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!

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.

Research and Public Perception

by Terry A. Rondberg, DC

The media constantly communicates to its vast audience the recent medical breakthroughs. Traditional medicine dominates our society. The recent medical mishaps such as dangerous prescription painkillers, are associated with the failures of regulators who ignore the apparent loopholes of allopathic medicine.

However, alternative health care is gaining attention. It is commonly utilized by the general population. A recent study by Hong at Ohio State University found that nearly three out of four adults over age 50 use some type of alternative medicine. Hong noted, “The most commonly used…was chiropractic, which about 43% of respondents had used.” [1]

Research and Public Perception - by Dr. Terry RondbergUnfortunately, the general public is unaware of chiropractic’s potential contribution to overall wellness.

According to the results of the World Federation of Chiropractic (WFC) survey titled, “Identity of the Chiropractic Profession,” only five percent of participating DCs believed the public considers that chiropractors are doctors who correct subluxations, while 81% believe the public defines chiropractic as doctors who help treat back and neck pain.” [2]

Eighty‑five percent of the chiropractors said the nervous system is essential to the practice of chiropractic, and 65% indicated the public should define chiropractic as stress and  subluxation correction.

In 2003, the Institute for Social Research at Ohio Northern University conducted a survey of  North American chiropractors.  The results showed that 89.8% of respondents felt adjustments should not be limited to musculoskeletal conditions and 88.1% felt that the term vertebral subluxation complex should be withheld. [3]

Some chiropractors have expressed that the public perception should identity the profession. Others wish to limit our role to musculoskeletal pain practitioners, justifying their position by claiming that only low back pain has sufficient research evidence and backing. Both sides are incorrect for reasons I have discussed elsewhere. [4,5]

A successful public relations approach should match the public’s interest with our vision of chiropractic. It is necessary for the public to be properly educated on how chiropractic meets their needs.

The success of this strategy came to light when Dr. Madeline Beherendt’s study on infertility was published in the Journal of Vertebral Subluxation Research, (JVSR) which resulted in positive and credible media coverage for chiropractic.

Among the television programs reporting the study’s results were: KBCI Boise, WCBS New York, KING Seattle, KYW Philadelphia, WTNH New Haven, KUTV Salt Lake City, WCPO Cincinnati, WOAI San Antonio, KOLD Tucson, and KPTM Omaha. On one of the specialized health news wire services, the press release was accessed by journalists more than 700 times by the end of March. [6]

Furthermore, Dr. Erin Elster, an upper cervical chiropractor in Boulder, Colo., gathered data from 44 MS patients and 37 PD patients treated during the span of five years. After treating upper neck injuries in 81 patients, 91% of MS patients and 92% of PD patients improved, suggesting that correction of neck injuries may reverse MS and PD.

The Chiropractic Journal reported, “The World Chiropractic Alliance (WCA), publisher of JVSR, distributed a press release on the research results, which was quickly picked up by major news media, including Reuter’s wire service. The news was relayed to newspapers and television stations around the world, and the story showed up in a wide array of media.

“Viewers watching CNN coverage of the Florida hurricanes saw the headline scroll by on the late breaking news crawl … readers saw all the details in The Washington Post … Internet browsers found the story on sites as varied as the National Institutes of Health’s MEDLINE and the Armenian Medical Network. Yahoo News featured the story and it even appeared on the Merck pharmaceutical company’s website.

“Within days, millions of people were exposed to information about chiropractic and how correction of subluxations might result in an improvement or reversal MS and PD. Although the research examined the two specific diseases, the press release emphasized that the role of chiropractic was not to diagnose or treat those diseases directly, but to correct subluxations and, in doing so, affect the progress of the diseases.” [7]

More recently, a collaborative study of chiropractic care, oxidative stress, and DNA repair has peeked the interests of medical news services and alternative health websites. [8, 9]

The public and journalists are not interested in “manipulation” for the treatment of low back pain. However, they are interested in learning about chiropractic as a focal point on wellness and quality‑of‑life issues often neglected by traditional medicine.

The answer is university-based research and not just a few studies focusing on small case histories. Although encouraging, a long‑term solution must be implemented. The university based research, should involve thousands of patients, and published in prestigious, medical journals. The group QOLR has embodied this challenge but your assistance is paramount.

References

1. Hong G‑S: “About 70 percent of older adults use alternative medicine.” News release. Ohio State University . April 9, 2005.
2. “Consultation on Identity: Quantitative Research Findings.” World Federation of Chiropractic, Dec. 7, 2004.
3. McDonald W, Durkin K, Iseman S, et al: “How Chiropractors Think and Practice.” Institute for Social Research. Ohio Northern University. Ada , OH . 2003.
4. Kent C: “A challenge and three myths.” The Chiropractic Journal. September 2004.
5. Kent C: “Where are we going?” The Chiropractic Journal. August 1997.
6. “Infertility research still a top news story in U.S.” The Chiropractic Journal. May 2004.
7. JVSR, WCA hit two more publicity home runs. The Chiropractic Journal. October 2004.
8. “Chiropractic Influence on Oxidative Stress and DNA Repair.” Medical News Today. March 7, 2005.
9. “Doctors crack code on chiropractic care.” Mercola.com. 4/27/05.

About the Author – Dr. Terry Rondberg
Terry A. Rondberg, DC, is a tireless advocate for drug-free chiropractic, chiropractic patients, wellness, and the mind-body connection for physical, mental, emotional and spiritual well-being. As CEO of the World Chiropractic Alliance, he is a global activist for the interests of doctors of chiropractic and their patients.

Back pain surgery results may be overrated

By Terry A Rondberg, DC

Months following spinal surgery for back pain, patients remember their initial pain as worse than they rated it at the time, reports a recent study in the journal Spine.

A research team, headed by Dr. Ferran Pellisé of Hospital Vall d’Hebron, Barcelona, Spain, concluded that studies relying on such after-the-fact ratings may overestimate the effectiveness of spinal surgery in relieving chronic back pain.

Lower back pain - spineThe researchers studied before-and-after ratings made by 58 patients who underwent lumbar fusion surgery for chronic low back pain. Before their operation, all patients completed standard evaluations of back pain and related disability. These prospective (“forward-looking”) ratings were compared with retrospective (“backward-looking”) ratings made an average of three years after surgery.

Patients consistently rated themselves worse than in their original questionnaires, when recalling their preoperative state. For example, on a simple 10-point scale, the patients’ original average pain rating was 7.0. On follow-up ratings, the patients recalled their pain as being significantly worse, with average rating of 8.2.

Based on the original ratings, surgery produced an average pain reduction of 3.3 points on the 10-point scale. Yet, if the recalled ratings were used, the average improvement would have been 4.6 points. Similar patterns were noted for other standard ratings of back pain and related disability.

Whether the time since surgery was shorter or longer, the extent of patient recall bias did not differ significantly. The ratings did not vary in any systematic way, so there was no way to adjust for them statistically.

Retrospective studies – in which patients are asked to remember and rate their state of health before treatment – are widely used in medical research. Few prior studies, however, have looked at how patients’ recollections measure up to actual pretreatment ratings. The use of retrospective studies to assess the results of spinal surgery has increased in recent years.

Relying on such after-the-fact pain ratings may give the impression that surgery for back pain is more effective than it actually is, the new results suggest.

“Our study shows that relying on a patient’s recall of his or her preoperative status a few months or years after surgery is not a valid method for establishing baseline status when treating low back pain,” Dr. Pellisé and colleagues concluded.

SOURCE: “Reliability of Retrospective Clinical Data to Evaluate the Effectiveness of Lumbar Fusion in Chronic Low Back Pain.” Pellise, Ferran MD; Vidal, Xavier MD, PhD; Hernandez, Alejandro MD; Cedraschi, Christine PhD; Bago, Joan MD; Villanueva, Carlos MD. Spine. 30(3):365-368

About the Author – Dr. Terry Rondberg
Terry A Rondberg, DC, is a tireless champion for drug-free chiropractic and mind-body wellness. As publisher of The Chiropractic Journal, on a monthly basis he reaches more than 70,000 chiropractors across the globe.

HRQL- An Important Research Instrument

by Terry A. Rondberg, DC

Stethoscope and ClipboardPreviously, researchers determined a patient’s level of health by measuring vital signs, recording frequency of symptoms, examining X‑Rays, and observing character. Rarely did they ask the patient how he or she felt. They took pride in judging the patient’s quality of life based just on objective measurements.

Recently, a new instrument allows researchers a more accurate picture into the patient’s state of well-being ‑‑ the health related quality of life survey.

According to a paper published in the British Medical Journal (BMJ 1998;316:542‑545), “It is now widely acknowledged that the personal burden of illness cannot be described fully by measures of disease status such as size of infarction, tumor load, and forced expiratory volume. Psychosocial factors such as pain, apprehension, restricted mobility and other functional impairments, difficulty fulfilling personal and family responsibilities, financial burden, and diminished cognition must also be encompassed. The area of research that has resulted from this recognition is termed ‘health related quality of life’ [HRQL]. It moves beyond direct manifestations of illness to study the patient’s personal morbidity.  That is, the various effects that illnesses and treatments have on daily life and life satisfaction. Although quality of life assessment was almost unknown a few years ago, it has rapidly become an integral variable of outcome in clinical research.”

The Internet has made these surveys more prominent and meritorious for scientists. The surveys are also more convenient for the researcher and the patient. “Instruments administered via the Internet appear to be reliable, and to be answered similarly to the way they are answered when they are administered via traditional mailed paper questionnaires,” reported Stanford University researchers in the Journal of Medical Internet Research (J Med Internet Res 2004;6(3):e29).

Measuring the impact of health care on the patient’s well-being has become so crucial that many medical experts say research that disregards such an element, may not be worthwhile for practitioners.

One research paper, published by Canada ‘s Centre for Health Evidence, reports, “When the goal of treatment is to improve how people are feeling (rather than to prolong their lives) and physiological correlates of patients’ experience are lacking, HRQL measurement is imperative. For example, we would pay little attention to studies of antidepressants that failed to measure patients’ mood, or trials of anti‑migraine medication that failed to measure pain.” (“How to Use Articles about Health‑Related Quality of Life Measurements,” by Gordon H. Guyatt, et.al, for the Evidence Based Medicine Working Group).

Chiropractic care is no different.

If research fails to measure how patients view their own health, the results will be inaccurate and will fail to establish the relationship between subluxation correction and quality of life. Objective tests may show some stress reduction on the nervous system, but we must step out-of-bounds to clarify the effect of that reduction on the way people behave and feel.

We should not rely solely on health questionnaires, but combine the results with standardized clinical exams and observations.  This will enable us to answer many questions about chiropractic.

Prior to the Self‑Reported Quality of Life (SRQL) study, no specific outcome measurement existed for chiropractic care and very few non‑chiropractic quality of life surveys directed to chiropractic existed. With more than 7,000 records regarding the development and testing of patient‑reported health instruments indexed by the National Centre for Health Outcomes Development in Britain, only 17 engaged chiropractic. Of those 17, nine were specifically focused on back and neck pain, two on the symptom duration of myofascial pain, one on migraines, and two on general pain. One record was published in a non‑scientific trade newspaper when it should have appeared in a medical journal with comments and reviews from team experts.

Only one case out of 7,000 contained a broader application of chiropractic to quality of life issues – “A retrospective assessment of chiropractic care using a survey of self‑rated health, wellness and quality of life,” by Robert Blanks PhD, and colleagues, published in the Journal of Subluxation Research (JSR1997, 1:15‑31).

The quality of life questionnaire was created to specifically assess wellness via the patient’s self‑rating of the following: physical state, mental/emotional state, stress evaluation, life enjoyment, and general quality of life at two intervals: before and after they began chiropractic care.

I won’t regurgitate the technicalities involving the creation of this survey instrument.  The study revealed that patients reported significant change in all areas, including quality of life. They felt better physically and emotionally, experienced less stress and enjoyed themselves more simply thanks to chiropractic.

According to the results, improvements took effect about one month after care began. As long as they continued chiropractic care, they continued to make progress.  If this study had generated the international attention it deserved, thousands of people would have become better educated on how chiropractic could improve their well-being.  News flashes would have lit up the television screen while major newspapers would have posted such revolutionary news on the front-page.  Patients would have begun undergoing weekly adjustments and put aside their daily dose of aspirin.

There several reasons this did not occur.  The most obvious involves the domination of the pharmaceutical industry that pays advertisers a tremendous amount of money.

One research study out of 7,000 will not persuade the research community, the media and the general population. Data is necessary from thousands of patients along with dozens of well-conducted research papers published in major medical journals.

For every human being, we have composed a study to assess chiropractic’s influence on quality of life.  Mainstream media and the general public will not ignore this kind of evidence. It can transform health care to a higher level.