RESISTING THE BROKEN BONE BUSINESSES

From: Dr. Jai Maharaj (usenet_at_mantra.com)
Date: 10/31/04 

Date: Sun, 31 Oct 2004 21:57:18 GMT

RESISTING THE BROKEN BONE BUSINESSES

Forwarded message from fidyl@yahoo.com

[ Subject: Resisting the Broken Bone Businesses
[ From: fidyl@yahoo.com
[ Date: Sun, 31 Oct 2004

Resisting the Broken Bone Businesses:

Bone Mineral Density Tests and the Drugs That Follow

-From The McDougall Newsletter

Glenda writes: "Now, at age 45 and undergoing a rather early natural
menopause, I had a ‘dexa bone scan’ to check my bone mineral density
(BMD), which yielded the diagnosis of osteopenia, the precursor to
osteoporosis. That very day I went to the ob/gyn doctor to discuss
my "treatment options," which I have been told are medications."

Glenda is yet another victim of the "Broken Bone Businesses" -- a
conglomerate of pharmaceutical companies, medical instrument
manufacturers, "consumer organizations," and misinformed, but
well-meaning, doctors who spread fear by targeting women’s worries
about aging -- threatening them with disability and premature death
from broken bones due to osteoporosis. There's a lot of money to be
made from telling healthy people they are sick, and this activity is
sometimes referred to as "disease-mongering."1

Osteoporosis is a real health problem, affecting many more women than
men. However, the emphasis needs to be placed on prevention with
diet and exercise, rather than on expensive and relatively
ineffective tests and drug treatments. Money is the obvious reason
for the misplaced emphasis.

They Say Most Women Have Bad Bones

The first step in "disease mongering" is to define a disease in a
manner that will lead to huge profits by selling the potential
customer expensive tests and treatments. With osteoporosis this is
done by establishing the diagnosis of this disease by measuring the
density of the bones -- bone mineral density (BMD).

According to the BMD standards used today, about two-thirds of
middle-aged and older women in Western countries have bone disease
worthy of testing and treatment. For example, using the population
of British Columbia in 1995, estimates are 536,000 of the 813,560
women over age 40 (that is 66%) would be labeled as either having
"osteoporosis" or a pre-osteoporosis condition, "osteopenia."2
Another recent study found low BMD in 44% of participants younger
than 65 years, and in 70% older than 65.3 The World Health
Organization has estimated that 30% of all women over 50
(postmenopausal women) have osteoporosis.4 Stated in meaningful
financial figures, the majority of women middle-aged and beyond are
sick and in need of help from the "Broken Bone Businesses."

The consequences of all this disease-mongering go beyond dollars.
Just the thought of taking a BMD test creates fear and anxiety in a
woman. The diagnosis of "thin bones" changes a woman forever from
"healthy" to "sick." If testing was universally accepted, then most
women after menopause would be encouraged to take drugs, like
estrogen/progestin (HRT) or bisphosphonates, like Fosamax
(alendronate) and Actonel. These medications are for a lifetime and
they have real side effects and financial costs. Undoubtedly, the BMD
examination has the potential to do much more harm than good.

Drug Companies Create the Market

The diagnostic criteria of BMD used by drug companies, and almost all
doctors, were set up by the World Health Organizations (WHO). The
WHO established the bone density (BMD) of young white women as
"normal," and as the standard by which to judge the bones of older
women. Your suspicions should be raised by knowing a key meeting for
the WHO group defining the diagnosis of osteoporosis was funded by
three pharmaceutical companies.1

The second step in "disease mongering" is to aggressively search for
older women with bones less dense than those of young women. In
order to increase the number of "sick women" in need of medications,
pharmaceutical companies encourage women to have their BMD measured
by promoting testing through medical doctors, and by conveniently
providing free or low-cost testing at shopping centers, workplaces,
and health fairs. Realize, because of changes in a woman’s physical
activity, her levels of female hormones, and her reproductive role,
her bones naturally become less dense as she becomes older. This
change in her BMD does not mean she is now "diseased," but rather
that the demands on her skeletal tissues have changed with normal
aging.

The truth is that for most people the risk of a fracture is low
and/or distant (limited mostly to the very elderly) and the benefit
from any drug is small. Furthermore, while bone density is
associated with fracture risk, this test is not accurate enough to
guide doctors to proper treatments. A recent analysis of 11 separate
study populations and over 2000 fractures found that bone mineral
density "cannot identify individuals who will have a fracture."5 The
authors concluded, "We do not recommend a program of screening
menopausal women for osteoporosis by measuring bone density.5 In
other words, BMD testing does not accurately identify women who will
go on to suffer a fracture as they age, and is, therefore, unable to
accurately distinguish women at low risk of fracture from those at
high risk.

There are characteristics which will predict a woman’s risk for
future fractures more accurately than BMD, such as her age, having a
close relative with a history of a serious fracture, her activity
level, and her overall quality of health. The reason for this is
because fractures are due to poor overall bone quality, and not
directly the result of a lesser amount of calcium found in her bones
by testing.

The Reason BMD Is Inaccurate6

Bones are made of living tissues. Minerals, like calcium, are
deposited within these tissues. Osteoporosis is caused by the
disintegration of this vital structural material, which is made up of
proteins, fats, minerals, and many other biologically active
substances. When the bone tissues disintegrate, calcium is also lost.
The loss of calcium seen on the BMD is misinterpreted to mean
osteoporosis is caused by calcium loss -- this is not true. Calcium
is only one element necessary for the proper development of bone, and
its presence alone cannot compensate for degenerating tissues.

Confirming this poor association of calcium (BMD) and bone strength
is the observation that "bone building drugs," such as HRT and
Fosamax, show a decrease in risk of fracture with very little
improvement in BMD.6 One classic example of how "nice-looking
bones," with high BMD, can actually be very weak bones, is seen with
fluoride treatment of osteoporosis. This mineral supplement
noticeably increases bone density, yet at the same time bone
fragility and fractures are dramatically increased because the bone
tissues are sickened by the treatment.7 Surprising for many people
is the fact that taking calcium supplements can actually suppress the
growth of bone tissue (by suppressing parathyroid hormone activity)
and increase the risk of fractures.6

What Is Your Actual Risk and Benefit?

Women are sold "anti-osteoporosis therapies," such as hormone
replacement therapy (HRT) and Fosamax and Actonel, with promises such
as, "You will double your risk of fractures if you do not take this
medication." But what does that mean to you in real numbers?

The public promotion of the benefits of treatments relies upon the
use of "relative risk reduction," instead of the "absolute risk
reduction." For example, Fosamax taken for four years by women who
are free of fractures, but who have a bone mineral density that would
indicate they have trouble and need treatment, found fractures of the
spine to occur in 3.8% in the placebo group and 2.1% in the drug
group.8

So, the absolute reduction was only 1.7% -- a figure that in real-life
terms, appears insignificant, and hardly deserving of a costly
lifelong medication with serious side effects. However, when
presented in the deceitful terms of relative risk reduction, the
benefits from treatment sound too good to refuse. The relative risk
reduction is 44%.

The relative risk reduction is obtained by dividing the absolute
figures -- 2.1% by 3.8%, which equals 56%, -- and then subtracting this
number from 100%, which equals 44%. In other words, you cut your
risk almost in half by taking drugs, but your original risk was very
low, so in real numbers you gain exceedingly little.

What Organizations Say about BMD

Pharmaceutical industries provide funding for sham "consumer
organizations," such as the International Osteoporosis Foundation, to
promote their agenda. Here is what this industry front says about
BMD:

"Bone mineral density (BMD) measurements are effective in assessing
fracture risk, confirming a diagnosis of osteoporosis and monitoring
the effect of treatment."

Other phony industry-sponsored "consumer organizations" with similar
support for BMD and treatments are the US National Osteoporosis
Foundation and the Osteoporosis Society of Canada.

Now consider these assessments of the value of BMD made by
organizations not supported by industries:2

Office of Health Technology Assessment, University of British
Columbia:

"Research evidence does not support either whole population or
selective bone mineral density testing of well women at or near
menopause as a means to predict future fractures."

The International Network of Agencies for Health Technology
Assessment:

"The currently available evidence does not support the use of BMD
screening in combination with hormone replacement therapy or
intranasal salmon calcitonin treatment."

Canadian Task Force on the Periodic Health Examination:

"Widespread bone mineral density screening is inadvisable at
present."

U.S. Preventive Services Task Force:

"There is insufficient evidence to recommend for or against routine
screening for osteoporosis with bone densitometry in postmenopausal
women."

Swedish Council on Technology Assessment in Health Care:

"There is no scientific basis for recommending bone density
measurement in mass screening, selective screening, or as an extra
component in health check-ups of asymptomatic individuals
(opportunistic screening)."

University of Newcastle Osteoporosis Study Group, Australia:

"In summary, the measurement of BMD is not a useful screening test
for the identification of women at high risk of hip fracture and
requiring preventative treatment with estrogens."

Effective Health Care Bulletin, U.K:

"Given the current evidence, it would be inadvisable to establish a
routine population based bone screening programme for menopausal
women with the aim of preventing fractures."

Osteoporosis Is Real, Preventable, and Curable

For most women, I recommend they do not have BMD testing done in the
first place. If, however, they have already gone that route, and are
now facing an abnormal BMD test result, then I recommend they delay
accepting drug treatment (unless they have evidence of severe
osteoporosis complicated by fractures). In most cases, a repeat BMD
test two to three years later is the only future test I recommend.
In the meantime, a woman should be eating a healthy diet and
exercising. Her efforts are expected to cause her next BMD test
results to be the same (showing no further loss) or improved (showing
some gain) over the first test that initiated the doctor’s
recommendation for drugs.

A few women concerned about their bones may also choose HRT (I
usually recommend estradiol 0.05 mg with 20 mg of progesterone to be
used daily as a skin cream). HRT is very effective for strengthening
bones, along with benefits for alleviating hot flashes and vaginal
dryness. However, there are very small, but concerning, risks of
breast and uterine cancer, blood clots, and gallbladder disease to
consider in this decision. (Read the McDougall Program for Women
book for much more information on these subjects.)

The assaults on bone health caused by the American diet are
well-established. The most serious damage comes from the high acid
content of cheese, red meat, poultry, fish, seafood and eggs -- the
centerpieces of most people’s diets. After this acid enters the body
it must be neutralized. The primary buffering (acid-neutralizing)
system of the body is the bones, which dissolve to release alkaline
substances. The next stage of loss occurs with the kidneys where the
bone material is filtered into the toilet. Consuming alkaline foods
(fruits and vegetables) is the most important step you can take to
preserve your bones and actually reverse bone loss. (Note: legumes
and grains are slightly acidic and should be limited by people at
great risk for bone loss.) Exercise is an established way to rebuild
lost bone and prevent future fractures.

A woman is designed to live, on average, 85 years in good health.
Logically, her bone tissues should be strong and fracture-resistant
for all those years, too. In order to realize this life plan, a
woman must resist billions of corporate dollars teaching false
messages. Instead, as against other common diseases, she must defend
herself and avoid the medical businesses by staying healthy by taking
advantage of the simple cost-free effects of a proper diet and
lifestyle.

References:

1) Moynihan R, Heath I, Henry D. Selling sickness: the
pharmaceutical industry and disease mongering. BMJ 2002; 324: 886-891

2) British Columbia Office of Health Technology: Building Bridges
Conference. April 2000:
http://www.chspr.ubc.ca/bcohta/pdf/bco00-05C.pdf.

3) Rohr CI, Sarkar A, Barber KR, Clements JM. Prevalence of
prevention and treatment modalities used in populations at risk of
osteoporosis. J Am Osteopath Assoc. 2004 Jul;104(7):281-7.

4) WHO Study Group on Assessment of Fracture Risk and its
Application to Screening for Post Menopausal Osteoporosis. Assessment
of fracture risk and its application it screening for post menopausal
osteoporosis: report of a WHO study group. Geneva: WHO, 1994. (WHO
technical series 843.)

5) Marshall D, Johnell O, Wedel H. Meta-analysis of how well
measures of bone mineral density predict occurrence of osteoporotic
fractures. BMJ 1996;312:1254-1259.

6) Wilkin TJ. Changing perceptions in osteoporosis. BMJ. 1999 Mar
27;318(7187):862-4.

7) Fratzl P, Roschger P, Eschberger J, Abendroth B, Klaushofer K.
Abnormal bone mineralization after fluoride treatment in
osteoporosis: a small-angle x-ray-scattering study. J Bone Miner
Res. 1994 Oct;9(10):1541-9.

8) Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor
E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T,
Wallace R, Yates AJ, LaCroix AZ. Effect of alendronate on risk of
fracture in women with low bone density but without vertebral
fractures: results from the Fracture Intervention Trial.
JAMA. 1998 Dec 23-30;280(24):2077-82.

9) Banks E, Beral V, Reeves G, Balkwill A, Barnes I; Million Women
Study Collaborators. Fracture incidence in relation to the pattern
of use of hormone therapy in postmenopausal women. JAMA. 2004 May
12;291(18):2212-20.

End of forwarded message from fidyl@yahoo.com

Jai Maharaj
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