U.S. Allows Chemicals in Food That Are Illegal Elsewhere

One more reason to read ingredient lists and not to trust the safety of listed items that aren’t actually recognizable foods.

Why the difference? The U.S. Food and Drug Administration would not provide a representative for an interview, but in past statements to the media and on its website the agency has presented a variety of reasons for allowing controversial chemicals in food, ranging from a lack of resources for research to assurances that the substances are safe in small doses.

In the case of BVO, the agency has allowed “interim” use of the ingredient since 1970, pending additional toxicological tests. Asked why it has not addressed the interim status in more than 40 years, the agency cited a need to “maximize its resources” and said addressing the issue is “not a priority for the agency at this time.”

“FDA’s mission is first and foremost to protect public health by ensuring that foods are safe and properly labeled,” the agency said in a statement, contending that science-based implementation of federal law has helped make the U.S. food supply “the safest in the world.”

Unsatisfied with these kinds of answers, activists and public health watchdogs have urged the FDA and food makers to halt the use of various chemicals until safety can be fully determined. Food companies, they note, have reformulated their products for other countries — including members of the European Union, China, Australia, Japan and India — but seem reluctant to change their products in the U.S. until they must.”

Flaxseed Helpful for Hypertension

From a report delivered at this week’s American Heart Association conference:

LOS ANGELES — Adding flaxseed to the diets of patients with peripheral arterial disease (PAD) resulted in large drops in blood pressure (BP) of around 10 mm Hg systolic and 7 mm Hg diastolic after six months, according to the results of a double-blind, placebo-controlled study.

“This reduction of SBP and DBP after administration of dietary flaxseed is the largest decrease in BP ever shown by any dietary intervention,” said Dr Delfin Rodriguez (University Hospital Holguin, Cuba) speaking here today at the American Heart Association 2012 Scientific Sessions. Such reductions would be expected to result in around a 50% fall in the incidence of stroke and a 30% reduction in MI, he added.

Rodriguez explained that the trial, FLAX-PAD, was conducted in PAD patients because they happened to have a clinic for the disease in their center and, as around 75% of PAD patients have concomitant hypertension, “it was an easy population to study.”

Subgroup analyses of only the PAD patients with hypertension showed a greater reduction in SBP, of about 15 mm Hg, in these patients than in the study population as a whole and a similar reduction in DBP, he noted.

“Flaxseed represents a particularly attractive strategy for controlling hypertension in economically disadvantaged communities and countries, and its BP-lowering effects compare favorably with those of antihypertensive drugs and lifestyle modifications, such as a low-salt diet and weight loss,” he noted.

Rodriguez said that he and his colleagues chose to study flaxseed because animal studies have shown it has antiatherogenic, anti-inflammatory, and antiarrhythmic effects and may reduce circulating cholesterol and trans-fatty acid levels.

Oregon’s Major Medicaid Experiment

As the reporters in this Washington Post article explain, the effort to get more effective health care while controlling costs is the goal of many of the health reform efforts now underway. This Oregon project may be the most of all. If it works, it can create a model for others to emulate.

So Kitzhaber did something that many before him have done in desperate times. The governor who favors cowboy boots over dress shoes made a bet that Oregon could not afford to lose.

The deal Kitzhaber struck was this: The Obama administration would give the state $1.9 billion over five years, enough to patch the budget hole. The catch: To secure that, Oregon’s Medicaid program must grow at a rate that is 2 percent slower than the rest of the country, ultimately generating $11 billion savings over the next decade. If it fails, those federal dollars disappear.

Oregon is pursuing the Holy Grail in health-care policy: slower cost growth. If it succeeds, it could set a course for the rest of the country at a pivotal moment for the Affordable Care Act. Under the law, many states will expand Medicaid programs to cover everyone below 133 percent of the federal poverty line, adding 7 million Americans to the program in 2014 and leaving states looking for the most cost-effective way to cover that influx of patients.

In Oregon alone, Medicaid is expected to enroll 400,000 new patients by 2022, nearly doubling its current numbers, according to an Urban Institute analysis.

As Oregon’s population grows, the state has come to realize that Medicaid is not a bottomless bucket of money. The state’s budget cannot sustain that. Instead, it strives to deliver what health policy experts call “the triple aim”: higher-quality care that leads to better outcomes, all delivered at a lower cost.

 

Provider Nondiscrimination Update

My editorial on the Affordable Care Act’s section that prohibits insurance companies from discriminating against classes of health care providers is now posted at Health Insights Today.

When fully implemented, this federal nondiscrimination policy will for the first time forbid any American health insurance company from refusing to cover services legally provided by a class of licensed health care practitioners (e.g., chiropractors, acupuncturists or clinical social workers) acting within the scope of their state licenses, if it covers those services when provided by a different class of practitioners (e.g., medical or osteopathic physicians). While the Affordable Care Act does not mandate equal payment for equal work (i.e., paying a chiropractor providing a service the same rate as an MD providing the same service), friend and foe alike understand that Section 2706 would make it illegal for insurers to cover any health service for one class of providers licensed to perform it while rejecting coverage for another also licensed to do so. (This nondiscrimination policy does not apply to the two largest government insurance plans—Medicare, which offers partial chiropractic coverage nationwide, and Medicaid, where coverage varies from state to state.)

This part of  the law goes into effect on January 1, 2014. Because it applies to all services that a practitioner is licensed to provide under state law, the implications are quite broad. I’ll be writing more about this in the near future, and presenting on the prevention and health promotion part of this equation at the March ACC-RAC conference in Washington, DC. (ACC-RAC is the annual Association of Chiropractic Colleges Research Agenda Conference).

Arthritis Drugs May Trigger Shingles

Because arthritis affects so many people as they age, this finding is important for health practitioners to add to their diagnostic radar screens. This is particularly true for those who deal primarily with musculoskeletal conditions.

Patients with rheumatoid arthritis (RA) undergoing treatment with agents such as Enbrel (etanercept), Remicade (infliximab) or Humira (adalimumab) appear to have a significantly increased risk for developing shingles.

The incidence of shingles among patients on anti-tumor necrosis factor (TNF) treatment was 1.6 per 100 patient-years, compared with an incidence of 0.8 per 100 patient-years among those receiving traditional disease-modifying anti-rheumatic drugs (DMARDs), according to Kimme L. Hyrich, MD, of the University of Manchester in England, and colleagues.

 

New Study Distinguishes Specific and Nonspecific Effects of Acupuncture

This is a very clarifying study for those who follow the controversy about specific vs. nonspecific effects of acupuncture. It strongly counters the claim that nonspecific effects are the whole story and that therefore one can insert needles at random and achieve effects equal to classical acupuncture. Conceptually, this also relates to the specific and nonspecific effects of manual therapies including spinal manipulation.

The full text is available here: http://www.hindawi.com/journals/ecam/2013/427265/

Karner M, Brazkiewicz F, Remppis A, et al. Objectifying Specific and Nonspecific Effects of Acupuncture: A Double-Blinded Randomised Trial in Osteoarthritis of the Knee. Evidence-Based Complementary and Alternative Medicine. 2013;2013:7.

Abstract: Acupuncture was recently shown to be effective in the treatment of knee osteoarthritis. However, controversy persists whether the observed effects are specic to acupuncture or merely nonspecifc consequences of needling. Therefore, the objective of this study is to determine the efficacy of different acupuncture treatment modalities. Materials and Methods. We compared between three different forms of acupuncture in a prospective randomised trial with a novel double-blinded study design. One-hundred and sixteen patients aged from 35 to 82 with osteoarthritis of the knee were enrolled in three study centres. Interventions were individualised classical/ modern semistandardised acupuncture and non-specifc needling. Blinded outcome assessment comprised knee flexibility and changes in pain according to the WOMAC score. Results and Discussion. Improvement in knee flexibility was significantly higher after classical Chinese acupuncture (10.3 degrees; 95% CI 8.9 to 11.7) as compared to modern acupuncture (4.7 degrees; 3.6 to 5.8). All methods achieved pain relief, with a patient response rate of 48 percent for non-specific needling, 64 percent for modern acupuncture, and 73 percent for classical acupuncture. Conclusion. This trial establishes a novel study design enabling double blinding in acupuncture studies. The data suggest a specific effect of acupuncture in knee mobility and both non-specific and specific effects of needling in pain relief.