Pesticides and the Collapse of Bee Colonies

The alarming collapse of the bee population in many areas appears to be due to a widely used class of pesticides called neonicotinoids. Should this be allowed to continue, it has the potential to wreak havoc on the world’s food supply, much of which is dependent on bees for pollination. No small thing.

At first, there had been concern that electromagnetic waves from increasingly ubiquitous cell phones might be the cause, or reduced resistance to mites or parasites, research failed to document a strong link. But with neonicotinoids, the evidence is now strong to the point of damning.

From the Harvard School of Public Health:

Two widely used neonicotinoids—a class of insecticide—appear to significantly harm honey bee colonies over the winter, particularly during colder winters, according to a new study from Harvard School of Public Health (HSPH). The study replicated a 2012 finding from the same research group that found a link between low doses of imidacloprid and Colony Collapse Disorder (CCD), in which bees abandon their hives over the winter and eventually die. The new study also found that low doses of a second neonicotinoid, clothianidin, had the same negative effect.

Further, although other studies have suggested that CCD-related mortality in honey bee colonies may come from bees’ reduced resistance to mites or parasites as a result of exposure to pesticides, the new study found that bees in the hives exhibiting CCD had almost identical levels of pathogen infestation as a group of control hives, most of which survived the winter. This finding suggests that the neonicotinoids are causing some other kind of biological mechanism in bees that in turn leads to CCD.

FDA Moves Against Trans Fats

This move should complete the elimination of artificial trans fats from the American diet. Previous advice from the government had already lowered the amount of trans fats in packaged foods substantially.

On the basis of a review of scientific evidence and findings from expert panels, the agency made a preliminary determination that the oils “are not generally recognized as safe for use in food” and should be eliminated, FDA Commissioner Margaret Hamburg, MD, said on a conference call with reporters.

The decision “is very welcome and strongly supported by massive scientific evidence that trans fat has many adverse effects on health,” Walter Willett, MD, DrPH, of the Harvard School of Public Health, said in an email to MedPage Today. “Trans fat has no place on the table, and this step will help make the diets of Americans safer.”

Harvard School of Public Health’s Walter Willett, PhD, puts the change into context:

Willett added, “Further removal of trans fats will also likely nudge down rates of diabetes, obesity, and other conditions as well.”

“Importantly, by getting trans fat off the table entirely, we will be able to focus attention on other aspects of diet that also need to be improved,” he said. “This will likely have a ripple effect worldwide because other countries are considering similar actions.”

Despite Practice Guidelines for Back Pain, Prescriptions for Narcotics Rise While Those for NSAIDs Fall

Medical practice guidelines are voluntary. Sometimes, this leads to clearly dysfunctional outcomes.

This interview with the author of a new article in JAMA Internal Medicine underscores the conclusions reached in the 2010 study by Bishop and colleagues at the National Spine Center in Canada, published in Spine Journal, which found management of low by pain by primary care medical physicians (PCPs) to be highly “guideline-discordant” with regard to medications. (Bishop’s article also found that for low back pain, guideline-based care that includes spinal manipulation by chiropractors is significantly more effective than usual care by PCPs).

The new JAMA Internal Medicine article’s lead author is John N. Mafi, MD, chief medical resident and fellow in general medicine at Beth Israel Deaconess Medical Center in Boston:

We saw a decline in use of NSAIDs that was discordant with the guidelines. The guidelines recommend it as a first-line treatment. What we are seeing instead is a rise in narcotic prescriptions. The guidelines are cautious about narcotics and say to be cautious and recommend them only as second- or third-line therapies.

There is also discordance between the guidelines and physician use of imaging. In patients with new-onset back pain, ordering an MRI or CT scan is not indicated in most cases. Finally, we saw a rise in referrals to specialists, though primary care clinicians are usually able to manage patients with routine cases of back pain themselves with minimal treatment.

news@JAMA: What do you think is driving physicians to pursue these more aggressive treatment approaches?

Dr Mafi: We are a society that demands instant solutions, but back pain doesn’t play by these rules. It takes time, and unfortunately, the fancier treatments haven’t been shown to decrease patient’s pain or increase their quality of life. That’s why we have to rely on the less-is-more approach.

news@JAMA: What do you think is driving the shift from NSAIDs to narcotics?

Dr Mafi: It is in part patient expectations and a sentiment that emerged in the 1990s physicians weren’t paying enough attention to patient pain. The Joint Commission made pain the fifth vital sign. In response, there has been an overcorrection and now narcotics are reached for first. Since that time, there has been a 300% increase in narcotic prescriptions and rise in narcotic overdoses and deaths. In 2008 almost 15000 people died—more than for cocaine and heroin overdoses combined. There are huge public health implications.

References:

1. Mafi JN, McCarthy EP, Davis RB, Landon BE. WOrsening trends in the management and treatment of back pain. JAMA Internal Medicine. 2013 (epub before print).

2. Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. The Spine Journal. 2010;10(12):1055-1064.

EPA Backs Off Factory Farm Regulation

Whether it’s a Democratic or a Republican administration, favoring corporate power over the well-being of the public seems to carry the day more often than not. What a disappointment this administration has been on these types of issues.

The Environmental Protection Agency is obliged under the Clean Water Act to monitor America’s waterways and shield them from the toxic runoff from factory farms. But the growth of that industry, and its courtroom tenacity, has far outstripped the E.P.A.’s efforts to restrict runoff from manure lagoons and feedlots.

Last year, the agency meekly withdrew two proposed rules. One would have gathered basic information from all factory farms. The other proposed rule would have expanded the number of such farms required to have a national pollution discharge permit. Fewer than 60 percent do now.

Then, last week, in yet another retreat, the agency announced that promised new regulations governing feedlot discharges nationally would not be forthcoming.

According to the E.P.A.’s own studies, agricultural runoff is the leading cause of impaired water quality. The amount of manure produced by factory farms is staggering. The agency estimates that those operations create between 500 million and 1 billion tons of manure, three times as much waste as humans produce in the United States. The task of keeping those hundreds of millions of tons of animal waste out of rivers, lakes and estuaries is enormous, clearly requiring a strong set of revised regulations for the handling of factory-farm waste, including provisions for tracking waste when it’s been moved offsite.

Right now, the patchwork of regulations — which assume a great deal of self-policing — suits the factory-farm industry all too well. So does the E.P.A.’s inability to gather even the most basic information about those farms.

 

JAMA’s Low Back Pain Patient Page

To chiropractic students today, it may seem altogether ordinary (and certainly evidence-based) to recommend chiropractic care for low back pain. The evidence supporting this has been quite strong since at least the mid-1990s. Yet for those of us who remember the days of the boycott and the ethical proscriptions against medical physicians who cooperated in any way with chiropractors, seeing this recommendation in the pages of the Journal of the American Medical Association is a milestone moment.

From my editorial in the current issue of Health Insights Today: 

So why is this news? Ask any chiropractor who’s been in the field for more than a decade or two and they’ll know. When we became chiropractors, and in some cases for long after that, it was taken for granted that JAMA, the official voice of the medical profession, would never publish a handout recommending chiropractic care for any condition. Long after research had demonstrated the effectiveness of spinal adjustments for low back pain (as recognized, for example, by the federal Agency for Healthcare Policy and Research report in 1994), such a recommendation never appeared in the pages of JAMA.

Why now? It’s hard for an outsider to say with certainty, but after a certain point, the consistent  conclusions of all major practice guidelines (including the influential 2007 Low Back Pain Guidelines jointly prepared by the American College of Physicians and American Pain Society) probably became impossible to ignore while seeking to maintain an aura of integrity. In addition, this likely represents a generational change in the medical profession. More and more medical doctors in leadership positions came of age professionally at a time when a fair reading of available research clearly led to the conclusion that spinal manual care (what the new JAMA Patient Page calls “chiropractic therapy”) is in fact helpful for acute, subacute and chronic low back pain.

40% Failure Rate on Hip Transplants: Executives Knew But Hid the Evidence

This level of corruption in the service of corporate profits is no surprise to anyone who follows developments in the drug and medical device industries. Still, if I step back a bit, it is nothing short of breathtaking.

THIS month, Johnson & Johnson is facing more than 10,000 lawsuits over an artificial hip that has been recalled because of a 40 percent failure rate within five years. Mistakes happen in medicine, but internal documents showed that executives had known of flaws with the device for some time, but had failed to make them public.

It would be nice to imagine that this kind of behavior is exceptional, but in reality, the entire evidence base for medicine has been undermined by a casual lack of transparency. Sometimes this is through a failure to report concerns raised by doctors and internal analyses, as was the case with Johnson & Johnson. More commonly, it involves the suppression of clinical trial results, especially when they show a drug is no good. These problems would be bad enough on their own, but they are compounded by a generation of “fake fixes” that have delivered false reassurance, and so prevent realistic public discussion.

The best evidence shows that half of all the clinical trials ever conducted and completed on the treatments in use today have never been published in academic journals. Trials with positive or flattering results, unsurprisingly, are about twice as likely to be published — and this is true for both academic research and industry studies.

Read the rest of the article. It actually gets worse.

 

 

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.

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.

Supreme Court Accepts Gene Patenting Case

In the long run, this case may have greater influence than many of the higher profile cases on which the Court decides.

The U.S. Supreme Court on Friday agreed to decide whether human genes can be patented, a hotly contested issue with broad practical and ethical consequences for the future of gene-based medicine for millions of people worldwide.

The nation’s highest court in a brief order agreed to review a case over whether Myriad Genetics Inc may patent two genes linked to hereditary breast and ovarian cancer.

In a 2-1 ruling on Aug. 16, a panel of the U.S. Federal Circuit Court of Appeals in Washington, D.C., upheld the biotechnology company’s right to patent “isolated” genes that account for most inherited forms of the two cancers.

That ruling also denied Myriad’s effort to patent methods of “comparing” or “analyzing” DNA sequences.

The appeal against Myriad and the University of Utah Research Foundation was being pursued by a variety of medical associations and doctors, led by the Association for Molecular Pathology. Their case is being handled by lawyers for the American Civil Liberties Union.

There are many issues at play here. Consider this one: gene patents like these held by Myriad can be used (and are used) to deny researchers the right to conduct research related to the patented genes (i.e., breast cancer research) unless they pay the patent holder whatever fee the corporation wishes to charge.

From both ethical and economic perspectives, this is a most controversial topic. I hope the Court decides that genes are the common heritage of all humanity and are not patentable under any circumstances.

Dispelling Soy Myths

Two articles on soy appear in today’s Huffington Post. Neal Barnard, MD, sums up the evidence clearly and accurately, with aptly chosen scientific references to support his assertions, while Joseph Mercola, DO, takes a different approach.

From Dr. Barnard:

Soybeans are handy. Aside from the traditional foods they bring us — edamame, tofu, tempeh, and many others — they transform into tasty substitutes for milk, yogurt, ice cream, bacon, burgers, and sausage. With no animal fat, cholesterol, or sensitizing animal proteins, they side-step the problems that animal products can cause. Cow’s milk, for example, is linked to Type 1 diabetes and anemia in children and increases the risk of prostate cancer in men. Hamburgers are linked to heart disease, diabetes, and colon cancer. Soy-based milks and burgers help you skip all this. But soy has other huge benefits you may not know about.

Among the other well-documented effects of soy products is that they boost survival in breast cancer patients (contrary to an oft-repeated set of false claims) and lower cholesterol levels.

Read Dr. Barnard’s entire article for a further debunking of soy mythology.