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Dynamic Chiropractic
April 8, 1994, Volume 12, Issue 08

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Book Reviews


By Judy Silvestrone, DC

Title: Chiropractic: A Primary Care Gatekeeper Author: Arnold E. Cianciulli, DC, MS, FICC, FACC Publisher: FCER, 1992 Category: Patient Education Publication: Booklet, softcover, 12 pages

The above cited essay (produced in booklet form by FCER) is a provoking exploration of the potential role of the chiropractic physician as a "gatekeeper" for health care services in a track parallel, but alternative, to allopathic medicine. Author Arnold Cianciulli, well known in his role as president of NCMIC, is also noted as a lecturer, consultant, authority on chiropractic standards and champion of Medicare coverage for chiropractic services. In this treatise (pre-dating the current national health care bandwagon), Dr. Cianciulli examines concerns intrinsic to the U.S. health care system, i.e., the high-cost, depersonalizing trends toward specialization and "high-tech medicine." Of greatest interest is the discussion of how chiropractic and its practitioners might best be utilized to fill the gap in supply of family practitioners. Toward that end, the essay delineates the educational and licensure qualifications of chiropractic physicians and chiropractic concepts of "wellness."

It then pursues the more difficult territory of chiropractic's unique approach to the patient without Descartian division of mind and body, with diagnosis inclusive of "hereditary, environmental, psychological and degenerative factors which affect each person." It is the comparisons drawn between allopathy and chiropractic that I find contentious: The relegation of medical practice to somatic vs. psychoneuroimmunology (a.k.a. the neurodystrophic tenet). Certainly there are those practitioners in all fields who excel in humanism, caring and consistency in assessment of the full human impact of illness. The need to promote the chiropractic paradigm at the expense of allopathic failings is a distraction in an otherwise intriguing essay.

Dr. Cianciulli also presents components of "primary care" as it should be available through a team of providers. The components include "accessibility, comprehensiveness of service, coordination of services, continuity of service and accountability." There appears to be a gray area in the differentiation of a "portal of entry" physician from a "primary care" provider. The definition of primary care as "first choice care and direct access care" appears to be more definitive of "portal of entry" and provides some confusion relative to integration of services.

In summary, this essay helps to define the position of chiropractic in an alternative health care track. It provokes many questions which should be examined by all those meditating the fate of the American health care system and the role of chiropractic within that system.

Silvestrone Rating: 6


Steven Eggleston, DC

Title: Beyond Antibiotics: Healthier Options for Families Authors: Michael Schmidt, DC, Lendon Smith, MD, Keith Sehnert, MD Publisher: North Atlantic Books Berkeley, CA (510) 644-2116 Category: Doctor and patient education Publication: Softcover, 307 pages

"Are antibiotics the best medicine?" This is the title of Part I of this excellent work. Here are a few interesting quotes from this section. "Overuse of antibiotics is a major contributing factor to the development of chronic fatigue ... Tetracycline was shown to inhibit the ability of white cells to engulf and destroy bacteria ... antibiotics have been shown to increase the likelihood of repeat infections ... children with strep throat who were given antibiotics experienced a rate of recurrent infections two to eight times higher than those not receiving antibiotics ... vaginitis is often a direct result of antibiotic use ... children on amoxicillin (for ear infections) fare no better than those taking placebos (sugar pills)."

If the above quotes sound like the book is quoting the scientific literature, that is because it is. These quotes were taken off only five or six pages of the first section. There are a lot more very interesting studies cited. If you ever wanted to own a book of scientific studies done by MDs that say what chiropractors have been saying for years, this would be an excellent choice for your library.

Part 2 of the book is called "Why we get sick." An excellent discussion of immunity, healthy eating, and why vitamin supplements are helpful. Part 3 is titled "Natural Medicine." The reader is advised to learn about the beneficial aspects of vitamins, herbs, homeopathy, chiropractic, and acupuncture before resorting to drugs.

Finally, Part 4 is the section on "Selfcare/Wellcare." Specific conditions are enumerated and advice is given on the myriad of nondrug treatments available, including natural remedies, immune-boosters, and dietary recommendations for each condition.

Michael Schmidt, DC, has authored and co-authored many works, including: Ear Infections: What Every Parent and Physician Should Know; Managing the Patient with Chronic Fatigue; and he edits Current Topics in Preventive Pediatrics and Family Practice.

Lendon Smith, MD, is an internationally known pediatrician, author, and lecturer. He has written 10 books and is a frequent guest on "Donahue," "Oprah," and "The Tonight Show."

Keith Sehnert, MD, has written books and articles that have appeared in Family Health, Parade, Newsweek, Ladies Home Journal, McCalls, Money, and Reader's Digest.

I must admit that this book sat on my shelf for several months without grabbing my attention. Then one day after several patients with colds had told me they were on antibiotics, I took this book home and began reading. Am I glad I did! Although written for the general public and obviously destined for sale in mall bookstores throughout America, there is a lot of very weighty scientific data. There are 368 references and the index is very helpful looking up specific drugs, illnesses, and journals used as sources.

This is one of those books which, after reading, you will feel an urgency to share with your patients. The list price is $16.95 and would be a tremendous value at twice that price. I highly recommend this book to all doctors, students, and staff members. For the price, it would be good to have several copies in your office for waiting rooms and even lending to patients.

Eggleston Rating: 9

Review Editor
Dynamic Chiropractic
P.O. Box 6100
21541 Surveyor Circle
Huntington Beach, CA 92615-6100

Items submitted for review will not be returned. All items accepted for review will receive a rating from 1-10, 10 being best.

.margin 6

Book Reviews

Judy Silvestrone, DC

Title: Chiropractic: A Primary Care Gatekeeper Author: Arnold E. Cianciulli, DC, MS, FICC, FACC Publisher: FCER, 1992 Category: Patient Education Publication: Booklet, softcover, 12 pages

The above cited essay (produced in booklet form by FCER) is a provoking exploration of the potential role of the chiropractic physician as a "gatekeeper" for health care services in a track parallel, but alternative, to allopathic medicine. Author Arnold Cianciulli, well known in his role as president of NCMIC, is also noted as a lecturer, consultant, authority on chiropractic standards and champion of Medicare coverage for chiropractic services. In this treatise (pre-dating the current national health care bandwagon), Dr. Cianciulli examines concerns intrinsic to the U.S. health care system, i.e., the high-cost, depersonalizing trends toward specialization and "high-tech medicine." Of greatest interest is the discussion of how chiropractic and its practitioners might best be utilized to fill the gap in supply of family practitioners. Toward that end, the essay delineates the educational and licensure qualifications of chiropractic physicians and chiropractic concepts of "wellness."

It then pursues the more difficult territory of chiropractic's unique approach to the patient without Descartian division of mind and body, with diagnosis inclusive of "hereditary, environmental, psychological and degenerative factors which affect each person." It is the comparisons drawn between allopathy and chiropractic that I find contentious: The relegation of medical practice to somatic vs. psychoneuroimmunology (a.k.a. the neurodystrophic tenet). Certainly there are those practitioners in all fields who excel in humanism, caring and consistency in assessment of the full human impact of illness. The need to promote the chiropractic paradigm at the expense of allopathic failings is a distraction in an otherwise intriguing essay.

Dr. Cianciulli also presents components of "primary care" as it should be available through a team of providers. The components include "accessibility, comprehensiveness of service, coordination of services, continuity of service and accountability." There appears to be a gray area in the differentiation of a "portal of entry" physician from a "primary care" provider. The definition of primary care as "first choice care and direct access care" appears to be more definitive of "portal of entry" and provides some confusion relative to integration of services.

In summary, this essay helps to define the position of chiropractic in an alternative health care track. It provokes many questions which should be examined by all those meditating the fate of the American health care system and the role of chiropractic within that system.

Silvestrone Rating: 6


Steven Eggleston, DC

Title: Beyond Antibiotics: Healthier Options for Families Authors: Michael Schmidt, DC, Lendon Smith, MD, Keith Sehnert, MD Publisher: North Atlantic Books Berkeley, CA (510) 644-2116 Category: Doctor and patient education Publication: Softcover, 307 pages

"Are antibiotics the best medicine?" This is the title of Part I of this excellent work. Here are a few interesting quotes from this section. "Overuse of antibiotics is a major contributing factor to the development of chronic fatigue ... Tetracycline was shown to inhibit the ability of white cells to engulf and destroy bacteria ... antibiotics have been shown to increase the likelihood of repeat infections ... children with strep throat who were given antibiotics experienced a rate of recurrent infections two to eight times higher than those not receiving antibiotics ... vaginitis is often a direct result of antibiotic use ... children on amoxicillin (for ear infections) fare no better than those taking placebos (sugar pills)."

If the above quotes sound like the book is quoting the scientific literature, that is because it is. These quotes were taken off only five or six pages of the first section. There are a lot more very interesting studies cited. If you ever wanted to own a book of scientific studies done by MDs that say what chiropractors have been saying for years, this would be an excellent choice for your library.

Part 2 of the book is called "Why we get sick." An excellent discussion of immunity, healthy eating, and why vitamin supplements are helpful. Part 3 is titled "Natural Medicine." The reader is advised to learn about the beneficial aspects of vitamins, herbs, homeopathy, chiropractic, and acupuncture before resorting to drugs.

Finally, Part 4 is the section on "Selfcare/Wellcare." Specific conditions are enumerated and advice is given on the myriad of nondrug treatments available, including natural remedies, immune-boosters, and dietary recommendations for each condition.

Michael Schmidt, DC, has authored and co-authored many works, including: Ear Infections: What Every Parent and Physician Should Know; Managing the Patient with Chronic Fatigue; and he edits Current Topics in Preventive Pediatrics and Family Practice.

Lendon Smith, MD, is an internationally known pediatrician, author, and lecturer. He has written 10 books and is a frequent guest on "Donahue," "Oprah," and "The Tonight Show."

Keith Sehnert, MD, has written books and articles that have appeared in Family Health, Parade, Newsweek, Ladies Home Journal, McCalls, Money, and Reader's Digest.

I must admit that this book sat on my shelf for several months without grabbing my attention. Then one day after several patients with colds had told me they were on antibiotics, I took this book home and began reading. Am I glad I did! Although written for the general public and obviously destined for sale in mall bookstores throughout America, there is a lot of very weighty scientific data. There are 368 references and the index is very helpful looking up specific drugs, illnesses, and journals used as sources.

This is one of those books which, after reading, you will feel an urgency to share with your patients. The list price is $16.95 and would be a tremendous value at twice that price. I highly recommend this book to all doctors, students, and staff members. For the price, it would be good to have several copies in your office for waiting rooms and even lending to patients.

Eggleston Rating: 9

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Dynamic Chiropractic
April 8, 1994, Volume 12, Issue 08

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