Prevent Back Pain and Other Common Problems by Sitting Correctly

By Dr. Mercola

From smart phones to computers to iPads, our beloved electronic devices are crippling our posture and contributing to weight gain, back pain, and joint problems like carpal tunnel syndrome.

Fortunately, there are a few strategies and exercises – such as changing your position often and “reorganizing” your torso – that can address a lot of these potential problems and help keep you more fit and properly aligned.

As miserable as back pain is, that may be the least of your worries if you spend a significant portion of your time on your duff. Sitting may actually cut years off your life. Lack of exercise is sitting’s evil accomplice. The more you sit, the less your body wants to move.

According to a study in the British Medical Journal,¹ reducing the average time you spend sitting to less than three hours per day could increase your life expectancy by two years, which is a significant decrease from the 4.5 to 5 hours per day the average American now spends on a chair or sofa.

An analysis of 18 studies showed that people who sat for the longest periods of time were twice as likely to have diabetes or heart disease, compared to those who sat the least.² Sitting has actually joined smoking and obesity as an important risk factor for chronic disease.

The Price You Pay for a Sedentary Lifestyle

A number of studies have investigated the health ramifications of a sedentary lifestyle. The research linking too much sitting with increased risks of disease and premature death is quite noteworthy:

1. Men who were sedentary for more than 23 hours a week had a 64 percent greater risk of dying from heart disease than those who were sedentary less than 11 hours a week, according to a 2010 study in Medicine & Science in Sports & Exercise.³
2. A study of more than 17,000 Canadians found that the mortality risk from all causes was 1.54 times higher among people who spent most of their day sitting, compared to those who sat infrequently.⁴
3. According to an Australian study, sitting time is a predictor of weight gain among women, even after controlling for calories consumed and leisurely physical activity, such as exercise.⁵
4. People who use a computer for at least 11 hours per week or watch TV for more than 21 hours per week are more likely to be obese than those who use a computer or watch TV for more than 5 hours per week.⁶
5. Your risk of metabolic syndrome rises in a dose-dependent manner depending on your "screen time" (the amount of time you spend watching TV or using a computer). Physical activity has only a minimal impact on the relationship between screen time and metabolic syndrome.⁷

Going to the Gym May NOT Be Enough

Interestingly, research has also suggested a regular fitness regimen might be insufficient to counteract the effects of excessively sedentary habits during the remaining hours of the day, due to the adverse metabolic impact of sitting. Especially if the fitness regimen is focused around equipment that puts you back in a seated position like a recumbent bike or rowing machine. A 2009 study⁸ highlighted much of the contemporary evidence linking sitting with biomarkers of poor metabolic health, showing how total sitting time correlates with an increased risk of type 2 diabetes, heart disease and other prevalent chronic health problems.

According to the authors:

"Even if people meet the current recommendation of 30 minutes of physical activity on most days each week, there may be significant adverse metabolic and health effects from prolonged sitting – the activity that dominates most people's remaining 'non-exercise' waking hours."

In other words, even if you're fairly physically active, riding your bike to work or hitting the gym four or five days a week, you may still succumb to the effects of too much sitting if the majority of your day is spent behind a desk or on the couch. Researchers have dubbed this phenomenon the "active couch potato effect."

According to a New York Times article,⁹ after just an hour of sitting, the production of enzymes that burn fat in your body declines by as much as 90 percent. Extended sitting slows your body’s metabolism of glucose and decreases your HDL, which is the type of lipid you want MORE of, instead of less. This explains why those who sit habitually for extended periods of time have higher risk for type 2 diabetes and cardiovascular problems.

The Key To Sitting Successfully: Stand Up

The basic remedy is to get up and do a few simple exercises – but you have to do this frequently if you spend a lot of your life in a chair. Most back, neck, and other muscle pains are related to imbalanced absorption of force throughout your body, created by working in unnatural positions for extended periods. When you teach your body to establish and repeat correct positioning, the pain often goes away. You must correct your foot, pelvis, torso, shoulder and neck positions as these are all required for good posture and balance. When these core areas are positioned improperly, you will likely develop pain first in those areas, with other areas soon to follow. As the center of your body changes its structure to adapt to the demands you ask it to do most frequently, the extremities will follow..

For example, a great deal of carpal tunnel issues do not result solely from improper wrist position, but from forward rotation of the shoulder. The forward rotation of the shoulder is directly connected to the position of your lower back, and pelvis. As the shoulder changes position all of the muscles and nerves below the shoulder are adversely affected. The result is symptoms within the wrist that cannot be fixed at the wrist.

A basic remedy is to simply get up! But additionally, there are certain exercises you can perform to further reduce the adverse impact of sitting.

In the interview above, Kelly Starrett, popular mobility expert and physical therapist with Crossfit, shares some excellent tips for maintaining good posture while working for extended periods in a chair.¹⁰ The key is to change positions often – at least every 20 to 30 minutes – and maintain proper torso alignment, regardless of what position you’re in. Starrett recommends standing up often and doing some specific realignment exercises, which are actually quick and easy.

Sitting, especially while doing computer work or texting, tends to result in leaning forward with your head, neck, shoulders and upper back. The key is to teach your body to support itself in a more neutral position, without overcorrecting.

Realigning Your Body in Five Easy Steps

Starrett recommends a five-step series of body “reorganizations” or realignments, done in the following sequence:

1. Stand up with your with feet pointing straight forward or slightly inward.
2. In the interview Kelly recommends that we realign the pelvis by simply squeezing your butt tightly, we would like to add that this will be more effective for the majority of people if also told to internally rotate their feet 10-15 degrees (big toes slightly towards each other), roll feet to the outside of the arch and then try to pull the back of the legs together without the heels moving. This will allow the thigh and butt muscles to work together; the squeeze alone is otherwise less effective.
3. Create some tension in your core by slightly tightening your abdominals (this is not an extreme tightening – just to 20 percent of your max)
4. Correct your shoulder position by externally rotating (think of unscrewing) your shoulders and arms (rolling your shoulders back), which brings your shoulder blades closer together, your chest up and forward, and your thumbs pointing away from your body
5. While keeping your shoulders externally rotated, turn your hands back to neutral, so that your thumbs are now facing forward

These basic alignments can be applied no matter what position you’re in – whether you’re standing, sitting, kneeling, or anything in between. In the video, Starrett demonstrates exactly how to perform these simple corrections, making it much easier to visualize. If you practice these exercises regularly, you’ll be preventing many of the problems that commonly arise.

In case you’re wondering if you can just substitute a balance ball for your chair, there is little evidence for any benefit. Studies show minimal, if any, postural improvement, and one study even showed “spinal shrinkage” from using these balls as a chair.¹¹The apparatus you sit on is far less important than the positions in which you teach your body to sit.

However, the ergonomic revolution has led to the birth of some interesting desks and workstations that offer the option of standing up to work. Some workstations even have a treadmill underneath for walking. Sales of the “TredDesk” have reportedly grown tenfold since its introduction in 2008. There are a number of companies putting a lot of money into research and development in this area, and I suspect to see many more of these designs coming down the pike.

Foundation Training Exercises:

Foundation Training is another way to compensate for long hours spend sitting. Foundation training exercises are powerful simple structural movements that help strengthen and realign your body posture. This program was developed by Chiropractor Eric Goodman as a way to address his personal chronic back pain, and have been a great answer to the increasing physical challenges of modern society. As a starting point, Dr. Goodman suggests making the following adjustments to your body when sitting. These recommendations are not meant to replace the way you sit constantly, but to give you useful alternative positions to use. It is recommended that you try them often, as your body is likely in need:

1. Backrests tend to promote excessive rounding of the spine and push us into what's called an anterior head carriage. Sit upright on the front edge of a chair and practice the next 2 tips. At least 2/3 of your thigh should be off of the chair, and your knees should be no more than 6 inches apart while practicing.
2. When sitting, try to keep your chin behind your chest bone. When your chin is too far forward, you will inadvertently teach your hip flexors to remain abnormally short and you set yourself up for increased compression and degeneration.
3. An easy way to learn to lengthen your hip flexors without hyperextending your spine is to slowly increase the distance between your rib cage and pelvis while keeping your chin pulled in and down towards your throat. This is demonstrated in the last 5 minutes of the TED Talk listed above.

For more information on Foundation Training, please refer to my earlier article and interview with Dr. Goodman, as well as watching the videos below in which Dr. Goodman demonstrates two of his favorite exercises:..

Yet another type of exercise called Egoscue can also be helpful in mitigating the damage from excess sitting

Take Breaks from Sitting to Ground Yourself to the Earth

Another downside to sitting is the lack of contact with the Earth, since most of us are sitting indoors. Have you noticed how much better you feel when you walk barefoot on the Earth, whether it’s dirt or sand or grass?

Science has finally solved this mystery!

For most of our evolutionary history, humans have had continuous contact with the Earth, but this is certainly not the case today. We are separated from it by a barrier of asphalt, wood, rugs, plastics, and especially shoes. Living in direct contact with the Earthgrounds your body, producing beneficial electrophysiological changes that help protect you from potentially disruptive electromagnetic fields. Some of the EMFs closest to our bodies are those generated by the electronic devices that have practically become a modern appendage – like smart phones and iPads.

Your immune system functions optimally when your body has an adequate supply of electrons, which are easily and naturally obtained by barefoot/bare skin contact with the Earth. Research indicates Earth’s electrons are the ultimate antioxidants, acting aspowerful anti-inflammatories.

Chronic inflammation leads to a multitude of health problems. Therefore, reducing inflammation will help mitigate the negative effects of excessive sitting. Earthing (grounding) decreases the effect of the potentially disruptive electromagnetic fields that are emitted by those electronic devices we’ve come to depend on.

Bottom line: the more you can walk or stand barefoot upon the Earth, the healthier you will be. Whenever possible, take a moment to venture outside and plant your feet in the wet grass!

We are designed to move well, sit well and play well within our environment. It is up to us to teach our body to do these things as it is designed to. We can only deprive our body of what it requires for so long before it begins to rebel against us physically.

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 is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. 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:

Website - http://www.hiyh.info.
ScolioTrack Website - http://www.ScolioTrack.com.
Facebook - https://www.facebook.com/HealthInYourHands.
Youtube - http://www.youtube.com/user/DrKevinLau.
Twitter - http://www.Twitter.com/DrKevinLau.

By Dr. Mercola

From smart phones to computers to iPads, our beloved electronic devices are crippling our posture and contributing to weight gain, back pain, and joint problems like carpal tunnel syndrome.

Fortunately, there are a few strategies and exercises – such as changing your position often and “reorganizing” your torso – that can address a lot of these potential problems and help keep you more fit and properly aligned.

As miserable as back pain is, that may be the least of your worries if you spend a significant portion of your time on your duff. Sitting may actually cut years off your life. Lack of exercise is sitting’s evil accomplice. The more you sit, the less your body wants to move.

According to a study in the British Medical Journal,¹ reducing the average time you spend sitting to less than three hours per day could increase your life expectancy by two years, which is a significant decrease from the 4.5 to 5 hours per day the average American now spends on a chair or sofa.

An analysis of 18 studies showed that people who sat for the longest periods of time were twice as likely to have diabetes or heart disease, compared to those who sat the least.² Sitting has actually joined smoking and obesity as an important risk factor for chronic disease.

The Price You Pay for a Sedentary Lifestyle

A number of studies have investigated the health ramifications of a sedentary lifestyle. The research linking too much sitting with increased risks of disease and premature death is quite noteworthy:

1. Men who were sedentary for more than 23 hours a week had a 64 percent greater risk of dying from heart disease than those who were sedentary less than 11 hours a week, according to a 2010 study in Medicine & Science in Sports & Exercise.³
2. A study of more than 17,000 Canadians found that the mortality risk from all causes was 1.54 times higher among people who spent most of their day sitting, compared to those who sat infrequently.⁴
3. According to an Australian study, sitting time is a predictor of weight gain among women, even after controlling for calories consumed and leisurely physical activity, such as exercise.⁵
4. People who use a computer for at least 11 hours per week or watch TV for more than 21 hours per week are more likely to be obese than those who use a computer or watch TV for more than 5 hours per week.⁶
5. Your risk of metabolic syndrome rises in a dose-dependent manner depending on your "screen time" (the amount of time you spend watching TV or using a computer). Physical activity has only a minimal impact on the relationship between screen time and metabolic syndrome.⁷

Going to the Gym May NOT Be Enough

Interestingly, research has also suggested a regular fitness regimen might be insufficient to counteract the effects of excessively sedentary habits during the remaining hours of the day, due to the adverse metabolic impact of sitting. Especially if the fitness regimen is focused around equipment that puts you back in a seated position like a recumbent bike or rowing machine. A 2009 study⁸ highlighted much of the contemporary evidence linking sitting with biomarkers of poor metabolic health, showing how total sitting time correlates with an increased risk of type 2 diabetes, heart disease and other prevalent chronic health problems.

According to the authors:

"Even if people meet the current recommendation of 30 minutes of physical activity on most days each week, there may be significant adverse metabolic and health effects from prolonged sitting – the activity that dominates most people's remaining 'non-exercise' waking hours."

In other words, even if you're fairly physically active, riding your bike to work or hitting the gym four or five days a week, you may still succumb to the effects of too much sitting if the majority of your day is spent behind a desk or on the couch. Researchers have dubbed this phenomenon the "active couch potato effect."

According to a New York Times article,⁹ after just an hour of sitting, the production of enzymes that burn fat in your body declines by as much as 90 percent. Extended sitting slows your body’s metabolism of glucose and decreases your HDL, which is the type of lipid you want MORE of, instead of less. This explains why those who sit habitually for extended periods of time have higher risk for type 2 diabetes and cardiovascular problems.

The Key To Sitting Successfully: Stand Up

The basic remedy is to get up and do a few simple exercises – but you have to do this frequently if you spend a lot of your life in a chair. Most back, neck, and other muscle pains are related to imbalanced absorption of force throughout your body, created by working in unnatural positions for extended periods. When you teach your body to establish and repeat correct positioning, the pain often goes away. You must correct your foot, pelvis, torso, shoulder and neck positions as these are all required for good posture and balance. When these core areas are positioned improperly, you will likely develop pain first in those areas, with other areas soon to follow. As the center of your body changes its structure to adapt to the demands you ask it to do most frequently, the extremities will follow..

For example, a great deal of carpal tunnel issues do not result solely from improper wrist position, but from forward rotation of the shoulder. The forward rotation of the shoulder is directly connected to the position of your lower back, and pelvis. As the shoulder changes position all of the muscles and nerves below the shoulder are adversely affected. The result is symptoms within the wrist that cannot be fixed at the wrist.

A basic remedy is to simply get up! But additionally, there are certain exercises you can perform to further reduce the adverse impact of sitting.

In the interview above, Kelly Starrett, popular mobility expert and physical therapist with Crossfit, shares some excellent tips for maintaining good posture while working for extended periods in a chair.¹⁰ The key is to change positions often – at least every 20 to 30 minutes – and maintain proper torso alignment, regardless of what position you’re in. Starrett recommends standing up often and doing some specific realignment exercises, which are actually quick and easy.

Sitting, especially while doing computer work or texting, tends to result in leaning forward with your head, neck, shoulders and upper back. The key is to teach your body to support itself in a more neutral position, without overcorrecting.

Realigning Your Body in Five Easy Steps

Starrett recommends a five-step series of body “reorganizations” or realignments, done in the following sequence:

1. Stand up with your with feet pointing straight forward or slightly inward.
2. In the interview Kelly recommends that we realign the pelvis by simply squeezing your butt tightly, we would like to add that this will be more effective for the majority of people if also told to internally rotate their feet 10-15 degrees (big toes slightly towards each other), roll feet to the outside of the arch and then try to pull the back of the legs together without the heels moving. This will allow the thigh and butt muscles to work together; the squeeze alone is otherwise less effective.
3. Create some tension in your core by slightly tightening your abdominals (this is not an extreme tightening – just to 20 percent of your max)
4. Correct your shoulder position by externally rotating (think of unscrewing) your shoulders and arms (rolling your shoulders back), which brings your shoulder blades closer together, your chest up and forward, and your thumbs pointing away from your body
5. While keeping your shoulders externally rotated, turn your hands back to neutral, so that your thumbs are now facing forward

These basic alignments can be applied no matter what position you’re in – whether you’re standing, sitting, kneeling, or anything in between. In the video, Starrett demonstrates exactly how to perform these simple corrections, making it much easier to visualize. If you practice these exercises regularly, you’ll be preventing many of the problems that commonly arise.

In case you’re wondering if you can just substitute a balance ball for your chair, there is little evidence for any benefit. Studies show minimal, if any, postural improvement, and one study even showed “spinal shrinkage” from using these balls as a chair.¹¹The apparatus you sit on is far less important than the positions in which you teach your body to sit.

However, the ergonomic revolution has led to the birth of some interesting desks and workstations that offer the option of standing up to work. Some workstations even have a treadmill underneath for walking. Sales of the “TredDesk” have reportedly grown tenfold since its introduction in 2008. There are a number of companies putting a lot of money into research and development in this area, and I suspect to see many more of these designs coming down the pike.

Foundation Training Exercises:

Foundation Training is another way to compensate for long hours spend sitting. Foundation training exercises are powerful simple structural movements that help strengthen and realign your body posture. This program was developed by Chiropractor Eric Goodman as a way to address his personal chronic back pain, and have been a great answer to the increasing physical challenges of modern society. As a starting point, Dr. Goodman suggests making the following adjustments to your body when sitting. These recommendations are not meant to replace the way you sit constantly, but to give you useful alternative positions to use. It is recommended that you try them often, as your body is likely in need:

1. Backrests tend to promote excessive rounding of the spine and push us into what's called an anterior head carriage. Sit upright on the front edge of a chair and practice the next 2 tips. At least 2/3 of your thigh should be off of the chair, and your knees should be no more than 6 inches apart while practicing.
2. When sitting, try to keep your chin behind your chest bone. When your chin is too far forward, you will inadvertently teach your hip flexors to remain abnormally short and you set yourself up for increased compression and degeneration.
3. An easy way to learn to lengthen your hip flexors without hyperextending your spine is to slowly increase the distance between your rib cage and pelvis while keeping your chin pulled in and down towards your throat. This is demonstrated in the last 5 minutes of the TED Talk listed above.

For more information on Foundation Training, please refer to my earlier article and interview with Dr. Goodman, as well as watching the videos below in which Dr. Goodman demonstrates two of his favorite exercises:..

Yet another type of exercise called Egoscue can also be helpful in mitigating the damage from excess sitting

Take Breaks from Sitting to Ground Yourself to the Earth

Another downside to sitting is the lack of contact with the Earth, since most of us are sitting indoors. Have you noticed how much better you feel when you walk barefoot on the Earth, whether it’s dirt or sand or grass?

Science has finally solved this mystery!

For most of our evolutionary history, humans have had continuous contact with the Earth, but this is certainly not the case today. We are separated from it by a barrier of asphalt, wood, rugs, plastics, and especially shoes. Living in direct contact with the Earthgrounds your body, producing beneficial electrophysiological changes that help protect you from potentially disruptive electromagnetic fields. Some of the EMFs closest to our bodies are those generated by the electronic devices that have practically become a modern appendage – like smart phones and iPads.

Your immune system functions optimally when your body has an adequate supply of electrons, which are easily and naturally obtained by barefoot/bare skin contact with the Earth. Research indicates Earth’s electrons are the ultimate antioxidants, acting aspowerful anti-inflammatories.

Chronic inflammation leads to a multitude of health problems. Therefore, reducing inflammation will help mitigate the negative effects of excessive sitting. Earthing (grounding) decreases the effect of the potentially disruptive electromagnetic fields that are emitted by those electronic devices we’ve come to depend on.

Bottom line: the more you can walk or stand barefoot upon the Earth, the healthier you will be. Whenever possible, take a moment to venture outside and plant your feet in the wet grass!

We are designed to move well, sit well and play well within our environment. It is up to us to teach our body to do these things as it is designed to. We can only deprive our body of what it requires for so long before it begins to rebel against us physically.

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 is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. 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:

Website - http://www.hiyh.info.
ScolioTrack Website - http://www.ScolioTrack.com.
Facebook - https://www.facebook.com/HealthInYourHands.
Youtube - http://www.youtube.com/user/DrKevinLau.
Twitter - http://www.Twitter.com/DrKevinLau.

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FDA could require tamper-resistant painkillers; without such action, prescription-drug abuse problem would worsen

UPDATE, Jan. 14 : Laura Ungar of The Courier-Journal reports, "Addicts by the scores used to get a quick and easy high from snorting or shooting up the powerful narcotic OxyContin — until manufacturer Purdue Pharma developed a new version that’s harder to abuse. But with the company’s patent on its original drug set to expire in April, activists, lawmakers and doctors are worried that cheaper, easily crushable generic versions will flood Kentucky and worsen the state’s already-devastating prescription drug abuse problem."

The Food and Drug Administration will force generic manufacturers of powerful pain pills to switch to a tamper-resistant composition if it finds evidence the composition curbs prescription drug abuse and addiction, Alan Rappeport of The Financial Times reports. Public-health advocates worry that if generic versions of opiate pills are not made tamper-resistant, the prescription drug abuse epidemic may worsen.

If the agency finds tamper-resistance significantly deter abuse, it has legal authority to require generic drug makers to switch their opiate formulas. Just as manufacturers of some pain pills began switching formulas to make the pills harder to crush, easily crushable, generic forms of OxyContin and Opana were released. Purdue Pharma and Endo Pharmaceuticals, which make Opana, have hoped to extend patent life of their drugs by pushing the FDA to prevent generic makers from using old versions of their drugs. Generic makers argue this will keep patients from buying cheaper drugs.

The FDA said it will take a "flexible" approach to determining the effectiveness of tamper-resistant drugs because abusers are constantly finding new ways to avoid deterrents. (Read more)

UPDATE, Jan. 14 : Laura Ungar of The Courier-Journal reports, "Addicts by the scores used to get a quick and easy high from snorting or shooting up the powerful narcotic OxyContin — until manufacturer Purdue Pharma developed a new version that’s harder to abuse. But with the company’s patent on its original drug set to expire in April, activists, lawmakers and doctors are worried that cheaper, easily crushable generic versions will flood Kentucky and worsen the state’s already-devastating prescription drug abuse problem."

The Food and Drug Administration will force generic manufacturers of powerful pain pills to switch to a tamper-resistant composition if it finds evidence the composition curbs prescription drug abuse and addiction, Alan Rappeport of The Financial Times reports. Public-health advocates worry that if generic versions of opiate pills are not made tamper-resistant, the prescription drug abuse epidemic may worsen.

If the agency finds tamper-resistance significantly deter abuse, it has legal authority to require generic drug makers to switch their opiate formulas. Just as manufacturers of some pain pills began switching formulas to make the pills harder to crush, easily crushable, generic forms of OxyContin and Opana were released. Purdue Pharma and Endo Pharmaceuticals, which make Opana, have hoped to extend patent life of their drugs by pushing the FDA to prevent generic makers from using old versions of their drugs. Generic makers argue this will keep patients from buying cheaper drugs.

The FDA said it will take a "flexible" approach to determining the effectiveness of tamper-resistant drugs because abusers are constantly finding new ways to avoid deterrents. (Read more)

Read More

Pike court will keep lawsuit county and attorney general filed against Purdue Pharma over damage done by its OxyContin

A state court will hear the Kentucky attorney general's 2007 lawsuit against OxyContin manufacturer Purdue Pharma, against the wishes of the company. The U.S. Court of Appeals for the 2nd Circuit affirmed a lower court's order returning the suit to Kentucky from New York's Southern District, where Purdue wanted the case heard. The suit was filed in Pike Circuit Court, in Kentucky's easternmost county.

"After years of delay tactics, Purdue will now answer to a Kentucky court and a Kentucky jury," Attorney General Jack Conway said. Purdue Pharma spokeswoman Libby Holman said the company is disappointed by the decision, but now it is "fully prepared to vigorously defend this action on its merits, and we expect to prevail."

Then-AG Greg Stumbo and Pike County sued Purdue Pharma in October 2007, alleging that the company's "aggressive and deceptive marketing campaign saddled taxpayers with millions of dollars in social, health care and other costs," Laura Ungar of The Courier-Journal in Louisville reports. The suit also alleges the company misled health-care providers, consumers and the government about the highly addictive nature of OxyContin. The suit is largely based on admissions of guilt made by the company and several top-ranking company officials in a May 2007 Virginia federal court settlement. Purdue Pharma, its president, chief legal counsel and former medical director pleaded guilty to misleading doctors, regulators and patients about OxyContin during that case.

The nation's prescription-drug epidemic apparently began in the region, largely because of the introduction and high rate of prescription of OxyContin. Kentucky has nearly 1,000 overdose deaths a year. Conway's office said the suit against Purdue Pharma seeks reimbursement for drug-abuse programs, law-enforcement actions and prescription payments through Medicaid and the Kentucky Pharmaceutical Alliance Program. (Read more)

A state court will hear the Kentucky attorney general's 2007 lawsuit against OxyContin manufacturer Purdue Pharma, against the wishes of the company. The U.S. Court of Appeals for the 2nd Circuit affirmed a lower court's order returning the suit to Kentucky from New York's Southern District, where Purdue wanted the case heard. The suit was filed in Pike Circuit Court, in Kentucky's easternmost county.

"After years of delay tactics, Purdue will now answer to a Kentucky court and a Kentucky jury," Attorney General Jack Conway said. Purdue Pharma spokeswoman Libby Holman said the company is disappointed by the decision, but now it is "fully prepared to vigorously defend this action on its merits, and we expect to prevail."

Then-AG Greg Stumbo and Pike County sued Purdue Pharma in October 2007, alleging that the company's "aggressive and deceptive marketing campaign saddled taxpayers with millions of dollars in social, health care and other costs," Laura Ungar of The Courier-Journal in Louisville reports. The suit also alleges the company misled health-care providers, consumers and the government about the highly addictive nature of OxyContin. The suit is largely based on admissions of guilt made by the company and several top-ranking company officials in a May 2007 Virginia federal court settlement. Purdue Pharma, its president, chief legal counsel and former medical director pleaded guilty to misleading doctors, regulators and patients about OxyContin during that case.

The nation's prescription-drug epidemic apparently began in the region, largely because of the introduction and high rate of prescription of OxyContin. Kentucky has nearly 1,000 overdose deaths a year. Conway's office said the suit against Purdue Pharma seeks reimbursement for drug-abuse programs, law-enforcement actions and prescription payments through Medicaid and the Kentucky Pharmaceutical Alliance Program. (Read more)

Read More

Rep. Westrom, bolstered by increasing public support, thinks third time may be the charm to pass a statewide smoking ban law

A coalition of health groups say they will give state Rep. Susan Westrom, D-Lexington, the most public support ever for a bill to ban smoking in Kentucky restaurants and workplaces, a bill she's tried to get passed twice, Jacqueline Pitts of CN2 reports. The coalition, which includes Smoke-Free Kentucky and the American Lung Association, revealed plans yesterday for a two-week ad campaign about the benefits of a statewide smoking ban law.

So far, 24 states have approved smoking bans, and more than 30 Kentucky cities and counties have passed similar local bans. Westrom said that Gov. Steve Beshear, who once said bans should be left to localities to decide, is more supportive of a statewide ban now. A 2012 Foundation for a Healthy Kentucky poll shows that 59 percent of Kentucky adults are in favor of a statewide ban. Westrom said she wants to work with new legislators to get their support for the bill. (Read more)

A coalition of health groups say they will give state Rep. Susan Westrom, D-Lexington, the most public support ever for a bill to ban smoking in Kentucky restaurants and workplaces, a bill she's tried to get passed twice, Jacqueline Pitts of CN2 reports. The coalition, which includes Smoke-Free Kentucky and the American Lung Association, revealed plans yesterday for a two-week ad campaign about the benefits of a statewide smoking ban law.

So far, 24 states have approved smoking bans, and more than 30 Kentucky cities and counties have passed similar local bans. Westrom said that Gov. Steve Beshear, who once said bans should be left to localities to decide, is more supportive of a statewide ban now. A 2012 Foundation for a Healthy Kentucky poll shows that 59 percent of Kentucky adults are in favor of a statewide ban. Westrom said she wants to work with new legislators to get their support for the bill. (Read more)

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Evolving insights into FIP virulence

Terada Y, Shiozaki Y, Shimoda H, et al. Feline infectious peritonitis virus with a large deletion in the 5'-terminal region of the spike gene retains its virulence for cats. The Journal of general virology. 2012; 93: 1930-4. 

The acquisition of macrophage tropism appears to be an essential step in the transformation of feline enteric corona virus (FECV) to feline infectious peritonitis virus (FIPV).This is a transformation from a largely non-pathogenic and localized enterocyte pathogen to a highly virulent and systemic monocyte/macrophage pathogen. Therefore, determining the critical genetic mutation(s) leading a change in tropism is required for understanding the pathogenic phenomena of feline coronavirus (FCoV) infections. Although various viral proteins such as 3c and 7b have been considered to be involved in the transformation, the spike (S) protein may also play a role in a switch toward macrophage tropism and enhanced virulence. 

In coronaviruses, the S protein functions in cell entry and is responsible for receptor attachment and membrane fusion. While the receptor-binding site is located in the N-terminal part of the protein, fusion is mediated by its membrane proximal part. Surprisingly, previous studies have suggested virulence mutation(s) in the S protein occur in the membrane-proximal domain of the protein and not in the N-terminal region. 

In the present study, a type I FCoV strain, C3663, was found to have a large deletion of 735 bp within the gene encoding for the S protein, resulting in an estimated 245 amino acid loss in the N-terminal region of the protein. FIP developed in three out of four cats that were infected with strain C3663, suggesting that the 5’-terminal region of the S gene is not essential for pathogenic transformation. If the S protein is indeed involved in the transformation and development of FIP, then this result is consistent with the localization of the determinant for macrophage tropism lying in the domain responsible for membrane fusion suggesting a role for fusion function rather than for receptor binding. [GO]

See also: Rottier PJ, Nakamura K, Schellen P, Volders H and Haijema BJ. Acquisition of macrophage tropism during the pathogenesis of feline infectious peritonitis is determined by mutations in the feline coronavirus spike protein. J Virol. 2005; 79: 14122-30. 

Related blog articles:
Understanding FIP virulence (October 2012)
Development of new therapies for FIP (March 2012)

More on cat health:
Winn Feline Foundation Library
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Terada Y, Shiozaki Y, Shimoda H, et al. Feline infectious peritonitis virus with a large deletion in the 5'-terminal region of the spike gene retains its virulence for cats. The Journal of general virology. 2012; 93: 1930-4. 

The acquisition of macrophage tropism appears to be an essential step in the transformation of feline enteric corona virus (FECV) to feline infectious peritonitis virus (FIPV).This is a transformation from a largely non-pathogenic and localized enterocyte pathogen to a highly virulent and systemic monocyte/macrophage pathogen. Therefore, determining the critical genetic mutation(s) leading a change in tropism is required for understanding the pathogenic phenomena of feline coronavirus (FCoV) infections. Although various viral proteins such as 3c and 7b have been considered to be involved in the transformation, the spike (S) protein may also play a role in a switch toward macrophage tropism and enhanced virulence. 

In coronaviruses, the S protein functions in cell entry and is responsible for receptor attachment and membrane fusion. While the receptor-binding site is located in the N-terminal part of the protein, fusion is mediated by its membrane proximal part. Surprisingly, previous studies have suggested virulence mutation(s) in the S protein occur in the membrane-proximal domain of the protein and not in the N-terminal region. 

In the present study, a type I FCoV strain, C3663, was found to have a large deletion of 735 bp within the gene encoding for the S protein, resulting in an estimated 245 amino acid loss in the N-terminal region of the protein. FIP developed in three out of four cats that were infected with strain C3663, suggesting that the 5’-terminal region of the S gene is not essential for pathogenic transformation. If the S protein is indeed involved in the transformation and development of FIP, then this result is consistent with the localization of the determinant for macrophage tropism lying in the domain responsible for membrane fusion suggesting a role for fusion function rather than for receptor binding. [GO]

See also: Rottier PJ, Nakamura K, Schellen P, Volders H and Haijema BJ. Acquisition of macrophage tropism during the pathogenesis of feline infectious peritonitis is determined by mutations in the feline coronavirus spike protein. J Virol. 2005; 79: 14122-30. 

Related blog articles:
Understanding FIP virulence (October 2012)
Development of new therapies for FIP (March 2012)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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Coalition of health groups launches two-week ad campaign to drum up support for a statewide smoking ban

A geographically targeted newspaper and online advertising campaign calling for "a comprehensive, statewide smoke-free law" is hitting Kentucky media outlets this week, as the legislature convenes, and next week. The campaign was launched by Smoke-Free Kentucky Coalition, the Campaign for Tobacco-Free Kids and the Robert Wood Johnson Foundation. The newspaper ad can viewed here.

Twenty-nine percent of Kentucky adults are smokers, giving the state the highest smoking rate in the U.S., and ranks very high in youth smoking, according to the Centers for Disease Control. Kentucky also has the nation's highest lung cancer death rates, 87 percent of which are caused by smoking, according to the National Cancer Institute. The state also "lags behind other states in enacting a comprehensive, statewide smoke-free law that covers all indoor workplaces, including bars and restaurants," a press release about the ad campaign says. Twenty-four states have smoking bans. A fall poll for the Foundation for a Healthy Kentucky showed that 59 percent of Kentucky adults support a smoking ban in workplaces, restaurants and bars. For a story on the poll, click here.

Tobacco-Free Kids communications manager Catherine Butsch said the ad is running in the Lexington Herald-Leader, the Messenger-Inquirer of Owensboro, the Daily Independent of Ashland, the Commonwealth Journal of Somerset, the Kentucky New Era of Hopkinsville, the Glasgow Daily Times, the Paducah Sun, the Paducah-based West Kentucky News, the Sentinel-Echo of London, the Lebanon Enterprise, the Jessamine Journal, the Tompkinsville News, the Carlisle Weekly of Bardwell, the Fulton Leader, the Marshall County Tribune Courier, and the Kentucky Gazette, a government-oriented twice-monthly in Frankfort. The online ad will run on websites of the Herald-Leader, Business Lexington, The Lane Report and CN2, a cable news service. The campaign will cost $93,000, Butsch said.

A geographically targeted newspaper and online advertising campaign calling for "a comprehensive, statewide smoke-free law" is hitting Kentucky media outlets this week, as the legislature convenes, and next week. The campaign was launched by Smoke-Free Kentucky Coalition, the Campaign for Tobacco-Free Kids and the Robert Wood Johnson Foundation. The newspaper ad can viewed here.

Twenty-nine percent of Kentucky adults are smokers, giving the state the highest smoking rate in the U.S., and ranks very high in youth smoking, according to the Centers for Disease Control. Kentucky also has the nation's highest lung cancer death rates, 87 percent of which are caused by smoking, according to the National Cancer Institute. The state also "lags behind other states in enacting a comprehensive, statewide smoke-free law that covers all indoor workplaces, including bars and restaurants," a press release about the ad campaign says. Twenty-four states have smoking bans. A fall poll for the Foundation for a Healthy Kentucky showed that 59 percent of Kentucky adults support a smoking ban in workplaces, restaurants and bars. For a story on the poll, click here.

Tobacco-Free Kids communications manager Catherine Butsch said the ad is running in the Lexington Herald-Leader, the Messenger-Inquirer of Owensboro, the Daily Independent of Ashland, the Commonwealth Journal of Somerset, the Kentucky New Era of Hopkinsville, the Glasgow Daily Times, the Paducah Sun, the Paducah-based West Kentucky News, the Sentinel-Echo of London, the Lebanon Enterprise, the Jessamine Journal, the Tompkinsville News, the Carlisle Weekly of Bardwell, the Fulton Leader, the Marshall County Tribune Courier, and the Kentucky Gazette, a government-oriented twice-monthly in Frankfort. The online ad will run on websites of the Herald-Leader, Business Lexington, The Lane Report and CN2, a cable news service. The campaign will cost $93,000, Butsch said.

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Republicans moving to gain a say over Beshear's decisions about insurance exchange, Medicaid expansion; Democrat dismissive

Kentucky Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, left, said yesterday that she would file legislation that would block Democratic Gov. Steve Beshear from setting up a health-insurance exchange or expanding Medicaid coverage without legislative approval, Joseph Gerth of The Courier-Journal reports. Beshear has already established an exchange under the federal health reform, but hasn't announced whether he will expand Medicaid.

Denton said the exchanges and Medicaid expansion would be too costly for the state and shouldn't be something Beshear can set up unilaterally. But her effort will likely face opposition in the Democrat-controlled House, Gerth writes. Liberal Rep. Tom Burch, D-Louisville, said Denton "should save the ink that it would take to print the bills," and House Democrats would not receive the bill favorably. Burch has been in the legislature longer than any other current member.

State health-insurance exchanges will allow the uninsured to buy insurance from private companies and perhaps get government subsidies to help pay for it. If Medicaid were expanded in Kentucky, hundreds of thousands of more people would be covered, with the fedreal government paying all the extra cost in 2014-16, decreasing to 90 percent by 2020. Gerth reports that Senate Republicans said they will make it a priority "to rein in Beshear on Medicaid," which they fear would be unsustainable if it were expanded. Denton said requiring legislative approval of these parts of "Obamacare" would give Kentucky citizens a greater voice in the process. (Read more)

Kentucky Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, left, said yesterday that she would file legislation that would block Democratic Gov. Steve Beshear from setting up a health-insurance exchange or expanding Medicaid coverage without legislative approval, Joseph Gerth of The Courier-Journal reports. Beshear has already established an exchange under the federal health reform, but hasn't announced whether he will expand Medicaid.

Denton said the exchanges and Medicaid expansion would be too costly for the state and shouldn't be something Beshear can set up unilaterally. But her effort will likely face opposition in the Democrat-controlled House, Gerth writes. Liberal Rep. Tom Burch, D-Louisville, said Denton "should save the ink that it would take to print the bills," and House Democrats would not receive the bill favorably. Burch has been in the legislature longer than any other current member.

State health-insurance exchanges will allow the uninsured to buy insurance from private companies and perhaps get government subsidies to help pay for it. If Medicaid were expanded in Kentucky, hundreds of thousands of more people would be covered, with the fedreal government paying all the extra cost in 2014-16, decreasing to 90 percent by 2020. Gerth reports that Senate Republicans said they will make it a priority "to rein in Beshear on Medicaid," which they fear would be unsustainable if it were expanded. Denton said requiring legislative approval of these parts of "Obamacare" would give Kentucky citizens a greater voice in the process. (Read more)

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