Sleep Better, Naturally

By James P. Meschino, DC, MS

insomnia_sheepChronic pain, which is reported to affect approximately 110 million Americans, is defined as three consecutive months of a painful condition. The most common conditions associated with chronic pain include arthritis / rheumatism; fibromyalgia; migraine headache; and low back pain.

Evidence suggests that a multidisciplinary approach yields the best results in chronic pain management, whereas the method yielding the worst results for the patient, the health care system and society entails reliance on prescription narcotic drugs.

Over the years medical doctors have prescribed and recommended many analgesic drugs such as acetaminophen, nonsteroidal anti-inflammatory dsleeping_pills_640rugs (NSAIDs), and in more severe cases, narcotic drugs, as primary and sometimes exclusive methods of treatment in the management of chronic and acute muscle, joint and arthritic conditions. In recent years, documented evidence has shown that the frequent use of these medications for pain control has led to many serious unforeseen complications.

Fortunately, in recent years, research has shown the safe, effective pain-killing effects of California poppy (Eschscholzia californica). This herb has been shown to reduce night pain and induce sleep in patients with night pain without producing euphoria, addiction potential, physical dependency or serious side effects of any kind.

Health Complications From Standard Analgesic Drugs

Frequent use of acetaminophen has been shown to be a leading cause of liver failure, and acetaminophen ingestion is the leading cause of drug-induced liver failure, accounting for 50 percent of all acute liver failure cases in the U.S., half of which are unintentional (not suicide driven). Chronic intake of the recommended dosage of acetaminophen (up to 4 grams per day, with no single dose to exceed 1 gm) is responsible for most cases of acetaminophen-induced liver failure. Chronic use of acetaminophen has also been shown to damage the kidneys.

Heavy reliance on NSAIDs for chronic pain control has also yielded devastating health consequences. Recent studies confirm that in addition to gastrointestinal erosion, ulceration and bleeding, chronic NSAID use also increases the risk of kidney damage, liver damage, congestive heart failure, high blood pressure and sudden cardiovascular death. Aspirin has long been associated with gastrointestinal damage and associated internal bleeding, but other NSAIDs are largely responsible for increased risk of cardiovascular death. This appears to be related to the promotion insomnia (1)of thrombosis, associated with many NSAIDs from ibuprofen to diclofenac (Voltaren ) to COX-2 inhibitors (e.g., Celebrex, Vioxx)

As such, doctors have been instructed not to recommend any NSAIDs, other than aspirin, for patients at high risk for heart disease. These recommendations also extend to precluding the recommendation of all NSAIDs for patients with any compromised kidney function. Low-dose aspirin, although recommended as a blood thinner for those who have suffered a previous heart attack, is no longer recommended to prevent first heart attack (primary prevention) due to the increasing reports of intestinal bleeds and bleeding into the brain, seen in patients prescribed low-dose aspirin (75-81 mg) for this purpose.

Narcotic Drugs – Rising Concerns About Addiction

Since the early 1990s governments have allowed doctors to prescribe narcotic drugs (e.g., oxycodone) for patients presenting with a wide variety of musculoskeletal pain conditions. Prior to this, narcotic drugs were only prescribed for patients with intractable pain, primarily due to terminal cancers (e.g., morphine drip). As such, physicians commonly use narcotics to reduce a patient’s post-operative pain or to reduce anxiety and induce anesthesia prior to an operation. These drugs are also commonly prescribed in an attempt to enable individuals with chronic pain to lead productive lives.

The problem is that many people who are prescribed and taking opioids for a period of time develop a physical dependence on the drug which canarticle-new_ehow_images_a00_01_jo_break-sleeping-pill-800x800 lead to abuse of the painkiller. Studies now show that 2.5 million Americans, of the 4.7 million who begin to abuse prescription drugs in any given year, use pain pills. Thus, more than 50 percent of all drug abuse cases involve analgesic drugs, and very often narcotics.

Recognizing the potential for opioid abuse, addiction, diversion and related mortality, many jurisdictions have developed guidelines or implemented programs to promote more judicious use of these drugs. Across the board, medical doctors are being instructed to cut back on their prescription writing for narcotic drugs, and systems are being put in place to track and integrate pharmacy dispensing of these drugs using electronic recording and monitoring systems.

A Safe Herbal Alternative

Recent studies have shown that the medicinal ingredients in the herb Eschscholzia californica(California poppy) block nighttime pain, allowing the patient to sleep through the night without being awakened by musculoskeletal pain. The herb also helps to induce sleep, enabling patients who are in pain to fall asleep and experience a restful sleep through the night. This, in turn, allows more rapid healing and improved response to other treatments.

Sleeping-PillsThe active ingredients in Eschscholzia californica relieve pain without producing euphoria or having addiction potential. Stimulation of opioid receptors blocks pain sensation in the brain and blocks pain conduction in the spinal cord from reaching higher brain centers. Activation of serotonin receptors is also known to block the sensation of pain and induce sleep.

Unlike narcotic drugs (e.g., Percocet, Oxydone) and benzodiazepine drugs (e.g., Valium, Ativan) often used to help patients in pain sleep through the night, supplements containing Eschscholzia californica do not cause addiction or destroy a person’s motivation to return to a productive life. The active constituents in this herb do not cause euphoria or feeling of being “stoned,” which allows individuals to function normally and better comply with treatment recommendations, including exercise.

Precautionary Notes

Patients should not take this herb if they are taking an evening or nighttime dose of a narcotic drug (e.g., Percodan, Oxycontin), anti-anxiety drug and/or a sleep-inducing drug (e.g., Valium, Sonata, Ambien). Patients taking narcotic or benzodiazepine drugs who wish to wean themselves off of these drugs by using Eschscholzia californica as a replacement for chronic pain management, must do so under the supervision and monitoring of their attending physician. Narcotic and benzodiazepine drugs are highly addictive; thus, each case requires individualized evaluation and attention. As always, talk to your doctor for more information.


James Meschino, DC, MS, practices in Toronto, Ontario, Canada and is the author of four nutrition books, including The Meschino Optimal Living Program and Break the Weight Loss Barrier.

 

Resource: To Your Health
March, 2013 (Vol. 07, Issue 03)

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Back Surgery: Too Many, Too Costly and Too Ineffective

By J.C. Smith, MA, DC

There’s an 80 percent chance you’ll suffer back pain during your lifetime, for which your medical doctor will likely recommend over-the-counter pain medication or prescription medication to relieve the pain temporarily.

Depending on your doctor’s assessment and how you respond, they may even consider you a candidate for spine surgery at some point, an increasingly likely (and dangerous) option.

Then there’s chiropractic, which research and experience show is the safest, most effective option for most cases of back pain. Unfortunately, too many people end up in a medical doctor’s office instead of a chiropractor’s office, which accounts for the rampant use of medications and surgery for back pain, particularly here in the U.S. Here’s why back surgery – and medical management of back pain in general – is too frequent, too costly and too ineffective, and why chiropractic care should be your first option when dealing with back pain.

Too Many, Too Costly

Research suggests that of the 500,000-plus disk surgeries that are performed annually (a significant increase of late), as many as 90 percent are unnecessary and ineffective. Richard Deyo, MD, a professor at Oregon Health and Science University, notes, “It seems implausible that the number of patients with the most complex spinal pathology [has] increased 15-fold in just six years” and mentions one strong motivation includes “financial incentives involving both surgeons and hospitals.”

broken backA study conducted by Deyo and Cherkin in 1994compared international rates of back surgeries and discovered that the rate of American surgery is unusually excessive and directly attributed to the supply of spine surgeons: “The rate of back surgery in the United States was at least 40 percent higher than any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per-capita supply of orthopedic and neurosurgeons.”

On the Top 10 list of diseases in America, “back pain” stands at number eight, which according to Forbes.com costs over $40 billion annually for treatment costs alone. Other estimates that include disability, work loss and total indirect costs range between $100 and $200 billion per year. Back pain sent over 3 million people to emergency rooms in 2008 at a cost of $9.5 billion, making it the ninth most expensive condition treated in U.S. hospitals.

What accounts for these staggering costs? We know one thing: Doctors and hospitals are making huge profits off the backs (no pun intended) of unsuspecting patients who are not told there may be better and cheaper ways to solve their back pain with chiropractic care or other non-invasive methods. Back surgeries are among the most expensive, and these costs do not include hospitalization, imaging, drugs or medications. Just take a look at these per-surgery costs for various types of back surgeries:

  • Anterior cervical fusion: $44,000
  • Cervical fusion: $19,850
  • Decompression surgery: $24,000
  • Lumbar laminectomy: $18,000
  • Lumbar spinal fusion: $34,500

Dr. Deyo found the mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former to $80,888 for the latter. When combined with surgical costs, medications, magnetic resonance imaging (MRI), rehabilitation and disability, the average spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion and $112,000 for a cervical fusion.

Fortune 500 companies spend over $500 million a year on avoidable back surgeries for their workers and lose as much as $1.5 billion in indirect costs associated with these procedures in the form of missed work and lost productivity, according to a two-year study by Consumer’s Medical Resource (CMR). The study, “Back Surgery: A Costly Fortune 500 Burden,” found that one out of three workers recommended for back surgery said they avoided an unnecessary procedure after being given independent, high-quality medical research on their diagnosed condition and treatment options. In addition, patients who refused surgery and opted for alternative and less invasive procedures to treat their back pain reported experiencing healthier and more personally satisfying outcomes.

Too Ineffective

Back surgery “has been accused of leaving more tragic human wreckage in its wake than any other operation in history,” according to Gordon Waddell, MD, director of an orthopedic surgical clinic for over 20 years in Glasgow, Scotland.

“Low back pain has been a 20th century health care disaster,” said Waddell. “Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem.”

 

In 2010, researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in the hopes of resolving their low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, only 26 percent of those who had surgery had returned to work, compared to 67 percent of patients who did not have surgery. Of the lumbar fusion subjects, 36 percent had complications and 27 percent required another operation. Permanent disability rates were 11 percent for patients undergoing surgery, compared to only 2 percent for patients who did not undergo surgery. In what might be the most troubling finding, researchers determined there was a 41 percent increase in the use of painkillers, with 76 percent of surgery patients continuing opioid use after surgery. Seventeen surgical patients died by the end of the study.

Surgical Hand with ScalpelThe study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs do not work, according to the study’s lead author, Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. His study concluded: “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers’ compensation setting is associated with a significant increase in disability, opiate use, prolonged work loss, and poor return-to-work status.”

Commenting on the procedure in general, Dr. Nguyen said, “The outcomes of this procedure for degenerative disc disease and disc herniation make it an unfortunate treatment choice.”

In 1994, the conducted the most thorough investigation into acute low back pain in adults and came to the following conclusion in its Patient Guide: “Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back pain problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”

In his 2009 article, “Overtreating Chronic Back Pain: Time to Back Off?” Dr. Deyo speaks of the shortcomings of medical spine treatments in the U.S.: “Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction. Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels.”

Dr. Deyo is not alone in his call for reform in spine care. The editors of The Back Letter, a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C., agreed with his frustration:

“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate … There is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedical screws to fusion cages to artificial discs – there is little evidence that patient outcomes have improved … Many would like to see an entirely new research effort in this area, to see whether degenerative disc disease and/or discogenic pain are actually diagnosable and treatable conditions.”

Chiropractic: The First Option for Back Pain

According to Pran Manga, PhD, a health economist, “There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.” He is not alone in his assessment. Numerous international and American studies have shown that for nonspecific back pain, manipulation is heads above all other treatments. In fact, Anthony Rosner, PhD, testifying before the Institute of Medicine, stated: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”

Chiropractic care not only has catapulted to the top of the list for back pain care; chiropractic patients are also extremely positive about their treatments. TRICARE, the health program for military personnel and retirees, evaluated patients’ response to chiropractic care.

The enormously high patient satisfaction rates astounded the TRICARE administrators, with scores that ranged from 94.3 percent in the Army. The Air Force tally was also high, with 12 of 19 bases scoring 100 percent; and the Navy also reported ratings in the 90 percent or higher. Even the TRICARE outpatient satisfaction surveys (TROSS) rated chiropractors at 88.54, which was 10 percent “higher than the overall satisfaction with all [health care] providers.”

T.W. Meade, MD, of the Wolfson Institute of Preventive Medicine in London, surveyed patients three years after treatment and found that “significantly more of those patients who were treated by chiropractic expressed satisfaction with their outcome at three years than those treated in hospitals – 84.7 percent vs. 65.5 percent.”

The Treatment of Choice

The truth is now emerging. There is broad agreement internationally that surgery should not generally be considered until there has been a trial of conservative nonsurgical care. Here are a few of the many examples supporting chiropractic’s use as the first-line treatment for back pain:

Dr. Manga conducted two studies in the 1990s and noted, “There should be a shift in policy now to encourage the utilization of chiropractic services for the management of low back pain, given the impressive body of evidence on the effectiveness and comparative cost-effectiveness of these services, and on the high levels of patient satisfaction.”

An editorial in the Annals of Internal Medicine published jointly by the American College of Physicians and the American Society of Internal Medicine in 1998 noted that “spinal manipulation is the treatment of choice”: “The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain … Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.”

William Lauerman, MD, chief of spine surgery and professor of orthopedic surgery at Georgetown University Hospital, stated: “I’m an orthopedic spine surgeon, so I treat all sorts of back problems, and I’m a big believer in chiropractic.”

Dr. Deyo has mentioned chiropractic as a solution: “Chiropractic is the most common choice, and evidence accumulates that spinal manipulation may indeed be an effective short-term pain remedy for patients with recent back problems.”

Dr. Waddell also suggests chiropractic care as a solution: “There is now considerable evidence that manipulation can be an effective method of providing symptomatic relief for some patients with acute low back pain.”

And Jo Jordan, PhD, has written that spinal manipulation may be the “lone ray of light” for back pain treatment.

Be Safe, Not Sorry

In 2006, doctors performed at least 60 million surgical procedures of all types; one for every five Americans. No other country does nearly as many operations. Not only are surgeries rampant, but many are being shown to be ineffective and dangerous.

According to Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, medical care is now the third-leading cause of death in the U.S., causing 225,000 preventable deaths every year as tools to make them safer go unused.

So, what’s the take-home message? Most people experience back pain, and much more often than not, it’s caused by something that doesn’t require extreme intervention, like a tumor, fracture, infection, etc. When back pain strikes, chiropractic is a great first choice, but too many people end up taking medication – or even worse, they end up in a vicious cycle of medical care that eventually can lead to the operating room – for back pain that could have been managed conservatively in the overwhelming majority of cases. That’s something to think about the next time your back hurts.

Article from: http://www.toyourhealth.com/mpacms/tyh/article.php?id=1447


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Breakthrough Treament For Carpal Tunnel Syndrome: Should You Have Surgery or Can Chiropractic Help?

hand heart

What is carpal tunnel syndrome?

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized.

Symptoms of carpal tunnel syndrome:

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the numbnessthumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

Causes of carpal tunnel syndrome

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.

There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer’s cramp – a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity – is not a symptom of carpal tunnel syndrome.

Who is at risk of developing carpal tunnel syndrome

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person’s risk of developing carpal tunnel syndrome.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

How is carpal tunnel syndrome diagnosed?

Carpel tunnelEarly diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient’s complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.

Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

Do you Really have Carpal Tunnel Syndrome or is it a neck or shoulder problem?

Your problem might be coming from you neck or shoulder because that is where the median nerve passes to get to your hand. How would you know where the problem is? You need to get a thorough exam and maybe an Xray or MRI to determine where your problem is coming from.

 

Retrieved from: http://woudsmachiropractic.wordpress.com/2012/12/11/carpal-tunnel-syndrome-should-you-have-surgery-or-can-chiropractic-help/

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The Beginnings of Back Pain

More than two thirds of us will experience significant back pain in our lifetime. It could be acute (pain experienced less than a month) from activity or injury, or it could be chronic (pain experienced more than a month) that comes from a degenerative condition. Sprains, strains, spasms, and herniated disks are some of the reasons for acute pain and . . . . READ MORE!

 

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 The Back Pain Relief Center

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A Conspiracy to Get Us to Take More Prescription Drugs?

prescription-drugsReady for your wake-up call to why prescription medications – and their accompanying health dangers – are an increasing part of your daily life? From the Annals of Family Medicine comes one of the most important studies to date in the effort to define and understand how drug companies are influencing both the practice of medicine and the health of patients who seek care from medical providers.

Conducted by a pair of anthropologists from Michigan State University, the study examines the impact of lower diagnostic thresholds, clinician rewards systems and the prescribing cascade on the health of patients diagnosed with diabetes and hypertension.

The authors lay the foundation for their study by noting, “Spending on prescription drugs in the Unites States has risen nearly 6-fold since 1990, reflecting substantial increases in treatment of chronic conditions and subsequent polypharmacy. As many as 45% of Americans have at least 1 diagnosed chronic condition, and 60% of the most prescribed medications were for hypertension, high cholesterol levels and diabetes. The Centers for Disease Control and Prevention estimates that 11% of the US population and 40% of people older than age 60 take 5 medications or more.”

In conducting the study, the authors studied primary care clinicians and their patients over a two-year period (2009-2010), with specific emphasis on management of type 2 diabetes and hypertension, two of the most common chronic health conditions. As the study progressed, the authors realized the overwhelming prevalence of prescription drug use in managing these two conditions and thus focused on their influence more closely.

Lower Diagnostic Thresholds

Simply put, lower diagnostic thresholds mean that more people are diagnosed with a disease they didn’t previously have. The authors point to changes in the diagnosis of diabetes, hypertension and their “pre-” conditions as increasing the number of people subjected to intense prescription management, suggesting that an estimated 10 million additional people are being treated for diabetes, and an additional 22 million for hypertension, due to these lower thresholds.

In 1998, the fasting plasma glucose level that defined a person as diabetic was lowered from 140 to 126. This resulted in an additional 10.3 million people being medically defined as diabetics. The prediabetes fasting glucose level was established at 110 in 1998 and changed to 100 in 2003, resulting in many more pre-diabetics.

In 1993, the blood pressure definition for hypertension was lowered from 160/95 to 140/90 in non-diabetic patients. In 1998, the hypertension blood pressure definition for diabetics was established at 130/80, lower than that of non-diabetics. These changes resulted in an estimated 22 million additional hypertension diagnoses. The prehypertension definition was also established in 1998 at 120/80.

Rewarded to Prescribe?

Medical doctors are monitored and rewarded for keeping their patients below certain standards that stem from established guidelines. But “the committees and organizations setting the standards often have substantial pharmaceutical industry support and include many individuals with industry ties.” According to the authors, “many insurance companies assess individual clinicians on the basis of whether their patients meet these standards, often paying substantial bonuses that encourage clinicians to respond to marginal test results with aggressive use of pharmaceuticals.”

The Prescribing Cascade

Prescription drugs can have adverse health impacts on patients, producing symptoms that prompt the prescribing of additional drugs. This is particularly true for patients of clinicians who fail to recognize these adverse reactions. Two-thirds of patients “reported experiencing symptoms they attributed to their diabetes medications, hypertension medications, or both,” with several patients hospitalized because of symptoms, prompting a medication change.

In this study, 89% of the patients “reported taking multiple medications, averaging 4.8 prescriptions with more than half (51%) taking 5 or more.” In many cases, the patients were expected to continue taking these medications “permanently.”

Real People, Real Problems

One of the things that makes this paper so interesting is the approach taken by the authors. They interviewed 58 clinicians and 74 patients for about an hour each, providing insightful clinician comments and patient vignettes that are included in the study:

A 61-year-old man is taking “3 medications for hypertension, 2 for diabetes, 2 for high cholesterol levels, 1 for acid reflux, and daily doses of aspirin and ibuprofen, and uses an inhaler for chronic bronchitis, for a grand total of 11 medications. … Since starting the hypertension and diabetes medications, he has developed severe indigestion and breathing problems.”

A family practice physician stated, “I tell most new diabetics the sad news is that they’re going to be on 5 meds.”

A 54-year-old woman is “currently taking 8 prescription medications: 3 for hypertension, 2 for diabetes, 1 for high cholesterol levels, and 2 for depression. She also had 5 visits to the emergency department in 1 month for excruciating headaches before they were determined to be an adverse effect of the additional hypertension medication she had been prescribed.”

Another clinician noted, “I’ve got patients on 4 different medications and their blood pressure is still uncontrolled. We try sending them to the cardiologists, and they say, ‘Just keep adding stuff because there’s really nothing we can do about this.’ Some people whose blood pressure that we get normal again, they don’t function very well at all. I’m not sure why.”

A Chance to Change

In their concluding remarks, the authors call for a reform on how much influence thepharmaceutical industry has on the practice of medicine: “At a minimum, we urge policies excluding individuals or organizations with financial conflicts of interest from involvement with guideline-writing panels. The presumption that mere disclosure resolves such conflicts must be rejected.” They also suggest that physicians “be discouraged from seeing drug representatives.”

So, armed with this information, what’s your next step? The next time you see a drug ad on TV, think about this study. The next time your medical doctor recommends a prescription drug for your health problem, think about this study and ask if there’s a better, safer, natural way that doesn’t require medication.

 

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