DC Online (Wellness Research)
By Brian Sutton, DC
This column highlights the latest wellness research relevant to chiropractic practice. Each summary includes one or more references/resources to assist readers interested in learning more about the research discussed.
Researchers report that there may be either a link or a potentiating relationship between diabetes and Alzheimer's disease processes.1 Certainly you would expect that the vascular-impairing effects of diabetes might impact the circulatory system around the brain at some point. However, this study of close to 3,000 older volunteers suggests that impairment begins even before the diagnosis of diabetes can be made. An outright case of Alzheimer's disease becomes two to three times more likely if you've been diagnosed with type 2 diabetes. This research suggests that the risk of cognitive impairment should be thought of as more of a continuum of sugar metabolic function, not just whether or not the patient has crossed some diagnostic threshold.
1. Associated Press, March 17, 2009, reporting on work by Wake Forest University scientists published in the February issue of Diabetes Care; and data from the March 2009 issue of Archives of Neurology.
Smart (or Maybe Not-So-Smart) Drug
A prescription drug that has been called a "smart drug" because of its effect on alertness appears to be addictive, according to a study in the Journal of the American Medical Association (JAMA).2 Provigil is used to treat narcolepsy, but is also used (illegally) by college students while cramming for exams, among other things. The drug first attracted attention when the Air Force found that it enhanced alertness in sleep-deprived fighter pilots. Positron emission tomography (PET) studies indicate that the drug increases release of dopamine similar to Ritalin, contrary to previous thinking. Dopamine release is a key factor in many addictions. Sales of the drug, which has been on the market since 1999, were nearly $1 billion last year.
2. JAMA, March 18, 2009.
Electronic Record-Keeping Quandary
A study by a private consulting company that advises the government and health care industry (Avalere Health) suggests that the billions of stimulus dollars being spent to "encourage" doctors to switch to electronic records may not be enough. They report that, especially for doctors with small practices, the initial systems costs "could outweigh the incentives and penalties for failing to comply."3 The cost of such a system is estimated at $124,000 for a single-doctor practice to upgrade in the 2011-2015 time frame; however, the incentive payments the doctor could expect (that will be allocated over those five years) would total only $44,000. In 2015, the penalties kick in if you haven't yet upgraded, but they would only be $5,100 per year, far less than the initial outlay cost. So, it seems likely that many offices will choose not to participate, begging the question, "How will they be encouraged to comply?" Obviously, either increase the incentives or increase the penalties. Which do you think it will be?
3. Associated Press, March 9, 2009.
Peanut Allergy Update
More studies are being conducted on the promise of using micro-levels of peanut proteins to treat peanut allergies. Researchers at Duke University and Arkansas Children's Hospital are closely monitoring children in a program that attempts to very slowly train the body to tolerate the potentially fatal legume. One child, who could not tolerate one-sixth of a peanut at age 2½, could handle 15 peanuts at age 5. But don't try this at home; the amounts used to train the subjects are very miniscule, averaging about 1/1,000th of a peanut and varying quite a bit per subject, with the specific amount determined during intensive monitoring.4
4. Associated Press, March 16, 2009.
Get Your (Sunshine) Vitamins
Researchers from Johns Hopkins Bloomberg School of Public Health report that teenagers with low levels of vitamin D are more than twice as likely to have high blood pressure and high blood sugar, and are at four times the risk of developing metabolic syndrome.5 The study involved 3,600 teenage boys and girls, very few of whom showed adequate levels of vitamin D in their blood. The blood levels of vitamin D correlated loosely with skin color (light complexions scored higher), suggesting that more exposure to sunlight would have a major impact.
5. Reis J. Presenting to the American Heart Association conference in Palm Harbor, Fla., in March 2009.
An anesthesiologist from Massachusetts who has published a large number of research papers relating mostly to COX-2 inhibitors is now being accused of faking those studies. So far, 13 papers written by Dr. Scott Reuben have been retracted by the journals Anesthesiology and Anesthesia & Analgesia. Unfortunately, according to one of the editors, "His findings had a huge impact on the field."6 Many of the studies reported favorable results from painkillers such as Bextra, Celebrex and Vioxx. He also reported benefits for non-COX-2 inhibitors Lyrica and Effexor. Bextra and Vioxx are no longer on the market. Many of these studies now considered invalid were funded by Pfizer, the manufacturer of many of these drugs. Doctors who based their prescriptions on such studies are now having to re-evaluate their use, and many studies will probably have to be repeated to re-instill confidence.
6. Associated Press, March 11, 2009.
Got the Lead Out
New government research is reporting great success in decreasing the amount of lead that is being absorbed by children in the United States. In 1988, the number of children with "elevated" levels of lead (more than 10 micrograms per deciliter of blood, though effects can still be seen at that level) was nearly 9 percent. The latest figures, from 2004, put the number at 1.4 percent, an 84 percent decrease.7 The decline is seen as a result of eliminating lead in gasoline, paint, water and soil, as well as other sources. (Apparently, we're still working on imported toys.) The CDC still recommends avoiding use of hot tap water for drinking, cooking or making baby formula, as lead tends to leech more from plumbing joints into hot water.8
7. Pediatrics, March 2, 2009.
Vitamin Pills Lacking Iodine
Researchers at the Boston University Iodine Research Laboratory report that many prenatal vitamins that claim to supply iodine do not correctly identify the amount on their labels.9 The study found problems with both prescription and over-the-counter brands. The recommended amount of iodine ranges from 220-290 micrograms per day. One of six brands tested supplied less than half the amount specified on the label. A few, most notably those in which the iodine came from kelp, varied dramatically, ranging from much lower to up to 50 percent higher than labeled.
9. NEJM, Feb. 26, 2009.
Soldier Stress Injuries
Army officials report an increase in the number of stress injuries to bone and muscle structures, bad enough to sideline troops, resulting from carrying gear for long periods weighing as much as, in at least one case, 142 pounds. The rule-of-thumb limit is about 50 percent of body weight per soldier, but many units are not able to meet that goal. Many of these injuries occur during training, preventing troops from being deployed.10
10. Associated Press, March 11, 2009.
A new study published in the British Medical Journal reports that an effective way to clean up leg ulcers is to use maggots. The study compared outcomes from the usual gel-based treatment with letting the little rice-sized scavengers free to munch their way through whatever dead tissue they could find. Overall healing time between the two groups was about the same, but the maggots appeared to be quicker at getting rid of the dead tissue in the ulcers. There was a bit more pain in the maggot group, possibly from enzymes irritating active nerve endings. Researchers say they don't expect maggot therapy to make a comeback (before antibiotics came along, they were used quite frequently for ulcerative and traumatic wounds), but said they could certainly be considered as an alternative to current treatments.11
11. British Medical Journal, March 20, 2009.
B Vitamins for Your Eyes
A new study from Brigham and Women's Hospital in Boston reports that a mixture of B vitamins (B6, folic acid and B12) reduced the chance of middle-aged women developing macular degeneration by one-third.12 The study involved more than 5,000 women ages 40 years and older. The study suggests an additional tool, other than cessation of smoking, to help prevent age-related macular degeneration (AMD). The study was part of a larger heart disease study sponsored by the National Institutes of Health.
12. Archives of Internal Medicine, Feb. 23, 2009.
Influenza Vaccine Mix-Up
A small number of international news sources (but none I could find in the U.S. press) are reporting on an event that happened recently involving an influenza vaccine produced by the U.S.-based pharmaceutical company, Baxter. It seems that while doing a routine check on a new shipment of H3N2 seasonal flu vaccines, a subcontractor in the Czech Republic noticed a problem. Normally, the vaccine has little effect when injected into ferrets, although they may become ill if some remnants of the virus are still viable. However, this time the ferrets died.
Further investigation revealed that the vaccine, which had also been shipped to Slovenia and Germany, contained a live H5N1 avian flu virus. Somehow, a live experimental culture of avian flu was mixed into the influenza vaccine before shipment. This is especially disturbing since the avian flu, which is not as easily spread as influenza, could become very contagious through a process called "reassortment" when mixed with something spread by airborne contact like influenza. Reassortment is one process responsible for many pandemic viruses. According to experts, "Accidental release of a mixture of live H5N1 and H3N2 viruses could have resulted in dire consequences."13
At least four countries are conducting investigations into the incident, which critics say should not have been possible because of the number of safeguards that are supposedly in place, leading to a number of interesting speculations and one or two rather disturbing conspiracy theories.14
13. Branswell H. "Baxter: Product Contained Live Bird Flu Virus." Toronto Sun, May 5, 2009. www.torontosun.com/news/canada/2009/02/27/8560781.html.
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