Drug research, even from clinical trials sponsored by the federal government, routinely is suppressed, harming patients and increasing health care costs, according to new data highlighting an ethical controversy that continues to plague the field of medicine.

“The current situation is a disservice to research participants, patients, health systems and the whole endeavor of clinical medicine,” according to an editorial accompanying the papers published in the British Medical Journal.

Turning up the heat, the journal, in an editorial, posed a remedy that is likely to get the attention of doctors who take part in clinical trial research.

“Concealment of data should be regarded as the serious ethical breach that it is, and clinical researchers who fail to disclose data should be subject to disciplinary action by professional organizations,” wrote Richard Lehman of the University of Oxford, and Elizabeth Loder, a BMJ editor.

The BMJ papers are the latest thunderbolts in a gathering storm that has swirled around medicine in recent years. The revelations add to the calls for reform in the field.

“It is grossly unethical and an insult to the integrity of medicine when this is allowed to occur and go unpunished,” said orthopedic surgeon Chuck Rosen, president of the Association for Medical Ethics.

It’s easy enough to round up the usual suspects, which is what a story in the Daily Livestock Report did last month. It blames the decline on growing exports, which make less meat available for Americans to buy. It blames it on ethanol, which has caused feed costs to rise, production to drop and prices to go up so producers can cover their increasing costs. It blames drought. It doesn’t blame recession, which is surprising, because that’s a factor also.

All of which makes some sense. The report then goes on to blame the federal government for “wag[ing] war on meat protein consumption” over the last 30-40 years.

Is this like the war on drugs? The war in Afghanistan? The war against cancer? Because what I see here is:

• a history of subsidies for the corn and soy that’s fed to livestock
• a nearly free pass on environmental degradation and animal abuse
• an unwillingness to meaningfully limit the use of antibioticsin animal feed
• a failure to curb the stifling power that corporate meatpackerswield over smaller ranchers
• and what amounts to a refusal — despite the advice of real, disinterested experts, true scientists in fact —  to unequivocally tell American consumers that they should be eating less meat

Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.

The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.

But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.

“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”

An intervention aimed at helping patients accept the pain and disability associated with rheumatoid arthritis, while at the same time blocking negative thoughts and anxiety about their condition, reduced patients’ depression and improved coping skills, researchers in Norway reported.

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The researchers noted that the increase in emotional processing, by which they meant recognition and understanding of one’s own emotions, was of particular note because patient avoidance of disease-related emotions has increasingly been linked with negative outcomes in chronic disease.

They also pointed out that emotional expression improved in the control group at 12 months.

Although the control patients did not attend sessions, they received telephone calls from the researchers 12 times during the year’s follow-up, in which they were invited to discuss any emotional concerns. This may have increased their psychological awareness, according to Zangi and colleagues.

Many other psychological interventions for patients with chronic disease such as arthritis have found only short-term benefits, but in this study the benefits persisted for a year after the program.

“These lasting improvements indicate that the participants may have incorporated some mindfulness strategies into their daily lives and that these strategies have strengthened their ability to respond to their stressful experiences in a more flexible way,” the researchers observed.

A week of wound debridement using maggots cleared necrotic tissue more effectively than conventional debridement in patients with chronic venous ulcers, a randomized French study showed.

At day eight of treatment, the percentage of the wound area covered by slough was 54.5% in patients given maggot therapy compared with 66.5% (P=0.04) of the wound area in a control group, according to Anne Dompmartin, MD, PhD, of Centre Hospitalier Universitaire de Caen, and colleagues.

However, there was no difference between the groups in percentage of the necrotic tissue on the wound at day 15 (55.4% versus 53.8%, P=0.78), which was the study’s primary endpoint.

Bottom line: your wound can heal with either type of therapy, but it should heal somewhat more quickly with the maggots. This would seem to be a good example of the need to consider patient preference in the decision on therapeutic strategy.

How can this be? The idea that prevention saves money feels intuitive. “When we think of prevention, we tend to think of the individual who benefited,” Russell writes. We conjure up an image of the woman who caught breast cancer early, averting expensive treatments, or the man who brought his weight down and lived a long, healthy life. That, however, discounts all the mammograms that didn’t detect cancer and didn’t prevent anything and all the individuals for whom weight management programs didn’t work. All those costs add up to the point that most preventive interventions cost more than they save.

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In her chapter, Russell also runs through what $1 million invested in a given treatment buys us in Quality Life Years. Investing $1 million in screening men over 55 for colon cancer would, according to the research, translate into a gain of 577 quality life years. Investing the same amount in cholesterol-lowering medications for high-risk, middle aged men would only translate into 12 additional quality life years. Not all preventive interventions, it turns out, are created equal.

A study this month in the journal Academic Pediatrics provides a pithy example of a persistent disconnect for the wellness movement in the healthcare workplace.

The study by researchers at the UCLA School of Medicine and the RAND Corp. examined the menus at 14 children’s hospitals in California and found that only 7% of the nearly 400 entrees were considered healthy.

“As health professionals, we understand the connection between healthy eating and good health, and our hospitals should be role models in this regard,” Lenard Lesser, MD, the primary investigator on the study, said in a media release.  ”Unfortunately, the food in many hospitals is no better—and in some cases worse—than what you would find in a fast food restaurant.”

A Denver, Co., public school has set the bar high for reconnecting the next generation of children with the food they eat. ABC 7 News in Denver reports that Denver Green School (DGS), an urban “innovation” school, has brought new life to an unused, one-acre athletic field by turning it into an organic garden — and the garden has been such a success in just eight months that the school is able to serve fresh produce from it to students in the cafeteria.”We have harvested over 3,000 pounds of produce from this ground,” said Megan Caley, the programs and outreach coordinator for Sprout City Farms (SCF), which partnered with DGS to create the garden. “Lots of salad greens and root vegetables, tomatoes, eggplant, peppers.”

The goal of SCF is to transform unused or underused urban land into thriving agricultural space, which can then be used to grow food for local residents. And the group’s partnership with DGS has been landmark in that it not only produces a plethora of fruits and vegetables, but it has also sparked a renewed interest among children in growing and eating them.

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“It’s been extremely gratifying to see the kids out here,” said Chad Hagedorn, farm manager for SCF. “They are in constant awe and amazement of how food grows, and when they get to touch and really see how it happens, it’s a huge experience for them both educationally and emotionally.”

Besides inspiring children to eat the fruits and vegetables — and actually enjoy eating it — the DGS garden is also saving the school money by providing a continuous supply of healthy, organic produce at minimal cost. And because it is partially funded through a community supported agriculture (CSA) program where local residents can purchase weekly boxes of fresh produce, the program is financially viable in the long term.

“She couldn’t remember names, where she’d been or what she’d done that day,” Ms. Atkins recalled in an interview. “Initially, I was not too worried. I thought it was part of normal aging. But over time, the confusion and memory problems became more severe and more frequent.”

Her mother couldn’t remember the names of close relatives or what day it was. She thought she was going to work or needed to go downtown, which she never did. And she was often agitated.

A workup at a memory clinic resulted in a diagnosis of early Alzheimer’s disease, and Ms. Katz was prescribed Aricept, which Ms. Atkins said seemed to make matters worse. But the clinic also tested Ms. Katz’s blood level of vitamin B12. It was well below normal, and her doctor thought that could be contributing to her symptoms.

Weekly B12 injections were begun. “Soon afterward, she became less agitated, less confused and her memory was much better,” said Ms. Atkins. “I felt I had my mother back, and she feels a lot better, too.”

 

The more antioxidants in a woman’s diet the less chance there is she’ll have a stroke, possibly due to the reduced oxidative stress and inflammation, according to the results of a long-term study in Sweden.

Among women with no history of cardiovascular disease at baseline, age-adjusted analysis showed that those with the highest intake of antioxidant-rich food had a 17% lower risk of total stroke when compared with those with the lowest antioxidant intake after an average 11-year follow-up, Alicja Wolk, DrMedSci, from the Karolinska Institute in Stockholm, and colleagues found.

In the cohort of women with cardiovascular disease upon entry, the age-adjusted model showed no significant relationship, but the fully adjusted model showed a significant 46% to 57% reduction in stroke risk among those in the quartiles with highest consumption of antioxidant foods compared with those with the lowest intake, according to the study published online in Stroke: Journal of the American Heart Association.

The multivariable adjustment included age, education, smoking, body mass index, physical activity, stroke, myocardial infarction, angina pectoris, atrial fibrillation, hypertension, hypercholesterolemia, diabetes, family history of myocardial infarction, aspirin use, dietary supplement use, and intakes of total energy, alcohol, and coffee.