John Wiens DC

BCA v. Singh: Making Legal History

By John Wiens DC|December 16, 2009|News|

Previous articles relating to this case can be found here, here and here.

The case of British Chiropractic Association against Simon Singh is now likely to make legal history.

The news broke today that the Court of Appeal panel hearing the appeal of the preliminary hearing on meaning will be joined by the Lord Chief Justice.

The panel will now consist of England’s two most senior appeal judges – the Lord Chief Justice and the Master of the Rolls – as well as the formidable Lord Justice Sedley.

This is exceptional and, as far as I am aware, unprecedented for an appeal on just a preliminary point, rather than on a full substantive appeal of a decided case.

This is the heavy artillery of the judiciary.

This panel means that any judgment of the Court of Appeal could have immense effect on the future approach of the High Court to the question of what constitutes fair comment or a factual statement, and it may give firm guidance the extent to which the High Court can again impose a meaning of dishonesty either generally or against corporations in particular.

The Court of Appeal may not take this opportunity to adopt a robust approach, but having the two very most senior appeal judges on one panel rather tells against this. The composition of the panel does not by itself tell us how the appeal will be decided, just the potential significance of the judgment on future cases.

It is thereby probable that this Court of Appeal hearing on BCA v Singh will become a landmark case.

Moreover, should such a panel choose to criticise either party, or indeed the High Court itself, the effect could be damning.

It is becoming very interesting.

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Incurable Tuberculosis Making a Comeback

By John Wiens DC|December 11, 2009|Public Health|

Source Newsweek

It’s been nearly a decade since U2 frontman Bono turned the entire continent of Africa into a pet cause, drawing attention to the problems of -developing-world health like never before. By some accounts, that publicity has started to pay off: since 2000, malaria incidence is down 50 percent in some of the hardest-hit regions, and in the past five years, the number of people with access to life-saving HIV medications has increased 10-fold. But while First World philanthropists and rock-star do-gooders were out to conquer AIDS and malaria, they left a far more ancient killer to fester. Tuberculosis has been traced back as far as the Egyptian mummies. It still kills 5,000 people every day—more people than swine flu has killed in the past year. And right now, natural selection and human fallibility are conspiring to make the germ indestructible.

Since the first effective medications were made available in 1944, Mycobacterium tuberculosis has routinely developed resistance to one drug after another. But in the late 1990s a more disturbing trend emerged: strains of tuberculosis called multidrug-resistant, or MDR-TB, that were resistant to not one but several of the most effective medications (called first-line drugs), began popping up in Africa, Asia, and Eastern Europe. Now those strains have evolved into something even more deadly: extensively drug-resistant, or XDR-TB, which is impervious to first-, second-, and third-line drugs—virtually all the antibiotics in existence. It’s the kind of bug that gives epidemiologists nightmares. And in the past two years, while the world was distracted by the financial crisis, it has emerged in nearly every country on the planet. Experts say it’s time to start worrying. In a 2009 speech delivered to the U.N., World Health Organization director Margaret Chan warned that without swift, decisive action, we might soon find ourselves back in “an era that predates the development of antibiotics,” when tuberculosis was completely incurable. In country after country, drug-resistant strains will start to replace drug-susceptible strains, spreading from the inner cities to the suburbs and from the slums to the countryside. And as scientists start from scratch in a hunt for effective antibiotics, the death toll will steadily rise in rich countries as well as poor. (more…)

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Painkiller Deaths Double In Ontario

By John Wiens DC|December 8, 2009|Safety|

Source The Globe and Mail
December 8th, 2009
ANNA MEHLER PAPERNY

Painkillers are causing twice the number of overdose deaths they were two decades ago, a new study has revealed. And most of those who died obtained the medications through a doctor’s prescription and had seen a physician within the last month of their life.

The increase mirrors a dramatic rise in prescriptions for oxycodone. The potent opiate, found in OxyContin and Percocet, has proliferated in an epidemic of chronic pain turning Canadians into a nation of pill-poppers – using more prescription opioids per capita than any country but the United States and Belgium.

It’s an indication that many doctors have underestimated the power and complexity of prescription opioids, and their ability to harm as well as help, said Irfan Dhalla, a doctor at St. Michael’s Hospital in Toronto and the report’s primary author.

Dr. Dhalla is one of many physicians and researchers who argue that prescribing physicians – from general practitioners to gynecologists – need to reconsider the treatment of patients suffering from chronic pain and addiction.

“Physicians will be very surprised to learn just how many deaths occur from prescription opioids each year,” Dr. Dhalla said. (more…)

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Virtual World Will Offer Students a Unique Patient Experience

By John Wiens DC|December 4, 2009|Education|

Source NORTHWESTERN HEALTH SCIENCES UNIVERSITY
Dec 2, 2009

2nd Life New technology that will give chiropractic students the opportunity to conduct an online clinical rotation with a virtual geriatric patient is being introduced at Northwestern Health Sciences University. Second Life is a 3D virtual world that uses avatars, moveable icons representing people, to interact through free voice and text chat. During the winter trimester, the Northwestern clinical education department will administer a Second Life beta test that will allow students to conduct virtual interviews with patients in an online simulated clinical training environment.

“This is a rare opportunity because students will be able to interact with unique patient populations of varying ethnicities and abilities,” said Lynne Hvidsten, DC, associate dean of clinical education. “The students can more routinely interact with patients that have disabilities or conditions such as multiple sclerosis – patients they are apt to see in practice, but have little opportunity to experience in a classroom.”

Glori Hinck, DC, assistant professor and pioneer of this program, spoke about Second Life at a technology conference in Australia last summer. Since then, she has been working to integrate the technology into an active education program. “This is the way that education is moving,” Dr. Hinck said. “This beta test is just an introduction. I hope that it will soon supplement mock interviews that students conduct with each other in the classroom.”

Mary Berg, MA, assistant professor, coordinates the chiropractic rotation experiences for the T8 students. “We had about five to 10 students interested in participating in the rotation on Second Life. We know that Second Life may not be for everybody, but we are encouraged by this initial response.”

Dr. Hvidsten, Dr. Hinck, and Berg currently use Second Life and avatars as a means of interacting with each other from separate locations. “It’s like having a conference call with avatars,” said Dr. Hvidsten. To learn more about Second Life, check out a brief introduction created by Dr. Hinck at http://www.youtube.com/watch?v=6RdwqK2di7M.

“We are very excited about this new collaboration” said Dr. Hvidsten. “Education is certainly changing and we are seeking to meet the various needs of the students. We hope to usher in a new generation of learners.”

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Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

By John Wiens DC|October 23, 2009|Research|

This review, was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.

Executive Summary:

Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment.

The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations.

High quality randomized cost-effectiveness studies have to date only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.

The results of the researchers’ analysis are as follows:

-Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.

Total cost of care per year:

-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.

-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.

Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.

These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve.

The full report can be downloaded here.

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Science writer Simon Singh wins ruling in chiropractic libel battle

By John Wiens DC|October 15, 2009|Ethics|

In two previous articles, here and here, I talked about author Simon Singh’s battle with the British Chiropractic Association. The Guardian reported yesterday that the initial ruling has been overturned.
From The Guardian:

A science writer who is being sued for libel by the British Chiropractic Association is to fight on after a preliminary judgment against him was overturned on appeal today.

Simon Singh was sued by the BCA after he wrote an article in the Guardian criticising the association for supporting members who claim that chiropractic treatments – which involve manipulation of the spine – can treat children’s colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying.

Singh described the treatments, for which he said there is not a lot of evidence, as “bogus” and criticised the BCA for “happily promoting” them.

In May, Mr Justice Eady in the high court ruled on the meaning of the words, saying they implied the association was being deliberately dishonest. Singh said that interpretation would make it difficult for him to defend himself at a full trial.

Singh was initially refused leave to appeal, but Eady’s interpretation was rejected by Lord Justice Laws, who said Eady had risked swinging the balance of rights too far in favour of the right to reputation and against the right to free expression. Laws described Eady’s judgment as “legally erroneous”.

Many scientists and science writers have rallied to Singh’s support, claiming that the freedom of scientific opinion is at stake.

Speaking after the judgment, Singh said this was the “best possible result”.

“Simon Singh’s battle in this libel case is not only a glaring example of how the law and its interpretation are stifling free expression, it shows how urgent the case for reform has become,” said Jo Glanville, editor of Index on Censorship.

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About John Wiens DC

BCA v. Singh: Making Legal History

Incurable Tuberculosis Making a Comeback

Painkiller Deaths Double In Ontario

Virtual World Will Offer Students a Unique Patient Experience

Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

Science writer Simon Singh wins ruling in chiropractic libel battle