Sunday, January 31, 2010

Editor earned more than $20m in royalties from device manufacturer

Editor earned more than $20m in royalties from device manufacturer

[I just had to post this since, I have a relative selling spinal implants for Medtronic. The funny thing is my relative is always complaining that another company, Stryker, is unethical in their research. Please try conservative chiropractic care for back and leg pain first. Widely accepted medical and chiropractic guidelines recommend spinal manipulation as the first line treatment for acute low back and leg pain.]

A medical journal editor who received millions of dollars from a medical device manufacturer wrote and edited articles favourable to the manufacturer without stating his conflicts of interest to readers.

Thomas Zdeblick, a University of Wisconsin orthopaedic surgeon who took over as editor in chief of the Journal of Spinal Disorders & Techniques in 2002, received more than $20m (12.4m; £14m) in patent royalties and $2m in consulting fees from Medtronic for spinal implants sold by the company during his tenure as editor. The amount of money Dr Zdeblick received became public in January 2009 as a result of an investigation into spinal device products launched by the US senator Charles Grassley (

Now a Milwaukee, Wisconsin, newspaper, the Journal Sentinel, has conducted a review of all articles published by the medical journal during Dr Zdeblick’s tenure as editor in chief

Parents' perceptions of their child’s competence linked to physical activity

Parents' perceptions of their child’s competence linked to physical activity

[Of course we perceive our children as gifted, in the sports of bed jumping, living room basketball, and wrestling daddy DOWN!]

The study by Oregon State University researchers Stewart Trost and Paul Loprinzi, published in the journal Preventive Medicine, studied 268 children ages 2 to 5 in early childhood education centers in Queensland, Australia. Of these children, 156 parents or caregivers were surveyed on their parental practices, behaviors related to physical activity and demographic information.

What they found is that parents' level of physical activity is not directly associated with their children, but instead that the direct link was between parental support and a child's level of physical activity.

"Active parents may be more likely to have active children because they encourage that behavior through the use of support systems and opportunities for physical activity, but there is no statistical evidence that a child is active simply because they see that their parents exercise," Trost said.

Trost, who is director of the Obesity Prevention Research Core at the new Hallie Ford Center for Healthy Children and Families at OSU, is an international expert on the issue of childhood obesity.

His study found that parents who think their children have some sort of athletic ability were much more likely than other parents to provide instrumental and emotional support for young children to be physically active.

"I think this underscores the need for parents to provide emotional support, as well as opportunities for activity," Trost said. "Regardless of whether a child is athletic or is perceived to be physically gifted, all children need opportunities and encouragement of physical activity."

However, Trost said parental support of physical activity did not translate to a child's behavior once they were not in the home and were in a childcare setting. He said this adds to the body of research showing that both parents as well as childcare providers must provide support for physical activity.

Scientists find survival factor for keeping nerve cells healthy

Scientists find survival factor for keeping nerve cells healthy

[This will certainly not lead to clinically useful materials for years, if it ever does. It may be worth a read for those with Multiple Sclerosis, Alzheimers, or other motor neuron diseases.]

Inside Medicine: Samples of drugs aren't free - Sacramento Bee

Inside Medicine: Samples of drugs aren't free - Sacramento Bee

[Main points as written by the author;]
1)A huge part of pharmaceutical companies' budgets goes to promotion and advertising rather than research and development of new drugs. A large part of the drug-promotion budget goes to free drug samples given to doctors – over $15 billion a year worth at the last count.
2)What happens when the few days' worth of free samples given to a patient runs out? Studies show the doctor rarely writes a prescription for the same drug the patient has always used. Instead, since the patient started a new medicine, the doctor continues to use that expensive drug – and it is likely it's not even covered by the patient's insurance company.
3)Also, the free samples the doctor gets from the sales reps are not samples of inexpensive drugs or drugs that have been on the market for a long time and are known to be safe and effective. Rather, the samples are of the newest drugs on the block – ones that have limited safety records, are extremely expensive and are usually no better than drugs that cost one-fourth or sometimes one-tenth as much.

Friday, January 29, 2010

Physical activity associated with healthier aging: Links between exercise and cognitive function, bone density and overall health

Physical activity associated with healthier aging: Links between exercise and cognitive function, bone density and overall health

[It doesn't take a doctor, or multiple good concordant studies, to tell you that exercise provides amazing short term and long term benefits. Read the full text of this article for some serious motivation!]

"Drug marketing is a very sophisticated system which corrupts every part of the scientific and medical network,"

"Drug marketing is a very sophisticated system which corrupts every part of the scientific and medical network,"

[Yet another totally horrifying article about drug industry marketing. There is another one it seems like everyday. I don't know if I should keep posting them.]

In Pain? Early Intervention is Essential

Patient Money: Migraines Force Sufferers to Do Their Homework

“What might be a miracle drug for one person could be a dud for another,” explained Dr. Joel Saper, director of the Michigan Headache and Neurological Institute, a treatment and research center in Ann Arbor. “There is no universally effective therapy.”

If that sounds murky, one thing is not: early intervention is important. If you get a migraine every few months and can cope by taking an over-the-counter med, great — you’ve got the problem somewhat under control. But if recurring pain is not responding to your own efforts, seek expert help.

“Some early data suggests that if you let headache pain go without treatment it can lower your threshold for pain down the line,” Dr. Saper said. In other words, untreated headaches can make you more vulnerable to pain.

[This article illustrates maybe the most important concept about the development of chronic pain, that doctors know but often forget to share. Early intervention is essential. The old saying that the brain is fully formed by childhood and thats all you get is absolutely untrue. In actuality the brain can still form all types of new connections and connections that are not used become weaker. Therefore, through what's known as Neural Plasticity, the mind gets better and more efficient at something that is practiced. Constant or frequently occuring pain teaches the body to get better at experiencing pain. The small nerves that carry pain signals proliferate. One of the best ways to counteract this happening is motion. Chiropractic moves joints in a safe way near their end range. This sends floods of signals through large nerves that overpower the pain signals and diminish their importance. This is an example of an effective and safe way to prevent or improve hypersensitivity to pain.]

Thursday, January 28, 2010

Heavy Backpacks Affect Children's Spines

Heavy Backpacks Affect Children's Spines

[Whole article follows, chiropractors are experts in measuring maximum weight load for children and customizing backpack fit. Additionally, educating the kids is of huge importance, as they often further strain their spines by carrying the pack off one shoulder or not tightening straps and allowing it to hang down the body. We offer backpack safety checks in our clinic and I know other chiropractors do also]

Heavy Backpacks Affect Children's Spines
Main Category: Pediatrics / Children's Health
Also Included In: Neurology / Neuroscience; Back Pain
Article Date: 28 Jan 2010 - 3:00 PST

Heavy backpacks place a measurable strain on the spines of children, with heavier loads causing greater spinal strain and increased back pain, reports a study in the January 1 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Magnetic resonance imaging (MRI) scans show compression of the spinal discs and spinal curvature caused by typical school backpack loads in children, according to Dr. Timothy Neuschwander of University of California, San Diego, and colleagues.

Backpacks' Effects on Disc Height and Spinal Curve Linked to Back Pain

The study included eight children, mean age 11 years. A special upright MRI scanner was used to image the children's spines in standing position-first with an empty backpack, then with increasing weights of 9, 18, and 26 lb. These weights represented about 10, 20, and 30 percent of the children's body weight.

Two key spinal measurements changed as the backpack load increased. Heavier weights caused compression of the intervertebral discs, which act as a cushion between the vertebrae (bones of the spine). Especially in the lower spine, the disc height became smaller (reflecting greater disc compression) at heavier backpack weights.

Heavier loads were also associated with increased curvature of the lower spine, either to the right or the left. Half of the children had a significant spinal curve even with the 18 lb weight. Most of the children had to adjust their posture to bear the 26 lb backpack load.

As backpack weight increased, so did the amount of pain reported by the children. At the heaviest load, the average pain score was nearly five (on a ten-point scale).

More than 90 percent of U.S. children carry backpacks, typically with weights equal to 10 to 22 percent of their body weight. Parents are increasingly concerned about the heavy backpacks their children have to carry. The new study is the first to use imaging techniques to see how backpacks affect children's spines.

The results suggest that heavy backpacks cause compression of the spinal disks and increased spinal curvature, both of which are related to back pain reported by the children. Although the children were wearing the backpack straps over both shoulders when the MRI scans were performed, the researchers note that spinal curvature could be even greater if the backpack was carried over one shoulder-as many children do.

"Low back pain in children may be worsened by discogenic [disc-related] or postural changes," Dr. Neuschwander and colleagues write. This could have long-term implications, as children with back pain are at increased risk of having back pain as adults. The researchers call for similar studies to examine the effects of heavy backpacks in children with existing back pain.

About Spine

Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among subspecialty orthopedic titles. Visit the journal website at

Lead may be the culprit in ADHD / STEM for kids

Lead may be the culprit in ADHD

[Excerpt from article] ADHD, or attention-deficit/hyperactivity disorder, is among the costliest of behavioral disorders. New research suggests that the culprit may be an old villain -- lead -- and what's more it explains the causal pathway from exposure to disability

[Another article] Survey Reveals Ways to Enhance Teens' Interest in Science, Technology, Engineering and Mathematics

[I have been doing my own strange experiment on my son, or we do experiments together, which is my experiment. It is really easy to set up science experiments for kids. Like today he asked what swelling was. I told him we would see and put different types of cereal on a plate with a little water in it. Of course the cereal soaked up the water and we compared its characteristics to dry cereal and also talked about why certain cereals might swell more. Anyway, as he is only four it may take awhile to determine if these moments actually help him to excel in STEM subjects.]

ScienceDaily (Jan. 29, 2010) — The nation is hoping for a bright future. Many believe the key to strengthening the U.S. economy and competing globally lies in fostering an innovative culture and educating America's youth in science, technology, engineering and mathematics (STEM). According to this year's Lemelson-MIT Invention Index , an annual survey that gauges Americans' perceptions about invention and innovation, teens are enthusiastic about these subjects, with 77 percent interested in pursuing a STEM career.

Wednesday, January 27, 2010

Take your pills, please

Take your pills, please

[This is a fabulous product. Not that I love meds but the only thing worse than too many meds is not taking your prescriptions as directed.]

This pillbox has an embedded cellular phone that can send reminders by phone call, text message, or email. It also has lights that blink and sound alerts that beep. You can program it to send reminders in any or all of these formats -- but not just to the patient. The reminders can also go to a trusted family member and/or the provider. These can be easily programmed on the company website. You load up a month's worth of medications, and on you go. Or, if you forget to load up the medicines, you can have an alert about that.

Study: Higher Co-Pays Mean More Trips to the Hospital

Study: Higher Co-Pays Mean More Trips to the Hospital

[This study, published in the New England Journal of Medicine, looked at more than 900,000 people. Now that is a nice sample size. The conclusions are intuitive but depressing. In chiropractic care especially, we feel the primary goal of a doctor is to keep patients healthy rather than to heal them once they are hurting. That is why we provide education, rehabilitation and strengthening exercises, and maintainence wellness care. We do not want our patients getting sick, hurting themselves, and aging without vitality. Unfortunately, once again, insurers are not on our side - or yours!]

A new study in the New England Journal of Medicine has a provocative finding: Bigger co-payments for primary-care and specialty doctor visits were tied to more in-patient hospital time for elderly patients.

The implication is that people avoided the doctor’s office to save money, then ended up in the hospital when their problems weren’t detected or treated in their early stages. The apparent effect seemed stronger among people living in low-income areas, and for those with high blood pressure, diabetes or a history of heart attack, among other groups.

The bottom line was that raising co-pays “may be a self-defeating cost-containment strategy and may have adverse health consequences,” says Amal Trivedi, the study’s lead author and a professor at Brown’s Alpert Medical School.

The result is generally consistent with a number of other studies, many focused on patients’ out-of-pocket costs for drugs. They’ve linked higher co-pays to reduced use of medications, and vice versa. Here’s one of those and here’s another. Advocates of so-called value-based benefits design point to them as evidence for why insurers and employers should try to align patients’ financial incentives with the care they most need, particularly preventive treatment for chronic conditions.

Doubts Build On Glaxo's Antiaging Drugs -

Doubts Build On Glaxo's Antiaging Drugs -

GlaxoSmithKline shocked the pharmaceutical industry in 2008 when it dropped $720 million to buy Sirtris Pharmaceuticals, a biotechnology company working on drugs based on resveratrol, a chemical in red wine thought to combat the effects of aging.
The drugs are thought to enhance the activity of SIRT1, a key enzyme involved with the aging process. Glaxo hopes the drugs will lead to myriad new treatments for diabetes, cancer and other diseases.
But now researchers at rival companies are openly questioning whether the compounds will work. They say they are unable to replicate key laboratory experiments backing the drugs' promise.

[As you know my family is in the wine business so I thought this article was interesting. Reservatrol and other supposedly beneficial compounds can be found in the pomace and lees of red and white wines. You would think that Red would yield more of these compounds but studies indicate that the lees and pomace of white wines actually have more potential to be used in this sort of capacity. Of course any success of these compounds would be major for the wine industry. Currently the lees and pomace are considered waste products and just a few progressive estate wineries, meaning they have their own vineyards, compost the material and use it in fields.]

Monday, January 25, 2010

Mayo Clinic is refusing to see Medicare patients

This is a great article from the KevinMD blog. First problem - Primary Care Practitioners (PCP) can not cover their costs with Medicare, Second problem - they are not graduating enough PCP's, everyone wants to go into surgery (cosmetic, orthopedic, SPINAL) where the money is, Third problem - Medicare supplements are expensive, can force you into managed care, and they often base their pay scale off of Medicare. I guess this will result in less PCP visits for seniors and probably a continuing spike in adverse drug events and deaths.

Why the Mayo Clinic is refusing to see Medicare patients
January 25, 2010

by Toni Brayer, MD

Medicare, the government insurance company for everyone over age 65 (and for the disabled) pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70% of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for primary care physician visits. Mayo gets it. Nationwide, physicians are paid 20% less from Medicare than from private payers. If you are not paid a sustainable amount, you can’t make it up in volume. It just doesn’t pencil out.

Mayo lost $840 million last year on Medicare. Since Mayo is considered a national model for efficient health care, if they are losing money it doesn’t bode well for the rest of us who are much less efficient and who have fewer resources for integrated patient care. Instead of Medicare payments for clinic visits, Mayo will start charging patients a $2,000 fee for patients to be seen at their Glendale, Arizona clinic. Much like a “retainer”, this fee will cover an annual physical and three other doctor visits. Each patient will also be assessed a $250 annual administrative fee.

Primary care physicians are on the front line of patient care and senior patients are the most time consuming. The average Medicare patient takes 11 different medications. Just refilling and coordinating the medication can take up an entire office visit, without addressing other health concerns. I grant all Medicare patients a 1/2 hour visit because I would be chronically behind if I didn’t. After paying office overhead, I am broke with Medicare.

I do not welcome the 65th birthday of my patients, but I continue to see them because I love my senior patients. No kidding, I really love being their doctor. They are grateful and respectful and have interesting health conditions. I am able to see them because I make my income from my administrative position and I have private pay patients.

Sad but true. Unless we have true payment reform that values primary care and pays for coordination of care, I fear Medicare patients will not find enough willing physicians who accept Medicare in the future.

Poll: Coffee Lowers Brain Cancer Risk

Poll: Coffee Lowers Brain Cancer Risk

Being a major coffee drinker myself, I am loving the huge benefits they are discovering coffee conveys, like decreased diabetes risk, decreased cancer risk, and improved overall health.

Play, Then Eat: Shift May Bring Gains at School

Play, Then Eat: Shift May Bring Gains at School

I have seen this article a few times and it totally makes sense. When the kids are excited for recess they can't settle down and enjoy lunch.

Sunday, January 24, 2010

FDA Warns Drug Companies On Faulty Ads

[Please, please, please consider using conservative methods of care before going the pharmaceutical route. Especially for poorly understood issues like Fibromyalgia. These people may not have your best interests at heart]

FDA Warns Four Drug Companies Regarding Faulty Ads
The U.S. Food and Drug Administration sent warning letters to four drug companies, saying their promotional materials for four drugs make inaccurate or incomplete statements. The FDA demands Bayer, Eli Lilly (LLY), Cephalon (CEPH) and Amylin Pharmaceuticals (AMLN) stop using ads the agency says exaggerate the efficacy of a drug or downplay its risks.

The letters on Tuesday were sent to Eli Lilly regarding its ads for the antidepressant Cymbalta and to Lilly and Amylin Pharmaceuticals regarding their co-marketed diabetes drug Byetta. Cephalon got a letter regarding its lymphoma and leukemia treatment Treanda while Bayer received one for its intrauterine device (IUD) Mirena.

Drugs With Potential Adverse Effects

While in some cases the FDA may be quite picky in its scrutiny, generally these are serious drugs with potentially adverse effects that should be fully disclosed. For example, the Lilly letter notes that the print ad for Cymbalta for fibromyalgia "entirely omits risk information," while the WebMD's Little Blue Book ad minimizes risk information and overstates efficacy.

In response, Lilly said it "is committed to providing clinically accurate and balanced promotional materials to healthcare professionals and patients. We are taking immediate steps to stop using the two pieces in marketing tactics and we are reviewing all Cymbalta promotional materials."

With the diabetic drug Byetta, the ads broaden indication and promote unapproved use, the FDA says. The letter continues to note how a Lilly representative also overstated the efficacy of Byetta and "misleadingly exaggerate the weight loss demonstrated in clinical trials," while Lilly and Amylin reps state different efficacy claims.

Amylin and Lilly in response said they have "a strong track record of compliance around education and promotion of Byetta." They added they "take this letter very seriously" and that they "will take action as needed in order to ensure all product communications adhere to regulatory requirements."

Misleading Information on Cancer Drugs

Of particular concern is misleading information for cancer drugs. The lymphoma and leukemia treatment Treanda letter says that "The dosing card [a pocket-size flash card containing prescribing information doctors use] includes an extremely limited risk presentation under the header "Important safety information" (ISI) on the back cover," and "omits important material information related to the dosing claims on the front of the card."

Upon receiving the letter, Cephalon immediately informed its organization and stopped using the cards. The safety of patients is of utmost importance to Cephalon, spokesperson Jenifer Antonacci said, adding the company has initiated a review and revision of all its Treanda promotional material.

Finally, perhaps somewhat amusing, is the claim in Mirena's ad that "the use of Mirena instead of other means of contraception will result in increased levels of intimacy, romance, and by implication, emotional satisfaction." The FDA knows nothing about such effects, however, saying "These claims misleadingly overstate the proven efficacy of Mirena."

The FDA also isn't happy about the claim the IUD could help women "look and feel great." The FDA continues, in its serious, dry tone, to say it hasn't heard of "any evidence suggesting that women who are using Mirena for birth control look great or feel great." Omission and minimization of risk information, as well as out right false and misleading statements are also mentioned in the Mirena letter.

Consumers Must Be Wary Of Drug Ads

Ads for drugs are tricky. Just a day before these letters were sent, BNet wrote about the new ad from AstraZeneca (AZN) for its antipsychotic drug Seroquel, which is already being fought in court in different suit. The ad, which was likely written by lawyers, BNet quips, has five pages containing "nothing but small print, warning of the drug's side effects."

These letters represent one more example of how the FDA has been trying to increase its oversight on such matters ever since the new administration has taken over. As these four letters are just a few of the many such letters the agency has sent in the past year, it's important for consumers to still be very careful when considering drug ads.

Drug companies market and promote drugs to increase sales. They have to play a fine balancing act with relaying all the proper information a user might need. No doubt, this can lend itself to omitting more than one or two side effects while pushing the boundary of efficacy claims. Consumers need to understand that and find drug information at unbiased sources such as the FDA.

United Health Care vs. You - Reading this will make you sick

[I find this article very interesting because Swedish in seattle recently went through something very similar with United. What basically happens in these situations is that you end up not being able to use your insurance benefits at these hospitals because the hospitals won't accept the low rates and intrusion into your care decisions by the insurance company. The problem is that you lose either way. If the hospital refuses United patients, many will just choose not to get care and go home or put off a procedure = more money for United. If the hospital backs down and accepts lower rates and restrictions on patient care and procedures, you get worse care, still = more money for United. This trend is SCARY]

The article is worth reading: front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.

Dr. Gary Burke said warnings that coverage with some doctors could be cut off left some of his older patients panicked.

The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare, which includes Oxford health plans and has 25 million members across the country, one million of them in New York.

While Congress has been haggling over covering as many as 15 million uninsured Americans, the prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.

UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.

UnitedHealthcare is negotiating or imposing similar rules at hospitals across the country, and often meeting fierce opposition. Tennessee passed a law saying the penalty would not apply on weekends or federal holidays, when hospitals are short-staffed. Florida hospital officials said that the new rule could play a role in coming contract negotiations there, and that the state hospital association had asked Florida’s insurance regulators to monitor the situation.

The dispute signals a “ratcheting up” of a long tradition of insurers trying to cut costs, said Jeffrey Rubin, an economics professor at Rutgers University.

But Dr. Rubin said UnitedHealthcare’s approach is particularly aggressive and might be part of a wave of pressure insurance companies feel from employers to cut costs and to keep premiums lower to avoid penalties, like the “Cadillac tax” on expensive insurance plans.

“It’s an example of the insurance company getting between you and your doctor,” Dr. Rubin said.

Disputes between insurers and providers have flared up before, and it is rare for them to ultimately part ways. But the negotiations in New York have become especially tense. UnitedHealthcare has sent letters over the last few weeks to tens of thousands of patients, warning that they could be cut off from coverage at Continuum hospitals and affiliated doctors, and advising them to start shopping for new ones. Last year, 85,000 UnitedHealthcare customers received treatment from Continuum.

The hospital system went to court and got an injunction preventing the insurance company from cutting access to Continuum doctors until the matter could be arbitrated. And the Greater New York Hospital Association, a trade group, has complained to the state attorney general that the 50 percent penalty would be “confiscatory.” The attorney general’s office said it was reviewing the matter.

Health care analysts say that such battles could become more common if federal policy promotes competition among insurance companies, perhaps including insurance exchanges, as an important engine for driving down health care costs.

The fate of health care reform in Congress is unclear now that Democrats have lost their filibuster-proof majority in the Senate. The House and Senate have not reconciled their disparate bills, but both proposals would prevent health insurers from excluding people with pre-existing conditions, which is one way they hold down costs.

So the insurers will need to find other ways to control expenses, said Sean Cavanaugh, an analyst for the United Hospital Fund, a New York-based research institute. “That means you try to negotiate price reductions and control utilization, which is the hardest way for insurers to hold down costs,” he said.

The UnitedHealthcare-Continuum dispute may also be a sign of the times, a showdown between corporate oligopolies reminiscent of the recent fight between Time Warner Cable and the Fox Broadcasting network, only with the spoils being doctors and patients rather than cable television subscribers and “American Idol.”

UnitedHealthcare’s New York chief executive, William Golden, said in an interview that the tension had been fanned by a greedy and intransigent hospital system that had been seeking unseemly rate increases of more than 40 percent. Mr. Golden said it was the toughest negotiation he had seen in 13 years.

“This negotiation is really coming down to affordability,” Mr. Golden said. “These are kind of unique circumstances for all of us involved. It’s probably not surprising in this economic climate. There are tremendous pressures on all of us to make health care more affordable.”

Kristin Binns, a spokeswoman for WellPoint, which runs Blue Cross plans in more than a dozen states and has more subscribers than any other company, said, “We are not enforcing any sort of penalty” like UnitedHealthcare’s, and a spokeswoman for the American Hospital Association said that it knew of no other major insurer that did so.

Officials from Continuum Health Partners acknowledge that they are looking for rate increases to pay for rising costs of technology, drugs, overhead and union contracts.

The hospital chain said that after initial tough-guy posturing — including a demand from UnitedHealthcare for a 7 percent to 10 percent cut — both sides have narrowed the gap in their demands. But Continuum says the crux of the standoff is its refusal to bend to UnitedHealthcare’s notification rules.

Some plans already ask patients and hospitals to notify their insurance companies of hospital admissions, but officials at Continuum and some other hospital systems say the penalty for noncompliance is either minimal or rarely enforced. In memos outlining the new policy, UnitedHealthcare officials have said that patient compliance with notification rules is erratic.

Dr. Sam Ho, UnitedHealthcare’s chief medical officer, said the company wanted to work with hospital staff to reduce the amount of time patients stay in the hospital, which is associated with complications like infection, and to prevent readmission, a major cost.

“If you had a car that needed to be repaired and then it had to go back in the garage within a week, then a month, then again in two months, then perhaps the original quality of the work that was done was substandard,” Dr. Ho said. He said that UnitedHealthcare’s push for notification was not motivated by money and that it would be happy if it never had to impose a penalty.

“Absolutely, honestly, sincerely, this is a genuine attempt to try to improve outcomes for patients,” he said.

But Ruth Levin, Continuum’s chief contract negotiator, said that the hospital chain did not believe that UnitedHealthcare could do a better job of reducing readmissions than its own medical staff could. Her account of negotiations on this point shows just how caustic they have become: “When we say, ‘Show me where you went to medical school,’ then they back down,” she said.

”It’s the ridiculous punitive nature of this,” she said. “If we provide a medically necessary service, we should be paid at the medically necessary rate.”

UnitedHealthcare has been rolling out a similar policy across the country since 2007, but has repeatedly postponed deadlines and penalties in the face of opposition. Most recently, it postponed a Jan. 19 deadline to begin imposing the 50-percent penalty. (UnitedHealthcare documents suggest that in some cases, the full penalty would kick in only after 72 hours, but Continuum officials say that UnitedHealthcare is forcing them to negotiate such terms.)

Integris Health, an 11-hospital system based in Oklahoma City, has tried to meet the notification requirement and has been frustrated by the administrative burden, even using electronic notification, said Greg Meyers, vice president for revenue integrity. “That doesn’t feel to us like cost control, it feels like a revenue stream enhancement to the insurance companies,” Mr. Meyers said.

Continuum officials say that cutting reimbursement in half would mean the loss of at least $25,000 for a patient who had bypass surgery and $15,000 to $20,000 for elective joint replacement.

Dr. Gary Burke, a doctor affiliated with St. Luke’s-Roosevelt Hospital Center, said the letters warning that coverage with Continuum doctors could be cut off left some of his older patients panicked at the prospect of losing a long-term relationship with a doctor they trusted.

“They’re kind of like, ‘If I get sick, does this mean I can’t see you?’ ” Dr. Burke said.

Continuum says it believes that some larger hospital systems have been able to negotiate immunity from the penalty. UnitedHealthcare officials refused to say whether that was true, saying that their contracts were subject to confidentiality agreements. Likewise, several other hospital systems, including the city’s Health and Hospitals Corporation, which runs its public hospitals, and NewYork-Presbyterian Hospital, declined to discuss the terms of their contracts with UnitedHealthcare.

“When all the other hospitals are doing it, we’ll do it,” Ms. Levin said. “If you go out there and succeed with NewYork-Presbyterian, we’ll do it. Then I think it’s unreasonable for me to stand out there and say, ‘Well, I can’t.’ ”

Soccer moms take note

Soccer Injuries: Cleat-Natural Grass Combination May Be Less Likely to Result in Anterior Cruciate Ligament Injury
ScienceDaily (Jan. 23, 2010) — Athletes put less strain on their anterior cruciate ligament (ACL) while making a cut on a natural grass surface while wearing a cleat.
"Our model looks at how forces travel up the kinetic chain, and that is something that should be looked at more closely, meaning you can't just look at the knee injuries by looking at the knee in isolation," Dr. Drakos said.

The investigators found that the natural grass/cleat combination placed a statistically lower maximum strain on the leg than any of the remaining three groups. All other combinations placed a greater amount of strain compared to the natural/grass cleat combination. The Astroturf shoe was 80.2 percent greater, modern playing turf/turf shoe was 47.5 percent greater, and the modern playing turf/cleat was 45.1 percent greater.
[I don't really have anything to add, just thought it was an interesting study. I do think I will shy away from involving my kids in gymnastics or football as I feel they are extremely hard on the body.]

Wednesday, January 20, 2010


Good video on dealing with migraines. They do not specifically mention chiropractic but discuss ergonomic modification, improved posture, massage therapy, and reducing stress though biofeedback and exercise. Below is a study performed comparing spinal manipulation (chiropractic) to the best available medication, Amitriptyline, in the treament of migraine. Chiropractic resulted in a comparable reduction from baseline pain levels vs. medication.....short term relief. In post-treatment follow-up only those patients who had received spinal manipulation continued to have the same reduction in with no further treatment, they were still doing better.
The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache.
CONCLUSION: There was no advantage to combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

Monday, January 18, 2010

Death of the Drug Rep

I found this article at PharmaGossip. What I found shocking was that drug reps had such unfettered access to physicians until now. I have often gone into my M.D. and seen her talking to these reps, but I did not realize it is because they are there so often. I know reps personally and they are the nicest people you could ever meet. You can't help but love them. I guess that is the nature of sales...

In one of the largest industry restructurings in years, just about every one of the nation's major drug makers is shrinking its sales force. The move is a stark turnaround from years of bulking up their sales ranks and blitzing doctors' offices with samples, literature and free lunches.

Increasingly, doctors have gotten tired of the nonstop sales visits, which have cut into their time to see patients. These days, more than a third of medical schools require sales reps to have an appointment before calling on physicians or residents, according to the American Medical Association. About one in four physicians works in a practice that refuses to admit sales reps. Of those who do see reps, nearly half require an appointment, up about 23 percent from 2008.

"It just got out of hand, with the number of people calling on these doctors every week," said Linda Bannister, a drug analyst for Edward Jones in St. Louis. "It wasn't a good use of resources anymore for the drug companies."

To compliment this article read:
Inappropriate prescribing and adverse drug events in older people - Conclusion
Ultimately, the high prevalence of IP and preventable ADEs in older people is unacceptable, and represents a public health hazard likely to grow in tandem with ageing populations. Improved undergraduate and postgraduate training in geriatric pharmacotherapy is crucial. Though valid IP screening tools are desirable, they should enhance, not replace, clinical judgement. These screening tools need to be tested as an intervention in order to assess their impact on the incidence of ADEs in this vulnerable population.
Rise in antiobesity drug prescribing for children and adolescents in the UK: a population-based study
CONCLUSIONSPrescribing of unlicensed antiobesity drugs in children and adolescents has dramatically increased in the past 8 years. The majority are rapidly discontinued before patients can see weight benefit, suggesting they are poorly tolerated or poorly efficacious when used in the general population. Further research into the effectiveness and safety of antiobesity drugs in clinical populations of children and adolescents is needed.


Sunday, January 17, 2010

Annals of Internal Medicine Systematic Review of the Literature finds spinal manipulations (chiropractic adjustments) among most effective treatments

When people talk about evidence based medicine, this is what they mean. Have the methods utilized in your practice been studied in a randomized controlled trial and found efficacious? Read the conclusion of the following abstract below; this study was performed to provide guidelines for the American Pain Society and American College of Physicians. If you have chronic low back pain, has your physician recommended the following therapies to you? If they havn't, maybe they are not up to date with current guidelines in the treatment of the low back.

Being an evidence-based clinic we utilize - spinal manipulation, exercise, rehabiltation, aspects of CBT, heat and ice - in the treatment of low back pain.

Ann Intern Med. 2007 Oct 2;147(7):492-504.

Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.
Chou R, Huffman LH; American Pain Society; American College of Physicians.

Oregon Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon 97239, USA.

Erratum in:

Ann Intern Med. 2008 Feb 5;148(3):247-8.

Comment in:

Ann Intern Med. 2008 May 20;148(10):790-1; author reply 791-2.

Summary for patients in:

Ann Intern Med. 2007 Oct 2;147(7):I45.

BACKGROUND: Many nonpharmacologic therapies are available for treatment of low back pain. PURPOSE: To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain). DATA SOURCES: English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). These electronic searches were supplemented by hand searching of reference lists and additional citations suggested by experts. STUDY SELECTION: Systematic reviews and randomized trials of 1 or more of the preceding therapies for acute or chronic low back pain (with or without leg pain) that reported pain outcomes, back-specific function, general health status, work disability, or patient satisfaction. DATA EXTRACTION: We abstracted information about study design, population characteristics, interventions, outcomes, and adverse events. To grade methodological quality, we used the Oxman criteria for systematic reviews and the Cochrane Back Review Group criteria for individual trials. DATA SYNTHESIS: We found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain. Benefits over placebo, sham therapy, or no treatment averaged 10 to 20 points on a 100-point visual analogue pain scale, 2 to 4 points on the Roland-Morris Disability Questionnaire, or a standardized mean difference of 0.5 to 0.8. We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain. For acute low back pain (<4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat (good evidence for moderate benefits) and spinal manipulation (fair evidence for small to moderate benefits). Although serious harms seemed to be rare, data on harms were poorly reported. No trials addressed optimal sequencing of therapies, and methods for tailoring therapy to individual patients are still in early stages of development. Evidence is insufficient to evaluate the efficacy of therapies for sciatica. LIMITATIONS: Our primary source of data was systematic reviews. We included non-English-language trials only if they were included in English-language systematic reviews.

CONCLUSIONS: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat. (You will see in the article that spinal manipulations also provided benefit for the acute low back.)

Saturday, January 16, 2010

Even WebMD Back Pain Center recommends Chiropractic Care

If you have back pain read this article carefully, especially the part about getting a SECOND OPINION if you are recommended surgery! Sorry Mike, my brother sells the equipment used in spinal surgeries.

Back Pain Health Center
From Massage to Acupuncture, People Favor Hands-on Therapies to Treat Back Pain
By Bill Hendrick
WebMD Health News
Reviewed by Louise Chang, MD

April 6, 2009 -- Back pain can be a big pain in the neck. To deal with it, many U.S. adults favor hands-on therapies such as chiropractic manipulation, massage, and physical therapy, a new survey says.

Consumer Reports says in its May issue that 80% of adults in the U.S. report having been bothered by back pain at some point in their lives. The Consumer Reports Health Ratings Center surveyed 14,000 subscribers who reported experiencing back pain in the past year but who had never undergone back surgery. More than half said the pain severely limited their daily routines for at least a week, and many said it interfered with sex, sleep, and weight control.

It found that:

88% of respondents said back pain recurred through the year.
35% said they’d never consulted a professional to help with lower back pain.
Of those who’d sought help:

58% said chiropractic manipulation had helped a lot.
48% said massage had eased their pain.
46% said physical therapy had benefited them.
The respondents were also asked about their satisfaction with various treatments. Of those reporting they were highly satisfied:

59% had seen chiropractors
55% had seen physical therapists
53% had seen acupuncturists
44% had seen physician specialists
34% had seen primary care doctors

Consumer Reports says most respondents had tried five or six different treatments and that many with prolonged pain said they hadn’t seen a health professional because they didn't believe anything could help.

The survey also found that:

45% of people who took prescription drugs said they helped a lot.
55% of people given a prescription drug received an opioid pain reliever, even though the publication says there’s little research to support the use of such medications for acute low-back pain.
“There are almost always better solutions than opioids for low-back pain,” says Orly Avitzur, MD, a neurologist and medical advisor to Consumers Union. “They have numerous adverse effects, such as drowsiness, respiratory depression, constipation, and nausea.”

Also, she says, overdose is a major concern.

Consumer Reports advises people with low back pain to:

Discuss the problem with a primary care doctor.
Consider seeing a chiropractor or physical therapist.
Use caution when considering surgery.
Get a second opinion before deciding on surgery.
It conducted a separate survey of about 1,000 people who’d had back surgery in the past five years and found that only 60% were completely or very satisfied with the results. And more than 50% reported at least one problem with recovery.

“Patients should be aware that significant problems during recovery may be underestimated,” Consumer Reports says in a news release.

Ridiculous - Unfair- Actually probably saving lives by making prescription drugs to expensive to use them.

Patent deals between generic and branded drug makers have been getting lot of attention lately on both sides of the Atlantic. Today, Pfizer took a turn in the spotlight.

The world’s largest pharma company said it was among those asked Tuesday by European regulators to disclose their patent agreements with generic makers. Pfizer said that its record is clean and that it’s cooperating with European Union officials, Dow Jones Newswires reported.

The EU’s regulatory arm has been upset that cheaper generic drugs aren’t getting to consumers faster as they come off patent and it wants to know if branded makers are making payments to generic rivals to delay the competition. As we noted yesterday, the EU also sent requests for information to AstraZeneca, GlaxoSmithKline, Roche, Novartis and Sanofi-Aventis.

U.S. regulators are stoking the pay-for-delay issue as well. The FTC said this week that payments in patent settlements typically delay generic competition by 17 extra months, compared with deals when there are no payments.

Nation of Chronic Disease - Break the Cycle

This first article succinctly states the obvious, prevention is the key to health. Doctors should be focusing on keeping you healthy, not medicating you to treat the symptoms of sickness. The second article makes clear that, over 70% of Americans want increased focus on prevention to be a key component of health care reform. Chiropractors are already considered primary health care providers and covered by insurance in all 50 states and would be perfect guides along this path to optimal health.

Over the holidays, we were very busy. My son began with a dry cough that ended up lasting for a month. By January, he was fully ill and I took him to his pediatrician. The pediatrician examined him and though he had no obvious signs, diagnosed a bacterial sinus infection and prescribed antibiotics. I have never given Marko medications and was not about to start, but I did realize something from the visit. First, we should have been adjusting him regularly and not allowed the busy holidays to hinder our wellness care. Second, why was the M.D. not concerned about why he became susceptible to an infection. A healthy body, even a child, should have an immune system that can fight off infections. It is when other factors in life, poor nutrition, lack of sleep, etc.. interfere that we become susceptible to illness. Whenever I seek advice about my children having symptoms of illness, I am always seeking to understand if there is an UNDERLYING condition leading to reduced immune system functioning. Anyway, good articles....and we gave Marko chiropractic adjustments the next three days in a row. He had no further symptoms after the first night... without meds (another time I will talk about antibiotic side-effects).

Excerpt: Dr. Dana King of the Medical University of South Carolina recently published two papers on the erosion of American lifestyle habits between 1988 and 2006. Here’s a summary of what he found:

1. The prevalence of obesity increased from 28% to 36%.
2. The percentage of people getting minimal amounts of exercise fell from 53% to 43%.
3. Smoking remained unchanged at about 26% of the population.
4. The percentage of people eating at least five or more fruits and vegetables per day fell from 46% to only 26%.
5. Moderate alcohol consumption increased from 40% to 51% of adults.

It appears the only public health message resonating with Americans is that moderate alcohol consumption may have some health benefits. It’s the easiest of the five habits to adopt, and the most dubious.

There is nothing else in medicine that has the power of these simple habits to prevent the most common chronic diseases plaguing our society. The World Health Organization has stated that a healthy lifestyle can prevent 90% of all cases of type 2 diabetes, 80% of all cases of coronary heart disease and about a third of all cancers.

Dr. King found that declining lifestyle habits have been associated with increasing rates of chronic diseases, and our use of prescription drugs to treat these chronic diseases has exploded by 121%. Death rates from coronary heart disease are declining, but the actual prevalence of coronary heart disease is increasing.

New Years Resolutions

This link offers great advice on actually achieving your goals this year. Similar to the cook "The Beck Diet Plan", it is based in concepts of cognitive behavioral therapy, something we will all hear more about over the years. This methodology is common sense and should be successful, assuming you follow the steps regarding, writing out your goals and reviewing them each day. Lets see if I can stick to my goal of getting a monthly massage, for wellness, and to accomplish my other resolution, being peaceful rather than letting the kids drive me crazy.

Its as safe as taking an aspirin...........hmmm.


Johnson & Johnson issued a massive recall Friday of over-the-counter drugs including Tylenol, Motrin and St. Joseph's aspirin because of a moldy smell that has made people sick.

It was the second such recall in less than a month because of the smell, which regulators said was first reported to McNeil in 2008. Federal regulators criticized the company, saying it didn't respond to the complaints quickly enough, wasn't thorough in how it handled the problem and didn't inform the Food and Drug Administration quickly.

The recall includes some batches of regular and extra-strength Tylenol, children's Tylenol, eight-hour Tylenol, Tylenol arthritis, Tylenol PM, children's Motrin, Motrin IB, Benadryl Rolaids, Simply Sleep, and St. Joseph's aspirin.

The FDA and Johnson & Johnson's McNeil Consumer Healthcare Products said they did not know the number of bottles recalled. It included caplet and geltab products sold in the Americas, the United Arab Emirates, and Fiji.

Consumers should check the full list at to identify the recalled batches.

Wait there's more!

Also on Friday, federal prosecutors in Boston said Johnson & Johnson paid tens of millions of dollars in kickbacks so nursing homes would put more patients on its blockbuster schizophrenia drug.

The government's complaint states that J&J gave special rebates to Omnicare Inc., the country's biggest dispenser of prescription drugs to nursing homes, in return for recommendations from its pharmacists that patients be given Risperdal, in many cases when it was inappropriate.