dras knowledge

Thursday, May 11, 2006

Dr. Jin Zhou invents and advocates ZHT chiropractic treatment for snoring.

Dr. Jin Zhou invents and advocates ZHT chiropractic treatment for snoring.

1. His ZHT: http://www.zhtcare.com/whatiszht.html



WHAT IS ZHT?

In ONE sentence on the Website:

"It is a new clinical concept of etiology,
pathophysiology and clinical therapy, which identifies
Trachea Caudal displacement (TCD) included chronic
intermittent hypoxia through Silent upper Airway
Resistance Syndrome (SUARS) and Frequent & Recurrent
Upper Airway Collapse Syndrome (FRUACS) as a new
fundamental physio-pathological mechanism, as one of
the main causes, for mild to moderate but prolonged
hypoxia for most illness & diseases."

With a clinical background in sleep studies, I
recognize most of the big words, but I read this
several times and still can't tell what "ZHT" is.

I have not met Dr. Zhou, but our paths have crossed.
My impression is that Dr. Zhou is a salesman. Like any
good door-to-door salesman, he intimately knows about
and believes in the products he sells.

Probably many shortcomings we see in how he presents
information on the website results from a combination
of a 100-mile-per-hour personality, Chinese as a
native language, and an American medical language that
has been influenced by what we might call on this list
as Chirospeak. Looks like Dr. Zhou has created a
Website to effectively appeal to the intended
population of his product. I also believe he could
write volumes on ZHT and cite hundreds of legitimate
references to tidbits of information that stand to
support his theories.

His "erisaclaim.com" website follows the same
character. It presents almost like a supermarket
tabloid, intentionally so (I think) in order to appeal
to the projected audience. Again, the product is
well-referenced with tons of legitimate details.

"Fringe" is the word I'd use to describe these sites.
Most of us have practical or learned wisdom about the
risks of buying something from a door-to-door
salesman.


dras

Tuesday, May 09, 2006

Electrodiagnostic testing legitimacy

The most comprehensive and authoritative review of electrodiagnostic testing and procedure coding:
http://www.aanem.org/documents/recpolicy.pdf

Aetna's medical policy:
http://www.aetna.com/cpb/data/CPBA0485.html
(they don't seem to think too highly of these tests)

Local intermediary LCD:
http://www.medicarenhic.com//cal_prov/draft/nervousstudies.htm

An old Noridian LMRP:
http://www.noridianmedicare.com/provider/pubs/med_a/policy/final/mn/mn99.08a.html

A review article from a professional pain journal.
I'd encourage you read the whole thing because I think it explains exactly the practices and devices in your case. Although this information is somewhat credible,
keep in mind this is essentially an opinion from a (looks like)forward-thinking pain treatment practitioner, and shouldn't be necessarily accepted as standard practice, or evidence-based practice, or even accepted practice.
http://www.painphysicianjournal.com/2006/january/2006;9;69-82.pdf

I think if the testing is used and coded as described
in the AANEM guideline linked above, it is not fraud
in practice, or on a claim. That doesn't mean an
insurance carrier won't deny it as not medically
necessary/experimental. You have every reason to be
skeptical if it looks like this doctor is essentially
basing his whole practice on the use of this test or
machine - that doesn't sound like good medicine. Good
luck.

Friday, May 05, 2006

Are Neurotesting devices only for Quacks?

The device had many of the same characteristics that> Dr. Barrett describes under quack electrodiagnostic devices at http://www.quackwatch.org/01QuackeryRelatedTopics/electro.html.>


The most comprehensive and authoritative review of electrodiagnostic testing and procedure coding:
http://www.aanem.org/documents/recpolicy.pdf

Aetna's medical policy:
http://www.aetna.com/cpb/data/CPBA0485.html
(they don't seem to think too highly of these tests)

Local intermediary LCD:
http://www.medicarenhic.com//cal_prov/draft/nervousstudies.htmAn old

Noridian LMRP:
http://www.noridianmedicare.com/provider/pubs/med_a/policy/final/mn/mn99.08a.html

A review article from a professional pain journal. Although this information is somewhat credible, keep in mind this is essentially an opinion from a (looks like) forward-thinking pain treatment practitioner, and shouldn't be necessarily accepted as standard practice, or evidence-based practice, or even accepted practice.
http://www.painphysicianjournal.com/2006/january/2006;9;69-82.pdf

I think if the testing is used and coded as described in the AANEM guideline linked above, it is not fraud in practice, or on a claim. That doesn't mean an insurance carrier won't deny it as not medically necessary/experimental. You have every reason to be skeptical if it looks like this doctor is essentially basing his whole practice on the use of this test or machine - that doesn't sound like good medicine.

The testing is done using an instrument called EDX Epi-Scan

I'm only a little familiar with autonomic function tests. Tests like the QSART mentioned in CPT 95923 have been around a long time, although I had the impression their clinical application and use had shrunk some over the years. And that's probably why most insurers allow them - they haven't been a significant source of utilization or expense. Neurologists use these tests to assess function and develop care plans for people with, for example, Sjogren's Syndrome, diabetic neuropathies, and sometimes spinal cord injuries. Diagnosis of regional pain syndrome is a new one on me. But, given the suspected etiology of this poorly defined condition, I suppose it can make sense.

Like I said, the QSART has been around and is used fairly infrequently in clinical practice within the whole of medicine. The other tests described in the CPT 95923 probable have very little true clinical utility. They might make the clinician nod and scratch a chin, but won't really change the treatment approach one way or another.

So, is it a quack device? Probably not. Is it's use important and essential in the diagnostic work up of regional pain syndrome? Well, it might have it's place. If you have a reputable (board certified) neurologist or rheumatologist doing it for selected patients, and it's not something his/her whole medical practice is based on, I wouldn't be too skeptical.

dras

Wednesday, May 03, 2006

Ephedra FDA Ban...The Saga Continues

I have a couple questions:

First, if Brigham Tea is growing naturally all over Utah and the SW (drive along any rural road in southern Utah and I can probably find it within 15 minutes), why is EMAX, Neurtraceutical, or anyone else, all bitter about not being able to ship ephedra in by the ton from China to SLC and Denver?

Second, probably unrelated question. Is there a bigger picture to the trafficking and marketing of bulk Chinese-refined ephedra that's being overlooked here?

See:
K. M. Andrews. Ephedra's Role As a Precursor in the Clandestine Manufacture of Methamphetamine. Journal of Forensic Sciences 40(4), 551-560 (1995)
"Conclusion"Discussed issues concerning accessibility, chemical regulation, and profitability support the theory that ephedra is a feasible and practical material for synthesizing methamphetamine. Therefore, it has the potential for replacing synthetic preparations of ephedrine and pseudoephedrine as a major precursor material for illicit methamphetamine manufacturing. Three "marker compounds" differentiating material synthesized from ephedra versus synthetic ephedrine have been discussed."

dras