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Empowered Health: Week 3

The Vancouver Sun hasn’t stopped publishing this series, so I will not stop critiquing it.

10 ways to evade Alzheimer’s

Anyone who has a close relative with Alzheimer’s shares the same worry: Am I next? However, a growing body of research indicates that our lifestyles — particularly what we eat and whether we’re obese — play a greater role than our genes in determining our brain health as we age. “For years, scientists thought that Alzheimer’s was primarily genetic,” said Gary Wenk, professor of neuroscience at Ohio State University. “We now believe that, while there’s a genetic component, Alzheimer’s is primarily a lifestyle disease.”

This little blurb really does give you all the information you need about this article. Gerontologists (those who study human aging) know that maintaining an active, healthy lifestyle is a key component of avoiding all kinds of chronic illnesses. Many of these diseases were thought to be the natural consequence of getting old, but as we learn more about aging and the importance of diet and exercise on human health we recognize that it plays a role in all kinds of degenerative conditions. Alzheimer’s is no exception, although the disease’s genetic cause is still a major factor in learning to treat it. This piece isn’t about curing Alzheimer’s though, it’s about steps people can take to avoid it, or reduce its impact.

Overall rating: 5/5 – nothing particularly innovative or informative here, but it doesn’t make any missteps and I’m constantly surprised by how little people know about this stuff.

Headaches…What a Pain in the Neck!

Most of us can relate to the pain of a headache.  Whether it’s due to stress, injury, genetics or one too many glasses of wine, there is no question that headaches are debilitating.  They get in the way of what is most important in life.  Several studies review common daily practice outcomes from the effectiveness of common treatment provided by chiropractic doctors.   These studies report what patients experience including relieving the frequency and intensity of migraine, tension and cervicogenic (involving the neck) headaches.

Hoo boy. They have an entire section of this series devoted to chiropractic. Never a good sign. This particular article is about the use of spinal manipulation to treat headaches. Now far be it from me to suggest that chiropractic is useless at everything – it certainly stands to reason that the physical arrangement of nerves along the spine could contribute to pain (including headache). If you’ve pursued pain-killers as a method of managing chronic headache, and they’ve been either unsuccessful or yielded problematic side-effects then I can understand why you would pursue a modality like chriopractic. The author of this piece links to 4 articles (one of which is not peer-reviewed) as evidence of efficacy. Let’s just say I’m underwhelmed:

  1. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. [Haas M et al., Spine J. 2010 Feb;10(2):117-28.] – compares spinal manipulation to light massage. No blinding of practitioner or patient, but outcome collection was blinded. Moderate improvement in symptoms. Not too wild about control group, but it should be sufficient to control for some placebo response.
  2. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. [Boline PD et al., J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):148-54.] – compares spinal manipulation to drugs. They appear to work equally well, but symptom reduction persists after discontinuation of drugs (not so for spinal manipulation). A letter was published that criticizes the methodology (rebound headache phenomenon at the end of drug therapy, effects of mixing amitripyltine with over-the-counter pain meds), but doesn’t find serious flaws. The study is pretty old though, which is something of a red flag.
  3. Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache [McCrory DC, et al.] – not peer-reviewed, not going to bother counting this as evidence.
  4. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. [Nelson CF et al., J Manipulative Physiol Ther. 1998 Oct;21(8):511-9.] – adding drugs to spinal manipulation didn’t increase the efficacy in pain reduction. Without a sham control, no way to measure placebo effect. Otherwise, same problems as #2.

I don’t want to be unfair here, and I am happily willing to admit that I have an anti-chiropractic bias, but when this is the best quality of evidence you can produce in support of your field: a single decent study that shows that manipulating the neck helps alleviate headaches that involve the neck, I’ve got to give this one the old thumbs down.

Overall rating: 2/5 – I gave an extra 0.5 for actually including a reference to the scientific literature.

Q & A: Massage therapy

Q: What can a massage therapist do for you?

A: Massage therapy, as it is practised in B.C., is not a singular modality approach that only uses “massage” or soft tissue techniques. Rather, massage therapy in B.C. is a health care profession, which is well-rounded in musculoskeletal care. Massage therapists provide therapy for patients that have back and neck pain, sport injuries, pregnancy related aches and pains. RMTs also assist many patients with chronic long-term illnesses. Massage therapy has also found to be effective in assisting patients with anxiety and depression.

Another Q & A. Like the last one, there is only one question I really care about, and once again they fail to answer it. Does it work?

“MTABC encourages and actively promotes an evidence-based approach to the teaching and practice of massage therapy.”

Not impressed.

Overall rating: 1/5 – I don’t have a beef with massage therapy, but ducking the efficacy question is enough to drag this one down to the bottom.

An active approach to fighting MS

Katherine Louman-Gardiner was on the Canadian women’s bobsleigh team when she was diagnosed with multiple sclerosis three years ago. “During my training, I started to experience symptoms and I went to see a specialist,” the Vancouver resident recalled in an interview. The news wasn’t good. When multiple sclerosis progresses, the results can be devastating, particularly for an athlete. Symptoms include loss of balance, impaired speech, extreme fatigue, double vision and paralysis.

Once again, I am surprised and impressed with the restraint shown in these personal anecdotes. This one, the story of a woman who remained active after a diagnosis of MS, basically makes the same points that the Alzheimer’s one does – that physical activity and positive lifestyle factors can lessen the impact of a variety of diseases (including MS). I almost want to give it bonus point for not saying word one about “liberation therapy”.

Overall rating: 5/5 – nothing at all wrong with promoting physical activity, no mention of anything woo-ish, which is quite an accomplishment with a disease like this.

I’ve got to say, as a closing statement, I expected this series to be way worse than it’s actually been. I’m waiting for them to get to reflexology and acupuncture and other “TCM” modalities that are much the rage here in the city. So far they’ve been (intentionally?) staying away from the strongest of the woo.

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Comments

  1. Beth says

    Though the blurb still appears on the “Empowered Health” main page, the link to the MS article gets only “Sorry, this story is not available.” Too bad, I would’ve really liked to comment on it.

    I will say, I think it’s unfortunate that physical activity seems to be promoted as fighting the disease rather than living well with MS. Also, I hope the article didn’t actually suggest MS progresses in a particular way, such as the symptoms listed in the blurb. (MS has many possible symptoms. There are more and less common ones, but no one knows what anyone’s progression will be — or even if the disease will progress at all.)

  2. Enkidum says

    Not many comments on these pieces, but you’re doing a service here. I’m as surprised as you at the low level of total horseshit you’re finding.

  3. Dianne says

    I expected this series to be way worse than it’s actually been.

    Me too. I’m both relieved and a tad disappointed.

    I’d only have given the Alzheimer’s article a 4.5/5 though. It’s got a slight edge of victim blaming and seems to be overpromising. You can do everything right in terms of eating, exercise, habits, etc and still get Alzheimer’s and other nasty diseases and I don’t think that is acknowledged clearly enough.

  4. Enkidum says

    Ah, well in that case maybe you should stop writing these articles and get your ass into a church!

    P.S. Off topic, but in one of the comment pages recently you mentioned you grew up in the Okanagan? You have any posts about what it’s like to be a big-ass black kid in an area which seems to be composed entirely of white people over 60? (Or maybe my impressions of it are unfair, coming mostly from getting stuck hitch-hiking in Penticton.)

  5. says

    There were lots of young families in my immediate area. I should point out that I moved away when I was 10, so I was much smaller then than I am now.

  6. Mclean says

    No no no! This material is very harmful and you didn’t blast it enough!

    I can’t believe they are recommending neck manipulations for headache! Neck manipulations are very dangerous, incredibly so when headache is involved.

    This is a good place to start, but there is much more out there:

    http://www.quackwatch.com/01QuackeryRelatedTopics/chirostroke.html

    I personally know of at least one case where someone (under 30) has died due to this (but the case wasn’t reported), and might recall another but can’t remember the details. There is enough of a time delay for the chiropractic practitioner to deny involvement, but I’m surprised with the amount of deaths and that we know the mechanism of stroke that neck manipulations are not categorically prohibited, especially if you have a headache. Even within chiropractic circles there is discussion on outright banning neck manipulations. I was shocked to see the opposite recommendation here. It is important to get out the message exactly opposite to the one suggested in the Vancouver Sun.

    IF YOU HAVE A HEADACHE, SEEING A CHIROPRACTOR MAY CAUSE STROKE.

  7. Mclean says

    Addendum on headache:

    I realize my post is telling you what not to do with a headache.

    Here’s something that might actually help: if it is a debilitating migraine, ask your doctor about Triptan-based medicine. Most doctors these days should have free samples lying around that you can try.

    http://en.wikipedia.org/wiki/Triptan

    Triptans are one of the few newer drugs that work amazingly well. They will stop a migraine headache and work for most people most of the time. Better still, the patents are starting to expire, so the current price of ~$20 a pill/wafer will surely drop and become more affordable in the near future.

    I’ve seen the results first-hand, and they are amazing. Excruciating sick days spent in bed become work days with this medicine.

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