BRUCE ROSEMAN, M.D.
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BRUCE ROSEMAN, M.D.
NICOLE LIVESCU, R.N.
Whooping Cough An Epidemic After 5 Deaths

California authorities have declared ‘whooping cough’ an epidemic after at least five infants were killed by the disease. The state appealed to the residents to get vaccinated to prevent the disease. The state announced the disease as epidemic after a sharp rise in the cases of pertussis (scientific name for whooping cough) was noticed. The disease is like common cough and cold and is contagious in nature.
A total of 910 cases have been confirmed with the epidemic and several others are under observation. The authorities fear that if the pace of spreading of disease remains the same, it would be the largest outbreak in past 50 years.

The Deputy Director of the department’s Center for the Infectious Disease, Dr. Gilberto Chavez said that there has been a fourfold increase in the disease as compared to last year. Dr Chavez said that summer is the most sensitive season for this disease to spread. The highest number of cases is usually reported in July and August. Dr Chavez said that these cases are expecting to rise more if prevention is not take on an immediate basis.

It is worth mentioning here that almost 5000-7000 cases of this disease are reported in US every year. The health department is making all efforts to reach out to public. It is spreading the message online and also sending its representatives in person to spread the word about the prevention of whooping cough.
 
 
Pneumonia Vaccine May Protect Your Heart,
There's substantial (but controversial) evidence that the PPSV shot (pneumococcal polysaccharide vaccine) may dampen the fire of inflammation and keep artery-blocking plaque from rupturing and causing a heart attack or stroke - especially if you're at risk of heart disease. In fact, the rate of myocardial infarction (ER talk for heart attack) was 50 percent lower in people who had gotten the shot two years earlier than recommended, according to a recent Canadian hospital study.
There are a couple of theories about why a vaccine that neuters nasty pneumonia bugs also protects your heart. One is that it specifically inhibits the kind of inflammation that riles up cardiovascular disease. Another is that the antibodies it generates handcuff lousy LDL cholesterol in a way that keeps the cholesterol from building plaque in your arteries.
But frankly, we're not waiting for the definitive explanation to get the shot (Oz just turned 50, so he's due). Not getting pneumonia or heart disease is more than reason enough for us - and you - to get vaccinated. If you need another prod, consider this: About one-third of deaths blamed on H1N1 (aka swine flu), which is still lurking out there, have been in people who've also had bacterial pneumonia.
The You Docs - Mike Roizen and Mehmet Oz - are authors of the best-selling "You: On A Diet." To submit questions and for more info, go to www.RealAge.com.


special note from Dr. Roseman:  Yes, I am aware of the recent Kaiser Study saying it does not help. Nevertheless, it has no downside, I am taking it myself and I am recommending it to others.

Red and Processed Meat Consumption and Risk of Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus. A Systematic Review and Meta-Analysis
Renata Micha RD, PhD*, Sarah K. Wallace BA, and Dariush Mozaffarian MD, DrPH
From the Department of Epidemiology (R.M., S.K.W., D.M.), Harvard School of Public Health, and Division of Cardiovascular Medicine and Channing Laboratory (D.M.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
* To whom correspondence should be addressed. E-mail: rmicha@hsph.harvard.edu .
Background—Meat consumption is inconsistently associated with development of coronary heart disease (CHD), stroke, and diabetes mellitus, limiting quantitative recommendations for consumption levels. Effects of meat intake on these different outcomes, as well as of red versus processed meat, may also vary.
Methods and Results—We performed a systematic review and meta-analysis of evidence for relationships of red (unprocessed), processed, and total meat consumption with incident CHD, stroke, and diabetes mellitus. We searched for any cohort study, case-control study, or randomized trial that assessed these exposures and outcomes in generally healthy adults. Of 1598 identified abstracts, 20 studies met inclusion criteria, including 17 prospective cohorts and 3 case-control studies. All data were abstracted independently in duplicate. Random-effects generalized least squares models for trend estimation were used to derive pooled dose-response estimates. The 20 studies included 1 218 380 individuals and 23 889 CHD, 2280 stroke, and 10 797 diabetes mellitus cases. Red meat intake was not associated with CHD (n=4 studies; relative risk per 100-g serving per day=1.00; 95% confidence interval, 0.81 to 1.23; P for heterogeneity=0.36) or diabetes mellitus (n=5; relative risk=1.16; 95% confidence interval, 0.92 to 1.46; P=0.25). Conversely, processed meat intake was associated with 42% higher risk of CHD (n=5; relative risk per 50-g serving per day=1.42; 95% confidence interval, 1.07 to 1.89; P=0.04) and 19% higher risk of diabetes mellitus (n=7; relative risk=1.19; 95% confidence interval, 1.11 to 1.27; P<0.001). Associations were intermediate for total meat intake. Consumption of red and processed meat were not associated with stroke, but only 3 studies evaluated these relationships.
Conclusions—Consumption of processed meats, but not red meats, is associated with higher incidence of CHD and diabetes mellitus. These results highlight the need for better understanding of potential mechanisms of effects and for particular focus on processed meats for dietary and policy recommendations.

 
Authors and Disclosures
E. Ernst

Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, UK

Correspondence to
E. Ernst, Complementary Medicine, Peninsula Medical School, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK Tel.: + 44 1392 424989 Fax: + 44 1392 427562 Email: Edzard.Ernst@pms.ac.uk

Disclosures
None.

From International Journal of Clinical Practice
Deaths after Chiropractic: A Review of Published Cases
E. Ernst


Posted: 08/30/2010; Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing

Abstract and Introduction
Abstract
Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.
Design: This study is a systematic review of case reports.
Methods: Literature searches in four electronic databases with no restrictions of time or language.
Main outcome measure: Death.
Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.
Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.

Introduction
Vascular accidents after upper spinal manipulation are a well-recognised problem (e.g.[1,2]). Dissection of a vertebral artery, caused by extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism.[2] Several deaths have been reported as a consequence. Some proponents of chiropractic seem to believe that the critical evaluation of this evidence amounts to a 'scare story' (Chairman of the UK General Chiropractic Council)[3] or to 'puffing up (the evidence) out of all proportion' (President of the British Chiropractic Association).[4] A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts.

In this review, I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature.

Methods
Electronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009). No restrictions of time or language were applied. Search terms were chiropractic, spinal manipulation, vascular accidents, stroke, death and fatality. In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor. Data were extracted from the included articles according to predefined criteria (Table 1).

[ CLOSE WINDOW ]
Table 1. Published case reports of deaths after chiropractic treatments
References Year of publication Victim Type of vascular accident Time between treatment and death
Anon[5]  1934 Woman, age unknown Tear in left lateral sinus 2 weeks
Pratt-Thomas and Berger[6]  1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h
Pratt-Thomas and Berger[6]  1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h
Anon[7]  1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h
Ford and Clark[8]  1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h
Ford and Clark[8]  1956 No information provided Thrombosis of basilar artery No information provided
Smith and Estridge[9]  1962 33-year-old woman Infarct of cerebellar and brainstem 3 days
Lorenz and Vogelsang[10]  1972 39-year-old woman Thrombosis of basilar artery 58 days
Schmitt[11]  1976 35-years-old woman Infarct of brainstem 1 h
Krueger and Okazaki[12]  1980 25-year-old man Infarct of brainstem and cerebellum 48 h
Sherman et al.[13]  1981 60-year-old woman Dissection of vertebral artery 4 days
Ali Cherif et al.[14]  1983 51-year-old man Infarct of medulla oblongata 11 days
Nielsen[15]  1984 34-year-old man Dissection of vertebral artery aneurysen 3 h
Zak and Carmody[16]  1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days
Modde[17]  1985 26-year-old woman Dissection of vertebral artery 1 day
Jentzen et al.[18]  1987 51-year-old man Infarct of cerebellum and brainstem No information provided
Sherman et al.[20]  1987 37-year-old man Infarct of brainstem 3 days
Mas et al.[19]  1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h
Raskind and North[21]  1990 47-year-old woman Cerebellar haemorrheae No information provided
Sullivan[22]  1992 41-year-old woman Haemorrhage in ventricular system 8 h
Haynes[23]  1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided
Peters et al.[24]  1995 29-year-old woman Infarct of right hemisphere 3 days
Klougart et al.[25]  1996 34-year-old man Unclear Few hours
Haldeman et al.[26]  2002 Previously unpublished legal cases No information provided No information provided
Haldeman et al.[26]  2002 Previously unpublished legal cases No information provided No information provided
Dziewas et al.[27]  2003 No information provided No information provided No information provided

Results
Twenty-six fatalities were published since 1934 in 23 articles (Table 1).[5–27]

[ CLOSE WINDOW ]
Table 1. Published case reports of deaths after chiropractic treatments
References Year of publication Victim Type of vascular accident Time between treatment and death
Anon[5]  1934 Woman, age unknown Tear in left lateral sinus 2 weeks
Pratt-Thomas and Berger[6]  1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h
Pratt-Thomas and Berger[6]  1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h
Anon[7]  1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h
Ford and Clark[8]  1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h
Ford and Clark[8]  1956 No information provided Thrombosis of basilar artery No information provided
Smith and Estridge[9]  1962 33-year-old woman Infarct of cerebellar and brainstem 3 days
Lorenz and Vogelsang[10]  1972 39-year-old woman Thrombosis of basilar artery 58 days
Schmitt[11]  1976 35-years-old woman Infarct of brainstem 1 h
Krueger and Okazaki[12]  1980 25-year-old man Infarct of brainstem and cerebellum 48 h
Sherman et al.[13]  1981 60-year-old woman Dissection of vertebral artery 4 days
Ali Cherif et al.[14]  1983 51-year-old man Infarct of medulla oblongata 11 days
Nielsen[15]  1984 34-year-old man Dissection of vertebral artery aneurysen 3 h
Zak and Carmody[16]  1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days
Modde[17]  1985 26-year-old woman Dissection of vertebral artery 1 day
Jentzen et al.[18]  1987 51-year-old man Infarct of cerebellum and brainstem No information provided
Sherman et al.[20]  1987 37-year-old man Infarct of brainstem 3 days
Mas et al.[19]  1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h
Raskind and North[21]  1990 47-year-old woman Cerebellar haemorrheae No information provided
Sullivan[22]  1992 41-year-old woman Haemorrhage in ventricular system 8 h
Haynes[23]  1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided
Peters et al.[24]  1995 29-year-old woman Infarct of right hemisphere 3 days
Klougart et al.[25]  1996 34-year-old man Unclear Few hours
Haldeman et al.[26]  2002 Previously unpublished legal cases No information provided No information provided
Haldeman et al.[26]  2002 Previously unpublished legal cases No information provided No information provided
Dziewas et al.[27]  2003 No information provided No information provided No information provided

Most of the victims were relatively young; 14 were below the age of 40. There was a slight majority of female patients. The type of complication associated with death frequently related to a vascular accident leading to thrombosis and cerebral infarction. The time between treatment and death ranged from 1 h to 58 days; in 10 cases, it was 1 day or less. Unfortunately, the published information was often incomplete.

Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, Lewis, Fawcett, Parisien, Standt. Long also states that 'many others [are] unknown hidden behind legal agreements of silence'.[28] A website names further North American fatalities: Linda Epping (California), G. Fowden (Utah), Ronald Grainger (Alberta), John Hoffman (Maryland), Renate Dora Labonte (Ontario), Jose Lopez (California), Donald Pereyra (Connecticut), Elizabeth A. Roth (Ontario) and Kimberly Lee Strohecker (Pennsylvania).[29]

Discussion
This systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death.[1,2,26,30]

Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g.[30,31]). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition.[32] Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive.

Reliable estimates of the frequency of vascular accidents are prevented by the fact that under-reporting is known to be substantial. In a survey of UK neurologists, for instance, under-reporting of serious complications was 100%.[33] Those cases which are published often turn out to be incomplete. Of 40 case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome.[34] Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available.

This review is focussed on deaths after chiropractic, yet neck manipulations are, of course, used by other healthcare professionals as well. The reason for this focus is simple: chiropractors are more frequently associated with serious manipulation-related adverse effects than osteopaths, physiotherapists, doctors or other professionals. Of the 40 cases of serious adverse effects mentioned above, 28 can be traced back to a chiropractor and none to an osteopath.[34] A review of complications after spinal manipulations by any type of healthcare professional included three deaths related to osteopaths, nine to medical practitioners, none to a physiotherapist, one to a naturopath and 17 to chiropractors.[35] This article also summarised a total of 265 vascular accidents of which 142 were linked to chiropractors. Another review of complications after neck manipulations published by 1997 included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic and none with physiotherapy.[36] The most obvious explanation for the dominance of chiropractic is that chiropractors routinely employ high-velocity, short-lever thrusts on the upper spine with a rotational element, while the other healthcare professionals use them much more sparingly.[37,38]

In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly.

Sidebar
What's Known
Chiropractic upper spinal manipulation has repeatedly been associated with arterial dissection followed by stroke and, in some cases, death.

What's New
The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished.

[ CLOSE WINDOW ]
References
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3.Dixon P. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444.
4.Lewis BJ. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444.
5.Anon. Medicolegal. Malpractice: death resulting from chiropractic treatment for headache. J Am Med Assoc 1934; 103:1260, 1935; 105:1712–4, 1937; 109:233–4.
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7.Anon. Medicolegal abstracts. Chiropractors: injury to spinal meninges during adjustments. J Am Med Assoc 1955; 159: 809.
8.Ford FR, Clark D. Thrombosis of the basilar artery with softenings in the cerebellum and brain stem due to manipulation of the neck; a report of two cases with one post-mortem examination, reasons are given to prove that damage to the vertebral arteries is responsible. Bull Johns Hopkins Hosp 1956; 98: 37–42.
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Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing