Terry A. Rondberg, DC | Wellness for Mind and Body

A recent report published in the Journal of the American Medical Association (JAMA) revealed that many medical doctors have direct, personal knowledge of an impaired or incompetent physician in their workplaces but won’t report them.

The researchers, led by Catherine DesRoches of Harvard Medical School, surveyed 1,891 practicing US doctors in order to “understand physicians’ beliefs, preparedness, and actual experiences related to colleagues who are impaired or incompetent to practice medicine.”

A majority of the doctors surveyed (64%) said they agreed that it was important to report other MDs who were “significantly impaired or otherwise incompetent to practice.” But just 69% said they were prepared to really do anything about the situation if it came up in their practice.

More shocking was the revelation that 17% of the doctors had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice. But of those, a full one third (33%) had not reported the colleague to the relevant authority.

The reasons they gave for their silence were the belief that someone else would take care of the problem (19%), the belief that nothing would happen as a result of the report (15%) and fear of retribution (12%).

The actual numbers might be even higher since, of the 2,938 physicians contacted, only 1,891 agreed to take the survey — the other 36% might have decided the questions were a bit too delicate to answer.

As bad as this sounds, I wonder how it differs from the chiropractic profession (or any health care profession). Granted, an incompetent chiropractor is far less of a threat to a patient’s well being than an incompetent MD, but what do we do when we realize a fellow DC is significantly impaired? If we know a colleague is drinking or using drugs during work, or is otherwise unfit to care for patients, do we report him or her to the board?

I realize that there have been many (far too many) cases where chiropractors have “tattled” on their competition for the most trivial infractions of the rules, but that’s a far cry from accusing another practitioner of being incompetent.

This is one of those grey areas that require soul searching and total honesty. If we truly believe that a colleague might do any harm to patients or to the profession as a whole, we owe it to those patients and chiropractic to take a courageous stand. We might try approaching the doctor and discussing the situation with him or her, offering to assist in getting the person proper help overcoming the problem. If that doesn’t work, we may have no choice but to file a complaint with the state board.

SOURCE: “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues,” JAMA. 2010;304(2):187-193. doi:10.1001/jama.2010.921

By Terry A. Rondberg, DC

A commentary published in the July 28 issue of the Journal of the American Medical Association (JAMA) revealed that diagnostic errors are the single largest contributor to medical malpractice claims, accounting for about about 40% of all claims and costing approximately $300,000 per claim.

The authors — Mark Graber, MD, of Stony Brook University Medical Center; and Hardeep Singh, MD, MPH, of Baylor College of Medicine — pointed their fingers at everything BUT the practitioners themselves.

“The great majority of diagnostic errors have root causes that derive from the properties of the healthcare setting, organization and practice,” Dr. Graber said. “By working together, cognitive scientists, informaticians, clinicians, and human factors engineers have a unique opportunity to decrease the likelihood of diagnostic error to the extent that the five principles we outline in JAMA can be incorporated into every new medical home.”

The authors discussed a new model of primary care, called the patient-centered medical home, developed and endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association.

The model facilitates partnerships between individual patients, their personal physician, and, when appropriate, the patient’s family. Care is assisted by physician “extenders,” nurse empowerment, information technology, and other means to assure that patients get care when and where they need and want it in a culturally and linguistically appropriate manner.

The medical home model places emphasis on team-based care, and primary care teams could include not only physicians but also nurses, allied health professionals and personnel, the authors explained.

In this model, the medical doctor would be the gatekeeper and decide what role the “allied” health professions would have. “The physician could take a leadership role, while the entire group collectively takes care of the patient,” explained Dr. Singh.

It’s always heartening to see the medical profession recognize and admit the problems inherent in the current disease-oriented system, such as misdiagnoses, prescription errors, unnecessary surgeries, etc.

Still, I’ll continue to work toward the time when we supplant the old paradigm of labeling and treating conditions and symptoms with the new holistic view of the human body as a complex system of energy patterns that responds to non-invasive care such as chiropractic and other “energy medicine” approaches. And I especially look forward to the time when we don’t label all wellness and healing modalities as “medicine!”

By Terry A. Rondberg

In recent years, researchers have piled up the proof that many of the prescription and OTC pills sold to “treat” colds and flu in kids are ineffective. Even worse, they all have potentially negative side effects. One study, conducted by researchers at Penn State, found that placebos were just as effective as OTC drugs in suppressing coughs due to colds.

“Consumers spend billions of dollars each year on over-the-counter medications for cough,” said Ian Paul, assistant professor of pediatrics, Penn State Children’s Hospital, Penn State Milton S. Hershey Medical Center. “Our study showed that the two ingredients used in most over-the-counter medications were no better than a placebo, non-medicated syrup, in providing nighttime relief for children with cough and sleep difficulty as a result of upper respiratory infection… The desire to ease symptoms is strong for both parents and clinicians. This study, however, questions whether over-the-counter medications have a place in the treatment of these illnesses for children.” (“Effect of Dextromethorphan, Diphenhydramine and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents,” July 2004 issue of Pediatrics.

Another study showed a significant percentage of children with attention-deficit-hyperactivity disorder improved when placebos replaced some of their daily meds.

“In ADHD, you can reduce the dose of the real medicine, substitute placebo pills and get the same effect on ADHD,” Walter Brown, MD, Clinical Professor of Psychiatry at Brown University and Tufts University School of Medicine, stated.

One theory is that the caring and hopeful attitude of the parents or caregivers has a powerful effect on the child. If the parent and child have a strong belief in the efficacy of the remedy, it will work. In the tests, participants had no more “faith” in one pill over another, so they all worked about the same. That’s the very definition of placebo effect.

You’d think that, given this evidence, parents — and their medical doctors — would be convinced that grabbing the pill bottle isn’t the best response to sniffles and sneezes.

But that’s not the way some people see it. Now, there’s a new pill being marketed to parents for use on their kids: a chewable, cherry-flavored tablet called Obecalp. You guessed it: that’s placebo spelled backwards, and the pill is nothing but sugar.

Giving a child a sugar pill is definitely an improvement to giving them chemical medications. But this still teaches the child that health can be delivered in pill form from outside. Why not skip the pill altogether and try activities such as yoga or meditation, both of which can be presented as a game or healing action? Health comes from INSIDE and the sooner we truly understand that, and share that understanding with our kids, the sooner they’ll take control of their health and wellness.

By Terry A. Rondberg

A new study published by JAMA shows that among patients age 65 years and older, rosiglitazone (a medication for treating Type 2 diabetes) is associated with an increased risk of stroke, heart failure, and all-cause mortality (death) when compared with pioglitazone (another medication for diabetes).

In their conclusion, the authors wrote: “…in a population of more than 227,000 patients 65 years or older who initiated treatment with a thiazolidinedione, we found that, compared with pioglitazone, rosiglitazone was associated with an increased risk of stroke, heart failure, and death and the composite of AMI (heart attack), stroke, heart failure or death.” (JAMA.doi:10.1001/jama.2010.954)

Despite trying to put rosiglitazone in the most “favorable” light possible, researchers had to admit that “analysis showed no differences in the risk for heart attack between rosiglitazone and pioglitazone,” even though the study found that rosiglitazone was associated with a 1.25-fold increase in risk of heart failure compared with pioglitazone.

Obviously, BOTH medications have serious negative side effects, but the report’s wording seems somewhat biased to me so I delved a little deeper. Within the past five years, the study’s head researcher, Steven E. Nissen, MD, has received research support from numerous drug companies, including AstraZeneca, Atherogenics, Novartis, Pfizer, Resverlogix, Daiichi-Sankyo, Sanofi-Aventis and — most importantly — Eli Lilly and Takeda.

The drug that fared better in this study (branded name Actos) is manufactured by Eli Lilly and Takeda. Avandia, the branded version of rosiglitazone, is made by GlaxoSmithKline, a name curiously absent from the list of Nissen’s financial benefactors.

Probably just a coincidence, right? Yet, only this month, the BMJ (which used to be called British Medical Journal) published a report that explored a possible link between authors’ financial conflicts of interest and their position on the association of rosiglitazone with increased risk of myocardial infarction in patients with diabetes.

The research abstract noted: “Of the 202 included articles, 108 (53%) had a conflict of interest statement. Ninety authors (45%) had financial conflicts of interest. Authors who had a favourable view of the risk of myocardial infarction with rosiglitazone were more likely to have financial conflicts of interest with manufacturers of antihyperglycaemic agents in general, and with rosiglitazone manufacturers in particular, than authors who had an unfavourable view (rate ratio 3.38, 95% CI 2.26 to 5.06 and 4.29, 2.63 to 7.02, respectively). There was likewise a strong association between favourable recommendations on the use of rosiglitazone and financial conflicts of interest (3.36, 1.94 to 5.83)” (BMJ 2010;340:c1344)

In another, even more chilling report (also published in BMJ), the author writes: “Casually following the fortunes of the blockbuster diabetes drug rosiglitazone (Avandia), you can’t help but imagine a Hollywood thriller. There is the scene where a leading scientist secretly records a meeting with drug company executives, a high powered congressional investigation, and a bitter legal battle waiting in the wings. Yet when you look more closely, the facts are even stranger than fiction. An expensive new drug shown to raise the risk of heart failure and suspected of increasing the chance of heart attacks has been taken by millions of people around the world and is being kept on the market by an industry funded regulatory system, despite calls from senior safety experts to withdraw it.” (BMJ 2010;340:c1848)

I took a look at one other factor as well: pricing. The most common price I could find for Avandia — the drug touted as “safer” by the research paper — was $3.32 per pill (for 30 pills of 8mg, which is considered the normal dose). For Actos, the price was $1.34 per pill (for 30 pills of 30mg, again, considered the normal dose).

When it comes to this type of medical drug research, the saying “follow the money” seems to apply. Perhaps it’s also time to follow the advice of “X-Files” character Fox Mulder: TRUST NO ONE.

About Terry A. Rondberg, DC
Terry A. Rondberg is founder and CEO of the World Chiropractic Alliance. He is an ardent advocate for drug-free chiropractic care not just for back pain, but total body wellness. He has spoken globally on the issue of alternative care and the abuses of our current “health care” system.

By Terry A. Rondberg

Like many wellness practitioners, I don’t believe in the traditional “germ theory.” Of course I know germs exist, but I don’t think they “cause” illness. The true cause is the inability of the human body to deal with germs and counter their effects. After all, if germs were the actual root cause of illness, everyone who came into contact with them would be ill — that is, ALL of us!

Having said that, most of the people we see in our offices have impaired immune systems, to some degree or another. The existence of subluxations; the lack of proper diet or exercise; the overuse of antibiotics; and even physical, mental or emotional stress can all weaken the immune system to the point where the body is vulnerable to the impact of germs and viruses.

That’s why proper infection control procedures are critical in any wellness office. Unfortunately, this basic tenet of hygiene is often overlooked in medical settings. In fact, a report published in the June 9 issue of JAMA found that such lapses were common in many of the 70 ambulatory surgical centers studied. These centers are rapidly becoming the primary facility for a wide variety of medical and surgical procedures that don’t require hospitalization. In 2007, these facilities performed more than 6 million procedures including endoscopy, pain injections, and dental procedures.

The problem is, these places are often germ breeding environments where medical personnel don’t adhere to basic infection control procedures such as washing their hands.

Melissa K. Schaefer, MD, of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted the study and assessed procedures in five different categories: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment.

More than half of the facilities (67.6%) studied had at least one lapse in infection control noted by surveyors and 17.6% of the facilities had lapses identified in three or more categories.

Nearly one in five facilities (19.4%) didn’t properly apply “hand hygiene” (a euphemism for washing hands!) or use proper personal protective equipment such as gloves. More than one quarter of them (28.4%) had deficiencies related to injection practices or medication handling, primarily through use of single-dose vials for more than one patient.

Another 28.4% of these facilities failed to adhere to recommended practices regarding reprocessing of surgical equipment; and 18.8% didn’t properly clean high-touch surfaces in patient care areas.

Thankfully, chiropractors don’t have to be concerned with the high risk procedures involving injections and drugs, but tables and other high-touch surfaces need to be kept clean and disinfected.

The recommendations given by researchers from Parker Chiropractic College — published in Chiropractic & Osteopathy in 2007 — are excellent. They stated:

“Pathogenic microbes may be present on chiropractic treatment tables and can be effectively killed with proper disinfecting. Hand washing/sanitizing is an important measure in infection control as is table disinfecting. Rudimentary behavioral changes to improve chiropractic clinic infection control are needed. More comprehensive behavioral models are needed. All teaching clinics and private chiropractic offices should adopt infection control practices including routine table disinfecting and hand sanitizing. Effective measures can be put in place at minimal costs.”

References: JAMA. 2010;303[22]:2273-2279 — Abstract

“Assessment and risk reduction of infectious pathogens on chiropractic treatment tables,” Chiropractic & Osteopathy 2007

While pharmaceutical companies have boasted for decades that their pills and potions are “approved by the FDA,” does that really mean anything? Apparently, very little, if the story of how one drug — Multaq (dronedarone) — “earned” its approval is any indication.

Drug maker Sanofi-Aventis touts Multaq on its website as “a prescription medicine used to lower the chance you would need to go into the hospital for heart problems.” The FDA’s decision to approve the drug was based primarily on a study conducted last year by Richard Page, chairman of the department of medicine at the University of Wisconsin School of Medicine and Public Health. The paper was published in The New England Journal of Medicine.

However, it turns out that Page was pretty much “bought and paid for” by Sanofi-Aventis. The drug company PAID for the research, collected data, and performed the analysis without an external audit. Page put his name on the paper, never having seen the raw data. He simply trusted the company to be honest and ignored the fact that the major financial experts, including Morgan Stanley, estimated the drug could reach nearly $3 billion in revenues.

In addition, Page and four co-authors were Sanofi-Aventis paid consultants and/or speakers, and two co-authors worked directly for Sanofi-Aventis, and owned stock in the company.

Despite all that, Page shrugged it off with a glib, “There is a sense of trust that they won’t falsify data.” Either he’s incredibly naïve, or he thinks the rest of us are.

To add injury to insult, the Multaq branded pill was selling for 47 times as much as its generic equivalent — in Britain Sanofi was selling the drug for £2.25 pounds per day, compared to 5 pence a day for a generic competitor, amiodarone. That equates to $3.30 compared to 7¢!

But wait … it gets better. Another research study (this one, by researchers at the Cedars-Sinai Heart Institute — Journal of the American College of Cardiology, 2010; 55: 1569-76) has concluded that the branded drug is far less effective than the current standard drug, Cordarone (amiodarone) for atrial fibrillation, and has no safety benefits.

That’s pretty much what was known back in 2003, when a drug trial was actually stopped because patients receiving Multaq were dying in greater numbers than those getting a placebo.

Still, the drug was “approved” by the FDA. You have to ask yourself — what would it take for a drug to be rejected?

In some traditional cultures, the elderly are revered. In others, they’re taken out to the woods and left to die. Generally, in America, they’re over medicated, often with harmful or useless drugs.

A recent study of the records of 470,000 patients over 65 who were admitted to an emergency department (ED) between 2000 and 2006 revealed that nearly 17% were given what the medical industry refers to as “potentially inappropriate medications (PIMs)” — in other words, the wrong drug.

“Approximately 19.5 million patients … of eligible ED visits were associated with one or more PIMs,” researchers concluded in their report, published in the March 2010 issue of Academic Emergency Medicine journal (2010; 17:231).

“There are certain medications that probably are not good to give to older adults because the potential benefits are outweighed by potential problems,” admitted lead author, William J. Meurer, MD.

The two worst offenders, which accounted for nearly 40% of the errors, were the drugs promethazine and ketorolac. Promethazine is a powerful and potentially risky sedative which can cause everything from confusion in older patients to, in rare cases, seizures. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used as an analgesic, fever reducer, and anti-inflammatory.

This isn’t the first time such results have been shown. In July 1994, the Journal of the American Medical Association reported on a study that revealed close to 25% of all elderly patients received wrong drugs.

Among their findings:

** 1.8 million older people had prescriptions for dipyridamole, a blood thinner that, the researchers say, is useless for all except people with artificial heart valves.

** More than 1.3 million older Americans were given prescriptions for propoxyphene, an addictive narcotic that is no better than aspirin in relieving pain.

** More than 1.2 million were prescribed diazepam or chlordiazepoxide, long-acting sedatives and sleeping pills that can make patients groggy, dizzy, and prone to falls.

“Standard published sources support the view that the 20 drugs in our primary analysis should virtually never be prescribed for the elderly,” researchers stated at the time.

One doctor, Jerry H. Gurwitz, MD, of Brigham and Women’s Hospital in Boston, was quoted in The New York Times as saying he hoped the study would serve as “a wake-up call” to America’s doctors. “I hope that the medical community will take it as seriously as the general public, I think, will,” he said, adding that the study might have actually understated the problem since it did not factor in drug interactions or the long-term effect of drugs like sleeping pills.

If we aren’t going to revere our elderly, it might be kinder to leave them in the woods!

The first rule of the medical profession is supposed to be “Do No Harm.” I don’t think the pharmaceutical industry ever took that pledge. We’ve known for ages that pills and potions passed out like candy by the medical and drug cartels are seldom effective and often have dangerous side effects.

A study published in the April 14, 2010 issue of the Journal of the American Medical Association (JAMA) puts another layer of concern onto that knowledge: An analysis of prescription and clinical claims data suggests that the use of certain anticonvulsant medications may be associated with an increased risk of suicide, attempted suicide or violent death! Now that’s a side effect that should cause all these drugs to be pulled off the market immediately. But, knowing how strong the drug lobby is in this country, doctors will continue to prescribe these drugs with nothing more than a “warning” attached.

Anticonvulsant medications are a primary therapeutic approach for patients with epilepsy, but labeled indications also include bipolar disorder, mania, neuralgia (sudden occurrences of short, sharp pains along a nerve), migraine, and neuropathic pain.

“The wide range of indications and common use of anticonvulsants in patients with or without psychiatric comorbidities make their safety an issue of great relevance,” the study’s authors wrote. “In 2008, the U.S. Food and Drug Administration mandated warning labeling for anticonvulsant medications regarding the increased risk of suicidal thoughts and behaviors. The decision was based on a meta-analysis not sufficiently large to investigate individual drugs.”

Elisabetta Patorno, MD, of Brigham and Women’s Hospital and Harvard Medical School, Boston, and her colleagues evaluated whether there was an increased risk of attempted or completed suicide, and combined suicidal acts or violent death associated with a range of individual anticonvulsant medications and within patient subgroups.

The researchers analyzed data for 14 states from the HealthCore Integrated Research Database (which includes information on filled prescriptions and clinical encounters) for patients 15 years and older who began taking an anticonvulsant between July 2001 and December 2006.

The study identified 827 suicidal acts (801 attempted suicides and 26 completed suicides) and an additional 41 violent deaths (868 combined suicidal acts or violent deaths) in 297,620 new episodes of treatment with an anticonvulsant. “This exploratory analysis contributes to the understanding of the complex and little-understood relationship between anticonvulsant medication use and suicide risk.”

Sadly, that will be small comfort to the families of the people who die as a result of taking this drug. If any non-medical procedure — chiropractic, acupuncture, etc. — was found to increase the rate of suicides and violent deaths in patients, it would be prohibited. When will we start imposing the same standard of “do no harm” to the profession that supposedly is guided by that principle?

SOURCE: JAMA. 2010;303[14]:1401-1409.