Cutting back on carbohydrates or fats leads to the same weight loss over time, but the low-carb approach increases HDL levels, according to an Annals of Internal Medicine study.  Some 300 obese adults (mean body mass index, 36) were randomized either to an Atkins-style, low-carbohydrate diet or to a calorie-restricting, low-fat diet for 2 years. Both groups received more than 35 group behavioral treatments.  Weight loss was virtually identical on both diets — 11% of initial weight at the end of the first year and roughly 7% at 2 years. Of note, HDL levels rose more on the low-carbohydrate regimen and remained higher at the 2-year mark.  This is only one reason why I always tell my patients that diets are not healthy. The main reason being that diets always have an end which is why within 2 years, the original weight lost is gained back plus 10%.  However here is a physiological reason why a low fat diet does not work.  Yes, you lose weight, but at the same time do not lower your HDLs.  Think Moderate Protein, Low Fat , Low Carbs.   

9 Spinal Rules to Live By:

1. Be careful when you lift.  Know the weight of the load you are lifting.  Plan where you are going to place it.  Bend your knees and not your back.  This places the weight on your thigh muscles and not your back structures. 
2. When bending be sure not to twist your spine at the same time.
3. Don't sit for longer than 20 minutes without getting up.
4. Sit on an ergonomic chair.  If you don't have one, then a chair with arm rests and place a small pillow or rolled up towel behind your lower back.  Don't slump.  
5. Stretch your back and legs several times per day.
6. Sleep on your side or on your back.  Never on your stomach!
7. Use a cervical pillow.  Never sleep on more than one pillow.  
8. The spine requires a firm mattress.  I like the select comfort mattresses.  (www.selectcomfort.com)
9. The average conventional mattress lasts 7 years.  If yours is older, consider buying a new mattress. I don't care what the mattress companies tell you!
10. Get your chiropractic examination periodically to detect any minor problems before they become major.

1. Drink 100 oz of water per day to flush out your system.  Poisons are constantly produced and they need to be flushed out.  
2. Stop eating junk food and sugary desserts.  Stick to vegetables and fruit (80% of eating regimen) and the rest broiled or baked chicken or fish.  Avoid red meat.  Read labels!!
3. Exercise for at least 30 minutes EVERY day.
4. Get plenty of rest.
5. The main goal in life should be your health.  If you are not healthy, you can't help others.  Prevention is the key to health.  What most people do is neglect themselves for 30-40-50 years, then they develop health problems, have to take medication which can result in side effects and make issues worse.  The health problems become chronic and they eventually regret that they didn't take better care of themselves.  
6. Weight loss is not a goal.  It is only part of the journey to health.  When losing weight is the goal, it is usually unsuccessful.  95% of all people who lose weight gain it back plus 10% within two years.  Once they lose their weight goal, they stop dieting and gain it back.  This is why dieting does not work.  
7. Change your attitude.  You must decide that you are going to lead a healthy lifestyle in order to become healthy.  This includes drinking water, eating properly and exercising every single day.  
8. 100% funcitioning nervous system is so important because it is the electrical system of the body and controls all bodily funcitons.  

Risk for atrial fibrillation was especially elevated among new users of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors.

Use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or selective cyclooxygenase (COX)-2 inhibitors has been associated with elevated risk for chronic atrial fibrillation (Arch Intern Med 2010; 170:1450). In this population-based case-control study from Denmark, investigators assessed risk for atrial fibrillation (AF) or flutter associated with these drugs.

After adjustments for multiple variables including AF risk factors, NSAID or COX-2 inhibitor use was associated with significantly elevated risk for AF . Results were similar for individual NSAIDs and COX-2 inhibitors such as Celebrex and Vioxx.  

Comment:In this study, NSAIDs and COX-2 inhibitors were associated with elevated risk for AF, especially among new users. As an editorialist noted, these findings have important public health implications because these drugs are used widely and because AF prevalence increases with age. Although the results could be influenced by confounding (e.g., the investigators lacked body-mass index data; obesity is strongly associated with arthritis — a common indication for these drugs — and a risk factor for AF), the findings are plausible: These drugs can exacerbate hypertension and heart failure and, therefore, might precipitate AF or flutter.  Be very careful when taking these types of pain meds.  

In nearly 80% of U.S. hospitals, breastfeeding infants are given formula when it's not medically necessary, according to an analysis from the Center for Disease Control's  2009 Maternity Practices in Infant Nutrition and Care survey.

The biennial survey, which collects data from all U.S. facilities with maternity beds, measures whether hospitals follow the WHO/UNICEF's "Ten Steps to Successful Breastfeeding." Among the other findings, published in MMWR:

• Only 14% of hospitals have model breastfeeding policies.
• Just one third practice "rooming in," where babies stay in their mothers' rooms rather than the hospital nursery.
• In almost three quarters of hospitals, mothers do not get the necessary support at discharge to continue breastfeeding (e.g., referral to lactation consultants).

The CDC advises providers to take several steps, including:

• Learn to educate mothers on breastfeeding at prenatal visits.
• Support breastfeeding after delivery until breastfeeding stops.
• Include breastfeeding experts on patient care teams.

Editor's note: One would expect the reverse statistics in the year 2011 particularly after the hundreds of studies that have clearly proven the overwhelming benefits of breast feeding.  

Symptoms And Your Health –Why Are You Waiting For Them?

Dr. Arthur Barsky, associate professor of psychiatry at Harvard Medical School, believes that some people are more sensitive to bodily sensations and have a lower tolerance for pain. "Symptoms are a general barometer of how you feel psychologically and much less so medically," Barsky said.

“Despite the existing medical establishment who would have you believe that you should always be battling one health problem or another in order to buy their drugs and line their pockets, the truth is, your body is designed to maintain the ideal you. To provide you optimal energy, to heal you when you are sick or injured, and to live a long and satisfying life.”

According to physician, Dr. Joe Mercola

• Structure determines function
• Body structure affects health
• Understanding body structure will result in a better understanding of our overall health

This is almost a direct quote from Hippocretes.  Chiropractors have been teaching their patients for over 110 years that:

* The body is a self-healing, self regulating organism -  with the nervous system functioning as the master control system of the body.

* If the nervous system is compromised in any way (interfered with) the body cannot function normally – Only then do symptoms develop.

Try Chiropractic To GET And STAY Healthy!

Prenatal BPA Exposure Tied to Behavioral and Emotional Problems in 3-Year-Old Girls

You all must know that the bisphenol A (BPA) in plastics can cause cancer.  When you drink out of the softer plastic bottles (the ones with a 7 on the bottom), the BPA has been found to leach off the bottles and into the liquids.  This increases the risk for a number of different types of cancer.  A new study published in the journal, Pediatrics, shows a relationship between prenatal exposure to BPA and increased behavioral problem risk in girls.  

Prenatal exposure to bisphenol A (BPA) — found in many consumer products (e.g., certain food and beverage containers) — is associated with neurobehavioral problems in girls at age 3 years, according to a prospective study in Pediatrics.

The study included some 240 mother-infant pairs from the Cincinnati area. Urine BPA concentrations were measured in the mothers during pregnancy and in the children during the first 3 years of life. Children's behavior and executive function were assessed at age 3 years with parental surveys.

Each 10-fold increase in gestational BPA concentration was associated with poorer scores for anxiety, hyperactivity, depression, emotional control, and inhibition among 3-year-old girls (but not boys). Childhood BPA concentrations were not related to neurobehavioral outcomes.

The researchers say that although the clinical relevance of their results "is unclear at this point ... clinicians can advise concerned patients to reduce their [BPA] exposure ... by avoiding canned and packaged foods, [thermal] receipts, and polycarbonate bottles with the recycling symbol 7."

 Symptoms And Your Health –Why Are You Waiting For Them?

Dr. Arthur Barsky, associate professor of psychiatry at Harvard Medical School, believes that some people are more sensitive to bodily sensations and have a lower tolerance for pain. "Symptoms are a general barometer of how you feel psychologically and much less so medically," Barsky said.

“Despite the existing medical establishment who would have you believe that you should always be battling one health problem or another in order to buy their drugs and line their pockets, the truth is, your body is designed to maintain the ideal you. To provide you optimal energy, to heal you when you are sick or injured, and to live a long and satisfying life.”

Dr. Joe Mercola (physician):

• Structure determines function
• Body structure affects health
• Understanding body structure will result in a better understanding of our overall health

Please understand that the body is a self-healing, self regulating organism -  with the nervous system functioning as the master control system of the body.  If the nervous system is compromised in any way (interfered with) the body cannot function normally – Only then do symptoms develop.  Symptoms are the body's way of expressing itself....telling you that something is wrong.  If you cover them up, your problems will only get worse.  

As expected, subjects who were overweight or obese in both childhood and adulthood had significantly increased risks for type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis, compared with adults who were never obese. However, subjects who were overweight or obese in childhood and then became nonobese as adults had similar risks as those who were never obese.

Therefore, it is never too late to change your lifestyle habits.  

Compared with placebo, niacin therapy induced significant changes in LDL cholesterol, HDL cholesterol, and triglyceride levels. Nevertheless, the trial was stopped after average follow-up of 3 years when no hint of cardiovascular benefits and a trend toward more strokes with niacin were reported. The primary outcome (a composite of adverse coronary events, strokes, and revascularization) occurred in 16% of patients in each group; the incidence of stroke was 1.7% with niacin and 1.1% with placebo (P=0.09).

Comment: These results — are straightforward: Extended-release niacin doesn't benefit patients with known cardiovascular disease who achieve low LDL cholesterol levels with statin monotherapy (the average LDL cholesterol level in this study's statin-plus-placebo group was about 70 mg/dL). Note that this study was purely a secondary prevention trial; we also have no evidence that niacin improves outcomes in contemporary primary prevention.  One can also question from this study whether lowering LDL, increasing HDL, lowering cholesterol and triglycerides all reduce cardiovascular disease.

This is why we cannot place so much importance on just one study.  They need to be repeated and the variables need to be reduced so that whatever is being tested is what affects the results.  However sometimes there are variables that cannot be controlled which results in uncertainties.  No one is infurring that niacin supplements should be discontinued.  The need for additional studies is evident at this point in time.  

Patients may ask about a study suggesting that eating canned soup leads to spikes in urinary excretion of bisphenol A (BPA), a chemical found in the linings of many canned goods and plastics.  This is why you should never reuse plastic water bottles and why I store water in glass bottles.   The small randomized crossover trial was reported in a research letter in JAMA.

Some 75 adults ate 12 ounces of either fresh or canned soup for 5 days, and then crossed over to the other soup for another 5 days. Urine samples, collected on days 4 and 5 of each phase, were positive for BPA in 77% of participants after eating fresh soup and in 100% after eating canned soup. Average urinary BPA concentration was roughly 23 μg/L higher after consuming canned versus fresh soup.

The authors note that elevated urinary BPA concentrations have previously been linked to cardiovascular disease and diabetes, and conclude that the increase observed here "may be important."

A few medications — including warfarin, insulins, oral antiplatelet agents, and oral hypoglycemic agents — cause most of the problems that lead to emergency hospitalization in older patients.

So what does one do with this information?  Stop taking the meds?  No, of course not.  Warfarin is coumadin, an anti-coagulant, given to patients who had strokes or heart attacks.  Obviously insulin is used for certain cases of diabetes.  You can't stop these medications, but you can do everything possible to get as healthy as you can by eating fruits and vegetables, avoiding fried foods, red meat, and refined foods.  Of course, exercise should be a major priority in your life.  Speak to your doctor about these options.  As I always say, prevention is much easier than treatment.  For those of you who are not on medication, adopt a healthy lifestyle now before you develp problems that will require the use of medications. Chiropractic patients have a distinct advantage over those who have never been to a chiropractor.  They are exposed to healthy living and taught the specific things they can do to improve their health.  Whether they choose to make the effort is their choice.  

What levels are truly dangerous?  Also although 22 ppm is considered safe, how about if you drink much more than the average person?  How about if you drink a variety of different drinks and canned foods containing arsenic?  These are some very good questions to consider while being concerned about so many other dangers that we face in our lives.  

My lesson is to do as much as i possibly can to reduce the toxins in my life, but understand that I can't eliminate them all.  From the air we breathe to the carpeting we walk on to the funiture we sit on, to the clothes we wear and the food we eat, we can try to be perfect, but we just can't eliminate every possible toxin out there.  It is sad, but there are things out of our control.  The more we do, the healthier we will be and the greater chance of maintaining our health.  

Pediatric ambulatory care visits in the U.S. frequently lead to antibiotic prescriptions for conditions in which they are not clearly indicated, according to a Pediatrics study.

Researchers examined nationally representative data from more than 60,000 pediatric ambulatory visits for the years 2006 through 2008. Among the findings:

• Antibiotics were prescribed in roughly 20% of the visits.
• Broad-spectrum antibiotics were prescribed in about half the visits that resulted in antibiotic prescriptions.
• Roughly a quarter of visits resulting in antibiotics were for acute respiratory tract infections in which antibiotics are not clearly indicated.
• Factors increasing the likelihood of broad-spectrum prescriptions included the use of private health insurance and geographic variation (with the highest risk rates in the South).  
•  Please, before giving your child antibiotics, have a serious talk with your pediatrician to be sure that you are treating bacteria and that the bacteria cannot be handled naturally by the immune system.  
• Remember, antibiotics are worthless against viruses.  

Among the findings:

• Maintaining or improving cardiorespiratory fitness between the two exams conferred lower mortality risk, even after controlling for BMI changes.
• For each 1-MET increase in fitness, the risks for all-cause and CVD mortality dropped by 15% and 19%, respectively.
• BMI changes did not independently predict mortality.

The authors conclude: "The long-term effect of fitness change, primarily resulting from increasing physical activity, is likely to be at least as important as weight loss for reducing premature mortality."

Pediatric ambulatory care visits in the U.S. frequently lead to antibiotic prescriptions for conditions in which they are not clearly indicated, according to a Pediatrics study.

Researchers examined nationally representative data from more than 60,000 pediatric ambulatory visits for the years 2006 through 2008. Among the findings:

• Antibiotics were prescribed in roughly 20% of the visits.
• Broad-spectrum antibiotics were prescribed in about half the visits that resulted in antibiotic prescriptions.
• Roughly a quarter of visits resulting in antibiotics were for acute respiratory tract infections in which antibiotics are not clearly indicated.
• Factors increasing the likelihood of broad-spectrum prescriptions included the use of private health insurance and geographic variation (with the highest risk rates in the South).  
• Speak to your doctor before giving antibotics to your child.

Compared with other smoking-cessation treatments, the risk for suicidal behavior or depression was markedly increased with varenicline.

The FDA is investigating serious bleeding events with the anticoagulant dabigatran (marketed as Pradaxa) but maintains that for now, the drug's benefits "continue to exceed the potential risks" when it is used according to the prescribing information.

The agency says that while "even fatal" bleeding events have been reported since dabigatran was approved for reducing risks for stroke in patients with nonvalvular atrial fibrillation, it remains to be seen whether the rate is higher than would be expected.

Providers should continue prescribing the drug according to its approved label, the FDA says.Coming soon.

Comment: Why does the FDA continue to approve drugs, then find problems with them after they are on the market and result in either health issues or death?

Doctors Rate Best & Worst Payers

• Survey fielded to 307,000 US physicians

• Total respondents: 10,214 US physicians

• United States was divided into 9 geographic regions to account for differing insurance companies by region

• Fieldwork conducted by Medscape from 9/23/11 to 11/7/11

• Data collected via third-party online survey collection site

Picking a favorite insurer is not easy when so many physicians told us they find almost all payers to be problematic at times. Still, a number of factors make some insurers rise above the others. The nation's largest insurers scored highest. That "honor" is somewhat mitigated, however, because the same companies also show up on physicians' worst insurer list. A Blues plan was named one of the best and is a major payer in nearly all geographic regions. Of those physicians who named a favorite, 29% say a Blues plan is their best insurer.  Three in 10 physicians said they do not know which plan is best. Many doctors are employees and earn a straight salary or work in practices where administrative staff handle most insurance issues.

Blues plans scored the highest in every one of the 32 specialties surveyed. This ranged from 36% of pulmonary medicine specialists to 14% of HIV/AIDS specialists choosing Blues plans as the best payers. Primary care physicians also said Blues plans were their best insurers: 29% of family physicians and internists said a Blues plan is their choice for best insurer. United Healthcare was the number-2 choice of family physicians (9%), internists (10%), and obstetrician/gynecologists (11%), whereas Aetna was the second choice among pediatricians (10%).

Aetna was also the number-2 choice of gastroenterologists (15%), general surgeons (11%), ophthalmologists (10%), orthopaedic surgeons (8%), plastic surgeons (11%), and urologists (13%).

Medscape asked, "What factors were the most important to your having a positive opinion of an insurer?" Clearly, physicians focus on the financial bottom line when evaluating insurers. A majority of physicians (54%) said amount of payment is the most important factor in having a positive opinion about a health plan. However, "easy to do business with" and "frequency of denials" also were important to more than a quarter of physicians.

Insurers often talk about being easy to do business with, having fewer claims denials, and paying more quickly. Approximately 15% of physicians said the top factor is whether the insurer is easy to do business with, whereas 13% ranked frequency of denials as being crucial. Physicians are willing to wait a little longer for reimbursement if the reimbursement is higher.

Nationwide, respondents noted that Blues plans pay noticeably faster than all other insurers. One in 5 doctors said a Blues plan was the speediest payer. In second position -- but significantly lower -- were United Healthcare and Aetna at 7%. On a regional basis, physicians in the Northwest (18%) said Absolute Total Care is the fastest payer followed by Humana at 7%.

Physicians in the South Central, Southeast, Southwest, and the West listed Humana as number 1 for quick reimbursements. One quarter of doctors cited a smaller regional insurer as the speediest payer. Four in 10 doctors nationwide said they do not know which insurer is best. That is likely because many physicians are either employed or work in practices where the administrative staff handle insurance matters.

Doctors considered not only their current insurers, but also those they previously participated with. United Healthcare had the dubious distinction of being voted the worst insurer nationwide in the eyes of the highest percentage of physicians (14%), followed by Blues plans (10%), Aetna (8%), and Cigna and Humana (both at 6%). These plans also ranked highest as best insurers by a plurality of physicians. That is not necessarily contradictory because the major payers are most likely to win praise and complaints as a result of the volume of their dealings with doctors.

There was less fervor to name some insurers as the worst than there was enthusiasm to name them the best. For example, the Blues plans got 28% of votes for best insurer but only 10% of votes for worst.

Almost 90% of the more than 4700 responses were negative about insurers, ranging from mild frustration to fury, mostly about denials of payment and difficulty getting straight answers from health plans.  Therefore please understand that although BC was rated "best", it was not necessarily rated a good insurance.  This is all relatively speaking which makes makes a huge difference.  

FDA says this dose should only be used by patients who have been taking it for 12 months or longer without ill effect.

“Our overall goal is to get doctors to not start patients on 80 mg of simvastatin,” says Eric Colman, M.D., deputy director of FDA’s Division of Metabolism and Endocrinology Products.

And if health care professionals find that patients now taking 40 mg of simvastatin aren’t meeting their LDL cholesterol goal, FDA is advising them to choose a different statin rather than raising the simvastatin dose to 80 mg, says Amy Egan, M.D., deputy director for safety in the FDA division.  

This was posted June 8, 2011 on the FDA website.  

I am going to conclude with one question.  Would you rather take a drug or a combination of drugs to allow you to eat artery clogging foods, but subject you to known and unknown dangerous side effects or eat a primarily fruit and vegetable diet with chicken and fish?  Why not take the drugs when they are absolutely necessary?

David Spodick, MD, professor of medicine at the University of Massachusetts, has stated: "Surgery is the sacred cow of our health-care system and surgeons are the sacred cowboys who milk it."³³ Indeed, spine surgery has become the cash cow in the medical world and will only grow larger unless sensibility prevails over profiteering.

In reality, doctors and hospitals are making huge profits off the backs of unsuspecting patients who are not told there may be better and cheaper ways to solve their back pain with chiropractic care or other non-invasive methods. The costs of back surgeries are among the most expensive, and these costs do not include hospitalization, imaging, drugs or medications:³⁴

• Anterior cervical fusion: $44,000
• Cervical fusion: $19,850
• Decompression back surgery: $24,000
• Lumbar laminectomy: $18,000
• Lumbar spinal fusion: $34,500

Deyo found that the mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former to $80,888 for the latter.³⁵ When combined with surgical costs, medications, MRIs, rehab, and disability, every spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion, and for a cervical fusion as high as $112,480.³⁶

Research suggests that of the 500,000-plus disk surgeries performed annually, as many as 90 percent are unnecessary and ineffective.³⁷ This is unsustainable, and yet growing at incredible rates. Deyo noted, "It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just six years," and he mentioned one strong motivation included "financial incentives involving both surgeons and hospitals."³⁸

In the current era of evidence-based medicine, it is difficult to understand the huge increase in spine fusions considering their high costs, poor outcomes and increased disability costs. Indeed, it certainly appears we have now entered into the era of economic-based medicine instead of evidence-based. Despite the huge increase in numbers and costs for spine surgery, the evidence shows this has been a waste.

In 2010, 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 the hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.³⁹

After two years, only 26 percent of those who had surgery returned to work compared to 67 percent of patients who did not have surgery. Of the lumbar fusion subjects, 36 percent had complications and the reoperation rate was 27 percent for surgical patients. Permanent disability rates were 11 percent for cases and 2 percent for nonoperative controls. In what might be the most troubling finding, researchers determined that there was a 41 percent increase in the use of painkillers, with 76 percent of cases continuing opioid use after surgery. Seventeen surgical patients died by the end of the study.⁴⁰

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs do not work, according to the study's lead author, Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. His study concluded: "Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a Workers' Compensation setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor return to work status."⁴¹

Commenting on spine surgery, Nguyen said, "The outcomes of this procedure for degenerative disc disease and disc herniation make it an unfortunate treatment choice."⁴² According to the editors of The Back Letter, a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C., "This form of surgery in workers' compensation subjects appears to be a gamble at best."

Deyo admitted to The New York Times that the spine profession is ignoring the call for restraint on drugs, shots and back surgery. "People say, 'I'm not going to put up with it,' and we in the medical profession have turned to ever more aggressive medication, narcotic medication, and more invasive surgery."⁴³

In his 2009 article, "Overtreating Chronic Back Pain: Time to Back Off?" Dr. Deyo speaks of the shortcomings of the medical spine treatments in the U.S.:⁴⁴

"Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction.

"Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels."

Dr. Deyo is not alone in his call for reform in spine care. The editors of The Back Letter agreed with his frustration with the medical approach:^45-46

The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate ... There is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedical screws to fusion cages to artificial discs –there is little evidence that patient outcomes have improved ... Many would like to see an entirely new research effort in this area, to see whether degenerative disc disease and/or discogenic pain are actually diagnosable and treatable conditions. (Emphasis added)

Another study conducted by Deyo and Cherkin in 1994 compared international rates of back surgeries and found the startling fact that the rate of American surgery is unusually excessive and directly attributed to the supply of spine surgeons:⁴⁷

"The rate of back surgery in the United States was at least 40% higher than any other country and was more than five-times those in England and Scotland. Back surgery rates increased almost linearly with the per capita supply of orthopedic and neurosurgeons in that country." (Emphasis added)

"While many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating," says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. "It's a case of, if you have a hammer, everything looks like a nail."⁴⁸

And be certain that spine surgeons have been nailing patients for decades. Not only have spine surgeries skyrocketed, so have emerging treatments that have also not proven effective, although very profitable – the increased use of opioids and epidural steroid injections.

The recent growth in "pain management" clinics featuring epidural steroid injections (ESI) has received troubling criticism from medical experts like Robert J. Barth, a neuropsychologist, who believes these ESI treatments "reliably fail, the treatments seems to lead to a progressive worsening of the claimant's presentation, the ineffective treatment never ends, and the original treating doctors refer the claimants into pain management simple as a means of escaping from or 'dumping' a problematic patient."⁴⁹

Barth believes "pain management does not accomplish anything but getting the patient addicted." He concludes that the "pain management situation in the U.S. is, indeed, horrific."⁵⁰Nonetheless, it is among the fastest growing segments in medicine today.

A similar review of pain management via ESI was regarded as "goofy" by R. Norman Harden, MD, in the American Pain Society Bulletin:⁵¹

"We practice at a time when unproven experimental, invasive, and expensive procedures are often compensated without question. Many of the surgical and interventional techniques have never been subjected to evidence based inquiry. Oddly, the FDA approves devices and procedures relatively easily ... in this context, there has been a proliferation of extremely goofy therapies, which are expensive at best, and downright dangerous at worst."

Another criticism of ESI appeared in the American Pain Society Bulletin by Steven H. Sanders, PhD, who revealed nerve blocks for back pain are not supported by scientific research: "From the current review, we must conclude injections and nerve blocks produce a large amount of money with very little science to support their application."⁵²

Not only have epidural injections come under criticism; so has the widespread use of opioids in the long-term treatment of back pain. "There is increasing recognition that this massive treatment movement may have been a mistake," opined the editors of The Back Letter. "The proven benefits of opioids do not extend to the long-term treatment of chronic pain ... Editorials and commentaries in medical journals are starting to pose the question, 'How could this have happened?'"⁵³

A new study on opioid use from Denmark reveals more disturbing news. Although proponents of opioid drugs speculate they provide significant pain relief, improve function, and enhance quality of life over the long term, a new study by Per Sjogren, MD, and colleagues refutes this claim. They found the use of opioids was associated with inadequate pain relief, poor quality of life, long-term unemployment, and high levels of medical care-seeking.⁵⁴

"Furthermore, the results indicated that individuals with chronic pain using strong opioids had a higher risk of death than individuals without chronic pain," according to Sjogren."⁵⁵

Chiropractic: The Best Buy

Not only can most medical spine treatments be avoided, but they also must be reigned in if America hopes to reduce its health-care spending crisis. This problem has become more apparent after research found that the Fortune 500 companies spent over $500 million a year on avoidable back surgeries for their workers and lost as much as $1.5 billion in indirect costs associated with these procedures in the form of missed work and lost productivity, according to a two-year study by Consumer's Medical Resource (CMR).⁵⁶

This CMR study, "Back Surgery: A Costly Fortune 500 Burden," found one out of three workers recommended for back surgery said they avoided an unnecessary procedure after being given independent, high-quality medical research on their diagnosed condition and treatment options. In addition, those patients who refused surgery and opted for alternative and less invasive procedures to treat their back pain reported healthier and more personally satisfying outcomes.

As the TRICARE study found, patients are more satisfied with chiropractic care than medical care treatments for low back pain. T.W. Meade, MD, of the Wolfson Institute of Preventive Medicine, London, England, surveyed patients three years after treatment and found that "significantly more of those patients who were treated by chiropractic expressed satisfaction with their outcome at three years than those treated in hospitals – 84.7 percent vs. 65.5 percent."⁵⁷

A recent comparative study of back pain treatments by Antonio P. Legorreta, MD, MPH, et al., "found cost savings relating to chiropractic treatment of common complaints such as neck and back pain. Focusing on low back pain diagnoses that were selected specifically for comparability between medical and chiropractic practice, our analysis found that patients with chiropractic coverage had significantly lower rates of use of resource-intensive technologies, such as x-ray examinations, MR image, and surgery, and lower use of more expensive patient care settings, such as inpatient care. This is reflected in the significantly lower cost, at both the episode level and the patient level, of providing care for back pain."⁵⁸

Another study by Niteesh Choudhry, MD, PhD, from Harvard Medical School and Arnold Milstein, MD, from Mercer Health and Benefits consulting firm, also found, in terms of clinical and cost effectiveness, that "chiropractic physician care for low back and neck pain is highly cost-effective,represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds."⁵⁹

Not only is manual therapy more clinically effective, another large study shows it is also less costly than medical care. A study published in 2010 revealed data over a two-year span from 85,000 Blue Cross Blue Shield beneficiaries with low back pain in Tennessee. The patients had open access to MDs and DCs through self-referral, and there were no limits applied to the number of visits allowed and no differences in co-pays. Results show that paid costs for episodes of care initiated by a chiropractor were almost 40 percent less than care initiated through an MD. They estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee.⁶⁰

Not only are these spine surgeries very expensive and in many cases unnecessary; the latest research has shown that chiropractic care is more effective and less expensive. However, the medical profession has ignored this call for restraint and in many cases, continues its boycott of chiropractic care despite the evidence. Indeed, it appears to be a case of "don't confuse us with the facts."

Editor's note: Part 1 of this article appeared in the March 26 issue; part 3 will appear in the next (April 22) issue.

References

35. "New Study Demonstrates a Three-Fold Increase in Life-Threatening Complications With Complex Surgery." The Back Letter, June 2010;25(6):66.

36. Schlapia A, Eland J. "Multiple Back Surgeries and People Still Hurt." April 22, 2003.

37. Finneson BF. A lumbar disk surgery predictive score card: a retrospective evaluation." Spine, 1979:141-144.

38. Ibid.

39. Carroll L. "Back Surgery May Backfire on Patients in Pain." MSNBC.com, Oct. 14, 2010.

40. Nguyen TH, Randolph, DC, et al. Long-term outcomes of lumbar fusion among workers' compensation subjects: an historical cohort study. Spine, Feb. 15, 2011;36(4):320-331.

Most enlightened health care professionals are familiar with the experimental and preclinical studies showing that antioxidants quench and neutralize free radicals. Free radicals are unstable compounds that have been shown to damage DNA and increase risk of genetic mutations that can lead to cancer. Human clinical trials have also shown that antioxidant supplements can improve immune function in older individuals.

Immune function is an important part of cancer prevention, as various immune cells either directly kill emerging cancer cells or modulate other immune cells that destroy cancer cells or prompt cancer cells to undergo apoptosis (programmed cell death). 

Diet, Lifestyle and Cancer

There is a marked overall difference in total cancer incidence between developed and developing countries. Cancers of the cervix, liver, stomach and mouth are the most common cancers in developing countries. In Iran, esophageal cancer is a major concern and in Southeast Asia, naspharyngeal cancer is disproportionately high. In developed countries, lung cancer, colon cancer, breast cancer, prostate cancer and bladder cancer are the leading cancers of clinical significance. (Skin cancer has the highest incidence of all cancers, but only melanomas present significant mortality risk.) Worldwide, the incidence of colon cancer varies 20-fold (highest in the U.S.; lowest in India), and breast cancer varies seven-fold (highest in U.S. Hawaiians; lowest in Israeli non-Jews). In Europe, total cancer rates are approximately 50 percent lower in Greece compared to Germany.  Evidence that this variation in cancer incidence is primarily a result of environmental and lifestyle factors, rather than genetic factors, is derived from several lines of investigation. First, studies of migrants moving from low- to high-risk areas have shown that migrants acquire the cancer incidence rate of their new country within a relatively short period of time. For example, colon cancer incidence can increase up to 20-fold within a single generation. Rising and declining incidence of tobacco-associated lung cancer has also been shown.

Forty years ago, the incidence of colon cancer in Japan was extremely low and rare. Today, Japanese men living in Japan have colon cancer rates twice as high as seen in the United Kingdom. Clearly, there has been too little time for the Japanese gene pool to change sufficiently to account for this sudden rise in colon cancer incidence. However, the affluence witnessed in Japan after World War II brought with it significant changes in terms of dietary patterns (e.g., more meat consumption, less fiber consumption) that mirrors the dietary patterns of much of the Western world, where colon cancer is the second-leading cause of cancer death (after lung cancer). A similar transformation has occurred in Hong Kong, where rates of colon, breast, prostate, endometrium and lung cancer have gone from being among the lowest in the world to incidence rates similar to that of the United States. Again, recently acquired affluence has brought about a Westernized shift in dietary and lifestyle practices in this region.

In regard to colon cancer in Japan, experts suggest the Japanese likely had a susceptibility to colon cancer that has been unmasked in recent years by their rapidly changing dietary patterns. Additional evidence to validate the contention that diet and lifestyle factors influence cancer risk more than genetic inheritance is highlighted by the finding that there is only a 10 percent cancer correlation among identical twins, even though both twin pairs stem from the same sperm and egg cell at conception. As such, in 90 percent of cases in which one of the twin pairs develops a particular cancer, the other twin pair does not, even though they share the same genetic blueprint.

Additionally, since the 1940s, many population studies have examined the association between diet and cancer. Taken together, the evidence suggests that 32-35 percent of cancers are attributed to nutrition, although the contribution of diet to specific types of cancer varies from as little as 10 percent for lung cancer to 80-90 percent for colorectal cancers. These studies suggest that nutrition appears to account for approximately 50 percent of breast cancers and 75 percent of prostate cancers.

What is under intense investigation at this time are studies examining individual dietary nutrients to help discern which dietary factors promote cancer and which may prevent cancer. There is broad consensus at this time that factors such as obesity and alcohol consumption increase cancer risk, while consumption of fruits and vegetables reduces cancer risk. Experts also agree that cancer arises from a complex interaction of genetic factors, individual metabolic characteristics and diet.

By themselves, common gene polymorphisms (variation in gene coding from one individual to another) that regulate metabolism of food constituents and/or frequently encountered environment agents (tobacco smoke, air pollution, asbestos exposure, etc.) are unlikely to confer large cancer risks, but they might do so in individuals who smoke, drink alcohol regularly, have a particular dietary pattern or are exposed to environmental agents to which they are susceptible.

The EPIC Study

To help decipher the complex relationship between diet and cancer, the European Prospective Investigation into Cancer and Nutrition (EPIC) Study was initiated in 1992. The EPIC Study has been following over 500,000 people living in 10 European countries (Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the United Kingdom). A great deal of data including weight, height, lifestyle factors (including dietary behaviors) personal history and blood samples were collected at the beginning of the study, with periodic follow-up of these parameters collected on an ongoing basis.

In the 2011 EPIC Study update, published by Li, et al., in the European Journal of Nutrition,1 researchers showed impressive evidence for the use of antioxidant supplements in the prevention of cancer and all-cause mortality, as mentioned above. In the 2011 report, scientists based these findings on the analysis of 23,943 subjects, all free of cancer and heart disease at the start of the study.

After 11 years of monitoring, there were 1,101 deaths, of which 513 were from cancer and 264 from cardiovascular conditions. After controlling for other confounding variables, researchers noted that individuals who voluntarily started taking antioxidant supplements prior to the beginning of the study showed a significantly reduced risk of both cancer and all-cause mortality.  Researchers affiliated with the EPIC Study indicate that research such as this, which involves following a large number of subjects for many years, is the only valid method to evaluate the influence of diet, lifestyle and environmental factors on cancer risk.

The EPIC Study suggests that antioxidant supplements have the potential to help reduce the risk of cancer, heart disease and all-cause mortality. Many experimental and preclinical studies have shown impressive anti-cancer and anti-heart-disease mechanisms through which antioxidants may reduce the risk of these and other diseases.

The bottom line is that there is no downside to taking anti-oxidants and the upside is limitless.  

Urinary tract infections are common. About half of all women have had at least one. For those who have had at least 2 or more UTIs per year, low-dose antibiotics are often prescribed for prevention, but this can create strains -- usually Escherichia coli-- that are resistant to most antibiotics.

So, is a more organic treatment, such as cranberries, preferable? Cranberries have been used as the alternative treatment of choice for UTI prevention for years. Exactly how they work isn't totally clear. Cranberries contain both fructose and Type A proanthocyanadins (PACs) that prevent bacteria from attaching to the urinary tract lining. A combined look at 2 randomized control trials found that cranberry products do work better than placebo. They reduced risk of UTI recurrence by 39%.

However, unlike these studies, the one discussed in this commentary compared cranberries to an antibiotic -- trimethoprim sulfa (Bactrim^®). This was a year-long, double-blind, double-dummy, randomized, noninferiority trial of more than 200 premenopausal women with recurrent UTIs.

Patients received either trimethoprim sulfa, 480 mg once a day, or cranberry capsules, 500 mg twice a day. The PAC dose in the cranberries was 9.1 mg. Antibiotics were better at preventing urinary tract infections in the women. However, bacteria did become more resistant to trimethoprim sulfa as well as amoxicillin and ciprofloxacin. Increased bacterial resistance was not seen in the cranberry group.

Research published in the journal BMC Infectious Diseases finds that 72 mg of PACs prevent bacteria from adhering to the urinary tract lining. This is much higher than the 9.1 milligrams used in this study.^[3]

Does more cranberry equal more prevention? It might be worth another study. But in the meantime, taking cranberry pills or drinking cranberry juice can't hurt.  

The American Heart Association has released a compendium of statistics about the nation's cardiovascular health in Circulation. Among the highlights:

• In 2004, women consumed an average of 22% more calories per day than they did in 1971, and men consumed 10% more.
• A third of adults do not undertake any physical activity.
• Cardiovascular mortality fell 31% from 1998 to 2008, possibly because of improved treatment options.
• Nonetheless, one in every three U.S. deaths in 2008 could be attributed to cardiovascular disease. 
• ONE DOES NOT NEED TO BE A ROCKET SCIENTIST TO REALIZE THE PROBLEM HERE!   

Two people in Louisiana have died this year from primary amebic meningoencephalitis after using tap water to irrigate their sinuses with neti pots, prompting the state's health department to remind consumers to use only distilled, sterile, or boiled water in neti pots.

To avoid infections caused by Naegleria fowleri, the CDC also recommends thoroughly rinsing neti pots after each use and letting the devices air dry completely.

Louisiana Department of Health and Hospitals news release

A new study in Lancet obliterates that excuse.^[1] Conducted in Taiwan, the study followed more than 400,000 people for more than 8 years. Participants kept exercise diaries and self-reported weekly exercise as inactive, low, medium, high, or very high. It turns out that even the low average, which was 15 minutes of exercise a day, reduced mortality, with a 10% decrease in cancer death, 14% decrease in death overall, and an average increase of 3 years of life. Whereas even a low amount of exercise is good, more is better. Each additional 15 minutes of daily exercise -- half an hour total -- produced an additional 1% decrease in cancer death and an additional 4% decreased risk for death overall. Participants who could not find 15 minutes to spare and did not exercise at all had a 17% higher death risk compared with even the low exercise group.

This is an observational study, but its bottom line is that just 15 minutes a day -- 105 minutes a week -- of moderate-intensity physical activity is all it takes to reap major benefits. A little bit of exercise can do a lot of good, and some is always better than none.

Don't have the time?  17% lower death risk not enough to find the time?

A study in the journal Tobacco Control casting doubt on the effectiveness of nicotine replacement therapy has garnered widespread media attention.

Over several years, researchers followed some 800 smokers after they quit. By 2 years, relapse rates were the same among people who had and had not used nicotine replacement (with or without counseling), according to news reports. At 4 years, two thirds of participants were smoking again.

The therapies were the centerpiece of a state-sponsored program to encourage quitting in Massachusetts, but, according to a study coauthor quoted in the Boston Globe, "what we found is that they have absolutely no effect." The New York Times quotes another of the study's authors as observing that "what happens in the real world is very different" from what happens in clinical trials.

In patients with lumbosacral radiculopathy, MRI might not affect outcomes substantially, but it can aid planning of injections.

Exhaustive data from the past decade suggest that runners with no preexisting heart disease have little cause for anxiety.

For the past couple of years, I have expressed that the latest research demonstrates the importance of Vitamin D and how it affects your overall health and not just the strength of bones.  Here is a study that possibly relates it to multiple sclerosis.  

Mutations that lead to altered vitamin D activation are identified as rare variants in familial MS.

Drug companies may soon have to reveal payments made to doctors for research, drug promotion, and other activities, according to an article in the New York Times.

The measure is part of the Affordable Care Act and is designed to deter conflicts of interest. If a firm's product is covered by Medicare or Medicaid, it will need to disclose all money paid to physicians who are not company employees. Such payments include those given for product development and promotion, food or gifts delivered by a pharmaceutical representative, royalties for discoveries, and payments to teaching hospitals. The data will be posted on a public website.

The public can comment on the proposed rules until February 17, after which Medicare will issue a final regulation.

Comment: This is long overdue.  There are physicians who are paid to lecture to other physicians about new drugs.  Many physicians are given gifts, lunches, dinners for the purpose of promoting drugs.  These relationships need to be disclosed to patients, who then have the right to ask why they are being prescribed certain drugs over others.  Is there a conflict of interest?  Probably in the majority of cases, no.  But there may be some cases where the physicians are "pressured" into prescribing certain drugs or feel obligated to do so.  Do they want to bite off the hand that feeds them?

Screening for carotid atherosclerosis does not improve smoking cessation rates or control of cardiovascular risk factors, according to an Archives of Internal Medicine study.

Some 540 smokers were randomized to either ultrasonographic carotid screening or no screening, with all participants also undergoing a year-long smoking cessation program that included counseling and nicotine replacement therapy. Patients with atherosclerosis identified on screening were given pictures of their plaque plus additional counseling.

At 1 year, there were no significant differences between the groups in smoking cessation rates, control of cardiovascular risk factors, or changes in Framingham risk scores.  Commenting on the study's findings, an editorialist urges physicians to focus on improving their relationships with patients — instead of using "simple pictures" — when attempting to motivate them to change their lifestyles.

Comment: I am sorry, but I am not shocked by these results.  If heart attack victims who are lucky to survive, only make lifestyle changes for several months following their heart attacks, reverting back to their old habits once the scare wears off, then why would smokers stop smoking when they see plaque clogging up their carotid arteries thereby increasing their chances of suffering a stroke?

Archives of Internal Medicine article (Free)

If people want to live a long high quality healthy life, they need to reflect that goal in their lifestyle: 

1. No smoking; no chemicals.

2. Exercise every day

3. Make organic fruit and veggies 80% of their food consumption.

4. Eliminat junk food and sugary desserts.

5. Improve nervous system and immune system function.  

Exposure to perfluorinated compounds (PFCs) is associated with reduced antibody responses to childhood immunizations, according to a JAMA study. (PFCs are widely used in manufacturing and food packaging and can contaminate food and water.)

The study included some 600 children living on the Faroe Islands. Researchers measured maternal serum concentrations of PFCs during pregnancy, as well as concentrations in the children at age 5 years, before their tetanus and diphtheria booster. Antibody responses to tetanus and diphtheria were measured before the booster and 2 years afterward.

Increased maternal PFC concentrations were associated with reduced antibody levels in the children at age 5. Similarly, increased serum PFCs at age 5 were linked to reduced antibody responses at age 7.

The authors conclude: "These results indicate that PFC exposures at commonly prevalent serum concentrations are associated with lower antibody responses ... and an increased risk of antibody concentrations below the level needed to provide long-term protection." They add that the findings "may reflect a more general immune system deficit."

JAMA article (Free abstract)

Comment: What I take from this study is that we can't measure the effects chemicals in our lives (whether taken in medication form, consumed in our food, or inhaled in the air we breathe) have on our health.  In this case, the effect on our immune system.  The more you can do to reduce chemicals in your life, the healthier you will be.  You can't eliminate all chemicals because there are things you can't control, but certainly the less the better!  See my previous blog

A systolic blood pressure difference of 15 mm Hg or more between a patient's arms is associated with increased risks for peripheral vascular disease and mortality, according to a Lancet meta-analysis.

The analysis included 20 studies, most involving patients at high cardiovascular risk. Overall, a between-arm difference in systolic BP of 10–15 mm Hg or more was associated with an increased likelihood of peripheral vascular disease (risk ratio, nearly 2.5). A difference of 15 mm Hg or more was also associated with a heightened likelihood of cerebrovascular disease and cardiovascular and all-cause mortality.

The researchers say between-arm BP differences "might help to identify patients who need further vascular assessment." Commentators point out numerous limitations (e.g., many studies were cross-sectional), but conclude that the analysis "supports existing guidelines stating that blood pressure should be measured in both arms. Ascertainment of differences should become part of routine care, as opposed to a guideline recommendation that is mostly ignored."

Comment: When I was in school and even very recently, we were taught that the pressure taken in the left arm would always be 10mm higher than the right because the heart was on the left and therefore closer to the cuff.  It certainly doesn't hurt to ask your doctor to take it bilaterally. 

Infection and even inflammation were not reliably present in the scans of patients with classic sinusitis symptoms.

In a randomized trial, screening was ineffective.

More than 40% of sodium consumed in the U.S. comes from 10 food categories, with bread and poultry among the top 5, according to an MMWR report.

CDC researchers examined data on some 7200 U.S. individuals aged 2 years and older who completed 24-hour dietary recalls as part of the 2007–2008 National Health and Nutrition Examination Survey. Overall, the mean daily sodium consumption (excluding table salt) was 3266 mg, well above recommendations to keep intake below 2300 mg.

The top 10 food categories contributing to sodium consumption were, in descending order: bread and rolls, cold cuts, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes, and savory snacks. Two thirds of sodium came from foods purchased at stores; the rest came from restaurants, cafeterias, and other sources.

Interesting study, but we need more specifics.  Where did the bread and poultry come from?  Did the they come from fast food restaurants?  What was added to the bread?

Amoxicillin doesn't ameliorate the severity of acute, uncomplicated bacterial rhinosinusitis any better than placebo, according to a JAMA study.

Some 160 patients with clinically confirmed disease (purulent nasal discharge and maxillary pain or facial tenderness) were randomized to receive either 1500 mg/day of amoxicillin or placebo for 10 days. In addition, all received a supply of symptomatic treatments (e.g., acetaminophen) for use as needed.

Patients' assessment of improvement in 16 sinus-related symptoms did not differ between groups at day 3 or at day 10. (While symptom scores did favor antibiotics at day 7, the authors judge the difference to be "too small to represent any clinically important change.")

In his Journal Watch HIV and ID Observations blog, Dr. Paul Sax says the study reminds us that "most of the common community-acquired infections resolve spontaneously."

JAMA article (Free abstract)

The American Heart Association has released a "call-to-action" to raise awareness of the burden of peripheral artery disease (PAD) in U.S. women.

Published in Circulation, the statement emphasizes the dearth of research on PAD in women, but notes the following based on existing data:

• Women have at least as many PAD-related physician visits as men.
• Like men, most women with PAD do not present with "classic symptoms" of intermittent claudication; rather, many are asymptomatic or have atypical leg symptoms.
• Women face greater risk for graft failure and limb loss than men.

In addition, the statement advises primary care clinicians to use ankle-brachial index measurements to identify women who have PAD or who are at high risk for it.

AHA statement in Circulation (Free)

I know this is going to come as a shock, but  people who meet more of the healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes, according to a Journal of the Americian Medical Association study.

Researchers used NHANES surveys and physical exams of 13,000 people to study the prevalence of seven ideal cardiovascular health factors promoted by the AHA, including:

• not smoking;
• moderate exercise at least 5 times a week;
• untreated blood pressure under 120/80;
• HbA1_c under 5.7%;
• total cholesterol under 200 mg/dL;
• BMI less than 25;
• a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages.

What is sad is that Less than 2% of people reached all seven ideals. Over a 15-year median follow-up, the proportion meeting zero or one goal increased from 7.2% to 8.8%. Those who met six or seven goals had reduced risks for all-cause mortality (adjusted hazard ratio, 0.49), compared with participants meeting zero or one goal.

Improvements in one measure somewhat — but not completely — offset deteriorations in the other.

Systematically asking primary care patients to report such histories substantially increased the percentage identified as having high CV risk.

This finding was particularly marked in Asian populations.

• Approximately 33% of physicians did not completely agree with disclosing serious medical errors to patients.
• Almost 20% did not completely agree that physicians should never tell a patient something untrue
• Just over 10% said they had told a patient something untrue over the past year.
• 20% said they had not fully disclosed a medical mistake to patient in the past year for fear of getting sued.  
• Nearly 40% did not completely agree that they should disclose their financial relationships with drug and device companies to patients.

Comment: I personally find these results shocking.  I always felt that most doctors are honest with high integrity and truly want to help their patients.  Looks like ego and fear are standing in the way of some of them.  There was an article authored by a medical doctor about three years ago in the NY Times who worked for the drug industry giving lectures on the value of their drugs.  In the article, he noted that there are about 200,000 US physcians paid by companies to promote their drugs.  Based on the numbers from the Department of Labor, that accounts for about 30% of practicing physcians out hocking drugs.  Don't you think that should be disclosed to patients who are being prescribed certain drugs?

First-time use of oral bisphosphonates is associated with greater risk for uveitis and scleritis, (parts of the eye) according to a retrospective study in the Canadian Medical Association Journal.  Researchers assessed the health records of all patients who visited an ophthalmologist over 7 years. Nearly 11,000 filled their first prescription for oral bisphosphonates, while 920,000 did not have any recorded bisphosphonate use. Bisphosphonate users had increased risks for uveitis and scleritis, relative to nonusers. The authors estimate numbers needed to harm of 1100 for uveitis and 370 for scleritis.

They propose that patients may experience a surge of inflammatory mediators when they begin taking bisphosphonates, which may put them at greater risk for inflammatory eye diseases. They conclude that clinicians should "inform their patients about the signs and symptoms of scleritis and uveitis, so that prompt treatment may be sought and further complications averted."

Healthy behaviors are significantly associated with decreased mortality, but recent decades have seen little progress toward improving those behaviors.

Patients may ask about a widely reported study suggesting an association between frequent dental x-rays and intracranial meningioma (benign tumor). The case-control study, published in Cancer, included roughly 1400 patients with intracranial meningioma and 1350 controls matched for age, sex, and state of residence. Patients with meningioma were more than twice as likely as controls to recall ever having received bitewing dental x-rays.  Risk increased with the number of bitewings. Panoramic x-rays before age 20 were also associated with meningioma.

The authors point out that participants may have inaccurately reported their dental x-rays, thereby limiting the study's conclusions. However, they cite a recent American Dental Association statement, which "highlights the need for dentists to examine the risk/benefit ratio associated with the use of dental x-rays and confirms that there is little evidence to support the use of dental x-rays to search for hidden disease in asymptomatic patients."

The Higher the Body-Mass Index, the Higher the Risk for Adenoma

A 5-unit increase in BMI was associated with a 19% increased risk for colorectal adenoma.

An actigraphy study supports the role of activity in preventing AD.