Case of the Month October 2009

October 26, 2009

Mrs. X presented to the office with bilateral carpal tunnel.

First a little background.  Carpal tunnel is a common term for pain in the wrist.  For many years it was assumed that because the pain was in the wrist, then the problem was originating in the wrist.  Chiropractors have worked to show there may be other factors that influence the pain in the wrist, including neck misalignment, muscle spasm and joint misalignment.

Back to the patient.  Mrs. X reported no significant history of trauma.  She did report that she spent between 8 and 1o hours at the computer, with about half of that on a laptop.  When asked to reproduce her work position I noted there was significant leaning forward with a lot of slumping of the shoulders.

Examination showed significant restrictions in the neck and muscle spasm in the shoulders and forearms.  X-Ray exam showed a 7 degree curve in the neck, where 45 is ideal and 36mm of forward head carriage.

After going through my findings with Mrs. X I suggested a 5 visit trial where I would get to see how she responded to the care and she would determine if this course of care was for her.  Care consisted of neck and midback adjustments, extension traction and trigger point therapy.  After evaluating the wrists, I made the decision to not mobilize the wrists as I judged they were already moving well.

On the first visit I asked Mrs. X to rate the pain in the wrists, it came in at a 7.  I adjusted Mrs. X, had her stretch and worked on the muscle spasm in the forearms.  This went on for 5 visits.

At the beginning of the fifth visit, Mrs. X reported her wrist pain had improved to a 3!!!  As excited as she was about this, her objective changes were what was getting me fired up.  The muscle spasm in the forearms was significantly better, the restrictions in the neck were clearing up and I was even seeing a change in her posture.

This is a classic example of the pain being in one area but the problem located in another area.

If you would like to see a research report that shows chiropractic as effective as taking a bunch of pain killers for carpal tunnel click here.  Please remember, what we did with Mrs. X involved no drugs, which for sure saved some wear and tear on the liver, stomach, etc.


Can We Trust the FDA?

October 13, 2009

fda-logoThe Food and Drug Administration (FDA) is a federal agency in the Department of Health and Human Services established to regulate the release of new foods and health-related products.  Health related products includes but are not limited to medicine, cosmetics, supplements, and even certain veterinary products.  Their mission is to be responsible for ensuring that foods are safe, wholesome and sanitary; human and veterinary drugs, biological products and medical devices are safe and effective; cosmetics are safe; and electronic products that emit radiation are safe.

In a nutshell, we trust them to have our back when new products hit the market.

There have always been whispers that the FDA was ignoring the risks of artificial sweeteners, that they had been bought off by the companies that produced and used them.  MSG was another one that people have forever said the FDA is looking the other way despite mounting evidence that it may not be all that great for you.

Most of these claims were written off to conspiracy theorists with nothing better to do…..until now.

The FDA recently came out and admitted that 2 senators and 2 representatives from New Jersey placed undo influence on the FDA to approve a knee operation patch made by the company ReGen Biologics, which happens to be located in New Jersey.  The well wishing senators claim that the money that was donated to their coffers, around $26,000, had nothing to do with the pressure they put on the FDA, they were merely looking out for a constituent company.

Here is how it went down.  The agency’s scientists for years unanimously ruled that this device was unsafe due to a high failure rate, forcing the patient to have another surgery.  A clinical trial of the device failed to show that it worked any better than routine surgery.  That should have been the end of it, however, the agency managers overruled the scientists and approved the device for use.

The FDA’s report said that its Office of Legislation began receiving calls from members of Congress in December 2007 complaining about its review of the device, and the office’s director “described the pressure from the Hill as the most extreme he had seen.”

With all this pressure from the Congress the FDA caved and approved a device that does not appear to work.  The San Antonio Spurs, of the NBA, orthopedic physician Dr. David R. Schmidt said he was involved in the original clinical trial of ReGen’s Menaflex device and concluded that patients did not benefit. He said he was surprised that the FDA approved it.

In January, the Government Accountability Office concluded that it was long past time that the agency demanded that manufacturers prove that all complex devices are safe and effective before being approved for sale.

What should we make of this?  Do we need more oversight?  Do we really want politicians placing calls to the FDA to approve things that shouldn’t get approved?

Hopefully in the future these agencies can stay above the fray of campaign finance and rule on things as they see fit.


Doctors Getting Paid To Market Drugs

October 5, 2009
Drug Marketing

Drug Marketing

A while back I wrote a post on a drug company, Eli Lilly, using ghost writers to write favorable articles and having doctor’s sign their names to them as if they had written them.  You can read that here.  At best it is a murky situation.

Recently, Eli Lilly was back in the news here in Boston, when the Boston Globe reported that at least 60 area doctors received more than a half million dollars in speakers fees.

A very common practice in the drug industry is to hire physicians as speakers , provide them with the literature on the drug they are marketing, and turn them loose speaking on behalf of the company that hired them.

Imagine the difference in credibility between a drug salesman and a renowned doctor.  When that doctor, whom may be at the top of their field, speaks people will listen.  The drug companies know this and have very smartly used the doctor’s credibility to help them push drugs through these talks.  The question I have is this:  Hasn’t that doctor become nothing more that a glorified drug salesman?  Is their credibility now under fire?  I think it has to be and I am not alone in those thoughts.

Mass General researcher, Eric Campbell found out that 16% of all US doctors and 25% of hospital department heads belong to one speaking bureau or another.  Mr Campbell is quoted as saying, “Academics who want to be drug salesmen should go be drug salesman. But don’t do it under the shroud of academia.’’

Everyone from politicians to other physicians are voicing concern that these company paid doctors cannot give unbiased information, whether that may be downplaying the side effects of a drug or not talking about the generic equivalent which would cost less.

What do these doctor’s whom are paid this money say?  They claim they vet all information and would only present material that they believe in, even if the company is the one providing the material.  They also claim these talks are great ways to educate other doctors about new drugs.  Although one doctor did admit he was doing the talks in order to cover his children’s college tuition.

The public is starting to wake up to this and put pressure on these companies to disclose their financial relationship with doctors.  To their credit Eli Lilly released a list of all their paid speakers.  Good for them, it is nice to see that the much asked for transparency is starting to become reality.

Because of this debate and other problems – pharmaceutical firms have paid millions in fines for illegally marketing medications – companies are under political pressure to disclose their financial relationships with doctors. Lilly is one of the first companies to publicly release a list of paid consultants and speakers.

In January the FDA reported they were fining Eli Lilly 1.4 billion dollars for illegally marketing a drug.  That is a lot of money until you realize that Eli Lilly did 20.38 billion in sales in 2008.

The drug they are getting fined over….in 2006 did 4.7 billion in sales.

Now let me ask you this, if I told you I would let you market a drug to 4.7 billion in sales, but if you get caught you would have to pay a fine of 1.4 billion would you take that deal?  Darn right you would.

Paying doctors to market drugs needs a complete overhaul.  We need to be demanding complete transparency.  Good for Eli Lilly to be the first one to do it, let’s hope it keeps going.