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October 2007

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World Spine Day - October 16, 2007

October 16th 2007 is "World Spine Day" as declared by the World Federation of Chiropractic (WFC), and observed by numerous chiropractic organizations around the world. According to the WFC "World Spine Day is specifically designed to create leverage for spinal health advocacy and increased public awareness regarding the burden of spinal disorders."

World Spine Day is part of a multi faceted health awareness movement as part of the "Bone and Joint Decade." It was on January 13, 2000, that the Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland.   According to the Bone and Joint Decade's website, "The goal of the Bone and Joint Decade is to improve the health- related quality of life for people with musculoskeletal disorders throughout the world. These disorders are the most notorious and common causes of severe long-term pain and physical disability, affecting hundreds of millions of people across the world. The Decade aims to raise awareness and promote positive actions to combat the suffering and costs to society associated with musculoskeletal disorders such as joint diseases, osteoporosis, spinal disorders, severe trauma to the extremities and crippling diseases and deformities in children."

One of the organizations also participating in this event is the Congress of Chiropractic State Associations.  In their September 24, 2007 release they urge all chiropractic associations  to support the initiative by promoting World Spine Day 2007 to the doctors in their respective organizations.

Part of the observance of World Spine Day is a program known as "Straighten Up America".  According to the Bone and Joint Decade release: "Straighten Up America was set up to celebrate World Spine Day in collaboration with the United States Bone and Joint Decade. Doctors of chiropractic will be teaching patients, school children, civic organizations, corporations and others simple enjoyable exercises to improve their spinal health."  There are similar "Straighten Up" programs in numerous countries throughout the world including South Africa and Australia.

According to their website, www.straightenupamerica.org, Straighten Up America is a bold and innovative health promotion initiative designed to empower the American people toward better spinal health and an improved quality of life."  This website has a lot of helpful and health information on spinal health.  A video on Straighten Up America and spinal health was produced by Life University and can be seen at: http://www.life.edu/chiropractic_and_wellness/SUA_video.asp .

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Millions at Risk in Clinical Drug Trials According to Report

On September 27, 2007 the New York Times published an article that questioned the risk to millions who participate in drug trials. The article was based on a report released by the US Department of Health and Human Services Office of Inspector General on September 28, 2007. 

The report noted that the federal health officials with the FDA (US Food and Drug Administration) did not know how many clinical trials were being conducted, and actually audited fewer than 1 percent of the testing sites.  The Office of Inspector General report also noted that in the few cases when inspectors did appear at the trial site they generally showed up long after the tests had been completed.

The report noted that there were approximately  350,000 testing sites ongoing and that the FDA only had 200 inspectors to review these sites.  As a result the report noted that only about 1% of all test sites were audited by the FDA.  It was also reported that when inspectors found serious problems in human trials, in 68% of those instances top drug officials in Washington downgraded those report findings.  The report also noted that in the remaining cases, the FDA almost never followed up with inspection findings to determine whether the corrective actions that the agency demanded had occurred.

Responding to the report Arthur L. Caplan, chairman of the department of medical ethics at the University of Pennsylvania commented  in the Times article, "In many ways, rats and mice get greater protection as research subjects in the United States than do humans".   Caplan also noted, "Animal research centers have to register with the federal government, keep track of subject numbers, have unannounced spot inspections and address problems speedily or risk closing, none of which is true in human research".

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How the Elderly Utilize Chiropractic in the US

From the Australian scientific journal, Chiropractic & Osteopathy, comes a report dated September 6, 2007 that chronicles how elderly adults in the United States utilize chiropractic care.  The study interviewed over four thousand seniors over 70 years of age, and then correlated those interviews to Medicare records.  The results of the study were then extrapolated to give a picture of the overall population.

The research, headed by Dr. Fredric D Wolinsky, and Dr. Gary E Rosenthal of the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center reported that on an annual basis about 4.6% of seniors 70 or older see a chiropractor.  These seniors are more likely to be in pain and have a means of self transportation to get to the chiropractor's office. 

The report also noted that predominantly, there were unexplainable racial discrepancies noting that, "African Americans and Hispanics are simply much less likely to visit chiropractors than Whites in the United States".  Researchers also reported that those who used chiropractic were much more likely to have arthritis and/or drink alcohol.

The report showed that over the 4 year study about 30% of those seniors who did have chiropractic visits continued to see a chiropractor over at least three of the four years studied. Researchers concluded that these seniors made chiropractic a regular part of their healthcare regime.  Conversely, about 48 percent of those who visited a chiropractor did not have any visits in more than one of the four years in the study.  They also found that,  "among those who had seen a chiropractor, the volume of chiropractic visits was lower for those who lived alone, had lower incomes, and poorer cognitive abilities, while it was greater for the overweight and those with lower body limitations."

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Inappropriate Antibiotic Prescribing in Canada

A research study published in the October 9, 2007 issue of the Canadian Medical Association Journal, reports on the inappropriate usage of antibiotics in Canada.  The study suggests that doctors who are overworked, have been trained outside Canada, or have been practicing a long time are most likely to over prescribe antibiotics.

The study by scientists at Montreal's McGill University and at Montreal General Hospital, reviewed 852 primary care physicians who became certified in Canada between 1990 and 1993. Researchers tracked these doctors for 6 to 9 years and looked at their prescribing habits for viral and bacterial infections.  Researchers also looked at records of 729 patients, who had a total of 3,526 visits during the study period.

One of results that the study showed that was doctors who were not University of Montreal graduates and were trained outside Canada were more likely to prescribe antibiotics for viral upper respiratory infections, a condition for which antibiotics are totally useless and could create problems.

The study authors noted in their report, "Both the use of antibiotics for the treatment of viral respiratory infections and the overuse of broad-spectrum antibiotics to treat bacterial infections promote antibiotic resistance, increase the likelihood of preventable drug-related adverse events and increase the use and cost of health-care services."

One of the interesting findings of the study was that the longer a doctor was in practice the more he or she would likely prescribe antibiotics inappropriately.  The study noted that for each year that a doctor was in practice, there would be an increase of several percentage points of inappropriate prescribing. Additionally, the busier the doctor was, the more likely they would also overuse antibiotics.

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Guidelines Should Encourage Patients to Utilize Chiropractic

The above is the essence of a release from the  American Chiropractic Association (ACA).  It was in response to a report titled, "Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society" released on October 2, 2007 by Roger Chou, MD and other researchers.

The report was published in the scientific journal, the Annals of Internal Medicine and offers several suggestions for patients with back pain.  One such suggestion is for patients who do not improve with self-care options.  In these cases the report recommends that doctors should consider the addition of nonpharmacologic therapy with proven benefits, one of which they suggest is spinal manipulation. 

Glenn Manceaux, DC, President of the ACA issued comments as a result of the report and stated, "As shown in the literature, chiropractic spinal manipulation is a very effective treatment for low-back pain and other musculoskeletal injuries."

Although several of the recommendations in the American College of Physicians report do suggest the use of medications, the ACA release points to several previous studies promoting a non drug approach.  They noted that in one study published in  2003 in the medical journal Spine, manual manipulation showed better short-term relief of chronic spinal pain than did a variety of medications.

Dr. Manceaux, ACA president recommended, "If your back pain is not resolving quickly, visit your doctor of chiropractic." He continued,  "Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment. The relief and return to function they experience after a month of treatment is often greater than after seeing a family physician."

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American Healthcare: An Oxymoron

The above headline is from an interesting article in a Canadian publication the "Financial Post" and was written by Diane Francis, a journalist who took an outside look at the US healthcare system and compared it to the Canadian system.  Ms. Francis's views add some interesting insights into the healthcare system in the US and the discussion, or lack thereof, related to this issue.

In the article, Ms. Francis starts off by comparing the two systems and concludes, "Canadians are lucky on this one. We may have line-ups and our newspapers may occasionally publish horror stories about someone left in a gurney for hours outside an emergency room. But the U.S. system is the worst-executed in the world and its private sector interests have convinced the government to insure the riskiest people Ė namely veterans, indigents and seniors Ė while leaving the gravy to private-sector insurers."

The article notes that the US government provides insurance for almost half of the Americans who are insured.  But that half are the highest risk portion of the population that will incur the most expenses. The article also suggests that there are two types of medical systems in the US.  One system is for the well-off with insurance where medical costs are passed off to those paying for the insurance. The article suggests that the second medical system "takes care of the old, disabled, impoverished or militarily wounded."

In her article Diane Francis also comments on the human side of the US healthcare and notes, "Itís hard to imagine the human suffering that has resulted from this situation. Canadians donít have the anxiety about healthcare that underlies American existence. People there donít leave jobs, donít start new ones or businesses because they fear losing insurance benefits."

The article lists a series of facts about the US health care system that helped Ms Francis come to her conclusions.  These facts are:

  • The United States is spending 15.3% of its Gross National Product (GNP) on medicine and that doesnít include the cost of litigation over medical bills.
  • There are 49 million people without any insurance. The same number are inadequately insured.
  • Despite that shortfall, the U.S. spends about $5,700 per capita compared with Canada's $2,900 and has worse results in areas such as lifespan or infant mortality.
  • Some estimate is that half of the personal bankruptcies in the U.S. are because of high medical bills due to a catastrophic illness.

In a previous article by Ms. Francis earlier in the year, she notes one of the glaring facts about the US healthcare system and states, "Health spending is rising faster than incomes in most developed countries, which raises questions about how these countries will pay for future health care needs. The issue may be particularly acute in the United States, which not only spends much more per capita on health care than any other country, but which also has had one of the fastest growth rates in health spending among developed countries."

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