For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Issue 18
09/01/08 11:33
Issue 18
Now its ok not to refer to Chiropractors.
Here is the evidence.
My friend Dr Hart points out that MDs get CPD credit for reading these poorly produced studies.
That is how you sustain ignorance: provide evidence for its adherence...
Diclofenac or Spinal Manipulative Therapy Not Helpful for Acute Low Back Pain
News Author: Laurie Barclay, MD
November 13, 2007 — Patients with acute low back pain receiving recommended first-line care did not recover more quickly with the addition of diclofenac or spinal manipulative therapy, according to the results of a randomized controlled trial in the November 8 issue of The Lancet.
"Present treatment guidelines for acute low back pain recommend that general practitioners should give advice (remain active, avoid bed rest, and reassurance of favourable prognosis) and paracetamol as the first line of care," write Mark J. Hancock, MAppSc, from the University of Sydney in Australia, and colleagues. "Non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulative therapy are recommended as second-line management options for patients who have slow recovery. We do not know whether NSAIDs or spinal manipulative therapy, or both, in addition to advice and paracetamol as initial treatment results in quicker recovery for such patients."
In this community-based study, 240 patients with acute low back pain who had been given advice and paracetamol by their general practitioner were randomized to receive diclofenac 50 mg twice daily and placebo manipulative therapy (n = 60), spinal manipulative therapy and placebo drug
(n = 60), diclofenac 50 mg twice daily and spinal manipulative therapy (n = 60), or double placebo (n = 60). The main endpoint was days to recovery from pain, evaluated with survival curves in an intent-to-treat analysis.
Compared with placebo drug or placebo manipulative therapy, neither diclofenac nor spinal manipulative therapy significantly decreased the number of days until recovery (diclofenac hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.84 - 1.42; P = .516; spinal manipulative therapy HR, 1.01; 95% CI, 0.77 - 1.31; P = .955). By 12 weeks after randomization, 237 (99%) patients had either recovered or were censored.
Secondary analyses showed no significant effects on pain, disability, or global perceived effect at 1, 2, 4, or 12 weeks, when diclofenac or spinal manipulative therapy, or both, was added to baseline care.
Possible adverse reactions occurred in 22 patients; these included gastrointestinal tract disturbances, dizziness, and heart palpitations. Half of these patients were in the active diclofenac group, and the other half were taking placebo. One patient taking active diclofenac stopped treatment because of a suspected hypersensitivity reaction.
"Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery," the study authors write. "We can reasonably assume that when quality baseline care is provided, previously effective treatments might no longer provide additional benefit."
Limitations of the study include cointerventions during the study period in 28 patients and imperfect compliance rates.
"These results are important because both diclofenac and spinal manipulative therapy have potential risks and additional cost for patients," the study authors conclude. "If patients have high rates of recovery with baseline care and no clinically worthwhile benefit from the addition of diclofenac or spinal manipulative therapy, then GPs [general practitioners] can manage patients confidently without exposing them to increased risks and costs associated with NSAIDs or spinal manipulative therapy."
Alphapharm donated the active diclofenac and Bill Rae provided the placebo tablets. Australia's National Health and Medical Research Council mainly funded the trial. One of the study authors had been a member of an advisory board about paracetamol for GlaxoSmithKline. Some of the study authors have obtained funding.
Lancet. 2007;370:1638-1643.
-=-=-=-=-=-
Drug trial scandal: babies born disabled
Natasha Wallace Health Reporter
November 19, 200
Disabled births after drug trial
Up to 12 mothers who had disabled children after a drug trial could sue a hospital for millions of dollars after it agreed to pay more than $750,000 to a woman whose child was born with cerebral palsy. more
UP TO 12 mothers who had disabled children after a drug trial could sue a hospital for millions of dollars after it agreed to pay more than $750,000 to a woman whose child was born with cerebral palsy.
The mothers are among 50 worried about their involvement in the trial at Wagga Wagga Base Hospital of the drug misoprostol to induce labour at full term.
The trial has been shrouded in secrecy, but the manufacturer of misoprostol, marketed as Cytotec, had warned as early as 2000 that it should not be used by pregnant women because it could cause unwanted abortion and birth defects such as club foot, missing fingers and brain injury.
Kimberley Reid sued the hospital after her son, Joshua, was born in 2001 with severe cerebral palsy. She said she was told that misoprostol was the only available drug for induction at the time and that she was not informed of the associated risks.
Her lawyer, John Potter, said yesterday that Ms Reid was asked during labour if she wanted to take part in the trial.
The Greater Southern Area Health Service had fought the case for the past three years. It was due to go to a six-week hearing today, but the hospital settled late on Friday after local media published details of it. The area health service has refused to provide any information on the trial, believed to have taken place between 2000 and 2003.
Misoprostol is licensed in Australia for the treatment of gastrointestinal ulcers in men and non-pregnant women and to treat hemorrhage after normal delivery.
It can also be used for low-cost abortions or in the case of a stillbirth, but is not licensed here for those purposes.
Joshua's father, Tony Reid, is also suing, and is expected to settle today. All cases heard in the NSW Supreme Court are for more than $750,000 in damages.
Mr Potter said the terms of Ms Reid's settlement were confidential and should be finalised in court on Wednesday, but the hospital had already admitted negligence.
"They certainly admitted that they had breached some of their obligation to the plaintiff," Mr Potter said. "Whilst this lady signed a consent form she wasn't informed of the risks involved, so we say there was no informed consent. The allegation is that they said there was no other treatment available at the time."
The Herald understands the hospital settled for more than what Ms Reid had offered to accept a year ago.
Mr Potter said 50 other mothers who had taken part in the trial had contacted him since the case was made public in July.
"Half-a-dozen of them have children with disabilities, but I can't yet sheet that home to the trial," he said. He was still investigating their cases.
Mr Potter said the manufacturers of the drug warned it should not be used for live births. "It [the warning] was certainly there at the time that the trial was conducted at Wagga Wagga," he said. "The only countries that I can find [using it for live births] are Egypt and Libya."
The Department of Health will not reveal how many women took part in the trial, nor who was responsible for it.
Mr Potter said misoprostol was a fraction of the price of other labour-inducing drugs.
Joshua is the Reids' first child and requires 24-hour care. "It's a very tragic case … it has been devastating," Mr Potter said.
Mr Reid told the Herald yesterday that it had been a long and painful journey. "It's definitely not celebrations here," he said.
A spokeswoman for the area health service said she could not discuss the trial because the case was still before the courts.
http://newsletters.fairfax.com.au/cgi-bin16/DM/y/hBUZ40T1LXb0Bhi0P7Ni0Gs
-=-=--=
it would be something if the vaccine proponents attempted to be scientific and individualistic in application of medicine
like the new discovery whether chemotherapy is actually working on each individual
BMJ 2007;335:1016 (17 November), doi:10.1136/bmj.335.7628.1016-b
Immunity against some viruses would last for centuries
The immune system has a very long memory after live viral infections, say researchers who examined repeated blood samples from 45 volunteers working in a primate research centre in Oregon. The samples spanned up to 26 years of follow-up and showed that antibodies generated in response to natural viral infections have half lives ranging from an estimated 50 years for varicella zoster virus to more than 11 000 years for Epstein-Barr virus.Antibodies against mumps, measles, and rubella were also remarkably stable, implying lifelong immunity (estimated half lives 542 years, 3014 years, and 114 years).
Humoral immunity against tetanus and diphtheria, induced by vaccination with protein antigens, decayed much faster than that triggered by a natural viral infection. In vaccinated volunteers, tetanus specific antibodies had an estimated half life of just 11 years, and those directed against diphtheria had a half life of 19 years.
N Engl J Med 2007;357:1903-15
-=-=-==
The NSW Coroner has found there is sufficient evidence for the Director of Public Prosecutions to consider laying charges against the parents of a baby who died after they treated her with homeopathic remedies.
.....more below
http://www.smh.com.au/news/national/baby-death-call-for-homeopath-rules/2007/11/19/1195321684868.html
-=-=-=-
this http://www.atlasprofilax.ch
has got to be a scam of scams
its one thing to discredit upper cervical by saying we cause strokes, but another to fob yourself off as an upper cervical practitioner with NO education
procedure is also being offerec in beauty parlours, last I heard
i had yet ANOTHER enquiry from the public about it...this time when they asked if it would help their daughter with MS, they stated that the parents had to be treated first
sounds worse than scams we know all to well
watch out for it in your state
-=-=-=-=-
as my friend says, they are baffled...imagine giving adjustments and 80% of your patients get worse?
AIDS vaccines experts confused and dismayed
Thu Nov 8, 2007 1:56pm EST
By Maggie Fox, Health and Science Editor - Analysis
WASHINGTON (Reuters) - AIDS vaccine researchers are worried about the future of their field after learning an experimental HIV vaccine not only does not work, but just might make recipients more susceptible to infection with the AIDS virus.
They are worried about their volunteers and the future of AIDS vaccines in general. And they are worried because they cannot understand how a vaccine would make a person more vulnerable.
Researchers from Merck & Co. (MRK.N: Quote, Profile , Research), which makes the vaccine, and the National Institute of Allergy and Infectious Diseases, which is helping develop it, said on Wednesday they believe a type of common cold virus used as the basis of the vaccine may somehow have made their volunteers more susceptible to HIV.
They are meeting this week in Seattle to hash through the data and figure out what happened.
This is what they know: Out of 1,500 people vaccinated, 82 became infected with the AIDS virus. Of these, 49 got the vaccine and 33 got a placebo shot.
While they are counseling volunteers that they may have raised their own risk of becoming infected, they are also trying to figure out what happened.
"The data are disappointing and puzzling but we don't have definitive answers," Dr. Lawrence Corey of Fred Hutchinson Cancer Research Center in Seattle, who was organizing the trial, told reporters.
Only one woman in the trial became infected with HIV. The rest were men having sex with other men, and it was the men who started out with the highest immune response to the adenovirus 5 common cold bug used to make the vaccine who were the most likely to become infected with the AIDS virus.
But the infected men were also less likely to have been circumcised -- circumcision can also prevent HIV infection -- and may have engaged in more risky behavior. So did the vaccine actually do something, or were the results a fluke?
"I don't think we really do know," Dr. Keith Gottesdiener of Merck Research Laboratories told Reuters.
FUTURE OF THE FIELD
Nearly 30 potential AIDS vaccines are being tested in people around the world.
"It is very important for the future of the field," said Margaret Johnston, director of the AIDS vaccine research program at the NIAID.
"It makes us rethink some of the candidates that are in trial," said Dr. Seth Berkley, president of the International AIDS Vaccine Initiative.
Even vaccine advocates are calling it a setback.
"These data are deeply disappointing and troubling, and raise more questions than answers for the field of AIDS vaccine," said AIDS Vaccine Advocacy Coalition executive director Mitchell Warren.
"This setback should not and can not diminish our commitment to developing an effective HIV vaccine," said NIAID director Dr. Anthony Fauci. "Every day, another 12,000 people become infected with HIV, most of whom live in resource-poor countries," he added.
-=-=-=-=-
for full story click link...
Health authority bans physician shadowing
Deborah Jones
Vancouver
In British Columbia's biggest health authority, the days when a pharmaceutical or medical equipment sales representative could scrub in and attend a surgery in an operating theatre, wander unattended through the emergency room or even be involved in the delivery of medications to patients, are now over.
http://www.cmaj.ca/cgi/content/full/177/11/1339?etoc
-=-==-
interesting vax article relating Autoimmune diseases
click link for whole article
Key messages
• It is tempting to consider that 2 events that occur in close temporal association are causally related. This temptation is greatest for outcomes that are unexpected, severe or disabling; for outcomes whose pathophysiology is poorly understood; and for outcomes that affect previously healthy people whom we love or care for.
• The temptation to consider a temporal association as causal increases if the event is perceived to be aggressive or complex, if it has long-lasting effects or if the disease is only partly characterized.
• The likelihood of a temporal association between vaccination and an adverse event is proportional to vaccine coverage and to disease prevalence in the target population.
• Autoimmune diseases occur in adolescents and young women, and they are more frequent in young women.
• The large-scale implementation of a new vaccination program in a population of adolescent and young women inevitably will markedly increase the number of apparent cases of autoimmune diseases occurring after immunization.
• Coincidences are not indicative of a causal link.
• Determining local health-resource use before and after initiation of a new vaccination program may be a useful method to provide the rapid answers that vaccine safety concerns deserve to protect public health.
Begin forwarded message:
Hi Joe,
For the Group.
This topic is the main struggle for vaccines.
But its example also has some inferences as to how we look at Stroke and practice related injuries.
http://www.cmaj.ca/cgi/content/full/177/11/1352?etoc
Donald
-=-=-=-
Cholesterol Drug May Affect Sleep
Study Shows Some Users of Zocor Report a Poorer Quality of Sleep
By Charlene Laino
WebMD Medical News
Reviewed by Louise Chang, MD
Nov. 7, 2007 (Orlando, Fla.) -- Are you tossing and turning at night? A popular cholesterol-lowering drug may be to blame.
In a new study, those who took the statin drug Zocor reported they had a significantly worse quality of sleep than those who took a placebo or Pravachol , another statin drug, says researcher Beatrice Golomb, MD, an associate professor of medicine at the University of California, San Diego.
Participants did not report any specific sleep disturbance, just generally having a worse night's sleep, she says.
"Problems with sleep initiation, problems with sleep maintenance, a feeling that sleep was unrestful, and napping during the day -- none of those actually were what was going on," Golomb tells WebMD.
So what's left?
Maybe nightmares, something related to sleep-disordered breathing, or some as yet unexplored problem, Golomb says.
"Although the average effect on sleep was detrimental on Zocor, this does not mean that everyone on Zocor will experience worse sleep," she says.
The study involved 1,016 people with no signs of heart disease and LDL "bad" cholesterol levels between 115 and 190. LDL levels below 100 are optimal, according to the American Heart Association.
They were randomly assigned to Zocor, Pravachol, or a placebo for six months. Participants rated "sleep quality" and "sleep problems" on two standardized sleep scales.
Insomnia is listed as a possible side effect on the labeling of all statin drugs. Â
The findings were reported at the American Heart Association's (AHA) Scientific Sessions 2007.
The National Institutes of Health funded the study.
Fat-Soluble vs. Water-Soluble
Zocor and Pravachol dissolve in the body differently, says Gordon Tomaselli, MD, chairman of the committee that picked the studies to highlight at the meeting. Tomaselli is chief of cardiology at Johns Hopkins University School of Medicine in Baltimore.
Zocor dissolves in fat, so it can more easily penetrate cell membranes and cross the blood-brain barrier into the brain. Pravachol dissolves in water, so it has a hard time penetrating these barriers.
"It's easy to theorize that if you get a foreign substance in the brain, it might affect sleep, cognition and other processes controlled by the brain," Tomaselli tells WebMD.
Tomaselli says statins do not interfere with most people's sleep. "But if you are having sleep problems, ask you doctor if you should switch to a medication that has less fat solubility," he advises.
Other statins that are fat soluble include Lipitor and Mevacor. The statins Crestor and Lescol are water soluble.
Merck, the maker of Zocor, says in a statement that it conducted sleep studies with Zocor, Pravachol, and a placebo and found no difference with regard to sleep disturbances between Zocor and the placebo.
Additionally, in a study of more than 20,000 patients, people taking Zocor were no more likely to stop taking it because of sleep disorders than those on placebo, Merck says.
-=-=-=-=-=
From the BBC:
http://news.bbc.co.uk/1/hi/health/7104155.stm
Half of trauma care 'not good'
About 800 trauma patients end up transferring hospitals
More than half of trauma patients are not receiving good care, experts say.
The National Confidential Enquiry into Patient Outcome and Death looked at the care given to 795 patients, many with head injuries from falls and crashes.
It found medical staff in 200 hospitals in England, Wales and Northern Ireland often did not appreciate the severity and displayed little urgency.
It said care would improve if services were centred at fewer sites - something which is already government policy.
NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced.
Our mortality rates are among the worst in the developed world, and yet trauma care remains a low priority for the government
Royal College of Surgeons spokesman
'They just diagnosed a broken arm'
In particular, they found patients were not always given essential tests such as CT scans or assessed by hospital consultants, especially during the night.
Researchers said most hospitals would only deal with one trauma patient a week and this meant staff did not get the necessary experience to keep skills up to date.
They also said about 800 trauma patients each year needed to be transferred to other hospitals - often in an "ad hoc" manner - because of a lack of specialist facilities such as neurological services.
Ambulance crews were also criticised for failing to always unblock airways and alert hospitals of incoming cases.
But the researchers said in hospitals which dealt with more than 20 cases a week the care was classed as good.
The report said this in itself was a good argument for centralising services in regional centres.
Services
This is already a government policy, but it is proving controversial because of the aim of a whole host of other services such as maternity and A&E being centralised as well.
Campaigners say such a move would lead to many local hospitals being stripped of key services.
Report author Dr George Findlay said: "The number of patients seen has a direct bearing on the experience and ability of clinicians to manage challenging cases.
"It is not possible for all hospitals to have a trauma team on call with the necessary experience, organisation and support structures.
"We need to look at how we can organise trauma care on a regional basis."
The Royal College of Surgeons said care urgently needed to improve.
A spokesman said: "Our mortality rates are among the worst in the developed world, and yet trauma care remains a low priority for the government.
"This a national health service and what we need is a national trauma system."
Health Minister Ben Bradshaw said: "We have argued for some time that it is not the proximity of the nearest A&E that matters to most trauma victims but the care they receive from ambulance and paramedic staff and the quality of care they receive once they arrive at hospital.
"Concentrating trauma treatment in specialist centres can arouse opposition from some people concerned about 'downgrading' of their local A&E facilities, but what the opponents often fail to recognise is that lives will be saved and the quality of care improved, as this report makes clear."
-=-=-=
scope practice bill in NJ is of interest to all
http://www.courierpostonline.com/apps/pbcs.dll/article?AID=/20071120/NEWS01/711200360/1006
-=-=-=-=
do back supports help?
MAYBE!
http://www.annals.org/cgi/content/abstract/147/10/685
Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers
A Randomized Trial
Pepijn D.D.M. Roelofs, MSc; Sita M.A. Bierma-Zeinstra, PhD; Mireille N.M. van Poppel, PhD; Petra Jellema, PhD; Sten P. Willemsen, MSc; Maurits W. van Tulder, PhD;Willem van Mechelen, MD, PhD; and Bart W. Koes, PhD
20 November 2007 | Volume 147 Issue 10 | Pages 685-692
Background: People use lumbar supports to prevent low back pain. Secondary analyses from primary preventive studies suggest benefit among workers with previous low back pain, but definitive studies on the effectiveness of supports for the secondary prevention of low back pain are lacking.
Objective: To determine the effectiveness of lumbar supports in the secondary prevention of low back pain.
Design: Randomized, controlled trial.
Setting: Home care organization in the Netherlands.
Patients: 360 home care workers with self-reported history of low back pain.
Intervention: Short course on healthy working methods, with or without patient-directed use of 1 of 4 types of lumbar support.
Measurements: Primary outcomes were the number of days of low back pain and sick leave over 12 months. Secondary outcomes were the average severity of low back pain and function (Quebec Back Pain Disability scale) in the previous week.
Results: Over 12 months, participants in the lumbar support group reported an average of –52.7 days (CI, –59.6 to –45.1 days) fewer days with low back pain than participants who received only the short course. However, the total sick days in the lumbar support group did not decrease (–5 days [CI, –21.1 to 6.8 days]). Small but statistically significant differences in pain intensity and function favored lumbar support.
Limitations: Study participants were unblinded, and a substantial amount of missing data required imputation. Objective data on sick days due to low back pain were not available.
Conclusion: Adding patient-directed use of lumbar supports to a short course on healthy working methods may reduce the number of days when low back pain occurs, but not overall work absenteeism, among home care workers with previous low back pain. Further study of lumbar supports is warranted.
-=-=-=-=-
wow, you've found another great study... showing that breast milk is important for bacteria development in infants
link follows...
Summary
Background The sources and the impact of maternal bacteria on the initial inoculum of the intestinal microflora of newborn infants remain elusive.
Objective To assess the association between maternal breast-milk and fecal bifidobacteria and infants' fecal bifidobacteria.
Methods Sixty-one mother–infant pairs were included, special emphasis being placed on the maternal allergic status. Bifidobacteria were analysed by a direct PCR method in fecal samples from mothers at 30–35 weeks of gestation and from infants at 1 month of age and from breast-milk samples 1 month post-partum.
Results Fecal Bifidobacterium adolescentis and Bifidobacterium bifidum colonization frequencies and counts among mother–infant pairs correlated significantly (P=0.005 and 0.02 for frequencies, respectively, and P=0.002 and 0.01 for counts, respectively). Only infants of allergic, atopic mothers were colonized with B. adolescentis. Each of the breast-milk samples contained bifidobacteria [median 1.4 × 103 bacterial cells/mL; interquartile range (IQR) 48.7–3.8 × 103]. Bifidobacterium longum was the most frequently detected species in breast-milk. Allergic mothers had significantly lower amounts of bifidobacteria in breast-milk compared with non-allergic mothers [median 1.3 × 103 bacterial cells/mL (IQR 22.4–3.0 × 103) vs. 5.6 × 103 bacterial cells/mL (1.8 × 103–1.8 × 104), respectively, (P=0.004)], and their infants had concurrently lower counts of bifidobacteria in feces [3.9 × 108 bacterial cells/g (IQR 6.5 × 106–1.5 × 109) in infants of allergic mothers, vs. 2.5 × 109bacterial cells/g (6.5 × 108–3.2 × 1010) in infants of non-allergic mothers, P=0.013].
Conclusions Breast-milk contains significant numbers of bifidobacteria and the maternal allergic status further deranges the counts of bifidobacteria in breast-milk. Maternal fecal and breast-milk bifidobacterial counts impacted on the infants' fecal Bifidobacterium levels. Breast-milk bacteria should thus be considered an important source of bacteria in the establishment of infantile intestinal microbiota.
-=-=-=-=-
wiggle into chiropractic:
http://www.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20071017005757&newsLang=en
October 17, 2007 09:53 AM Eastern Time
Chiropractic Care: On the Road with `The Wiggles' and Other Celebrities
CHICAGO & CARMICHAEL, Calif.--(BUSINESS WIRE)--When entertainers such as the Australian children’s entertainment group “The Wiggles”, and their cast and crew members are on tour, they often discover that chiropractic care is an essential ingredient for addressing the impact of demanding schedules, late hours and constant physical exertion. Many of these entertainers during their national tours turn to Heidi Froehlich, Heidi’s Fabulous Fatigue Fighters Worldwide, http://www.FabulousFatigueFighters.com a reliable resource for chiropractors, massage therapists and wellness professionals.
“Nearly all of the 14 dancers on tour with The Wiggles were suffering from shin splints, sore knees and hamstring problems from their grueling tour schedule before enlisting the help of Dr. James Stoxen's in 2004,” said Anthony Field, the "blue Wiggle," speaking from Sydney, Australia.
“Many of their pains were due to lack of proper injury prevention exercises and poor dance performance footwear,” Field said. "Dr. Stoxen a local Chicago chiropractor showed us exercises and the right footwear. Once the foot was right, the rest of our bodies were OK."
Too often, in fact, athletic shoes cause body aches that people don't associate with their footwear, says Stoxen. The foot becomes lazy as the muscles that would naturally be exercised while walking are allowed to remain lax, he says. "Walking and running (are) a natural stress placed on the foot," he said. "Each step we take puts a stress on the body muscles. They rebuild and the body gets stronger. The arch of the foot has a natural spring mechanism that through evolution has allowed walking and running efficiently. It's a magnificent structure, the foot.
Dr. Stoxen explains that, “Shoes designed with too much spongy material increases the natural stress the on foot and the arch. Initially, the leg muscles compensate, but eventually, they become exhausted.”
“The realignment can lead to the displacement of the kneecap, hip and back,” says Stoxen who is working with major shoe manufacturers to design a better athletic shoe that will replicate "natural barefoot" walking and running, and presumably eliminate the foot, knee and hip problems that can develop later in life.
Chiropractic care is now recognized as one the most effective approaches to achieving wellness and optimal health, asserts The Foundation for Chiropractic Progress (FCP) www.f4cp.com, an organization dedicated to increasing the awareness about the benefits of Chiropractic services.
“Entertainers with physically demanding tour schedules benefit significantly from chiropractic care because the relief is often immediate,” says James Stoxen, DC. He has lectured to over 20,000 medical doctors and scientists from 60 countries on the effects of abnormal biomechanics of the foot and the effect on the musculoskeletal system. Over the last 4 years he has been called to treat the cast and crew of over 130 concert tours including more than 40 Grammy-nominated recording artists. He is a favorite of the Australian children's and The Wiggles that entertain young children across the world.
About F4CP
The Foundation for Chiropractic Progress is a 501c6 corporation that represents a cross section of the chiropractic and vendor communities with the goal of increasing the public’s awareness of the benefits of chiropractic. http://www.f4cp.org.
-=-=-=-=
Mercola
http://www.youtube.com/watch?v=FPI7zdGdqo4
If you can pick up youtube video, then its worth a look.
This is an exceptionally good 'infomercial' for Dr Mercola.
Mercola is an osteopathic physician, I believe.
Its amazing he's not been assassinated yet for this video.
Obviously not ALL medicine is evil...but many of the facts in this are tragically true, esp. for USA.
I met a fellow just TODAY who had holes burned in his gut: by taking ASPIRIN. It happens.
-=-=-=
if you have the time, watch this...its long
http://www.juryroll.com/forum/view_topic.php?id=1257&forum_id=27
click on the movie screen to play...
BUT:
you might learn why the medical system is the way it is today
I dont think the drug in question is of much relevance, but look at the attitude of the doctors to this "cure"...if they cant control it, they get very upset...
thanks Dr Michael for this Canadian documentary
...now to look up if it really exists or not...
-=-=-=-=-
Fear and loathing over
canine vaccination
The index case involved – and I
don’t know if I want to read too
much into this – a lawyer’s dog.
It received a routine triple vaccination,
went into anaphylaxis and died, despite
aggressive therapy. Nothing strange here,
except that the grieving owner was
convinced this particular vaccine is too
dangerous for dogs and should be
banned. She started a campaign against
this family of vaccines by writing to
kennel club publications and numerous
chat lines for dog enthusiasts.
http://www.ava.com.au/avj/0305/03050237.pdf
-=-=-=-=
I think this group released a great article in the Australian Journal recently about atlas adjusting and BP.
Here is another..
Effects of body position on autonomic regulation of cardiovascular function in young, healthy adults
Nobuhiro Watanabe , John Reece and Barbara I Polus
Chiropractic & Osteopathy 2007, 15:19doi:10.1186/1746-1340-15-19
Background
Analysis of rhythmic patterns embedded within beat-to-beat variations in heart rate (heart rate variability) is a tool used to assess the balance of cardiac autonomic nervous activity and may be predictive for prognosis of some medical conditions, such as myocardial infarction. It has also been used to evaluate the impact of manipulative therapeutics and body position on autonomic regulation of the cardiovascular system. However, few have compared cardiac autonomic activity in supine and prone positions, postures commonly assumed by patients in manual therapy. We intend to redress this deficiency.
Methods
Heart rate, heart rate variability, and beat-to-beat blood pressure were measured in young, healthy non-smokers, during prone, supine, and sitting postures and with breathing paced at 0.25 Hz. Data were recorded for 5 minutes in each posture: Day 1 - prone and supine; Day 2 - prone and sitting. Paired t-tests or Wilcoxon signed-rank tests were used to evaluate posture-related differences in blood pressure, heart rate, and heart rate variability.
Results
Prone versus supine: blood pressure and heart rate were significantly higher in the prone posture (p < 0.001). Prone versus sitting: blood pressure was higher and heart rate was lower in the prone posture (p < 0.05) and significant differences were found in some components of heart rate variability.
Conclusions
Cardiac autonomic activity was not measurably different in prone and supine postures, but heart rate and blood pressure were. Although heart rate variability parameters indicated sympathetic dominance during sitting (supporting work of others), blood pressure was higher in the prone posture. These differences should be considered when autonomic regulation of cardiovascular function is studied in different postures.
-=-=-=-=-=-=-
I would guess the chiro profession is guilty of this in terms of efficacy...however, there are virtually nil cases of iatrogenesis per year? THE INSURERS in the USA are denying claims for children...what about this?
Begin forwarded message:
Joe, this begs the question, "Is there a double standard in EBM ?" - not only for children but with regards other professions!
Regards,
Peter
Prescription safeguards failing children
Alarms are ringing over the lack of safety data for drugs prescribed for children. Health editor Adam Cresswell reports |
The Weekend Australian December 01, 2007 ((Careers Supplement p20)
MOST people assume that drugs used in children are studied more carefully for potentially dangerous side effects than those available for adults. But they are wrong. Far from being subject to more scrutiny, the use of prescription drugs in children remains a glaring blind spot in health systems across the world.
The uncomfortable truth is that, for the vast majority of drugs used in children, there is very little proper scientific data to reassure doctors about the drugs' safety and side effects, how well they work -- if at all -- or what dosages are best.
Without this data, many drugs are not officially approved for use in children, and the manufacturers publish no guidelines for doctors in how they should be used in younger age groups. Doctors can still prescribe drugs for other groups not covered by the original licence, such as children, a practice known as "off-label" prescribing.
Such use may be appropriate in some circumstances, but it leaves children exposed to potentially ineffective or unsafe medicines. Doctors prescribing off-label are effectively left to infer from adult trials and their own experience what dosages will work best.
Recent data shows that from 2002 to 2004 there were 820 suspected serious adverse drug reactions reported spontaneously to the European Agency for the Evaluation of Medicinal Products -- 130 of which were fatal, and 361 of which caused prolonged hospitalisation.
A separate Swedish study of adverse drug reaction reports related to children found 158 cases, of which 42.4 per cent were linked to off-label prescribing.
Drugs for behavioural and psychiatric disorders, and newer antibiotics and analgesics are all examples of drugs that are both frequently prescribed for children, and for which there is poor evidence for their safety and efficacy.
Studies suggest that up to 92 per cent of hospitalised children are prescribed at least one drug off-label during their stay, and up to 97 per cent of newborn babies. And with the world's top health body about to step in, paediatricians and ethical experts are now saying enough's enough.
"A lot of paediatricians have become concerned in recent years that the data isn't there to reassure them that these prescribing practices are safe," says doctor Robert Loblay, chairman of the ethics review committee for Sydney South-West Area Health Service.
"There's been a growing call ... for pharmaceutical companies to do the necessary studies to assure them that these drugs are safe and effective (in children).
"The pharmaceutical companies don't have a lot of incentive to do that, unless it's a big slice of their market. It's a very expensive thing to run clinical trials."
Loblay warned experts attending the national ethics conference of the National Health and Medical Research Council, held in Melbourne in October, that doctors were "treading on very thin ice" by continuing to prescribe drugs to children when the clinical trials conducted to test the safety of those drugs had not included children.
In answer to a question, Loblay told the conference that hospital ethics review committees should be more vigilant for the possibility that drugs might have a use in patients under 18.
In such cases, he said ethics committees ought to ask researchers seeking permission to conduct trials if children were included in the study population -- and if not, why not.
"The answer may be 'we are (including children), but not at this hospital'," Loblay told Weekend Health. "That's fine -- but we need to be asking the question."
In London next week the WHO is expected to launch a list of medicines approved for use in children, to help guide doctors about which medicines are safe and effective in children.
In the meantime, experts here are pushing for regulatory bodies such as the Therapeutic Goods Administration, NHMRC and drug manufacturers to address the problem.
Dr Madlen Gazarian, a paediatric clinical pharmacologist, has been warning of the dangers caused by inadequate data in paediatric prescribing for several years. The chairwoman of the paediatric portfolio of the therapeutics committee of the Royal Australasian College of Physicians, Gazarian in 2003 wrote an editorial for the professional journal Australian Prescriber (2003;26(6):122-3) reporting that adverse reactions were more common when drugs were prescribed off-label. While many children had undoubtedly benefited from drug treatment, data on benefits was poor and it was also true that in a few cases "some children have died as a result" of off-label prescribing.
"Widespread off-label prescribing really is a major issue -- it's been around for yonks, but seems now to have grabbed enough people's attention for something to be done about it," Gazarian told Weekend Health.
Loblay says although doctors currently have little option but to prescribe drugs for children off-label, the fact that they do so removes the incentive for drug companies to do further studies. The problem is compounded by the fact that adverse reactions are less likely to be reported when the drug was prescribed off-label, so there is not even good data to show which drugs are causing most adverse reactions in kids.
There is also a financial angle, in that drugs do not attract a subsidy under the Pharmaceutical Benefits Scheme when prescribed outside the terms of their licence, so parents also end up out of pocket.
Loblay likens the situation to a similar research gap that existed for women as late as the 1990s.
"Fifteen to 20 years ago ... most clinical trials did not include women of childbearing age, because they were worried women might be pregnant (without realising it) and the drug might affect the developing baby," Loblay says. "So it was standard practice to exclude women from most clinical trials. But then people started to realise that we are prescribing these drugs for women, but there's no data to say it's safe. The (US) Food and Drug Administration was the first regulatory body to say, and the TGA followed, that to get a drug registered companies had to include women as well as men. So they all started doing it; now it's standard to do pregnancy tests on women of childbearing age (when they are enrolled in trials)."
Loblay, Gazarian and others agree that what's needed to tackle the evidence gap for children is better research -- either by giving bodies such as the TGA the power to order drug companies to include children in trials, or to allocate public funds to run trials directly -- as in the US and European Union.
Loblay concedes that including children in trials is not as straightforward as including women, due to ethics and safety issues. But Gazarian says suggestions these are a major hurdle are overblown, and points to the alacrity with which drug giants in the US rushed to take up financial incentives offered by the FDA to run children-specific trials.
"Whenever you remove a financial barrier or create a financial incentive (for drug companies), lo and behold, the research seems able to be done," she says.
"But it's tended to happen with more profitable drugs with a larger market. It's becoming clear that the (US) incentives are not going to ensure that all the needed research will be done."
Earlier this year Gazarian wrote a discussion paper for the World Health Organisation on the question of off-label prescribing in children. While her paper said the practice not illegal, "and may sometimes be appropriate", it was "associated with important clinical and ethical concerns".
The paper added that off-label prescribing "does bypass the safeguards of the drug regulatory process and places a greater onus of responsibility on the individual prescriber to assess the benefits and risks of such use for an individual patient.
"While this may be acceptable as an exception, it is clearly unacceptable when it becomes the norm."
While she defends the right of doctors to prescribe off-label, and says restricting this right would impose too great a limit on clinical freedom, Gazarian thinks it is over-used and should be limited to circumstances where it can be justified by pre-specified criteria, as this will reduce inappropriate use and exposure to unnecessary risk.
A separate paper, published in the Medical Journal of Australia last year, of which she was lead author, found the level of off-label prescribing was also common in adults -- between 7.5 and 40 per cent of the total.
That paper proposed three scenarios where off-label use was appropriate: when such use was justified by high-quality research evidence, within the context of a formal trial or research project, and in exceptional circumstances, where such use was justified by individual clinical circumstances.
The Australian Health Ministers Advisory Council has already commissioned a working group to review the issue and consider how the safety of paediatric prescribing can be improved.
To close the evidence gaps, Gazarian argues for a "co-ordinated and well-resourced national approach" -- including the commitment of public funds -- to conduct studies on children. She also says there should be a national evidence-based prescribing information resource, to give doctors, pharmacists, nurses and others the latest evidence on what drugs work best.
And she calls for US-style incentives for pharmaceutical companies to conduct studies, and for drug licences to be updated when new research data shows a particular use for a drug is safe and effective. At the moment, licence provisions are only extended if a manufacturer makes an application to the TGA -- something they currently have little incentive to do.
A spokesman for the drug manufacturers' umbrella body Medicines Australia said it "acknowledges the need for ethically conducted, evidence-based research for the benefit of all children who may need medicines which haven't been specifically designed for them.
"One of the questions that needs to be considered is how best to establish a regime which can provide appropriate incentives to encourage research that will provide children with licensed medicines," he said.
A spokeswoman for the TGA said the regulator was "very keen to progress better paediatric information about drugs" and the AHMAC initiative was key to achieving that.
"The TGA is very keen to see increased paediatric data, bearing in mind the ethical considerations, and to find solutions that would encourage companies to produce better paediatric evidence," she said.
-=-=-=-=-
Fever and Autism
from Reuters
By Michael Conlon
CHICAGO (Reuters) - Fever can temporarily unlock autism's grip on children, a finding that could shed light on the roots of the condition and perhaps provide clues for treatment, researchers reported on Monday.
It appears that fever restores nerve cell communications in regions of the autistic brain, restoring a child's ability to interact and socialize during the fever, the study said.
"The results of this study are important because they show us that the autistic brain is plastic, or capable of altering current connections and forming new ones in response to different experiences or conditions," said Dr. Andrew Zimmerman, a pediatric neurologist at Baltimore's Kennedy Krieger Institute, who was one of the study authors.
The study, published in the journal Pediatrics, was based on 30 children with autism aged 2 to 18 who were observed during and after a fever of at least 100.4 degrees Fahrenheit.
More than 80 percent of those with fever showed some improvements in behavior during it and 30 percent had dramatic improvements, the researchers said. The change involved things like longer concentration spans, more talking, improved eye contact and better overall relations with adults and other children.
Zimmerman's team said the fever effect had been noted anecdotally in the past by parents and doctors.
Lee Grossman, president and chief executive officer of the Autism Society of America, said he had noticed it in his own son, who is now 20.
But he noted in an interview that the study's authors said expanded research was needed on the fever effect and its implications. "It's good that they've noticed this and are bringing it forward," he said.
People with autism spectrum disorders suffer in varying degrees from limited social interactions, lack of verbal and non-verbal communication and other abilities.
As many as 1.5 million Americans have some form of autism, according to ASA. It is not known what causes the condition.
Zimmerman said that while there currently is no definitive medical treatment, speech and language therapy started as soon as possible after diagnosis "can make a significant difference."
He called the fever research, headed by colleague Laura Curran, "an exciting lead" that could help point the way to a treatment that would reconnect the autistic brain. He said the fever effect was believed found only in children, whose brains are more "plastic" than those of adults.
(Editing by Andrew Stern and Eric Beech)
-=-=-=--=
Paediatrician struck off register
A leading British paediatrician has been struck off the medical register after wrongly accusing an Adelaide woman of her son's murder.
The General Medical Council (GMC) found Dr David Southall, who was regarded as one of the UK's leading child protection experts, guilty of serious professional misconduct.
The GMC found Southall added to the distress of Mandy Morris, whose 10-year-old son, Lee, hanged himself at home in Shropshire, England, in 1996.
Southall claimed Morris - identified only as Mrs M when she gave video evidence against him from her new home in Adelaide last month - had drugged and murdered the boy.
He made the allegations during an interview with her about the safety of her surviving son.
During proceedings, GMC panel chairwoman Dr Jacqueline Mitton told Southall: "Although Mrs M was not your patient, your action in accusing her of drugging and murdering Child M1 (her son) by hanging him was inappropriate, added to her distress and was in the circumstances an abuse of your professional position."
Morris has begun a new life in Australia.
She waived her anonymity in a recent interview with the website of Britain's Evening Standard newspaper, thisislondon.co.uk, in which she said Southall's allegations had "ripped the heart out" of her family.
It is the second time in three years Southall has been found guilty of serious professional misconduct.
In 2004, he was suspended from child protection work over his role in the case of Sally Clark, who was wrongly jailed over the death of her two sons.
Clark was cleared on appeal in 2003 after serving four years in prison. She died earlier this year.
Southall wrongly accused Clark's husband, Steve, of murdering the two boys on the basis of a television interview.
Dr Mitton said Southall had "attitudinal problems".
"Your multiple failings over an extended period caused the panel great concern," Dr Mitton said.
"Furthermore, the panel is influenced by the fact that although the events in the current case predate those in the Clark case, there are now two instances where, without justification, you have accused a parent of murdering their child."
In a brief statement, Southall said he was taking legal advice about the prospect of launching an appeal.
© 2007 AAP
-=-=-=-
is this a landmark study?
how many papers will ignore this one?
There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.
...could be?
Complementary Therapies in Medicine
Volume 15, Issue 4, December 2007, Pages 271-283 doi:10.1016/j.ctim.2007.01.008
Copyright © 2007 Elsevier Ltd All rights reserved.
Psychological response in spinal manipulation (PRISM): A systematic review of psychological outcomes in randomised controlled trials
Summary
Background
The most important risk factors for back and neck pain are psychosocial. Nevertheless, systematic reviews of spinal manipulation have concentrated on pain and spine related disability, and ignored psychological outcomes.
Objective
To assess whether spinal manipulation was effective in improving psychological outcome.
Design
Systematic review of randomised controlled trials (RCTs).
Methods
RCTs were identified by searching Medline, CINAHL, Embase, CENTRAL, AMED, PsycINFO until November 2005. Trials reporting psychological outcomes including the mental health components of generic outcomes were extracted, and combined where appropriate in meta-analyses.
Results
One hundred and twenty nine RCTs of spinal manipulation were identified; 12 had adequately reported psychological outcomes. Six trials with a verbal intervention comparator were combined in a meta-analysis, and found a mean benefit from spinal manipulation equivalent to 0.34 of the population standard deviation (S.D.) [95% confidence interval (CI) 0.23–0.45] at 1–5 months; 0.27 of the S.D. [95% CI 0.14–0.40] at 6–12 months. Eight trials with a physical treatment comparator were combined in a meta-analysis and found a mean benefit of 0.13 of the S.D. [95% CI 0.01–0.24] in favour of manipulation at 1–5 months; 0.11 of the S.D. [95% CI −0.02 to 0.25] at 6–12 months.
Conclusions
There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.
...wow!!!!!!!!!
-=-=-=-
Israeli study says regular mobile use increases tumour risk
Regular use of mobile telephones increases the risk of developing tumours, a new scientific study by Israeli researchers and published in the American Journal of Epidemiology revealed on Friday.
An extract of the report seen by Israel's Yedoit Aharonot newspaper put the risk of developing a parotid gland tumour nearly 50 percent higher for frequent mobile phone users -- more than 22 hours a month.
The risk was still higher if users clamped the phone to the same ear, did not use hands-free devices or were in rural areas.
"Analysis restricted to regular users or to conditions that may yield higher levels of exposure (eg heavy use in rural areas) showed consistently elevated risks," said an abstract of the report in the US journal made available to AFP.
The study included 402 benign and 58 malignant incident cases of parotid gland tumour diagnosed in Israel at age 18 years or more, in 2001-2003.
The research was led by Dr Siegal Sadetzki, a cancer and radiation expert at the Chaim Sheba Medical Centre in Israel and as part of a World Health Organisation project.
Copyright AFP 2007, AFP stories and photos shall not be published, broadcast, rewritten for broadcast or publication or redistributed directly or indirectly in any medium
Now its ok not to refer to Chiropractors.
Here is the evidence.
My friend Dr Hart points out that MDs get CPD credit for reading these poorly produced studies.
That is how you sustain ignorance: provide evidence for its adherence...
Diclofenac or Spinal Manipulative Therapy Not Helpful for Acute Low Back Pain
News Author: Laurie Barclay, MD
November 13, 2007 — Patients with acute low back pain receiving recommended first-line care did not recover more quickly with the addition of diclofenac or spinal manipulative therapy, according to the results of a randomized controlled trial in the November 8 issue of The Lancet.
"Present treatment guidelines for acute low back pain recommend that general practitioners should give advice (remain active, avoid bed rest, and reassurance of favourable prognosis) and paracetamol as the first line of care," write Mark J. Hancock, MAppSc, from the University of Sydney in Australia, and colleagues. "Non-steroidal anti-inflammatory drugs (NSAIDs) and spinal manipulative therapy are recommended as second-line management options for patients who have slow recovery. We do not know whether NSAIDs or spinal manipulative therapy, or both, in addition to advice and paracetamol as initial treatment results in quicker recovery for such patients."
In this community-based study, 240 patients with acute low back pain who had been given advice and paracetamol by their general practitioner were randomized to receive diclofenac 50 mg twice daily and placebo manipulative therapy (n = 60), spinal manipulative therapy and placebo drug
(n = 60), diclofenac 50 mg twice daily and spinal manipulative therapy (n = 60), or double placebo (n = 60). The main endpoint was days to recovery from pain, evaluated with survival curves in an intent-to-treat analysis.
Compared with placebo drug or placebo manipulative therapy, neither diclofenac nor spinal manipulative therapy significantly decreased the number of days until recovery (diclofenac hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.84 - 1.42; P = .516; spinal manipulative therapy HR, 1.01; 95% CI, 0.77 - 1.31; P = .955). By 12 weeks after randomization, 237 (99%) patients had either recovered or were censored.
Secondary analyses showed no significant effects on pain, disability, or global perceived effect at 1, 2, 4, or 12 weeks, when diclofenac or spinal manipulative therapy, or both, was added to baseline care.
Possible adverse reactions occurred in 22 patients; these included gastrointestinal tract disturbances, dizziness, and heart palpitations. Half of these patients were in the active diclofenac group, and the other half were taking placebo. One patient taking active diclofenac stopped treatment because of a suspected hypersensitivity reaction.
"Neither diclofenac nor spinal manipulative therapy gave clinically useful effects on the primary outcome of time to recovery," the study authors write. "We can reasonably assume that when quality baseline care is provided, previously effective treatments might no longer provide additional benefit."
Limitations of the study include cointerventions during the study period in 28 patients and imperfect compliance rates.
"These results are important because both diclofenac and spinal manipulative therapy have potential risks and additional cost for patients," the study authors conclude. "If patients have high rates of recovery with baseline care and no clinically worthwhile benefit from the addition of diclofenac or spinal manipulative therapy, then GPs [general practitioners] can manage patients confidently without exposing them to increased risks and costs associated with NSAIDs or spinal manipulative therapy."
Alphapharm donated the active diclofenac and Bill Rae provided the placebo tablets. Australia's National Health and Medical Research Council mainly funded the trial. One of the study authors had been a member of an advisory board about paracetamol for GlaxoSmithKline. Some of the study authors have obtained funding.
Lancet. 2007;370:1638-1643.
-=-=-=-=-=-
Drug trial scandal: babies born disabled
Natasha Wallace Health Reporter
November 19, 200
Disabled births after drug trial
Up to 12 mothers who had disabled children after a drug trial could sue a hospital for millions of dollars after it agreed to pay more than $750,000 to a woman whose child was born with cerebral palsy. more
UP TO 12 mothers who had disabled children after a drug trial could sue a hospital for millions of dollars after it agreed to pay more than $750,000 to a woman whose child was born with cerebral palsy.
The mothers are among 50 worried about their involvement in the trial at Wagga Wagga Base Hospital of the drug misoprostol to induce labour at full term.
The trial has been shrouded in secrecy, but the manufacturer of misoprostol, marketed as Cytotec, had warned as early as 2000 that it should not be used by pregnant women because it could cause unwanted abortion and birth defects such as club foot, missing fingers and brain injury.
Kimberley Reid sued the hospital after her son, Joshua, was born in 2001 with severe cerebral palsy. She said she was told that misoprostol was the only available drug for induction at the time and that she was not informed of the associated risks.
Her lawyer, John Potter, said yesterday that Ms Reid was asked during labour if she wanted to take part in the trial.
The Greater Southern Area Health Service had fought the case for the past three years. It was due to go to a six-week hearing today, but the hospital settled late on Friday after local media published details of it. The area health service has refused to provide any information on the trial, believed to have taken place between 2000 and 2003.
Misoprostol is licensed in Australia for the treatment of gastrointestinal ulcers in men and non-pregnant women and to treat hemorrhage after normal delivery.
It can also be used for low-cost abortions or in the case of a stillbirth, but is not licensed here for those purposes.
Joshua's father, Tony Reid, is also suing, and is expected to settle today. All cases heard in the NSW Supreme Court are for more than $750,000 in damages.
Mr Potter said the terms of Ms Reid's settlement were confidential and should be finalised in court on Wednesday, but the hospital had already admitted negligence.
"They certainly admitted that they had breached some of their obligation to the plaintiff," Mr Potter said. "Whilst this lady signed a consent form she wasn't informed of the risks involved, so we say there was no informed consent. The allegation is that they said there was no other treatment available at the time."
The Herald understands the hospital settled for more than what Ms Reid had offered to accept a year ago.
Mr Potter said 50 other mothers who had taken part in the trial had contacted him since the case was made public in July.
"Half-a-dozen of them have children with disabilities, but I can't yet sheet that home to the trial," he said. He was still investigating their cases.
Mr Potter said the manufacturers of the drug warned it should not be used for live births. "It [the warning] was certainly there at the time that the trial was conducted at Wagga Wagga," he said. "The only countries that I can find [using it for live births] are Egypt and Libya."
The Department of Health will not reveal how many women took part in the trial, nor who was responsible for it.
Mr Potter said misoprostol was a fraction of the price of other labour-inducing drugs.
Joshua is the Reids' first child and requires 24-hour care. "It's a very tragic case … it has been devastating," Mr Potter said.
Mr Reid told the Herald yesterday that it had been a long and painful journey. "It's definitely not celebrations here," he said.
A spokeswoman for the area health service said she could not discuss the trial because the case was still before the courts.
http://newsletters.fairfax.com.au/cgi-bin16/DM/y/hBUZ40T1LXb0Bhi0P7Ni0Gs
-=-=--=
it would be something if the vaccine proponents attempted to be scientific and individualistic in application of medicine
like the new discovery whether chemotherapy is actually working on each individual
BMJ 2007;335:1016 (17 November), doi:10.1136/bmj.335.7628.1016-b
Immunity against some viruses would last for centuries
The immune system has a very long memory after live viral infections, say researchers who examined repeated blood samples from 45 volunteers working in a primate research centre in Oregon. The samples spanned up to 26 years of follow-up and showed that antibodies generated in response to natural viral infections have half lives ranging from an estimated 50 years for varicella zoster virus to more than 11 000 years for Epstein-Barr virus.Antibodies against mumps, measles, and rubella were also remarkably stable, implying lifelong immunity (estimated half lives 542 years, 3014 years, and 114 years).
Humoral immunity against tetanus and diphtheria, induced by vaccination with protein antigens, decayed much faster than that triggered by a natural viral infection. In vaccinated volunteers, tetanus specific antibodies had an estimated half life of just 11 years, and those directed against diphtheria had a half life of 19 years.
N Engl J Med 2007;357:1903-15
-=-=-==
The NSW Coroner has found there is sufficient evidence for the Director of Public Prosecutions to consider laying charges against the parents of a baby who died after they treated her with homeopathic remedies.
.....more below
http://www.smh.com.au/news/national/baby-death-call-for-homeopath-rules/2007/11/19/1195321684868.html
-=-=-=-
this http://www.atlasprofilax.ch
has got to be a scam of scams
its one thing to discredit upper cervical by saying we cause strokes, but another to fob yourself off as an upper cervical practitioner with NO education
procedure is also being offerec in beauty parlours, last I heard
i had yet ANOTHER enquiry from the public about it...this time when they asked if it would help their daughter with MS, they stated that the parents had to be treated first
sounds worse than scams we know all to well
watch out for it in your state
-=-=-=-=-
as my friend says, they are baffled...imagine giving adjustments and 80% of your patients get worse?
AIDS vaccines experts confused and dismayed
Thu Nov 8, 2007 1:56pm EST
By Maggie Fox, Health and Science Editor - Analysis
WASHINGTON (Reuters) - AIDS vaccine researchers are worried about the future of their field after learning an experimental HIV vaccine not only does not work, but just might make recipients more susceptible to infection with the AIDS virus.
They are worried about their volunteers and the future of AIDS vaccines in general. And they are worried because they cannot understand how a vaccine would make a person more vulnerable.
Researchers from Merck & Co. (MRK.N: Quote, Profile , Research), which makes the vaccine, and the National Institute of Allergy and Infectious Diseases, which is helping develop it, said on Wednesday they believe a type of common cold virus used as the basis of the vaccine may somehow have made their volunteers more susceptible to HIV.
They are meeting this week in Seattle to hash through the data and figure out what happened.
This is what they know: Out of 1,500 people vaccinated, 82 became infected with the AIDS virus. Of these, 49 got the vaccine and 33 got a placebo shot.
While they are counseling volunteers that they may have raised their own risk of becoming infected, they are also trying to figure out what happened.
"The data are disappointing and puzzling but we don't have definitive answers," Dr. Lawrence Corey of Fred Hutchinson Cancer Research Center in Seattle, who was organizing the trial, told reporters.
Only one woman in the trial became infected with HIV. The rest were men having sex with other men, and it was the men who started out with the highest immune response to the adenovirus 5 common cold bug used to make the vaccine who were the most likely to become infected with the AIDS virus.
But the infected men were also less likely to have been circumcised -- circumcision can also prevent HIV infection -- and may have engaged in more risky behavior. So did the vaccine actually do something, or were the results a fluke?
"I don't think we really do know," Dr. Keith Gottesdiener of Merck Research Laboratories told Reuters.
FUTURE OF THE FIELD
Nearly 30 potential AIDS vaccines are being tested in people around the world.
"It is very important for the future of the field," said Margaret Johnston, director of the AIDS vaccine research program at the NIAID.
"It makes us rethink some of the candidates that are in trial," said Dr. Seth Berkley, president of the International AIDS Vaccine Initiative.
Even vaccine advocates are calling it a setback.
"These data are deeply disappointing and troubling, and raise more questions than answers for the field of AIDS vaccine," said AIDS Vaccine Advocacy Coalition executive director Mitchell Warren.
"This setback should not and can not diminish our commitment to developing an effective HIV vaccine," said NIAID director Dr. Anthony Fauci. "Every day, another 12,000 people become infected with HIV, most of whom live in resource-poor countries," he added.
-=-=-=-=-
for full story click link...
Health authority bans physician shadowing
Deborah Jones
Vancouver
In British Columbia's biggest health authority, the days when a pharmaceutical or medical equipment sales representative could scrub in and attend a surgery in an operating theatre, wander unattended through the emergency room or even be involved in the delivery of medications to patients, are now over.
http://www.cmaj.ca/cgi/content/full/177/11/1339?etoc
-=-==-
interesting vax article relating Autoimmune diseases
click link for whole article
Key messages
• It is tempting to consider that 2 events that occur in close temporal association are causally related. This temptation is greatest for outcomes that are unexpected, severe or disabling; for outcomes whose pathophysiology is poorly understood; and for outcomes that affect previously healthy people whom we love or care for.
• The temptation to consider a temporal association as causal increases if the event is perceived to be aggressive or complex, if it has long-lasting effects or if the disease is only partly characterized.
• The likelihood of a temporal association between vaccination and an adverse event is proportional to vaccine coverage and to disease prevalence in the target population.
• Autoimmune diseases occur in adolescents and young women, and they are more frequent in young women.
• The large-scale implementation of a new vaccination program in a population of adolescent and young women inevitably will markedly increase the number of apparent cases of autoimmune diseases occurring after immunization.
• Coincidences are not indicative of a causal link.
• Determining local health-resource use before and after initiation of a new vaccination program may be a useful method to provide the rapid answers that vaccine safety concerns deserve to protect public health.
Begin forwarded message:
Hi Joe,
For the Group.
This topic is the main struggle for vaccines.
But its example also has some inferences as to how we look at Stroke and practice related injuries.
http://www.cmaj.ca/cgi/content/full/177/11/1352?etoc
Donald
-=-=-=-
Cholesterol Drug May Affect Sleep
Study Shows Some Users of Zocor Report a Poorer Quality of Sleep
By Charlene Laino
WebMD Medical News
Reviewed by Louise Chang, MD
Nov. 7, 2007 (Orlando, Fla.) -- Are you tossing and turning at night? A popular cholesterol-lowering drug may be to blame.
In a new study, those who took the statin drug Zocor reported they had a significantly worse quality of sleep than those who took a placebo or Pravachol , another statin drug, says researcher Beatrice Golomb, MD, an associate professor of medicine at the University of California, San Diego.
Participants did not report any specific sleep disturbance, just generally having a worse night's sleep, she says.
"Problems with sleep initiation, problems with sleep maintenance, a feeling that sleep was unrestful, and napping during the day -- none of those actually were what was going on," Golomb tells WebMD.
So what's left?
Maybe nightmares, something related to sleep-disordered breathing, or some as yet unexplored problem, Golomb says.
"Although the average effect on sleep was detrimental on Zocor, this does not mean that everyone on Zocor will experience worse sleep," she says.
The study involved 1,016 people with no signs of heart disease and LDL "bad" cholesterol levels between 115 and 190. LDL levels below 100 are optimal, according to the American Heart Association.
They were randomly assigned to Zocor, Pravachol, or a placebo for six months. Participants rated "sleep quality" and "sleep problems" on two standardized sleep scales.
Insomnia is listed as a possible side effect on the labeling of all statin drugs. Â
The findings were reported at the American Heart Association's (AHA) Scientific Sessions 2007.
The National Institutes of Health funded the study.
Fat-Soluble vs. Water-Soluble
Zocor and Pravachol dissolve in the body differently, says Gordon Tomaselli, MD, chairman of the committee that picked the studies to highlight at the meeting. Tomaselli is chief of cardiology at Johns Hopkins University School of Medicine in Baltimore.
Zocor dissolves in fat, so it can more easily penetrate cell membranes and cross the blood-brain barrier into the brain. Pravachol dissolves in water, so it has a hard time penetrating these barriers.
"It's easy to theorize that if you get a foreign substance in the brain, it might affect sleep, cognition and other processes controlled by the brain," Tomaselli tells WebMD.
Tomaselli says statins do not interfere with most people's sleep. "But if you are having sleep problems, ask you doctor if you should switch to a medication that has less fat solubility," he advises.
Other statins that are fat soluble include Lipitor and Mevacor. The statins Crestor and Lescol are water soluble.
Merck, the maker of Zocor, says in a statement that it conducted sleep studies with Zocor, Pravachol, and a placebo and found no difference with regard to sleep disturbances between Zocor and the placebo.
Additionally, in a study of more than 20,000 patients, people taking Zocor were no more likely to stop taking it because of sleep disorders than those on placebo, Merck says.
-=-=-=-=-=
From the BBC:
http://news.bbc.co.uk/1/hi/health/7104155.stm
Half of trauma care 'not good'
About 800 trauma patients end up transferring hospitals
More than half of trauma patients are not receiving good care, experts say.
The National Confidential Enquiry into Patient Outcome and Death looked at the care given to 795 patients, many with head injuries from falls and crashes.
It found medical staff in 200 hospitals in England, Wales and Northern Ireland often did not appreciate the severity and displayed little urgency.
It said care would improve if services were centred at fewer sites - something which is already government policy.
NCEPOD said many of the problems identified in nearly 60% of patients treated across 200 hospitals were associated with staff being too inexperienced.
Our mortality rates are among the worst in the developed world, and yet trauma care remains a low priority for the government
Royal College of Surgeons spokesman
'They just diagnosed a broken arm'
In particular, they found patients were not always given essential tests such as CT scans or assessed by hospital consultants, especially during the night.
Researchers said most hospitals would only deal with one trauma patient a week and this meant staff did not get the necessary experience to keep skills up to date.
They also said about 800 trauma patients each year needed to be transferred to other hospitals - often in an "ad hoc" manner - because of a lack of specialist facilities such as neurological services.
Ambulance crews were also criticised for failing to always unblock airways and alert hospitals of incoming cases.
But the researchers said in hospitals which dealt with more than 20 cases a week the care was classed as good.
The report said this in itself was a good argument for centralising services in regional centres.
Services
This is already a government policy, but it is proving controversial because of the aim of a whole host of other services such as maternity and A&E being centralised as well.
Campaigners say such a move would lead to many local hospitals being stripped of key services.
Report author Dr George Findlay said: "The number of patients seen has a direct bearing on the experience and ability of clinicians to manage challenging cases.
"It is not possible for all hospitals to have a trauma team on call with the necessary experience, organisation and support structures.
"We need to look at how we can organise trauma care on a regional basis."
The Royal College of Surgeons said care urgently needed to improve.
A spokesman said: "Our mortality rates are among the worst in the developed world, and yet trauma care remains a low priority for the government.
"This a national health service and what we need is a national trauma system."
Health Minister Ben Bradshaw said: "We have argued for some time that it is not the proximity of the nearest A&E that matters to most trauma victims but the care they receive from ambulance and paramedic staff and the quality of care they receive once they arrive at hospital.
"Concentrating trauma treatment in specialist centres can arouse opposition from some people concerned about 'downgrading' of their local A&E facilities, but what the opponents often fail to recognise is that lives will be saved and the quality of care improved, as this report makes clear."
-=-=-=
scope practice bill in NJ is of interest to all
http://www.courierpostonline.com/apps/pbcs.dll/article?AID=/20071120/NEWS01/711200360/1006
-=-=-=-=
do back supports help?
MAYBE!
http://www.annals.org/cgi/content/abstract/147/10/685
Lumbar Supports to Prevent Recurrent Low Back Pain among Home Care Workers
A Randomized Trial
Pepijn D.D.M. Roelofs, MSc; Sita M.A. Bierma-Zeinstra, PhD; Mireille N.M. van Poppel, PhD; Petra Jellema, PhD; Sten P. Willemsen, MSc; Maurits W. van Tulder, PhD;Willem van Mechelen, MD, PhD; and Bart W. Koes, PhD
20 November 2007 | Volume 147 Issue 10 | Pages 685-692
Background: People use lumbar supports to prevent low back pain. Secondary analyses from primary preventive studies suggest benefit among workers with previous low back pain, but definitive studies on the effectiveness of supports for the secondary prevention of low back pain are lacking.
Objective: To determine the effectiveness of lumbar supports in the secondary prevention of low back pain.
Design: Randomized, controlled trial.
Setting: Home care organization in the Netherlands.
Patients: 360 home care workers with self-reported history of low back pain.
Intervention: Short course on healthy working methods, with or without patient-directed use of 1 of 4 types of lumbar support.
Measurements: Primary outcomes were the number of days of low back pain and sick leave over 12 months. Secondary outcomes were the average severity of low back pain and function (Quebec Back Pain Disability scale) in the previous week.
Results: Over 12 months, participants in the lumbar support group reported an average of –52.7 days (CI, –59.6 to –45.1 days) fewer days with low back pain than participants who received only the short course. However, the total sick days in the lumbar support group did not decrease (–5 days [CI, –21.1 to 6.8 days]). Small but statistically significant differences in pain intensity and function favored lumbar support.
Limitations: Study participants were unblinded, and a substantial amount of missing data required imputation. Objective data on sick days due to low back pain were not available.
Conclusion: Adding patient-directed use of lumbar supports to a short course on healthy working methods may reduce the number of days when low back pain occurs, but not overall work absenteeism, among home care workers with previous low back pain. Further study of lumbar supports is warranted.
-=-=-=-=-
wow, you've found another great study... showing that breast milk is important for bacteria development in infants
link follows...
Summary
Background The sources and the impact of maternal bacteria on the initial inoculum of the intestinal microflora of newborn infants remain elusive.
Objective To assess the association between maternal breast-milk and fecal bifidobacteria and infants' fecal bifidobacteria.
Methods Sixty-one mother–infant pairs were included, special emphasis being placed on the maternal allergic status. Bifidobacteria were analysed by a direct PCR method in fecal samples from mothers at 30–35 weeks of gestation and from infants at 1 month of age and from breast-milk samples 1 month post-partum.
Results Fecal Bifidobacterium adolescentis and Bifidobacterium bifidum colonization frequencies and counts among mother–infant pairs correlated significantly (P=0.005 and 0.02 for frequencies, respectively, and P=0.002 and 0.01 for counts, respectively). Only infants of allergic, atopic mothers were colonized with B. adolescentis. Each of the breast-milk samples contained bifidobacteria [median 1.4 × 103 bacterial cells/mL; interquartile range (IQR) 48.7–3.8 × 103]. Bifidobacterium longum was the most frequently detected species in breast-milk. Allergic mothers had significantly lower amounts of bifidobacteria in breast-milk compared with non-allergic mothers [median 1.3 × 103 bacterial cells/mL (IQR 22.4–3.0 × 103) vs. 5.6 × 103 bacterial cells/mL (1.8 × 103–1.8 × 104), respectively, (P=0.004)], and their infants had concurrently lower counts of bifidobacteria in feces [3.9 × 108 bacterial cells/g (IQR 6.5 × 106–1.5 × 109) in infants of allergic mothers, vs. 2.5 × 109bacterial cells/g (6.5 × 108–3.2 × 1010) in infants of non-allergic mothers, P=0.013].
Conclusions Breast-milk contains significant numbers of bifidobacteria and the maternal allergic status further deranges the counts of bifidobacteria in breast-milk. Maternal fecal and breast-milk bifidobacterial counts impacted on the infants' fecal Bifidobacterium levels. Breast-milk bacteria should thus be considered an important source of bacteria in the establishment of infantile intestinal microbiota.
-=-=-=-=-
wiggle into chiropractic:
http://www.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20071017005757&newsLang=en
October 17, 2007 09:53 AM Eastern Time
Chiropractic Care: On the Road with `The Wiggles' and Other Celebrities
CHICAGO & CARMICHAEL, Calif.--(BUSINESS WIRE)--When entertainers such as the Australian children’s entertainment group “The Wiggles”, and their cast and crew members are on tour, they often discover that chiropractic care is an essential ingredient for addressing the impact of demanding schedules, late hours and constant physical exertion. Many of these entertainers during their national tours turn to Heidi Froehlich, Heidi’s Fabulous Fatigue Fighters Worldwide, http://www.FabulousFatigueFighters.com a reliable resource for chiropractors, massage therapists and wellness professionals.
“Nearly all of the 14 dancers on tour with The Wiggles were suffering from shin splints, sore knees and hamstring problems from their grueling tour schedule before enlisting the help of Dr. James Stoxen's in 2004,” said Anthony Field, the "blue Wiggle," speaking from Sydney, Australia.
“Many of their pains were due to lack of proper injury prevention exercises and poor dance performance footwear,” Field said. "Dr. Stoxen a local Chicago chiropractor showed us exercises and the right footwear. Once the foot was right, the rest of our bodies were OK."
Too often, in fact, athletic shoes cause body aches that people don't associate with their footwear, says Stoxen. The foot becomes lazy as the muscles that would naturally be exercised while walking are allowed to remain lax, he says. "Walking and running (are) a natural stress placed on the foot," he said. "Each step we take puts a stress on the body muscles. They rebuild and the body gets stronger. The arch of the foot has a natural spring mechanism that through evolution has allowed walking and running efficiently. It's a magnificent structure, the foot.
Dr. Stoxen explains that, “Shoes designed with too much spongy material increases the natural stress the on foot and the arch. Initially, the leg muscles compensate, but eventually, they become exhausted.”
“The realignment can lead to the displacement of the kneecap, hip and back,” says Stoxen who is working with major shoe manufacturers to design a better athletic shoe that will replicate "natural barefoot" walking and running, and presumably eliminate the foot, knee and hip problems that can develop later in life.
Chiropractic care is now recognized as one the most effective approaches to achieving wellness and optimal health, asserts The Foundation for Chiropractic Progress (FCP) www.f4cp.com, an organization dedicated to increasing the awareness about the benefits of Chiropractic services.
“Entertainers with physically demanding tour schedules benefit significantly from chiropractic care because the relief is often immediate,” says James Stoxen, DC. He has lectured to over 20,000 medical doctors and scientists from 60 countries on the effects of abnormal biomechanics of the foot and the effect on the musculoskeletal system. Over the last 4 years he has been called to treat the cast and crew of over 130 concert tours including more than 40 Grammy-nominated recording artists. He is a favorite of the Australian children's and The Wiggles that entertain young children across the world.
About F4CP
The Foundation for Chiropractic Progress is a 501c6 corporation that represents a cross section of the chiropractic and vendor communities with the goal of increasing the public’s awareness of the benefits of chiropractic. http://www.f4cp.org.
-=-=-=-=
Mercola
http://www.youtube.com/watch?v=FPI7zdGdqo4
If you can pick up youtube video, then its worth a look.
This is an exceptionally good 'infomercial' for Dr Mercola.
Mercola is an osteopathic physician, I believe.
Its amazing he's not been assassinated yet for this video.
Obviously not ALL medicine is evil...but many of the facts in this are tragically true, esp. for USA.
I met a fellow just TODAY who had holes burned in his gut: by taking ASPIRIN. It happens.
-=-=-=
if you have the time, watch this...its long
http://www.juryroll.com/forum/view_topic.php?id=1257&forum_id=27
click on the movie screen to play...
BUT:
you might learn why the medical system is the way it is today
I dont think the drug in question is of much relevance, but look at the attitude of the doctors to this "cure"...if they cant control it, they get very upset...
thanks Dr Michael for this Canadian documentary
...now to look up if it really exists or not...
-=-=-=-=-
Fear and loathing over
canine vaccination
The index case involved – and I
don’t know if I want to read too
much into this – a lawyer’s dog.
It received a routine triple vaccination,
went into anaphylaxis and died, despite
aggressive therapy. Nothing strange here,
except that the grieving owner was
convinced this particular vaccine is too
dangerous for dogs and should be
banned. She started a campaign against
this family of vaccines by writing to
kennel club publications and numerous
chat lines for dog enthusiasts.
http://www.ava.com.au/avj/0305/03050237.pdf
-=-=-=-=
I think this group released a great article in the Australian Journal recently about atlas adjusting and BP.
Here is another..
Effects of body position on autonomic regulation of cardiovascular function in young, healthy adults
Nobuhiro Watanabe , John Reece and Barbara I Polus
Chiropractic & Osteopathy 2007, 15:19doi:10.1186/1746-1340-15-19
Background
Analysis of rhythmic patterns embedded within beat-to-beat variations in heart rate (heart rate variability) is a tool used to assess the balance of cardiac autonomic nervous activity and may be predictive for prognosis of some medical conditions, such as myocardial infarction. It has also been used to evaluate the impact of manipulative therapeutics and body position on autonomic regulation of the cardiovascular system. However, few have compared cardiac autonomic activity in supine and prone positions, postures commonly assumed by patients in manual therapy. We intend to redress this deficiency.
Methods
Heart rate, heart rate variability, and beat-to-beat blood pressure were measured in young, healthy non-smokers, during prone, supine, and sitting postures and with breathing paced at 0.25 Hz. Data were recorded for 5 minutes in each posture: Day 1 - prone and supine; Day 2 - prone and sitting. Paired t-tests or Wilcoxon signed-rank tests were used to evaluate posture-related differences in blood pressure, heart rate, and heart rate variability.
Results
Prone versus supine: blood pressure and heart rate were significantly higher in the prone posture (p < 0.001). Prone versus sitting: blood pressure was higher and heart rate was lower in the prone posture (p < 0.05) and significant differences were found in some components of heart rate variability.
Conclusions
Cardiac autonomic activity was not measurably different in prone and supine postures, but heart rate and blood pressure were. Although heart rate variability parameters indicated sympathetic dominance during sitting (supporting work of others), blood pressure was higher in the prone posture. These differences should be considered when autonomic regulation of cardiovascular function is studied in different postures.
-=-=-=-=-=-=-
I would guess the chiro profession is guilty of this in terms of efficacy...however, there are virtually nil cases of iatrogenesis per year? THE INSURERS in the USA are denying claims for children...what about this?
Begin forwarded message:
Joe, this begs the question, "Is there a double standard in EBM ?" - not only for children but with regards other professions!
Regards,
Peter
Prescription safeguards failing children
Alarms are ringing over the lack of safety data for drugs prescribed for children. Health editor Adam Cresswell reports |
The Weekend Australian December 01, 2007 ((Careers Supplement p20)
MOST people assume that drugs used in children are studied more carefully for potentially dangerous side effects than those available for adults. But they are wrong. Far from being subject to more scrutiny, the use of prescription drugs in children remains a glaring blind spot in health systems across the world.
The uncomfortable truth is that, for the vast majority of drugs used in children, there is very little proper scientific data to reassure doctors about the drugs' safety and side effects, how well they work -- if at all -- or what dosages are best.
Without this data, many drugs are not officially approved for use in children, and the manufacturers publish no guidelines for doctors in how they should be used in younger age groups. Doctors can still prescribe drugs for other groups not covered by the original licence, such as children, a practice known as "off-label" prescribing.
Such use may be appropriate in some circumstances, but it leaves children exposed to potentially ineffective or unsafe medicines. Doctors prescribing off-label are effectively left to infer from adult trials and their own experience what dosages will work best.
Recent data shows that from 2002 to 2004 there were 820 suspected serious adverse drug reactions reported spontaneously to the European Agency for the Evaluation of Medicinal Products -- 130 of which were fatal, and 361 of which caused prolonged hospitalisation.
A separate Swedish study of adverse drug reaction reports related to children found 158 cases, of which 42.4 per cent were linked to off-label prescribing.
Drugs for behavioural and psychiatric disorders, and newer antibiotics and analgesics are all examples of drugs that are both frequently prescribed for children, and for which there is poor evidence for their safety and efficacy.
Studies suggest that up to 92 per cent of hospitalised children are prescribed at least one drug off-label during their stay, and up to 97 per cent of newborn babies. And with the world's top health body about to step in, paediatricians and ethical experts are now saying enough's enough.
"A lot of paediatricians have become concerned in recent years that the data isn't there to reassure them that these prescribing practices are safe," says doctor Robert Loblay, chairman of the ethics review committee for Sydney South-West Area Health Service.
"There's been a growing call ... for pharmaceutical companies to do the necessary studies to assure them that these drugs are safe and effective (in children).
"The pharmaceutical companies don't have a lot of incentive to do that, unless it's a big slice of their market. It's a very expensive thing to run clinical trials."
Loblay warned experts attending the national ethics conference of the National Health and Medical Research Council, held in Melbourne in October, that doctors were "treading on very thin ice" by continuing to prescribe drugs to children when the clinical trials conducted to test the safety of those drugs had not included children.
In answer to a question, Loblay told the conference that hospital ethics review committees should be more vigilant for the possibility that drugs might have a use in patients under 18.
In such cases, he said ethics committees ought to ask researchers seeking permission to conduct trials if children were included in the study population -- and if not, why not.
"The answer may be 'we are (including children), but not at this hospital'," Loblay told Weekend Health. "That's fine -- but we need to be asking the question."
In London next week the WHO is expected to launch a list of medicines approved for use in children, to help guide doctors about which medicines are safe and effective in children.
In the meantime, experts here are pushing for regulatory bodies such as the Therapeutic Goods Administration, NHMRC and drug manufacturers to address the problem.
Dr Madlen Gazarian, a paediatric clinical pharmacologist, has been warning of the dangers caused by inadequate data in paediatric prescribing for several years. The chairwoman of the paediatric portfolio of the therapeutics committee of the Royal Australasian College of Physicians, Gazarian in 2003 wrote an editorial for the professional journal Australian Prescriber (2003;26(6):122-3) reporting that adverse reactions were more common when drugs were prescribed off-label. While many children had undoubtedly benefited from drug treatment, data on benefits was poor and it was also true that in a few cases "some children have died as a result" of off-label prescribing.
"Widespread off-label prescribing really is a major issue -- it's been around for yonks, but seems now to have grabbed enough people's attention for something to be done about it," Gazarian told Weekend Health.
Loblay says although doctors currently have little option but to prescribe drugs for children off-label, the fact that they do so removes the incentive for drug companies to do further studies. The problem is compounded by the fact that adverse reactions are less likely to be reported when the drug was prescribed off-label, so there is not even good data to show which drugs are causing most adverse reactions in kids.
There is also a financial angle, in that drugs do not attract a subsidy under the Pharmaceutical Benefits Scheme when prescribed outside the terms of their licence, so parents also end up out of pocket.
Loblay likens the situation to a similar research gap that existed for women as late as the 1990s.
"Fifteen to 20 years ago ... most clinical trials did not include women of childbearing age, because they were worried women might be pregnant (without realising it) and the drug might affect the developing baby," Loblay says. "So it was standard practice to exclude women from most clinical trials. But then people started to realise that we are prescribing these drugs for women, but there's no data to say it's safe. The (US) Food and Drug Administration was the first regulatory body to say, and the TGA followed, that to get a drug registered companies had to include women as well as men. So they all started doing it; now it's standard to do pregnancy tests on women of childbearing age (when they are enrolled in trials)."
Loblay, Gazarian and others agree that what's needed to tackle the evidence gap for children is better research -- either by giving bodies such as the TGA the power to order drug companies to include children in trials, or to allocate public funds to run trials directly -- as in the US and European Union.
Loblay concedes that including children in trials is not as straightforward as including women, due to ethics and safety issues. But Gazarian says suggestions these are a major hurdle are overblown, and points to the alacrity with which drug giants in the US rushed to take up financial incentives offered by the FDA to run children-specific trials.
"Whenever you remove a financial barrier or create a financial incentive (for drug companies), lo and behold, the research seems able to be done," she says.
"But it's tended to happen with more profitable drugs with a larger market. It's becoming clear that the (US) incentives are not going to ensure that all the needed research will be done."
Earlier this year Gazarian wrote a discussion paper for the World Health Organisation on the question of off-label prescribing in children. While her paper said the practice not illegal, "and may sometimes be appropriate", it was "associated with important clinical and ethical concerns".
The paper added that off-label prescribing "does bypass the safeguards of the drug regulatory process and places a greater onus of responsibility on the individual prescriber to assess the benefits and risks of such use for an individual patient.
"While this may be acceptable as an exception, it is clearly unacceptable when it becomes the norm."
While she defends the right of doctors to prescribe off-label, and says restricting this right would impose too great a limit on clinical freedom, Gazarian thinks it is over-used and should be limited to circumstances where it can be justified by pre-specified criteria, as this will reduce inappropriate use and exposure to unnecessary risk.
A separate paper, published in the Medical Journal of Australia last year, of which she was lead author, found the level of off-label prescribing was also common in adults -- between 7.5 and 40 per cent of the total.
That paper proposed three scenarios where off-label use was appropriate: when such use was justified by high-quality research evidence, within the context of a formal trial or research project, and in exceptional circumstances, where such use was justified by individual clinical circumstances.
The Australian Health Ministers Advisory Council has already commissioned a working group to review the issue and consider how the safety of paediatric prescribing can be improved.
To close the evidence gaps, Gazarian argues for a "co-ordinated and well-resourced national approach" -- including the commitment of public funds -- to conduct studies on children. She also says there should be a national evidence-based prescribing information resource, to give doctors, pharmacists, nurses and others the latest evidence on what drugs work best.
And she calls for US-style incentives for pharmaceutical companies to conduct studies, and for drug licences to be updated when new research data shows a particular use for a drug is safe and effective. At the moment, licence provisions are only extended if a manufacturer makes an application to the TGA -- something they currently have little incentive to do.
A spokesman for the drug manufacturers' umbrella body Medicines Australia said it "acknowledges the need for ethically conducted, evidence-based research for the benefit of all children who may need medicines which haven't been specifically designed for them.
"One of the questions that needs to be considered is how best to establish a regime which can provide appropriate incentives to encourage research that will provide children with licensed medicines," he said.
A spokeswoman for the TGA said the regulator was "very keen to progress better paediatric information about drugs" and the AHMAC initiative was key to achieving that.
"The TGA is very keen to see increased paediatric data, bearing in mind the ethical considerations, and to find solutions that would encourage companies to produce better paediatric evidence," she said.
-=-=-=-=-
Fever and Autism
from Reuters
By Michael Conlon
CHICAGO (Reuters) - Fever can temporarily unlock autism's grip on children, a finding that could shed light on the roots of the condition and perhaps provide clues for treatment, researchers reported on Monday.
It appears that fever restores nerve cell communications in regions of the autistic brain, restoring a child's ability to interact and socialize during the fever, the study said.
"The results of this study are important because they show us that the autistic brain is plastic, or capable of altering current connections and forming new ones in response to different experiences or conditions," said Dr. Andrew Zimmerman, a pediatric neurologist at Baltimore's Kennedy Krieger Institute, who was one of the study authors.
The study, published in the journal Pediatrics, was based on 30 children with autism aged 2 to 18 who were observed during and after a fever of at least 100.4 degrees Fahrenheit.
More than 80 percent of those with fever showed some improvements in behavior during it and 30 percent had dramatic improvements, the researchers said. The change involved things like longer concentration spans, more talking, improved eye contact and better overall relations with adults and other children.
Zimmerman's team said the fever effect had been noted anecdotally in the past by parents and doctors.
Lee Grossman, president and chief executive officer of the Autism Society of America, said he had noticed it in his own son, who is now 20.
But he noted in an interview that the study's authors said expanded research was needed on the fever effect and its implications. "It's good that they've noticed this and are bringing it forward," he said.
People with autism spectrum disorders suffer in varying degrees from limited social interactions, lack of verbal and non-verbal communication and other abilities.
As many as 1.5 million Americans have some form of autism, according to ASA. It is not known what causes the condition.
Zimmerman said that while there currently is no definitive medical treatment, speech and language therapy started as soon as possible after diagnosis "can make a significant difference."
He called the fever research, headed by colleague Laura Curran, "an exciting lead" that could help point the way to a treatment that would reconnect the autistic brain. He said the fever effect was believed found only in children, whose brains are more "plastic" than those of adults.
(Editing by Andrew Stern and Eric Beech)
-=-=-=--=
Paediatrician struck off register
A leading British paediatrician has been struck off the medical register after wrongly accusing an Adelaide woman of her son's murder.
The General Medical Council (GMC) found Dr David Southall, who was regarded as one of the UK's leading child protection experts, guilty of serious professional misconduct.
The GMC found Southall added to the distress of Mandy Morris, whose 10-year-old son, Lee, hanged himself at home in Shropshire, England, in 1996.
Southall claimed Morris - identified only as Mrs M when she gave video evidence against him from her new home in Adelaide last month - had drugged and murdered the boy.
He made the allegations during an interview with her about the safety of her surviving son.
During proceedings, GMC panel chairwoman Dr Jacqueline Mitton told Southall: "Although Mrs M was not your patient, your action in accusing her of drugging and murdering Child M1 (her son) by hanging him was inappropriate, added to her distress and was in the circumstances an abuse of your professional position."
Morris has begun a new life in Australia.
She waived her anonymity in a recent interview with the website of Britain's Evening Standard newspaper, thisislondon.co.uk, in which she said Southall's allegations had "ripped the heart out" of her family.
It is the second time in three years Southall has been found guilty of serious professional misconduct.
In 2004, he was suspended from child protection work over his role in the case of Sally Clark, who was wrongly jailed over the death of her two sons.
Clark was cleared on appeal in 2003 after serving four years in prison. She died earlier this year.
Southall wrongly accused Clark's husband, Steve, of murdering the two boys on the basis of a television interview.
Dr Mitton said Southall had "attitudinal problems".
"Your multiple failings over an extended period caused the panel great concern," Dr Mitton said.
"Furthermore, the panel is influenced by the fact that although the events in the current case predate those in the Clark case, there are now two instances where, without justification, you have accused a parent of murdering their child."
In a brief statement, Southall said he was taking legal advice about the prospect of launching an appeal.
© 2007 AAP
-=-=-=-
is this a landmark study?
how many papers will ignore this one?
There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.
...could be?
Complementary Therapies in Medicine
Volume 15, Issue 4, December 2007, Pages 271-283 doi:10.1016/j.ctim.2007.01.008
Copyright © 2007 Elsevier Ltd All rights reserved.
Psychological response in spinal manipulation (PRISM): A systematic review of psychological outcomes in randomised controlled trials
Summary
Background
The most important risk factors for back and neck pain are psychosocial. Nevertheless, systematic reviews of spinal manipulation have concentrated on pain and spine related disability, and ignored psychological outcomes.
Objective
To assess whether spinal manipulation was effective in improving psychological outcome.
Design
Systematic review of randomised controlled trials (RCTs).
Methods
RCTs were identified by searching Medline, CINAHL, Embase, CENTRAL, AMED, PsycINFO until November 2005. Trials reporting psychological outcomes including the mental health components of generic outcomes were extracted, and combined where appropriate in meta-analyses.
Results
One hundred and twenty nine RCTs of spinal manipulation were identified; 12 had adequately reported psychological outcomes. Six trials with a verbal intervention comparator were combined in a meta-analysis, and found a mean benefit from spinal manipulation equivalent to 0.34 of the population standard deviation (S.D.) [95% confidence interval (CI) 0.23–0.45] at 1–5 months; 0.27 of the S.D. [95% CI 0.14–0.40] at 6–12 months. Eight trials with a physical treatment comparator were combined in a meta-analysis and found a mean benefit of 0.13 of the S.D. [95% CI 0.01–0.24] in favour of manipulation at 1–5 months; 0.11 of the S.D. [95% CI −0.02 to 0.25] at 6–12 months.
Conclusions
There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.
...wow!!!!!!!!!
-=-=-=-
Israeli study says regular mobile use increases tumour risk
Regular use of mobile telephones increases the risk of developing tumours, a new scientific study by Israeli researchers and published in the American Journal of Epidemiology revealed on Friday.
An extract of the report seen by Israel's Yedoit Aharonot newspaper put the risk of developing a parotid gland tumour nearly 50 percent higher for frequent mobile phone users -- more than 22 hours a month.
The risk was still higher if users clamped the phone to the same ear, did not use hands-free devices or were in rural areas.
"Analysis restricted to regular users or to conditions that may yield higher levels of exposure (eg heavy use in rural areas) showed consistently elevated risks," said an abstract of the report in the US journal made available to AFP.
The study included 402 benign and 58 malignant incident cases of parotid gland tumour diagnosed in Israel at age 18 years or more, in 2001-2003.
The research was led by Dr Siegal Sadetzki, a cancer and radiation expert at the Chaim Sheba Medical Centre in Israel and as part of a World Health Organisation project.
Copyright AFP 2007, AFP stories and photos shall not be published, broadcast, rewritten for broadcast or publication or redistributed directly or indirectly in any medium