Consumer Health Digest #13-18

Your Weekly Update of News and Reviews
May 9, 2013

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., with help from William M. London, Ed.D., M.P.H. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making.

Vaccine Education Center debunks breastfeeding myth. The Children's Hospital of Philadelphia Vaccine Education Center is warning that breast-feeding is not a substitute for immunization:

Sometimes parents wonder whether they can forgo immunizations for their baby because the baby is being breastfed; however, this is not the safest decision because antibodies in human breast milk bathe the intestinal surface but are not absorbed. Therefore, breast milk antibodies never enter the lymphatics or circulation where they would be needed to protect against diseases for which infection in the blood (circulation) is an important part of how viruses and bacteria cause disease. Examples of these types of diseases include diphtheria, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox), pneumococcus, Haemophilus influenzae type b, polio, hepatitis A and hepatitis B.

The statement was issued in response to faulty naturopathic advice to delay immunization because breast milk provides a "natural alternative" to immunization.

British ad regulators blast common chiropractic claims. The British Advertising Authority (ASA) has ordered the Advanced Wellness Chiropractic Clinic of West Yorkshire to stop advertising two messages:

After reviewing documents said to support these statement, the ASA concluded:

We noted the advertiser's argument that chiropractic treatment involved more than just physical manipulation of the spine. It also included lifestyle and nutritional advice, which we understood could influence factors such as energy and muscle tone. However, we considered that more objective claims relating to a re-charged nervous system and improved immune function were likely to be considered breakthrough claims which would need a high level of evidence to support them. We did not consider self-reporting of improved immune function was sufficient to support such claims.

. . . . We acknowledged that chiropractic treatment could contribute to general health, but noted the claim made broad references to surgery and drugs which could be interpreted as an alternative to these options when this would not always be the case. We also considered the claim "costly drugs or surgery" was misleading as treatment would be offered in most cases by the National Health Service. We therefore concluded that the claims were misleading. [ASA adjudication on Advanced Wellness Chiropractic Clinic, May 1, 2013]

Georgia appeals court rejects light sentence for insurance fraud. The U.S. Court of Appeals for the Eleventh Circuit has ruled that a sentence given to a chiropractor who had pleaded guilty to health care fraud was too lenient. Records in the case indicate that over a 5-year period, Rick Kuhlman, D.C., who operates five clinics in Atlanta, Georgia and one in Nashville, Tennessee, collected $2,944,883 million from insurance companies for services not rendered. Kuhlman's plea agreement called for restitution, community service in which he lectured about health fraud, and a recommended sentence of 36 months months in prison. While awaiting sentencing, Kuhlman paid the restitution and carried out the community service. The lower court judge, noting that he had never seen anyone pay such a large restitution amount prior to sentencing, sentenced Kuhlman to probation for the time served during his pre-sentence release. However, the Appeals Court ruled:

Although the United States Sentencing Guidelines set forth a sentencing range of 57 to 71 months of imprisonment, Kuhlman was able to avoid a custodial sentence by simply paying the money back and performing community service, including speaking to medical and nursing students about the perils of health care fraud. . . .

When the government obtains a conviction in a health care fraud prosecution, one of the primary objectives of the sentence is to send a message to other health care providers that billing fraud is a serious crime that carries with it a correspondingly serious punishment. . . .

Kuhlman knowingly and methodically stole millions of dollars from insurance companies over a period of several years. The district court's sentence does not reflect the seriousness and extent of the crime, nor does it promote respect for the law, provide just punishment, or adequately deter other similarly inclined health care providers. We therefore find the sentence to be substantively unreasonable, and an abuse of the district court's discretion.

Kuhlman has asked the U.S. Supreme Court to review the Appeals Court ruling.

Enbrel stroke treatment in the news. The Los Angeles Times has reported that a family paid a total of $132,000 for 165 injections of Enbrel® (etanercept) for Alzheimer's disease over a 4-year period in which the patient did not improve. The drug, an immune response modifier, is FDA-approved for treating several forms of arthritis but not for Alzheimer's disease. The treatment was administered by Edward Tobinick, M.D., at his Institute of Neurological Recovery (INR). The INR Web site offers Enbrel injections for residual symptoms of stroke, traumatic brain injury, and other conditions that it considers "neuroinflammatory." In 2006, the Medical Board of California accused Tobinick of improperly advertising Enbrel as a "breakthrough" in the treatment of disc-related back and neck pain. The case was settled with a stipulation under which Tobinick agreed to serve 1 year on probation during which he was required to complete courses in ethics and prescribing practices and have his practice monitored by another physician or complete a professional enhancement program. The probation period ended in 2008. The INR Web site cites supposedly supportive studies, but, according to neurologist Steven Novella, M.D., none of them establish the effectiveness of Enbrel for any of the conditions Tobinick treats. A recent Aetna Clinical Policy Bulletin provides a detailed analysis of relevant research. Amgen (Enbrel's manufacturer) and the Alzheimer's Association have issued skeptical statements.

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This page was revised on May 12, 2013.