March Comes in Like a Lamb!

This month I am bringing you some health care topics that will, hopefully, raise your awareness of health care options and bring a bit of sanity to marketing epidemics.  I call marketing an epidemic because that is the way trends seem to occur.  Even a bad product can run rampant if marketers can create a ‘buzz’ with the buying public.

Some of you may remember the Edible algae craze or the Body Solutions diet aid.  There is a reason that both of them are no longer on everyone's tongue.  The marketing was great, but the products were flawed (or illegally represented) and legal action was taken by individual states to protect the public.  

There are many health-related products on the market that do not do what they are touted to do, but unless the public is being ‘physically harmed’ by using the products, they are often passed over as a minimally significant infraction.  

I have discussed several of these in past Enews issues.  It may be a good idea from time to time, that you go back and review some of my past newsletters.  I think that you’ll be surprised at how relevant the information continues to be.

Have fun with this issue and don’t let the research references scare you!  I like to cite research whenever possible to support an idea or position, but I also try to break it down to the simplest explanation that I can use.

When reading newspapers and magazines, remember that "7 out of 10 dentists say..." is not real research.  Research requires planning and an in-depth review of what already exists before attempting a study.  Sometimes, reporting on clinical observations can be considered research if comparative measures are used and sampling issues are addressed.  As you read the first article of this month's ENews, I think that you will see what I mean!

I started out this issue with a serious topic, but I finished it with a wonderful insight into life.  I think that we could all benefit by paying closer attention to how we approach issues and life-goals that we have set for ourselves.

Enjoy this issue of ENews!

Dr. Frisch

Buyer Beware!

You may have noticed recently that there are many advertisements in the major newspapers and local fliers that promise an 86% success rate in treating low back pain.  There are even commercials on television that, although nicely packaged and enticing, leave the viewer with a feeling "If it sounds to good to be true, then it probably is".  The viewer would not be completely wrong in taking that objective approach.

The topic of this marketing is 'spinal decompression'.  Spinal decompression is not a new idea; in fact, spinal decompression is simply a fancy term for 'traction'.  Traction means 'to pull apart' and when addressing the spine, traction means separating the vertebra.  Pure and simple.   

Those of you who are old enough to remember, hospital traction was used heavily in the 1960's and 1970's.  The patient would enter the hospital with back pain, usually from discal trauma, and spend the next 7-10 days in a hospital bed with weights hanging off of the end of the bed to 'traction the spine' and relieve the pressure.  The idea was that traction of the spine would create a vacuum and suck the disc off of a nerve and back into position.  Unfortunately, the success rates were weak and even if the initial pain reduced, it usually returned.  An unexpected complication also resulted from being immobile for that long, the low back muscles atrophied (shrank in size) and the patient's low back condition worsened!  There were isolated studies that proclaimed magnificent results with traction, but on the whole, the results of traction were not supportive of the therapy and clinical use waned.

Fast forward to 2006.

There are several ‘decompression’ machines on the market today.  Instead of being simple weights hanging off of a bed, however, they are now computerized monsters that cost $ 80,000 and more!  The computerized treatment is supposed to be better than the ‘old-style’ traction and the success rate is touted as 86%.  There are, however, some problems with the ONE STUDY that claims an 86% success rate.

·        The study was not a randomized clinical trail, which could have easily been done with the number of subjects (500+) that were available.

·        The patients were all chosen because they suffered with discal trauma as determined by MRI.  The MRI was the defining diagnostic test used to determine a problem, but the MRI was not the defining test to used determine a successful treatment!

·        An object medical index scoring was used to determine successful treatment.  The form is called an Oswestry Questionnaire and it provides an objective ‘number score’ for a patient’s subjective complaints of pain or improvement with their pain.  The Oswestry gives a number score to daily functions like the ability to bend, lift, sit, walk, social life, travel, etc….the patient gets to determine the success.  If a patient wanted to ‘help out’ a project’s success, it would be easy to skew the data!  This was the part of the data accumulation that showed an 86% success rate in lessening low back pain, not the MRI measure initially used to determine that they qualified for treatment!  I hope that you can see where this study falls apart, but wait…there is more!

·        Each patient accepted for care received 20 sessions of decompression, was placed on restricted, light-work duty, made to use a back brace, and required to take anti-inflammatory medication twice daily for the first 2 weeks of care.  This means that there were, at least, 4 components to the treatment program, but all success was attributed to the decompression machine.  A more appropriate study would have been to take 50% of the patients and apply all of the components, while giving the other ½ everything, BUT the decompression.  That would have indicated if the decompression machine was even a factor in the reported success of treatment.  Then, a post-treatment MRI study should have been performed.  I hope that you followed me on that point.

·        Finally, the ‘advertised’ pictures showing the ‘before treatment trauma’ and ‘after treatment’ success are not the same slice through the spine.  It would be much like taking a picture of your house with the front door in the middle and then moving sideways, taking another picture with the front door out of the scene and then claiming that the front door disappeared.  A trained eye should immediately note the marketing ‘slight of hand’.

The sad thing about this type of marketing is that there may actually be some benefits to spinal decompression after trauma!  Unfortunately, the success rates aren’t accurate for what was being studied!  As presented, they merely put bells and whistles on a 1970’s model of care. 

The true function of a disc is for cushioning of the spine, and to provide neurological information to the brain about what is happening in and around the vertebra and spinal cord.  Discs are ‘weight-bearing’ structures that require constant neurological stimulation to provide proper balance to the spinal column.  When the neurological component fails, the mechanical structure falls apart.  Simply providing a vacuum distraction to a disc will not return the neurological balance to the joint, and unless neurological balance is returned, the joint will fail when placed under a load, like standing up.

“I continue to preach ‘structure and function’ in treating trauma like the discal injuries described above.  The Activator Technique and the Activator Adjusting Instrument used in my clinic have over 300 peer-review, published medical studies supporting their effectiveness!  Do not be fooled by promises of a ‘quick fix’ for low back pain.  The problem is not over until the joint is neurologically stable.

Want to Run Away From It All?       

If you said yes to this question, then you would probably be in the majority.  There are many stressors in today's society the can seem quite overwhelming.  "Can you pick up the kids?"  "Did you remember to pay the Insurance?" "Why is there so much month left after the money is gone?"

Stress, however, is more than just a feeling or situation.  Stressful situations and events do actually affect how our brains work!  A couple of recent studies attempted to track brain activity as a result of emotional stimulation.  The results were quite amazing!

The first study involved 16 people who underwent brain source imaging.¹  Previous studies were slow in comparison to the millisecond imaging that this study used.  The subjects were exposed to auditory stimulation (sounds, words, phrases, etc..) that had a subjective meaning to the individual.  This means that an emotional 'charge' existed went the person heard the stimulus.

The researchers were able to track the brain activity and surprisingly enough, the same brain regions responded in each person, even though the stimulus was different.  The importance was that if an emotional attachment existed  to a stimulus, it went to distinct brain areas for processing.  This means that emotional integration follows a distinct pattern of processing in the frontal gyri, Broca's and Wernicke's areas, the insula, and the cingulate gyri.....regardless if it is a positive or negative stimulation.  WOW!

A second study mirrored  the first and even clarified the processing further.  This study, published in the Journal of Cognitive Neuroscience (Oct 2005), reported the brain tracking of 4 epileptic patients who already had electrodes implanted in their brains to prevent seizures.²  

The individuals were subjected to complex, visual scenes that depicted neutral, pleasant or aversive material.  Recording measures were taken from 267 brain neurons in the right and left orbital cortex and the cingulate gyri.

It was found that there were significant statistical responses in 56 of the 267 neurons.  It was also determined that 16 of these neurons were specific for only one class of emotion.....aversive (negative)!  This means that although the prefrontal cortex is responsive to emotion, a negative emotion may have more dominance in behavior than a positive one.  

Maybe that is why the phrase, "Don't play with that. You'll poke your eye out." has a more lasting impression than, "Didn't we talk about not playing with that stick?"

This type of research is exciting because it really does show that we are integrated as humans. Words do have meaning and the emotions associated with situations and memories will affect our physical health.

1, Ofek, E., Pratt, H. (2005). Neurophysiological correlates of subjective significance. Clinical Neurophysiology. October; 116(10): 2354-62. 

2. Kawasaki, H., Adolphs, R., Ova, H., Kovach, C., Damasio, H., Kaufman, O., Howard, M 3rd. (2005) Analysis of single-unit responses to emotional scenes in human ventromedial prefrontal cortex. Journal of Cognitive Neuroscience. October; 17(10): 1509-18.

Wonder Why Your Doctor Doesn't Refer You For Care?

I have stated repeatedly that I believe medicine and chiropractic are symbiotic fields of health care.  Medicine is based on chemistry.  By administering drugs (chemistry) to you, your MD may alter your internal chemistry to stop an adverse reaction, like pain or infection.  A chiropractor treats your neurology by structural and functional care.  Doing so, he or she alters your pain, improves your ability to function and improves your health.  These two healing professions promote health, but their approaches to doing so are distinctly different, and in some instances, miles apart!

A recent study published in the Journal of General Internal Medicine attempted to determine if medical doctors were following proper protocol in the treatment of low back pain and sciatica.¹  The results of the study were surprising, in that the medical profession often ignores their own evidence-based guidelines when it comes to what they recommended for care!  To date, Occupational Medicine has been determined to be the most effective at achieving success for low back pain, with and without sciatica, within the medical community.

Interesting Results

Participants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties.  A questionnaire was sent to each physician asking for recommendations on 2 case scenarios, one involving low back pain without sciatica and the other demonstrating low back with sciatica.  

In the case of low back pain without sciatica, only 26.9% of physicians used the appropriate referral.  When low back pain was accompanied by sciatica, less than 5% of the physicians complied with the guidelines for appropriate care.  

I don't know if MD's have a bias against Occupational Medicine, but I am curious if something else was a determining factor for a lack of referral.  It was found that for each year that a physician was in practice, their odds of of non-compliance rose by 1.03 times when recommending treatment for low back pain.  This does seem strange in light of the dominance of literature out there for care options.  One is Chiropractic.  Chiropractic care is not only a viable option for referral, but a scientifically valid and successful method of resolving low back pain, both with and without sciatica.  

If we wonder, as a profession, why some MD's will not refer patients for chiropractic care, can you imagine what the Occupational Medicine MD's must think?

One interesting point made from this study was that MD's may overestimate the severity of low back pain with sciatica and attempt more radical treatment measures, when in actuality, they should refer for conservative care!

If there ever was a study that pointed to gross misunderstanding of treating a condition, this was probably it!  Chiropractors would be held accountable and likely crucified if they were to begin improperly treating conditions like cardiac disease.  Why is medicine not held to the same standard of accountability?

1. Webster, B., Courtney, T., Huang, Y., Matz, S., Christianni, D. (2005). Physicians' initial management  of acute low back pain versus evidence-based guidelines. Influence of Sciatica. Journal of General Internal Medicine. December; 20(12): 1132-5.

Eileen's Corner

Have a great March!

Eileen

Don't Worry, Be Happy!

Increasing amounts of legitimate research is pointing to the fact that physical health and longevity are both directly related to happiness.  We all know someone who seems to be bright and bubbly too much of the time and we want to go “Ugh… doesn’t she ever have a bad day?”  It would be smarter if we took a step back and evaluated why she and others seem to put on a smile, even when it would be easier to frown…and sometimes cry!

When we allow ourselves to experience frequent and repetitive stress our brains begin to work differently.  This phenomenon was taken for granted, but not well documented, until the invention of MRI imaging.  Under stress, the prefrontal cortex, insula and putamen experience an alteration of blood flow.(1)  A recent study revealed that a change in brain activity was directly related to the stress of performing tasks like mathematical problems and NOT related to higher-order thinking, like describing, planning or visualization.  The parts of the brain stimulated while under stress were also directly associated with negative emotions.  This means that stress may physically make us unhappy.

We can all attest to the fact that stress makes us irritable and jumpy, but what about the stress junkie?  You know the go-getter type!  He or she seems to work better under pressure and deadlines, and always seems too busy to sit and talk a while.  I was curious if their brains were affected negatively by stress and if their health would suffer as a result of their habits and behaviors.  The answer may be….YES and NO.  If the typical, Type-A, goal-oriented person actually enjoys challenges and is truly happy performing the tasks, they will likely not suffer ill effects.  If, however, they do not enjoy the challenges and are ‘working not to fail’ they may suffer a negative physical response.

A study published in November of 2005 (2) reported that there is a ‘happiness-success link’.  The link encapsulates life experiences of marriage, friendship, income, work performance, and health.  The investigators posited and then supported the theory that a happiness-success link exists not only because success makes people happy, but also because being happy engenders success.  Being happy not only leads to more success, but it also parallels and contributes to successful situations and opportunities.  Who doesn’t like being around someone who is upbeat, communicative and genuine.  Would it surprise anyone if he or she were offered an opportunity that a talented, but negative, grumpy-sort wasn’t?

It has been previously reported that workers who are happy with their jobs take less time off due to illness, perform better at work and are pleasant to other employees.  This may seem like common sense, but a three-year study published in the Journal of Neurobiological Aging gives us an added perspective of being happy during our working years.(3)  This study found that ….. greater happiness is associated with lower salivary cortisol both on working and nonworking days, reduced fibrinogen stress responses, and lower ambulatory heart rate in men. These effects are independent of age, socioeconomic status, smoking, body mass and psychological distress.

A three-year follow up reported that the physical changes resulting from being happy were long-lasting and would have a significant relevance in old age, when the typical accumulation of health-risk factors result in chronic and degenerative diseases.

If you want to be more successful, physically healthier and live a longer life there just might be an answer…BE HAPPY!

1. Wang, J., Rao, H., Wetmore, G., Furlan, P., Korczykowski, M., Dinges, D., Detre, J. (2005). Perfusion functional MRI reveals cerebral blood flow pattern under psychological stress. Proceedings of the National Academy of Sciences, USA. December 6;102 (49): 17804-9.

2. Lyubomirsky, S., King, L., Diener, E. (2005). The benefits of frequent positive affect: does happiness lead to success? Psychological Bulletin. November;131(6):803-55.

3. Steptoe, A., Wardle, J. (2005). Positive affect and biological function in everyday life. Neurobiological Aging. December; 26 Suppl 1:108-12.

Thanks For Reading!

Dr. Frisch