Evidence-Based Medicine: The Current System of Scoliosis Management in the United States is Not Supported by EBM

Evidence-based medicine (EBM) or evidence-based practices (EBP) are poorly understand by the general public and also by many members of the healthcare profession. They are often misinterpreted to mean that only interventions with published research can be considered part of EBM; this is untrue. EBM began in Ontario, Canada, at McMaster's University, as a way of closing the gap between clinical practice and clinical research. David Sackett, one of the originators, describes EBM as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. [emphasis added]"

It is also important to note that it is the patient who has the final say in accepting, rejecting, or modifying care. For example, if surgery is found to be the best intervention through research and the clinical expertise of the doctor, but the patient either does not want surgery or there are reasons why that individual patient might be at a greater risk in having the surgery performed, the published research & doctor's expertise play only a secondary role to the free will of the patient.

The triad of EBM is thus; the patient's preferences, combined with the doctor's clinical expertise, and the best available research evidence.

The difficulties arise when no high-quality evidence is available on a specific intervention. In these cases, it is appropriate to apply lower levels of evidence, such as observational studies and case reports. According to a study published in the British Medical Journal in 2007, 15% of the interventions evaluated so far have been proven to be beneficial; 22% are likely to be beneficial; 2% appear to be a "trade-off" between potential risks & benefits; 5% are unlikely to be beneficial; and, 4% have been shown to be likely to harm. The remainder of interventions, 47%, do not have sufficient evidence to make a decision either way.

One of the most interesting facts about EBM is that it itself fails its own test! The process of EBP has not been rigorously tested according to its own standards, so we do not know for certain if it actually results in improved health. (Straus & McAlister 2000) This does not mean that EBP has been proven to be ineffective; it means, quite simply, we do not know enough to decide either way. "No evidence of effect is not the same asevidence of no effect." (Tarnow-Mordi & Healy 1999)

When the standards of EBM are applied to bracing (Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review, Dolan & Weinstein, Spine 2007), the conclusion is, "Comparing the pooled rates for these two interventions shows no clearadvantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by 'troublingly inconsistent or inconclusive studies of any level.'"

When EBM is applied to surgery, "a medical indication for this treatment cannot be established in view of the lack of evidence." (Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the literature, Scoliosis 2008)

Interestingly enough, exercises have been shown to have the most evidence to support their use in the treatment of scoliosis, yet there are no medical scoliosis centers in the United States that currently utilize these methods.

"A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults." (The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature, Hawes 2003)

"Contrary to current dogma, the condition may be corrected with this therapy." (Mooney et al, Exercise for managing adolescent idiopathic scoliosis, Journal of Musculoskeletal Medicine, 2007, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain)

"Results show that in literature there is proof of level 1b on exercises." (Negrini et al, Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies, Europa Medicophysica-SIMFER 2007 Award Winner, Eur J Phys Rehabil Med 2008)

On the topic of chiropractic and scoliosis, preliminary evidence appears to indicate that manual therapy alone (e.g., chiropractic adjustments performed in the absence of any other modalities) does not alter the natural history of scoliosis (Negrini et al, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review, Scoliosis 2008). However, a growing body of case reports have reported positive results when manual therapy is combined with other rehabilitation approaches (Brooks 2009, Chen 2008, Brooks 2007, Morningstar 2004 & 2006). According to the standards of EBM, case reports and case series are considered level 3 evidence - above expert opinion, but below case-control studies, RCT's & systematic reviews. This places the level of evidence in support of CLEAR's treatment approach as equal to the level of evidence in favor of bracing. All it will take is one well-conducted case-control study to place the level of evidence in favor of CLEAR above the level of evidence in favor of bracing(and believe me, I'm working overtime and donating all of my time to make that happen!).


Warm Regards,
Josh Woggon DC
Director of Research, CLEAR Institute
jwoggon@clear-institute.org

Evidence-based medicine (EBM) or evidence-based practices (EBP) are poorly understand by the general public and also by many members of the healthcare profession. They are often misinterpreted to mean that only interventions with published research can be considered part of EBM; this is untrue. EBM began in Ontario, Canada, at McMaster's University, as a way of closing the gap between clinical practice and clinical research. David Sackett, one of the originators, describes EBM as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. [emphasis added]"

It is also important to note that it is the patient who has the final say in accepting, rejecting, or modifying care. For example, if surgery is found to be the best intervention through research and the clinical expertise of the doctor, but the patient either does not want surgery or there are reasons why that individual patient might be at a greater risk in having the surgery performed, the published research & doctor's expertise play only a secondary role to the free will of the patient.

The triad of EBM is thus; the patient's preferences, combined with the doctor's clinical expertise, and the best available research evidence.

The difficulties arise when no high-quality evidence is available on a specific intervention. In these cases, it is appropriate to apply lower levels of evidence, such as observational studies and case reports. According to a study published in the British Medical Journal in 2007, 15% of the interventions evaluated so far have been proven to be beneficial; 22% are likely to be beneficial; 2% appear to be a "trade-off" between potential risks & benefits; 5% are unlikely to be beneficial; and, 4% have been shown to be likely to harm. The remainder of interventions, 47%, do not have sufficient evidence to make a decision either way.

One of the most interesting facts about EBM is that it itself fails its own test! The process of EBP has not been rigorously tested according to its own standards, so we do not know for certain if it actually results in improved health. (Straus & McAlister 2000) This does not mean that EBP has been proven to be ineffective; it means, quite simply, we do not know enough to decide either way. "No evidence of effect is not the same asevidence of no effect." (Tarnow-Mordi & Healy 1999)

When the standards of EBM are applied to bracing (Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review, Dolan & Weinstein, Spine 2007), the conclusion is, "Comparing the pooled rates for these two interventions shows no clearadvantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by 'troublingly inconsistent or inconclusive studies of any level.'"

When EBM is applied to surgery, "a medical indication for this treatment cannot be established in view of the lack of evidence." (Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the literature, Scoliosis 2008)

Interestingly enough, exercises have been shown to have the most evidence to support their use in the treatment of scoliosis, yet there are no medical scoliosis centers in the United States that currently utilize these methods.

"A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults." (The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature, Hawes 2003)

"Contrary to current dogma, the condition may be corrected with this therapy." (Mooney et al, Exercise for managing adolescent idiopathic scoliosis, Journal of Musculoskeletal Medicine, 2007, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain)

"Results show that in literature there is proof of level 1b on exercises." (Negrini et al, Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies, Europa Medicophysica-SIMFER 2007 Award Winner, Eur J Phys Rehabil Med 2008)

On the topic of chiropractic and scoliosis, preliminary evidence appears to indicate that manual therapy alone (e.g., chiropractic adjustments performed in the absence of any other modalities) does not alter the natural history of scoliosis (Negrini et al, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review, Scoliosis 2008). However, a growing body of case reports have reported positive results when manual therapy is combined with other rehabilitation approaches (Brooks 2009, Chen 2008, Brooks 2007, Morningstar 2004 & 2006). According to the standards of EBM, case reports and case series are considered level 3 evidence - above expert opinion, but below case-control studies, RCT's & systematic reviews. This places the level of evidence in support of CLEAR's treatment approach as equal to the level of evidence in favor of bracing. All it will take is one well-conducted case-control study to place the level of evidence in favor of CLEAR above the level of evidence in favor of bracing(and believe me, I'm working overtime and donating all of my time to make that happen!).


Warm Regards,
Josh Woggon DC
Director of Research, CLEAR Institute
jwoggon@clear-institute.org

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Health In Your Hands Launches Innovative New iPhone App for Patients to Track Individual Progression of Scoliosis at Home

2011-02-24 10:00

ScolioTrack technology for iPhones has been released on February 24, 2011 SINGAPORE, Feb. 24, 2011 /PRNewswire-Asia/ -- Dr. Kevin Lau, D.C., author of "Your Plan for Natural Scoliosis Prevention and Treatment - Health In Your Hands" book and exercise DVD, announces the release of a Singapore made application called ScolioTrack, an innovative new iPhone application which places an instrument similar to a doctor's scoliometer into the hands of scoliosis patients worldwide. The device proves much safer than x-ray technology and can be used in between doctor's visits to track one's individual condition. "With ScolioTrack, the patient can track the curvature in the spine from month to month by using the iPhone accelerometer and camera function, just as a doctor would with a scoliometer," said Dr. Lau. "A scoliometer is a device which objectively measures the severity of curvature, or more specifically the Angle of Trunk Rotation." The new ScolioTrack technology tracks the patient's Angle of Trunk Rotation (ATR), a key measurement in screening and planning for the "Health In Your Hands" approach to treatment. ScolioTrack records a person's height and weight, both beneficial for growing teenagers or health-conscious adults, and also uses the camera function on the iPhone to capture the person's back to see changes in back deformity. ScolioTrack saves the information in one convenient location and provides touch-of-the-finger retrieval for future checkups and comparison between tracks. An easy-to-read display shows data output in graph format for ease of tracking variations, and can save the data of multiple users. With ScolioTrack's access to the latest breaking news, and its user-friendly support guides, patients gain an effortless handle on their disorder. For more information or to install ScolioTrack for iPhone, iPod or iPad go to http://appshopper.com/link/scoliotrack or http://www.hiyh.info/about-iphone-app.html About Dr. Kevin Lau, D.C. and Health In Your Hands Dr. Kevin Lau's ScolioTrack is one element of his comprehensive "Health In Your Hands" series for a natural, non-surgical, highly effective and proven method for reversing scoliosis. The other elements include his in-depth book and a newly-released exercise DVD for scoliosis. He is a recipient of the "Best Health-care Provider Award" by the Straits Time and featured on Prime Time Channel News Asia. Contact Information: Dr. Kevin Lau D.C. Address: 302 Orchard Road #06-03, Singapore 238862 http://www.hiyh.info

2011-02-24 10:00

ScolioTrack technology for iPhones has been released on February 24, 2011 SINGAPORE, Feb. 24, 2011 /PRNewswire-Asia/ -- Dr. Kevin Lau, D.C., author of "Your Plan for Natural Scoliosis Prevention and Treatment - Health In Your Hands" book and exercise DVD, announces the release of a Singapore made application called ScolioTrack, an innovative new iPhone application which places an instrument similar to a doctor's scoliometer into the hands of scoliosis patients worldwide. The device proves much safer than x-ray technology and can be used in between doctor's visits to track one's individual condition. "With ScolioTrack, the patient can track the curvature in the spine from month to month by using the iPhone accelerometer and camera function, just as a doctor would with a scoliometer," said Dr. Lau. "A scoliometer is a device which objectively measures the severity of curvature, or more specifically the Angle of Trunk Rotation." The new ScolioTrack technology tracks the patient's Angle of Trunk Rotation (ATR), a key measurement in screening and planning for the "Health In Your Hands" approach to treatment. ScolioTrack records a person's height and weight, both beneficial for growing teenagers or health-conscious adults, and also uses the camera function on the iPhone to capture the person's back to see changes in back deformity. ScolioTrack saves the information in one convenient location and provides touch-of-the-finger retrieval for future checkups and comparison between tracks. An easy-to-read display shows data output in graph format for ease of tracking variations, and can save the data of multiple users. With ScolioTrack's access to the latest breaking news, and its user-friendly support guides, patients gain an effortless handle on their disorder. For more information or to install ScolioTrack for iPhone, iPod or iPad go to http://appshopper.com/link/scoliotrack or http://www.hiyh.info/about-iphone-app.html About Dr. Kevin Lau, D.C. and Health In Your Hands Dr. Kevin Lau's ScolioTrack is one element of his comprehensive "Health In Your Hands" series for a natural, non-surgical, highly effective and proven method for reversing scoliosis. The other elements include his in-depth book and a newly-released exercise DVD for scoliosis. He is a recipient of the "Best Health-care Provider Award" by the Straits Time and featured on Prime Time Channel News Asia. Contact Information: Dr. Kevin Lau D.C. Address: 302 Orchard Road #06-03, Singapore 238862 http://www.hiyh.info

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Breakfast Is an Important Meal,Especially for Teen Moms and Their Kids

Newswise — Teen mothers who eat breakfast have healthier weights and snacking habits and may influence healthy eating habits among their children, says a recent study by obesity prevention expert Debra Haire-Joshu, PhD, professor at the Brown School at Washington University in St. Louis.

“It’s important to look at dietary patterns among postpartum teens to help reduce weight retention and prevent intergenerational obesity,” she says. “Overall, breakfast consumption among postpartum teens is low and interventions are needed to encourage breakfast consumption among teen mothers.”

Haire-Joshu, who also is director of the Center for Obesity Prevention and Policy Research at the Brown School, points out that “teen mothers now control the food environment for their child.

“Thus, patterns exhibited by the mothers, including lack of breakfast and high-risk sweetened drink and snacking behavior, might influence the intake of their young child,” Haire-Joshu says.

“Over time and left unchanged, these behaviors are reinforced as the child observes that parent and has access to high risk foods in their environment.”

Haire-Joshu’s study, “Postpartum Teens’ Breakfast Consumption Is Associated with Snack and Beverage Intake and Body Mass Index,” followed 1,330 postpartum teens across 27 states.

Participants were enrolled in the Parents as Teachers Teen Program and completed a seven-day recall of their breakfast, snack and beverage consumption.

Almost half (42 percent) of the sample consumed breakfast fewer than two days per week.

Those who ate breakfast six to seven days per week consumed 1,197 fewer kilocalories per week from sweet and salty snacks, 1,337 fewer kilocalories per week from sweetened drinks, and had a lower BMI compared to those who ate breakfast fewer than two days per week.

Consumption of fruits, vegetables, milk, water and cereal as a snack were higher among regular breakfast consumers.

Haire-Joshu’s study ran in a recent issue of the Journal of the American Dietetic Association. Her co-authors are Cynthia Schwarz, Elizabeth Budd, Byron W. Yount and Christina Lapka from the Center for Obesity Prevention and Policy Research at WUSTL.

Newswise — Teen mothers who eat breakfast have healthier weights and snacking habits and may influence healthy eating habits among their children, says a recent study by obesity prevention expert Debra Haire-Joshu, PhD, professor at the Brown School at Washington University in St. Louis.

“It’s important to look at dietary patterns among postpartum teens to help reduce weight retention and prevent intergenerational obesity,” she says. “Overall, breakfast consumption among postpartum teens is low and interventions are needed to encourage breakfast consumption among teen mothers.”

Haire-Joshu, who also is director of the Center for Obesity Prevention and Policy Research at the Brown School, points out that “teen mothers now control the food environment for their child.

“Thus, patterns exhibited by the mothers, including lack of breakfast and high-risk sweetened drink and snacking behavior, might influence the intake of their young child,” Haire-Joshu says.

“Over time and left unchanged, these behaviors are reinforced as the child observes that parent and has access to high risk foods in their environment.”

Haire-Joshu’s study, “Postpartum Teens’ Breakfast Consumption Is Associated with Snack and Beverage Intake and Body Mass Index,” followed 1,330 postpartum teens across 27 states.

Participants were enrolled in the Parents as Teachers Teen Program and completed a seven-day recall of their breakfast, snack and beverage consumption.

Almost half (42 percent) of the sample consumed breakfast fewer than two days per week.

Those who ate breakfast six to seven days per week consumed 1,197 fewer kilocalories per week from sweet and salty snacks, 1,337 fewer kilocalories per week from sweetened drinks, and had a lower BMI compared to those who ate breakfast fewer than two days per week.

Consumption of fruits, vegetables, milk, water and cereal as a snack were higher among regular breakfast consumers.

Haire-Joshu’s study ran in a recent issue of the Journal of the American Dietetic Association. Her co-authors are Cynthia Schwarz, Elizabeth Budd, Byron W. Yount and Christina Lapka from the Center for Obesity Prevention and Policy Research at WUSTL.

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How Omega-3 Fatty Acids Help Prevent Several Forms of Blindness

Omega-3 fatty acids -fats commonly found in fish oil -- were shown several years ago to prevent retinopathy, a major form of blindness, in a mouse model of the disease. A follow-up study, from the same research team at Children's Hospital Boston, now reveals exactly how omega-3's provide protection, and provides reassurance that widely used COX-inhibiting drugs like aspirin and NSAIDs don't negate their benefit.

The findings, published in the February 9th issue of Science Translational Medicine, also suggest that omega-3's may be beneficial in diabetes.

Retinopathy -- an eye disease caused by the proliferation of tortuous, leaky blood vessels in the retina -- is a leading cause of blindness, affecting 4.1 million Americans with diabetes (a number expected to double over the next 15 years) and many premature infants. Another 7 million-plus Americans have age-related macular degeneration (AMD); this too will increase as the population ages. The most common "wet" form of AMD is also caused by abnormal blood vessel growth.

The ability to prevent these "neovascular" eye diseases with omega-3 fatty acids could provide tremendous cost savings, says Children's ophthalmologist Lois Smith, MD, PhD, senior investigator on the study. "The cost of omega-3 supplementation is about $10 a month, versus up to $4,000 a month for anti-VEGF therapy," she says, referring to drugs such as Macugen and Lucentis used in AMD and diabetic retinopathy. "Our new findings give us new information on how omega-3s work that makes them an even more promising option."

Omega-3 fatty acids, highly concentrated in the retina, are often lacking in Western diets, which tend to be higher in omega-6 fatty acids. In Smith's previous study, mice fed diets rich in omega-3 fatty acids by Smith's team had nearly 50 percent less pathologic vessel growth in the retina than mice fed omega-6-rich diets. Smith and colleagues further showed that the omega-3 diet decreased inflammatory messaging in the eye.

In the new study, they document another protective mechanism: a direct effect on blood vessel growth (angiogenesis) that selectively promotes the growth of healthy blood vessels and inhibits the growth of abnormal vessels.

In addition, Smith and colleagues isolated the specific compound from omega-3 fatty acids that has these beneficial effects in mice (a metabolite of the omega-3 fatty acid DHA, known as 4-HDHA), and the enzyme that produces it (5-lipoxygenase, or 5-LOX). They showed that COX enzymes are not involved in omega-3 breakdown, suggesting that aspirin and NSAIDs -- taken by millions of Americans -- will not interfere with omega-3 benefits.

"This is important for people with diabetes, who often take aspirin to prevent heart disease, and also for elderly people with AMD who have a propensity for heart disease," says Smith. (One drug used for asthma, zileuton, does interfere with 5-LOX, however.)

Finally, the study demonstrated that 5-LOX acts by activating the PPAR-gamma receptor, the same receptor targeted by "glitazone" drugs such as Avandia, taken by patients with type 2 diabetes to increase their sensitivity to insulin. Since these drugs also increase the risk for heart disease, boosting omega-3 intake through diet or supplements might be a safer way to improve insulin sensitivity in patients with diabetes or pre-diabetes. "There needs to be a good clinical study in diabetes," Smith says.

Smith works closely with principal investigators at the National Eye Institute who are conducting an ongoing multicenter trial of omega-3 supplements in patients with AMD, known as AREDS2. The trial will continue until 2013. An earlier retrospective study, AREDS1, found higher self-reported intake of fish to be associated with a lower likelihood of AMD.

In addition, Smith is collaborating with a group in Sweden that is conducting a clinical trial of omega-3 fatty acids in premature infants, who are often deficient in omega-3. That study will measure infants' blood levels of omega-3 products and follow the infants to see if they develop retinopathy. If results are promising Smith will seek FDA approval to conduct a clinical trial in premature infants at Children's.

Meanwhile, in her lab work, Smith plans to continue seeking beneficial lipid pathways, while looking for the most harmful omega 6 metabolites. "We found the good guys, now we'll look for the bad ones," says Smith. "If we find the pathways, maybe we can selectively block the bad metabolites. We would hope to start with drugs that are already available."

Przemyslaw Sapieha and Andreas Stahl in Smith's lab were co-first authors on the study. Funders include the National Eye Institute, the Children's Hospital Boston Mental Retardation and Developmental Disabilities Research Center, Research to Prevent Blindness, the Alcon Research Institute, MacTel Foundation, the Roche Foundation for Anemia Research and the V. Kann Rasmussen Foundation.

Omega-3 fatty acids -fats commonly found in fish oil -- were shown several years ago to prevent retinopathy, a major form of blindness, in a mouse model of the disease. A follow-up study, from the same research team at Children's Hospital Boston, now reveals exactly how omega-3's provide protection, and provides reassurance that widely used COX-inhibiting drugs like aspirin and NSAIDs don't negate their benefit.

The findings, published in the February 9th issue of Science Translational Medicine, also suggest that omega-3's may be beneficial in diabetes.

Retinopathy -- an eye disease caused by the proliferation of tortuous, leaky blood vessels in the retina -- is a leading cause of blindness, affecting 4.1 million Americans with diabetes (a number expected to double over the next 15 years) and many premature infants. Another 7 million-plus Americans have age-related macular degeneration (AMD); this too will increase as the population ages. The most common "wet" form of AMD is also caused by abnormal blood vessel growth.

The ability to prevent these "neovascular" eye diseases with omega-3 fatty acids could provide tremendous cost savings, says Children's ophthalmologist Lois Smith, MD, PhD, senior investigator on the study. "The cost of omega-3 supplementation is about $10 a month, versus up to $4,000 a month for anti-VEGF therapy," she says, referring to drugs such as Macugen and Lucentis used in AMD and diabetic retinopathy. "Our new findings give us new information on how omega-3s work that makes them an even more promising option."

Omega-3 fatty acids, highly concentrated in the retina, are often lacking in Western diets, which tend to be higher in omega-6 fatty acids. In Smith's previous study, mice fed diets rich in omega-3 fatty acids by Smith's team had nearly 50 percent less pathologic vessel growth in the retina than mice fed omega-6-rich diets. Smith and colleagues further showed that the omega-3 diet decreased inflammatory messaging in the eye.

In the new study, they document another protective mechanism: a direct effect on blood vessel growth (angiogenesis) that selectively promotes the growth of healthy blood vessels and inhibits the growth of abnormal vessels.

In addition, Smith and colleagues isolated the specific compound from omega-3 fatty acids that has these beneficial effects in mice (a metabolite of the omega-3 fatty acid DHA, known as 4-HDHA), and the enzyme that produces it (5-lipoxygenase, or 5-LOX). They showed that COX enzymes are not involved in omega-3 breakdown, suggesting that aspirin and NSAIDs -- taken by millions of Americans -- will not interfere with omega-3 benefits.

"This is important for people with diabetes, who often take aspirin to prevent heart disease, and also for elderly people with AMD who have a propensity for heart disease," says Smith. (One drug used for asthma, zileuton, does interfere with 5-LOX, however.)

Finally, the study demonstrated that 5-LOX acts by activating the PPAR-gamma receptor, the same receptor targeted by "glitazone" drugs such as Avandia, taken by patients with type 2 diabetes to increase their sensitivity to insulin. Since these drugs also increase the risk for heart disease, boosting omega-3 intake through diet or supplements might be a safer way to improve insulin sensitivity in patients with diabetes or pre-diabetes. "There needs to be a good clinical study in diabetes," Smith says.

Smith works closely with principal investigators at the National Eye Institute who are conducting an ongoing multicenter trial of omega-3 supplements in patients with AMD, known as AREDS2. The trial will continue until 2013. An earlier retrospective study, AREDS1, found higher self-reported intake of fish to be associated with a lower likelihood of AMD.

In addition, Smith is collaborating with a group in Sweden that is conducting a clinical trial of omega-3 fatty acids in premature infants, who are often deficient in omega-3. That study will measure infants' blood levels of omega-3 products and follow the infants to see if they develop retinopathy. If results are promising Smith will seek FDA approval to conduct a clinical trial in premature infants at Children's.

Meanwhile, in her lab work, Smith plans to continue seeking beneficial lipid pathways, while looking for the most harmful omega 6 metabolites. "We found the good guys, now we'll look for the bad ones," says Smith. "If we find the pathways, maybe we can selectively block the bad metabolites. We would hope to start with drugs that are already available."

Przemyslaw Sapieha and Andreas Stahl in Smith's lab were co-first authors on the study. Funders include the National Eye Institute, the Children's Hospital Boston Mental Retardation and Developmental Disabilities Research Center, Research to Prevent Blindness, the Alcon Research Institute, MacTel Foundation, the Roche Foundation for Anemia Research and the V. Kann Rasmussen Foundation.

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How to Avoid Sore Muscles after a Workout – and What to Do When Muscle Pain Occurs?

Do your muscles feel sore after a good workout?

It often occurs that you finish a workout and feel great, but the next day your body starts to ache and you dread hitting the gym the next day. This is not the right way to workout. Irrespective if your muscles are aching or not you need to continue your workout.

After a workout your muscles feel sore because they are damaged and need time to recover. This is called DOMS, delayed onset muscle soreness; it occurs 8-24 hours after a workout and can take up to 72 hours to dissipate. DOMS is a natural occurrence for those who do not exercise on a regular basis or for those who resume activity after a long term of inactivity.

It is important to burn your muscles and then recover from the burn, this is known as stressing and recovering. Which is why athletes take a very hard workout on one day and then go easy for the next seven days, before taking on a hard workout again. Even world-class marathon runners run very fast only twice a week and professional weightlifters lift very heavy weights only once every two weeks.

What causes muscle pain and soreness after exercise?


One needs to remember that muscle pain and soreness is a part of an adaptation process that leads to greater stamina and strength as the muscles recover.

One theory a few years ago suggested that the build up of lactic acid in the muscles after a workout was the main cause of soreness, but now it is known this is not the case. Lactic acid is quickly removed after an exercise session and does not remain in muscle tissue for very long.

Other theories suggest that;

• Muscle soreness occurs because of microscopic tears in muscle fibres

• It is caused due to tears in the tissue that connects the muscle not the muscle itself

• The damaged muscles release chemical irritants, which irritate pain receptors.

• The damaged muscles become inflamed hence causing soreness

• Changes in osmotic pressure, muscle spasms and a change in the way the muscle cells regulate calcium may be responsible for the soreness.

Though the exact cause is yet to be identified these proposed theories are reported to be the most likely causes for this phenomenon.

The extent of tearing and the resulting soreness depends on a number of factors including, the type of exercise as well as the degree of difficulty. Usually, exercises involving eccentric muscle contractions, especially the ones that cause the muscle to contract quite forcefully, while it lengthens, have been observed to cause more muscle soreness.

Do your muscles feel sore after a good workout?

It often occurs that you finish a workout and feel great, but the next day your body starts to ache and you dread hitting the gym the next day. This is not the right way to workout. Irrespective if your muscles are aching or not you need to continue your workout.

After a workout your muscles feel sore because they are damaged and need time to recover. This is called DOMS, delayed onset muscle soreness; it occurs 8-24 hours after a workout and can take up to 72 hours to dissipate. DOMS is a natural occurrence for those who do not exercise on a regular basis or for those who resume activity after a long term of inactivity.

It is important to burn your muscles and then recover from the burn, this is known as stressing and recovering. Which is why athletes take a very hard workout on one day and then go easy for the next seven days, before taking on a hard workout again. Even world-class marathon runners run very fast only twice a week and professional weightlifters lift very heavy weights only once every two weeks.

What causes muscle pain and soreness after exercise?


One needs to remember that muscle pain and soreness is a part of an adaptation process that leads to greater stamina and strength as the muscles recover.

One theory a few years ago suggested that the build up of lactic acid in the muscles after a workout was the main cause of soreness, but now it is known this is not the case. Lactic acid is quickly removed after an exercise session and does not remain in muscle tissue for very long.

Other theories suggest that;

• Muscle soreness occurs because of microscopic tears in muscle fibres

• It is caused due to tears in the tissue that connects the muscle not the muscle itself

• The damaged muscles release chemical irritants, which irritate pain receptors.

• The damaged muscles become inflamed hence causing soreness

• Changes in osmotic pressure, muscle spasms and a change in the way the muscle cells regulate calcium may be responsible for the soreness.

Though the exact cause is yet to be identified these proposed theories are reported to be the most likely causes for this phenomenon.

The extent of tearing and the resulting soreness depends on a number of factors including, the type of exercise as well as the degree of difficulty. Usually, exercises involving eccentric muscle contractions, especially the ones that cause the muscle to contract quite forcefully, while it lengthens, have been observed to cause more muscle soreness.

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Exercise helps overweight children think better, do better in math

AUGUSTA, Ga. – Regular exercise improves the ability of overweight, previously inactive children to think, plan and even do math, Georgia Health Sciences University researchers report.

They hope the findings in 171 overweight 7- to 11-year-olds – all sedentary when the study started - gives educators the evidence they need to ensure that regular, vigorous physical activity is a part of every school day, said Dr. Catherine Davis, clinical health psychologist at GHSU's Georgia Prevention Institute and corresponding author on the study in Health Psychology

"I hope these findings will help reestablish physical activity's important place in the schools in helping kids stay physically well and mentally sharp," Davis said. "For children to reach their potential, they need to be active."

To measure cognition, researchers used the Cognitive Assessment System and Woodcock-Johnson Tests of Achievement III that measure abilities such as planning and academic skills such as math and reading. A subset of the children received functional magnetic resonance imaging highlighting increased or decreased areas of brain activity.

MRIs showed those who exercised experienced increased brain activity in the prefrontal cortex – an area associated with complex thinking, decision making and correct social behavior - and decreased activity in an area of the brain that sits behind it. The shift forward appears consistent with more rapidly developing cognitive skills, Davis said.

And the more they exercised, the better the result. Intelligence scores increased an average 3.8 points in those exercising 40 minutes per day after school for three months with a smaller benefit in those exercising 20 minutes daily.

Activity in the part of their brain responsible for so-called executive function also increased in children who exercised. "In kids you just don't know what impact you are going to have when you improve their ability to control their attention, to behave better in school, to make better choices," Davis notes. "Maybe they will be more likely to stay in school and out of trouble."

Similar improvements were seen in math skills; interestingly, no improvements were found in reading skill. Researchers note that improved math achievement was "remarkable" since no math lessons were given and suggests longer intervention could produce even better results.

Children in the exercise program played hard, with running games, hula hoops and jump ropes, raising their heart rates to 79 percent of maximum, which is considered vigorous.

Cognitive improvements likely resulted from the brain stimulation that came from movement rather than resulting cardiovascular improvements, such as increased blood and oxygen supplies, Davis said. "You cannot move your body without your brain."

The researchers hypothesize that such vigorous physical activity promotes development of brain systems that underlie cognition and behavior. Animal studies have shown that aerobic activity increases growth factors so the brain gets more blood vessels, more neurons and more connections between neurons. Studies in older adults have shown exercise benefits the brain and Davis's study extends the science to children and their ability to learn in school.

AUGUSTA, Ga. – Regular exercise improves the ability of overweight, previously inactive children to think, plan and even do math, Georgia Health Sciences University researchers report.

They hope the findings in 171 overweight 7- to 11-year-olds – all sedentary when the study started - gives educators the evidence they need to ensure that regular, vigorous physical activity is a part of every school day, said Dr. Catherine Davis, clinical health psychologist at GHSU's Georgia Prevention Institute and corresponding author on the study in Health Psychology

"I hope these findings will help reestablish physical activity's important place in the schools in helping kids stay physically well and mentally sharp," Davis said. "For children to reach their potential, they need to be active."

To measure cognition, researchers used the Cognitive Assessment System and Woodcock-Johnson Tests of Achievement III that measure abilities such as planning and academic skills such as math and reading. A subset of the children received functional magnetic resonance imaging highlighting increased or decreased areas of brain activity.

MRIs showed those who exercised experienced increased brain activity in the prefrontal cortex – an area associated with complex thinking, decision making and correct social behavior - and decreased activity in an area of the brain that sits behind it. The shift forward appears consistent with more rapidly developing cognitive skills, Davis said.

And the more they exercised, the better the result. Intelligence scores increased an average 3.8 points in those exercising 40 minutes per day after school for three months with a smaller benefit in those exercising 20 minutes daily.

Activity in the part of their brain responsible for so-called executive function also increased in children who exercised. "In kids you just don't know what impact you are going to have when you improve their ability to control their attention, to behave better in school, to make better choices," Davis notes. "Maybe they will be more likely to stay in school and out of trouble."

Similar improvements were seen in math skills; interestingly, no improvements were found in reading skill. Researchers note that improved math achievement was "remarkable" since no math lessons were given and suggests longer intervention could produce even better results.

Children in the exercise program played hard, with running games, hula hoops and jump ropes, raising their heart rates to 79 percent of maximum, which is considered vigorous.

Cognitive improvements likely resulted from the brain stimulation that came from movement rather than resulting cardiovascular improvements, such as increased blood and oxygen supplies, Davis said. "You cannot move your body without your brain."

The researchers hypothesize that such vigorous physical activity promotes development of brain systems that underlie cognition and behavior. Animal studies have shown that aerobic activity increases growth factors so the brain gets more blood vessels, more neurons and more connections between neurons. Studies in older adults have shown exercise benefits the brain and Davis's study extends the science to children and their ability to learn in school.

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Do the Chemicals That Turn Soda Brown Also Cause Cancer?

Soda is not good for you. The high-calorie, sugary drinks have been linked to obesity and a host of other health problems. Soda can be particularly dangerous to children, who can consume lots of calories quickly through colas and other pop without feeling full. And then there's the dental toll — it doesn't take a peer-reviewed study to tell you that drinking lots of sweetened soda isn't great for your teeth.

But soda isn't just water, corn syrup and carbonation — a can of Coke or Pepsi also contains chemical additives for coloring and flavoring. And according to one public health group, those additives could increase your chance of getting cancer. (More on Time.com: Five New Rules for Good Health)

That's the message from the Center for Science in the Public Interest (CSPI), a Washington-based consumer watchdog group. CSPI has petitioned the Food and Drug Administration (FDA) to ban the "caramel coloring" that is used in Coke, Pepsi and other sodas, on the grounds that the chemicals are carcinogenic.

CSPI says the artificial brown coloring — which doesn't have much to do with actual caramel, despite the name — is made by reacting corn sugar with ammonia and sulfites under high pressures and at high temperatures. (Just like Mom used to do it!) Those reactions produce the chemicals 2-methylimidazole and 4-methylimidazole — chemicals that government studies have found to cause lung, liver or thyroid cancer in lab rats or mice. "It's a small but significant risk, and it's the kind of thing that government agencies should deal with," says Michael Jacobson, the executive director of CSPI.

Is Jacobson right? A 2007 study by the National Toxicology Program (NTP) found "clear evidence of carcinogenic activity of 4-methylimidazole (4-MEI) in male and
female B6C3F1 mice based on increased incidences of alveolar/bronchiolar neoplasms," otherwise known as lung tumors. The state of California has also concluded that 4-MEI is a carcinogen, and is in the process of crafting regulations that may require food and drinks containing significant levels of the chemical to bear cancer warnings. (More on Time.com: Ways to Improve Your Diet on the Cheap)

According to California's regulators, a level of more than 16 micrograms per day would pose a significant risk — meaning it could result in at least one excess case of cancer per 100,000 exposed people. Given that there are roughly 130 micrograms of 4-MI per 12-ounce can of soda — and given that the average American drinks 14 ounces of soda a day, with young men drinking far more — that would mean that most of us would be at some risk.

As a result, CSPI has been petitioning the FDA to change the name or ban the use of the chemicals in soda and other foods, or at least force manufacturers to put warning labels on their packaging. "We think industry can solve this problem," says Jacobson. "They don't want to put warning labels on their products." (More on Time.com: Fitness Apps to Get You Off the Couch)

Soda is not good for you. The high-calorie, sugary drinks have been linked to obesity and a host of other health problems. Soda can be particularly dangerous to children, who can consume lots of calories quickly through colas and other pop without feeling full. And then there's the dental toll — it doesn't take a peer-reviewed study to tell you that drinking lots of sweetened soda isn't great for your teeth.

But soda isn't just water, corn syrup and carbonation — a can of Coke or Pepsi also contains chemical additives for coloring and flavoring. And according to one public health group, those additives could increase your chance of getting cancer. (More on Time.com: Five New Rules for Good Health)

That's the message from the Center for Science in the Public Interest (CSPI), a Washington-based consumer watchdog group. CSPI has petitioned the Food and Drug Administration (FDA) to ban the "caramel coloring" that is used in Coke, Pepsi and other sodas, on the grounds that the chemicals are carcinogenic.

CSPI says the artificial brown coloring — which doesn't have much to do with actual caramel, despite the name — is made by reacting corn sugar with ammonia and sulfites under high pressures and at high temperatures. (Just like Mom used to do it!) Those reactions produce the chemicals 2-methylimidazole and 4-methylimidazole — chemicals that government studies have found to cause lung, liver or thyroid cancer in lab rats or mice. "It's a small but significant risk, and it's the kind of thing that government agencies should deal with," says Michael Jacobson, the executive director of CSPI.

Is Jacobson right? A 2007 study by the National Toxicology Program (NTP) found "clear evidence of carcinogenic activity of 4-methylimidazole (4-MEI) in male and
female B6C3F1 mice based on increased incidences of alveolar/bronchiolar neoplasms," otherwise known as lung tumors. The state of California has also concluded that 4-MEI is a carcinogen, and is in the process of crafting regulations that may require food and drinks containing significant levels of the chemical to bear cancer warnings. (More on Time.com: Ways to Improve Your Diet on the Cheap)

According to California's regulators, a level of more than 16 micrograms per day would pose a significant risk — meaning it could result in at least one excess case of cancer per 100,000 exposed people. Given that there are roughly 130 micrograms of 4-MI per 12-ounce can of soda — and given that the average American drinks 14 ounces of soda a day, with young men drinking far more — that would mean that most of us would be at some risk.

As a result, CSPI has been petitioning the FDA to change the name or ban the use of the chemicals in soda and other foods, or at least force manufacturers to put warning labels on their packaging. "We think industry can solve this problem," says Jacobson. "They don't want to put warning labels on their products." (More on Time.com: Fitness Apps to Get You Off the Couch)

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