Friday, November 26, 2010

Passive smoking 'kills 600,000' worldwide


The first global study into the effects of passive smoking has found it causes 600,000 deaths every year.
One-third of those killed are children, often exposed to smoke at home, the World Health Organization (WHO) found.
The study, in 192 countries, found that passive smoking is particularly dangerous for children, said to be at higher risk of sudden infant death syndrome, pneumonia and asthma.
Passive smoking causes heart disease, respiratory illness and lung cancer.
"This helps us understand the real toll of tobacco," said Armando Peruga, of the WHO's Tobacco-Free Initiative, who led the study.
'Deadly combination'
The global health body said it was particularly concerned about the 165,000 children who die of smoke-related respiratory infections, mostly in South East Asia and in Africa.
It said that this group was more exposed to passive smoking than any other group, principally in their own homes.
"The mix of infectious diseases and second-hand smoke is a deadly combination," Mr Peruga said.
As well as being at increased risk of a series of respiratory conditions, the lungs of children who breathe in passive smoke may also develop more slowly than children who grow up in smoke-free homes.
Worldwide, 40% of children, 33% of non-smoking men and 35% non-smoking women were exposed to second-hand smoke in 2004, researchers found.
This exposure was estimated to have caused 379,000 deaths from heart disease, 165,000 from lower respiratory infections, 36,900 from asthma and 21,400 from lung cancer.
According to the study, the highest numbers of people exposed to second-hand smoke are in Europe and Asia and the lowest rates of exposure were in the Americas, the Eastern Mediterranean and Africa.
The research also revealed that passive smoking had a large impact on women, killing about 281,000 worldwide. This is due to the fact that in many parts of the world, the study suggests, women are at least 50% more likely to be exposed to second-hand smoke than men.

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Thursday, November 25, 2010

New Study Reveals That Back Surgery Fails 74% of the Time


Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.
After two years, just 26 percent of those who had surgery had actually returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.
“The study [1] provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work”, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. [2]
Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”
Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.
Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.
This new study in the journal Spine [1] shows that in many cases surgery can even backfire, leaving patients in more pain.
The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. [3]
27 Million Adults With Back Problems
A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, twenty-seven million adults reported back problems, with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.
Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned. [4]
You may also want to review the recently published
European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain, because it specifically states:
“Surgery for non-specific CLBP cannot be recommended unless 2 years of all other recommended conservative treatments — including multidisciplinary approaches with combined programs of cognitive intervention and exercises — have failed”.
This study also re-confirms the findings of the UK BEAM Trial, published in the British Medical Journal in 2004. [5] Those authors stated:
“Manipulation, with or without exercise, improved symptoms more than best care (medical care) alone after three and 12 months. However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise” (page 1381).
You may also want to read these 3 recent Editorials:
Why Do Spinal Surgery Rates Continue To Rise? 
Chiro.Org Blog ~ April 10th, 2010
If Not Chiropractic Care, Then What’s Your Alternative?
Chiro.Org Blog ~ September 25th, 2010
REFERENCES:
2. Study Says Back Surgery Often Makes Things Worse
The Daily Hit ~ Oct 14, 2010
4. Why Do Spinal Surgery Rates Continue To Rise?
Chiro.Org Blog Editorial ~ April 10th, 2010

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Tuesday, November 23, 2010

SURGERY FOR THE MOST OBESE

Dr. Green Says:  I'm posting this article to show the misguided thinking towards bariatric surgery that exists in the minds of the medical community itself.  Despite the huge saving in money to England, they are rationing this life saving surgery.  There remains an attitude that being obese is somehow the fault of the individual.  Ridiculous and anyone who is truly familiar with obesity research knows that we don't understand why it is happening but it is. Also, the Gastric Band is one of the worst surgeries available.  It often leads to complications and has to be removed.  I recommend the Gastric Sleeve.  That was my surgery of choice.  Here is the article, read it with a wary eye.

VIEWPOINT By Dr David HaslamA GP specialising in obesity care
Thermograms of an obese woman. Pic Tony McConnell/SPLSurgery is needed before you get too fat
Britain is in the grip of an obesity epidemic, with more than a million severely and morbidly obese.
Surgery is available. But in this week's Scrubbing Up, Dr David Haslam, from the group Experts in Severe and Complex Obesity (ESCO), warns the wrong people are getting it and says some of those who are biggest should just be offered "palliative care" for their obesity.
Weight-loss - bariatric - surgery is a rare and precious resource that has the capacity to permanently induce major weight loss, and 'cure' diabetes in 90% of cases, sometimes within days.

Scrubbing Up

It is cost-effective, with gastric bypass paying for itself within three-and-a-half years due to reduced drug costs and hospital admissions, and this is before we take into account the individual's renewed productivity, and benefit - rather than burden - to the economy.
Even the most cynical, fat-phobic taxpayer should rejoice in the benefits of bariatric surgery.
According to the National Institute of health and Clinical Excellence (NICE), of the 1,010,000 severely and morbidly obese population in the UK, there are currently 230,000 people both eligible and willing to have surgery.
However, this year fewer than 2% of these patients will actually receive treatment.

“Start Quote

Some people are just too big for any constructive cure to be countenanced”
Professor David Haslam
Wrong people
The availability of surgery is limited, as relatively few surgeons perform laparoscopic techniques within a limited number of designated centres, with a substantial initial financial outlay, so it should be used carefully and offered only for those who will benefit most.
Like anything precious, bariatric surgery should be rationed. But the wrong people are currently benefiting.
NICE guidelines are well-considered and based on clinical-effectiveness and cost-effectiveness, deeming surgery appropriate in anyone with a BMI (Body Mass Index) of 40+, or 35+ if they have other illnesses.
However current barriers, set out by administrators rather than clinicians, ration access to surgery and are discriminating against deserving patients and reducing the number who benefit - and promoting surgery for the wrong people.

How gastric bands work

Graphic: how gastric bands work
  • Gastric band fitted around the upper end of the stomach
  • This restricts flow of food into the lower stomach
  • Band can be adjusted via the access port
Here are a couple of examples of the kind of cases that occur.
Doris is 62, with a BMI of 72. She has been housebound for 10 years in her fourth floor flat and has complaints including heart disease and chronic leg ulcers.
She smokes 40 cigarettes a day and sleeps in front of the television, as severe osteoarthritis prevents her from moving. She lives just one street from the sea, but can't get there.
Sean is 38, married with two young children and has suffered from type 2 diabetes for 10 years.
He is insulin resistant, on 300 units of insulin, has retinopathy (damage to the retina), burning feet and erectile dysfunction as a result of diabetes. He has depression and is gaining weight rapidly due to insulin, with a BMI of 35.
His prognosis is dreadful. He can look forward to a future of weight gain, blindness, heart disease and the prospect of an early death, leaving his wife to support their children alone.
Shocking concept
Doris will be granted surgery because she has sleep apnoea and weighs enough to fulfil local guidelines, despite the risk, and has limited potential gain in health, longevity and productivity.

“Start Quote

The current route to treatment means that the most needy and deserving individuals often go without”
Professor Haslam
Sean will be denied surgery, and will resort to gaining weight for a few more years before becoming eligible.
If both could have surgery, all well and good, but if only one can, clearly Sean is the more deserving.
What then should become of Doris? Physical activity is out of the question, dietary interventions won't scratch the surface, and most anti-obesity drugs have been removed from pharmacies.
Like anyone else with incurable, terminal diseases, she can be offered palliative care. The concept is a shocking one, and recognises that some people are just too big for any constructive cure to be countenanced. There are times when palliative care is appropriate for obesity: enough is enough when there is no chance of effective treatment.
Doris will then fulfil her ambition to see the ocean, by moving into warden-controlled accommodation by the beach, receiving pain management for arthritis, smoking cessation advice from the district nurse, psychotherapy from the community mental health team, while remaining irreparably obese.
Sean, having undergone surgery, will return to work as a security guard, feed his family and pay his taxes.
It's inevitable that bariatric surgery is rationed, but the current route to treatment means that the most needy and deserving individuals often go without.





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Wednesday, November 10, 2010

Death by Chiropractic: Another Misbegotten Review


Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC 

    

ChiroACCESS 


Published on 

July 27, 2010



The title of one of Edzard Ernst’s most recent articles, “Deaths after chiropractic: A review of published cases”, seems to have wasted no time in creating a worst-case scenario, frightening the reader from a profession which has successfully treated patients for 115 years and for which evidence supporting its effectiveness and safety is abundant.  Ernst has declared an opposing view with copious publications for at least the past 16 years.  Unfortunately, many of Ernst’s assertions regarding spinal manipulation and chiropractic have been discredited in the past and, in several instances, found to be blatantly misleading.  The current article is no exception.
  1. The problem in perspective:

    Ernst reports a total of 26 deaths in 75 years of chiropractic practice.  That would average to less than 1/3 death per year.  Given the facts that there are an estimated 250M chiropractic visits per year in the United States,18 13.4M chiropractic visits per year in Canada,19 and 2.25M visits per year in the United Kingdom,20 the death rates in each country after chiropractic according to Ernst’s figures calculate to be 0.000000132%, 0.00000246%, and 0.0000132%, respectively.

    These figures are absurdly infinitesimal when compared to the 230,000-280,000 deaths caused by iatrogenesis in medical treatment as reported by the Institute of Medicine,21 or from just the use of NSAID medications, producing 10,000-20,000 fatalities from multiple organ systems adversely affected—in the United States alone.22-24  Even what has been regarded as the more relatively benign COX-2 inhibitors and acetaminophen medications have been described to generate serious GI, cardiovascular, and hepatic problems at rates an order of magnitude greater than the side-effects attributed to spinal manipulation.25-29

    A more complete accounting of the extremely low relative risks of spinal manipulation compared to medical interventions for back and neck pain has been presented elsewhere.30-32  Given far too little consideration by Ernst is the fact that the majority of vertebral artery dissections have been found to be spontaneous, possibly exacerbated by high levels of endogenous homocysteine.32,33  Final credibility to this argument is the fact that there was no evidence of excess risk of vertebrobasilar artery stroke associated with chiropractic care as compared to the primary care administered by allopathic physicians.34  This fact alone should do much to dismiss the unmistakable implications from Ernst’s argument that at least a large proportion of the deaths listed could be attributed to chiropractic care.
  2. Lack of risk-benefit analysis: 

    A balanced view of any healthcare intervention needs to make use of risk-benefit ratios in order that a fair and balanced analysis be presented.  There is no such mention of any benefits in Ernst’s current publication,1 as is the case for any of his other papers as cited.7-14 This is in spite of the fact that the clear benefits of spinal manipulation as administered by chiropractors have been already discussed.2-6  Simple mathematics dictates that a denominator [benefits] which is set to zero will yield a risk-benefit ratio of infinity, regardless as to how infinitesimal the numerator [risks] may be.
  3. Incompleteness and carelessness of review:

    In addition to the substantial lack of considerations pointed out above, it is peculiar to hear of Ernst’s assertion that his review is “systematic” when in fact through 1985 it accounts for just 16 deaths, whereas 24 through the same period were carefully described in a review of 257 cases that Ernst himself cited in his bibliography in discussing a different subject.35  Even more worrisome is the fact that in the same reference Terrett clearly points out that the majority of the cases of vertebrobasilar artery accidents were mistakenly—often deliberately—attributed to chiropractors instead of the myriad of other practitioners responsible for the adverse events.35  This point was not only ignored by Ernst but deliberately distorted to suggest that more chiropractors (17) were responsible for complications than medical practitioners (9), naturopaths (1), or physiotherapists (0).1  To make matters worse, there is more recent data which clearly demonstrates that vertebrobasilar artery accidents are more likely to occur in the hands of nonchiropractors rather than actual chiropractors.36  Finally, there is an inaccuracy in this actual citation itself35, in which the entity responsible for its publication is listed in Ernst’s article as “JCMIC” instead of “NCMIC.”  All of these indications suggest that the article by Ernst falls far short of what would normally be considered as a carefully prepared, scholarly systematic review worthy of publication in the peer-reviewed, scientific literature.

    What is peculiar is an apparent disclaimer by Ernst himself, in which he states in his article that “Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available.”  Under these circumstances, one has to question how Ernst ever was able to invoke the term “systematic” in the first place.
  4. Signs of bias and blanket statements:

    Statements to the effect that “when carefully evaluating the known facts, one does arrive at the conclusion that causality [of arterial dissection] is at least likely.”  Unfortunately, we are never privy to what the “facts” may be, in addition to being given a statement that is contradicted by both the mechanistic32,33 and actual patient data34 supporting spontaneity discussed earlier.  Finally, Ernst’s assertion that “the risks of chiropractic neck manipulations far outweigh their benefits” is clearly unsupported by the data in the literature with the complete ignorance of any benefits or risk-benefit ratios as argued earlier.

    For these reasons, one must greet Ernst’s current article with extreme skepticism and hope that the host of its inaccuracies does not misguide the journal’s readership. It is certainly regrettable to contemplate the prospect of having this error-prone paper emulated in future citations in the scientific literature for years to come.

References can be found in original article.
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