5 Things You’re Not Supposed To Know About Chiropractors

There are a few things that you may not know about D.C.’s, which surprised us, included the mounting research.

1.   Their education is equal to their medical colleagues … and might be better in some areas. [1]

This might be difficult to accept, but chiropractic students spend markedly more hours in the classroom than medical students, especially in the areas of anatomy, physiology, orthopedics, and x-ray. [2] Of course, their training is different since “Chiros” concentrate on muscles, bones, joints, and nerves. Their education only touches on medication, emergency situations, etc. Many are beginning to think this gives them a better background in physical rehab.

A study of the curriculum of North American chiropractic and medical colleges found “Considerable commonality exists between chiropractic and medical programs. Regarding the basic sciences, these programs are more similar than dissimilar.” [2]

Even more interesting was a test given to both chiropractic and medical students. Chiropractic students scored higher than medical students did on the musculoskeletal (bones, joints, and muscles) portion of the exam, while the medical students faired slightly better in other areas. [1]

In another study, chiropractors and chiropractic students tested “significantly higher” in reading X-Rays when compared with their medical colleagues in a study at the University of California Medical Center. [3]

2.   They do more than crunch backs and necks

While chiros are known for treating back and neck problems with joint manipulation, most are well versed and board certified to perform physical therapies. They are also licensed to function as primary care physicians. [4] Based on their education many use nutrition as a form of treatment.

3.   It’s safe

Even though ghost stories of adjustments gone wrong are common, the actual risk of injury from chiropractic treatment is rare. [5] Generally, the malpractice insurance that doctors have to pay is based, among other things, on their field. Chiropractors as a group pay the less for malpractice insurance than any other type of physician. Why? Lawsuits claiming injuries or negligence are less common against chiropractors.

In the past there was concern that there was an increased risk of stroke could upper neck manipulation treatments. However a 7-year study organized by The United Nations and the World Health Organization just found that there is no association with chiropractic treatment and stroke. [6]

4.   They took the AMA to court … and won … twice

For decades chiropractors were campaigned by the AMA (American Medical Association) as not being “real doctors” and met fierce resistance from medical organizations. Chiropractors claimed the AMA was trying to snuff out the competition with fear tactics and bogus research. The U.S. Supreme Court agreed with them in 1987… and again in 1990. It was found that the AMA was guilty of illegal antitrust activities against the chiropractic profession, ordered an injunction on their activity, and forcing them to print the courts findings in the Journal of the American Medical Association.

5.   M.D.’s and D.C.’s are now working together

It’s becoming more common to find integrated offices, where M.D.’s, D.O.’s, and D.C.’s are working side-by-side. Many medical offices now try to provide multi-specialty approaches to treatment. With natural forms of treatment becoming more popular, drugless forms of treatment have become preferred by many over pain-medication.

One survey of 266 medical students at Georgetown University revealed more than 75% felt that alternative medicine techniques should be included in their curriculum. [7] Chiropractic, acupuncture, herbal medicine, and nutritional supplements were the most desired areas of interest. PH&W

The views expressed in this editorial are soley those of PH&W Magazine and do not reflect the opinion of any contributing parties or advertisers.

Sidebar: In a basic test designed by orthopedic residency professors to test the knowledge of medical residents vs. chiropractic students, 82% of medical school graduates failed the examination. [8] Four years later the test was simplified and, once again, 78% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. [9] When this test was given to final quarter chiropractic students 70% of them passed the same exam! [10]

References:

1.   Assessment of knowledge of primary care activities in a sample of medical and chiropractic students
J Manipulative Physiol Ther. 2005 (Jun); 28 (5): 336-44
http://www.chiro.org/LINKS/ABSTRACTS/Assessment_of_Knowledge_of_Primary_Care_Activities.shtml

2.   A Comparative Study of Chiropractic and Medical Education 
Altern Ther Health Med. 1998 (Sep); 4 (5): 64 75
http://www.chiro.org/LINKS/ABSTRACTS/Comparison.shtml

3.   Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic
Spine. 1995 May 15;20(10):1147-53; discussion 1154
http://www.ncbi.nlm.nih.gov/pubmed/7638657

4.   Chiropractic: a profession at the crossroads of mainstream and alternative medicine
Ann Intern Med 136 (3): 216–27
http://www.chiro.org/ChiroZine/ABSTRACTS/Chiropractic_Profession_at_Crossroads.shtml

5.   Safety of chiropractic manipulation of the cervical spine: a prospective national survey
Spine. 2007 Oct 1;32(21):2375-8; discussion 2379
http://www.chiro.org/LINKS/ABSTRACTS/Safety_of_Chiropractic_Manipulation.shtml

6.   Bone and Joint Decade Task Force
Press Release: “Seven-Year Neck Pain Study Sheds Light on Best Care.”
February 2008
http://www.newswire.ca/en/releases/archive/February2008/15/c2658.html

7.   A large-sample survey of first- and second-year medical student attitudes toward complementary and alternative medicine in the curriculum and in practice
Georgetown University School of Medicine, Washington, DC, USA
Altern Ther Health Med. 2007 Jan-Feb;13(1):30-5
http://www.chiro.org/alt_med_abstracts/ABSTRACTS/A_Large_sample_Survey.shtml

8.   Adequacy of Medical School Education in Musculoskeletal Medicine 
Journal of Bone and Joint Surgery 1998 (Oct); 80-A (10): 1421–1427
http://www.chiro.org/ChiroZine/ABSTRACTS/Adequacy.shtml

9.   Educational Deficiencies in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 2002 (Apr); 84–A (4): 604–608
http://www.chiro.org/ChiroZine/ABSTRACTS/Educational_Deficiencies.shtml

10.   A Comparison of Chiropractic Student Knowledge Versus Medical Residents
Proceedings of the World Federation of Chiropractic Congress 2001 Pgs. 255
http://www.chiro.org/ChiroZine/ABSTRACTS/A_Comparison_of_Chiropractic_Student_Knowledge.shtml

19 Potentially Dangerous Drugs Pushed By Big Pharma

Nation of Pill Poppers: 19 Potentially Dangerous Drugs Pushed By Big Pharma By Martha Rosenberg, AlterNet Posted on December 5, 2010, Printed on December 7, 2010 http://www.alternet.org/story/149078/ Since direct-to-consumer drug advertising was legalized 13 years ago, Americans have become a nation of pill poppers -- choosing the type of drug they desire like a new toothpaste, sometimes whether or not they need it. But if patients want the drugs, doctors and pharma executives want them to have the drugs and media gets full page ads and huge TV flights (when many advertisers have dried up), is the national pillathon really a problem? Yes, when you consider the cost of private and government insurance and the health of patients who take potentially dangerous drugs like these. Seroquel, Zyprexa, Geodon, atypical antipsychotics Even though the antipsychotic Seroquel surpasses 71 drugs on the FDA's January quarterly report with 1766 adverse events, even though it's linked to eight corruption scandals, even though military parents blame Seroquel for unexplained troop deaths, it is the fifth biggest-selling drug in the world and netted AstraZeneca almost $5 billion last year. Atypicals were originally promoted to replace side-effect prone drugs like Thorazine but soon became pharmaceutical Swiss Army Knives for depression, anxiety, insomnia, bipolar and conduct disorders and other off label uses -- and betrayed the same side effects as older antipsychotics. (Especially tardive dyskinesia-linked Abilify.) Foisted disproportionately on the young, poor and disadvantaged, atypicals cause such weight gain and metabolic derangement -- 16 percent of Zyprexa patients gain 66 pounds and some gain over 100 -- manufacturer Lilly Eli Lilly agreed to pay the state of Alaska $15 million in 2008 for the Medicaid costs of Zyprexa patients whodeveloped diabetes. Atypicals carry warnings of death in demented patients but are widely used in nursing homes. And even though Risperdal maker Johnson & Johnson, Geodon maker Pfizer, Abilify maker Bristol-Myers Squibb, Lilly and AstraZeneca have all entered into government settlements that acknowledge fraudulent or wrongful atypical marketing, FDA rewarded atypical makers by approving Zyprexa and Seroquel for children last year. And approved a new atypical antipsychotic, Latuda, in October. Maybe the FDA is bipolar. Ritalin, Concerta, Strattera, Adderall and ADHD drugs When it comes to the epidemic of 5.3 million US children between 3 and 17 diagnosed with ADHD, suspicions of pharma pushing the disorder are exceeded only by pharma's admissions thereof. During an August conference call with financial analysts, Shire specialty pharmaceuticals president Mike Cola credited the "very dynamic ADHD market" to Shire's globalization efforts and "investments we have made in new uses for ourexisting products." Those uses, a.k.a. diagnoses, for Shire products like stimulants Adderall, Vyvanse and Intuniv include adult ADHD, cognitive impairment, depression and excessive daytime sleepiness. Still, Cola says despite the 10 percent ADHD "new starts" that are helping Shire "grow the market," and the "co-administration market" of add-on prescription drug$, the ADHD franchise suffers from patients who drop out when they quit seeing their pediatrician. "We don't see those patients show up again until their mid-to-late 20s," laments Cola. ADHD drugs, in addition to "robbing kids of their right to be kids, their right to grow, their right to experience their full range of emotions, and their right to experience the world in its full hue of colors," as Anatomy of an Epidemic author Robert Whitaker puts it, can also be deadly. A 2009 article in the American Journal of Psychiatry called Sudden Death and Use of Stimulant Medications in Youths found 1.8 percent of youthful stimulant users died sudden deaths from cardiac dysrhythmia or unexplained causes versus 0.4 percent who were not on stimulants.  Though it helped fund the study, the FDA said the results proved no "real risk" and kids should keep taking their meds. Meanwhile, says Robert Whitaker, kids on ADHD meds "are told they are going to be on these drugs for life. And next thing they know, they're on two or three or four drugs," a phenomenon also known as the co-administration market. Prozac, Paxil, Zoloft, SSRIs Selective serotonin reuptake inhibitor (SSRIs) antidepressants like Prozac, Paxil, Zoloft and Lexapro probably did more to inflate pharma profits in the last decade than direct-to-consumer advertising and Viagra put together, no pun intended: over 60 million prescriptions were filled in the US in 2007 with many patients reporting their depression lifted. But some critics say for mild depression, SSRIs don't work at all and are no better than placebo. And others say they can add aggression, bizarre behavior, self-harm and suicidal thoughts to depression. In fact, there are 4,200 published reports of SSRI-related violence, aggression, bizarre behavior, self-harm and suicide since the drugs wereintroduced in 1988  including the well known gun massacres at Columbine (1999),Red Lake (2005), NIU and likely, Virginia Tech (2007). SSRIs have non-behavioral perks both sides agree on: life-threatening serotonin syndrome when taken with migraine drugs, gastrointestinal bleeding when taken with aspirin, Aleve or Advil and the bone condition, osteoporosis. Paxil can reduce or abolish the effect of tamoxifen in breast cancer patients and increase deaths says British Medical Journal. It's linked to a two-fold increased risk of cardiac birth defects in infants according to its own manufacturer, GSK. And sex? SSRIs are so linked to dysfunction even the pharma-identified web site WebMD admits many will experience impotence, delayed ejaculation or no orgasm. But there is a solution (besides going off SSRIs) says WebMD: Add another antidepressant that's not an SSRI, like Wellbutrin! Effexor, Cymbalta, Pristiq, SNRIs Selective norepinephrine reuptake inhibitors (SNRIs) are like their SSRIs chemical cousins except their norepinephrine effects can modulate pain, which has ushered in your-depression-is-really-pain, your-pain-is-really-depression and other crossover marketing. But the problem with giving a psychoactive drug for pain is that you're giving a psychoactive drug for pain. "After three months of taking Savella [another SNRI], I started self-destructing and cutting myself," writes a 40 year old woman on askapatient.com. "I don't know why or anything, but it does similar to Prozac where it makes you think and do weird things." And Cymbalta, approved this fall for chronic back pain and osteoarthritis? Cymbalta was the drug healthy 19-year-old volunteer Traci Johnson was testing when she hung herself in an Eli Lilly dorm in 2005. It was the drug Carol Anne Gotbaum killed herself on at Phoenix's Sky Harbor airport in 2007. SNRI's are also harder to quit than SSRIs, especially Effexor. 25-year-old Chicagoan David F. told AlterNet he stood at the top of an 8-story parking lot contemplating jumping every day for weeks after quitting. It's also the drug Andrea Yates was on when she drowned her five children in 2001. But not all SNRI side effects are behavioral. The FDA would not approve Pristiq, a newer version of Effexor, when Wyeth/Pfizer tried to market it for vasomotor symptoms, because it caused heart attacks, coronary artery obstruction and hypertension in clinical trials. That's similar to another SNRI, the diet pill Meridia, which was just withdrawn from the market for causing heart problems. Pristiq is still available. Foradil Aerolizer, Serevent Diskus, Advair and Symbicort How could asthma drugs that increase the chance of dying of asthma become pharma's top sellers? The same way antidepressants that cause depression and antifracture drugs that cause fractures become top sellers: good consumer marketing. Still, unlike drugs that look safe in trials and develop safety signals postmarketing, the long-acting beta agonists (LABA), salmeterol and formoterol, found in many asthma products, never looked safe. In fact it was their links to deaths and adverse events that led to studies in the 1990s and 2000s which showed more deaths and adverse events: LABAS increase death in users, say the studies, especially African-Americans and children. Original safety trials were also marred with major fraud. Pharma doctors, when reviewing the study results at FDA hearings in 2005 and 2008, blamed LABA deaths on patients' underlying disease and non-compliance and dismissed hospitalization as a side effect less serious than death. They danced around FDA testimony, including from Dr David Graham of Vioxx fame, that there is no scientific evidence that the inhaled corticosteriods found in Advair and Symbicort make the products safer and that LABA's modest clinical benefit does not justify their 28-fold increase in mortality risks. (5,000 deaths in ten years estimated Graham.) While many regard LABAs as a medical mishap, marketing for "step up" asthma treatment is no misttake. Though inhaled corticosteriods are still considered the best asthma treatment, millions have been convinced they need two drugs to control their asthma and that the combination is keeping them out of hospitals. Except when it isn't. Singulair and Accolate, leukotriene receptor antagonists How did Merck convince Americans to use an allergy drug that works no better than over-the-counter antihistamines but costs eight times as much? A drug in which "asthma control deteriorates when switched from low dose inhaled corticosteriods" according to original FDA reviewers in 1998 -- but was approved anyway? How did Merck convince pediatricians and mothers to give kids such a drug on a daily basis for seasonal allergies, runny noses and minor wheezing? Even though FDA reviewers cautioned that adult trials "may not be predictive of the response" in children in the New England Journal of Medicine? And infant monkeys given Singulair had to be euthanized because "infants may be more sensitive" FDA reviewers wrote? Last month, the saga of Singulair mismarketing story continued when Fox TV reported that Merck's top selling allergy drug is suspected of producing aggression, hostility, irritability, anxiety, hallucinations and night-terrors in kids, symptoms that are being diagnosed as ADHD.  And that Singulair is being huckstered to parents by the trusted educational service Scholastic, Inc. and the American Academy of Pediatrics. Eight-nine parents on the drug site askapatient.com report hyperactivity, tantrums, depression, crying, school trouble, facial tics and strange eye movements after their children, some as young as one, were put on Singulair. Similar reports appear on medications.com and parentsforsafety.org. Most symptoms subside when Singulair is stopped. "Do NOT recommend this drug to other parents," writes one mother. "4 year olds that suddenly talk about killing themselves are influenced by a DRUG!! "THE GOVERNMENT SHOULD BE ASHAMED OF THEMSELVES FOR APPROVING THIS!!!!" writes another mother, though the shame may well not stop there. Martha Rosenberg frequently writes about the impact of the pharmaceutical, food and gun industries on public health. Her work has appeared in the Boston Globe, San Francisco Chronicle, Chicago Tribune and other outlets. © 2010 Independent Media Institute. All rights reserved. View this story online at: http://www.alternet.org/story/149078/

ASPIRIN DANGER TO THE BRAIN

A DAILY dose of the 'wonder drug' aspirin can cause bleeding in the brain, researchers have found.

Brain scans on more than 1,000 patients revealed a 70 per cent higher incidence of microscopic bleeding among those taking the drug.

The shock findings will be of major concern to the millions of Britons who take aspirin every day to stave off fatal heart attacks and strokes. 

The drug is used to thin the blood, which reduces the risk of dangerous clots forming in key blood vessels.

At the moment, I would only give it to people at high risk of heart attack

Dr Mike Knapton, associate medical director of the British Heart Foundation

Previous research has already shown that anti-clotting medicines can increase the risk of bleeding in the gastrointestinal tract – the oesophagus, stomach, or intestines.

But the new findings suggest they can also raise the odds of “cerebral microbleeds” that can be a sign of brain vessel disease.

British experts welcomed the findings but urged people using aspirin not to suddenly stop taking their medication.

Dr David Werring, honorary consultant neurologist at the National Hospital for Neurology and Neurosurgery in London, said: “More research is needed to decide whether these micro-bleeds raise the risk of serious bleeding in the brain in people who take aspirin.

Read more: http://www.express.co.uk/posts/view/95207/Aspirin-danger-to-the-brainAspirin-danger-to-the-brain#ixzz17PEluTzX

Healthy people who take aspirin to prevent heart attacks could be doing themselves more harm than good.

The drug, which reduces the risk of blood clots, can be taken by patients who have already suffered a heart attack or are at risk of one.

Millions of others are also believed to take a daily dose as an "insurance policy" with the hope of guarding against heart trouble.

But the routine use of aspirin by healthy people to prevent heart problems "cannot be supported," professors from the Aspirin for Asymptomatic Atherosclerosis (AAA) said.

Their study found that the risk of cardiovascular problems had to be set against the increased risk of internal bleeding.

Professor Peter Weissberg, of the British Heart Foundation which partially funded the research, said: "We know that patients with symptoms of artery disease, such as angina, heart attack or stroke, can reduce their risk of further problems by taking a small dose of aspirin each day.

"The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits."

The study recruited 28,980 men and women aged between 50 and 75 who were free of clinically evident cardiovascular disease in central Scotland.

They were given either a daily dose of 100 milligrams of aspirin or a placebo.

Major bleeding requiring admission to hospital occurred in 34 (2 percent) subjects in the aspirin group and 20 (1.2 percent) of the placebo group.

Read more: http://www.foxnews.com/story/0,2933,544575,00.html?test=latestnews#ixzz17Orl3ykw

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.

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

New Study Finds Chiropractic Care Superior to Family Physician-directed Usual Care
Chiro.Org Blog ~ October 7th, 2010

If Not Chiropractic Care, Then What’s Your Alternative?
Chiro.Org Blog ~ September 25th, 2010

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REFERENCES:

1. Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects: An Historical Cohort Study
Spine (Phila Pa 1976). 2010 (Aug 23) [Epub ahead of print]

2. Study Says Back Surgery Often Makes Things Worse
The Daily Hit ~ Oct 14, 2010

3. Back surgery may backfire on patients in pain
MSNBC.com ~ Oct 14, 2010

4. Why Do Spinal Surgery Rates Continue To Rise?
Chiro.Org Blog Editorial ~ April 10th, 2010

5. Findings from the: “United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial” 
British Medical Journal 2004 (Dec 11); 329 (7479)

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

Surgery 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.

Continue reading the main story

Scrubbing Up

• Doctors 'should check no-shows'
• Cancer race bias 'costs lives'
• Surgery 'not entertainment'
• The dangers of laziness

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.

Continue reading the main story

“Start Quote

Some people are just too big for any constructive cure to be countenanced”

Professor David Haslam

• Read your comments
• BMI Calculator

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.

Continue reading the main story

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.

Continue reading the main story

“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.

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 mechanistic^32,33 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.