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Iatrogenic Injury

Epidural Steroid Injections: Are long-term Risks Worth Short Term Benefits?

By |January 5, 2014|Iatrogenic Injury, Steroids|

Epidural Steroid Injections: Are long-term Risks Worth Short Term Benefits?

The Chiro.Org Blog

SOURCE:   ACA News ~ February 2014

By William Morgan, DC

Outpatient procedures are where the money is in medicine these days. Such procedures are invasive treatments that are not quite surgery but are not conservative care either. Non-surgical procedura lists are falling over themselves at an alarming rate to learn these lucrative businesses. This is true in several medical specialties: cardiac catheterization labs, GI endoscopies and colonoscopies, interventional radiology procedures, PMR pain procedures, urologic cystoscopies, chiropractic manipulation under anesthesia, epidural steroid injection therapies and many other pain procedures. If utilized correctly, these procedures may be valuable tools in the treatment of patients by preventing more invasive procedures, and in the case of cystoscopies and colonoscopies, aid in the early detection of cancer.

These procedures can be done quickly with assembly line efficiency and are very profitable for the physicians. In the case of epidural steroid injections (ESI), a ten-minute epidural procedure will generally yield anywhere from a couple hundred to a couple thousand dollars, though I have heard of a series of three epidurals going for as much as $8,000. Furthermore, if done in an outpatient facility, the physician does not have to split the fees with a hospital, and the insurance company does not need to pay the higher costs that normally accompany hospital-based procedures. Last year in the United States, the Centers for Medicare and Medicaid Services (CMS) paid for nearly nine million ESI. This number may not appear surprising at first, but when you consider that ESI therapies are neither approved by the FDA [1] nor recommended by the manufacturers [2] due to reports of severe adverse events, it becomes alarmingly relevant. Note that the CMS number is not the total number of ESI performed in the United States. The nine million number represents only those ESI paid for by CMS. When we add in the number of ESI performed in the DOD, VA, workers’ compensation systems and private insurance, that number could conceivably be in the tens of millions.

While it is true that ESI are not FDA approved, Medicare, Medicaid, workers’ compensation and most other insurers continue to pay hundreds of millions of dollars per year for this controversial procedure.

Ironically, on every vial of Kenalog (a popular steroid used for epidural injections) there is actually a warning against its use for epidural injections, yet proceduralists continue to use it.

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A Review of the Beneficial and Harmful Effects of Laughter

By |December 14, 2013|Humor, Iatrogenic Injury, Laughter|

A Review of the Beneficial and Harmful Effects of Laughter

The Chiro.Org Blog

SOURCE:   British Medical Journal 2013 (Dec 13); 347: f7274

R E Ferner, honorary professor of clinical pharmacology [12],
J K Aronson, fellow [3]


Christmas 2013: Food For Thought

Laughter and MIRTH (Methodical Investigation of Risibility, Therapeutic and Harmful): Narrative Synthesis

Every December, the BMJ publishes hilarious Christmas research.

Their 2013 offerings are now online at:

A big Thanks to Anne Taylor-Vaisey

Objective   To review the beneficial and harmful effects of laughter.

Design   Narrative synthesis.

Data sources and review methods   We searched Medline (1946 to June 2013) and Embase (1974 to June 2013) for reports of benefits or harms from laughter in humans, and counted the number of papers in each category.

Results   Benefits of laughter include reduced anger, anxiety, depression, and stress; reduced tension (psychological and cardiovascular); increased pain threshold; reduced risk of myocardial infarction (presumably requiring hearty laughter); improved lung function; increased energy expenditure; and reduced blood glucose concentration.

However, laughter is no joke — dangers include syncope, cardiac and oesophageal rupture, and protrusion of abdominal hernias (from side splitting laughter or laughing fit to burst), asthma attacks, interlobular emphysema, cataplexy, headaches, jaw dislocation, and stress incontinence (from laughing like a drain). Infectious laughter can disseminate real infection, which is potentially preventable by laughing up your sleeve. As a side effect of our search for side effects, we also list pathological causes of laughter, among them epilepsy (gelastic seizures), cerebral tumours, Angelman’s syndrome, strokes, multiple sclerosis, and amyotrophic lateral sclerosis or motor neuron disease.

Conclusions   Laughter is not purely beneficial. The harms it can cause are immediate and dose related, the risks being highest for Homeric (uncontrollable) laughter. The benefit-harm balance is probably favourable. It remains to be seen whether sick jokes make you ill or jokes in bad taste cause dysgeusia, and whether our views on comedians stand up to further scrutiny.



“Mirth . . . prorogues life, whets the wit, makes the body young, lively, and fit for any manner of employment.”— Robert Burton, The Anatomy of Melancholy (1621)

The BMJ has not dealt seriously with laughter since 1899, when an editorialist, following an Italian correspondent’s suggestion that telling jokes could treat bronchitis, proposed the term “gelototherapy” (in Greek gelōs means laughter; in Italian gelato means ice cream). [1] The journal had, a year before, described heart failure following prolonged laughter in a 13 year old girl. [2]


Get the Lead Out!

By |May 13, 2013|Iatrogenic Injury, Pediatrics, Pregnancy, Supplementation|

Get the Lead Out!

The Chiro.Org Blog

SOURCE:   MedPage Today ~ May 13, 2013

By Nancy Walsh, Staff Writer, MedPage Today

When the FDA finally got around to testing 324 multivitamin-mineral products that target children and pregnant women, they found that only 4 of them were lead-free.   [1]

Now, new research published in the Pediatrics Journal suggests that even low levels of lead in a supplement can have adverse effects on your children.   [2]   Why not use a supplement made correctly, so you can protect your family?

Here’s the Bad news from MedPage Today:

Even Low Lead Exposure Hinders Kids’ Reading

Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.

On tests of reading readiness, children with blood lead levels between 5 and 9 µg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 µg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.

And those with lead levels of 10 µg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics.  [2] (more…)

More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

By |October 4, 2012|Iatrogenic Injury, Low Back Pain, Steroids|

More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

The Chiro.Org Blog

SOURCE:   Associated Press ~ Oct 4, 2012


Medication Linked to Meningitis Deaths May Have Reached 23 States

The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.

UPDATE: October 09, 2012: The number of identified cases has reached 119, with 11 deaths in 10 different states.

UPDATE: October 11, 2012: The number of identified cases has reached 170, with 14 deaths in 11 different states.

UPDATE: October 12, 2012: from MedScape The number of people exposed to potentially contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC) in Framingham, Massachusetts, is closer to 14,000 — not 13,000 — as originally reported on October 8, federal health officials said today.

“These 14,000 patients received the medication as a steroid injection either into the spinal area or into a joint space such as a knee, shoulder or ankle,” said J. Todd Weber, MD, incident manager of the multistate meningitis outbreak at the Centers for Disease Control and Prevention (CDC). More than 12,000 of these people have been contacted to date, he said.

As of today, the CDC said a total of 170 cases (including the 14 deaths) have been reported across 11 states: Florida (7 cases, 2 deaths), Idaho (1 case), Indiana (21 cases, 1 death), Maryland (13 cases, 1 death), Michigan (39 cases, 3 deaths), Minnesota (3 cases), New Jersey (2 cases), North Carolina (2 cases), Ohio (3 cases), Tennessee (49 cases, 6 deaths), and Virginia (30 cases, 1 death).

UPDATE: October 25, 2012: from MedScape There are currently 328 reported cases of fungal infection, with 24 deaths now reported in 18 states. This includes 5 peripheral joint infections.

UPDATE: November 27, 2012: from Fox News There are currently 510 reported cases of fungal infection, with 36 deaths now reported in 19 states, and another 14 cases of peripheral joint infection reported.

NEW YORK (AP) — The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.


Clinics and medical centers rushed to contact patients who may have received the apparently fungus-contaminated shots. And the Food and Drug Administration urged doctors not to use any products at all from the Massachusetts pharmacy that supplied the suspect steroid solution.

It is not clear how many patients received tainted injections, or even whether everyone who got one will get sick.

So far, 35 people in six states — Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana — have contracted fungal meningitis, and five of them have died, according to the Centers for Disease Control and Prevention. All had received steroid shots for back pain, a highly common treatment.

This is especially disturbing, because

Steroid Injections Offer Minimal Relief for Lower Back Pain


A Replication of the Ernst Study“Adverse Effects of Spinal Manipulation: A Systematic Review”

By |September 24, 2012|Iatrogenic Injury, Spinal Manipulation|

A Replication of the Ernst Study
“Adverse Effects of Spinal Manipulation: A Systematic Review”

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2012 (Sep 21)

Peter J. Tuchin, GradDipChiro, DipOHS, PhD

Macquarie University, Bld E5A Rm 355,
Waterloo Rd, North Ryde,
Sydney, NSW 2109, Australia

Objective   To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernst. (J R Soc Med. 2007 (Jul); 100 (7): 330-338).

Method   Replication of a 2007 Ernest paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine.

Results   The review of the 32 papers discussed by Ernst found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulation therapy (SMT) as chiropractic treatment when it had been reported in the original paper as delivered by a non-chiropractic provider (e.g. Physician).

The original case reports often omitted to record the time lapse between treatment and the adverse event, and other significant clinical or risk factors. The country of origin of the original paper was also overlooked, which is significant as chiropractic is not legislated in many countries. In 21 of the cases reported by Ernest to be chiropractic treatment, 11 were from countries where chiropractic is not legislated.

Conclusion   The number of errors or omissions in the 2007 Ernest paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects.


The Full-Text Article:


The use of a treatment by health care providers requires examination of the evidence of effectiveness and assessment of the evidence for risks or adverse events (AE) caused by the treatment [1]. Spinal manipulation therapy (SMT) has strong evidence for treatment of low back pain, neck pain, headache and migraine [2-6]. This is supported by numerous systematic reviews of a large number of randomized controlled trials [7-10] (more…)

A Practical Guide to Avoiding Drug-Induced Nutrient Depletion

By |June 25, 2012|Clinical Decision-making, Complementary Medicine, Diagnosis, Drug-Induced Nutrient Depletion, Evaluation & Management, Evidence-based Medicine, Iatrogenic Injury, Supplementation|

A Practical Guide to Avoiding Drug-Induced Nutrient Depletion

The Chiro.Org Blog

SOURCE:   Nutrition Review ~ October 2011

By Hyla Cass, MD

A little known, but potentially life-saving fact is that common medications deplete your body of a host of vital nutrients essential to your health. This practical guide will show you how to avoid drug-induced nutrient depletion and discuss options for replacing nutrient-robbing medications with natural supplements.

America has been called a pill-popping society, and the statistics bear this out. Nearly 50 percent of all American adults regularly take at least one prescription drug, and 20 percent take three or more. [1] Our increasing reliance on prescription medications has contributed to the growing problem with nutrient depletion. The truth is that every medication, including over-the-counter drugs, depletes your body of specific, vital nutrients. This is especially concerning when you consider that most Americans are already suffering from nutrient depletion. Additionally, many of the conditions physicians see in their everyday practice may actually be related to nutrient depletion. The good news is that, armed with information and the right supplements, you can avoid the side effects of nutrient depletion, and even better, you may be able to control and prevent chronic diseases, such as diabetes, cardiovascular disease and osteoporosis.

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A Common Scenario