After establishing that a product is registered, legal and contains actives, we look at efficacy. chiropractic and rehabilitation in private practice we are concerned with evi-dence-based treatments – ones that we know work, that can be used within our regulated scope of practice, that deliver value for money, and that can turn a profit (or at least not lose money) if sold to patients. However reluctantly, we feel we must set aside practices and prod-ucts whose value are debated or un-proven. Health Canada regulates topicals under two distinct regulatory systems: drug products and licensed natural health products, with their respective DIN or NPN number. We do not eval-uate any new products that are not registered with Health Canada. Surpris-ingly, that eliminates a large number of www.canadianchiropractor.ca products on the market today. Drug products and their various med-ical and pharmacological implications, we leave to physicians and pharmacists. Looking at the natural health product side of the market, we do our own due diligence. We always check the Health Canada Drug database to compare a product’s marketing to its Health Can-ada registered active ingredients. We want to know that a product contains what it says it does, and at the concen-trations claimed. After establishing that a product is registered, legal and contains actives, we look at efficacy. We rely a lot on PubMed, the U.S. National Library of Medicine online collection of global research, to give us a sense of the landscape. Search an active ingredient and you’ll find out all you really need to know about the claims being made by product marketers. Amongst natural health topical prod-ucts for instance, research points to the efficacy of the double-punch of methyl salicylate (MS) combined with menthol ( Clinical Therapeutics 2010 Jan;32(1):34-43 “Efficacy and safety profile of a topical methyl salicylate and menthol patch in adult patients with mild to moderate muscle strain: a ran-domized, double-blind, parallel-group, placebo-controlled, multicenter study.” Higashi Y, Kiuchi T, Furuta K.), and the great results from clinical trials of men-thol on chronic pain related to joint injury related to repetitive tasks (Reha-bil Res Pract. 2014; “Acute effect of topical menthol on chronic pain in slaughterhouse workers with carpal tunnel syndrome: triple-blind, rand-omized placebo-controlled trial.” Sund-strup et al). If a claim made by a product’s mar-keting is not reflected in PubMed re-search abstracts, then it’s a good sign the product’s treatment value is unproven, and we set it aside. Apart from all these criteria we must December 2015 Canadian Chiropractor 35
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