BackgroundChiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.AimThe purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.MethodsThe databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.ResultsThe criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.ConclusionThere is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.

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Little is known about the numbers of disabled people employed in industry except for those registered with the Department of Employment and Productivity. A joint survey by six factory doctors covering 11,399 men aged 16 to 64 in seven companies is described. 1,233 men (10.8 per cent of the population) were identified as having chronic medical impairments which could affect working capacity. The prevalence rose from 3 per cent under the age of 25 to 28 per cent over the age of 60. Only one third of these men were officially registered and they were not representative of all the disabled either in terms of severity or of diagnosis. The commonest causes of disablement were chronic bronchitis and asthma, disorders of the spine, coronary heart disease and severe visual loss.

Introduction. Ibandronic acid 150 mg/month (Bonviva) is a bisphosphonate that was licensed in the UK in 2005 for the treatment of postmenopausal osteoporosis in women. Prescription-event monitoring (PEM) is a non-interventional observational cohort technique conducted by the Drug Safety Research Unit to monitor the safety of newly marketed drugs prescribed in general practice in England. Objective. To describe the utilization characteristics of the patients prescribed ibandronic acid based on an analysis of a completed PEM cohort and to assess, where possible, if the product is being used outside terms of license of marketing approval. Methods. An observational cohort PEM study was conducted. Exposure data were collected from dispensed prescriptions issued by general practitioners (GPs) between November 2005 and November 2007. Outcome data (event, patient demographic and selected clinical characteristics) were collected by sending questionnaires (green forms) to GPs at least six months after the drug was first prescribed for an individual patient. Summary descriptive statistics were calculated. For this study, menopause was defined by female age at 50þ years. Results. The cohort consisted of 11,034 patients, of which 9% (n ¼ 991 patients) were reported to be men. Where age was specified, 4.8% (529/11,017) were aged ,50 years, of which 0.4% (2/529) were ,20 years. A total of 398 deaths occurred (3.6% cohort). Where specified, primary indications other than postmenopausal osteoporosis were reported for 11.7% (1218/10,446) patients including 'prophylaxis' (n ¼ 715), 'osteopenia' (n ¼ 231) and 'fracture spontaneous' (n ¼ 41). The most frequently reported clinical reasons for stopping treatment were 'intolerance' (n ¼ 176) and 'dyspepsia' (n ¼ 158). There was one pregnancy, reported as the reason for stopping treatment. Where dose was specified, 99.9% of patients (8625/8637) were prescribed the approved dose of 150 mg per month. Conclusion. This study has highlighted that some clinicians are prescribing this product outside the recommended terms of the licence. Use in premenopausal women and men was reported. This study assumed natural menopause occurred when aged 50þ years, though this does not apply for surgically menopausal women. Prescribing for indications other than osteoporosis was common, but unusual dose regimens were uncommon. Drug utilization studies are important in describing populations that may not have been adequately studied in terms of risk in premarketing development programmes and are important in the postmarketing risk management of medicines.