Health Waste: Spinal Fusion Added to List

Spinal fusion for unexplained back pain will today be put on the list of unnecessary, wasteful and risky medical procedures, promising patients more clarity over their options and potentially saving the health system tens of millions of dollar a year.

The move comes after The Australian revealed health insurers had nominated a reduction in spinal fusion surgery as one of the doctor-led responses required to contain the rising costs that are driving up premiums. Even a 20 per cent reduction in hospital cases would save the industry $60 million a year, with flow-on savings for members.

The Australian Prudential Regulation Authority has warned that insurers are “under duress” and more work needs to be done to reduce costs and stabilise the industry. Its latest figures, ­released yesterday, showed the proportion of Australians with hospital cover had fallen again, to 45.6 per cent, the lowest rate since mid-2011.

While spinal fusion surgery may have a role in cases of spinal instability, in recent years it has often been used in an attempt to treat chronic low back pain where there is no obvious cause. Experts are alarmed by the trend and, ­according to one estimate, the surgery cost $2.3 billion over a ­10-year period despite more than half of those operations likely being unnecessary.

The pain medicine faculty of the Australian and New Zealand College of Anaesthetists has now recommended that spinal fusion be added to the list of unnecessary procedures being developed through the professions-led ­initiative Choosing Wisely.

The college is urging doctors not to refer patients with axial or mechanical lower back pain for spinal fusion surgery. It is one of five recommendations from the pain experts for the list, with some of the others being not to prescribe benzodiazepines for low back pain and to avoid prescribing opioids for patients in chronic non-cancer pain where the risks outweigh any benefits. The college’s Mick Vagg said yesterday it was hoped that by ­advising against spinal fusion surgery, clinicians and their patients would be able to focus on other options.

“It is also legitimising people choosing not to have surgery,” said Dr Vagg, a pain medicine physician. “A surgeon once said to me he spent four times as much time talking to people he wasn’t going to operate on than those he was going to operate on. That’s because sometimes it is more psychologically comforting to do something than not.”

Medibank has estimated that about 2000 of its members have spinal fusion surgery each year, costing just under $35,000 each. There is also a huge disparity in the rates of surgery, depending on where it takes place and whether in the public or private system. The Australian Commission on Safety and Quality in Health Care found variation by area on a factor of 6.9. It noted that spinal ­fusion surgery in NSW increased by 2 per cent between 1997 and 2006 in the public system — and by 167 per cent in the private ­sector.

Private Healthcare Australia head Rachel David said spinal fusion was another example of where evidence-based medicine helped patients and the system.

“We know that probably only around 20 patients out of every 100 who get spinal fusion surgery are helped by it,” Dr David said. “But it gets a lot of funding through the (Medicare Benefits Schedule) and doctors will just come back and say we don’t know which 20 per cent benefit, so they are continuing to operate on people. That is the difficulty, when the evidence is unclear about patient selection and the MBS continues to pay, it is difficult under our regulatory system not to pay.”

APRA figures show the level of hospital treatment benefits paid by insurers was 4.7 per cent higher in the December quarter than the same period the year before. But the average out-of-pocket cost for patients in that period increased 6.1 per cent.

Dr David said health insurers returned more of their premiums to members than any other insurance category. She suggested the figures would also put lie to the claims, most recently made by Labor leader Bill Shorten, that some health insurers were making 25 per cent profits, in comments that appeared to reflect he confused a return on equity measure with profit.

“Health fund profit margins were 5.16 per cent in the 12 months to December 2017 and health fund profits have remained stable over the last decade running between 4.5 and 6 per cent, significantly below the returns made by private hospital groups and medical specialist practices,” she said.

The continued slide in the proportion of Australians with hospital cover — 12,294 fewer members in the quarter — came after Health Minister Greg Hunt announced a package of reforms and before he approved long-time low premium increases.

-- Dr Joseph J. Ierano

Doctor of Chiropractic

.Sc. (NSW), D.C.(Palmer), BCAO


Food For Thought

Did you know that although the brain accounts for less than 2% of a person’s weight, it consumes 20% of the body’s energy? Something pretty important must be going on up top. Life’s stresses can sometimes go unchecked or ignored and through the natural ageing process, our brain can slowly become susceptible to various degenerative processes. These range from having a foggy head or lapses in memory to a severe reduction in brain power such as that seen in Alzheimer’s disease.

Fortunately, there are some simple ways to keep you on your mental toes well into those golden years:

Challenge It: What happens if you can’t be bothered cleaning under the sofa? Dust accumulates and other then the odd two-dollar coin or your keys, this isn’t something we want.  In a sense, if you don’t push your brain, dust can settle and the cogs will slowly stop turning. The easy solution is to have a good crack at the crossword and Sudoko puzzles in the paper or download a “brain gym” application for your phone.

Exercise It: Regular physical activity is vital for bedding down memories and firing up your nerve system. We don’t all have to be out pounding the pavement for 30km every morning; it just has to be consistent movement everyday. Examples include walking, gardening and swimming. The activities that use both sides of your body will also nourish both sides of your brain.

Feed It: A brain without sound nutrition is running on an empty tank of gas. Think back to the last time you only had a coffee for breakfast or skipped the meal entirely. How well did your brain function that day? The outer layer of the brain requires a constant supply of fatty acids so try to include plenty of omega-3s in your diet, such as those found in cold water fish like salmon and flaxseed oil. Other foods such as eggs, broccoli, kale and wheat germ all provide essential building blocks for neurotransmitters. These special molecules act as the chemical messenger system for your nerve system and without them; doing up your shoes or shutting your eyes at night wouldn’t be possible. A good rule of thumb with your diet is: “Put garbage in, you’ll get garbage out.”

Take care of your brain and it will take care of you.

Written By: Dr Matt Jacob

Being Good is Good for Your Health

Science is beginning to demonstrate why selfless acts are so good for us. It has been demonstrated that when people volunteer or donate to charity, their brains register pleasure and reward. These are the very same areas of the brain that light up when you eat your favourite food, kiss a lover, or win a race.

At Care Chiropractic QLD, we are responsible for looking after the health of our community not just at an individual level, but on a larger scale. At least once a month all of our clinics run free health seminars, workplace safety classes, or charity events such as the Ambrose Golf Day for the Mareeba Hospital Foundation. Through the support of our patients, we have donated 107kg of clothing to Papua New Guinea.  We also run annual Christmas drives at our practices with patient support.

So maybe nice guys don’t always finish last. Selflessness can enhance our lives in multiple areas such as health, romance and finances. Here’s why:

  • It’s good for your health - The same feel good chemicals that are released when you do a good deed are also naturally occurring painkillers and promote healing
  • It’s good for your bottom line - Altruists may reap unexpected financial benefits because others will feel compelled to reward their kindness
  • It’s good for those with addictions – getting involved in the community has been shown to significantly reduce relapse rates amongst both adolescents and adults  
  • It promotes social connection – when we give to others, they feel closer to us and we feel closer to them. 

So, how can you, your business or family help? There are a number of ways you can start reaping the benefits of giving.

  • Connect with like-minded groups. People are much more likely to help members of their own group. Examples include liking the same sport, hobby or social service groups such as Rotary
  • Give thanks – grateful people are more generous
  • Lead by example – great leaders inspire other to follow, not simply getting people to do what they want
  • Get time on your side – individuals are much more likely to help someone in need if they believe they have the time to do so
  • Fight inequality – whether it is in the workplace, home or schoolroom. We aren’t born with prejudice, it’s something we learn.  

"Never doubt that a small group of thoughtful, committed  people can change the world. Indeed, it is the only thing that ever has." - Margaret Mead

By Dr Matt Jacob

Care Chiropractic QLD

Get Back to Your Best

Everybody associates the concept of fitness with something that you have to work at and maintain. Ever thought about your postural fitness? Here are the facts:

• 1 in 11 suffers from back pain, which accounts for 2 million Australians

• Back pain is the 3rd biggest cause of years lost due to disability

• 280,000 Australians are forced into early retirement due to back pain and arthritis 1

• Back pain costs Australian taxpayers $12 billion dollars

Postural fitness means optimal spinal health and alignment. It gives you greater strength, endurance, better coordination and balance. The biggest impact on postural fitness is sitting too long.

Sitting can:

• Increase the stress on the discs between your vertebrae

• Lead to inflammation, pain and possible early degeneration of your spine

Everybody associates the concept of fitness with something that you have to work at and maintain. Ever thought about your postural fitness? Here are the facts:

• 1 in 11 suffers from back pain, which accounts for 2 million Australians

• Back pain is the 3rd biggest cause of years lost due to disability

• 280,000 Australians are forced into early retirement due to back pain and arthritis 1

• Back pain costs Australian taxpayers $12 billion dollars

Postural fitness means optimal spinal health and alignment. It gives you greater strength, endurance, better coordination and balance. The biggest impact on postural fitness is sitting too long.

Sitting can:

• Increase the stress on the discs between your vertebrae

• Lead to inflammation, pain and possible early degeneration of your spine

• Cause the natural curves in your back to deteriorate

• Reduce the overall function and stability of your spine

Chiropractors are uniquely positioned to help assess your postural fitness and improve it. Here is some of the advice we offer people who would like to strengthen their posture and avoid damage:

• Think tall. Take that notch in the middle of your chest below your chin and lift it. It will draw your shoulders back and head up naturally

• Stand when on the phone for extended periods

• Take stretch breaks during long meetings and computer work

• Get moving! Join yoga, Pilates, or a gym to get your spine working better

If you think your workstation isn’t set up ideally, contact one of your local chiropractors to come in and do a workplace assessment. Our mission is to get you back to your best.

1. D Schofeild, Chair of Health Economics University of Sydn

A fizzy drink today will make your bones fade away

Everybody has heard about what happens to a tooth if you leave it in a glass of fizzy drink over night, but what about its effect on the rest of your skeleton? More on exactly how later, but it certainly puts you at risk of developing an often silent and common skeletal disorder known as osteoporosis. The name literally means ‘porous bone’ and it’s a condition that is characterised by a reduction in the density or amount of bone present. Your bones are not becoming ‘soft’, just thinner. Often you will feel absolutely no discomfort, however your risk of fracture, especially of the hip, is greatly increased. It’s a bit like if you start to remove the stumps from underneath a pole home; eventually the floor is going to cave in even though there is nothing wrong with the foundations that are left behind.

So, is osteoporosis only found in those who are more vintaged? Contrary to popular opinion, it isn’t. Just like arthritis, osteoporosis is more influenced by lifestyle factors as opposed to age. The biggest risk factors for osteoporosis are a lack of regular exercise, abnormal hormonal levels, nutritional deficiencies, and a diet high in acidic and inflammatory foods.

1.       Exercise – Your bones are alive and are continually remodelling themselves. Every time you take a step, your skeleton absorbs the impact and a small electric current is created within the bones. This electrical energy, known as the piezoelectric effect, stimulates bone growth which is why weight bearing exercise like walking is an important part of maintaining healthy bone mass. If walking isn’t an option, try removing some gravity and start water aerobics.

2.       Hormones – low levels of estrogen or testosterone will greatly affect your body’s ability to rebuild bone. Detected with a blood test, the cause is often complex however menopause, gonad surgery, anorexia and extreme physical exertion are just some of the risk factors.

3.       Nutrients - magnesium, calcium, vitamin K and vitamin D are essential for maintaining healthy bone mass and can be sourced from whole foods such as kale, parsley, spinach and brussel sprouts. One of the best sources of Vitamin D is natural sunlight, so the motto should be to avoid sunburn not sunshine! If you feel you may need additional supplementation, please discuss this with a health professional first as not all supplements are created equal.

4.       Diet – refined sugars, white flour, processed foods, unhealthy fats, soft drinks and alcohol will all increase inflammation within your digestive system, which reduces your ability to process and extract essential nutrients. Fizzy drinks not only contain extreme amounts of sugar but also high levels of phosphates, which bind to calcium and strip it from the body.

Prevention takes far less effort then trying to put out a fire once it has started, and our health is no different. Taking proactive steps early to keep our frame in tip-top condition is essential because we only get one and the better we move, the better we feel.

Motivation to Move More

We know sedentary time is bad for us. Previous research has suggested a link between the total amount of time spent sitting each day and health problems or even early death. Now, an observational study published online Sept. 12, 2017, by Annals of Internal Medicine suggests that it also matters how many minutes at a time you spend sitting in an office chair or lounging on a couch. Researchers looked at the health and activity of about 8,000 men and women (ages 45 or older) who wore activity trackers for a week, and then they followed the participants for four years. Sitting for 30, 60, or 90 minutes at a time was associated with the greatest risk for death if sedentary time was more than 12 or 13 hours per day. Sitting less than 30 minutes at a time was associated with a lower risk of death during the follow-up period, regardless of the total amount of inactivity for the day. But study authors point out that an inactive lifestyle is hazardous no matter how you rack up sedentary time. The takeaway: Study authors say their findings support guidelines that recommend we all get up and move every 30 minutes.

Source: Harvard Health Publishing