For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Issue 16
04/12/07 13:52
Issue
16
Manipulation is very dangerous ...DONT DO IT...but take your aspirin as it has many benefits...
Aspirin: It kills 20,000 Americans every year
Common over-the-counter painkillers such as aspirin kill around 20,000 Americans every year, and another 100,000 end up in hospital as a result of taking the drug, new research reveals.
Painkillers known as NSAIDs (non-steroidal, anti-inflammatory drugs) are far more dangerous than people have been told, and can cause life-threatening gastrointestinal (GI) bleeding, stomach perforations and ulcers.
More than 14 million Americans regularly take an NSAID for their arthritis pain alone, and around 60 per cent of these will suffer gastrointestinal side effects – and will probably never blame the drug, researchers from the Eastern Virginia Medical School estimate.
Researchers realized that patients weren't associating the painkiller with their stomach problems when they carried out a survey among patients at a clinic that specialises in gastrointestinal disease. Around one in five of the patients was taking an NSAID such as an aspirin, and was not reporting the fact to medical staff because they didn't regard it as significant.
"This reflects a common misperception that these medications are insignificant or benign when actually their chronic use, particularly among the elderly and those with conditions such as arthritis, is linked to serious and potentially fatal GI injury and bleeding," said Dr David Johnson, one of the researchers.
(Source: Proceedings of the Annual Scientific Meeting of the American College of Gastroenterology, October 15, 2007).
Story from WDDTY:
http://www.wddty.com/03363800371681349145/aspirin-it-kills-20-000-americans-every-year.html
-=-=-=-
Music is BiG
"It has been found that ...the corpus callosum is 15% larger in adults who started playing the piano before the age of eight. Remarkably, pianists who began later show no significant difference from those who have never played the instrument."
Freeman P. Mind Matter. The Bulletin, Jan 9th. 2001 pp51. Citing: Jourdain R. "The Brain and Ecstasy. How Music Captures Our Imagination"
-=-=-=
Isn't MYSPACE cool?
Look at this chiro related one:
http://profile.myspace.com/index.cfm?fuseaction=user.viewprofile&friendid=114496867
-=-=-=
Dr Henry reckons this will please me.
Certainly.
Patient-Physician Email Communication May Be Effective CME
News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD
October 3, 2007 — Patients prefer patient-physician email communication, which takes less time for physicians than does telephone messaging, according to the results of a survey reported in the October issue of Pediatrics.
"The 2001 Institute of Medicine (IOM) report Crossing the Quality Chasm: A New Health System for the 21st Century called for care that is based on continuous healing relationships," write Paul Rosen, MD, MPH, MMM, and C. Kent Kwoh, MD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "In its first rule on redesign, the IOM report stated, 'Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.'"
The goals of this study were to evaluate the patterns of patients using a patient-physician email service, to measure physician time required to answer a patient question via email vs via telephone, and to assess the satisfaction of families who were provided email access to their child's rheumatologist.
During a 2-year period, a consecutive series of the families of pediatric patients were offered email access, and the investigators collected data on patient email use. Studied parameters included urgency, subject matter, and volume of the message; time of day of messaging; and timed duration with use of a stopwatch of the pediatric rheumatologist's email interactions and telephone interactions with patients. After 1 year of enrollment in the patient-physician email service, families were mailed a 12-item satisfaction survey concerning their email experience.
Of 328 families who were offered patient-physician email access, 306 enrolled, and 121 used the service. Of all patient emails sent, 40% were sent during nonbusiness hours, and 5.7% were urgent (notification of disease flare or of new symptoms or parent expectation of same-day response). Only 0.002% of the emails to the physician required emergent attention.
On average, the physician received 1.2 emails per day from patients. For the physician, answering patient questions by email was 57% faster than by telephone. Families who responded to the survey reported that patient-physician email improved access to the physician as well as quality of care, and they did not believe that patient-physician email distanced them from the pediatrician.
"Patient-physician e-mail is a service that patients will use given the opportunity," the study authors write. "The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service."
Limitations of the study include lack of generalizability to practices in other pediatric subspecialties or in general pediatrics; lack of measurement of the impact of the email service on the number of telephone calls to the office; survey instrument used to evaluate patient satisfaction not being a validated tool; and only 41% of surveys returned, introducing sampling bias.
"For some physician practices, a staff-based triage system may be more efficient than a non–triage-based system," the study authors conclude. "However, the comments of the families who used the service demonstrate that PPEM [patient-physician email] is one method of improving communication and providing consumer-driven health care.... Given the nature of family-centered care for pediatric patients, pediatricians and pediatric subspecialists are well positioned to transform health care delivery."
The Children's Arthritis Network supported this study. The authors have disclosed no relevant financial relationships.
Pediatrics. 2007;120:701-706.
-=-=-
...hey its rubbish but its PR, right?
MILLS STRUGGLED THROUGH DANCING SHOW WITH A BROKEN PELVIS
Dancing With The Stars
The glitz and glamour of the ballroom is back!
www.yahoo7.com.au/dancing
Model/activist HEATHER MILLS braved her way through U.S. TV show DANCING WITH THE STARS with a broken pelvis. The one-legged former wife of Sir Paul MCCartney has revealed she has been suffering with a broken plate for years - and her will was really tested on the last season of the reality dancing show. She says, "I had a broken pelvis when I danced in Dancing With The Stars. I've had a broken plate for a few years now and it just pops out now and again." The injury forced Mills into a wheelchair, but now she's walking again after her hip was "realigned and cracked back into place by a chiropractor". Mills now has to find time in her busy schedule to undergo surgery. She adds, "I just can't take four months out right now." The model lost a leg when she was hit by a speeding police motorcycle in a London street in 1993.
http://www.contactmusic.com/news.nsf/article/mills%20struggled%20through%20dancing%20show%20with%20a%20broken%20pelvis_1047660
-=-=-=-
Ok Then, Lets just stay depressed...
POSITIVE OUTLOOK DOESN'T BEAT CANCER
(Health & Medical, 23/10/07)
The power of positive thinking has been dealt a blow by a study that shows cancer patients' state of mind has no influence on their survival chances.
http://www.abc.net.au/science/news/stories/2007/2067473.htm?health
-=-=-
AMA blames the government for poor hospitals.
Of course. Nothing to do with medical care or education, right?
See it here:
http://www.smh.com.au/news/national/hospitals-in-poor-health-medics-say/2007/10/25/1192941206493.html?sssdmh=dm16.285714
-=-=-
Panic Attacks Lead to Heart Attacks
Women with histories of full-blown panic attacks had elevated risks for coronary heart disease.
Could the autonomic arousal that accompanies anxiety contribute to cardiovascular instability? To find out, these investigators extracted data from the Myocardial Ischemia and Migraine Study, a prospective, community-based study of 3369 generally healthy women (age range, 51–83). Most of the data were obtained from questionnaires, which were supplemented by physical examination and ambulatory EKG monitoring and by individual follow-up or event confirmation of patients who had died or been hospitalized for serious cardiovascular events.
Full-blown panic attacks were defined as sudden fear, anxiety, or extreme discomfort accompanied by four or more DSM-defined panic attack symptoms. A total of 330 patients reported experiencing full-blown panic attacks over the 6 months before the study, and 273 had experienced limited-symptom panic attacks (anxiety plus 1–3 panic attack symptoms).
Researchers determined risk for coronary heart disease (CHD, defined as myocardial infarction or cardiac death) after adjustment for all relevant risk factors, including smoking, hypertension, body-mass index, depression history, and physical activity. The risk for subsequent CHD was 4.2 times higher in women who had experienced full-blown panic attacks than in those without panic histories. Women with limited-symptom attacks did not have significantly elevated risks for subsequent CHD (but did have elevated risks for stroke and all-cause mortality). Depression was not associated with cardiovascular events after adjustment for panic attacks.
Comment: It is not clear whether panic attacks are a manifestation of autonomic instability that predisposes to cardiac events or whether the physiology of panic anxiety brings out latent coronary instability. In either case, panic attacks in postmenopausal women appear to be an independent risk factor for CHD. Patients having panic attacks with or without panic disorder should be evaluated for comorbid CHD. It will take some creativity to explain these findings to patients while working to reduce catastrophic reactions to perceived dangers.
— Steven Dubovsky, MD
Published in Journal Watch Psychiatry October 29, 2007
-=-=-
I like this story and would suggest it applies to our profession...
Once upon a time, there lived six blind men in a village. One day the villagers told them, "Hey, there is an elephant in the village today."
They had no idea what an elephant is. They decided, "Even though we would not be able to see it, let us go and feel it anyway." All of them went where the elephant was. Everyone of them touched the elephant.
"Hey, the elephant is a pillar," said the first man who touched his leg.
"Oh, no! it is like a rope," said the second man who touched the tail.
"Oh, no! it is like a thick branch of a tree," said the third man who touched the trunk of the
elephant.
"It is like a big hand fan" said the fourth man who touched the ear of the elephant.
"It is like a huge wall," said the fifth man who touched the belly of the elephant.
"It is like a solid pipe," Said the sixth man who touched the tusk of the elephant.
They began to argue about the elephant and everyone of them insisted that he was right. It looked like they were getting agitated. A wise man was passing by and he saw this. He stopped and asked them, "What is the matter?" They said, "We cannot agree to what the
elephant is like." Each one of them told what he thought the elephant was like. The wise man calmly explained to them, "All of you are right. The reason every one of you is telling it differently because each one of you touched the different part of the elephant. So, actually the elephant has all those features what you all said."
"Oh!" everyone said. There was no more fight. They felt happy that they were all right.
The moral of the story is that there may be some truth to what someone says. Sometimes we can see that truth and sometimes not because they may have different perspective which we may not agree too. So, rather than arguing like the blind men, we should say, "Maybe you have your reasons." This way we don't get in arguments. In Jainism, it is
explained that truth can be stated in seven different ways. So, you can see how broad our religion is. It teaches us to be tolerant towards others for their viewpoints. This allows us to live in harmony with the people of different thinking. This is known as the Syadvada, Anekantvad, or the theory of Manifold Predictions.
-=-=-=
I first learned about CoQ10 from my wonderful patient Greg Buchanan.
awesome factoid about Co Enzyme Q10 follows... even if you dont use it, the story is intriguing..
Thanks Dr Henry Battistoni for this, and he quotes:
---
My fave fact about CoQ10:
In 1958, Professor Carl Folkers elucidated the chemical structure of Coenzyme Q10 while working at Merck, Inc. Working with minute quantities, Folkers was able to determine that CoQ10 had great promise in the treatment of cardiovascular disease. However, Professor Folkers was not able to convince his superiors to pursue the development of C0Q10 because Merck had recently launched their new blockbuster drug in the cardiovascular arena called Diuril. Consequently, the formula and patent rights for coenzyme Q10 were sold to a Japanese company. The Japanese quickly developed new methods of synthesizing large quantities, and coenzyme Q10 has become the best selling natural product for cardiovascular disease in Japan. The story of the miracle nutrient, coenzyme Q10, is just beginning to be recognized in the United States.
Drug Induced Nutrient Depletion Handbook, Pelton, RPh, PhD, CCN, Lexi-Comp, 2001.
-=-=-=
Physios agree with chiros???
http://www.bmj.com/cgi/content/full/314/7090/1320
Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study
Correspondence to: Dr J C Winters Nieuwe Schoolweg 2A, 9756 BB Glimmen, Netherlands.
Objective:
To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice.
Design:
Randomised, single blind study.
Setting:
Seven general practices in the Netherlands.
Subjects:
198 patients with shoulder complaints, of whom 172 were divided, on the basis of physical examination, into two diagnostic groups: a shoulder girdle group (n = 58) and a synovial group (n = 114).
Interventions: Patients in the shoulder girdle group were randomised to manipulation or physiotherapy, and patients in the synovial group were randomised to corticosteroid injection, manipulation, or physiotherapy.
Main outcome measures: Duration of shoulder complaints analysed by survival analysis.
Results:
In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%).
Conclusions:
For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.
-=-=-
Maybe we could settle all the cases of chiropractic harm for such a price, without criminal conviction or charges?
Merck settles Vioxx suits for $4.85B
Drugmaker agrees to resolve most of nearly 27,000 suits over blockbuster painkiller drug.
November 9 2007: 8:05 AM EST
NEW YORK (CNNMoney.com) -- Merck & Co. announced Friday that it will pay $4.85 billion to settle about 27,000 claims over injuries linked to its blockbuster Vioxx painkiller.
Merck said in a statement that the company will pay the money into a settlement fund for qualifying claims that enter into the resolution process and that claims will be evaluated on an individual basis.
The company said the agreement was not a class-action settlement.
The agreement represents a change in stance for the drugmaker, which earlier had insisted it would fight each Vioxx case.
The settlement - one of the biggest ever in civil litigation - comes after almost 20 Vioxx civil trials were held over the last two years.
The amount plaintiffs will receive from the settlement will depend on how long they took the pain medication and the severity of their injuries.
"This is a good and responsible agreement that will allow the company to concentrate even more fully on its mission of discovering, developing and delivering novel medicines and vaccines," said Richard Clark, chairman and CEO of Merck. "The agreement is structured to provide a significant degree of certainty toward resolving the majority of the outstanding Vioxx product liability claims in the United States for a fixed amount."
Merck ( Charts, Fortune 500) shares edged higher in Frankfurt trading on Friday.
Vioxx became a popular pain medication after it was approved for sale in 1999, with annual sales rising to $2.5 billion. Merck pulled the drug from the market in September 2004 due to safety concerns.
-=-=-=-
Stupid Paper!
I recently wrote to a prominent journal about this article. They published my comment. The paper's abstract appears under my comment.
see it here or read on:
Begin Comment:
Flawed paper stirs a profession.
By Joseph J. Ierano,
Doctor of Chiropractic
Private, solo practice of chiropractic.
Chiropractic is at times a very nervous profession. Especially unnerving is a paper that addresses a serious subject, necessary in its execution, flawed in its production.
A meta-analysis such as this simply re-states the flaws of other studies; work done by others of dubious merit.
Dubious merit because there is no examination of the uniformity of interventions administered in the studies which they categorise at "spinal manipulation". Examination of a procedure surely deliniates that procedure in detail and presents it to the reader. Just what is "pediatric spinal manipulation"?
This study is what it is: a precurser to the study being rightly done. Lets just see what the adverse effects are of this procedure which seems to define chiropractors. But first, define the procedure, and don't make any serious assumptions until that scientific method is applied properly.
This may sound unbelievable, but In my experience (over a decade) of adjusting hundreds of children there has not been one event that could be categorised as "adverse". Similarly, in communication with my profession and state boards here in Australia, I do not think that one solitary action of litigation against a chiropractor has been brought for seriously harming or death of a child in administrering care. Is this not an astounding statistic in comparison with proper medical paediatric care? Bring on the science, please.
Conflict of Interest:
Registered Chiropractor educated in University-based undergraduate paediatric chiropractic and post- graduate specialisation in upper cervical chiropractic.
The article:
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e275-e283 (doi:10.1542/peds.2006-1392)
Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review
Sunita Vohra, MD, FRCPC, MSca, Bradley C. Johnston, NDa, Kristie Cramer, MSca and Kim Humphreys, DC, PhDb
a Complementary and Alternative Research and Education Program, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
b Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
BACKGROUND. Spinal manipulation is a noninvasive manual procedure applied to specific body tissues with therapeutic intent. Although spinal manipulation is commonly used in children, there is limited understanding of the pediatric risk estimates.
OBJECTIVE. Our goal was to systematically identify and synthesize available data on adverse events associated with pediatric spinal manipulation.
METHODS. A comprehensive search was performed of 8 major electronic databases (eg, Medline, AMED, MANTIS) from inception to June 2004 irrespective of language. Reports were included if they (1) were a primary investigation of spinal manipulation (eg, observation studies, controlled trials, surveys), (2) included a study population of children who were aged 18 years or younger, and (3) reported data on adverse events. Data were summarized to demonstrate the nature and severity of adverse events that may result rather than their incidence.
RESULTS. Thirteen studies (2 randomized trials, 11 observational reports) were identified for inclusion. We identified 14 cases of direct adverse events involving neurologic or musculoskeletal events. Nine cases involved serious adverse events (eg, subarachnoidal hemorrhage, paraplegia), 2 involved moderately adverse events that required medical attention (eg, severe headache), and 3 involved minor adverse events (eg, midback soreness). Another 20 cases of indirect adverse events involved delayed diagnosis (eg, diabetes, neuroblastoma) and/or inappropriate provision of spinal manipulation for serious medical conditions (ie, meningitis, rhabdomyosarcoma).
CONCLUSIONS. Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.
Now you can see what I was harping on about. In actuality the paper speaks of a tremendous safety record, unparalleled in modern health history.
Manipulation is very dangerous ...DONT DO IT...but take your aspirin as it has many benefits...
Aspirin: It kills 20,000 Americans every year
Common over-the-counter painkillers such as aspirin kill around 20,000 Americans every year, and another 100,000 end up in hospital as a result of taking the drug, new research reveals.
Painkillers known as NSAIDs (non-steroidal, anti-inflammatory drugs) are far more dangerous than people have been told, and can cause life-threatening gastrointestinal (GI) bleeding, stomach perforations and ulcers.
More than 14 million Americans regularly take an NSAID for their arthritis pain alone, and around 60 per cent of these will suffer gastrointestinal side effects – and will probably never blame the drug, researchers from the Eastern Virginia Medical School estimate.
Researchers realized that patients weren't associating the painkiller with their stomach problems when they carried out a survey among patients at a clinic that specialises in gastrointestinal disease. Around one in five of the patients was taking an NSAID such as an aspirin, and was not reporting the fact to medical staff because they didn't regard it as significant.
"This reflects a common misperception that these medications are insignificant or benign when actually their chronic use, particularly among the elderly and those with conditions such as arthritis, is linked to serious and potentially fatal GI injury and bleeding," said Dr David Johnson, one of the researchers.
(Source: Proceedings of the Annual Scientific Meeting of the American College of Gastroenterology, October 15, 2007).
Story from WDDTY:
http://www.wddty.com/03363800371681349145/aspirin-it-kills-20-000-americans-every-year.html
-=-=-=-
Music is BiG
"It has been found that ...the corpus callosum is 15% larger in adults who started playing the piano before the age of eight. Remarkably, pianists who began later show no significant difference from those who have never played the instrument."
Freeman P. Mind Matter. The Bulletin, Jan 9th. 2001 pp51. Citing: Jourdain R. "The Brain and Ecstasy. How Music Captures Our Imagination"
-=-=-=
Isn't MYSPACE cool?
Look at this chiro related one:
http://profile.myspace.com/index.cfm?fuseaction=user.viewprofile&friendid=114496867
-=-=-=
Dr Henry reckons this will please me.
Certainly.
Patient-Physician Email Communication May Be Effective CME
News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD
October 3, 2007 — Patients prefer patient-physician email communication, which takes less time for physicians than does telephone messaging, according to the results of a survey reported in the October issue of Pediatrics.
"The 2001 Institute of Medicine (IOM) report Crossing the Quality Chasm: A New Health System for the 21st Century called for care that is based on continuous healing relationships," write Paul Rosen, MD, MPH, MMM, and C. Kent Kwoh, MD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "In its first rule on redesign, the IOM report stated, 'Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and access to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits.'"
The goals of this study were to evaluate the patterns of patients using a patient-physician email service, to measure physician time required to answer a patient question via email vs via telephone, and to assess the satisfaction of families who were provided email access to their child's rheumatologist.
During a 2-year period, a consecutive series of the families of pediatric patients were offered email access, and the investigators collected data on patient email use. Studied parameters included urgency, subject matter, and volume of the message; time of day of messaging; and timed duration with use of a stopwatch of the pediatric rheumatologist's email interactions and telephone interactions with patients. After 1 year of enrollment in the patient-physician email service, families were mailed a 12-item satisfaction survey concerning their email experience.
Of 328 families who were offered patient-physician email access, 306 enrolled, and 121 used the service. Of all patient emails sent, 40% were sent during nonbusiness hours, and 5.7% were urgent (notification of disease flare or of new symptoms or parent expectation of same-day response). Only 0.002% of the emails to the physician required emergent attention.
On average, the physician received 1.2 emails per day from patients. For the physician, answering patient questions by email was 57% faster than by telephone. Families who responded to the survey reported that patient-physician email improved access to the physician as well as quality of care, and they did not believe that patient-physician email distanced them from the pediatrician.
"Patient-physician e-mail is a service that patients will use given the opportunity," the study authors write. "The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service."
Limitations of the study include lack of generalizability to practices in other pediatric subspecialties or in general pediatrics; lack of measurement of the impact of the email service on the number of telephone calls to the office; survey instrument used to evaluate patient satisfaction not being a validated tool; and only 41% of surveys returned, introducing sampling bias.
"For some physician practices, a staff-based triage system may be more efficient than a non–triage-based system," the study authors conclude. "However, the comments of the families who used the service demonstrate that PPEM [patient-physician email] is one method of improving communication and providing consumer-driven health care.... Given the nature of family-centered care for pediatric patients, pediatricians and pediatric subspecialists are well positioned to transform health care delivery."
The Children's Arthritis Network supported this study. The authors have disclosed no relevant financial relationships.
Pediatrics. 2007;120:701-706.
-=-=-
...hey its rubbish but its PR, right?
MILLS STRUGGLED THROUGH DANCING SHOW WITH A BROKEN PELVIS
Dancing With The Stars
The glitz and glamour of the ballroom is back!
www.yahoo7.com.au/dancing
Model/activist HEATHER MILLS braved her way through U.S. TV show DANCING WITH THE STARS with a broken pelvis. The one-legged former wife of Sir Paul MCCartney has revealed she has been suffering with a broken plate for years - and her will was really tested on the last season of the reality dancing show. She says, "I had a broken pelvis when I danced in Dancing With The Stars. I've had a broken plate for a few years now and it just pops out now and again." The injury forced Mills into a wheelchair, but now she's walking again after her hip was "realigned and cracked back into place by a chiropractor". Mills now has to find time in her busy schedule to undergo surgery. She adds, "I just can't take four months out right now." The model lost a leg when she was hit by a speeding police motorcycle in a London street in 1993.
http://www.contactmusic.com/news.nsf/article/mills%20struggled%20through%20dancing%20show%20with%20a%20broken%20pelvis_1047660
-=-=-=-
Ok Then, Lets just stay depressed...
POSITIVE OUTLOOK DOESN'T BEAT CANCER
(Health & Medical, 23/10/07)
The power of positive thinking has been dealt a blow by a study that shows cancer patients' state of mind has no influence on their survival chances.
http://www.abc.net.au/science/news/stories/2007/2067473.htm?health
-=-=-
AMA blames the government for poor hospitals.
Of course. Nothing to do with medical care or education, right?
See it here:
http://www.smh.com.au/news/national/hospitals-in-poor-health-medics-say/2007/10/25/1192941206493.html?sssdmh=dm16.285714
-=-=-
Panic Attacks Lead to Heart Attacks
Women with histories of full-blown panic attacks had elevated risks for coronary heart disease.
Could the autonomic arousal that accompanies anxiety contribute to cardiovascular instability? To find out, these investigators extracted data from the Myocardial Ischemia and Migraine Study, a prospective, community-based study of 3369 generally healthy women (age range, 51–83). Most of the data were obtained from questionnaires, which were supplemented by physical examination and ambulatory EKG monitoring and by individual follow-up or event confirmation of patients who had died or been hospitalized for serious cardiovascular events.
Full-blown panic attacks were defined as sudden fear, anxiety, or extreme discomfort accompanied by four or more DSM-defined panic attack symptoms. A total of 330 patients reported experiencing full-blown panic attacks over the 6 months before the study, and 273 had experienced limited-symptom panic attacks (anxiety plus 1–3 panic attack symptoms).
Researchers determined risk for coronary heart disease (CHD, defined as myocardial infarction or cardiac death) after adjustment for all relevant risk factors, including smoking, hypertension, body-mass index, depression history, and physical activity. The risk for subsequent CHD was 4.2 times higher in women who had experienced full-blown panic attacks than in those without panic histories. Women with limited-symptom attacks did not have significantly elevated risks for subsequent CHD (but did have elevated risks for stroke and all-cause mortality). Depression was not associated with cardiovascular events after adjustment for panic attacks.
Comment: It is not clear whether panic attacks are a manifestation of autonomic instability that predisposes to cardiac events or whether the physiology of panic anxiety brings out latent coronary instability. In either case, panic attacks in postmenopausal women appear to be an independent risk factor for CHD. Patients having panic attacks with or without panic disorder should be evaluated for comorbid CHD. It will take some creativity to explain these findings to patients while working to reduce catastrophic reactions to perceived dangers.
— Steven Dubovsky, MD
Published in Journal Watch Psychiatry October 29, 2007
-=-=-
I like this story and would suggest it applies to our profession...
Once upon a time, there lived six blind men in a village. One day the villagers told them, "Hey, there is an elephant in the village today."
They had no idea what an elephant is. They decided, "Even though we would not be able to see it, let us go and feel it anyway." All of them went where the elephant was. Everyone of them touched the elephant.
"Hey, the elephant is a pillar," said the first man who touched his leg.
"Oh, no! it is like a rope," said the second man who touched the tail.
"Oh, no! it is like a thick branch of a tree," said the third man who touched the trunk of the
elephant.
"It is like a big hand fan" said the fourth man who touched the ear of the elephant.
"It is like a huge wall," said the fifth man who touched the belly of the elephant.
"It is like a solid pipe," Said the sixth man who touched the tusk of the elephant.
They began to argue about the elephant and everyone of them insisted that he was right. It looked like they were getting agitated. A wise man was passing by and he saw this. He stopped and asked them, "What is the matter?" They said, "We cannot agree to what the
elephant is like." Each one of them told what he thought the elephant was like. The wise man calmly explained to them, "All of you are right. The reason every one of you is telling it differently because each one of you touched the different part of the elephant. So, actually the elephant has all those features what you all said."
"Oh!" everyone said. There was no more fight. They felt happy that they were all right.
The moral of the story is that there may be some truth to what someone says. Sometimes we can see that truth and sometimes not because they may have different perspective which we may not agree too. So, rather than arguing like the blind men, we should say, "Maybe you have your reasons." This way we don't get in arguments. In Jainism, it is
explained that truth can be stated in seven different ways. So, you can see how broad our religion is. It teaches us to be tolerant towards others for their viewpoints. This allows us to live in harmony with the people of different thinking. This is known as the Syadvada, Anekantvad, or the theory of Manifold Predictions.
-=-=-=
I first learned about CoQ10 from my wonderful patient Greg Buchanan.
awesome factoid about Co Enzyme Q10 follows... even if you dont use it, the story is intriguing..
Thanks Dr Henry Battistoni for this, and he quotes:
---
My fave fact about CoQ10:
In 1958, Professor Carl Folkers elucidated the chemical structure of Coenzyme Q10 while working at Merck, Inc. Working with minute quantities, Folkers was able to determine that CoQ10 had great promise in the treatment of cardiovascular disease. However, Professor Folkers was not able to convince his superiors to pursue the development of C0Q10 because Merck had recently launched their new blockbuster drug in the cardiovascular arena called Diuril. Consequently, the formula and patent rights for coenzyme Q10 were sold to a Japanese company. The Japanese quickly developed new methods of synthesizing large quantities, and coenzyme Q10 has become the best selling natural product for cardiovascular disease in Japan. The story of the miracle nutrient, coenzyme Q10, is just beginning to be recognized in the United States.
Drug Induced Nutrient Depletion Handbook, Pelton, RPh, PhD, CCN, Lexi-Comp, 2001.
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Physios agree with chiros???
http://www.bmj.com/cgi/content/full/314/7090/1320
Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study
Correspondence to: Dr J C Winters Nieuwe Schoolweg 2A, 9756 BB Glimmen, Netherlands.
Objective:
To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice.
Design:
Randomised, single blind study.
Setting:
Seven general practices in the Netherlands.
Subjects:
198 patients with shoulder complaints, of whom 172 were divided, on the basis of physical examination, into two diagnostic groups: a shoulder girdle group (n = 58) and a synovial group (n = 114).
Interventions: Patients in the shoulder girdle group were randomised to manipulation or physiotherapy, and patients in the synovial group were randomised to corticosteroid injection, manipulation, or physiotherapy.
Main outcome measures: Duration of shoulder complaints analysed by survival analysis.
Results:
In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%).
Conclusions:
For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.
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Maybe we could settle all the cases of chiropractic harm for such a price, without criminal conviction or charges?
Merck settles Vioxx suits for $4.85B
Drugmaker agrees to resolve most of nearly 27,000 suits over blockbuster painkiller drug.
November 9 2007: 8:05 AM EST
NEW YORK (CNNMoney.com) -- Merck & Co. announced Friday that it will pay $4.85 billion to settle about 27,000 claims over injuries linked to its blockbuster Vioxx painkiller.
Merck said in a statement that the company will pay the money into a settlement fund for qualifying claims that enter into the resolution process and that claims will be evaluated on an individual basis.
The company said the agreement was not a class-action settlement.
The agreement represents a change in stance for the drugmaker, which earlier had insisted it would fight each Vioxx case.
The settlement - one of the biggest ever in civil litigation - comes after almost 20 Vioxx civil trials were held over the last two years.
The amount plaintiffs will receive from the settlement will depend on how long they took the pain medication and the severity of their injuries.
"This is a good and responsible agreement that will allow the company to concentrate even more fully on its mission of discovering, developing and delivering novel medicines and vaccines," said Richard Clark, chairman and CEO of Merck. "The agreement is structured to provide a significant degree of certainty toward resolving the majority of the outstanding Vioxx product liability claims in the United States for a fixed amount."
Merck ( Charts, Fortune 500) shares edged higher in Frankfurt trading on Friday.
Vioxx became a popular pain medication after it was approved for sale in 1999, with annual sales rising to $2.5 billion. Merck pulled the drug from the market in September 2004 due to safety concerns.
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Stupid Paper!
I recently wrote to a prominent journal about this article. They published my comment. The paper's abstract appears under my comment.
see it here or read on:
Begin Comment:
Flawed paper stirs a profession.
By Joseph J. Ierano,
Doctor of Chiropractic
Private, solo practice of chiropractic.
Chiropractic is at times a very nervous profession. Especially unnerving is a paper that addresses a serious subject, necessary in its execution, flawed in its production.
A meta-analysis such as this simply re-states the flaws of other studies; work done by others of dubious merit.
Dubious merit because there is no examination of the uniformity of interventions administered in the studies which they categorise at "spinal manipulation". Examination of a procedure surely deliniates that procedure in detail and presents it to the reader. Just what is "pediatric spinal manipulation"?
This study is what it is: a precurser to the study being rightly done. Lets just see what the adverse effects are of this procedure which seems to define chiropractors. But first, define the procedure, and don't make any serious assumptions until that scientific method is applied properly.
This may sound unbelievable, but In my experience (over a decade) of adjusting hundreds of children there has not been one event that could be categorised as "adverse". Similarly, in communication with my profession and state boards here in Australia, I do not think that one solitary action of litigation against a chiropractor has been brought for seriously harming or death of a child in administrering care. Is this not an astounding statistic in comparison with proper medical paediatric care? Bring on the science, please.
Conflict of Interest:
Registered Chiropractor educated in University-based undergraduate paediatric chiropractic and post- graduate specialisation in upper cervical chiropractic.
The article:
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e275-e283 (doi:10.1542/peds.2006-1392)
Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review
Sunita Vohra, MD, FRCPC, MSca, Bradley C. Johnston, NDa, Kristie Cramer, MSca and Kim Humphreys, DC, PhDb
a Complementary and Alternative Research and Education Program, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
b Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
BACKGROUND. Spinal manipulation is a noninvasive manual procedure applied to specific body tissues with therapeutic intent. Although spinal manipulation is commonly used in children, there is limited understanding of the pediatric risk estimates.
OBJECTIVE. Our goal was to systematically identify and synthesize available data on adverse events associated with pediatric spinal manipulation.
METHODS. A comprehensive search was performed of 8 major electronic databases (eg, Medline, AMED, MANTIS) from inception to June 2004 irrespective of language. Reports were included if they (1) were a primary investigation of spinal manipulation (eg, observation studies, controlled trials, surveys), (2) included a study population of children who were aged 18 years or younger, and (3) reported data on adverse events. Data were summarized to demonstrate the nature and severity of adverse events that may result rather than their incidence.
RESULTS. Thirteen studies (2 randomized trials, 11 observational reports) were identified for inclusion. We identified 14 cases of direct adverse events involving neurologic or musculoskeletal events. Nine cases involved serious adverse events (eg, subarachnoidal hemorrhage, paraplegia), 2 involved moderately adverse events that required medical attention (eg, severe headache), and 3 involved minor adverse events (eg, midback soreness). Another 20 cases of indirect adverse events involved delayed diagnosis (eg, diabetes, neuroblastoma) and/or inappropriate provision of spinal manipulation for serious medical conditions (ie, meningitis, rhabdomyosarcoma).
CONCLUSIONS. Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.
Now you can see what I was harping on about. In actuality the paper speaks of a tremendous safety record, unparalleled in modern health history.