Dr. Roundy - The Spinal Column

June 2002 Issue

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In this issue:

Chiropractors Mobilize to Protect Children's Rights
States Told to Monitor Drug Prescriptions
Chiropractic's Role in Sports
New Drugs Have Side Effects
Association Between Duration of Breastfeeding and Adult Intelligence
More Children Taking Central Nervous System Drugs

Chiropractors Mobilize to Protect Children's Rights

Manitoba, Canada has become the focal point of a heated battle by the chiropractic profession to protect the rights of children to receive the benefits of chiropractic care. Over the past year several anti-chiropractic forces have started a false smear campaign to gain publicity by trying to say that chiropractic care may be dangerous. This flies in the face of all evidence showing that chiropractic has always been among the safest health care professions.

In spite of facts to the contrary the Canadian smear campaign has been effective and accomplished their first goal in getting the government of Manitoba to discontinue chiropractic coverage for children up to the age of 19. This move effectively forces many children away from a natural choice of chiropractic and toward drugs or surgery. In a statement dated May, 10, 2002, one of the world's renowned chiropractic pediatric experts, Dr. Maxine McMullen Vice President of the International Chiropractors Association (ICA) and founder and president of the ICA Council of Chiropractic Pediatrics stated, "This decision is not based on science or good health care practice. Chiropractic care has been proven to be safe and effective for children and people of all ages. This decision is based in fear and not in fact. The world chiropractic community will mobilize to take those steps necessary to see that fairness and open access for all people prevail."

Other chiropractic organizations have also begun to mobilize. In a release dated May, 8, 2002 Dr. Jeanne Ohm, Secretary of the International Chiropractic Pediatric Association asked all their members to, "Please e-mail the Premier of Manitoba, the Honorable Gary Doer with a short, professional e-mail on behalf of chiropractic care for children. Take the moment now to turn this around. His address: Premier@leg.gov.mb.ca .

In the 1970's the American Medical Association was sued for restraint of trade and antitrust activities. In that famous "Wilk vs. AMA suit", the AMA lost, and had to publicly admit wrongdoing in their journals as well as cease any illegal and unlawful activity against chiropractic. Since then the AMA has been barred from the types of false smear campaigns in the US that have now taken place in Canada. The chiropractic community and the patients we serve are continuing to mobilize to reverse this situation. It is our belief that everyone should have open access to chiropractic care if that is the form of health care they choose.

States Told to Monitor Drug Prescriptions

The head of the US Drug Enforcement Agency (DEA), Asa Hutchinson, is calling for all 50 states to establish programs to track prescriptions of schedule II drugs. This story appears in the April 22 - 29, 2002 issue of the American Medical News, reporting on the National Association of Attorneys General meeting. On March 22, DEA administrator, Asa Hutchinson spoke and urged the leading legal officers of each state to consider instituting monitoring programs in their home jurisdictions. Presently 18 states have already initiated some type of prescription-monitoring program.

To put their money where their federal mouth is, the U.S. Department of Justice has set aside $2 million in grant money to help states set up their own programs. This move has come about because of, what the story describes as the "epidemic" of pain medication prescriptions, especially the popular drug OxyContin.

Some MD's are very leery of this new intrusion into their prescribing habits. Dr. Clark, assistant professor of philosophy at Union College in Schenectady, N.Y., voiced his concerns by saying, "Any time we sense a third party looking over the shoulders of our doctors, and especially when that third party is the long arm of governmental authority, we feel our right to confidentiality is threatened and subject to the possibility of compromise."

In an opinion from the pro-side of this issue, William Douglass, executive director of the West Virginia Board of Pharmacy states "If they do their job to verify the legitimate need for [the prescription] and do a good job of monitoring their patient's pain management, they should have no fear of repercussion. If they don't do their job and are writing prescriptions like candy, they should have fear because this program can pinpoint it."

Chiropractic's Role in Sports

As more athletes discover the benefits of chiropractic care not only for injuries but additionally for increased performance, more athletes and teams are using chiropractic to gain an important edge. A recent study published in the March/April 2002 issue of the Journal of Manipulative and Physiological Therapeutics, (JMPT) examined the usage of chiropractic care by National Football League teams throughout the US.

The Journal article reported on the results of a survey of NFL trainers on their usage and referral to chiropractic care. Participants of the survey were head athletic trainers of the 36 National Football League teams. They were all men, and all had at least 17 years of experience and had served with their present team in their current position for a minimum of 1 year .

The results of the survey showed that 45% percent of the trainers themselves have been treated by a chiropractor. Presently 31% of NFL teams use chiropractors in an official capacity as part of their staffs. However, even though not necessarily on the staff of the NFL team a full 77% of the trainers have referred to a chiropractor for evaluation or treatment. Probably the most telling result of the survey is that 100% of trainers agree that some players use chiropractic care without referral from team medical staff.

Several other questions were also asked in the survey and the answers were as follows:

Should trainers refer players with suspected spinal subluxations to chiropractors? - Five percent of trainers strongly agree, 48% agree, 24% disagree, and 19% have no opinion.
Is there a role for the doctor of chiropractic in the NFL? - Eighty-one percent agree that there is a role for the chiropractor in the NFL, 5% strongly agree, 14% have no opinion, and none disagree.
Is the role of the sport chiropractor different from that of the team physician? - All (100%) of the trainers see these roles as different from each other.

In addition to NFL players, many athletes from many sports depend on chiropractic care. One such athlete is John Stockton, a professional basketball player and future hall of famer with the Utah Jazz. In an April 2, 2002 article that appeared in the Toronto Star, writer Doug Smith asks and answers the question concerning John Stockton's longevity, "What is the secret to John Stockton's continued success on the NBA basketball court at age 40? A Good Chiropractor." When asked to explain his usage of chiropractic John's response was, "I'm not a good enough expert on what that (chiropractic) entails, but it's not just adjustments, it's balancing muscles and overall health." John then added, "it's been great for me, and for my family." The article reports that along with chiropractic, Stockton says that a love for the game and fun with his family are two other secrets to his continued success.

New Drugs May Not Be Safe

In an April 30, 2002, Associated Press report, came a story based on a May 1, 2002 article in the Journal of the American Medical Association (JAMA) that claims that many newly released drugs are still dangerous when released because not enough is known about them before they are released into the market. The AP story begins with a dangerous warning, "One in five new drugs has serious side effects that do not show up until well after the medicine has received government approval."

The study published in JAMA was conducted at the Department of Medicine, Cambridge Hospital and Harvard Medical School, and also starts off with an ominous statement, "Recently approved drugs may be more likely to have unrecognized adverse drug reactions (ADRs) than established drugs, but no recent studies have examined how frequently postmarketing surveillance identifies important ADRs." The JAMA article goes on to say, "Adverse drug reactions (ADRs) are believed to be a leading cause of death in the United States. Prior to approval, drugs are studied in selected populations for limited periods, possibly contributing to an increased risk of ADRs after approval. Pharmaceutical companies frequently market new drugs heavily to both patients and clinicians before the full range of ADRs is ascertained."

This study suggests that in many cases newer drugs are not fully understood, or their reactions fully known before the general public is given them. Robert J. Temple, MD; and Martin H. Himmel, MD, also commented in the same JAMA issue by warning that even those who check common sources for drug reactions may not be getting the full story. They stated, "Use of the Physicians' Desk Reference to determine the timing of the labeling change is convenient, but does not give an accurate measure." Additionally, they commented, "Premarketing trials in a few thousand (usually relatively uncomplicated) patients do not detect all of a drug's adverse effects, especially relatively rare ones."

The results of the study as published in JAMA showed that out of a total of 548 new drugs that were approved in 1975-1999; 56 (10.2%) acquired a new 'black box' warning or were withdrawn. Forty-five drugs (8.2%) acquired 1 or more black box warnings and 16 (2.9%) were withdrawn from the market. In Kaplan-Meier analyses, the estimated probability of acquiring a new black box warning or being withdrawn from the market over 25 years was 20%.

Black box warnings are special warnings that are prominently displayed in the Physicians' Desk Reference to alert practitioners to serious risks. According to the Federal Register; special problems, particularly those that may lead to death or serious injury, may be required by the Food and Drug Administration to be placed in a prominently displayed box, known as the 'black box'.

The conclusion of the researchers was, "Serious ADRs commonly emerge after Food and Drug Administration approval. The safety of new agents cannot be known with certainty until a drug has been on the market for many years."

Association Between Duration of Breastfeeding and Adult Intelligence

From the May 8, 2002 issue of The Journal of the American Medical Association ( JAMA) reports a study that suggests that the longer an infant breast feeds, the more likely their intelligence level will be higher when they become an adult. According to the study the results showed that the duration of breastfeeding was associated with significantly higher scores on the Verbal, Performance, and Full Scale IQs testing.

The study was conducted in a sample of 3253 men and women, all of whom were born in Copenhagen, Denmark, between October 1959 and December 1961. The subjects were divided into 5 categories based on duration of breastfeeding, as assessed by physician interview with mothers at a 1-year examination. The average results showed that for infants that breast fed for less than 1 month the average adult IQ at age 27 was 99.4. Conversely infants that breast fed for more than 9 months showed an average IQ at age 27 of 104.0. Infants in between the breast fed durations of less than one month and more than 9 months showed IQs that were between 99.4 and 104.0.

This data convinced researchers of a direct correlation between length of time that an infant breast feeds and the probable adult IQ rate later in life. The researchers concluded, "Independent of a wide range of possible confounding factors, a significant positive association between duration of breastfeeding and intelligence was observed in 2 independent samples of young adults, assessed with 2 different intelligence tests."

More Children Taking Central Nervous System Drugs

The Journal of the American Medical Association (JAMA) April 17, 2002 issue published a Health Agency Update titled, "More Children on CNS Drugs". This article reports on a study funded by the Agency for Healthcare Research and Quality, which states that, "The proportion of children and adolescents receiving psychotropic medicines increased substantially between 1995 and 1999." Drugs to treat attention-deficit/hyperactivity disorder (ADHD) were the most commonly prescribed CNS (Central Nervous System) medications according to the study.

The shocking conclusion of the study was that 3% of the population under age 20 years were receiving drugs for ADHD. The number of children taking new antidepressant drugs jumped 195%, from 1995 to 1999. The study reported on 750,000 children and adolescents throughout the United States who were covered by employer-sponsored insurance. Similar trends were also identified in earlier research on children insured by health maintenance organizations and Medicaid.

The United States has continually had the highest rate of usage of these types of drugs. This leads to the inevitable question of why? The two possible answers to this question are that either the children in the United States are more prone to psychological problems and therefore need these drugs at a much higher level than the rest of the world, or children in this country are greatly over medicated because of the popularity of the diagnosis and the promotion of the drug by the pharmaceutical industry.