The paper, "Smoking, a Cause of Back Trouble?" in the British Journal of Rheumatology, contends that "...smoking leads to malnutrition of the disc which in turn renders it more vulnerable to mechanical stress." The Austrian study suggests that malnutrition may be the factor that cause epidemiological studies to "strongly imply that smoking may be a risk factor for back problems."
The paper hypothesizes that "chronic smoking causes reduced vertebral blood flow" brought about by five mechanisms working in concert: "formation of carboxyhaemoglobin, vasoconstriction, development of athroma, fibrinolytic defect and haemorheological impairment." The effects of oral contraceptives leading to "systemic changes, very similar to those caused by smoking" is also discussed.
The paper concludes:
"The association between smoking and back pain is consistent throughout many epidemiological studies. Yet it is by far too weak to be the only risk factor. Numerous other factors exist, their casual role, however, still needs to be established. Smoking induces disc degeneration at all levels of the lumbar spine, suggesting a systemic effect of smoking rather than a localized one. Smoking possible leads to malnutrition via several mechanisms working in concert. The time has come to regard smoking as a casual risk factor for back pain. This attitude seems sensible regardless of the underlying mechanism. Abstention programmes should now be integrated into back pain prevention measures such as, for example, the back school."
Federal Drug Research
AHCPR Spends $14.5 MillionIn an age when aspirin "has been shown to be effective" in treating everything from headaches to high blood pressure, the need for objective research on drug effectiveness (or lack thereof) has never been greater. The June 1993 issue of Research Activities, the digest of research finding produced by the Agency for Health Care Policy and Research (AHCPR), announced the AHCPR has awarded grants totaling approximately $14.5 million.
The announcement stated:
"The effectiveness and appropriateness of drugs used to treat patients with human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), Lyme disease, depression, asthma, arthritis, hypertension, congestive heart failure, and other illnesses will be examined in a series of 14 new studies funded by the Agency for Health Care Policy and Research.Outcomes research will put these drugs on a level playing field upon which chiropractic care can be compared for similar ailments. This will be particularly relevant in terms of quality-of-life factors."The overall value of the awards, including $3.5 million in first-year grants, totals approximately $14.5 million. It is expected that the projects will provide critical information on the ways drug therapy affects patient outcomes, including objective measures such as morbidity, mortality, and health services use, and subjective measures such as quality of life."
The chiropractic profession will want to increase the amount of time, money, and effort spent on outcomes research in these and all other areas of health care. Research in general, and outcomes research in particular, is fast becoming the best way to demonstrate which therapies are superior.
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