For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Issue 13
10/10/07 18:16
Evil Ernst
who wants to adjust Ernst?
I can offer up a permanent adjustment...
I like the BCA president's quote:
He accuses Ernst of 'puffing up his evidence out of all proportion'.
Meantime, see my next message on adverse events. Medics are killing them ever so much better now...sad to say.
http://observer.guardian.co.uk/uk_news/story/0,,2175332,00.html
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Alternative therapy for backache 'can kill or disable'
Robin McKie, science editor
Sunday September 23, 2007
The Observer
One of the most common 'alternative' treatments for backache is dangerous and can kill, says Britain's leading expert on complementary medicine, Professor Edzard Ernst.
Spinal manipulation, used by chiropractors to treat hundreds of thousands of patients a year, poses serious risks, he warns in a paper published in the Journal of the Royal Society of Medicine
'[It] is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death.'
Spinal manipulation involves sharp thrusts against a patient's spine to push individual vertebrae beyond normal levels of stress. But Ernst says that such violent therapy can seriously damage the arteries running near the spine, triggering thrombosis or a stroke.
The claim has incensed chiropractors. In letters to be published in the journal's October issue, they accuse Ernst of distortion, errors and misinterpreting data.
'The major body of published evidence points to manipulation being a safe and effective tool,' says Barry Lewis, president of the British Chiropractic Association. He accuses Ernst of 'puffing up his evidence out of all proportion'.
One case involves Frances Denoon, who was in her 20s when she pulled a nerve in her neck while exercising. She visited a registered chiropractor and recalled feeling a 'crack' when he began his treatment. 'I couldn't focus and realised I wasn't saying words clearly,' she says on the Action for Victims of Chiropractic's website. Denoon suffered a brain-stem stroke and now has poor balance and cannot write with her right hand. A court cleared her chiropractor of negligence.
Such stories are just the tip of an iceberg, says Ernst, director of complementary medicine at the Peninsula Medical School, run by Exeter and Plymouth universities. He has collected details of about 700 cases.
'I am not calling for a ban on chiropractors carrying out spinal manipulation but I think we have to think about regulating the practice far more carefully than we do at present,' he said.
A spokeswoman for the General Chiropractic Council (GCC) said 2,300 chiropractors were registered with it and that since 2001 only one had been disciplined for breaching guidelines.
Peter Dixon, the council's chairman, said the report was 'yet another research scare' story.
'This does not serve the interests of the public or those of researchers who are dedicated to improving the public's health,' he said.
-=-=-
Sep 17, 10:56 PM EDT
MDs Don't Issue Pregnancy, Drugs Warning
By JOANN LOVIGLIO
Associated Press Writer
Doctors aren't doing a good job of warning young women to avoid
getting pregnant when they're taking prescription drugs that can cause
birth defects, according to a study published in the Annals of Internal
Medicine.
The study of nearly 500,000 women found that nearly half of the women
taking the medicines didn't get counseling from their doctor about using
contraceptives or other birth control measures, while researchers noted
that the study might overestimate the problem because the data is from
health plan billing codes, which don't have the same detailed medical
histories as patient medical charts, reported the Associated Press. Even
with the study's limitations, it is clear that many women aren't getting
the message about avoiding pregnancy while taking certain drugs that may
cause birth defects, including some antibiotics, acne medications,
cholesterol reducers, anti-seizure drugs, sleep aids and blood thinners,
the Associated Press added.
Associated Press, September 17, 2007
Read on...
-=-=-=
'Proof still needed' for flu jab
There is not enough evidence to support the effectiveness of immunising older people against flu, fresh research in the US has concluded.
Researchers from George Washington University, Washington DC, say the benefits in reducing deaths among over 70s have been "greatly exaggerated".
The findings echo a controversial 2006 British Medical Journal study.
But the latest study, in The Lancet Infectious Diseases, nonetheless urges vaccination to continue for the moment.
Most rich countries recommend vaccinating the old and the weak against flu annually in time for the winter.
As well as preventing flu, it is also thought to prevent deaths from other underlying chronic conditions.
In many studies, flu-related deaths are considered to be all those above the expected winter baseline. This is known as winter excess mortality.
Researchers from George Washington University, led by Dr Lone Simonson, say that in the US - despite an increase in vaccination coverage from 15% to 65% since 1980 - excess mortality among elderly people actually increased during the 1980s and 1990s.
The effectiveness of this strategy is under debate
Dr Lone Simonson
They also cited an Italian study, which found no decline in flu-related mortality rates, even as vaccine coverage rose from 5% to 65%.
The study also deplored what it saw as a lack of placebo-controlled randomised clinical trials (RCTs) among those over the age of 70.
They accepted that such trials were, however, unlikely as they would involve denying some participants access to a treatment which it is recommended they receive, and as such would not pass ethical review.
As an alternative, the team recommended that future studies should use "more specific endpoints" than just overall winter deaths.
This should include "vaccine effectiveness against the highly-specific outcome of laboratory-confirmed influenza virus, which although labour intensive and expensive, is more likely to obtain more realistic estimates of vaccine efficacy".
But despite its reservations about the quality of the available evidence, the team nonetheless recommended that people over the age of 70 should continue to be vaccinated until better data could be collected.
Trials call
Dr Tom Jefferson, of the Cochrane Library - a body that determines the relative effectiveness of health interventions - welcomed the study, which repeated many of his own assertions made in a paper published a year ago.
Writing in an editorial, he said it was time to carry out a placebo-based trial in which some participants are denied the jab.
"Head-to-head comparisons with other types of influenza vaccine will not allow direct assessment of absolute vaccine effectiveness," he wrote.
"Could governments be courageous and honest enough to reassess their cherished policies?"
It costs about £115m to vaccine the vulnerable against flu in the UK each year.
This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue
Department of Health
"The aim of our influenza policy is to protect those who are most at risk of serious illness or death should they develop influenza," a spokesperson for the Department of Health said.
"UK policy is constantly under review to take into consideration all available evidence. This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue."
The Royal College of GPs said it endorsed current policy and suggested that the study was lacking.
"There is a widely-held view that many respiratory virus infections cause mild, self-limiting disease and this is true," it said in a statement.
"But it is equally true that the relatively infrequent serious outcomes from this apparently minor illness add up to a major public health problem.
"Routine annual influenza vaccination of the elderly and persons with co-morbidity remains a vital element in this attack."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7010717.stm
Published: 2007/09/25 00:34:18 GMT
© BBC MMVII
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RE: load carried in military packs
An interesting suggestion, Donald.
I think that the military turns a blind eye to this, judging by my soldier patients in the past.
My thought is that this also relates to Police constables, who get lots of back problems from the utility belt, holsters, and wearing such stuff in highway patrol and cars in general. Most of them complain about this to me. I believe there is a lightweight belt it is not stadard issue.
joe
Begin forwarded message:
Hi Joe,
I wonder how many kids carry 60%+ of their body weight in school back packs?
D
The effect of military load carriage on ground reaction forces
Stewart A. BirrellCorresponding Author Contact Information, a, E-mail The Corresponding Author, Robin H. Hoopera and Roger A. Haslama
aDepartment of Human Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
Received 13 March 2006; revised 28 November 2006; accepted 9 December 2006. Available online 6 March 2007.
Abstract
Load carriage is an inevitable part of military life both during training and operations. Loads carried are frequently as high as 60% bodyweight, and this increases injury risk. In the military, load is carried in a backpack (also referred to as a Bergen) and webbing, these combined form a load carriage system (LCS). A substantial body of literature exists recording the physiological effects of load carriage; less is available regarding the biomechanics. Previous biomechanical studies have generally been restricted to loads of 20% and 40% of bodyweight, usually carried in the backpack alone. The effect of rifle carriage on gait has also received little or no attention in the published literature. This is despite military personnel almost always carrying a rifle during load carriage. In this study, 15 male participants completed 8 conditions: military boot, rifle, webbing 8 and 16 kg, backpack 16 kg and LCS 24, 32 and 40 kg. Results showed that load added in 8 kg increments elicited a proportional increase in vertical and anteroposterior ground reaction force (GRF) parameters. Rifle carriage significantly increased the impact peak and mediolateral impulse compared to the boot condition. These effects may be the result of changes to the vertical and horizontal position of the body's centre of mass, caused by the restriction of natural arm swing patterns. Increased GRFs, particularly in the vertical axis, have been positively linked to overuse injuries. Therefore, the biomechanical analysis of load carriage is important in aiding our understanding of injuries associated with military load carriage.
Keywords: Load carriage; Ground reaction force; Military; Gait; Rifle carriage
Corresponding Author Contact InformationCorresponding author. Tel.: +44 1509 228484; fax: +44 1509 223940.
Gait & Posture
Volume 26, Issue 4, October 2007, Pages 611-614
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you'll love this one, boys and girls!
Al Sears, MD
12794 Forest Hill Blvd., Suite 16
Wellington, FL 33414
September 24, 2007
Dear Joe,
If you’ve ever felt guilty about reaching for a cold one, I have great news…
That cool, refreshing beer just might save you from heart disease.
Don’t let the puritans make you afraid of casual beer drinking. Consuming a reasonable amount of alcohol is nothing to feel guilty about. In fact, it can be good for your health.
Beer also contains antioxidants like vitamin C, as well as hundreds of flavonoids such as Epicatechin.
Flavonoids are anti-oxidant compounds that provide the dark color in many fruits and vegetables. They stem from the seeds, skin and certain other parts of fermenting plants, and they help prevent hardening of the arteries. Flavonoids also improve blood flow and blood pressure. Dark beer has more of these nutrients than a lighter beer.
People who don’t indulge may be denting their bodies of essential nutrients, minerals and vitamins, such as magnesium, calcium and iron. Beer has always added protein, fiber, calcium, iron and potassium to diets around the world.
Almost everybody has heard of the benefits of drinking red wine. But in a recent study I came across beer drinkers had the lowest risk of heart disease. 2
Like wine, beer has been shown to:
∙ reduce strokes ∙ reduce heart disease
∙ reduce blood pressure ∙ increase coronary blood flow
∙ fight Alzheimer’s ∙ fight diabetes
∙ fight ulcers ∙ fight hepatitis A
∙ fight pancreatic cancer ∙ fight Parkinson’s disease
∙ raise good cholesterol ∙ lower bad cholesterol
Many of us associate drinking beer at social events, like a football game, with friends and family. These events cut back stress and in combination with conservative drinking, the risk of coronary disease is lowered by 32%.
Drinking a beer a day decreases cholesterol levels, increases antioxidants and reduces levels of fibrinogen, a clot-producing protein.
Keep in mind that the carbs in beer can add inches to your waistline. But there are new brews that are lower in carbs. They have the fuller flavor of “real” beer and put their low-calorie cousins to shame.
Since Busch released the first low-carb beer on the market, Michelob Ultra has experienced the best sales of any beer they’ve ever introduced. The good news here is that brewers are looking for their slice of the new market. And each new brew seems to outperform the last, in terms of flavor and fullness. The reigning three kings of low-carb brews are:
∙ Michelob Ultra by Anheuser Busch with 2.6 g of carbs.
∙ Aspen Edge by Coors with 2.6 g of carbs.
∙ Rock Green Light by Rolling Rock with 2.6g of carbs.
Compared to the average count of 11 grams of carbs for domestic beer – and as much as 20-30 g. for European imports, you can dramatically cut your carbs by making the switch to a low-carb variety. These low-carb beers compare well to mixed drinks.
Myself, I enjoy a nice Michelob Ultra with friends and family.
To Your Good Health,
Al Sears, MD
References:
1 Beer’s Essential Ingredients, Helium, August, 2001, www.sindicerv.com.br/site_ingl/cerveja/txt_cerveja_saude.htm.
2 Alcohol and Brain Function, All About Beer Magazine, July, 2002, www.allaboutbeer.com/features/233beer&health.html.
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BMJ 2007;335:585 (22 September), doi:10.1136/bmj.39339.624711.DB
News
Number of serious adverse events doubles in seven years in US
David Spurgeon
Quebec
The number of reported serious adverse events from drug treatment more than doubled in the United States from 1998 to 2005, rising from 34 966 to 89 842, says a new study.
Over the same period the number of deaths relating to drugs nearly tripled, from 5519 to 15 107, show data from the US Food and Drug Administration's adverse event reporting system, which collects all reports of adverse events submitted voluntarily to the agency either directly or through drug manufacturers (Archives of Internal Medicine 2007;167:1752-9).
Using extracts from the system that were published for use by researchers, the study's authors—Thomas Moore and Michael Cohen, of the Institute for Safe Medication Practices at Wake Forest University, Winston-Salem, North Carolina, and Curt Furberg, of the university's public health sciences division—analysed all adverse drug events and treatment errors reported to the agency from 1998, when the FDA started operating the system, to 2005.
Over the period the number of reported serious events grew four times faster than the total number of prescriptions to outpatients, which increased from 2.7 billion to 3.8 billion. In the subset of drugs associated with 500 or more reports in any year, those drugs that were withdrawn for safety reasons accounted for 26% of the reported events in 1999, this percentage falling to less than 1% in 2005. For 13 new biotechnology products, the number of reported serious events grew by nearly 16-fold, from 580 reported events in 1998 to 9181 in 2005.
A relatively small number of drugs were responsible for the overall increase in the number of adverse events reported: 298 of the 1489 drugs identified (20%) from the data accounted for 407 394 of the 467 809 events (87%).
Better systems for managing the risks from prescription drugs are needed, the authors say. But they also say that the increase may be partly due to a population increase as well as to greater reliance on intensive drug treatment. Drugs to relieve pain and those that alter the immune system were the drugs that were likeliest to result in death.
In Canada in 2006 the federal health department received reports of 10 518 cases of suspected adverse reactions to drug treatments, up by 108 from the figure for 2005. However, the country's adverse drug reactions database has been criticised for being plagued by under-reporting and for not being used optimally (bmj.com, 22 May 2004, doi: 10.1136/bmj.328.7450.1222-f).
Meanwhile, a new Canadian study has said that mixing herbal medicines with prescription drugs could pose undiscovered health risks because many negative reactions are not being reported or tracked (www.cbc.ca/health/story/2007/07/23/drug-study.html).
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from a colleague in USA
seems sound.....
How About Some Artificial Sweeteners?
"Saccharin (through taste) appears to elicit parasympathetic (insulin release) and sympathetic (hepatic glucose production increase) reflexes in lean and obese rats.
Taste-induced changes in plasma insulin and glucose turnover in lean and genetically obese rats. Diabetes. 1988 Jun;37(6):773-9.
Comment:
Insulin release starts with taste and when no glucose reaches the gut and bloodstream, a drop in blood sugar surely ensues from the already released insulin, triggering hunger to offset the resulting deficit. Drink More Diet Soda, Gain More Weight
For diet soft-drink drinkers, the risk of becoming overweight or obese was:
–
36.5% for up to 1/2 can each day
–
37.5% for 1/2 to one can each day
–
54.5% for 1 to 2 cans each day
–
57.1% for more than 2 cans each day.
For regular soft-drink drinkers, the risk of becoming overweight or obese was:
–
26% for up to 1/2 can each day
–
30.4% for 1/2 to one can each day
–
32.8% for 1 to 2 cans each day
–
47.2% for more than 2 cans each day.
Fowler, S.P. 65th Annual Scientific Sessions, American Diabetes Association, San Diego, June 10-14, 2005
Comment: If you want to lose weight, you're better off with sugar than artificial sweeteners!
The Stevia Question
The combination of stevioside and soy supplementation appears to possess the potential as effective treatment of a number of the characteristic features of the metabolic syndrome, that is, hyperglycemia, hypertension, and dyslipidemia.
Stevioside exerts beneficial effects in type 2 diabetic Zucker diabetic fatty rats. We did not detect any effect on insulin or glucagon responses.
Metabolism. 2005 Sep;54(9):1181-8.
Comment: It appears that stevia is a viable alternative to artificial sweeteners and sugar without negative side effects. More information is needed, but stevia is a natural substance rather than artificial. "
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Do it yourself chiro
I guess this could read...
... "Idiot performs appendectomy and patient gets septicemia?"
However, if you take note of how many people get a loved one to "crack" them, then this is worth running by those patients who think they can save a few bucks by not seeing a chiro!
CASE REPORT
Trauma-Induced Pneumothorax After "Bear-Hug Back Crack" Home Remedy: Attempted Spinal Manipulation by a Layperson
David A. Masneri, DO; Jeremy S. Helphenstine, DO; Shannon M. Masneri, DO; Michael A. Miller, MD; Marc E. Levsky, MD
From the Department of Emergency Medicine (Drs D.A. Masneri, Helphenstine, Miller, and Levsky) and the Department of Family Medicine (Dr S.M. Masneri) at Carl R. Darnall Army Medical Center in Fort Hood, Tex.
Address correspondence to David A. Masneri, DO, Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544-5095. E-mail: david.masneri@amedd.army.mil
Spinal manipulation, as practiced by US-trained osteopathic physicians, is a safe and effective method of resolving patient pain and encouraging desirable physiologic improvement— often without pharmacologic intervention. Though novices, laypeople, and other clinicians also use manual techniques with similar goals in mind, their results are varied and sometimes dangerous to those they would help. The authors describe a case in which a layperson attempted spinal manipulation on a 20-year-old woman who later required a chest tube thoracostomy and hospitalization as a result of a pneumothorax. Osteopathic physicians are encouraged to consider patient risk factors for pneumothorax as a contraindication for the use of thoracic thrust techniques.
-=-=-
A nice tidbit....
I have prescribed 2 sets of heel lifts successfully in 10 yrs.
In the same time I have removed about one per year to great relief to the patient, and used something called "adjustments to the spine" ;-)
One time it was a domino put there by an unnamed D.O., YES, a domino. In this case, the DO did good!
check this, then...
CASE REPORT
Chronic Psoas Syndrome Caused by the Inappropriate Use of a Heel Lift
Christopher M. Rancont, DO
Address correspondence to Christopher M. Rancont, DO, Pontiac Osteopathic Hospital, 50 N Perry St, Pontiac, MI 48342-2217. E-mail: crancont@yahoo.com
Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies.
However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty.
Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome.
Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain.
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should you see your GP every year?
...Not in America! Wonder if it applies here?
BMJ 2007;335:631 (29 September), doi:10.1136/bmj.39349.383194.DB
News
Annual check-ups aren't needed, US study says
Janice Hopkins Tanne
New York
Annual physical examinations, a staple of medical care in the United States for decades, cost too much and are not necessary for conveying messages on preventing illness, says a new study.
Patients get most messages on prevention through other visits, explains the study, published in the Archives of Internal Medicine (2007;167:1876-83). But annual gynaecological exams may be helpful for women, it says.
Ateev Mehrotra and colleagues from the University of Pittsburgh Medical Center examined data from 2002, 2003, and 2004 from the US national ambulatory medical care survey and the national hospital ambulatory medical care survey, which record visits made by patients with health insurance to office based physicians and to hospital outpatient departments for annual check-ups and gynaecological examinations.
Dr Mehrotra, the lead author and an assistant professor at the University of Pittsburgh Centre for Research on Health Care, said that no major North American clinical organisation recommends check-ups and no medical organisation specifies what should be included in one. "Physicians need to reach a consensus on whether patients should have annual physicals and what the exam should consist of," he said.
During 2002-4 about 44 million US adults had an annual preventive physical check-up and about 19 million women had a preventive gynaecological examination each year. The authors say that that's about 21% of US men and 18% of women, for a cost estimated at $5.2bn (£2.6bn; {euro}3.7bn) for general check-ups and $2.6bn for gynaecological examinations. The total amount nearly equals all spending on care of breast cancer patients in 2004, they report.
Check-up visits accounted for one in 12 adult care visits. Almost every check-up included a blood pressure measurement. People in the north east of the US were 60% more likely than those in the west to have a physical check-up.
Most preventive examinations were done by general and family practitioners, general internists, and gynaecologists. Preventive physical check-ups lasted an average of 23 minutes, preventive gynaecological visits averaged 20.5 minutes, and visits for other reason averaged 18 minutes. The average cost was $116 for a physical check-up and $136 for a gynaecological examination, including tests.
Many tests are unnecessary and in total cost more than $350m a year, the authors say. A complete blood count, serum electrolytes test, urinalysis, and an electrocardiogram are often ordered as part of an annual check-up but are not necessary unless there is a reason to request them, Dr Mehrotra said. However, during gynaecological examinations women were likely to receive or be sent for evidence based tests such as mammography or cervical smear tests.
The study looked at whether patients had received preventive or counselling messages about mammography, prostate specific antigen testing, cervical smear testing, cholesterol testing, stopping smoking, weight loss, and exercise and nutrition. Although advice on prevention is sometimes given as a reason for annual check-ups, the researchers found that almost 80% of preventive messages were given when a patient visited for another problem during the same year.
Making annual examinations available to all US residents is unrealistic, the authors say. Instead US doctors should offer advice on prevention when they see patients for other reasons.
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are you safe?
Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey.
Thiel HW, Bolton JE, Docherty S, Portlock JC.
From the *Department of Research and Professional Development, Anglo-European College of Chiropractic, Bournemouth, United Kingdom; and †Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
STUDY DESIGN.: Prospective national survey.
OBJECTIVE.: To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.
SUMMARY OF BACKGROUND DATA.: The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations.
METHODS.: We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.
RESULTS.: Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.
CONCLUSION.: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.
who wants to adjust Ernst?
I can offer up a permanent adjustment...
I like the BCA president's quote:
He accuses Ernst of 'puffing up his evidence out of all proportion'.
Meantime, see my next message on adverse events. Medics are killing them ever so much better now...sad to say.
http://observer.guardian.co.uk/uk_news/story/0,,2175332,00.html
-=-=-=-
Alternative therapy for backache 'can kill or disable'
Robin McKie, science editor
Sunday September 23, 2007
The Observer
One of the most common 'alternative' treatments for backache is dangerous and can kill, says Britain's leading expert on complementary medicine, Professor Edzard Ernst.
Spinal manipulation, used by chiropractors to treat hundreds of thousands of patients a year, poses serious risks, he warns in a paper published in the Journal of the Royal Society of Medicine
'[It] is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death.'
Spinal manipulation involves sharp thrusts against a patient's spine to push individual vertebrae beyond normal levels of stress. But Ernst says that such violent therapy can seriously damage the arteries running near the spine, triggering thrombosis or a stroke.
The claim has incensed chiropractors. In letters to be published in the journal's October issue, they accuse Ernst of distortion, errors and misinterpreting data.
'The major body of published evidence points to manipulation being a safe and effective tool,' says Barry Lewis, president of the British Chiropractic Association. He accuses Ernst of 'puffing up his evidence out of all proportion'.
One case involves Frances Denoon, who was in her 20s when she pulled a nerve in her neck while exercising. She visited a registered chiropractor and recalled feeling a 'crack' when he began his treatment. 'I couldn't focus and realised I wasn't saying words clearly,' she says on the Action for Victims of Chiropractic's website. Denoon suffered a brain-stem stroke and now has poor balance and cannot write with her right hand. A court cleared her chiropractor of negligence.
Such stories are just the tip of an iceberg, says Ernst, director of complementary medicine at the Peninsula Medical School, run by Exeter and Plymouth universities. He has collected details of about 700 cases.
'I am not calling for a ban on chiropractors carrying out spinal manipulation but I think we have to think about regulating the practice far more carefully than we do at present,' he said.
A spokeswoman for the General Chiropractic Council (GCC) said 2,300 chiropractors were registered with it and that since 2001 only one had been disciplined for breaching guidelines.
Peter Dixon, the council's chairman, said the report was 'yet another research scare' story.
'This does not serve the interests of the public or those of researchers who are dedicated to improving the public's health,' he said.
-=-=-
Sep 17, 10:56 PM EDT
MDs Don't Issue Pregnancy, Drugs Warning
By JOANN LOVIGLIO
Associated Press Writer
Doctors aren't doing a good job of warning young women to avoid
getting pregnant when they're taking prescription drugs that can cause
birth defects, according to a study published in the Annals of Internal
Medicine.
The study of nearly 500,000 women found that nearly half of the women
taking the medicines didn't get counseling from their doctor about using
contraceptives or other birth control measures, while researchers noted
that the study might overestimate the problem because the data is from
health plan billing codes, which don't have the same detailed medical
histories as patient medical charts, reported the Associated Press. Even
with the study's limitations, it is clear that many women aren't getting
the message about avoiding pregnancy while taking certain drugs that may
cause birth defects, including some antibiotics, acne medications,
cholesterol reducers, anti-seizure drugs, sleep aids and blood thinners,
the Associated Press added.
Associated Press, September 17, 2007
Read on...
-=-=-=
'Proof still needed' for flu jab
There is not enough evidence to support the effectiveness of immunising older people against flu, fresh research in the US has concluded.
Researchers from George Washington University, Washington DC, say the benefits in reducing deaths among over 70s have been "greatly exaggerated".
The findings echo a controversial 2006 British Medical Journal study.
But the latest study, in The Lancet Infectious Diseases, nonetheless urges vaccination to continue for the moment.
Most rich countries recommend vaccinating the old and the weak against flu annually in time for the winter.
As well as preventing flu, it is also thought to prevent deaths from other underlying chronic conditions.
In many studies, flu-related deaths are considered to be all those above the expected winter baseline. This is known as winter excess mortality.
Researchers from George Washington University, led by Dr Lone Simonson, say that in the US - despite an increase in vaccination coverage from 15% to 65% since 1980 - excess mortality among elderly people actually increased during the 1980s and 1990s.
The effectiveness of this strategy is under debate
Dr Lone Simonson
They also cited an Italian study, which found no decline in flu-related mortality rates, even as vaccine coverage rose from 5% to 65%.
The study also deplored what it saw as a lack of placebo-controlled randomised clinical trials (RCTs) among those over the age of 70.
They accepted that such trials were, however, unlikely as they would involve denying some participants access to a treatment which it is recommended they receive, and as such would not pass ethical review.
As an alternative, the team recommended that future studies should use "more specific endpoints" than just overall winter deaths.
This should include "vaccine effectiveness against the highly-specific outcome of laboratory-confirmed influenza virus, which although labour intensive and expensive, is more likely to obtain more realistic estimates of vaccine efficacy".
But despite its reservations about the quality of the available evidence, the team nonetheless recommended that people over the age of 70 should continue to be vaccinated until better data could be collected.
Trials call
Dr Tom Jefferson, of the Cochrane Library - a body that determines the relative effectiveness of health interventions - welcomed the study, which repeated many of his own assertions made in a paper published a year ago.
Writing in an editorial, he said it was time to carry out a placebo-based trial in which some participants are denied the jab.
"Head-to-head comparisons with other types of influenza vaccine will not allow direct assessment of absolute vaccine effectiveness," he wrote.
"Could governments be courageous and honest enough to reassess their cherished policies?"
It costs about £115m to vaccine the vulnerable against flu in the UK each year.
This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue
Department of Health
"The aim of our influenza policy is to protect those who are most at risk of serious illness or death should they develop influenza," a spokesperson for the Department of Health said.
"UK policy is constantly under review to take into consideration all available evidence. This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue."
The Royal College of GPs said it endorsed current policy and suggested that the study was lacking.
"There is a widely-held view that many respiratory virus infections cause mild, self-limiting disease and this is true," it said in a statement.
"But it is equally true that the relatively infrequent serious outcomes from this apparently minor illness add up to a major public health problem.
"Routine annual influenza vaccination of the elderly and persons with co-morbidity remains a vital element in this attack."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7010717.stm
Published: 2007/09/25 00:34:18 GMT
© BBC MMVII
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RE: load carried in military packs
An interesting suggestion, Donald.
I think that the military turns a blind eye to this, judging by my soldier patients in the past.
My thought is that this also relates to Police constables, who get lots of back problems from the utility belt, holsters, and wearing such stuff in highway patrol and cars in general. Most of them complain about this to me. I believe there is a lightweight belt it is not stadard issue.
joe
Begin forwarded message:
Hi Joe,
I wonder how many kids carry 60%+ of their body weight in school back packs?
D
The effect of military load carriage on ground reaction forces
Stewart A. BirrellCorresponding Author Contact Information, a, E-mail The Corresponding Author, Robin H. Hoopera and Roger A. Haslama
aDepartment of Human Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
Received 13 March 2006; revised 28 November 2006; accepted 9 December 2006. Available online 6 March 2007.
Abstract
Load carriage is an inevitable part of military life both during training and operations. Loads carried are frequently as high as 60% bodyweight, and this increases injury risk. In the military, load is carried in a backpack (also referred to as a Bergen) and webbing, these combined form a load carriage system (LCS). A substantial body of literature exists recording the physiological effects of load carriage; less is available regarding the biomechanics. Previous biomechanical studies have generally been restricted to loads of 20% and 40% of bodyweight, usually carried in the backpack alone. The effect of rifle carriage on gait has also received little or no attention in the published literature. This is despite military personnel almost always carrying a rifle during load carriage. In this study, 15 male participants completed 8 conditions: military boot, rifle, webbing 8 and 16 kg, backpack 16 kg and LCS 24, 32 and 40 kg. Results showed that load added in 8 kg increments elicited a proportional increase in vertical and anteroposterior ground reaction force (GRF) parameters. Rifle carriage significantly increased the impact peak and mediolateral impulse compared to the boot condition. These effects may be the result of changes to the vertical and horizontal position of the body's centre of mass, caused by the restriction of natural arm swing patterns. Increased GRFs, particularly in the vertical axis, have been positively linked to overuse injuries. Therefore, the biomechanical analysis of load carriage is important in aiding our understanding of injuries associated with military load carriage.
Keywords: Load carriage; Ground reaction force; Military; Gait; Rifle carriage
Corresponding Author Contact InformationCorresponding author. Tel.: +44 1509 228484; fax: +44 1509 223940.
Gait & Posture
Volume 26, Issue 4, October 2007, Pages 611-614
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you'll love this one, boys and girls!
Al Sears, MD
12794 Forest Hill Blvd., Suite 16
Wellington, FL 33414
September 24, 2007
Dear Joe,
If you’ve ever felt guilty about reaching for a cold one, I have great news…
That cool, refreshing beer just might save you from heart disease.
Don’t let the puritans make you afraid of casual beer drinking. Consuming a reasonable amount of alcohol is nothing to feel guilty about. In fact, it can be good for your health.
Beer also contains antioxidants like vitamin C, as well as hundreds of flavonoids such as Epicatechin.
Flavonoids are anti-oxidant compounds that provide the dark color in many fruits and vegetables. They stem from the seeds, skin and certain other parts of fermenting plants, and they help prevent hardening of the arteries. Flavonoids also improve blood flow and blood pressure. Dark beer has more of these nutrients than a lighter beer.
People who don’t indulge may be denting their bodies of essential nutrients, minerals and vitamins, such as magnesium, calcium and iron. Beer has always added protein, fiber, calcium, iron and potassium to diets around the world.
Almost everybody has heard of the benefits of drinking red wine. But in a recent study I came across beer drinkers had the lowest risk of heart disease. 2
Like wine, beer has been shown to:
∙ reduce strokes ∙ reduce heart disease
∙ reduce blood pressure ∙ increase coronary blood flow
∙ fight Alzheimer’s ∙ fight diabetes
∙ fight ulcers ∙ fight hepatitis A
∙ fight pancreatic cancer ∙ fight Parkinson’s disease
∙ raise good cholesterol ∙ lower bad cholesterol
Many of us associate drinking beer at social events, like a football game, with friends and family. These events cut back stress and in combination with conservative drinking, the risk of coronary disease is lowered by 32%.
Drinking a beer a day decreases cholesterol levels, increases antioxidants and reduces levels of fibrinogen, a clot-producing protein.
Keep in mind that the carbs in beer can add inches to your waistline. But there are new brews that are lower in carbs. They have the fuller flavor of “real” beer and put their low-calorie cousins to shame.
Since Busch released the first low-carb beer on the market, Michelob Ultra has experienced the best sales of any beer they’ve ever introduced. The good news here is that brewers are looking for their slice of the new market. And each new brew seems to outperform the last, in terms of flavor and fullness. The reigning three kings of low-carb brews are:
∙ Michelob Ultra by Anheuser Busch with 2.6 g of carbs.
∙ Aspen Edge by Coors with 2.6 g of carbs.
∙ Rock Green Light by Rolling Rock with 2.6g of carbs.
Compared to the average count of 11 grams of carbs for domestic beer – and as much as 20-30 g. for European imports, you can dramatically cut your carbs by making the switch to a low-carb variety. These low-carb beers compare well to mixed drinks.
Myself, I enjoy a nice Michelob Ultra with friends and family.
To Your Good Health,
Al Sears, MD
References:
1 Beer’s Essential Ingredients, Helium, August, 2001, www.sindicerv.com.br/site_ingl/cerveja/txt_cerveja_saude.htm.
2 Alcohol and Brain Function, All About Beer Magazine, July, 2002, www.allaboutbeer.com/features/233beer&health.html.
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BMJ 2007;335:585 (22 September), doi:10.1136/bmj.39339.624711.DB
News
Number of serious adverse events doubles in seven years in US
David Spurgeon
Quebec
The number of reported serious adverse events from drug treatment more than doubled in the United States from 1998 to 2005, rising from 34 966 to 89 842, says a new study.
Over the same period the number of deaths relating to drugs nearly tripled, from 5519 to 15 107, show data from the US Food and Drug Administration's adverse event reporting system, which collects all reports of adverse events submitted voluntarily to the agency either directly or through drug manufacturers (Archives of Internal Medicine 2007;167:1752-9).
Using extracts from the system that were published for use by researchers, the study's authors—Thomas Moore and Michael Cohen, of the Institute for Safe Medication Practices at Wake Forest University, Winston-Salem, North Carolina, and Curt Furberg, of the university's public health sciences division—analysed all adverse drug events and treatment errors reported to the agency from 1998, when the FDA started operating the system, to 2005.
Over the period the number of reported serious events grew four times faster than the total number of prescriptions to outpatients, which increased from 2.7 billion to 3.8 billion. In the subset of drugs associated with 500 or more reports in any year, those drugs that were withdrawn for safety reasons accounted for 26% of the reported events in 1999, this percentage falling to less than 1% in 2005. For 13 new biotechnology products, the number of reported serious events grew by nearly 16-fold, from 580 reported events in 1998 to 9181 in 2005.
A relatively small number of drugs were responsible for the overall increase in the number of adverse events reported: 298 of the 1489 drugs identified (20%) from the data accounted for 407 394 of the 467 809 events (87%).
Better systems for managing the risks from prescription drugs are needed, the authors say. But they also say that the increase may be partly due to a population increase as well as to greater reliance on intensive drug treatment. Drugs to relieve pain and those that alter the immune system were the drugs that were likeliest to result in death.
In Canada in 2006 the federal health department received reports of 10 518 cases of suspected adverse reactions to drug treatments, up by 108 from the figure for 2005. However, the country's adverse drug reactions database has been criticised for being plagued by under-reporting and for not being used optimally (bmj.com, 22 May 2004, doi: 10.1136/bmj.328.7450.1222-f).
Meanwhile, a new Canadian study has said that mixing herbal medicines with prescription drugs could pose undiscovered health risks because many negative reactions are not being reported or tracked (www.cbc.ca/health/story/2007/07/23/drug-study.html).
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from a colleague in USA
seems sound.....
How About Some Artificial Sweeteners?
"Saccharin (through taste) appears to elicit parasympathetic (insulin release) and sympathetic (hepatic glucose production increase) reflexes in lean and obese rats.
Taste-induced changes in plasma insulin and glucose turnover in lean and genetically obese rats. Diabetes. 1988 Jun;37(6):773-9.
Comment:
Insulin release starts with taste and when no glucose reaches the gut and bloodstream, a drop in blood sugar surely ensues from the already released insulin, triggering hunger to offset the resulting deficit. Drink More Diet Soda, Gain More Weight
For diet soft-drink drinkers, the risk of becoming overweight or obese was:
–
36.5% for up to 1/2 can each day
–
37.5% for 1/2 to one can each day
–
54.5% for 1 to 2 cans each day
–
57.1% for more than 2 cans each day.
For regular soft-drink drinkers, the risk of becoming overweight or obese was:
–
26% for up to 1/2 can each day
–
30.4% for 1/2 to one can each day
–
32.8% for 1 to 2 cans each day
–
47.2% for more than 2 cans each day.
Fowler, S.P. 65th Annual Scientific Sessions, American Diabetes Association, San Diego, June 10-14, 2005
Comment: If you want to lose weight, you're better off with sugar than artificial sweeteners!
The Stevia Question
The combination of stevioside and soy supplementation appears to possess the potential as effective treatment of a number of the characteristic features of the metabolic syndrome, that is, hyperglycemia, hypertension, and dyslipidemia.
Stevioside exerts beneficial effects in type 2 diabetic Zucker diabetic fatty rats. We did not detect any effect on insulin or glucagon responses.
Metabolism. 2005 Sep;54(9):1181-8.
Comment: It appears that stevia is a viable alternative to artificial sweeteners and sugar without negative side effects. More information is needed, but stevia is a natural substance rather than artificial. "
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Do it yourself chiro
I guess this could read...
... "Idiot performs appendectomy and patient gets septicemia?"
However, if you take note of how many people get a loved one to "crack" them, then this is worth running by those patients who think they can save a few bucks by not seeing a chiro!
CASE REPORT
Trauma-Induced Pneumothorax After "Bear-Hug Back Crack" Home Remedy: Attempted Spinal Manipulation by a Layperson
David A. Masneri, DO; Jeremy S. Helphenstine, DO; Shannon M. Masneri, DO; Michael A. Miller, MD; Marc E. Levsky, MD
From the Department of Emergency Medicine (Drs D.A. Masneri, Helphenstine, Miller, and Levsky) and the Department of Family Medicine (Dr S.M. Masneri) at Carl R. Darnall Army Medical Center in Fort Hood, Tex.
Address correspondence to David A. Masneri, DO, Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544-5095. E-mail: david.masneri@amedd.army.mil
Spinal manipulation, as practiced by US-trained osteopathic physicians, is a safe and effective method of resolving patient pain and encouraging desirable physiologic improvement— often without pharmacologic intervention. Though novices, laypeople, and other clinicians also use manual techniques with similar goals in mind, their results are varied and sometimes dangerous to those they would help. The authors describe a case in which a layperson attempted spinal manipulation on a 20-year-old woman who later required a chest tube thoracostomy and hospitalization as a result of a pneumothorax. Osteopathic physicians are encouraged to consider patient risk factors for pneumothorax as a contraindication for the use of thoracic thrust techniques.
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A nice tidbit....
I have prescribed 2 sets of heel lifts successfully in 10 yrs.
In the same time I have removed about one per year to great relief to the patient, and used something called "adjustments to the spine" ;-)
One time it was a domino put there by an unnamed D.O., YES, a domino. In this case, the DO did good!
check this, then...
CASE REPORT
Chronic Psoas Syndrome Caused by the Inappropriate Use of a Heel Lift
Christopher M. Rancont, DO
Address correspondence to Christopher M. Rancont, DO, Pontiac Osteopathic Hospital, 50 N Perry St, Pontiac, MI 48342-2217. E-mail: crancont@yahoo.com
Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies.
However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty.
Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome.
Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain.
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should you see your GP every year?
...Not in America! Wonder if it applies here?
BMJ 2007;335:631 (29 September), doi:10.1136/bmj.39349.383194.DB
News
Annual check-ups aren't needed, US study says
Janice Hopkins Tanne
New York
Annual physical examinations, a staple of medical care in the United States for decades, cost too much and are not necessary for conveying messages on preventing illness, says a new study.
Patients get most messages on prevention through other visits, explains the study, published in the Archives of Internal Medicine (2007;167:1876-83). But annual gynaecological exams may be helpful for women, it says.
Ateev Mehrotra and colleagues from the University of Pittsburgh Medical Center examined data from 2002, 2003, and 2004 from the US national ambulatory medical care survey and the national hospital ambulatory medical care survey, which record visits made by patients with health insurance to office based physicians and to hospital outpatient departments for annual check-ups and gynaecological examinations.
Dr Mehrotra, the lead author and an assistant professor at the University of Pittsburgh Centre for Research on Health Care, said that no major North American clinical organisation recommends check-ups and no medical organisation specifies what should be included in one. "Physicians need to reach a consensus on whether patients should have annual physicals and what the exam should consist of," he said.
During 2002-4 about 44 million US adults had an annual preventive physical check-up and about 19 million women had a preventive gynaecological examination each year. The authors say that that's about 21% of US men and 18% of women, for a cost estimated at $5.2bn (£2.6bn; {euro}3.7bn) for general check-ups and $2.6bn for gynaecological examinations. The total amount nearly equals all spending on care of breast cancer patients in 2004, they report.
Check-up visits accounted for one in 12 adult care visits. Almost every check-up included a blood pressure measurement. People in the north east of the US were 60% more likely than those in the west to have a physical check-up.
Most preventive examinations were done by general and family practitioners, general internists, and gynaecologists. Preventive physical check-ups lasted an average of 23 minutes, preventive gynaecological visits averaged 20.5 minutes, and visits for other reason averaged 18 minutes. The average cost was $116 for a physical check-up and $136 for a gynaecological examination, including tests.
Many tests are unnecessary and in total cost more than $350m a year, the authors say. A complete blood count, serum electrolytes test, urinalysis, and an electrocardiogram are often ordered as part of an annual check-up but are not necessary unless there is a reason to request them, Dr Mehrotra said. However, during gynaecological examinations women were likely to receive or be sent for evidence based tests such as mammography or cervical smear tests.
The study looked at whether patients had received preventive or counselling messages about mammography, prostate specific antigen testing, cervical smear testing, cholesterol testing, stopping smoking, weight loss, and exercise and nutrition. Although advice on prevention is sometimes given as a reason for annual check-ups, the researchers found that almost 80% of preventive messages were given when a patient visited for another problem during the same year.
Making annual examinations available to all US residents is unrealistic, the authors say. Instead US doctors should offer advice on prevention when they see patients for other reasons.
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are you safe?
Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey.
Thiel HW, Bolton JE, Docherty S, Portlock JC.
From the *Department of Research and Professional Development, Anglo-European College of Chiropractic, Bournemouth, United Kingdom; and †Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
STUDY DESIGN.: Prospective national survey.
OBJECTIVE.: To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.
SUMMARY OF BACKGROUND DATA.: The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations.
METHODS.: We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.
RESULTS.: Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.
CONCLUSION.: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.