28
engage your conscious attention.
• Stay mentally active and socially con-
nected. Contact with family members
and friends as well as active engagement in groups and church, community or other organizations can keep
your mind active, help reduce stress
and a sense of isolation and help prepare your mind for a good night’s
sleep. Write notes or e-mails, use the
telephone, read and keep learning. All
these activities will help you sleep better.
ing professional advice. While sleeping in separate bedrooms is always an
option, it doesn’t help keep that vital
sense of connection couples should enjoy throughout their entire lives.
• Work at relaxing and winding sown
with soft music, dim lights, and stretching, breathing or other relaxation exercises. Many people find a bath helps
them relax.
• Carefully monitor your medications.
• Carefully watch your desire to take
naps. Watch so that any naps you
might take do not interfere with nighttime sleeping. A brief nap early in the
day may help you stay active and alert
longer and make a good night’s sleep
easier to attain. Long naps late in the
day are not going to help when night
time comes.
Always involve your doctor(s) in making
any changes, but always ask if a medication is absolutely necessary. Look for
drugless alternatives. Your doctor of
chiropractic can help since chiropractic
is a drugless science. If medications are
absolutely necessary, carefully follow
the directions provided by your doctor
or pharmacist. Always throw away old
prescriptions. Never take old drugs for
a new condition or problem.
• Exposure to natural sunlight helps
• Avoid sleep medications, especially
self-administered substances. Sleep
medications often have the opposite
effect intended since they can both create dependency and at the same time
make deep, healthy sleep more difficult to achieve and maintain. As well,
the levels and quality of sleep can be
negatively impacted.
regulate melatonin production, which
in turn helps regulate your sleep-wake
cycles. A couple of hours in the sunlight, especially if you are walking, gardening or engaging in some physical
activity, can really help.
• Work with your spouse if snoring or
excessive movements are issues keeping you awake. Do not hesitate to talk
openly if such issues are hurting your
sleep. Look at all the options, from earplugs and “white noise’ devices to seek-
The ChiropracticChoice
Diet and sleep deserve a special discussion because of how important such
inputs are to the sleep process. One
sleep expert made the comment, “We
sleep what we eat,” because nutritional
inputs, good or bad, can have a major
impact on our sleeping habits. Some
basic guidelines for senior citizens include the following:
• Avoid caffeine from coffee, tea, cola
drinks and chocolate, especially late
April, 2017
in the day. It takes the body at least
six hours to process half the caffeine
in a large cup of coffee and caffeine is
a proven barrier to easy and uninterrupted sleep.
• Alcohol is a bad and perhaps even a
dangerous choice as a sleeping aid. It
might seem to make you sleepy, but
will disrupt your sleep. If you do drink
alcohol, do so with a meal and make
sure you have three or four hours to
process it through your system before
trying to sleep.
• Never go to bed hungry. Regular
meals are an essential element for our
general health and should be a priority
for everyone. Sometimes, a light snack
an hour or so before bed time can eliminate any hunger edge that might keep
you awake or wake you up after you
have fallen asleep. Remember; avoid
alcohol and foods with high-sugar, sodium or caffeine contents.
• Watch out for foods that you know
are going to be a problem. This might
include hot or spicy foods, certain kinds
of meats or vegetables that you have
difficulty digesting, and watch the quantities of everything you eat. To overeat
almost always means discomfort on
some level. Also, timing can make a big
difference in how food impacts sleep.
Try to eat your evening meal, especially
if it is a big one, at least three hours before you try to go to sleep.
• Finally, watch your intake of liquids
before bedtime. It is important that
you drink plenty of water and fruit or
vegetable juices as part of a healthy
diet. In fact, dehydration among the
elderly is important to watch out for.
However, remember that drinking lots
of liquids right before bedtime will
have consequences on the other end
and will most certainly require one or
more trips to the bathroom during the
night, further disrupting your sleep patterns.
Perhaps the most difficult dimensions of sleep problems are those that
stem from emotional or psychological
stresses and problems. Worrying about
family, health or money issues can
easily escalate into serious stressors,
especially for someone living alone. A
sense of isolation and deep feelings of
loneliness or abandonment can wreck
havoc with healthy sleep. Sometimes
professional help is needed, but family support and family attention and
concern are always important. Family
members need to make a special effort
to be in both physical as well as emotional touch with aging relatives and
to understand their deeper, more personal feelings and needs and respond
accordingly. A loving message or telephone call from a family member can
be a highly effective sedative.
Serious illness and chronic pain are real
threats to healthy sleep and it is important to involve your health care professionals in a sleep discussion when
treatment options are considered and
decided upon. If certain medications
have serious sleep side-effects, perhaps alternatives can be explored. In
fact, the need for any medication and
all its side-effects should be a central
part of every doctor visit.
Serious sleep deprivation or sleeping
for excessive periods of time may indicate problems with medications, illness or infection or serious emotional
or psychological issues family members
may not be otherwise aware of. Families need to learn to talk about sleep
and sleep problems and also be on the
lookout for danger signals that might
indicate the need to consult a health
care professional. Do not be afraid to
err on the side of caution and seek
help. It is always better to hear that
your elderly family member is ok that
to learn that early intervention could
have prevented or mitigated a serious
problem.4
In so many aspects of life it is commonly said that attitude is everything.
This applies to healthy sleep as well.
You can work to attain a healthy, restorative sleeping pattern, but it takes
awareness, follow-up and support from
friends and family. Consciously adopt
a positive, can-do attitude towards
healthy sleep. Since sleep is so vital,
like good nutrition and healthy exercise, it can add years to your life and
life to your years, so it is really worth it.
Ronald Hendrickson is the Executive Director of
the
International
Chiropractors Association (ICA) and
has worked closely
with ICA’s partner,
King Koil Inc., for nearly three decades.
Many of King Koil’s mattresses have
been developed and tested by the ICA
Posture Committee.
References
1. Cohen, Sheldon, PhD; Doyle, William J. PhD; Alper, Cuneyt, M., MD; Janicki-Deverts, Denise, PhD; Turner, Ronald B., MD, “Sleep Habits and
Susceptibility to the Common Cold,” Archives of Internal Medicine, 2009;169(1):62-67.
2. “Aging and Sleep,” National Sleep Foundation, http://www.sleepfoundation.org
3. Kamel, NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006 Jun; 119(6):463-9.
4. “Sleep Disorder, Geriatric: Follow-up,” Brannon, Guy E., MD, Coauthor(s): Vij, Subir, MD, MPH, Gentili, Angela MD, WebMD,
http://emedicine.medscape.com/article/292498-followup Updated: Aug 3, 2009.
The International Chiropractors Association
Page 29
The International Chiropractors Association
The ICA Choice newspaper
Display Advertising Policy, Rates and Information
The ICA Choice is a profession-wide newspaper published by the International Chiropractors Association, chiropractic’s oldest
and most distinguished international organization. Published in a digital newspaper format for easy reading, The ICA Choice covers issues of importance and relevance to the practicing chiropractor; provides a forum for debate on controversial issues, and
addresses topics to help the practitioner become more successful as a business person as well as a clinician. Articles written by
recognized chiropractic leaders and experts in the field are timely, provocative and compelling.
The ICA Choice is read because ICA has an important standing in the chiropractic community. It makes news and the viewpoints
of its leaders are of significance to the practicing chiropractor and to the future of chiropractic. Every issue is jam-packed with exciting news, timely articles and important issues. Your advertisement in The ICA Choice will be seen and read! Advertise and see
the difference! January 2016 Google Analytic readership numbers: 1,771 readers and 1,988 sessions.
Issues
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
Ad Type
Deadline
Dec. 16
March 21
June 24
September 23
Ad Size
Issue Date
January 6, 2017
April 7, 2017
July 8, 2017
October 7, 2017
1 run
2 runs
4 runs
Two Page Spread 17 1/4” wide by 11 1/4” tall
$2,999 $2,759 $2,519
Full page (bleed) 8 5/8” wide by 11 1/4” tall
$1,800 $1,656 $1,512
Full page (boxed) 8” wide by 9 3/4” tall
$1,800 $1,656 $1,512
Half page 8” wide by 4 3/4” tall
$1,070 $984
$898
One Third (V)
2 7/8” wide by 7 1/2” tall
$760
$699
$638
One Third (H)
8” wide by 3 1/8” tall
$760
$699
$638
Quarter Page
3 7/8” wide by 4 3/4” tall
$637
$586
$535
One Sixth
3 5/8” wide by 2 7/8” tall
$420
$386
$352
Ad Sizes and Rates
ICA reserves the right to determine position and placement of all advertising. Special positioning may be purchased
for an additional 20% if space is available. The inside front cover spot, and a two-page spread immediately after the
cover are charged additional 20% for special positioning. 15% off these rates for ICA Members!
Rates above are for full color ads per insertion. Flash animation (.swf files), animations (.gif format) and video clips can be added
to any ad. There is no extra charge for video clips or multi-media in ads unless “assembly” of the ad is required. Some file size
limitations apply. For information call Steve at C&S Publishing at (916) 729-5432 or email Steve at [email protected].
Email camera-ready ads in high resolution Adobe Acrobat (.pdf) format to: [email protected]. Ad creation and graphic
design services are available through C&S Publishing at $75 an hour — FREE to ICA members!
Format: The ICA Choice is produced in a state-of-the-art digital format. It can be opened and viewed online from both the ICA
web site, located at www.chiropractic.org/ and also from the publication site, www.ICAchoice.com. The publication site has both
current and back issues. Questions about the digital format, the web site, or display advertising should be directed to Steve at
C&S Publishing, (916) 729-5432, online at www.candspub.com
Acceptance of Advertising: Publisher reserves the right to refuse any advertisement with or without reason or explaination
including any ad that, in the opinion of ICA, is unethical, makes extravagant claims, misrepresents, is unfair or harmful to other
Page 30
The Chiropractic
Choice
April,
2017
advertisers;
violates postal, anti-trust or U.S. currency
regulations; or
is deemed inconsistent with the objectives
of the
ICA.