This news release from the American Chiropractic Association just arrived:

Congressional Committee Calls Chiropractic “Key Benefit” Within DoD Health Care System, Urges Pay Equity System      

 

Arlington, Va.- Members of the House Armed Services Committee have approved the inclusion of a strong, pro-chiropractic directive in their official committee report accompanying the FY 2013 National Defense Authorization Act. The committee language asserts that services provided by doctors of chiropractic (DCs) for our nation’s men and women in uniform is of “high quality” and has become a “key” benefit within the military health care system. Read relevant pages from the committee report here.

 

According to the American Chiropractic Association (ACA) and Association of Chiropractic Colleges (ACC), the language is significant for several reasons. “What we have here–and this is very important–is an official statement from one of the House’s oversight committees with authority over the Pentagon that directly links the services of DCs to the treatment of conditions experienced as a result of combat operations. This is a huge validation that chiropractic services are of significant, direct value to a combat fighting force,” said ACA President Keith Overland, DC.

 

Equally significant, the thrust of the language is aimed at ensuring that DCs within the military achieve “pay equality” and appropriate “job classifications” that are on par with other health care providers with similar training, education and scopes of practice. Regarding that language, Dr. Overland noted, “Our advocacy efforts have not only been aimed at getting DCs into federal health care programs such as the DoD’s, and expanding their presence there, but they also have been aimed at ensuring that DCs are provided with appropriate status, authority, salaries and other benefits equal to those enjoyed by comparable-level providers. This is a major step forward in this advocacy process. It demonstrates that Congress is not just interested in simple DC inclusion, but inclusion in the right way which fully recognizes the status, training and professional capabilities of a DC. Part of the ACA’s mission is to level the playing field down to every last detail.”

 

Inclusion of the language follows a bi-partisan letter sent last year to the Assistant Secretary of Defense for Health Affairs, signed by 15 members of the House Armed Services Committee, requesting the Department of Defense take action to correct the wage rate disparity experienced by doctors of chiropractic within the DoD. Full congressional action on the Defense Authorization bill that includes the House committee language has not yet taken place, but enactment is expected later this year, according to ACA officials, and will be a positive indicator that Congress continues to support a robust chiropractic program within the Department of Defense.

 

“The Association of Chiropractic Colleges is gratified that the extensive education and training that doctors of chiropractic receive has been recognized and that appropriate compensation is vital,” said ACC President Dr. Richard Brassard. Dr. Overland added, “I want to thank House Armed Services Committee Chairman Buck McKeon, Ranking Member Adam Smith and especially Congressmen Mike Rogers of Alabama and Dave Loebsack of Iowa for moving this issue forward.”

 

For further information on chiropractic inclusion in the military, or to learn more about ACA’s ongoing legislative efforts, go to ACA’s Advocacy webpage at www.ACAToday.org

 

From MedPage:

Your mother was right: regular bedtimes and a good night’s sleep are good for you — or at least, researchers reported, irregular bedtimes and not enough sleep are bad for you.

In a 39-day experiment with healthy volunteers, shortened sleep time and varying bedtimes — meant to mimic shift work — led to impaired glucose regulation and metabolism, according to Orfeu Buxton, PhD, of Brigham and Women’s Hospital in Boston, and colleagues.

Over time, the observed changes could increase the risk of obesity and diabetes, Buxton and colleagues reported online in Science Translational Medicine.

The findings support epidemiological studies linking disrupted sleep with an increased risk of metabolic syndrome and diabetes, the researchers noted — especially in workers on the night shift.

 

To see major medical groups such as the American Board of Internal Medicine endorse this policy is heartening. I would add that my profession, chiropractic, has made major changes along these lines within our educational institutions over the last decade. Student interns cannot routinely x-ray patients; for imaging studies to be approved, specific guidelines (such as the Canadian Cervical Spine Rule) must be followed.

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

…

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures “whose necessity … should be questioned and discussed.”

The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.

Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.

Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.

The effort represents a growing sense that there’s a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

This new research confirms what was strongly suggested by earlier studies — that bariatric surgery leads to major weight loss, and either directly or indirectly leads to major improvements in the diabetic status of these formerly obese individuals.

I’ve lectured on this topic in my clinical nutrition class and it generally stimulates fruitful class dicsussion. Essentially, we’re looking at a dangerous condition that is almost entirely preventable through diet and exercise. We then see tens of millions of people failing at prevention and then finding themselves in a terrible situation. Once they’ve reached that point, this surgery clearly leads to much improved outcomes. It’s a classic example of radical measures being offered at a late stage for something that should never have reached that point.

It concerns me that we are now seeing, for what to my knowledge is the first time, a serious suggestion that bariatric surgery be provided to diabetics who are even slightly overweight. Again, where is the prevention?

The following quotes are from the National Public Radio coverage of the story, which I’m citing because unlike the MedPage story cited above, this one mentions recommending this surgery for diabetics with a Body Mass Index as low as 26, which is just barely overweight. (Obesity starts at a BMI of 30, and morbid obesity, which is usually when bariatric surgery is provided, starts at a BMI of 40).

This research raises an important question: Should diabetics start getting this operation more often? Paul Zimmet of the International Diabetes Federation, who co-authored an editorial accompanying the studies, thinks they should.

“Diabetes coupled with obesity is probably the largest epidemic in human history. At the moment, bariatric surgery is seen as a last resort. And it should be offered earlier in management,” Zimmet said in a telephone interview.

But others aren’t so sure. The new studies followed only about 200 patients. And while the operations appear to be pretty safe, there can be complications. And the complications can be serious.

“I think we need longer-term follow-up than what was done in these studies to make sure you’re not trading one problem for another,” said Vivian Fonseca of the American Diabetes Association.

…

Researchers are now testing whether the surgery works on diabetics who aren’t even obese — people with BMIs as low as 26. And doctors and patients are waiting to see if insurance companies will pay for the operations just to treat diabetes.

Earlier this year, I attended (and spoke) at a U.S. Department of Health and Human Services listening session here in Kansas City that focused on what services should be included in an essential benefits package under health reform. For me, the most unexpected thing at the event was that of perhaps 30 presenters, four were bariatric surgeons. I was surprised, in part, because I was aware of the research supporting bariatric surgery and had assumed they were in no danger of being excluded.

Now, in light of this new research that was certainly in the pipeline at the time of the hearing, it occurs to me that their presence (which I assume will be duplicated in many other venues), may have been part of a concerted push for a major expansion of their services into the non-obese market.

Because diabetes is intimately linked to heart disease, hypertension, and obesity (as part of the Metabolic Syndrome), this is really about far more than diabetes.

Patients who ate the greatest amounts of the grain had a 27% greater risk of developing the disease than those who ate the least, and the relative risk was higher among Asian patients, Qi Sun, PhD, of Harvard, and colleagues, reported in BMJ.

“Although rice has been a staple food in Asian populations for thousands of years, this transition [to more sedentary lifestyles and greater availability of food] may render Asian populations more susceptible to the adverse effects of high intakes of white rice, as well as other sources of refined carbohydrates, such as pastries, white bread, and sugar sweetened beverages,” they wrote.

The glycemic index of white rice is higher than that of other whole grains, largely due to processing. It’s also the primary contributor to dietary glycemic load for populations that consume rice as a staple food, such as Asians.

Pink slime — that ammonia-treated meat in a bright Pepto-bismol shade — may have been rejected by fast food joints like McDonald’s, Taco Bell and Burger King, but is being brought in by the tons for the nation’s school lunch program.

The U.S. Department of Agriculture is purchasing 7 million pounds of the “slime” for school lunches, The Daily reports. Officially termed “Lean Beef Trimmings,” the product is a ground-up combination of beef scraps, cow connective tissues and other beef trimmings that are treated with ammonium hydroxide to kill pathogens like salmonella and E. coli. It’s then blended into traditional meat products like ground beef and hamburger patties.

“We originally called it soylent pink,” microbiologist Carl Custer, who worked at the Food Safety Inspection Service for 35 years, told The Daily. “We looked at the product and we objected to it because it used connective tissues instead of muscle. It was simply not nutritionally equivalent [to ground beef]. My main objection was that it was not meat.”

Custer and microbiologist Gerald Zernstein concluded in a study that the trimmings are a “high risk product,” but Zernstein tells The Daily that “scientists in D.C. were pressured to approve this stuff with minimal safety approval” under President George H.W. Bush’s administration. The USDA asserts that its ground beef purchases “meet the highest standard for food safety.”

This Men’s Health article has numerous examples, including these two:

Serving Size Rip-Off: Kellogg’s Pop-Tarts

Listed calories: 200
Servings per box: 2
Total calories: 400

What’s worse than eating 200 calories of enriched flour stuffed with sugary fruit goo? Eating twice that many calories without even realizing it. The nutritional information on a box of Pop-Tarts lists one tart as a serving, but these iconic morning pastries come wrapped in twos, forcing you to decide between eating two Pop-Tarts now or one stale Pop-Tart tomorrow. Here’s a smarter option: Drop a piece of whole-wheat bread into your toaster, and then spread it with strawberry jam and be on your way. You’ll take in fewer calories with more fiber and real fruit.

20 Habits That Make You Fat

Serving Size Rip-Off: Campbell’s Chunky Microwaveable Soup

Listed calories: 200
Servings per container: 2
Total calories: 400

 

Okay, clearly this is a single-serve cup. As if you’d ever microwave the cup, eat half, and then put the rest in the fridge to microwave another day. C’mon Campbell’s, you’re better than that.

The usual caveats apply, in that this study does not prove a cause-and-effect relationship. However, the researchers quoted in this MedPage article seem quite concerned.

The use of hypnotic sleep aids was associated with a three- to five-fold higher mortality risk compared with the risk for nonusers, even when the prescription was for a small number of pills, investigators reported.

A prescription for 0.4 to 18 doses per year was associated with a mortality hazard ratio of 3.60 compared with patients who had no prescriptions for hypnotics.

The hazard jumped to 5.32 for patients prescribed more than 132 doses a year, investigators reported online in BMJ Open.

“Rough order-of-magnitude estimates … suggest that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the U.S. alone,” Daniel F. Kripke, MD, of the Scripps Clinic in La Jolla, Calif., and co-authors wrote. “From this nonrandomized study, we cannot be certain what portion of the mortality associated with hypnotics may have been attributable to these drugs, but the consistency of our estimates across a spectrum of health and disease suggests that the mortality effect of hypnotics was substantial.”

Patients who used hypnotics most often also had an increased risk of cancer, with an overall cancer increase of 35% among those prescribed high doses.

 

See if you can read this article without spotting the not-so-hidden hand of Big Pharma lurking in the shadows. If you arrive at the end of the article without finding it, be sure to read the conflict-of-interest disclosure at the end of the piece.

Menopausal hormone therapy doesn’t have to follow “the lowest dose for the shortest time” strategy for all women anymore, the North American Menopause Society said today.

The group endorsed a flexible approach to duration that takes into account the type and timing of therapy and individual patient characteristics in a statement in its journal, Menopause.

For women in their 50s, the absolute risks are low; younger women without a history of breast cancer can use replacement hormones at least until the normal menopause age around 51, and longer if needed for symptom management, according to the guidelines.

“No ‘one size fits all’ approach is acceptable anymore,” JoAnn E. Manson, MD, DrPH, NCMP, of Harvard, and president of the society, said in answer to a query from ABC News and MedPage Today.

Manson’s position is somewhat surprising since she was a principal investigator for the Women’s Health Initiative, the landmark randomized trial that derailed the hormone therapy movement when it reported a link between Premarin (estrogen/progestin) and increased risk of breast cancer and thromboembolic conditions.

As an organization, “NAMS has close ties with industry, which provides grant support for the organization, advertises in its journal, pays annual dues, etc.,” noted Diana Zuckerman, PhD, president of the D.C.-based National Research Center for Women & Families Cancer Prevention and Treatment Fund.

The new guidelines loosen up on timing, agreed Michelle P. Warren, MD, NCMP, of Columbia Presbyterian Medical Center in New York City, who was also involved with the guidelines.

Women who need hormone therapy can use it for as long as needed, she said in an interview.

That shift should be reassuring for many women, Manson suggested.

After reading the conflict-of-interest disclosures about drug company funding, are you feeling reassured?

As the WSJ reports today, British researchers showed that by systematically collecting detailed family history from patients, they boosted the number of patients at high risk for heart disease detected by standard assessment tools from 12% to 18%. Catching more high-risk patients would mean doctors could better steer preventive care that could avert heart attacks.

“In the genomic revolution, we’ve forgotten basic family history as a tool,” says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and the president-elect of the American Heart Association. “I practice genetic epidemiology and look for genetic markers, but by far, the most important thing we can do in the prevention of heart disease is to identify family history,” says Arnett, who was not involved in the latest research.

The study, published today in the Annals of Internal Medicine, pushed patients to fill out detailed questionnaires — which asked, for instance, the age relatives suffered heart disease — and went far beyond the checked boxes most patients would recognize from doctors’ waiting-room forms.

Other research has verified that certain types of family history, such as a parent who had a heart attack before reaching age 60, increases a patient’s heart disease risk by as much as 50%. Probability remains the best tool most doctors have to work with.