No Need to Fear Chiropractic

Hotly contested by health practitioners is whether chiropractic manipulations of the neck can increase risk for strokes, which occur when blood flow to the brain is blocked by a clot formed in an artery. Many claim that cervical chiropractic adjustments lead to strokes in patients after manipulation, while chiropractors and their patients are obviously concerned if there is any truth to these allegations.

A study in the Canadian Medical Association Journal estimated the risk of stroke in a series of cases covered by the Canadian Chiropractic Protective Association (CCPA). The authors reviewed malpractice records to evaluate stroke claims following chiropractic treatments from 1988-1997. This number was compared to the total number of cervical manipulations performed yearly by chiropractors covered by the CCPA.

Twenty-three cases of stroke after chiropractic adjustment were on record; approximately 135 million cervical adjustments were carried out by these chiropractors over the 10-year period. Based on the fact that Canada has 4,500 licensed chiropractors, the odds that a patient will suffer a stroke after receiving cervical manipulation are one per 8 million office visits, or one per roughly 6 million cervical manipulations.

These data indicate that stroke is probably much less likely in chiropractic patients than has been estimated by neurologists (about one per 500,000-1 million). If you have any questions or concerns about stroke related to chiropractic, ask your chiropractor for more information.

Reference: Haldeman S, Carey P, Townsend M, et al. Arterial dissections following cervical manipulation: The chiropractic experience. Canadian Medical Association Journal 2001:165(7), pp. 905-906.

For more background information on chiropractic, click here.

Should You Forget Ginkgo Biloba?

The herb ginkgo biloba has been used in China for hundreds of years to enhance memory, improve mood, and alleviate headaches. Many Americans currently take the supplement for the same reasons, as it is marketed to offer these benefits, but proof of its success has been limited to few tests of memory and to people suffering from an illness.

In a recent study in the Journal of the American Medical Association, 115 people over 60 years old took 40 milligrams of ginkgo three times per day (the recommended dosage) for six weeks, while another 115 took a placebo at the same frequency for comparison. Neither group was aware of which type of pills they were taking.

No improvements in memory or mental sharpness were observed in either group, based on a battery of neuropsychological tests. Even when different outcome measures like verbal memory, concentration, and attention were looked at separately, the supplement offered no significant benefits.

So should you bother taking ginkgo biloba? The verdict is still out. If the supplement does offer improvements to concentration and memory, it has yet to be scientifically proven. In the meanwhile, other ways to keep a sharp mind include an antioxidant-rich diet, low alcohol consumption, and performing regular leisure activities to give your mind a workout.

Reference: Solomon PR, Adams F, Silver A, et al. Ginkgo for memory enhancement: A randomized controlled trial. Journal of the American Medical Association 2002:288(7), pp. 835-840.

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Worth the Occasional Mustache

One of the most prevalent and dangerous cancers is colorectal cancer, or cancer of the large intestine. Colorectal cancer causes more deaths in the U.S. than any other type except lung cancer, but there may be a way to help avoid it. Research suggests that consuming milk and dairy products may protect against this disease.

To evaluate the association between consumption of dairy products and the risk of colorectal cancer, cancer cases reported by the Finnish Cancer Registry were determined over approximately 25 years. This European Journal of Clinical Nutrition study was conducted in Finland because it has one of the highest per-capita rates of milk consumption in the world.

People who consumed the most milk and milk products were less likely to develop colon cancer than those who consumed the least, although there was no significant link between rectal cancer and milk and/or milk products. Those with diets high in lactose (a sugar found in milk) also had a reduced risk of colon cancer, but vitamin D and calcium intake did not reduce the risk.

Lactose may have properties that inhibit the growth and development of cancer cells in the bowels. The best known natural source of lactose is milk, so be sure to consume the U.S. recommended daily allowance of dairy products (2-3 daily servings for adults; 3-4 for children), and always try to stick to the low-fat versions.

Reference: Jarvinen R, Knekt P, Hakulinen T, et al. Prospective study on milk products, calcium and cancers of the colon and rectum. European Journal of Clinical Nutrition 2001:55, pp. 1000-1007.

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Big Spenders

We've all seen the recent increase in television commercials for various drugs. In 1997, the Food and Drug Administration (FDA) reduced its restrictions for mass media advertising of prescription drugs, allowing pharmaceutical companies to air TV commercials without including details on the side effects of these drugs. Drug companies have been spending much more on advertising as a result.

Using data on advertising costs and prescription drug sales from 1999-2000, the authors of a recent study investigated whether drug sales are being disproportionately influenced by increased advertising, through a sampling of approximately 40,000 retail outlets.

Merely 1% of all prescription drugs in the U.S. accounted for half of the money spent on drug advertising. In other words, nearly 50% of the money spent on the total of almost 10,000 available prescription drugs was spent on the 50 most-advertised drugs. The sale of these drugs jumped approximately one-third, while sales of all other drugs combined increased only 14%.

In 2000, the arthritis drug Vioxx topped the list for advertising costs, at $160 million - 7% of the total $2.3 billion per-year drug-market spending. Prilosec (for stomach ulcers) and Claritin (for allergies) followed Vioxx in advertising costs. Of concern is that doctors and their patients are seeking particular drugs because they are well known; not necessarily because they are the best or safest treatments for a condition.

Reference: Findlay S, Sherman D, Chockley N, et al. Prescription drugs and mass media advertising, 2000. National Institute for Health Care Management Research and Education Foundation, November 2001. Online at http://www.nihcm.org.

If you're interested in studies like this one, click here.

Which Activities Cause Your Kids Pain?

Have your kids ever complained to you about persistent neck or shoulder pain? More than one in 10 adolescent boys, and one in five girls, suffer from long-term neck and shoulder symptoms; some data suggests that these problems may appear in more than half of adolescents. The repetitive movements involved with playing musical instruments, working, and participating in sports have been considered possible causes of these conditions.

On three occasions, each spaced six months apart, researchers collected data from approximately 500 adolescents in Montreal, Canada, regarding musculoskeletal health and participation in various activities. The students, all in grades 7-9, were assessed for neck or upper-limb (including upper back, shoulders, and arms) pain occurring at least weekly in the preceding six months.

Upper-limb pain appeared weekly in almost one-third of the students. Risk factors that increased the likelihood for neck/upper-limb pain were involvement in childcare (more than doubled risk); holding a job (nearly doubled risk); and lower mental health. In this study, involvement in sports or music was not associated with developing these forms of pain.

Interestingly, students were more likely to develop neck/upper-limb pain in the period from fall to spring, as opposed to spring to fall. It is possible that these types of pain are more common during the school year due to the additional stresses of making friends, getting good grades, and having other responsibilities.

Reference: Feldman DE, Shrier I, Rossignol M, et al. Risk factors for the development of neck and upper limb pain in adolescents. Spine 2002:27(5), pp. 523-528.

For more information about pediatric health, click here.

Folate Is First-Rate

Did you know that if you have a family history of colorectal cancer, you're twice as likely as the average person to suffer from the condition? You may be able to reduce your chances for colorectal cancer by moderating your alcohol intake and eating foods high in folate, according to a recent study in Cancer Epidemiology, Biomarkers and Prevention.

The authors studied the diets of close to 90,000 30- to 55-year-old women, using a food-frequency questionnaire. Diets were examined for consumption of folate, multivitamins, alcohol, and methionine (an essential amino acid). The women were followed for 16 years to determine cases of colon cancer.

Women with a family history of colorectal cancer who consumed at least the U.S. recommended daily allowance (RDA) of folate each day, or took a multivitamin supplement daily for at least five years, were approximately 50% less likely to suffer from colon cancer than those who consumed less than half the RDA for folate. Those without a family history of colorectal cancer also showed a decrease in colon-cancer risk when taking the RDA of folate. Moderate-to-heavy alcohol intake increased risk for colon cancer in those with family history by nearly four times, though.

The RDA for folate is 400 micrograms, which is about the amount found in 3-4 servings of foods high in folate, such as leafy greens, citrus fruits, asparagus, beans, chicken, and whole grains. As this study suggests, necessary folate can also be obtained from vitamin supplements.

click here for more studies on the benefits of good nutrition.

Reference: Fuchs CS, Willett WC, Colditz GA, et al. The influence of folate and multivitamin use on the familial risk of colon cancer in women. Cancer Epidemiology, Biomarkers and Prevention 2002:11, pp. 227-234.

More Side Effects in Newer Drugs

Prior to approval from the Food and Drug Administration (FDA), possible negative side effects of prescription drugs are often determined in only small groups of people over short time periods. Pharmaceutical companies also often publicize a drug before all of its side effects are known. As a result, many new drugs may be approved by the FDA without full knowledge of their side effects, and previously unknown side effects are reported to the administration only after some drugs have already hit the market.

A study in the Journal of the American Medical Association determined the relationship between new prescription drugs and the addition of "black box warnings" (warnings required by the FDA to be placed on drug packaging that indicate potentially severe or life-threatening side effects) or removal from the market. The authors examined all new drugs approved from 1975-1999, and all drugs withdrawn from the market for safety reasons from 1975-2000.

An estimated 20% of prescription drugs released to the public during that time received a black box warning or were removed from the market. Half of changes to drug warning labels occurred within seven years of introduction; half of withdrawals from the market took place within two years of introduction.

The safety of new drugs is uncertain until they have been widely used for many years. Don't be one of the first people to suffer a previously unknown side effect of a drug. If you must take a prescription drug, opt for one that is tried and true -- not the heavily marketed, newer one. Also, consider alternative therapies besides drugs to treat your condition.

Reference: Lasser KE, Allen PD, Woolhandler SJ, et al. Timing of new black box warnings and withdrawals for prescription medications. Journal of the American Medical Association 2002:287(17), pp. 2215-2220.

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Light at the End of the Tunnel?

Roughly 5% of pregnant women suffer from major depression, which may lead to health risks for the mother and developmental problems in the child. The safety of antidepressant use during pregnancy is uncertain, which has prompted searches for alternative treatments. Preliminary studies on daily bright-light exposure have shown it may successfully treat depression during pregnancy.

Morning bright-light therapy was self-administered by pregnant women suffering from major depression. The subjects underwent one hour of light treatment with a white fluorescent light approximately one foot from their faces, initiated within 10 minutes of waking, for at least three weeks. A depression rating scale was used to evaluate depression levels in this study from the American Journal of Psychiatry.

Following three weeks of bright-light therapy, average depression ratings in the women improved by about 50%. For women who were followed through five weeks of treatment, an additional improvement to almost 60% over initial scores was observed. Light therapy did not negatively affect pregnancies, although two women experienced nausea as a side effect to therapy. But withdrawal from the light treatment was linked to an increase in depressive symptoms.

This form of treatment needs to be further investigated, but it does suggest that there may be ways to treat depression besides taking antidepressant drugs. In the meanwhile, do your best to avoid taking any drugs while pregnant, perform light exercises at least several times per week, and maintain a healthy diet.

Reference: Oren DA, Wisner KL, Spinelli M, et al. An open trial of morning light therapy for treatment of antepartum depression. American Journal of Psychiatry 2002:159(4), pp. 666-669.

For more information on women's health, click here.