­¦ý°±·>œ vxœuÏ€¡s øîJjbjb¿ ¿ ½kkîF]¢¢¢¢¢¢¢ööööö ¶tö >>>>>>>>¿¬¬¬¬¬¬,#Ù¿Ó¢>>>>>ÓP¢¢>>>PPP>¢>¢>¿r(r¢¢¢¢>¿PpP¿¢¢¿$ ^¸…ööP¿ANTHRAX, NEUROIMMUNOLOGY AND CHIROPRACTIC By Christopher Kent, D.C., F.C.C.I. Recent reports of the spread of anthrax through letters, has resulted in many questions from the chiropractic community. It has been said, "knowledge is the antidote for fear." It is essential that the real issues be placed in proper perspective, so that effective strategies for processing the recent events may be implemented. LIFE WITHOUT FEAR According to an editorial in the October 20, 2001 issue of the British Medical Journal, the mere threat of anthrax may be far worse that the possibiliy of physical illness. The authors wrote, "The ostensible purpose of chemical and biological weapons is to endanger lives. Biological agents, however, are particularly ineffective as military weapons...Instead, chemical and biological weapons are quintessentially weapons of terror...The purpose of these weapons is to wreak destruction via psychological means-by inducing fear, confusion, and uncertainty in everyday life. (1) This is precisely what terrorists hope to achieve, and media reports suggest that they are achieving some success. People are purchasing antibiotics from pharmacies or over the internet. One entrepreneur is selling equipment that will sterilize letters for $2770. The House of Representatives is closed. As one author noted, "People are much more afraid of exotic, seemingly uncontrollable risks like anthrax than they are of familiar ones like flu (which kills more than 20,000 Americans each year)." (2) As with any infectious illness, not everyone exposed to an organism gets sick. D.D. Palmer, the discoverer of chiropractic, asked an important question. He wanted to know one man was sick and one was well when both, worked at the same job, in the same shop, at the same bench, while living in the same house, and eating the same food. (3) The difference was not the bacterial or viral agent, but the patient. The key to health is to maintain your physical, mental, and social well-being. ABOUT ANTHRAX What are the facts? Most people are surprised to learn that anthrax is not contagious. It is not transmitted from person to person through the air. Anthrax is a disease of animals, particularly cattle, sheep, goats, and other herbivores. The organism associated with anthrax is a bacterium, Bacillus anthracis. This organism develops a spore form, which can live in soil for years. Anthrax is transmitted to humans by skin contact, inhalation, or ingestion. (4) Anthrax is also known as "woolsorter's disease," because it is seen in mill workers. Wool sorters inhale 150 to 700 anthrax spores continually without danger. It has been suggested that about 10,000 spores are necessary to start an infection by inhalation. (5) How likely are you to contract anthrax? The recent anthrax cases are very few in number. Prior to these, there have been only 18 cases of inhalation anthrax in the 20th century and none since 1978. As one official stated, "One death, one easily treated rash, and seven symptom-free people with anthrax spores in their noses or antibodies in their blood are hardly what experts expected from terrorists wielding a bioweapon." Furthermore, making effective weapons using anthrax has been described as "hugely difficult." (2) WHAT IS THE RISK? According to Newsweek (2), only 2 pieces of mail (one in New York and one in Reno) have tested positive for anthrax. To put this in perspective, the Postal Service handles 680 million pieces of mail per day. Let's compare some causes of death in the United States (6,7): Adverse drug reactions-106,000 deaths per year. Accidents-90,140 deaths per year. Medical malpractice-80,000 deaths per year. HIV/AIDS-41,930 deaths per year. Deaths due to lightning strikes-100 per year. Anthrax deaths-1 this year. In short, taking medicine, driving a car, HIV/AIDS, and being struck by lightning are far more likely to kill you than anthrax. VACCINES Anthrax vaccine, of questionable efficacy, is not available. The sole manufacturer of this highly controversial product has been cited for numerous violations, and is currently unable to provide it. If it could, the vaccine would go the military. The current hysteria over anthrax is being used to promote childhood vaccines, and influenza vaccine for adults. These vaccines DO NOT provide (or even claim to provide) any protection against anthrax or other biological agents associated with terrorism. PRACTICAL STRATEGIES So what should we do? Ignore the risk and hope it goes away? No. Here are some tips: *DO NOT stockpile antibiotics. Antibiotics may have serious side effects. As Dr. Tim Johnson of ABC wrote, "Taking continual antibiotics is medically stupid. It is dangerous to take antibiotics on a continuing basis, both in terms of short-term and long-term side effects, including the development of antibiotic resistance." (8) Antibiotics should be reserved for the very few cases where they are deemed medically necessary, and should not be taken without informed consent and physician supervision. *In the extremely unlikely event you receive a suspicious letter or package, report it. If there is suspicious powder, do not touch or inhale it. *DO acknowledge your fears. Empower yourself with knowledge. Do not let the terrorists rob you of the joys of life. *DO maintain your health with regular chiropractic care, good nutrition, exercise, and a positive attitude. MAINTAINING HEALTH The World Health Organization defines health as complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Chiropractic holds that interference with the function of the nerve system, caused by vertebral subluxations, compromises health. Adjustment of vertebral subluxations allows you to express your life potential without interference. NEUROIMMUNOLOGY In the recent years, a growing number of scientists have become interested in the role of the nervous system in modulating immune system function. To doctors of chiropractic, the field of neuroimmunology is rich with clinical promise. Physiologist I.M. Korr proposed that spinal "lesions" (analogous to the vertebral subluxation complex) are associated with exaggerated sympathetic activity. It is interesting that Korr, like D.D. Palmer, employed the term "tone" in reference to ambient nervous system activity. According to Korr, "High sympathetic tone may alter organ and tissue responses to hormones, infectious agents, and blood components." (9) More recently, other authors have explored the relationship of sympathetic activity to immune system function in greater depth. Murray et al examined the effect of sympathetic stimulation on the immune system. Sympathetic stimulation was induced in human volunteers by exhaustive exercise. They found that acute sympathetic stimulation leads to selective release of immunoregulatory cells into the circulation, with subsequent alterations in cellular immune function. These authors stated, "Growing evidence suggests that immune function is regulated in part by the sympathetic nervous system. Sympathetic nerve endings densely innervate lymphoid tissue such as the spleen, lymph nodes and thymus, and lymphoid cells have beta 2 andregenergic receptors." In their experiments, there was a sharp rise in T suppressor/cytotoxic cells and natural killer cells following sympathetic stimulation. However, only modest rises were seen in T helper and B cells. The cells most affected, the T suppressor/cytotoxic cells and the natural killer cells, are those with the largest density of beta receptors." (10) Felten et al reported that the neurotransmitter norepinephrine is present in postganglionic sympathetic fibers which innervate lymphoid organs and act on the spleen. Furthermore, there are available receptors on cells in the white pulp and the localized neurotransmitter terminal which directly contact T lymphocytes in the periarticular lymphatic sheath. The authors propose that norepinephrine in lymphoid organs fulfills the criteria for neurotransmission, and plays a significant role in the modulation of immune responses. They state, "Stressful conditions lead to altered measures of immune function, and altered susceptibility to a variety of diseases. Many stimuli, which primarily act on the central nervous system, can profoundly alter immune responses. The two routes available to the central nervous system for communication with peripheral organs are neuroendocrine channels and autonomic nerve channels." (11) In a more recent paper, Felten's team reviewed aspects of neural- immune signaling. "Noradrenergic and peptidergic nerve fibers abundantly innervate the parenchyma of both primary (bone marrow) and secondary (spleen, lymph nodes) lymphoid organs. Nerve fibers distribute within the parenchyma of these organs, as well as along smooth muscle compartments. Both noradrenaline and peptides such as substance P have been shown to fulfill the basic criteria for neurotransmission with lymphocytes, macrophages, and other immunocytes as targets. Denervation or pharmacological manipulation of these neurotransmitters can profoundly alter immunological reactivity at the individual cellular level, at the level of complex multicellular interactions (such as antibody response), and at the level of host responses to a disease-producing challenge." (12) The relationship between the nervous system and the immune system has attracted the attention of the popular press. An article in the New York Times stated, "Scientists have found the first evidence of an anatomical connection between the nervous system and the immune system. Nerve cell endings in the skin and white blood cells of the immune system are in intimate contact, and chemicals secreted by the nerves can shut down immune system cells nearby." (13) The New York Times author was describing the findings of a paper written by Hossi et al. (14) Inflammatory disease is influenced by the nervous system. Undem noted that nerve stimulation can affect the growth and function of inflammatory cells. (15) Sternberg et al stated, "The central nervous system may coordinate both behavioral and immunologic adaptation during stressful situations. The pathophysiologic perturbation of this feedback loop, through various mechanisms, results in the development of inflammatory syndromes, such as rheumatoid arthritis, and behavioral syndromes, such as depression. Thus, diseases characterized by both inflammatory and emotional disturbances may derive from common alteration in specific central nervous system pathways. (16) Fricchoine and Stefano also reviewed what they termed the "neuroendocrine-neuroimmune stress response system." (17) Central nervous system influences on lymphocyte migration was addressed by Ottaway and Husband. These authors suggested that "Many of the alterations in immunity resulting from CNS activity may be explained in terms of changes in lymphocyte migration patterns in response to endocrine signals, neural signals via neurotransmitter release, or direct contacts between nerves and cells of the immune system." (18) Weihe and Krekel observed that "Peptides, being presenting small-diameter nerve fibers, could exert an indirect immunoregulatory role by influencing vascular tone and/or permeability." (19) A very interesting hypothesis proposed by Grossman et al is that cells can learn to associate responsiveness to antigens and other immunoactive agents, with responsiveness to signals originating in the CNS delivered via neuroendocrine or autonomic nervous channels. They propose storage (memory) of stimuli in the immune system rather than in the brain. (20) Just what does this mean to the chiropractor? Can spinal adjustments alter immune system activity? Brennan et al found that when a thoracic "manipulation" was applied, the response of polymorphonuclear neutrophils isolated from blood collected 15 minutes after the manipulation was significantly higher than blood collected 15 minutes before and 30 and 45 minutes after manipulation. A slight, but significant rise in substance P was also observed. (21) What are the clinical implications of the nervous system--immune system link? A small controlled study of HIV positive patients was conducted by Selano et al. The effects of specific upper cervical adjustments on the immune system CD4 cell counts of HIV positive individuals was studied. Half the patients received atlas adjustments based upon Grostic upper cervical analysis. The other half received a placebo in the form of an inactive adjusting instrument applied to the mastoid bone. Over the six month period of the study, the control group experienced a 7.96% decrease in CD4 cell counts, while the adjusted group experienced a 48% increase in CD4 cell counts over the same period. (22) Contemporary research is beginning to shed light on the neurobiological mechanisms which may explain the outstanding clinical results chiropractors have experienced when managing patients with infectious diseases. The popular press has been filled with stories describing the emergence of antibiotic resistant pathogens, and the futility of the long term strategy of developing new, stronger antibiotics. (23, 24) As author Geoffrey Cowley observed, "Drug resistant microbes don't threaten us all equally. A healthy immune system easily repels most bacterial invaders, regardless of their susceptibility to drugs." (25) Maintaining a healthy immune system depends upon maintaining a healthy nervous system. Regular chiropractic care, good nutrition, exercise, and an attitude of empowerment are the most effective strategies to turn fear into power. REFERENCES 1. Wessely S, Hyams KC, Bartholomew R: Psychological implications of chemical and biological weapons. British Medical Journal 2001;323:878. 2. Begley S, Isikoff M: Anxious about anthrax. Newsweek. October 22, 2001. Beginning on page 28. 3. Palmer DD: The Chiropractor's Adjuster. Portland Printing House. 1910. 4. What you need to know about anthrax. HealthScout. 10/18/01. 5. Milloy S: Concerns vs. chaos in the anthrax scare. Foxnews.com. 10/12/01. 6. Kalb C: When drugs do harm. Newsweek. April 27, 1998. Page 61. 7. Public Citizen. May/June 1994. 8. Johnson T: Anthrax considered. Abcnews.com. 10/11/01. 9. Korr IM: Andrew Taylor Still memorial lecture: research and practice--a century later. J Am Osteopath Assoc 1974 73:362. 10. Murray DR, Irwin M, Reardon CA, et al: Sympathetic and immune interactions during dynamic exercise. Mediation via a beta 2 - andrenergic-dependent mechanism. Circulation 1992 86(1):203. 11. Felten DL, Felten SY, Bellinger DL, et al: Norandrenergic sympathetic neural interactions with the immune system: structure and function. Immunol Rev 1987 100:225. 12. Felten DL, Felten SY, Bellinger DL, Madden KS: Fundamental aspects of neural-immune signaling. Psychother Psychosom 1993 60(1):46. 13. Kolata G: Nerve cells tied to immune system. New York Times May 13, 1993. 14. Hosoi J, Murphy GF, Egan CL et al: Regulation of Langerhans cell function by nerves containing calcination gene-related peptide. Nature 1993 363(6425):159. 15. Undem BJ: Neural-immunologic interactions in asthma. Hosp Pract (Off Ed) 1994 29(2):59. 16. Sternberg EM, Chrousos GP, Wilder RL, Gold PW: The stress response and the regulation of inflammatory disease. Ann Intern Med 1992 117(10):854. 17. Fricchoine GL, Stefano GB: The stress response and autoimmunoregulation. Adv Neuroimmunol 1994 4(1):13. 18. Ottaway CA, Husband AJ: Central nervous system influences on lymphocyte migration. Brain Behav Immun 1992 6(2):97. 19. Weihe E, Krekel J: The neuroimmune connection in human tonsils. Brain Behav Immun 1991 5(1):41. 20. Grossman Z, Heberman RB, Livnat S: Neural modulation of immunity: conditioning phenomena and the adaptability of lymphoid cells. Int J Neurosci 1992 64(1-4):275. 21. Brennan PC, Triano JJ, McGregor M, et al: Enhanced neutrophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. JMPT 1992 15(2):83. 22. Selano JL, Hightower BC, Pfleger B, et al: The effects of specific upper cervical adjustments on the CD4 counts of HIV positive patients. Chiropactic Research Journal 1994 3(1):32. 23. The end of antibiotics. Newsweek. March 28, 1994. 24. Revenge of the killer microbes. Time. September 12, 1994. 25. Cowley G: Too much of a good thing. Newsweek. 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