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High blood pressure, arteriosclerosis, ulcerative colitis, diabetes, infectious hepatitis, epilepsy, goiter, pancreatitis, kidney failure and receding gums are not the kinds of ailments chiropractors should treat. In 1987, however, two dozen chiropractors gathered in Fort Lee, New Jersey, to hear how to treat these and many other diseases nutritionally. And they were taught how to bilk insurance companies in the process.
The chiropractors each paid $125 to attend a six-hour seminar hosted by Berman Chiropractic Supply (BCS), of Warwick, New York, which sells chiropractic instruments and supplies. BCS is the exclusive northeastern distributor for Nutri-West, a supplement manufacturer based in Douglas, Wyoming. Not surprisingly, the supplements recommended were made by NutriWest.
The real star of the seminar was Nutri-West's 1987 "therapeutic food manual," a $60 item given to everyone who pre-registered for the meeting. Entitled Silver Bullets: "A Clinician's Guide to Therapeutic Nutrition," this 164-page book lists 142 conditions ranging from acidosis to whooping cough and lists Nutri-West products for each one.
The seminar's featured speaker was Robert Cass, a naturopath with close ties to Nutri-West. Cass works with Paul White, D.C., the company's owner, in developing new supplement formulas and helped write some product literature that Nutri-West distributes. The seminar flyer also describes Cass as "executive director of the Los Angeles-based Nutritional Blood Analysis Program, a national clinical and therapeutic diagnostic program" and currently involved in setting up a chiropractic college in India. Although Cass wrote Silver Bullets, he is not identified in the book as its author. Instead, the title page states that "permission to reproduce and market this manual has been assigned to Clinical Results, 24000 Bessemer St., Woodland Hills, CA 91367" -- which is Cass's business address.
Silver Bullets begins with disclaimers that presumably represent attempts to protect Cass from liability. The front cover states: "RESTRICTED TO DOCTORS LICENSED IN THE PROFESSIONAL HEALING ARTS." This message is repeated on the title page, which also states:
It is left to the discretion of the licensed healing arts professional to determine if the considerations and commentaries included in this manual are appropriate for their patient. Neither Clinical Results nor the publishers of this manual can be held responsible for errors, inaccuracies, omissions or any inconsistency herein.
The book's introduction gives an additional caution:
The information contained in this manual should not be construed as rendering diagnosis or treatment of any disease or preclude clinical testing or to substitute for necessary medical care. Therefore the statements contained herein should be viewed as being merely empiricle [sic] based on reported clinical investigation and research of symptomatology, blood and urine chemistries, physical examination, observation, etc. The treating physician is solely responsible for his patient's treatment program and should understand that the commentary in this manual does not relieve him of his liabilities and responsibilities for his patient's diagnosis and treatment programs. Nutritional suggestions presented are certainly not designed to constitute a cure, specific or otherwise of any condition noted but are in fact designed to offer supplemental suggestions for the overall general nutrition of his patient's diet and are designed as an adjunctive support to medical, chiropractic, osteopathic, acupuncture, naturopathic, dental etc. procedures and treatments deemed necessary by the practicing physician. It is left to the sole discretion of the user of this manual to determine if the commentary and considerations in this manual are appropriate for their patient.
The book's foreword was written by George Goodheart, D.C., who states: "Concise and to the point [this manual] carries the authority that only clinical experience can bring. Healing arts professionals all over the world will find themselves referring to it throughout their busy practice schedules."
Goodheart is the originator of "applied kinesiology," a system of diagnosis and treatment based on the theory that every organ dysfunction is accompanied by muscle weakness that may be correctable by "nutritional" methods. Its practitioners also claim that nutritional deficiencies, allergies, and other adverse reactions to food substances can be detected by placing substances in the mouth so that the patient salivates. "Good" substances will make specific muscles stronger, whereas "bad" substances will cause specific muscle weaknesses. Dr. White learned about applied kinesiology from Dr. Goodheart and has promoted it vigorously ever since.
Despite the many disclaimers, Silver Bullets offers a system of treating illnesses that is as simple as following a cookbook. Each ailment is followed by a list of Nutri-West products, the recommended dosage (the accuracy of which is said to be "greatly enhanced" with applied kinesiology testing), and phrases describing the supposed purpose of each product. A "commentary" section provides additional explanation and advice. For most conditions the number of products recommended is between two and eight.
Take epilepsy for example. The book prescribes 40 tablets daily: 2 tablets 4 times a day of Pit-LyphWhole ("regulates endocrine balance"); 2 tablets 4 times a day of RNA-DNA-Plus ("specific cell activators"); 3 tablets 3 times a day of Liva-Lyph-Plus ("liver metabolism factors"); 2 tablets 4 times a day of Chlorophyll Plus ("liver detoxification and source of organic magnesium"); and 1 tablet 4 times a day of niacin ("nourishes nerve supply").
For arteriosclerosis, Silver Bullets recommends: Super EPA ("anti-plaquing factors"); GB-Plus ("thins bile viscosity, liver/gall bladder decongestant"); Lipotrophic Plus ("to reduce cholesterol/blood fats"); Aspartic-K ("source of potassium/cardiac support"); Lyso-Lyph Forte ("anti-fibrolytic factors/proteolytic enzymes"); and Cardio Lyph Chelate ("supports vasculature to increase circulation").
At the seminar Cass said Cardio-Lyph Chelate is an oral chelation product that is "absolutely wonderful." He said it "takes plaque off the wall" of arteries and .scrapes them down. " According to the commentary in Silver Bullets, after improvement occurs, the "maintenance program is 1 three times a day for life'
Cass asked the many people who had brought tape recorders not to use them. His reason: "We'll get into some sensitive material later on." And with no tape recorders, "I'll deny everything that I say."
Cass said a lot about two services he offers-Nutritional Blood Analysis and The Bio*West Report-that are designed for the chiropractors who use Silver Bullets. For years, he said, chiropractors have complained that they want to use nutrition but can't get paid for it. According to Cass, his services diagnose patient diseases and prescribe the supplements to help solve that problem. "I want to help you make money selling nutrition," Cass said.
For Nutritional Blood Analysis, the chiropractor sends Cass a specimen of the patient's blood and a "subjective but useful" questionnaire that the patient has filled out. After the blood is tested, Cass feeds the results plus data from the questionnaire into his computer. The doctor then receives a printout-the patient's "personalized therapeutic report.'
The profit, however, is in the blood, which Cass has analyzed by one of several cooperating laboratories. These labs carry out a complete blood count, a SMAC-24 (which measures the blood levels of 24 chemicals), and several other tests. If the patient is insured, the labs accept insurance assignment as payment in full.
"Private insurance and Medicare-that's hot, hunh?" said Cass, emphasizing that the analysis "doesn't cost anybody anything, " The blood work and analysis is worth $110, Cass said. But the labs bill the insurance companies $290 to compensate for reimbursements that may amount to only 60-80% of the total. The lab pays Cass a fee and keeps $130 to $140 for itself
The chiropractor profits from nutritional blood analysis in two ways: by selling patients the Nutri-West supplements prescribed in the Nutritional Blood Analysis Report, and by "creative billing" of insurance companies, Cass said. He explained that chiropractors can't bill insurance companies for the therapeutic report itself. To get around that problem, Cass advised them to bill the report -- worth between $35 and $50-as an office visit. "Generally speaking," Cass said with a smile, .creative insurance billing is the way to go these days."
A chiropractor using nutritional blood analysis can bill for other things as well, said Cass, including the charge for drawing the blood (code 9900 on the insurance form, he noted helpfully) and the office visit (code (90060) at which the blood was drawn. The total take for one patient's blood analysis "could come to $200 when all is said and done-very easily," Cass said.
Cass provides the chiropractor with two reports: one "for professional use only" and one for the patient. What's in a typical Nutritional Blood Analysis Report? Each chiropractor was given a sample on a patient identified as Barbara, a 51-year-old woman. The analysis, which bears a 1986 Cass copyright, contains this disclaimer:
The information in this outline should not be construed as rendering diagnosis or treatment of any disease or preclude additional clinical testing or to substitute for necessary medical care, Therefore the statements contained herein should be viewed as being merely empiricle [sic] based upon clinical research and investigation. The treating physician is soley [sic] responsible for his patient's diagnosis and treatment programs and by requesting this discussion acknowledges full and complete liability for his patient's diagnosis and treatment programs. Nutritional suggestions presented are not designed to constitute a specific cure for the treatment of any condition but are designed to offer supplemental feedings in the overall nutritional enhancement of the patient's diet. Although Nutri-West products are suggested in this report, the considerations expressed are not necessarily those of Nutri-West.
The sample report contains fifteen pages of tables and text. Seven pertain to "Barbara" and the rest give general information and advice that includes warnings against white flour and refined sugar. One page is a list of "vitamin and mineral robbers" said to be adapted from a magazine article by Earl Mindell on "Why We Should Take Vitamins." Barbara's analysis begins with a table that compares the results of Barbara's blood tests with "lab ranges" and "nutritional balance" ranges and interprets the results outside the "nutritional range" as "high" or "low." [Editor's note: For most values, the "nutritional balance" range is narrower than the range considered normal by the scientific community. Thus many people will have "high" or "low" values inappropriately reported.]
Barbara's report lists many problems: functional digestive disturbances and malabsorption syndrome; liver, adrenal, biliary, thyroid, pituitary and autonomic imbalances; reactive hypoglycemia; calcium mobilization problems; lowered resistance; possible parasite involvement; presence of bacterial/viral infection; dehydration pattern; high sodium; protein malabsorption; overstimulated osteoblastic activity indicating osteoarthritis/osteitis and other bone problems; creatine phosphokinase (CPK) pattern disturbances; menopausal "hot flashes"; and circulatory insufficiencies.
The recommended solution includes dietary changes and copious amounts of Nutri-West supplements. Barbara was prescribed Nutri-West's Adreno-Lyph-Plus (for "adrenal support, reactive hypoglycemia, hypotension, and allergies"), Hypo-Di-Gest (for "blood sugar handling problems and digestive support"), Core Level Thymus (for "support of immune functions"), Lipotrophic-Plus ("fat metabolizer and bile thinner/mobilizer"), GB-Plus ("gallbladder/liver decongestant"), and Pare-X and #8 VMF (for "digestive function, parasites, and inflammation").
The report instructed Barbara on the proper times to take the supplements and the number of tablets to take. And it offered this advice: "FOLLOW the Schedule of Nutritional Adjuncts and the dietary outlines contained in your report JUDICIOUSLY. The road back to health can be a fascinating and rewarding ADVENTURE!" Chiropractors get a 50% discount on Nutri-West products and presumably charge list price to patients. Barbara's program would cost more than $5.00/day.
For chiropractors who don't want to do blood work, Cass offered another way to make money: his BioWest Report. The chiropractor sends Cass a questionnaire that the patient has filled out, along with other information about the patient's blood pressure, medications taken, health habits, and underarm temperatures (which supposedly indicate thyroid function). The questionnaire-also used for the Nutritional Blood Analysis-contains more than 150 signs and symptoms for the patient to circle. Cass enters the information in his computer and produces the patient's Bio*West Report-a prescribed list of nutritional supplements for the patient's "clinical nutritional program'
The Bio*West Report contains a disclaimer almost identical to that of the Nutritional Blood Analysis. However, according to the sample Cass distributed, if the patient circles "tendency to asthma," the printout responds: "Indicative of a need for HCl and adrenal support. Also indicative of possible food reaction sensitivities. " The recommended supplements are LysoLyph-Forte, #6 LNG, Calc-Acid, C-1000-TR, PneumoLyph, Adreno-Lyph-Plus, Histo-O-Cal, Duo-Lyph, Pare-X, and #8 VMF. The Chiropractor is referred to Silver Bullets to learn how many times a day the patient should take each supplement.
What if the patient needs coffee to get going? "Indicative of a reactive hypoglycemia pattern with biliary adrenal insufficiencies," the printout reports. The suggested supplements: Core Level Bile, GB-Plus, Hypo-DiGest, Multi-Gland-Chelate, Amino-AII, Adreno-Lyph-Plus, and B-Complex.
Heart palpitations indicate "a need for vitamin B and alkaline minerals"-which means the supplements Trypto-CLM, B-Complex, and Cardio-Lyph Chelate.
The Bio*West Report costs the patient $30, Cass said, adding that insurance companies probably can't be billed for it. But insurance code 99050 -- retrieval of data -- was "a possibility" that chiropractors could try using to obtain insurance reimbursement.
Chiropractic is based on the false belief that spinal misalignments are the major cause of diseases, and that many if not most ailments can be helped by manipulation ("adjustment") of the spine. Chiropractors are licensed to do spinal adjustment in all 50 states, but they are not allowed to prescribe drugs, and in many states they are not permitted to diagnose or treat disease.
Cass suggested that nutrition supplements may be necessary for chiropractors' spinal adjustments to work. "As the chiropractic profession knows, our responsibility is to get the spine into alignment. That's the bottom line," he said. Nutritional supplements "assist the body to come into balance," he said. And once that happens, "the body can come back into alignment"
Chiropractic journals carry ads from many companies that sell supplement products, and several of these companies conduct seminars on the use of their products to treat disease. The number of chiropractors using these approaches is unknown, but is probably several thousand.
Under federal law, substances intended for use in "the diagnosis, cure, mitigation, treatment or prevention of a disease" are considered drugs. Products not generally recognized by experts as safe and effective for their intended use are "new drugs," which cannot legally be marketed in interstate commerce. This also applies to vitamins and related products purported to treat or prevent disease even if they are marketed as "foods" or "nutritional supplements." Federal law also requires that drugs be labeled with adequate directions for use. Some states have similar laws.
Nutri-West markets more than 200 products which it classifies as glandulars, minerals, amino acids, digestives, enzymes, herbals, unsaturated fatty acids, specialty items, gels and topical applications. The "glandular" products and some of the mineral and specialty products contain bits of "raw tissue concentrates" from various animal glands. Although Nutri-West labels merely list ingredients, the intended use of the products for treating and preventing disease is clear from this seminar as well as materials given out by Nutri-West and its distributors.
According to an article in the Cheyenne Star-Tribune, Nutri-West was investigated by the FDA in 1985 and stopped selling an alleged gallbladder remedy to which the FDA objected. Federal regulatory agencies tend to shy away from the activities of state-licensed practitioners, leaving them to the supervision of state boards. This seminar indicates that Nutri-West and Cass deserve a closer look.