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April 2005

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• US Medicare System Expands Chiropractic Coverage
• Drug Complaints Reach Record High
• Drinking Milk May Raise Parkinson's Risk in Men
• More Canadians Using Chiropractors
• Doctors Speed Death of ill Babies
• Kids Follow Parents in Using Chiropractic and Alternative Care

US Medicare System Expands Chiropractic Coverage

News of a pilot program to expand chiropractic coverage in Medicare was reported in the April 7, 2005 issue of the Senior Journal.  According to the report the Centers for Medicare and Medicaid have announced the start of a two-year demonstration to expand Medicare coverage of chiropractic services in five states.  The purpose of this pilot program is to determine the impact on satisfaction, use of services, and costs for Medicare beneficiaries.

The states involved in the pilot program involve areas in Maine, New Mexico, Illinois, Iowa, and Virginia.  In the areas of this pilot program, chiropractors are able to offer Medicare Part B patients an expanded array of services that they are allowed to provide by state law to their entire list of patients, but that were not previously paid for by Medicare. 

Normally, only chiropractic adjustments are a covered service under Medicare.  In the pilot program the services that will also be covered will include diagnostic and therapy services, including extraspinal manipulation or adjustment of a body part other than the spine, x-rays, EMG and nerve conduction studies, clinical lab tests, and certain additional procedures.

The program is designed to last for two years and evaluate the possibility of expanding chiropractic coverage in Medicare across the entire program.  Centers for Medicare Services Administrator Mark B. McClellan, M.D., Ph.D noted, "Medicare currently only pays for a limited number of services from doctors of chiropractic, even though chiropractic services may be less costly alternatives to other types of medical care."  He continued, "By expanding chiropractic coverage in this demonstration, we are reducing out-of-pocket costs for seniors who visit chiropractors, and we will learn whether paying chiropractors for delivering these additional services can help improve health outcomes and keep Medicare costs down.”

The above headline comes from the March 13, 2005 USA Today. The article starts by noting that in 2004 preliminary reports show that the Food and Drug Administration (FDA) has received roughly 422,500 adverse-event reports from pharmaceutical companies, health professionals and patients, up nearly 14% from the 370,887 reports filed in 2003.

The article noted that the FDA requires drug companies to report adverse drug reactions or events when they are made aware of them.  However, doctors, nurses and patients also file reports, but their reports are voluntary.  The result is that the number posted by the FDA only represents a portion of the actual drug adverse effects that occur in each year. 

Paul Seligman, director of the FDA's Office of Pharmacoepidemiology and Statistical Sciences suggests that the increase may not be due completely to an increase of adverse reactions, but also due to an increase in usage of drugs in general.  He suggested, "There are more drugs on the market and more use of pharmaceuticals in general. Clearly, when you have more products on the market, you're likely to have more side effects."

According to IMS Health, a pharmaceutical market research firm, prescription drug sales totaled $235 billion nationally in 2004, this historic high represented an 8.3% increase from 2003 and is more than triple the volume just a decade ago in1995.

Sidney Wolfe, director of Public Citizen's Health Research Group, a Washington-based consumer watchdog group partially agreed that the increase may be due in part to the increased usage of drugs but he suggested that awareness also played an important role to the increase in reports. He noted, "There's much more public awareness of the potential for drugs to cause adverse reactions," Wolfe said. "The whole concept of drug-induced disease is much better known than it was 10 or 15 years ago."

The above headline comes from the April 6, 2004 Reuters Health reporting on a study published in the medical journal Neurology.  A new study suggests that middle-aged men who drink a glass or two of milk each day may be increasing their risk of developing Parkinson's disease.  The study notes that the risk does not include women. 

This new study supports the results of an earlier report linking high consumption of dairy products with an elevated risk of Parkinson's disease among men.  In this recent study 7504 men between the age of 45 and 68 years, were enrolled in the Honolulu Heart Program and followed for 30 years for the development of Parkinson's disease.  Of all the participants a total of 128 developed Parkinson's disease during follow-up.

Dr. R. D. Abbott, from the University of Virginia Health System in Charlottesville, and colleagues noted that the risk of Parkinson's disease increased with increase in the amount of milk consumed each day.  The final statistical analysis showed that heavy milk drinkers were 2.3-times more likely to develop Parkinson's disease than non-milk drinkers.

In all, researchers found that the risk of Parkinson's disease was small. The researchers noted that over a period of a year, 6.9 cases of the disease would normally be expected among 10,000 people who did not drink milk each day.  That number rose to, 14.9 cases per 10,000 people who drank more than 16 ounces of milk per day.

The authors ruled out calcium as the contributing factor as they could find no relationship that calcium either from dairy or non-dairy sources, had any effect on the risk of Parkinson's disease.  They concluded that some other component in milk must be responsible for the increase in the cases of Parkinson's.

From the March 16, 2005 CBC Health & Science News, comes a report on a study that shows that more Canadians are using Chiropractic than ever before.  The study by the agency "Statistics Canada" (StatsCan) also showed an increase in the usage of other non-medical forms of healthcare the study called alternative.

StatsCan conducted  a health survey in 2003 and found that about 20 per cent of Canadians aged 12 and older – an estimated 5.4 million people – had used some type of what they called, alternative health care in the year 2002. This is in comparison to a similar study almost a decade ago that showed that only 15% of Canadians over age 17 had used some form of alternative care. 

Chiropractic was clearly the highest usage of the non-medical forms of care in the study.  The 2003 study showed that 11 per cent of those 12 years and older had gone to a Chiropractor in the previous year.  Of the other forms of non-medical care the study showed that eight per cent had consulted a massage therapist, two per cent an acupuncturist and two per cent a homeopath or a naturopath.

According to the study those most likely to consult a non-medical practitioner were people in middle age, women, people with higher incomes, those with higher education and people living in the western provinces.

This shocking headline comes from the April 8, 2005 United Press International, but was also reported by Reuters news service and Medical News Today.  The basis of this headline is a survey of doctors in Belgium recently published in the The Lancet medical journal, that showed that when faced with a critically ill baby,  three out of four doctors polled would be willing to take action that they knew could result in the child's death. The article goes further to reveal that some had already done so.

Professor Luc Deliens (Vrije Universiteit Brussels, Belgium) and colleagues looked at the death certificates for all neonates and infants in the whole of Flanders (a province in Belgium) who died between August 1999 and July 2000. Researchers looked at 292 children that were born alive and died in Flanders within the first year of life over the period of the study. They identified 175 doctors who were in charge of these cases and sent them anonymous questionnaires. Of all that were sent the questionnaire, 121 of the 175 doctors involved completed the questions. The study revealed that in 143 cases, or 57 percent, an end-of-life decision had been taken. These decisions involved either withholding treatment, giving drugs to alleviate pain in doses that could shorten the life of the child or administering a lethal dose of a treatment.

Professor Deliens concluded: “We found that about three in four physicians who are confronted with critically ill neonates and infants are willing to participate in certain forms of life termination in these children. The main reasons for shortening of the neonate's life were the absence of real survival chances, and, if the baby survived, an expected very poor quality of life.”  Professor Yvan Vandenplas, also of Vrije University Brussels commented by saying, "When there is no chance of a positive outcome then many pediatricians take an end-of-life decision." 

Although in Belgium the use of lethal drugs in minors is illegal, the study revealed that lethal doses or lethal drugs were administered in 17 cases representing about 9%. The study also showed that 95 (or 79%) of the 121 doctors thought that their professional duty sometimes included the prevention of unnecessary suffering by hastening death and 69 (58%) of 120 doctors said they would support legalization of termination in some cases.

The April 5, 2004 issue of the Atlanta Journal Constitution (AJC) reports on a study from Metropolitan State University in Minneapolis that shows that children and teens are more likely to use what the researchers called "complementary and alternative medicine" if their parents also use these procedures.  Although chiropractic was included in this study as one of the "complementary and alternative" procedures, many authors no longer list chiropractic as an alternative as it has been considered more main stream.

The AJC article notes that a previous study in 1997 found that 42 percent of American adults reported the use of these types of procedures, and the rates were increasing.  However, they noted that there's been little information on the popularity of these treatments among children and teens until this most recent study.

Researchers at Metropolitan State University looked at data from insurance claims from two large private health insurers in Washington state in the year 2002. The researchers found that of the187,000 insured children, nearly 157,000 were listed on insurance claims.  The researchers observed that a little over 6 percent of the children had visited a complementary or alternative professional during that year.

The study authors wrote, "Not surprisingly, the most significant factor that determined whether a pediatric patient would use complementary or alternative medicine is whether an adult in the family used it."  In fact the researchers noted that the largest reason by far that children used these services including chiropractic was if their parents were using these services.

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