August 25, 2000 Research Update

Declines in DHEA Sulfate Concentrations and Cognitive Performance

This article suggests that no relationship exists between lowered levels of DHEA with aging and cognitive decline. There are two ways to take this. First, the proves that DHEA is another of the over the counter wonder drugs that is more hype than performance. On the other hand, this would not be the first time that researchers have found negative results with a substance that later turned out to have benefits. The idea with research is to look at the totality of the evidence, and keep an open mind until to jury is no longer out. The Relationship Between Longitudinal Declines in Dehydroepiandrosterone Sulfate Concentrations and Cognitive Performance in http://archinte.ama-assn.org/issues/v160n14/abs/ioi90684.html

Current Tests Cannot Identify Pain of Discogenic Origin

research strongly points to annular tears of the intervertebral disc as a major cause of low back pain. The problem with this is that diagnosing tears is very difficult using modern technology. The author of this study than goes on to infer that the difference between patients with and without LBP is psychological. This wouldn't be the first time that mainstream medicine has suggested a psychologic origin for pain or symptoms that they did not know how to diagnose. Mainstream medicine has to find a STRUCTURAL problem for disease to be present. One day they will come to realize that FUNCTIONAL problems exist long, long before structural problems arise. Chiropractors have and will continue to do well treating LBP because we don't keep ourselves limited by typical "Western Medicine" which can be very narrowminded.

The Back Letter 15(6):61,68,69, 2000 The study found that high-intensity zones (HIZs) on MRI scans - even when accompanied by a positive discogram - are not reliable indicators that pain stems from the disc. "For better or for worse, the identification of an annular tear has been one of the main tools used to diagnose the cause of low back pain, and now it looks like it's a false start in many patients," said Eugene Carragee, MD, lead author of the new study. Carragee says that he personally believes that annular fissures may be the cause of some forms of low back pain. However, he suggests that what distinguishes self-limiting back pain from severe, disabling low back pain illness may not be physical pathology. "I think that those with annular fissures and low back pain of no consequence may not have different spinal pathology than people with severe low back pain illness," Carragee suggests. "However, their coping mechanisms, emotional responses, and social circumstances may be very different."

Ciprofloxacin For Reactive Arthritis Has No Advantage Over Placebo

Although it is well known that certain gastrointestinal infections can cause a reactive arthritis, this study suggests that long term strong antibiotics do not help with symptoms. Unfortunately, these researchers have missed the evidence that suggests that it is not the infectious agent itself that causes the problems, but rather the environment set up by the presence of the infection. Adding strong antibiotics will just kill off more of the normal flora that's supposed to be there, and evidence suggests that this flora may protect our bodies from the environment.

Ann Rheum Dis 2000;59:565-570 Treatment of reactive arthritis with a 3-month course of ciprofloxacin is no more beneficial than placebo, according to study results published in the July issue of Annals of the Rheumatic Diseases. Antibiotic treatment of reactive arthritis is controversial, the investigators note. "Eradication of the causative microbe appears logical," but previous studies have shown that "short-term antibiotic treatment has no beneficial effect on the outcome of reactive arthritis," they write.

Increase in Chiropractic Patients With Work-Related Injuries

Chiropractic is the natural choice for work injuries, and many studies suggest that chiropractic is cheaper with better results than non-chiropractic treatment. Although this would make one think that chiropractic would be a wise first choice, that has not been the case in the past. This attitude does seem to be changing.

Medical biases against doctors of chiropractic in the workers' compensation arena are beginning to fade, as new research points to chiropractic's effectiveness at getting workers back on their feet more quickly and less expensively than traditional medical care, according to the July issue of the Journal of the American Chiropractic Association. As a result, some doctors of chiropractic are experiencing an increase in the number of patients with work-related injuries who are being referred to them by medical doctors. America's medical bias becomes particularly evident with companies that have international investments, says Robert Sherman, Esq, general counsel for the Ohio State Chiropractic Association. The Japanese, for example, advocate the most cost-effective healthcare provider while their American counterparts lean toward medical doctors. During the past 5 years, however, he finds that the effectiveness of chiropractic treatment and the resulting cost savings to employers and insurers are helping to reverse traditional thinking.

Is Type-2 Diabetes an Inflammatory Disease?

This is not a new theory. Inflammation in the human body can be a devasting process and is believed to contribute to most diseases known to man. This is a nice summary of the link between inflammation and Type 2 diabetes.

The 82nd Annual Meeting of the Endocrine Society Dr. Steven Shoelson of the Joslin Diabetes Center, Boston, Massachusetts, presented the first lecture entitled, "The I-kappa B Kinase Mediates Insulin Resistance in Diabetes and Obesity."[1] The provocative question at the outset was -- is type-2 diabetes an inflammatory disease? Certainly, patients with type-2 diabetes exhibit circulating markers of an "acute phase response," and some of these, such as tumor necrosis factor-alpha, may contribute to the pathophysiology of type-2 diabetes. However, is there a rationale for treating type-2 diabetic patients with anti-inflammatory drugs? Dr. Shoelson gave historical evidence -- dating from 1876, but "rediscovered" as recently as 40 years ago -- that high doses of aspirin (ASA) of the order of 10 g per day can attenuate hyperglycemia quite markedly. The Joslin investigators hypothesized that I-kappa B kinases (IKKs), key regulators of the NF-kappa B pathway of proinflammatory signaling, might be the target of ASA, since this dose is known to inhibit their activity. (Of note, much smaller doses are needed to inhibit the cyclooxygenase enzymes that are generally the target of ASA's anti-inflammatory actions, but these doses of ASA do not appear to affect glycemia.)