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Friday, September 2, 2011
Results of medication studies in top medical journals may be misleading to readers
erivero@mednet.ucla.edu
UCLA-Harvard study highlights 3 types of confusing outcome measures
Studies about medications published in the most influential medical journals are frequently designed in a way that yields misleading or confusing results, new research suggests.
Investigators from the medical schools at UCLA and Harvard analyzed all the randomized medication trials published in the six highest-impact general medicine journals between June 1, 2008, and Sept. 30, 2010, to determine the prevalence of three types of outcome measures that make data interpretation difficult.
In addition, they reviewed each study's abstract to determine the percentage that reported results using relative rather than absolute numbers, which can also be a misleading.
The findings are published online in the Journal of General Internal Medicine.
The six journals examined by the investigators— the New England Journal of Medicine, the Journal of the American Medical Association, The Lancet, the Annals of Internal Medicine, the British Medical Journal and the Archives of Internal Medicine — included studies that used the following types of outcome measures, which have received increasing criticism from scientific experts:
Surrogate outcomes (37 percent of studies), which refer to intermediate markers, such as a heart medication's ability to lower blood pressure, but which may not be a good indicator of the medication's impact on more important clinical outcomes, like heart attacks.
Composite outcomes (34 percent), which consist of multiple individual outcomes of unequal importance lumped together — such as hospitalizations and mortality — making it difficult to understand the effects on each outcome individually.
Disease-specific mortality (27 percent), which measures deaths from a specific cause rather than from any cause; this may be a misleading measure because, even if a given treatment reduces one type of death, it could increase the risk of dying from another cause, to an equal or greater extent.
"Patients and doctors care less about whether a medication lowers blood pressure than they do about whether it prevents heart attacks and strokes or decreases the risk of premature death," said the study's lead author, Dr. Michael Hochman, a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at the David Geffen School of Medicine at UCLA's division of general internal medicine and health services research, and at the U.S. Department of Veterans Affairs' Los Angeles Medical Center.
"Knowing the effects of a medication on blood pressure does not always tell you what the effect will be on the things that are really important, like heart attacks or strokes," Hochman said. "Similarly, patients don't care if a medication prevents deaths from heart disease if it leads to an equivalent increase in deaths from cancer."
Dr. Danny McCormick, the study's senior author and a physician at the Cambridge Health Alliance and Harvard Medical School, added: "Patients also want to know, in as much detail as possible, what the effects of a treatment are, and this can be difficult when multiple outcomes of unequal importance are lumped together."
The authors also found that trials that used surrogate outcomes and disease-specific mortality were more likely to be exclusively commercially funded — for instance, by a pharmaceutical company.
While 45 percent of exclusively commercially funded trials used surrogate endpoints, only 29 percent of trials receiving non-commercial funding did. And while 39 percent of exclusively commercially funded trials used disease-specific mortality, only 16 percent of trials receiving non-commercial funding did.
The researchers suggest that commercial sponsors of research may promote the use of outcomes that are most likely to indicate favorable results for their products, Hochman said.
"For example, it may be easier to show that a commercial product has a beneficial effect on a surrogate marker like blood pressure than on a hard outcome like heart attacks," he said. "In fact, studies in our analysis using surrogate outcomes were more likely to report positive results than those using hard outcomes like heart attacks."
The new study also shows that 44 percent of study abstracts reported study results exclusively in relative — rather than absolute — numbers, which can be misleading.
"The way in which study results are presented is critical," McCormick said. "It's one thing to say a medication lowers your risk of heart attacks from two-in-a-million to one-in-a-million, and something completely different to say a medication lowers your risk of heart attacks by 50 percent. Both ways of presenting the data are technically correct, but the second way, using relative numbers, could be misleading."
Still, the authors acknowledge that the use of surrogate and composite outcomes and disease-specific mortality is appropriate in some cases. For example, these outcomes may be preferable in early-phase studies in which researchers hope to quickly determine whether a new treatment has the potential to help patients.
To remedy the problems identified by their analysis, Hochman and McCormick believe that studies should report results in absolute numbers, either instead of or in addition to relative numbers, and that committees overseeing research studies should closely scrutinize study outcomes to ensure that lower-quality outcomes, like surrogate makers, are only used in appropriate circumstances.
"Finally, medical journals should ensure that authors clearly indicate the limitations of lower-quality endpoints when they are used — something that does not always occur," McCormick said.
About Dr Kevin LauDr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
erivero@mednet.ucla.edu
UCLA-Harvard study highlights 3 types of confusing outcome measures
Studies about medications published in the most influential medical journals are frequently designed in a way that yields misleading or confusing results, new research suggests.
Investigators from the medical schools at UCLA and Harvard analyzed all the randomized medication trials published in the six highest-impact general medicine journals between June 1, 2008, and Sept. 30, 2010, to determine the prevalence of three types of outcome measures that make data interpretation difficult.
In addition, they reviewed each study's abstract to determine the percentage that reported results using relative rather than absolute numbers, which can also be a misleading.
The findings are published online in the Journal of General Internal Medicine.
The six journals examined by the investigators— the New England Journal of Medicine, the Journal of the American Medical Association, The Lancet, the Annals of Internal Medicine, the British Medical Journal and the Archives of Internal Medicine — included studies that used the following types of outcome measures, which have received increasing criticism from scientific experts:
Surrogate outcomes (37 percent of studies), which refer to intermediate markers, such as a heart medication's ability to lower blood pressure, but which may not be a good indicator of the medication's impact on more important clinical outcomes, like heart attacks.
Composite outcomes (34 percent), which consist of multiple individual outcomes of unequal importance lumped together — such as hospitalizations and mortality — making it difficult to understand the effects on each outcome individually.
Disease-specific mortality (27 percent), which measures deaths from a specific cause rather than from any cause; this may be a misleading measure because, even if a given treatment reduces one type of death, it could increase the risk of dying from another cause, to an equal or greater extent.
"Patients and doctors care less about whether a medication lowers blood pressure than they do about whether it prevents heart attacks and strokes or decreases the risk of premature death," said the study's lead author, Dr. Michael Hochman, a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at the David Geffen School of Medicine at UCLA's division of general internal medicine and health services research, and at the U.S. Department of Veterans Affairs' Los Angeles Medical Center.
"Knowing the effects of a medication on blood pressure does not always tell you what the effect will be on the things that are really important, like heart attacks or strokes," Hochman said. "Similarly, patients don't care if a medication prevents deaths from heart disease if it leads to an equivalent increase in deaths from cancer."
Dr. Danny McCormick, the study's senior author and a physician at the Cambridge Health Alliance and Harvard Medical School, added: "Patients also want to know, in as much detail as possible, what the effects of a treatment are, and this can be difficult when multiple outcomes of unequal importance are lumped together."
The authors also found that trials that used surrogate outcomes and disease-specific mortality were more likely to be exclusively commercially funded — for instance, by a pharmaceutical company.
While 45 percent of exclusively commercially funded trials used surrogate endpoints, only 29 percent of trials receiving non-commercial funding did. And while 39 percent of exclusively commercially funded trials used disease-specific mortality, only 16 percent of trials receiving non-commercial funding did.
The researchers suggest that commercial sponsors of research may promote the use of outcomes that are most likely to indicate favorable results for their products, Hochman said.
"For example, it may be easier to show that a commercial product has a beneficial effect on a surrogate marker like blood pressure than on a hard outcome like heart attacks," he said. "In fact, studies in our analysis using surrogate outcomes were more likely to report positive results than those using hard outcomes like heart attacks."
The new study also shows that 44 percent of study abstracts reported study results exclusively in relative — rather than absolute — numbers, which can be misleading.
"The way in which study results are presented is critical," McCormick said. "It's one thing to say a medication lowers your risk of heart attacks from two-in-a-million to one-in-a-million, and something completely different to say a medication lowers your risk of heart attacks by 50 percent. Both ways of presenting the data are technically correct, but the second way, using relative numbers, could be misleading."
Still, the authors acknowledge that the use of surrogate and composite outcomes and disease-specific mortality is appropriate in some cases. For example, these outcomes may be preferable in early-phase studies in which researchers hope to quickly determine whether a new treatment has the potential to help patients.
To remedy the problems identified by their analysis, Hochman and McCormick believe that studies should report results in absolute numbers, either instead of or in addition to relative numbers, and that committees overseeing research studies should closely scrutinize study outcomes to ensure that lower-quality outcomes, like surrogate makers, are only used in appropriate circumstances.
"Finally, medical journals should ensure that authors clearly indicate the limitations of lower-quality endpoints when they are used — something that does not always occur," McCormick said.
About Dr Kevin LauDr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
Half of Americans sip sugary drinks daily
August 31, 2011 -- Updated 1747 GMT (0147 HKT)
(CNN) -- When it was first invented, soda pop was a treat most people had once in a while for special occasions.
Now it's a daily fixture in American life -- in bright containers glowing inside vending machines, chugged from 32-ounce bucket-like containers at self-service stations and served as the default beverage in fast-food meals.
In today's carbonation nation, half of the U.S. population over age 2 consumes sugary drinks daily, according to a report released by National Center for Health Statistics.
The sugary drinks include sodas, sweetened waters, and energy, sports and fruit beverages. Not included in the total were diet drinks, 100% fruit juices, sweetened teas and flavored milk. The report states that sugary drinks have been linked to "poor diet quality, weight gain, obesity, and in adults, type 2 diabetes."
Male teens are the most frequent consumers and guzzle about 252 to 273 calories every day from various drinks, the report says. Their one-day consumption is more than half the weekly intake suggested by the American Heart Association, which recommends no more than three 12-ounce cans of soda in one week (equivalent to 450 calories).
The consumption of such sugary drinks has increased over the last 30 years, the report stated.
A 2003 study published in the Journal of the American Dietetic Association found that soda drinking for youths between the ages of 6 and 17 was at 37% in the 1970s and then 56% in the 1990s. This latest research from the Centers for Disease Control and Prevention suggests that from 2005 to 2008, consumption increased again.
"If you look at male children, 70% consume on a given day," said lead author Cynthia Ogden, a CDC epidemiologist who specializes in obesity.
The analysis was based on 17,000 participants who were asked to recall what they ate in the last 24 hours in the National Health and Nutrition Examination Survey.
The American Beverage Association denied that its products fueled obesity: "Contrary to what may be implied ... sugar-sweetened beverages are not driving health issues like obesity and diabetes."
It pointed to market data indicating that the calories in beverages decreased by 21% from 1998 to 2008, while obesity rates climbed. It also stated that sugar-sweetened beverages account for 7% of calories in the average American diet.
"That means Americans get 93 percent of their calories from other foods and beverages," the group stated.
The latest CDC research released Wednesday also found similar results: Kids and teens get about 6.7% to 8.2% of their daily caloric intake from the beverages, and adults get about 5% to 8%.
But the extra calories from drinks could add several pounds every year, said Marisa Moore, a nutritionist.
"A lot of times, people don't think of beverages as part of their daily total calories," she said. "When I think about soda drinking -- in general, it provides empty calories. It takes the place of more nutritious options."
She suggested alternatives like water, sparkling water, tea and skim milk.
The CDC's report found major differences in soda consumption depending on race, sex and income level.
In every age category, males consumed more sugary drinks than females. This could be because males consume more calories than females, Ogden said.
In terms of race, black children got about 8.5% of their total daily calories from sugary drinks, compared with 8.2% for Mexican-American and 7.7% for white children. Black adults received 8.6% of their daily calories from sugary drinks, and the figure was 8.2% for Mexican-Americans and 5.3% for whites.
There was also a direct association between income level and sugary beverage consumption. Adults living in a family of four earning approximately $29,000 per year got 8.8% of their daily calories from sugary drinks, compared with 4.4% for those who earned about $77,000.
Last year, New York attempted to end subsidizing the purchase of sodas in the food stamps program, saying the benefits were used to fuel a serious public health problem. But this month, the U.S. Department of Agriculture rejected the city's proposal, citing agency concerns that "the scale and scope" of banning soda would be "too large and complex."
The Big Apple has actively campaigned for soda reduction with a stomach-churning ad that likened drinking soda to chugging dollops of fat.
The recent CDC report also found that while half of the population doesn't drink sugary beverages, about 25% consumes amounts of the drinks that total fewer than 200 calories per day. About 5% drink about 567 calories on any given day, which amounts to more than four 12-ounce cans of cola.
Sugary drinks became ingrained in American daily life because of effective ad campaigns, fast-food restaurants and increased serving sizes, said Michael Jacobson, executive director of the Center for Science in the Public Interest. But the tides are turning, he said.
The group announced a campaign Wednesday called Life's Sweeter to nationally organize civic associations, minority groups and religious communities to reduce soda consumption.
"There's pretty much a consensus among health officials that soft drinks are a major cause of obesity," Jacobson said.
Boston's government buildings have banned soda, several public school systems have kicked them out of their campuses, and the Cleveland Clinic has stopped selling the beverages in its hospitals.
"There's a real movement in that direction, and the soda industry recognizes this and is diversifying away from traditional carbonated drinks to bottled water and noncarbonated things like energy drinks and sports drinks," Jacobson said. "The soft drink industry is very nervous and will diversify to maintain their profits."
While energy drinks and sports drinks may have fewer calories and less sugar, they enjoy health halos that are not warranted, he said.
Pediatricians: No energy drinks for kids; greatly limit use of sports drinks
Dr. Sandeep Gupta, director of the Pediatric Overweight Education and Research Program at Indiana University Health, said it's easy to be misled by drink labels.
"Many times, they don't know," he said about his pediatric patients who guzzle sugar-sweetened beverages with labels touting vitamins and antioxidants. "The marketing is so skewed. 'Get your 100% vitamin C, juice.' They don't tell you how much sugar is there. Look at the back, not the front of the package."
About Dr Kevin Lau
Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
August 31, 2011 -- Updated 1747 GMT (0147 HKT)
(CNN) -- When it was first invented, soda pop was a treat most people had once in a while for special occasions.
Now it's a daily fixture in American life -- in bright containers glowing inside vending machines, chugged from 32-ounce bucket-like containers at self-service stations and served as the default beverage in fast-food meals.
In today's carbonation nation, half of the U.S. population over age 2 consumes sugary drinks daily, according to a report released by National Center for Health Statistics.
The sugary drinks include sodas, sweetened waters, and energy, sports and fruit beverages. Not included in the total were diet drinks, 100% fruit juices, sweetened teas and flavored milk. The report states that sugary drinks have been linked to "poor diet quality, weight gain, obesity, and in adults, type 2 diabetes."
Male teens are the most frequent consumers and guzzle about 252 to 273 calories every day from various drinks, the report says. Their one-day consumption is more than half the weekly intake suggested by the American Heart Association, which recommends no more than three 12-ounce cans of soda in one week (equivalent to 450 calories).
The consumption of such sugary drinks has increased over the last 30 years, the report stated.
A 2003 study published in the Journal of the American Dietetic Association found that soda drinking for youths between the ages of 6 and 17 was at 37% in the 1970s and then 56% in the 1990s. This latest research from the Centers for Disease Control and Prevention suggests that from 2005 to 2008, consumption increased again.
"If you look at male children, 70% consume on a given day," said lead author Cynthia Ogden, a CDC epidemiologist who specializes in obesity.
The analysis was based on 17,000 participants who were asked to recall what they ate in the last 24 hours in the National Health and Nutrition Examination Survey.
The American Beverage Association denied that its products fueled obesity: "Contrary to what may be implied ... sugar-sweetened beverages are not driving health issues like obesity and diabetes."
It pointed to market data indicating that the calories in beverages decreased by 21% from 1998 to 2008, while obesity rates climbed. It also stated that sugar-sweetened beverages account for 7% of calories in the average American diet.
"That means Americans get 93 percent of their calories from other foods and beverages," the group stated.
The latest CDC research released Wednesday also found similar results: Kids and teens get about 6.7% to 8.2% of their daily caloric intake from the beverages, and adults get about 5% to 8%.
But the extra calories from drinks could add several pounds every year, said Marisa Moore, a nutritionist.
"A lot of times, people don't think of beverages as part of their daily total calories," she said. "When I think about soda drinking -- in general, it provides empty calories. It takes the place of more nutritious options."
She suggested alternatives like water, sparkling water, tea and skim milk.
The CDC's report found major differences in soda consumption depending on race, sex and income level.
In every age category, males consumed more sugary drinks than females. This could be because males consume more calories than females, Ogden said.
In terms of race, black children got about 8.5% of their total daily calories from sugary drinks, compared with 8.2% for Mexican-American and 7.7% for white children. Black adults received 8.6% of their daily calories from sugary drinks, and the figure was 8.2% for Mexican-Americans and 5.3% for whites.
There was also a direct association between income level and sugary beverage consumption. Adults living in a family of four earning approximately $29,000 per year got 8.8% of their daily calories from sugary drinks, compared with 4.4% for those who earned about $77,000.
Last year, New York attempted to end subsidizing the purchase of sodas in the food stamps program, saying the benefits were used to fuel a serious public health problem. But this month, the U.S. Department of Agriculture rejected the city's proposal, citing agency concerns that "the scale and scope" of banning soda would be "too large and complex."
The Big Apple has actively campaigned for soda reduction with a stomach-churning ad that likened drinking soda to chugging dollops of fat.
The recent CDC report also found that while half of the population doesn't drink sugary beverages, about 25% consumes amounts of the drinks that total fewer than 200 calories per day. About 5% drink about 567 calories on any given day, which amounts to more than four 12-ounce cans of cola.
Sugary drinks became ingrained in American daily life because of effective ad campaigns, fast-food restaurants and increased serving sizes, said Michael Jacobson, executive director of the Center for Science in the Public Interest. But the tides are turning, he said.
The group announced a campaign Wednesday called Life's Sweeter to nationally organize civic associations, minority groups and religious communities to reduce soda consumption.
"There's pretty much a consensus among health officials that soft drinks are a major cause of obesity," Jacobson said.
Boston's government buildings have banned soda, several public school systems have kicked them out of their campuses, and the Cleveland Clinic has stopped selling the beverages in its hospitals.
"There's a real movement in that direction, and the soda industry recognizes this and is diversifying away from traditional carbonated drinks to bottled water and noncarbonated things like energy drinks and sports drinks," Jacobson said. "The soft drink industry is very nervous and will diversify to maintain their profits."
While energy drinks and sports drinks may have fewer calories and less sugar, they enjoy health halos that are not warranted, he said.
Pediatricians: No energy drinks for kids; greatly limit use of sports drinks
Dr. Sandeep Gupta, director of the Pediatric Overweight Education and Research Program at Indiana University Health, said it's easy to be misled by drink labels.
"Many times, they don't know," he said about his pediatric patients who guzzle sugar-sweetened beverages with labels touting vitamins and antioxidants. "The marketing is so skewed. 'Get your 100% vitamin C, juice.' They don't tell you how much sugar is there. Look at the back, not the front of the package."
About Dr Kevin Lau
Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
Belly bacteria boss the brain
By Tina Hesman Saey
Friendly intestinal bacteria not only keep the gut happy, they may help keep their host happy, too, a new study in mice finds.
Mice fed broth fortified with a type of friendly intestinal bacteria called Lactobacillus rhamnosus behaved less anxiously than mice fed broth without bacteria. Those behavior changes were accompanied by differences in levels of a brain-chemical sensor and stress hormones.
The bacteria telegraph these brain-chemical and behavior-changing messages via the vagus nerve, which connects the brain stem to various internal organs, researchers report online August 29 in the Proceedings of the National Academy of Sciences.
Some studies have suggested that changing the mix of bacteria in the intestines could influence behavior (SN: 6/18/11, p. 26). The new research goes a step further to investigate how those changes come about, says Paul Patterson, a neuroimmunologist at Caltech in Pasadena, Calif. “Most people haven’t gone that far to look at what’s happening in the brain,” he says.
The research team — led by John Bienenstock of McMaster University in Hamilton, Canada, and John Cryan of the University College Cork in Ireland — looked at the mice’s brains to examine levels of the GABA receptor, a protein that senses and responds to an important brain chemical messenger called GABA. Alterations in the way GABA and other brain chemical systems work influence behavior. Mice fed bacteria-containing broth had higher levels of the receptor protein in some parts of the brain and lower levels in other parts than did mice fed sterile broth.
Mice usually stay close to walls, but ones that consumed the bacterium spent more time in open spaces in a special maze — a measure that tells scientists the mice are less anxious than usual. The researchers also gave the mice a stress test by forcing the animals to swim in a water tank. Stressed mice that had eatenLactobacillus rhamnosus had lower levels of stress hormones than did mice that ate broth alone.
When the scientists severed the vagus nerve, the mice no longer had altered levels of the GABA receptor and didn’t exhibit behavior differences, indicating that nerve is probably the major route gut bacteria use to transmit information to the brain.
The vagus nerve “is the obvious route, but that’s not to say it’s the only route,” says Bienenstock. Messages may also be transmitted through other nerves or through chemicals in the blood. The researchers still don’t know what sort of message the bacteria send to the brain or whether bacterial supplements can make a difference in regulating people’s behavior.
Some researchers have proposed, based on experiments in mice, that gut bacteria could play a role in a wide variety of brain and psychiatric disorders, such as depression, anxiety, autism and schizophrenia.
But, “one has to be cautious. This is exciting science in rodents, but you can’t just extrapolate to humans,” says Emeran Mayer, a gastroenterologist and neuroscientist at UCLA’s Center for Neurobiology of Stress who was not involved in the new study.
Drug and food companies that make probiotics — beneficial bacteria taken in a pill or eaten in food such as yogurt — hope the products can help relieve depression, improve weight loss and cure other conditions, but there is little evidence in people that probiotics can accomplish those goals, Mayer says.
“It’s almost like science fiction; you can imagine the most amazing things because so little is known about it,” he says. But, “So far there’s really no evidence that probiotics affect emotions in humans.”
About Dr Kevin Lau
Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
By Tina Hesman Saey
Friendly intestinal bacteria not only keep the gut happy, they may help keep their host happy, too, a new study in mice finds.
Mice fed broth fortified with a type of friendly intestinal bacteria called Lactobacillus rhamnosus behaved less anxiously than mice fed broth without bacteria. Those behavior changes were accompanied by differences in levels of a brain-chemical sensor and stress hormones.
The bacteria telegraph these brain-chemical and behavior-changing messages via the vagus nerve, which connects the brain stem to various internal organs, researchers report online August 29 in the Proceedings of the National Academy of Sciences.
Some studies have suggested that changing the mix of bacteria in the intestines could influence behavior (SN: 6/18/11, p. 26). The new research goes a step further to investigate how those changes come about, says Paul Patterson, a neuroimmunologist at Caltech in Pasadena, Calif. “Most people haven’t gone that far to look at what’s happening in the brain,” he says.
The research team — led by John Bienenstock of McMaster University in Hamilton, Canada, and John Cryan of the University College Cork in Ireland — looked at the mice’s brains to examine levels of the GABA receptor, a protein that senses and responds to an important brain chemical messenger called GABA. Alterations in the way GABA and other brain chemical systems work influence behavior. Mice fed bacteria-containing broth had higher levels of the receptor protein in some parts of the brain and lower levels in other parts than did mice fed sterile broth.
Mice usually stay close to walls, but ones that consumed the bacterium spent more time in open spaces in a special maze — a measure that tells scientists the mice are less anxious than usual. The researchers also gave the mice a stress test by forcing the animals to swim in a water tank. Stressed mice that had eatenLactobacillus rhamnosus had lower levels of stress hormones than did mice that ate broth alone.
When the scientists severed the vagus nerve, the mice no longer had altered levels of the GABA receptor and didn’t exhibit behavior differences, indicating that nerve is probably the major route gut bacteria use to transmit information to the brain.
The vagus nerve “is the obvious route, but that’s not to say it’s the only route,” says Bienenstock. Messages may also be transmitted through other nerves or through chemicals in the blood. The researchers still don’t know what sort of message the bacteria send to the brain or whether bacterial supplements can make a difference in regulating people’s behavior.
Some researchers have proposed, based on experiments in mice, that gut bacteria could play a role in a wide variety of brain and psychiatric disorders, such as depression, anxiety, autism and schizophrenia.
But, “one has to be cautious. This is exciting science in rodents, but you can’t just extrapolate to humans,” says Emeran Mayer, a gastroenterologist and neuroscientist at UCLA’s Center for Neurobiology of Stress who was not involved in the new study.
Drug and food companies that make probiotics — beneficial bacteria taken in a pill or eaten in food such as yogurt — hope the products can help relieve depression, improve weight loss and cure other conditions, but there is little evidence in people that probiotics can accomplish those goals, Mayer says.
“It’s almost like science fiction; you can imagine the most amazing things because so little is known about it,” he says. But, “So far there’s really no evidence that probiotics affect emotions in humans.”
About Dr Kevin Lau
Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
Another Reason to Ignore the Warnings About This Super Food
The idea that eggs, as a source of saturated fats, are unhealthy and promote heart disease is a complete myth. While it's true that fats from animal sources contain cholesterol, this is not necessarily something that will harm you. On the contrary, the evidence clearly shows that eggs are one of the most healthful foods you can eat, and can actually help prevent disease, including heart disease.For example, one 2009 study discovered that the proteins in cooked eggs are converted by gastrointestinal enzymes, producing peptides that act as ACE inhibitors (common prescription medications for lowering blood pressure). This certainly flies in the face of 'conventional wisdom,' and the latest findings support the stance that eggs are in fact part of a heart-healthy diet.Although egg yolks are relatively high in cholesterol, numerous studies have confirmed that eggs have virtually nothing to do with raising your cholesterol. For instance, research published in the International Journal of Cardiology showed that, in healthy adults, eating eggs every day did not produce a negative effect on endothelial function (an aggregate measure of cardiac risk); nor did it increase cholesterol levels.A number of people have cholesterol levels that are too low. While eating egg yolks is a great idea for a number of reasons, it will not increase your cholesterol level. If you need to do that a fairly reliable method is to use coconut oil. Usually about 2-4 tablespoons a day are required to increase your cholesterol.
The Egg—A Source of Health Promoting Antioxidants!
In the featured study, the researchers examined the nutrient content of egg yolks from hens fed primarily wheat or corn. They determined that the yolks from these conventional chickens contain two amino acids with potent antioxidant properties, which is important for the prevention of cardiovascular disease and cancer:
- Tryptophan
- Tyrosine
Below, I will discuss the nutrient content of organic, pastured eggs, which is far superior to conventional eggs. What's really interesting is that conventional eggs, despite their inferior nutritional content still were found to be such a potent source of heart healthy antioxidants! The analysis showed that two raw egg yolks have antioxidant properties equivalent to half a serving of cranberries (25 grams), and almost twice as many as an apple.The research also illustrates just how destructive cooking is. The antioxidant properties were reduced by about 50 percent when the eggs were fried or boiled, followed by microwaving, which resulted in an even greater reduction.Although not specifically mentioned in the featured study, egg yolks are also a rich source of the antioxidants lutein and zeaxanthin, which belong to the class of carotenoids known as xanthophylls. These two are powerful prevention elements of age-related macular degeneration; the most common cause of blindness.Additionally, as a side note, the amino acid tryptophan is also an important precursor to the brain chemical serotonin, which helps regulate your mood, and tyrosine synthesizes two key neurotransmitters, dopamine and norepinephrine, which promote alertness and mental activity. I mention this to remind you that the potential health benefits of eggs certainly go far beyond heart health...
Not All Eggs are Created Equal
Eggs are also an incredible source of high-quality protein and fat—nutrients that many are deficient in. And I believe eggs are a nearly ideal fuel source for most of us.However, there are two caveats:
- Free-range or “pastured” organic eggs are far superior when it comes to nutrient content, and
- Cooking destroys many of these nutrients, so ideally, you’ll want to consume your eggs raw (but ONLY if they’re pastured organic, as conventionally-raised eggs are far more likely to be contaminated with disease-causing bacteria such as salmonella)
An egg is considered organic if the chicken was only fed organic food, which means it will not have accumulated high levels of pesticides from the grains (mostly GM corn) fed to typical chickens.Additionally, testing has confirmed that true free-range eggs are far more nutritious than commercially raised eggs. In a 2007 egg-testing project, Mother Earth News compared the official U.S. Department of Agriculture (USDA) nutrient data for commercial eggs with eggs from hens raised on pasture and found that the latter typically contains:
- 1/3 less cholesterol
- 1/4 less saturated fat
- 2/3 more vitamin A
- 2 times more omega-3 fatty acids
- 3 times more vitamin E
- 7 times more beta carotene
The dramatically superior nutrient levels are most likely the result of the differences in diet between free ranging, pastured hens and commercially farmed hens.
Should You Refrigerate Your Eggs?
Before we get into the issue of eating raw versus cooked eggs, let's review the ideal storage method for your eggs. Contrary to popular belief, fresh pastured eggs that have an intact cuticle do not require refrigeration, as long as you are going to consume them within a relatively short period of time.This is well known in many other countries, including parts of Europe, and many organic farmers will not refrigerate their eggs. In the U.S., refrigeration of eggs became the cultural norm when mass production caused eggs to travel long distances and sit in storage for weeks to months before arriving at your local supermarket. Additionally, the general lack of cleanliness of factory farms increases the likelihood that your eggs have come into contact with pathogens, amplifying the need for both disinfection and refrigeration.So, if your eggs are fresh from the organic farm, with intact cuticles, and will be consumed within a few days, you can simply leave them on the counter or in a cool cupboard. The shelf life for an unrefrigerated egg is around 7 to 10 days.When refrigerated, they'll stay fresh for 30-45 days. Keep this in mind when purchasing eggs from your grocery store, as by the time they hit the shelf, they may already be three weeks old, or older... USDA certified eggs will have a pack date and a sell-by date on the carton, so check the label. For more information about the date codes on your egg carton, see this link.
How to Eat Your Eggs for Maximum Health Benefits
Quite a few people are allergic to eggs, but I believe this is because they are cooked. When you heat the egg, the protein changes its chemical shape, and this type of distortion can easily lead to allergies. When consumed in their raw state, the incidence of egg allergy virtually disappears.This distortion may be further magnified depending on the manner in which it's cooked. Microwaves heat food by causing water molecules in it to resonate at very high frequencies and eventually turn to steam, which heats your food. But it also changes your food's chemical structure in ways that regular cooking does not.It is my belief that eating eggs raw helps preserve many of the highly perishable nutrients, and the results in the featured study confirms this as raw egg yolk lost about half of its antioxidant potential when boiled, fried, or worse, microwaved.Remember that most of the nutrition in an egg is in the yolk, not the white which is merely protein and many have a texture problem when eating them raw. The yolk on the other hand is loaded with nutrients, like bioflavonoids, brain fats like phosphatidyl choline, powerful antioxidants and sulfur. I have four raw egg yolks almost every day and throw away the whites as I don't need the extra protein, but one can soft boil or poach them I personally put my raw egg yolks over a bed of dehydrated kale and cucumber pulp left over from juicing, along with a whole avocado and some chopped red onions.If you choose not to eat your eggs raw, poached or soft-boiled is your next best option. Aside from microwaving, scrambling your eggs is one of the worst ways to cook them as it oxidizes the cholesterol in the egg yolk, which may in fact harm your health.
What about the Risk of Salmonella?
The CDC and other public health organizations advise you to thoroughly cook your eggs to lower your risk of salmonella, but as long as they're pastured and organic, eating your eggs raw is actually the best in terms of your health.The salmonella risk is primarily heightened when the hens are raised in unsanitary conditions, which is extremely rare for small organic farms where the chickens are raised in clean, spacious coops, have access to sunlight, and forage for their natural food. The salmonella risk can be high in conventional eggs, however, which is why I advise against eating conventional eggs raw. One study by the British government found that 23 percent of farms with caged hens tested positive for salmonella, compared to just over 4 percent in organic flocks and 6.5 percent in free-range flocks.
How to Find Fresh Pastured Organic Eggs
The key to getting high quality eggs is to buy them locally, either from an organic farm or farmers market. Fortunately, finding organic eggs locally is far easier than finding raw milk as virtually every rural area has individuals with chickens. Farmers markets are a great way to meet the people who produce your food. With face-to-face contact, you can get your questions answered and know exactly what you're buying. Better yet, visit the farm and ask for a tour.To locate a free-range pasture farm, try asking your local health food store, or check out the following web listings:If you absolutely must purchase your eggs from a commercial grocery store, look for ones that are marked free-range organic. They're still going to originate from a mass-production facility (so you'll want to be careful about eating them raw), but it's about as good as it gets if you can't find a local source.I would strongly encourage you to AVOID ALL omega-3 eggs, as they are some of the least healthy for you. These eggs typically come from chickens that are fed poor-quality sources of omega-3 fats that are already oxidized. Also, omega-3 eggs perish much faster than non-omega-3 eggs.For more tips on eggs, including how to identify fresh, high-quality eggs, please read Raw Eggs for Your Health.
About Dr Kevin LauDr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
The idea that eggs, as a source of saturated fats, are unhealthy and promote heart disease is a complete myth. While it's true that fats from animal sources contain cholesterol, this is not necessarily something that will harm you. On the contrary, the evidence clearly shows that eggs are one of the most healthful foods you can eat, and can actually help prevent disease, including heart disease.For example, one 2009 study discovered that the proteins in cooked eggs are converted by gastrointestinal enzymes, producing peptides that act as ACE inhibitors (common prescription medications for lowering blood pressure). This certainly flies in the face of 'conventional wisdom,' and the latest findings support the stance that eggs are in fact part of a heart-healthy diet.Although egg yolks are relatively high in cholesterol, numerous studies have confirmed that eggs have virtually nothing to do with raising your cholesterol. For instance, research published in the International Journal of Cardiology showed that, in healthy adults, eating eggs every day did not produce a negative effect on endothelial function (an aggregate measure of cardiac risk); nor did it increase cholesterol levels.A number of people have cholesterol levels that are too low. While eating egg yolks is a great idea for a number of reasons, it will not increase your cholesterol level. If you need to do that a fairly reliable method is to use coconut oil. Usually about 2-4 tablespoons a day are required to increase your cholesterol.
The Egg—A Source of Health Promoting Antioxidants!
In the featured study, the researchers examined the nutrient content of egg yolks from hens fed primarily wheat or corn. They determined that the yolks from these conventional chickens contain two amino acids with potent antioxidant properties, which is important for the prevention of cardiovascular disease and cancer:
- Tryptophan
- Tyrosine
Below, I will discuss the nutrient content of organic, pastured eggs, which is far superior to conventional eggs. What's really interesting is that conventional eggs, despite their inferior nutritional content still were found to be such a potent source of heart healthy antioxidants! The analysis showed that two raw egg yolks have antioxidant properties equivalent to half a serving of cranberries (25 grams), and almost twice as many as an apple.The research also illustrates just how destructive cooking is. The antioxidant properties were reduced by about 50 percent when the eggs were fried or boiled, followed by microwaving, which resulted in an even greater reduction.Although not specifically mentioned in the featured study, egg yolks are also a rich source of the antioxidants lutein and zeaxanthin, which belong to the class of carotenoids known as xanthophylls. These two are powerful prevention elements of age-related macular degeneration; the most common cause of blindness.Additionally, as a side note, the amino acid tryptophan is also an important precursor to the brain chemical serotonin, which helps regulate your mood, and tyrosine synthesizes two key neurotransmitters, dopamine and norepinephrine, which promote alertness and mental activity. I mention this to remind you that the potential health benefits of eggs certainly go far beyond heart health...
Not All Eggs are Created Equal
Eggs are also an incredible source of high-quality protein and fat—nutrients that many are deficient in. And I believe eggs are a nearly ideal fuel source for most of us.However, there are two caveats:
- Free-range or “pastured” organic eggs are far superior when it comes to nutrient content, and
- Cooking destroys many of these nutrients, so ideally, you’ll want to consume your eggs raw (but ONLY if they’re pastured organic, as conventionally-raised eggs are far more likely to be contaminated with disease-causing bacteria such as salmonella)
An egg is considered organic if the chicken was only fed organic food, which means it will not have accumulated high levels of pesticides from the grains (mostly GM corn) fed to typical chickens.Additionally, testing has confirmed that true free-range eggs are far more nutritious than commercially raised eggs. In a 2007 egg-testing project, Mother Earth News compared the official U.S. Department of Agriculture (USDA) nutrient data for commercial eggs with eggs from hens raised on pasture and found that the latter typically contains:
- 1/3 less cholesterol
- 1/4 less saturated fat
- 2/3 more vitamin A
- 2 times more omega-3 fatty acids
- 3 times more vitamin E
- 7 times more beta carotene
The dramatically superior nutrient levels are most likely the result of the differences in diet between free ranging, pastured hens and commercially farmed hens.
Should You Refrigerate Your Eggs?
Before we get into the issue of eating raw versus cooked eggs, let's review the ideal storage method for your eggs. Contrary to popular belief, fresh pastured eggs that have an intact cuticle do not require refrigeration, as long as you are going to consume them within a relatively short period of time.This is well known in many other countries, including parts of Europe, and many organic farmers will not refrigerate their eggs. In the U.S., refrigeration of eggs became the cultural norm when mass production caused eggs to travel long distances and sit in storage for weeks to months before arriving at your local supermarket. Additionally, the general lack of cleanliness of factory farms increases the likelihood that your eggs have come into contact with pathogens, amplifying the need for both disinfection and refrigeration.So, if your eggs are fresh from the organic farm, with intact cuticles, and will be consumed within a few days, you can simply leave them on the counter or in a cool cupboard. The shelf life for an unrefrigerated egg is around 7 to 10 days.When refrigerated, they'll stay fresh for 30-45 days. Keep this in mind when purchasing eggs from your grocery store, as by the time they hit the shelf, they may already be three weeks old, or older... USDA certified eggs will have a pack date and a sell-by date on the carton, so check the label. For more information about the date codes on your egg carton, see this link.
How to Eat Your Eggs for Maximum Health Benefits
Quite a few people are allergic to eggs, but I believe this is because they are cooked. When you heat the egg, the protein changes its chemical shape, and this type of distortion can easily lead to allergies. When consumed in their raw state, the incidence of egg allergy virtually disappears.This distortion may be further magnified depending on the manner in which it's cooked. Microwaves heat food by causing water molecules in it to resonate at very high frequencies and eventually turn to steam, which heats your food. But it also changes your food's chemical structure in ways that regular cooking does not.It is my belief that eating eggs raw helps preserve many of the highly perishable nutrients, and the results in the featured study confirms this as raw egg yolk lost about half of its antioxidant potential when boiled, fried, or worse, microwaved.Remember that most of the nutrition in an egg is in the yolk, not the white which is merely protein and many have a texture problem when eating them raw. The yolk on the other hand is loaded with nutrients, like bioflavonoids, brain fats like phosphatidyl choline, powerful antioxidants and sulfur. I have four raw egg yolks almost every day and throw away the whites as I don't need the extra protein, but one can soft boil or poach them I personally put my raw egg yolks over a bed of dehydrated kale and cucumber pulp left over from juicing, along with a whole avocado and some chopped red onions.If you choose not to eat your eggs raw, poached or soft-boiled is your next best option. Aside from microwaving, scrambling your eggs is one of the worst ways to cook them as it oxidizes the cholesterol in the egg yolk, which may in fact harm your health.
What about the Risk of Salmonella?
The CDC and other public health organizations advise you to thoroughly cook your eggs to lower your risk of salmonella, but as long as they're pastured and organic, eating your eggs raw is actually the best in terms of your health.The salmonella risk is primarily heightened when the hens are raised in unsanitary conditions, which is extremely rare for small organic farms where the chickens are raised in clean, spacious coops, have access to sunlight, and forage for their natural food. The salmonella risk can be high in conventional eggs, however, which is why I advise against eating conventional eggs raw. One study by the British government found that 23 percent of farms with caged hens tested positive for salmonella, compared to just over 4 percent in organic flocks and 6.5 percent in free-range flocks.
How to Find Fresh Pastured Organic Eggs
The key to getting high quality eggs is to buy them locally, either from an organic farm or farmers market. Fortunately, finding organic eggs locally is far easier than finding raw milk as virtually every rural area has individuals with chickens. Farmers markets are a great way to meet the people who produce your food. With face-to-face contact, you can get your questions answered and know exactly what you're buying. Better yet, visit the farm and ask for a tour.To locate a free-range pasture farm, try asking your local health food store, or check out the following web listings:If you absolutely must purchase your eggs from a commercial grocery store, look for ones that are marked free-range organic. They're still going to originate from a mass-production facility (so you'll want to be careful about eating them raw), but it's about as good as it gets if you can't find a local source.I would strongly encourage you to AVOID ALL omega-3 eggs, as they are some of the least healthy for you. These eggs typically come from chickens that are fed poor-quality sources of omega-3 fats that are already oxidized. Also, omega-3 eggs perish much faster than non-omega-3 eggs.For more tips on eggs, including how to identify fresh, high-quality eggs, please read Raw Eggs for Your Health.
About Dr Kevin LauDr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
In Depth Analysis of Current Scoliosis Treatment
To Brace or Not to Brace?
There are several types of commonly used scoliosis braces:
1. Thoraco-Lumbo-Sacral-Orthosis (TLSO) The most common form of a TLSO brace is called the "Boston brace", and it may be referred to as an "underarm" brace. This brace is fitted to the child's body and custom molded from plastic. It works by applying three-point pressure to the curvature to prevent its progression. It can be worn under clothing and is typically not noticeable. The TLSO brace is usually worn 23 hours a day. This type of brace is usually prescribed for curves in the lumbar or thoraco-lumbar part of the spine.
2. Cervico-Thoraco-Lumbo-Sacral-Orthosis (known as a Milwaukee brace) The Milwaukee brace is similar to the TLSO described above, but also includes a neck ring held in place by vertical bars attached to the body of the brace. It is also usually worn 23 hours a day. This type of brace is often prescribed for curves in the thoracic spine.
3. Charleston Bending Brace This type of brace is also called a "nighttime" brace because it is only worn while sleeping. A Charleston back brace is molded to the patient while they are bent to the side, and thus applies more pressure and bends the child against the curve. This pressure improves the corrective action of the brace. This type of brace is worn only at night while the child is asleep. Curves must be in the 20 to 40 degree range and the apex of the curve needs to be below the level of the shoulder blade for the Charleston brace to be effective.
Effectivity of Scoliosis Brace
As early as 1993, a report by the US Preventive Services Task Force noted that, "Beyond temporary correction of curves, there is inadequate evidence that braces limit the natural progression of the disease."13 Then again, a 1984 study on scoliosis braces noted a "slight but insignificant" improvement in those who had been braced, "suggesting that bracing reduced the overall probability of progression in the braced curves." The study authors went on to report, "However, noting that nearly 75% of the control group curves were non-progressive, it is possible that a similar proportion of the braced curves need not have been braced."14 Years later, in 1995, a third study done by the Scoliosis Research Society found bracing to be effective.15 However it is important to note that the study was sponsored by the Scoliosis Research Society, an industry body of orthopedists who could have had a definite monetary interest in continuing to prescribe bracing as a major treatment option for scoliosis. I personally think it is always prudent to view studies such as these, where the people funding the research stand to profit monetarily from the study findings, with a healthy dose of skepticism. A 2007 study published in Spine by Drs. Dolan and Weinstein concluded that "observation only or scoliosis brace treatment showed no clear advantage of either approach. Furthermore one can not recommend one approach over another to prevent scoliosis surgery. They gave the recommendation for bracing a grade "D" relative to observation only because of "troublingly inconsistent or inconclusive studies on any level."
The rational way of gauging the effectivity of brace strategy will incorporate comparing results obtained in patients using brace against the expected genetic outcome of non0treated patients. Ogilvie et al. at Axial Bio-Tech performed a similar study and reported in 2009 in the journal Scoliosis that spinal brace has absolutely no positive effect on scoliosis. Research thus far has failed to prove definitively that bracing works, the investigators conclude. As reported by Dr. Stefano Negrini of the Italian Scientific Spine Institute of Milan, Italy, and colleagues report in The Cochrane Library (2010), the evidence for bracing is weak, as is the evidence of any long-term benefits of bracing. The available literature cumulatively constitutes "low quality evidence" in favor of using braces. Questions and uncertainties about the effectiveness and need for use of brace for scoliosis will be more definitively answered once the five-year, multimillion-dollar study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases results are analyzed impartially. The Spine Journalof September 2001 reported in an article titled 'Effectiveness of Bracing Male Patients with Idiopathic Scoliosis' that "Progression of 6 degrees occurred in 74% of boys and 46% reached surgical thresholds.
Bracing of male patients with Idiopathic Scoliosis is ineffective." In another article the 'Children's Research Center in Dublin, Ireland' states "Since 1991 bracing has not been recommended for children with AIS (Adolescent Idiopathic Scoliosis) at this center. It cannot be said to provide meaningful advantage to the patient or the community."16 On the other hand, Musculoskeletal Disorders reported a study on September 14th, 2004 titled, "Scoliosis treatment using a combination of manipulative and rehabilitative therapy," by Mark Morningstar, D.C., Dennis Woggon, D.C., and Gary Lawrence, D.C. 22 scoliosis patients with Cobb angles between 15 to 52 degrees were subjected to a rehabilitation protocol involving specific spinal adjustments, exercise therapy, and vibratory stimulation. Of the 19 patients completing the study, the average reduction in Cobb angle after 6 weeks was 62% (ranging between 8 to 33 degrees reduction and not even a single case of increase). This warrants further expansion and testing of such innovative and non-invasive procedure that target the causes of scoliosis and not the manifested symptoms alone. Despite all these studies, the standard non-surgical treatment for moderate curves (24 to 40 degrees) is still a body brace. Its non-cosmetic appearance is a major deterrent and the main reason for non-compliance, especially among girls.
Conventional brace therapy carries several significant drawbacks. Because the brace stabilizes the spine by exerting pressure on the chest at critical points, it must envelop the trunk, and in so doing, can be bulky and uncomfortable. A brace also restricts body movement, which can over time cause atrophy and weakness of the chest and spinal musculature. As a result, the child's spine begins to lose some of its earlier flexibility and is prone to injury whenever the brace is taken off. When the muscles around the spine weaken, this can further complicate the scoliosis. Worse, in some cases the constant pressure of the brace can cause permanent deformation of the rib cage or the soft tissues directly under the pressure points. In a recent study on the psychological impact of bracing on a growing child, it was revealed that "60% felt that bracing had handicapped their life and 14% considered that it had left a psychological scar."18 Surely, you don't want any of those effects for your child?
Could Surgery Be An Option?
Obviously, if bracing was truly as effective as it is made out to be, then the need for spinal surgery would be reduced quite significantly. Unfortunately this is not the case. Of the 30,000 to 70,000 spinal surgery procedures done each year, about a third is performed for severe scoliosis.19 There are different forms of scoliosis surgery as underlined below.
1. Harrington Procedure:This procedure was the most standard technique involved in scoliosis surgery until 10 years ago. The process involves use of a steel rod that extends from the bottom to the top of the curve, which in turn is supposed to support the fusion of the vertebrae. Pegs are inserted in the bones and serve as the anchors for the suspended rod(s). Of note, a full body cast and complete bed rest for 3-6 months is a pre-requisite post-surgery. Inexplicably, even though the rod is not required after 1-2 years, surgeons never think of taking out the rods until infection or other complications strike. The standout disadvantages of the Harrington procedure are: 1. Extremely tough, especially for adolescents. 2. 10-25% loss of curve correction over time (which is 50% at best); additionally, the procedure is ineffective in correcting the spine rotation and hence does not alleviate the resultant rib hump. 3. Flat back syndrome in upto 40% of patients undergoing the procedure as it removes the normal inward curving of the lower back (lordosis). Prolonged duration of flat back syndrome might incapacitate a person by inhibiting a person to stand erect. 4. Chances of crankshaft phenomenon in kids younger than 11 years having the surgery. The underlying reason is continuing ossification process of the skeleton during the age of the surgery, and the front of the fused spine outgrows after the surgery. The spine curves as it cannot grow straight due to the traction.
2. Cotrel-Dubousset Procedure:Slightly better than Harrington procedure in that it remedial in principle for both the curve and the rotation of the spine, and flat back syndrome is not a complication. The procedure involves cross-linking parallel rods to render more stability to the fused vertebrae. The recovery time is around 3 weeks. The major disadvantages are the complexity of the surgery itself and the number of hooks and cross-links involved (Humke et al., 1995).
3. The Texas Scottish-Rite Hospital (TSRH) Instrumentation:This is very similar in design to the Cotrel-Dubousset procedure, the only difference being use of smoother textured hooks and rods, which are supposed to make subsequent removal or readjustment in case of post-operative complications. Disadvantages also mimic the Cotrel-Dubousset protocol. Other instrumentation that has been used is the Luque instrumentation, which can maintain normal lordosis and was initially thought to circumvent the need of post-surgery brace use. But the flip side was curve correction achieved through surgery was completely reversed in the absence of brace usage and also resulted in incremental incidences of spinal cord injuries. Among others, Wisconsin Segmental Sine Instrumentation (WSSI) is often used but seems to inherit the problems associated with the Luque as well as the Harrington rod procedures and is thus very problematic. Surgeons have classically used the Posterior Approach (access the surgical area through incision at the back of the patient), whereas Anterior Approach(access the surgical area by opening the chest wall) finds lot of supporters among surgeons these days. The major complications arising out of the posterior approach are increased risk of occurrence of the crankshaft phenomenon, where the curve increases with time; and, not amicable to the thoracolumbar region. For the anterior approach, kyphosis (increasing outer curve), increased susceptibility to lung and chest infection, and pseudoarthrosis (pseudo joint at the fusion locale) are the major associated complications. All this and more can be avoided simply by working on the health of the person through making some dietary changes and following an exercise routine, as described in this book. I've worked with hundreds of scoliosis patients and have come to the conclusion that often the cure does not lie in a one-stop surgery or uncomfortable bracing. Often, all that is needed is for the patient to be willing to take a proactive role in the improvement of their own health.
Complications rate were estimated at 15% in children and 25% in adults for all fusion procedures in a study conducted between 1993 and 2002. The major complications were as follows:
Blood loss: Like for any surgical procedure there is significant blood loss which necessitates blood transfusion and so patients are encouraged to donate blood in the pre-operative period, causing further stress on the already suffering patient. Newer endoscopic techniques and use of recombinant human erythropoietin (rhEPO) to boost increased hematopoiesis are being examined to counter the blood loss.
Prone to infection: As with any other surgical procedure, chances of infection are pertinent in scoliosis surgery. Infection in the urinary tract and pancreas are most common and an antibiotic-coverage post-surgery is usually recommended.
Neuronal complications:Neuronal damage occurs in ~1% of patients undergoing surgery, with adults at a considerable higher risk than younger patients. Muscle weakness and/or paralysis are the usual outcome of nerve damage.
Pseudoarthrosis: Happens if the fusion does not heal and a pseudo joint develops at the site of surgery. It is a very painful condition. The anterior approach has higher chances of causing this complication, occurring upto in 20% of all surgery cases.
Low back pain and disk degeneration: The stress on the lower back as a result of the fusions in the lumbar region can ultimately result in disk degeneration. Additionally, compromised muscle strength, lower limb mobility, and balance can also cause excruciating back pain.
Pulmonary function: Younger adults and kids have high risk of developing pulmonary problems post-surgery upto about 2 months after the surgery. The risk is considerably higher in patients where scoliosis is a secondary outcome of neuromuscular problems. Other than the above, gallstones, pancreatitis, intestinal obstruction and hardware injury (resulting from dislodged hooks, breakage of hooks and rusting, or a fracture in a fused vertebrae) are also associated with scoliosis surgery. To alleviate some of the major concerns, few different forms (growing rod technique, vertebral body stapling and anterior spinal tethering) of minimally invasive surgery has been devised. Even though these techniques have shown short-term encouraging results, long term observance of effects and improvements are required for them to be considered seriously.
The Untold Truth about Scoliosis Surgery
The approximate average cost of scoliosis surgery in the U.S. is $120,000 per operation and there are roughly 20,000 such operation each year20. Shockingly, 8000 patients who had underwent scoliosis surgery become disabled each year, and in those who do not become disabled total recourse to the pre-operative condition happens within 22 years of surgery.22 Additionally, there are follow-up surgeries to take care of loosened hooks, broken rods, rust formation!24 Worse, 25% of patients having surgery have compromised motor control post-surgery.23 In some quarters it is suggested that the pitfalls of remedial surgery is actually worse than scoliosis itself. Are these not reasons enough to avoid surgery as the treatment regimen, until of course it is the last resort and pertinent? Do we not have a social responsibility to utilize and incorporate ways in our lifestyle that can significantly cut down on the critical and serious disadvantages of surgery? Precisely, my technique will lead you to just taking that first step towards your rehabilitation without even needing to resort to any of the dangers associated with scoliosis surgery. Alongside, it will improve your overall quality of life as understanding your disease and its cause is the beginning of the end of scoliosis in you.
Some true-life examples and case studies discussed here will reinforce my aforementioned assertions.
[I] Stuart Weinstein, MD, University of Iowa reported in 2003 in the Journal of the American Medical Association(JAMA) "Many with curvature of spine go on to lead normal lives. Many adolescents diagnosed with spine curvatures can skip braces, surgery or other treatment without developing debilitating physical impairments, a 50 year study suggests." Do we really need to incorporate bracing or surgery in young patients?
[II] Dr. J. Steinbeck reported in 2002 that "Forty percent of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons 16.7 years after the surgery." Does surgery really improve quality of life over time?
[III] Dr. Sponseller reported back in 1987 that "Frequency of pain was not reduced...pulmonary function did not change... 40% had minor complications, 20% had major complications, and... there was 1 death [out of 45 patients]. In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to the patient." Why have we still persisted as surgery the method of choice?
[IV] Dr. H Moriya reported in 2005 that "Corrosion was seen on many of the rod junctions (66.2%) after long-term implantation." Why are effective and less dangerous alternatives not being embraced?
[V] Reuters Health (New York) reported on Jan 29, 2008: "Screening for scoliosis and subsequent brace treatment appears to be of no utility in avoiding surgery, Dutch researchers report in the January issue of Pediatrics for Parents. "We think that abolishing screening for scoliosis seems justified," lead investigator Eveline M. Bunge told Reuters Health. This is "because of the lack of evidence that screening and/or early treatment by bracing is beneficial."
[VI] Dr. M. Hawes reported in The Journal of Pediatric Rehabilitation that "Pediatric scoliosis is associated with signs and symptoms including reduced pulmonary function, increased pain and impaired quality of life, all of which worsen during adulthood, even when the curvature remains stable. In 1941, the American Orthopedic Association reported that for 70% of patients treated surgically, the outcome was fair or poor.... Successful surgery still does not eliminate spinal curvature and it introduces irreversible complications whose long-term impact is poorly understood. For most patients there is little or no improvement in pulmonary function.... The rib deformity is eliminated only by rib resection which can dramatically reduce respiratory function even in healthy adolescents. Outcome for pulmonary function and deformity is worse in patients treated surgically before the age of 10 years, despite earlier intervention. Research to develop effective non-surgical methods to prevent progression of mild, reversible spinal curvatures into complex, irreversible spinal deformities is long overdue."
Do we really need surgery? Why Follow my Regimen?
Hereditary pre-disposition: James W. Ogilvie's group discovered genetic markers, two major genetic loci and 12 minor loci that are related to the development of scoliosis. 95% of patients having a curve greater than 40 degrees had a correlation to the identified genetic markers. Hence, it is now possible to predict the hereditary predisposition to scoliosis and based on the same, individualized management regimen can be laid out using my comprehensive care therapeutic strategy, which has the added advantage of being completely non-invasive. The main reason for all these procedures not working is that they try to cure the condition and not the cause. While we are powerless to change our genes we can still change the way it interacts with the environment and thus suppress these genetic faults and how they are ultimately expressed through disease. This is where my proposed regimen of balancing metabolic, neurological and biochemical homeostatic factors using of customized nutrition, exercises and lifestyle regime will be most effective-weed out the cause of scoliosis.
About Dr Kevin LauDr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
To Brace or Not to Brace?
There are several types of commonly used scoliosis braces:
1. Thoraco-Lumbo-Sacral-Orthosis (TLSO) The most common form of a TLSO brace is called the "Boston brace", and it may be referred to as an "underarm" brace. This brace is fitted to the child's body and custom molded from plastic. It works by applying three-point pressure to the curvature to prevent its progression. It can be worn under clothing and is typically not noticeable. The TLSO brace is usually worn 23 hours a day. This type of brace is usually prescribed for curves in the lumbar or thoraco-lumbar part of the spine.
2. Cervico-Thoraco-Lumbo-Sacral-Orthosis (known as a Milwaukee brace) The Milwaukee brace is similar to the TLSO described above, but also includes a neck ring held in place by vertical bars attached to the body of the brace. It is also usually worn 23 hours a day. This type of brace is often prescribed for curves in the thoracic spine.
3. Charleston Bending Brace This type of brace is also called a "nighttime" brace because it is only worn while sleeping. A Charleston back brace is molded to the patient while they are bent to the side, and thus applies more pressure and bends the child against the curve. This pressure improves the corrective action of the brace. This type of brace is worn only at night while the child is asleep. Curves must be in the 20 to 40 degree range and the apex of the curve needs to be below the level of the shoulder blade for the Charleston brace to be effective.
Effectivity of Scoliosis Brace
As early as 1993, a report by the US Preventive Services Task Force noted that, "Beyond temporary correction of curves, there is inadequate evidence that braces limit the natural progression of the disease."13 Then again, a 1984 study on scoliosis braces noted a "slight but insignificant" improvement in those who had been braced, "suggesting that bracing reduced the overall probability of progression in the braced curves." The study authors went on to report, "However, noting that nearly 75% of the control group curves were non-progressive, it is possible that a similar proportion of the braced curves need not have been braced."14 Years later, in 1995, a third study done by the Scoliosis Research Society found bracing to be effective.15 However it is important to note that the study was sponsored by the Scoliosis Research Society, an industry body of orthopedists who could have had a definite monetary interest in continuing to prescribe bracing as a major treatment option for scoliosis. I personally think it is always prudent to view studies such as these, where the people funding the research stand to profit monetarily from the study findings, with a healthy dose of skepticism. A 2007 study published in Spine by Drs. Dolan and Weinstein concluded that "observation only or scoliosis brace treatment showed no clear advantage of either approach. Furthermore one can not recommend one approach over another to prevent scoliosis surgery. They gave the recommendation for bracing a grade "D" relative to observation only because of "troublingly inconsistent or inconclusive studies on any level."
The rational way of gauging the effectivity of brace strategy will incorporate comparing results obtained in patients using brace against the expected genetic outcome of non0treated patients. Ogilvie et al. at Axial Bio-Tech performed a similar study and reported in 2009 in the journal Scoliosis that spinal brace has absolutely no positive effect on scoliosis. Research thus far has failed to prove definitively that bracing works, the investigators conclude. As reported by Dr. Stefano Negrini of the Italian Scientific Spine Institute of Milan, Italy, and colleagues report in The Cochrane Library (2010), the evidence for bracing is weak, as is the evidence of any long-term benefits of bracing. The available literature cumulatively constitutes "low quality evidence" in favor of using braces. Questions and uncertainties about the effectiveness and need for use of brace for scoliosis will be more definitively answered once the five-year, multimillion-dollar study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases results are analyzed impartially. The Spine Journalof September 2001 reported in an article titled 'Effectiveness of Bracing Male Patients with Idiopathic Scoliosis' that "Progression of 6 degrees occurred in 74% of boys and 46% reached surgical thresholds.
Bracing of male patients with Idiopathic Scoliosis is ineffective." In another article the 'Children's Research Center in Dublin, Ireland' states "Since 1991 bracing has not been recommended for children with AIS (Adolescent Idiopathic Scoliosis) at this center. It cannot be said to provide meaningful advantage to the patient or the community."16 On the other hand, Musculoskeletal Disorders reported a study on September 14th, 2004 titled, "Scoliosis treatment using a combination of manipulative and rehabilitative therapy," by Mark Morningstar, D.C., Dennis Woggon, D.C., and Gary Lawrence, D.C. 22 scoliosis patients with Cobb angles between 15 to 52 degrees were subjected to a rehabilitation protocol involving specific spinal adjustments, exercise therapy, and vibratory stimulation. Of the 19 patients completing the study, the average reduction in Cobb angle after 6 weeks was 62% (ranging between 8 to 33 degrees reduction and not even a single case of increase). This warrants further expansion and testing of such innovative and non-invasive procedure that target the causes of scoliosis and not the manifested symptoms alone. Despite all these studies, the standard non-surgical treatment for moderate curves (24 to 40 degrees) is still a body brace. Its non-cosmetic appearance is a major deterrent and the main reason for non-compliance, especially among girls.
Conventional brace therapy carries several significant drawbacks. Because the brace stabilizes the spine by exerting pressure on the chest at critical points, it must envelop the trunk, and in so doing, can be bulky and uncomfortable. A brace also restricts body movement, which can over time cause atrophy and weakness of the chest and spinal musculature. As a result, the child's spine begins to lose some of its earlier flexibility and is prone to injury whenever the brace is taken off. When the muscles around the spine weaken, this can further complicate the scoliosis. Worse, in some cases the constant pressure of the brace can cause permanent deformation of the rib cage or the soft tissues directly under the pressure points. In a recent study on the psychological impact of bracing on a growing child, it was revealed that "60% felt that bracing had handicapped their life and 14% considered that it had left a psychological scar."18 Surely, you don't want any of those effects for your child?
Could Surgery Be An Option?
Obviously, if bracing was truly as effective as it is made out to be, then the need for spinal surgery would be reduced quite significantly. Unfortunately this is not the case. Of the 30,000 to 70,000 spinal surgery procedures done each year, about a third is performed for severe scoliosis.19 There are different forms of scoliosis surgery as underlined below.
1. Harrington Procedure:This procedure was the most standard technique involved in scoliosis surgery until 10 years ago. The process involves use of a steel rod that extends from the bottom to the top of the curve, which in turn is supposed to support the fusion of the vertebrae. Pegs are inserted in the bones and serve as the anchors for the suspended rod(s). Of note, a full body cast and complete bed rest for 3-6 months is a pre-requisite post-surgery. Inexplicably, even though the rod is not required after 1-2 years, surgeons never think of taking out the rods until infection or other complications strike. The standout disadvantages of the Harrington procedure are: 1. Extremely tough, especially for adolescents. 2. 10-25% loss of curve correction over time (which is 50% at best); additionally, the procedure is ineffective in correcting the spine rotation and hence does not alleviate the resultant rib hump. 3. Flat back syndrome in upto 40% of patients undergoing the procedure as it removes the normal inward curving of the lower back (lordosis). Prolonged duration of flat back syndrome might incapacitate a person by inhibiting a person to stand erect. 4. Chances of crankshaft phenomenon in kids younger than 11 years having the surgery. The underlying reason is continuing ossification process of the skeleton during the age of the surgery, and the front of the fused spine outgrows after the surgery. The spine curves as it cannot grow straight due to the traction.
2. Cotrel-Dubousset Procedure:Slightly better than Harrington procedure in that it remedial in principle for both the curve and the rotation of the spine, and flat back syndrome is not a complication. The procedure involves cross-linking parallel rods to render more stability to the fused vertebrae. The recovery time is around 3 weeks. The major disadvantages are the complexity of the surgery itself and the number of hooks and cross-links involved (Humke et al., 1995).
3. The Texas Scottish-Rite Hospital (TSRH) Instrumentation:This is very similar in design to the Cotrel-Dubousset procedure, the only difference being use of smoother textured hooks and rods, which are supposed to make subsequent removal or readjustment in case of post-operative complications. Disadvantages also mimic the Cotrel-Dubousset protocol. Other instrumentation that has been used is the Luque instrumentation, which can maintain normal lordosis and was initially thought to circumvent the need of post-surgery brace use. But the flip side was curve correction achieved through surgery was completely reversed in the absence of brace usage and also resulted in incremental incidences of spinal cord injuries. Among others, Wisconsin Segmental Sine Instrumentation (WSSI) is often used but seems to inherit the problems associated with the Luque as well as the Harrington rod procedures and is thus very problematic. Surgeons have classically used the Posterior Approach (access the surgical area through incision at the back of the patient), whereas Anterior Approach(access the surgical area by opening the chest wall) finds lot of supporters among surgeons these days. The major complications arising out of the posterior approach are increased risk of occurrence of the crankshaft phenomenon, where the curve increases with time; and, not amicable to the thoracolumbar region. For the anterior approach, kyphosis (increasing outer curve), increased susceptibility to lung and chest infection, and pseudoarthrosis (pseudo joint at the fusion locale) are the major associated complications. All this and more can be avoided simply by working on the health of the person through making some dietary changes and following an exercise routine, as described in this book. I've worked with hundreds of scoliosis patients and have come to the conclusion that often the cure does not lie in a one-stop surgery or uncomfortable bracing. Often, all that is needed is for the patient to be willing to take a proactive role in the improvement of their own health.
Complications rate were estimated at 15% in children and 25% in adults for all fusion procedures in a study conducted between 1993 and 2002. The major complications were as follows:
Blood loss: Like for any surgical procedure there is significant blood loss which necessitates blood transfusion and so patients are encouraged to donate blood in the pre-operative period, causing further stress on the already suffering patient. Newer endoscopic techniques and use of recombinant human erythropoietin (rhEPO) to boost increased hematopoiesis are being examined to counter the blood loss.
Prone to infection: As with any other surgical procedure, chances of infection are pertinent in scoliosis surgery. Infection in the urinary tract and pancreas are most common and an antibiotic-coverage post-surgery is usually recommended.
Neuronal complications:Neuronal damage occurs in ~1% of patients undergoing surgery, with adults at a considerable higher risk than younger patients. Muscle weakness and/or paralysis are the usual outcome of nerve damage.
Pseudoarthrosis: Happens if the fusion does not heal and a pseudo joint develops at the site of surgery. It is a very painful condition. The anterior approach has higher chances of causing this complication, occurring upto in 20% of all surgery cases.
Low back pain and disk degeneration: The stress on the lower back as a result of the fusions in the lumbar region can ultimately result in disk degeneration. Additionally, compromised muscle strength, lower limb mobility, and balance can also cause excruciating back pain.
Pulmonary function: Younger adults and kids have high risk of developing pulmonary problems post-surgery upto about 2 months after the surgery. The risk is considerably higher in patients where scoliosis is a secondary outcome of neuromuscular problems. Other than the above, gallstones, pancreatitis, intestinal obstruction and hardware injury (resulting from dislodged hooks, breakage of hooks and rusting, or a fracture in a fused vertebrae) are also associated with scoliosis surgery. To alleviate some of the major concerns, few different forms (growing rod technique, vertebral body stapling and anterior spinal tethering) of minimally invasive surgery has been devised. Even though these techniques have shown short-term encouraging results, long term observance of effects and improvements are required for them to be considered seriously.
The Untold Truth about Scoliosis Surgery
The approximate average cost of scoliosis surgery in the U.S. is $120,000 per operation and there are roughly 20,000 such operation each year20. Shockingly, 8000 patients who had underwent scoliosis surgery become disabled each year, and in those who do not become disabled total recourse to the pre-operative condition happens within 22 years of surgery.22 Additionally, there are follow-up surgeries to take care of loosened hooks, broken rods, rust formation!24 Worse, 25% of patients having surgery have compromised motor control post-surgery.23 In some quarters it is suggested that the pitfalls of remedial surgery is actually worse than scoliosis itself. Are these not reasons enough to avoid surgery as the treatment regimen, until of course it is the last resort and pertinent? Do we not have a social responsibility to utilize and incorporate ways in our lifestyle that can significantly cut down on the critical and serious disadvantages of surgery? Precisely, my technique will lead you to just taking that first step towards your rehabilitation without even needing to resort to any of the dangers associated with scoliosis surgery. Alongside, it will improve your overall quality of life as understanding your disease and its cause is the beginning of the end of scoliosis in you.
Some true-life examples and case studies discussed here will reinforce my aforementioned assertions.
[I] Stuart Weinstein, MD, University of Iowa reported in 2003 in the Journal of the American Medical Association(JAMA) "Many with curvature of spine go on to lead normal lives. Many adolescents diagnosed with spine curvatures can skip braces, surgery or other treatment without developing debilitating physical impairments, a 50 year study suggests." Do we really need to incorporate bracing or surgery in young patients?
[II] Dr. J. Steinbeck reported in 2002 that "Forty percent of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons 16.7 years after the surgery." Does surgery really improve quality of life over time?
[III] Dr. Sponseller reported back in 1987 that "Frequency of pain was not reduced...pulmonary function did not change... 40% had minor complications, 20% had major complications, and... there was 1 death [out of 45 patients]. In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to the patient." Why have we still persisted as surgery the method of choice?
[IV] Dr. H Moriya reported in 2005 that "Corrosion was seen on many of the rod junctions (66.2%) after long-term implantation." Why are effective and less dangerous alternatives not being embraced?
[V] Reuters Health (New York) reported on Jan 29, 2008: "Screening for scoliosis and subsequent brace treatment appears to be of no utility in avoiding surgery, Dutch researchers report in the January issue of Pediatrics for Parents. "We think that abolishing screening for scoliosis seems justified," lead investigator Eveline M. Bunge told Reuters Health. This is "because of the lack of evidence that screening and/or early treatment by bracing is beneficial."
[VI] Dr. M. Hawes reported in The Journal of Pediatric Rehabilitation that "Pediatric scoliosis is associated with signs and symptoms including reduced pulmonary function, increased pain and impaired quality of life, all of which worsen during adulthood, even when the curvature remains stable. In 1941, the American Orthopedic Association reported that for 70% of patients treated surgically, the outcome was fair or poor.... Successful surgery still does not eliminate spinal curvature and it introduces irreversible complications whose long-term impact is poorly understood. For most patients there is little or no improvement in pulmonary function.... The rib deformity is eliminated only by rib resection which can dramatically reduce respiratory function even in healthy adolescents. Outcome for pulmonary function and deformity is worse in patients treated surgically before the age of 10 years, despite earlier intervention. Research to develop effective non-surgical methods to prevent progression of mild, reversible spinal curvatures into complex, irreversible spinal deformities is long overdue."
Do we really need surgery? Why Follow my Regimen?
Hereditary pre-disposition: James W. Ogilvie's group discovered genetic markers, two major genetic loci and 12 minor loci that are related to the development of scoliosis. 95% of patients having a curve greater than 40 degrees had a correlation to the identified genetic markers. Hence, it is now possible to predict the hereditary predisposition to scoliosis and based on the same, individualized management regimen can be laid out using my comprehensive care therapeutic strategy, which has the added advantage of being completely non-invasive. The main reason for all these procedures not working is that they try to cure the condition and not the cause. While we are powerless to change our genes we can still change the way it interacts with the environment and thus suppress these genetic faults and how they are ultimately expressed through disease. This is where my proposed regimen of balancing metabolic, neurological and biochemical homeostatic factors using of customized nutrition, exercises and lifestyle regime will be most effective-weed out the cause of scoliosis.
About Dr Kevin LauDr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau D.C. is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition from Clayton College of Natural Health in USA. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.
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