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The math on prescription drug benefits

September 19, 2011 Dr. Barbara Kaiser, DC, CCWP Aging, Bone Health, Medicine, Research, Safety Leave a comment  

Here is something you and your medical doctor may both be unaware of: the math on prescription drug benefits. If you see a drug advertisement, the numbers sound impressive: 45% or 50% reduction in heart attack, stroke, or bone fracture. That’s what the drug companies tell medical doctors, too. But these numbers are misleading because they are relative, not absolute. Let’s explain this important difference in reporting the math.

Let’s say we study 100 people for 5 years and tally the number of heart attacks. If four people have heart attacks, the absolute risk is 4%. If a second group of 100 people of similar age and lifestyle take a drug for 5 years and three people have heart attacks, the absolute risk has dropped to 3%. The absolute risk reduction from the drug intervention is 1%. However, the relative risk reduction has gone from 4% to 3%, which is a 25% drop in heart attacks. This 25% is what the drug companies broadcast in the news media, in medical education courses, and directly to you as a consumer. But what they are truly hanging their hat on is a 1% benefit, and a 99% chance that the drug will be useless.

Now let’s say you really want to be that one person out of 100 that is able to avoid a heart attack through drug therapy. As an informed consumer, you need to consider the risks of long-term drug therapy. Do the risks outweigh the benefits? For example, is there a 1% chance of developing a chronic illness like diabetes?

Let’s stop using hypothetical numbers. What is the math from medical research journals? Here it is: of people without known heart disease who took statin drugs for 5 years, 98% saw no benefit. The most recent literature suggests a 0.6% risk of developing diabetes as a result of long-term statin drug use. For every 20 people who avoided a heart attack or stroke, 6 people developed diabetes, which carries its own set of cardiovascular risks, plus kidney, visual, and neurological disabilities.

If health truly came in a bottle, Americans would be dying of old age.

 

About the author: Dr. Barbara Kaiser, DC, CCWP, is a wellness-certified chiropractor at Vital Life Chiropractic in Eagan, Minnesota.

 


Chiropractic and Stroke

October 5, 2009 Dr. Barbara Kaiser, DC, CCWP Chiropractic, Safety 2 Comments

What Kind of Stroke?

Chiropractic care has been reported to damage the vertebrobasilar arteries, sometimes called the vertebral arteries. The loss of blood flow to the brain resulting from this damage is called a vertebrobasilar artery (VBA) stroke. The rare incidents of VBA stroke reportedly related to chiropractic care have received special publicity. Some uninformed people claim that chiropractors cause strokes. Let us examine this issue further.

 How Frequent is VBA Stroke?

Most VBA strokes are spontaneous and can be caused by car crashes, checking the blind spot while driving, and working overhead. Risk factors for VBA stroke include high blood pressure, atherosclerosis, and disorders affecting the integrity of blood vessels, among other conditions. The best estimate of frequency of VBA stroke is 0.001-0.003 percent. Between 1934 and 1994, Terrett (1996) found 183 case reports of VBA stroke after chiropractic care. Forty-two cases resulted in complete or almost complete recovery. Of the 33 cases resulting in death, 12 were attributed to chiropractor, 5 to chiropractic, and most of the remainder to medical doctors and osteopaths. With data this sparse covering a 60-year span, the estimates of VBA stroke following chiropractic care range from 1 in 400,000 to 1 in 1 million.

 Recent Research

The most recent research on this issue was published in Spine journal in 2008. Over a nine-year period, 818 VBA strokes were treated in Ontario hospitals. The researchers found no excess risk of VBA stroke associated with chiropractic care compared to primary care (Cassidy et al., 2008). Headaches and neck pain are the early symptoms of VBA damage in eighty percent of cases. The authors suggest that people with undiagnosed VBA damage are seeking care before having a VBA stroke. In other words, saying that chiropractors cause strokes is like saying that hospitals cause heart attacks.

 Cadaver Research

Researchers at the University of Calgary used unembalmed cadavers to measure the force applied during chiropractic care. They compared these forces to what was required to cause damage to the vertebral arteries. They found that the force needed to damage the vertebral arteries was about 10 times what was measured in a typical chiropractic adjustment to the upper neck (Symons et al., 2002).

Last Words

As we can see, the risk of VBA stroke following chiropractic care is extremely small. It is worth noting that the malpractice insurance premium for a newly licensed chiropractor is less than $500 per year. If someone makes false statements about the supposed dangers of chiropractic, please share this information with them.

 Resources:

  1. Cassidy, David J., et al. 2008. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine 33(4S): S176-S183.
  2. Symons, Bruce P., et al. 2002. Internal forces sustained by the vertebral artery during spinal manipulative therapy. Journal of Manipulative and Physiological Therapeutics 25:504-510.
  3. Terrett, Allan G.J. 1996. Malpractice Avoidance for Chiropractors: Vertebrobasilar Stroke Following Manipulation. Des Moines, IA: National Chiropractic Mutual Insurance Company.