Dr. Roundy - The Spinal Column

August 2002 Issue

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In this issue:

Manitoba Government Reverses Discriminatory Policy on Chiropractic Care for Children
Investigative Report Shows Lax Hospital Procedures Kill Thousands of Infants
US Congressional Committee Slams Medicare for Harassment and Targeting of Chiropractors
Drug Sales Globally Continue to Increase
Article Touts Increased Demand for Chiropractic and Alternative Services
Medical Journals May Have Bias or Conflicts
Moms Who Breast-Feed Reduce Infants' Asthma Risk

Manitoba Government Reverses Discriminatory Policy on Chiropractic Care for Children

In a victory for children and health freedom of choice, the government of Manitoba Canada has reversed itself with regards to payment for chiropractic care for children. A report in the July 15, 2002 issue of the International Chiropractors Association's (ICA) "Chiropractic News Service", started by saying, "In a highly significant and uncharacteristic move, the Provincial Government of Manitoba has reversed an earlier decision that denied payment for chiropractic services to anyone under the age of nineteen. The reversal of the controversial policy signals an important victory for chiropractic in that the completely unsupportable and prejudicial restriction of reimbursement for younger patients has been rescinded."

The Information Services Division of the Manitoba government released the following notice on July 12th: "MANITOBA GOVERNMENT SIGNS LONG-TERM AGREEMENT WITH CHIROPRACTORS; COMMISSION CREATED. The Manitoba government today announced it has reached an agreement with the Manitoba Chiropractors' Association that provides coverage to all Manitobans while achieving significant savings. Retroactive to July 1, 2002, Manitoba Health will specifically provide coverage for Manitobans under 19 years of age..."

In an attempt to save money the government of Manitoba had stopped all payments for chiropractic care for anyone under the age of 19. This was done without any studies that showed that this move would save any money at all. Chiropractors in that area argued that the discontinuation of chiropractic benefits increased overall health care costs by forcing those not covered for chiropractic to seek more expensive medical care, when chiropractic could more affordably do the job.

"The battle for full inclusion and full compensation in Manitoba is far from over and the need to be proactive and determined will continue," said Dr. Daniel Schaeffer, the ICA representative for Manitoba. Doctors of chiropractic and Manitoba chiropractic patients in the tens of thousands mounted a powerfully resonating campaign to restore the chiropractic cuts since the announcement of the new policy some months ago. "Our grass-roots campaign has had a major impact on the government and should stand as a very important lesson to other jurisdictions that such policies can and will be reversed if opposed with dignity and resolve," Dr. Schaeffer concluded.

Investigative Report Shows Lax Hospital Procedures Kill Thousands of Infants

In a series of articles dated July 21 and 22, 2002 from the Chicago Tribune comes a frightening report of needless deaths of thousands of infants due simply to actions of hospitals and their workers. According to an analysis done by the Tribune of records at the federal Centers for Disease Control and Prevention, pediatric intensive care units experience up to three times the number of infections as other hospital areas, including operating rooms. The article reports that state and federal health-care records show that the rate of lethal pediatric infections acquired in hospitals is rising.

The article highlighted a tragic case from Sinai-Grace Hospital in Detroit, during a three month period in the spring of 1997, on the same floor, within the same nursery unit, along the same row of bassinets, hospital germs contributed to the deaths of three babies and slipped undetected into 15 more newborns.

Probably the most chilling part of the expose were the statistics gathered by the Tribune that linked the deaths of 2,610 infants in the year 2000 alone to preventable hospital-acquired infections. The Tribune further identified 75,000 preventable deaths where hospital-acquired infections played a major role. Their analysis was based on the most recent national data, and was the most comprehensive of its kind drawing on information from thousands of hospital and government inspection reports.

According to a Tribune inspection and investigation of files at the U.S. Department of Health and Human Services, the majority of cases in pediatric intensive care units where needless deaths occurred, lives might have been saved by such simple acts such as washing hands or isolating patients the moment infections were detected. The Tribune's analysis found an estimated 103,000 total deaths linked to hospital infections in 2000. The Centers for Disease Control and Prevention (CDC), which bases its numbers on extrapolations from 315 hospitals, estimated there were 90,000 that year. The Tribune article estimated that 75,000 of the deadly hospital infections took place in conditions that were preventable.

In an article on the same subject in the July 21, 2002 issue of the Atlanta Journal-Constitution it was also noted that according to the federal Centers for Disease Control and Prevention in Atlanta, deaths linked to hospital germs now represent the fourth-leading cause of mortality among Americans, behind heart disease, cancer and strokes. To put this in perspective these infections kill more people each year than car accidents, fires and drowning combined.

US Congressional Committee Slams Medicare for Harassment and Targeting of Chiropractors

For the past several years Medicare administrators have made doctors of chiropractic and their patients a target for selective enforcement and regulatory restriction under Medicare because of a medical prejudice that is a gross disservice to both the patient and doctor of chiropractic. On May 16th, 2002, before a packed congressional hearing room, that trend was significantly exposed and debated.

At that hearing Small Business Committee Chairman, The Hon. Donald Manzullo (R-IL) and over a dozen other Members of the U.S. House of Representatives, pounded Medicare Administrator Thomas Scully for that program's ongoing policy of provider harassment. In a four-hour hearing, witness after witness, including ICA's Central Regional Director Dr. Michael Hulsebus (right) of Rockford, Illinois told the Committee how Medicare had conducted completely unjustified and overtly hostile and prejudicial attacks, post-payment audits and other strong-arm activities aimed at hurting non-MD providers.

Dr. Hulsebus addressed the issue succinctly with his testimony in which he stated, "Chiropractic providers and patients alike find it alarming when Medicare administrators take it upon themselves to use program policies to force health care decisions onto beneficiaries that ought to be left to the patients themselves. How else can you characterize policies that restrict access to one form of care, in this case chiropractic care, regardless of the clinical realities, and force those beneficiaries onto second-choice, specialist-based care that is far more expensive than the chiropractic care that is being denied? This is not only offensive in terms of personal liberties and control over one's own health care; it is also very poor public policy."

This historic hearing marks a major change in the role Congress is willing to play in protecting Medicare providers and Medicare patients from the heavy handed, arbitrary and prejudice driven operations of the Centers for Medicare and Medicaid Services (CMS). Formerly known as the Health Care Financing Administration (HCFA), the May 16th hearing was titled: "CMS, New Name, Same Old Game?" The anger and outrage of the Committee reached a peak when it was revealed that witnesses at earlier hearings on Medicare harassment had been subjected to snap Medicare audits on the very day they appeared before the Small Business Committee. Chairman Manzullo immediately called for an investigation of what he described as intimidation and witness tampering by Medicare and set a July 17th hearing date for a full review of this "horrific and frightening" abuse of power by Medicare authorities.

Drug Sales Globally Continue to Increase

IMS HEALTH, a global healthcare information company, reported on August 1, 2002, an 11% growth in drug sales through retail pharmacies in 13 key markets in the 12-month period from June 2001 through May 2002, adding up to a whopping US$263 billion. IMS HEALTH is the world�s leading provider of information to the pharmaceutical and healthcare industries. They use leading-edge technologies to transform billions of pharmaceutical records collected from thousands of sources worldwide into statistical data that can be used by drug companies to track sales.

Some interesting statistics showed that the US leads the way in drug usage growth. According to IMS Health, North America posted a 16% sales growth to $146 billion in sales in the 12 months prior to May 2002. The USA showed the highest growth at constant exchange and is the country with the highest dollar growth in their survey, for the fourth consecutive month. Comparatively sales in the top five European markets dropped 1% point, as did the sales in Japan.

By categories the largest increase was seen in drugs used for the central nervous system. According to IMS Health the biggest increase worldwide, for the 8th consecutive month, was the CNS group of products, with a sales growth of 16% to $45.3 billion. Antidepressant drugs experienced an 18 percent sales growth in 2000, to $13.4 billion which accounted for 4.2 percent of all global pharmaceutical sales. North America was the dominant user of these drugs, accounting for 74.6 percent of sales with a 19 percent growth rate. Interestingly enough, in Europe, sales fell by 1 percent, while the Africa/Asia/Australia region and Latin America, accounted for only 4.5 percent and 2.4 percent sales growth, respectively. Prozac was the leading product in the class with a market share of 21.5 percent.

With such disparities among drug sales globally, the question begs to be asked if Americans suffer from a larger variety of health issues, is there a problem with over-medication? With 74.6% of all antidepressant drugs being sold in North America, one must ask if there are truly health related issues that account for the difference, or are the numbers due to a "Quick fix" drug culture. Chiropractic has been the one profession in the health care arena that has consistently touted a drug free approach as an alternative to medication.

Article Touts Increased Demand for Chiropractic and Alternative Services

The Boston Globe Online In the July 14, 2002 issue of the Boston Globe appeared an article with the headline, "Demand for Alternative Medicine Rises - Acupuncturists and Chiropractors Increasingly Sought." The article defines all forms of healthcare that are not medical as "Alternative Medicine". Most chiropractors object to the usage of this term since chiropractic care is clearly not medicine. Chiropractic stands as a separate and distinct form of health care.

Despite this terminology issue, the Globe article cited numbers from the National Institutes of Health that calculate that all of "alternative" health care represents a $21 billion-a-year industry. This number should be kept in context. According to figures released in a report on February 7, 2001, the US Census Bureau showed that US health care industry revenues hit $1.01 trillion in 1999. The article also states that surveys show about one-third of Americans visit one of these "alternative" practitioners at least once a year, and that this percentage will increase.

In an attempt to have the medical profession better understand chiropractic and other forms of health care classified as alternative, Tufts University received a five-year, $1.5 million grant last August from the National Institutes of Health (NIH) for finding ways to include alternative medicine as part of the required medical school curriculum. Dr. Mary Lee, dean of educational affairs at Tufts' School of Medicine stated, "The NIH is interested, and so are we, in training traditional doctors to understand complementary medicine."

To meet the increased demand the article cited statistics and projections that showed the current and future numbers of doctors of chiropractic. According to the US Bureau of Labor Statistics, (BLS) in the year 2000, there were an estimated 49,949 chiropractors. The BLS projects that by 2010 that number will grow to 61,654 chiropractors, representing a 23 percent increase. "Since the average growth rate for all occupations over a 10-year period is 15 percent, those figures are significant," said BLS economist Alan Lacey. This projected growth represents the ever-increasing desire on the part of the public to continue to embrace chiropractic care.

Medical Journals May Have Bias or Conflicts

In the June 5, 2002 issue of the Journal of the American Medical Association there are several studies and articles on the weaknesses and possible conflicts of articles that appear in a variety of medical journals. The story also reported in the June 5, 2002 Intelihealth starts by stating, " One of world's leading medical journals has put itself and its competitors under the microscope with research showing that published studies are sometimes misleading and frequently fail to mention weaknesses."

Rob Logan, director of the Science Journalism Center at the University of Missouri-Columbia stated " (this) underscores that the findings presented in the press and medical journals are not always facts or as certain as they seem". Dr. Catherine DeAngelis, JAMA's editor said that problems are most likely to occur in research funded by drug companies, which have a vested interest in findings that make their products look good. The article also stated that several Journal editors are also concerned that drug manufacturers sometimes unduly influence how researchers report research results, and even suppress unfavorable findings.

Dr. Jeffrey Drazen, editor of the New England Journal of Medicine addresses the issue of conflicts of interest by stating that many top journals require researchers to disclose any ties to drug companies. However, he admits there is a weakness in that system in that editors rely on researchers to be truthful. Additionally, the experts who do the peer reviews are not accountable. Most print medical journals allow peer reviewers to remain anonymous. This means that if the peer reviewers have conflicts of interest it will go unnoticed.

Dr. Jim Nuovo of the University of California at Davis stated in one article that medical journal studies on new treatments often use only the most favorable statistic in reporting results. He went on to say, "Most reported only the "relative risk reduction" linked to a specific treatment, which is the percentage difference between drug-treated patients and those in a placebo group. That figure is more misleading than the "absolute risk reduction," which measures the actual difference between the treatment results compared with the placebo group." Nuovo said. "For example, if 5.1 percent of placebo-treated patients had heart attacks compared with 3.7 percent of drug patients, the absolute risk reduction in the drug group would be 1.4 percent. But researchers could use the relative risk reduction to claim that the drug lowers the risk of a heart attack 34 percent - which sounds a lot more impressive."

Moms Who Breast-Feed Reduce Infants' Asthma Risk

Reuters Health of July 31, 2002 posted an article reporting on the results of a study conducted at the Telethon Institute for Child Health Research in Perth Australia. In the study researchers studied more than 2,600 infants from preterm to age 6 years. The results were published in the July 2002 issue of the Journal of Allergy and Clinical Immunology. The results showed that the risk of childhood asthma increased by 28% if exclusive breast-feeding was stopped and other milk was introduced before the infant was 4 months old.

Chief researcher, Dr. Wendy H. Oddy stated, "Among many other health benefits, breast-feeding provides protection against infection through defense agents in the milk." She continued, "Given our findings, we continue to recommend that infants with or without a maternal history of asthma be exclusively breast-fed for 4 months and beyond."

The Reuters article also stated, "In general, breast-feeding is the best nutrition for infants. It is full of beneficial hormones, enzymes and growth factors, and reduces infections, respiratory illness and diarrhea in babies."