Q and A 1

The following past entries are in descending order. The most recent letter is at the top.

Letter #20:

Just read your site and enjoyed your " balanced " approach to UC.

I have been practicing the grostic /gregory procedures- minus many of it's inherent shortcomings for 25 years. I realized a long time ago that most of the "measurements" are way off base as well as the mathematical evaluations. In spite of that I have enjoyed a successfull practice with no hype, selling or
other crap that has infested this so-called profession.

My kid is chasing me off the computer,

Dr G__________, Pennsylvania

Reply by oncause to letter #20:
Thank you for your response to the message contained in our oncause web site. Your reply shows both clarity and honesty of thought.

In our opinion, regardless of all the "hoopla and hype" this type of integrity is the only hope for the survival of "cause and effect chiropractic."

Letter #19:
Please let me know if you receive my overview on blair (faxed)
Dr C__________ State Unknown

Reply by oncause to letter #19:
Thank you for the information you sent via the fax on Blair work. As close as I can tell, it seems to be quite a refinement of HIO. Very interesting.

Now I would like to ask you a question. On page two of the material you sent, Dr. Addington (It appears as though he is the author of the paper.) mentions that Blair practitioners use "a dual probe instrument," gliding it on the cervical paraspinal musculature in order to record "persistent differential paraspinal dermothermographic" patterns. My question is: In Blair work what specifically is considered to be the source of those dermothermographic differentials?

Letter # 18:
(The following is a dialogue with excerpts from letter #16 written by Dr. R. and replies to these excerpts written by oncause.)
Quote from oncause, reply # 16: In short, even though the instruction and scrutiny in the week-long classes were very intense and comprehensive, a "R.9" reliability factor was no where in the vicinity. And Dr. Grostic continually let us know about it in no uncertain terms. Is anyone conducting this kind of scrutiny and instruction now?

On one occasion, when I called his office to ask for a recommendation for a DC that an out-of-state patient of mine might see, Maxine Harris, his receptionist, told Dr. Grostic the nature of the call, and although he was busy with patients, he picked up the phone. This was in the middle of his practice time. Dr. Grostic kept me on the line for about 20 minutes, going down the roster, explaining how very few people there were whose work he could rely on. There was only a handful.

Rebuttal Dr. R: Orthospinology has been teaching this work since 1977! We have reorganized the material and teach it over 3, 15 hour seminars held at Life University (continuing education). Also, we have some very well trained instructors at Life University that are teaching the x-ray portion, that has been incorporated into the New Life Cervical Procedure. Although the Orthospinology classes are not as intense as those taught by Dr. Grostic, Sr. the doctors are still well trained. We have more people that actually practice this work in a proficient manner than ever before.

Quote from oncause, reply # 16: One of the major factors that John Grostic Sr., on was the Spinal Balance Test (leg check). He consistently stayed on this, emphasizing its importance, because it is the when factor, which, all things being equal, is very often the difference between success and failure in a case.

He set up a grading system in which each 1/16" had a value of 25%. If a Dr. missed the right answer by 1/8", his or her score on that leg check was 50%. If he or she missed by 3/16, his or her score was 25%, etc.

At the beginning of each week-long seminar it was not unusual for a doctor to have a score of -150 or -200 -- that is an error factor of 5/8" or 3/4", respectively. (Keep in mind that in the first 1/4" you were in positive territory.) It also wasn't unusual at all for a good percentage of the doctors to find the leg deficiency on the wrong side.

Rebuttal Dr. R: That is a very good point. One does have to be proficient in the Supine Leg Check Procedure. It is a procedure and doctors should have proper instruction in order to be proficient. Incidentally, the supine leg check procedure has a reliability of .92 (R) testing well trained doctors. The average error at a 95 percent confidence level is .19 inches. The average error is 1/10 inches. Dr. Grostic was very strict. Using the bell curve maybe 25% for 1/8 inch error would be more realistic. There is nothing wrong with setting your goal high though.

Quote from oncause, reply # 16: Is anyone providing this kind of instruction now?
Rebuttal Dr. R: Again, Orthospinology and for that matter NUCCA and AO also have very good training programs at the post graduate level.

Quote from oncause, reply # 16: How all of this has changed. Although there is nowhere near the instruction and scrutiny now, reliability factors are expressed by a simple mathematical symbol, and that takes care of it.

Rebuttal Dr. R: I disagree with this statement. The training is very good, and the simple mathematical symbol expresses the gauge of "how reliable" the check really is in scientific terms and gives us a measure to learn if we are improving! How else would one know if they are up to par.

Quote from oncause, reply # 16: While on this subject, would you tell us -- the U.C. people who undoubtedly have an intense interest in this matter -- how the R.9 figure was achieved?

Rebuttal Dr. R: As with any group of people, you have about 10% of the group that will show intense interest. These folks are usually the leaders. I estimate about 200 doctors.

Quote from oncause, reply # 16: Questions like: How did you go about finding the focal spot in the X-ray unit that was used? Or, if there were multiple units used in the study, were the focal spots found and the X-ray equipment accordingly aligned?

Rebuttal Dr. R: Again, great questions. We (Orthospinology) ask these question all the time. But now we recommend "laser" alignment, usually done by someone like American X-ray. They issue a certificate of alignment. We recommend double checking the system using the old methods with the "bike spoke", "beaded chain," "alignment block," and "alignment rod." We find that the laser alignment is very good.

Quote from oncause, reply # 16: What Dr. Grostic repeated almost ad infinitum was (this is not a direct quote, but a very accurate paraphrase), "Structures that you see on your films are just shadows -- two dimensional representations of three dimensional structures. And the shadows are only as reliable as the equipment that was used to project them onto the film.

From X-ray alignment and the Spinal Balance Test any reliability study of necessity needs to go on to X-ray placement, X-ray analysis, table placement, contact location, and then all the variables involved in the adjustment itself. All of these factors tend to permutate on one another -- a very dicey combination of variables to investigate and measure, wouldn't you say?

Rebuttal Dr. R: Most of this has been done! Some of it is published in peer review journals.

See: http://orthospinology.org/links.html
The combination of variables require proficiency, but are a far cry from "a dicey combination." Again, Orthospinology (Grostic), along with NUCCA and AO continue to lead and expect to "take the arrows" but I would challenge all techniques to withstand the same objective, scientific scrutiny. It is interesting how easy it is to sit back and find fault, without oneself objectively, scientifically, scrutinizing self!
Quote from oncause, reply # 16: Add this to the inherent table placement error and you do have a rather large "cushion.

Rebuttal Dr. R: The "cushion" is not that large using these procedures. Can you imagine putting the same arguments up against, other more non specific techniques? How will they fair under the same scrutiny? Inquiring minds want to know.

Quote from oncause, reply # 16: I wish to thank you for your comments, Dr. R. They did stimulate thought. However, I think we have very differing opinions on just what causes confusion. In my opinion, it is a failure to grasp and employ fundamentals. As I have mentioned previously, when you fail to grasp fundamentals everything from that point on is subject to misconception and confusion.

I may be wrong on this. But you will have to admit that something has happened to U.C. cause-and-effect chiropractic. It is fading below the horizon. As I said in one of my previous entries, there is a steady, inexorable decline, and this decline seems to be very much a decline in the economics of upper cervical practice. DC's simply do not know enough about the fundamentals to earn a decent living at their work.
Rebuttal Dr. R: I agree, totally with these statements. Let's face it, results are what matter when it comes to a successful practice. The difference between a true professional is the "consistent, proficient application of the basics (or fundamentals) of the professional procedure." This holds true for anything from a "golf swing" to the "chiropractic adjustment."
Dr. R__________, Georgia

Reply by oncause to letter #18:
I am very much a fan of Ernest Hemingway's. Although he was not the originator of the concept, I believe that the philosophy and method he used in developing his prose is in many ways applicable to the practice of chiropractic -- keep it true and unadorned, and you achieve a much more profound effect.

Hemingway mentioned that he very often started his day by WRITING ONE TRUE SENTENCE.

We, as DCs, have many true sentence options in which to start our days. But, in my opinion, if you claim to be an instructor in what is supposed to be a continuation of "Grostic" work, the one true sentence with which you should start your day is: Grostic work and full-spine work are mutually exclusive. This was a statement about which Dr. Grostic was adamant. He made it with so much emphasis and so often, he almost wore the words out. It is a simple, true, unadorned sentence. There is no way around it.

Why do you not mix Grostic work in with other technics that push on and twist the backbone? Because you are introducing an enormous number of variables into your care of the patient, and therefore your ability to bring that patient back to full health is drastically impaired.

This will cause a major drop in your overall success rate, a major drop in your referral rate, and inevitably a major drop in the financial fundamentals of your practice.

Frankly, to me, mathematically expressed reliability studies have a very suspicious and hollow ring to them when someone who would not be considered by Dr. Grostic to be practicing Grostic work expresses them.

Maybe there is some new interpretation of Grostic work in the air. Maybe we have a case here of new bottles for old wine. Or, maybe it is a case of new bottles for new wine. If so, I think myself and the few truly UC practitioners who are left in the world would appreciate an explanation of what the new rationale is.

Letter #17:
I am a "cause and effect" upper cervical chiropractor in GA. I started practice in May of 1999 and would love any advice in the area of patient referrals. I help people, they get excited, but then they just haven't referred. I would love to know what you do and how you do it. Do you ask them to refer or hint about it? What do you find to be the most effective?

I would love to be placed on your email update list for your website. I look forward to hearing from you. Thank you for the letter.
Dr. B__________ Georgia

Reply by oncause to letter #17:
First of all, sorry for the delay in getting back to you regarding your practice-development questions.

Building a cause-and-effect U.C. practice takes time. A good analogy is the old fable of the Three Little Pigs. One did not want to put the time and effort into it, so he built his house out of straw. We all know what happen to him. And we all know what happened to the one who built his house out of sticks. But the one who took the time and effort to build his house out of bricks is, as far as we know, still hanging around.
This fable applies only in a certain sense, with regard to building a U.C. practice. The analogy only stretches so far. The difference is this: the pigs only had to build something that was "hands on," that is, there were no abstractions involved in their task.

However, in building a successful U.C. practice, after the hands-on work (finding an office, installing the X-ray unit, adjusting table, painting, decorating, etc.,) is finished, then the far more difficult part still remains to be done.

The difficult part is the abstract part, building within yourself the consciousness that will attract new patients to your office.

Getting sick people well, regardless of how miraculous the results, will not make your phone ring. What will make your phone ring is your consciousness -- your intensity, your integrity and your enthusiasm for your work.

If all three of these are present in the right amount within you, people cannot help but be struck by you. They will REMEMBER you. They will REMEMBER you when they come in contact with friends, relatives, acquaintances who need your care.

This is FUNDAMENTAL. It is FUNDAMENTAL Rule#1. AND YOU CANNOT FAKE IT.

Now, speaking of REMEMBERING you, my advice to you is to not do any advertising outside of your patient roster. Especially, do not advertise in any of the public media: TV, radio or newspaper. It does not work in a U.C. practice. You may, in the short term, attract a certain element of the community. But the substantial part of the community, the part that pays its bills and has standing and credibility (credibility means the ability to convince and refer other people) within the community, is very much put off by doctors who RETAIL THEIR SERVICES. Whether consciously, or subconsciously, the substantial part of the community tends to REMEMBER and SHUN these types of practitioners .

Simply put, peddling your wares can only have a significant, long-term, downside effect on your practice.

I hope this advice will help you in your work.

I can only say, hang in there like the wise little pig who had enough sense to build of brick. In the long run, there will develop in the community a sense of your sincerity and the value of your work, and you will be as busy as you want to be.

AND THE BIG BAD HMO WOLF WON'T HAVE YOU FOR HIS LUNCH.

Letter #16:
Dear Chiropractor,
Quote from oncause, reply # 12: Incidentally, speaking of "cushions," here is another point you might ponder: When using the Grostic/NUCCA calculations, consider the difference in the adjusting vector (final resultant, notch transverse resultant, whichever you wish to call it) when a female DC who is 5'4" tall with commensurate arm length/notch transverse distance, uses the same tables to calculate her adjusting vector as a male DC who is 6'4" with commensurate arm length/notch transverse distance.

Add this to your rotational and laterality "cushion" and you have a real "cushion."
Rebuttal Dr. R: Again, apparently you are speaking from an uneducated position. We performed those calculations for an actual doctor 5'8" compared to a doctor 6'2". You know what the variance was, only 1/4 inch in Height factor. Converting that to degrees of instrument setting or hand adjustment vector angularity that equals 6/10 OF ONE DEGREE. Wow, big error. I really do not intend on bordering on being rude, I simply believe that if you are going to try to expand upper cervical work, whether it is Orthospinology, Grostic, NUCCA, Sweat, Blaire or Kale you should at least be up on the current research and not try to confuse doctors with statements that are based on critical fallacies from 10 years ago or more.

Same goes for your comments on the "pencil" corrections. This only shows you are not up to speed on the current research. The Orthospinology/Grostic, NUCCA, and Sweat (Orthogonality) x-ray analysis has already been show to be reliable, with reliability ratings around R=.9 with 1 being perfect. Please stop misleading doctors.

Please do not misunderstand my responses, I am all for raising awareness of upper cervical work, however, let us concentrate on what makes us similar, not different. So far your site has concentrated on trying to mislead doctors, based on your responses. Let's not repeat the mistakes made over the last 10 - 20 years concerning upper cervical chiropractic care. There are too few of us already.
Dr. R__________, Georgia

Reply by oncause to letter #16:
I’m sure that Dr. John Grostic Sr., were he alive today, would be comfortably reassured by the R.9 reliability figure you mention.

However, in his life span, having conducted for years four seminars per year for approximately 200 DCs per year (there was an average of about 50 DCs per seminar) in very demanding, close scrutiny, week-long classes, he consistently expressed his extreme vexation with the degree of unreliability that was present in the work that was submitted to him by the field doctors. (Seven films were required in order to be admitted to the class -- vertex and nasium alignment films and a complete set of Pre and Posts on a case -- lateral, nasium and vertex Pre’s and nasium and vertex Posts.) Please keep in mind that this vexation was the sentiment of the developer of the Grostic technic, who was analyzing and grading the work of field doctors -- spending, in his own words, an average of four hours per doctor, per class. That amounts to about 600 hours per year, or over ten hours per week year round, (the DCs in the elementary class obviously did not have to send in alignment films and Pre and Post X-rays).

In short, even though the instruction and scrutiny in the week-long classes were very intense and comprehensive, a "R.9" reliability factor was no where in the vicinity. And Dr. Grostic continually let us know about it in no uncertain terms. Is anyone conducting this kind of scrutiny and instruction now?

One of the major factors that John Grostic, Sr. focused on was the Spinal Balance Test (leg check). He consistently stayed on this, emphasizing its importance, because it is the when factor, which, all things being equal, is very often the difference between success and failure in a case.

At the beginning of each week-long seminar it was not unusual for a doctor to have a score of -150 or -200 -- that is an error factor of 5/8" or 3/4", respectively. (Keep in mind that in the first 1/4" you were in positive territory.) It also wasn’t unusual at all for a good percentage of the doctors to find the leg deficiency on the wrong side.

However, as the class progressed through the week, with the doctors being repeatedly drilled and checked on, the error margins came way down, and on the last day or two most of us were pretty well on target.

Is anyone providing this kind of instruction now?

How all of this has changed. Although there is nowhere near the instruction and scrutiny now, reliability factors are expressed by a simple mathematical symbol, and that takes care of it.

While on this subject, would you tell us -- the U.C. people who undoubtedly have an intense interest in this matter -- how the R9 figure was achieved?

Questions like: How did you go about finding the focal spot in the X-ray unit that was used? Or, if there were multiple units used in the study, were the focal spots found and the X-ray equipment accordingly aligned?

What Dr. Grostic repeated almost ad infinitum was (this is not a direct quote, but a very accurate paraphrase), "Structures that you see on your films are just shadows -- two dimensional representations of three dimensional structures. And the shadows are only as reliable as the equipment that was used to project them onto the film."

Now, on to our previous conversation on the inherent error in table placement, and the inherent vector error between DCs of varying height and Notch-Transverse-Distances:

Add this to the inherent table placement error and you do have a rather large "cushion".

I wish to thank you for your comments, Dr. R. They did stimulate thought. However, I think we have very differing opinions on just what causes confusion. In my opinion, it is a failure to grasp and employ fundamentals. As I have mentioned previously, when you fail to grasp fundamentals everything from that point on is subject to misconception and confusion.

I may be wrong on this. But you will have to admit that something has happened to U.C. cause-and-effect chiropractic. It is fading below the horizon. As I said in one of my previous entries, there is a steady, inexorable decline, and this decline seems to be very much a decline in the economics of upper cervical practice. DC’s simply do not know enough about the fundamentals to earn a decent living at their work.
Maybe fundamentals are not as important as I have portrayed them to be. But I would arm wrestle you a long time on this issue. It has been my experience that attention to fundamentals builds skills, skills build results and results build a lively, thriving practice.

We welcome any further comments you may have. We would be happy to discuss with you the fundamental reasons for not mixing full spine technics in with "Grostic" work. We would also be happy to discuss the downside effect that the mixing of full spine technics with Grostic work has on referral activity

Letter # 15:
Dear Chiropractor,
Very bold statement "worlds largest exclusively UC practice". How do you know this?? I also seen your paper on NUCCA which I happen to agree with.I practiced NUCCA for 3 yrs.and AO for about 2.Stopped both when my health started going down hill due to being adjusted to 90/90 and alsofinding out for the first time that, the UC area as a rule is asymmetrical, foramen mag. being off center 62% of the time as one example.I am now adjusting Blair because it is the only UC tech.that I know of that takes this in to account.Do you have any thoughts on this?? Any way its nice to talk to other UC Chiroprators.
Dr. C____________ State Unknown

Reply by oncause to letter #15:
Glad to hear that you have regained your health with the Blair technic.

Regarding the "90/90" that you mention in your letter: I assume that you are speaking of the NUCCA/AO, etc., axiom of 90 degrees being the optimum in the angle formed by the juncture of the "central skull" line and a line drawn through the inferior attachments of the posterior arch of the atlas, and 90 degrees being the optimum angle for the juncture of the lower cervical line with the inferior attachment line, and also, on the vertex film, 90 degrees being the optimum angle in the juncture of a line drawn through the "center" of the long axis of the skull and a line drawn through the centers of the foremena transversarii.

Good point to think about and good point to question!

Can any Nucca/AO, etc., practitioners answer this question?

Why do you draw your horizontal line through the inferior attachments? Why not, for instance, the superior attachments? Why not the inferior tips of the lateral masses? Why not the inferior attachments of the transverse processes? And why do you draw your "central skull" line the way you do? And, more to the point, why are you attempting to adjust the cervical spine so that these lines (when drawn accurately) form right angles?

Also, Dr. C, from your side of the ocean, do you know if the NUCCA/A0 practitioner who was adjusting you had his or her X-ray unit in perfect alignment Did he or she start by finding the focal spot in the unit and then work forward on tube alignment from there, eliminating variables?

Were the films that were taken on you free of distortion -- head rotation on the nasium, head tip on the vertex? Were the films clear and sharp so that the dots could be placed accurately and duplicated on the post? Was the skull divider used accurately?

Since you practiced NUCCA for 3 years and AO for 2 years, did you start by finding the focal spot on your X-ray unit and proceed to align your equipment?

Another question, regarding the issue of the foremen magnum being off center in 62% of the cases: I believe you. I can see no reason why the foremen magnum should be in the center of the skull. But could you tell us the exact method that you or someone else used to arrive at that conclusion -- how many cases were in the study? How exactly were the measurements made? Which views? Were the films sharp in detail and contrast, and was the equipment in alignment?

I think all U.C. practitioners would be interested in the answers to these questions.
Would you please let us know?

Also, I do not have an in depth knowledge of the Blair technic. Could you tell us what test or tests are used to determine when the patient needs to be adjusted?

S.N.) We, in chiropractic, have a seemingly endless assortment of technics and practice-building courses, but at root they are all an attempt to answer the questions: "WHO ARE WE, AND WHAT SHOULD WE BE DOING?"

Letter #14:
Dear Chiropractor,
I am interested in learning the concepts of the technique that you utilize in your system of Chiropractic. Will you be having more info on the web site in regards to this?
Thank You,
Dr. E__________, North Dakota

Reply by oncause to letter #14:
This web site is different from anything you have previously experienced in chiropractic. Believe it or not, it does not have a proprietary intent. We are not selling or promoting any technic or product. We are simply providing, at the expense of our time and effort, a venue which may prompt the U.C. chiropractor to think, discuss, and thus have his or her consciousness drawn more into his or her work.

Letter #13:
Dear Chiropractor,
I recently received your intro. letter and was pleased to be able to access other straight D.C. professionals info. re: the subject of U.C. chiropractic. However, my wife and I were confused on the point and purpose of your "U.C. Technique" section. Were you intent on discrediting vector based atlas procedures or trying to jump start a discussion on this topic. There were no points about alternatives/implications re: vector work.

My wife is inclined to view this as a spark to inspire improvement in methods of this work. I, however, am dismayed by the lack of pertinent info. that this section has on the body of your invitation , which was after all, on "cause and effect" chiropractic. That philosophy contends there is no relevance to procedure if nerve interference is located, removed and monitored.

Bottom line is, how do I tell my wife all of those patients that she has seen improve had a 400% head placement error....the odds on correction are astonishing.
Yours in chiropractic,
Drs. G__________, New Mexico

Reply by oncause to letter #13:
Your wife’s comment was right on target. That indeed is our intention, our only intention.

I do not understand the last part of your second paragraph, particularly the last sentence. If you will clarify, I will be glad to respond.

Regarding your last paragraph: How would you tell a practitioner who uses a less precise approach -- or even a diversified practitioner -- that they don’t, at times, get miraculous results? The system we are dealing with is obviously very forgiving; if it weren’t, chiropractic would never have survived. However, having said that, it is my strongly held opinion that, over the long haul, the more accurate your work, the more consistent your percentage of results, the better you position yourself to build a thriving practice.

To use a metaphor: It’s a 162 game schedule, and all things being equal, the baseball team that best plays the percentages, has the percentages on its side, will always finish ahead.

Letter #12:
Hi Dr. Molthen et., al.:
Nice try on the 100 / 200% error message but your comments show your lack of knowledge of the Grostic, Orthospinology, NUCCA, Orthogonality and other Grostic based procedures.

Point #1:
First of all, the anterior/posterior rotational component of the adjusting vector is not measured with reference to the floor, it is measured with reference to the skull and atlas, therefore the position of the skull relative to the floor, table or a point on the odontoid is TOTALLY irrelevant. Your point would only be true if the Grostic Vector anterior or posterior component was measured with reference to anything other than the skull. Since, during the adjustment procedure, the anterior or posterior C1 rotation is measured with reference to the skull, and the C1 rotation, from x-ray analysis, is in reference to the skull, your argument amounts to nothing more than a SMOKE SCREEN to confuse other uneducated UC practitioners.

Point #2
John F. Grostic, D.C. was apparently very well educated in physics and statistical analysis (or had engineers helping him) because he realized the potential error of measuring such small magnitudes of rotation for the rotational component of the Oc/C1 relationship. Understanding physics, he knew that to adjust the rotational component of Oc/C1, it was ONLY NECESSARY to be OUTSIDE the rotation of C1 so that the Line of Correction would initiate an "A - P" force for anterior C1/Oc rotations and a "P - A" force for posterior C1/Oc rotations. In order to accomplish this one must be sure to be close to but OUTSIDE the Oc/C1 rotational misalignment. Realizing these facts and knowing that errors will occur, and realizing the complexity of teaching other doctors to reproduce this procedure clinically, Dr. Grostic did a very ingenious thing. For every 1 degree of C1/Oc rotational misalignment, in clinical practice, measure 1 inch anterior or posterior from the TP of C1 at a 90 degree angle from an imaginary line from the C1 TP to EOM, for the adjusting vector. Using simple trigonometry, one can see that assuming 24 inches from the pisiform to a point central to the pivot points of each shoulder (approx. 1 - 2 inches behind the episternal notch) we can see that the Arc sin (1/24) is equal to 2.38 degrees. So, in actuality, the Grostic vector is delivered Outside the rotational misalignment of C1/Oc by a minimum of 138%, the minimum cushion to insure a successful initiation of a correction as applied to the MAJORITY of doctors using it in a clinical setting. Even if your argument held water, which it doesn't from the Point #1 reason, even with a 200% error as you described, the Grostic vector would still initiate the appropriate correction 70% of the time due to a built in "cushion" that was designed in the procedure.

With that said, I want to congratulate you on your successful UC practice. Without knowing anything else about you or your organization, I am sure you have many valuable things to contribute to the practicing UC chiropractors. I would be interested in hearing more of what you have to say about the practice of UCC chiropractic. I do disagree with your argument against the Grostic based procedures, though. Also, I would be interested in seeing the rebuttals from the NUCCA chiropractors.
Dr. R__________, Georgia

Reply by oncause to letter #12:
Having taken six seminars in Ann Arbor from Dr. Grostic and three seminars in Monroe from Dr, Gregory, I am thoroughly familiar with the various hypothesis and calculations involved in the Grostic/NUCCA technic.

The point I am making is a very simple one: you are constructing a vector which is a compound of two anatomical planes aimed at an anatomical target -- the subluxation complex -- of which the skull is an integral part. Therefore, if you cannot place the skull in a precise position in relationship to your precise vector, you have an extreme likelihood of an error of such magnitude that your previous, precise calculations are rendered insignificant.

This does not mean, that you are not getting sick people well. It’s just that, "cushions" notwithstanding, you are not doing what you think you are doing.

Incidentally, speaking of "cushions," here is another point you might ponder: When using the Grostic/NUCCA calculations, consider the difference in the adjusting vector (final resultant, notch transverse resultant, whichever you wish to call it) when a female DC who is 5’4" tall with commensurate arm length/notch transverse distance, uses the same tables to calculate her adjusting vector as a male DC who is 6’4" with commensurate arm length/notch transverse distance.

Add this to your rotational and laterality "cushion" and you have a real "cushion."
I would like to add here that your letter was rather strident, with an edge of impoliteness to it. There has been far too much of this in the past. As Yogi Berra would say, "It was deja vu all over again."

We will be glad to continue a dialogue with you, but please follow the rules of professional etiquette. Even though, as we mentioned in our opening letter, our numbers have apparently diminished to the point where we are on the endangered species list, we consider what is left of the upper-cervical community to be the most solidly "on cause" part of our profession. The purpose of this web site is not to sell or promote any technic. We are simply providing, at the expense of our time and effort, a venue which may prompt the U.C. chiropractor to think, discuss, and thus have his or her consciousness drawn more into his or her work. This can have no effect other than making him or her more professionally and financially successful.

Letter #11:
Howdy,
I am familiar with the conversation between Dr. Molthen and Dr. Gregory that took place in Chiropractic Economics twenty years ago. I know very little of the technique you are practicing in your office. Your web site doesn't enlighten me very much. Rather than try to guess, can you refer me to some information so I could evaluate it myself? I am always interested in answers that have come from research into the upper cervical work. Dr. Gregory was at times, a difficult man to come to terms with, but he has been dead now for nine and a half years. The antipathies of the past can be released. We never know enough and I would be happy to be able to read a bit about your work.
Thank you for your time,
T__________, D.C. (I am, by the way, the only Chiropractor I know of for many hours around me.... the rest call themselves Chiropractic Physicians and our board in Florida is now The Board of Chiropractic Medicine...yes, it is sad.)
Dr. T__________, Florida

Reply by oncause to letter #11:
As we have mentioned in our previous responses, although this may be a chiropractic first, our intention is not to sell or promote any technic or product. We are simply attempting to stimulate thought in the area of U.C. practice. I agree with you, we never know enough. That’s why, in any field, the reviewing of professional dialogues is done. Inducing people to think for themselves can, in the long run, only have a positive effect.

Letter #10:
Dear Dr. Molthen et al,
Your letter dated 08-27-99 interested me in the web site, which I visited today. Imagine my disappointment to see the article challenging adjusting concepts of NUCCA. I thought this site would provide some common ground for upper cervical chiropractors.

No technique is above criticism. The constant inter-technique wars that our profession endures have shackled our progress. If you have something to advance, why do it at the expense of another technique? Harrison, in his CPB paper does a decent job already of challenging and criticizing other techniques.
I hope your web site will reflect a better standard in the future.
Dr. R__________, (State Unknown)

Reply by oncause to letter #10:
We are simply providing, at the expense of our time and effort, a venue which may prompt the U.C. chiropractor to think, discuss, and thus have his or her consciousness drawn more into his or her work. This can have no effect other than making him or her more professionally aware and financially successful.

Letter #9:
Dear chiropractors,
I received your letter and think its a good idea that you have. My name and address is: [G__________, D.C. __________, __________]
Dr. G__________, New Jersey

Reply by oncause to letter #9:
Our intention is none other than to induce thought and dialogue into what is left of the U.C. community. Thank you for your positive response and the picture.

Letter #8:
Dear Dr. Molthen,
Hi. My name is Dr. [G__________]. I have been practicing NUCCA in CA for the last 8 years. My partner who also practices NUCCA is about to give the duel support head piece a try. Recently, my partner traveled to Dr. [B__________'s] office in Oklahoma because he uses the duel support head piece. Evidently, his two associate doctors are consistently getting 80% corrections after only 5 years of practice. The duel support head piece is not tilted for Type 2 or Type 4 listings. They claim to simply adjust by the X-ray listing with the head always in a neutral position. The muscles are always relaxed. Large audibles can be heard and the post x-rays show 80% corrections. Is this the great big secret which has been withheld from upper cervical chiropractors which continue to struggle with getting great corrections consistently. Are you using the same or similar type head piece. I'm frustrated because I have been practicing the upper cervical technique for 8 years and although I achieve some great corrections I'm still inconsistent. Please talk to me.
Dr. G__________, California

Reply by oncause to letter #8:
Not having seen the headpiece or the Post x-rays you mention in your letter, I cannot comment. However, I will give you my honest opinion.

Based on over forty years of conducting a large, exclusively U.C. practice, and over forty years of absorption in and scrutiny of the problems inherent in analyzing and adjusting the U.C. area, it has been my experience that all too frequently the reduction is in the eye of the adjustor.

That was one of the things that disillusioned me back in the sixties. With very, very few exceptions when I had a chance to personally analyze Pre and Post cervical films the reductions were of the pencil type. This was one of the things that prompted me to begin working down my own path.

The usual scenario would go something like this: (For simplicity's sake I will just use one factor of the subluxation, the laterality factor, as an example; however, this applies to all factors of the "subluxation" that are listed.) Typically on a film that some DC was displaying in some way, the Pre atlas laterality would be listed at, say, an R 4. The Post would be listed at N, or possibly an R 1/4 or R 1/2. Now this is a very fine reduction, right? 4 degrees of the laterality factor has been removed from the "subluxation."

In almost every instance of this sort, when I had the opportunity to read the film honestly and objectively, I would find something like the following: Pre atlas laterality R 2, Post atlas laterality R 2 or possibly, R 1 3/4 or R 1 1/2. The misalignment was read significantly greater on the Pre than it actually was and significantly lesser on the Post than it actually was, thus yielding a complete, or almost complete reduction.

Why did this occur? Because we are dealing with, first, human nature where favorable interpretation is and always has been the norm, and secondly, because when taking and reading Pre and Post films we are dealing with a huge bowl of spaghetti -- the possibility of a large number of variables enters the picture, all of which can easily be subordinated to favorable interpretation. To name only two of the obvious variables: 1) Incorrect tube alignment -- if exact tube alignment is not there, STOP! You are kidding yourself from there on; 2) Patient placement -- if there is more than 1/8 of an inch of head rotation in the nasium film, STOP! You are kidding yourself from there on. The skull is an elliptical object with its long axis being from A to P. Therefore, x-rays being a projection of shadows on the film, a slight turning of the object in relation to the source of radiation will produce an illusion. You are, no doubt, familiar with the old game of hand shadows on the wall cast by a flashlight. Move or turn the fingers slightly and how much does the shadow change? Move the flashlight slightly and how much does the shadow change? Rotate the hand slightly, slant the flashlight slightly. If you could, slant the wall (in this case the bucky) slightly. What happens? How about all three of these factors in incorrect alignment with each other?
I’m sure you see what I mean.

Now, add to this our old nemesis favorable interpretation and you can see what can and will happen.

And this is just for starters.

Now let's include something else: Clarity of film -- contrast and detail. More latitude, right? Ability to locate the exact ossification centers for the inferior attachments of the posterior arch. These dots are close enough to each other so that it takes very little "penciling" -- on the Pre, up a little on one side, down a little on the other side, then reverse this on the Post film --and, Viola! we have a nice "reduction." Unless your films are very clear and your posterior arch is shot just right so you can definitely see the attachments, you have more latitude to play around in. Whistling in the fog! How about the Central Skull Line? Do you understand the skull divider, what you are doing with it and do you know how to use it precisely?

This, of course, does not mean that you cannot get sick people well unless you follow these very precise axioms in your work. As I mentioned in one of my other responses, we are obviously dealing with a very forgiving system.

What it does mean though, is that consistency in your results is a function of your accuracy and your understanding of your work. And consistency is how you get referrals and build a practice. Inconsistency will stop a referral tangent COLD! (By referral tangent, I mean a group of patients who are in a particular social group who begin talking to each other about the results they received under your care.) Usually a particular referral tangent will continue as long as you are getting good results. Sometimes it take only one failure case to shut a referral tangent down, two failure cases from the same tangent and you’d better find a new tangent.

As a side note here -- have you ever heard of a DC coming up with an idea or a product that didn’t work, or wasn’t a breakthrough?

Now, referring back to my previous example of the phantom or penciled reduction, a very interesting result often occurs. The dialogue goes something like this: "I took this case from an R 4 down to a 0 (N) and the condition did not clear up. So, I decided that there must have been interference at some other place in the spine. I adjusted L 4 and the patient felt better." Ergo, the lumbars or dorsals need to be adjusted too.

I have no doubt that the patient can feel better with various backbone adjustments. But two major problems arise from this misinterpretation of the actual facts: 1) The DC has fooled and confused himself and thus added confusion to chiropractic; and 2) The patient continues to carry nerve interference, which, if not removed, will cause his or her system to continue to breakdown, resulting in more illness, which can ultimately be the cause of his or her death. I think we can safely say that the Death Certificate will not read, "Cause of Death -- Nerve Interference."

Dr. G., it is a very weighty thing we do when we step up to make an adjustment. But all we can do is our best. We can start this process by immersing ourselves in our work. And our first order of business should be honesty. Be honest in how you locate and remove variables.

The first variable in our work is tube alignment. And the first variable in x-ray tube alignment is the location of the anode. Anodes are not always in the center of apertures.

Do you know how to locate the anode of your x-ray unit?

In closing, my best advice to you is to be painfully honest in scrutinizing your work. This can be done in a very positive way, interesting and absorbing -- far more interesting, absorbing and rewarding than improving your golf game. (Don’t know whether you play golf or not -- just an example.)
Addendum: Can any of you U.C. practitioners out there explain to Dr. G. how to go about locating the anode in his x-ray unit?
Letter #7:
Dear Doctors, When I adjust a patient and they still hurt I feel inclined to do more, so that when they leave they feel better. How do you approach this scenario?

Reply by oncause to letter #7:
No scenario involved. Adjust the patient properly then let the body repair itself. If this is done properly you will get good results and good referrals.

Letter #6:
Dear Doctors, My practice is dying. I used to be a straight U.C. Doctor, but I can’t stay busy with managed care. How has your office done with managed care? I have had to add traction to my office to help placate my patients and to bring in some revenue.

Reply by oncause to letter #6:
We have grown during the so called "managed care crisis." We had to add another D.C. to our staff. We do not belong to any managed care groups. We have very few insurance cases and even fewer P.I. cases and almost no Work Comp cases. You can do very well during the managed care era. To build a busy practice at any time you have to find the answers within yourself.

Incidentally, I wouldn’t feel too badly about using traction, one of the most high profile U.C. technique gurus uses traction in his practice. However, it’s better for all concerned if you stay with the removal of the cause. Spinal traction as you know is counterproductive to the patient’s well being. You are changing the spinal biomechanics in a forced aberrant way. When the proper adjustment is made the central nervous system rectifies and stabilizes spinal mechanics in a proper way.

Letter #5:
Dear Doctors, I have had a few miracle cases with asthma (3), in 11 years of practicing, but sometimes asthma cases are unchanged and occasionally they have gotten worse. What do I need to do?
Reply by oncause to letter #5:
Asthma responds beautifully to the proper adjustment. You have hit it right randomly.

Letter #4:
Dear Doctors, I had a low back, sciatic neuritis case, that had an MRI and was told that they need surgery for a bulging disc. Do you handle these cases?

Reply by oncause to letter #4:
Of course we handle these cases, with excellent success, MRI not withstanding. We see 200-300 of these "MRI bulging disc" cases per year and run into a truly surgical case about once every two years -- you do the math. This tells you something about looking into the body with high technology and forgetting about the body’s inherent ability to repair itself, doesn’t it?

Letter #3:
Dear Doctors, I have heard of some UC doctors not adjusting patients on office visits. Do you not adjust someone when they come in hurting?

Reply by oncause to letter #3:
Approximately 50-60% of our office visits are check ups with no adjustment required. We do not see patients for their symptoms, we see them for the cause of their symptoms. Therefore, when our analysis shows the patient to be in adjustment, they are not adjusted. Where, how and when all have to be there. The why, I’m sure you know.

Letter #2:
Dear Doctors, How come I have never heard of your group before? You mention that you are the world’s largest exclusively upper cervical practice.

Reply by oncause to letter #2:
We have kept a low profile for 30+ years, because of the confusion within the profession. We were hoping it would straighten out, but it has only gotten worse. Some of you might comment that this web page will only add to your confusion. So be it. Rise to the occasion. If you cannot do so, then get out there and sell your vitamins, Amway products, therapeutic massages etc.

Letter #1:
Dear Doctors, Every time I do a spinal screening at the county fair, I bring in some new patients because I offer them free services for a month, then they drop out. During this month my practice increases and it has more energy and it is more fun. What happened?
Reply by oncause to letter #1:
Good observation, you started to enjoy what you were doing, and you were concentrating on your work. Drop the spinal screenings and stop giving away your services, but maintain that spizzerinctum as BJ called it. (Unfortunately many of you have not heard this word, it means excitement for "cause-and-effect chiropractic.")