Consumer Reports Survey: Chiropractic best for low back pain.

From WebMD Health News

Americans Are Flocking to Alternative Therapies

Bill Hendrick

July 22, 2011 — Most Americans believe that prescription medications are the most effective treatments for many common illnesses, but a Consumer Reports survey of more than 45,000 people finds that three-fourths of us are turning to alternative therapies like yoga and acupuncture.
The new report says 38 million adults make more than 300 million visits per year to acupuncturists, chiropractors, massage therapists, and other practitioners of alternative and complementary techniques.
"Despite the hoopla over alternative therapies, when we asked respondents how well the therapies they used worked for 12 common health problems, results showed that they were usually deemed far less helpful than prescription medicine for most of the conditions," Consumer Reports Health says in its September issue.
Also, over-the-counter medications in many cases are more popular among consumers than widely used dietary supplements, according to the survey.
Most Popular Alternative Therapies
Chiropractic, deep-tissue massage, and mind-body practices like yoga dominated the list of alternative treatments that respondents said were helpful for back pain, neck pain, and the aches of osteoarthritis.
And though meditation is widely touted as an effective way to relieve anxiety, insomnia, and depression, the survey says prescription antidepressants are used by more people.
Among key findings of the survey:

• Consumers ranked prescription drugs as most effective for nine of 12 conditions -- allergies, cold and flu, depression, anxiety, digestive problems, headache and migraine, insomnia, irritable bowel syndrome, and osteoarthritis.
• Of the 46% of respondents who used prescription drugs for osteoarthritis pain, 53% said it helped a lot; 54% of respondents used glucosamine/chondroitin for osteoarthritis symptoms, and 25% said it helped a lot.
• Of the 27% of respondents who used meditation, 42% said it helped "a lot" with anxiety.
• 43% of respondents used deep-breathing exercises for anxiety, and 34% found it helped a lot.
• Chiropractic care was ranked as the most effective treatment for back pain.
• Pilates, yoga, and deep-tissue massage all rated about the same as prescription medication for back pain.
• Vitamins and minerals were the most commonly used alternative treatments for general health, with 73% of respondents taking them.
• A majority of people who said they used alternative therapies had told their doctors about it.

Respondents were online subscribers of Consumer Reports.
Consumer Reports recommends that people who decide to try alternative treatments talk to their doctor first to set realistic expectations for improvement.
SOURCES:
News release, Consumer Reports Health.
Consumer Reports, September 2011.

FDA Responds to IOM Report Concerning 510(K) Process

IOM Device Report Gets Strong Response

By Emily P. Walker, Washington Correspondent, MedPage Today Published: July 29, 2011

WASHINGTON -- The FDA reacted swiftly to the Institute of Medicine's recommendation that the agency's 501(k) medical device approval process be abandoned; so did industry and patient groups. In a press release sent just minutes after the IOM report was released on Thursday, Jeffrey Shuren, MD, director of the FDA's Center for Devices and Radiological Health, said the agency doesn't think the fast-track approval process for moderate-risk devices should be scrapped. "FDA believes that the 510(k) process should not be eliminated but we are open to additional proposals and approaches for continued improvement of our device review programs," Shuren said. Then on Friday morning the agency announced that it would open a public docket to accept comments on the report, and hold a public meeting in the next few weeks. The IOM report -- written by a 12-person panel of doctors, lawyers, and academics -- concluded that the 510(k) process does not ensure safety or effectiveness of medical devices and needs to be replaced with a new regulatory framework. The majority of devices -- ranging from tongue depressors to pacemakers -- go through the fast-track 510(k) approval, which was established under the 1976 Medical Device Amendments to deal with the growing array of medical devices. To earn 510(k) approval, companies seeking approval for a low-to-moderate risk device must prove that the it is substantially similar to another device already on the market. Unlike the premarket approval process -- which is used for brand-new devices and high-risk devices -- a company does not have to provide clinical data to support its contention that its device is safe and effective. The FDA commissioned the report from the IOM, but it doesn't have to follow the advice of the committee. Three of the authors of the IOM report who spoke at a public event on Friday said they thought it was a good idea that the FDA open the group's recommendations up for public comment. Industry Weighs In The FDA may have been tempered in its reaction to the report, but the device industry didn't hold back in its total disagreement with the IOM's recommendations. "The report's conclusions do not deserve serious consideration from the Congress or the Administration," said Stephen Ubl, president and CEO of the Advanced Medical Technology Association (AdvaMed), in a press release. "It proposes abandoning efforts to address the serious problems with the administration of the current program by replacing it at some unknown date with an untried, unproven and unspecified new legal structure. This would be a disservice to patients and the public health." Ubl said numerous studies have shown the 510(k) process is "overwhelmingly safe." The IOM committee didn't say that the process was unsafe, just that it isn't set up to ensure safety or efficacy. The Medical Imaging & Technology Alliance (MITA) said it was "concerned and disappointed" by the recommendation to get rid of the 510(k) process, saying it falls "far outside the current conversation" on how to improve FDA's device approval process. "The IOM has offered the wrong approach," Dave Fisher, executive director of MITA, said in a press release. The device industry has been highly critical of the FDA's device review process, calling it unpredictable and sluggish to approve new devices, which they say is hampering innovation and causing medical device manufacturers to seek approval outside of the U.S. AdvaMed and MITA both support the 25-step plan announced by the FDA earlier this year, but those who have pushed for tougher device regulation criticized the plan for being watered down and said it wouldn't do much to improve device safety. Patient Groups Are on Board Patient and consumer advocates, on the other hand, praised the IOM report. "We applaud the report for its findings and recommendations and we think they are critically important," Michael Carome, MD, deputy director of Public Citizen's health research group, told MedPage Today. Public Citizen has long asserted that the 510(k) process allows potentially unsafe devices on the market. "It's clear that devices that are not safe and effective are making their way to market and that reflects a failure in the current system," Carome said. He said he disagrees with the FDA's response that the 510(k) process does not need to be discarded and said he hopes the agency takes more time to consider the IOM's recommendations. Diana Zuckerman, PhD, president of the National Research Center for Women and Families, who agrees with the report findings, said the report must have came as a "big shock" to the FDA. "I think for all of us who work within the system, it's shocking when an outside entity says, 'This whole system is crazy' even when I think all of us know that this whole system is nonsensical," she told MedPage Today. Zuckerman said there are four major problems with the 510(k) process: It doesn't require device-makers to submit clinical trials; it doesn't mandate inspections of manufacturing facilities; it doesn't require post-marketing studies; and it doesn't give the FDA any authority to rescind approval if the device is found to be unsafe or ineffective. However, the FDA does not have the resources to "fix the system in the way that really does the job at the moment," she acknowledged. The device side of FDA is much less well-funded that the drug side, because pharmaceutical companies pay user fees that are 10 times higher than those paid by device companies. Zuckerman said device companies should be paying higher user fees in order to help fund a safer device approval system.

Age & Ethnicity Adversely Effects Disc Health....Sex? Not So Much.

The Effects of Age, Sex, Ethnicity, and Spinal Level on the Rate of Intervertebral Disc Degeneration: A Review of 1712 Intervertebral Discs

Siemionow, Krzysztof MD*; An, Howard MD*; Masuda, Koichi MD†; Andersson, Gunnar MD; PhD*; Cs-Szabo, Gabriella PhD‡

Abstract

Study Design. A gross anatomic and magnetic resonance imaging study of intervertebral disc (IVD) degeneration in fresh cadaveric lumbar spines.

Objective. The purpose of this study was to find the rate of IVD degeneration.

Summary of Background Data. Age, sex, race, and lumbar level are among some of the factors that play a role in IVD degeneration. The rate at which IVDs degenerate is unknown.

Methods. Complete lumbar spine segments (T11/T12 to S1) were received within 24 hours of death. The nucleus pulposus, anulus fibrosus, cartilaginous and bony endplate, and the peripheral vertebral body were assessed with magnetic resonance imaging and IVD degeneration was graded by two observers from grade 1 (nondegenerated) to grade 5 (severely degenerated) on the basis of a scale developed by Tanaka et al. The specimens were then sectioned and gross anatomic evaluation was performed according to Thompson et al.

Results. A total of 433 donors and 1712 IVDs were analyzed. There were 366 whites, 47 Africans, 16 Hispanics, 4 Asian. There were 306 male and 127 female donors. The age range was 14 to 81 years, (average: 60.5 ± 11.3). For donors greater than age 40, the L5/S1 IVD degenerated at a significantly faster rate of 0.043 per year compared to 0.031, 0.034, 0.033, 0.027 for L1/L2, L2/L3, L3/L4, L4/L5, respectively. For donors younger than 40, L5/S1 IVD degenerated at a significantly faster rate of 0.141/y compared to 0.033, 0.021, 0.031, 0.050 for L1/L2, L2/L3, L3/L4, L4/L5, respectively. Multiple regression analysis revealed that sex had no significant effect on IVD degeneration whereas African ethnicity was associated with lower Thompson score at L1/L2, L2/L3, L3/L4, L4/L5 when compared with whites.

Conclusion. The relatively early degeneration at L5–S1 in all races and lower Thompson grade in donors of African ethnicity needs further investigation. Factors such as sagittal alignment, facet joint arthritis, and genetics potentially play a role in IVD degeneration.

Are Generic Drugs Really Equivilant to the Patented Pharmaceutical? The FDA Wants to Know...

FDA Mulls Tighter Standards for Generics

By Emily P. Walker, Washington Correspondent, MedPage Today Published: July 26, 2011

WASHINGTON -- An FDA advisory committee met Tuesday to discuss the agency's proposed standards for determining when generic drugs can be considered bioequivalent to the brand-name version of the medication. Responding to concerns from industry and physicians, the FDA is proposing imposing stricter standards for bioequivalency on medications known as "critical dose drugs" or "narrow therapeutic index" (NTI) drugs. Small changes in the dose of NTIs could cause serious or life-threatening adverse results, so making sure that each and every pill carries the same dose and works the same is crucial. Generic drugs win FDA approval by showing bioequivalence -- after administration of a standard dosage, blood levels of the generic drug are the same as for the branded original. But although the generic's mean maximal concentration and area under the concentration-time curve are typically within a few percentage points of the original's -- typically about 4% -- the 90% confidence interval for those results means the generics can be as much as 20% below or 25% above the branded drug's mean. That window may be appropriate for, say, a headache drug, but many experts question whether that window is too wide for drugs with very specific action, for instance, drugs to treat epileptics. In 2010, the FDA's Pharmaceutical Science and Clinical Pharmacology Advisory Committee voted 11-2 that current bioequivalence requirements aren't sufficient for NTIs. At the conclusion of that meeting, the committee voted 13-0 that the FDA should develop a list of NTI drugs with clear, specialized criteria for including drugs on the list. These medications include anti-arrhythmics, anticoagulants, and tricyclic antidepressants, among others. The NTI list that FDA developed includes seven drugs: warfarin, levothyroxine, carbamazepine, lithium carbonate, digoxin, phenytoin, and theophylline. Tuesday's advisory committee was slated to discuss whether FDA's definition of an NTI is appropriate and whether the agency's proposed scale for deciding whether an agent is bioequivalent is appropriate. The FDA is proposing that generic drugmakers looking to get approval for an NTI should conduct a replicate design study to quantify the variability of both the generic and the reference product to determine bioequivalence. The issue is especially relevant as use of generic drugs continues to grow. Generic drugs constituted 78% of total prescriptions dispensed in the U.S. in 2010.

Are drugs and medical devices being approved too slowly, too quickly? Here's what the head of the FDA has to say:

FDA Chief Defends Approval Process

By Emily P. Walker, Washington Correspondent, MedPage Today Published: July 25, 2011

WASHINGTON -- FDA Commissioner Margaret Hamburg, MD, addressed on Monday the "increasing drumbeat" of criticism suggesting that the agency is slowing innovation by requiring drug and device companies to wait excessively long periods for approval. "You may be aware of increasing drumbeat of the FDA as a 'bureaucratic regulatory agency' impeding innovation of certain industries, the drug and device industries in particular ... potentially driving U.S. companies overseas," she told a small crowd at a discussion sponsored by the watchdog group Public Citizen. Hamburg said she wanted to clear up some misconceptions, among them the notion that the FDA takes much longer to approve drugs and devices than Europe. In priority drug approval -- approval for new drugs that meet an unmet public health need -- the FDA is often the first regulatory body to award approval, she said. In any case, speed is not the most important factor, she said. "The number of new drugs, the speed of their delivery matters, but the most important foundation of all that we do and what really makes a difference ... and is the number one issue for the American people, is that they can have trust and confidence that the products we reviewed are in accordance with science and efficacy and that our agency has the commitment to that regulatory process that is unwavering," she said. The FDA has come under criticism, especially from the device industry, for not being clear enough on what it expects from device makers from the get-go, for taking too much time from application to approval, and for having poorly trained device reviewers. The head of the FDA's Center for Devices and Radiological Health (CDRH), Jeffery Shuren, MD, has said that device arm of the FDA is plagued by an "unacceptably high" turnover rate for reviewers. When asked about the cause of the turnover at CDRH, Hamburg said that the FDA's drug division used to have the same problems, but things improved when the drug division began collecting user fees from pharmaceutical companies -- the FDA's drug division collects about 10 times more in user fees than the agency's device arm. Since then, the agency's drug reviewers haven't been "stretched a million ways" and the work environment got better, she said. Although she didn't mention increasing user fees for devices, she implied that having more resources for device approvals would go a long way to help attract and retain highly skilled device reviewers. On the other hand, she said, "The more embattled FDA becomes ... the more difficult it will be to recruit more staff." CDRH's workload has increased by 26% since 2007, driven by a significant increase in requests from device makers, and nearly half of the reviewers in the CDRH have four years or less of reviewing experience, Shuren has said. Hamburg also addressed the recent reorganization at the top of the FDA, which installed Stephen Spielberg, MD, PhD, a pediatrician and pharmacologist, in a newly created position that will oversee medical products and tobacco. "We're seeing products that come before the agency that don't fit into one or the other stovepipes," Hamburg said. Spielberg's role as deputy for medical products will serve to coordinate and provide oversight for all medical products. During the discussion, Sidney Wolfe, MD, the health research director at Public Citizen, was sharply critical of Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research, whom he said has been at the helm of the FDA's decision-making process on drugs that were pulled in other countries long before they were pulled in the U.S., including Darvon and Meridia. He said he was worried back in 2009 that Woodcock would be promoted to FDA Commissioner, but was pleased that the administration chose Hamburg instead because she has public health experience that other FDA officials lack, according to Wolfe. Hamburg played a crucial role in HIV and tuberculosis programs in New York City while she was health commissioner there. "I think the FDA has been better off with her at the top than it would have been with Dr. Woodcock," Wolfe said. Hamburg did not defend Woodcock or address Wolfe's comments that Hamburg was the better choice for the job. She did say that the Obama administration's selection process was a "total mystery" to her. She said she had spoken with people in the administration about possibly taking a public health role, but when she got the call asking her to be commissioner, that was first conversation she had about taking taking the helm of the FDA. Public Citizen invited Hamburg to their headquarters as part of a speaker's series commemorating the group's 40th anniversary. The group has been a highly visible and vocal presence on many public health, drug, and device issues, asking the FDA to pull 35 drugs over the past four decades. Two-thirds of those drugs are still on the market, Wolfe said. Wolfe is a familiar face at FDA advisory committee hearings, where he sometimes serves as a patient representative on advisory panels and often presents public testimony on behalf of Public Citizen. "Of course we haven't always agreed on every issue, and in many cases you wished that we would have done more or done something differently," Hamburg said, but "your efforts are much-noted and much appreciated."

A Bad Thing or Good Thing?: Most Parents Unaware of Medical Research Opportunities for Their Children.

Most Parents Unaware of Medical Research Opportunities for Their Kids

Released: 7/25/2011 8:00 AM EDT
Source: University of Michigan Health System

Newswise — ANN ARBOR, Mich. – One in nine adults have participated in medical research. In contrast, only one in 20 children have done so.
Those are the findings of a poll earlier this year by the University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health. The poll asked adults and parents about their views on medical research and past participation for themselves and their children.
The poll also found that most adults (68%) are aware of medical research opportunities for adults. In contrast, the majority of parents (84%) are not aware of medical research opportunities for children.
“Medical research is the backbone of improving medical care. Without volunteers, medical research cannot move forward,” says Matthew Davis, M.D., director of the poll and associate professor in the Child Health Evaluation and Research Unit at the U-M Medical School. “Awareness about research opportunities, which is a necessary step before participation, is reasonably high among adults but strikingly low for children’s research. To improve participation rates among children, researchers and institutions evidently need to do a better job of getting the word out to parents.”
Participation in research is key to continued medical progress, Davis says. Over the last 100 years, infant mortality in the United States has been reduced by 90 percent. Millions of deaths from diseases such as polio, diphtheria, pneumonia and influenza have been prevented by vaccines. Children with life-threatening diseases such as cystic fibrosis, sickle cell disease and diabetes now survive beyond childhood, into adult years.
All these advances have been made possible through medical research. Successful pediatric research requires the voluntary participation of children and the support of their parents, Davis adds.
The poll also found that participation in medical research by adults is higher among non-Hispanic whites (14%) than among Hispanics (4%) or non-Hispanic blacks (2%). There are no racial/ethnic disparities for kids related to research participation. This positive finding sets an equitable foundation for efforts to expand awareness and recruit children from all backgrounds for medical research in the future.
For more information, please visit the C.S. Mott Children’s Hospital National Poll on Children’s Health:
http://www.med.umich.edu/mott/npch/
Resources:
UM Clinical Studies: http://www.umclinicalstudies.org/
Children and Clinical Studies:
http://www.nhlbi.nih.gov/childrenandclinicalstudies/index.php

New Rules by the Dept. of Health & Human Services will impact human research studies.

HHS Considers New Rules for Human Research

By Emily P. Walker, Washington Correspondent, MedPage Today Published: July 23, 2011

WASHINGTON -- The Department of Health and Human Services has announced it is planning to change its rules on research involving human study participants. One piece of the plan -- announced Friday in an advance notice of proposed rule making -- would require researchers to get participants' consent to having biospecimens, such as blood, used in studies other than the one in which they are enrolled. Specimens collected for one study may find their way into dozens of others. Under a law known as the Common Rule -- which governs human research at 17 federal agencies and offices -- sharing of biospecimens is a legitimate practice because the specimen is considered "deidentified" from the person to whom it belongs. However, with relatively recent scientific advances -- think DNA testing -- a person's tissue, blood, and other bodily fluids actually hold the key to a person's identity and therefore can't be "unidentified." The proposed rule "acknowledges that biospecimens are inherently identifiable," explained Kathy Hudson, PhD, deputy director for Science, Outreach, and Policy at the National Institutes of Health (NIH) in a Friday call with reporters. Another major change in the proposed rules would require all institutions that receive any federal funding to follow federal guidelines for research involving human participants. Currently, if an institution is not receiving grant money from the federal government for a particular study, and the study isn't part of the FDA approval process, the institution does not have to abide by the federal government's rule on human research for that study. But under the proposal, if any branch of the institution receives any money at all from the federal government for research, then all research performed at the institution would have to abide by the federal rules, even if investigators don't have a federal grant for the particular study in question. According to HHS, about two-thirds of all universities have agreed to follow the federal human research rules, and one-third have not. Most of the other proposed rules announced Friday would pertain to making the research trial process faster and more streamlined. For instance, in large, multi-centered studies performed at a number of universities, each institution generally needs to clear the study protocol with its institutional review board, or IRB. In the case of a large study, that can be an extremely time-consuming process. An HHS official recalled one case in which so much time went by after the researchers submitted their proposed study to various IRBs, that the staff at several of the IRBs turned over and the new staff wanted to start over with the review. The whole study was eventually canned, said Carl Wieman, PhD, associate director for science in the White House Office of Science and Technology Policy. Under the new proposal, approval of a single IRB (likely chosen by the drug company funding the study) would suffice in the case of multi-center trials, ostensibly allowing study sites to begin enrolling patients more quickly. "Being able to shrink the time from having a protocol in hand and being able to recruit patients is key," Hudson said. Another key provision to speed up studies: Researchers who are conducting a study that is very unlikely to pose any sort of harm to participants would not have to go before an IRB every year to update the board on the progress of the research. The rule also proposes to update the process and forms used for informed consent, and to implement a uniform and more efficient approach to collecting and analyzing data on adverse events observed in clinical trials. The basis for the Common Rule dates back to a the 1978 "Belmont Report," which was prompted by the infamous Tuskegee syphilis study, in which impoverished African-American sharecroppers in Alabama who had syphilis were enrolled in a study to monitor the natural progress of syphilis. They were given free medical care, meals, and burial insurance, and never told they had syphilis. The Belmont Report laid the ethical framework for the government's stance on human research and includes principles such as treating all participants with courtesy and respect, allowing for informed consent, and adhering to the philosophy of "do no harm" while maximizing research benefits and minimizing risks to the subject. The proposed rule was published in the Federal Register and the government will be accepting comments on it for 60 days.

Is Complementary Medicine OK?

From Medscape Family Medicine > Physicians Are Talking About...

Is CAM Always a SCAM? Physicians Are Talking

Brandon Cohen

Authors and Disclosures

Posted: 07/19/2011

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"How do you counsel patients interested in complementary or alternative therapies?" asked a neurologist, citing a recent study that failed to show a benefit for cranial osteopathy in children with cerebral palsy.^[1] This sparked a discussion on Medscape's Physician Connect, an all-physician discussion group, and evinced some sharp contrasts in physicians' attitudes and practices concerning treatments that fall outside of the scientific mainstream.
Some doctors vigorously opposed alternative approaches. Several referred to alternative practitioners as quacks. One oncologist wrote, "I tell patients that there is a lot of evidence that almost all SCAM therapies (supplements, complementary, and alternative medicines) do not work but are expensive."
A general practitioner from Singapore concurred: "Those patients who practice it are doing it out of blind faith. Trying to talk them out of it is like talking religion to them. It is impossible as it is no longer a matter of rational reasoning, but a matter of faith."
Another oncologist grimly added, "My terminal cancer patients often come up with 'treatments' and frequently state that they know the FDA or insurance or whoever is keeping these 'cures' from the public. Of course these treatments are generally completely mad...I tell all of them to try it, but please come back to my office in a year and let me know that it worked! So far, no one has made it that long."
But some colleagues strongly disagreed with these dismissals of alternative medicine.
"Why the narrow mind?" asked a general practitioner. "We are trying to solve medical puzzles. We ought to want to use every tool available. If you [only] knew the detailed understanding of biochemistry, endocrinology, genetics, and immunology that well-trained naturopaths (for example) possess and utilize...you might be a little shamed."
An enthusiastic pulmonary specialist agreed and wrote, "I welcome the opportunity to collaborate and provide something that will be synergistically beneficial for those in my care."
A number of physicians continued along these lines, with several citing the antiquity of some herbal remedies as a recommendation: "Many great and ancient civilizations have natural treatments for various ailments that are safe and effective. Drugs developed in a Petri dish are not the only answer," offered an oncologist.
An allergist tried to temper this passion for the ancient and organic by writing, "In regards to natural medicines, I usually remind my patients that just because they are natural they are not [necessarily] safe."
Others were undeterred. One general practitioner proclaimed, "Complementary medicine is here to stay, and actually herbal medicine is the grandmother of many of our first drugs, so when a doctor says that herbal medicine is dangerous, he may be just showing his own ignorance."
"I wonder whether what is considered 'alternative' today that may become tomorrow's 'standard of care,'" speculated a pathologist.
Among the doctors who advised against alternative treatment, many reported that their counsel was frequently ignored. One oncologist reported that his warnings to patients about the dangers of nontraditional medicine often had no effect: "Of course, they do it anyway."
Other physicians contemplated the causes of this indomitable lure and put some of the blame at the feet of contemporary medical practices. One doctor wrote, "Physicians have trended so far away from direct patient care that patients seek medical information and remedies elsewhere. Medicine has reached the point where...patients self-diagnose via the Internet and visit nonphysician providers who spend the time with them, to sit, to listen and simply acknowledge their own humanity."
An internist added, "I've found that many people looking for alternative medicine 'cures' are dissatisfied with their current treatment. Medication prices are too high; [there are] unpleasant side effects [and] less than optimal results."
Another topic raised was the undeniable effectiveness of the placebo. "Placebo is so effective that most every clinical study has to have a placebo group to compare with the study group. What we fail to consider is that if a patient responds to placebo by reducing both symptoms and signs, it must be because a self-healing mechanism exists. Do we ask, if the patient has an internal self-healing mechanism, how does it work? Or, if the patient has an internal self-healing mechanism, why isn't the patient using it unaided? No we don't, and this represents gross negligence," wrote an anesthesiologist.
"Placebo effect could be a way to diagnose a certain disease -- ok! But it is a dangerous avenue when this drug becomes the treatment instead of the real one," countered a neurosurgeon.
And an anesthesiologist pointed out, "If the practitioner knows the treatment is placebo yet pretends it's real -- that's fraud."
An accompanying poll showed that 31% of respondents supported their patients' use of alternate paths of treatment. Only 18% discouraged it as a general rule, and a full 38% advocated "telling [patients] there is little evidence one way or the other and leaving it open."
It is likely that this will remain an open question among physicians, as few involved in the debate seemed liable to persuasion by counterarguments; and as long as there are willing patients, alternative medicine itself is not going to disappear.

Taller Women at Risk for Cancer?

From MedPage Today, an article reports on the risk of cancer being higher in taller women: 

http://www.medpagetoday.com/HematologyOncology/OtherCancers/27646?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=371484

What's your thoughts?

Sciatica....or.....Pseudosciatica?

Patients often complain of sciatica, an electric-like pain that courses down one or both legs.  Often times they come into my office with a pre-diagnosis of sciatica given to them by another healthcare provider.  True sciatica is most often caused by a lumbar disc pathology such as a herniation, by boney osteocyte growth such as a spur into the IVF where a nerve exits from the spinal cord through the skeletal spine, and can occr from a stenosis or narrowing of the spinal canal.  Pain typical runs the full course of the nerve being affected, in the case of sciatica, often the lumbar nerves L4-5 and the first sacral nerve.  It is distinguished from a lumbar facet imbrication (a jammed posterior joint) by the fact that nerve irritation from a lumbar imbrication usually doesn't follow the path of the nerve all the way to the foot, but rather often ends before it reaches the knee.

Often, however, sciatica is the wrong diagnosis and the patient should be examined for pseudosciatica or a pain similar to the pain of sciatica but not caused by a disc or skeletal pathology.  Rather, the more common pseudosciatica is caused by over tonicity or spasm of the piriformis muscle, a muscle in the gluteal complex running from the sacrum, across the sciatic notch of the pelvis, and inserting on the femur (long bone of the upper leg).  When the piriformis muscle is tonic, or spastic, it compresses the branches of the sciatic nerve (L4-S1 nerves) causes irritation to the nerve bundle and similar pain to true sciatica.

If you do experience sciatic pain, this differential diagnosis should be made by your health care provider.  Treatment for the pseudosciatica can be as simple as employing myofascial release techniques, electrotherapies to fatigue the muscle, and simple stretches to elongate the muscle whereas true sciatica may involve more extensive treatment and quite possibly surgical intervention if conservative approaches fail to bring relief.

Study on Chronic Low Back Pain.....not so conclusive.

Here's a study article from the International Journal of Clinical Rheumatology.  Judge the outcomes for yourself.

http://www.medscape.com/viewarticle/745459?src=mp&spon=17

Back pain.....

Have you experienced back pain?  What have you done to alleviate it?  What have you tried that's worked and what's not worked for you?

Ouch....my aching back!

It is often said that 80% of the population will experience back pain one or more times in their lives.  Treatment costs are in the $billions worldwide and treatment for these conditions vary from conservative (chiropractic) to radical (surgical).  Outcomes from treatment vary widely based on both procedure and skill of the physician as well as patient compliance, correct diagnosis and correct treatment, overall health condition of the patient, and complications which inevitably arise during the course of treatment.

Perhaps the best cure for back pain is prevention, but even that doesn't always work because of genetic predisposing factors, environmental and occupational exposures, lack of proper diet and exercise, and more.

So let's talk about it.

SPLOG will discuss etiology of spine pain, historical perspectives, current treatments, research, nutrition, exercise, pain syndromes, CAM and allopathic approaches, the impact of other body systems on the musculoskeletal system and how spinal health may cause other health issues.

If you have an idea for a topic - whether its the latest in medical treatments and devices or wanting to explore old wives' tales - let's talk about it.  But take note...this is not a blog to diagnose your ailments or provide you any suggestions for treatment, rather, its an opportunity to explore the myriad of options available and the latest news and research that may have an impact on....your aching back and other matters of health.