United Kingdom back pain exercise and manipula-tion (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care

Objective: To estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain.

Design: Pragmatic randomised trial with factorial design.

Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom.

Participants: 1334 patients consulting their general practices about low back pain.
Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores.

Results: All groups improved over time. Exercise improved mean disability questionnaire scores at three months by 1.4 (95% confidence interval 0.6 to 2.1) more than "best care." For manipulation the additional improvement was 1.6 (0.8 to 2.3) at three months and 1.0 (0.2 to 1.8) at 12 months. For manipulation followed by exercise the additional improvement was 1.9 (1.2 to 2.6) at three months and 1.3 (0.5 to 2.1) at 12 months. No serious adverse events occurred.

Conclusions: Relative to "best care" in general practice, manipulation combined with exercise produced the greatest benefits. While exercise stopped demonstrating continued relief at 3 months manipulation continued to demonstrate relief for the entire 12 months of the study.
BMJ 2004;329:1377 (published 19 November 2004)

My advice: Exercise and get adjusted every month! 

The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%

Objective: The Polypill concept, proposed in 2003 (a "cocktail" of six existing drugs mixed into a single pill), is claimed to be promising in terms of benefits for cardiovascular risk management The potential costs and adverse effects are its main pitfalls. The objective of this study was to identify a tastier and safer alternative to the Polypill: the Polymeal.

Methods: Data on the ingredients of the Polymeal were taken from the literature. The evidence based recipe included wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. Data from the Framingham heart study and the Framingham offspring study were used to build life tables to model the benefits of the Polymeal in the general population from age 50, assuming multiplicative correlations.

Results: Combining the ingredients of the Polymeal would reduce cardiovascular disease events by 76%. For men, taking the Polymeal daily represented an increase in total life expectancy of 6.6 years, an increase in life expectancy free from cardiovascular disease of 9.0 years, and an increase in life expectancy with cardiovascular disease of 2.4 years. The corresponding differences for women were 4.8, 8.1, and 3.3 years.

Conclusion: The Polymeal promises to be an effective, non-pharmacological, safe, cheap, and tasty alternative to reduce cardiovascular morbidity and increase life expectancy in the general population. BMJ 2004;329:1447-1450 (18 December)

My advice: Dinner of fish with veggies in garlic sauce with fruit and chocolate covered almonds for desert, AND you live longer, GO FOR IT!! Am I your best doctor or what!