Lipitor Paradox

It has been a long time since I posted anything.  Here is a funny/scarry video about Lipitor and statins in general.  Enjoy.http://www.youtube.com/watch?v=GqdzJLOQM2I&sns=fb

Workers' Comp and Chiropractic

This is a great article about the cost effectiveness of chiropractic in the worker's comp arena versus traditional medical care care for back pain.  There has been numerous studies showing the effectiveness and reduced cost of chiropractic. 

Bottom line is if you want to feel better faster with less expense and greater satisfaction as a patient, use chiropractic.

Here is list of some of the studies analyzed and their findings.

Research Suggesting Effectiveness And Reduced Costs Attributable To Chiropractic Care For Spinal-Related Injuries And Conditions

Study / Source Summary of Findings

Utah Workers' Compensation Board Study:  Total treatment costs for back-related injuries averaged $775.30 per case when treated by a chiropractor; $1,665.43 when injured workers received standard medical treatment.

North Carolina Workers' Compensation Patients:  Average medical care cost for lumbosacral sprain was $3,425, but only $634 when treated with chiropractic.

Ministry of Health, Ontario, Canada:   "Injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."

American Journal of Managed Care:   Health care costs for back and neck pain were substantially lower for chiropractic patients than patients receiving medical care ($539 versus $774, respectively)..

Medical Care Journal:  1. Mean total payments were lower for chiropractic care ($518) versus medical care ($1,020).  2. Favorable satisfaction and quality indicators suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending.

University of Ottawa:  1. Chiropractic treatment was significantly more effective than hospital outpatient treatment, especially in patients with chronic and severe back pain. Significantly fewer patients needed to return for further treatments at the end of the first and second years when receiving chiropractic care vs. medical care (17 percent vs. 24 percent).  2. Highly signifi cant cost savings could be achieved if more management of low-back pain was transferred from physicians to chiropractors.

Oakland University Study:  Health insurance claims for 395,641 chiropractic and medical care patients indicated that patients who received chiropractic care, solely or in conjunction with medical care, experienced signifi cantly lower health care costs compared with those who received only medical care. Total insurance payments were 30 percent higher for those who elected medical care only.

Medical College of Virginia:  By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.

Florida Workers' Compensation Board:  Of 10,652 back-related injuries occurring while on the job, individuals who received chiropractic care compared with standard medical care experienced a (1) 51.3 percent shorter temporary total disability duration; 2) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case); and 3) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.

Australian Workers' Compensation Study: Individuals who received chiropractic care for their back pain returned to work four times faster (6.26 days vs. 25.56 days) and had treatment that cost four times less ($392 vs. $1,569) than those who received treatments from medical doctors.

VU Medical Center Extramural Medicine: Total costs of manual therapy (447 Euro) were around one third of the costs of physiotherapy (1,297 Euro) and general practitioner care (1,379 Euro) for neck pain.

Journal of Manipulative and Physiological Therapeutics: For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs.



CBS and Consumer Reviews Pick Chiropractic

Check out this video.  I has some good stuff.  80% of people surveyed picked chiropractic.

Fosamax and Increased Fracture Risk

I recently read an article about the long term use of Bisphosphonate (Fosamax) and increased fracture risk.  Typically Fosamax is typically given to postmenopausal women with osteopenia (osteoporosis) to slow bone loss and to prevent fractures due to osteoporosis.  It is noted that several studies have reported a the occurrence of specific and rare types of femur fractures in individuals (mostly women) who have been taking bisphosphonates (Fosamax) for approximately 4-8 years.  It should be noted that the fractures occurred with no apparent trauma.  These fractures were not from falls.  In fact, in most cases, individuals were performing low energy exercise, sometimes just walking down a flight of stairs.

To give some background and technical info, bisphosphonates work by supressing osteoclasts (the cells that break down and recycle bone).  The theory is that if you inhibit bone turn-over you will be left with more bone and less net bone loss. However, bisphosphonates accumulate in the bone tissue and stay active for up to 10 years after their consumption is stopped.  What you are left with is increased bone density, but the quality of the bone is not not good.  When the osteoclast are suppressed the osteoblasts (cell used that form new bone)  are also affected.  Bone remodeling and turnover is a natural part of maintaining bone health and when bone resorption is decreased, bone formation is also decreased.  The microdamage that occurs regularly in bones and is normally repaired accumulates over time and is apparently not repaired because the normal process of bone resorption and formation has been altered by treatment with bisphosphonates.  After long term use, the quality of bone is not maintained. 

Present conclusion are that during long term alendronate (generic name for Fosamax) therapy, severe suppression of bone turnover may occur, resulting in increased susceptability of nonspinal fractures along with delayed healing.  Current evidence suggests that bisphosphonates should be stopped after 5 years.  In otherwise healthy perimenopausal women who merely have osteopenia, the best therapeutic option is probably not bisphosphonates. 

Weight-bearing exercise is essential for the prevention and treatment of osteoporosis and unfortunately, it is often overlooked and underutilized.  Muscle strength is an accurate predictor of bone strength weight-bearing exercise has been shown the most effective way to strengthen bone and thus protect against osteoporosis-related fractures.

Once again, medication is not the best way to prevent osteoporosis: nutrition and exercise are key for bone health (and overall health).

On a side note, in 2008, bisphonphonates sales exceeded $3.5 billion according to data from IMS Health.

Chiropractic and High Blood Pressure

This is a very good video about a CBS News piece depicting chiropractic and reducing  high blood pressure.  Chiropractors have been saying for years that chiropractic care is good for much, much more than just back pain.  It is very refreshing to see some formal studies being done by the government and researchers.  Just think of all the money that could be saved if the reliance on hypertension medication could be reduced, not to mention the savings in indirect costs by not having to pay for the consequences of the side effects caused by the medication. 

The basic premise of chiropractic is that chiropractors help remove the interference on the nervous system which then allows the body to better regulate itself. 

If you don't have facebook, you can also look at this video on youtube which is very simular.

Try Chiropractic First - Avoid Costly, Risky Surgery

I read an article in last Wednesday’s San Jose Mercury News that spinal surgery is on the rise for Medicare patients. This was based on a Medicare study that showed spinal fusion surgeries are on the rise and they are often done unnecessary. The main reason state for the operation is for arthritis and aging or just plain old back pain. The focus of the article is that more spinal fusions are being done rather than simple decompression surgeries as in the past. The difference is that decompression costs about $20,000.00 and the fusion costs $80,000.00 plus it is riskier and more challenging leading to more complications, longer hospital stays and even death, the article goes on to say.
The really interesting thing is that the spinal fusion surgery is no more effective than the less costly surgery, and there is “no good evidence that the expensive one is being used appropriately in the majority of cases.” The study goes on to say that the cost to Medicare, just for the hospital charges for the three kinds of back surgery reviewed, is about $1.65 billion per year. The study analyzed 32,000 Medicare patients who had one of the three kinds of surgery in 2007.
When talking about complications the article stated that about 5 in 100 patients who had simple or complex fusions suffered major complications such as stroke compared to 2 in 100 with decompressions. The risk of death within 30 days after surgery was 6 in 1000 for complex fusions, 5 in 1000 for simple fusions and 3 in 1000 for decompressions.
The article also says that patients should ask their doctor about alternatives such as steroid injections or physical therapy.  No mention of chiropractic!!
What bothers me most about this article is that nowhere chiropractic is mentioned! This is outrageous since it has been shown over and over that chiropractic is the safest and most effective treatment for back pain and has the highest levels of patient satisfaction and has the least complications and is the most cost effective of conventional treatments. Additionally, the risk of death is between 3-6/1000 and 2-5/100 for serious complications such as a stroke. The most common complication is from chiropractic is occasionally some temporary soreness. How would like to go to your doctor and have him tell you that you had a 2-5% chance of having a stroke from this procedure and a 0.5% chance of dying!!! Would you not opt to try chiropractic first?

Let’s hope everyone reads this article and uses chiropractic as first choice rather than a last resort.

Expanding Chiropractic in Medicare

I just read an interesting article in Dynamic Chiropractic about expanding the role of chiropractic in Medicare.

The final report for the chiropractic demonstration project by the federal government has finally been released. The purpose of the study was to determine whether it was feasible to expanding chiropractic coverage in the Medicare program. The project was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

Medicare patients gave chiropractors high marks when rating their satisfaction with care. In a report from Centers for Medicare & Medicaid Services from 2005 through 2007, 87% of patients surveyed gave their chiropractor a score of 8 or higher when asked to rate their satisfaction with care (1-10 scale), and 56% percent rated their chiropractor a perfect 10. Moreover, healthcare costs did not increase significantly with the addition of chiropractic services.

Other key findings in the report included:

· The most frequent reason for care favorable earlier experiences (59%) and insufficient relief of symptoms (39%).

· Clinical problems included back pain 78%, neck pain 50%, hip problems 38% and shoulder problems 32%.

· 60% of respondents indicated that they received “complete” relief of their symptoms or “a lot of relief of symptoms from chiropractic treatments.”

The conclusions are that Medicare is cost-effective and has a high patient satisfaction level and chiropractic benefits should be increased in the Medicare system. Hopefully, chiropractic will play a prominent role in the upcoming healthcare reforms just passed!!

The entire report can been reviewed at www.acatoday.org/pdf/demo_report.pdf