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Ask Dr. Scott: Daily use of common pain medication. Good or bad?



Q: Dr. Scott, my mother uses an anti-inflammatory every day for pain. Is there a risk to her health in doing this?

A: Your mom is not alone — she makes up a part of the approximately 60 million Americans who use non-steroidal anti-inflammatory drugs (NSAIDs) regularly. A recent study in the American Journal of Gastroenterology by Lanas et al. (Lanas et al, 2012) on aspirin and NSAIDs reveals shocking mortality rates. In the United States there are 10,000–20,000 fatalities and multiple organ systems adversely affected by NSAIDs reported every year according to the World Journal of Gastroenterology. (Kim et al., 2016)

Another shocking fact is that every 19 minutes, someone in the United States dies from an unintentional prescription drug overdose. (American Public Health Association, 2017) Chronic pain is the primary reason for the use of these medications, and no other disease can make that claim.

Older patients who have hypertension and coronary artery disease and who also use nonsteroidal anti-inflammatory drugs (NSAIDs) chronically for pain are at significantly increased risk of cardiovascular events according to research published in the American Journal of Medicine. (Bavry et al, 2011)

Dr. Bavry, lead author of this study said, “We found significant increase in adverse cardiovascular outcomes, primarily driven by an increase in cardiovascular mortality. This is not the first study to show there is potential harm with these agents, but I think it further solidifies that concern.” Dr. Bavry said the observational study was particularly relevant to everyday practice because the patients included were typical of those seen in internal-medicine, geriatric, and cardiology clinics — they were older, with hypertension and clinically stable cardiovascular disease. Bavry and colleagues were not able to differentiate between NSAIDs in the study — most people were taking ibuprofen, naproxen, or celecoxib — and said that until further work is done, he considers the risks of NSAIDs “a class effect”, and their use should be avoided whenever possible.

Fundamentally, it is the lack of access to other pain treatments that is the primary reason for NSAID over-prescribing. We have evidence-based treatments for pain — mostly ‘low-tech, high-touch treatments — that most people with chronic pain either do not know about or cannot access. Chronic back pain and its medical misdiagnosis and mistreatment appear to be dragging down the US economy. And along with other forces, this may be driving millions of prime age workers out of the economy altogether.

Your mother is medicating herself (possibly with the advice and consent of her medical doctor) for chronic pain, which afflicts more Americans than diabetes, heart disease, stroke and cancer combined. (The American Academy of Pain Medicine, 2017) Not only a huge social cost to our society in terms of disability, addiction and deaths, but the annual national economic cost associated with chronic pain is estimated by the Institute of Medicine to be $600 billion (an amount equal to about $2,000 for everyone living in the United States).

When I see patients like these taking NSAIDs, I have an informed discussion with them that if  a patient with chronic pain and inflammation is to improve, we must redraw their picture of chronic pain and NSAID use with a new but complete set of dots different.

One big clue missed by our media in this epidemic of chronic pain is the fact that back pain is the leading reason for the use of NSAIDs and prescription painkillers. (Boudreau et al., 2009) Mark Schoene, the 25-year editor of an international spine research journal, The BackLetter, wrote of this mess:

“There is an urgent need to restrain the routine prescription of opioids and NSAIDs for common non-cancer pain conditions — and especially chronic low back pain. There is no evidence that they are an effective long-term treatment. And their risks are obvious.” (BackLetter, 2016)

These medical interventions fail to address the cause of the pain: they treat only the symptoms — an approach that lessens pain for a limited period of time.

I suspect that the popularity of complementary and alternative medicine is a coded message about aspirations for more acceptable or more effective health care throughout the developed world. This is also what health care reform in the United States intends to achieve. Yet if “modernization” allows the voices of poorly met needs to be heard, it will surely take more than high-tech medicine (drugs, shots, surgeries, hospitals) to satisfy them. Therefore, if too few chiropractors, nurses, physiotherapists, health educators, counselors, osteopaths, nutritionists, naturopaths, acupuncturists and massage practitioners are working in primary care in the United States today who provide the recommended treatment methods for chronic pain, then it may be a measure of how little holistic care is actually being delivered in this country…for your mother and the rest of us.

Dr. Scott Cuthbert is the chief clinician at the Chiropractic Health Center in Pueblo, Colorado, as well as the author of two new textbooks and over 50 peer-reviewed research articles. 

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Trump is considering firing special counsel Mueller, friend says



WASHINGTON — A friend of the president says Donald Trump is considering “terminating” special counsel Robert Mueller.

Newsmax CEO Chris Ruddy tells Judy Woodruff of “PBS NewsHour”: “I think he’s considering perhaps terminating the special counsel. I think he’s weighing that option.”

The White House did not immediately respond to questions about Ruddy’s claims.

Under current Justice Department regulations, such a firing would have to be done by Attorney General Jeff Sessions’ deputy, Rod Rosenstein, not the president— though those regulations could theoretically be set aside.

Mueller is leading the investigation into Russia’s meddling in the 2016 election and potential ties between Moscow and Trump’s presidential campaign. Sessions has recused himself from the investigation.

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Puerto Rico votes for statehood, opponents boycott the vote



SAN JUAN, Puerto Rico — Puerto Rico’s governor announced that the U.S. territory overwhelmingly chose statehood on Sunday in a nonbinding referendum held amid a deep economic crisis that has sparked an exodus of islanders to the U.S. mainland.

Nearly half a million votes were cast for statehood, about 7,600 for free association/independence and nearly 6,700 for the current territorial status, according to preliminary results. Voter turnout was just 23 percent, leading opponents to question the validity of a vote that several political parties had urged their supporters to boycott.

And the U.S. Congress has final say in any changes to Puerto Rico’s political status.

But that didn’t stop Gov. Pedro Rossello from vowing to push ahead with his administration’s quest to make the island the 51st U.S. state and declaring that “Puerto Rico voted for statehood.” He said he would create a commission to ensure that Congress validate the referendum’s results.

“In any democracy, the expressed will of the majority that participates in the electoral processes always prevails,” Rossello said. “It would be highly contradictory for Washington to demand democracy in other parts of the world, and not respond to the legitimate right to self-determination that was exercised today in the American territory of Puerto Rico.”

It was the lowest level of participation in any election in Puerto Rico since 1967, according to Carlos Vargas Ramos, an associate with the Center for Puerto Rican Studies at Hunter College in New York. He also said that even among voters who supported statehood, turnout was lower this year compared with the last referendum in 2012.

“Supporters of statehood did not seem enthusiastic about this plebiscite as they were five years ago,” he said.

Puerto Rico’s main opposition party rejected the pro-statehood result.

“The scant participation … sends a clear message,” said Anibal Jose Torres, a party member. “The people rejected it by boycotting an inconsequential event.”

The referendum coincides with the 100th anniversary of the United States granting U.S. citizenship to Puerto Ricans, though they are barred from voting in presidential elections and have only one congressional representative with limited voting powers.

Among those hoping Puerto Rico will become a state is Jose Alvarez, a 61-year-old businessman.

“Now is the moment to do it,” he said. “We’ve spent a lot of years working on a socioeconomic model that has not necessarily given us the answer.”

Many believe the island’s territorial status has contributed to its 10-year economic recession, which has prompted nearly half a million Puerto Ricans to flee to the U.S. mainland and was largely sparked by decades of heavy borrowing and the elimination of federal tax incentives.

Puerto Rico is exempt from the U.S. federal income tax, but it still pays Social Security and Medicare and local taxes and receives less federal funding than U.S. states.

Those inequalities and the ongoing crisis prompted 66-year-old Maria Quinones to vote for the first time in such a referendum, the fifth on Puerto Rico’s status.

“We have to vote because things are not going well,” she said. “If we were a state, we would have the same rights.”

Quinones said many of her relatives are among the nearly half a million Puerto Ricans who have moved to the U.S. mainland in the past decade to find a more affordable cost of living or jobs as the island of 3.4 million people struggles with a 12 percent unemployment rate.

Those who remain behind have been hit with new taxes and higher utility bills on an island where food is 22 percent more expensive than the U.S. mainland and public services are 64 percent more expensive.

Those who oppose statehood worry the island will lose its cultural identity and warn that Puerto Rico will struggle even more financially because it will be forced to pay millions of dollars in federal taxes.

“The cost of statehood on the pocketbook of every citizen, every business, every industry will be devastating,” Carlos Delegado, secretary of the opposition Popular Democratic Party, told The Associated Press. “Whatever we might receive in additional federal funds will be cancelled by the amount of taxes the island will have to pay.”

His party also has noted that the U.S. Justice Department has not backed the referendum.

A department spokesman told the AP that the agency has not reviewed or approved the ballot’s language. Federal officials in April rejected an original version, in part because it did not offer the territory’s current status as an option. The Rossello administration added it and sent the ballot back for review, but the department said it needed more time and asked that the vote be postponed, which it wasn’t.

No clear majority emerged in the first three referendums on status, with voters almost evenly divided between statehood and the status quo. During the last referendum in 2012, 54 percent said they wanted a status change. Sixty-one percent who answered a second question said they favored statehood, but nearly half a million voters left that question blank, leading many to claim the results weren’t legitimate.

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Cyptic Trump counterpunches Comey, says ‘100 percent’ willing to testify, no word on tapes



WASHINGTON — Punching back a day after his fired FBI director’s damaging testimony, President Donald Trump on Friday accused James Comey of lying to Congress and said he was “100 percent” willing to testify under oath about their conversations.

Trump cryptically refused to say whether those private exchanges were taped — a matter at the heart of the conflicting accounts of what passed between them at a time when Comey was leading an FBI investigation into Russia’s interference in the presidential election and its ties to the Trump campaign.

He asserted that nothing in Comey’s testimony to the Senate pointed to collusion with Russia or obstruction of justice. “Yesterday showed no collusion, no obstruction,” Trump said.

He further denied ever asking Comey for his “loyalty,” contradicting Comey’s detailed sworn testimony about a private dinner the two men had in the White House.

“No I didn’t say that,” Trump stated abruptly, taking questions at a joint press conference with Romanian President Klaus Iohannis in the Rose Garden. Asked if he would make that denial under oath, he said, “100 percent.”

Trump’s aides have dodged questions about whether conversations relevant to the Russia investigation have been recorded, and so did the president, in series of teases.

“Well, I’ll tell you about that maybe sometime in the very near future,” Trump said. Pressed on the issue, he insisted he wasn’t “hinting anything,” before adding, “Oh you’re going to be very disappointed when you hear the answer, don’t worry.”

The House intelligence committee sent a letter Friday asking White House counsel Don McGahn whether any tape recordings or memos of Comey’s conversations with the president exist now or had existed in the past. The committee also sent a letter to Comey asking for any notes or memos in his possession about the discussions he had with Trump before being abruptly fired last month. The committee is seeking the materials by June 23.

Comey told the Senate intelligence committee Thursday about several one-on-one interactions with the president, during which he said Trump pressed him to show “loyalty,” to back off on the FBI investigation of his former national security adviser, Michael Flynn, and to disclose that Trump himself was not under investigation.

Comey said he refused on all points, told senators of the detailed memos he had written after his conversations with Trump and said he hoped those conversations were taped because he is confident of their veracity.

Standing with the president of Romania, a NATO partner, Trump at last confirmed his commitment to the alliance’s mutual defense pact, Article 5, uttering words he deliberately did not say when he spoke at NATO’s gathering in Belgium last month. On Friday he said he was “committing the United States to Article 5.”

He also accused Qatar, a key U.S. military partner, of funding terrorism “at a very high level,” and said solving the problem in the tiny Persian Gulf nation could be “the beginning of the end of terrorism.” It was a forceful endorsement of this week’s move by Saudi Arabia, Egypt, Bahrain and the United Arab Emirates to cut off ties to Qatar, but a very different message from the one delivered just an hour before by Secretary of State Rex Tillerson. Tillerson had called on the Arab nations to immediately ease their blockade on Qatar.

Trump also saluted the United States’ relationship with Romania and praised its contribution to the global fight against terror.

The president had previewed his attacks against Comey in an early-morning tweet that broke his previous day’s silence on his favorite social media megaphone.

“Despite so many false statements and lies, total and complete vindication,” Trump wrote. It was a stunning accusation, suggesting that the former FBI director had lied to Congress, while under oath.

He also seized on Comey’s revelation that he had directed a friend to release contents of memos he’d written documenting his conversations with the president to a reporter.

“. . . and WOW, Comey is a leaker!” Trump wrote at 6:10 a.m. He derisively repeated the “leaker” moniker when speaking to reporters in the Rose Garden.

Trump’s private attorney, Marc Kasowitz, seized on Comey’s admission that he had orchestrated the public release of the information. Kasowitz is expected to file a complaint with the Justice Department inspector general next week, according to a person close to the legal team who agreed to speak before the filing on condition that the person’s name is not used.

Richard Burr, the Republican chairman of the Senate intelligence committee, and Sen. Mark Warner, the top Democrat on the committee, both said Thursday they believed Comey’s account of the events.

“And I think you saw today the overwhelming majority of the intel members, Democrats and Republicans, feel that Jim Comey is credible. Even folks who have been his critics don’t question his integrity, his commitment to the rule of law and his intelligence,” Warner said.

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