Research Review – Page 5 – The American Chiropractor

Truth in Advertising?

Creating Demand for Prescription Drugs: A Content Analysis of Television
Direct-to-Consumer Advertising Annals of Family Medicine Vol. 5, No. 1, January/February 2007 by Dominick L. Frosch, Ph.D., Patrick M. Krueger, Ph.D., Robert C. Hornik, Ph.D., Peter F. Cronholm, M.D.,
Frances K. Barg, Ph.D.

FROM ABSTRACT

PURPOSE

American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers.

This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives.

METHODS

We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters.

RESULTS

Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%).

No ads mentioned lifestyle change as an alternative to products. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition.

The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%).

Products were frequently (58%) portrayed as medical breakthroughs.

CONCLUSIONS

Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes.

The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.

THE ABOVE ARTICLE GENERATED
THE FOLLOWING EDITORIAL

Direct-to-Consumer Advertising: Is It Too Late to Manage the Risks?

by David A. Kessler, M.D. and Douglas A. Levy, J.D.

School of Medicine, University of California,
San Francisco, CA

Pharmaceutical spending on television commercials nearly doubled from $654 million in 2001 to a staggering $1.19 billion in 2005.

Nearly one third of the 2005 spending was on only one category: sleep medicines. Yet, sleep disorders, however problematic and serious they may be, are almost inconsequential when compared with the major causes of the death in the United States: cardiovascular disease, cancer, and unintentional injuries.

No matter how much the [drug] industry claims its advertising provides public health benefits, the amount spent promoting drugs for conditions of varying severity begs the question of whether the industry truly is acting for the public benefit.

As Frosch, et al., show in this issue, nearly all pharmaceutical ads are based on emotional appeals, not facts, and few provide necessary details about the causes of a medical condition, risk factors, or lifestyle changes that may be appropriate alternatives to pharmaceutical intervention.

Patients walk in the door having just seen a television ad showing a miserable allergy sufferer dancing through a weed-filled field. They expect that a simple stroke of a pen onto a prescription pad will solve whatever their problems may be.

Patients learn for the first time about conditions they never worried about before and ask physicians for new medicines by trade name because they saw it on television.

Patients have always expected simple answers to complex questions, but direct-to-consumer (DTC) advertising has elevated this problem to new heights, because patients, in some ways, now rely on Madison Avenue as a provider of health information.

Consumers who make health decisions based on what they learn from television commercials ultimately take medicines they may not need, spend money on brand medicines that may be no better than alternatives, or avoid healthy behaviors because they falsely think a medicine is all they need.

In general, the ads that consumers see do not contain the right balance of information to provide any meaningful health education. The facts gleaned from DTC ads are minimal at best.

The drug companies “have done a skillful job of portraying complex medicines in the simplest terms—even if doing so creates inaccurate perceptions in the minds of our patients.”

One fact is unquestionable: DTC ads do not effectively or consistently convey important information about product risks and benefits.

Physicians, consumers, and policy makers must take further action so that the facts about medicines are not lost in the advertising fog. As Frosch, et al., correctly point out, the consequences of poor judgments are quite different for drugs than they are for soap.

KEY POINTS FROM DR. DAN MURPHY

1) American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year. Notice that this does not include over-the-counter television drug advertisements.

2) Nearly all television drug ads use the “emotional appeals” approach to promote their products; the ads never mention lifestyle change as an alternative to drugs; 18% of ads portrayed lifestyle changes as insufficient for controlling a condition.

3) Despite the claims by drug companies that their television ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk and they minimize the value of health promotion through lifestyle changes.

4) Television drug ads “have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.”

5) “The United States and New Zealand are the only developed countries that permit direct-to-consumer advertising of prescription drugs.”

6) The Food and Drug Administration relaxed direct-to-consumer advertising regulations in 1997.

7) Direct-to-consumer advertising misleads consumers and “prompts requests for products that are unneeded or more expensive than other equally effective drugs or nonpharmacologic treatment options.”

8) “Television advertising now comprises most of the consumer-directed prescription pharmaceutical marketing expenditures.”

“Television pharmaceutical ads are among the most common forms of mediated health communication in the United States.”

9) The average television drug ad length is 45 seconds.

10) Television drug ads are often “ambiguous about whether viewers might legitimately need the product.”

11) “By ambiguously defining who might need or benefit from the products, DTCA implicitly focuses on convincing people that they may be at risk for a wide array of health conditions that product consumption might ameliorate, rather than providing education about who may truly benefit from treatment.”

12) “Direct-to-consumer drug advertising contributes to the medicalization of what was previously considered part of the normal range of human experience.”

13) “Several ads for cholesterol-lowering drugs appeared to suggest that nonpharmacological approaches were almost futile.”

14) Drug ad “characters typically regained complete control over their lives after using the product, whereupon they also received social approval from friends or family.”

15) “DTCA often presents best-case scenarios that can distort and inflate consumers’ expectations about what prescription drugs can accomplish.”

16) “Pharmaceutical spending on television commercials nearly doubled from $654 million in 2001 to a staggering $1.19 billion in 2005.”

17) “Nearly all pharmaceutical ads are based on emotional appeals, not facts, and few provide necessary details about the causes of a medical condition, risk factors, or lifestyle changes that may be appropriate alternatives to pharmaceutical intervention.”

18) “Patients have always expected simple answers to complex questions, but direct-to-consumer advertising has elevated this problem to new heights, because patients in some ways now rely on Madison Avenue as a provider of health information.”

19) “Consumers who make health decisions based on what they learn from television commercials ultimately take medicines they may not need, spend money on brand medicines that may be no better than alternatives, or avoid healthy behaviors because they falsely think a medicine is all they need.”

20) “In general, the ads that consumers see do not contain the right balance of information to provide any meaningful health education. The facts gleaned from DTC ads are minimal at best.”

21) “One fact is unquestionable: DTC ads do not effectively or consistently convey important information about product risks and benefits.”

22) “Physicians, consumers, and policy makers must take further action so that the facts about medicines are not lost in the advertising fog. As Frosch, et al., correctly point out, the consequences of poor judgments are quite different for drugs than they are for soap.”

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic.

Malic Acid and Fibromyalgia

Key Points from Dan Murphy

1) An explanation for the soft tissue pain experienced by patients with fibromyalgia was that muscle energy production of ATP may be compromised.

[This has significant relevance to low level laser therapy because of their ability to increase the production of cellular ATP].

2) Also, abnormal blood flow may deprive muscle of sufficient oxygen and other nutrients.

[This has significant relevance to chiropractic because of the evidence that chiropractic spinal adjustments improve spinal mechanics, which inhibits the sympathetic nervous system and improves blood flow.]

3) The muscles of patients with fibromyalgia are deficient in ATP and magnesium.

4) Malic acid and magnesium play a pivotal role in mitochondrial ATP synthesis.

5) Malic acid is “widely distributed in the vegetable kingdom including concentrations of 4 to 8 g/l of apple juice.”

6) Malic acid plus magnesium can increase mitochondrial production of ATP energy.

7) The best results were observed from “use of a higher dosage and longer duration of treatment” with malic acid and magnesium.

8) Study results “indicate that it may be beneficial on the painful fibromyalgia symptoms in dosages in excess of 8 tablets/day for up to 6 months.”

[8 tablets X 200 mg per tablet = 1600 mg malic acid per day]
[8 tablets X 50 mg per tablet = 400 mg magnesium per day]

9) The proposed mechanism for the benefit of malic acid plus magnesium supplementation is that they “increase production of ATP.”
This article suggests that the minimum dosage should be 6 tablets per day (2 with each meal), which would supply 1764 mg of malic acid and 354 mg of magnesium.

Another article suggests that the optimal dosage should be 9 tablets per day (3 with each meal), supplying 2646 mg of malic acid and 531 mg of magnesium.

This article suggests that the minimum dosage should be 6 tablets per day (2 with each meal), which would supply 1764 mg of malic acid and 354 mg of magnesium.

Another article suggests that the optimal dosage should be 9 tablets per day (3 with each meal), supplying 2646 mg of malic acid and 531 mg of magnesium.

Omega-3 Fatty Acids in Pregnant Women and Infants

It is well known that diets containing adequate levels of omega-3 fatty acids have significant health benefits. Improvement in cardiovascular health, vision, improved immune system function and brain function are only a few examples. As chiropractors, we often treat pregnant women, infants and young children in our daily practices. Although well published, there is oftentimes a lack of appreciation regarding the many benefits of supplementation with long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFA’s) for this group of patients. This article will review a small portion of the current literature regarding this topic and touch on the following points.

Fish Oils…

• Improve postpartum depression
• Improve mean birth-weight and gestation times for pregnant women
• Improve infant visual development
• Improve neurological development in the fetus and infant
• Improve children’s IQ
• Improve ADHD symptoms better than Ritalin
• May improve/reduce atopic diseases such as asthma and allergies
• May be beneficial in children with primary nocturnal enuresis

According to a recent article by Genuis and Schwalfengerg¹ in the Journal of Perinatology, there is mounting evidence implicating omega-3 deficiency as a determinant of various maternal and pediatric afflictions. As a consequence, physicians should consider recommending purified fish oil supplement during pregnancy and lactation.

Hibbeln² reported in Journal of Affective Disorders that mothers can become depleted of critical nutrients during pregnancy, with adverse consequences for both mother and infant. Deficiencies of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and arachidonic acid (AA) are related to neuropsychiatric consequences such as post partum depression, loss of visual acuity for the infant as well as less than ideal neurological development of the fetus and infant. Hibbeln noted that the prevalence of postpartum depression varied nearly fifty-fold depending on the amount of DHA in the mother’s blood stream. The higher the DHA, the less depression.

“Supplementation with omega-3 fatty acids from both marine and algal sources during pregnancy is not only safe but has several important benefits during pregnancy, including longer gestational times and greater birth weights.” The researchers report that supplementation with 2.7 g/day of EPA plus DHA during the last trimester increased mean birth weight and gestation time up to an average of seven days among infants whose mothers had a poor baseline omega-3 status.

Hibbeln also reported that there was a decreased risk of preterm delivery, and no significant adverse side effects after supplementation with doses ranging from 2.7 g/day to 6.1 g/day of EPA plus DHA. “No adverse side effects, specifically no increased bleeding times or hemorrhage during parturition, were observed in a treatment study of 223 women with high-risk pregnancies including gestational diabetes and pre-eclampsia.”

The current recommendation, according to Hibbeln, is that pregnant women should consume a minimum of 650 mg/day of EPA plus a minimum of 300 mg/day DHA.

Helland, Smith, et al.,³ in Pediatrics reports that there is a growth spurt in the human brain during the last trimester of pregnancy and the first postnatal months, with a large increase in the cerebral content of AA and DHA. The fetus and the newborn infant depend on maternal supply of DHA and AA. Docosahexaenoic acid and arachidonic acid are critical for development of the central nervous system. The ability for the fetus and the newborn to convert vegetarian plant sources of omega-3 fatty acids, also known as short-chain omega-3’s, like flax seed oil (alpha-linolenic acid) to EPA and DHA is inadequate. It must be supplied by fish or marine algae sources.

Helland found that supplementation of the mother by very-long-chain n-3 PUFAs during pregnancy and lactation improves the intelligence of children at four years of age.

In the Oxford Durham Study⁴ researchers noted, Omega-3 fatty acids are essential for normal brain development and function and must be provided by the diet. However, their low levels in modern diets in developed countries are a known risk factor for physical disorders such as cardiovascular and inflammatory diseases.

“Converging evidence indicates that fatty acid deficiencies or imbalances may also contribute to a range of adult psychiatric and neurologic disorders and several common and overlapping childhood neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), dyslexia (specific reading difficulties), dyspraxia (developmental coordination disorder [DCD]), and autistic spectrum disorders.”

The Oxford Durham Study was a randomized, double blind, placebo-controlled trial. This study involved children between five and twelve years of age, from mainstream schools, all of whom met Developmental Coordination Disorder criteria, but were otherwise normal and not receiving any other treatment for their specific learning difficulties. Active treatment was provided by a supplement containing 80 percent fish oil and 20 percent evening primrose oil. (Evening primrose oil contains the omega-6 gamma linoleic acid.) A daily dose of six capsules provided 558 mg of eicosapentaenoic acid omega-3, 174 mg of docosahexaenoic acid omega-3, 60 mg of gamma-linoleic acid omega-6 fatty acid, and 9.6 mg of vitamin E (natural form, alpha-tocopherol).

Before treatment, achievement scores for reading and spelling were one year below chronologic age. With active treatment with oils for three months, reading age increased by 9.5 months and 3.3 months for placebo, a highly significant difference.” The increase in spelling age was 6.6 months for active treatment and 1.2 months for placebo, again, a highly significant difference. Between 3-6 months, the oil treatment group reading age improved by 13.5 months and their spelling age improved by 6.2 months. “In the follow-up phase, they continued to make improvements above what would be expected for chronologic age.” Children in the placebo group fell even more behind with spelling during the 0 to 3 month phase. “No adverse events were reported, and the high compliance rate also suggests good acceptability of fatty acid supplements.”

It was also reported in this study that the omega-3 fatty acid supplementation improved ADHD symptoms better than Ritalin.

Horrocks and Yeo⁵ published an article concerning the health benefits of DHA, in the journal Pharmacological Research. They discuss how docosahexaenoic acid is essential for the growth and functional development of the brain in infants. DHA is also required for maintenance of normal brain function in adults. The inclusion of plentiful DHA in the diet improves learning ability, whereas deficiencies of DHA are associated with deficits in learning.

The visual acuity of healthy, full-term, formula-fed infants is increased when their formula includes DHA. During the last fifty years, many infants have been fed formula diets lacking DHA and other omega-3 fatty acids. Note that infants do not appear to require EPA as part of their diet. DHA deficiencies are associated with fetal alcohol syndrome, attention deficit hyperactivity disorder, cystic fibrosis, phenylketonuria, unipolar depression, aggressive hostility, and adrenoleukodystrophy.

“Both neural integrity and function can be permanently disturbed by deficits of omega-6 and omega-3 essential fatty acids during fetal and neonatal development.”

Breast-feeding provides both AA and DHA to infants. However, the levels of DHA in breast milk will vary greatly according to the mother’s diet. For optimal levels, it is necessary to supplement the mother’s diet with the preformed long-chain polyunsaturated fatty acids AA and DHA.

During fetal development, DHA is transported across the placenta into the fetal circulation. Although the fetal brain can produce a limited amount of DHA from the precursor ALA and produce some DHA in the liver, it is not enough for optimal brain development.

Premature and low birth weight infants are born with deficits of DHA. This contributes to the fragility of the periventricular vascular system and hemorrhage risk. The vascular network serving the developing brain cannot accommodate the brain neuronal growth. Therefore, supplementation of their formulas with the amounts of DHA and AA typically found in human milk is critical.

Preterm infants fed with breast milk had an IQ that was 8.3 points higher at the age of 7.5-8 years when compared to those fed with formula containing LA and ALA (no DHA). Preterm infants fed formula supplemented with DHA had a higher Mental Development Index score at twelve months than control infants fed formula without DHA.

Studies indicate that the mental development and visual acuity of infants are positively affected by breastfeeding and that breastfed infants have higher levels of DHA in their brain tissue and enhanced mental ability later in life when compared to those fed infant formula not containing DHA.

“Brain development in humans takes place primarily in the last trimester in utero and in the first twelve months of post-natal life and then at a slower pace up to 30 years of age.”

There is growing evidence of anti-inflammatory omega-3 polyunsaturated fatty acids preventing allergic disease. In a study by Dunstan,⁶ et al., a group of researchers supplemented pregnant women from twenty weeks gestation until delivery with ether 3.7 g of omega-3 polyunsaturated fatty acids or a placebo. All neonatal cytokine responses to allergens tended to be lower in the fish oil group. Although this study was not designed to examine clinical effects, the authors noted that infants in the fish oil group were three times less likely to have a positive skin prick test to egg at one year of age. In addition, infants in the fish oil group also had significantly less severe atopic dermatitis disease by 91 percent.

Logan and Lesperance,⁷ in the journal Medical Hypothesis, reported physiological abnormalities in children with primary nocturnal enuresis (PNE). They found deficits within the central nervous system and noted that omega-3 fatty acids are known to influence these abnormalities. In addition, they state that omega-3 fatty acids are well documented to play a critical role in the normal development of the central nervous system. Omega-3 fatty acids may, therefore, have therapeutic value in treatment of PNE. They conclude, “Given the current excess of omega-6 rich oils in Western countries, all health professionals should at least ensure adequate intake of omega-3 fatty acids in children with PNE.”

Omega-3 essential fatty acids are necessary at all stages of life and, since they cannot be synthesized by the body, must be ingested. Caution must be utilized in obtaining these PUFAs from eating fish due to the oftentimes high levels of contaminants, such as mercury, dioxins, polychlorinated biphenyls and estrogens. Many researchers recommend purified fish oils that have been tested and found to be free of contaminants. Gallagher states that women can safely commence omega-3 intake in early pregnancy to allow the full benefits of it to be incorporated into the body and preprogram the babys cell membranes for optimum lifelong wellness.⁸ Untainted fish oils containing abundant levels of Omega-3 fatty acids should be a routine supplement during pregnancy and lactation.

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic.

Michael L. Underhill, D.C., C.C.S.P., C.C.S.T., is a 1981 graduate of Western States Chiropractic College. He is certified in Chiropractic BioPhysics® as well as being certified as a sports chiropractor and in spinal trauma. He holds a diplomate in thermography. Dr. Underhill is also a contributing author to both editions of the book Motor Vehicle Collision Injuries: Mechanisms, Diagnosis, and Management. He has been in private practice in Beaverton, Oregon, for the past twenty-five years and has taught both chiropractic postgraduate and undergraduate classes. Dr. Underhill can be reached by email at [email protected].

References
1. Genuis S J and Schwalfenberg G K. Time for an oil check: the role of essential omega-3 fatty acids in maternal and pediatric health. Journal of Perinatology May 4, 200 26: 359-365

2. Joseph R. Hibbeln, Laboratory of Membrane Biophysics and Biochemistry, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. Seafood consumption, the DHA content of mothers milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. Journal of Affective Disorders May 2002 Volume 69 Issues 1-3 15-29

3. Ingrid B. Helland, MD, Lars Smith, PhD, Kristin Saarem, PhD, Ola D. Maternal Supplementation with Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children’s IQ at 4 Years of Age. Pediatrics January 2003; Vol. 111, No. 1: e39-e44

4. Richardson A J and Montgomery P. The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation with Fatty Acids in Children with Developmental Coordination Disorder. Pediatrics, Vol. 115 No. 5, May 2005, pp.1360-1366

5. Lloyd A Horrocks, Young K Yeo. Health Benefits of Docosahexaenoic Acid. Pharmacological Research 1999 Sep;40(3):211-25

6. Dunstan JA, Mori TA, Barden A, Beilin LJ, Taylor AL, Hoit PG, Prescott SL. Fish Oil Supplementation in Pregnancy Modifies Neonatal Allergen-Specific Immune Responses and Clinical Outcomes in Infants at Higher Risk of Atopy: a Randomized, Controlled Trial. Journal of Allergy Clinical Immunology December 2003;112(6):1178-84

7. Logan A C, Lesperance F. Primary nocturnal enuresis: Omega-3 fatty acids may be of therapeutic value. Medical Hypothesis Volume 64, Issue 6, 2005, pages 1188-1191

8. Gallagher S. Omega-3 oils and pregnancy. Midwifery Today International Midwife Spring 2004;(69):26-31

Kids and Earaches

Reference
Wait-and-See Prescription for the Treatment of Acute Otitis Media
A Randomized Controlled Trial
Journal of the American Medical Association
Vol. 296 No. 10, September 13, 2006, pp. 1235-1241
by David M. Spiro, MD, MPH; Khoon-Yen Tay, MD; Donald H. Arnold, MD,
MPH; James D. Dziura, PhD; Mark D. Baker, MD; Eugene D. Shapiro, MD

Key Points from Dan Murphy

1) “Acute otitis media is the most common reason for which an antibiotic is prescribed to children,” accounting for an “estimated 15 million antibiotic prescriptions written per year in the United States.”

2) “Untreated acute otitis media has a high rate of spontaneous resolution, with similar rates of complications whether antibiotics are prescribed or withheld.”

3) “Resistance to antibiotics is a major public health concern worldwide and is associated with the widespread use of antibiotics.”

4) The typical length of antibiotic therapy prescribed for children with acute otitis media is a ten-day course, and Amoxicillin is prescribed 92% of the time.

5) Diarrhea is the most frequently reported side effect of taking antibiotics for acute otitis media.

6) Immediate treatment of acute otitis media with antibiotics increases the rates of diarrhea by two to three times, compared to the wait-and-see approach to treating acute otitis media.

7) These authors showed that waiting to prescribe antibiotics for acute otitis media is a “successful treatment strategy.”

8) This randomized controlled trial has shown that waiting to use antibiotics for acute otitis media “significantly reduces the use of antibiotics” without compromising clinical results.

9) Most pediatricians in the United States are trained to routinely prescribe antibiotics for acute otitis media and “believe that many parents expect a prescription.”

10) Only a “small minority of practitioners who care for children routinely use watchful waiting” before prescribing an antibiotic for acute otitis media.

11) “The risks of antibiotics, including gastrointestinal symptoms, allergic reactions, and accelerated resistance to bacterial pathogens, must be weighed against their benefits for an illness that, for the most part, is self- limited.” [Very Important]

12) “The routine use of waiting to prescribe antibiotics for acute otitis media “will reduce both the costs and adverse effects associated with antibiotic treatment and should reduce selective pressure for organisms resistant to commonly used antimicrobials.” [Very Important]

13) The waiting to prescribe antibiotics approach “substantially reduced unnecessary use of antibiotics in children with acute otitis media.”

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit www.danmurphydc.com.

Hold the Phone!

KEY POINTS FROM DAN MURPHY, D.C.

1) This is the longest study to date on the malignant brain tumor risk from using wireless phones, both cell phones and cordless home phones.
2) This is not the first epidemiological study to find a significant association between the use of cellular telephones and brain tumors.
3) The risk of malignant brain tumors (primarily high-grade astrocytomas) increases with the longer the use of wireless phones.
4) The risk for all malignant brain tumors increased rather dramatically for those who used combinations of a cell phone and a walk-around cordless phone.
5) Analog cell phone use for more than 15 years increased the risk of malignant brain tumor to 510% with a range between 150% to 1,400%.
6) The incidence of malignant brain tumors found in this study is low because those that died of malignant brain tumors were not counted. They were only counted if they were still living.
7) For a variety of reasons, the microwave radiation dose was higher for cordless home phone users than for digital cellular phone users, making these devices even more dangerous.

IMPORTANT QUESTIONS:
• Do you use a cell phone?
• For how many years have you been using a cell phone?
• Do you use a headset (or other attenuating device) with your cell phone?
• Do you use a walk-around-the-house cordless phone?
• For how many years have you been using a walk-around-the-house cordless phone?
• Are you currently using both a cell phone and a walk-around-the-house cordless phone?

Reference:
Case-control study of the association between the use of cellular and cordless telephones and malignant brain tumors diagnosed during 2000–2003
Environmental Research
Volume 100, Issue 2, February 2006, Pages 232-241
by Lennart Hardell, Michael Carlberg and Kjell Hansson Mild

Don’t Look Back if You’re Rear-ended!

Key Points from Dan Murphy

A rotated head posture at the time of vehicular rear impact is correlated with a higher incidence and greater severity of chronic radicular symptoms than accidents occurring with the occupant facing forward.

1. The greatest potential for cervical ganglion compression injury is at C5–6 and C6–7.
2. In patients with a stenotic foramen, the injury risk greatly increases and spreads to include the C3–4 through C6–7 ganglions and nerve roots.
3. Chronic radicular symptoms such as neck, shoulder, upper-back, and arm paresthesias have been documented in whiplash-injured patients. These symptoms have been associated with dorsal root ganglion and nerve root compression within the cervical intervertebral foramen.
4. The Spurling test, which couples cervical extension, rotation, lateral flexion and compression, is valid in the clinical diagnoses of cervical radiculopathy.
5. A rotated head posture at the time of rear impact caused significantly greater neck pain and increased the risk of chronic symptoms.
6. Cervical ganglion and nerve root injury is exacerbated if the head is rotated at the time of rear impact.
7. Clinical and epidemiological studies have documented increased chronic radicular symptoms, including muscle weakness and neck, shoulder, upper-back, and arm paresthesias, in individuals whose heads were rotated at the time of a rear-impact collision compared with individuals who are facing forward.
8. Foraminal width narrowing due to head-turned rear impact can potentially compress the cervical ganglia and nerve roots causing injury and leading to chronic radicular symptoms, especially in individuals with stenotic spines. [Key Point]
9. Analysis of the present data suggests that a head-turned rear impact may cause cervical ganglion or nerve root injury that leads to chronic radicular symptoms.
10.Increase in nerve injury and symptom severity leads to a worse clinical prognosis, including increased chronic radicular symptoms.
11.The increased ganglion impingement observed in the present study, in conjunction with the residual joint instability documented in a previous head-turned rear-impact study explains the increased severity and duration of radicular symptoms associated clinically with rotated head posture, compared with head-forward rear-impact collision.
12.Compression injury at these spinal levels may cause pain and paresthesias in the periclavicular region, anterior and posterior neck, deltoid and trapezius muscles, and dorsal arm, forearm, and hand.

Pain

Reference:
Omega-3 Fatty Acids (Fish Oil) as an Anti-inflammatory: An Alternative to Nonsteroidal Anti-inflammatory Drugs for Discogenic Pain
by Joseph Charles Maroon, M.D., Jeffrey W. Bost, P.A.C. (These authors are from the Department of Neurological Surgery, University of Pittsburgh Medical Center)

Surgical Neurology
April 2006, pp. 326– 331
(This paper won first prize in the poster competition at the American Association of Neurological Surgeons Annual Meeting, New Orleans, April 2005)

KEY POINTS FROM DAN MURPHY

1) The use of NSAID’s is associated with extreme complications, including gastric ulcers, bleeding, myocardial infarction, stroke, and even death.

2) In this study, after seventy-five days on fish oil, 59% of patients who were taking NSAID’s for chronic spinal pain and who had degenerative spine disease were able to discontinue their prescription NSAID’s, and 88% stated they were satisfied with their improvement and that they would continue to take the fish oil.

3) In this study, fish oil supplementation was not associated with any significant side effects.

4) “Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAID’s for treatment of nonsurgical neck or back pain.”

5) “More than 70 million NSAID prescriptions are written each year, and 30 billion over-the-counter NSAID tablets are sold annually.” [Notice: 30 BILLION over-the-counter NSAID tablets are sold annually.]

6) “5% to 10% of the adult US population and approximately 14% of the elderly routinely use NSAID’s for pain control.”

7) Selling NSAID’s is a 9 billion dollar per year US industry.

8) Prescription NSAID’s for rheumatoid and osteoarthritis, alone, conservatively cause 16,500 deaths per year.

9) “NSAID’s are the most common cause of drug-related morbidity and mortality reported to the FDA and other regulatory agencies around the world.”

10) “The agent best documented by hundreds of references in the literature for its anti-inflammatory effects is omega-3 EFA’s found in fish and in pharmaceutical-grade fish oil supplements.”

11) The beneficial anti-inflammatory effects of high-dose fish oil include the reduction of joint pain from rheumatoid and osteoarthritis, improvement in dry eyes and macular degeneration, reduced plaque formation, reduced arrhythmias, and reduced infarction from coronary arthrosclerosis.

12) Both natural and synthetic corticosteroids decreased healing capabilities, decreased the normal immune response, and have significant bone and gastric side effects.

13) COX-2 inhibitors significantly increase gastric and cardiovascular side effects.

14) Omega-3 DHA and EPA are used to make the anti-inflammatory eicosanoids (Prostaglandin E3: PG3), whereas excess omega-6 EFA’s form inflammatory arachidonic acid based eicosanoids (Prostaglandin E2: PG2).

15) “Animal proteins, especially red meat, also contain an abundant amount of arachidonic acid.”

16) A deficiency in omega-3 fatty acids, especially EPA and DHA, will result in a deficiency of anti-inflammatory prostaglandins.

17) The delta-5 desaturase enzyme is the gatekeeper to inflammation and is increased from elevated levels of insulin [from being diabetic, consuming refined carbohydrates, or consuming any high fructose corn syrup].

18) “To encourage the production of anti-inflammatory PG’s and to discourage the production of inflammatory PG’s, saturated fats, trans-fatty acids, and arachidonic acid should be reduced in the diet; blood glucose should be controlled; and appropriate amounts of omega-3 fatty acids found in fish oils should be consumed.”

19) Omega-3 supplementation is safe and effective for many inflammation-related conditions and has a low incidence of side effects.

20) NSAID’s inhibit the effectiveness of fish oil in producing anti-inflammatory prostaglandins.

21) “The US Department of Agriculture has limited fish consumption to one fish serving per week in adults and even less in children and pregnant women because of the concern of toxic contaminants, such as mercury, polychlorinated biphenyls, and dioxin in our fish population.”

22) These authors did not recommend the fish oil for those on anticoagulants or fish-related allergies, but noted “aspirin use was not a contraindication.” The ratios of the various omega-3 essential fatty acids is important (ALA/EPA/DHA plus GLA, etc.). [I use those from Nutri-West along with their necessary double bond protective co-factors (Nutri-West: 800-443-3333).]

Cervical Adjustments to Prevent Sudden Infant Death?

Reference:

Heart Rate Changes in Response to Mild Mechanical Irritation of the High Cervical Spinal Cord Region in Infants
Forensic Science International
Volume 128, Issue 3, August 28, 2002, Pages 168-176
L. E. Koch, H. Koch, S. Graumann-Brunt, D. Stoll, J. M. Ramirez and K. S. Saternus.

Key Points from Dan Murphy, D.C.

• Sudden infant death (SID) is the most common cause of death in the first 12 months of life in developed countries.

• SID may be caused by bradycardia and apnea.

• Bradycardia and apnea can be caused by mechanical irritations to the upper cervical spine.

• Mechanical irritations of the upper cervical spine present as asymmetries of posture and/or spinal motion, and can be diagnosed radiographically.

• Mechanical irritations of the upper cervical spine can be corrected by a chiropractic spinal adjustment.

• Chiropractic upper cervical adjustments inhibit the sympathetic nervous system. [IMPORTANT]

• Pediatric chiropractic adjustments are safe and effective for newborns, infants and older children with neuro-musculoskeletal and other problems.

• Minor mechanical irritation of the cervical region may be related to the events that lead to SID.

• Children with a disturbed symmetry of the atlanto-occipital region [chiropractic subluxation complex] could be of higher risk for SID.

Factors in Whiplash

Reference:
Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading.

Journal of Biomechanics
Volume 38, Issue 6, June 2005, Pages 1313-1323
Brian D. Stemper, Narayan Yoganandan, and Frank A. Pintar
From the Department of Neurosurgery, Medical College of Wisconsin.

Key Points from Dan Murphy, D.C.

The whiplash experiments in this study were collisions at less than 6 miles/hour.

1. This study showed that pre-whiplash accident straight or kyphotic curvatures of the cervical spine increase injury to the facet joint ligaments.

2. Specifically, straight or kyphotic curvatures of the cervical spine increased cervical facet capsular ligament stretch by up to 70%.

3. Increased capsular ligament stretch induces laxity to the facet joint, particularly at regions of kyphotic posture.

4. Increased laxity predisposes the cervical spine to accelerated degenerative changes, over time, and leads to instability. [Very Important]

5. Straight cervical spines and cervical kyphosis affect injury mechanisms and lead to increased acute and chronic disorders.

6. Pre-whiplash impact alignment of the cervical spine significantly affects injury mechanisms and severity of injury.

7. There is increased whiplash injury severity for patients with pre-existing abnormal cervical postures.

8. Chronic illness is associated with abnormal spinal posture.
[Important]

9. The first phase of whiplash injury is a non-physiologic S-curvature characterized by flexion in upper and extension in lower cervical segments, and this is when the primary whiplash injury occurs.

10. During the initial whiplash non-physiologic S-curvature phase, the cervical facet joints are injured due to the stretch of the capsular ligaments.

11. Subcatastrophic facet capsular injuries can initiate a pain response.

12. Pre-accident abnormal kyphotic posture increases likelihood of reaching the subcatastrophic threshold for injury.

13. In a 5-year study of 146 patients, those with cervical kyphosis, but with no degenerative changes after whiplash injury, had a significantly higher incidence of disc degeneration in the lower cervical spine (C5-C6) than those with normal curvatures at the time of injury.

14. Disc degeneration at a single level alters segmental loading patterns, which accelerates degenerative changes at adjacent levels.

15. Cervical spondylosis at one level pre-disposes the levels above to early instability and decreased load carrying capacity.

16. Straight or kyphotic curvatures of the cervical spine influence ligament elongations during whiplash trauma, and also influence the long-term prognosis of the injury.

17. Head restraints have limited (5-20%) ability to decrease neck injuries in rear impacts, because greatest ligament stretch occurs during the S-curvature, before the head contacts the head restraint.

18. Capsular ligament stretch from whiplash, particularly in kyphotic postures, leads to motor unit laxity and to spinal degeneration over time.

Drugs, a Major Cause of Morbidity

Reference:
“Prescription-related illness—a scandalous pandemic”
Journal of Evaluation in Clinical Practice
Nov. 2004, Vol. 10, No. 4, pp. 491–497
Hugh McGavock, B.Sc., M.D., F.R.C.G.P.

Key Points from Dan Murphy

1. Prescribed drugs are a major cause of global morbidity and mortality.

2. Prescription-related disease is a pandemic.

3. Medical doctors:

• Often prescribe drugs unnecessarily.
• Often prescribe drugs with a wrong or “guessed at” diagnosis.
• Are poorly trained in pharmacology.
• Follow evidence based guidelines, which do not work when there is more than one condition requiring more than one drug.

4. About 5 percent of all acute hospital visits are because of prescribed drugs.

5. Seniors over age 70 are the most vulnerable group to prescription drug adverse reactions.

6. 18 percent of all deaths of elderly patients in hospitals are related to prescription drugs, and half of these deaths were avoidable.

7. “More than 70 percent of upper respiratory infections are caused by viruses which will not be affected by antibiotics; but the antibiotics will devastate the normal bacterial flora throughout the body and make it more likely that the viruses will flourish, that secondary pathogenic bacteria will supervene and that resistant strains will emerge.” (WOW!)

8. More than 1000 patients in the United Kingdom die every year of antibiotic-related adverse drug reactions.

9. The most commonly prescribed drugs for children, women, and men are antibiotics, pain drugs and asthma drugs.

10. In the USA, drug-caused illness costs more than $1 billion per year, causes more than 100,000 deaths per year, and is responsible for more than 12 percent of elderly hospitalizations per year.

11. The more prescription drugs a person is on, the more likely that they will suffer a serious adverse reaction (i.e., for seniors, it is 33 percent, if taking six drugs).

12. More patients receive their antibiotics over-the-phone than from actually visiting the doctor, which is “perilously close to malpractice.”

13. In medicine (and probably in chiropractic), diagnostic uncertainty is unavoidable.

14. Many drugs are prescribed with no expectation of improving the underlying condition, but with the hope of symptom relief and placebo effect.

15. It is perfectly correct for GPs to prescribe drugs to relieve symptoms and to use drugs for self-limiting conditions and for non-curable conditions.

(I believe that it is perfectly correct for chiropractors to prescribe adjustments, etc., for temporary symptom relief, and for self-limiting, and noncurable conditions.)

16. When a medical doctor prescribes drugs following a presumptive or “guess” diagnosis, the doctor is subjecting the patient to measurable risk of iatrogenic disease, without the certainty of benefit.

17. The most important long-term harm to patients is caused by non-steroidal anti-inflammatory drugs, responsible for over 30 percent of all serious adverse drug reactions. (Wow!)

18. 90 percent of drugs used today have been developed since 1970. Medical doctors are poorly trained in drugs in medical school. It is impossible for a fulltime pharmacologist to have adequate knowledge of all the drugs in use. Prescribing problems resulting in morbidity and mortality are inevitable.

19. The drug industry has played upon the doctors’ relative ignorance of pharmacology to indicate that every new drug is effective and safe, which they are not.

20. It takes a few years of use before a drug’s potential for harm is discovered.