RE: problems of overdiagnosis

June 5, 2012

Yes, most chiropractors have never met an "un-subluxated" person. The science of "killer subluxations" seems strongest in the research around global postural distortions, where we see earlier death in those with thoracic hyperkyphosis and cervical kyphosis. Jamey Dyson, DC

csimpson@... O | C6600 SW 105th Ave, Ste 115 | Beaverton, OR 97008http://www.bmj.com/content/344/bmj.e3502.full?ijkey=tzRK2ncLto2JJ9I & keytype=ref

Problems of overdiagnosis

Asthma—Canadian study suggests 30% of people with diagnosis may not have asthma, and 66% of those may not require medications37

Attention deficit hyperactivity disorder—Widened definitions have led to concerns about overdiagnosis; boys born at the end of the school year have 30% higher chance of diagnosis and 40% higher chance of medication than those born at the beginning of the year46

Breast cancer—Systematic review suggests up to a third of screening detected cancers may be overdiagnosed4

Chronic kidney disease—Controversial definition classifies 1 in 10 as having disease; concerns about overdiagnosis of many elderly people 23

Gestational diabetes—Expanded definition classifies almost 1 in 5 pregnant women 31

High blood pressure—Systematic review suggests possibility of substantial overdiagnosis22

High cholesterol—Estimates that up to 80% of people with near normal cholesterol treated for life may be overdiagnosed3

Lung cancer—25% or more of screening detected lung cancers may be overdiagnosed56

Osteoporosis—Expanded definitions may mean many treated low risk women experience net harm18

Prostate cancer—Risk that a cancer detected by prostate specific antigen testing is overdiagnosed may be over 60%12

Pulmonary embolism—Increased diagnostic sensitivity leads to detection of small emboli. Many may not require anticoagulant treatment 39

Thyroid cancer—Much of the observed increase in incidence may be overdiagnosis28

June 5, 2012

Here are a couple abstracts. The first abstract is the best one to date showing the connection between poor posture and increased mortality. The second abstract found more spinal deformity in those with increased anterior sagittal balance (forward head or forward body syndrome). The link between cervical kyphosis and mortality has not been directly measured in a prospective study to my knowledge. However, there have been population studies looking at the shape of the cervical curve across all ages and they find that the incidence of cervical kyphosis becomes much less in the elderly vs. the young. Why is that? Well, you can infer that those with cervical kyphosis died off at an earlier age than their lordotic counterparts. I don't have those references on hand, but Deed on or Haas or Lenny Siskin with CBP would be able to point you in the right direction.It would be great if chiropractors could rally around the idea of spinal correction. This is our niche! We can do x-rays and PT's can't. The ability to x-ray and make predictable corrections to the spine is one of the major differences between us and other professions. Jamey Dyson, DCJ Am Geriatr Soc. 2004 Oct;52(10):1662-7.Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study.Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E, Greendale GA.SourceDivision

of Geriatrics, Department of Medicine, Geffen School of Medicine at University of California, Los Angeles, California 90095, USA. dkado@...AbstractOBJECTIVES: To determine the association between hyperkyphotic posture and rate of mortality and cause-specific mortality in older persons.DESIGN: Prospective cohort study.SETTING: Rancho Bernardo, California.PARTICIPANTS: Subjects

were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991.MEASURES: Kyphotic posture was measured as

the number of 1.7-cm blocks that needed to be placed under the participant's head to achieve a neutral head position when lying supine on a radiology table. Demographic and clinical characteristics and health behaviors were assessed at a clinic visit using standard questionnaires. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.RESULTS: Hyperkyphotic posture, defined as requiring one or more blocks under the occiput to achieve a neutral head

position while lying supine, was more common in men than women (44% in men, 22% of women, P<.0001). In age- and sex-adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality (95% confidence interval (CI)=1.12-1.86, P=.005). In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40, 95% CI=1.08-1.81, P=.012). In cause-specific mortality analyses, hyperkyphotic posture was

specifically associated with an increased rate of death due to atherosclerosis.CONCLUSION: Older men and women with hyperkyphotic posture have higher mortality rates.Spine (Phila Pa 1976). 2005 Sep 15;30(18):2024-9.The impact of positive sagittal balance in adult spinal deformity.Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F.SourceDepartment

of Orthopaedic Surgery, University of Louisville School of Medicine, The Kenton D. Leatherman Spine Center, Louisville, KY, USA. tallgeyer@...AbstractSTUDY DESIGN: This

study is a retrospective review of 752 patients with adult spinal deformity enrolled in a multicenter prospective database in 2002 and 2003. Patients with positive sagittal balance (N = 352) were further evaluated regarding radiographic parameters and health status measures, including the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index.OBJECTIVES: To

examine patients with adult deformity with positive sagittal balance to

define parameters within that group that might differentially predict clinical impact.SUMMARY OF BACKGROUND DATA: In a multicenter study of 298 adults with spinal deformity, positive sagittal

balance was identified as the radiographic parameter most highly correlated with adverse health status outcomes.METHODS: Radiographic

evaluation was performed according to a standardized protocol for 36-inch standing radiographs. Magnitude of positive sagittal balance and

regional sagittal Cobb angle measures were recorded. Statistical correlation between radiographic parameters and health status measures were performed. Potentially confounding variables were assessed.RESULTS: Positive

sagittal balance was identified in 352 patients. The C7 plumb line deviation ranged from 1 to 271 mm. All measures of health status showed significantly poorer scores as C7 plumb line deviation increased. Patients with relative kyphosis in the lumbar region had significantly more disability than patients with normal or lordotic lumbar sagittal Cobb measures.CONCLUSIONS: This

study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion

with progressive sagittal imbalance. The results also show that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine.<<

research around global postural distortions, where we see earlier death in those with thoracic hyperkyphosis and cervical kyphosis. >> Interesting. Citations? A. Simpson, DC | Vice President, Medical Director

The CHP Group | Smart Solutions. Healthy Results.Like us on Facebook | Follow us on Twitter | Follow us on LinkedIn | www.chpgroup.com

csimpson@... O | C6600 SW 105th Ave, Ste 115 | Beaverton, OR 97008

research around global postural distortions, where we see earlier death in those with thoracic hyperkyphosis and cervical kyphosis.

June 5, 2012

Aren't we 'already there' .... Vern's having to fight right now because the CCO would have us relegated to 'spine only' Your concept is good Jamey but I am not willing to be contained to the spine only. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com CC: oregondcs To: csimpson@...From: drjdyson1@...Date: Tue, 5 Jun 2012 13:22:03 -0700Subject: Re: problems of overdiagnosis