The Northwestern Health Advocate

Center for Healthcare Innovation and Policy

Stay current with the latest policy and research news in integrative health care

Welcome back! From headline news about the Zika virus, prescription opioid abuse, and runners' injuries, there is something for everyone in this month's Northwestern Health Advocate. Please take special note of the call to action: a bill to provide chiropractic services to military families.

Healthcare Practice

Patient Travel Advice: the Zika Virus

As some of us are dreaming about a warm weather escape from winter, the Zika virus has called into question many travel plans. The Zika virus, transmitted by mosquitoes, has been newly introduced to the western hemisphere and has infected millions in the tropical regions of Central and South America.

For most, infection causes mild or no symptoms, and has no long term effects. The greatest concern is infection of pregnant women, who themselves can develop severe symptoms. Notably, there has been a sharp increase in the number of infants born to Zika infected mothers who suffer from microcephaly, or a smaller than normal head size. This condition is often accompanied by brain damage. The CDC has issued interim guidelines for pregnant women who are concerned they may be infected. Also of significant concern are a small number of studies indicating that the Zika virus can be sexually transmitted from infected male partners.

It is unknown whether the Zika virus itself, or an interaction between a Zika infection and other conditions or infections, is the root cause of the increased rate of microcephaly. Regardless, the CDC has issued travel advisories for several regions where there is transmission of the Zika virus, encouraging enhanced precautions. These include using insect repellent, covering exposed skin, staying in screened-in environments, and using condoms. British health authorities have advised that sexually active men who have traveled to an area where Zika infection is ongoing should use condoms for at least 28 days after their trip, and throughout the pregnancy of any sexual partner.


“Deaths Due to Prescription Opioid Overdose is Unacceptable”

In response to the prescription drug abuse epidemic, the FDA recently issued a plan to make substantive changes to its approach toward opioid medications. Authors of the report note that the number of annual opioid prescriptions written in the U.S. is roughly equal to the number of adults in the population. Opioid misuse and abuse has had well publicized public health consequences, including patterns of prescribing opioids for chronic use despite a lack of evidence, its role as a gateway drug to heroin use, and a death rate associated with prescription opioids that the FDA has deemed “unacceptable”.

A new framework will attempt to balance patients’ needs for pain control with greater consideration for the potential misuse and abuse of opioids. The FDA wisely acknowledges that better reinforcement of current opioid-related activities is inadequate to curb current trends of abuse in the U.S. Instead, they seek to categorically reexamine the risk vs. benefit paradigm for opioid use.

Among suggested changes include better support for pain management options, including what they refer to as “alternative treatments”. Non-pharmacologic approaches to pain management were identified as an urgent priority. Other areas of focus include abuse-deterrent formulations of opioid products, improved access to naloxone for opioid abuse treatment, greater scrutiny of approved uses, and a framework for pediatric use.

A broad based national campaign is currently being led by the Department of Health and Human Services. External stakeholders are encouraged to contribute to the process through open comment opportunities, and participation through professional association and governmental agencies.


Lighten your (Running) Load

As runners take to the trails and ramp up their training mileage for spring events, many find their way into clinicians’ offices. Joint pain, plantar fasciitis, and muscle spasm can bring even the most dedicated runner’s training to a stand-still. Popular theories for the cause of these common injuries often blame opposing causes: modern running shoes versus bare foot running; trails versus pavement, muscle weaknesses versus overall body weight; and a wide range of training programs.

Recent research from Harvard Medical School studied long-time runners who have never experienced a running related injury. As a New York Times article describing the study put it, these runners are “the athletic equivalent of unicorns”. Of particular interest was impact loading—the amount of force created when runners’ feet strike the ground. It is theorized that this repetitive force inherent to running is a major contributor to common injuries, particularly among heel strike runners (which is the most common running gait).

After controlling for weight and running distance (and only looking at women to control the influence of gender), researchers found that those who had never had a running injury has significantly lighter foot strike than those who had been injured. Their impact load was lighter even than that seen in the average forefoot runner. Study authors suggest all runners consciously focus on generating softer landings with each foot strike, and shifting toward midfoot or forefoot landing when possible to decrease impact load and prevent injury.

Call To Action

Chiropractic Health Parity for Military Beneficiaries Act

Chiropractic care has been available to active-duty military personnel and veterans since the early 2000’s, albeit with obstacles to access. Unfortunately, chiropractic care has not been made available within the military TRICARE system, which provides healthcare benefits to many retirees, dependents, and survivors. While a chiropractic demonstration program that made chiropractic services available to TRICARE beneficiaries demonstrated overwhelmingly positive results, the benefit was not extended into policy.

To remedy this, Congressmen Rogers (R-AL) and Loebsack (D-IA) have introduced HR 802, to provide TRICARE recipients with a chiropractic benefit. Contact your Congressional representative today and ask them to co-sponsor HR 802, particularly if they serve on the House Armed Services Committee. Also, contact your members of Senate to contact their colleagues on the Senate Armed Services Committee to ask for incorporation of the provisions in HR 802 within the next National Defense Authorization Act. Importantly, encourage the TRICARE beneficiaries you know to do the same.

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Center for Healthcare Innovation and Policy

Michele Maiers, DC, MPH, PhD
Executive Director of Research and Innovation