Archive for Uncategorized
Allergies can be characterized by an imbalance in the way that our immune system reacts to things. We need balance in our immune system, but this balance is trained; it is not hard wired.
On one side, we have the cell-mediated immune cells, referred to as the Th1 cytokine profile. Too much of this arm of the immune system leads to autoimmune disorders where the body tries to attack itself. On the other side we have the Th2 cytokine profile, also referred to as humoral immune system. This is responsible for keeping things out of the body. Too much of this system leads to allergies and asthma.
These systems are present in your body early as early as the womb and remain with you throughout your life. The balance between the Th1 and Th2 systems is constantly in flux. Get an infection? Your Th1 system kicks in to fight off the invader, be it a virus, bacteria or fungus. Dust storm kicked up in Phoenix? Your Th2 system will kick in to deal with the dust coming in through the respiratory system.
This is how it is designed to work. At least in a perfect world that isn’t subject to the manipulations by mainstream medicine and our Westernized lifestyle. Antibiotics, sterile lifestyles, vaccinations and unhealthy diets all contribute.
But just how early do the dietary factors kick in?
According to this particular study, they may begin as early as in the womb.
Healthy fats play a strong role in the function and balance of the immune system. In a study that was originally designed to look at fish oil supplementation (DHA and EPA) on depressive symptoms in pregnant women, the researchers looked at the cytokine balance (Th1 / Th2) in the cord blood of these babies born to the mothers in this study. Here’s what they found:
- Omega-3 supplementation during pregnancy resulted in immune balance consistent with less allergies.
- Even more surprising, C-section delivery was associated with an immune balance consistent with more allergies.
Pretty interesting information, especially considering that we already know that C-section births lead to a higher risk of allergies in the child. Personally, I have always felt that this finding was due to the difference in bacterial exposure from not passing through the birth canal, but I’m always open to new ideas.
The bottom line is that the balance, or imbalance, of the immune system begins as early as the womb. Mom’s dietary and supplementation choices, as well as the method of birth, can begin to influence the development of the immune system in the as of yet unborn child.
Few things are as difficult as seeing your child in pain. I remember when Keegan broke his leg and how much it hurt me knowing he hurt.
Headaches in children can be just as unbearable for a parent, but with the added concern of whether something more ominous is causing the headaches. While misguided, most parents will present to his or her pediatrician for evaluation and some type of answer. This usually prompts imaging of the brain despite the absence of red flags. MRI if you are lucky, CT scans if your pediatrician wouldn’t recommend a medical journal if he or she got whacked upside the head with it.
Side note: In the absence of red flags, advanced imaging is not recommended. Even when imaging should be done, it should be an MRI (with the single exception of looking for a subarachnoid hemorrhage, which is much more likely to occur in the elderly population). The radiation exposure with a CT scan is extremely high and has been linked to some 29,000 cancers per year.
So everything comes back normal, but your little baby is still having nightmare headaches. It’s nice to know there is nothing “real” going on, but this doesn’t take care of the migraine headaches. Your pediatrician’s only answer at this point is medication.
It is unfortunate, but a referral to a chiropractor is rarely undertaken before the medication. Many of the kids who come into our office for treatment of his or her headaches have already tried everything including medications. Most often we are able to help in a very short period of time, although there have been cases over the years that treatment in our office was not able to help and we just became one more therapy in a long list of failed attempts.
Anecdotally, I can tell you that we do extremely well with headaches. However, our comprehensive approach (manipulation, soft tissue work, diet, stress management) to migraines in children has not been studied in any type of clinical trial that I’m aware of, so maybe I could understand a pediatrician’s reluctance to refer out to a chiropractor. After all, we don’t want to subject our children to anything that has no research to back it up, right?
Which, of course, brings us to this particular study. Basically, researchers looked across multiple studies to see which medications have been shown to be effective for the treatment of migraines in children. Here’s what they found:
- Topiramate (Topamax) led to 0.7 less headache days per month.
- Trazodone was slightly less effective at 0.6 less headache days per month.
- Drugs with no benefit included clonidine, flunarizine, pizotifen, propranolol, and valproate (Depakote).
- A single trial of fluoxetine for chronic daily headaches found it ineffective.
- However, kids given placebo experienced an almost 50% drop in headache days (down 2.7 days / month).
Basically, the evidence sucks for the use of most medications for treatment of migraines in children.
Placebo, on the other hand, plays a far, far stronger role in slashing headache frequency in the children in these studies. Something to consider strongly should your pediatrician recommend medications (with a long list of side effects) to help control migraines in children.
It also brings us back to the use of a comprehensive chiropractic approach to the treatment of headaches in children. Our care is extremely safe when compared to any medication, and, at least according to this review, it certainly couldn’t be any less effective!
We love to shoot for the low hanging fruit when it comes to chronic disease management and prevention. Don’t avoid processed foods high in sodium–just by the same junk in a “low sodium” version. Don’t exercise too hard–a light 30 minute walk around the block is enough. Don’t avoid refined carbohydrates–just eat more whole grains.
You get the idea.
We seem fixated on the idea of making “easy” to make changes that have a really small impact on chronic disease. Can’t lower your cholesterol through lifestyle? This class of drugs will lower your risk of heart attacks by 1%. High blood pressure? Forget lifestyle, just take a beta blocker–you won’t lower your risk of stroke (actually increases risk) but you’ll have a better looking blood pressure to tell your friends.
Just how good is aspirin at preventing heart attacks? Treat 1,000 people with aspirin for 5 years and you prevent 2.9 heart attacks, although 2.8 of you will suffer a major bleeding episode as a result, leading to a net benefit of .1 person for every 1,000 treated. Or, for those of you who haven’t had a math class for several decades, you have to treat 10,000 people for 5 years to prevent a single heart attack.
Sounds like the only person the recommendations to take aspirin for your heart benefitted was Bayer.
So it’s a little money out of my pocket. At least there are no dangers associated with aspirin use. Unless, of course, you count these:
- Increased risk of pancreatic cancer
- Asprin use may make you more susceptible to gluten allergies.
- Increased risk of esophageal lesions and cancer
The list is probably longer, but these are a few of the studies I’ve reviewed over the years.
Thanks to this particular study, now we can add a new one.
Neovascular age-related macular degeneration. Almost 246% higher risk in regular users of aspirin.
So, if you’re one of the lucky 1 in 10,000 that avoided a heart attack by regular use of aspirin, then congratulations. If however, you’re in the group with everyone else, just hope that your eyesight is still intact as a result of taking a daily aspirin for a perceived lowered risk of having a heart attack.
If you are still taking aspirin to lower your risk of having a heart attack, is this choice because your doctor has recommended it, or because society general thinks that this will protect your heart?
Sometimes, Going to Work Just Doesn’t Pay
Some people like to “tough it out” and come to work every day, regardless of how under the weather they feel; however, this might not be the best idea: Employees who work while sick are often less productive than healthy employees. Research is showing that in some instances, this slowdown in production – known as “presenteeism” – may cost a company more than if an employee stays home for the day.
Researchers tried to estimate the losses in productivity caused by common health conditions such as allergies and headaches, and compared that estimate with other costs associated with the condition. The estimates were based on about 375,000 employees, including claims for medical care and disability over a three-year period.
The analysis showed that for many conditions, the costs of presenteeism were greater than other health care costs, such as absenteeism or health benefits. When other costs were added to losses from presenteeism, absenteeism, health benefits and disability benefits, the most expensive condition for employers was high blood pressure ($392 per employee per year), followed by heart disease ($368), mental health problems ($348), arthritis ($327) and allergies ($271).
If you’re an employer, consider examining your company’s sick-time policy and adjust it if necessary so employees don’t feel burdened to come to work when they are sick. As an employee, take the day off the next time you are sick. Toughing it out will likely prolong your illness, and you’ll be less productive and end up costing your company money in the long run.
To learn more about how to stay healthy – on the job and off – talk to your chiropractor and click here.
Long-range destruction of Der p 1 using commercially available ionizers
I’ve been consiering buying the new style of air cleaner, such as the Quiet Breeze from Sharper Image, but have been concerned as to their effectiveness. This article seems to support the fact that they do have a positive effect for removing allergens from the air. Synergy Abstract - Click here for more information.
When ANY child has headaches, something is wrong. They don’t just happen and they darn sure aren’t because that child is deficient in some medication. And yet, we seem to think this is the case because the administration of medication seems to be the treatment of choice in mainstream medicine.
Even if a medication controls the headache for that moment, it has in no way, shape or form fixed what was causing the headache. As a parent, it is your job to NEVER accept anything less than an answer.
Most often, the answer is not immediate. I find that stress in children is a major contributor to headaches. Even if you initiate stress management approaches (meditation, biofeedback using the Resperate, relaxation CDs, massage) these will take some time for the benefits to be noticed.
If the problem is structural, very commonly from carrying backpacks that are too heavy for the child, then they need structural work from a chiropractor that focuses on this aspect of treatment.
I cannot begin to describe the frustration we’ve had with patients here in the office. We recently had a cheerleader who had several falls and had high stress levels and a “challenging” diet. Despite a year of headaches and seeing virtually every other type of provider (including a neurologist at Barrow’s) there was never a suggestion of seeing a chiropractor. After the first first, she didn’t have a headache for a week and they have been getting better managed since. The patient is, needless to say, very pleased after just 4 visits.
I have another patient that was recently put on a triptan medication to manage his headaches. He’s a very intelligent 11 year old boy, but he clearly stresses heavily over school. There has not been any discussion about managing his stress. It’s all been about medication. Our office is working with his mother to get something type of relaxation program for his iPod and I’m very confident this will help greatly with his headaches.
Since I brought up the triptan class of medications (nice, segue, huh?), we should look at this particular study.
Researchers looked at multiple studies on the use of triptans for migraine headaches in children. Here’s the catch:
The children’s placebo response rate was incredibly strong, with pain relief at 2 hours ranging from 53% to 57.5%.
Basically, because of this, none of the medications were more powerful than placebo in these trials.
So what does this mean? It means that the brain is a powerful tool in managing migraine headaches–at least as powerful as commonly used medications. This all points back to the ability of mind based therapies like meditation or biofeedback to control or eliminate migraine headaches in adolescents.
If this type of approach is NOT recommended in the care of any child with migraine headaches, I would personally pack up and run the other way. If stress is a major contributor to headaches and this aspect is not addressed, the long term health consequences are going to be grave.
Medicine is NOT supposed to be about controlling the symptoms. Medicine is finding the cause of a problem and fixing that cause so that the long term health of the patient is preserved. Anything less is deficient.
If your child experienced migraine headaches, what did you find was the best therapy for them?
If queried, many would name high cholesterol as one of the major risk factors for heart disease. Not even close. Many wouldn’t think of a condition 50% of us have.
I was giving a short presentation last week and one of the participants asked about diabetes and heart disease. I had mentioned that, for me, there is little difference between the two, and this appeared to be something she had not heard before.
While not surprising, this fact is very true. 84% of diabetics die of cardiovascular related complications (heart disease and stroke combined). So it would seem to me that every diabetic needs to work on protecting his or her heart.
Here’s the good news: improving your lifestyle to protect or improve diabetes and improving your lifestyle to protect your heart are one and the same. Good luck trying to find something to avoid or improve your diabetes that doesn’t have a protective effect on the heart. Exercise? Both. Stress management? Both. Avoiding BPA in plastics? Both. Nuts? Both.
You get the idea.
So why does this concept seem to be a secret? Maybe it’s because primary care doctors or endocrinologists manage diabetes and cardiologists manage heart disease. Sad to think this way, but it seems to fit. The closest we seem to come to managing both conditions is to make sure that diabetics are taking his or her diabetic medications or that diabetics are taking their Lipitor. No one seems to take into account that these two conditions are caused by the same lifestyle choices, rather than being two separate entities needing to be managed with distinct tools.
This particular study drives this concept home. Researchers looked at HbA1c levels and how they related to the risk of heart disease. HbA1c is a marker to see how well you have been managing your blood sugars over the past 3 months or so. HbA1c is actually a protein in red blood cells that gets damaged by blood sugar when it goes up. So, higher blood sugar = more damage to the proteins in your body. EVERY protein, not just this one. So lower is always better. Higher means that every protein in every cell of your body is being damaged more. Not good.
Here’s the problem: elevations in HbA1c do not just occur in diabetes. Basically, it’s a spectrum, with lower numbers being better and higher numbers getting worse. Whether or not you are diagnosed with diabetes, higher HbA1c numbers are not good, and in the study, elevated HbA1c levels were associated with heart disease regardless of whether or not the person had been diagnosed with diabetes (yet).
The bottom line is, regardless of whether you are diabetic or prediabetic, your heart is in grave danger. Luckily, you don’t need to pick which condition you want to make lifestyle changes for. My recommendations can be found here.
Are you at risk?
Supplementation with branched-chain amino acids in advanced cirrhosis.
It seems like I’ve been coming across more and more patients who have or know someone close to them that has a liver that is failing. Given the increased pharmaceutical drug and over the counter pain relievers (Tylenol is now one of the top or possibly even #1 cause of liver failure) this is not surprising. Here we see branched chain amino acids protecting the liver. Add to this regimen milk thistle and N-acetyle cysteine and you’ve got some powerful tools to help retain what functional liver these patients have left.
Gastroenterology Online - Click here for more information.
Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus.
This study found that licorice was more effective than many other common prescription antivirals on the market. I’m trying to figure out why this wasn’t all over the news…
The Journal : Current Issue - Click here for more information.
SSRIs: suicide risk and withdrawal.
Wow. GlaxoSmithkline withheld info from the UK’s regulatory agency when it got approval for paroxetine (Paxil). The study basically showed no increased efficacy over placebo. My question is…this kind of behavior is rampant here in the US as well. How on Earth do these companies not get shut down by the regulatory agencies? Unfortunately, I think we can all guess at the answer.
The Journal : Current Issue - Click here for more information.
Induction of interleukin-12 production in mouse macrophages by berberine deviates CD4+ T cells from a Th2 to a Th1 response.
Berberine is a compound that was made famous by goldenseal. In this study berberine was able to shift the cytokine balance from a Th2 to a Th1 mediated profile. In essence, this would help shift an asthma or allergy sufferer towards a more normal response. Interestingly, berberine is also well known to be an effective broad spectrum antibiotic, antihelminth and antiviral compound. Click here for more information.
Epidural corticosteroid injections for sciatica.
The epidural for low back pain is always one that hits close to home. In my own practice, I rarely see long term benefit from steroid injections. Flexion/distraction therapy is an extremely effective and safe treatment for sciatic pain. Also, I see a high number of patients that have been told they have sciatica but, clinically have no evidence of it. This may be another example of clinicians using advanced imaging like MRIs instead of using their exam findings and intuition.
Ann Rheum Dis — Abstracts: Valat et al. 62 (7): 639 - Click here for more information.
Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance
I must admit this is a very interesting concept. Basically, this article opens up the idea that sleep apnea may actually be a manifestation of underlying insulin resistance and obesity. We have always known that abdominal obesity was a risk factor for sleep apnea, but the association with insulin resistance would really change the approach to treatment. I am always in support of a CPAP machine because sleep apnea can have some pretty serious long term consequences, but now we should add aggresive lifestyle changes for insulin resistance as well. Click here for more information.
Effect of vitamins and aspirin on markers of platelet activation, oxidative stress and homocysteine in people at high risk of dementia.
It was nice to see therapeutic levels of the vitamins used in this study. Many times the researchers will use levels just barely above the RDA and when the findings do not show a benefit, the results are plastered all over the news. Here we see 1 mg of B12 (something like 15,000 times the RDA) and 2 mg of folic acid (5X). The antioxidant levels are not as high as I would like but they still showed lowering of markers of oxidative stress. Click here for more information.
Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillation.
This article touches on what I consider a controversial topic. The chronic use of warfarin in a patient with atrial fibrillation produces a “small beneficial effect” on stroke and major vascular events. The question is, does a “small beneficial effect” justify the continued use of warfarin that would prohibit intake of foods (green, leafy veggies, ginko, ginseng, high dose Vit E, fish oils) that have a huge beneficial effects across the spectrum of multiple chronic diseases? This is a question that only a patient and their prescribing physician can answer, evaluating the risk for other chronic diseases vs ischemic stroke. Click here for more information.
Adolescent diet and risk of breast cancer.
While it should come as no surprise that the diets we eat in our teenage years will affect our risk of cancer down the line, at some point our national organizations (AHA, American Cancer Society, American Dietetic Association) need to wake up and smell the coffee. As a nation, we do a sickeningly poor job at prevention given the sheer volume of preventative measures. Now, at a time when the bar is raised further (i.e. educating our teens…) our national organizations maintain the status quo. Click here for more information.
Effect of supplemental phytonutrients on impairment of the flow-mediated brachialartery vasoactivity after a single high-fat meal.
UGHHH!! That’s just what we need–a research article that finds that a fruit-and-veggies-in-a-pill can help balance out the effects of a high fat meal!!! As Americans we are always looking for the easy way out and this will just support that attitude. NOTHING will ever replace a diet low in saturated fats and high in fruits and veggies. NOTHING!!
Cardiosource - Click here for more information.
Spinal manipulative therapy is an independent risk factor for vertebral artery dissection.
Had to comment on this one. With the risks that some researchers have stated, patients would be dropping dead left and right in my office alone. Other, more favorable researchers doing very large studies (this one had 171) have estimated that 1 chiro in 40 will experience a cerebral-vascular incident in THEIR LIFETIME OF PRACTICE. When we talk deaths, there are literally less than 100 on record over the past 50 years or so. Compare this to NSAIDs, a common therapy for neck pain. Conservatively, 16,000 deaths PER YEAR. And a quick search on PubMed did not produce ANY articles showing benefit of NSAIDs in neck pain. And yet these researchers have started a cascade of controversy that states that risks of spinal manipulation outweighs benefits. Talk about double standards!! Neurology — Abstracts: Smith et al. 60 (9): 1424 - Click here for more information.
Peppermint oil reduces gastric spasm during upper endoscopy.
Peppermint has been used for centuries to calm GI spasms. For patients with irritable bowel syndrome, many have found relief with peppermint oil. Here we see it replacing a commonly used antispasmodic during endoscopy. Gastrointestinal Endoscopy Online - Click here for more information.
Risk of CVD–Related, All-Cause Death & Serum Enterolactone.
There is much evidence suggesting a protective effect of plant lignans (found in whole grains, flaxseed, soy…) on many diseases including CVD and breast and endometrial cancer. However, many of these studies are not raising a fundamental question. Lignans are converted by intestinal bacterial to enterolactone. What impact does the widespread destruction of normal flora with antibiotics have on this conversion rate? Arch Intern Med — Abstracts: Vanharanta et al. 163 (9): 1099 - Click here for more information.
Intermittent fasting effects on glucose metabolism, neuronal resistance to injury from calorie intake.
One of the only well founded true “anti-aging” approaches out there is calorie restriction w/o nutrient restriction. Well, unfortunately, this approach is just not fun. Well, we may have an easier alternative. Alternate day fasting in mice appears to produce the same favorable changes in insulin sensitivity, serum glucose and ability to protect neurons from injury. PNAS — Abstracts: Anson et al. 100 (10): 6216 - Click here for more information.
Seasonal Prevalence of Intestinal Parasites in US During 2000.
Most people are blissfully unaware of the high prevalence of parasites here in the US and believe infection with parasites is limited to those outside of the US. Welcome to reality. A study of 5,792 samples showed a prevalence as high as 43% in the summer of several types of parasites. Think that course of diarrhea last week was the flu???… Thanks to DSD newsletter for bringing this to my attention. American Journal of Tropical Medicine and Hygiene, June 2002 Abstracts - Click here for more information.
Inertia on folic acid has caused unnecessary deaths.
I commend this author on her heroism in stating that some 350,000 deaths due to cardiovascular disease could have been prevented in the past decade if physicians would’ve started recommending and industry fortifying with folic acid. Of course, this number would need to be extraplated back an additional 3 decades because first hints that folic acid could prevent neural tube defects begin in the late 50′s. The morale?? While waiting on the sidelines to recommend a potentially beneficial vitamin like folic acid, which, incidently, has never been linked to one single death at 400 mcg, millions were dying. How many nutrients are in the same situation now that folic acid was in 40+ yrs ago? bmj.com Ellis 326 (7398): 1054-c - Click here for more information.
Mitochondrial dysfunction in elderly: possible role in insulin resistance.
This is an interesting concept and would lead to some additional intervention for lower insulin resistance in an elderly population. Mitochondrial support with supplements such as coenzyme Q10, carnitine and malic acid may be warranted in this situation. This would, of course, be on top of lifestyle changes, resistance training, chromium and essential fatty acids to affect the insulin resistance. Entrez-PubMed - Click here for more information.
Adverse renal effects of anti-inflammatory agents: evaluation of selective and nonselective cyclooxygenase inhibitors.
With the sharp increase in COX-2 use such as Celebrex and Vioxx (most of this use being inappropriate for its indications), we really need to evaluate the selective COX-2 inhibitors against other known damages from NSAIDs. Here we see that the COX-2 inhibitors are just as dangerous to the kidneys as traditional NSAIDs. And much more expensive. Hey–just use the cheaper NSAIDs and save the extra money for that kidney transplant!! Click here for more information.
Evaluation of cyclooxygenase 2 inhibitor use in patients admitted to a large teaching hospital.
For those of you that thought I was just babbling about the overuse of COX-2 inhibitors…Click here for more information
Up regulation of TNF-alpha, interferon gamma in ankylosing spondylitis during treatment with etanercept.
This article really raises some concern with me (beyond my previous level of concern over this class of drugs). Recall that TNF-alpha is a cytokine that controls many other aspects of the immune system and is generally thought of as an up-regulator of the immune system. However, we do know that this class of molecule is also important in fighting cancer cells. Elevated TNF-alpha levels are associated with autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis and Crohns and a new class of drugs “binds up” these TNF-alpha molecules floating around in an attempt to lower clinical aspects of these conditions. However, in this article we see that etanercept (a TNF-alpha blocker) surely does binds up TNF-alpha, but the T-cells of the body respond by producing even more. While this may be okay while on the therapy, what happens with the patient terminates medication usage? Will this “super” elevated TNF-alpha level result in even worse degree of disease than prior to medication usage? We just don’t know yet. Ann Rheum Dis — Abstracts: Zou et al. 62 (6): 561 - Click here for more information.
Effects of fruit and vegetables on antioxidant concentrations, BP.
This is another of those “how much did we spend on this study???” study. Is there anyone out there that thinks that increased consumption of fruits and veggies won’t positively impact markers of health? Do we really need to spend money just to quantify what common sense already tells us? The Journal : Back Issues - Click here for more information.
Breastfeeding and lowering the risk of childhood obesity.
With the rates of diabetes and obesity skyrocketing, it is always good to see studies outlining protective behaviors. Unfortunately, whether or not an infant was formula fed cannot be changed in the child’s later years. The US government is considering spending millions on educating children on exercise and healthy eating but are missing the obvious (as surprising as that may be for government…). How about a multi-million dollar advertising campaign towards the benefits of breastfeeding? The Journal : Back Issues - Click here for more information.
Activation of the mucosal immune system in irritable bowel syndrome.
It has been difficult to find structural abnormalities in IBS and it is nice to see some research along these lines. IBS is primarily a functional disorder and I’m sure that the localized inflammation found in this study is a result of the altered function. Imbalance in pathogenic flora, improper digestion leading to putrefactive by products and yeast overgrowth have all shown to play a factor in IBS. Each of these by themselves could lead to a localized inflammatory response. Gastroenterology Online - Click here for more information.
Oral Contraceptives and Glucose, Insulin, and Diabetes.
Articles like this are good to see, but the citations appearing in other medical journals does make me scratch my head in wonder. This study did show lower fasting glucose levels and lowered risk of diabetes (after ten years of use). However, insulin levels were elevated. Medscape’s review implied that insulin levels were lowered!! And then you wonder why our health system is so screwed up. My interpretation?? Elevated insulin from pharmacological interventions can never be a good thing. It is entirely possible that oral contraceptives has some type of insulin secretagogue property yielding higher insulin and lower glucose and lowered risk of diabetes in the short term. I feel confident that if this study were to be followed up in another decade the results would not be so “drug friendly.” Dia Care — Abstracts: Kim et al. 25 (6): 1027 - Click here for more information.
Lawyers poised to sue US junk food manufacturers.
Doesn’t that just take the cake?? Oops…might not have cake after the attorneys get through all this mess. So much for personal responsibility!! If we sue the junk food manufacturers might as well go after anyone who uses enriched wheat flour (and how about the government for forcing “enriching??”). While I can say this is absolutely ridiculous, I’m sure they can find a jury somewhere that will award some money. bmj.com Charatan 324 (7351): 1414 - Click here for more information.
Gosh…what can I add to this article? This topic has the potential to be the future of medicine if we would drop the dogma and take the money out of pharmaceutical drugs. There are currently urine tests to analyze certain genetic variations that alter a patient’s need for certain nutrients. While clinically available now, I would guess that I’ll be long retired before this actually makes it into standard practice. It will take half that long for the researchers to spend the money to determine that nutrition really does play a role is disease prevention/management and half again for the clinicians to read their own medical journals. bmj.com Elliott and Ong 324 (7351): 1438 - Click here for more information.
Physical Activity and Inflammation in Middle-aged and Older US Adults.
This study finds that exercise lowers overall levels of CRP, a marker of chronic inflammation. This is really not an unexpected result;moderate exercise is a key component to a natural approach to any disease process since most diseases have an inflammatory component.
Relationship Between Physical Activity and Inflammation Among Apparently Healthy Middle-aged and Older US Adults. Click here for more information.
Study Questions Cost-Effectiveness of COX-2 Drugs.
This is one of those articles that raises some eyebrows. The fabulous new selective COX-2 inhibitors are being severely overused. The overview of this study goes into the specifics, but I do know one thing for sure–you can bet the pharmaceutical reps and direct to consumer advertising had something to do with it. Makes me wonder if some nutriceutical company came up with millions of dollars to advertising saw palmetto for prostate health to women, how effective would it be? Money talks and buyer beware!! Click here for information.
New evidence suggests that health plan sponsors may want to break doctors’ habit of prescribing COX-2 drugs for arthritis, acute pain and other conditions without first having tried less expensive treatments. The study, released today at the Express Scripts Outcomes Conference, questions the overall cost-effectiveness of COX-2 inhibitors, such as Pharmacia’s Celebrex (celecoxib) and Bextra (valdecoxib) and Merck & Co.’s Vioxx (rofecoxib). The analysis reinforces lingering doubts about the benefit of COX-2 drugs compared with traditional nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. The debate centers on whether COX-2 drugs provide an added safety benefit for patients at risk of stomach problems, such as ulcers and bleeding, that can occur when using traditional NSAIDs. Researchers in the June 1st issue of the British Medical Journal conclude that an earlier study of Celebrex leaves the false impression that the COX-2 drug has fewer gastrointestinal side effects than NSAIDs (see Reuters Health report, May 30). Express Scripts’ study focuses on the cost-effectiveness aspect. Annual spending for COX-2 drugs spiked 38% in 2000, the study found. The increase reflected a huge influx of new patients taking the drugs, said Fred Teitelbaum, the company’s vice president for research and planning. Spending grew another 15% in 2001. When the St. Louis-based pharmacy benefits management company probed deeper into utilization patterns, it discovered that 74% of new users had no evidence of being at risk for gastrointestinal adverse events. Furthermore, 29% of new users had a diagnosis of lower back pain, a condition not yet listed as an approved indication for COX-2s, it said. No clinical studies have shown COX-2 drugs to be any better than NSAIDs for lower back pain, according to Emily Cox, Ph.D., manager for outcomes research at Express Scripts. Also, short-term use of COX-2s was greater than expected, suggesting that these agents are not being reserved for patients requiring long-term treatment for which gastrointestinal side effects may be an issue. Cox said the study underscores a “significant opportunity” for health plan sponsors to encourage a more cost-effective approach. Express Scripts advocates an approach called step therapy, whereby physicians are encouraged to start new patients without risk of gastrointestinal side effects on a generic NSAID before progressing, if necessary, to a COX-2 drug. Express Scripts estimates that step therapy alone can trim health plan sponsors’ total spending within the NSAIDs class by 12%, said Brenda Motheral, the company’s senior director of outcomes research. So far, only a small percentage of Express Scripts clients have implemented a step therapy program, which typically blocks payment for a COX-2 claim without a clinical reason justifying the choice, explained Raulo S. Frear, vice president of clinical services. By presenting this new data, the company hopes to stimulate greater interest in “appropriate cost-effectiveness,” he said.