Chiropractic + Naturopathic Doctor • October 2015 • Roundup

Hypertensive patients Treated with acupuncture experienced drops in blood pressure lasting more than a month, researchers with the Susan Samueli Center for Integrative Medicine in Costa Mesa, Calif., found.

It is the first to scientifically confirm this ancient Chinese practice is beneficial in treating mild to moderate hypertension, and indicates regular use could help people control their blood pressure and lessen risk of stroke and heart disease.

“By using Western scientific rigor to validate an ancient Eastern therapy, we feel we have integrated Chinese and Western medicine and provided a beneficial guideline for treating a disease that affects millions in the U.S,” said Dr. John Longhurst, a University of California, Irvine cardiologist and former director of the Samueli Center.

Longhurst and his UCI colleagues Dr. Peng Li and Stephanie Tjen-A-Looi conducted tests on 65 hypertensive patients who were not receiving any hypertension medication. Separated randomly into two groups, the subjects were treated with electroacupuncture at different acupoints on the body.

In one group of 33 receiving electroacupuncture on both sides of the inner wrists and slightly below each knee, researchers found a noticeable drop in blood pressure rates in 70 per cent of participants – an average of six to eight mmHg for systolic blood pressure and four mmHg for diastolic blood pressure. These improvements persisted for a month and a half.

Also in this group, the team identified significant declines in blood concentration levels of norepinephrine, which constricts blood vessels and increases blood pressure and glucose levels, and renin, an enzyme produced in the kidneys that helps control blood pressure. Eletroacupuncture also decreased aldosterone, a hormone that regulates electrolytes.

No consequential blood pressure changes were found in the group of 32 who received electroacupuncture at other acupoints along the forearm and lower leg.

Although the blood pressure reductions in the first cohort were relatively small, the researchers noted they were clinically meaningful and that the technique could be especially useful in treating systolic hypertension in patients over 60.

“Because electroacupuncture decreases both peak and average systolic blood pressure over 24 hours, this therapy may decrease the risk for stroke, peripheral artery disease, heart failure and myocardial infarction in hypertensive patients,” Longhurst said.

British Columbia may soon become the site of a new academic institution for chiropractic.The new Pacific Academic Institute of Chiropractic (PAIC) has released a progress report that outlined recent developments about the planned chiropractic academic institution, which will include a chiropractic school, a research program and a multidisciplinary primary care clinic.

The PAIC is currently exploring the possibility of collaborating with a U.S.- based university. The details of this potential partnership is yet to be finalized.

The PAIC is projecting an intake of 100 new students once the school becomes operational. Historically, about 75 per cent of new chiropractic registrants in western Canada graduate from U.S. institutions, George Eisler, CEO of PAIC said. The intent is to capture students from western Canada who would otherwise go to the U.S. for chiropractic education.

Educating future chiropractors within Canada has been a long-standing goal of B. C. chiropractors. This led the profession in 2009 to create a special fund – which chiropractors in the province contribute to – administered by the College of Chiropractors of B.C. The goal is to raise $6 million by 2018. This money will be used to fund the establishment of a new health education, research and community primary care in B.C. – which now form part of the newly established PAIC.

In addition, the profession also spearheaded the establishment of the Pacific Spine Research and Education Foundation, a charitable organization tasked to develop and implement fundraising strategies for the PAIC. The foundation hopes to raise an additional $24 million.

PAIC will be building the 100,000 square-foot academic and research facility on Simon Fraser University (SFU) property in Burnaby, B. C. under a lease agreement.

In addition to the education component, progress is also being made in the research and clinic fronts. The PAIC plans to open up a multidisciplinary primary care clinic inside SFU’s UniverCity – a sustainable community development project in Burnaby.

Eisler said the planned primary care clinic will be located within UniverCity, in response to current demand for physicians, chiropractic and other health care services in the new mountaintop community. It was an opportunity that PAIC was not going to pass up.

“We are looking to lease a space and develop what will essentially be a satellite clinic to our institution,” Eisler said. The PAIC hopes to open the clinic by January 2016.

In addition to the clinic, PAIC is also in talks with SFU about potential research collaboration projects, Eisler said. While no concrete strategy is in place yet, a joint research seminar was held on September 11 involving chiropractic researchers and SFU scientists to discuss opportunities for establishing potential research initiatives.

The collaboration with SFU is an important aspect of the development of the academic institute, according to Eisler, particularly in pursuing the ultimate goal of integrating the PAIC with the public post-secondary education system.

“The interest for just another private school was not that high, but the opportunity to be close to and be well-integrated with the public system was attractive. Our long-term goal is to essentially become as integrated as possible with the SFU system.”

There are currently more than 1,000 registered chiropractors in B.C. Most recent data has revealed chiropractic utilization rate in B.C. – the percentage of the population who are under chiropractic care – is at 24 per cent. This figure is significantly higher than utilization rate in Ontario at 11 to 12 per cent, and where more than 4,000 chiropractors currently practice.

According to Dr. Don Nixdorf, co-founder of the Pacific Spine Foundation and a big proponent of establishing a chiropractic education program in B.C., annual licensing of chiropractors in western Canada has remained steady for the last 15 years, with no significant surge in the numbers.

“The B.C. school is designed to have intake which represents the historical growth and aging demographic of Dcs in western provinces,” Nixdorf said.

He said having a chiropractic school in B.C. would “significantly contribute to public and stakeholder awareness when utilizing chiropractic doctors.”

New research from Toronto Western Hospital’s Spondyloarthritis Program reveals people with a type of spinal arthritis called ankylosing spondylitis (AS) have a higher risk of dying from a heart attack or stroke than the general population.

The study, “Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality : a population-based study,” published online in the Annals of Internal Medicine links AS with a 35 per cent higher risk of dying from heart attack and a 60 per cent increased risk of dying from stroke than those without AS.

Drs. Nigil Haroon and Nisha Haroon, a husband and wife team, designed a population-based study including over 21,000 AS patients and 86,000 controls without AS, to determine the level of mortality risk AS patients face.

“This research provides a bigger picture as to what patients with AS might face living with this disease,” said Dr. Nigil Haroon, lead researcher and specialist in spondyloarthritis. “The study shows that it is important that patients receive comprehensive screening, preventative care, as well as optimal management of cardiovascular and cerebrovascular disease.”

This increased risk is particularly significant considering AS typically starts at a relatively young age, between the ages of 20 and 40, much earlier than other forms of arthritis like rheumatoid arthritis.

AS is a type of inflammatory arthritis. Apart from inflammation, new bone formation is a major feature of AS. As a result, the bones of the spine begin to fuse together causing the spine to become very stiff and inflexible. While there is no cure for AS, drug treatments known as biologics (engineered proteins derived from cells) have been shown to reduce symptoms and halt the progression of the disease. Haroon led an international research study of 335 patients, published in the leading rheumatology journal Arthritis and Rheumatism, that showed at least 50 per cent reduction in the risk of progression of AS with the use of TNF inhibitors, type of biologic therapy.

“Another additional factor to consider is that male AS patients have 82 per cent higher risk of vascular mortality compared to females with AS,” said Haroon. “This further underscores the importance of understanding all of the additional health risks associated with AS and the need for more research to fully understand the connection between chronic inflammation and heart disease and stroke.”

The Institute for Work and Health (IWH) is now accepting abstracts for presentation proposals for the 19th International Scientific Conference on the Prevention of Work-related Musculoskeletal Disorders (Premus 2016).

IWH is inviting researchers, scientists, students, academics and practitioners to submit proposals on research findings that are important to advancing understanding of work-related musculoskeletal disorders (MSDs).

The call for proposals include symposia, presentations and posters, and will ideally align with one of the conference themes:

Proposals falling outside these themes are also welcome. The deadline for abstracts is October 30, 2015.

For more information, and to submit a proposal, please visit: premus2016. Iwh.on.ca

The CFL and NFL have teamed up to add a two-minute test to standard sideline examinations for suspected concussion, with the aim of quickly determining whether a player should be pulled from the field or can safely return to play.

But just how effective is the King-Devick test for diagnosing concussion? And is its implementation merely a public relations gambit by the football leagues – both defendants in lawsuits launched by groups of former players – or a bona fide means of looking after their athletes’ brain health?

The timed test, which involves rapidly reading aloud lines of irregularly spaced, non-sequential numbers on flip cards or smartphone/ tablet apps, was initially developed by American optometrists Alan King and Steven Devick in 1976 to diagnose eye movement dysfunction that affects reading ability.

But in the last five years, research groups around the world began studying the test to see if it could detect concussion, a brain injury that can affect attention and concentration.

Dr. David Dodick, a neurologist at the Mayo Clinic in Phoenix who specializes in concussion, said numerous studies have concluded the King-Devick test is highly accurate in picking up the brain injury.

“And that’s what makes it a very valuable tool,” said Dodick, noting that the timebased test is more objective than standard balance and cognition assessment tests like the SCAT3 and is not affected by player fatigue.

Players are given K-D tests before the start of their season to establish a baseline time for recounting all 120 numbers, which are laid out in increasingly difficult-to-follow patterns.

If a player is suspected of having sustained a concussion during play, he or she is retested and the results compared. Should the task take longer to complete or include errors, the athlete should be removed from play and seen by a doctor.

The Mayo Clinic, a nonprofit U. S. health-care institution, this year endorsed the test for school-based, amateur and pro contact sports in a licensing agreement with King-Devick Test Inc.

“The reason we got involved with this is because we recognized the need for a simple, rapid and cost-effective sideline test,” said Dodick, who was born in Ontario and grew up in Nova Scotia. “So to have an objective and reliable test, we felt it was very important and we saw the potential for this King-Devick test to make a huge difference in increasing the likelihood of identifying concussion on the sidelines.”

The test, sold through annual subscription, costs US$20 per user per year and can be downloaded using the company’s new app, which uses Cloud-based data storage so parents, coaches or health professionals can easily enter and access test results, co-inventor Steven Devick said from Chicago.

“You need a baseline every year for the test to work,” he said, explaining that a person’s ability to fire off the numbers improves over time until about age 40.

The company now has about 75,000 annual users, despite not spending “a dollar” to market the repurposed product, said Devick. “But we expect to roll this out in a big worldwide way very soon.”

Dr. Richard Wennberg, a neurologist at Toronto Western Hospital, said that while studies suggest the test is effective in detecting concussion, he’s not sure how big a problem it’s addressing.

“They are making the point and you’ll read all the hype ... saying this is a huge step forward because now we’ll be able to get players on the field out of the game and to the treatment they need,” he said. “That’s probably a pretty small group of individuals that really accounts for because most times it’s pretty obvious who’s had a concussion.”

Dr. Paul Echlin, a Burlington, Ont., sports medicine physician who treats young athletes with head trauma, doesn’t use the K-D examination and questions the ability of a two-minute test to diagnose the complex condition with any certainty – especially when it’s administered by parents or coaches.

“One test can’t say someone is concussed or non-concussed,” said Echlin, adding that if there’s any suspicion a player might have sustained the brain injury, they should be removed from play and fully evaluated by a physician.

Dodick at the Mayo acknowledged that some of his colleagues have voiced a similar criticism, saying the test should be given to youth athletes by qualified professionals – not lay people like parents or coaches.

“By the same token, do we not do anything? When we do have the tool, do we not administer it?

“What would the harm be? You identify someone slower and you take them out. You err on the side of caution.”

Still, Wennberg and Echlin worry the King-Devick test is just one more money-making scheme to cash in on fears about the high-profile brain injury, which they say has become big business.

“It doesn’t address the bigger issue that you don’t want the concussion in the first place,” said Wennberg. “So we have to curb our enthusiasm here.

As for the CFL, the league is trying out the test for players on four teams – the B.C. Lions., Edmonton Eskimos, Calgary Stampeders and Winnipeg Blue Bombers – to determine if adding the King-Devick to other sideline examinations will improve identification of potential concussions in players.

“It’s really just to collect some numbers to see if this gives us an additional tool,” said Kevin McDonald, CFL vice-president of football operations.

The CFL is facing a $200-million lawsuit filed in May by two former players, who are seeking class-action status on behalf of all retired players going back to 1952. The suit, which has not been proven in court, alleges the league, former commissioner Mark Cohon, a Toronto doctor and clinic withheld information about how repeated concussions can lead to longterm cognitive disorders.

Organizations that offer health benefits to their employees are looking for more information and analysis regarding their plans, according to the 2015 edition of The Sanofi Canada Healthcare Survey, a comprehensive survey on Canadian health benefit plans.

Survey showed 72 per cent desire better reporting and evaluation of the return on investment (ROI) of their health and wellness program; 76 per cent want a better understanding of how their benefit plan affects health outcomes, productivity and absenteeism; 62 per cent want a better understanding of their claims data; and 68 per cent want a better understanding of connections between claims and utilization of programs.

“It’s encouraging that plan sponsors are looking for more information in these areas. It tells us there could be an appetite to do more, which we really haven’t seen before,” said Marilee Mark, vice-president, market development, at Sun Life Financial and a member of the advisory board for The 2015 Sanofi Canada Healthcare Survey.

Sanofi Canada president and CEO Jon Fairest said survey helps industry make important connections between health benefits, wellness and chronic disease management.

“It is necessary to make these links so they can offer effective and sustainable programs. The benefits of good health go beyond reducing costs. We know that healthy, happy individuals are more satisfied in their personal lives and more productive in the workplace. It just makes good business sense,” Fairest said.

The survey reveals plan sponsors and plan members are not making the link regarding their plans and the prevalence of chronic disease in the workplace. Plan sponsors estimate that about one-quarter (26 per cent on average) of their workforce has a chronic condition. However, more than half (56 per cent) of plan members indicate they have a chronic condition.

“Employers underestimate the prevalence of chronic disease in their workplaces and they underestimate the positive impact they can have on employee health,” said David Willows, advisory board member and vice-president, strategic market solutions, at Green Shield Canada.

On the wellness front, 45 per cent of employers report offering programs or support for health and fitness (such as weight-loss programs, fitness challenges), a finding that has not changed much since first explored in 2012. Among employees who say they have access to such programs, 34 per cent say they definitely (11 per cent) or somewhat regularly (23 per cent) participate. Level of participation is even lower among employees who describe themselves as being in poor or very poor health (30 per cent), and 39 per cent do not participate at all.

Most plan sponsors regard benefit plans as a form of compensation or reward (39 per cent), or as a cost of doing business to be competitive (26 per cent). Almost a third (31 per cent), meanwhile, indicate they make the connection between healthy employees and healthy businesses – which is the right approach, says the advisory board.

“Managing health becomes as important as managing turnover, competitive compensation, etc.,” said Serafina Morgia, senior consultant at Towers Watson. “We can reshape how to use benefits dollars more effectively, for example, so that dollars can be put toward health risk screenings.”

The survey shows that almost half (47 per cent) of plan members submitted at least one claim for paramedical services in the past year, and those that did had submitted a total of 7.3 claims on average – a frequency second only to prescription medications (9.5). While paramedical services can help make the connection between health productivity for those suffering from injury or chronic pain, their level of use may suggest the need for eligibility based on clinical criteria rather than self-perceived needs, survey proponents said.

“When you consider the disability issues in some workplaces and the issues around specialty pharmaceuticals, which can be life-changing for plan members, the cost and use of some paramedicals just don’t seem to make sense,” said Paula Allen, vice-president of research and integrative solutions at Morneau Shepell.

Three-quarters (77 per cent) of plan members say they would not move to a job that did not include health benefits.

Drug (94 per cent), dental (basic 92 per cent; major 83 per cent) and vision care (89 per cent) remain the most valued components of health benefit plans according to plan members.

When offered a list of seven possible new health benefits, plan members were most likely to select onsite health risk screenings (45 per cent), followed by onsite immunizations for infectious diseases (40 per cent).

Eighty-five per cent of plan members say they have one or more health or fitness goals – and one in five reports that their workplace is a barrier to reaching those goals.

The 2015 edition of The Sanofi Canada Healthcare Survey was initiated by Rogers Insights Custom Research group on behalf of Sanofi Canada. In total, a national sample of 1,504 primary holders of group health benefit plans completed the study. The data has been statistically weighted to ensure the age, gender and regional composition of the sample reflect those of the adult population according to the 2011 Census data. This survey was coupled with another online survey of 504 health benefit plan sponsors from across the country to bring employers perspective on the issues at hand.