For years I have run a casual email
list serving the chiropractic profession, its students
and various interested non-chiropractor supporters.
Oct 2007
Issue 14
16/10/07 13:44
Welcome to issue 14
"There is no worse tyranny than to force a man to pay for what he does not
want merely because you think it would be good for him."
--Robert Heinlein
-=--=-
Evidence you need?
Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly
http://content.nejm.org/cgi/content/full/357/14/1373?query=TOC
ABSTRACT
Background Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results.
Methods Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990–1991 through 1999–2000 and of two other HMOs for 1996–1997 through 1999–2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding.
Results There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant — though lower — reductions in the risks of both hospitalization and death.
Conclusions During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved.
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what is this... evil?
is it global? Or just American?
I dont know.
joe
https://www.jvsr.com/researchupdate/detail.asp?ID=1056
-=-=-
CLINICAL GUIDELINES
Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society
Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Donald Casey, MD, MPH, MBA; J. Thomas Cross, Jr, MD, MPH; Paul Shekelle, MD, PhD; Douglas K. Owens, MD, MS, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel*
2 October 2007 | Volume 147 Issue 7 | Pages 478-491
Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence).
Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).
Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).
Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence).
Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence).
Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.
Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
-=-=
-=-=-=
nothing is without risk, remember!
vaccines do cost the drug companies occasionally, according to this report, as well as making them squillions...but still no link to Autism.
WDDTY
Vaccine Damage: Parents receive $2bn compensation pay-outs
Vaccine manufacturers have paid out nearly $2bn in damages to parents in America whose children were harmed by one of the childhood jabs such as the MMR (measles-mumps-rubella) or DPT (diphtheria-pertussis-tetanus).
In all, around 2,000 families have received compensation payments that have averaged $850,000 each. There are a further 700 claims that are going through the pipeline.
None of the claims is for autism as medical researchers say they have failed to find a link between the disease and the MMR vaccine, despite the initial findings made by Dr Andrew Wakefield. Instead they are for a wide spectrum of physical and mental conditions that are likely to have been caused by one of the vaccinations.
Around 7,000 parents have filed a claim of an adverse reaction with America's Vaccine Injury Compensation Program (VICP). To win an award, the claimant must prove a causal link to a vaccine. As the medical establishment has refused to recognise any link to autism, the VICP has so far rejected 300 claims for this outright.
(Source: New England Journal of Medicine, 2007; 357: 1275-9).
Click here to receive health news by email.
Story from WDDTY:
http://www.wddty.com/03363800370060881833/vaccine-damage-parents-receive-2bn-compensation-pay-outs.html
Published: 04/10/2007 10:03:00 GMT
© WDDTY MMVI
-=-=-
this is quite amazing
war is hell
joe
To Print: Click your browser's PRINT button.
NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/563542
United States Prepares for Onslaught of War-Related Epilepsy
Caroline Cassels
Medscape Medical News 2007. © 2007 Medscape
September 28, 2007 — With traumatic brain injury (TBI) being the signature wound of the current conflicts in Iraq and Afghanistan, the US government is being asked to establish 6 epilepsy centers of excellence (CoEs) to identify, treat, and monitor the thousands of returning head-injured veterans at potential risk of developing posttraumatic epilepsy (PTE).
Initiated by the American Academy of Neurology (AAN), the Epilepsy Centers of Excellence Act of 2007 is currently before the US Congress and expected to pass sometime in 2008.
The bill was proposed by the AAN in response to concerns from its members that the anticipated onslaught of returning veterans with traumatic brain injury (TBI) who will ultimately develop PTE would outstrip the capacity of the Veterans Health Administration to adequately manage large numbers of such individuals.
"There was a great deal of concern among our members that much of this traumatic brain injury among returning vets was, over time, going to manifest itself in [posttraumatic] epilepsy and that the Veterans Administration [VA] was terribly unprepared for this," Mike Amery, who is the AAN legislative counsel at its Office for Federal Affairs, told Medscape Neurology & Neurosurgery.
Data from the Vietnam War show that 53% of soldiers who survived penetrating head wounds subsequently developed posttraumatic epilepsy, some up to 15 years later, says John Booss, MD, former national director, neurology service, Department of Veterans Affairs, who is also a member of the AAN Legislative Affairs Committee and a volunteer advocate for the proposed legislation.
Unprecedented Numbers of Closed Brain Injury
Dr. Booss told Medscape Neurology & Neurosurgery that in the current conflict, various factors, including Kevlar body armor and helmets, have made penetrating wounds — and specifically penetrating head wounds — much less common.
However, the widespread use of improvised explosive devices (IEDs), also known as roadside bombs, by insurgents in Iraq and Afghanistan, coupled with improved survival, is contributing to an unprecedented number of concussive closed head injuries.
The US government has cited national security concerns for not making an official total of the numbers of returning troops who have been treated for TBI publicly available. However, a position paper published earlier this year by the Brain Injury Association of America estimates that as of March 24, 2007, a total of 12,274 US service members have sustained a TBI in either Iraq or Afghanistan but projects this number "could grow as high as 150,000."
Other estimates assert that 22% of all returning service personnel have some form of TBI, 69% of whom were injured by roadside bombs, rocket-propelled grenades, and other blasts. TBI screening, which began in August 2007 at the National Naval Medical Center, showed 83% of wounded Marines and sailors had brain injuries.
Although the US Department of Defense supports mass TBI screening for all returning troops, currently it does not have the resources or a standardized screening process in place.
Exactly what proportion of brain-injured soldiers will subsequently develop PTE is uncertain, but according to Dr. Booss, it is likely to be significant. He points out that even "mild" TBI can trigger subsequent epilepsy.
"In the civilian sector, the rate of epilepsy from closed head injuries is somewhere just under 5%. In the military, it ranges from about 6% to 14%, but in all candor, at this point we simply don't know," Dr. Booss said.
"What we do know is the [Veterans Health Administration] is not prepared to handle an influx of veterans with TBI, a significant percentage of whom will develop epilepsy. However, this is something we believe this legislation will remedy."
Enormous Research Need
If passed, the bill will establish 6 epilepsy CoEs strategically distributed around the country. Through a competitive process, healthcare facilities affiliated with an academic research center would be invited to submit proposals for consideration by an expert peer-review panel that will assess their scientific and clinical merits.
Under the legislation, each center would receive $1 million per year for 4 years, with a mandate to conduct research, education, and clinical care activities. "This is really just seed money to get the centers started," said Mr. Amery. "The real money will come from grants and the participation of other research institutions and foundations."
According to Dr. Booss, there is an "enormous need" for TBI research with respect to both post-TBI sequelae, including epilepsy, and the psychosocial integration aspects of these injuries.
Many veterans, he said, have masked brain injuries and require systematic screening
Once a world leader in epilepsy research, the Veterans Health Administration saw funding for epilepsy research and care dry up during the mid-1990s as an unintended consequence of a major reorganization of the VA health care system..
"The VA epilepsy centers literally went from a position of international leadership to, in many instances, falling below community standards. As a result, many were shut down or saw services dramatically cut," said Dr. Booss.
Funding Stability Critical
The aim of the current legislation, said Dr. Booss, is to create a permanent, nationally organized hierarchy of care so that no matter where a veteran lives in the United States there will be a network of referral centers affiliated with a regional epilepsy CoE.
According to Mr. Amery, the model for the epilepsy CoEs is based on similar CoEs for Parkinson's disease (PD) and multiple sclerosis (MS) that have been established over the past 4 to 6 years and been successful.
However, there was a potential threat to continued funding with these centers. As a result, last year the AAN, along with other organizations, including the Parkinson's Action Network, the Paralyzed Veterans of America, and the National Multiple Sclerosis Society, successfully lobbied to have legislation passed that would permanently authorize funding.
Dr. Booss said the same must happen with the epilepsy CoEs. "The MS and PD centers of excellence were set up during my tenure [at the Department of Veterans Affairs], but there was no permanence associated with their establishment. We were very concerned that given other priorities, they might be allowed to wither or become victims of cutbacks, so the AAN mounted an effort to put into law permanent authorization of these centers, and the president signed the bill in December 2006," he said
"Funding stability is critically important to attracting the type of high-caliber researchers, clinicians, and educators that will ensure success of these centers. It is my hope that the epilepsy centers will also be permanently authorized by law," he added.
Spillover Effect
Rep. Ed Perlmutter, a Democrat from Colorado and the bill's sponsor, told Medscape Neurology & Neurosurgery that as the father of a young woman with epilepsy he has a personal interest in ensuring the legislation passes as quickly as possible.
A coordinated national approach to TBI and subsequent PTE, said Rep. Perlmutter, will ensure high-quality care for returning veterans. In addition, the mandated affiliation with established research institutions will benefit the larger epilepsy population; it is estimated that 3 million Americans, or 1% of the US population, has some form of epilepsy.
"The research and resulting medical advances will help the men and women who are serving our country and will also be very helpful to the [general] epilepsy population," said Rep. Perlmutter.
For more information visit www.aan.com/go/advocacy.
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can you trust a man called Edzard?
Dr Battistoni sent item below...
more on the man who is not only bringing chiropractic down, but anything else up for grabs by the drug companies?
joe
Begin forwarded message:
Ernst, Ernst, Ernst.
http://community.wddty.com/blogs/adverse_reactions/archive/2007/10/05/Herbicide.aspx
-=-=-
American Journal of Clinical Nutrition, Vol. 86, No. 4, 899-906, October 2007
© 2007 American Society for Nutrition
REVIEW ARTICLE
Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease1,2,3
Richard J Johnson, Mark S Segal, Yuri Sautin, Takahiko Nakagawa, Daniel I Feig, Duk-Hee Kang, Michael S Gersch, Steven Benner and Laura G Sánchez-Lozada
1 From the Division of Nephrology and Department of Medicine, University of Florida, Gainesville, FL (RJJ, MSS, YS, TN, and MSG); the Division of Pediatric Nephrology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (DIF); the Division of Nephrology, Ewha Woman's University College of Medicine, Seoul, Korea (D-HK); the Foundation for Applied Molecular Evolution, Gainesville, FL (SB); and the Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico (LGS-L)
Currently, we are experiencing an epidemic of cardiorenal disease characterized by increasing rates of obesity, hypertension, the metabolic syndrome, type 2 diabetes, and kidney disease. Whereas excessive caloric intake and physical inactivity are likely important factors driving the obesity epidemic, it is important to consider additional mechanisms. We revisit an old hypothesis that sugar, particularly excessive fructose intake, has a critical role in the epidemic of cardiorenal disease. We also present evidence that the unique ability of fructose to induce an increase in uric acid may be a major mechanism by which fructose can cause cardiorenal disease. Finally, we suggest that high intakes of fructose in African Americans may explain their greater predisposition to develop cardiorenal disease, and we provide a list of testable predictions to evaluate this hypothesis.
Key Words: Fructose • uric acid • sugar • arteriosclerosis • endothelial dysfunction • hypertension • obesity • chronic kidney disease • metabolic syndrome
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American Journal of Clinical Nutrition, Vol. 86, No. 4, 1243-1247, October 2007
© 2007 American Society for Nutrition
ORIGINAL RESEARCH COMMUNICATION
Tea drinking is associated with benefits on bone density in older women1,2,3
Amanda Devine, Jonathan M Hodgson, Ian M Dick and Richard L Prince
1 From the School of Medicine and Pharmacology, University of Western Australia, Perth, Australia (JMH, IMD, and RLP); the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia (IMD and RLP); and the School of Exercise, Biomedical and Health Science, Edith Cowan University, Joondalup, Australia (AD)
Background: Impaired hip structure assessed by dual-energy X-ray absorptiometry (DXA) areal bone mineral density (aBMD) is an independent predictor for osteoporotic hip fracture. Some studies suggest that tea intake may protect against bone loss.
Objective: Using both cross-sectional and longitudinal study designs, we examined the relation of tea consumption with hip structure.
Design: Randomly selected women (n = 1500) aged 70–85 y participated in a 5-y prospective trial to evaluate whether oral calcium supplements prevent osteoporotic fractures. aBMD at the hip was measured at years 1 and 5 with DXA. A cross-sectional analysis of 1027 of these women at 5 y assessed the relation of usual tea intake, measured by using a questionnaire, with aBMD. A prospective analysis of 164 women assessed the relation of tea intake at baseline, measured by using a 24-h dietary recall, with change in aBMD from years 1 to 5.
Results: In the cross-sectional analysis, total hip aBMD was 2.8% greater in tea drinkers (: 806; 95% CI: 797, 815 mg/cm2) than in non-tea drinkers (784; 764, 803 mg/cm2) (P < 0.05). In the prospective analysis over 4 y, tea drinkers lost an average of 1.6% of their total hip aBMD (–32; –45, –19 mg/cm2), but non-tea drinkers lost 4.0% (–13; –20, –5 mg/cm2) (P < 0.05). Adjustment for covariates did not influence the interpretation of results.
Conclusion: Tea drinking is associated with preservation of hip structure in elderly women. This finding provides further evidence of the beneficial effects of tea consumption on the skeleton.
Key Words: Tea drinking • cross-sectional study • prospective study • bone mineral density • fracture • elderly women
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Study: Cholesterol drugs' protection long-lasting
Story Highlights
Statins help prevent heart attacks for at least a decade after use ends
Next Article in Health »
(AP) -- Cholesterol-lowering statin drugs help prevent heart attacks for at least a decade after people stop taking them, the first long-term study of the world's top-selling type of medication finds.
The research follows up on a study in Scotland showing that men taking the drug Pravachol for five years substantially lowered their risk of heart attack and death from heart disease.
They were followed for 10 more years after most stopped taking the drug. That group was compared with a group of men who were given dummy pills during the five-year study. There was a 25 percent lower risk of heart attack or death from heart disease among those in the statin group, when compared with the placebo group.
The study participants were middle-aged men who had never had a heart attack but who had a very high average level of LDL, or bad cholesterol -- 192.
While the study found protection lasted after statin use stopped, the drugs usually are prescribed indefinitely, especially for people with known heart disease. Federal guidelines say these drugs are very safe and may be used by people with LDL levels as low as 130, or even 100 if they are at very high risk of heart attack.
The new results, based on medical records from more than 90 percent of the men in the original experiment, appear in Thursday's New England Journal of Medicine.
Don't Miss
NIH: Cholesterol Education Program
Health for Her: Alcohol and breast cancer
The researchers wrote that statin's protective effect was probably because existing plaque was stabilized and the progression of coronary artery disease was slowed.
"Continuing treatment after five years may be beneficial," they wrote.
After the original study ended in 1995, participants returned to their own doctor's care and decided whether to continue or start taking statins. Five years later, about 39 percent of the original statin patients were still taking the drugs, and 35 percent of the placebo takers were using statins.
Over the 15-year period, 619 of the original statin takers and 674 of the placebo takers died.
Dr. Michael J. Domanski of the National Heart, Lung, and Blood Institute said the study's biggest weakness is the fact that after the study ended, more of the original statin patients took the drugs than those in the placebo group.
The researchers argued that that difference couldn't explain the overall long-term protection demonstrated in the study.
Your Health Tools
MayoClinic.com: Health Library
Healthology: Health Video Library
Domanski wrote in an editorial that the study clearly shows the benefit of statin use "is durable over the long term" and that there now can be no doubt reducing levels of LDL cholesterol has a role in preventing and treating heart disease.
Still uncertain, he added, is how early people with high cholesterol should start using statins and how low one's LDL should be for the most benefit.
Currently, the National Cholesterol Education Program, a federally funded advisory group, and leading heart doctor groups recommend cutting the LDL level to below 70 for patients at very high risk of a heart attack, below 100 for high-risk patients and below 130 for moderate-risk patients.
The follow-up study was partly funded by Bristol-Myers Squibb Co., the maker of Pravachol, and Daiichi Sankyo Inc., maker of the statin WelChol. All but one of the researchers reported receiving consulting fees, lecture fees or research grants from a total of five other pharmaceutical companies, four of which sell statins. E-mail to a friend
Copyright 2007 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.
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Even the Sydney Children's Hospital a few years ago said cold medications were mostly garbage. Why dont we use the old time proven remedies? (like let the body heal itself, steam, hot drinks, honey, lemon, herbs, etc..) Are we in too much of a hurry?
joe
Makers pull cold medicines sold for infants
(CNN) -- The makers of several leading over-the-counter cold medications are voluntarily withdrawing products sold for infants, the Consumer Healthcare Products Association said Thursday.
The Consumer Healthcare Products Association recommends not using cold medicines for kids under 2.
The trade group said the products were being withdrawn "out of an abundance of caution" and insisted the products are safe when used as directed.
"The reason the makers of over-the-counter, oral cough and cold medicines for infants are voluntarily withdrawing these medicines is that there have been rare patterns of misuse leading to overdose recently identified, particularly in infants, and safety is our top priority," Linda A. Suydam, the association's president, said in a statement.
"It's important to point out that these medicines are safe and effective when used as directed, and most parents are using them appropriately," she said.
CVS stores planned to stop selling the withdrawn products and store-brand equivalents, it said. Refunds are being offered if customers return the products. Watch Dr. Sanjay Gupta on whether the medicines are effective »
Withdrawn Medicines
Dimetapp
Decongestant Plus Cough Infant Drops
Decongestant Infant Drops
Little Colds
Decongestant Plus Cough
Multi-Symptom Cold Formula
Pediacare
Infant Drops Decongestant (containing pseudoephedrine)
Infant Drops Decongestant & Cough (containing pseudoephedrine)
Infant Dropper Decongestant (containing phenylephrine)
Infant Dropper Long-Acting Cough
Infant Dropper Decongestant & Cough (containing phenylephrine)
Robitussin
Infant Cough DM Drops
Triaminic
Infant & Toddler Thin Strips Decongestant
Infant & Toddler Thin Strips Decongestant Plus Cough
Tylenol
Concentrated Infants' Drops Plus Cold
Concentrated Infants' Drops Plus Cold & Cough
Last month, federal health officials recommended that the "consult your physician" advice to parents on the labels of cold and cough medicines aimed at young children be dropped and a warning not to use the medications in children under 2 be added. The U.S. Food and Drug Administration will officially consider revising the labels at a meeting next week.
After reviewing reports of side effects over the last four decades, the FDA found 54 child fatalities from over-the-counter decongestant medicines.
The agency found 69 reports of children's deaths connected with antihistamines, which are used to treat runny noses.
Baltimore health commissioner Dr. Joshua Sharfstein and other health officials in Maryland had requested a review by the FDA, saying 900 children under four in Maryland had overdosed on the products in 2004.
"When it comes to children under age two there are no recommended doses on these products so it's not reasonable to claim they are safe and effective when used as directed," Sharfstein told The Associated Press on Thursday.
Consumer Healthcare Products Association is a trade group representing U.S. manufacturers and distributors of over-the-counter medications and nutritional supplements.
The withdrawal does not affect medicines intended for children ages 2 and older.
The association said it would back any FDA move to change the advice on oral children's cough medicine.
CNN's Dr. Sanjay Gupta said over-the-counter cold medicines can cause side effects such as sedation, irritability, allergy and heart abnormalities.
Instead of the drugs, Gupta said, parents of sick infants can use vaporizers or hydrators, saline nose drops, rubber nose bulbs, and chicken soup and other fluids to keep an infant hydrated. E-mail to a friend
Copyright 2007 CNN. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed. Associated Press contributed to this report.
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40 hospital complaints since miscarriage
1:39pm The head of Royal North Shore's new complaints body says there have been 40 cases since the incident when a pregnant woman miscarried in an emergency room toilet. more
Get your kids checked free.
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yes!
they published the comment
here
joe
http://pediatrics.aappublications.org/cgi/content/full/119/1/e275?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=spinal+manipulation&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Begin forwarded message:
From: Joseph Ieranò
Date: 14 October 2007 9:47:40 PM
To: infoierano
Cc: weeklydigest
Subject: I sent this comment
This article was published in Pediatrics, sadly:
http://pediatrics.aappublications.org/cgi/content/full/119/1/e275?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=spinal+manipulation&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
my response is here, freshly sent....dont know if they'll add it
this is the sort of feedback forum that chiropractors are notably absent from...SEE the feedback under the article: ONLY ONE submission!
no wonder they ignore us
oh well hope they put this up there
joe
Flawed paper stirs a profession.
Joseph J. Ierano,
Doctor of Chiropractic
Private, solo practice of chiropractic.
Send letter to journal:
Re: Flawed paper stirs a profession.
E-mail Joseph J. Ierano
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.
"There is no worse tyranny than to force a man to pay for what he does not
want merely because you think it would be good for him."
--Robert Heinlein
-=--=-
Evidence you need?
Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly
http://content.nejm.org/cgi/content/full/357/14/1373?query=TOC
ABSTRACT
Background Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading pictures of long-term benefits, and residual confounding may have biased past results. This study examined the effectiveness of influenza vaccine in seniors over the long term while addressing potential bias and residual confounding in the results.
Methods Data were pooled from 18 cohorts of community-dwelling elderly members of one U.S. health maintenance organization (HMO) for 1990–1991 through 1999–2000 and of two other HMOs for 1996–1997 through 1999–2000. Logistic regression was used to estimate the effectiveness of the vaccine for the prevention of hospitalization for pneumonia or influenza and death after adjustment for important covariates. Additional analyses explored for evidence of bias and the potential effect of residual confounding.
Results There were 713,872 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza (adjusted odds ratio, 0.73; 95% confidence interval [CI], 0.68 to 0.77) and a 48% reduction in the risk of death (adjusted odds ratio, 0.52; 95% CI, 0.50 to 0.55). Estimates were generally stable across age and risk subgroups. In the sensitivity analyses, we modeled the effect of a hypothetical unmeasured confounder that would have caused overestimation of vaccine effectiveness in the main analysis; vaccination was still associated with statistically significant — though lower — reductions in the risks of both hospitalization and death.
Conclusions During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved.
-=-=-=-
what is this... evil?
is it global? Or just American?
I dont know.
joe
https://www.jvsr.com/researchupdate/detail.asp?ID=1056
-=-=-
CLINICAL GUIDELINES
Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society
Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Donald Casey, MD, MPH, MBA; J. Thomas Cross, Jr, MD, MPH; Paul Shekelle, MD, PhD; Douglas K. Owens, MD, MS, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel*
2 October 2007 | Volume 147 Issue 7 | Pages 478-491
Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence).
Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).
Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).
Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence).
Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence).
Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.
Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
-=-=
-=-=-=
nothing is without risk, remember!
vaccines do cost the drug companies occasionally, according to this report, as well as making them squillions...but still no link to Autism.
WDDTY
Vaccine Damage: Parents receive $2bn compensation pay-outs
Vaccine manufacturers have paid out nearly $2bn in damages to parents in America whose children were harmed by one of the childhood jabs such as the MMR (measles-mumps-rubella) or DPT (diphtheria-pertussis-tetanus).
In all, around 2,000 families have received compensation payments that have averaged $850,000 each. There are a further 700 claims that are going through the pipeline.
None of the claims is for autism as medical researchers say they have failed to find a link between the disease and the MMR vaccine, despite the initial findings made by Dr Andrew Wakefield. Instead they are for a wide spectrum of physical and mental conditions that are likely to have been caused by one of the vaccinations.
Around 7,000 parents have filed a claim of an adverse reaction with America's Vaccine Injury Compensation Program (VICP). To win an award, the claimant must prove a causal link to a vaccine. As the medical establishment has refused to recognise any link to autism, the VICP has so far rejected 300 claims for this outright.
(Source: New England Journal of Medicine, 2007; 357: 1275-9).
Click here to receive health news by email.
Story from WDDTY:
http://www.wddty.com/03363800370060881833/vaccine-damage-parents-receive-2bn-compensation-pay-outs.html
Published: 04/10/2007 10:03:00 GMT
© WDDTY MMVI
-=-=-
this is quite amazing
war is hell
joe
To Print: Click your browser's PRINT button.
NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/563542
United States Prepares for Onslaught of War-Related Epilepsy
Caroline Cassels
Medscape Medical News 2007. © 2007 Medscape
September 28, 2007 — With traumatic brain injury (TBI) being the signature wound of the current conflicts in Iraq and Afghanistan, the US government is being asked to establish 6 epilepsy centers of excellence (CoEs) to identify, treat, and monitor the thousands of returning head-injured veterans at potential risk of developing posttraumatic epilepsy (PTE).
Initiated by the American Academy of Neurology (AAN), the Epilepsy Centers of Excellence Act of 2007 is currently before the US Congress and expected to pass sometime in 2008.
The bill was proposed by the AAN in response to concerns from its members that the anticipated onslaught of returning veterans with traumatic brain injury (TBI) who will ultimately develop PTE would outstrip the capacity of the Veterans Health Administration to adequately manage large numbers of such individuals.
"There was a great deal of concern among our members that much of this traumatic brain injury among returning vets was, over time, going to manifest itself in [posttraumatic] epilepsy and that the Veterans Administration [VA] was terribly unprepared for this," Mike Amery, who is the AAN legislative counsel at its Office for Federal Affairs, told Medscape Neurology & Neurosurgery.
Data from the Vietnam War show that 53% of soldiers who survived penetrating head wounds subsequently developed posttraumatic epilepsy, some up to 15 years later, says John Booss, MD, former national director, neurology service, Department of Veterans Affairs, who is also a member of the AAN Legislative Affairs Committee and a volunteer advocate for the proposed legislation.
Unprecedented Numbers of Closed Brain Injury
Dr. Booss told Medscape Neurology & Neurosurgery that in the current conflict, various factors, including Kevlar body armor and helmets, have made penetrating wounds — and specifically penetrating head wounds — much less common.
However, the widespread use of improvised explosive devices (IEDs), also known as roadside bombs, by insurgents in Iraq and Afghanistan, coupled with improved survival, is contributing to an unprecedented number of concussive closed head injuries.
The US government has cited national security concerns for not making an official total of the numbers of returning troops who have been treated for TBI publicly available. However, a position paper published earlier this year by the Brain Injury Association of America estimates that as of March 24, 2007, a total of 12,274 US service members have sustained a TBI in either Iraq or Afghanistan but projects this number "could grow as high as 150,000."
Other estimates assert that 22% of all returning service personnel have some form of TBI, 69% of whom were injured by roadside bombs, rocket-propelled grenades, and other blasts. TBI screening, which began in August 2007 at the National Naval Medical Center, showed 83% of wounded Marines and sailors had brain injuries.
Although the US Department of Defense supports mass TBI screening for all returning troops, currently it does not have the resources or a standardized screening process in place.
Exactly what proportion of brain-injured soldiers will subsequently develop PTE is uncertain, but according to Dr. Booss, it is likely to be significant. He points out that even "mild" TBI can trigger subsequent epilepsy.
"In the civilian sector, the rate of epilepsy from closed head injuries is somewhere just under 5%. In the military, it ranges from about 6% to 14%, but in all candor, at this point we simply don't know," Dr. Booss said.
"What we do know is the [Veterans Health Administration] is not prepared to handle an influx of veterans with TBI, a significant percentage of whom will develop epilepsy. However, this is something we believe this legislation will remedy."
Enormous Research Need
If passed, the bill will establish 6 epilepsy CoEs strategically distributed around the country. Through a competitive process, healthcare facilities affiliated with an academic research center would be invited to submit proposals for consideration by an expert peer-review panel that will assess their scientific and clinical merits.
Under the legislation, each center would receive $1 million per year for 4 years, with a mandate to conduct research, education, and clinical care activities. "This is really just seed money to get the centers started," said Mr. Amery. "The real money will come from grants and the participation of other research institutions and foundations."
According to Dr. Booss, there is an "enormous need" for TBI research with respect to both post-TBI sequelae, including epilepsy, and the psychosocial integration aspects of these injuries.
Many veterans, he said, have masked brain injuries and require systematic screening
Once a world leader in epilepsy research, the Veterans Health Administration saw funding for epilepsy research and care dry up during the mid-1990s as an unintended consequence of a major reorganization of the VA health care system..
"The VA epilepsy centers literally went from a position of international leadership to, in many instances, falling below community standards. As a result, many were shut down or saw services dramatically cut," said Dr. Booss.
Funding Stability Critical
The aim of the current legislation, said Dr. Booss, is to create a permanent, nationally organized hierarchy of care so that no matter where a veteran lives in the United States there will be a network of referral centers affiliated with a regional epilepsy CoE.
According to Mr. Amery, the model for the epilepsy CoEs is based on similar CoEs for Parkinson's disease (PD) and multiple sclerosis (MS) that have been established over the past 4 to 6 years and been successful.
However, there was a potential threat to continued funding with these centers. As a result, last year the AAN, along with other organizations, including the Parkinson's Action Network, the Paralyzed Veterans of America, and the National Multiple Sclerosis Society, successfully lobbied to have legislation passed that would permanently authorize funding.
Dr. Booss said the same must happen with the epilepsy CoEs. "The MS and PD centers of excellence were set up during my tenure [at the Department of Veterans Affairs], but there was no permanence associated with their establishment. We were very concerned that given other priorities, they might be allowed to wither or become victims of cutbacks, so the AAN mounted an effort to put into law permanent authorization of these centers, and the president signed the bill in December 2006," he said
"Funding stability is critically important to attracting the type of high-caliber researchers, clinicians, and educators that will ensure success of these centers. It is my hope that the epilepsy centers will also be permanently authorized by law," he added.
Spillover Effect
Rep. Ed Perlmutter, a Democrat from Colorado and the bill's sponsor, told Medscape Neurology & Neurosurgery that as the father of a young woman with epilepsy he has a personal interest in ensuring the legislation passes as quickly as possible.
A coordinated national approach to TBI and subsequent PTE, said Rep. Perlmutter, will ensure high-quality care for returning veterans. In addition, the mandated affiliation with established research institutions will benefit the larger epilepsy population; it is estimated that 3 million Americans, or 1% of the US population, has some form of epilepsy.
"The research and resulting medical advances will help the men and women who are serving our country and will also be very helpful to the [general] epilepsy population," said Rep. Perlmutter.
For more information visit www.aan.com/go/advocacy.
-=-=
can you trust a man called Edzard?
Dr Battistoni sent item below...
more on the man who is not only bringing chiropractic down, but anything else up for grabs by the drug companies?
joe
Begin forwarded message:
Ernst, Ernst, Ernst.
http://community.wddty.com/blogs/adverse_reactions/archive/2007/10/05/Herbicide.aspx
-=-=-
American Journal of Clinical Nutrition, Vol. 86, No. 4, 899-906, October 2007
© 2007 American Society for Nutrition
REVIEW ARTICLE
Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease1,2,3
Richard J Johnson, Mark S Segal, Yuri Sautin, Takahiko Nakagawa, Daniel I Feig, Duk-Hee Kang, Michael S Gersch, Steven Benner and Laura G Sánchez-Lozada
1 From the Division of Nephrology and Department of Medicine, University of Florida, Gainesville, FL (RJJ, MSS, YS, TN, and MSG); the Division of Pediatric Nephrology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (DIF); the Division of Nephrology, Ewha Woman's University College of Medicine, Seoul, Korea (D-HK); the Foundation for Applied Molecular Evolution, Gainesville, FL (SB); and the Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico (LGS-L)
Currently, we are experiencing an epidemic of cardiorenal disease characterized by increasing rates of obesity, hypertension, the metabolic syndrome, type 2 diabetes, and kidney disease. Whereas excessive caloric intake and physical inactivity are likely important factors driving the obesity epidemic, it is important to consider additional mechanisms. We revisit an old hypothesis that sugar, particularly excessive fructose intake, has a critical role in the epidemic of cardiorenal disease. We also present evidence that the unique ability of fructose to induce an increase in uric acid may be a major mechanism by which fructose can cause cardiorenal disease. Finally, we suggest that high intakes of fructose in African Americans may explain their greater predisposition to develop cardiorenal disease, and we provide a list of testable predictions to evaluate this hypothesis.
Key Words: Fructose • uric acid • sugar • arteriosclerosis • endothelial dysfunction • hypertension • obesity • chronic kidney disease • metabolic syndrome
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American Journal of Clinical Nutrition, Vol. 86, No. 4, 1243-1247, October 2007
© 2007 American Society for Nutrition
ORIGINAL RESEARCH COMMUNICATION
Tea drinking is associated with benefits on bone density in older women1,2,3
Amanda Devine, Jonathan M Hodgson, Ian M Dick and Richard L Prince
1 From the School of Medicine and Pharmacology, University of Western Australia, Perth, Australia (JMH, IMD, and RLP); the Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia (IMD and RLP); and the School of Exercise, Biomedical and Health Science, Edith Cowan University, Joondalup, Australia (AD)
Background: Impaired hip structure assessed by dual-energy X-ray absorptiometry (DXA) areal bone mineral density (aBMD) is an independent predictor for osteoporotic hip fracture. Some studies suggest that tea intake may protect against bone loss.
Objective: Using both cross-sectional and longitudinal study designs, we examined the relation of tea consumption with hip structure.
Design: Randomly selected women (n = 1500) aged 70–85 y participated in a 5-y prospective trial to evaluate whether oral calcium supplements prevent osteoporotic fractures. aBMD at the hip was measured at years 1 and 5 with DXA. A cross-sectional analysis of 1027 of these women at 5 y assessed the relation of usual tea intake, measured by using a questionnaire, with aBMD. A prospective analysis of 164 women assessed the relation of tea intake at baseline, measured by using a 24-h dietary recall, with change in aBMD from years 1 to 5.
Results: In the cross-sectional analysis, total hip aBMD was 2.8% greater in tea drinkers (: 806; 95% CI: 797, 815 mg/cm2) than in non-tea drinkers (784; 764, 803 mg/cm2) (P < 0.05). In the prospective analysis over 4 y, tea drinkers lost an average of 1.6% of their total hip aBMD (–32; –45, –19 mg/cm2), but non-tea drinkers lost 4.0% (–13; –20, –5 mg/cm2) (P < 0.05). Adjustment for covariates did not influence the interpretation of results.
Conclusion: Tea drinking is associated with preservation of hip structure in elderly women. This finding provides further evidence of the beneficial effects of tea consumption on the skeleton.
Key Words: Tea drinking • cross-sectional study • prospective study • bone mineral density • fracture • elderly women
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Study: Cholesterol drugs' protection long-lasting
Story Highlights
Statins help prevent heart attacks for at least a decade after use ends
Next Article in Health »
(AP) -- Cholesterol-lowering statin drugs help prevent heart attacks for at least a decade after people stop taking them, the first long-term study of the world's top-selling type of medication finds.
The research follows up on a study in Scotland showing that men taking the drug Pravachol for five years substantially lowered their risk of heart attack and death from heart disease.
They were followed for 10 more years after most stopped taking the drug. That group was compared with a group of men who were given dummy pills during the five-year study. There was a 25 percent lower risk of heart attack or death from heart disease among those in the statin group, when compared with the placebo group.
The study participants were middle-aged men who had never had a heart attack but who had a very high average level of LDL, or bad cholesterol -- 192.
While the study found protection lasted after statin use stopped, the drugs usually are prescribed indefinitely, especially for people with known heart disease. Federal guidelines say these drugs are very safe and may be used by people with LDL levels as low as 130, or even 100 if they are at very high risk of heart attack.
The new results, based on medical records from more than 90 percent of the men in the original experiment, appear in Thursday's New England Journal of Medicine.
Don't Miss
NIH: Cholesterol Education Program
Health for Her: Alcohol and breast cancer
The researchers wrote that statin's protective effect was probably because existing plaque was stabilized and the progression of coronary artery disease was slowed.
"Continuing treatment after five years may be beneficial," they wrote.
After the original study ended in 1995, participants returned to their own doctor's care and decided whether to continue or start taking statins. Five years later, about 39 percent of the original statin patients were still taking the drugs, and 35 percent of the placebo takers were using statins.
Over the 15-year period, 619 of the original statin takers and 674 of the placebo takers died.
Dr. Michael J. Domanski of the National Heart, Lung, and Blood Institute said the study's biggest weakness is the fact that after the study ended, more of the original statin patients took the drugs than those in the placebo group.
The researchers argued that that difference couldn't explain the overall long-term protection demonstrated in the study.
Your Health Tools
MayoClinic.com: Health Library
Healthology: Health Video Library
Domanski wrote in an editorial that the study clearly shows the benefit of statin use "is durable over the long term" and that there now can be no doubt reducing levels of LDL cholesterol has a role in preventing and treating heart disease.
Still uncertain, he added, is how early people with high cholesterol should start using statins and how low one's LDL should be for the most benefit.
Currently, the National Cholesterol Education Program, a federally funded advisory group, and leading heart doctor groups recommend cutting the LDL level to below 70 for patients at very high risk of a heart attack, below 100 for high-risk patients and below 130 for moderate-risk patients.
The follow-up study was partly funded by Bristol-Myers Squibb Co., the maker of Pravachol, and Daiichi Sankyo Inc., maker of the statin WelChol. All but one of the researchers reported receiving consulting fees, lecture fees or research grants from a total of five other pharmaceutical companies, four of which sell statins. E-mail to a friend
Copyright 2007 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.
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Even the Sydney Children's Hospital a few years ago said cold medications were mostly garbage. Why dont we use the old time proven remedies? (like let the body heal itself, steam, hot drinks, honey, lemon, herbs, etc..) Are we in too much of a hurry?
joe
Makers pull cold medicines sold for infants
(CNN) -- The makers of several leading over-the-counter cold medications are voluntarily withdrawing products sold for infants, the Consumer Healthcare Products Association said Thursday.
The Consumer Healthcare Products Association recommends not using cold medicines for kids under 2.
The trade group said the products were being withdrawn "out of an abundance of caution" and insisted the products are safe when used as directed.
"The reason the makers of over-the-counter, oral cough and cold medicines for infants are voluntarily withdrawing these medicines is that there have been rare patterns of misuse leading to overdose recently identified, particularly in infants, and safety is our top priority," Linda A. Suydam, the association's president, said in a statement.
"It's important to point out that these medicines are safe and effective when used as directed, and most parents are using them appropriately," she said.
CVS stores planned to stop selling the withdrawn products and store-brand equivalents, it said. Refunds are being offered if customers return the products. Watch Dr. Sanjay Gupta on whether the medicines are effective »
Withdrawn Medicines
Dimetapp
Decongestant Plus Cough Infant Drops
Decongestant Infant Drops
Little Colds
Decongestant Plus Cough
Multi-Symptom Cold Formula
Pediacare
Infant Drops Decongestant (containing pseudoephedrine)
Infant Drops Decongestant & Cough (containing pseudoephedrine)
Infant Dropper Decongestant (containing phenylephrine)
Infant Dropper Long-Acting Cough
Infant Dropper Decongestant & Cough (containing phenylephrine)
Robitussin
Infant Cough DM Drops
Triaminic
Infant & Toddler Thin Strips Decongestant
Infant & Toddler Thin Strips Decongestant Plus Cough
Tylenol
Concentrated Infants' Drops Plus Cold
Concentrated Infants' Drops Plus Cold & Cough
Last month, federal health officials recommended that the "consult your physician" advice to parents on the labels of cold and cough medicines aimed at young children be dropped and a warning not to use the medications in children under 2 be added. The U.S. Food and Drug Administration will officially consider revising the labels at a meeting next week.
After reviewing reports of side effects over the last four decades, the FDA found 54 child fatalities from over-the-counter decongestant medicines.
The agency found 69 reports of children's deaths connected with antihistamines, which are used to treat runny noses.
Baltimore health commissioner Dr. Joshua Sharfstein and other health officials in Maryland had requested a review by the FDA, saying 900 children under four in Maryland had overdosed on the products in 2004.
"When it comes to children under age two there are no recommended doses on these products so it's not reasonable to claim they are safe and effective when used as directed," Sharfstein told The Associated Press on Thursday.
Consumer Healthcare Products Association is a trade group representing U.S. manufacturers and distributors of over-the-counter medications and nutritional supplements.
The withdrawal does not affect medicines intended for children ages 2 and older.
The association said it would back any FDA move to change the advice on oral children's cough medicine.
CNN's Dr. Sanjay Gupta said over-the-counter cold medicines can cause side effects such as sedation, irritability, allergy and heart abnormalities.
Instead of the drugs, Gupta said, parents of sick infants can use vaporizers or hydrators, saline nose drops, rubber nose bulbs, and chicken soup and other fluids to keep an infant hydrated. E-mail to a friend
Copyright 2007 CNN. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed. Associated Press contributed to this report.
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40 hospital complaints since miscarriage
1:39pm The head of Royal North Shore's new complaints body says there have been 40 cases since the incident when a pregnant woman miscarried in an emergency room toilet. more
Get your kids checked free.
-=-=-=-
yes!
they published the comment
here
joe
http://pediatrics.aappublications.org/cgi/content/full/119/1/e275?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=spinal+manipulation&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Begin forwarded message:
From: Joseph Ieranò
Date: 14 October 2007 9:47:40 PM
To: infoierano
Cc: weeklydigest
Subject: I sent this comment
This article was published in Pediatrics, sadly:
http://pediatrics.aappublications.org/cgi/content/full/119/1/e275?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=spinal+manipulation&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
my response is here, freshly sent....dont know if they'll add it
this is the sort of feedback forum that chiropractors are notably absent from...SEE the feedback under the article: ONLY ONE submission!
no wonder they ignore us
oh well hope they put this up there
joe
Flawed paper stirs a profession.
Joseph J. Ierano,
Doctor of Chiropractic
Private, solo practice of chiropractic.
Send letter to journal:
Re: Flawed paper stirs a profession.
E-mail Joseph J. Ierano
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.
|
Issue 13
10/10/07 18:16
Evil Ernst
who wants to adjust Ernst?
I can offer up a permanent adjustment...
I like the BCA president's quote:
He accuses Ernst of 'puffing up his evidence out of all proportion'.
Meantime, see my next message on adverse events. Medics are killing them ever so much better now...sad to say.
http://observer.guardian.co.uk/uk_news/story/0,,2175332,00.html
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Alternative therapy for backache 'can kill or disable'
Robin McKie, science editor
Sunday September 23, 2007
The Observer
One of the most common 'alternative' treatments for backache is dangerous and can kill, says Britain's leading expert on complementary medicine, Professor Edzard Ernst.
Spinal manipulation, used by chiropractors to treat hundreds of thousands of patients a year, poses serious risks, he warns in a paper published in the Journal of the Royal Society of Medicine
'[It] is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death.'
Spinal manipulation involves sharp thrusts against a patient's spine to push individual vertebrae beyond normal levels of stress. But Ernst says that such violent therapy can seriously damage the arteries running near the spine, triggering thrombosis or a stroke.
The claim has incensed chiropractors. In letters to be published in the journal's October issue, they accuse Ernst of distortion, errors and misinterpreting data.
'The major body of published evidence points to manipulation being a safe and effective tool,' says Barry Lewis, president of the British Chiropractic Association. He accuses Ernst of 'puffing up his evidence out of all proportion'.
One case involves Frances Denoon, who was in her 20s when she pulled a nerve in her neck while exercising. She visited a registered chiropractor and recalled feeling a 'crack' when he began his treatment. 'I couldn't focus and realised I wasn't saying words clearly,' she says on the Action for Victims of Chiropractic's website. Denoon suffered a brain-stem stroke and now has poor balance and cannot write with her right hand. A court cleared her chiropractor of negligence.
Such stories are just the tip of an iceberg, says Ernst, director of complementary medicine at the Peninsula Medical School, run by Exeter and Plymouth universities. He has collected details of about 700 cases.
'I am not calling for a ban on chiropractors carrying out spinal manipulation but I think we have to think about regulating the practice far more carefully than we do at present,' he said.
A spokeswoman for the General Chiropractic Council (GCC) said 2,300 chiropractors were registered with it and that since 2001 only one had been disciplined for breaching guidelines.
Peter Dixon, the council's chairman, said the report was 'yet another research scare' story.
'This does not serve the interests of the public or those of researchers who are dedicated to improving the public's health,' he said.
-=-=-
Sep 17, 10:56 PM EDT
MDs Don't Issue Pregnancy, Drugs Warning
By JOANN LOVIGLIO
Associated Press Writer
Doctors aren't doing a good job of warning young women to avoid
getting pregnant when they're taking prescription drugs that can cause
birth defects, according to a study published in the Annals of Internal
Medicine.
The study of nearly 500,000 women found that nearly half of the women
taking the medicines didn't get counseling from their doctor about using
contraceptives or other birth control measures, while researchers noted
that the study might overestimate the problem because the data is from
health plan billing codes, which don't have the same detailed medical
histories as patient medical charts, reported the Associated Press. Even
with the study's limitations, it is clear that many women aren't getting
the message about avoiding pregnancy while taking certain drugs that may
cause birth defects, including some antibiotics, acne medications,
cholesterol reducers, anti-seizure drugs, sleep aids and blood thinners,
the Associated Press added.
Associated Press, September 17, 2007
Read on...
-=-=-=
'Proof still needed' for flu jab
There is not enough evidence to support the effectiveness of immunising older people against flu, fresh research in the US has concluded.
Researchers from George Washington University, Washington DC, say the benefits in reducing deaths among over 70s have been "greatly exaggerated".
The findings echo a controversial 2006 British Medical Journal study.
But the latest study, in The Lancet Infectious Diseases, nonetheless urges vaccination to continue for the moment.
Most rich countries recommend vaccinating the old and the weak against flu annually in time for the winter.
As well as preventing flu, it is also thought to prevent deaths from other underlying chronic conditions.
In many studies, flu-related deaths are considered to be all those above the expected winter baseline. This is known as winter excess mortality.
Researchers from George Washington University, led by Dr Lone Simonson, say that in the US - despite an increase in vaccination coverage from 15% to 65% since 1980 - excess mortality among elderly people actually increased during the 1980s and 1990s.
The effectiveness of this strategy is under debate
Dr Lone Simonson
They also cited an Italian study, which found no decline in flu-related mortality rates, even as vaccine coverage rose from 5% to 65%.
The study also deplored what it saw as a lack of placebo-controlled randomised clinical trials (RCTs) among those over the age of 70.
They accepted that such trials were, however, unlikely as they would involve denying some participants access to a treatment which it is recommended they receive, and as such would not pass ethical review.
As an alternative, the team recommended that future studies should use "more specific endpoints" than just overall winter deaths.
This should include "vaccine effectiveness against the highly-specific outcome of laboratory-confirmed influenza virus, which although labour intensive and expensive, is more likely to obtain more realistic estimates of vaccine efficacy".
But despite its reservations about the quality of the available evidence, the team nonetheless recommended that people over the age of 70 should continue to be vaccinated until better data could be collected.
Trials call
Dr Tom Jefferson, of the Cochrane Library - a body that determines the relative effectiveness of health interventions - welcomed the study, which repeated many of his own assertions made in a paper published a year ago.
Writing in an editorial, he said it was time to carry out a placebo-based trial in which some participants are denied the jab.
"Head-to-head comparisons with other types of influenza vaccine will not allow direct assessment of absolute vaccine effectiveness," he wrote.
"Could governments be courageous and honest enough to reassess their cherished policies?"
It costs about £115m to vaccine the vulnerable against flu in the UK each year.
This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue
Department of Health
"The aim of our influenza policy is to protect those who are most at risk of serious illness or death should they develop influenza," a spokesperson for the Department of Health said.
"UK policy is constantly under review to take into consideration all available evidence. This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue."
The Royal College of GPs said it endorsed current policy and suggested that the study was lacking.
"There is a widely-held view that many respiratory virus infections cause mild, self-limiting disease and this is true," it said in a statement.
"But it is equally true that the relatively infrequent serious outcomes from this apparently minor illness add up to a major public health problem.
"Routine annual influenza vaccination of the elderly and persons with co-morbidity remains a vital element in this attack."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7010717.stm
Published: 2007/09/25 00:34:18 GMT
© BBC MMVII
-=-=-=-
RE: load carried in military packs
An interesting suggestion, Donald.
I think that the military turns a blind eye to this, judging by my soldier patients in the past.
My thought is that this also relates to Police constables, who get lots of back problems from the utility belt, holsters, and wearing such stuff in highway patrol and cars in general. Most of them complain about this to me. I believe there is a lightweight belt it is not stadard issue.
joe
Begin forwarded message:
Hi Joe,
I wonder how many kids carry 60%+ of their body weight in school back packs?
D
The effect of military load carriage on ground reaction forces
Stewart A. BirrellCorresponding Author Contact Information, a, E-mail The Corresponding Author, Robin H. Hoopera and Roger A. Haslama
aDepartment of Human Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
Received 13 March 2006; revised 28 November 2006; accepted 9 December 2006. Available online 6 March 2007.
Abstract
Load carriage is an inevitable part of military life both during training and operations. Loads carried are frequently as high as 60% bodyweight, and this increases injury risk. In the military, load is carried in a backpack (also referred to as a Bergen) and webbing, these combined form a load carriage system (LCS). A substantial body of literature exists recording the physiological effects of load carriage; less is available regarding the biomechanics. Previous biomechanical studies have generally been restricted to loads of 20% and 40% of bodyweight, usually carried in the backpack alone. The effect of rifle carriage on gait has also received little or no attention in the published literature. This is despite military personnel almost always carrying a rifle during load carriage. In this study, 15 male participants completed 8 conditions: military boot, rifle, webbing 8 and 16 kg, backpack 16 kg and LCS 24, 32 and 40 kg. Results showed that load added in 8 kg increments elicited a proportional increase in vertical and anteroposterior ground reaction force (GRF) parameters. Rifle carriage significantly increased the impact peak and mediolateral impulse compared to the boot condition. These effects may be the result of changes to the vertical and horizontal position of the body's centre of mass, caused by the restriction of natural arm swing patterns. Increased GRFs, particularly in the vertical axis, have been positively linked to overuse injuries. Therefore, the biomechanical analysis of load carriage is important in aiding our understanding of injuries associated with military load carriage.
Keywords: Load carriage; Ground reaction force; Military; Gait; Rifle carriage
Corresponding Author Contact InformationCorresponding author. Tel.: +44 1509 228484; fax: +44 1509 223940.
Gait & Posture
Volume 26, Issue 4, October 2007, Pages 611-614
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you'll love this one, boys and girls!
Al Sears, MD
12794 Forest Hill Blvd., Suite 16
Wellington, FL 33414
September 24, 2007
Dear Joe,
If you’ve ever felt guilty about reaching for a cold one, I have great news…
That cool, refreshing beer just might save you from heart disease.
Don’t let the puritans make you afraid of casual beer drinking. Consuming a reasonable amount of alcohol is nothing to feel guilty about. In fact, it can be good for your health.
Beer also contains antioxidants like vitamin C, as well as hundreds of flavonoids such as Epicatechin.
Flavonoids are anti-oxidant compounds that provide the dark color in many fruits and vegetables. They stem from the seeds, skin and certain other parts of fermenting plants, and they help prevent hardening of the arteries. Flavonoids also improve blood flow and blood pressure. Dark beer has more of these nutrients than a lighter beer.
People who don’t indulge may be denting their bodies of essential nutrients, minerals and vitamins, such as magnesium, calcium and iron. Beer has always added protein, fiber, calcium, iron and potassium to diets around the world.
Almost everybody has heard of the benefits of drinking red wine. But in a recent study I came across beer drinkers had the lowest risk of heart disease. 2
Like wine, beer has been shown to:
∙ reduce strokes ∙ reduce heart disease
∙ reduce blood pressure ∙ increase coronary blood flow
∙ fight Alzheimer’s ∙ fight diabetes
∙ fight ulcers ∙ fight hepatitis A
∙ fight pancreatic cancer ∙ fight Parkinson’s disease
∙ raise good cholesterol ∙ lower bad cholesterol
Many of us associate drinking beer at social events, like a football game, with friends and family. These events cut back stress and in combination with conservative drinking, the risk of coronary disease is lowered by 32%.
Drinking a beer a day decreases cholesterol levels, increases antioxidants and reduces levels of fibrinogen, a clot-producing protein.
Keep in mind that the carbs in beer can add inches to your waistline. But there are new brews that are lower in carbs. They have the fuller flavor of “real” beer and put their low-calorie cousins to shame.
Since Busch released the first low-carb beer on the market, Michelob Ultra has experienced the best sales of any beer they’ve ever introduced. The good news here is that brewers are looking for their slice of the new market. And each new brew seems to outperform the last, in terms of flavor and fullness. The reigning three kings of low-carb brews are:
∙ Michelob Ultra by Anheuser Busch with 2.6 g of carbs.
∙ Aspen Edge by Coors with 2.6 g of carbs.
∙ Rock Green Light by Rolling Rock with 2.6g of carbs.
Compared to the average count of 11 grams of carbs for domestic beer – and as much as 20-30 g. for European imports, you can dramatically cut your carbs by making the switch to a low-carb variety. These low-carb beers compare well to mixed drinks.
Myself, I enjoy a nice Michelob Ultra with friends and family.
To Your Good Health,
Al Sears, MD
References:
1 Beer’s Essential Ingredients, Helium, August, 2001, www.sindicerv.com.br/site_ingl/cerveja/txt_cerveja_saude.htm.
2 Alcohol and Brain Function, All About Beer Magazine, July, 2002, www.allaboutbeer.com/features/233beer&health.html.
-=-=-=-=-
BMJ 2007;335:585 (22 September), doi:10.1136/bmj.39339.624711.DB
News
Number of serious adverse events doubles in seven years in US
David Spurgeon
Quebec
The number of reported serious adverse events from drug treatment more than doubled in the United States from 1998 to 2005, rising from 34 966 to 89 842, says a new study.
Over the same period the number of deaths relating to drugs nearly tripled, from 5519 to 15 107, show data from the US Food and Drug Administration's adverse event reporting system, which collects all reports of adverse events submitted voluntarily to the agency either directly or through drug manufacturers (Archives of Internal Medicine 2007;167:1752-9).
Using extracts from the system that were published for use by researchers, the study's authors—Thomas Moore and Michael Cohen, of the Institute for Safe Medication Practices at Wake Forest University, Winston-Salem, North Carolina, and Curt Furberg, of the university's public health sciences division—analysed all adverse drug events and treatment errors reported to the agency from 1998, when the FDA started operating the system, to 2005.
Over the period the number of reported serious events grew four times faster than the total number of prescriptions to outpatients, which increased from 2.7 billion to 3.8 billion. In the subset of drugs associated with 500 or more reports in any year, those drugs that were withdrawn for safety reasons accounted for 26% of the reported events in 1999, this percentage falling to less than 1% in 2005. For 13 new biotechnology products, the number of reported serious events grew by nearly 16-fold, from 580 reported events in 1998 to 9181 in 2005.
A relatively small number of drugs were responsible for the overall increase in the number of adverse events reported: 298 of the 1489 drugs identified (20%) from the data accounted for 407 394 of the 467 809 events (87%).
Better systems for managing the risks from prescription drugs are needed, the authors say. But they also say that the increase may be partly due to a population increase as well as to greater reliance on intensive drug treatment. Drugs to relieve pain and those that alter the immune system were the drugs that were likeliest to result in death.
In Canada in 2006 the federal health department received reports of 10 518 cases of suspected adverse reactions to drug treatments, up by 108 from the figure for 2005. However, the country's adverse drug reactions database has been criticised for being plagued by under-reporting and for not being used optimally (bmj.com, 22 May 2004, doi: 10.1136/bmj.328.7450.1222-f).
Meanwhile, a new Canadian study has said that mixing herbal medicines with prescription drugs could pose undiscovered health risks because many negative reactions are not being reported or tracked (www.cbc.ca/health/story/2007/07/23/drug-study.html).
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from a colleague in USA
seems sound.....
How About Some Artificial Sweeteners?
"Saccharin (through taste) appears to elicit parasympathetic (insulin release) and sympathetic (hepatic glucose production increase) reflexes in lean and obese rats.
Taste-induced changes in plasma insulin and glucose turnover in lean and genetically obese rats. Diabetes. 1988 Jun;37(6):773-9.
Comment:
Insulin release starts with taste and when no glucose reaches the gut and bloodstream, a drop in blood sugar surely ensues from the already released insulin, triggering hunger to offset the resulting deficit. Drink More Diet Soda, Gain More Weight
For diet soft-drink drinkers, the risk of becoming overweight or obese was:
–
36.5% for up to 1/2 can each day
–
37.5% for 1/2 to one can each day
–
54.5% for 1 to 2 cans each day
–
57.1% for more than 2 cans each day.
For regular soft-drink drinkers, the risk of becoming overweight or obese was:
–
26% for up to 1/2 can each day
–
30.4% for 1/2 to one can each day
–
32.8% for 1 to 2 cans each day
–
47.2% for more than 2 cans each day.
Fowler, S.P. 65th Annual Scientific Sessions, American Diabetes Association, San Diego, June 10-14, 2005
Comment: If you want to lose weight, you're better off with sugar than artificial sweeteners!
The Stevia Question
The combination of stevioside and soy supplementation appears to possess the potential as effective treatment of a number of the characteristic features of the metabolic syndrome, that is, hyperglycemia, hypertension, and dyslipidemia.
Stevioside exerts beneficial effects in type 2 diabetic Zucker diabetic fatty rats. We did not detect any effect on insulin or glucagon responses.
Metabolism. 2005 Sep;54(9):1181-8.
Comment: It appears that stevia is a viable alternative to artificial sweeteners and sugar without negative side effects. More information is needed, but stevia is a natural substance rather than artificial. "
-=-=-=-
Do it yourself chiro
I guess this could read...
... "Idiot performs appendectomy and patient gets septicemia?"
However, if you take note of how many people get a loved one to "crack" them, then this is worth running by those patients who think they can save a few bucks by not seeing a chiro!
CASE REPORT
Trauma-Induced Pneumothorax After "Bear-Hug Back Crack" Home Remedy: Attempted Spinal Manipulation by a Layperson
David A. Masneri, DO; Jeremy S. Helphenstine, DO; Shannon M. Masneri, DO; Michael A. Miller, MD; Marc E. Levsky, MD
From the Department of Emergency Medicine (Drs D.A. Masneri, Helphenstine, Miller, and Levsky) and the Department of Family Medicine (Dr S.M. Masneri) at Carl R. Darnall Army Medical Center in Fort Hood, Tex.
Address correspondence to David A. Masneri, DO, Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544-5095. E-mail: david.masneri@amedd.army.mil
Spinal manipulation, as practiced by US-trained osteopathic physicians, is a safe and effective method of resolving patient pain and encouraging desirable physiologic improvement— often without pharmacologic intervention. Though novices, laypeople, and other clinicians also use manual techniques with similar goals in mind, their results are varied and sometimes dangerous to those they would help. The authors describe a case in which a layperson attempted spinal manipulation on a 20-year-old woman who later required a chest tube thoracostomy and hospitalization as a result of a pneumothorax. Osteopathic physicians are encouraged to consider patient risk factors for pneumothorax as a contraindication for the use of thoracic thrust techniques.
-=-=-
A nice tidbit....
I have prescribed 2 sets of heel lifts successfully in 10 yrs.
In the same time I have removed about one per year to great relief to the patient, and used something called "adjustments to the spine" ;-)
One time it was a domino put there by an unnamed D.O., YES, a domino. In this case, the DO did good!
check this, then...
CASE REPORT
Chronic Psoas Syndrome Caused by the Inappropriate Use of a Heel Lift
Christopher M. Rancont, DO
Address correspondence to Christopher M. Rancont, DO, Pontiac Osteopathic Hospital, 50 N Perry St, Pontiac, MI 48342-2217. E-mail: crancont@yahoo.com
Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies.
However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty.
Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome.
Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain.
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should you see your GP every year?
...Not in America! Wonder if it applies here?
BMJ 2007;335:631 (29 September), doi:10.1136/bmj.39349.383194.DB
News
Annual check-ups aren't needed, US study says
Janice Hopkins Tanne
New York
Annual physical examinations, a staple of medical care in the United States for decades, cost too much and are not necessary for conveying messages on preventing illness, says a new study.
Patients get most messages on prevention through other visits, explains the study, published in the Archives of Internal Medicine (2007;167:1876-83). But annual gynaecological exams may be helpful for women, it says.
Ateev Mehrotra and colleagues from the University of Pittsburgh Medical Center examined data from 2002, 2003, and 2004 from the US national ambulatory medical care survey and the national hospital ambulatory medical care survey, which record visits made by patients with health insurance to office based physicians and to hospital outpatient departments for annual check-ups and gynaecological examinations.
Dr Mehrotra, the lead author and an assistant professor at the University of Pittsburgh Centre for Research on Health Care, said that no major North American clinical organisation recommends check-ups and no medical organisation specifies what should be included in one. "Physicians need to reach a consensus on whether patients should have annual physicals and what the exam should consist of," he said.
During 2002-4 about 44 million US adults had an annual preventive physical check-up and about 19 million women had a preventive gynaecological examination each year. The authors say that that's about 21% of US men and 18% of women, for a cost estimated at $5.2bn (£2.6bn; {euro}3.7bn) for general check-ups and $2.6bn for gynaecological examinations. The total amount nearly equals all spending on care of breast cancer patients in 2004, they report.
Check-up visits accounted for one in 12 adult care visits. Almost every check-up included a blood pressure measurement. People in the north east of the US were 60% more likely than those in the west to have a physical check-up.
Most preventive examinations were done by general and family practitioners, general internists, and gynaecologists. Preventive physical check-ups lasted an average of 23 minutes, preventive gynaecological visits averaged 20.5 minutes, and visits for other reason averaged 18 minutes. The average cost was $116 for a physical check-up and $136 for a gynaecological examination, including tests.
Many tests are unnecessary and in total cost more than $350m a year, the authors say. A complete blood count, serum electrolytes test, urinalysis, and an electrocardiogram are often ordered as part of an annual check-up but are not necessary unless there is a reason to request them, Dr Mehrotra said. However, during gynaecological examinations women were likely to receive or be sent for evidence based tests such as mammography or cervical smear tests.
The study looked at whether patients had received preventive or counselling messages about mammography, prostate specific antigen testing, cervical smear testing, cholesterol testing, stopping smoking, weight loss, and exercise and nutrition. Although advice on prevention is sometimes given as a reason for annual check-ups, the researchers found that almost 80% of preventive messages were given when a patient visited for another problem during the same year.
Making annual examinations available to all US residents is unrealistic, the authors say. Instead US doctors should offer advice on prevention when they see patients for other reasons.
-=-=-=-
are you safe?
Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey.
Thiel HW, Bolton JE, Docherty S, Portlock JC.
From the *Department of Research and Professional Development, Anglo-European College of Chiropractic, Bournemouth, United Kingdom; and †Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
STUDY DESIGN.: Prospective national survey.
OBJECTIVE.: To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.
SUMMARY OF BACKGROUND DATA.: The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations.
METHODS.: We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.
RESULTS.: Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.
CONCLUSION.: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.
who wants to adjust Ernst?
I can offer up a permanent adjustment...
I like the BCA president's quote:
He accuses Ernst of 'puffing up his evidence out of all proportion'.
Meantime, see my next message on adverse events. Medics are killing them ever so much better now...sad to say.
http://observer.guardian.co.uk/uk_news/story/0,,2175332,00.html
-=-=-=-
Alternative therapy for backache 'can kill or disable'
Robin McKie, science editor
Sunday September 23, 2007
The Observer
One of the most common 'alternative' treatments for backache is dangerous and can kill, says Britain's leading expert on complementary medicine, Professor Edzard Ernst.
Spinal manipulation, used by chiropractors to treat hundreds of thousands of patients a year, poses serious risks, he warns in a paper published in the Journal of the Royal Society of Medicine
'[It] is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death.'
Spinal manipulation involves sharp thrusts against a patient's spine to push individual vertebrae beyond normal levels of stress. But Ernst says that such violent therapy can seriously damage the arteries running near the spine, triggering thrombosis or a stroke.
The claim has incensed chiropractors. In letters to be published in the journal's October issue, they accuse Ernst of distortion, errors and misinterpreting data.
'The major body of published evidence points to manipulation being a safe and effective tool,' says Barry Lewis, president of the British Chiropractic Association. He accuses Ernst of 'puffing up his evidence out of all proportion'.
One case involves Frances Denoon, who was in her 20s when she pulled a nerve in her neck while exercising. She visited a registered chiropractor and recalled feeling a 'crack' when he began his treatment. 'I couldn't focus and realised I wasn't saying words clearly,' she says on the Action for Victims of Chiropractic's website. Denoon suffered a brain-stem stroke and now has poor balance and cannot write with her right hand. A court cleared her chiropractor of negligence.
Such stories are just the tip of an iceberg, says Ernst, director of complementary medicine at the Peninsula Medical School, run by Exeter and Plymouth universities. He has collected details of about 700 cases.
'I am not calling for a ban on chiropractors carrying out spinal manipulation but I think we have to think about regulating the practice far more carefully than we do at present,' he said.
A spokeswoman for the General Chiropractic Council (GCC) said 2,300 chiropractors were registered with it and that since 2001 only one had been disciplined for breaching guidelines.
Peter Dixon, the council's chairman, said the report was 'yet another research scare' story.
'This does not serve the interests of the public or those of researchers who are dedicated to improving the public's health,' he said.
-=-=-
Sep 17, 10:56 PM EDT
MDs Don't Issue Pregnancy, Drugs Warning
By JOANN LOVIGLIO
Associated Press Writer
Doctors aren't doing a good job of warning young women to avoid
getting pregnant when they're taking prescription drugs that can cause
birth defects, according to a study published in the Annals of Internal
Medicine.
The study of nearly 500,000 women found that nearly half of the women
taking the medicines didn't get counseling from their doctor about using
contraceptives or other birth control measures, while researchers noted
that the study might overestimate the problem because the data is from
health plan billing codes, which don't have the same detailed medical
histories as patient medical charts, reported the Associated Press. Even
with the study's limitations, it is clear that many women aren't getting
the message about avoiding pregnancy while taking certain drugs that may
cause birth defects, including some antibiotics, acne medications,
cholesterol reducers, anti-seizure drugs, sleep aids and blood thinners,
the Associated Press added.
Associated Press, September 17, 2007
Read on...
-=-=-=
'Proof still needed' for flu jab
There is not enough evidence to support the effectiveness of immunising older people against flu, fresh research in the US has concluded.
Researchers from George Washington University, Washington DC, say the benefits in reducing deaths among over 70s have been "greatly exaggerated".
The findings echo a controversial 2006 British Medical Journal study.
But the latest study, in The Lancet Infectious Diseases, nonetheless urges vaccination to continue for the moment.
Most rich countries recommend vaccinating the old and the weak against flu annually in time for the winter.
As well as preventing flu, it is also thought to prevent deaths from other underlying chronic conditions.
In many studies, flu-related deaths are considered to be all those above the expected winter baseline. This is known as winter excess mortality.
Researchers from George Washington University, led by Dr Lone Simonson, say that in the US - despite an increase in vaccination coverage from 15% to 65% since 1980 - excess mortality among elderly people actually increased during the 1980s and 1990s.
The effectiveness of this strategy is under debate
Dr Lone Simonson
They also cited an Italian study, which found no decline in flu-related mortality rates, even as vaccine coverage rose from 5% to 65%.
The study also deplored what it saw as a lack of placebo-controlled randomised clinical trials (RCTs) among those over the age of 70.
They accepted that such trials were, however, unlikely as they would involve denying some participants access to a treatment which it is recommended they receive, and as such would not pass ethical review.
As an alternative, the team recommended that future studies should use "more specific endpoints" than just overall winter deaths.
This should include "vaccine effectiveness against the highly-specific outcome of laboratory-confirmed influenza virus, which although labour intensive and expensive, is more likely to obtain more realistic estimates of vaccine efficacy".
But despite its reservations about the quality of the available evidence, the team nonetheless recommended that people over the age of 70 should continue to be vaccinated until better data could be collected.
Trials call
Dr Tom Jefferson, of the Cochrane Library - a body that determines the relative effectiveness of health interventions - welcomed the study, which repeated many of his own assertions made in a paper published a year ago.
Writing in an editorial, he said it was time to carry out a placebo-based trial in which some participants are denied the jab.
"Head-to-head comparisons with other types of influenza vaccine will not allow direct assessment of absolute vaccine effectiveness," he wrote.
"Could governments be courageous and honest enough to reassess their cherished policies?"
It costs about £115m to vaccine the vulnerable against flu in the UK each year.
This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue
Department of Health
"The aim of our influenza policy is to protect those who are most at risk of serious illness or death should they develop influenza," a spokesperson for the Department of Health said.
"UK policy is constantly under review to take into consideration all available evidence. This study acknowledges that, whilst waiting for an improved evidence base, vaccination with flu vaccine in this group should continue."
The Royal College of GPs said it endorsed current policy and suggested that the study was lacking.
"There is a widely-held view that many respiratory virus infections cause mild, self-limiting disease and this is true," it said in a statement.
"But it is equally true that the relatively infrequent serious outcomes from this apparently minor illness add up to a major public health problem.
"Routine annual influenza vaccination of the elderly and persons with co-morbidity remains a vital element in this attack."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7010717.stm
Published: 2007/09/25 00:34:18 GMT
© BBC MMVII
-=-=-=-
RE: load carried in military packs
An interesting suggestion, Donald.
I think that the military turns a blind eye to this, judging by my soldier patients in the past.
My thought is that this also relates to Police constables, who get lots of back problems from the utility belt, holsters, and wearing such stuff in highway patrol and cars in general. Most of them complain about this to me. I believe there is a lightweight belt it is not stadard issue.
joe
Begin forwarded message:
Hi Joe,
I wonder how many kids carry 60%+ of their body weight in school back packs?
D
The effect of military load carriage on ground reaction forces
Stewart A. BirrellCorresponding Author Contact Information, a, E-mail The Corresponding Author, Robin H. Hoopera and Roger A. Haslama
aDepartment of Human Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
Received 13 March 2006; revised 28 November 2006; accepted 9 December 2006. Available online 6 March 2007.
Abstract
Load carriage is an inevitable part of military life both during training and operations. Loads carried are frequently as high as 60% bodyweight, and this increases injury risk. In the military, load is carried in a backpack (also referred to as a Bergen) and webbing, these combined form a load carriage system (LCS). A substantial body of literature exists recording the physiological effects of load carriage; less is available regarding the biomechanics. Previous biomechanical studies have generally been restricted to loads of 20% and 40% of bodyweight, usually carried in the backpack alone. The effect of rifle carriage on gait has also received little or no attention in the published literature. This is despite military personnel almost always carrying a rifle during load carriage. In this study, 15 male participants completed 8 conditions: military boot, rifle, webbing 8 and 16 kg, backpack 16 kg and LCS 24, 32 and 40 kg. Results showed that load added in 8 kg increments elicited a proportional increase in vertical and anteroposterior ground reaction force (GRF) parameters. Rifle carriage significantly increased the impact peak and mediolateral impulse compared to the boot condition. These effects may be the result of changes to the vertical and horizontal position of the body's centre of mass, caused by the restriction of natural arm swing patterns. Increased GRFs, particularly in the vertical axis, have been positively linked to overuse injuries. Therefore, the biomechanical analysis of load carriage is important in aiding our understanding of injuries associated with military load carriage.
Keywords: Load carriage; Ground reaction force; Military; Gait; Rifle carriage
Corresponding Author Contact InformationCorresponding author. Tel.: +44 1509 228484; fax: +44 1509 223940.
Gait & Posture
Volume 26, Issue 4, October 2007, Pages 611-614
-=-=-=
you'll love this one, boys and girls!
Al Sears, MD
12794 Forest Hill Blvd., Suite 16
Wellington, FL 33414
September 24, 2007
Dear Joe,
If you’ve ever felt guilty about reaching for a cold one, I have great news…
That cool, refreshing beer just might save you from heart disease.
Don’t let the puritans make you afraid of casual beer drinking. Consuming a reasonable amount of alcohol is nothing to feel guilty about. In fact, it can be good for your health.
Beer also contains antioxidants like vitamin C, as well as hundreds of flavonoids such as Epicatechin.
Flavonoids are anti-oxidant compounds that provide the dark color in many fruits and vegetables. They stem from the seeds, skin and certain other parts of fermenting plants, and they help prevent hardening of the arteries. Flavonoids also improve blood flow and blood pressure. Dark beer has more of these nutrients than a lighter beer.
People who don’t indulge may be denting their bodies of essential nutrients, minerals and vitamins, such as magnesium, calcium and iron. Beer has always added protein, fiber, calcium, iron and potassium to diets around the world.
Almost everybody has heard of the benefits of drinking red wine. But in a recent study I came across beer drinkers had the lowest risk of heart disease. 2
Like wine, beer has been shown to:
∙ reduce strokes ∙ reduce heart disease
∙ reduce blood pressure ∙ increase coronary blood flow
∙ fight Alzheimer’s ∙ fight diabetes
∙ fight ulcers ∙ fight hepatitis A
∙ fight pancreatic cancer ∙ fight Parkinson’s disease
∙ raise good cholesterol ∙ lower bad cholesterol
Many of us associate drinking beer at social events, like a football game, with friends and family. These events cut back stress and in combination with conservative drinking, the risk of coronary disease is lowered by 32%.
Drinking a beer a day decreases cholesterol levels, increases antioxidants and reduces levels of fibrinogen, a clot-producing protein.
Keep in mind that the carbs in beer can add inches to your waistline. But there are new brews that are lower in carbs. They have the fuller flavor of “real” beer and put their low-calorie cousins to shame.
Since Busch released the first low-carb beer on the market, Michelob Ultra has experienced the best sales of any beer they’ve ever introduced. The good news here is that brewers are looking for their slice of the new market. And each new brew seems to outperform the last, in terms of flavor and fullness. The reigning three kings of low-carb brews are:
∙ Michelob Ultra by Anheuser Busch with 2.6 g of carbs.
∙ Aspen Edge by Coors with 2.6 g of carbs.
∙ Rock Green Light by Rolling Rock with 2.6g of carbs.
Compared to the average count of 11 grams of carbs for domestic beer – and as much as 20-30 g. for European imports, you can dramatically cut your carbs by making the switch to a low-carb variety. These low-carb beers compare well to mixed drinks.
Myself, I enjoy a nice Michelob Ultra with friends and family.
To Your Good Health,
Al Sears, MD
References:
1 Beer’s Essential Ingredients, Helium, August, 2001, www.sindicerv.com.br/site_ingl/cerveja/txt_cerveja_saude.htm.
2 Alcohol and Brain Function, All About Beer Magazine, July, 2002, www.allaboutbeer.com/features/233beer&health.html.
-=-=-=-=-
BMJ 2007;335:585 (22 September), doi:10.1136/bmj.39339.624711.DB
News
Number of serious adverse events doubles in seven years in US
David Spurgeon
Quebec
The number of reported serious adverse events from drug treatment more than doubled in the United States from 1998 to 2005, rising from 34 966 to 89 842, says a new study.
Over the same period the number of deaths relating to drugs nearly tripled, from 5519 to 15 107, show data from the US Food and Drug Administration's adverse event reporting system, which collects all reports of adverse events submitted voluntarily to the agency either directly or through drug manufacturers (Archives of Internal Medicine 2007;167:1752-9).
Using extracts from the system that were published for use by researchers, the study's authors—Thomas Moore and Michael Cohen, of the Institute for Safe Medication Practices at Wake Forest University, Winston-Salem, North Carolina, and Curt Furberg, of the university's public health sciences division—analysed all adverse drug events and treatment errors reported to the agency from 1998, when the FDA started operating the system, to 2005.
Over the period the number of reported serious events grew four times faster than the total number of prescriptions to outpatients, which increased from 2.7 billion to 3.8 billion. In the subset of drugs associated with 500 or more reports in any year, those drugs that were withdrawn for safety reasons accounted for 26% of the reported events in 1999, this percentage falling to less than 1% in 2005. For 13 new biotechnology products, the number of reported serious events grew by nearly 16-fold, from 580 reported events in 1998 to 9181 in 2005.
A relatively small number of drugs were responsible for the overall increase in the number of adverse events reported: 298 of the 1489 drugs identified (20%) from the data accounted for 407 394 of the 467 809 events (87%).
Better systems for managing the risks from prescription drugs are needed, the authors say. But they also say that the increase may be partly due to a population increase as well as to greater reliance on intensive drug treatment. Drugs to relieve pain and those that alter the immune system were the drugs that were likeliest to result in death.
In Canada in 2006 the federal health department received reports of 10 518 cases of suspected adverse reactions to drug treatments, up by 108 from the figure for 2005. However, the country's adverse drug reactions database has been criticised for being plagued by under-reporting and for not being used optimally (bmj.com, 22 May 2004, doi: 10.1136/bmj.328.7450.1222-f).
Meanwhile, a new Canadian study has said that mixing herbal medicines with prescription drugs could pose undiscovered health risks because many negative reactions are not being reported or tracked (www.cbc.ca/health/story/2007/07/23/drug-study.html).
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from a colleague in USA
seems sound.....
How About Some Artificial Sweeteners?
"Saccharin (through taste) appears to elicit parasympathetic (insulin release) and sympathetic (hepatic glucose production increase) reflexes in lean and obese rats.
Taste-induced changes in plasma insulin and glucose turnover in lean and genetically obese rats. Diabetes. 1988 Jun;37(6):773-9.
Comment:
Insulin release starts with taste and when no glucose reaches the gut and bloodstream, a drop in blood sugar surely ensues from the already released insulin, triggering hunger to offset the resulting deficit. Drink More Diet Soda, Gain More Weight
For diet soft-drink drinkers, the risk of becoming overweight or obese was:
–
36.5% for up to 1/2 can each day
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37.5% for 1/2 to one can each day
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54.5% for 1 to 2 cans each day
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57.1% for more than 2 cans each day.
For regular soft-drink drinkers, the risk of becoming overweight or obese was:
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26% for up to 1/2 can each day
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30.4% for 1/2 to one can each day
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32.8% for 1 to 2 cans each day
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47.2% for more than 2 cans each day.
Fowler, S.P. 65th Annual Scientific Sessions, American Diabetes Association, San Diego, June 10-14, 2005
Comment: If you want to lose weight, you're better off with sugar than artificial sweeteners!
The Stevia Question
The combination of stevioside and soy supplementation appears to possess the potential as effective treatment of a number of the characteristic features of the metabolic syndrome, that is, hyperglycemia, hypertension, and dyslipidemia.
Stevioside exerts beneficial effects in type 2 diabetic Zucker diabetic fatty rats. We did not detect any effect on insulin or glucagon responses.
Metabolism. 2005 Sep;54(9):1181-8.
Comment: It appears that stevia is a viable alternative to artificial sweeteners and sugar without negative side effects. More information is needed, but stevia is a natural substance rather than artificial. "
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Do it yourself chiro
I guess this could read...
... "Idiot performs appendectomy and patient gets septicemia?"
However, if you take note of how many people get a loved one to "crack" them, then this is worth running by those patients who think they can save a few bucks by not seeing a chiro!
CASE REPORT
Trauma-Induced Pneumothorax After "Bear-Hug Back Crack" Home Remedy: Attempted Spinal Manipulation by a Layperson
David A. Masneri, DO; Jeremy S. Helphenstine, DO; Shannon M. Masneri, DO; Michael A. Miller, MD; Marc E. Levsky, MD
From the Department of Emergency Medicine (Drs D.A. Masneri, Helphenstine, Miller, and Levsky) and the Department of Family Medicine (Dr S.M. Masneri) at Carl R. Darnall Army Medical Center in Fort Hood, Tex.
Address correspondence to David A. Masneri, DO, Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544-5095. E-mail: david.masneri@amedd.army.mil
Spinal manipulation, as practiced by US-trained osteopathic physicians, is a safe and effective method of resolving patient pain and encouraging desirable physiologic improvement— often without pharmacologic intervention. Though novices, laypeople, and other clinicians also use manual techniques with similar goals in mind, their results are varied and sometimes dangerous to those they would help. The authors describe a case in which a layperson attempted spinal manipulation on a 20-year-old woman who later required a chest tube thoracostomy and hospitalization as a result of a pneumothorax. Osteopathic physicians are encouraged to consider patient risk factors for pneumothorax as a contraindication for the use of thoracic thrust techniques.
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A nice tidbit....
I have prescribed 2 sets of heel lifts successfully in 10 yrs.
In the same time I have removed about one per year to great relief to the patient, and used something called "adjustments to the spine" ;-)
One time it was a domino put there by an unnamed D.O., YES, a domino. In this case, the DO did good!
check this, then...
CASE REPORT
Chronic Psoas Syndrome Caused by the Inappropriate Use of a Heel Lift
Christopher M. Rancont, DO
Address correspondence to Christopher M. Rancont, DO, Pontiac Osteopathic Hospital, 50 N Perry St, Pontiac, MI 48342-2217. E-mail: crancont@yahoo.com
Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies.
However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty.
Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome.
Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain.
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should you see your GP every year?
...Not in America! Wonder if it applies here?
BMJ 2007;335:631 (29 September), doi:10.1136/bmj.39349.383194.DB
News
Annual check-ups aren't needed, US study says
Janice Hopkins Tanne
New York
Annual physical examinations, a staple of medical care in the United States for decades, cost too much and are not necessary for conveying messages on preventing illness, says a new study.
Patients get most messages on prevention through other visits, explains the study, published in the Archives of Internal Medicine (2007;167:1876-83). But annual gynaecological exams may be helpful for women, it says.
Ateev Mehrotra and colleagues from the University of Pittsburgh Medical Center examined data from 2002, 2003, and 2004 from the US national ambulatory medical care survey and the national hospital ambulatory medical care survey, which record visits made by patients with health insurance to office based physicians and to hospital outpatient departments for annual check-ups and gynaecological examinations.
Dr Mehrotra, the lead author and an assistant professor at the University of Pittsburgh Centre for Research on Health Care, said that no major North American clinical organisation recommends check-ups and no medical organisation specifies what should be included in one. "Physicians need to reach a consensus on whether patients should have annual physicals and what the exam should consist of," he said.
During 2002-4 about 44 million US adults had an annual preventive physical check-up and about 19 million women had a preventive gynaecological examination each year. The authors say that that's about 21% of US men and 18% of women, for a cost estimated at $5.2bn (£2.6bn; {euro}3.7bn) for general check-ups and $2.6bn for gynaecological examinations. The total amount nearly equals all spending on care of breast cancer patients in 2004, they report.
Check-up visits accounted for one in 12 adult care visits. Almost every check-up included a blood pressure measurement. People in the north east of the US were 60% more likely than those in the west to have a physical check-up.
Most preventive examinations were done by general and family practitioners, general internists, and gynaecologists. Preventive physical check-ups lasted an average of 23 minutes, preventive gynaecological visits averaged 20.5 minutes, and visits for other reason averaged 18 minutes. The average cost was $116 for a physical check-up and $136 for a gynaecological examination, including tests.
Many tests are unnecessary and in total cost more than $350m a year, the authors say. A complete blood count, serum electrolytes test, urinalysis, and an electrocardiogram are often ordered as part of an annual check-up but are not necessary unless there is a reason to request them, Dr Mehrotra said. However, during gynaecological examinations women were likely to receive or be sent for evidence based tests such as mammography or cervical smear tests.
The study looked at whether patients had received preventive or counselling messages about mammography, prostate specific antigen testing, cervical smear testing, cholesterol testing, stopping smoking, weight loss, and exercise and nutrition. Although advice on prevention is sometimes given as a reason for annual check-ups, the researchers found that almost 80% of preventive messages were given when a patient visited for another problem during the same year.
Making annual examinations available to all US residents is unrealistic, the authors say. Instead US doctors should offer advice on prevention when they see patients for other reasons.
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are you safe?
Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey.
Thiel HW, Bolton JE, Docherty S, Portlock JC.
From the *Department of Research and Professional Development, Anglo-European College of Chiropractic, Bournemouth, United Kingdom; and †Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
STUDY DESIGN.: Prospective national survey.
OBJECTIVE.: To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.
SUMMARY OF BACKGROUND DATA.: The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations.
METHODS.: We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.
RESULTS.: Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.
CONCLUSION.: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.