Here is another article to read when considering the current health care debate:

Health, life insurers hold $1.88 billion in fast-food stocks: AJPH article

Harvard researchers say insurers put profits over health

EMBARGOED until:
April 15, 2010, 5 p.m. Eastern time

Contact:
Arun Mohan, M.D., M.B.A.
J. Wesley Boyd, M.D., Ph.D.
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Just weeks after the passage of a health bill that will dramatically increase the number of Americans covered by private health insurers, Harvard researchers have detailed the extent to which life and health insurance companies are major investors in the fast-food industry.

Although fast food can be consumed responsibly, research has shown that fast-food consumption is linked to obesity and cardiovascular disease, two leading causes of death, and contributes to the poor health of children. The evidence is so compelling that as part of the new law more than 200,000 fast-food and other chain restaurants will be required to include calorie counts on their menus, including their drive-through menus.

A new article on insurance company holdings, published online in today's [Thursday, April 15] American Journal of Public Health, shows that U.S., Canadian and European-based insurance firms hold at least $1.88 billion of investments in fast-food companies.

"These data raise questions about the opening of vast new markets for private insurers at public expense, as is poised to happen throughout the United States as a result of the recent health care overhaul," says lead author Dr. Arun Mohan.

Among the largest owners of fast-food stock are U.S.-based Prudential Financial, Northwestern Mutual and Massachusetts Mutual Life Insurance Company, and European-based ING.

U.S.-based Northwestern Mutual and Massachusetts Mutual Life Insurance Company both offer life insurance as well as disability and long-term care insurance. Northwestern Mutual owns $422.2 million of fast-food stock, with $318.1 million of McDonald's. Mass Mutual owns $366.5 million of fast-food stock, including $267.2 in McDonald's.

Holland-based ING, an investment firm that also offers life and disability insurance, has total fast-food holdings of $406.1 million, including $12.3 million in Jack in the Box, $311 million in McDonald's, and $82.1 million in Yum! Brands (owner of Pizza Hut, KFC and Taco Bell) stock.

New Jersey-based Prudential Financial Inc. sells life insurance and long-term disability coverage. With total fast-food holdings of $355.5 million, Prudential Financial owns $197.2 of stock in McDonald's and also has significant stakes in Burger King, Jack-in-the-Box, and Yum! Brands.

The researchers also itemize the fast-food holdings of London-based Prudential Plc, U.K.-based Standard Life, U.S.-based New York Life, Scotland-based Guardian Life, Canada-based Manulife and Canada-based Sun Life. (See table; all data current as of June 11, 2009.)

"Our data illustrate the extent to which the insurance industry seeks to turn a profit above all else," says Dr. Wesley Boyd, senior author of the study. "Safeguarding people's health and well-being take a back seat to making money."

Mohan, Boyd and their co-authors, Drs. Danny McCormick, Steffie Woolhandler and David Himmelstein, all at the Cambridge Health Alliance and Harvard Medical School, culled their data from Icarus, a proprietary database of industrial, banking and insurance companies. Icarus draws upon Securities and Exchange Commission filings and news reports from providers like Dow Jones and Reuters. In addition, the authors obtained market capitalization data from Yahoo! Finance.

The authors write, "The health bill just enacted in the Washington will likely expand the reach of the insurance industry. Canada and Britain are also considering further privatization of health insurance. Our article highlights the tension between profit maximization and the public good these countries face in expanding the role of private health insurers. If insurers are to play a greater part in the health care delivery system they ought to be held to a higher standard of corporate responsibility."

Several of these same researchers, all of whom are affiliated with Physicians for a National Health Program, have previously published data about the extent to which the insurance industry is invested in tobacco. They say that because private, for-profit insurers have repeatedly put their own financial gain over the public's health, readers in the United States, Canada and Europe should be wary about insurance firms' participation in care.

Insurance industry holdings in fast-food companies (in millions of U.S. dollars) as of June 11, 2009.

Insurance Company	Jack in the Box	McDonald's	Burger King	Yum! Brands	Wendy's/ Arby's Group	Total
Prudential plc				80.5		80.5
Prudential Financial	34.1	197.2	43.7	80.5		355.5
Mass Mutual	23.1	267.2	58.8	17.4		366.5
New York Life	2.4					2.4
Northwestern Mutual	40.9	318.1		63.2		422.2
Sun Life				26.8		26.8
Standard Life		63.0				63.0
ING	12.3	311.7		82.1		406.1
Manulife		89.1		53.7	3.3	146.1
Guardian Life	7.2				9.5	16.7
MetLife					2.2	2.2
Total	120.0	1,183.3	165.5	404.2	15.0	1,888.0

"Life and Health Insurance Industry Investments in Fast Food," Arun V. Mohan, M.D., M.B.A.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; and J. Wesley Boyd, M.D., Ph.D. American Journal of Public Health, April 15, 2010.

Dr Brian Lancaster

Valley Chiropractic in Frederick, MD

Rehab Study for Low Back Pain

Rehabilitation of a Patient with Functional Instability Associated with Failed Back Surgery,
The Journal of the American Chiropractic Association, Dec 2004 by Adams, Vincent
123456Next ..Abstract

Objective: A report of a case of a low-tech non-dynamometric functional exercise program in the rehabilitation of a functionally unstable lower back, associated with failed back surgery.

Clinical Features: A 41-year-old female presented to a chiropractic office with severe lower-back pain, with radiation down the left leg to the calf. Seven months prior, she had an L5-S1 discectomy. Two months after the surgery, her pain in the lower back and leg returned. An MRI 6 months after the surgery showed no evidence of a recurrent disc herniation, but revealed a small image enhancement along the, posterior annulus adjacent to the right S1 nerve root, consistent with post-operative change. Plain film radiography was unremarkable.
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Intervention and Outcome: The home-based therapeutic techniques used in this case were based on the patient's weaknesses demonstrated on a functional evaluation. This evaluation consisted of 4 functional tests, including the repetitive squat, Sorenson static back endurance, repetitive sit-up, and the repetitive arch-up tests. The exercises were performed over a 6-week period, and resulted in a decrease in both pain and functional disability based on visual analog scale, pain diagrams, and the Oswestry low-back pain questionnaire.

Conclusion: A home-based exercise program proved very effective in decreasing this patient's functional disability level, but was ineffective in reducing pain levels. Further investigation of chiropractic management of such cases is warranted.

Key Words or Phrases: functional instability, rehabilitation, failed back surgery

Dr. Joshua Brooks
Chiropractor Fairfax, VA

Chiropractic management of fibromyalgia syndrome: a systematic review of the literature.

This study concludes that chiropractic can be an effective treatment for fibromyalgia. In my chiropractic office in Takoma Park/Silver Spring, MD I see a fair amount of patients with fibromyalgia developing as the result of whiplash associated disorders.
-Dr. Tetro


Schneider M, Vernon H, Ko G, Lawson G, Perera J.

OBJECTIVE: Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine, including chiropractic. The purpose of this study was to perform a comprehensive review of the literature for the most commonly used treatment procedures in chiropractic for FMS and to provide evidence ratings for these procedures. The emphasis of this literature review was on conservative and nonpharmaceutical therapies.
METHODS: The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. Online comprehensive literature searches were performed of the following databases: Cochrane Database of Systematic Reviews; National Guidelines Clearinghouse; Cochrane Central Register of Controlled Trials; Manual, Alternative, and Natural Therapy Index System; Index to Chiropractic Literature, Cumulative Index to Nursing and Allied Health Literature; Allied and Complementary Medicine; and PubMed up to June 2006.
RESULTS: Our search yielded the following results: 8 systematic reviews, 3 meta-analyses, 5 published guidelines, and 1 consensus document. Our direct search of the databases for additional randomized trials did not find any chiropractic randomized clinical trials that were not already included in one or more of the systematic reviews/guidelines. The review of the Manual, Alternative, and Natural Therapy Index System and Index to Chiropractic Literature databases yielded an additional 38 articles regarding various nonpharmacologic therapies such as chiropractic, acupuncture, nutritional/herbal supplements, massage, etc. Review of these articles resulted in the following recommendations regarding nonpharmaceutical treatments of FMS. Strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification.
CONCLUSIONS: Several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS.

Dr. Paul S. Tetro
Chiropractor
Takoma Park/Silver Spring, MD

Study recommends conservative management of lumbar disc herniation before surgical discectomy

A recent article appeared in the Spine Journal examines the cost of previous conservative care for patients that ultimately elect to have spinal surgery. The study consisted of 30,709 patients. The average cost of conservative care in the 90 days period before surgery was $3,445 each. Magnetic resonance imaging and other diagnostic procedures represented a little over half of the total pre-surgery costs. Of the treatment costs, 16% were for injections, 5.7% physical therapy, and 1.2% chiropractic care. Despite the fact that these expenses were for failed back conservative care, the authors recognize the overall benefits of conservative care and recognize that many patients are able to avoid surgery. They conclude that “Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate”.

Previous studies have examined conservative versus surgical treatment related to several common causes of low back pain. For spinal stenosis, “Among patients with lumbar spinal stenosis completing 8- to 10-year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.” Another study of patients with disc herniation reported, “…with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.”

Sources:
Daffner SD, Hymanson HJ, Wang JC. Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine J. 2010 Mar 31.

http://www.chiroaccess.com/Articles/Studies-Recommend-Conservative-Care-for-Low-Back-Pain-before-Surgery.aspx?id=0000148

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

-This very interesting Sweedish study illustrates that the effects of whiplash can sometimes occur in body areas or systems that seem uncommon to most patients. In my chiropractic clinic in Greenbelt, MD, we focus on the body as a whole, not just the symptoms. As a specialist in whiplash related disorders, I strive to help patients overcome all aspects of this growing epidemic.
-Dr. C

Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD).

Kalezic N, Noborisaka Y, Nakata M, Crenshaw AG, Karlsson S, Lyskov E, Eriksson PO.

Centre for Musculoskeletal Research, University of Gavle, Sweden; Sports Medicine Unit, Umea University, Sweden.


OBJECTIVE: The present study aimed to elucidate possible physiological mechanisms behind impaired endurance during chewing as previously reported in WAD. We tested the hypothesis of a stronger autonomic reaction in WAD than in healthy subjects in response to dynamic loading of the jaw-neck motor system.

DESIGN: Cardiovascular reactivity, muscle fatigue indicies of EMG, and perceptions of fatigue, exhaustion and pain were assessed during standardised chewing. Twenty-one WAD subjects and a gender/age matched control group participated. Baseline recordings were followed by two sessions of alternating unilateral chewing of a bolus of gum with each session followed by a rest period.

RESULTS: More than half of the WAD subjects terminated the test prematurely due to exhaustion and pain. In line with our hypothesis the chewing evoked an increased autonomic response in WAD exhibited as a higher increase in heart rate as compared to controls. Furthermore, we saw consistently higher values of arterial blood pressure for WAD than for controls across all stages of the experiment. Masseter EMG did not indicate muscle fatigue nor were there group differences in amplitude and mean power frequency. Pain in the WAD group increased during the first session and remained increased, whereas no pain was reported for the controls.

CONCLUSION: More intense response to chewing in WAD might indicate pronounced vulnerability to dynamic loading of the jaw-neck motor system with increased autonomic reactivity to the test. Premature termination and autonomic involvement without EMG signs of muscle fatigue may indicate central mechanisms behind insufficient endurance during chewing.


Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Foot Orthotics and Chiropractic care in Temple Hills, MD

For decades, Foot Levelers has enthusiastically

supported and promoted chiropractic research.

Twenty-two years ago in our Success Express

magazine, we announced the commitment of a

quarter of a million dollars to fund the Greenawalt

Chair for Research at Northwestern College of

Chiropractic (now Northwestern Health Sciences

University).1 By that time Foot Levelers was

already an established financial backer of the

Foundation for Chiropractic Education and

Research (FCER), and we encouraged the readers

of our magazine—as well as other chiropractic

suppliers—to join us in giving to the profession’s

“primary source of financial support for chiropractic

research and postdoctoral research training of

doctors of chiropractic.”2-4

In the late 1990s, Foot Levelers teamed up with

New York Chiropractic College to establish “the

nation’s first gait research center in a chiropractic

setting” at NYCC’s Seneca Falls campus.5

Heeding Dr. Reed Phillips’ call to “be supportive

of chiropractic research in any way possible,”6

the partnership between Foot Levelers and NYCC

“sparked research that may reveal how the body’s

gait can disrupt chiropractic adjustments, which

could lead to the identification of ways an

adjustment can best be preserved, such as

through the use of orthotics.”7

This research booklet

is proof that “Foot Levelers’ products are a

beneficial adjunct to chiropractic care.”8 Here is

peer-reviewed research by some of the finest

academicians in the chiropractic profession,

including work done at NYCC’s Biomechanics/

Gait Research Laboratory in Seneca Falls.

The future of chiropractic research is limited only

by the support it receives from those who form

the chiropractic community of professionals,

staff, and suppliers. Foot Levelers pledges to

continue sponsoring and promoting chiropractic

research, and to share the benefits of that

research with our Partners In Progress.

References

1. [No author]. Chair for research announced. Success Express 1985; 9(2):59.

2. Rossman E. FCER’s role in chiropractic research. Success Express 1985;

9(3):57-61.

3. [No author]. Are your suppliers supporting chiropractic research? Success

Express 1985; 9(4):55-59.

4. [No author]. Chiropractic research…key to the future. Success Express

1988;12(1):45-47.

5. [No author]. NYCC and Foot Levelers team up to establish gait research

program. Success Express 1998; 18(3):28.

6. Phillips RB. A lesson in history: the need for research. Success Express

1988; 12(1):25-29.

7. [No author]. Foot Levelers gait research program is helping advance field

of chiropractic. Success Express 2000; 20(2):11.

8. [No author]. ACC conference highlights orthotics research. Success

Express 2004; 24(3):5.

Aekta Erry, D.C.

Chiroprator, Temple Hills, MD

Background: When conservative therapies for low back pain (LBP) are not effective, elective surgery may be proposed to these patients. Over the last 20 years, a new technology, disc replacement, has become increasingly popular because it is believed to maintain or restore the integrity of spinal movement and minimize the side-effects compared to fusion. Although disc replacement may relieve a patient from pain and related disability, soreness and stiffness of the lumbopelvic region seem to be common aftermaths of the surgery. This prospective case series was undertaken to identify and describe potential adverse events of lumbar spinal manipulation, a common therapy for low back pain, in a group of patients with symptoms after disc prostheses.Cases presentationEight patients who underwent lumbar spine total disc replacement were referred by an orthopaedic surgeon for chiropractic treatments.

These patients had 1 or 2 total lumbar disc replacements and were considered stable according to the surgical protocol but presented persistent, post-surgical, non-specific LBP or pelvic pain. They were treated with lumbar spine side posture manipulations only and received 8 to 10 chiropractic treatments based on the clinical evolution and the chiropractor's judgment. Outcome measures included benign, self-limiting, and serious adverse events after low back spinal manipulative therapy. The Oswestry Disability Index, a pain scale and the fear avoidance belief questionnaire were administered to respectively assess disability, pain and fear avoidance belief about work and physical activity. This prospective case series comprised 8 patients who all had at least 1 total disc replacement at the L4/L5 or L5/S1 level and described persistent post-surgical LBP interfering with their daily activities. Commonly-reported side-effects of a benign nature included increased pain and/or stiffness of short duration in nearly half of the chiropractic treatment period. No major or irreversible complication was noted. Conclusions: During the short treatment period, no major complication was encountered by the patients. Moreover, the benign side-effects reported after lumbar spine manipulation were similar in nature and duration to those frequently experienced by the general population.

Chiropractic management of patients post-disc arthroplasty: eight case reports

Julie O'Shaughnessy¹ , Marc Drolet² , Jean-François Roy³ and Martin Descarreaux¹

¹ Département de chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada

² Private practice, Québec City, Canada

³ Centre Hospitalier Universitaire de Québec, Hôpital St-François d'Assise, Québec, Québec, Canada

Rosa Rehab

4269 Branch ave

Temple Hills Maryland