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.

Obamacare Exchanges in CA, WA, and OR Post Premiums Drastically Lower Than Many Projections

From Sarah Kliff in the Washington Post:

The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of  $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.

Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.

On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium. For the 2.6 million Californians who will receive federal subsidies, the price is a good deal less expensive, the amount noted in green below.

 

This is what is happening in the states whose governors and legislatures are not seeking to sabotage the implementation of the Affordable Care Act. California, Washington, and Oregon are showing similarly low rate offerings on the insurance exchanges, which at the beginning will apply mainly to individuals who were not previously insured.

In other words, the Affordable Care Act is providing affordable insurance to those previously unable to purchase it.

UN Panel Urges Global Move Toward Meat and Dairy-Free Diet

This is from the UN Environmental Programme. It’s a fair reading of the available data, which indicates that changes in two sectors, animal agriculture and the burning of fossil fuel, are the keys to avoiding catastrophic climate change. This report goes public in the week that the world also surpassed the 400 ppm level of CO2.

This is a major health policy issue, ultimately dwarfing those that absorb more of our attention at the moment.

A global shift towards a vegan diet is vital to save the world from hunger, fuel poverty and the worst impacts of climate change, a UN report said today.

As the global population surges towards a predicted 9.1 billion people by 2050,  western tastes for diets rich in meat and dairy products are unsustainable, says the report from United Nations Environment Programme’s (UNEP) international panel of sustainable resource management.

It says: “Impacts from agriculture are expected to increase substantially due to population growth increasing consumption of animal products. Unlike fossil fuels, it is difficult to look for alternatives: people have to eat. A substantial reduction of impacts would only be possible with a substantial worldwide diet change, away from animal products.”

Professor Edgar Hertwich, the lead author of the report, said: “Animal products cause more damage than [producing] construction minerals such as sand or cement, plastics or metals. Biomass and crops for animals are as damaging as [burning] fossil fuels.”

 

Obamacare Exchanges Already Forcing Private Insurers To Lower Their Premiums

From Oregon, which in many ways is fast becoming a model for how to do health reform right (their recently released low back pain guidelines are also excellent):

In a striking illustration of the promise that the health law holds for consumers, two Oregon private insurers vying to sell coverage on the state’s Obamacare insurance marketplace this October are reevaluating their opening bids for the plans’ monthly premiums. The reason? A side-by-side regional comparison of all proposed 2014 premiums for Oregon marketplace plans became public on Oregon’s marketplace website Thursday, and showed that the two insurers’ planned monthly premiums were far higher than other proposals. That raised fears among the companies’ officials that their plans wouldn’t be competitive on the market later this year, leading them to proactively request a rate reduction — and as more of Obamacare is implemented, state insurance commissioners expect that trend to continue:

“Posting rate comparisons company-by-company is a taste of what is to come,” says Cheryl Martinis of the Oregon Insurance Division.

Judging by the reaction, there’s already an impact.

Providence Health Plan on Wednesday asked to lower its requested rates by 15 percent. Gary Walker, a Providence spokesman, says the “primary driver” was a realization that the plan’s cost projections were incorrect. But he conceded a desire to be competitive was part of it.

A Family Care Health Plans official on Thursday said the insurer will ask the state for even greater decrease in requested rates. CEO Jeff Heatherington says the company realized its analysts were too pessimistic after seeing online that its proposed premiums were the highest.

“That was my question when I saw the rates was, ‘Can we go in and refile these?’” he said. “We’re going to try to get these to a competitive range.”

Although some insurers have been using Obamacare as an excuse to hike premiums despite record profits, such rate hikes have been rarer — and less extreme — since the law’s passage.

 

U.S. Compares Poorly to Europe on Agricultural Safety Policies

In Mother Jones, Tom Philpott flags seven food-related substances or procedures that are banned in Europe but allowed in the United States.

Here are the first three, and it doesn’t really look any brighter after that:

 1. Atrazine Why it’s a problem: A “potent endocrine disruptor,” Syngenta’s popular corn herbicide has been linked to a range of reproductive problems at extremely low doses in both amphibians and humans, and it commonly leaches out of farm fields and into people’s drinking water.

What Europe did: Banned it in 2003.

US status: EPA: “Atrazine will begin registration review, EPA’s periodic reevaluation program for existing pesticides, in mid-2013.”

2. Arsenic in chicken, turkey, and pig feed Why it’s a problem: Arsenic is beloved of industrial-scale livestock producers because it makes animals grow faster and turns their meat a rosy pink. It enters feed in organic form, which isn’t harmful to humans. Trouble is, in animals guts, it quickly goes inorganic, and thus becomes poisonous. Several studies, including one by the FDA, have found heightened levels of inorganic arsenic in supermarket chicken, and it also ends up in manure, where it can move into tap water. Fertilizing rice fields with arsenic-laced manure may be partially responsible for heightened arsenic levels in US rice.

What Europe did: According to the Institute for Agriculture and Trade Policy, arsenic-based compounds “were never approved as safe for animal feed in the European Union, Japan, and many other countries.”

US status: The drug giant Pfizer “voluntarily” stopped marketing the arsenical feed additive Roxarsone back in 2011. But there are still several arsenicals on the market. On May 1, a coalition of enviro groups including the Center for Food Safety, the Institute for Agriculture and Trade Policy, and the Center for Biological Diversity filed a lawsuit demanding that the FDA ban them from feed.

3. “Poultry litter” in cow feed

Why it’s a problem: You know how arsenic goes inorganic—and thus poisonous—in chickens’ guts? Consider that their arsenic-laced manure is then commonly used as a feed for cows. According to Consumers Union, the stuff “consists primarily of manure, feathers, spilled feed, and bedding material that accumulate on the floors of the buildings that house chickens and turkeys.” The “spilled feed” part is of special concern, because chickens are often fed “meat and bone meal from dead cattle,” CU reported, and that stuff can spill into the litter and be fed back to cows, raising mad cow disease concerns.

What Europe did: Banned all forms of animal protein, including chicken litter, in cow feed in 2001.

US status: The practice remains unrestricted. US cattle consume about 2 billion pounds of it annually, Consumers Union’s Michael Hansen told me last year.

Antibiotic-Resistant Germs in Supermarket Meats

One more reason to just stop eating it. Also a clarion call to drastically overhaul the industrial model of animal agriculture that considers antibiotics a normal part of animal feed.

More than half of samples of ground turkey, pork chops and ground beef collected from supermarkets for testing by the federal government contained a bacteria resistant to antibiotics, according to a new report highlighting the findings.

The data, collected in 2011 by the National Antimicrobial Resistance Monitoring System — a joint program of the Food and Drug Administration, the Agriculture Department and the Centers for Disease Control and Prevention — show a sizable increase in the amount of meat contaminated with antibiotic-resistant forms of bacteria, known as superbugs, like salmonella, E. coli and campylobacter.

Many animals grown for meat are fed diets containing antibiotics to promote growth and reduce costs, as well as to prevent and control illness. Public health officials in the United States and in Europe, however, are warning that the consumption of meat containing antibiotics contributes to resistance in humans. A growing public awareness of the problem has led to increased sales of antibiotic-free meat.

The Agriculture Department has confirmed that almost 80 percent of all antibiotics sold in the United States are used in animal agriculture, and public health authorities around the world increasingly are warning that antibiotic resistance is reaching alarming levels.

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.

 

 

Causing Our Children’s Illnesses by Starting Solid Foods Too Soon

When we forget the basics of natural healthcare, we and our children suffer the consequences. Feeding solids too early in a child’s life appears to lead to allergies and other problems as well.

Disturbingly, this is often done on the advice of ill-informed doctors:

Many mothers in the U.S. start infants on solid foods — including peanut butter, meat, and french fries — earlier than experts recommend, and half of them do so with their doctor’s support, according to new research from the U.S. Centers for Disease Control and Prevention.

The study found that 40.4 percent of U.S. mothers interviewed from 2005 to 2007 said they introduced solid foods to infants before they were 4 months old — that represents an increase of about 29 percent from earlier studies, the researchers reported today in the journal Pediatrics.

Introducing solids early may increase the risk of some chronic diseases, the authors noted, including diabetes, obesity, eczema, and celiac disease.

 

 

Diet Sodas Linked to Type 2 Diabetes Risk

The American Diabetes Association, without endorsing artifically sweetened sodas as a health food, has long recommended them in preference to the sugar- or high fructose corn syrup-sweetened variety.

This study may tip the balance away from diet sodas. The best answer, of course, is to avoid both.

Here’s the abstract, posted January 30, 2013 on the American Journal of Clinical Nutrition.

BACKGROUND: It has been extensively shown, mainly in US populations, that sugar-sweetened beverages (SSBs) are associated with increased risk of type 2 diabetes (T2D), but less is known about the effects of artificially sweetened beverages (ASBs). OBJECTIVE: We evaluated the association between self-reported SSB, ASB, and 100% fruit juice consumption and T2D risk over 14 y of follow-up in the French prospective Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. DESIGN: A total of 66,118 women were followed from 1993, and 1369 incident cases of T2D were diagnosed during the follow-up. Cox regression models were used to estimate HRs and 95% CIs for T2D risk. RESULTS: The average consumption of sweetened beverages in consumers was 328 and 568 mL/wk for SSBs and ASBs, respectively. Compared with nonconsumers, women in the highest quartiles of SSB and ASB consumers were at increased risk of T2D with HRs (95% CIs) of 1.34 (1.05, 1.71) and 2.21 (1.56, 3.14) for women who consumed >359 and >603 mL/wk of SSBs and ASBs, respectively. Strong positive trends in T2D risk were also observed across quartiles of consumption for both types of beverage (P = 0.0088 and P < 0.0001, respectively). In sensitivity analyses, associations were partly mediated by BMI, although there was still a strong significant independent effect. No association was observed for 100% fruit juice consumption. CONCLUSIONS: Both SSB consumption and ASB consumption were associated with increased T2D risk. We cannot rule out that factors other than ASB consumption that we did not control for are responsible for the association with diabetes, and randomized trials are required to prove a causal link between ASB consumption and T2D.

Fagherazzi G, Vilier A, Saes Sartorelli D, Lajous M, Balkau B, Clavel-Chapelon F. Consumption of artificially and sugar-sweetened beverages and incident type 2 diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l’Education Nationale-European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr. Jan 30 2013.

Meat Industry Now Consumes 4/5 of Antibiotics

Option A is to limit use of antibiotics to animals who are actually sick. Option B is for people to stop eating meat. The U.S. has chosen Option C, at least thus far, which is to look the other way and let the antibiotic-resistant organisms proliferate.

This will not end well unless the policy changes in substantial ways soon.

From a Mother Jones article by Tom Philpott:

Last year, the Food and Drug Administration proposed a set of voluntary “guidelines” designed to nudge the meat industry to curb its antibiotics habit. Ever since, the agency has been mulling whether and how to implement the new program. Meanwhile, the meat industry has been merrily gorging away on antibiotics—and churning out meat rife with antibiotic-resistant pathogens—if the latest data from the FDA itself is any indication.

The Pew Charitable Trusts crunched the agency’s numbers on antibiotic use on livestock farms and compared them to data on human use of antibiotics to treat illness, and mashed it all into an infographic, which I’ve excerpted below. Note that that while human antibiotic use has leveled off at below 8 billion pounds annually, livestock farms have been sucking in more and more of the drugs each year—and consumption reached a record nearly 29.9 billion pounds in 2011. To put it another way, the livestock industry is now consuming nearly four-fifths of the antibiotics used in the US, and its appetite for them is growing.

Pew Charitable Trusts.
h/t Diane V Gandee Sorbi