Doctors are seeking new ways to prevent muscle loss - buyer beware..

I was reading an article today published by the NY Times regarding aging and muscle loss (http://www.nytimes.com/2010/08/31/health/research/31muscle.html).  As people age, it is presumed that we lose muscle tone and strength due to many factors such as activity, fatty infiltration in the muscles, hormonal changes and they have even created a new medical term for this called sarcopenia, a fancy medical way of saying muscle loss.  The concept is patterned after the idea of osteopenia, which is a loss of bone in medical terminology.


I say buyer beware because drug companies would love to bottle this and sell this as the next life threatening malady that afflicts us which can be bottled, and then sold, side effects and all with the blessing of insurance companies who become convienced this is a true malady that is life threatening.  


The reality is that people need to remain active and stimulated.  People who work into their late 70's and 80's tend to be sharper mentally and physically, they move better although we have the problems of gravity, our body mechanics, degenerative changes in the spine leading to spinal stenosis which will cause muscular wasting (you cannot solve that in a pill) and there are of course, degenerative processes due to hormonal changes and also changes at the cellular level which are likely not to be helped by a pill.


My solutions are for people to have more active lives (many people are overweight and less active - a problem the army is experiencing with new recruits), to eat better (lets get away from our unhealthy food production methods and corn doping of many things we eventually eat) and to take care of biomechanical problems when we are young (true preventative care).  Trying to give someone a pill for a problem that in most cases is because biomechanical issues have been ignored for years because doctors did not understand them is absurd, and will also likely if history repeats itself will be expemsive and give us problems we dont have and are not likely to develop without the pharmaceutical companies help.


We need to embrace aging as a normal process, not a disease and people will have healthier muscles with a properly functioning body, and myofascial system, rather than the next pill to fix a problem that is a natural part of aging, given that most health care practitioners really do not understand human body mechanics very well.

What do you think?  As always, I value your opinion.

Parents in NJ are finding reasons to forgo vaccinations. Food for thought

I was reading in the NJ Star Ledger about the below average rates of vaccination in NJ children (http://articles.moneycentral.msn.com/news/article.aspx?feed=AP&date=20100822&id=11932980).  Like many of our patients, my children have received vaccinations and although on the surface this regular medical service that is part of our preventative healthcare and supported by the CDC.  Even in a state thought to be as affluent, and educated as in NJ, many middle and upper class parents are forgoing vaccinations because in many cases, based on some of the concerns in the media regarding the link between autism and mercury that is used in the vaccines may be harming their children.  I must admit, I still wonder weather my sons aspergers syndrome was linked to vaccines.  I will likely never know but I cannot go back in time, avoid vaccinations and then see how he turned out.  I just does not work that way.

Recently, there have been reports that whooping cough may be returning to our population, even though that population has largely been vaccinated.  Could it be that vaccinations are over hyped, religiously pursued by the NJ legislature because of the medical lobby as well as pursued by drug companies trying to cash in on the next flu scare (remember swine flu, H1N1) (http://www.chetday.com/fluscaregame.htm).  Our memories are as short as the media but someone made a ton of money scaring the public into getting vaccinated against the maybe disease.  In the case of H1N1, our government spent a ton of money, the public did not receive this scare with open arms and they were left with tons of expiring vaccines that were not worth the bottles they were printed on. What is a scare weary public to do?

The thing that really scares me is that one day, when we have a real scare, few people will listen and the chicken little effect will occur (few people will believe it when the sky really is falling). I think that day is nearing and NJ vaccination rates are a symptom of that malaise.

We really need to rethink many of our health policies, since they often amount to scare tactics with little or no health benefit and in many cases, side effects (cholesterol lowering drugs anyone).  Somehow, people in other countries have a healthier outlook without having all the stuff done to them. With regard to vaccines, this blog post is not designed to help someone decide weather or not to vaccinate their children.  People should read and make their own opinions, rather than have it written into law that they must do this.   It is true that some people have vaccine reactions (although a small sampling of the populace) and have neurological impairment or other problems as a result.  Somehow, our society has made these risks acceptable even though much of our immunity to many diseases is natural (natural immunity still occurs believe it or not without vaccines) and natural immunity occurs by reacting to the infection.

What would happen if we decided tomorrow that vaccines are no longer mandatory?  Would the masses avoid them in droves?  My opinion is that it depends on what you believe.  The only true way of finding out if vaccination is unnecessary is for the populace to avoid it.  It would take many years to see if we need it or if the diseases we have tried to prevent come back or if our improvements in sanitation and living standards are really the reason we no longer see many of the diseases we vaccinate for.

What do you think?  As always, I value your opinion.

Repeat athletic injuries - Should we change our way of competing or are we missing something.

I was reading today an article in the NY Times concerning athletic injuries in aging athletes (http://www.nytimes.com/2010/08/17/health/nutrition/17best.html?8dpc).  A thoughtful article, although I am surprised they did not ask the opinion of a non medical style provider.  Is being an overachiever athletically a psychological problem?

I have been treating older athletes for years.  It is always sad when an athlete has numerous injuries that are termed as overuse and then gives up the sport they love because the injuries continue to pile up.  I too injured my back playing softball this season and I am likely not to return.

Many athletes we treat have chronic problems because they are misunderstood.  Stress fractures, knee pain, hip pain, shoulder problems are often looked at as separate entities.  The reality is that they are usually part of a gait related issue, causing the person to slam their foot into the ground. It is my experience that most health care providers are trained to look at the pain, name and diagnose the condition and then treat it or put the person on rest for a while then send them back into the wild.  The problem is, without understanding the true cause, the next injury occurs, then the next and then the person eventually gives up after years of trying to fight through the eventual outcome of giving up.

A better idea is to understand the mechanism of the painful problem, name it functionally vs. using the typical dis ease monicre of itis, osis, tear, stress fracture and realize that functional problems require a functional solution which may include orthotics, gait retraining and other ideas.  Most often, these people will likely return to activity and back to the sports they love with far fewer injuries.  With the old way of thinking, they may require surgery, joint replacement and other interventions because the doctors were not trained to evaluate why the injuries occurred.  Athletes of all ages deserve better.  We should never treat or name anything we truly do not understand.  Athletes should not suffer because their health care providers do not understand why they hurt.  They joint replacement manufacturers will likely not enjoy this blog post however, if you are an aging athlete, for you it will.

What do you think.  As always, I value your opinions.

Survey shows majority who utilize chiropractic care for their low back pain report "a great deal" of benefit.

By Peter W. Crownfield, Executive Editor of Dynamic Chirorpactic The past 12 months have been good - very good - for the chiropractic profession in terms of data supporting the efficacy of chiropractic care. For starters, consider the Wellmark pilot study that suggests chiropractic reduces both costs and need for surgery;1 the Milliman USA analysis that concludes, "[S]pinal patients who seek chiropractic coverage have materially lower health care costs than those who do not";2 the Consumer Reports reader survey that found "hands-on" therapies, led by chiropractic care, were the top-rated treatments for back pain sufferers, with chiropractic receiving the highest satisfaction-with-care ratings (significantly higher than MDs);3 the "Mercer Report" that suggests chiropractic compares favorably to most therapies covered by health benefit plans and is "likely to achieve equal or better health outcomes";4 and the final report on the Medicare demonstration project, which notes that 87 percent of patients surveyed gave their DC a satisfaction score of 8 or higher and 56 percent gave a perfect 10.5 The latest thumbs-up comes courtesy of a survey analysis published in the June 2010 issue of the Journal of the American Board of Family Medicine.6 The analysis, based on data from the 2002 National Health Interview Survey, revealed that 60 percent of U.S. adults utilizing CAM therapies for back pain reported "a great deal" of benefit. Chiropractic was used most frequently (74 percent of respondents) and had the highest success rate (66 percent reporting significant benefit). The analysis evaluated utilization of six CAM modalities: chiropractic, acupuncture, massage, relaxation techniques, herbal therapy, and yoga / tai chi / qigong. Sixty-nine percent used one therapy only, 21 percent used two, 8 percent used three, 1 percent used four and less than 1 percent used five or more therapies. Massage was a distant second in terms of patient use for back pain (22 percent of respondents reporting use) and perceived benefit (56 percent reporting "a great deal" of benefit for their back pain). The percentage of respondents perceiving similar benefit for the other CAM therapies was as follows: 56 percent for yoga / tai chi / qigong; 42 percent for acupuncture; 32 percent for herbal therapies; and 28 percent for relaxation techniques. Two factors were independently associated with greater perceived benefit from CAM use for back pain: better self-reported health status and an indication that "conventional medical treatment would not help." The factor most associated with less benefit from CAM for back pain was "referral by a conventional practitioner." The authors of the survey analysis speculate that more or less perceived benefit may be attributable to several factors, including that an independent decision to utilize CAM (rather than being referred) may increase perceived benefit, while referred patients may have pain that is less responsive to treatment (contributing to less perceived benefit). What is not discussed is whether data is available on the professional usage patterns for those who self-referred vs. those referred by a medical provider. If those who self-referred chose different providers than those referred by an MD, it could have impacted perceived benefit with care, particularly the reduced benefit perceived by those referred by an MD. If there is a difference, and it can be shown that it did impact perceived benefit, it suggests that MDs need to have a better understanding of which CAM providers to refer to for back pain. Given that chiropractic continues to have the highest level of patient satisfaction, MDs who choose other CAM providers would want to ensure that they are not making that choice based on false assumptions. This difference also might ultimately lead to more specific referral criteria for MDs referring to CAM providers for back pain. References "Study Suggests Chiropractic Reduces Health Care Costs, Need for Surgery." Dynamic Chiropractic, Aug. 26, 2009. "Cost-Effective Care: The Evidence Mounts." Dynamic Chiropractic, Sept. 9, 2009. "Consumer Reports Survey Rates DCs Higher Than MDs." Dynamic Chiropractic, May 20, 2009. "How Chiropractic Helps the Insurance Industry." Dynamic Chiropractic, Dec. 2, 2009. "Medicare Patients Give Chiropractic High Marks." Dynamic Chiropractic, March 26, 2010. Kanodia AK, Legedza ATR, Davis RB, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: a national survey. J Am Board Fam Med 2010;23:354-62. Source: dynamicchiropractic.com

Economy Led to Cuts in Use of Health Care - what do we make of this?

I read an article today that stated that a study done by the  National Bureau of Economic Research says that the recession reduced the utilization of health care services, across the board (http://www.nytimes.com/2010/08/17/health/policy/17health.html?_r=1).  They compared our country to others with lower out of pocket costs and found that the higher out of pocket expenses contributed to the reduction of utilization.

Our office experienced this as well over the past 3-4 years.  I am aware of a recovery taking place since May of 2009 when business in our office picked up. Part of it was pent up demand and the other part of it is likely people coming to terms that higher copayments are here to stay and they are probably used to it by now.

I am troubled by this data for a few reasons:
1. There were fewer doctor visits and therefore fewer procedures done, yet, the overall health of the nation has not been compromised.  One would wonder that perhaps, many recommendations for tests and procedures may not be needed after all and are part of the problem.  In other words, people can be left alone, with fewer interventions which does not appear to affect life expectancy.  I hope the authors are looking at their data more closely now, and looking past the obvious.  In other words, do we need to lean on the health care system as much as we are advised to do if there is no real benefit, or possible detrimental effect of procedures and tests that just are not necessary?

2. Higher co payments means insurance companies paid out less and consumers were expected to pay more. Since we also used our doctors less and had fewer procedures, why did rates increase an average of 20 percent this year for many of us, yet there is evidence that medical inflation this year has almost come to a halt?  In other words, why the increase and who is benefiting (hint: its not the doctors and we personally were hit for another 18 percent on chiropractic fees by Aetna again)? In my opinion, health care reform did not go far enough and should have included a public option.  This would have prevented these increases which make our country less competitive in the world economy because of the ridiculous cost of health insurance.

3. Over the last year, chiropractic utilization is up markedly.  Perhaps, people are shifting their spending habits to a more cost effective and overall effective type of care.  It costs less to get problems taken care of the right way, regardless of the visit costs.  In other words, in our office treats a person with shoulder and neck pain.  Doctor A before us evaluates the neck and shoulder, sends the patient for 2 months of rehab and orders an MRI, the problem returns two months later.  The cost - Thousands of dollars for a non solution.  The patient visits us Doctor B.  We find out during the evaluation the person has right foot flare on the side of shoulder pain and his hip flexor is pulling the shoulder forward causing neck and shoulder pain.  The problem resolves in 12 visits and the person purchases foot orthotics and is now aware of why the problem exists.  The costs, slightly over $1000 but the person has to put our $40 per visit because of an outrageously high copayment which is not compatable with rehab.  The person shoulders much of the costs but is pain free with money well spent and we got it right the first time.  The lesson is that it is not the cost of the visit, or the amount of stuff that is done to someone.  It is the quality of the health care experience that counts.  Getting it right and improving the persons health for years to come is always better than having tests and procedures.  Perhaps, this study also is a reflection of market forces which have been largely absent from our monopolized healthcare system.

What do you think?  As always, I value your opinion.

Was Atkins right, new study shows low carb diets are better for you

Todays NJ Star ledger had an article talking about the benefits of low carbohydrate diets vs. the calorie restriction traditional type (http://www.washingtonpost.com/wp-dyn/content/article/2010/08/02/AR2010080204125.html) . Truth be told, low carbohydrate diets lead to healthier people with higher levels of HDL's as the study shows. As with politics, companies who have diets also have pundits who will spin and twist diets benefits, without real world proof.  I have always told patients that if you wish to lose weight quickly, cut your carbohydrate intake in half and you will likely drop some weight without working too hard at it.  I have gone on many diets by doing just that: lowering my carbohydrate intake.  The most offensive complex carbs (http://www.weightlossforall.com/complex-carbs.htm) are breads and pasta's because they are filling, satisfying however, easily converted to sugar by the body.  Simple carbs include sugar itself (http://www.weightlossforall.com/simple-carbs.htm), soft drinks, fruits.  Please check out these links because they will give you a better and more complete list of these products.

Atkins (http://www.weightlossforall.com/atkins%20low%20carb%20diet.htm) was persecuted for his beliefs in the low or no carb approach.  Low carbs has been vindicated in this current study.  I typically look at food as fuel since my job is quite physical.  Carbohydrates such as cookies can be addictive and for many, their dietary downfall is through snacks which are carb heavy.  I usually recommend increasing protein and decreasing carbs for a healthier diet.  Carbs are often cheap fillers.  If you go to any buffet, you will find food loaded with carbs at an affordable price.  These places are a minefield for those who are not food savvy.  You can, on the other hand do quite well at many of these by sticking with the salads, meats, cheeses and minimize the pastas, rices and other grains including the breads which cost less and people fill up on.

What do you think?  As always, I value your opinion