:dropcap_open:R:dropcap_close:ecently, I traveled to Madrid and London for an academic presentation and a technique seminar, respectively. At the invitation of Dr. Ricardo Fujikawa, who leads the chiropractic department at Real Centro Universitario Escorial, Maria Cristina, I was asked to discuss ways to enhance the college’s Activator Method Chiropractic Technique course that is included in core curriculum, and speak to the students who attend RCU. The campus includes a 16th century monastery, where I was provided accommodations during my stay.
At first, I was a little anxious, as the monastery was breathtaking, but sparse. None of the typical luxuries of a U.S. hotel room were included, not even a telephone or television. Only a crucifix hung over my bed, in a room that was simple but clean, just as you would imagine for a monk. After one good night’s sleep, I began to enjoy the serenity and forget about those standard comforts of home. The environment also enabled me to focus more directly on my presentation for the students, and inspired some of my comments to them.
I had planned to speak to the student body about the nearly 45-year history of instrument adjusting involving the Activator Method. But after touring and staying at the monastery, all I could think about was that modern-day chiropractic is still very much in its infancy. I’m sure those who constructed the monastery never imagined a world with smartphones, flat screen televisions, motorized vehicles and airplanes, but those advancements have been influenced by the foundations created by the people of centuries past.
In parallel, today’s chiropractic, at least in the United States, has its roots in a small town in Iowa, and its full integration into academic institutions around the world has taken a relatively short period of time. While we still have so much to accomplish in our profession, with research guiding our course, we should take a moment and look back on history, feeling proud of how far we’ve come. I hope the students I met during my stay in Madrid can look back four decades from now and feel the same sense of accomplishment and hope for the future as I do.
Dr. Arlan Fuhr travels extensively to chiropractic seminars, conferences and events around the world. He will be providing his insights and perspectives from these visits as a regular guest commentator for The American Chiropractor. You can reach him at 602-445-4230 or email [email protected].
June Issue Examines Controversial rhBMP-2 Research and Publications
(Burr Ridge, IL)— In a bold move, the nation’s leading spine journal is shining a critical light on the limitations of industry-sponsored research and is bolstering transparency initiatives to protect the integrity of scientific publishing. The June issue of The Spine Journal is dedicated to a review of recombinant bone morphogenetic protein-2 (rhBMP-2), a controversial synthetic bone growth product often used in spine fusion surgeries.
“The history of rhBMP-2 research is a cautionary tale for all medical professionals, researchers and patients,” said Christopher M. Bono, MD of Brigham & Women’s Hospital in Boston, MA and acting editor in chief of this issue of The Spine Journal. “As this matter demonstrates, the spine care field is currently at a precarious intersection of professionalism, morality and public safety. As physicians and journal editors, we felt an obligation to present a thorough examination of this controversial issue.”
Early industry-sponsored clinical research on rhBMP-2, published in a variety of orthopedic and spine-related medical journals, reported no adverse events or complications in hundreds of patients. However, in recent years, the use of rhBMP-2 has been associated with various early inflammatory reactions, cancer, osteolysis, infection, implant dislodgement and occasional life-threatening complications. A separate study also in the June issue of The Spine Journal suggests that rhBMP-2 usage could cause a higher incidence of male sterility than previously described by industry-sponsored researchers.
“Despite the growing list of complications associated with this product, rhBMP-2 still may be of great benefit to a small group of patients who have serious problems in healing bone,” said Dr. Bono. “In fact, this special issue features several interesting basic science and clinical studies exploring alternative dosing and delivery methods of rhBMP-2 that could prove to have fewer complications and adverse events in the future.”
The Spine Journal is the scientific, peer-reviewed journal of the North American Spine Society (NASS). NASS is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence-based and ethical spine care by promoting education, research and advocacy. NASS is comprised of more than 6,200 members from several disciplines including orthopedic surgery, neurosurgery, physiatry, neurology, radiology, anesthesiology, research, physical therapy and other spine care professionals. http://www.spine.org/. Find NASS on: NASS Facebook and NASS Twitter.
Simvastatin sold under the brand-name Zocor, as a single-ingredient generic product, and sold in combination with ezetimibe as Vytorin and in combination with niacin as Simcor
AUDIENCE: Family Practice, Cardiology, Pharmacy
ISSUE: FDA notified healthcare professionals that it is recommending limiting the use of the highest approved dose of the cholesterol-lowering medication simvastatin (80 mg) because of increased risk of muscle damage. Patients taking simvastatin 80 mg daily have an increased risk of myopathy compared to patients taking lower doses of this drug or other drugs in the same class. This risk appears to be higher during the first year of treatment, is often the result of interactions with certain medicines, and is frequently associated with a genetic predisposition toward simvastatin-related myopathy. The most serious form of myopathy, called rhabdomyolysis, can damage the kidneys and lead to kidney failure which can be fatal. FDA is requiring changes to the simvastatin label to add new contraindications (should not be used with certain medications) and dose limitations for using simvastatin with certain medicines.
BACKGROUND: The new changes to the drug labels for simvastatin-containing medicines are based on FDA’s review of the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) trial and other data described in the Agency’s March 2010 Ongoing safety review of high-dose Zocor (simvastatin) and increased risk of muscle injury. Simvastatin 80 mg should be used only in patients who have been taking this dose for 12 months or more without evidence of muscle injury (myopathy).
RECOMMENDATION: Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug.
Healthcare professionals and patients are encouraged to report adverse events, side effects, or product quality problems related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:
Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
Read the MedWatch safety alert, including links to the FDA Drug Safety Communication, Press Release, and Consumer Update, at:
SENECA FALLS, NY: New York Chiropractic College’s first Master of Science in Clinical Anatomy (MSCA) fellow, Kathy Dooley, DC, accepted a teaching consultant (adjunct professor) position at Cornell Medical College and Einstein College of Medicine and will be teaching gross anatomy lab to medical students at both colleges.
Dooley intends to further develop her teaching skills at the medical colleges while building a practice in chiropractic and acupuncture. Having earned a DC degree in 2007 and begun her acupuncture studies at the Finger Lakes School of Acupuncture and Oriental Medicine of NYCC – a program she called “fantastic” – she now plans to complete her acupuncture master’s course work in New York City while practicing and teaching. “I am so immensely grateful to the faculty and staff of NYCC. Without amazing mentors like Dr. Rob Walker my life would not have been possible. I am extremely happy, and doors seem to be flying open due to my experience gained at NYCC in the MSCA program,” she said.
Anthony Hamm, DC, FACO, president of the American Chiropractic Association’s Council of Delegates, is the first DC to be elected co-chair of the American Medical Association’s Health Care Professionals Advisory Committee Review Board (HCPAC), which develops recommendations on relative values for new and revised CPT® codes for non-MD/DO services.
Dr. Hamm will also serve on the AMA/Specialty Society Relative Value Scale Update Committee, which makes recommendations on relative values regarding new and revised services to the Centers for Medicare and Medicaid Services and performs broad reviews of the Resource-Based Relative Value Scale, which determines Medicare provider reimbursement. Read more at http://www.acatoday.org/press_css.cfm?CID=4430.
The American Chiropractic Association’s (ACA) Board of Governors has voted to join an existing class action lawsuit against UnitedHealthcare (United) initiated by the Ohio State Chiropractic Association, the Congress of Chiropractic State Associations and others. ACA’s involvement will expand the litigation to include problems with United’s claims review, tiering and payment policies.
ACA urges providers who believe that they and/or their patients have been affected by United or Optum’s unfair practices to visit the Chiropractic Networks Action Center (CNAC), where they will find instructions and forms that can be used to submit a complaint. CNAC can be accessed by going to: http://www.acatoday.org/CNAC.
I recently returned from the World Federation of Chiropractic Biennial Congress in Rio de Janeiro, Brazil, and the experience was an eye-opener. There were 900 attendees from all over the world and, because Brazil is getting ready to host the World Cup in 2012 and the Summer Olympics in 2014, the country was bustling with activity.
The quality of the research presentations at the WFC Congress was unparalleled, the best I have ever seen in chiropractic. In fact, I have attended the International Society for the Study of the Lumbar Spine, one of the most prestigious conferences in the medical world, and the presentations in the WFC’s scientific program could easily have been delivered there.
I was particularly intrigued by the fact that the top three prize-winning papers presented at the Congress hailed from research conducted in countries other than the U.S. Also, the winning papers focused on fresh topics and stayed away from chiropractic’s typical research emphasis on the low back and neck. It was gratifying to see evidence that we are expanding our scope and finally researching other conditions that we have been seeing on a practical basis in our clinics for years.
Third prize was awarded to an Australian who had studied Temporomandibular Joint Disorder, or TMJ. A researcher from Brazil who demonstrated that pain could be reduced in lab animals using the Activator technique was recognized with second place honors. His research showed not only that chiropractic works, but also how it works. The grand prize went to a doctor from Denmark who established the effectiveness of chiropractic on non-cardiac chest pain. In keeping with the trend, the highest ranking papers from U.S. researchers also avoided the topics of low back or neck pain, focusing on hypertension instead. One of the veteran researchers in attendance observed that every platform presentation involved randomized controlled trials, a first for chiropractic at the WFC. This Congress will likely be remembered as the one with a lot of “firsts,” an important acknowledgment of the progress we are making as a profession.
Following the theme of “firsts,” in the two days prior to the Biennial Congress, I had the opportunity to teach a technique seminar to Brazilian students for the first time. They were some of the most enthusiastic students I’ve ever encountered. They came early, stayed late, and wanted to absorb every possible aspect of the seminar. As an aside, over 75 percent of the students in attendance were female, so an increase in women practitioners is not something exclusive to the U.S.
I left Brazil with the sense that, while chiropractic is mature in the U.S., it is an emerging profession worldwide and one that deserves substantial notice. We still have work to do, especially because chiropractic is registered in only 90 of the 194 countries around the world. But, with research being conducted across continents and patients increasingly turning to chiropractic for their care, clinicians and patients are seeing results like never before. I came home energized and ready to continue reaching out to students, not only in the U.S., but in international markets as well. They are our rising stars and, if the students I met in Brazil are a reflection of others around the world, we can feel confident they will carry the chiropractic torch with both pride and aptitude.
Dr. Arlan Fuhr travels extensively to chiropractic seminars, conferences and events around the world. He will be providing his insights and perspectives from these visits as a regular guest commentator for The American Chiropractor. You can reach him at 602-445-4230 or email [email protected]
Stephen Press, DC, PhD, was the honoree last week in Rio de Janeiro, at the World Congress of Chiropractic, by representatives of 100 national associations, for founding the International Federation of Sports Chiropractic, known as “FICS”.
At the World Chiropractic Congress in Rio de Janeiro, last week, the representatives of some 100 national Chiropractic Associations met to hold the World meetings of the two agencies which represent the Chiropractic profession at the World level; the World Federation of Chiropractic (WFC) and FICS, the International Federation of Sports Chiropractic. The Executive Board of FICS voted to honor Dr. Stephen Press, of Englewood, NJ with the”Founder’s Award” for founding the federation in1987 in London.
At the beautiful Kensington Town hall in downtown London, in Sept 1987, the representatives of 23 National associations met on invitation of Dr. Press, who was serving as Chairman of the ACA (American Chiropractic Association) Sports Council’s International Affairs committee at the time. They voted to form the federation, and then elected him their first president.
He continues to practice in Englewood, NJ, and today serves as editor-in-chief for the Harvard Medical School based Wiki site, WikiDoc.org for Alternative medicine, and as Exec. Tech Dir. for the Columbia based site, called Ourmed.org.
:dropcap_open:T:dropcap_close:he White House unveiled a multi-agency plan aimed at reducing the “epidemic” of prescription drug abuse in the U.S.—including an FDA-backed education program that zeros-in on reducing the misuse and misprescribing of opioids.
Gil Kerlikowske, director of the White House Office of National Drug Control Policy, says the plan—a collaborative effort involving agencies of the departments of Justice, Health and Human Services, Veterans Affairs, Defense, and others—provides a national framework for reducing prescription drug abuse and the diversion of prescription drugs for recreational use.
Key elements of the plan—called Epidemic: Responding to America’s Prescription Drug Abuse Crisis—include:
- expansion of state-based prescription drug monitoring programs
- recommending convenient and environmentally responsible ways to remove unused medications from homes
- supporting education for patients and health care providers
- reducing the number of “pill mills” and doctor-shopping through law enforcement
In concert with the White House plan, the Food and Drug Administration (FDA) is announcing a new risk reduction program—called a Risk Evaluation and Mitigation Strategy—for all extended-release and long-acting opioid medications.
Opioids are synthetic versions of opium that are used to treat moderate and severe pain.
FDA experts say extended-release and long-acting opioids—including OxyContin, Avinza, Dolophine, Duragesic, and eight other brand names—are extensively misprescribed, misused, and abused, leading to overdoses, addiction, and even deaths across the United States. FDA says a 2007 survey revealed that more than half of opioid abusers got the drug from a friend or relative.
Opioids—such as morphine and oxycodone—are used to treat moderate and severe pain. Over the past few decades, drug makers have developed extended-release opioid formulas to treat people in pain over a long period.
FDA estimates that more than 33 million Americans age 12 and older misused extended-release and long-acting opioids during 2007—up from 29 million just five years earlier. And in 2006, nearly 50,000 emergency room visits were related to opioids.
FDA has had the power to request companies to develop REMS since 2007. The plans may also include medication guides and patient package inserts.