Triggerband Web Journal

I am determined to objectively and realistically present the scope of benefits Typaldos Manual Therapy (TMT) offers patients. These are amazing treatments, but they obviously have limitations.

TMT will not repair cataracts, reduce anxiety, ease the pain of an ingrown toenail, or finish off a lingering infection. TMT will definitely fix sprained ankles, will probably resolve chronic loss of shoulder abduction, and might help recover from stroke-induced paralysis.

From what I have observed, about half of all musculoskeletal injuries can be healed solely by correcting fascial distortions. And most of the remaining half will heal significantly, though not completely, from the application of TMT. Common non-fascial causes of acute injury include fractures, neurological damage, and inflammation.

Furthermore, about one third of chronic pain and loss of motion can be resolved with TMT. And another third can be improved with TMT, in cases such as fibromyalgia and post stroke spastic paralysis. The last third, which TMT cannot help, could be from arthritis, osteoporosis, and numerous other chronic diseases affecting the joints, muscles, or nervous system.

Keep in mind that correcting fascial distortions is the only thing Typaldos Manual Therapy does. And not all fascial distortions can be corrected using TMT. Even so, it is very fortunate that most can be treated effectively using manual therapy. Otherwise, the fascial distortion model would point out the problem without offering any solutions. What difference does it make what is causing pain if nothing can be done about it?

Our tendency, when we study a certain disease process in depth, is to believe that particular disease is more prevalent than it actually is. Likewise, when we are familiar with a certain treatment method, we begin to think it can cure or at least help almost every condition. Especially when we have economic incentives to sell a product or therapy, our supporting claims can become unrealistically broad.

Thus, patients and doctors become desensitized to outrageous claims. So when something comes along that really is great, they prudently approach it with skepticism. Even worse, some patients and doctors are willing to accept any and all claims, no matter how ridiculous. They quickly become imbalanced in their thinking and extreme in their practices.

Evidence-based medicine, supported by a body of carefully-scrutinized research, was designed to avoid warrantless claims. However, research has largely become a racket because of undue business interests and inherent bias in the researchers. Drug companies are among the few private entities that have funds to conduct double-blinded placebo-controlled studies. And federal research funds seem to be offered primarily to advance the careers of research scientists.

Good Idea, Problematic in the Real World

Most states require regular car inspections to make sure vehicles are in safe operating condition. This is a good idea, right? Nevertheless, some states have done away with car inspections. The reason is that corruption defeated the original purpose. Auto repair shops were passing cars easily without actually looking at them; or they were coercing customers into contracting unnecessary repairs.

Medical research as it now exists may be heading toward a similar demise. Doctors, pharmaceuticals, and insurance can support anything they want with “valid” research, by picking and choosing the studies they wish to present. When no favorable studies exist, they simply conduct their own. Even when their claims have so little merit that their own researchers balk, they can report that results are inconclusive. This inserts enough ambiguity into an area of prior consensus to justify deviation.

A Functional Research System

There is no substitute for the ability to think logically, rationally, and reasonably. Healthcare professionals and administrators must learn to think this way, or even a good system like evidence-based medicine will fail in practice.

Typaldos Manual Therapy diagnoses fascial distortions, treats them specifically, and produces consistent and measurable results. If that is not enough to get TMT accepted, then the healthcare system needs to change. Some promoters of TMT want to conduct a study that will prove its efficacy. I have hesitated to support a study of this nature, because it will not add to the body of knowledge. It will waste resources proving something that should be readily apparent.

So I advocate a new research system; one that is functional rather than academic. The core difference is that this research system will be subject to the requests and demands of doctors in practice. At present, researchers are the ones telling physicians how to do their job. In the new system, physicians will report to research scientists the difficulties they have in practice, and ask them to find better explanations and more effective therapies. When researchers find theories and treatment modalities that prove effective, doctors will adopt them, and researchers will then move on to the next challenge doctors have presented them with.

For this functional system to work, physicians, researchers, and administrators must be able to recognize whether treatments are effective. Otherwise, researcher scientists will get bogged down doing long and unproductive data analysis, conducting studies designed to prove claims that advance agendas, rather than discovering new, better therapies that offer patients immediate results.

How can we know whether treatments and theories work? By asking ourselves, are they logical, rational, and reasonable? And, ultimately, do the results support the claims?

Alexander Typaldos, JD

There are a lot of people who recognize problems in the healthcare system and agree there needs to be major changes. So why haven’t they happened yet? Lower prescription drug costs, access to affordable health insurance, and removing corporate interests remain little more than a Christmas wish list. This is because supporters of healthcare reform are too focused on pushing their agenda, while failing to provide real alternative solutions. What healthcare professionals, politicians, and the American public see are two competing agendas (reform and status quo) which promise about equal cost to benefit ratios.

I have mentioned before the supreme importance of mindset and philosophy in healthcare issues, but I think readers lose me in the process. If I were to spend half this article railing against corporate interests in healthcare, many would join me with “Good, say it like it is!” and “That’s what they deserve to hear!” If the bulk of the article talked about medical advances in the past 50 years and contrasted the quality of healthcare in America with the poor quality in developing nations, others would respond with “Yeah, what is everyone complaining about?” and “Be glad you’re an American.” However, if I tell you the truth – that healthcare’s biggest obstacles are faulty mindsets in practice, management, and public expectations, the majority of readers seem to be at a loss what to make of it.

The Hippie Movement

In the 1960s, many young Americans recognized the corruption in business, government, and religion – the overwhelming hypocrisy shadowing every American institution. Disgusted with society’s leaders who comprised the “establishment,” hippies launched a countercultural revolution. They listened to rock music, tried drugs, engaged in “free love,” and studied eastern religions.

Now let me ask you, did the hippie movement work? “What do you mean?” you might respond. What I mean is did the hippies solve the problems of corruption in business, government, and religion that led them to rebel against authority? I think recent political and corporate scandals reveal that corruption is probably more rampant now than during the 1960s, even while former hippies are running a large number of American institutions.

So why did the hippie revolution fail? It failed because it was never designed to succeed. The purpose was to advance a cultural agenda rather than solve America’s problems. Now, as then, our nation faces real challenges. Before we get angry and rail against anyone, we need to ask ourselves these questions: Do I have something better to offer? If I don’t like the way problems are being handled, then do I have a realistic plan to solve these problems more expediently?

No More Agendas

Whether it is insurance coverage for alternative therapies, medical malpractice reform, access to quality care for low income patients, or preserving physician salaries, neither the healthcare system nor society at large needs another agenda. And this is where mindset becomes important. If your goal is merely to advance an agenda, you will try to defeat your opponents (those with competing agendas) and likely end up in a stressful state of deadlock. Even if your agenda succeeds, it fails when it brings only change, not improvement. And opposing forces will immediately plan to undo your changes, robbing you of the peace of mind you have worked so hard to achieve.

If your goal, on the other hand, is to improve the current situation, you will take initiative to seek solutions with an open mind. You will encourage a cooperative environment instead of a combative one. You will be sensitive to the concerns of doctors, patients, and any other interested party. And you will work to find a structure that addresses these concerns, while rewarding good practices and discouraging bad ones.

The result will be a new system – a better way of doing things – within which those who hold agendas will continue to advance them. But, importantly, they will not attempt to undo the changes made because the changes are agenda-neutral. For example, in a dictatorship one might advance their agenda by flattering or bribing the dictator. In a democracy, one might advance their agenda by lobbying congress or running for political office; but they will not attempt to change government into a dictatorship so they can apply the previous methods – it is of no consequence to their agenda.

My Agenda-Free Goal

I want to create a healthcare system that serves patients’ needs by curing their diseases, not managing them. I would like healthcare to be affordable and uncomplicated. And I would like physicians and other healthcare professionals to be rewarded with seeing good patient results, in addition to healthy salaries.

If this can be accomplished in a private system, that is fine. If a form of national healthcare is necessary then I support making a change. Ultimately, though, the biggest gains will come by addressing the heart of the issue – improving treatments themselves. And that depends primarily on medical philosophy, as I will continue analyzing in this journal.

Alexander Typaldos, JD

It is a well-known fact that America suffers from nationwide shortages of primary care physicians.¹ This shortage has caused headaches for both doctors and patients. However, I have an effective mid- to long-term solution to this problem.

My solution is to federally charter a dozen or so large medical schools that are geographically dispersed throughout the nation. This act of Congress is constitutionally permissible under the commerce clause because employee healthcare is a major concern and expense of businesses who engage in interstate commerce.

There will certainly be enough qualified med school applicants to fill these schools, which could enroll as many as 1000 students per class at each school. Right now, many of our qualified med school applicants are choosing Caribbean schools and osteopathic degrees because there are simply not enough positions for them in U.S. medical schools. Other would-be qualified applicants choose ancillary or altogether unrelated professions because medical school admission is too competitive.

You might think this ultra-competitiveness in U.S. MD schools (and even osteopathic colleges) results in more highly skilled doctors and superior care. If you think that, you would be mistaken. What we end up with is medical schools full of perfectionists – students with college GPAs that approach 4.0 and competitive type A personalities whose drive is fueled largely by fear of failure.

Perfectionists like that might be valuable in a profession such as astrophysics; but medicine is not only complex, it is dynamic and personal. We need doctors who can handle failure and know how to make tough decisions. After all, there is a saying that every doctor kills somebody. They must also communicate with patients and their families on an emotional level. And perhaps most importantly, doctors must admit when their philosophies, procedures, and quality of care are poor and ineffective. This frequently happens, but type A personalities are loathe to be honest and acknowledge their own incompetence, and then make changes and seek solutions.

Pouring thousands of new doctors a year into the marketplace will balance supply and demand. The profession will find relief quickly, like arteries relieved of high blood pressure. Now doctors will have more time to spend with patients and be less overworked and stressed, and their quality of care will improve. And doctors will have to compete for patients, another powerful motivation for them to improve care. Currently, “bad” doctors have as many patients as “good” doctors. Most patients are obliged to take whatever care they can get.

What about the cost? Granted, the venture is costly, but the return is likewise large, even in the short term. New medical residencies will provide inexpensive care for patients and increased revenues for hospitals. The price of office visits and medical procedures will drop as a result of the market economics discussed above. And the cost of insurance programs will subsequently decline, including government-sponsored insurance programs.

If we delay this relief, the situation will continue to deteriorate. Overworked and stressed out doctors tend to provide subpar healthcare. And patients who receive subpar healthcare tend to not recover from their illnesses, so they return to the doctor repeatedly. This exacerbates the problem by further straining schedules and thus leading to even worse care. Where will this downward spiral end? With the patient dying, the doctor quitting, Medicare and Medicaid going bankrupt? I do not want to find out.

Alexander Typaldos, JD

¹Many Doctors Plan to Quit or Cut Back: Survey, November 18, 2008, http://news.yahoo.com/s/nm/20081118/us_nm/us_doctors_usa_survey;_ylt=AsuanTbXtgowlEJGt5xucHXLLJ94.

There is a lot of talk these days about how Medicare and Medicaid will bankrupt the federal government in a few decades or less. Likewise, the rising costs of private health insurance are placing an ever-increasing burden on families and small businesses. Furthermore, businesses of all sizes are becoming so overwhelmed with worker’s compensation costs, it is no wonder many of them are moving operations overseas to remain competitive in world markets.

What will it take to solve the current healthcare crisis and prevent this looming calamity? The most common suggestion put forth is national health insurance, European style. There is ongoing debate on this topic, and what I gather is that national health insurance will solve problems while creating new ones.

Ultimately, the plan will simply move the impending budgetary disaster to a new location, rather than solving it. But what about the lower costs of healthcare in Europe? Well, those savings presume that Americans are as healthy as Europeans, and they are not. Americans will use more healthcare services than their European counterparts regardless who pays for them.

For all the discussion about healthcare’s problems – going around in circles debating the same tired arguments – you would be surprised that the solution is an elephant in the room. It is that the medical treatments and healthcare services themselves need to improve. There is no other way to solve the healthcare crisis. It is not okay, to give you an example, for a doctor to tell someone they have arthritis and place them on potent pain killers forever with no hope of recovery. It is unacceptable to have cancer treatments that compete with the cancer itself in trying to kill the patient.

We assume that educated, hardworking, intelligent doctors and researchers will find and use the best treatments possible. That is simply not the case. There is as much corruption in the medical profession and healthcare system as Wall Street or anywhere else. I really believe that the only reason no one does anything is because no one understands the healthcare system. True, people understand parts of it, enough to keep things going. But no one really understands the system as a whole and recognizes that waste, corruption, and deceit are rampant.

Does this mean we need to work harder and develop better treatments? Yes and no. Technology allows for far better treatments than are currently available. Treatments can improve dramatically without any new advances in medical technology. Case in point: Researchers recently discovered that small doses of antibiotics can slow the progression of multiple sclerosis.¹ What is needed now is an effective system for implementing the practical changes this discovery demands into the medical profession worldwide, quickly and effectively. Such system does not exist, and this discovery will likely be in vain.

More important than working harder (and, believe me, healthcare professionals work hard) is the need to work smarter. Pharmaceutical companies spend billions of dollars a year promoting their medications to patients and doctors. If this money were spent creating better medications, and non-commercial professional organizations were left to evaluate the new medications and pass that information along to doctors, we would make more progress with the same resources.

Other areas of great waste are within the booming market for alternative medicine. Certain forms of alternative medicine are definitely legitimate, but others are, well, crazy. Acupuncture, magnets, crystal therapy, Reiki, chiropractic spinal adjustments – practitioners who perform this nonsense are often intelligent, hardworking, and otherwise competent. But their time and skill is sadly being wasted on treatments that are similar in nature (albeit more technologically oriented) to those found in primitive animist cultures.

I realize I am stepping on toes by saying some of these things. Nevertheless, I have a solution to healthcare’s problems at a time when Americans desperately need one. Eliminate waste, stamp out corruption, establish a universal standard by which treatments are evaluated and a centralized organizational network by which new treatments are disseminated – these are merely a few of the policy recommendations I have to save the life of a critically ill system.

Alexander Typaldos, JD

¹See BBC news article at http://news.bbc.co.uk/1/hi/health/7136088.stm.