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HEALTHBEAT SHOW NOTES .... Episode #65 - Recorded October 6, 2006

Hello and welcome to this week’s edition of HealthBeat, Chiropractic OnLine Today’s Health, News and informational Podcast.

In this week’s news:  We’ll Look At –  

• Backpack Weight and Low Back Pain in Children

• After effects of Exercise and Relaxation on Blood Pressure

• Chronic Widespread Pain and Its Comorbidities

• College Athletes Likely to use Chiropractic

• Study Condemns FDA’s Handling of Drug Safety

• CCGPP Responds to Criticism about Low Back Best Practice Document

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #65, recorded October 6, 2006.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.

This week’s Episode is sponsored by DaVinci Laboratories.  Please surf to our web site at ChiropracticRadio.com and click on the DaVinci link for your Health and Nutritional needs.

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And Now for some news ….

Backpack Weight and Low Back Pain in Children

A study in the Journal Back and Musculoskeletal Rehabilitation looked at the relationship between backpack weight and low back pain in children.

The weight of a child's backpack is widely thought to contribute to back pain. No studies directly support numerous general guidelines on backpack use. This study was designed to investigate the relationship between back pain and backpack weight in an American school population.

While there was a relationship between age and back pain, the relationship between back pack weight and back pain was not significant. Those who carried other objects (such as musical instruments, sports bags, etc.) had increased back pain, but this relationship disappeared with age adjustment.

The study concluded that contrary to media hype, laws, and position statements, this first study of the relationship between back pack weight and pain suggests that there is no independent relationship between back pack use and back pain in American school children.

Surf to our Show Notes for a link to this Study - http://iospress.metapress.com/(oy41u255wum0kr45vvd5d0vd)/app/home/contribution.asp?referrer=parent&backto=issue,4,5;journal,1,18;linkingpublicationresults,1:103166,1

After effects of Exercise and Relaxation on Blood Pressure

A study in the July 2006 issue of the Clinical Journal of Sport Medicine looked at the acute aftereffects of exercise and relaxation, performed alone and in combination, on blood pressure (BP) measured at baseline and during stressful conditions.

The study concluded that In normotensive and essential hypertensive (HT) subjects, a single bout of exercise or relaxation has hypotensive effects, further enhanced by their combination, and greater in the HT. Moreover, exercise performed alone or in combination with relaxation decreases systolic and diastolic BPs during mental stress.

Surf to our Show Notes for a link to this Study - http://www.cjsportmed.com/pt/re/cjsm/abstract.00042752-200607000-00010.htm;jsessionid=FRJPhXBqTByJ3LQp47hJk56tfpFpLhnHQPyQSFSTcq6DhXJyTQdL!1209472165!-949856144!8091!-1

Chronic Widespread Pain and Its Comorbidities

Chronic widespread pain (CWP), the cardinal symptom of Fibromyalgia, is prevalent and co-occurs with numerous symptom-based conditions such as chronic fatigue syndrome, joint pain, headache, irritable bowel syndrome, and psychiatric disorders. Few studies have examined the comorbidities of CWP in the general population.

Furthermore, little is known about the importance of familial (genetic and family environmental) factors in the etiology of co-occurrence.

The study, published in the August 2006 issue of the Archives of Internal Medicine found that associations between CWP and most comorbidities are mediated by unmeasured genetic and family environmental factors in the general population. The extent of mediation via familial factors is likely to be disorder specific.

Surf to our Show Notes for a link to this study - http://archinte.ama-assn.org/cgi/content/abstract/166/15/1649

College Athletes Likely to use Chiropractic

College athletes are likely to use chiropractic, say researchers in Hawaii who studied 122 female athletes and 187 male athletes representing 20 sports. Chiropractic was the second most common type of complementary and alternative medicine used, following massage therapy.

In particular, during the past 12 months, 38% of the subjects used massage, 29% used chiropractic, 14% used Lomilomi and 12% used acupuncture.

Women were more likely than men to use CAM . “ CAM usage overall did not differ significantly by sport, year in college, nor ethnicity. Hawaiian, Samoan, and Tongan subjects were more likely to use the Hawaiian-originated forms of CAM .”

For more information, surf to the May 2006 issue of the Clinical Journal of Sports Medicine – http://www.cjsportmed.com/

Study Condemns FDA’s Handling of Drug Safety

According to the NY Times, the nation’s system for ensuring the safety of medicines needs major changes, advertising of new drugs should be restricted, and consumers should be wary of drugs that have only recently been approved, according to a long-anticipated study of drug safety.

The report by the Institute of Medicine , part of the National Academy of Sciences, is likely to intensify a debate about the safety of the nation’s drug supply and the adequacy of the government’s oversight. The debate heated up in September 2004 when Merck withdrew its popular arthritis drug Vioxx after studies showed that it doubled the risks of heart attacks.

The report’s conclusions are often damning. It describes the Food and Drug Administration as rife with internal squabbles and hobbled by underfinancing, poor management and outdated regulations.

The report made these recommendations, most of which would require Congressional authorization:

1.   Newly approved drugs should display a black triangle on their labels for two years to warn consumers that their safety is more uncertain than that of older drugs.

2.   Drug advertisements should be restricted during this initial period.

3.   The F.D.A. should be given the authority to issue fines, injunctions and withdrawals when drug makers fail — as they often do — to complete required safety studies.

4.   The F.D.A. should thoroughly review the safety of drugs at least once every five years.

5.   The F.D.A. commissioner should be appointed to a six-year term.

6.   Drug makers should be required to post publicly the results of nearly all human drug trials.

Surf to our Show Notes for a  link to the full article - http://www.nytimes.com/2006/09/23/health/policy/23fda.html?hp&ex=1159070400&en=d8d4a701afa95d34&ei=5094&partner=homepage

Order Report Here - http://www.nap.edu/catalog/11750.html

CCGPP Responds to Criticism about Low Back Best Practice Document

Continuing our coverage of the Council on Chiropractic Guidelines and Practice Parameters, the CCGPP, which has come under criticism as of late for producing a document that may not be in Chiropractors best interest, the CCGPP Executive committee has addressed some of the communities concerns by release the following Important Observation document. 

Please note that the opinions of CCGPP do not reflect the views of COT’s HealthBeat and are solely presented here for informational purpose. 

To begin, the CCGPP Secretary, Dr. Ronald Farabaugh stated some benefits that the CCGPP Best Practice document provides:

• Education of medical providers

• Stimulate Referrals

• Education of third party payors, benefit managers, and employers to potentially expanded benefits

• Fight bad consultants

• Allows greater discretion for physician decision-making

• Patient information

Further, Dr. Farabaugh states that If we do nothing in the area of evidence-based practice we risk being tyrannized by those who will do it for us, without chiropractic input.

The Executive Committee as a whole stated the following – Quote -

The following observations are submitted to challenge those who believe the CCGPP Best Practice Initiative will limit chiropractic care. We have a differing opinion. Please consider the following:

Observation…Chronic care: The CCGPP Best Practice low back draft recommends treatment beyond every guideline in existence today. Given that reality, how could this document be used to limit chiropractic? This is the ONLY document we’ve seen supporting chiropractic treatment of chronic conditions. (see pages 5-19) Show us any others.

Observation…Literature ratings: "B" and "C" ratings in the scientific community are not all bad, in fact, with nearly every category of low back condition, no treatments are rated higher than spinal manipulation. (see pages 27-30) Therefore how could this document be used to limit care? “B” and “C” are the equivalent of hitting a triple (using a baseball analogy) in the world of science. There are few home runs in the scientific literature, but manipulation for acute, subacute, and chronic care are rated at the highest levels in the CCGPP Best Practice document, thus improving our chances of expanding benefits. (see pages 27-30)

Observation…Passive Modalities: Given that the insurance industry is fully aware of the low rating on passive modalities present in every guideline with which we are aware (ODG, ACOEM, AHCPR, Milliman and Robertson, etc.), what proof do the critics have that this will lead to a 30-40% reduction in income? This issue represents fear mongering at the lowest levels.

Observation…X-ray: Given that the CCGPP x-ray recommendations have set the bar as low as "pain and/or limitation of motion" (see page 69), how could this document be used against us, unless you are one of the 1.9% of the DC population who believes in x-raying every patient no matter how uncomplicated the case? Again, why would this lead to a 30-40% drop income? Is there any proof? Answer: NO.

Observation…Website as a Resource: Consider the incredible potential every DC will have by having access to reams of data supporting care at the click of a mouse using the website. We also will have the ability to share that information with those who would deny care using a cookbook guideline like ODG, Milliman and Robertson, and ACOEM.

Observation…Best Practice vs. Guidelines: The Best Practice Initiative represents an important shift from cookbook guidelines to the "process of care", educating the payors that medical necessity must be based upon clinical decision-making, patient values, risk factors, and documentation, i.e., the uniqueness of each case, versus a guideline cookbook. Encouraging the “process of care” may be the main benefit of CCGPP’s Best Practice Initiative.

Observation…Pragmatic viewpoint: To summarize, if the treatment recommendations for the core of what we do, manipulation and active care, expand from acute and subacute into the chronic pain patient population, and the x-ray and PT recommendations are basically no different from what we've been living with for the past 10 years, what is the real problem with this document? This document increases the support for chiropractic management of acute to chronic care in the third party reimbursement world. This document will enhance patient care. (again, please read pages 5-19, What Constitutes Evidence for Best Practice?” ) – End Quote

For more information, surf to – http://www.ccgpp.org

http://nysca.com/?id=406

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For Chiropractic OnLine Today’s HealthBeat, This is Dr. Todd Eglow.

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