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Saturday, December 29, 2012

Florida Emergency Medical Condition PIP No-Fault

Florida Emergency Medical Condition PIP No-Fault

Alan Himmel, DC.  
December 29, 2012

The changes to Florida's new PIP No-Fault law did not actually include any requirement that the insurance companies must advise policy holders of the changes.  This means that after Jan 1, 2013, if a Florida consumer gets into a car accident, they are going to expect to have their full $10,000 in coverage, but they will not, unless the injuries are considered a medical emergency.  Because car insurance companies are not required to tell, and the details of this new law are not explained in the language of the insurance policies, this is obviously an unfair tactic, and would expose insurance companies to the possibility of a law suit, which would be rightly justified.  When you buy insurance, its a contract that both the policy holder and insurance company agree and sign.  Nowhere in the current policy does it state that you are only entitled to $2500 for non emergency care.  It states that you are entitled to $10,000.

Imagine having an accident, going to the hospital to get checked, which could be thousands of dollars if any diagnostic test or injections for pain are given, and then you go for follow up care, to be left with unpaid medical bills.  This is exactly what is going to happen under the revised PIP law beginning 01-01-13.

So, in regard to this dilemma, the Florida Cabinet and Insurance Commissioner have adopted and approved an emergency form that will be either included in your new policy or mailed out to you separately advising you of this change.  Here is an article that explains what is going to happen:

By the way, I hate  This is a  "journal" or newsletter if you will, which is totally and completely biased toward insurance companies.  It is not meant for policy holders to read, it is meant for insurance adjusters, agents, representatives, etc.  You can tell this by the sponsors on the page and what they write in their articles...  but I digress.  This is really a topic for another blog post.

The main thing is that you should be made aware of the emergency provision on your auto policy starting Jan 1, 2013.  It looks like you can read it, as long as you take the time to look in the letter sent by your auto carrier.

Monday, December 24, 2012

If you don't use it, you lose it. (after 14 days)--Your Florida PIP Benefit

Your Florida PIP No-Fault benefits:  If you don't use it, you lose it.  (after 14 days)

That's exactly what happens.  If you have an accident, and you don't use your insurance, you lose it.

Imagine having insurance coverage that you paid for, but because you did not use it within a certain window, your insurance coverage expires and you get nothing.  Well, if you have an accident after Jan 1, 2013, and you decide to wait more than 14 days to go get checked out, your insurance will expire, and your insurance company which you pay good money, will deny your claim.  That's not much time is it, just 14 days?  Well according to the insurance companies, if you have an injury from a car accident in Florida, if there is truly an injury, you should have enough time, within those 2 weeks, to be looked at by a doctor.  Their rational is that pain, headaches, and impairments never arise after 14 days have passed.

Yes.  Its downright silly, yet it is exactly the way the law reads.

Anyway, I was talking to a friend of mine tonight, who lives in Colorado, and in regard to the recent changes to the Florida PIP law, he pointed something out to me that I had not even thought of.  First and foremost, we know that people NEED TO BE MADE AWARE OF THE CHANGES TO PIP, because their insurance company is not required to advise them of this change, and the new insurance policies don't even include this language in the paperwork.  It's a fact that they plan on keeping this detail hidden, because "the less an injured person knows about the procedure, the better."  Its obvious that your insurance company is banking on the fact that you will wait 14 days and one second, so they will be off the hook for any medical claims.

So, this brings up something very interesting and this is what he said:  If a person were to know that they would have no insurance if they waited too long to file a claim for injuries, why wouldn't you expect an increase the PIP claims that the insurance companies will get?  In other words, this may bring more claims to the insurance company, because  people are not going to want to lose their benefit.  

Could this 14 day thing backfire on the insurance companies?

Its very possibly could backfire.  I expect to start seeing radio and TV advertisements talking about the 14 days, which would prompt people to go get checked out who normally would have just dealt with the pain.  Some people may go to a doctor once, just for the purpose of securing their insurance benefit, which means some people may go get checked out, even if they have absolutely no pain.  Most intelligent people are cognizant of the fact that problems often show up later, due to injuries they suffer today.  I hope it doesn't cause people to bring in completely fake claims, just so future claims are not denied, but this is exactly what might happen when people become aware of the 14 day cut-off.  This may be a completely unintended consequence of the PIP change.  But, it was his opinion that even the most honest person would go get checked out by a doctor, if he knew that he would lose his insurance if he didn't go.

...just something to think of, right?

Have a Happy Holiday!

Saturday, December 15, 2012

Car Accident Victims: 14 Days Left to Begin Treatment

Attention Car Accident Victims in Florida

Beginning January 1, 2013, you will have UP TO 14 DAYS to initiate treatment of painful injuries if you have been involved in a Car Accident.  If you wait one extra minute, you will have NO COVERAGE for these injuries under the new State Law.

This is what our Doctors Do:

1.  We are licensed Doctors who will Personally See you at a moments notice at your home, your work, or our office BEFORE the 14 days have passed.

2.  We have 18 years experience treating and documenting painful car accident injuries.

3.  We handle ALL the paperwork on our end.  You don't have to worry.  We file the claim for you.  Don't go to any doctor for this type of injury care.  Most doctors are not familiar with the New No-Fault Law.  You will likely get stuck with a large out of pocket expense if you do not use the right doctors.

4.  If you wait one extra second you LOSE YOUR BENEFIT.

5.  Call if you Have Had a Car Accident.

954-659-8600:  Dr. Himmel

Professionally yours,

Doctors Mobile Rehab

Friday, December 14, 2012

Florida No-Fault PIP injunction denied by Judge Lazarra


Okay, the injunction for the Jan 1, 2013 PIP legislation was denied.  The Judge said that the plaintifs have not demonstrated that they had a chance of winning based on the arguments or merits of the case.

This is no big surprise.  Most of the House and Senate voted to move the bil to the governors desk, and the governor pledged that he was going to sign the bill into law.  At one point he said this will be the highlight of his career.  They keep touting this new law as such a savior of money for Florida drivers.  They say how its going to reduce premiums and eliminate fraud.  All sounds so good especially if you paint the picture you want to paint, and leave out the facts of this case.  Based on this, and its all political--no Judge wants to be the one to allow this injunction to go forward, and potentially delay the implementation of the new no fault law.  Especially before anyone has had a chance to see if it would actually work.

There are some very important changes to the law, which the Judge says has no merit.  The following are a list of things that you should know about this law.  The first thing is that you have up to 14 days to initiate treatment after an accident.  If you wait one extra minute, your insurance carrier will deny your injury claim.   In an environment where there is an insurance crises in the first place, I have no idea how this has no basis for an injunction.    Second, is that massage and acupuncture, which have been proven to be of great value for soft tissue injuries, are now eliminated. Even if you are a licensed doctor, your patient is not entitled to (under the terms of the no-fault law) any kind of soft tissue rub on the body.   The patient can have it, as long as they are willing to pay out of pocket.  This is wonderful for those who have suffered an injury in an automobile.  Third, the benefit is now 75% less than it used to be.  In most cases, you now have only $2500 in no fault insurance if you are injured.  This amount of money will last about 4 minutes in any emergency room.  Finally, there are thousands of people who make a living treating accident patients, who will now be out of work.  Oddly enough the majority of legislators in Florida are Republicans, who claim want to get people back to work.  I guess the trick to getting people back to work is to eliminate their income.

 What they have essentially accomplished is increasing insurance corporate profits by taking the insurance company responsibility away.  Yes, its true.  These people just do not care about the working man or the average Joe.

Anyway, I'm not sure about this. I would like to ask a lawyer what the next step is from here.  If anyone knows, please let me know.

Professionally yours,

Dr. Alan Himmel

Sunday, December 9, 2012

Federal Lawsuit Filed Against Florida HB119 PIP No-Fault Law


       THE NEW 2013 PIP BILL, HB119.

Dear Colleagues, 

Below is a letter written by Adam Levine, MD, JD., in regard to the Federal lawsuit recently filed Florida HB119.  Thanks to Dr. Levine, Esq., and Mr. Lirot, Esq, and for all their efforts on behalf of all Florida citizens and health care providers, who will be effected by this horrible legislation.  What you need to do is fill out the affidavit (below), get it notarized and fax it back to the lawyer.  Evidently there is a hearing on December 13, so these affidavits must be in by then.  Do this right away.

Share this on your facebook page, send it out by twitter, etc.

There are a lot of people affected by this.  Everyone should have a chance to at least be heard.


Re: Federal Lawsuit against HB119

Dear Friends,

Good morning. On behalf of a Florida Licensed Acupuncture Physician, a Florida Licensed Chiropractic Physician, two Florida Licensed Massage Therapists, John Doe (representing all Florida Licensed Acupuncture Physicians, Chiropractors, and Massage Therapists), and Jane Doe (representing all those injured as a result of a motor vehicle collision), o
n November 23 Luke Lirot, Esq., (Luke Charles Lirot, P.A.), and I filed a Complaint in Federal Court against Mr. Kevin McCarty in his Official Capacity as Commissioner of the Florida Office of Insurance Regulation respectfully requesting that the Court prevent the State of Florida from enforcing the provisions of the 2012 PIP Act. [also referred to as HB 119, and here I have taken the liberty of shortening the title because the actual title is 63 lines long]. The Florida Legislature enacted the 2012 PIP Act to prevent PIP Insurance Fraud and the provisions detailed below, preventing all care by all Acupuncture Physicians and all Licensed Massage Therapists, and severely limiting the care provided by all Chiropractic Physicians, applies to all patients injured as a result of a motor vehicle collision.

On November 30 we filed a Motion for Preliminary Injunction, scheduled for a hearing next week, because we believe that enforcement will irreparably harm all Acupuncture Physicians and all Licensed Massage Therapists in Florida and most likely harm many if not all Chiropractors in Florida. We believe that the 2012 PIP Act violates the Equal Protection and Due Process clauses of the 5th and 14th Amendments to the United States Constitution. Further, we believe that the 2012 PIP Act violates numerous provisions of the Florida Constitution. Essentially, the terms of the 2012 PIP Act require: 1) That despite a requirement that citizens owning a motor vehicle purchase $10,000 in Personal Injury Protection (PIP) insurance coverage, citizens failing to obtain medical evaluations within two weeks of an accident will receive no coverage, and citizens not diagnosed by an MD, DO, or DDS with an emergency medical condition will only receive $2,500 in coverage; 2) That Chiropractors (DC) may only provide manual manipulations and no other therapies (e-stim, traction, massage, heat/cold etc.) for a period limited to that allowed by Medicare or Workers Compensation, depending; 3) That all Acupuncture Physicians may not provide any evaluation or treatment of any kind; 4) That all Licensed Massage Therapists may not provide any evaluation or treatment of any kind.

Unfortunately, although we can all agree that PIP fraud exists, the mechanism chosen by the State Legislature abrogates our fundamental rights protected by the United States Constitution and violates multiple provisions of the Florida Constitution. Logically, preventing all patients from accessing all Florida licensed Acupuncture Physicians and all Licensed Massage Therapists that have already been providing care for motor vehicle accident victims for many years cannot rationally be related to preventing PIP fraud – these same providers may continue to provide care under any other 3rd party payor – just not PIP Insurance which just happens to be mandatory in Florida. Similarly, preventing all patients from accessing all the modalities available to all Florida licensed Chiropractic Physicians and limiting those patients to one quarter of the care previously allowed and then only to manual manipulations cannot rationally be related to the prevention of PIP fraud.
Please contact me by email,, if I can provide you with any further information, if you can provide us with any information or would like to file an affidavit documenting any irreparable harm that will occur to you as a result of the 2012 PIP Act, or if you would like to participate in any way.

Best wishes and warmest regards,

Adam Levine, M.D., J.D.
Florida Legal Advocacy Group of Tampa Bay

Thanks again!

Best wishes,

Adam Levine




ROBIN A. MYERS, A.P., an individual
person and Acupuncture Physician,

GREGORY S. ZWIRN, D.C., an individual
persona and Chiropractic Physician,

SHERRY L. SMITH, L.M.T., an individual
person and Licensed Massage Therapist, Case No. 8:12-cv-2660-T-26TBM

CARRIE C. DAMASKA, L.M.T., an individual
person and Licensed Massage Therapist,

“JOHN DOE,” on behalf of all similary
situated health care providers,

“JANE DOE,” on behalf of all those injured
by motor vehicle collisions,



KEVIN N. McCARTY, in his Official Capacity as
Commissioner of the Florida Office of Insurance


AFFIDAVIT OF  ______________[INSERT YOUR NAME HERE]_______________


Before me, the undersigned authority, appeared    [YOUR NAME HERE], having been duly identified and who states under oath the following:

  1. I am over the age of 18 years and otherwise competent to make this affidavit;
  2. I have personal knowledge of the facts set forth herein;
  3. I am a resident of  [FILL IN COUNTY] County;
  6. My business is located in [INSERT COUNTY HERE] County;
  7. I possess license number [INSERT LICENSE NUMBER HERE] issued by the State of Florida to practice [INSERT TYPE OF LICENSE HERE];
  8. I read the 2012 Motor Vehicle Personal Injury Protection Insurance Act;
  9. Although I [UNDERSTAND, AM CONFUSED BY ETC.] the aforementioned Act, I believe that the Act will [what you think the Act will do in your own words. Generally injunctions are granted for things that will cause you irreparable harm – i.e. even if they could give you money, you would still be harmed because your business was destroyed etc.  With an injunction, you are asking the Court to provide you with an extraordinary remedy – something that will potentially cause you such harm that you will be permanently damaged.];
  10. At this time, this Act has already  [what was the impact of the act on your business?];
  11. Further, I have the following comments:
  12. I am requesting that this Court maintain the status quo so that I am not irreparably harmed until the Court can proceed with a full hearing or trial regarding this matter.



The foregoing Affidavit was sworn and acknowledged before me on this ___th day of _____________________ 2012 by  [INSERT NAME HERE], ___who is personally known to me, or ___ who produced the following identification: __________________________________________.

Notary signature: ________________________________
Notary name: ________________________________
Notary Expiration Date: ____________________________
Notary Seal:

Thursday, November 22, 2012

A Typical Chiropractic Visit with Dr. Himmel

A Typical Chiropractic Visit with Dr. Himmel

I routinely spend up to 45 minutes (and sometimes more) with my patients.  It's a decision I made a very long time ago, that I wasn't going to short change or sacrifice patient care for the purpose of cramming as many patients as possible into the day.  Yes, the more patients that get on my table, the more money I make.  But, its not about the money.  Patients come to me for help.  They are hurting.  Honestly, I never figured out a way to make a quality adjustment on a patient's spine, and make them feel better, in three minutes or less, like other chiropractors like to do.  

Everything takes time:

When a patient walks in, it could take up to 10 minutes just to listen and evaluate the patient's complaints.   I have to know if there was improvement since the last visit, or there are new issues, or the condition is getting worse.  All my visits consist of at least a basic exam to see whats going on since last visit. Sometimes the patient's subjective complaints involve a mental component, which complicates things and oftentimes, outright prevents the healing process from commencing.  The patient is his own worst enemy.  This is a different topic for a different blog post.

Therapies, if necessary are timed.  They usually last up to 15 minutes.  I do all the therapies myself with the patient.  I have no helpers or chiropractic assistants.  I have never met a patient that would rather have an assistant apply therapies.  They would rather have the doctor do it.  

An adjustment takes a careful approach.  It's not just "rack-em and crack-em."  There is an analysis to my adjustments.  Its important to know where to adjust, but it's even more important to know where not to adjust.

Then there are exercises and special stretches that I sometimes do with patients.  In my opinion, this makes a huge difference in the patient's recovery.

Professionally yours,

Alan Himmel, DC, PA


Tuesday, November 20, 2012

14 day Deadline to get treatment after a Car Accident Begins in Florida. Patients and Doctors are OUTRAGED!



You have only 14 days to get treatment if you have been involved in a Car Accident in Florida.

Do you know what this means? This means if you are in an accident, and think that the pain will go away by itself, but it doesn't after 14 days, your insurance company that you pay all that money to every month, will DENY your claim.

Don't wait! Call Now.  954-659-8600.  Dr. A. Himmel

 14 Day Emergency Treatment offered to Car Accident Patients in Florida.

We have doctors who will see you 24 hours a day and 7 days a week at your home or our offices in Broward, Dade, or Palm Beach Counties.

If you wait one extra minute over 14 days, you lose $10,000 in PIP benefits that your are paying for by law.

CALL NOW.  This is no joke.  You will be forfeiting $10,000 of your insurance benefit if you wait.  

We have doctors who will travel to YOU so that you can initiate your treatment before the 14 day deadline expires.  We file ALL the paperwork for you so that the ONLY thing you need to worry about is feeling better after your car accident!  Any questions, just call us at 954-659-8600.  Dr. A.  Himmel

Thursday, October 25, 2012

The Changes to The Florida No-Fault Law: Who will you VOTE for?

The Changes to The Florida No-Fault Law (PIP):  Who will you VOTE for?

Alan Himmel, DC, PA.

I wasn't going to do it.  I told myself that I would not turn this blog into a political tirade or debate.  In fact, if you read through these posts, you will notice that not once have I mentioned my feelings toward a specific political party in the State of Florida.  I mean, I have bashed Governor Scott, because of what he did to the no-fault law.  I think, personally that he is a bad governor.  His stance on education and the school system in Florida is horrible.  He has taken more than a billion dollars of funding from education, to divert to for-profit charter schools.  Oh, now that he has to start thinking of his next term, he is slowly warming up a bit to public education.  It's time to try and look good, and pretend that he cares.

But, I think it's okay that from time to time I talk about politics--a subject that I loath.  Here we go:  I want to point you in the direction of one of my blog posts which lists all the senators that voted for the new no-fault (pip) bill in Florida.

The top group is a list of Senators who fought the changes to the Florida no-fault law, so that your State required benefits remain intact.  The bottom group fought to disrupt and change the law, so that the insurance companies can now deny your claim more easily, and to only give you 25% of the insurance coverage you had before.  It now also eliminates massage and acupuncture from being reimbursable, as well.

Click the link above and open the page.  You will see two groups of politicians.

                                       I encourage you to PRINT THAT PAGE!!

You will need this when you go and vote.  If you are happy with the changes to the no-fault law, then there is a nice list of Senators to vote for.  You can bring the list, and if you see any of these guys who fought for the profits of the Insurance industry on the ballot, just vote for them. You can also find out what district you are in: Here is a site that you can use to figure out what district you are in and who your Florida Senator is: 

If you want to spend a little time looking at the two lists of Senators who voted for or against the No Fault law, you will quickly see that the politicians who voted to move greater profits into the hands of the Billion Dollar Insurance companies were...............  drum roll.............:

Republicans!  There was only one Democrat who voted for the changes out of the 21 Senators who voted for the horrible changes.  That's right.  20 out of 21 Senators are republicans.  If you are a republican, in the health care field, and voted for these guys on this list, you voted to put yourself out of business or at least to reduce your income by 75%.  You also voted to make sure that the big insurance companies like State Farm and Geico, are now guaranteed to make more profit (they always report record profits year after year).  And you also voted to take valuable needed coverage away from Florida drivers.

So, I'm just sayin'...   next time its time to vote, get out there and do what you feel is best, either for yourself, your family, and your patients.  Or, the other option is you can vote to put more profit in the bank accounts of the insurance companies.  If you work for or have a financial interest in,  or have a relationship with an insurance company, I guess the decision is easy.  Good luck. 

Monday, October 22, 2012

Whiplash, Damage to the Ligaments, Normal vs Abnormal Spinal Curves, etc.

More on Whiplash, damage to the ligaments, normal vs abnormal cervical curves, etc.

Alan Himmel, DC.

There is no doubt that chiropractors are best known for their excellence in conservatively treating conditions of the spine, and related back pain.  Whiplash of the neck, whiplash of the low back are certainly the most common.  These injuries happen, of course, when a person's body is thrown by force in one direction or the other, which causes the person's head, for example, to want to stay in its original resting position.  Studies show that head restraints reduce cervical spine whiplash injury.  (1)  When the person's body is thrown forward, and the head stays in its original position, only to catch up with the rest of the body after the impact, a person will likely sustain an injury to the cervical spine.  Likewise, if a person's lower body is quickly and forcefully thrown in one direction while the rest of the body is perfectly comfortable in its original resting spot, a person will likely wind up with an injury to the lumbar spine.

As you can see from the illustration above, the forces involved that affect the spine, in these types of traumas, can be very damaging to the muscles of the neck.

These spinal type whiplash injuries vary.  Sometimes the injury is simply to the muscles that support the neck or the low back.  These injuries are usually the least dangerous.  Other times the injury could be to the muscles and tendons, which is more of a troublesome type sprain of the soft tissues.  And, in the more severe cases, the injury could be to the muscles, tendons, nerves, and ligaments.  Any one of the above injuries are very painful and debilitating.  However, the whiplash type injuries to the ligaments are by far the most difficult for patients, and usually require more frequent therapies for a longer period of time.

Above you can see the ligaments that hold the vertebrae together.  As you can see, these ligaments are crucial for the integrity and maintaining the normal anatomy of the spine.  Any disruption of the above ligaments can cause weakness, hyper-mobility, or movements of the bones.

The issue with injuries to ligaments, is that these are supporting structures that connect two or more bones to each other.  These ligaments include the longitudinal ligaments of the spine, and from time to time, depending on who you talk to, I have heard the inter-vertebral discs being referred to as ligaments, because they connect between two bones.  Think of the longitudinal ligaments like the bark on a tree.  They go lengthwise up and down the spine, and in the case of the spine, offer support, so that each of the bones of the spine are lined up on top of the next in a certain fashion, which don't allow the bones to shift and move easily forward or backward. They are very important for support. (2) Very often, one of the most common things I see on x-ray or MRI, to a person's spine after a car collision, is what the radiologist calls "straightening of the spine", or in the more severe cases,  retro (backward) listhesis where a bone moves backward compared to another bone, or antero (forward) listhesis, where a bone moves forward compared to another bone. Take a look below:


The image on the left is a good example of straightening.  The image on the right is the way the cervical curve is supposed to look.

In my opinion, both straightening of the spine or either antero or retro listhesis confirms an injury to the longitudinal ligaments.  This is because these ligaments are designed to keep the vertebra in the correct anatomical position.  Bones that are out of position have lost their supporting structure, which is the function of the ligaments.

Note that the bones have moved in relation to the bone above or below.  This can happen with a disruption of the posterior or anterior longitudinal ligaments.

A colleague of mine likes to tell his patients that these injuries are "very tricky" because often times the patient begins to feel better within a couple of weeks, only to have a relapse in pain, as if the injury just happened.  Worse than that, if left untreated, these types of injuries become more debilitating, and eventually can result in chronic, lifelong physical issues.  Typically, these patients, when left untreated, begin to develop arthritic conditions  because now the mechanics of the joints are not correct, and are stressed.

1.  2009 Nov;24(9):699-707. Epub 2009 Aug 8. Whiplash injury prevention with active head restraint. Ivancic PCSha DPanjabi MMBiomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT 06520-8071, USA.

2.   2012 Oct 11;45(15):2668-72. doi: 10.1016/j.jbiomech.2012.08.012. Epub 2012 Aug 30.  The effects of ligamentous injury in the human lower cervical spine.
Devin Leahy PPuttlitz CM.  Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA.

Wednesday, October 10, 2012

Spamming Blogs


Dear potential Blog Spammers,

Congratulations!  You found my Blog.  This is basically where I post my thoughts regarding the Florida No-Fault Law, and the changes that are coming in 2013.   This is also a place to discuss injuries, treatments,  therapies that work, therapies that don't work, and some interesting facts.  The original intent of this blog was to pool some thoughts together with other doctors, lawyers, injured people, and frustrated Florida residents.

However, over the last few months, and the couple thousand visitors who have cruised through the articles, all I seem to get here is people spamming.  They are trying to post their url on this blog, with a useless comment.  At least if you are going to take the time to find this blog, and post your url, can you at least make an intelligible comment?  I will allow you to post your url here, but if you are not going to contribute in a useful way, I am going to delete your post.  In other words, please don't bother because I am the moderator and you will be removed.  Understand?   I have been nice so far and have let some people on, but I am not being nice anymore.

Oh, and there are sponsors on this blog.  If you like what you read, please visit the sponsors on this page.

Professionally yours,
Alan Himmel, DC.

Saturday, September 29, 2012

"Doctored" Official Movie Trailer. 2012 Documentary.

Doctored.  Official movie trailer.


New Film 2012: Doctored. Here is the Film Review

This should be good...

Film Review: Doctored

Doctored, as the title implies, blames doctors for America’s failed healthcare system.

Sept 19, 2012
-By Maria Garcia

For movie details, please click here.
Doctored is a documentary about the chiropractic profession primarily, and the American Medical Association’s longstanding opposition to it. Chronicling the suits and countersuits filed by the AMA and a group of chiropractors (beginning with Milk v. AMA in 1973), director Bobby Sheehan leaves the impression that the final outcome legitimized chiropractics. Actually, the lawsuits were filed and resolved under federal antitrust legislation. The judge found evidence that the AMA and some healthcare providers were guilty of restraining “trade,” of trying to put chiropractors out of business; her 1987 decision ended their campaign. Having sufficiently demonized doctors, Sheehan then blames them, rather disingenuously, for the unwillingness of health insurers to pay for alternative cures.

Less than 30 percent of the nation’s physicians are members of the AMA, so the organization’s views can hardly be said to represent the medical community. Healthcare providers’ policies with regard to which procedures or treatments will be covered are decided by actuarial formulas, not by doctors or the standards of medical practice. Blaming the AMA, and physicians who harbor prejudicial views of alternative medicine, for what ails the American healthcare system, as Sheehan does here, is as simplistic as believing that what will repair it are chiropractors and enlightened doctors who embrace alternative therapies. As other documentaries on this subject point out, including the upcoming Escape Fire: The Fight to Rescue American Healthcare (from Roadside Attractions), the fault lies with lawmakers who have failed to reform profit-oriented insurers and pharmaceutical companies.

Sheehan will succeed with TV viewers accustomed to ripped-from-the-headlines “journalism”; in fact,Doctored opens with a 1980s broadcast of “The David Susskind Show.” Aired when alternative therapy generally referred to chiropractic intervention, the program pitted a sneering doctor against a composed and articulate chiropractor. Through a mix of archival footage and interviews with doctors, chiropractors and their patients—sometimes in ineffective, staged conversations—Doctored, as its title implies, appears to put Western medicine on trial. Employing conspiratorial thinking rather than thoughtful commentary, in the end the documentary is actually little more than a deftly edited commercial for the chiropractic profession.

Sheehan gets some candid interviews with doctors in which they admit to unholy alliances with drug companies, and failures in Western medical practice that compel patients to seek alternative therapies, but these startling disclosures are edited to within an inch of apprehension, undermined by the film’s proselytizing. Ironically, the most effective criticism of America’s healthcare system comes from doctors, not from the self-aggrandizing chiropractors. Doctored offers no fix for the problems it identifies, beyond a visit to your local chiropractor. 

Saturday, September 22, 2012

STANDARD OF CARE: Just my two cents.

STANDARD OF CARE:  Just my two cents.

Alan Himmel, DC. PA

If there is one thing I am very sure of by now, it is the fact that not all patients respond the same to medical treatments.  For example, if you have five patients and they all come in with the identical complaint of lumboscacral radiculopathy, caused by the identical thing, you will find that each one of these patients will typically respond different than the next patient to medical care.  I have learned over the years to respect this fact.  This, by the way, is a fact across the entire list of medical conditions.  There is no such thing as a guaranteed success with any medical treatment, because each patient is unique.  Any physician who tells you otherwise is lying to you. The treatments given to a patient for any one particular reason, are usually one that comes out of a bag of questionable tricks.  I use the metaphor "bag" here, because that's exactly what doctors have--a bag of tricks or treatments in their arsenal which they grab from, when a condition calls for it.

Within the arsenal of treatments that doctors have, is what is called "standard of care."  In other words, the standard of care treatments are treatments that all your doctor's colleagues do, and so, since everyone else is doing it, it makes it the treatment of choice.  Since the standard of care is the treatment that everyone else does, it is therefore reasonable and correct for your doctor to do the same.  In fact, many doctors are reluctant to step out of the box, and prescribe a medication, or do something, which is not considered the standard of care.

Reaching for the standard of care each time, in my opinion is problematic and can also be dangerous to a patient's health.  This type of thinking by doctors opens up several issues because physicians are well aware that standard treatments do not always equate to resolution of  a medical condition.   Treating patients is not like mathematics where you can predict the outcome, every time.   If you think about it,  if it was as simple as choosing the standard of care, then we wouldn't need doctors at all.  Could you imagine if we could do away with most docs and create a computer program which people would keep on their home computer, or even as an app for the smart phone, that would do everything, including calling in a prescription at your pharmacy?    Several years ago, a well respected friend of mine, who is in medical research once told me that most doctors and researchers are like robots.  She used to say that these people have lost their ability to think on their own, that they have no curiosity, and they don't question anything.  She asked me once, how many physicians do I think go home at the end of the day and do research, and try to find the BEST options and treatments for their patients?  This is something that I never thought of before, but certainly with the advent of the internet, this type of research is pretty easy to do, and reasonable, especially with a patient with a life threatening condition.

If you ever want to stop a physician in her tracks, look your doctor straight in the eyes and ask her what she would do if her mother or father or child was the patient.  This usually works.  If the doctor is giving her honest opinion of the best treatment, then she will confidently look you right back in the eyes and stick to her original recommendation.  If the doctor seems uneasy with the question, or looks away or down, I would be concerned and would seek another opinion.

Sunday, September 16, 2012

Politicians (Senators and Representatives) who Voted for and Against The New Florida PIP Bill, SB 1860 and HB 119

Politicians (Senators and Representatives) who Voted for and Against The New Florida PIP Bill, SB 1860 and HB 119

Here are two Groups of Politicians.  The first list of Senators and Representatives voted against the passage of the New Florida PIP Law.  These are our friends.

The second list of Senators and Representatives voted FOR the New Florida PIP Bill.  In other words, the second group of politicians voted to give the Insurance companies more reasons they can DENY your injury claim.  It took away your rights as a consumer and limited your income as a practitioner.

Here are our 19 FRIENDS in the Senate – These Senators stood up for your consumer rights:
Diaz de la Portilla

Here are our 30 FRIENDS in the House - The House Representatives Stood up Up For Consumer Rights:

Here are our 21 FOES in the Senate -- They stood up for Insurance Industry Profits:

Here are 86 House Representatives FOES who supported Insurance Industry Profits:

Van Zant

Tuesday, September 4, 2012

Rear End Collisions and Injuries. It's Not What You Think!

Rear-End Collisions, Crumple Zones, and Injuries. 

For the purposes of simplicity, I'd rather skip over the details of Newton's laws of motion and try my hand at  quickly explaining with the use of a few images and facts, why its better to be fully stopped when someone rear-ends your car, rather than rolling forward.

One has to be aware of the way modern vehicles are manufactured.  They are made much different than the way they used to be made in the early days.  Nowadays, and actually for the last several decades, automobiles are made with crumple zones.  A crumple zone is part of the structure of vehicles that simply allows the metal to deform and bend.  The purpose of these crumple zones are to absorb energy from the impact.  To give you an example of the importance of a crumple zone in a vehicle, just think; if you for example, fall from a roof and land on a concrete floor, the chance of injury to your body would be much greater than if you fell from the same roof and landed on, say a very thick mattress.  This is due to the ability of the mattress to slow your body down by absorbing the energy of your falling body.

Look at the way the cars are deformed and will absorb the energy of the collision.

Here is another car.  Look at the way the hood folds up and practically acts like an accordion.  Again, its designed to absorb energy.

Here is a diagram of a car hitting a fixed object.  The crumple zones in a car are located in both the front and the back.

Now if you try to relate this concept to the impact of a car collision, it will begin to make sense why it is advantageous (in most cases) for your car to be completely stopped if you get rear ended.  It is difficult for some people to get this concept.  The mathematical brain is thinking mathematics.  "Okay, if I am traveling forward at about 10 miles per hour and get hit in the back by someone who is traveling at 20 miles per hour, you simply subtract 10 mph from 20 mph to get a net force on the back of my car of only 10 mph."  The thought process is 20 mph-10 mph = 10 mph impact which always sounds better than getting hit at 20 mph.  The math is correct.  You are only being hit at 10 mph.  But, in terms of shock and impact to the body, including the neck and head, during the rear end collision and whiplash, you are probably better to be standing still with your foot on the brake when you are hit from behind.  "But wait, you just told me a 10 mph hit is better than a 20 mph rear end hit?"   Here is the confusion.  Read on.

Okay, back to the crumple zones.  Remember, the crumple zones are designed to absorb energy.  They are designed to absorb energy that that would normally get transferred to the occupants of the vehicle.  So,  here are both scenarios; the first scenario is car rolling and second is car completely stopped: 

Scenario 1.  You are rolling forward 10 mph, you get hit from the back, your car's crumple zones do NOT have the chance or ability to fully absorb the impact of the other car hitting you.  Your car lunges forward from the impact, and your neck and head flies back in the seat as a result of the other car hitting you.

Scenario 2.  Your car is completely stopped, foot on the brake.  You are going 0 mph, and you get hit at 20 mph.  In this case, the crumple zones have a chance to do their job, which is to absorb the impact of the collision and reduce the forces upon the occupants of the vehicle getting hit.  Your car will (generally) not lunge forward as much if you were already rolling forward.

The other way I can explain this to you is for you to just look at the way race cars are made.  Have you ever seen a race car going 150+ mph that crashes into a wall or another car?   What does it do?  It comes apart.  Parts fly everywhere, including the wheels, which fly everywhere.  The purpose here is the same thing.  It's to absorb energy so that the driver of the car gets less of a shock to his body.  Of course, this is just a very simple way for me to explain how these car accident impacts cause injuries, and how the relative motion of the car paradoxically affects the injuries to the passengers.  I say, paradoxically, because it goes against ones rational thinking.  Just remember, crumple zones are your friend.  

A piece of advice to you:  If you think you are about to get get rear ended, good advice would be to firmly plant your foot on the brake and put your head against the head rest.  Let the cars absorb the impact, not your neck!  Also, call a chiropractor right away.

I treat these injuries all the time.  My address is 3161 Dykes Road in Miramar Florida. 33027. Dr. Alan Himmel. My Telephone Numbers are: 954-659-8600 and 305-979-5549. My Web address is: