June 24, 2002 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com

Effects of fruit and vegetables on antioxidant concentrations, BP

This is another of those "how much did we spend on this study???" study. Is there anyone out there that thinks that increased consumption of fruits and veggies won't positively impact markers of health? Do we really need to spend money just to quantify what common sense already tells us?

The Journal : Back Issues

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Breastfeeding and lowering the risk of childhood obesity

With the rates of diabetes and obesity skyrocketing, it is always good to see studies outlining protective behaviors. Unfortunately, whether or not an infant was formula fed cannot be changed in the child's later years. The US government is considering spending millions on educating children on exercise and healthy eating but are missing the obvious (as surprising as that may be for government...). How about a multi-million dollar advertising campaign towards the benefits of breastfeeding?

The Journal : Back Issues

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Activation of the mucosal immune system in irritable bowel syndrome

It has been difficult to find structural abnormalities in IBS and it is nice to see some research along these lines. IBS is primarily a functional disorder and I'm sure that the localized inflammation found in this study is a result of the altered function. Imbalance in pathogenic flora, improper digestion leading to putrefactive by products and yeast overgrowth have all shown to play a factor in IBS. Each of these by themselves could lead to a localized inflammatory response.

Gastroenterology Online

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Oral Contraceptives and Glucose, Insulin, and Diabetes

Articles like this are good to see, but the citations appearing in other medical journals does make me scratch my head in wonder. This study did show lower fasting glucose levels and lowered risk of diabetes (after ten years of use). However, insulin levels were elevated. Medscape's review implied that insulin levels were lowered!! And then you wonder why our health system is so screwed up. My interpretation?? Elevated insulin from pharmacological interventions can never be a good thing. It is entirely possible that oral contraceptives has some type of insulin secretagogue property yielding higher insulin and lower glucose and lowered risk of diabetes in the short term. I feel confident that if this study were to be followed up in another decade the results would not be so "drug friendly."

Dia Care -- Abstracts: Kim et al. 25 (6): 1027

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Lawyers poised to sue US junk food manufacturers

Doesn't that just take the cake?? Oops...might not have cake after the attorneys get through all this mess. So much for personal responsibility!! If we sue the junk food manufacturers might as well go after anyone who uses enriched wheat flour (and how about the government for forcing "enriching??"). While I can say this is absolutely ridiculous, I'm sure they can find a jury somewhere that will award some money.

bmj.com Charatan 324 (7351): 1414

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Nutritional genomics

Gosh...what can I add to this article? This topic has the potential to be the future of medicine if we would drop the dogma and take the money out of pharmaceutical drugs. There are currently urine tests to analyze certain genetic variations that alter a patient's need for certain nutrients. While clinically available now, I would guess that I'll be long retired before this actually makes it into standard practice. It will take half that long for the researchers to spend the money to determine that nutrition really does play a role is disease prevention/management and half again for the clinicians to read their own medical journals.

bmj.com Elliott and Ong 324 (7351): 1438

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Physical Activity and Inflammation in Middle-aged and Older US Adults

This study finds that exercise lowers overall levels of CRP, a marker of chronic inflammation. This is really not an unexpected result;moderate exercise is a key component to a natural approach to any disease process since most diseases have an inflammatory component.

Relationship Between Physical Activity and Inflammation Among Apparently Healthy Middle-aged and Older US Adults

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Study Questions Cost-Effectiveness of COX-2 Drugs

This is one of those articles that raises some eyebrows. The fabulous new selective COX-2 inhibitors are being severely overused. The overview of this study goes into the specifics, but I do know one thing for sure--you can bet the pharmaceutical reps and direct to consumer advertising had something to do with it. Makes me wonder if some nutriceutical company came up with millions of dollars to advertising saw palmetto for prostate health to women, how effective would it be? Money talks and buyer beware!!

(article)

New evidence suggests that health plan sponsors may want to break doctors' habit of prescribing COX-2 drugs for arthritis, acute pain and other conditions without first having tried less expensive treatments. The study, released today at the Express Scripts Outcomes Conference, questions the overall cost-effectiveness of COX-2 inhibitors, such as Pharmacia's Celebrex (celecoxib) and Bextra (valdecoxib) and Merck & Co.'s Vioxx (rofecoxib). The analysis reinforces lingering doubts about the benefit of COX-2 drugs compared with traditional nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. The debate centers on whether COX-2 drugs provide an added safety benefit for patients at risk of stomach problems, such as ulcers and bleeding, that can occur when using traditional NSAIDs. Researchers in the June 1st issue of the British Medical Journal conclude that an earlier study of Celebrex leaves the false impression that the COX-2 drug has fewer gastrointestinal side effects than NSAIDs (see Reuters Health report, May 30). Express Scripts' study focuses on the cost-effectiveness aspect. Annual spending for COX-2 drugs spiked 38% in 2000, the study found. The increase reflected a huge influx of new patients taking the drugs, said Fred Teitelbaum, the company's vice president for research and planning. Spending grew another 15% in 2001. When the St. Louis-based pharmacy benefits management company probed deeper into utilization patterns, it discovered that 74% of new users had no evidence of being at risk for gastrointestinal adverse events. Furthermore, 29% of new users had a diagnosis of lower back pain, a condition not yet listed as an approved indication for COX-2s, it said. No clinical studies have shown COX-2 drugs to be any better than NSAIDs for lower back pain, according to Emily Cox, Ph.D., manager for outcomes research at Express Scripts. Also, short-term use of COX-2s was greater than expected, suggesting that these agents are not being reserved for patients requiring long-term treatment for which gastrointestinal side effects may be an issue. Cox said the study underscores a "significant opportunity" for health plan sponsors to encourage a more cost-effective approach. Express Scripts advocates an approach called step therapy, whereby physicians are encouraged to start new patients without risk of gastrointestinal side effects on a generic NSAID before progressing, if necessary, to a COX-2 drug. Express Scripts estimates that step therapy alone can trim health plan sponsors' total spending within the NSAIDs class by 12%, said Brenda Motheral, the company's senior director of outcomes research. So far, only a small percentage of Express Scripts clients have implemented a step therapy program, which typically blocks payment for a COX-2 claim without a clinical reason justifying the choice, explained Raulo S. Frear, vice president of clinical services. By presenting this new data, the company hopes to stimulate greater interest in "appropriate cost-effectiveness," he said.