Follow the money

By Terry A. Rondberg

Follow the Money - Terry A. Rondberg, DCA new study published by JAMA shows that among patients age 65 years and older, rosiglitazone (a medication for treating Type 2 diabetes) is associated with an increased risk of stroke, heart failure, and all-cause mortality (death) when compared with pioglitazone (another medication for diabetes).

In their conclusion, the authors wrote: “…in a population of more than 227,000 patients 65 years or older who initiated treatment with a thiazolidinedione, we found that, compared with pioglitazone, rosiglitazone was associated with an increased risk of stroke, heart failure, and death and the composite of AMI (heart attack), stroke, heart failure or death.” (JAMA.doi:10.1001/jama.2010.954)

Despite trying to put rosiglitazone in the most “favorable” light possible, researchers had to admit that “analysis showed no differences in the risk for heart attack between rosiglitazone and pioglitazone,” even though the study found that rosiglitazone was associated with a 1.25-fold increase in risk of heart failure compared with pioglitazone.

Obviously, BOTH medications have serious negative side effects, but the report’s wording seems somewhat biased to me so I delved a little deeper. Within the past five years, the study’s head researcher, Steven E. Nissen, MD, has received research support from numerous drug companies, including AstraZeneca, Atherogenics, Novartis, Pfizer, Resverlogix, Daiichi-Sankyo, Sanofi-Aventis and — most importantly — Eli Lilly and Takeda.

The drug that fared better in this study (branded name Actos) is manufactured by Eli Lilly and Takeda. Avandia, the branded version of rosiglitazone, is made by GlaxoSmithKline, a name curiously absent from the list of Nissen’s financial benefactors.

Probably just a coincidence, right? Yet, only this month, the BMJ (which used to be called British Medical Journal) published a report that explored a possible link between authors’ financial conflicts of interest and their position on the association of rosiglitazone with increased risk of myocardial infarction in patients with diabetes.

The research abstract noted: “Of the 202 included articles, 108 (53%) had a conflict of interest statement. Ninety authors (45%) had financial conflicts of interest. Authors who had a favourable view of the risk of myocardial infarction with rosiglitazone were more likely to have financial conflicts of interest with manufacturers of antihyperglycaemic agents in general, and with rosiglitazone manufacturers in particular, than authors who had an unfavourable view (rate ratio 3.38, 95% CI 2.26 to 5.06 and 4.29, 2.63 to 7.02, respectively). There was likewise a strong association between favourable recommendations on the use of rosiglitazone and financial conflicts of interest (3.36, 1.94 to 5.83)” (BMJ 2010;340:c1344)

In another, even more chilling report (also published in BMJ), the author writes: “Casually following the fortunes of the blockbuster diabetes drug rosiglitazone (Avandia), you can’t help but imagine a Hollywood thriller. There is the scene where a leading scientist secretly records a meeting with drug company executives, a high powered congressional investigation, and a bitter legal battle waiting in the wings. Yet when you look more closely, the facts are even stranger than fiction. An expensive new drug shown to raise the risk of heart failure and suspected of increasing the chance of heart attacks has been taken by millions of people around the world and is being kept on the market by an industry funded regulatory system, despite calls from senior safety experts to withdraw it.” (BMJ 2010;340:c1848)

I took a look at one other factor as well: pricing. The most common price I could find for Avandia — the drug touted as “safer” by the research paper — was $3.32 per pill (for 30 pills of 8mg, which is considered the normal dose). For Actos, the price was $1.34 per pill (for 30 pills of 30mg, again, considered the normal dose).

When it comes to this type of medical drug research, the saying “follow the money” seems to apply. Perhaps it’s also time to follow the advice of “X-Files” character Fox Mulder: TRUST NO ONE.

About Terry A. Rondberg, DC
Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance. He is an ardent advocate for drug-free chiropractic care not just for back pain, but total body wellness. He has spoken globally on the issue of alternative care and the abuses of our current “health care” system.

Researchers discover additional benefit of Vitamin A

By Terry A. Rondberg, DC

For years, chiropractors and other non-medical wellness professionals have advocated taking nutritional supplements to make up for the deficiencies in our modern diets. Vitamin A has always been among the most recommended, since it’s critical to maternal health and child survival.

Terry A. Rondberg, DC - Vitamin A BenefitsRecently, researchers at The Johns Hopkins Bloomberg School of Public Health have found a link between a newborn’s lung function and the vitamin A supplementation the mother has taken. The results were published in the May 13, 2010, issue of the New England Journal of Medicine.

“Children of mothers who received vitamin A supplementation before, during and after pregnancy had significantly improved lung function when compared to those whose mothers received beta-carotene supplementation or placebo,” said lead author of the study, William Checkley, MD, PhD, assistant professor in the Division of Pulmonary and Critical Care of the Johns Hopkins School of Medicine with a joint appointment in the Bloomberg School’s Department of International Health. “Lung function of offspring in mothers who received maternal vitamin A supplementation improved by about 40 ml versus those whose mothers received a placebo. This represents an approximately 3 percent increase in lung function. Furthermore, the magnitude of effect observed in this study is slightly greater than that associated with preventing exposure to parental smoking in school-age children.”

Vitamin A deficiency isn’t as widespread in the US as it is in some developing countries, where nearly 190 million pre-school age children worldwide don’t get enough vitamin A — the underlying cause of night blindness among children, as well as 650,000 early childhood deaths annually. But since the main sources of natural vitamin A are raw vegetables like carrots, sweet potatoes, winter squash, spinach, and cantaloupe, many people in America and Europe are not getting enough A either.

The new study emphasizes the need to eat nutritional, wholesome meals including plenty of vegetables, or to take supplementation as a safeguard. Since medical doctors receive little or no training in nutrition, this is where chiropractors and other wellness professionals can really make a difference. By educating patients and even providing access to nutritional supplements, we can make profound differences in the lives of all the people we serve.

New Study: Millions of Elderly Given Wrong Drugs

In some traditional cultures, the elderly are revered. In others, they’re taken out to the woods and left to die. Generally, in America, they’re over medicated, often with harmful or useless drugs.

Elderly given wrong drugs - by Terry A. Rondberg, DCA recent study of the records of 470,000 patients over 65 who were admitted to an emergency department (ED) between 2000 and 2006 revealed that nearly 17% were given what the medical industry refers to as “potentially inappropriate medications (PIMs)” — in other words, the wrong drug.

“Approximately 19.5 million patients … of eligible ED visits were associated with one or more PIMs,” researchers concluded in their report, published in the March 2010 issue of Academic Emergency Medicine journal (2010; 17:231).

“There are certain medications that probably are not good to give to older adults because the potential benefits are outweighed by potential problems,” admitted lead author, William J. Meurer, MD.

The two worst offenders, which accounted for nearly 40% of the errors, were the drugs promethazine and ketorolac. Promethazine is a powerful and potentially risky sedative which can cause everything from confusion in older patients to, in rare cases, seizures. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used as an analgesic, fever reducer, and anti-inflammatory.

This isn’t the first time such results have been shown. In July 1994, the Journal of the American Medical Association reported on a study that revealed close to 25% of all elderly patients received wrong drugs.

Among their findings:

** 1.8 million older people had prescriptions for dipyridamole, a blood thinner that, the researchers say, is useless for all except people with artificial heart valves.

** More than 1.3 million older Americans were given prescriptions for propoxyphene, an addictive narcotic that is no better than aspirin in relieving pain.

** More than 1.2 million were prescribed diazepam or chlordiazepoxide, long-acting sedatives and sleeping pills that can make patients groggy, dizzy, and prone to falls.

“Standard published sources support the view that the 20 drugs in our primary analysis should virtually never be prescribed for the elderly,” researchers stated at the time.

One doctor, Jerry H. Gurwitz, MD, of Brigham and Women’s Hospital in Boston, was quoted in The New York Times as saying he hoped the study would serve as “a wake-up call” to America’s doctors. “I hope that the medical community will take it as seriously as the general public, I think, will,” he said, adding that the study might have actually understated the problem since it did not factor in drug interactions or the long-term effect of drugs like sleeping pills.

If we aren’t going to revere our elderly, it might be kinder to leave them in the woods!

Chiropractic Neurology – Q & A

by Terry A. Rondberg, DC

Chiropractic Neurology - by Terry A. RondbergBased on my previous articles on the subject, it’s clear there is a lot of interest about chiropractic neurology. What’s it all about? I’m posting this blog in frequently asked question (FAQ) format to ensure you can quickly find the answers you need.

Q. What’s chiropractic neurology?

A. According to the American Chiropractic Neurology Board (ACNB), chiropractic neurology is defined as “the field of functional neurology that engages the internal and external environment of the individual in a structured and targeted approach to affect positive changes in the neuraxis and consequent physiology and behavior.”

Q. So what does that mean in plain English?

A. It means that a chiropractic neurologist examines how the nervous system is functioning (or malfunctioning). If the system is out of balance, chiropractic treatment focuses on repairing the imbalance, such as vertigo, Autism, attention deficit disorder (ADD), to restore the patient to health.

Q. What others types of disorders can chiropractic neurology address?

A. Chiropractic neurologists may treat the above conditions, as well as dizziness, disequilibrium and imbalance, dystonia, tremors, chronic pain syndromes, back pain and movement disorders. They may also treat behavioral disorders such as Tourette’s Syndrome, as well as changes in personality or motor, sensory or cognitive impairments resulting from head traumas, accident injuries, traumatic brain injury (TBI) and mild TBI.

Q. So what’s the difference between a chiropractic neurologist and a medical neurologist?

A. According to the ACNB, the chiropractic neurologist provides the same manner of consultation as a medical neurologist, with the major difference being that the therapies and applications are performed without the use of drugs or surgery. So, a medical neurologist or neurosurgeon will prescribe medications, injections or brain surgery to correct a disorder or condition. On the other hand, the chiropractic approach is to therapeutically change brain and nervous-system function.

Q. How is a chiropractic neurologist different than a “traditional” chiropractor?

A. Most chiropractors are trained in the detection and correction of spinal dysfunction. But spinal function is just one of many influences on the nervous system. A neurologist not only has completed the doctor of chiropractic program, but must receive three years of additional training and testing to become a board-certified neurologist in the chiropractic profession. The extra training is specific to the field of neurology and includes the study of neurophysiology and clinical and diagnostic techniques.

Q. What are the benefits of chiropractic neurology?

A. Simply put, many conditions of the brain and nervous system do not respond well to aggressive interventions such as drug therapy or surgery. Both drugs and surgery are often associated with increased risks for serious complications or dangerous side effects. Thus, the approach taken by chiropractic neurologists can be highly beneficial in treating brain and nervous system disorders using safe and effective methods with lasting health benefits.

Welcome News: Study Confirms Chiropractic Benefits

As most of my readers know, I regularly point out biased claims from organized medicine (often parroted by the mainstream press) that chiropractic is not supported by research. That’s why it’s always welcome news when studies are published that DO point out research proving the effectiveness of chiropractic.

Maurice Jones-Drew
Jaguars Running Back Maurice Jones-Drew relies on chiropractic to put him on top of his game.

The latest, a report published by Australia’s Cochrane Collaboration, confirms what may seem obviously to chiropractors and their patients — that chiropractic can be effective in helping people overcome low-back pain.

The research, led by Bruce Walker, DC, of the Murdoch University School of Chiropractic and Sports Science in Australia, analyzed a number of different techniques provided by chiropractors. Walker and his colleagues at Murdoch studied 12 randomized controlled trials that included 2,887 participants. Each trial compared combined chiropractic interventions to some other therapeutic approach to low-back pain.

The result: in the short-term (within one month after the study began), pain improved in patients treated both with chiropractic and comparison treatments. Benefits were somewhat greater in the chiropractic group , although the difference was not considered “clinically significant,” the study’s authors wrote.

“If consumers have acute or subacute back pain they can have some confidence that if they go to the chiropractor they’ll see some improvement,” Dr. Walker reported.

References: Walker BF, et al. Combined chiropractic interventions for low-back pain (Review). Cochrane Database of Systematic Reviews. Issue 4, 2010.

About the Author – Terry A. Rondberg, DC
Dr. Terry Rondberg is an outspoken supporter for research on chiropractic care for not just back pain, but total body wellness. He is founder and CEO of the World Chiropractic Alliance, and is a much sought-after speaker worldwide on the issue of drug-free chiropractic.